If the syrinx extends into the brainstem, syringobulbia results. This
may affect one or more cranial nerves, resulting in facial palsies.
Sensory and motor nerve pathways may be affected by interruption
and/or compression of nerves.
Hypnagogic or hypnopompic hallucinations are visual, tactile,
auditory, or other sensory events, usually brief but occasionally
prolonged, that occur at the transition from wakefulness to sleep
(hypnagogic) or from sleep to wakefulness (hypnopompic).
The person may hear sounds that are not there and see visual
hallucinations. These visual and auditory images are very vivid and
may be bizarre or disturbing.
Usually it is part of the tetrad of narcolepsy that includes:
Excessive daytime sleepiness
Cataplexy
Hypnagogic hallucinations
Sleep paralysis.
This tetrad is rarely seen in children.
Ulcer on posterior stomach wall – always bleed (gastroduodenal
artery) – blood in lesser sac or beneath diaphragm
Ulcer on anterior wall – always perforate – gas under diaphragm
Clonidine drug of choice for hot flushes…tibolone also given
Reloxifine given for osteoporosis prevention in menopause
pitting nails is psoriasis
0-14yrs- ALL
15-59yrs- AML
40-60yrs- CML
60+ CLL
Status epilepticus
Administer intravenous lorazepam as first-line treatment. Administer
intravenous diazepam if intravenous lorazepam is unavailable, or
buccal midazolam if unable to secure immediate intravenous access.
Administer a maximum of two doses of the first-line treatment
(including pre-hospital treatment)
Phenytoin is 2nd line.
to correct Hyperkalemia
1st n qickest is calcium gluconate
Then insulin n dextrose
Then calcium resonium
Laparoscopy is the criterion standard for the diagnosis of PID. It is
significantly more specific and sensitive than are clinical criteria
alone. The minimum criteria for diagnosing PID laparoscopically
include tubal wall edema, visible hyperemia of the tubal surface, and
the presence of exudate on the tubal surfaces and fimbriae.
For severe PID— broad spectrum (ceftriaxone) plus doxycycline
Moderate PID—–moderate doxy plus metro
when AIDS (Active disease) do not give any vaccination
when HIV, only BCG is contraindicated
Afib is the most common arrythmia in alcoholics. Also known as
holiday heart syndrome
in holiday heart syndrome AF occurs due to binge drinking and theres
no underlying heart patho
swelling in ankles in an elderly female indicates heart failure.
alcoholic so AF hence reathlessness and palpitations
CRAO, cherry red sopt is clincher. applying pressure might increase
the blood flow
A 40 year old man after an operation had a heavy bleeding. What
abnormality will you find? Low calcium
TIA. Doppler usg. Majority of TIA develop due to emboli which are
picked up on carotid doppler.
Carbimazole (used in hyperthyroidism), clozapine (atypical
antipsychotics), INH ….s/e…agranulocytosis (neutropenia)
statins cause muscle ache
neuroleptic malignant syndrome….typical antipsychotics suchas
haloperidol
osteosarcoma is relatively painless whereas ewings presents with pain
and redness around the tumor area.
Remember
Knee or shoulder..painless..osteosarcoma
Thigh or pelvis..painful..ewings
for dehydration and dka its NS and for burns its hartmans solution
if on the electrolyte picture it shows hypernatremia only then go for
0.45% NS. otherwise give 0.9% NS if normonatremia or
hyponatremia.
and potassium is always added to the fluid regimen after confirming
the lab values and a good urine output
before surgery for diabetics iv insulin n glucose n k
Anti-smooth muscle antibodies are antibodies (immunoglobulins)
formed against smooth muscle. These antibodies are typically
associated with autoimmune hepatitis.[
Chicken has blisters of different ages .. Some healing ( crusted in this
case ) , others ( the new ones ) still erupting ( weeping in this case )
In Shingles , all come at same time and with preceding pain in
dermatomal area and heal by crusting at the same time
for shingles , there should be some history , a minor clincher towards
immunocompromised state . It doesnt usually erupt just like that in
healthy young individuals whereas chicken pox can
Also though chicken pox starts from trunk , it surely is there on face
and around eyes.
Aspirin should b given from the 1st day of +ve pregnancy test n
heparin should b given as soon as fetal heart is seen on us….Anti
phospholipids syndrome
in children UTI always present due to some underlying disease…it
could be VUR or something. So even on single episode of UTI we
need to further investigate by doing an USG
Cerebral abscess presents as ring enhancing lesion
Toxoplasmosis being one of the causes of cerebral abscess
dexa scan for osteoporosis and nuclear bone scan to see metastasis
Normal is a T-score of -1.0 or higher
Osteopenia is defined as between -1.0 and -2.5
Osteoporosis is defined as -2.5 or lower, meaning a bone density that
is two and a half standard deviations below the mean of a thirty-year-
old man/woman.
Calcium stones : Envelop or dumbell shaped
Struvite ( ammonium Mg PO4 stones ) : Coffin lid shaped
Uric acid : Rhomboid or Rossette shaped
Cystine : Hexagonal
All are Radio opaque except Uric acid stones
Also ammonium Mg stones and cystine stones can form ” staghorn
calculi ” which if large enough require surgical removal
Beningn essential tremors ease off and become less noticeable on use
of affected limb or movement
Whereas in cerebellar disease there are tremors specifically on desired
movement ( intention tremors )
lung cancer 2 complication hyponatremea or hypercalcamia
Lung carcer particularly small cell CA lung releases ADH one of its
paraneoplastic features leading to dilutional hyponatremia
The Valgus stress test is a test for ligament damage. It involves
placing the leg into extension, with one hand placed as a pivot on the
knee. With the other hand placed upon the foot applying an abducting
force, an attempt is then made to force the leg at the knee into valgus.
If the knee is seen to open up on the medial side, this is indicative of
medial collateral ligament damage and may also indicate capsular or
cruciate ligament laxity.
similarly varus stress test for lateral collateral
Patient allergy to contrast media or renal failure do V/Q scan. If they
give chest Xray is normal or if no significant cardiopulmonary history
in the patient then again V/Q scan preferred.
CTPA in all other cases
Otitis media with effusion aka secretory otitis media aka glue ear.
Common in young children, 40db hearing loss, increase volume of tv.
Dull greyish blue tympanic membrane with air fluid levels are all the
clinchers
BCC usually presents as a pearly nodule with telangiectatic edge
Any lesion above the neck is BCC until proved otherwise
Actinic keratosis presents as yellowish scaly crusts not as a nodule
Acute management of SVT is vagal maneouvers, if not then iv
adenosine. If patient is asthmatic (breathless as in this case) then
verapamil is the option
B blockers and radiofrequency ablation are for prevention of SVT
episodes
SIADH is a common complication of small cell lung ca, paancreas,
prostate ca. 1st line is fluid restriction
Hoarsness persisting > 3 weeks requires investigation
Right dominant circulation= 85%= Post desc artery arises from Right
coronary artery
Left dominant circulation= 8%= PD arises from Left coronary artery
so basically dominancy depends on this Post desc artery.. from where
it arises
Isonatremic and hyponatremic volume depletion states may be treated
with normal saline or other isotonic solutions. The goal for correction
rates for either hyponatremic or hypernatremic patients should be no
more than 1 mEq/L/h to prevent the devastating CNS complications of
overrapid correction (central pontine myelinolysis and cerebral edema,
respectively). Full correction of severe sodium abnormalities usually
should be staged over 24 hours or longer.
Although a potassium deficit is present in all cases of volume
depletion, it is not usually clinically significant; few patients with
moderate dehydration require supplemental potassium. However,
failure to correct for hypokalemia during volume repletion may result
in clinically significant hypokalemia.
Add potassium to fluids when the patient has documented
hypokalemia. For all other patients, avoid adding
potassium to fluids until the patient has received several hours of
resuscitation and the patient has demonstrated adequate urine output.
Painful ulcers on vulva………Anti-HSV antibodies check for herpes
Forking HAY” + upper zone consdolidation ….farmers lung treatment
is prednisolone
Rathke cleft cysts (RCCs) are benign lesions that typically arise within
the sella between the anterior and posterior lobes of the pituitary.Most
often they are asymptomatic. These lesions, however, can cause mass
effect on surrounding structures such as the pituitary gland and optic
chiasm, leading to headache, pituitary dysfunction, or visual
disturbance.Rathke cleft cysts are remnants of the Rathke pouch, a
structure of ectodermal origin formed during the fourth week of
gestation
discharge swelling n redness of ear with normal tympanic
membrane..thats otitis externa treatment: topical gentamicin or
steriod drops
No gas bubble means oesophageal atresia. Double bubble sign for
duodenal atresia
Synonyms: HAE, hereditary angioneurotic oedema, C1-inhibitor
deficiency, C1-esterase inhibitor deficiency, familial angioneurotic
oedema, hereditary bradykinin-induced angioedema, hereditary non
histamine-induced angioedema
Hereditary angio-oedema (HAE) is a rare genetic condition causing
episodes of angio-oedema – including life-threatening laryngeal
oedema. Episodes can be unpredictable, or triggered by factors such as
trauma, drugs or dental treatment.
In Symptomatic patient (test once only) : fasting glucose >=7 or
Random blood glucose>=11.0 confirms diabetes
In asymptomatic patient (do test on 2 occasions): fasting glucose > 7
or random blood glucose> 11 confirms diabetes
Propranolol is used AF with hyperthyroidism due to the additional
benefit of inhibition of peripheral conversion of T4 to T3.
Acamprosate works by reducing the desire or craving to drink alcohol.
It is only given to people who have successfully stopped drinking.
Acamprosate calcium helps to reduce the chances of you drinking
again. People who are taking Acamprosate calcium will usually have a
programme of counselling as part of their treatment. Treatment with
Acamprosate calcium usually lasts one year.
Clang associations are ideas that are related only by similar or
rhyming sounds rather than actual meaning.[8] Example: “He ate the
skate, inflated yesterdays gate toward the cheese grater
Smoking is the most important risk factor for bladder cancer. Smokers
are at least 3 times as likely to get bladder cancer as nonsmokers.
Smoking causes about half of the bladder cancers in both men and
women.
atypical depression..characterized by temporary mood lifting by good
news,weight gain n increased sleep usually mote than 10 hrs
Typical – decreased sleep ( esp. early morning awakening in maj dep) ,
appetite. Atypical – increased
HTN+ hypoK = conn’s
Ovarian torsion
‘sudden onset vomiting and pain abdomen’ + mobile swelling in RIF is
the clincher.
Drug of choice for a hypertensive who is above 55 years of age with
no cough or renal problems (no contraindications i mean) CCB
PRADER WILLI: After birth there is hypotonia, failure to thrive and
sleepiness. The child usually has blue eyes and blond hair. They tend
to lag behind other children in the transition to solid food.
The second stage becomes apparent at the age of 12-18 months, when
an exceptional interest in food becomes apparent.[7] Hyperphagia,
obesity, hypogonadism, short stature and sleep apnoea and cor
pulmonale occur.[12] They have markedly elevated levels of ghrelin, a
hormone associated with hunger.
