The following AP thoracolumbar x-ray is from a 65 year old who has presented to the ED with severe thoracic pain. He is noted to have acute renal failure and hypercalcaemia on blood tests. What subtle finding can be seen? Continue reading
Category Archives: Clinical Reasoning
The daily educational pearl – Liver function tests
When we order liver function tests (LFTs) we normally get ALT / GGT / ALP / bilirubin / total protein / albumin. But are these true liver function tests? Should we add anything?
The daily educational pearl – the Buerger’s test
So you think your patient has chronic limb arterial insufficiency.
You decide to the Buerger’s test
– with the patient supine, ask them to slowly lift the legs up (above the level of the right atrium) and look for colour change in the feet – if it occurs when the legs are elevated at an angle of less than 20 degrees it indicates severe ischaemia; in a limb with a normal circulation the toes stay pink, even when the limb is raised by 90 degrees
– the ask them to exercise the feet ~ 30 sec and look for colour change
– then ask them to sit up and measure the time to return of normal colour – if it’s > 20 sec, it is sign of ischaemia
The daily educational pearl – VT vs SVT with aberrancy
With thanks to Eugen, Ed Burns (@edjamesburns), http://lifeinthefastlane.com, http://en.ecgpedia.org
Your patient is a 38 yo man who presents with palpitations.
Dim at the Top ?
So you’ve just seen a patient with confusion and abnormal behaviour.
- Where do you start ?
- What are the causes ?
Consider are they dim at the top (DIMTOPPE) ?