Hey guys, Ikan posted a clinical vignette based on this differentiation. So I did a little digging.
Both Akathisia and RLS can be caused due to antipsychotics, Akathisia goes more with typical ones and RLS with atypical ones.
Besides RLS has some other characteristic features:
1. Associated with dysesthesia originating in legs whereas in case of akathisia patient feels like it's originating in the central core of the body.
2. RLS has evening-predominance, it disturbs sleep of the patient as the patient jerks his legs during sleep which might be noted by his gf or wife.
3. There is positive family history in RLS.
4. RLS can be induced by other centrally acting drugs like Diphenhydramine, Citalopram, Clonazepam etc if there is a positive family history.
Treatment:
First intervention should always be reduction of dose of antipsychotics.
While RLS responds well to dopamine agonists like Pramipexol and Ropinirole, Akathisia responds well to Mirtazapine, a tetracyclic antidepressant. Although withdrawing the causative drug works the best.
According to latest clinical trial reports, The first line treatment of akathisia is propranolol, second line is Benztropine and if these doesn't work we resort to benzodiazepines.
That's all! You never stop learning.
-VM
Hello everybody!
Let's learn a quick way to remember a few important X-linked Dominant Disorders.
The mnemonic goes like:
All Hypo Pigmented Rats Have Resistant Rickets.
All - Alport Syndrome.
Hypo - Familial Hypophosphatemia.
Pigmented - Incontinentia Pigmenti.
Rats - Rett Syndrome.
Resistant Rickets - Vit.D Resistant Rickets.
X linked dominant disorders are rare pattern of inheritance.
All affected males will transmit it to all their daughters and all affected females will transmit the disease to 50% of her sons/daughters.
If you have another mnemonic on the same do share.
Let's learn Together!
-Medha.
Did you know corticosteroid therapy can cause depression, mania, psychosis, and delirium?
Why?
The mechanism by which the corticosteroid induces symptoms such as mania, depression, and psychosis is not clear.
The administration of prednisone is associated with decreased levels of corticotrophin, norepinephrine, and beta-endorphin in the cerebrospinal fluid. Furthermore, corticosteroids induce an increased release of glutamate that induces neuronal toxicity due to accumulation effect.
-IkaN
Benzodiazepines frequently are administered to patients to induce sedation.
Paradoxical reactions to benzodiazepines, characterized by increased talkativeness, emotional release, excitement, and excessive movement, are relatively uncommon and occur in less than 1% of patients.
The exact mechanism of paradoxical reactions remains unclear.
It is important to be aware of this side effect because increasing the dose of benzodiazepine would worsen the condition.
Hello!
Let's learn about Acalculous cholecystitis today. These are my step 2 CK notes, made from UpToDate.
What is acalculous cholecystitis?
Acalculous cholecystitis is an acute necroinflammatory disease of the gallbladder with a multifactorial pathogenesis. It is typically seen in patients who are hospitalized and critically ill.
Clinical features:
In critically ill patients, the appearance of unexplained fever, leukocytosis, or vague abdominal discomfort may be the only sign of acalculous cholecystitis. Patients may also have jaundice or a right upper quadrant mass. Laboratory test abnormalities may include a leukocytosis or abnormal liver tests, but they are nonspecific.
Diagnosis: USG.
Why?
Advantages of ultrasonography are that it is noninvasive, can be done at the bedside, and has good sensitivity and specificity for diagnosing acalculous cholecystitis. In addition, ultrasonography may reveal alternative diagnoses (such as calculous cholecystitis). Thickening of the gallbladder wall is the most reliable feature seen in patients with acalculous cholecystitis.
Ultrasonographic features:
●Absence of gallstones or sludge
●Thickening of the gallbladder wall (>3 mm)
●Pericholecystic fluid
●Striated gallbladder
●A positive Murphy's sign induced by the ultrasound probe (may be absent in patients who are obtunded or sedated)
●Mucosal sloughing
●Gallbladder distension (>5 cm).
Treatment:
In patients with acalculous cholecystitis, we recommend the initiation of broad spectrum antibiotics as soon as blood cultures have been drawn.
Infection with enteric pathogens, including E. coli, E. faecalis, Klebsiella, Pseudomonas, Proteus species, and Bacteroides is common.
Preferred surgery: Cholecystostomy rather than cholecystectomy.
Why?
Cholecystostomy is effective and is less invasive than cholecystectomy. (especially in critically ill patients.)
However, cholecystectomy should be performed if there are findings suggesting gallbladder necrosis, emphysematous cholecystitis, or perforation. Cholecystectomy is also a reasonable alternative in patients who are good surgical candidates.
That's all!
-IkaN
Hello
Women who have had breast biopsies in the recent past, that showed atypical hyperplasia, are at increased risk of breast cancer in the future. This is because of the changes in the breast that prompted the biopsies and not the biopsy itself, according to the Gail model of breast cancer risk assessment.
Moreover, high breast density (due to high fat diet and obesity) - individualised and as a modifiable risk factor itself, in combination with proliferative benign breast disease, increase the risk of cancer, but is relatively uncommon.
Source: http://jnci.oxfordjournals.org/content/105/14/1043.full.pdf
Thats all
- Jaskunwar Singh
Why does pertussis cause lymphocytosis even though it is a bacteria?
Pertussis toxin (PT), from Bordetella pertussis, causes lymphocytosis.
Lymphocytosis is because of impaired entry of lymphocytes into lymph nodes.
