Asthma + Eosinophilia

Let us suppose that a patient has the classic signs & symptoms of Asthma and with that she has eosinophilia ( Absolute eosinophil count above 500/mm3).

The next step should be to look at the serum IgE levels.

If it is also elevated-

1. Do a stool examination and serological testing for strongyloidiasis.

2. Do Aspergillus-skin testing and check for aspergillus specific IgE.

If you have got a positive result for one of the above two, you have your diagnosis.

But what if both of the above results come out to be negative.

Then consider Churg Strauss syndrome or Eosinophilic granulomatosis with polyangiitis.

That's it!

-VM

Subpleural opacities and Ground Glass Opacities

Hey guys!

I saw a patient today, a 37 year old female patient with chief complaints of cough and shortness of breath. She has a history of allergic rhinitis and migraine. She is also obese with an BMI of 31.

As you must have guessed already she was diagnosed with Bronchial asthma. On the spirometry report done 4 months back,  there was an obstructive pattern and after giving bronchodilators her FEV1 increased by 22% (>12%) and FEV1 vol increased by 300ml (>200ml). These findings also strongly support the diagnosis of asthma.

She was started on Albuterol as needed and Salmeterol-fluticasone MDI. She didn't show good response in the first 4 weeks, so she was also started on Montelukast and Tiotropium inhaler.

Now after 4 months, she still had cough and shortness of breath. She had bilateral polyphonic wheezes. A chest X Ray was done which came out to be normal. On pulse oximetry, SaO2 was 97% while breathing ambient air. On chest CT we found two attributes:
Subpleural opacities and Ground glass opacities.

So based on the CT scan findings, differential diagnosis:

Subpleural opacities:
1. Eosinophilic granulomatosis with polyangiitis( previously called Churg Strauss).

2. Organizing pneumonia

3. Pulmonary embolism with resultant subpleural pulmonary infarction

4. Allergic bronchopulmonary aspergillosis ( well, not really, actually in this case, there is peripheral air space opacification which looks identical to subpleural opacities)

Now Ground glass opacities:

1. Atypical pneumonia

2. Hypersensitivity pneumonia

3. Several ILDs

4. Sarcoidosis

5. Pulm Edema

6. Pulm Haemorrhage

That's all!

-VM

Cutaneous manifestations of Streptococcus

Hello awesomites!
Here's a collection of Cutaneous infections/diseases caused by Streptococcus pyogenes

Direct infections of skin or subcutaneous tissue-

1. Cellulitis
2. Impetigo
3.Ecthyma,Erysipelas
4. Vulvovaginitis
5. Perianal infection
6. Streptococcal ulcers
7. Blistering distal dactylitis
8. Necrotizing fasciitis

Secondary infection-

Eczema, infestations, ulcers, etc.

Tissue damage from circulating toxins-

1. Scarlet fever
2. Toxic‐shock‐like syndrome
3. Recurrent toxin‐mediated perineal erythema

Skin lesions due to allergic hypersensitivity to Streptococcal antigens

1. Erythema nodosum
2. Vasculitis

Skin disease provoked or influenced by Streptococcal infection (mechanism uncertain)-

1. Psoriasis, especially guttate forms.
2. Kawasaki disease.

That's all!

MD Mobarak Hussain (Maahii)

Gross specimen description

Description of gross specimens is a compulsory exercise in almost all exams.

So, what should you describe about a specimen?

Is it an entire tissue/ organ and which one? And then describe the organ from the capsule to the parenchyma if it is a solid organ or from inside out - mucosa to the serosa if it is an intestine and from the intima to the externa if it is a vessel!

And don't forget the code "C2S2".....
Describe the consistency, the colour and the shape and the size...

So, for eg- description of a fatty liver would be
" A slice of a liver, enlarged in size with rounded borders, capsule not thickened, parenchyma yellowish and greasy, soft in consistency- probably fatty liver"

Is it a bit simple now?

Masks and Respirators (Respiratory type of PPE)

Hello :)

Have you ever seen people wearing those mask like thing during certain infections?

I used to consider it some kind of fashion or trend. But now I got to know what those masks are for?

Those are the RESPIRATORY types of the PPE (Personal protective equipment).

RESPIRATORS:-

It protect against multiple airborne contaminants. 

These are different from surgical masks.

INDICATION:-

It is used in emergencies like influenza epidemic. Here you need protection from air-borne transmissible diseases.

AIR-BORNE TRANSMISSIBLE DISEASES:-

-TB

-Pandemic Flu outbreak

-Avian Flu

-SARS

-Small pox

TYPES OF RESPIRATORS SELECTED:-

-N95 (means the respirator blocks at least 95% of very small (0.3 micron) test particles.)

-High efficiency particulate air (HEPA)

-Powered air purifying respirators (PAPRs)

N95 limitation:-

-they leak 

-Risk reduced but not eliminated

-facial hair compromises seal

-Don't work for Oxygen deficient conditions

-Breathing resistance increases overtime.

SURGICAL MASKS:-

The surgical masks are the main barriers to protect the patient against possible infection or contamination of exhaled organism by medical personnel, and in turn are barrier to surgical personnel against possible splashing fluids.

For more details, Click the link below :

https://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/GeneralHospitalDevicesandSupplies/PersonalProtectiveEquipment/ucm055977.htm

It is important for prevention of the community. 

Although the main reason for sudden spread and increased mortality are:-

-Delay in reporting to health care centre 

-Further delay in diagnosing the disease and referral services.

 Studies have been done to compare the effectiveness of surgical masks and respirators during Respiratory infection emergency.

1. AMONG HEALTH CARE WORKERS

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4868605/
2. AMONG THE PATIENTS  
https://www.ncbi.nlm.nih.gov/pubmed/23505369/

That's all for today.

:D

-Upasana Y.  :)

Flexion Tear Drop Fracture

Hello guys!

Here's a short description on Flexion Tear Drop Fracture and its radiological findings.

It typically occurs from severe flexion and compression forces, most commonly at C5-C6 (diving head first, motor vehicle collision deceleration).

Radiographic features -

1. Sagittal fracture through the vertebral body.
2. Fracture of the anteroinferior vertebral body (Tear Drop Sign)
3. Loss of anterior height of the vertebral body -Cervical kyphosis.
4. Posterior cervical displacement above the level of injury.
5. Widening of interspinous processes.
6. Intervertebral disc space narrowing.
7. Disruption of the spinolaminar line.
8. Vertebral body rotation with an AP diameter that appears smaller than on other levels.
9. Anterior dislocation of the facet joints.

That's all! 

Thank you.

MD Mobarak Hussain (Maahii) 

Image Based MCQ on Shoulder Dystocia

Hello awesomites!
Yesterday we posted an Image based MCQ on Shoulder Dystocia.
And as promised here is the answer.

#Obs_Gynae
Q. The image given below represents:

A. Mc Roberts maneuver
B. Woods corkscrew maneuver
C. Cleidotomy
D. Zavanelli maneuver

The correct answer is A.

The given image shows Mc Roberts maneuver.

All of the above mentioned maneuvers are used for management of shoulder dystocia.

Mc Roberts maneuver:
In this maneuver, legs of the mother will be abducted and flexed against the abdomen. It causes cephalic rotation of the pelvis. Along with this gentle suprapubic pressure is applied by the assistant.

MD Mobarak Hussain  (Maahii)

Image Based MCQ on Health Programs

Hello awesomites!
Yesterday we posted an Image based MCQ on Health Programs.
And as promised here is the answer to the question.

Image Based MCQ
#PSM
#Community_Medicine
Q. The following image represents:
A. Rashtriya swasthya bima yojana
B. Mid day meal program
C. Integrated child development service
D. Mission Indradhanush

The correct answer is B. Mid day meal program.

Option A-

Option C-

Option D-

Thank you. 

MD Mobarak Hussain (Maahii) 

Sequence of appearance of papilledema

The optic disc margins start to blur in the following order in papilledema-

1. Superior
2. Inferior
3. Nasal
4. Temporal

Blurring first occurs where the nerve fibre density is the highest.The optic disc being ovoid in shape, with taperings superiorly and inferiorly, the nerve fibre density is higher there. Hence such a sequence.

That's all!

-Sushrut Dongargaonkar

Question on larynx

So here is answer of our previous questions.
#Anatomy
Sensory supply of larynx, below the vocal cord-
A) Superior laryngeal nerve
B) Inferior laryngeal nerve
C) Recurrent laryngeal nerve
D)Internal laryngeal nerve

Ans is "C" Recurrent laryngeal nerve.


Things must be know.
All intrinsic muscles of larynx are supplied by recurrent laryngeal nerve except cricothyroid. Cricothyroid is supplied by external laryngeal nerve. 

By ojas gite

Image Based MCQ on Blood Agar

Hello awesomites!

Yesterday, we posted an Image based MCQ - And as promised, here is the answer!

#Microbiology
Q. Which organism shows the below depicted phenomenon when incubated with staphylococcus aureus on blood agar:

A. Clostridium perfringens
B. Bacillus anthracis
C. Haemophilus influenzae
D. Corynebacterium diphtheria

The correct answer is C. Haemophilus influenzae.

The given image shows the phenomenon of satellitism which is exhibited by Haemophilus influenzae when incubated on blood agar along with Staphylococcus. Factor V produced by Staph aureus helps in growth of Haemophilus. Haemophilus   colonies will be larger and well developed alongside the streak of staphylococcus aureus since V factor diffuses into surrounding medium. This is known as satellitism.

MD Mobarak Hussain (Maahii) 

Myopathies series -Part 5

Hello! :)

8. APPEARNACE OF MUSCLE :-

- Hypertrophy of Calf muscles = Dytrophinopathies or Limb girdle muscular dystrophy.

-Pseudohypertrophy= Duchene's muscular dystrophy, infiltration by sarcoid granulomas,amyloid deposit, bacterial and parasitic infections.

-Atrophy of gastrocnemius muscles in medial aspect = Dysferlinooathies 

- Atrophy of humeral muscles= FSHD

9. REFLEXES PRESERVED

10. LAB INVESTIGATIONS:-

1. ENZYMES: - I have already discussed its role in metabolic myopathies.

- ALT, AST, LDH,aldolase :- Found in both skeletal muscle and liver.Elevated GGT help to establish its liver origin.

-CK (MM) help to evaluate myopathies.

2. ELECTRODIAGNOSTIC STUDIES: 

-EMG: - diagnose myopathy and help to choose right muscle for biopsy.

-NCS (nerve conduction studies):-Help to differentiate myopathies from neuropathy and NMJ disorders.

       

Diagnostic test for specific type of myopathies:-

1. FOREARM EXERCISE TEST:-

- Place an indwelling catheter in to an antecubital vein and obtain baseline blood sample for lactic acid and ammonia.

-The forearm muscles are exercised. Vigorously squeeze the sphygmomanometer bulb for 1 min.

-Blood is then obtained at the intervals of 1,2,4,6 and 10 min for comparison with baseline.

Normally, Both glucose and ammonia increases with exercise.

Interpretation:-

-Glycolytic defects: - Lactic acid rise is absent or below normal while rise in ammonia will reach the control values.

-Myoadenylate deaminase deficiency: - there occur a selective failure to increase ammonia.

2. DNA ANALYSIS: - Some muscle disorder are associated with gene defects like deletions and mutations. (In Duchene muscular dystrophy, we will see it.)

3. MUSCLE BIOPSY:-

-Safe diagnostic procedure in establishing the final diagnosis of suspected myopathy.

-Different techniques of microscopic evaluation: - Histology, immunohistochemistry with antibodies, electron microscopy.

-SITE: - muscle selected may have mild to moderate muscle weakness.

-NOT PERFORMED ON: - Muscle injured by previous trauma,injections and EMG needles 

-COMMON MUSCLES USED FOR BIOPSY:-

PROXIMAL: biceps, triceps, quadriceps

DISTAL: - Extensor carpi radialis, Anterior tibialis.

*Claps* 

We are done with the basic for myopathy.

Now I will go through individual myopathy. :D

I remember age and progression of myopathy part. :) I will discuss it in next part. 

Take care.

-Upasana Y. 

Image based question on toxicology

Hello awesomites!

Yesterday, we posted an Image based MCQ - And as promised, here is the answer!

#FMT
#Pharmacology 

Q. A child accidentally consumed a fruit shown in the picture. Which of the following drugs is used for management?

A. Neostigmine
B. Pyridostigmine
C. Physostigmine
D. Atropine

The correct answer is C. Physostigmine.

The plant shown in the picture is Datura Stramonium. It contains Atropine which is Anticholinergic. The drug of choice for Anticholinergic toxicity is Physostigmine.

MD Mobarak Hussain (Maahii)