Not 2nd

I got this sms from one of my student yesterday:

“We didn’t get 2nd but we got 1st. Thanks dr J.”

A group of my students went to Penang to attend a conference on acute medicine organised by the Malaysian Medical Association. They decided to present their research project, which they completed some time ago, in the poster presentation.

I knew deep in my heart that they stood a good chance of winning it.

And they did!

Well done! Darn proud of you fellas!!!

Mon, 260508 @ 0800

Case #38: The man with the MDM

This 24-year-old man presented with hemoptysis of 3 days duration which were minimal in quantity and mixed with saliva. There is no history of fever, cough or SOB.
On examination, his pulse was 100/min, regular and good volume.
The apex is located in the left 6th intercostal space just lateral to the mid-clavicular line. Examination of the precordium revealed a mid-diastolic murmur with a tapping apex. There is an occasional gurgling sound heard as welll over the apex.

On further questioning, he also gives history of frequent burping as well as reflux symptoms.

This is his CXR:

Questions:

1. Describe the findings in the CXR.
2. What is his cardiac diagnosis?
3. What might be the cause of his GI symptoms?

Mon, 260508 @ 0700