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1. what is piriformis syndrome? As you may recall from your anatomy, the piriformis is the small muscle that crosses the greater sciatic foramen, cutting it into two spaces as the muscle passes from the edge of the sacrum to the greater trochanter. The sciatic nerve comes out of the greater sciatic foramen below the piriformis, and is subject to compression by the muscle. Symptoms are as described above; bicycle riding and running may also set off the symptoms, which may take the form of chronic nagging ache, pain, tingling, or numbness. Treatment is usually to teach the patient to avoid maneuvers that set off the symptoms. Some patients have been helped by corticosteroid injection near the site where the piriformis muscle crosses the sciatic nerve; this therapy is thought to work by reducing the fat around the muscle and thereby increasing the available space in the area.
2. In Addison disease, laboratory findings include hyponatremia (due to aldosterone deficiency), hyperkalemia, and normocytic anemia with eosinophilia and lymphocytosis. The diagnosis is made with the ACTH stimulation test. Cortisol and aldosterone levels do not increase when the ACTH is given. The treatment is glucocorticoid and mineralocorticoid replacement.
3. HIV encephalitis is clinically known as AIDS dementia complex. The pathologic substrate is a subacute inflammatory infiltration of the brain caused by direct spread of HIV to the CNS.
4. The diagnosis of HIV encephalitis (or AIDS dementia complex) must be reached by exclusion of other infective and neoplastic conditions associated with AIDS. AIDS dementia complex is characterized by cognitive impairment, incontinence, impairment of motor skills, and confusion. MRI studies and CSF analysis are useful in excluding other CNS diseases.
5. HIV myelopathy manifests mainly with spastic paraparesis. It is a complication similar in pathologic substrate to vitamin B12 deficiency, i.e., vacuolar degeneration of the posterior and lateral columns of the spinal cord.
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hi savi
thanks a lot
what i learnt
fromu today
1/ warfarin better choice in hip surg
2. in euthyroid tsh is normal t3 is high and t4 n or high sick thyroid is in sickk icu bed
in hypo real one tsh reaches 30
3. piriformis preses sciatic
4.hiv encephalitis isdirect infiltration of brain by hiv virus causig adcomplex
5,hiv myelo is poste and lateral and like b12
6cardi cath by femoral artery cancause psedo and pulsatile anew ry and cholestral emboli syndro or blue toe and unexplain drop in hb and flank purpura
7 fibromyel amnd fibrocytis are same involve central big joint area but joints are niormal and incontrast to polymyelgia come in prime of women lif and need antidepressiv
8 sympathe dystrophy is actually ortho prob aith atrophy and vasom instablity
9inaddison adrenocortical def causing mineralo and glucocor def and need to supplement bith
10 in addiso n u do cosyntrophin or acth test to find out primary or secondary
in primary no response
in secondary cort i will increse
inaddison there will be hyper pigmen
11basalcell uper face
12 sqa is ulcer
12 keratoacanthoma is quick crust and benign and a good news
13. laxative also cause hypokalemia like diuretic ,u wave tetany
14 hypokale can cause rhabdo myelysis and rhabdo can cause hyper kalemia
15 tinel finkel sign carpal also in lekemia
16 in hepatorenal vasoconstiction do liver transplant and renal prob wii go away
17 b thale will hv normal alpha
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************************************************** 1.Progressive multifocal leukoencephalopathy consists of multifocal areas of myelin destruction. These changes will be visible on MRI. This complication is due to JC virus, a papovavirus that causes asymptomatic infections in immunocompetent individuals.
2. Patients with longstanding extensive ulcerative colitis for at least 10 years are at increased colon cancer risk. Appropriate surveillance involves annual or biannual colonoscopy with multiple biopsies at regular intervals, even of normal appearing mucosa, to check for dysplasia.
3. Individuals with herpes zoster are contagious and can spread the VZV virus.
4. Decreased esophageal peristalsis AND decreased LES pressure:SCLERODERMA , These patients are therefore at risk for severe GERD and subsequent complications of peptic stricture and Barrett's esophagus.
5. Patients with erythema infectiosum (Fifth disease) are only infectious before the onset of the rash, during the period with the nonspecific febrile illness. The virus typically only causes a significant, severe illness in individuals with sickle cell disease and other hemoglobinopathies. In rare cases, parvovirus contracted during pregnancy has been associated with fetal hydrops and death.
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1. If a pregnant woman was in contact with a patient with fifth disease during the phase of the illness before the onset of the rash, she should have serologic testing and a fetal ultrasound to evaluate the health of her and the baby. It should be mentioned that the complications of parvovirus in pregnant women typically occur during the first half of pregnancy.
2. Most authorities think that it is appropriate to initiate a progestin-only method of contraception immediately postpartum. It has no impact on lactation or the quality of breast milk.
3. The triad of miosis, respiratory depression, and coma is suggestive of opioid intoxication.
4. Phenelzine is an antidepressant monoamine oxidase inhibitor (MAOI) that causes hypertensive crises and the serotonin syndrome (hypertension, tachycardia, fever, coma, and possibly death) when combined with tyramine-containing food (cheese) and/or serotonin-altering drugs. Pseudoephedrine and other nasal decongestants, bronchodilators, amphetamines can cause severe hypertension when monoamine oxidase is inhibited and should be avoid.
5. the classic signs of chronic plaque psoriasis are silvery or pink well-defined plaques, which can span the whole body from the scalp to the feet. The most classically involved areas include the scalp, ears, elbows, knees, sacrum and ankles.
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1. Fiberoptic bronchoscopy is part of the evaluation of a patient with hemoptysis, but it is typically performed after a chest x-ray (CXR). It is the next step if a CXR shows a mass, if the CXR is normal and there are major risk factors for cancer, or if the CXR is normal and there are no risk factors for cancer, but there is a recurrence of hemoptysis after weeks to months of observation. Then remember, if you have a patient with hemoptysis with past history of smoking ,your first step is CXR even if he/she is normal right now but keep in mind that a CXR is not part of a routine physical examination of an asymptomatic smoker.
2. Complications of ovarian torsion include infection, peritonitis, sepsis, adhesions, chronic pelvic pain, and infertility due to the loss of the viability of the torsed ovary.
3. One of the most important considerations in evaluating patients with conjunctivitis is to rule out any vision-threatening conditions such as iritis, keratitis, glaucoma, or a corneal ulceration. Symptoms such as marked photophobia, decreased visual acuity, or globe pain suggest that ocular structures other than the conjunctiva are involved and should trigger immediate ophthalmologic evaluation.
4. The pathophysiology of ITP involves antibodies(IgG or IgM) binding to platelets. These antibody coated platelets are subsequently destroyed in the spleen.
5. An extremely important aspect of management of the asplenic patient includes permanent penicillin prophylaxis in addition to pneumococcal and Haemophilus influenza vaccines. These measures decrease the risk of morbidity and mortality associated with overwhelming sepsis by encapsulated organisms in asplenic patients.
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1. Multifocal glioblastoma multiforme (GBM) , the most frequent malignant primary brain neoplasm, manifests as an ill-defined mass in the white matter.
2. Wernicke encephalopathy is characterized by nystagmus progressing to ophthalmoplegia, truncal ataxia and confusion.
3. Korsakoff syndrome refers to alcohol-related amnesia and confabulation. Wernicke-Korsakoff syndrome is due to vitamin B1 deficiency, which is often seen in chronic alcoholics. This deficiency results in degeneration of periaqueductal gray matter.
4. Huntington disease, an autosomal dominant condition, is caused by an unstable expansion of a CAG trinucleotide repeat. MRI examination of the brain reveals hyperintensity in the region of the caudate on T2-weighted images.
5. The pathologic substrate of Huntington disease is degeneration of the striatal neurons, especially those in the caudate nucleus.
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1. The pathogenesis of stress-induced gastritis: Diffuse gastric mucosal vasoconstriction.
2. Right-sided endocardial fibrosis, with pulmonary stenosis and tricuspid regurgitation, is common in carcinoid patients and is the result of toxic damage to the heart.
3. Ondansetron, a 5-hydroxytryptamine3 antagonist, is the most potent antiemetic available for chemotherapy-induced vomiting. It has side effects only infrequently, the most common being constipation.
4. Copper deficiency can present with anemia and neutropenia; Zinc deficiency will present with alopecia, impaired wound healing , dermaititis; Selenium deficiecny will present with dilated cardiomyopathy.
5. Bernard-Soulier syndrome is an autosomal recessive disease of platelet adhesion which causes prolonged bleeding times in the presence of normal platelet counts. These defective platelets can not bind to subendothelial collagen properly because of a deficiency or dysfunction of the glycoprotein Ib-IX complex. Clinically the patients have impaired hemeostasis and recurrent severe mucosal hemorrhage. The only treatment for an acute episode is a transfusion of normal platelets. This patient has a slightly decreased hemoglobin due to blood loss.
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what i learnt from
2; acalculous cholecystitis occu in dm immunosuppresed debilated icu and ct shows peri fluid and wall thickening and biliary sludge
3' sle has no erosion but rh. has, needing methotrex
atrial myxoma has a fixed mitra like murmur w/o opening snap
5.kallman has not only reduce smeell but hypogondotrophic gondism no brest no pubic axillary hai and has hypo thalam tumo.
6. cause primary amenorrha
7 ther is one syndrome in primary ;many in second lke ashermamn rokitsky and so one
8juvenile angiofibrma lik juv delequency occu in adolescent presnt w/t epistax
9. inhalant cause encephalopath and brain damage
10esophage atrsia and fistula r rel'd to polyhydra in fetus
1 untreated hyperthy cause abortion nd prematur deliv-y and treat with lowest taperi-ng propyl thyouracil.
12.hypospadis a/w the congeni defect ;do ua and usg
13 presense of endocervical tissue is must in smoker hige risk cevical pap but in low risk even limited is not considered inadequate rpt afte 1 yr but in hy risk repeat quick
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savi. It would take you days to compile the great information. That is very impressive.
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1.Von Willebrand's disease causes increased bleeding times with normal platelet counts. It is the most common inherited bleeding disorder, caused by a defect in von Willebrand factor, which aids the binding of platelets to collagen. Even though the platelets themselves are normal, binding is impaired, thus a platelet transfusion would not correct the problem. Cryoprecipitate, a plasma fraction rich in von Willebrand factor, would help in the case of von Willebrand's disease, but would not help with Bernard-Soulier syndrome.
2. Coarctations account for approximately 7% of congenital cardiac abnormalities, occur more frequently (2x) in men than in women, and are associated with gonadal dysgenesis and bicuspid aortic valves. Adults will present with hypertension, manifestations of hypertension in the upper body (headache, epistaxis), or leg claudication. Physical examination reveals diminished and/or delayed lower extremity pulses, enlarged collateral vessels in the uppe r body, or reduced development of the lower extremities.
3. Lymphoma is well known to develop specifically in the late stage of Sjogren's syndrome. Common manifestations of this malignant condition include persistent parotid gland enlargement, purpura, leukopenia, cryoglobulinemia, and low C4 complement levels.
4. If they give you a farmer patient presenting with acute-onset pulmonary symptoms, including wheezing, with no other medical problems and was recently handling hay, think about farmer's lung; a hypersensitivity pneumonitis caused by Actinomyces. In this disorder moldy hay with spores of actinomycetes are inhaled and produce a hypersensitivity pneumonitis. The disorder is seen most commonly in rainy periods, when the spores multiply. Patients present generally 4 to 8 h after exposure with fever, cough, and shortness of breath without wheezing. Chest radiograms often show patchy bilateral, often upper lobe infiltrates. The exposure history will differentiate this disorder from other types of pneumonia.
5. The Women's Health Initiative (WHI) demonstrated that estrogen-progestin therapy in Postmenopausal can reduce the risk of hip fractures by 34%. However, the WHI also demonstrated that estrogens are associated with a 30% increase in myocardial infarction, a 40% increase in stroke, a 100% increase in venous thromboembolism, and a 25% increase in breast cancer. In the WHI study there was no overall effect of estrogen-progestin therapy on mortality, probably because of the balance between the detrimental cardiovascular effects and the beneficial effects (in addition to fractures, there was a beneficial effect on the development of colon cancer) - Harrison's new eddition!
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