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Student Discussions:


Conversations in October 2017
Assignment 1

Assignment 2

1. In a patient, I noticed an ECG in which the P wave was upright in Lead 1 but inverted in Lead aVL. I want to discuss why this is so and some things related to P waves like:
a. How to differentiate a P wave from a T wave
b. What to consider when the P wave is not seen at all in the ECG
c. What to consider when the P wave is inverted in Lead 1 but upright in aVF.

2. I want to talk about auscultation of the chest. What do crepitations in the lungs indicate? When does it indicate pulmonary edema and when does it indicate pneumonia? Can a person have a lower respiratory infection without having a consolidation in the lung? How to differentiate crepitations from a pleural rub? Regarding heart sounds, the S2 is made up of A2 and P2 - by auscultation, how to know that it is the P2 which is loud?

3. Read this summary written by a student and do the task that is requested. Summary

4. A 68 year old retired gardener living in Taman Batu Pahat, who had preexisting dilated ischemic cardiomyopathy with congestive cardiac failure diagnosed 2 years ago under follow up at Hospital Sultanah Aminah JB with no other co-morbidities presented with central chest pain at rest which lasted 45 minutes and was not radiating elsewhere, associated with profuse sweating, a presyncopal attack, shortness of breath, decreased effort tolerance and vomiting one episode. I want to know why he is described as having ischemic cardiomyopathy and not ischemic heart disease.

5. This is the description of a report written by a student: "The full blood count showed leukocytosis with predominant neutrophils. Sputum culture and sensitivity revealed gram positive cocci in chains and gram negative bacilli". Do you think there is any error here?

6. This is the description of a chest x-ray written by a student: "The chest X-ray showed hyperinflated lungs, flattened hemidiaphragm, perihilar opacity and underlying fibrotic changes suggestive of acute exacerbation of chronic obstructive pulmonary disease due to pneumonia". Something does not sound quite right to me. Do you feel the same way?

7. These are the physical findings of a patient with breathlessness. Please read the findings and give your opinion.

Dr Velayudhan Menon, MD
Clinical Associate Professor of Medicine
International Medical University, Malaysia

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