Felty syndrome

⚪Clinical features

Rheumatoid arthritis
Severe erosive joint disease & deformity
Rheumatoid nodules
Vasculitis (mononeuritis multiplex, necrotizing skin lesions)
Neutropenia (ANC <2000/µL)
Splenomegaly

⚪Diagnosis

Anti-CCP & RF are positive in >90% of patients
Markedly elevated ESR, often >85 mm/hr
Peripheral smear & bone marrow biopsy to rule out other causes of neutropenia

ANC = absolute neutrophil count; anti-CCP = anticyclic citrullinated peptide; ESR = erythrocyte sedimentation rate; RF = rheumatoid factor.

This patient with swollen, deformed hand joints and an elevated erythrocyte sedimentation rate likely has untreated inflammatory polyarthritis.  The presence of concurrent neutropenia and splenomegaly raise strong suspicion for Felty syndrome, an uncommon but serious complication of long-standing, erosive rheumatoid arthritis (RA).

Felty syndrome is marked by the formation of autoantibodies against neutrophil components and granulocyte colony-stimulating factor, leading to neutropenia (ie, absolute neutrophil count <2,000/mm3) and an increased risk of recurrent bacterial infection (particularly of the skin and sinuses).  Neutrophils coated with antibodies are also trapped in the spleen, which usually results in splenomegaly.  Most patients also have extraarticular manifestations of RA such as lymphadenopathy, rheumatoid nodules, and/or necrotizing skin lesions.

The diagnosis is made based on clinical features but is supported by the presence of high-titer rheumatoid factor and anticitrullinated peptide antibodies (both of which are usually elevated in RA).  Most patients are also HLA-DR4 positive (indicating a genetic susceptibility).  Other causes of neutropenia should be ruled out with bone marrow biopsy and peripheral smear prior to establishing the diagnosis.  Symptoms generally improve with treatment of the underlying RA.

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Causes of delirium

🇮‌  ‌🇼‌‌🇦‌‌🇹‌‌🇨‌‌🇭‌    ‌🇩‌‌🇪‌‌🇦‌‌🇹‌‌🇭‌ ❗👽


🪧 🅘nfectious (encephalitis, meningitis, UTI)

🪧 🅦ithdrawal (alcohol, benzodiazepines)
🪧 🅐cute metabolic disorder (electrolyte imbalance)
🪧 🅣rauma (head injury, postoperative)
🪧 🅒NS pathology (stroke, hemorrhage, tumor)
🪧 🅗ypoxia (anemia, cardiac failure)

🪧 🅓eficiencies (vitamin B12, folic acid, thiamine)
🪧 🅔ndocrinopathies (thyroid, glucose)
🪧 🅐cute vascular (shock, vasculitis,
hypertension)
🪧 🅣oxins, substance use, medications
🪧 🅗eavy metals (arsenic, lead, mercury)

#psychiatry 
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🧩 Medical Mnemonics

Modified Alvarado score for diagnosis of appendicitis


🌎 🇨🇦 ‌🇲‌‌🇴‌‌🇳‌‌🇹‌‌🇷‌‌🇪‌‌🇦‌‌🇱‌


❕𝗠igration 𝗢f pain to right lower quadrant (1 point)

❕𝗡ausea and vomiting (1 point)

❕𝗧enderness in right lower quadrant (2 points)

❕𝗥ebound tenderness (1 point)

❕𝗘levated temperature (1 point)

❕𝗔norexia (1 point)

❕𝗟eukocytosis >10 × 10⁹/liter (2 points)



- Score of ≥4 indicates that the patient should be further evaluated for appendicitis.


#surgery
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🧩 Medical Mnemonics


Hypokalemia causes


Eid Mubarak 🌺🌙 🎆🕋

⚡Enteric losses ( diarrhea)
⚡Insulin excess, Increase of Glucocorticoid (Cushing's, exogenous steroids, ectopic ACTH), Increased sweat losses
⚡Dialysis, Decrease of body temperature (hypothermia)

⚡Magnesium depletion
⚡Urinary losses(Diuretics)
⚡β-adrenergic activity, Bartter's or Gitelman's syndrome
⚡Alkalosis, Amphotericin B
⚡RTA types I and II
⚡Aldosteronism
⚡Ketoacidosis

#nephrology
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🧩 Medical Mnemonics

Differential diagnosis of elevated serum aminotransferases


🌠 ‌🇦‌‌🇧‌‌🇨‌‌🇩‌‌🇪‌‌🇫‌‌🇬‌‌🇭‌‌🇮‌


🪶 𝗔utoimmune hepatitis, 𝗔drenal insufficiency, 𝗔norexia nervosa
🪶 Hepatitis 𝗕
🪶 Hepatitis 𝗖, 𝗖eliac disease
🪶 𝗗rugs or toxins
🪶 𝗘thanol
🪶 𝗙atty liver
🪶 𝗚enetic disorders (Wilson disease, Hemochromatosis, Alpha-1 antitrypsin deficiency)
🪶 𝗛emodynamic disorders (CHF and MI)
🪶 𝗜nfiltration of the liver by malignancy, 𝗜njury to muscle (strenuous exercise, myopathy)

#gastroenterology
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©Medical Mnemonics

On MCU RESEARCH COLLABORATION, we provide you:

- Language revision
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Learn 🫧 SOAP BUBBLE appearance in Giant cell tumor of bone by #visual_mnemonics.

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#radiology 
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⚠ 🔔 𝐒𝐀𝐕𝐄 𝐓𝐇𝐈𝐒 𝐋𝐈𝐒𝐓 𝐅𝐎𝐑 𝐀 𝐑𝐀𝐈𝐍𝐘 𝐃𝐀𝐘 ! ⤵


1. 🧩 𝗠𝗘𝗗𝗜𝗖𝗔𝗟 𝗠𝗡𝗘𝗠𝗢𝗡𝗜𝗖𝗦 (𝗟𝗘𝗔𝗥𝗡 𝗘𝗔𝗦𝗜𝗟𝗬)

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20. 📝 𝗨𝗪𝗢𝗥𝗟𝗗 𝗘𝗗𝗨𝗖𝗔𝗧𝗜𝗢𝗡𝗔𝗟 𝗢𝗕𝗝𝗘𝗖𝗧𝗜𝗩𝗘𝗦

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🧩 Medical Mnemonics


The 4 ‌🇦‌‌'s of Guillain-Barré
syndrome 📝

✖ 𝗔cute inflammatory demyelinating
polyradiculopathy
✖ 𝗔scending paralysis
✖ 𝗔utonomic neuropathy
✖ 𝗔lbuminocytologic dissociation (increased albumin in CSF)


#neurology
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🧩 Medical Mnemonics

Crigler-Najjar and Gilbert have problems with CoNjuGation of bilirubin while Dubin-Johnson and Rotor have a defective DooR for secretion of bilirubin.

#in_a_tweet
#pediatrics
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Today, Medical Channels Union (MCU) launches a new group for cardiology enthusiasts;

🤓 Cardiology Cases is considering helping medical staff to become highly skilled in cardiology, particularly ECG interpretation.

🔗 https://t.me/Cardiology_Cases

🤝 We also welcome cardiologists from around the world to help us as group administrators.

Invite your Friends 🙋‍♂ 🦋

A 40-year-old man is evaluated for palpitations in the emergency department. He has had these symptoms several times over the past year but this episode is worse. He denies any associated chest pain, lightheadedness, or syncope. He denies any history of medical problems and takes no medications. Examination reveals an adult male in no significant distress. Cardiac examination is significant for regular tachycardia with no jugular venous pressure elevation. Lungs are clear without crackles or wheezing. There is no lower extremity edema. ECG shown below. What is the best intervention at this point?


A. Valsalva maneuver
B. Adenosine
C. Metoprolol
D. Digoxin
E. Cardioversion