Side effect of cyclophosphamide?
Bladder carcinoma is the commonest one!!
It can also lead to Haemorrhagic cystitis!
Maximum cyclophosphamide can be given for 18 months.. After that it has to be replaced with Methotrexate or azathioprine..
May cause infertility in male patients who received high doses as children.
Okay.. Didn't know that.. Thanks
Risk of potentially fatal and irreversible interstitial pulmonary fibrosis if given over prolonged periods.
Which nerves have a pseudoganglion?
Nerve to teres minor!
Correct.
Others are lateral terminal branch of deep peroneal nerve and posterior interosseous.
But why name pseudoganglion..??
Pseudo ganglion is only a nerve thickening resembling the presence of a ganglion.
Ohh.
What could be the possible cause of a sudden episode of nose bleeding in a patient who has a history of open heart surgery?
It could be because of anticoagulation. Hypertension is also a cause.
Since we are on this topic, any one would like to go over the differentials of epistaxis?
Excessive scratching of nasal area
Anticoagulation meds or any coagulation disorder
Traumatic
Leukemia
ITP
Problems in liver
Rhinosporidiosis
Polyps
Foreign bodies
I just studied that fatal familial insomnia is a prion disease.
We had a discussion on fatal familial insomnia before!
Fatal familial insomnia, harmful effects of working at night and sleeping during the day http://medicowesome.blogspot.com/2015/02/study-group-discussion-fatal-familial.html
Oh, I shall have a look over that discussion!
So basically it's thalamus that is missing :)
What is the centre for REM sleep in particular that is affected in idiopathic Parkinson's? I can't remember that center! It's important because in idiopathic Parkinson's disease, earliest symptom REM sleep behavior disorder.
Umm.. I can't remember that! Is it the one which regulates the circadian rhythm?
I found an interesting read on Parkinson's, rem in Harrison. I'll post it here!
REM Sleep Behavior Disorder RBD is a rare condition that is distinct from other parasomnias in that it occurs during REM sleep. It primarily afflicts men of middle age or older, many of whom have a history of prior neurologic disease.
Infact, over one-third of patients will go on to develop Parkinson's disease within 10 to 20 years.
Presenting symptoms consist of agitated or violent behavior during sleep, reported by a bedpartner. In contrast to typical somnambulism, injury to patient or bed partner is not uncommon, and, upon awakening, the patient reports vivid, often unpleasant, dream imagery.
The principal differential diagnosis is that of nocturnal seizures, which can be excluded with polysomnography. In RBD, seizure activity is absent on the EEG, and disinhibition of the usual motor atonia is observed in the EMG during REM sleep, at times associated with complex motor behaviors.
The Pathogenesis is unclear, but damage to brainstem areas mediating descending motor inhibition during REM sleep may be responsible. In support of this hypothesis are the remarkable similarities between RBD and the sleep of animals with bilateral lesions of the pontine tegmentum in areas controlling REM sleep motor inhibition.
Treatment with clonazepam (0.5 to 1.0 mgqhs) provides sustained improvement in almost all reported cases.
So it's the brainstem! :D
Yep!
Why do we ask about handedness in CNS case?
Dominant hemisphere and handedness http://medicowesome.blogspot.in/2014/12/dominant-hemisphere-and-handedness.html
Yup but in both LEFT is only dominant.. Then why bother asking?
There are exceptions where right hemisphere is dominant. Only 85% population has left dominant. 15% has right dominant.
I had seen a case in which the right hemisphere was dominant, in a right handed person!
How did you know she was right dominant?
We asked her to write, comb hair, thread needle - She was right handed.
She was right handed I agree ...
But how to know her right side is dominant?
She was right handed through history and examination.
Had UMN type of hemiparesis on the left side, clinically (Right hemisphere affected)
She also had difficulty in comprehension and speech, clinically (Brocas area affected)
So Brocas is usually on the left side, the dominant, that is.
But in this case, since the right hemisphere was affected, her Brocas was on the right side.
Our professors said shift of hemisphere can occur in childhood injury. Which could be a reason.. But there was no history suggestive of such insult in our case.
If broca is not affected.. We cant comment on right or left dominance?
I guess. No idea.
Best agent to be added into blood sample that has to be transported for glucose estimation?
Fluoride!
It prevents glycolysis.
How does it prevents glycolysis?
Inhibits the enzyme enolase
Yeah, correct!
Why do we use fluoride bulb for glucose estimation?
Fluoride inhibits glycolysis. So the glucose in RBCs don't get metabolized and you won't get a false lower value of glucose (:
This is the note I took on fluoride! Apparently when coupled with Mg it ihhibits enolase.. So it stops glycolysis.
*I was announcing the pre med group when this discussion took place*
We just created a premeds group for physics, chemistry and biology discussions. Message me if you wanna join in!
Yup. Cause those physics laws always get applied in case of resistance in vessels and especially in lung volume and pressure curves.
They do! I remember studying vectors for understanding ECG in first year!
Speaking of physics, can anyone name the mechanics behind the law applicable in Aortic aneurysms that lead to rupture?
:O
Physics never leaves us!
Okay, I dint know this! :(
It says as the diameter increases, tension on the vessel wall increases. The aneurysm keeps expanding, leading to rupture of the aneurysm.
Laplace law.
Yep.
Laplace's law states that tension on the wall of a container is directly proportional to the pressure inside it and also to the radius of the container. It's inversely proportional to wall thickness. Which explains the more bigger the aneurysm, the more susceptibility to rupture.
It's the same concept in Surfactant!
Really?
If the surface tension is not kept low when the alveoli become smaller during expiration, they collapse in accordance with the law of Laplace. In spherical structures like the alveoli, the distending pressure equals two times the tension divided by the radius (P = 2T/r); if T is not reduced as r is reduced, the tension overcomes the distending pressure.
What is Pouiselle's law?
Pouiselle's law states about the relationship between velocity of fluids, viscosity and the pressure in a capillary.
So physics is really important in Medicine!!! I haven't seen anything of physics yet!
It's just a matter of time! :D
I am waiting anxiously!
Question: Which inflammatory condition is associated with temporal arteritis?
Answer: Polymyalgia rheumatica!
Question: A patient comes with pain and weakness in the proximal muscles with not much of stiffness! What would it be? Polymyositis or PR?
Answer: Polymyositis.
Stiffness is a present in both but more of a feature of PR.
Pain in proximal muscles along with stiffness is PR, there will be no weakness of muscles in PR.
On the other hand, in case of Polymyositis, there is weakness of the muscles that is the main difference!
There might be little tenderness in this case.. But whether weakness is present or not that differentiates the two!
Rest we can further elaborate based on the enzymes!
So to summarize:
Muscle weakness is more of feature of polymyositis.
Stiffness, pain goes with Polymyalgia rheumatica.
Question: Which enzymes will be raised in PM?
Answer:
Creatine kinase.
Aldolase.
Question: What would be elevated in PR?
Answer: ESR.
Question: How does one differentiate between PM and DM?
Answer: In dermatomyositis, you will be see above symptoms plus skin manifestations - Gottron papules, Heliotrope rash, Shawl sign.
Question: What is the most common serious complication of PM/DM?
Answer: Malignancy!
Which malignancy?
Ovaries are most common. Others are cervix, breast, lungs, pancreas.
Testing for malignancy which CA is helpful?
CA-125 - That's for ovarian cancer.
19-9 for pancreas!
Question: Why does oxytocin cause volume overload?
Answer: It is similar to vasopressin in structure.
Vasopressin and oxytocin are similar in structure. So vasopressin is ADH. It retains water. Which will cause Intravascular volume expansion
There are a lot of compounds which have a similar structure and interesting clinical effects. Here are a few http://medicowesome.blogspot.in/2014/11/hormones-that-have-similar-structure.html
Doubt: Several pharmacology books said that oxytocin may cause hypertension. But Williams obstetrics says that it will cause serious hypotension if given as undiluted iv bolus. I'm confused.
Answer:
Bolus causes hypotension.
Normal infusion causes fluid retention.
Although unlike ergonovine, oxytocin does not produce hypertension.
So don't give bolus is the moral of the story. It can cause Placental hypoperfusion.
Question: How does it cause Placental hypoperfusion?
Answer: If your blood pressure drops, blood supply to all organs will be compromised. Comprehende?
Think of placenta as an organ. So Placental hypoperfusion!
Doubt: Does anyone know why iv bolus of oxytoxin will have adverse effect of hypotension and tachycardia?
Answer: In high doses... Oxytocin has vasodilator action which produces hypotension and reflex tachycardia.
From what I read, oxytocin decreases venous return and systemic vascular resistance. So that'll cause a compensatory tachycardia.
Source: http://www.ncbi.nlm.nih.gov/pubmed/18513945
Hutchinson's triad:
Seen in congenital syphilis. Includes -
1) Interstitial keratitis
2) Hutchinson's teeth (which are notched incisors)
3) Vestibular deafness
Hutchinson's Sign: Seen in Herpes Zoster Ophthalmicus.. Which says if the nose is involved, then the eyes have to be involved too.. Since they both are supplied by the Nasocilliary nerve.
Hutchinson's Pupil:
Seen in concussion injuries to brain (usually associated with the subdural hemorrhage).
The ipsilateral pupil is initially miotic... Then it becomes myriadtic due to raised IOP... Then as the IOP further increases, the contralateral pupil also dilates... So we have bilateral dilated pupils not reacting to light. This is an indication for immediate cerebral decompression.
Hutchinson's mask:
A sensation often associated with tabes dorsalis in which the face feels as if it is covered with a mask or cobwebs.
Hutchinson's facies:
The peculiar facial expression produced by the
drooping eyelids and motionless eyes in external
ophthalmoplegia.
Mitral facies - Malar erythema.
Hippocratic facies - Acute peritonitis.
Typhoid facies - Severe malaria.
Adenoid facies - Adenoids.
Chipmunk facies - Malar prominence, in Thalassemia.
Hepatic facies - liver failure.
Leonine facies - coarse features, leprosy.
Facies leprosa - Falling of teeth and nasal bridge depression in leprosy.
Mask face - Parkinsonism.
Cushing's face - Moon like round.
Hutchinson's facies - The peculiar facial expression produced by the
drooping eyelids and motionless eyes in external ophthalmoplegia.
Carbemazepine is contraindicated in which type of seizure?
During pregnancy, eclampsia and absence seizures.
Which anti eplielptic drug is contraindicated in pregnancy?
All of them.
Which antiepileptics can be used in pregnancy?
Sodium valproate, lamotrigine and lavatriacetram are safe in pregnancy.
Pregnant lady with epilepsy well controlled on sodium valproate wants to get pregnant. What will you do?
You do not switch the drug. Valproate has a dose dependent side effect on the fetus. You will try tapering down the dose. The main word is well controlled.
If while tapering the dose, she starts having seizures you switch to a safer drug.
