Forwarded from Medical Mnemonics
🧩 Medical Mnemonics
🧸Thromboangiitis obliterans (Buerger disease) diagnosis is EASY using the mnemonic! 😉
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©Medical Mnemonics
🧸Thromboangiitis obliterans (Buerger disease) diagnosis is EASY using the mnemonic! 😉
💻 Join us on the official Instagram page: Online Medical School
#surgery
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©Medical Mnemonics
👍11
⏳ Case-based MCQ | #Case_459
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A 41-year-old man presents to the ED with acute onset of a right-sided facial droop. He cannot close his right eye, and he also cannot move the right side of his face when asked to smile. He does admit that he had an upper respiratory infection recently. His speech is not impaired and he has normal motor and sensory exam of his extremities on both sides. His head CT is also normal.
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A 41-year-old man presents to the ED with acute onset of a right-sided facial droop. He cannot close his right eye, and he also cannot move the right side of his face when asked to smile. He does admit that he had an upper respiratory infection recently. His speech is not impaired and he has normal motor and sensory exam of his extremities on both sides. His head CT is also normal.
👍6❤1
This condition is thought to be most commonly associated with which of the following causative viral organisms?
Anonymous Poll
20%
A. Ebstein barr virus
55%
B. Herpes simplex virus
6%
C. Human immunodeficiency virus
5%
D. Human papillomavirus
14%
E. Respiratory syncytial virus
👍12❤2🔥1
⏳ Case-based MCQ | #Case_459 | #answer
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✅ B
Bell's palsy (idiopathic facial paralysis) is an unexplained weakness or paralysis of the facial nerve, the nerve that controls muscle movement on one side of the face. The condition causes drooping on the affected side, and patients may not be able to close the eye and may experience tearing, drooling and hypersensitive hearing. Although Bell's palsy is unsettling and inconvenient, it is typically not indicative of a serious health problem and in most cases completely resolves itself.
The condition can strike at any age, but young and middle-age adults seem to be the most vulnerable. Pregnant women and individuals with diabetes, influenza, a cold, or an upper respiratory infection seem to be at a greater risk. About eight percent of patients report a family history of Bell's palsy, but it's unclear if the disease has a genetic basis.
While the exact cause of Bell's palsy is not known, many believe that in most cases it is triggered by an infection of the facial nerve by herpes simplex virus (HSV) (choice B). HSV infection has been discovered in up to seventy percent of patients diagnosed with Bell's palsy.
⚠ Other infectious causes of acute peripheral facial palsy include adenovirus, coxsackievirus, cytomegalovirus, Epstein-Barr virus (choice A), influenza B, mumps, and rubella virus.
⚠ Other diseases including Lyme disease and, rarely, HIV (choice C), may also cause sudden facial paralysis. Varicella-zoster virus, a related herpes virus and the cause of chickenpox and shingles, is another cause.
⚠ Human papillomavirus (choice D) and Respiratory syncytial virus (choice E) are not associated with facial palsy.
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✅ B
Bell's palsy (idiopathic facial paralysis) is an unexplained weakness or paralysis of the facial nerve, the nerve that controls muscle movement on one side of the face. The condition causes drooping on the affected side, and patients may not be able to close the eye and may experience tearing, drooling and hypersensitive hearing. Although Bell's palsy is unsettling and inconvenient, it is typically not indicative of a serious health problem and in most cases completely resolves itself.
The condition can strike at any age, but young and middle-age adults seem to be the most vulnerable. Pregnant women and individuals with diabetes, influenza, a cold, or an upper respiratory infection seem to be at a greater risk. About eight percent of patients report a family history of Bell's palsy, but it's unclear if the disease has a genetic basis.
While the exact cause of Bell's palsy is not known, many believe that in most cases it is triggered by an infection of the facial nerve by herpes simplex virus (HSV) (choice B). HSV infection has been discovered in up to seventy percent of patients diagnosed with Bell's palsy.
⚠ Other infectious causes of acute peripheral facial palsy include adenovirus, coxsackievirus, cytomegalovirus, Epstein-Barr virus (choice A), influenza B, mumps, and rubella virus.
⚠ Other diseases including Lyme disease and, rarely, HIV (choice C), may also cause sudden facial paralysis. Varicella-zoster virus, a related herpes virus and the cause of chickenpox and shingles, is another cause.
⚠ Human papillomavirus (choice D) and Respiratory syncytial virus (choice E) are not associated with facial palsy.
👍12❤8
⏳ Case-based MCQ | #Case_460
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A 20-year-old female was brought to the ED with confusion. The patient was not oriented in time, place, and person and had Glasgow Coma Score of 14. Pulse rate was weak and regular at 112 bpm, respiration was regular and deep at 30 bpm, blood pressure 105/60 mmHg and her body temperature was 36.9°C.
The diagnosis of diabetic ketoacidosis was established. Treatment was initiated with the infusion of normal saline and then IV insulin and closely monitored. The patient started showing some improvement.
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A 20-year-old female was brought to the ED with confusion. The patient was not oriented in time, place, and person and had Glasgow Coma Score of 14. Pulse rate was weak and regular at 112 bpm, respiration was regular and deep at 30 bpm, blood pressure 105/60 mmHg and her body temperature was 36.9°C.
The diagnosis of diabetic ketoacidosis was established. Treatment was initiated with the infusion of normal saline and then IV insulin and closely monitored. The patient started showing some improvement.
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Which of the following should be used for monitoring the response of acidosis to treatment?
Anonymous Poll
25%
A. Blood pH
23%
B. Serum bicarbonate
18%
C. Serum ketone level
28%
D. Plasma anion gap
6%
E. Urine pH
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Diabetic ketoacidosis (DKA) is one of the life-threatening acute complications of diabetes mellitus. In addition to hyperglycemia and ketonemia, DKA is associated with severe electrolyte disturbances and dehydration.
Plasma anion gap (PAG) is the recommended test for monitoring of diabetic ketoacidosis (choice D). PAG estimates the concentration of all unmeasured anions contributing to acidosis in DKA. Although acetoacetate and beta-hydroxybutyrate are the anions responsible for the high PAG metabolic acidosis in this patient, contribution from other acids cannot be excluded. One such anion is lactate. If for any reason the patient develops hypoxia or ischemia, production of lactic acid and thus, of lactate will increase. Anion gap would thus, increase even if the production of ketoacids is curtailed by insulin therapy.
⚠ Blood pH (choice A) may be totally normal in some mixed acid-base disturbances. For example, if our patient develops hyperventilation due to severe pain and PaCO2 drops to 17mmHg, his pH would be 7.39 (normal range 7.35-7.45). Thus pH cannot be used to evaluate response to acid-base disturbances to treatment.
⚠ Normal serum bicarbonate (choice B) does not guarantee normal acid-base status. If our patient develops severe vomiting, an element of metabolic alkalosis will develop, and bicarbonate might rise to the normal range despite the persistence of metabolic acidosis. PAG will still remain high. Measurement of plasma bicarbonate level is thus, not suitable for the assessment of response to acidosis to treatment.
⚠ Serum ketone level (choice C), especially of beta-hydroxybutyrate, might be a good indicator for assessment of pure ketoacidosis. However, as outlined above, if other acids contribute to the acidosis, they will be missed if only ketone body level is used to monitor response to treatment.
⚠ For many reasons, pH of urine (choice E) is not suitable for monitoring the response to acidosis to treatment. Urine pH has a lower limit of 4.5, reflecting the maximum gradient against which hydrogen ions can be pumped in the distal part of the nephron. Regardless of the severity of acidosis, pH cannot drop below this lower limit. Additionally, urine pH does not reflect the total hydrogen ion carrying capacity of urine. Especially in acidosis, a large amount of hydrogen ion is carried in urine as ammonium (NH4). Third, urinary pH might also change in response to local factors in the kidney or urinary tract like infection.
🔖 Key point:
Plasma anion gap is the recommended test for monitoring of diabetic ketoacidosis.
Plasma anion gap (PAG) is the recommended test for monitoring of diabetic ketoacidosis (choice D). PAG estimates the concentration of all unmeasured anions contributing to acidosis in DKA. Although acetoacetate and beta-hydroxybutyrate are the anions responsible for the high PAG metabolic acidosis in this patient, contribution from other acids cannot be excluded. One such anion is lactate. If for any reason the patient develops hypoxia or ischemia, production of lactic acid and thus, of lactate will increase. Anion gap would thus, increase even if the production of ketoacids is curtailed by insulin therapy.
⚠ Blood pH (choice A) may be totally normal in some mixed acid-base disturbances. For example, if our patient develops hyperventilation due to severe pain and PaCO2 drops to 17mmHg, his pH would be 7.39 (normal range 7.35-7.45). Thus pH cannot be used to evaluate response to acid-base disturbances to treatment.
⚠ Normal serum bicarbonate (choice B) does not guarantee normal acid-base status. If our patient develops severe vomiting, an element of metabolic alkalosis will develop, and bicarbonate might rise to the normal range despite the persistence of metabolic acidosis. PAG will still remain high. Measurement of plasma bicarbonate level is thus, not suitable for the assessment of response to acidosis to treatment.
⚠ Serum ketone level (choice C), especially of beta-hydroxybutyrate, might be a good indicator for assessment of pure ketoacidosis. However, as outlined above, if other acids contribute to the acidosis, they will be missed if only ketone body level is used to monitor response to treatment.
⚠ For many reasons, pH of urine (choice E) is not suitable for monitoring the response to acidosis to treatment. Urine pH has a lower limit of 4.5, reflecting the maximum gradient against which hydrogen ions can be pumped in the distal part of the nephron. Regardless of the severity of acidosis, pH cannot drop below this lower limit. Additionally, urine pH does not reflect the total hydrogen ion carrying capacity of urine. Especially in acidosis, a large amount of hydrogen ion is carried in urine as ammonium (NH4). Third, urinary pH might also change in response to local factors in the kidney or urinary tract like infection.
🔖 Key point:
Plasma anion gap is the recommended test for monitoring of diabetic ketoacidosis.
👍30❤17
⏳ Case-based MCQ | #Case_460
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A 43-year-old woman with unremarkable medical history and normal physical examination had elevated levels of ALP and GGT. The diagnosis of primary biliary cholangitis (PBC) was established and the patient was treated appropriately. However, five years later, she started complaining of fatigue and generalized pruritus. Her liver was 3 cm below the costal margin.
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A 43-year-old woman with unremarkable medical history and normal physical examination had elevated levels of ALP and GGT. The diagnosis of primary biliary cholangitis (PBC) was established and the patient was treated appropriately. However, five years later, she started complaining of fatigue and generalized pruritus. Her liver was 3 cm below the costal margin.
👍7🔥1👏1
What is the single best prognostic variable in patients with PBC?
Anonymous Poll
33%
A. Serum bilirubin
21%
B. Prothrombin time
31%
C. Serum gamma-glutamyl transpeptidase
9%
D. Intensity of pruritus
6%
E. Duration of the symptomatic phase
👍21❤8
✔A
Primary biliary cholangitis (PBC; previously referred to as primary biliary cirrhosis) is a chronic inflammatory disease that leads to fibrous obliteration of intrahepatic bile ducts. The disease is much more common in females with a female to male ratio of 9:1 and a median age of onset around 50 years. Up to 25% of patients are usually diagnosed during routine blood evaluation.
Ursodiol is the major medication that is used to slow down the progression of PBC. The earlier treatment is initiated, the most effective it is.
Serum bilirubin (choice A) has been shown to be the best prognostic factor. Indeed, bilirubin enters in all the mathematical models that have been developed. When serum bilirubin is constantly above 34.2, 102.6 and 171 µmol/L, mean survival is 4.1, 2.1 and 1.4 years, respectively. Also, elevated alkaline phosphatase levels are associated with worse outcomes.
🔖 Key point:
Serum bilirubin and alkaline phosphatase have shown to be good prognostic factors in patients with primary biliary cholangitis.
Primary biliary cholangitis (PBC; previously referred to as primary biliary cirrhosis) is a chronic inflammatory disease that leads to fibrous obliteration of intrahepatic bile ducts. The disease is much more common in females with a female to male ratio of 9:1 and a median age of onset around 50 years. Up to 25% of patients are usually diagnosed during routine blood evaluation.
Ursodiol is the major medication that is used to slow down the progression of PBC. The earlier treatment is initiated, the most effective it is.
Serum bilirubin (choice A) has been shown to be the best prognostic factor. Indeed, bilirubin enters in all the mathematical models that have been developed. When serum bilirubin is constantly above 34.2, 102.6 and 171 µmol/L, mean survival is 4.1, 2.1 and 1.4 years, respectively. Also, elevated alkaline phosphatase levels are associated with worse outcomes.
🔖 Key point:
Serum bilirubin and alkaline phosphatase have shown to be good prognostic factors in patients with primary biliary cholangitis.
👍14❤1
Forwarded from Medical Mnemonics
🧩 Medical Mnemonics
✨ABCDEFGH of Hemochromatosis 📝
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©Medical Mnemonics
✨ABCDEFGH of Hemochromatosis 📝
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#endocrinology
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©Medical Mnemonics
👍7
⏳ Case-based MCQ | #Case_460
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A 21-year-old nonsmoker came to you complaining of shortness of breath and coughing up blood-tinged sputum. The cough, which accompanied the shortness of breath, started about five months ago, and it occurred only when he would lie down. During the last two weeks, both breathlessness and cough became more aggressive. He noticed increasing amounts of sputum, and even on several occasions some blood in his sputum. He denied any fever, chills or night sweats. He immigrated to Canada with his family eight years ago from a sub-Saharan African country. His past medical and family history were unremarkable.
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A 21-year-old nonsmoker came to you complaining of shortness of breath and coughing up blood-tinged sputum. The cough, which accompanied the shortness of breath, started about five months ago, and it occurred only when he would lie down. During the last two weeks, both breathlessness and cough became more aggressive. He noticed increasing amounts of sputum, and even on several occasions some blood in his sputum. He denied any fever, chills or night sweats. He immigrated to Canada with his family eight years ago from a sub-Saharan African country. His past medical and family history were unremarkable.
👍5❤4
Which of the following is the most likely cause of hemoptysis in this patient?
Anonymous Poll
36%
A. Tuberculosis
24%
B. Bronchiectasis
24%
C. Mitral stenosis
7%
D. Bronchitis
9%
E. Pulmonary arteriovenous malformation
👏12❤5👍4👎2
✔ CCCCC
Hemoptysis can range from blood-tinged sputum to coughing up large amounts of pure blood. Massive hemoptysis is defined as coughing up 100 to 600 ml of blood over 24 hours. It is important to differentiate hemoptysis from blood coming from the gastrointestinal tract and nasopharynx. In true hemoptysis, blood could come from tracheobronchial, pulmonary parenchymal, primary vascular or other miscellaneous sources. Causes of hemoptysis due to primary pulmonary vascular diseases include arteriovenous malformations, pulmonary embolism, pulmonary artery catheterization, and elevated pulmonary vascular pressure. The most important cause of the latter is mitral stenosis.
The two most common causes of hemoptysis are bronchitis and bronchogenic carcinoma. However, in this patient, the symptoms favour a cardiac cause. Specifically, breathlessness that is aggravated by adopting the supine position (orthopnea) and paroxysmal nocturnal dyspnea (PND) point towards a cardiac cause. Of the cardiac lesions, mitral stenosis (choice C) is a well-known cause of hemoptysis because it leads to marked elevation of pulmonary venous pressure and venous rupture.
⚠ Although the immigration history of the patient increases the possibility of tuberculosis (choice A), the symptoms are not typical for this disease. The absence of fever, chills, and night sweats is against this diagnosis.
⚠ The typical symptom of bronchiectasis (choice B) is a cough with mucopurulent sputum lasting months to years. Although dyspnea might develop in generalized severe bronchiectasis, orthopnea and PND are not typical of bronchiectasis.
⚠ Chronic productive cough with sputum that might be streaked with blood is a known symptom of bronchitis (choice D). However, in adults with bronchitis, dyspnea is not observed unless the patient has underlying chronic obstructive lung disease. Further, orthopnea and PND are not typical of bronchitis.
⚠ Arteriovenous malformations (choice E) rarely cause hemoptysis. The symptoms of these disorders are rather insidious and develop gradually over the years due to the slow enlargement of the malformation. Dyspnea requires many years to develop.
🔖 Key point:
Mitral stenosis is a well-known cause of hemoptysis because it leads to marked elevation of pulmonary venous pressure and venous rupture
Hemoptysis can range from blood-tinged sputum to coughing up large amounts of pure blood. Massive hemoptysis is defined as coughing up 100 to 600 ml of blood over 24 hours. It is important to differentiate hemoptysis from blood coming from the gastrointestinal tract and nasopharynx. In true hemoptysis, blood could come from tracheobronchial, pulmonary parenchymal, primary vascular or other miscellaneous sources. Causes of hemoptysis due to primary pulmonary vascular diseases include arteriovenous malformations, pulmonary embolism, pulmonary artery catheterization, and elevated pulmonary vascular pressure. The most important cause of the latter is mitral stenosis.
The two most common causes of hemoptysis are bronchitis and bronchogenic carcinoma. However, in this patient, the symptoms favour a cardiac cause. Specifically, breathlessness that is aggravated by adopting the supine position (orthopnea) and paroxysmal nocturnal dyspnea (PND) point towards a cardiac cause. Of the cardiac lesions, mitral stenosis (choice C) is a well-known cause of hemoptysis because it leads to marked elevation of pulmonary venous pressure and venous rupture.
⚠ Although the immigration history of the patient increases the possibility of tuberculosis (choice A), the symptoms are not typical for this disease. The absence of fever, chills, and night sweats is against this diagnosis.
⚠ The typical symptom of bronchiectasis (choice B) is a cough with mucopurulent sputum lasting months to years. Although dyspnea might develop in generalized severe bronchiectasis, orthopnea and PND are not typical of bronchiectasis.
⚠ Chronic productive cough with sputum that might be streaked with blood is a known symptom of bronchitis (choice D). However, in adults with bronchitis, dyspnea is not observed unless the patient has underlying chronic obstructive lung disease. Further, orthopnea and PND are not typical of bronchitis.
⚠ Arteriovenous malformations (choice E) rarely cause hemoptysis. The symptoms of these disorders are rather insidious and develop gradually over the years due to the slow enlargement of the malformation. Dyspnea requires many years to develop.
🔖 Key point:
Mitral stenosis is a well-known cause of hemoptysis because it leads to marked elevation of pulmonary venous pressure and venous rupture
👍27🔥5❤4
Forwarded from Medical Mnemonics
🧩 Medical Mnemonics
🪩 3-6-9 Rule of Bowel Dilation.
- these numbers are maximum diameters.
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〰〰〰〰〰〰〰〰〰〰〰
©Medical Mnemonics
🪩 3-6-9 Rule of Bowel Dilation.
- these numbers are maximum diameters.
💻 Join us on the official Instagram page: Online Medical School
#surgery
〰〰〰〰〰〰〰〰〰〰〰
©Medical Mnemonics
👍6❤5
⏳ Case-based MCQ | #Case_461
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A 27-year-old woman was brought to the hospital after collapsing an hour ago while she was lining up in a coffee shop. The patient stated that she was fine while she was standing in the long queue until she felt dizzy, and within seconds she became unaware of what happened next. Her medical, family and social histories are unremarkable. You strongly suspected this patient suffered a syncopal attack.
On physical examination, the patient was anxious but oriented to time, place, and person. She was not pale, jaundiced or cyanosed. Supine heart rate was 82 bpm, respiratory rate 15 bpm and blood pressure 132/84 mm Hg. Pulse and blood pressure were also evaluated 3 minutes after the patient stood upright. Compared to supine blood pressure, standing systolic and diastolic blood pressures were 10 and 5 mm Hg lower, respectively. Simultaneously, the heart rate increased from 82 to 92 bpm. The pulse was regular. The apex beat was located to the 5th intercostal space in the mid-clavicular line. The rest of the examination was normal.
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A 27-year-old woman was brought to the hospital after collapsing an hour ago while she was lining up in a coffee shop. The patient stated that she was fine while she was standing in the long queue until she felt dizzy, and within seconds she became unaware of what happened next. Her medical, family and social histories are unremarkable. You strongly suspected this patient suffered a syncopal attack.
On physical examination, the patient was anxious but oriented to time, place, and person. She was not pale, jaundiced or cyanosed. Supine heart rate was 82 bpm, respiratory rate 15 bpm and blood pressure 132/84 mm Hg. Pulse and blood pressure were also evaluated 3 minutes after the patient stood upright. Compared to supine blood pressure, standing systolic and diastolic blood pressures were 10 and 5 mm Hg lower, respectively. Simultaneously, the heart rate increased from 82 to 92 bpm. The pulse was regular. The apex beat was located to the 5th intercostal space in the mid-clavicular line. The rest of the examination was normal.
👍18😢1
What is the most likely type of syncope in this patient?
Anonymous Poll
6%
A. Medication-induced syncope
33%
B. Neurocardiogenic syncope
35%
C. Situational syncope
15%
D. Syncope due to cardiac arrhythmias
12%
E. Syncope due to carotid sinus hypersensitivity
👍14
Forwarded from Medical Mnemonics
- Do you want to publish your paper in the High Impact journal?
- Would you like your work to be seen in the best journals?
🔷 We will proceed with the journal publishing process with our professional team on MCU RESEARCH COLLABORATION
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- Would you like your work to be seen in the best journals?
🔷 We will proceed with the journal publishing process with our professional team on MCU RESEARCH COLLABORATION
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👍3
Forwarded from Medical Mnemonics
🧩 Medical Mnemonics
🔠 Risk Factors for GDM
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#obs_and_gyneacology
〰〰〰〰〰〰〰〰〰〰〰
©Medical Mnemonics
🔠 Risk Factors for GDM
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#obs_and_gyneacology
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©Medical Mnemonics
👍3❤1