Axis Deviation (High yielding topic for AIIMS) with AIIMS Nov 2012 Question

Normal QRS axis= -30* to +100*

Left axis deviation=> negative than -30*

Right axis deviation=more positive than +100*

LEFT axis deviation

Normal variant

Left ventricular hypertrophy

Left anterior fascicular block

Inferior myocardial infarction

Expiration

Lying down

Obesity  and short (truncate) person

Wolff-Parkinson-White-Syndrome

 RIGHT axis deviation-

Normal variant(children and young adults)

Right ventricular hypertrophy

Left posterior fascicular block

Lateral wall infarction of left ventricle

Inspiration

Standing up (Getting up)

Tall and thin people

Dextrocardia

Mnemonic to remember it-

LEFT for left axis deviation

L-LYING DOWN

E-EXPIRATION

F-FATTY PERSON

T-TRUNCATE(SHORT)

RIGHT for right axis deviation-

R-RIGHT VENTRICULAR HYPERTROPHY

 I-INSPIRATION

G-GETTING UP

 T-TALL AND THIN PERSON

Other way to remember it-

Left Hand-Less Active ie-fatty,short and lazy(sleeping/lying down) person

Right Hand-More active ie tall ,thin and running (standing ) person

AIIMS NOV 2012 QUESTION-

Q-Right axis deviation  is seen in-

OR

Q-Left axis deviation is seen in all except-

a. OBESE

b. THIN AND TALL INDIVUDAL

c. END OF EXPIRATION

d. LYING DOWN

ANS-b (Tall and thin person)

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DIAGONOSIS OF PULMONARY EMBOLISM( PE )

DVT & PULMONARY THROMBOEMBOLISM(PE)

NOTE 1 : In patients with low clinical likelyhood of DVT & low to moderate clinical likelyhood of PE , the D-Dimer level is used to determine whether imaging studies are required or not . POSITIVE D- DIMER IN SUCH CASES WARRANT IMAGING STUDIES

So ans to this Q1 : FIRST test to be done in a patient with low to moderate clinical suspicion of PE is = D-Dimer

Q2] Imaging study of choice for PE is …
A] lung scan
B] venous ultrasound
C] chest CT with IV contrast
D] trans esophageal echocardiography

Ans = [c]

Q3] Gold standard for diagonosing PE is = pulmonary angiography.

Note : Imaging study of choice is a test which combines technical ease + lower cost + preferably non invasive nature + excellent posttest probability of diagonosing a condition ( though its  post test problity is  lower than gold std tests yet its use is justifiable when we consider its other advantage). So imaging study of choice is not always the gold std one .

FIGURE BELOW DESCRIBES DIAGONOSTIC ALGORITHM OF PE

Image