It is 1am and you are seeing a 12 year old boy who has presented with a painful foot on the lateral aspect due to an inversion injury which was sustained when he fell off his skateboard earlier in the evening. The … Continue reading
Cauda equina syndrome It is a neurosurgical emergency, due to compression of the lumbar and sacral nerve roots in the spinal canal, below conus medularis. Symptoms / signs: - back pain, usually radiating to the lower limbs - saddle perianal … Continue reading
Kussmaul sign = paradoxical raise in jugular venous pressure on inspiration It indicates limited right ventricular filling due to: - pericardial tamponade - right heart failure (e.g. massive pulmonary embolus) - right ventricular acute ischaemia - constrictive pericarditis - tricuspid … Continue reading
How to do a pericardiocentesis Watch https://www.youtube.com/watch?v=BQTVqUPimdk - good video from NEJM on how to do it.
Dressler’ syndrome = delayed pericarditis (one week to one month) after an acute myocardial infarction or cardiac trauma Symptoms: - chest pain – usually pleuritic in nature - low-grade fever - shortness of breath Signs: - pericardial friction rub … Continue reading
Some (common) causes of anticholinergic syndrome Antihistamines: promethazine / doxylamine / chlorpheniramine / dexchlorpheniramine Antipsychotics: quetiapine / olanzapine / chlorpromazine / clozapine / zuclopenthixol Anticholinergics: benztropine, atropine, glycopyrrolate, hyoscyamine, oxybutynine Miscellanous medications: carbamazepine Cyclic antidepressants: amitriptyline, doxepin, clomipramine, nortriptyline Topical occular … Continue reading
It is 2 am and you have just seen a 30 year old female patient who just twisted her ankle at a party and is unable to weight-bear. Her ankle is swollen and painful and you decide to do an x-ray … Continue reading
One-and-a-half syndrome = caused by lesions of the dorsal pons Signs: - ipsilateral conjugate horizontal gaze palsy - internuclear ophthalmoplegia on contralateral gaze - exotropia of the eye opposite to the side of the lesion Causes: - any lesions causing … Continue reading
Internuclear ophtalmoplegia = due to lesions of the medial longitudinal fasciculus (MLF) dorsomedial pons or midbrain The side of the internuclear ophtalmoplegia is ipsilateral to the MLF lesion, the same side to have the adduction deficit. Signs: - loss of adduction … Continue reading
Parinaud syndrome = caused by lesions of the upper part of the midbrain Signs: - loss of vertical gaze + conjugate down gaze in resting position – the “setting-sun sign” - nystagmus on attempted convergence - pseudo-Argyll Robertson pupils - loss of … Continue reading
Peak expiratory flow = maximal flow rate generated during a forced expiration The expected normal value can be calculated based on age and height. Normal values in adults vary from 350 to 600 L/min. However, its measurement is effort-dependent and … Continue reading
Anticholinergic syndrome It can be causes by a large number of drugs and plants. There is probably a mnemonic for it but I hate mnemonics (and can’t remember them anyway). But as you look at your patient starting from the … Continue reading
When we order liver function tests (LFTs) we normally get ALT / GGT / ALP / bilirubin / total protein / albumin. But are these true liver function tests? Should we add anything? Well, ALT (alanine transaminase), AST (aspartate transaminase) … Continue reading
Your next patient is a 68 year old female with mild dyspnoea. On examination, she is stable with mild epigastric tenderness only. You obtain chest x-ray as part of your investigation and the x-rays are here. Looking at the PA … Continue reading
C1 inhibitor deficiency = autosomal dominant disease resulting in inherited or acquired deficiency in C1 inhibitor - symptoms generally start in late teenage years and present as recurrent episodes of angioedema without urticaria and abdominal pain (due to mesenteric oedema) … Continue reading
Angioedema without urticaria = non-mast cell mediated form of angioedema - due to accumulation of bradykinin (ACE-inhibitors, ARBs – angiotensin receptor blockers) or to excessive activation of the complement pathway (usually due to C1 inhibitor deficiency) Investigations: - if patient is … Continue reading
Urticaria - occurs due to local vasodilation, increased vascular permeability, and tissue edema secondary mast cell degranulation and histamine release. This can be mediated by 4 different mechanism: (1) immune mediated – type I hypersensitivity reaction (2) complement mediated (3) autoimmune … Continue reading
Schistosomiasis aka bilharziasis, snail fever - caused by blood flukes of genum Schistosoma – 2 big groups, one that causes gastrointestinal disease and one that causes urogenital disease - transmitted via freshwater – freshwater snails act as intermediate hosts; they … Continue reading
It is 1 am and you have just seen a 70 year old man in resus who has had a fall earlier in the night from a ladder. He is complaining of right sided chest pain. You request a trauma … Continue reading
Mitral regurgitation Causes: chronic - rheumatic heart disease - degenerative disease - mitral valve prolapse - papillary muscle dysfunction secondary to left ventricular failure or chronic ischaemia - cardiomyopathy - connective tissue disease – Marfan’s / rheumatoid arthritis / … Continue reading
Nutmeg toxicity You probably know it as a spice. But it is also a cheap hallucinogenic drug. Ingested in large quantities (more than 1 whole nut or 1 tablespoon of powder), it causes a toxic syndrome that occurs 3 … Continue reading
Basic knowledge again, but I’ve noticed some interesting numbers used to grade motor power in some medical notes recently, so I thought a reminder would be useful: 5 normal power 4 moderate movement against resistance 4 plus … Continue reading
Psychostimulants = broad range of substances that include: - amphetamines under various forms: amphetamine sulphate or hydrochloride = ‘speed’; methamphetamine tablets = ‘pills’, powder or “base”; crystal methamphetamine = ‘ice’, ‘crystal meth’; dexamphetamine (Ritalin); paramethoxyamphetamine; paramethoxymethamphetamine - methylenedioxymethamphetamine(MDMA), ‘ecstasy’ - cocaine … Continue reading
Austrian syndrome = meningitis, pneumonia and endocarditis (usually of the aortic valve) caused by Streptococcus pneumoniae It usually occurs in male patients aged 40 – 60, with a history of alcoholism. Mortality is 80%.
A 55 year old female comes to your ED with a feeling of something stuck in her throat after eating a meal of snapper fish the previous night. She has odynophagia and you perform a lateral neck x-ray looking for a fish … Continue reading
Hypokalaemic periodic paralysis = muscle weakness or paralysis with associated hypokalaemia It can be: - congenital - rare channelopathy - secondary to hyperthyroidism – also called thyrotoxic periodic paralysis caffeine abuse salbutamol aldosteronism (primary / secondary / pseudo) renal tubular acidosis … Continue reading
You’ve just seen a male who has been assaulted. He’s damaged three of his front teeth and you are going to refer him onto a dentist. How are you going to describe which teeth are injured ? Dental pain and tooth … Continue reading
The daily educational pearls will be back by popular demand on the 15th of October 2012. Stay tuned!
You have just seen a 7 year old girl with a swollen elbow after a fall onto her right elbow. She is in a lot of pain and is very distressed. You obtain an x-ray of the elbow. What can you … Continue reading
I hope you enjoyed the educational pearls. Unfortunately, due to other commitments, I am not able to continue writing them and they end today.