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

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 injur

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