Day-to-day medicine for medical students, interns and enthusiastic doctors!

These are some of the common abnormalities in rheumatological conditions involving the hands. 1. This is sclerodactyly in scleroderma. Note the thickening of the skin and telangiectasias. There can be many causes for ulceration in these patients. 2. This is classic rheumatoid arthritis. Note the involvement of wrist, metacarpophalangeal and proximal interphalangeal joints with sparing of distal interphalangeal joints. Deformities include 1. Volar subluxation at the wrist 2. Z thumb 3. Ulnar deviation at MCP joints 4. Boutonnieres 5. Swan neck 3. This is psoriatic arthritis. Note the involvement of distal interphalangeal joints. There are nail changes characteristic of psoriatic arthritis. Not only those, but there's psoriatic rash as well in the web between 3rd and 4th fingers of the left hand!! 4. This is osteoarthritis. PIP and DIP affected with prominent osteophyte formation. They are called Herbeden's and Bouchard'...

Thanks, Subodha Sugandika for your comprehensive answer. I will just add what's missing in red and will strikethrough  what is not that relevant. Microvascular complications of diabetes are diabetic nephropathy, diabetic retinopathy, and diabetic neuropathy.  1) Questions to ask from the patient:  Nephropathy: do u have a history of frothy urine? Have you noticed a change in the volume of urine you pass?  Or have u experienced dysuria or fever recently? Is there Increased fre quency of urination? Retinopathy: have u experienced any visual impairments recently?  Neuropathy:  Do not forget that there are different types of nerves! Sensory do u have numbness in your hands and feet? Are the limbs painful at night?  Do you lose your slippers when you are walking? When you are walking barefoot do  you feel as if you are walking on cotton? Autonomic Do you feel dizzy when you stand up from the bed or chair? Do you sweat profusely aft...

The commonest cause for pleural effusion is pneumonia when it's called a parapneumonic effusion. But if a patient comes with pleural effusion with no evidence of an infection, that effusion is considered malignant unless proven otherwise. The first investigation in any pleural effusion is a chest Xray. It will confirm the diagnosis There will be aetiological clues like Pneumonic patch Malignant lesion Rib erosions Infarctions Nowadays, an ultrasound scan of the chest is done routinely in all patients with effusions. USS can sometimes visualize consolidations, masses and pleural diseases that might not be apparent on the Xrays. When a malignancy is suspected or the cause is not evident in other investigation modalities, CT becomes the most useful investigation. The most important investigation in any pleural effusion is the pleural fluid aspiration. You all have to know the technique of doing it. But, now the blind approach is no longer recommended and it alwa...

Whenever we are examining a patient, we should have several objectives in mind. 1. Making a diagnosis 2. Grade the severity 3. Look for complication 4. Look for etiology 5. Look for associated conditions 6. Look for comorbid conditions 7. Look for drug-related side effects Remember this golden rule of physical examination. UNLESS YOU LOOK FOR A SIGN, YOU WILL NEVER SEE IT! Doing a thorough examination is a daunting task. Do not get depressed after reading this. I’m just trying to stimulate you. For your exam purposes telling 3-4 positives and negatives will be adequate. But, becoming a good clinician is not so easy. As an example let's see what we should look for in the general examination to find the aetiology (Only the aetiology!) of a pleural effusion. Please do not forget to read the part in red ! 1. Acute infection Fever Specific signs of some infections Melioidosis - Arthritis Atypical pneumonia - Skin rashes like erythemi...