Random Pearls 1

1. Two important diagnosis to consider in tall T in ECG: hyperkalemia and hyperacute phase of AMI
2. Myocarditis does not just present with sinus tachycardia although this is the most common ECG finding. Myocarditis can also present with bradyarrhythmias, including complete heart block. Look hard for the A-V dissociation even before the heart rate drops.
3. Palpitation at young age - SVT more likely, palpitation at older age - VT more likely.
4. Biphasic T-wave in V2-3 may indicates Wellen's syndrome. This is an indication of critical stenosis of proximal LAD. Stress test is not recommended.
5. Fecal impaction (e.g. secondary to malignancies or with constipation) can surprisingly with spurious diarrhea. This can happen when the impacted feces liquefies at its margin and the patient mistaken this as diarrhea.
6. Which size of the ureteric stones that can be predictably passed out spontaneously?<4mm> 95% chance; 4 - 6mm => 50%; >6mm => 10%
7. In pneumothorax, a patient maybe asymptomatic until the size of the pneumothorax is up to 40%. Small pneumothoraces are defined as less than 2 cm from the chest wall
8. DVT does not just occur in the lower limb but in upper limb as well. It may occur at the axillary vein or subclavian vein.
9. The 5 radiologic signs of blow out fracture are 1) black eye brow sign 2) tear drop in the maxillary sinus 3) chips or contents visible in the maxillary sinus 4) Air fluid level at the maxillary sinus 5) haziness or blood filled over the ethmoidal sinus
10. Pulmonary embolism is not just due to mechanical obstruction of one or more pulmonary vessels. It also follows because of platelet degranulation in the lungs, resulting in the release of chemical mediators causing bronchoconstriction and vasoconstriction, and V/Q mismatch
11. A very irregularly irregular wide-complex tachycardia, with rate approaching 300/min (and if delta wave is present as well) - think of AF with WPW. Do not give drugs ABCD
12. Triad of rhabdomyolysis - muscle pain, dark urine, constitutional symptoms such as malaise, low grade fever (Meyer-Betz disease). This occurs in only up to 50% of cases.
13. Most sensitive and reliable indicator of rhabdomyolysis is creatine kinase (with CKMB ratio of less than 5%).
14. Increasing periorbital swelling following sneezing or any action similar to Valsalva maneuver in a patient with facial trauma may indicate orbital emphysema. A communication between the ethmoidal sinus and the medical wall of the orbital cavity can occur secondary to #. Sneezing, blowing nose or Valsalva maneuver results in a one-way valve effect as the pressure from the ethmoidal sinus causes air to leak into the orbital cavity. Medial orbital wall is a common site because of the thin wall of lamina papyracea. Orbital emphysema is usually a benign condition as fibrosis at the fracture site of lamina papyracea will and close up the communication within 2 weeks.
15. Lightning injuries may just present with "stunned" appearance or short-term memory loss without loss of consciousness. Check the tympanic membrane for any rupture. Cardiac arrest may occur due to excessive catecholamine release in a hyperadrenergic state.
16. Visual hallucination suggests organic cause, auditory hallucination (especially first and third person) suggests psychotic causes.
17. Mechanical versus inflammatory joint pain. Mechanical pain tends to be aggravated with movement and relieved by rest. Inflammatory causes tend to persist or worsen at rest, especially at night, but may improve with movement. However, these features often overlap.
18. Thyrotoxicosis refers to the clinical effects, hyperthyroidism refers to the thyroxine oversecretion.
19. Fall in the elderly can be due to the mechanical causes or medical causes. Remember to ask for history of anticoagulation especially if it is associated with head injury.
20. In tetanus, the patient's conscious level is preserved. Think of tetanus in patient with trismus or difficulty to open mouth.
21. In wound closure, do not shave eye brow as this does not regrow.
22. In patient with hand trauma, remember to ask the patient's hand dominance.