welcome good evening everyone and thanks a lot for your patience I'm Dr niveda and I welcome you all uh to the second all India online quiz of wizards of Cardiology after an impre uh yes after an impressive response uh from our audience for the season one of wizards of medicine where we had over 2 000 doctors from all over India who played live uh we at Netflix are so very excited uh for this evening of wizards of ideology and we know you all also have been eagerly waiting uh for the Wizards quiz uh so uh uh we begin uh we will get to um know our quiz Master for tonight uh that's Dr karnal Sharma I know our Netflix regulars uh already know sir but for those of you who have uh joined are joining us for the first time tonight uh Dr Kamal Sharma is a renowned cardiologist from Ahmedabad uh there are a combination of DNB in medicine and a DNB in cardiology uh with over 200 Publications to his name and more than 8 000 citations on Google Scholar here are some facts about Sir that um making special and the best quiz master that we could have asked for uh to host the Wizards of Cardiology so sir has done the world's first uh vagal nerve stimulation uh device and plan and he also discovered the Winking coronary sign of VSR on angiography which is uh also known as the Kamal Sharma sign of VSR along with this um sir is also an author he is a researcher and an innovator and from my personal experience of the previous wizards of medicine an amazing quiz master and I promise you all that y'all are in for some thrilling experience uh lots of fun and lots of learning at each knot I welcome you sir to host this season of wizard.com good evening everyone so everybody is getting busy with the pre Diwali Seasons I believe and as she said we had two wonderful sessions first we had the prelim rounds and then we had the finals and as she said we had 2 000 plus people playing wizards of medicine and then we chose why not let's do whole business divided into 12 segments of specialty and here we are doing first specialty which is close to me and my profession which is Cardiology and let me announce this also a word diabetes day is here around the corner 14th which happens to be a Monday I can't help it it's a Monday but because it's World habit is day so I I invite you all and we'll be playing a lot on Diabetes on 14th of next month that that is again 9 p.m which is now going to be our time for the KBC of quizzing in medicine as we call it right so that's what we awaited and we'll have a fun time we'll have a lot of rounds and uh Dr nivedita will explain to you how the rules will roll and we first did the prelims where we had a lot of people playing in and then we had such a huge enthusiasm about prelims that people said Servo finals and that's the reason we are keeping just one round for specialty this time uh so we'll have Cardiology and everybody plays along and whosoever gets it first and gets the most gets the price so uh over to you Dr nivedita can we have the rules for our participants yes but before moving forward to the rules um we here's a quick question for everyone here how many of you all have um heard about uh the Harrison textbook that's the internal medicine textbook you all can mention in the comments and I'm sure all of you all must have heard of it um and how many of you all have actually read the whole Harrison that's an interesting answer that we would like to know so do put in your comments give us a thumbs up for everyone who has actually read the whole Harrison um I assume not many uh it's not possible to go through the whole textbook but uh we are happy to uh and proud to announce that the makers of Harrison that's the McGraw uh Hill education uh mhe is our co-sponsorer for tonight's uh quiz now getting into the instructions of the quiz uh we highly recommend using earphones for a better audio quality throughout the quiz uh keep in mind that you will not be able to use the comment feature when the questions are being displayed this is kept so intentionally so as to maintain the Integrity of the quiz while it's being cleared however if you do face any issues any technical issues any uh kind of queries that you have do put do put them in uh into the comments in between the questions you'll have a couple of seconds and we'll get to it uh immediately um uh for every question uh that you get you get plus four uh for every right answer and you get a negative point for every wrong answer so be mindful of the answer that you choose uh don't uh do keep in mind that it is fastest fingers first so choose the answers correctly and choose the answers quickly because every second counts this is from the experience of last two sessions uh at any point of the quiz if you are unable to uh submit your questions or if you're stuck uh you can use the rejoin option and this rejoin button will be available to you on the top right hand corners of your screen uh so one uh and then uh once you select the answer remember to hit submit only then your answers get recorded and that's an important step to do um so once uh all of that is done in case you all are not able to view any of the options so every question has four options in case you are not able to view the four options do remember to scroll on the screen all the four options are present and submit is right after that um once you submit uh once the timer goes off or your screens the answer screens uh for every right answer uh it turns uh the answer the right answer will be marked in green and in case you have uh marked the wrong answer it will be marked in um red for y'all so that's how your answer screen looks to you and at the bottom of that screen will be your score and your time taken uh to answer that question um I think we are running a little behind on the slides of the instructions so I'll just wait for two quick seconds uh so that we are on track with the instructions so yes as Dr nivita has explained this is all about speed because I think there are a lot of intelligent guys around 300 of them 300 plus now uh these are this is the live audience we have 307 now 307 people playing Cardiology quiz simultaneously this has probably never happened in the history of Cardiology I believe at least for India and I think this is fun part of this is the application how can you create an app where so many people are playing a quiz and your instantaneous result that's the fun of this app that we have created on Netflix so that's the fun and so this is how what she's explaining um I think the questions are going to be not that tough but where the guys crack is the wrong option that they take when they have to press it fast so I just I want to give you a clue that there'll be multiple choice questions some of them may look right or correct but actually the answer may be the other one so just read them properly before you submit your answer over to Dr nivedita if you you can show the demo that's happened yes so this is how the scoreboard will look to you this is your answer screen if you marked it wrong you get a red uh cross if you marked it right you get a green tick and the plus four um coming to the rounds that we have and yes your score for that uh that question and your time taken will be visible at the bottom of the screen uh so coming to the three rounds uh the first round of the ice click around which has seven questions like the name suggests it's just a simple warm-up round round two is the spotters round where you have uh where you have an image on which the question is based and the third round is a case-based uh question round where we have three cases uh each case will be followed by two questions related to the case that has been displayed so in a little bit uh details about the first round that's your ice break around uh like I said we have seven questions for you with four options each in case you are not able to uh see all the four options uh you need to scroll the screen uh select the one that you feel is the most appropriate answer and remember to hit that submit button uh for it to get recorded and you will have 25 seconds to read the question and make your decision uh coming to the second round that's your spotters round this is an image based round we'll start with the image uh read the question look at the image and toggle back to the options uh hit the right option select uh submit and um here is a small hint so you cannot zoom into the uh image that is being displayed but you can scroll it and um uh the third round that we have and this round is a little longer it's for 30 seconds uh because you need to watch view the image and then come back to the options so it's kept for 30 seconds the last round that we have is the case based term so here uh you will um keep a pen and paper handy to note down all the points that you need to know about the case um we'll have the screen that displays the question followed by a screen that displays the image related to the case that's being discussed and this is Then followed by two questions with four options each again every right answer gives you plus 4 and every wrong answer gives you a negative marking um this will be for 25 seconds each so we'll stay on the case or that's being discussed for a little longer so I will read the case we look at the image and then the questions are timed for just 25 seconds um so once you do that uh every round has its own scoreboard so once we finish the first round that's your eyes trick around it will display the scoreboard which will take which will show you the top 10 rankers for that round in case your name is not visible in the top 10 uh your rank and your name your score and your time taken will be displayed right at the bottom so it will give you an estimation of where you stand among the 300 odd uh live participants that we have right now uh the final scoreboard that is that uh that is going to take into consideration all the three rounds that have been played so far all the rounds that you have played all the questions that you marked right and this will be played at the end or this will be displayed right at the end and the top three winners from the final scoreboard will be the winners for the Wizards of Cardiology um and um I think we've covered up all the questions all the instructions and yes do be mindful of the negative marking uh uh that takes place because that's where the whole up and down happens you could probably just lose your third rank for that one wrong question that you've marked um so I think we can get started with the first uh question uh yes so before before we go to the first question I'll give you some professional tips so what what uh has given you in details is so who wins it one who gets maximum points which means you got to get it right and number two when what we saw in last two around times that we played wizards of medicine the finals in the prelim a lot of people get equal points but the one who submits quicker that time is also counted so one who gets the lesser amount of time to get the same points B is the one who gets the winner and that time is not when you choose the option the time counted is when you choose the submit button so the speed that is required is you're choosing the option and hitting the submit button and of course I wish you luck with your internet also not breaking down when we do go with the Icebreaker as well so let's start playing the ice break around I hope everybody is ready can I see couple of thumbs UPS there for the people who are ready to play oh that option would be turned off right now so you'll have to do that after playing the ice breakups let's get it rolling coming on let's let's have the first round Icebreaker round one is here and you have the question number one on your display can we have the question number one this is the first question these are going to be very simple question the question number one for Icebreaker round one is I think we are facing internal tissues uh just give up right so so so these are going to be four options this is the question one in a cath lab enabled Center which means this is a center which has got a cath lab and you can do a primary PCI what is the optimal time time that the door to balloon for an stmi should be option is 120 Minutes B is 90 minutes C is 60 Minutes D is 45 minutes in a cath lab enabled Center what is the optimal door to balloon time for St elevation Mi 120 Minutes 90 minutes 60 minutes 45 minutes the time is getting calculated and your scores are also getting calculated the door to balloon time means the time taken for the patient when he is entering the hospital and gets his balloon done for coronary acute MI so yes 55 got it correct our audience is such an enlightened one majority got it right it is 90 minutes why this question was framed a bit trickly is because in a non-cat lab enabled Center it is 120 minutes so if you reach a place where you have to do a thrombolysis you are not doing an angioplasty and you need to shift it to a cathlab enabled Center the time is 120 minutes but when you've reached a place where there is an angioplasty possible it is going to be 90 minutes that's the correct answer which 55 of our audience got it right fantastic going cheer up get your adrenalines going because you can either fight or flight as they call it the hormone of fight or flight get it ready we all need to fight it out the question number two is coming up now on your screen an Osborne wave called also the j-wave on an ECG is seen in a torsa de pontus B hypothyroidism c hypocalcemia d hypothermia Osborne wave is seen in dorsads hypothyroid hypocalcemia or hypothermia this is classical j-wave or so-called Osborne wave which is described in one of the four conditions your time is up let's get these scores calculated your points are going to get uh deposited in your account so that you can encash if you get it right that is how it is again majority got it right we have an enlightened audience you can see that 56 of people no Cardiology is so good that they can be a cardiologist like ECG interpreting like me so 17 said Tor sets ten percent said hypothyroid 16 said hypocalcemia but the correct answer is hypothermia a lot of times people say you go to Kashmir and you're in gulmarg and you fall and you some you somebody you find who's been collapsed and you do an ECG and you find Osborne waves you know why he's collapsed he's collapsed because of hypothermia so you don't miss it out as an acute coronary event and you just need to warm it up and he comes out that's why this question becomes clinical irrelevant good going audience is doing pretty well our participants are fed playing fantastically our audience is increasing as we are playing along we have 332 plus attendees right now we have four raised hands we can take them at the end of the quiz as well so let's move to question number three question number three for the round one icebreakers is the back Triads this is a Triad so you'll have three options for each option read them properly cardiac Temple not of backstride of cardiac tamponade consists of tachycardia dyspnea and race jvp bradycardia muffled sound and hypotension hypotension muffled sound or increased jvp or hypertension chest pain and palpitation options jvp B is bradycardia muffle Zone hypotension C is hypotension muffle sound and the time is up you have probably chosen the right option yes again sixty percent of our players got it right as I was telling you a lot of guys are going to come with the you know 100 marks so all that's going to count is the fastest finger and your internet connection speed so 60 got it right it is the Triad of low blood pressure low intensity of heart sound because there is pericardly Fusion the fluid is compressing the heart so the venous pressures will rise the compression on the ra will increase your jvp but because of the compression the blood pressure will fall and you can't hear the heart sound that was the backstride muffled heart sound Fallen blood pressure but increased venous pressure as assessed on jvp so 60 got it right and that's what I said that read out the options because bradycardia muffled and hypo is what people got confused in 20 clicked on it just for the sake of speed I'm sure those 20 knew the answer right but it's just the sheer stress of the adrenaline rushing through and the time that they might have opted on the wrong one let's not get disheartened with it those 20 and 60 people who got it right keep playing along and keep gluing the way you are doing fantastically everybody brace up for the question four the question four for the ice break around is here the Delta wave on ECG I believe hundred percent are going to get it is a wpw syndrome B atrial tachycardia C ventricular tachycardia d a v n r t Delta wave on ECG is seen in wpw syndrome atrial tachycardia ventricular tachycardia and AV node re-enter and tachycardia which of the three of the four options you will find Delta wave on ECG and our time is up and let's calculate how many people got it right I am anticipating anything between 90 to 100 but get it right wow that's 81 that's fantastic I mean we have such an enlightened Cardiology guys in this group I'm so happy uh and and the good thing is that I have not even taken any CG lecture I mean we are going to go live with one of the promotional lectures on Disney approach to case of Disney as a Diwali uh with the season bonus that's coming on Netflix but that's fantastic going ECG reading wpw syndrome is what you get Delta Delta is slurred up stroke on QRS complex which is because of the bundle of Kent which is an extra accessory pathway which allows the current to pass from the Atria to ventricle and because there is no AV node DeLay So the short PR interval takes place and this merging of the current passing through the bypass track and the normal QRS give rise to slurred up stroke which is called as Delta this is one of the feature of wpw syndrome one is Delta second is short PR and third is wide QRS complex this Triad defines wpw syndrome and a lot of a lot of our participants got it right congratulations to all of you let's move to question number five the question number five which medication if stop abruptly causes rebound hypertension the earliest all of them can cause but earliest which is taught in medicine nephedepine clonidine tell me Saturn and Verapamil this drug if you stop you can have the same time the earliest rebound hypertension one of the side effects explained in the drug the phytopene clonidine tell me certain Verapamil the time is running up and it's over time is over let's see I'm sure again I'm anticipating 80 percent guys getting it right 62 got it right so nifedipine is known to cause reflex tachycardia more commonly seen yes it can cause rebound hypertension but it's not at the earliest you miss one dose of clonidine and you have a rebound hypertension clonidine is the right answer 62 because we know where it acts attacks of the presynaptic receptor and then that receptor is getting going to get modulated with the drug withdrawal there is a surge of us of the uh not epinephrine epinephrine acetylcholine and this is going to lead into terms of rise in the sympathetic tone and then you can have a rebound hypertension tell me certain Verapamil are very unlikely to cause the same so the correct answer is Clonidine but I'm happy that most of our questions were pretty easy at least now it's same so probably next time I'm going to make more tougher questions along with the team we have a big Team all questions are not done by me we have a research team and a lot of guys on the background working on it so chloridine is the right answer 62 got it right let's move to question number six on the round one of Icebreaker we have just two questions more left how much of the exercise on an average each week is recommended to help prevent heart disease from the American Association ACC or aha or even who all guidelines recommend 60 Minutes 90 minutes 120 Minutes Or 150 minutes how many minutes of exercise you must accumulate over a week to prevent heart disease 60 Minutes 90 minutes 120 Minutes Or 150 minutes a week the time is up let's let's get this course let's get the scores I again feel that a lot of these again we'll have well so this time we've got again majority of the people who have got it right 38 but I mean though it's highest but it's not more than 50 percent for once this is a preventive Cardiology so we have lot of Interventional guys we have a lot of guys who learn a lot of you know treating the guys but this is a preventive Cardiology thing so probably we all need to refurbish our memories in that terms how to prevent heart disease is also an important aspect so to prevent it you need to accumulate 150 minutes of exercise a week so the right answer is 150 for once we did not have 50 plus people getting the right answer but still the majority got it right majority in the sense it is the highest percentage that we got so that brings us to the last question of the Icebreaker and believe me your scores that might be May influence what happens at the end Austin front murmur is heard in which condition often Flint a pulmonary regurgitation mitral stenosis severe aortic regurgitation and aortic stenosis this is a murmur that we all learned in our undergraduates where do you hear Austin Flint murmur pulmonary regurgitation Ms severe AR or aortic stenosis we still have nine seconds to go there were doubly named murmurs let me just share one interesting aspect of it about the doubly named murmurs was the time gets Prime gets over it's over all doubly named murmurs are diastolic murmur remember that any murmur that you hear where you have two names so carry coomb Austin Flint grahamstell Cole Cecil any murmur which has got two names is a diastolic murmur yes 63 got it right Austin a for a that's how I used to remember in my undergraduate days a for Austin Flint a for aortic regurgitation so a for a gram still you get in pulmonary regurgitation carry Coombs murmur you get an acute Rheumatic fever which is turbulence of mitral valvitis you have another murmur called cold senses which also you find in aortic regurgitation of course you don't find any named murmur in stenotic lesion uh in aortic stenosis because the murmur in aortic stenosis is going to be a systolic murmur so the clue was that doubly named murmurs are diastolic so that brings us to the end of round one and let's have a look at your scores you can see your score if you're there in top 10 or not we have Dr Madhuri who's she's got 28 which is likes all seven correct and her time was just 0.41 seconds I think she's on 5G Network gitanjali purvada got 28 2 she's 1.46 Dr Jim Jacob Roy got 0.47 that's the difference one second separates our rank one from rank two I think I should be making tougher questions we have all the top 10 guys getting full marks I think I need to be you know taking up something the level and I'm sure because this was Icebreaker we wanted all of you to get good marks and get good prizes so that's that's it for her comments thank you Phil and congratulations everyone who's in the top 10 and so before moving forward to the next round uh let's get to know our sponsors a little [Music] um and um can we have the next one thank you uh so McGraw Hill is delighted to provide the top three winners with access to their Flagship products access medicine and access Cardiology access medicine is an acclaimed online medical resource that helps practicing Physicians uh meet their milestones and patient care goals with key resources to support the prevention diagnosis and treatment of adult diseases access medicine includes nearly a 150 plus core titles including Harrison's 21st Edition uh cmdt 2023 Etc with 12 000 plus self-assessment uh q and A's uh around three thousand uh 1350 plus cases with about 130 plus podcasts 700 plus videos and an extensive drug database the platform is continuously updated with the latest edition and content uh the platform not only covers medical content but also contains quality improvement uh patient safety and Leadership business title with support practicing clinicians in administrative roles as well access Cardiology uh which from McGraw-Hill is um the world's most comprehensive online Cardiology resource which serves cardiologists in meeting their milestones and achieving patient care goals with resources covering the full scope of Cardiology the platform provides access to 25 plus core titles including the latest edition of pasta and Hearst the heart uh 1100 plus review or q a 1800 plus cardiac imaging videos uh 1500 plus full color illustrations 3D cases and 100 class practice impact extra podcast episodes and a lot more it is uh critical for uh every um can we have the next slide um it is uh critical for Physicians and other Healthcare professionals to have access to the Quality Medical content McGraw-Hill Medical Solutions provide unlimited access to invaluable content and updates from the best mind to Medicine uh McGraw-Hill not only covers clinical Specialties but also caters to Allied Health Online Solutions and medical test prep online Solutions uh thank you so much and we are greatly honored uh to be uh to have a McGraw-Hill uh sponsor this session or this episode of wizards of Cardiology I think I think I think I think I should talk about McGraw-Hill myself because people say Harrison is Bible and let me to be more precise is Gita of medicine it's the book that you read and then you're done with medicine everybody would you know know about it and have however about it if you know your Harrison inside out there's nothing that is probably untouched in the area of medicine a lot of times even as a cardiologist I go back to Harrison's textbook of medicine even today I have the current edition of Harrison with me and access card geology I want to tell you I have access to excess Cardiology because of my Institute and it's a fantastic platform you can see a lot of images you can actually prepare for entrance examination because a lot of entrance examinations have a lot of questions and where the question may not be picked up from there but the concept building with the questions is fantastic so and also the access to the hearse the heart hers the heart is one of the competitive look of the other book that you have for Cardiology and there are always chapters the heart has always got chapters in cardiology which are missing in the other textbooks of Cardiology because I remember doing certain topics rehearse the heart which were not there in what is the other textbook of Cardiology so that's the fun of these books I think it's a fantastic prize and we must thank McGraw-Hill for sponsoring this session in cardiology no other appropriate sponsor would have done it thank you very much for being our co-sponsor today thank you and we'll start with the second round this is the spotter round and remember that it is gonna be for 30 seconds this time uh you have to choose uh you it's a spot around image based so have a look at the image first and then as I was reading out the question uh you can then uh choose the option hit submit uh and be mindful of the negative yes as some of you guys might have thought that you've got just 20 points or maybe just 16 don't get disheartened because last time when we were playing along the round one had all people getting full marks and how the things change because with these spotters then comes your you know the negative marking you get carried away the guys who are leading can actually fall down so that's also a word of caution for our top 10 guys who can play for the top three prizes that be cautious Play Safe and just listen to the question re go through the image you may think that the question you have got it right but the image you might not have gone through don't do that mistake because image is going to tell you what the diagnosis is so we have the spotters around here and Navigator we have I think five questions six questions here seven questions seven questions we have for the round two so are we ready to roll it okay so everybody all the best red let's roll for these spotters round two here comes your question number one and you already know the instructions how to play along plus four minus one and it's the time to submit that's when you sub hit the submit button your times time is counted let's have the question number one the question number one for the spotter is coming on your screen yes identify the instrument identify the instrument you can see the image and we can show you the options the image options are it's a ptca balloon it's a ptmc balloon it's a PTA balloon or it's a vent tube so I'll give you full forms percutaneous transcatheter coronary angioplasty balloon per cutaneous transmitral commissionerotomy balloon peripheral transcatheter arterial angioplasty balloon or it's a wind so let's see the time is up let's see so 45 thought it was angioplasty balloon remember the angioplasty balloon does not have a gap in between it is there is no uh it's not dumbbell like what you're seeing is a dumbbell like structure it's the angioplasty balloon is a tapered single cylinder like balloon it's a ptmc balloon it's the Acura or a innovate balloon with which you do balloon angioplasty it's a balloon for BMV or what you call ptmc percutaneous transcatheter mitral commissionerotomy is the other name for pbmv or ptmc or BMV as you call it so that was the trick question as I said the fortunes do change after round two or 38 got it right 45 got it wrong so 45 will go to get minus one it's not a ptca balloon it's a balloon you can see the waste in between that waste is one that comes and hit is is hedged across the orifice of mitral valve so you have the distal part of the balloon you have proximal part of the balloon this is the mitral orifice and then this inflates so what you're seeing the Gap in between is actually the site where it will fit at the mitral annulus to do the dilatation of balloon mitral valve so that was the question on the first instrument let's move to the question number two the question number two and your image and the question is here it's an ECG question diagnose the pathology from this ECG look at the ECG look at the ECG and try to find what the pathology is the options are a atrial fibrillation B ventricular fibrillation C atrial flutter and D ventricular premature beads you can go back to the image you may not be able to zoom it but you can minimize myself and look at just only clicking on that and make really make it look bigger yes so the answers are submitted we are calculating your scores atrial flutter was the right option you could see the flutter waves in the ECG if you could see the image there were multiple what were looking like QRS complexes were actually the flutter waves and this was an ECG of 812 flat a 71 got it right fantastic so a lot of people got it right 14 thought it was atrial fibrillation the correct answer is atrial flutter the flutter waves were what you were able to pick up and that's why the current uh the correct answer is option C let's move to the image round the spotter round question number three diagnose the pathology from this ECG if it's Cardiology you need to have lot of ECGs coming in of course a psvt b atrial fibrillation C biocardial infarction D brugada syndrome just look at the CG I'm giving you a clue look at the ECG you have premature beat you look at the other waveforms and try to find what you're dealing with it's a psvt atrial fibrillation myocardial infarction or brugada syndrome the time is running out and the time is up the correct answer for it because the VPC was showing a risk of arrhythmia the correct answer is syndrome a lot of people got it right 60 fantastic playing our participants are doing fantastically well you can see the code the pattern in V1 look at the image again look at the V1 there is a code V1 pattern which is a feature of brugada syndrome this camel hump appearance as they say the Cove appearance that you find in V1 is a feature of brugada syndrome this is type 1 brugada and the hint to it being an uh an arithmogenic thing without an st elevation of Mi was the VPC the premature weight which is coming you can see the lead the lateral leads are positive uh and so it's coming from the right side and it can be diffused of course it's a long it's a type of arithmogenicity which is inherited uh the channelopathy that we know from the brigada so this is an ECG or brugada syndrome and I'm so happy that sixty percent of our audience got it right let's move to spotter number four remember it's plus four minus one identify the device in this chest x-ray you can see the four pointers pointing to us device which is located in the chest the options are a implanted cardioverty defibrillator B ASD device closure C Pacemaker and d a card extent I believe a lot of people are going to get it right aicd pacemaker card extent or HD device a ICD BSD C pacemaker D Card extent a time is running out and time is up let's look at the score and I am anticipating majority of you getting it right because the rest of the things don't look so big oh and oh I'm surprised 45 percent thought it was an ICD no it's an ASD device look at the position of the device it's looking like two rings present at the site of inter-atrial septal defect that's where the device is sitting around it's an employer device sitting at the level of between the two atria it's an ASD closure device ICD would look like a pacemaker with a lead in the pockets just below the level of clavicles with a lead going into the ventricle so you'll have one coil at The svcra Junction in the second coil at the level of the tip of the lead or where you have defibrillators between the two polarities and the generator so ICD would look like a pacemaker Pacemaker and ICD would differ because of the SVC coil larger battery thicker lead that's how ICD would differ from a pacemaker on identification stent was looking very would usually look very small not so big as you can see in this image it's a large device sitting in across the heart it's an ASD device which is sitting for the ASD device closure in chest X-ray let's move to another question the question number five from the round two of spotters is here on your screen identify the pathology from this just x-ray often called a very classical appearance the options are TA PVC or tapv are b tetralogy top C PDA which is patent ductus arteriosus and D is Eastern manga syndrome option is capvc or total anomalous pulmonary venous return B is tetrology of fallow C is patent ductus arteriosus and Diesel magnet Syndrome look at the image it's a classical appearance our time is up now let's see how many got it right it's a classical appearance and those who get this right are bound to be cardiologists 45 that's fantastic that's a huge number a lot of people got it right you can see a figure of eight appearance what you are seeing is also called a snowman appearance this is a snowman appearance figure of eight appearance some people call it the loaf of bread appearance looking like a loaf of bread or the figure of eight this is supracardiac TA PVC what you see in supracudic tapvc is that the pulmonary veins instead of opening into the left Atria join to form a common chamber behind the left Atria and Ascend as a vertical vein and goes up and joins into the superior vena cava this hole gives rise to a upper arm of figure of eight of course the lower part is the hard Shadow the upper part of the figure of eight the upper Arc of the eight is formed by the vertical vein the common chamber the vertical vein and its joining the innominate vein and into the superior vena cava so that gives rise to figure of eight appearance and this is classical of ta PVC especially of surupura cardiac tapvc so a lot of you got it right let's move to question number six identify the condition this is a finger ale and I believe everybody is going to get it right a clubbing B Splinter Hemorrhage C coil on a TR D fungal infection option A is clubbing B Splinter Hemorrhage C is coil or Nikia B is fungal infection being a Cardiology quiz I believe that you are going to get it right if you're dealing with A cardiology with a fingernail image these are the things that you will anticipate is it clubbing Splinter Hemorrhage coil on a cure a fungal infection or time is up let's get the scores let's get the scores how many got it right 80 percent that's fantastic we have a very ineligible playing along candidates who are as good as cardiologists especially in terms of clinical images Splinter Hemorrhage which is a sign of infective endocarditis apart from raw spots gen religions oslers node you got it right a hemorrhage in the nail bed which looks like a splinter is seen in acute infective endocarditis these are all immune complex mediated mechanisms of vasculitis that may happen because of circulating immune complexes in patients with infective endocarditis due to bacteremia so splinter hemorrhages are one of the peripheral signs of infective endocarditis 80 got it right audience is playing along fantastically this is fantastic going and let's move to the last question of round two that is spotters coming on your image identify now everybody he has got a cardiologist at home this is an angiography of left system the arrow is pointing to the vessel identify this vessel is it the left circumplex artery or is it the left anterior descending artery or is it the right coronary artery or is it ramus intermediate choose your option everybody in the family thinks they have got a cardiologist are you the one let's choose a circle left circumflex b a left interior descending C right coronary or D Rhema centimeters of course these are the four vessels that you can have in a coronary artery so the time is up let's see how many got it right twenty four percent got it right everybody thought the LED is the most important artery LED is often called as widowmaker's artery the artery that closes and creates widows but that's not the right answer the artery that runs on the back is the circumflex artery so this is the left circumflex what you see on the front that is on the right side of the image is your left anterior descending artery this is The Rao view which is audio caudal view where you are seeing the left main bifurcating into the left anterior descending which is the right most in your screen and what you're seeing is the arrow is the left circumflex artery so I had to keep certain questions in spotter so that you don't get 100 marks so this question was indeed of that level so that we can differentiate between the winners and the other winners so left circumflex is the right answer we have got round two spotters finished with this question are we going to have scores for this or are we going to have scores only after round three let's see to make it interesting if we can have scores let's go to the scores then yes so now Dr Prashant is playing with 28 so that's the fun round one when it got finished we had 28 as the top scorer after seven more questions we still have score 28 that's the difference and Dr prashanth is at points 53 seconds he's really playing fast and he was not even in top ten second rank is Dr selvaraj again 28 points one minute and 16 seconds and Dr nilanjan majumdar is on 28 as well with 1.18 if you go to this top scorers now we have the difference in scores emerging top six guys only at 28. the rest of the guys the points have started changing a lot of it probably coming from minus one to make the score difference don't get disheartened we have six more questions to play and things can change drastically you can see how the scores have changed Nevada your comments thank you sir uh so for everyone who is uh who would like to know more about access medicine and access Cardiology there are links in the comments that you can view at the end of the quiz uh and it also has an email address along with it so feel free uh to drop them an email if you want to get more information and we will also send you all an email with uh more details on these platforms so stay tuned for that and uh let's have the third uh round um like I said third round with the case based round so you'll have the case with you in detail sit with the pen and paper to note down the points that are required uh this is now gonna be followed with an image that is related to the case take down pointers from the image and from the cave and then you have two questions that are linked to the case um answer them again this is going to be for 25 seconds uh each question is going to be plus four for every right answer uh a negative marking for every wrong answer and um you can scroll the options to view all the four options and don't forget to hit that submit yes so this is going to change again a lot of things but today the whole purpose of quizzing is not just choosing a winner or a loser Everybody Must Be A Winner in terms of knowledge that's the whole idea of quizzing so what I'm going to do is give you three clinical case scenarios which you will not forget in your life because you will remember that you learned about Netflix in the Wizards of Cardiology so I'm going to give you three cases three scenarios three pictures and these three pictures will also have six questions two questions each for them but they will teach you three important clinical cardiovascular disorders that you should not forget or miss out in your clinical practice so let's start playing the case based questions and let's save the case number one for you so remember there'll be two questions one based on Quest case number one you will also have his image I just told you let's have the case number one here go through the case study read it properly and go through the image then comes a question and then you read the options and submit the answer so case one is a 72 year old male experience dyspnea for one month just discomfort for two days ECG is showing sinus rhythm with right bundle branch block with low voltages with loss of R waves in mid precorder leads so there is lots of R waves on ECG Echo is showing concentric left ventricular hypertrophy by atrial dilatation and ejection fraction 65 percent with mild LV basal hypokinesia with grade 2 diastolic dysfunction serial testing of cardiac biomarkers show persistently increase cardiac troponins and normal CPK myocardial Bank levels coronary angiography was non-obstructive coronary artery disease which means there was practically no problem with the coronary artery disease can we move to the image so we know this case and this is how it's looking like look at the ECG look at the echo image can you see the echo image the one on B is the parastern long axis one on C is the apical four chamber what you can see is the Q wave so timer has not started yet because I want everybody to go through the image and the craziest tree elderly male ECG is here Eco is here angiography is normal can we now have the options and once you see the options the timer will start the options are here what is the question one the what is the gold standard test for diagnosing this condition a coronary angiography B cardiac MRI C pet scan D myocardial biopsy the options are coron geography cardiac MRI pet scan and myocardial biopsy those are the four options your timer is running out and the time is up let's see what the answer is so this question was slightly tricky this yes 27 got it right it's myocardial biopsy so once we'll be done with both the questions I will explain the case a lot of people thought it would be cardiac MRI that would not be the gold standard to differentiate its differential diagnosis so let's move to the of question number two which is related to this can we have the question number two now the case Remains the Same and this is the question number two what is the recommended treatment in the attr variant of amylosis only you know what the diagnosis is option is b methotrex zc as a thioprene d adelimum the options are tough amides Methotrexate as so those are the four options so you know what you were dealing with amyloruses how do you treat the time is up and I believe a lot of you will get it right because you now know what the diagnosis was let's see how many got it right perform it is is the correct option 24 got it right 28 thought as a thyoprene and 30 thought it is Adali lumab but the answer is taphometis is the treatment of amyloidosis attendant so we know there are two types of amyloduses this was a case of amylodices if you can see the remember the image there is speckled appearance of the septum the septum was looking whitish compared to the brownish or the dark part of the other parts and despite loss of R waves in the mid precorder leads which is what is called a pseudo infarction pattern it looks like if the patient has got an MI pseudo-infaction but Eco is showing fantastic 65 so if you find an ECG in an elderly male where it is looking like an MI but Eco is not matching and you find speckled appearance of the septum you should suspect cardiacomyloidosis cardiacomyelodosis can be diagnosed you can scan either by the biopsy of The myocardium or subcutaneous fat or you can do a technician pyrophosphate scan to look for infiltration of cardiac involvement along with the bone you look at the density of the bone versus the cardiac density when you do a technician pyrophosphate scan so by that you can differentiate whether you're dealing with a case of cardiacomyeloid especially attr variant or not the gold standard to differentiate between Al type and attr would be a biopsy and hence the treatment of choice which is now available in India is staphometise is the new therapy which is used only in attr variant of a myelodyss not in Al variant so answer was the formidation the case was a myelody says I believe you got it now that when you see a patient with pseudo-infaction patient and an elderly patient who's got punk amylodosis are the features which you all know this is a Cardiology thing so I just tricked it to it but pseudo-infaction pattern Eco showing speckled appearance you suspect a myeloid and the treatment is staphometis that was the learning from the case one let's move to case number two that's another interesting case coming to your way the case number two the history for case number two is going to get displayed it's a 40 year old female presented with history of hypertension to your clinic with Disney on exertion headache dizziness for seven days she has normal vitals which means pulse blood pressure are normal she has got cardiomegali bilateral lymphadenopathy and multiple lung nodules ECG is recorded in other hospital is in the image that will be following the aqua Revolt RV dysfunction and reduction in systolic function as well dilatation with systolic function so you basically have RV dysfunction that's the history can we have the image look at the image now that's the CG so this was recorded somewhere else you can look at the ECG it's it's you can rotate your mobile it's upside down it's it's on it's tilted to the side because the ECG strip was long so it's been displayed uh in the vertical fashion rather than horizontal you can see it's some yeah I can give you that clue it's a white complexity so you know what it probably is likely to be it's coming from somewhere in a patient who's got infiltrates in the lung has got higher lymphadenopathy and is a young female that's our history and this is the ECG can we have our options and the timer will start as soon as the options are displayed the options are which investigation will you do next a halter monitoring B cardiac MRI C pet scan or d a spec scan holder monitoring cardiac MRI pet scan or spec scan so those are the options you still have seven six seconds to choose your option the timer is running out choose an option and submit the button the time is up let's see the scores yes so we have 20 taking care MRI a halter is not required because you already had an arrhythmia so you don't want to investigate further Pat inspect is equally divided by the audience the right answer was cardiac Mr why we will take that call after the question number two so the question number two is the question number two for this patient would be the therapeutic approach in this case would be a anti-hypertensive with steroids B diuretics with steroids see steroids with an aicd and D anti-hypertuck then saves with digoxin she had RV dilatation remember the history look at the ECG we have already shown it to you therapic options a hypertensive steroids B diuretic steroids see diuretic aicd and D hypertensive digoxin if you know what the ECG was you'll get it right the time is up and let's see these how many people got it right the majority got it right amongst the four options 41 got it right it's steroid any ICD so now you know the answer the disease is sarcoidosis and it's a cardiac saraccoidosis this is an RV OTV tvt is coming from RV outflow track so in some patients where you already have lung infiltrates in a patient with right ventricular outflow tract obstruct which is showing VT so in a patient who's got lymphadenopathy who's got lung infiltrates and also gets arrhythmia suspect a cardiac sarcoidosis and Sarcoidosis is treated with steroids and for arrhythmia you need to put an ICD which we saw in that case there was a VT you can evaluate it further the treatment of sarcoid is steroids and for arrhythmia if they are life-threatening or a cardiac arrest Survivor or a recurrent or a documented VT is an aicd so that was a case of sarcoidosis let's move to the final question final case where you have two questions the case number three 32 year old female presented with sudden onset of breathlessness non-productive cough abdominal distension bilateral lower limb edema since two months past history of pulmonary tuber clauses pulse is 118 per minute blood pressure 100 by 96 which is narrow our respiratory rate of 28 examination revealed elevated neck veins pulses paradoxes muffled heart sound Beetle edema raise DSR CRP low voltage QRS sinus tachycardia small left ventricles and the findings are as shown below can we have the image now and we have the image yes so that's you can see there is some inspiration expiration and there is what you can see about the signal of one of the vessels you can see if the above I can tell you there is IVC and there is something above the IVC which you can see a Doppler signal happening so that's the Doppler signal being recorded in achocardiography so now you know what you're probably dealing with let's go to the question the two final questions for the Wizards of Cardiology we are here what is the least likely theology to cause this disorder which is what disorder it is and which is the least likely theology for it history of pulmonary Cox acute rheumatic fever post cardiac surgery and staphylococcal infection which of the four is not likely to cause this disorder past history of Cox acute rheumatic fever post cardiac surgery or staphylococcal effusion the timer is up and let's see how many got it right 40 got it right acute robotic fever is unlikely to cause this disorder we'll take this case after finishing the next question let's move to the second question and the last question from Wizards of Cardiology to decide the final three winners a high jvp with prominent wide descent indicates a rot sign back sign kusamaal sign Frederick sign raised jvp with prominent wide descent is called as rot sign back sign kusumal sign or Frederick sign you still have six seconds I'll discuss all the signs at the end of the quiz and the timer is up yes you got it right it was a case of constructive pericarditis an impatient of constructive pericarditis acute rheumatic fever rarely ever causes constrictive pericardited rapid wide descent is called as Frederick sign rot sign or pin sign and e word sign are seen in cardiac tamponade or pericardial effusion dull note in the substantial area is called rot sign backs Triad or Maxine we already had as a question in our first icebreakers kusamaal sign is seen in again cardiac tamponade where you have a inspiratory increase in jvp so Fredericks is the right answer and let's see who got it right we'll be now not showing you shall we be showing William will we be showing the scoreboard for class round three as well and then we'll go to the final list right so can we have the can we have the score for round three wow so a lot of guys got everything right amazing so we had um we had five people who got all six right Dr nitin got 24 out and 0.53 seconds Dr Shivam got 24 and 1.21 and Dr Javed varsi got 24. again in 2.02 this is only for round three now what happens is we add up around one round two and round three at this place so the fun is that we hardly have top three rankers in either of the three none of them have got it you know repeatedly in all the three rounds am I correct you were looking more into the names as well right as I was engrossed in the quiz so probably all the three rounds had all the three different winners top three have right so that's that's that's that's really the adrenaline driver and I see a lot of guys actually getting worried and rejoining and I mean probably clicking on the rejoin button and I can see the numbers moving up and down and up and down so maybe the anxiety of not missing out the winners so are we ready with the final results okay so over tonight yes yes I think we can final score could uh displayed now so I had fun playing it long or maybe making you play along it is always fun doing with the uh you guys and we have the results with you and it's here Dr deepthika shivadasana has got 80 points at 7.27 she's the number one ranker for the game today we had seven plus seven plus six which is 20 Questions 20 into 4 is 80 and she was not there I thinking wrong one she was doing so fantastically well and she was hiding all behind the scene that's how the game is that's the fun rank two is Dr Neil limay who's got 75 points and rhyme was five minutes and 30 seconds he was faster but he got five points lesser and Dr Raj Narayan salwaraj got 70 with two minutes 52 seconds and he's a third ranked winner Dr Khanna Dr Javed warsi Dr Muhammad Shahid Iqbal Dr nitin Dr prashan Dr venkatsai and Dr Jim makeup you all deserve a big round of applause you're there in top ten and each of you had a fantastic participation each of you will have a lot of more things coming across to you from the team Netflix it's always a pleasure joining with you and I'll look forward to have you for the diabetes quiz as well you can see your individual ranks displayed below Rank 10 and that's how you know where you stand as well so congratulations to all the winners it was fun being with you you've been a great participant and a great audience I love you it's fantastic thank you and keep connected keep playing along and happy learning to all of you knowledge is the power and that power is something that's Invincible because as they say knowledge is one weapon is one uh wealth that you can share with others but still it increases neither your brother can divide it with you neither nor the thieves can steal it from you that's so it's it's a Sanskrit sloka foreign take it away from you nor your brothers can divide it with you nor the thieves can steal it from you that's one knowledge that increases as you share it with the others thank you very much for having me as the host it's always a pleasure to be connected over to you good night take care everyone bye bye thank you congratulations everyone
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