Professional Documents
Culture Documents
pneumonia+headache+confusion=legionella
H influenza and pseudomanas staphylococcus are most common
superimposed infections in CF
SOB + such high fever+ Localized pleural rub - seems Lobar pneumonia
Pleural rub present in pneumonia, PE and pleurisy.
This woman has lower abdominal pain and a positive pregnancy test
with signs of haemodynamic instability: an ectopic pregnancy (C) should
Important point
Increased thirst
Increased urination
High fever Weakness Drowsiness Altered mental state
Headache Restlessness Inability to speak Visual problems
Hallucinations Paralysis Warm skin that doest not prespire
(signs of hyperglycaemic shock....)
The palmar grasp reflex appears at birth and persists until five or
six months of age. When an object is placed in the infant's hand
and strokes their palm, the fingers will close and they will grasp it
with a palmar grasp.
Pregnant female exposed to child with chicken pox:Next step is measure her IgG antibodies- if she is immune- reassure
If she is non-immune- give varicella Igs
And if she unfortunately develops chicken pox, then give her acyclovir within a
day of appearance of rash (no immunoglobulins will help her once she
develops the disease so avoid)
If fetus develops chicken pox (soon after birth) give both immunoglobulin and
acyclovir A-- pale optic disc becoz artery is occluded
Features result from excessive copper deposition in the tissues, especially the
brain, liver and cornea:
liver: hepatitis, cirrhosis
neurological: basal ganglia degeneration, speech and behavioural problems
are often the first manifestations. Also: asterixis, chorea, dementia
Kayser-Fleischer rings
renal tubular acidosis (esp. Fanconi syndrome)
haemolysis
blue nails
Diagnosis
reduced serum caeruloplasmin
increased 24hr urinary copper excretion
Management
Penicillamine (chelates copper) has been the traditional first-line treatment
for a period of two years from the most recent event,[ Where
aspirin is contra-indicated or genuinely not tolerated (ie proven
hypersensitivity or history of severe low-dose aspirin-induced
dyspepsia), clopidogrel 75 mg daily is a suitable alternative to
aspirin (or aspirin plus dipyridamole post-stroke)
Myocardial ischaemia
A single dose of aspirin 300 mg and clopidogrel 300 mg (600 mg
- unlicensed in some centres prior to urgent percutaneous
coronary intervention (PCI)) should be given as soon as possible
after an ischaemic event (both non-ST segment elevation
myocardial infarction (NSTEMI) and STEMI), preferably dispersed
in water or chewed
Clopidogrel 75 mg daily is licensed for the treatment of acute
coronary syndrome (ACS) ST elevation, in combination with
aspirin (usually following loading doses)
Post-PCI clopidogrel 75 mg should continue for one month if a
bare metal stent is inserted and 12 months if a drug-eluting stent is
inserted. Thereafter, treatment should revert to low-dose aspirin
alone.
Eptifibatide and tirofiban are licensed for use with heparin and
aspirin to prevent early MI in patients with unstable angina or
NSTEMI where early percutaneous transluminal coronary
angioplasty (PTCA) is desirable but delay is likely.
Cerebral ischaemia
Acute ischaemic stroke - thrombolyse if appropriate and follow
with aspirin 300 mg once daily for 14 days. If not able to be
thrombolysed then aspirin alone should be given. Aspirin caused
an excess of about two intracranial and four extracranial
haemorrhages per 1,000 people treated, but these small risks were
more than offset by the reductions in death and disability from
other causes
Long-term management of both TIA or ischaemic stroke dipyridamole 200 mg bd with aspirin 75 mg once daily.
intracranial haemorrhage.
Fibrinolytic drugs act as thrombolytics by activating plasminogen to form
plasmin, which degrades fibrin and so breaks up the thrombi.
Streptokinase and alteplase have been shown to reduce mortality. Reteplase
and tenecteplase are also licensed for AMI.
Streptokinase and alteplase are given by intravenous infusion. Reteplase and
tenecteplase can be given by rapid bolus injection.
The benefit is greatest in those with ECG changes that include ST-segment
elevation (especially in those with anterior infarction) and in patients with
bundle branch block.
The earlier the treatment is given, the greater the absolute benefit. Alteplase,
reteplase and streptokinase need to be given within 12 hours of symptom
onset, ideally within one hour. Tenecteplase should be given as early as
possible and usually within six hours of symptom onset.
In patients presenting within 12 hours after the onset of symptoms but
reperfusion therapy is not given, or in patients presenting after 12 hours,
aspirin, clopidogrel and an antithrombin agent (heparin, enoxaparin or
fondaparinux) should be given as soon as possible
1:2:1
1:4 25% unaffected
2:4 or 1:2 50% carrier
1:4 25% affected
Muscle pain due to inflammation in the body's soft tissues. Myofascial pain is
a chronic condition that affects the fascia (connective tissue that covers the
muscles). Myofascial pain syndrome may involve either a single muscle or a
muscle group. In some cases, the area where a person experiences the pain
may not be where the myofascial pain generator is located. Experts believe
that the actual site of the injury or the strain prompts the development of a
trigger point that, in turn, causes pain in other areas. This situation is known
as referred pain.
Myofascial pain symptoms usually involve muscle pain with specific "trigger"
or "tender" points. The pain can be made worse with activity or stress. In
addition to the local or regional pain associated with myofascial pain
syndrome, people with the disorder also can suffer from depression, fatigue
and behavioral disturbances.
Diagnosis
Trigger points can be identified by pain that results when pressure is applied
Pancoast's Syndrome
Classically
caused by an apical (superior pulmonary sulcus) malignant
neoplasm of the lung. The neoplasm is usually bronchogenic in
origin (most commonly squamous cell carcinoma, sometimes
adenocarcinoma and large-cell carcinoma).
Presentation
causes:
DKA.
Hypoadrenalism.
Prolonged Infusion of 5% Dextrose.
Syndrome of Inappropriate ADH secretion.
In young lady psychologically disturbed and drinks water
excessively
Like
According to patient.co, sleep alarms is the best option in uncomplicated mildmod enuresis. Desmopressin for severe symptoms or when immediate effect
is needed. Behavioral therapy for daytime symptoms only. Please correct me
if I'm wrong.
Features
These are:[2]
Short stature.
Retinitis pigmentosa, nystagmus, choroidal atrophy, cataract and
squint.
Micropenis with hypoplastic scrotum.
Type 2 diabetes mellitus.
0-14yrs- ALL
15-59yrs- AML
40-60yrs- CML
60+ CLL
Status epilepticus
Administer intravenous lorazepam as first-line treatment. Administer
intravenous diazepam if intravenous lorazepam is unavailable, or buccal
midazolam if unable to secure immediate intravenous access. Administer a
maximum of two doses of the first-line treatment (including pre-hospital
treatment)
Phenytoin is 2nd line.
to correct Hyperkalemia
1st n qickest is calcium gluconate
Then insulin n dextrose
Then calcium resonium
Afib is the most common arrythmia in alcoholics. Also known as holiday heart
syndrome
in holiday heart syndrome AF occurs due to binge drinking and theres no
underlying heart patho
swelling in ankles in an elderly female indicates heart failure. alcoholic so AF
hence reathlessness and palpitations
CRAO, cherry red sopt is clincher. applying pressure might increase the blood
flow
TIA. Doppler usg. Majority of TIA develop due to emboli which are picked up
on carotid doppler.
Carbimazole (used in hyperthyroidism), clozapine (atypical antipsychotics),
INH .s/eagranulocytosis (neutropenia)
for dehydration and dka its NS and for burns its hartmans solution
if on the electrolyte picture it shows hypernatremia only then go for 0.45% NS.
otherwise give 0.9% NS if normonatremia or hyponatremia.
and potassium is always added to the fluid regimen after confirming the lab
values and a good urine output
before surgery for diabetics iv insulin n glucose n k
Chicken has blisters of different ages .. Some healing ( crusted in this case ) ,
others ( the new ones ) still erupting ( weeping in this case )
In Shingles , all come at same time and with preceding pain in dermatomal
area and heal by crusting at the same time
for shingles , there should be some history , a minor clincher towards
immunocompromised state . It doesnt usually erupt just like that in healthy
young individuals whereas chicken pox can !!
Also though chicken pox starts from trunk , it surely is there on face and
around eyes.
Aspirin should b given from the 1st day of +ve pregnancy test n heparin
should b given as soon as fetal heart is seen on us.Anti phospholipids
syndrome
in children UTI always present due to some underlying disease...it could be
VUR or something. So even on single episode of UTI we need to further
investigate by doing an USG
dexa scan for osteoporosis and nuclear bone scan to see metastasis
Normal is a T-score of -1.0 or higher
Osteopenia is defined as between -1.0 and -2.5
Osteoporosis is defined as -2.5 or lower, meaning a bone density that is two
and a half standard deviations below the mean of a thirty-year-old
man/woman.
Calcium stones : Envelop or dumbell shaped
Struvite ( ammonium Mg PO4 stones ) : Coffin lid shaped
Uric acid : Rhomboid or Rossette shaped
Cystine : Hexagonal
The Valgus stress test is a test for ligament damage. It involves placing the leg
into extension, with one hand placed as a pivot on the knee. With the other
hand placed upon the foot applying an abducting force, an attempt is then
made to force the leg at the knee into valgus. If the knee is seen to open up
on the medial side, this is indicative of medial collateral ligament damage and
may also indicate capsular or cruciate ligament laxity.
similarly varus stress test for lateral collateral
Patient allergy to contrast media or renal failure do V/Q scan. If they give
chest Xray is normal or if no significant cardiopulmonary history in the patient
then again V/Q scan preferred.
CTPA in all other cases
Otitis media with effusion aka secretory otitis media aka glue ear. Common in
young children, 40db hearing loss, increase volume of tv. Dull greyish blue
tympanic membrane with air fluid levels are all the clinchers
BCC usually presents as a pearly nodule with telangiectatic edge
Any lesion above the neck is BCC until proved otherwise
Actinic keratosis presents as yellowish scaly crusts not as a nodule
Acute management of SVT is vagal maneouvers, if not then iv adenosine. If
patient is asthmatic (breathless as in this case) then verapamil is the option
Right dominant circulation= 85%= Post desc artery arises from Right coronary
artery
Left dominant circulation= 8%= PD arises from Left coronary artery
so basically dominancy depends on this Post desc artery.. from where it arises
Rathke cleft cysts (RCCs) are benign lesions that typically arise within the
sella between the anterior and posterior lobes of the pituitary.Most often they
are asymptomatic. These lesions, however, can cause mass effect on
surrounding structures such as the pituitary gland and optic chiasm, leading to
headache, pituitary dysfunction, or visual disturbance.Rathke cleft cysts are
remnants of the Rathke pouch, a structure of ectodermal origin formed during
the fourth week of gestation
No gas bubble means oesophageal atresia. Double bubble sign for duodenal
atresia
Clang associations are ideas that are related only by similar or rhyming
sounds rather than actual meaning.[8] Example: "He ate the skate, inflated
yesterdays gate toward the cheese grater
in flight of ideas thy jump from topic to topic
Smoking is the most important risk factor for bladder cancer. Smokers are at
least 3 times as likely to get bladder cancer as nonsmokers. Smoking causes
about half of the bladder cancers in both men and women.
Ovarian torsion
'sudden onset vomiting and pain abdomen' + mobile swelling in RIF is the
clincher.
PRADER WILLI: After birth there is hypotonia, failure to thrive and sleepiness.
The child usually has blue eyes and blond hair. They tend to lag behind other
children in the transition to solid food.
The second stage becomes apparent at the age of 12-18 months, when an
exceptional interest in food becomes apparent.[7] Hyperphagia, obesity,
hypogonadism, short stature and sleep apnoea and cor pulmonale occur.[12]
They have markedly elevated levels of ghrelin, a hormone associated with
hunger.
Nappy rash is a skin inflammation. Most cases are due to a reaction of the
skin to urine and poo (faeces, stools, or motions). In addition, a germ called
candida commonly thrives on the inflamed skin. (This is the germ that causes
thrush.) Candida can cause a more inflamed rash which may include darker
red spots spreading around the nappy area ('nappy thrush')
of his or her affection feels the same toward him or her. This
condition is otherwise known as love obsession
Usually the object of their affection is inaccessible like a superstar,
an actress, a rock star