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UCL MBBS (Fach) / Data interpretation (Lektion)

Including imaging, biochemistry, lung function tests, etc.

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  • CXR - normal ---
  • CXR - pleural effusion ---
  • CXR - pneumonia ---
  • z CXR - pulmonary oedema Definiton: Radiological sign of left heart failure Features: Alveolar oedema - bat wing sign Inerstitial oedema - Kerley B lines Cardiomegaly > 50% of thracic diameter Upper lobe Diversion Pleural Effusions
  • CXR - Pneumothorax Definition: Air in pleural space Symptoms: SoB; Signs: rim of air, lung border Causes: jugular line, trauma, underlying lung disease, spontaneous Tx: needle decompression, chest drainage if appropriate; CXR to monitor
  • CXR - Haemothorax ---
  • CXR - Fractured ribs Check during review Bones, haemo-/pneumothorax?
  • CXR - Pulmonary fibrosis ---
  • z CXR - Hilar lymphadenopathy DDx Sarcoid Lymphoma Lung tumour Tuberculosis Reactive
  • CXR - Round shadows Solitary multiple
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  • CXR - Apical tuberculosis ---
  • CXR - Pulmonary embolism ---
  • Peak Flow Normal Reduced
  • Vital capacity Total volume that can be exhaled Reduced in restrictive lung disease; increased in obstructive lung disease
  • Complex lung function for changes to residual volume or diffusion variable intrathoracic airway obstruction - expiration impaired variable extrathoracic airway obstruction - inspiration impaired fixed upper airway obstruction - both impaired intrapulmonary obstruction, e.g. emphysema, asthma - prolonged expiration restrictive disease - decreased TLC, decreased inpiratory flow Diffusion coefficient KCO diffusion capacity normalized by alveolar volume increased in emphysema decreased in alveoloar haemorhage etc
  • Hypoxaemia ABG vs transcutaneous (aim 94-98%, 88-92% in COPD with increased CO2) W/ or w/o raised CO2: type I vs type II respiratory failure Tx: Oxygen, non-/invasive ventilation Ix: ABG, KCA, lung function tests, loop spirometry
  • Acidosis Definition: blood pH < 7.35 Types: Respiratory: ↑CO2, ± compensatory ↑HCO3-: caused by hypoventilation, e.g. drugs (benzos, opiates), neuromuscular disease, fatigue Metabolic: ↓HCO3-, ± compensatory hyperventilation and ↓pCO2; anion gap (Na+ + K+) - (Cl- + HCO3-) ≈ 3-11mEq High anion gap: Lactic acidosis, ketoaacidosis, toxins, renal failure Normal anion gap ∼ hyperchloraemic acidosis: Diarrhoea, type IV RTA, Addison's disease Notes: Indication for liver transplant after paracetamol overdose pH < 7.2, ignore APTT  >100s, creatinine, and encephalopathy as in King's
  • z Alkalosis Definition: blood pH > 7.45 Causes: respiratory: hyperventilation ↓pCO2, ± compensatory ↓HCO3-; causes: pregnancy, PE metabolic: ↑HCO3-, ± compensatory CO2 retention; relatively rare
  • Fractures clavicle, neck of humerus, Colles, neck of femur, femoral/tibial shaft, ankle
  • Osteoporosis Definition: z-score < 2.5 Risk factors: Female, age, low BMI, muscle weakness (e.g. immobility), family Hx, hyperpara/-thyroid, smoking & alcohol, ↓oestrogen exposure (early menopause), diabetes, bone disease (arthritis, myeloma); steroids Diagnosis: Bone studies - ALP, Ca2+, Phosphate, PTH normal DEXA - z-score < -2.5; <-1 osteopaenia or >75y/o + low-trauma fracture or risk-factors Treatment: Weight-gain, exercise; quit smoking & alcohol Bisphosphonates (weekly; advice!), Ca2+ supplements RANKL-inhibitors, e.g. denosumab; strontium; HRT; raloxifene Complications Fractures, e.g. NOF, vertebral collapse
  • Bone metastases Lytic Sclerotic
  • Paget's disease Osteitis deformans; increased bone turnover, rare in <40y/o; often asymptomatic, or pain and deformities; complications fractures and hypercalcaemia X-Ray: Spine, skull, pelvis, long bone patchy increased bone density, sclerosis, osteolysis, deformities; hot spots on bone scan Bone profile:  Ca2+ and Po43- normal, ↑↑ ALPTx: Analgesia, alendronate
  • Spine - degenerative changes ---
  • Osteoarthritis Hip, knee X-ray LOSS Loss of joint space Osteophytes Sclerosis Subchondral bone cysts
  • Rheumatoid arthritis hands
  • Gout with tophus
  • Nuclear scan of the skeleton ---
  • Subarachnoid haemorrhage ---
  • Brain haemorrhage ---
  • Cerebral infarct CT imaging acut (?bleeding) vs delayed (large hypodense area) Further Ix: 24h ECG, carotis USS, BP; manage risk factors
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  • Cerebral atrophy Sign of dementia
  • Intracerebral lesion with oedema  e.g. primary secondary tumour
  • Midline shift ---
  • Pituitary tumour ---
  • Extra/-subdural haematoma Clinical: Elderly fall, vs young with lucid interval Acute CT: Extradural: Lentiform, extraaxial, increased signal Subdural: Not stopped by sutures Management: Neurosurgery → SAH, intracranial bleed
  • Subdural haematoma ---
  • ECG - sinus rhythm ---
  • ECG - ectopic beats atrial ventricular
  • ECG - atrial fibrillation ---
  • ECG - atrial flutter ---
  • ECG - atrial & nodal tachycardia DDx Sinus - regular Supraventricular - regular absent / inverted P waves AF - irregular, no P waves Atrial flutter - 300bpm saw-tooth, 2:1 block (Multifocal) atrial tachycardia - abnormal P waves, >3 Junctional - 150-250 bpm, P waves buried or after QRS Tx: valsalva ⇒  carotid sinus massage ⇒ adenosine 6+12+12mg
  • ECG - WPW syndrome ---
  • ECG - ventricular tachycardia
  • ECG - ventricular fibrillation Broad-complex tachychardia, shockable or lidocaine May result from long-QT (RW, JLN), or peri-MI
  • z Atrial-ventricular conduction defects = Heart blocks 1st degreee heart block: PR interval > 5ss ≈ 200ms 2nd degree heart block - Mobitz type 1 ("Wenkebach"): growing PR intervall, until dropped beat occurs 2nd degree heart block - Mobitz type 2: unconducted / blocked P waves 3rd degree - complete - heart block: complete disassociation between P waves and QRS complexes Notes: ?normal, ?pacemaker; implications for adenosine
  • Bundle branch blocks Definition: Conduction defect in the left or right bundle or anterior / posterior branch of the left bundle. Mono-, bi-, trifascicular blocks. ECG features: broad QRS complexes > 3ss ≅ 120ms RBBB: "marrow" - RSR' in V1, dominant R in V1, inverted T in V1-V4, deep wide S in V6: may be normal, or PE, cor pulmonale LBBB: "william" - M pattern in V5 (large R waves), no septal Q waves in V1, inverted T in I, aVL, V5-5; new ⇒ STEMI Bifascicular block = RBBB + left hemiblock: anterior (posterior) ⇔ left (right) axis Trifascicular block = bifascicular block + 3rd degree AV-block Also specific axes deviations
  • ECG - Ischaemic changes Signs: ST depression / elevation, hyperacute T waves (tall, inverted), new LBBB, Q-waves Territories: LAD, circumflex , right; inferior (II, III, aVF), anterior (V1-V4), lateral (V5, V5, II, aVL), posterior Classsification: Stable angina ⇒ unstable angina or ACS ⇒ NSTEMI or STEMI Post-MI prophylaxis: BP, cholesterol, platelets, angina, symptoms
  • ECG - T wave changes ---
  • ECG - MI/ACS ---
  • ECG - ventricular hypertrophy ---

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