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

Gottron's sign and Gottron's papules in dermatomyositis

These are only some of the causes of a 'red face'. You might not be expected to know how to differentiate these, but at least learn the differential diagnosis. 1. This girl came with a history of joint pains for 2 months duration. What is the likely diagnosis? This is the malar rash of systemic lupus erythematosus . The clinical history is compatible. Note the sparing of nasolabial folds. 2.  This 58 years old lady presented with a history of bilateral shoulder pain and weakness for 3 weeks duration. What is this physical sign? What is the diagnosis? This is the well known Heliotrope rash of dermatomyositis . Note the characteristic colour and involvement of the eye lids and the nasolabial folds. 3.  This 65 years old lady is under cardiology clinic follow up for chronic shortness of breath. What is the likely diagnosis? This facial flushing is very non-specific. Note that it's just erythema and there's no true 'rash'

This 54 years old patient is under medical clinic follow up for hypertension and diabetes mellitus. Both his blood pressure and blood sugar control are suboptimal. What are the clinical features shown here? Coarse facial features Prominent supraorbital ridges Enlarged lips/ nose - But to confirm has to be compared with old photographs Prognathism Enlarged hands and feet What is the diagnosis? Acromegaly How do you confirm the diagnosis? IGF1 level Oral glucose tolerance test with GH level. GH will not be suppressed. It can even rise. What are the treatment options? The commonest cause is GH secreting pituitary macroadenoma It can be resected through trans-sphenoidal approach or open craniotomy. Medical management (If unresectable or persistent disease after resection) Somatostatin analogues (Octreotide) Dopamine agonists (Cabergoline) GH receptor antagonists (Pegvisomant)

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 after meals? Do you get explosive diar

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