-In the blood film in case of vir.B12 and folate deficiency, Oval Macrocytosis , but other causes of Macrocytosis give round shape.
-Hypersegmented neutrophils (first sign in blood film).
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-Hypersegmented neutrophils (first sign in blood film).
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Ivabradine
Mechanism of action: selectively inhibits "funny channels" If channel in the pacemaker cells of the SA node → prolongs slowdepolarization (phase 4) → slows heart rate.
Indications:
-Symptomatic stable coronary heart disease and congestive heart failure (NYHA II-IV) in patients who cannot tolerate beta blockers.
Adverse effects:
1-Vision changes: luminous phenomena (enhanced visual brightness)
2-Bradycardia
3-Hypertension.
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Mechanism of action: selectively inhibits "funny channels" If channel in the pacemaker cells of the SA node → prolongs slowdepolarization (phase 4) → slows heart rate.
Indications:
-Symptomatic stable coronary heart disease and congestive heart failure (NYHA II-IV) in patients who cannot tolerate beta blockers.
Adverse effects:
1-Vision changes: luminous phenomena (enhanced visual brightness)
2-Bradycardia
3-Hypertension.
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What is Caplan’s syndrome?
Rheumatoid lung nodules with pneumoconiosis is called Caplan’s syndrome. Common in coalworkers pneumoconiosis, may occur in any pneumoconiosis. Nodules are rounded, 0.5 to 2.5 cm, present at periphery of the lung. These may rupture causing pneumothorax or may cavitate and cause hemoptysis. It may be confused with tuberculosis or neoplasm.
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Rheumatoid lung nodules with pneumoconiosis is called Caplan’s syndrome. Common in coalworkers pneumoconiosis, may occur in any pneumoconiosis. Nodules are rounded, 0.5 to 2.5 cm, present at periphery of the lung. These may rupture causing pneumothorax or may cavitate and cause hemoptysis. It may be confused with tuberculosis or neoplasm.
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What are the mechanisms of anemia in rheumatoid arthritis?
Multiple factors are responsible:
1-Anemia of chronic disorder
2-Megaloblastic anemia (because of either folate deficiency or vitamin B12 deficiency, if associated with pernicious anemia)
3-Hypersplenism (in Felty’s syndrome)
4-Hemolytic anemia (Coombs’ test may be positive)
5-GIT bleeding (due to NSAID or vasculitis causing iron deficiency anemia)
6-Marrow suppression (gold and penicillamine—though less or no use now a days).
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Multiple factors are responsible:
1-Anemia of chronic disorder
2-Megaloblastic anemia (because of either folate deficiency or vitamin B12 deficiency, if associated with pernicious anemia)
3-Hypersplenism (in Felty’s syndrome)
4-Hemolytic anemia (Coombs’ test may be positive)
5-GIT bleeding (due to NSAID or vasculitis causing iron deficiency anemia)
6-Marrow suppression (gold and penicillamine—though less or no use now a days).
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In Osteoarthritis:
-Heberden nodes- distal
interphalangeal joints.
-Bouchard nodes- proximal interphalangeal joints.
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-Heberden nodes- distal
interphalangeal joints.
-Bouchard nodes- proximal interphalangeal joints.
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MS-typical regions = periventricular, juxtacortical, infratentorial, spinal cord.
"AO" is an initialism for the German "Arbeitsgemeinschaft für Osteosynthesefragen".
"OTA" is for "Orthopaedic Trauma Association" Committee.
"OTA" is for "Orthopaedic Trauma Association" Committee.
Contraindications for thrombolysis:
Recent stroke
Recent major surgery or major bleed like of varices
Recent eye surgery
History suggestive of or confirmed active duodenal/gastric ulcers
Pregnancy
Uncontrolled hypertension or coagulation disorders.
Recent stroke
Recent major surgery or major bleed like of varices
Recent eye surgery
History suggestive of or confirmed active duodenal/gastric ulcers
Pregnancy
Uncontrolled hypertension or coagulation disorders.
Complications of Chronic Osteomyelitis:
i. Acute excacerbation
ii. Growth abnormalities due to damage to adjacent growth plate
iii. Pathological fracture
iv. Joint stiffness
v. Sinus tract malignancy (very rare): Squamous cell carcinoma
vi. Amyloidosis
i. Acute excacerbation
ii. Growth abnormalities due to damage to adjacent growth plate
iii. Pathological fracture
iv. Joint stiffness
v. Sinus tract malignancy (very rare): Squamous cell carcinoma
vi. Amyloidosis
The Important Complications of Acute Osteomyelitis are:
i. Septicemia and pyaemia
ii. Septic arthritis
iii. Chronic osteomyelitis (most common complication)
iv. Metastatic infection to other body parts
v. Pathological fracture
vi. Altered growth from damage to epiphyseal growth plate.
vii. Recurrence
i. Septicemia and pyaemia
ii. Septic arthritis
iii. Chronic osteomyelitis (most common complication)
iv. Metastatic infection to other body parts
v. Pathological fracture
vi. Altered growth from damage to epiphyseal growth plate.
vii. Recurrence
In Multiple sclerosis:
-The most common presenting manifestations of MS are paresthesias.
-Motor symptoms are the second most common initial manifestation of MS and include limb weakness, loss of dexterity, and gait disturbance.
-The third most common presenting manifestation of MS is optic neuritis.
-The most common abnormal eye movement observed in MS is internuclear ophthalmoplegia
(INO).
-There only FDA-approved treatment for PPMS is ocrelizumab.
-The most common presenting manifestations of MS are paresthesias.
-Motor symptoms are the second most common initial manifestation of MS and include limb weakness, loss of dexterity, and gait disturbance.
-The third most common presenting manifestation of MS is optic neuritis.
-The most common abnormal eye movement observed in MS is internuclear ophthalmoplegia
(INO).
-There only FDA-approved treatment for PPMS is ocrelizumab.
What is rheumatoid nodule? Where is it found?
A. These are painless, firm, subcutaneous nodule, invariably associated with positive rheumatoid factor. It is present in 20 to 30% cases of rheumatoid arthritis.
Sites: Pressure points, such as elbow,
extensor surface of forearm and hands (fingers), scapula, scalp, sacrum, shin, Achilles tendon, toes, sclera, pleura, lungs and pericardium.
Significance of rheumatoid nodule:
1-It is one of the diagnostic criteria
2-Associated with high titer of; rheumatoid factor (positive RA test)
3-Associated with active and aggressive RA
4-A bad prognostic sign.
Histologically 3 zones:
1-Central zone of necrotic material including collagen fibril, noncollagen filament and cellular debris
2-Mid zone of palisading macrophages
3-Outer zone of granulation tissue.
Nodules may ulcerate and become infected.
Treatment with methotrexate may increase the number of rheumatoid nodule in some patients.
Nodules resolve when the disease is under control. If it causes problem, it may be removed surgically or by local injection of corticosteroid.
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A. These are painless, firm, subcutaneous nodule, invariably associated with positive rheumatoid factor. It is present in 20 to 30% cases of rheumatoid arthritis.
Sites: Pressure points, such as elbow,
extensor surface of forearm and hands (fingers), scapula, scalp, sacrum, shin, Achilles tendon, toes, sclera, pleura, lungs and pericardium.
Significance of rheumatoid nodule:
1-It is one of the diagnostic criteria
2-Associated with high titer of; rheumatoid factor (positive RA test)
3-Associated with active and aggressive RA
4-A bad prognostic sign.
Histologically 3 zones:
1-Central zone of necrotic material including collagen fibril, noncollagen filament and cellular debris
2-Mid zone of palisading macrophages
3-Outer zone of granulation tissue.
Nodules may ulcerate and become infected.
Treatment with methotrexate may increase the number of rheumatoid nodule in some patients.
Nodules resolve when the disease is under control. If it causes problem, it may be removed surgically or by local injection of corticosteroid.
#MCQ
#Medicine
Raynaud’s syndrome" Primary":
This common disorder affects 5–10% of young women aged 15–30 years in temperate climates. It does not progress to ulceration or infarction, and significant pain is unusual. The
underlying cause is unclear and no investigation is necessary.
The patient should be reassured and advised to avoid exposure to cold. Usually, no other treatment is required, although vasodilators such as nifedipine can may be helpful if symptoms are troublesome. More severe Raynaud’s syndrome can also occur in association with digital ulceration in patients with connective
tissue disease.
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This common disorder affects 5–10% of young women aged 15–30 years in temperate climates. It does not progress to ulceration or infarction, and significant pain is unusual. The
underlying cause is unclear and no investigation is necessary.
The patient should be reassured and advised to avoid exposure to cold. Usually, no other treatment is required, although vasodilators such as nifedipine can may be helpful if symptoms are troublesome. More severe Raynaud’s syndrome can also occur in association with digital ulceration in patients with connective
tissue disease.
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Pregnancy should be avoided if there is neurological, renal and cardiac abnormality in SLE.
If the mother has “anti-Ro antibody” (SSA), there may be congenital complete heart block of the baby, due to transplacental transfer of antibody. With anti Ro or anti La antibodies in mother, there is 2% risk of giving birth to a baby with neonatal lupus syndrome.
This is characterized by skin rash, hepatitis and fetal heart block.
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If the mother has “anti-Ro antibody” (SSA), there may be congenital complete heart block of the baby, due to transplacental transfer of antibody. With anti Ro or anti La antibodies in mother, there is 2% risk of giving birth to a baby with neonatal lupus syndrome.
This is characterized by skin rash, hepatitis and fetal heart block.
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