CXR pa view Rt sided massive pleural effusion Heart is pushed to Lt side with underlying collapse lung Patchy infiltration Lt lung ECG NSR Sinus tachycardia ST elevation in V1 & V2 with reciprocal baseline depression in lead 1,2,avL, avF SV1+RV6>35mm with ST depression with strain Polymorphleucocytosis with raised ESR Iron deficiency anaemia Massive pleural effusion with Pneumonia with ASMI with LVH with Anaemia with uncontrolled HTN Admit in ICU under care of Pulmonologist & Cardiologist urgently
HTN UNCONTROLLED ECG = SINUS TACHYCARDIA LVH WITH STRAIN OCCASIONAL VPC CXR = MEDIASTENAL SHIFT TO LEFT SIDE Rt LUNG COMPLETELY OPAQUE .. LEFT LUNG SHOWING PULMONARY EDEMA D = HYPERTENSIVE ISCHAEMIC HEART DISEASE WITH CHF OPAQUE RT SIDE DUE TO pLEURAL EFFUSION
Xray shows B/L pneumoniae. Right lung collapse may be due to effusion. May be liver abuses. CT CHEST NEED AND USG WHOLE ABD. MAY ABUSES. FLUID IN RT LUNG so need urgent CT chest and plan ICD in RT lung. Keep on bipap. Do ABG checks k+ also. Suspected Corona and viral. Pneumonitis. .........
Rt side pl effusion Trechea is in midline Lt side haziness Cardiomegaly Lvh S tachycardia St elevation in lead V1&2 Anaemia Raised est Raised WBC S creatinin? Ccf
Right Side Massive Pleural Effusion with left side consolidation.. D/d Pulmonary Oedema..
POSSIBLY PNEUMONIA PLEURAL. EFFUSION DD PULMONARY EDEMA
Pneumonitis CCF Pulmonary oedema COVID infection
Hypertensive emergency. Global ischaemia.
Bp suggest second stage hypertension. Saturation is low british thoracic society suggest SPO2 88 -92 in comatose patient and 94-98 in alert patients.. Unilateral homogeneous opacity right lung, with colapsed left lung Due to massive pleural effusion The EKG shows Sinus rythm with tachycardia heart rate of more than 120 beat /minutes. Cardiac axis is normal. There is S on Vi and R In V6 with T waves inversion on lead V6 and V5 may be left venticular hypertrophy. LVH The patient has low HB. differential of neutrophil signfying bacteria infection Esr is high more than 89 mm/hrs.a sign of inflammation. OVERALL ANEMIA WITH HYPERTENSION HAS POOR PROGNOSIS patient need to be on furosemide iv high dose up to 70mg ACEI low dose to prevent hypotensive crisis. Statin, but renal fuction test must be done before initiating. Fasting blood sugar and hba1cbe tested to rule out Dm
Right pleural effusion ,massive , with mediastinal shift to left Left lung shows fluffy infiltrations ECG- Sinus tachycardia, left atrial enlargement, LVH with strain, Poir progression of R in V1 to V3 Impression Rt sided pleural effusion ,with left sided pneumonia ,? COVID ,? PT Hypertension, LVH , ? Old ASMI , LVF Pleural aspirate analysis for AFB and CBNATT RTPCR for COVID CT chest
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Friends today I am discussing about Nail Abnormalities. What are nail abnormalities? Healthy nails appear smooth and have consistent coloring. As you age, you may develop vertical ridges, or your nails may be a bit more brittle. This is harmless. Spots due to injury should grow out with the nail. Abnormalities — such as spots, discoloration, and nail separation — can result from injuries to the fingers and hands, viral warts (periungual warts), infections (onychomycosis), and some medications, such as those used for chemotherapy. Certain medical conditions can also change the appearance of your fingernails. However, these changes can be difficult to interpret. Your fingernails’ appearance alone isn’t enough to diagnose a specific illness. A doctor will use this information, along with your other symptoms and a physical exam, to make a diagnosis. Abnormalities of the fingernail Some changes in your nails are due to medical conditions that need attention. See your doctor if you have any of these symptoms: discoloration (dark streaks, white streaks, or changes in nail color) changes in nail shape (curling or clubbing) changes in nail thickness (thickening or thinning) nails that become brittle nails that are pitted bleeding around nails swelling or redness around nails pain around nails a nail separating from the skin These nail changes can be caused by a variety of different conditions, including ones we describe below. Beau’s lines Depressions that run across your fingernail are called Beau’s lines. These can be a sign of malnourishment. Other conditions that cause Beau’s lines are: diseases that cause a high fever such as measles, mumps, and scarlet fever peripheral vascular disease pneumonia uncontrolled diabetes zinc deficiency Clubbing Clubbing is when your nails thicken and curve around your fingertips, a process that generally takes years. This can be the result of low oxygen in the blood and is associated with: cardiovascular diseases inflammatory bowel disease liver diseases pulmonary diseases AIDS Koilonychia (spooning) Koilonychia is when your fingernails have raised ridges and scoop outward, like spoons. It’s also called “spooning.” Sometimes the nail is curved enough to hold a drop of liquid. Spooning can be a sign that you have: iron deficiency anemia heart disease hemochromatosis, a liver disorder that causes too much iron to be absorbed from food lupus erythematosus, an autoimmune disorder that causes inflammation hypothyroidism Raynaud’s disease, a condition that limits your blood circulation Leukonychia (white spots) Nonuniform white spots or lines on the nail are called leukonychia. They’re usually the result of a minor trauma and are harmless in healthy individuals. Sometimes leukonychia is associated with poor health or nutritional deficiencies. Factors can include infectious, metabolic, or systemic diseases as well as certain drugs. Mees’ lines Mees’ lines are transverse white lines. This can be a sign of arsenic poisoning. If you have this symptom, your doctor will take hair or tissue samples to check for arsenic in your body. Onycholysis When the nail plate separates from the nail bed, it causes a white discoloration. This is called onycholysis. This can be due to infection, trauma, or products used on the nails. Other causes for onycholysis include: psoriasis thyroid disease Pitting Pitting refers to small depressions, or little pits, in the nail. It’s common in people who have psoriasis, a skin condition that causes the skin to be dry, red, and irritated. Some systemic diseases can also cause pitting. Terry’s nails When the tip of each nail has a dark band, it’s called Terry’s nails. This is often due to aging, but it can also be caused by: congestive heart failure diabetes liver disease Yellow nail syndrome Yellow nail syndrome is when the nails get thicker and don’t grow as fast as normal. Sometimes the nail lacks a cuticle and may even pull away from the nail bed. This can be the result of: internal malignancies lymphedema, swelling of the hands pleural effusions, fluid buildup between the lungs and chest cavity respiratory illnesses such as chronic bronchitis or sinusitis rheumatoid arthritis These are just some of the signs of abnormal fingernails. Having any of these signs isn’t proof of any medical condition. You’ll need to visit your doctor to determine if your condition is serious. In many cases, proper care of your nails is enough to correct their appearance. How to care for your nails You can prevent many nail abnormalities by taking good care of your nails. Follow these general guidelines to keep your nails healthy: Tips Don’t bite or tear at your nails, or pull on hangnails. Always use nails clippers and trim them after you bathe, when nails are still soft. Keep your nails dry and clean. Using sharp manicure scissors, trim your nails straight across, rounding the tips gently. If you have a problem with brittle or weak nails, keep them short to avoid breakage. Use lotion on your nails and cuticles to keep the nail and nail beds moisturized. Homoeopathic medicines for nail abnormalities Medicines according to Cause1 Cause Medicines From a hurt Ledum pal. Prick with a needle under the nail Allium cepa, Bovista, Sulphur; Hard work Rhus tox, Sepia; Prick near the nail Iodum; Splinters Baryta carb., Hepar sulph., Iodum, Lachesis, Nitricum acidum, Petroleum, Silicea, Sulphur; Splits of the skin adhering to the nails Allium cepa, Natrum mur. TABLE 2 Medicines according to the Sensation Sensations Medicines Irritable feeling under finger nails, relieved by biting them Ammonium brom. Itching-about roof of Upas tiente Pains-Burning under Sarsarparilla Pains, gnawing, beneath finger nails Alumina; Sarsaparilla.; Sepia Pains, neuralgic, beneath finger nails Berberis vulgaris Pains, neuralgic Alumina; Allium cepa; Colchicum Pains, smarting at roots Sulphur Pains, splinter-like, beneath toe nails Fluoric acidum Pains, ulcerative, beneath toe nails Antimonium crudum; Graphites; Teucrium Medicines according to Location1 Fig. Medicines according to location pastedGraphic.png TABLE 3 Medicines according to Pathology Pathology Medicines Atrophy Silicea Blueness Digitalis; Oxalicum Acidum Deformed-brittle, thickened (onchogryposis) Alumina; Anatherium; Antimonium crudum; Arsenicum album; Causticum; Dioscorea; Fluoricum acidum; Graphites; Merc. Sol.; Natrum muriaticum; Sabadilla; Secal cor..; Senecio aureus; Sepia; Silicea; Thuja.; X-ray. Falling off Brassica napus; Butyric acid; Helleborus faetidus; Helleborus Hangnails Lycopodium; Natrum muriaticum; Sulphur; Upas tiente Hypertrophy (onychauxis) Graphites Inflammation of pulp (onychia) Arnica; Calendula; Fluoricum acidum.; Graphites; Phosphorus; Psorinum; Sarsaparilla; Silicea; Upas tiente Inflammation, under toe nails Sabadilla Ingrowing toe nails Causticum; Magnetis polus austral.; Nitricum acidum; Silicea; Staphysagria; Teucrium; Tetrodymite Softening Plumbum met; Thuja Spots, white on Alumina; Nitricum acidum Trophic changes Radium brom Ulceration Alumina; Garphites; Merc. Sol.; Phosphorus; Sanguinaria; Sarsaparilla; Silicea; Teucrium; Tetrodymite Yellow color Conium maculatumDr. Rajesh Gupta5 Likes7 Answers
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7 yr pt came with c/o SOB after slight exertion or running, symptoms from early childhood, that's why not going even to school, on auscultation systolic murmur heard with thrill in all areas, belong to low socioeconomic class and used to consult quacks or pharmacist only, discuss possible dx considering ECG, CXR etc attached below..Dr. Manish Verma5 Likes17 Answers
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c/o fever, chills since 2 days. c/o breathlessness since 1 day. o/e tachypnea + PR 130bpm BP - 110/70 mm of hgDr. Amith Gupta1 Like23 Answers
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5 yrs old female c/o rhinitis ,cough ,off and on fever with normal apetite since last 8days. clinical examination insignificant wt 15 kg. Rv neg ,ESR 93, creat 0.84, urine nil. BSL 46. plz comment on approach to this case.Dr. Sandeep Ghodekar3 Likes20 Answers
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77yrs old/f came with complain tachypenia severe breathlessness with fever with chills headache bodyache 3day k/c/o Pulmonary Koch's completed R O/E bp 100/50 pul 108 temp afeb spo2- 96% RR 32/m RS rt crepes+ CNS conscious and oriented *investigation* CRP *267* pro-BNP - @ *11428* urine protien -1+ WBC *43,500* HB 11.8 PLT 2.20 BUN 22.5 creat 0.9 Na* 131 k 4.4 cl 95 sgot 18 sgpt 11Dr. Dawood A Khan2 Likes19 Answers