Investigations

Question 1

CKD

Answer 1

Urine analysis
PCR, ACR
GN screen
USS

MBD

• XRs
• DEXA
• PTH, phosphate, Vit D level

Question 2

ECG

Answer 2

Rate and rhythm
Axis
- Lead III +ve, Lead I -ve, RAD
- Lead I +ve, Lead III & II -ve, LAD
R wave progression
Intervals
- PR 0.12-0.2
- QRS 0.07-0.1
- QT 0.2-0.4 (<440 in men, <460 in women)
QRS morphoplogy

LVH

• Anterior leads (V4-6) R wave >26mm
• AvL R wave >11mm
• AvF R wave >20mm

IHD

• ST changes
• Reciprocal changes
• TWI
• Wellen sign
• Sgarbossa criteria

Question 3

JVP

Answer 3

INTERNAL jugular that runs from sternoclavicular angle to angle of jaw
Underneath SCM
Chosen as most directly above RA and no valve, providing most ‘accurate’ estimation of RA pressures

A wave - atrial contraction
Tricuspid closure
X descent
V wave - atrial filling
Y descent

Dominant a wave - tricuspid stenosis, pulmonary HTN
Cannon a wave - complete heart block, VT
Large v wave - tricuspid regurg
Absent a wave - AF
Kussmaul (increase w/ inspiration) - constrictive pericarditis

Question 4

CXR

Answer 4

General exposure/rotation

Airways, trachea
- Bronchial walls
- Air bronchograms
- Reticular changes, consolidation, opacities
- Nodules, masses, lesions
Breath, respiratory effort
Cardiac contours, vasculature
Diaphragm, pleural effusions
Extra-pulmonary
Foreign objects