I thought we’ll stay with how to relocate dislocated shoulders for now. This is another technique – takes longer, but you don’t need to sedate the patient. It might not work for all patients – especially the ones who can’t … Continue reading →

Today a video link for you to watch the new method (FARES) to reduce a dislocated shoulder and a nice revision of other methods: http://www.youtube.com/watch?v=NXFPWxSTK5c

Causes of stridor  foreign bodies infections – croup, epiglottitis, tracheitis; retropharyngeal or other deep neck space infection anaphylaxis / angioedema laryngeal or tracheal trauma vocal cord paralysis lesions of the vocal cords – benign or malignant   In very young children: laryngomalacia … Continue reading →

Blackwater fever This is the popular name for the haemolytic anaemia associated with severe malaria. It appears to be more commonly associated with Plasmodium falciparum, quinine therapy and recurrent malaria infection. Signs / symptoms: fever / rigors jaundice haemolytic anaemia … Continue reading →

Causes of miosis Toxins – opiates, organophosphates / nerve gas, clonidine, olanzapine Pontine haemorrhage or space occupying lesions Horner’s syndrome Anterior uveitis

The following lumbar spine x-ray is from a 60 year old patient who walked into the department with a chief complaint of lumbar back pain after a surfing accident. What can you see in the x-ray? Here is a magnified view:

Signs and symptoms of cholinergic syndrome SLUDGE is the usual mnemonic used. And “the 3 killer Bs”. But I don’t like mnemonics. So if we start from head and go down: CNS depression / coma seizures lacrimation miosis salivation bronchorea / … Continue reading →

Brown-Sequard syndrome Usually due to trauma and transsection of the hemicord. Signs: ipsilateral paralysis below the level of the lesion ipsilateral loss of pain and pinprick at the level of the lesion ipsilateral loss of vibration and position sense below the … Continue reading →

Central cord syndrome - usually occurs in the cervical cord, and the upper limbs are weaker than the lower limbs - dissociated sensory loss, with loss of  pain and temperature and preservation of other modalities Causes: trauma – especially hyperextension of the … Continue reading →

Cinchonism = toxidrome caused by quinine or cinchona bark overdose Signs and symptoms: tinnitus, impaired hearing blurred vision headache vertigo skin rash nausea & vomiting   Severe cases: reversible deafness blindness which can be irreversible arrhythmias hypotension hypoglycaemia death

Dieulafoy ulcer = upper GI bleeding caused by persistence of an arteriole in the stomach mucosa, that can bleed even with minuscule mucosal erosion; usually within 6 cm of the gastroesophageal junction on the lesser curvature of the stomach - NOT associated … Continue reading →

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 →