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Elsie Kugel: Test Results

EKG

Chest X-ray

Laboratory Test Results

CBC

wbc 7000 (5-10,000)
hct female 38% (36-44% male 40-50%)
polys 70% (60-80%)
lymphs 30% (20-40%)

Chemistries

bun 28 (18-25mg%)
creatinine 1.9 (5-1.7 mg%)
glucose 126 (up to 109)
sodium 140 (135-145 mmol/liter)
potassium 4.2 (3.3-4.9 mmol/liter)
bicarbonate 26 (22-32 mmol/liter)
chloride 98 (97-110 mmol/liter)

Self-assessment question:

What does Elsie's EKG show?

a. Remote myocardial infarction
b. Acute myocardial infarction
c. Ventricular aneurysm
d. Left bundle branch block

The correct answer is d. The ekg shows left bundle branch block (LBBB) which is characterized by wide QRS complexes of at least .12 seconds duration, upward deflections in leads 1 and V6, and QS complexes in the septal lads V1-3. ST elevation and inverted T waves are common with LBBB and do not necessarily indicate infarction or ischemia. If infarction or ischemia are suspected on the basis of history, other tests are required for diagnosis. What tests would be helpful in Elsie's case?

Self-assessment question:

Which of the following is not evident on Elsie Kugel's chest x-ray?

a. Cardiomegaly
b. Pulmonary venous hypertension
c. Pulmonary arterial hypertension
d. Kerley B lines
e. Pleural effusion

The correct answer is e. The plain film shows numerous stigmata of congestive heart failure as noted above. However, there is no evidence of pleural effusion. Can you find examples of the abnormalities mentioned in the question above?

Next: Questions about this case