Hello! So these are my notes on AML :)
Wednesday, November 2, 2016
Monday, October 31, 2016
Fever : What questions to ask your patient and why
Fever
So we're familiar with the definition and measurement of fever. But while taking a case or interacting with a patient with this simple and most basic symptom , what all should we ask for to make sure we don't miss out on anything ?
So we're familiar with the definition and measurement of fever. But while taking a case or interacting with a patient with this simple and most basic symptom , what all should we ask for to make sure we don't miss out on anything ?
Here's a list of things your Historytaking should elicit :
Ask for :
1. Onset and Duration.
When did the fever begin - and for how long has it lasted. (This would give a clue whether the person suffers from an Acute Febrile Illness - which can generally be attributed to Infectious Disease , or a rather Chronic form of fever which could be due to Granulomatous diseases or even Neoplastic and Autoimmune conditions )
1. Onset and Duration.
When did the fever begin - and for how long has it lasted. (This would give a clue whether the person suffers from an Acute Febrile Illness - which can generally be attributed to Infectious Disease , or a rather Chronic form of fever which could be due to Granulomatous diseases or even Neoplastic and Autoimmune conditions )
2. Progression.
(Has it worsened or Become better since its onset. This gives a clue about the present status of the patient. )
(Has it worsened or Become better since its onset. This gives a clue about the present status of the patient. )
3. Chills , Rigors , Sweat .
(It's essential to include the presence or absence of chills+Rigors + Sweat immediately in the fever description. Presence of Chills and Rigors indicate any infectious process in the body and can be found in Malaria and UTI's among other conditions. Sweating after feeling hot and then cold is characteristically associated with Malaria)
(Important : Presence of the B Symptoms - which are Night Sweats ; Fever ; Weight loss. Seen with Lymphomas and TB)
(It's essential to include the presence or absence of chills+Rigors + Sweat immediately in the fever description. Presence of Chills and Rigors indicate any infectious process in the body and can be found in Malaria and UTI's among other conditions. Sweating after feeling hot and then cold is characteristically associated with Malaria)
(Important : Presence of the B Symptoms - which are Night Sweats ; Fever ; Weight loss. Seen with Lymphomas and TB)
4. Periodicity .
(It's of extreme value to understand the pattern of the fever.
If the fever is present throughout the day with a variation of not more than 1°C it is of the Continuous Type : As seen in Enteric Fever and even UTI's .
If the fever is present throughout the day but the variation is more than 1°C it is of the 'Remittent' variety. It may not be possible to distinguish between these 2 on history alone.
Intermittent is when the fever stays only for some duration during the day and the patient is afebrile during the remaining part )
(It's of extreme value to understand the pattern of the fever.
If the fever is present throughout the day with a variation of not more than 1°C it is of the Continuous Type : As seen in Enteric Fever and even UTI's .
If the fever is present throughout the day but the variation is more than 1°C it is of the 'Remittent' variety. It may not be possible to distinguish between these 2 on history alone.
Intermittent is when the fever stays only for some duration during the day and the patient is afebrile during the remaining part )
5. Diurnal variation ?
(Night rise of fever could be suggestive of Tuberculosis)
(Night rise of fever could be suggestive of Tuberculosis)
6. Associated with Rash or any Spots ?
(Viral exanthems like Dengue , Chikungunya , Zika or even Rickettsial diseases commonly present with some form of rashes)
(Another possibility could be a primary Skin condition induced fever )
(Viral exanthems like Dengue , Chikungunya , Zika or even Rickettsial diseases commonly present with some form of rashes)
(Another possibility could be a primary Skin condition induced fever )
7. Arthralgia , Myalgia ?
(Arboviruses like Dengue and Chikungunya are infamous for these. Arthralgia is especially debilitating in Chikungunya fever. Body ache is also common in both. Retro-orbital pain and Bifrontal headache are common with Dengue.)
(Arboviruses like Dengue and Chikungunya are infamous for these. Arthralgia is especially debilitating in Chikungunya fever. Body ache is also common in both. Retro-orbital pain and Bifrontal headache are common with Dengue.)
8. Icterus , High colored urine.
(Presence of these - especially during the post monsoon season should raise suspicion of Leptospirosis or Acute Viral hepatitis. Enteric fever may be considered)
(Presence of these - especially during the post monsoon season should raise suspicion of Leptospirosis or Acute Viral hepatitis. Enteric fever may be considered)
9. Cough , weight loss?
(Presence of these should raise query of TB or Pneumonia )
(Presence of these should raise query of TB or Pneumonia )
10. Dysuria, urgency , frequency?
( UTI is a common cause of AFI especially in Diabetics )
( UTI is a common cause of AFI especially in Diabetics )
11. Altered sensorium, photophobia , vomiting ?
( Characteristic of Meningitis /Encephalitis)
( Characteristic of Meningitis /Encephalitis)
12. Eating outside , GI disturbances ? (Enteric fever or Gastroenteritis should be suspected )
I hope this gave a crisp summary of how a fever case can be approached . Goodbye ! Happy-Treating !
A.P.Burkholderia
A.P.Burkholderia
Sunday, October 30, 2016
Study group discussion: Why are agglutinates not seen in warm type autoimmune hemolytic anemia?
Why are agglutinates not seen in warm type autoimmune hemolytic anemia?
Because the antibody is IgG. IgG is called incomplete antibody.
RBCs have a strong negative charge on their surface called zeta potential. So the shortest distance attainable between two RBCs is 18nm. IgM molecule has a large pemtameric structure, so it has a distance of 30 nm between two binding sites. Hence, it is able to agglutinate RBCs.
But the small IgG molecule has only 12 nm gap between two binding sites. So it can't bind to multiple RBCs and hence fails to agglutinate them.
So it just coats the RBCs, which is taken to spleen to be killed.
That's all!
Thank you, Divya, for explaining this to us =)
-IkaN
Saturday, October 29, 2016
Marijuana and cannabinoids intoxication mnemonic
Hey!
So in this post, imma gonna talk about what happens when you smoke weed yo.
The symptoms of marijuana intoxication are:
Munchies (Polyphagia)
Autonomic hyperactivity (Mild hypertension, dry mouth)
Racing heart (Tachycardia)
Injection (Scleral, conjunctival injection)
Judgement impaired
Uphoria (Euphoria)
Anxiety
Nystagmus
Ataxia
Autonomic hyperactivity (Mild hypertension, dry mouth)
Racing heart (Tachycardia)
Injection (Scleral, conjunctival injection)
Judgement impaired
Uphoria (Euphoria)
Anxiety
Nystagmus
Ataxia
Treatment? Intoxication is self-limited to several hours. Interestingly, the treatment for marijuana intoxication and withdrawal are exactly the same: supportive care only.
That's all!
Don't do pot, you dope, you :P
-IkaN
Step 2 CK: Treatment of narcolepsy and cataplexy
Treatment of Narcolepsy:
Patients with sleepiness severe enough to require medication can be treated with stimulant medications.
Patients with sleepiness severe enough to require medication can be treated with stimulant medications.
Narcolepsy mnemonic
Hello!
This post is on narcolepsy.
For those who don't know, narcolepsy is characterized by:
Crown rump length and gestational sac diameter
The crown rump length in mm is calculated by subtracting 42 from the gestational age in number of days.
The gestational sac diameter in mm is calculated by subtracting 30 from the gestational age in number of days.
Friday, October 28, 2016
Step 2 CK: Treatment of bipolar disorder
For acute maniac episode:
Give antipsychotic (preferably IM) like Olanzapine, Haloperidol first because they act fast.
Give antipsychotic (preferably IM) like Olanzapine, Haloperidol first because they act fast.
Long term treatment for Bipolar disorder: Mood stabilizer like lithium.
If patient is on mood stabilizer and presents with maniac episode: Give antipsychotic.
For patients who have a history of multiple recurrences or have a partial but inadequate response to a maintenance drug that is tolerated, add a second drug:
For patients who have a history of multiple recurrences or have a partial but inadequate response to a maintenance drug that is tolerated, add a second drug:
Common combinations include lithium or valproate:
- Plus a second-generation antipsychotic, such as quetiapine, long-acting injectable risperidone, ziprasidone, or olanzapine
- Lamotrigine
- Carbamazepine
Step 2 CK: Treatment of anxiety disorders
Patient is in a panic attack:
Use benzodiazepines because they act fast.
Long term treatment for panic disorder:
SSRIs
Long term treatment for GAD:
SSRIs
Buspirone
Wednesday, October 26, 2016
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