MedEd 2 MEDICAL STUDENT ECG and CXR Worked examples Sam Ravenscroft

ECG 1 Image used from lifeinthefastlane.com

Pericarditis Saddle shaped ST elevation across multiple leads Differentiation from STEMI? QRS complexes and T waves remain unchanged ST elevation is concave and no more than 5mm from J point Across multiple leads*

Large STEMI Image used from http://hqmeded-ecg.blogspot.co.uk/2012/08/pericarditis-or-anterior-stemi-qrs.html

ECG 2 Image used from lifeinthefastlane.com

Left Bundle Branch Block Broad QRS in a WiLLiaM pattern Dominant S wave in V1 Left axis deviation It’s unusual to have LBBB without organic disease... NEW LBBB + Chest pain is a worry for MI Secondary to hypertrophy e.g. Hypertension, Aortic stenois

Right Bundle Branch Block Broad QRS in a MaRRoW pattern RSR complex in V1 RBBB can be a normal variant, but other causes include RVH, ischaemic injury, congenital disease.

Chest X-Ray 1

Chest X-Ray 2

Consolidation Collapse “Cotton wool” density Uniform density with smooth edges Lung markings persist May see air bronchograms No lung markings No features of volume loss Volume loss e.g. Shift of structures May have associated effusion Associated effusion only if related to shared cause e.g. Tumour Causes: Fluid in the alveoli Pus – infection Water – oedema Blood – haemoptysis? Causes: proximal obstruction of airflow -Luminal e.g. FB or mucus plugging -Mural e.g. tumour -Extrinsic compression