Welcome to this academic exercise. It's going to be fun and we'll learn at the time.

For further explanation about this thread click [url=https://www.nairaland.com/1235064/medix-call-r%C3%B6%C3%B3m]here[/url]

source :

Let's try this chest x-ray of a child

What abnormality/abnormalities can you appreciate?

Attempt a diagnosis

I see some atelectasis (unless its just my screen) and what appears to be TOF

SniperInADiaper: I see some atelectasis (unless its just my screen) and what appears to be TOF

wow,sniper who taught you all these...there's no atelectasis but TOF is a top most differential.

Pulmonary atresia or
tetralogy of fallot or
ventricular septal defect

centje: Let's try this chest x-ray of a child

What abnormality/abnormalities can you appreciate?

Attempt a diagnosis

a classical "boot-shaped" heart of Tetralogy of Fallot(TOF). The heart takes on this shape as a result of right ventricular hypertrophy occasioned by pulmonary stenosis of TOF, which apart from enlarging the heart, characteristically lifts the apex of the heart off the right dome of the diaphragm. Needless to repeat, there is obvious cardiomegaly. The lung fields and bony chest wall and the diaphragmatic domes appear normal.

Centje the title of "Medical Call Room" sounds more interesting to me. Or maybe " Ward Round - Where Doctors, Nurses, Med Students, Health Professionals Discuss" .....sth like that

You guys just dissected the x-ray. Omicron, can you throw more light on the management of the condition?

omicron: Centje the title of "Medical Call Room" sounds more interesting to me.

i actually reserved the title for off topic chat. Have you seen the thread?

centje: You guys just dissected the x-ray. Omicron, can you throw more light on the management of the condition?

Definitive management is Surgical.

Most patients will present with central cyanosis (bluish discoloration of the lips and toungue), chest symptoms-including chronic or intermitent cough, shortness of breath worse on exertion, fever(if secondary infection is present), failure to thrive (failure to gain expected weight, height or reach other expected milestones). Patients may also present in heart failure. On examination, patients are mostly cyanotic, /_ febrile, /_ pale. Underweight, below expected for height. Chest symptoms will correspond to prevailing chest infections and signs of cardiac failure. CVS signs of heartfailure. Displaced apex beat. ?a particular kind of murmur(someone should remind me)

Oxygen therapy is the mainstay of initial medical management. Concurrently, samples are taken for blood gas analysis, PCV/Hb, FBC, SEUCr, sputum m/c/s. Pulse oxymetry and CXR. Managed in cardiac position, or ?Tripod position. Antibiotic therapy as needed. Heart failure managed as appropriate too (frusemide, oxygen, etc) Blood transfusion witnout fluid overload. Nutritive management as needed.

Definitive treatment is corrective surgery.

Prognosis is bad.

In emergency treatment,i can recall this acronym POMA-Position(tripod or squatting), Oxygen, Morphine, and Acidosis

centje: In emergency treatment,i can recall this acronym POMA-Position(tripod or squatting), Oxygen, Morphine, and Acidosis

Excellent centje! Morphine for pain control. Acidosis arising from increased PCO2.(Respiratory), and this must be corrected too.

Do you know centers in Nigeria where this surgery can be done? And is the prognosis also that bad for surgically treated cases?

You mean proper diagnosis and surgery. Not in my Naijaaaaaaa. Common name- hole in the heart, indiaaaaaaa straight.
Except if we have a competent board certified consultant peadiatric cardiothoracic surgeon( experienced) hiding somewhere in this hellhole.

Joanna Sedley: You mean proper diagnosis and surgery. Not in my Naijaaaaaaa. Common name- hole in the heart, indiaaaaaaa straight.
Except if we have a competent board certified consultant peadiatric cardiothoracic surgeon( experienced) hiding somewhere in this hellhole.

i think there are trained professionals in nigeria. Maybe lack of required facilities will discourage them.

Well maybe.
But it requires a team you know, i mean full competent and experienced surgical team and extras.

centje: wow,sniper who taught you all these...there's no atelectasis but TOF is a top most differential.

Did you forget I ran an ICU.

I know way more medical stuff than I should.

@joan.
I will find out the centres in nigeria.

@sniper
You're lucky. That means you can save a life

What abnormality can you see on the lady(standing right)?

Attempt a diagnosis?

There's webbed neck.

Turner's syndrome.

Turner syndrome is caused by a missing or incomplete X chromosome. People who have Turner syndrome develop as females. The genes affected are involved in growth and sexual development, which is why girlswith the disorder are shorter than normal and have abnormal sexual characteristics.

How do people get Turner syndrome?

Normally, females inherit one X chromosome from their mother and one X chromosome from their father. But females who have Turner syndrome are missing one of their X chromosomes.

Turner syndrome is typically caused by what is called nondisjunction. If a pair of sex chromosomes fails to separate during the formation of an egg (or sperm), this is referred to as nondisjunction. When an abnormal egg unites with a normal sperm to form an embryo, that embryo may end up missing one of the sex chromosomes (X rather than XX). As the embryo grows and the cells divide, every cell of the baby's body will be missing one of the X chromosomes.

The abnormality is not inherited from an affected parent (not passed down from parent to child) because women with Turner syndrome are usually sterile and cannot have children.

In about 20 percent of Turner syndrome cases, one X chromosome is abnormal. It may be shaped like a ring, or missing some genetic material.

About 30 percent of girls with the disorder are only missing the X chromosome in some of their cells. This mixed chromosomepattern is known as mosaicism. Girls with this pattern may have fewer symptoms because they still have some normal (XX) cells.

One of the missing genes on the X chromosome is the SHOX gene, which is responsible for long bone growth. The missing SHOX gene is the reason girls who have the disorder are unusually short. Other missing genes regulate ovarian development, which influences sexual characteristics.

What are the symptoms of Turner syndrome?

Turner syndrome affects growth and sexualdevelopment. Girls with this disorder are shorter than normal, and may fail to start puberty when they should. This is because the ovaries (which produce eggs, as well as the sex hormones estrogen and progesterone) fail to develop properly.

Women with Turner syndrome appear to have a stocky appearance, arms that turn out slightly at the elbow, a receding lower jaw, a short webbed neck, and low hairline at the back of the neck.

Other medical symptoms include: lymphedema (swelling of hands and feet), heart and/or kidney defects, high blood pressure, and infertility (inability to have children).

How do doctors diagnose Turner syndrome?

About half of the cases are diagnosed within the first few months of a girl's life bythe characteristic physical symptoms (swelling of the hands and feet, or a heart defect). Other patients are diagnosed in adolescence because they fail to grow normally or go through puberty.

When the doctor suspects Turner syndrome, a blood sample can be used to make a karyotype (a chromosome analysis) and the diagnosis can be confirmed.

Turner syndrome may be diagnosed during pregnancy with a chorionic villus sampling (CVS) or amniocentesis. Alternatively, an ultrasound (a machine that uses sound waves to look inside a mother's uterus) canidentify the disorder by its physical symptoms before the baby is born.

How is Turner syndrome treated?

Hormone replacement therapy is the best way to treat this disorder. Teenagers are treated with growth hormone to help them reach a normal height. They may also be given low doses of androgens (male hormones which females also produce in small quantities) to increase height and encourage normal hair and muscle growth. Some patients may take the female hormone estrogen to promote normal sexual development.

Interesting facts about Turner syndrome

Turner Syndrome affects 60,000 females in the United States. This disorder is seen in 1 of every 2000 to 2500 babies born, with about 800 new cases diagnosed each year.

In 75-80% of cases, the single X chromosome comes from the mother's egg;the father's sperm that fertilizes the egg is missing its sex chromosome.

Turner syndrome is named for Dr. Henry Turner, who in 1938 published a report describing the disorder.

The average height of an untreated womanwith Turner syndrome is 4 feet 8 inches.

A female fetus (normally XX) can survive with only one X chromosome, but a male fetus (normally XY) could not survive with only one Y chromosome. This is because nothaving an X chromosome is much worse than not having a Y chromosome. The Y chromosome carries very few genes essential for life. In contrast, the X chromosome is a much longer DNA molecule and contains many, many genes that are needed for cells to function.

source

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Vicky

Fenks! Not only for medics,topics that you can make an input will definitely come up at some point.

@vicky
I think that my post after the pic will answer your questions. Don't tell me that small article in too lengthy to read

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Dr. Centje, lets yarn more stuff, please tell me a little about tako tsubo cardiomyopathy, we were asked during our final MBBS

~vicky~:


o sorry! is heredity
the pic above please throw more light
am learning

there's a part of the article you missed

Look very closely at fingers behind the write up in that pic. They appear abnormal,that abnormality is called finger clubbing. The possible causes of it were then listed.