Medicine Hack

This is also a case of perforated duodenal ulcer in a 34 yr old lady. Note the rim of gas above the fundal gas.

Massive  gas under diaphragm was seen in this case of perforated duodenal ulcer. Patient was a 28 yr old male with past history of chronic gastritis. He presented to A&E with acute abdomen. O/E rigidity of abdomen was positive and bowel sound was absent.

Subtotal lobectomy : resection of part of a lobe. Total lobectomy : resection of whole of a lobe. Isthmusectomy : resection of the isthmus. Hemi thyroidectomy : total lobectomy + isthmusectomy. Subtotal thyroidectomy : 2 x subtotal lobectomy + isthmusectomy. Near total thyroidectomy : total lobectomy + isthmusectomy + subtotal lobectomy. Total thyroidectomy : 2 x total lobectomy + isthmusectomy.

Fluid in the pericardial cavity is typically seen as a water bottle shaped heart. A pericardial paracentesis of only 15-30 mL can be very beneficial for the patient. This is done by using a syringe at a point 1-2 cm inferior to the left of the xiphochondral junction at a 45 degree angle to the skin and in the direction of the tip of scapula or shoulder. This procedure must be carefully carried out under continuous ECG monitoring.

X ray findings of pneumothorax include a discrete shadowed line beyond which no lung markings are present, as shown by the arrows. They usually occur at the apices which are the least dependent part of the lungs on erect posture. Inspiratory and expiratory films may aid in detection. In expiration, lung volume is decreased while that of the pneumothorax is constant. So there will be a relative increase in the size of the pneumothorax.

Assess the patient's chest and respiratory function. Administer oxygen at 12 L/min by mask. Identify the 2nd intercostal space in the midclavicular line on the side of the pneumothorax. If patient is conscious and time permits, add a little of L.A. Insert the needle of a 20 mL syringe attached.  Aspiration of air confirms the diagnosis. The syringe is remmoved and a hissing sound is usually heard as air is expelled rapidly. If you place your hand close to the needle, you can detect this rush of air. Doing this urgent procedure will convert a tension pneumothorax into an ordinary one. A wide-bore intercostal rube is then introduced laterally and directed to the apex of the pleural cavity. A second drain may be introduced basally to drain blood.  The site of insertion is in the triangle of safety which is defined as the anterior border of the latissimus dorsi, the posterior border of the pectoralis major and the superior border of the fifth rib. The area chosen is i

QJGXPY3W4EAW It states that in a case of painless jaundiced patient, if the gall bladder is palpable, stone pathology is ruled out. This is because stone formation is a long standing process and this leads to fibrosis. A fibrotic gall bladder is not usually palpable. The causes are more likely to be a ca of pancreas, ca of ampulla of Vater or a cholangiocarcinoma.