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DATA INTERPRETATION

SET A
A1) CXR of 40 year old patient, a known asthmatic.
Findings:

Endotracheal intubation
Pneumo-mediastinum (with air surrounding the heart)
Sub-cutaneous emphysema

Cause: Ventilator-induced lung injury

A2) CT Scan
Findings:

Left extradural bleed (lentiform shaped haematoma)


Left scalp haematoma
Right intra-parenchymal haemorrhage
Left skull fracture (temporal)

Question: GCS is 8/15. What would you do?


(Answer: Intubate to protect the airway, transfer to neurosurgical
centre)

A3) CXR (Dr. Rowis case: traumatic diaghragmatic hernia)


Findings: Describe the X-ray.
Question: Discuss how youll induce the patient for GA. (Rapid
sequence induction, avoid nitrous oxide)
A4) Arterial Blood Gas (On Fi O2 0.5)

Metabolic acidosis with respiratory compensation


Anaemia
Hyperkalaemia with hyponatriaemia
Hyperglycaemia
Base deficit

Diagnosis: Diabetic ketoacidosis

A5) ECG
Findings: Complete heart block
Question: Give reasons for your diagnosis.
What are the causes of complete heart block? (Answer:
Acute myocardial infarct, congenital)
What is the treatment? (Pacing)

SET B
B1) CXR
Finding:

Right lung cavity

What are possible causes?


Bacterial (e.g. Staph., Klebsiella), TB, Fungus (e.g.
aspergillosis)
If aspergillosis, what is your choice of treatment of choice
(Variconazole, Amphotericin B, Caspofungin)
B2) CXR
Findings:

Bilateral diffuse opacities


Heart normal
Costo-phrenic angles well demarcated

Causes: Adult respiratory distress syndrome, Severe bronchopneumonia, pulmonary oedema.


List 3 common causes of ARDS: Infection, Aspiration, Postblood transfusion, Pancreatitis
Ventilatory strategy: Low tidal volumes, plateau
pressure<30mmHg, Optimum PEEP, Inverse I/E ratio, High
frequency ventilation. APRV (Bilevel Ventilation)

B3) CXR Lateral view

Describe the X-ray


(Dilated thoracic aorta)

What are signs and symptoms of thoracic aneurysm?

Answer: Radiating pain to the back, syncope, hypertension, radiofemoral lag in pulses.

B4) Lung Function tests (Dr. Rowi/ Shamsul to get the charts)

B5) ECG with Pulmonary Artery catheter pressure with cardiac


output readings
60 year old for total hip replacement. Day 3 post-op, presents with
hypotension and shortness of breath. Interpret the data.
Findings
MAP low, CVP high, PAP high, Wedge pressure normal
ECG shows sinus tachycardia, S1, peaked P waves, T inversion

Pulmonary embolism

SET C

C1) CXR

Right pleural thickening

Diagnosis: Pleural TB, Empyema, Pleural TB, mesothelioma

C2) Haemodynamic values and PA catheter readings


Findings

Severe tachycardia and hypotension


Hyperdynamic circulation (Cardiac Index =5)
High mixed venous saturation

Septicaemic shock secondary to perforated gut(?)


Inotrope of choice: Noradrenaline infusion

C3) CXR
Findings

Cardiomegaly with bronchopneumonia

C4) ECG (patient came to A&E with chest pains, collapsed)

Pulseless ventricular tachycardia

C5) ABG and HB / BUSE


Blood results: Anaemia, renal failure,, sepsis, hyperglycaemia
ABG metabolic acidosis ( partially respiratory compensated )