Drum roll, please...
Lim Shu Yu, Group 35, Year 6!
Congratulations, Lim Shu Yu on your winning entry. Your prize will be passed to you by an MSA Committee representative.
This is her winning entry:
Answer for ECG:
Assuming that this is an ECG with the speed of 25mm/s- Sinus rhythm, rate-75/min, normal axis, PR interval prolonged-o.28s, QRS complex-broad ORS complexes, RSR pattern best seen in V2-V3 ,
ST elevation in leads II, III, aVF,
ST depression in leads aVL, V1-V5.
Interpretation: Acute inferior infarction, 1st degree block and RBBB.
It is a spontaneous discharge of an empyema(pus) that has burrowed through the parietal pleural, usually into the chest wall, to form a subcutaneous abcess that may eventually rupture through skin. More commonly secondary to pneumonia.
Other entries were as follows:
HR 75 bpm
left axis deviation-highest R in I and avL
Prolong PQ interval-0.32s
Acute inferior myocardial infarction (ST elevation as mentioned, transmural, due to the pathology Q ), with reciprocal changes in V1-3,avL ( ST depression ), RBBB and AV block 1st degree.
Most likely involve left anterior descending artery (LAD)which supplies the base, AV node, RBB, anterior division of LBB ( bifasicular block, which show left axis deviation on ECG )
Spot diagnosis: Pus discharge from fistula as a complication after chest trauma.
1.normal sinus rhythm
Right axis deviation
2.Non-ST elevated Myocardial Infarction(septal region)-abnormalities in V1 lead
the furuncle has already burst
presence of scar around wound is usually seen in cases of furuncle
ecg: regular sinus rhythm; rate 75-80bpm; left axis deviation (R tallest in I lead); RBBB (rSR pattern, wide QRS >120ms in V1, slur S wave in I and V6); inferior MI (ST elevation in II,III,aVF); qR complex in I, aVL and LAD (left anterior fascicular block) plus PR>200ms (first degree AV block) and RBBB (trifascicular block)
spot diagnosis: site for chest tube (tube thoracostomy) for empyema
Entry No.4Answer for ECG
1.- Sinus rhythm, heart rate 75bpm
- Left axis deviation
- PR prolongation
- Abnormal progression of R-wave in chest leads
- Pathological Q-wave & ST elevation in III, aVF
- Fragmentation of QRS in II
- ST depression in I, aVL
- Reversed tick-shaped ST depression in V1-V3
- Biphasic P-wave in V1, V2
- J-wave or Osborne wave in V3-V6
- Rollercoaster pattern in II
2.- First degree AV block
- Old infacrt or myocardial scar in inferior wall of left ventricle (LAD, deep Q-wave, QRS fragmentation)
- Possiblity of new acute MI (ST elevation in inferior lead, accompanied by reciprocal ST depression in left lead)
- Left atrial hypertrophy (biphasic P in V1-V2)
- Patient has hypothermia (J-wave) due to AMI
- Possibility of quinidine toxicity (AV block, rollercoaster pattern)
Answer for Spot Diagnosis:
Chylothorax with chyle fistula
Answer for ECG
1. Sinus rhythm, normal axis, prolonged PR-280ms, broad QRS complex, normal QT, ST elevation in lead II,III,AVF, RSR pattern in V1-V3, Osborne/J waves are noted in V4-V5.
2. Acute inferior myocardial infarction associated with first degree AV block and RBBB.
J wave may be due to severe ischemia etiology.
Answer for Spot Diagnosis:
From the location of the wound and the scar around the wound seen, it is most probably an old scar of chest tube drainage.
Dx: Empyema necessitans
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