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

This lady presented with a painful rash over the face for 2 days' duration. (Picture from internet) What is this? This is reactivation of varicella-zoster infection in the ophthalmic division of trigeminal ganglion, also known as herpes zoster or shingles. What are the features? The diagnosis is easy and the presentation is typical. Patients present like this with an extremely painful vesicular eruption confined to a single dermatome. Sometimes pain can be the presenting complaint and the rash can appear later. Who can get this? Anyone! But you see more complications in the elderly and in those who are immune compromised.  Is it contagious? Until the vesicles are crusted, it is contagious. So try to keep the rash covered if possible, and get the patient to wash hands frequently! So the treatment is aciclovir and gabapentin, isn't it? Herpes Zoster Ophthalmicus Well, in some patients that may suffice. But not in this patient. Why? One thing yo...

An 18 years old schoolboy came with epigastric burning pain for 2 days duration. He had similar episodes in the past which responded to over the counter antacids. This ECG was taken. What is it? Brugada syndrome. Well the nomenclature is confusing. But as long as you are not a cardiologist, call it Brugada Syndrome! What is Brugada syndrome? It is an autosomal dominant genetic disorder. Mutation is in a cardiac sodium channel. It leads to an abnormal ECG pattern called 'Brugada pattern' which carries an increased risk of ventricular arrhythmias and sudden cardiac deaths. Is it common? Do I really have to know it? It's not uncommon. Prevalence can be up to 1%, but could be even more as there can be many undetected people. But, if you miss it the consequences can be catastrophic! What are the ECG features? There are two patterns. Type 1 pattern is diagnostic. There will be 'coved' ST elevation of more than 2m...

A 63 years old retired teacher came to a GP to check her blood pressure as she had on and off headache for about 2 months. He denied vomiting, blurring of vision, angina or SOB. There was no significant past history except for a fall in the washroom causing a colles fracture to which had taken ayurvedic treatment. On examination her blood pressure was 180/100 in both arms and there was no other significant positive finding. GP adjusted the antihypertensives and within a several months, her BP was well controlled. However, about a year later she came to GP in a wheelchair! She had again fallen in the bathroom, and this time had fractured her hip. Oops!!! Yeah, that's so unfortunate isn't it. There was a chance to prevent this fracture. So what should have been done? Any patient with a fragility fracture needs to be investigated for osteoporosis and treated. What is osteoporosis? In the simplest terms, there is reduced d...

A 32 years old patient came with vomiting for one day after outside food consumption. He had vomited about 20 times during the last couple of hours. He complained of upper abdominal pain due to repeated vomiting. He had several episodes of cough and developed shortness of breath. Xray was taken to exclude aspiration. What would you do? This Xray on the first glance looks quite normal. But when you closely have a look you might see some abnormality in the right upper zone. However, if you look even more closely you will pick that there are some streaky air shadows along both sides of the trachea.  This is pneumomediatinum. In the context of vomiting you will have to consider the possibility of esophageal rupture. Which has the fancy name 'Boerhaave Syndrome'. What are the other features? A classical sign would be surgical emphysema. That is not a sign you should ever miss. Do you really have to know this? It should be rare isn't it? Rare indeed. But in Sri...