1.Atopic dermatitis presents on flexor surfaces in infants. T or F
ANSWER
F
Extensor surfaces
Flexor in older children and adults
How to remember this?
Infants slEEEEEEEp a lot right.
Hence EEEEEEEExtensor surface involved in infants in atopic dermatitis
That will help you remember the opposite ( flexor surfaces) involved in older children and adults
That's all.
Seizures often occurs in ethylene glycol poisoning. It has multifaceted pathophysiology but one of the major cause is hypocalcemia.
Hypocalcemia occurs in ethylene glycol poisoning because ethylene glycol is metabolized to oxalate, which forms calcium oxalate depleting calcium from ECF.
Also, correcting associated metabolic acidosis by bicarbonate supplementation can further cause hypocalcemia due to increased binding of calcium to albumin.
This is why, calcium levels should always be monitored meticulously in such patients.
- Kirtan Patolia ( BJ medical college)
In essential thrombocytosis, contrary to what might be surmised, bleeding is more of threat than thrombosis.
This is because high platelet count especially above 1 million/mm3 cause acquired von willebrand disease, much like type 2b von willebrand disease, where excessive affinity of vWF for platelet Gpib result in excessive removal of platelet-vWF complex by spleen results in thrombocytopenia and loss of high molecular weight vWF multimers.
However, incidence of erythromelalgia , transient ischemic attack and other microvascular events are also high in patients with essential thrombocytosis.
Pretty complex and contradictory, right?
- Kirtan Patolia ( BJ medical college).
Hello everyone!
Today, I will be talking about diabetic amyotrophy.
Diabetic amyotrophy has a lot of names!
It is also known as Bruns-Garland syndrome, diabetic myelopathy, proximal diabetic neuropathy, diabetic polyradiculopathy, diabetic motor neuropathy, diabetic radiculoplexopathy, diabetic lumbosacral plexopathy, and diabetic LRPN.
Diabetic amyotrophy typically occurs in patients with type 2 diabetes mellitus. The traditional features include the acute, asymmetric, focal onset of pain followed by weakness involving the proximal leg, with associated autonomic failure and weight loss. Progression occurs over months and is followed by partial recovery in most patients.
The diagnosis of diabetic amyotrophy is mainly based upon the presence of suggestive clinical features in a patient with known or newly diagnosed diabetes mellitus. Appropriate laboratory investigations, particularly electrodiagnostic studies, and neuroimaging in select patients, are useful to exclude other peripheral and central nervous system etiologies as a cause of the neurologic symptoms and signs.
No treatments are proven to be effective for diabetic amyotrophy or for idiopathic LRPN.
PS: Distal symmetric sensorimotor polyneuropathy is the most common type of diabetic neuropathy - it is characterized by a progressive loss of distal sensation correlating with loss of sensory axons, followed, in severe cases, by motor weakness and motor axonal loss. Classic "stocking-glove" sensory loss is typical in this disorder.
Source: UpToDate
That's all!
-IkaN
Hello everyone!
Let's talk about Lemierre's syndrome today.
Lemierre's syndrome is characterized by disseminated abscesses and thrombophlebitis of the internal jugular vein after infection of the oropharynx. The predominant pathogen is a gram-negative anaerobic bacillus, Fusobacterium necrophorum.
That's the Zebra for the day!
IkaN
1. Angiodysplasia is a high volume arterial bleed. T or F
2. Diverticulosis is a low volume arterial bleed. T or F
ANSWERS
1. FALSE
Angiodysplasia more often than not involves low volume venous bleeding.
Angiodysplasias are composed of ectatic, dilated, thin-walled vessels that are lined by endothelium alone or endothelium along with small amounts of smooth muscle. Studies in which casts of angiodysplasias were made by injecting a silicone material demonstrated that the most prominent feature in angiodysplasias is the presence of dilated, tortuous submucosal veins.
Small arteriovenous communications are also present and are due to incompetence of the precapillary sphincter. Enlarged arteries may be seen in larger angiodysplasias and may be associated with arteriovenous fistulas, which explains why bleeding can be brisk in some patients.
Histologic confirmation is often difficult. When obtained, it shows dilated vessels in the mucosa and submucosa, sometimes covered by only a single layer of surface epithelium.
2. FALSE
Diverticular bleeding involves high volume arterial bleed
Diverticular bleeding — As a diverticulum herniates, the penetrating vessel responsible for the wall weakness at that point becomes draped over the dome of the diverticulum, separated from the bowel lumen only by mucosa. Over time, the vasa recta is exposed to injury along its luminal aspect, leading to eccentric intimal thickening and thinning of the media. These changes may result in segmental weakness of the artery, predisposing to rupture into the lumen. Diverticular bleeding typically occurs in the absence of diverticulitis
1. Nightmare is a REM sleep behavior disorder. T or F
2. Night Terror is a REM sleep behavior disorder. T or F
ANSWERS
1. True
Things you should REMember for Nightmare disorder are :
REM
Second half of the night
Responsive to comfort
REMembers the dream
2. False
Night terrors: Abrupt arousals from sleep (panicked scream, terror, autonomic arousal, unresponsive to comfort)
- Little or no dream recall
- Amnesia for episodes
Sleep is a gift, always be grateful for it.
1. Narcolepsy exhibits a reduced REM latency. T or F
ANSWER
1. True
Narcolepsy: depletion of hypocretin secreting neurons in lateral hypothalamus that are involved in maintaining wakefulness
Diagnostic: recurrent lapses into sleep or napping several times in the same day, >3 times a week for >3mo. and at least 1 of the following
-Cataplexy: Conscious of bilateral loss of muscle tone precipitated by emotions or abnormal facial movement (without emotional triggers)
-Hypocretin - 1 (orexin A) deficiency in CSF
- REM sleep latency <15 minutes
Tetrad:
-Sleep attacks
-Cataplexy
-Hypnagogic or hypnopompic hallucinations
-Sleep paralysis
Dx: Shortened REM sleep latency on polysomnografy
Low levels of hypocretin 1 in CSF
You may feel weak, you may fall down, say no to Cataplexy, say yes to CATA GETUP!!
1. Imaging is contraindicated in pregnancy for diagnosing latent TB. T or F
2. Check for latent TB before prescribing Infliximab. T or F
ANSWERS
1. False
Diagnostic evaluation after positive test — Patients with a positive TST or IGRA must undergo clinical evaluation to rule out active tuberculosis. This includes evaluation for symptoms (eg, fever, cough, weight loss) and radiographic examination of the chest (with appropriate shielding), regardless of gestational age.
Patients with a positive TST or IGRA with no evidence of active TB may be presumed to have latent TB.
2. True
Toxicity of Infliximab includes :
Respiratory infection (possible reactivation of latent TB)
Fever
Hypotension
Last man standing wins. Keep grinding.
