12/18/2017

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By Live Dr - Wed Feb 11, 3:37 am

MEDICINE

DISEASES WITH THEIR SPECIFIC ANTIBODIES

DISEASES ANTIBODIES
SLE Anti ds DNA{ specific}

Anti Sm {Smith}

Drug induced SLE Anti Histone
Systemic sclerosis Anti DNA Topoisomerase {Scl 70}
Scleroderma {CREST } Anti Centromere
Sjogren syndrome SSA (Ro) SSB (La)
Primary biliary cirrhosis Anti Mitochondrial
Inflammatory myopathy Histidyl t-RNA synthetase
Mixed connective tissue disorders Anti Ribonucleoprotein
Churg Strauss Anti Myeloperoxidase ANCA
Multifocal motor neuropathy Anti GM1
Wegener’s granulomatosis

Henoch-Schonlein purpura

c-ANCA
Idiopathic crescentric nephritis

Ulcerative colitis

Microscopic polyangitis

Polyarteritis nodosa

p-ANCA
Crohn’s disease Anti saccharomyces Cerevisiae ( ASCA)
Celiac sprue Antiendomysial & Antigliadin
Psychosis/ depression due to cns sle Antiribosomal -P

CONFUSIBLES IN GRANULOMATOUS DISEASE TERMINOLOGY

Tabes dorsalis Neurosyphilis affecting posterior column of spinal cord.
Tabes mesenterica Tuberculous affection of mesenteric lymph nodes
Lupus vulgaris Skin TB
Lupus pernio A form of Sarcoidosis.
Tabes ergotica A condition similar to Tabes dorsalis due to ergotism
Friedrich’s tabes Friedrich’s ataxia

HLA ASSOCIATION OF DISEASES

HLA A3 Hemochromatosis
HLA B5/ B51 Behcets’s syndrome
HLA B27 Ankylosing spondylitis, Reiter’s syndrome, Reactive arthritis, Psoriatic arthritis, JRA.

QUOTE CORNER

Success does not consist in never making mistakes but in never making the same one a second time. -George Bernard Shaw

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HLA ASSOCIATION OF DISEASES CONTINUED…

HLA DR2 Narcolepsy, Multiple Sclerosis
HLA DR3 Celiac disease, Sjogren’s syndrome, Dermatitis herpetiformis, Chronic active hepatitis, Adrenal insufficiency.
HLA B8/ HLA DR3 Grave’s disease, Myasthenia gravis.
HLA DR4/ DW4 Rheumatoid arthritis
HLA DR2/DR3/DR4 IDDM
HLA DQ2/ HLA B8 Gluten sensitive enteropathy.
HLA BW47 Inherited errors of metabolism

Diagnostic nuclear magnetic resonance

isotope test
I 131, I- 123 Thyroid
Tc-99m DTPA Kidney glomerular function

Mucociliary clearance of lungs in pneumocystis carinii pneumoniae infection in AIDS

hida Liver function and biliary clearance
tc-99m maa Lung perfusion
tc-99m dmsa Kidney cortical scarring
tc-99m aerosol Lung ventilation
tc-99m mibi Thyroid carcinoma
cr-51 RBC scan
thallium Myocardial infarction
tc-99m pertechnate Hot spots
I 131 hippuran Kidney
Xe-133 Lung ventilation scan
Tc 99m MDP Bone tumors and infections
Gallium-67

Iridium-111

Leucocyte scan
Strontium Fracture neck femur
Gallium 67 Sarcoidosis
cold aiha warm aiha
Ig M Ig G
Mycoplasma infection

Mononucleosis

Idiopathic Paroxysmal cold hemoglobinuria (Ig G )

Lymphomas

sle

Methyldopa

TRIVIAL TRUTH

Over 80% of professional boxers have suffered brain damage.

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Therapeutic nuclear magnetic resonance

isotope disease
I 131 Thyroid cancer

Graves disease

I 131 mibi Pheochromocytomas, Neuroblastomas
Yttrium-90-Octreotide Carcinoma with Somatostatin receptors
P-32

Sr-87

Bone metastasis, Pain palliation

Rheumatoid arthritis

I 131, I 125 lipiodol Hepatic carcinoma
Au-198 Pleural / Pericardial effusion
EPSTEIN BARR VIRUS
Infectious mononucleosis

Thymoma

Burkitt’s lymphoma

Cns lymphoma

Hodgkin’s disease

Nhl

B cell lymphoma

T cell lymphoma

Oval hairy leukoplakia

Tonsillar carcinoma

Angioimmunoblastic lymphoma

Ecg changes in hyper and hypokalemia

HYPOKALEMIA HYPERKALEMIA
ST segmnet depressed

Flat or inverted T waves

U waves

PR prolonged

Peaked tall T waves

Sine-wave

P wave decreased

Widening of QRs complex

PR inetrval prolonged

Ventricular asystole / ventricular fibrillation

*Hypothermia -Osborn ( J wave ) is seen

POEMS syndrome
Polyneuropathy

Organomegaly

Endocrinopathy

M protein band on electrophoresis with less than 5 % plasma cells in bone marrow

Skin hyperpigmentation

QUOTE CORNER

Nothing is predestined: The obstacles of your past can become the gateways that lead to new beginnings.- Ralph Blum

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pentad OF thrombotic thrombocytopenic purpura
Fever

Thrombocytopenia

Microangopathic hemolytic anemia

Renal failure

Transient neurological effects

Concentrations of abnormal hemoglobin -complexes producing cyanosis

Sulph Hb 0.5 %
Meth Hb 1.5 %
Deoxy Hb 5%

VACCINES RECOMMENDED IN HIV POSITIVE PATIENTS

Pneumococcal vaccine Consider revaccination five years after initial dose.
Hepatitis B vaccine Administer to patients without serologic evidence of past or present hepatitis B infection. Vaccinated patients with should be tested for HBsAb response after the third dose; nonresponders should receive booster injections
Hepatitis A vaccine Administer to homosexual or bisexual men and to women who practice receptive anal intercourse. Serologic testing prior to vaccination is not necessary.
Hemophilus influenzae type B vaccine Administer to asplenic patients and those with history of recurrent hemophilus infection.
Influenza vaccine Administer to patients at high risk for exposure to or morbidity from influenza. There is evidence that the vaccine may transiently promote HIV replication.
Tetanus toxoid Td booster is recommended every 10 years.
Polio vaccine IPV is administered

Criteria for aids- If 2 of the major with at least 1 of the minor signs are present

major signs minor signs
-Weight loss of more than 10 % of body weight

-Chronic diarrhea for more than 1 month

-Prolonged fever for more than 1 month

-Persistent cough for more than 1 month

-Generalized pruritic dermatitis

-History of herpes zoster

-Oropharyngeal candidiasis

-Chronic progressive or disseminated herpes simplex infection.

-Generalized lymphadenopathy.

TRIVIAL TRUTH

Dorothea Erxleben was the first woman to receive a medical degree in 1754.

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classic triad of myeloma
Marrow plasmacytosis > 10%

Lytic bone lesions

Serum and / or urine M component

Hyperbaric oxygen  used in the treatment 0f
CO poisoning

Gas gangrene

Radiation induced tissue injury

Diabetic leg ulcers

Very severe blood loss, anemia

Decompression sickness.

Wallenberg syndrome Lateral medullary syndrome due to PICA infarct

Ipsilateral loss of pain and temperature over the face

Ipsilateral 9th, 10th and 11th cranial nerve palsy

Ipsilateral horners syndrome

Ipsilateral cerebellar signs

Ipsilateral vestibular signs

Contralateral loss of pain and temperature over the limbs

Jacksons syndrome Medial medullary syndrome

Ipsilateral twelfth nerve palsy

Contralateral hemiplegia

Contralateral loss of joint position sense and vibration

Millard Gubler syndrome Ventral pontine syndrome

Ipsilateral seventh nerve palsy

Contralateral hemiplegia

Raymond-Foville syndrome Ipsilateral; facial apalsy

Ipsilateral abducens aplsy

Contralateral hemiparesis

Weber’s syndrome Ipsilateral third nerve palsy

Contraleral hemiplegia

Bendicts syndrome Ipsilateral rubral tumpur

Contralateral hemiparesis

Cns causes of hemiplegia
Thrombosis of unpaired anterior cerebral artery

Superior sagittal sinus

Parasgittal meningioma

Cortical venous sinus thrombosis

QUOTE CORNER

Optimism is the father that leads to achievement. -Helen Keller

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Landry-Guillain Barre syndrome
Acute  inflammatory demyelinating polyradiculopathy

History of preceding viral infection.

Ascending weakness

Albumino-cytological dissociation present.

Treatment includes steroids, plasma exchange, intravenous immunoglobulin

Miller fisher variant of guillian barre syndrome
External ophtahlmoplegia

Ataxia

Areflexia

gait condition
Circumduction Hemiplegia
Scissoring gait Spastic paraplegia
Festinating gait Parkinson’s disease
Waddling gait Muscular dystophoes
Stamping gait Sensory atxia
Broad based gait Cerebellar disorders
Broad based high stpeiing gait Posteriro column disordersda
Charlie chaplin gait Homocystinuria
Lurching gait Cerebellar ataxia
Clinical triad of tuberous sclerosis
Adenoma sebaceum

Epilepsy

Mental reatrdation

Myasthenia gravis
Extraocular muscles are most commonly affected first

Pupils are never affected

Associated with thymoma

Edrophomium, a quick and short acting anticholinesterase is used for diagnosis

Lambert-eaton neuromuscular syndrome
Associated with malignancy in only 50 %

Most commonly associated with small cell carcinoma

Neoplasm induced Ig G antibody against the voltage gated calcium channels in the terminus of the motor neuron

TRIVIAL TRUTH

Quinine a derivative of the cinchona tree was probably discovered by a Red Indian, who tried to quench his thirst during a malarial attack by drinking water near the plant and saw the fever abate. Jesuit priests heard the story and popularised its use.

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Hemolytic transfusion reactions
Most common symptom is sensation of heat and pain along the vein into which the blood is being transfused, flushing on face, lumbar pain.

Oliguria and hemoglobinuria is seen.

In anesthetized patients-

Abnormal bleeding and continued hypertension despite adequate replacement are seen

Cluster headache
1-3 short lived daily attacks, of unilateral, orbital or temporal pain of 4-8 weeks interval followed by pain free interval often of 1 year

Associated with red, tearful eye, nasal stuffiness, Ptosis

Commonly in males

High amylase levels in pleural fluid
Esophageal rupture

Pancreatic pleural effusion

Malignancy

Pyrexia of unknown origin
In 1961 Petersdorf and Beeson suggested the following criteria

Fever higher than 38.3°C (101°F) on several occasions, persisting without diagnosis for at least 3 weeks.

At least 1 week’s investigation in hospital

Tuberculosis is the commonest cause of puo

*Bernard Soulier syndrome- platelet function disorder characterized by deficiency of glycoprotein Ib (Von Willebrand’s factor receptor)

Thrombocytopenia with giant platelets

*Glanzmann thrombasthenia

Deficiency of glycoprotein IIb and III a (fibrinogen receptor)

Platelet count is normal

*Low molecular weight heparin is associated with low incidence of thrombocytopenia

*Age at diagnosis is the most important prognostic factor in aml

All-peak incidence is before 10 years

Aml- after 65 years

*Kawasaki’s disease

Mucocutaneous lymph node syndrome

Aspirin and intravenous immunoglobulin is administered

QUOTE CORNER
A strong memory is commonly coupled with infirm judgement.-Montaigne, Essays.

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*Immune thrombocytopenic purpura-

Therapy includes steroids, intravenous immunoglobulins, anti-D immunoglobulin and splenectomy.

*Hereditary angioedema

Defeciency of C1 inhibitor

Autosomal dominant

*C2 defeciency is the most common hereditary defeciency of complement system

*In polymyositis- Ocular muscles are not involved

*Dermatomyositis

Classical rash-

Helkiotreope rash in butterfly distribution

Gottron rash-

Erythema of the knuckles with a rasied vilaceous scaly eruption seen in dermatomyositis

*Localised sporotrichosis is treated with potassium iodide

Systemic is treated with amphotercicin B

*Most common drug causing drug induced SLE is procaineamide

*Hatchet faced appearance is een in myotonic dystrophy

Glasgow coma scale

Remember EVM- 4-5-6

Eye opening Verbal response Motor activity
4-Spontaneous 5-Oriented 6-Follows command
3-On verbal stimuli 4-Confused 5-Localizes pain
2-On pain stimuli

(pressure on nail bed, if no response supraorbital pressure or suprasternal pressure)

3-Inappropriate words 4-Withdraws to pain
1- No response 2-Nonspecific sounds 3-Flexion to pain
1- No response 2-Extensiont o pain
1- None

TRIVIAL TRUTH

The symptoms of Alzheimer’s disease as a distinct entity were first identified by Kraepelin, and the characteristic neuropathology was first observed by Alzheimer, Because of the overwhelming importance Kraepelin attached to finding the neuropathological basis of psychiatric disorders, he made the generous decision that the disease would bear Alzheimer’s name.

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Maximum score-15

Minimum score-3

Neurological derangement Score
Severe 8 0r less
Moderate 9-12
Minor 13 or more
Other scales used in ICU
Sofa- Sequential Organ Failure Assessment score

Saps II – Simplified Acute Physiology Score

Apache II / III – Acute Physiology And Chronic Health Evaluation

Rancho Los Amigos cognitive scale.

Brown-Sequard syndrome
Ipsilateral lower motor neuron paralysis in the segment.

Ipsilateral  spastic paralysis below the level

Ipsilateral band of cutaneous anesthesia at the level

Ipsilateral band of posterior column sensation loss below the level

Contralateral loss of pain and temperature sensation below the level

Contralateral impaired tactile sensation below the level

Thalamic pain syndrome

(Dejerine -Roussy syndrome)

Affects contralateral side of the body

Due to thalamic infarct in ventral posterolateral nucleus

frontal disinhibition syndrome
Antisocial behavior is charcteristic

Impairment of judgement, insight and foresight

frontal abulic syndrome
Loss of initiative, creativity and curiosity

Pervasive emotional apathy

*Anomic aphasia is the single most common language disturbance seen in head trauma, metabolic encephalopathy and Alzheimer’s disease

*Prolactin is increased after an episode of seizures

Déjà vu and jamais vu phenomenon are seen in partial seizures

Déjà vu is seen in temporal lobe epilepsy, normal people, psychosis, hysteria

*Déjà vu-feeling of familiarity with unfamiliar sdituations

Jamais vu – feeling of unfamiliarity with familiar situations.

QUOTE CORNER

He, who learns but does not think, is lost! He who thinks but does not learn is in great danger. Confucius

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West syndrome
Epileptic encephalothy

Onset between 4-8 months  of  age

Salaam attacks

Hypsarrhythmia on eeg

Treatment with acth or vigabatrin

*Twilight sleep is seen in epilepsy

Twilight sleep is is the state of narrowing of field of consciousness for short duration followed by amnesia.

*Jacksosnian march-  seen in simple partail seizures, the abnormal motor activityu begins ain a limited area an then gradually spreads to involve larger areas.

*Todd’s paralysis- type of post ictal focal neurological deficit seen in partail motor seizures.

*Absence seizures

Typically 3 Hz spike and wave pattern discharge is seen.

Grading of Hepatic encephalopathy

grade clinical features
Subclinical Impaired psychomotor testing
1 Asterixis
2 Disorientation
3 Stupor
4 Deep coma

*Prolactinoma is the most common type of pituitary adenoima

Next is growth hormone secreting adenoma

*Craniopharyngioma is called 90% tumpour-

90 % are calcified

90 % are cystic

90 % show enhancement

*Most common secondaries to brain are from-

Carcinoma lung

Carcinoma breast

Carcinoma kidney

TRIVIAL TRUTH

The first medical use of leeches dates back to approximately 2,500 years ago. The leech’s saliva contains a property that acts as an anticoagulant for human blood.

ELEVENTH HOUR MEDICINE                                                                                                                 147

*ANEURYSM

Most common site is between anterior cerebral and anterior communicating artery

Intracranial aneurysms-rupture is likely if > 7mm in diameter

Progressively enlarging unruptured aneurysm most commonly involve occulomotor nerve

Most common nerve to be involved with raised intracranial tension is the abducent nerve

*Man in barrel syndrome-

Bibrachial paresis is seen in bilateral infarction of the motor cortex in the border zone between the aca and mca

*Most common site of hypertensive haemorrhage in brain is putamen

*Marchiafava Bignami syndrome-

Widespread demyelination of cerebral hemispheres due to chronic alcohlism

*Dancing eye-Dancing feet syndrome

Opsoclonus myoclonus

*Bell’s phenomenon-

Upon attempted closure of the lids, the eye on the paralyzed side rolls upwards

Seen in facial palsy

*Myerson’s sign

Sustained blinking in response to glabellar tap

Seen in parkninson disease

JUGULAR VENOUS PULSATION

NORMAL WAVES WITH THEIR CAUSES

WAVES CAUSES
a Atrial contraction
c Ventricular Contraction
v Inflow from Venacavae
x Atrial relaXation
y Atrial emptYing

QUOTE CORNER

Let me tell you the secret that has led me to my goal. My strength lies solely in my tenacity. Louis Pasteur

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ABNORMAL WAVES WITH CAUSES

WAVES CAUSES
Large ‘a’ Tricuspid stenosis / Pulmonary stenosis/ pulmonary hypertension
Absent ‘a’ Atrial fibrillation
Cannon ‘a’ Complete heart block
c-v waves Tricuspid regurgitation
Deep y descent Chronic constrictive pericarditis
Raised JVP Right Ventricular failure
Kussmaul’s sign Constrictive pericarditis, Constrictive cardiomyopathy, Pericardial effusion, severe Right Heart failure.
Deep x descent Acute cardiac tamponade
Prominent v wave Tricuspid regurgitation
Accentuated x descent Constrictive pericarditis
Reversed x descent Tricuspid regurgitation
pulse description seen in
Anacrotic Slow rising, twice beating, both in systole as
Pulsus bisferiens Rapid rising, twice beating, both in systole Idiopathic hypertrophic subaortic stenosis with mild ar
Dicrotic pulse Twice seating, 1 in systole, 1 in diastole Decreased peripheral resistance and diastolic pressure like

typhoid, ccf, cardiac tamponade, open heart surgery

Pulsus parvus et tardus Slow rising as

TRIVIAL TRUTH

Opium from poppies was probably used by the priestesses in ancient Greece. Medicine was primitive in the ancient world, and for most afflictions, there was little that a physician could really do. The sick and ailing would go to the temple and receive relief from the “Gods” by undergoing the temple sleep: a potion that would give them restful nights free from pain.

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pulse description seen in
Pulsus alternans Strong and weak beats alternately Left ventricular failure, toxic myocarditis, paroxysmal tachycardia, following a premature beat
Pulsus paradoxus Systemic blood pressure falls more than 10 mm of Hg on inspiration Superior vena cava  obstruction,

copd, pericardial effusion, severe ccf, constrictive pericarditis

Pulsus bigeminus Coupling of pulses Alternate premature beat, av block, sa node block with ventricular escape
Water hammer pulse Increased stroke volume Fever, pregnancy, alcoholism, anemia, beriberi, cor-pulmonale, cirrhosis, Paget’s disease, av fistula, thyrotoxicosis, ar, pda, rupture sinus of Valsalva, bradycardia, systolic hypertension
murmur characteristics
Murmur of AR High pitched, blowing, decrescendo, diastolic, best heard in 3rd intercostals space along left sternal border.
Austin flint murmur (seen in ar) Soft, low pitched ejection murmur
Mill wheel murmur Air embolism
Lerman scratch Grating systolic sound, heard over sternum in 2nd space seen in thyrotoxicosis
Graham Steel murmur Pulmonary regurgitation
Seagull murmur Seen in rheumatic fever, due to turbulence of flow around swollen valves.
CONTINUOUS MURMURS
Patent ductus arteriosus

Coronary fistula

Ruptured aneurysm of sinus of Valsalva

Aortic septal defect

Anomalous left coronary artery

Mammary souffle

Intercostal arterio venous fistula

Cervical venous hum

Bronchial collateral circulation

Loud S1 Mitral stenosis
Soft S1 Mitral regurgitation, mitral stenosis
Reversed splitting of S2 lbbb

QUOTE CORNER

Live as if you were to die tomorrow. Learn as if you were to live forever.-M. Gandhi

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*Standing increases murmur of MVP,  HOCM.

Sustained handgrip accentuates murmur of MR, AR, HOCM

SIGNS IN AORTIC REGURGITATION

sign explanation
Watsons sign/ Waterhammer pulse Bounding peripheral pulses
Corrigan’s pulse Rapid upstroke and collapse of the carotid artery pulse
de Musset’s sign Head nodding in time with the heart beat
Quincke’s sign Pulsation of the capillary bed in the nail
Duroziez’s sign Systolic and diastolic murmurs described as ‘pistol shots’ heard over the femoral artery when it is gradually compressed
Traube’s sign A double sound heard over the femoral artery when it is compressed distally
Lighthouse sign Blanching & flushing of forehead
Landolfi’s sign Alternating constriction & dilatation of pupil
Becker’s sign Pulsations of retinal vessels
Müller’s sign Pulsations of uvula
Mayen’s sign Diastolic drop of BP>15 mm Hg with arm raised)
Rosenbach’s sign Pulsatile liver
Gerhardt’s sign Enlarged spleen
Hill’s sign A ≥ 20 mmHg difference in popliteal and brachial systolic cuff pressures, seen in chronic severe AI
Lincoln sign Pulsatile popliteal
Sherman sign Dorsalis pedis pulse is quickly located & unexpectedly prominent in age>75 yr

Jone’s criteria for rheumatic fever

Major criteria Minor criteria
Carditis Fever
Sydenham’s chorea Arthralgia
Subcutaneous nodules Prolonged pr interval
Erythema marginatum Elevated acute phase reactants
Migratory polyarthritis

ESSENTIAL CRITERIA-

Evidence of recent group A streptococcal infection

Positive throat culture or rapid antigen detection test

Elevated or increasing streptococcal antibody test

TRIVIAL TRUTH

The first ambulances, in the sense of a vehicle dedicated to the transport of injured or ill persons to a treatment center, were the ambulance volantes designed by D. J. Larrey, Napoleon Bonaparte’s chief physician. These were horse drawn wagons used to transport fallen soldiers form the battlefield after they had received early treatment in the field.

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Lesion seen in infective endocarditis

Osler’s nodes Painful tender pea-sized erythematous nodules in the pulp of fingers and soles in patients of infective endocarditis
Janeway lesions Small maculopapular erythematous or hemorrhagic emboli to distal digital arteries, commonly seen in palm and soles
Roth’s spots Oval, retinal hemorrhages with a clear pale centre
Splinter haemorrhages Linear, subungual dark red streaks commonly seen in fingers.

a-v block

1st degree pr interval > 200 msec, every p is followed by qrs
2nd degree

Mobitz’s type I

(Wenkebach)

Progressive increase in pr till p is not transmitted.

block is usually localized to a-v node

Mobitz’s type II pr interval is constant and fixed

block is usually in the his-Purkinje system

3rd degree Atria and ventricles beat independently
arrhythmiaS drug of choice
Atrial extrasystole Quinidine
psvt Adenosine / Verapamil
Atrial flutter

Atrial fibrillation

Cardioversion

Verapamil

Ventricular extrasystole Lidocaine
Ventricular tachycardia Lidocaine / cardioversion
Ventricular fibrillation Defibrillation, Lidocaine
Wolff-Parkinson-White syndrome Cardioversion / Amiodarone

Prosthetic valve endocarditis

Early onset Onset of symptoms within 60 days Staphylococcus epidermidis
Late onset Onset of symptoms after 60 days Streptococcus viridans
mitral valve prolapse / barlow’s syndrome / floppy valve syndrome
Commoner in females

Mostly asymptomatic

Non-ejection systolic click

Echocardiography is the investigation of choice

QUOTE CORNER

Courage is the discovery that you may not win, and trying when you know you can lose. Tom Krause

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principle features of cardiac tamponade
Elevation of intracardiac pressure

Limitation of ventricular filling

Reduction of cardiac output

*Ewing’s sign

In case of pericardial effusion

Clinically a patch of dullness may be found beneath the angle of left scapula

*Torsades  de pointes

Ventricular tachycardia characterised by polymorphic QRS complexes that change in amplitude cand cylcle length

Magnesium sulphate is the drug of choice

*Most common site of syphilitic aneurysm is ascending and transverse portion of the arch of aorta

It also leads to ventricular dilatation (Cor bovinum)

*Holiday heart syndrome-atrial arrhythmias, particularly fibrillation seen in alcoholics

Contradinictaion to thrombolytic therapy

Absolute Relative
Past history of cerebrovascular haemorrhage

Any cerebrovascular event in the past one year

Suspicion of aortic dissection

Active internal blleding

Current use of anticoagulants

Recent invasive or surgical procedure or prolonged cardipulmonary resuscitation

Known blleding diasthesis

Preganancy

A hemorrhagic ophthalmic condition

Active peptic ulcer disease

Adequtely controlled severe hypertension.

ENZYME MARKERS IN M.I.

Creatinine phoshokinase Appears within 2-4 hours, peaks by 24 hours, returns to normal by 3 days. Very sensitive, less specific
Lactate dehyrogenase Seen within 24 hours, peaks by 4-5 days, returns to normal in 10 days. Not specific
Troponin T or Trponin I Rises within 4-8 hours, peaks in 10 days Most commonly used

Very sensitive and specific

TRIVIAL TRUTH

Traces of cocaine were found on 99% of UK bank notes in a survey in London in 2000.

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Troponin is elevated in
Myocardial infarction

Pulmonary embolism

Congestive heart failure

*Most sensitive indicator of myocardial infarction- raised ratio of ldh1 to ldh2

PARANEOPLASTIC SYNDROMES IN LUNG CANCER

Small cell carcinoma Adenocarcinoma Squamous cell carcinoma
Eaton-lambert syndrome

Cushing’s syndrome

Acromegaly

SIADH

Clubbing Hypercalcemia
Treatment of small cell carcinoma Chemotherapy
Treatment of squamous cell carcinoma and adenocarcinoma Radiotherapy and surgery

*Best response to chemotherapy and radiotherapy is shown by small cell carcinoma, but it has worst prognosis.

Bronchial carcinoids
No known relationship to cigarette smoking

Neuroendocrine differentiation of Kulchitsky cells of bronchial mucosa

*Carcinoid syndrome-

Episodic flushing, diarhhoea, bronchospasm, cyanosis

Due to release of vasoactive amines like serotonin, from carcinoid tumours

*Pancoast tumor is a type of squamous cell carcinoma.

*Clara cells are seen in broncho-alveolar carcinoma.

*Most common site of metastasis from lung carcinoma is adrenal glands

.

bronchial asthma

Creola bodies Desqaumated epithlial cells
Curschmann spirals Bronchial mucous casts
Sarcoidosis
Pseudo tuberculosis / Osteitis tuberculosa / Multiplex cystoides / Jungling disease /

Schaumann’s disease

Biopsy evidence of mononuclear cell granulomatous inflammatory process is mandatory for definitive diagnosis of sarcoidosis

Lung is the most common site to be biopsied

QUOTE CORNER

The man who removes a mountain begins by carrying away small stones.- Chinese Proverb

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shrinking lung syndrome
Seen in sle

Diaphragmatic dysfunction with loss of lung volume

Acute respiratory failure

Type 1 Severe hypoxemia refractory to oxygen

Due to airspace filling-intrapulmonary shunting

Type 2 Alveolar hypoventilation increased Pa CO2
Type 3 Perioperative
Type 4 Circulatory shock , acute respiratory failure

*Pneumocystis carinii pneumoniae-

Prophylaxis is given in hiv positive patients with CD 4 count of less than 200

Single double-strength tablet of sulphamethoxazole -trimethoprim is given daily.

*Mycobacterium avium intracellulare

Treatment of choice- clarithromycin + ethambutol+ rifabutin

*DLCO is elevated in pulmonary hemorrhages like Goodpasture’s syndrome

*Propranolol is contraindicated in acute pulmonary edema.

*Alpha 1 antitrypsin deficiency- panlobular emphysema

*Gold standard for diagnosis of pulmonary embolism is pulmonary angiography

Most commonly used / suitable test is lung scanning

Disease associated with massive splenomegaly
Chronic myelogenous leukemia

Lymphomas

Hairy cell leukemia

Myelofibrosis with myeloid metaplasia

Polycythemia vera

Gauchers disease

Chronic lymphocytic leukemia

Sarcoidosis

Autoimmune hemolytic anemia

Splenic hemangiomatosis

Malaria

Kala azar

TRIVIAL TRUTH

In March 2005, a government clinic for Internet addiction was opened at the Beijing Military Region Central Hospital in People’s Republic of China

ELEVENTH HOUR MEDICINE                                                                                                              155

Strawberry tongue
Scarlet fever

Kawasaki’s disease

Toxic shock syndrome

Hodgkin’s disease

Most common type Nodular sclerosis
Best prognosis Lymphocytic predominance
Popcorn cells are seen in Lymphocytic predominance
Lacunar cells  are seen in Nodular sclerosis
Reed Sternberg cells are seen in All varieties, maximum in mixed cellularity
order of Involvement  nodes in Hodgkin’s disease
Cervical, mediastinal, para-aortic
Causes OF Pseudomembranous colitis
Clostridium difficile

Ischemic colitis

Volvulus

Staphylococcus

Shigella

Candida

Gamma Gandy bodies
Are foci of fibrosis containing iron and calcium

Seen in sickle cell anemia, cml, cirrhosis with portal hypertension

Wilm’s tumor is associated with
wagr syndrome (Wilm’s tumor, Aniridia, Genital abnormalities, mental Retardation)

Denys-Drash syndrome

Beckwith-Weidman syndrome

Charcot’s triad

Seen in ascending cholangitis

Jaundice

Abdominal pain

Fever

saint’s triad
Diverticulosis

Gallstones

Hiatus hernia

QUOTE CORNER

I’m a great believer in luck, and I find the harder I work, the more I have of it.- Thomas Jefferson

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Reynold’s pentad
Jaundice

Abdominal pain

Fever

Shock

Confusion

ulcerative colitis crohn’s disease
Cigarette smoking is protective Cigarette smoking  causes disease
Commonest symptom is bloody diarrhoea and absominal pian Commonest symptom is non-bllody diarrhoea, abdominal pain
No cobblestoning of mucosa Cobblestoning of mucosa is seen
No fistula or sinus formation Fistual and sinus formation seen
Rectum is always involved Rectum is apred
Continuous lesions Skip lesions
No recurrence after surgery Recurs after surgery
Antibiotics not effective Antibiotics are effective
Toxic megacolon is seen Not seen
Lead pipe appearance on barium meal String sign on barium meal
p ANCA present ASCA present
PURTSCHNER’S RETINOPATHY
Complication of acute pancreatitis

Suddenand severe loss of vision

Due to occlusion of posterior retinal artery with aggregated granulocytes

Fundoscopic appearance of co\tton wioo, spots and hemorrhages confined to an area of optic disc and macula

*5′ nucleotidase-determines whether rasied alkaline phospahatase is hepatic in origin.

*Gamma glutamyl transpeptidase-

Increased in cholestasis

Increased in patients of alcohol abuse.

*Auxilliary liver tarnsplant

Transplanted liver provides temporary support till the native liver recovers.

Classical triad of pyonephrosis
Anemia

Fever

Loin swelling

TRIVIAL TRUTH

The term “dengue” is a Spanish attempt at the Swahili phrase “ki denga pepo”, meaning “cramp-like seizure caused by an evil spirit”.

ELEVENTH HOUR MEDICINE                                                                                                                 157

Causes of paipllary necrosis
Analgesic abuse

Diabetes mellitus

Infant in shock

Pyelonephritis

Obstruction

Sickle cell disease

Ethanol

*Dietl’s crisis

Intermittent unilateral hydronephrosis after an attack of renal colic, followed hours later by passage of urine, disappaerance of swelling and relief of pain.

*Marion’s disease-

Bladder neck obstruction

Prostatism without prostate hypertrophy

Vesical diverticulum and hydronephrosis

*Bartter’s syndrome-hypertrophy and hyperplasia of Juxtaglomerular cells

Hypokalemic alkalosis and hyperaldosteronism

Absence of hypertension in the presence of markedly increased renin concentration

Renal osteodystrophy in patients on hemodilaysis occurs due to deposition of aluminium.

*Moth eaten calyces are seen in renal tuberculosis

Putty kidney or cement charcteristic of renal tuberculosis

Somogyi effect Overnight hyperglycemia after hypoglycemia due to counter regulatory hormones.

Management-decrease insulin dose

Dawn phenomenon Early morning hyperglycemia.

Management-increase dose or delay it

Honeymoon period Seen in type I diabetes

Drastic decrease in  insulin requirement followed by rise due to temporary recovery of beta cells

Brittle diabetes Seen in type I diabetes

Rapid changes in blood glucose level, from hypoglycemia to ketoacidosis

QUOTE CORNER

At the end of a matter ask, “what will I learn from this to make me better?”- Mary Anne Radmacher

ELEVENTH HOUR MEDICINE                                                                                                                158

MEA I (Werner’s  syndrome) Parathyroid gland-chief cell hyperplasia-hyperparathyroidism

Pancreas-islet cell tumour- Zollinger Ellison syndrome

Pituitary-anterior-acromegaly, Cushing’s syndrome

MEA II a ( Sipple’s syndrome) Parathyroid gland- chief cell hyperplasia-hyperparathyroidism

Adrenal gland-pheochromocytoma

Thyroid -medullary carcinoma

MEA II b Parathyroid gland- chief cell hyperplasia-hyperparathyroidism

Adrenal gland-pheochromocytoma

neurofibromatosis

Thyroid -medullary carcinoma

Jod Basedow thyrotoxicosis Large doses of iodine given to hyperplastic endemic goiter which is iodine-avid may produce temporary hyperthyroidism and occasionally persistent hyperthyroidism
Wolff- Chaikoff effect In normal individuals large doses of iodine act directly on the thyroid to produce a mild and transient inhibition of organic binding of iodide and hence of hormone synthesis
wolf oram syndrome
Diabetes mellitus

Diabetis insipidus

Optic atrophy

Deafness

*siadh

Dilutional hyponatremia

Treatment

Water reduction, demeclocycline

*Primary hyperparathyroidism

Bones, groans, stones and psychic moans.

TRIVIAL TRUTH

The last case of wild smallpox occurred on October 26, 1977. In September, 1978, Janet Parker, an English medical photographer, who was exposed to smallpox as the result of a laboratory accident, became the last victim of smallpox On May 8, 1980, the World Health Organization declared smallpox eradicated. Cultures of the virus are kept by the Centers for Disease Control and Prevention (CDC) in the United States and at the Institute of Virus Preparations in Siberia, Russia. When scientists destroy the samples the smallpox virus will become the first life form intentionally eliminated from the earth.

ELEVENTH HOUR MEDICINE                                                                                                                 159

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  1. Smallpox, a highly contagious disease, is unique only to humans. The smallpox virus is caused by two virus variants called Variola major and Variola minor. Variola major is the more deadly form of the virus; it usually has a mortality rte of 20-40 percent of those that are infected with the virus. Variola minor on the other hand is much less severe and only kills 1% of its victims. Neither of the Variola’s are bugs that you want to get. Avoid them at all costs!.-

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