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

 

  This patient has complete ptosis of the right eye . When the eye lid is pulled up, it's seen that the eye is deviated outward and downward . Those two findings indicate that this is a third nerve palsy. Pupils of both eyes are equal. Pupil involvement (Fixed dilated pupil) is seen if the third nerve is compressed, because the parasympathetic fibers travel on the surface of the nerve. Conversely in non-compressive (Medical) third nerve palsies the pupil is spared . So this patient has right medical third nerve palsy. Lesions in various places can give rise to different presentations. For example..     Brain stem - The 6th nerve and other long tracts are close-by. So they will have involvement of either of those.     Cavernous sinus - A lot of structures pass adjacent to the nerve. So they will be involved. Now since none of those are affected, the lesion is probably in the nerve itself.  Common causes are diabetes and hypertension. Any other condition whic...

 Regarding ACEI 1. Beneficial in DM nephropathy (T) 2. Beneficial in acute MI (T)     Particularly in anterior MI and in those who develop heart failure. 3. Causes angioedema (T) 4. Causes hyperkalemia (T)     And hyponatremia. Always monitor K+ in patients with renal diseases. 5. Increases S.Cr (T)     ACEI reduces the GFR and causes a mild increase in S.Cr. ACEI can also preciptate acute renal failure in patients with B/L Renal artery stenosis.'

Which of the following would indicate the possibility of non-diabetic kidney disease in a patient with DM? 1. Absence of retinopathy (T)     However 30% of patients with nephropathy have no retinopathy. But if a patient has no retinopathy always consider the possibility of a non-diabetic renal diseases. 2. Short duration of DM (T)     However, at the time of diagnosis of T2DM, patients may have early nephropathy. 3. Dysmorphic RBC (T)     RBC may be present in DM nephropathy, but not dysmorphic ones. 4. Rapid decline of S.Cr (T)     In DM the decline is gradual. It will be a stright line if the 1/S.Cr is plotted against time. 5. 3+ Proteinuria (F)     DM can cause nephrotic syndrome.

  Which of the following are risk factors for the progression of diabetic retinopathy? 1. Hypertension (T) 2. Smoking (T) 3. Pregnancy (T)          Pregnant patient with pre-existing DM should be closely monitored to detect worsening of retinopathy. 4. Statins (F) 5. Vigorous exercise (?T)     Vigorous exercise can precipitate haemorrhages in patients with proliferative retinopathy. 

  MCQ Corner - T/F Which of the following can cause acute painless loss of vision in a patient with DM? 1. Vitreous haemorrhage (T)     Seen in DM. Acute. Painless 2. Central retinal artery occlusion (T)     Seen in DM. Acute. Painless 3. Retinal detachment (T)      Seen in DM. Acute. Painless 4. Cataract (F)      Seen in DM. Chronic. Painless 5. Acute angle closure glaucoma (F)     Not associated with DM. Painful. Acute.

  This female patient with a past history of papillary carcinoma of thyroid presented with SOB and lower limb edema for 1 week. She has a massive pericardial effusion, which is probably due to the recurrence and metastasis of the tumor.

  This patient presented with SOB and fever for 2 days. He has varicella-zoster infection with possible pneumonitis, which is a serious complication.

  This elderly patient with long-standing diabetes presented with faintishness. What is the ECG diagnosis? He has inferior STEMI with complete heart block.

Objectives 1. Clinical diagnosis of acute kidney injury. 2. Identifying the aetiology of acute kidney injury. 3. Learn the complications of acute kidney injury. 4. Management of complications of acute kidney injury. 5. Basics of renal replacement therapy in acute kidney injury. 1.  Clinical diagnosis of acute kidney injury. Usual manifestations of acute kidney injury is oliguria (Reduced urine output). With the progression of renal impairment, patients develop various complications such as acidosis/ uremia which give rise to other manifestations. There are various criterions to diagnose AKI, you don't have to memorise those. Increase in S.Cr by >0.3 mg/dl (>26.5 umol/l) within 48 hours; or Increase in S.Cr to >1.5 times baseline, which is known or presumed to have occurred within the prior 7 days; or  Urine volume < 0.5 ml/kg/h for 6 hours. 2. Identifying the aetiology of acute kidney injury. You must be already knowing that acute kidney ...

Objectives 1. Clinical diagnosis of COPD exacerbation 2. Principles of initial management 3. Assessing the clinical response 4. Principles of managing refractory exacerbation 1. Clinical diagnosis of COPD exacerbation Patients usually present with increasing SOB. If the precipitant is an infection, they may also have productive cough with yellowish sputum, fever, anorexia, pleuritic chest pain In patients with advanced COPD there will be Features of hyperinflation - Barrel shape, impaired cardiac and liver dullness Features of Cor-pulmonale - Elevated JVP, Edema, Tender hepatomegaly Generalized wasting Look for features of hypoxia - Cyanosis Look for features of CO2 retention - Flapping tremors, Bounding pulses 2. Principles of initial management These patients need HDU care. Patient should be propped up and attached to a monitor. Oxygen therapy Should be administered cautiously. In patients with long standing COPD, especially if they have fea...

A seventeen years old girl presents to you with a history of a short run of palpitations after running behind a bus. What are the abnormalities? What is the diagnosis? Scroll down for the answer. This ECG shows a short PR interval with a normal QRS complex. Diagnosis is  LOWN-GANONG-LEVINE syndrome.

This 58 years old teacher presented to your PP with a 3 days history of low grade fever one week back. At that time he had only a mild cough. He was treated with some cetirizine and oral azithromycin. A week later he presents to you again saying he still has on and off fever. What is your main concern? Scroll down for the answer. These are Janeway lesions. This patient had infective endocarditis. (Picture from Oxford case reports)

This patient has a long history of taking ayurvedic medications for chronic knee pain. What is the diagnosis? Scroll down for the answer Mee's line in chronic arsenic poisoning. There are many case reports in India describing arsenic poisoning associated with ayurvedic medications. There are several local articles as well!

This elderly lady presented with this itchy skin rash. The rash had been worsening for the last several weeks despite applying a betamethasone cream she found in a cupboard. What is the diagnosis? How would you treat? Scroll down for answer This is extensive scabies (Norwegian)

This kid was brought by a worried mother who thinks the kid has a problem in her neck. You examine the neck but neck looks normal. Where could be the actual problem? Scroll down for the answer She has right-sided trochlear (IV) nerve palsy

This belongs to a 68 years old man being investigated for altered bowel habits. What is abnormal? What is the main concern? Scroll down for the answer The right pedicle of L1 vertebra is missing!!  Suspect malignancy with metastasis or tuberculosis.

A 65 years old man presents with chronic backache. He has some symptoms of bladder outflow obstruction. He has no neurological signs in the lower limbs. DRE shows a moderately enlarged prostate with no suspicious features. How would you proceed? Scroll down for the answer. This shows the wall of a calcified aortic aneurysm. Lateral Xray