With Images Symptoms of Crest Syndrome

 

What is Dermatomyositis

long-term inflammatory disorder which affects skin and the muscles.

^[1] symptoms are  a skin rash and worsening muscle weakness over time.^[] These may occur suddenly or develop over months.^[1] Other symptoms  weight loss, fever, lung inflammation, or light sensitivity.^[1] Complications may include calcium deposits in muscles or skin.^[1]

The cause is unknown.^[1] Theories include that it is an autoimmune disease or a result of a viral infection.^[1] It is a type of inflammatory myopathy.^[1] Diagnosis is typically based on some combination of symptoms, blood tests, electromyography, and muscle biopsies.^[3]

While no cure for the condition is known, treatments generally improve symptoms.^[1] Treatments may include medication, physical therapy, exercise, heat therapy, orthotics and assistive devices, and rest.^[1] Medications in the corticosteroids family are typically used with other agents such as methotrexate or azathioprine recommended if steroids are not working well.^[1] Intravenous immunoglobulin may also improve outcomes.^[1] Most people improve with treatment and in some the condition resolves completely.^[1]

About one per 100,000 people per year are newly affected.^[3] The condition usually occurs in those in their 40s and 50s with women being affected more often than men.^[3] People of any age, however, may be affected.^[3] The condition was first described in the 1800s.^[4]

هل يساعد الجنس في فقدان الوزن - ممارسة الجنس

 أجرى باحثون عام 2013، دراسة شارك فيها مجموعة من الأزواج، تتراوح أعمارهم من 18 إلى 35 عامًا، لمعرفة عدد السعرات الحرارية التي يتم حرقها أثناء ممارسة العلاقة الحميمة.

وقام باحثو الدراسة بإلزام الأزواج بارتداء جهاز تعقب النشاط، لحساب مقدار السعرات المستهلكة أثناء الجماع، وطالبوهم بممارسة العلاقة الحميمة مرة واحدة في الأسبوع لمدة شهر.

وبعد انقضاء المدة، وجد الباحثون أن الرجال حرقوا ما يقارب من 101 سعرة حرارية أثناء الجماع، بينما حرقت النساء 69 سعرة فقط.

ومنذ ذلك الحين، بدأ التعامل مع العلاقة الحميمة على أنها تمرين رياضي متوسط الشدة، لأن الجهد المبذول أثناء الجماع كانت شدته أكبر من المشي وأقل من الجري.

العادة السرية وعلاقتها بفقدان الوزن

ترتفع ضربات القلب بشكل تدريجي عند ممارسة العادة السرية، وعند بلوغ النشوة الجنسية والوصول لمرحلة الاستمناء، وجد الأطباء أن الجسم يحرق من 200 إلى 300 سعرة حرارية، بحسب موقع "Womenday".

Signs of Lung Collapse

Lung collapse

Signs

Trachea- displaced towards the collapsed lung

Chest expansion- reduced on the affected side with flattening of the chest wall on the same side

Tactile fremitus- reduced on affected side

Percussion- dull over the collapsed lung

Breath sound- reduced +/- bronchial breath sound above the area of collapse

Cuauses of lung collapse

Intraluminal- mucus (post-operative, asthma, cystic fibrosis)

Mural- lung cancer

Extramural- peribronchial adenopathy 

Causes of Diplobia or Double Vision

 Cornea Problems 

Astigmatism - Dry Eyes - Infections like Herpes Zoster - Scars 

Lens Problems 

Cataract

Eye Muscles Problems 

Graves Disease - Strabismus or misaligned eyes

Nerve Problems 

Diabetes - Myasthenia Graves

Brain Problems 

Brain Aneurysm - Brain Tumor - Migraine Headache -Stroke 

Case Study : Bat bites and their treatment.

     A 15-year-old adolescent boy was cleaning some items in the shed in his backyard in afternoon,when he saw a bat in middle of the shed , the boy was administered to the ED (Emergency Department) With vital signs of 115/70 mm Hg BP, heart rate of 105 beats per minute , respiratory rate of 14 breaths per minute pulse oximetry of 99% on room air, and a temperature of 37.1°C (98.9°F) Inspection of the wound shows deep bite marks with a laceration close to the proximal interphalyngeal joint. The bat escaped after the boy was bitten and was not found.

What Is The Most Likely Diagnosis? 

     Unprovoked attack by a rabies-infected bat

    Analysis : The Bat shows abnormal behaviour ; It was active in the afternoon (while bats are nocturnal creatures) , and it bit the boy -while normal bats may bite when provoked , rabies infected bats are more likely to bite . The strange bat behaviour raises suspicions towards being infected by the rabies . 

Treatment And Considerations :

      Cleaning of the patient's wound should be the first priority , the medical service provider should keep in mind that the patient was bit close to the joint space of the proximal interphalengeal joint , take care of the possibility of retained teeth . The patient's tetanus status should be constantly checked . 

       In this patient’s case, postexposure prophylaxis for rabies and delayed primary closure to observe for infection are reasonable. Postexposure prophylaxis for rabies should include a combination of immediate, passive (rabies immunoglobulin) immunization and active immunization (human diploid cell vaccine). Tetanus vaccine should be administered if the patient has not received it within the last 5 years.

       The Animal Control agencies should be contacted to notify them of the loose animal so they deal with it , in order to avoid any further bite attacks .

5 Important issues in Clinical Problem Solving

 CLASSIC CLINICAL PROBLEM SOLVING 

There are typically five distinct steps that an emergency department clinician undertakes to systematically solve most clinical problems: 

 1. Addressing the ABCs and other life-threatening conditions 

 2. Making the diagnosis 

 3. Assessing the severity of the disease 

 4. Treating based on the stage of the disease 

 5. Following the patient’s response to the treatment

Definition of Azotemia

 AZOTEMIA: Presence of nitrogenous bodies, especially urea, in the blood that develops in urinary tract obstruction when overall excretion function is impaired

What to consider in Management of Acute Urinary Retention Case

Many disease processes, trauma, and medications can result in acute urinary retention  In elderly men, the most common cause is prostatic hypertrophy.

As with this patient, a thorough history and physical examination can help elucidate the etiology of the urinary retention. 

Passage of a urethral catheter to alleviate

the obstruction will bring about significant pain relief. 

Assessment of renal function is important, as is obtaining a urinalysis to rule out concomitant urinary tract infection. Imaging studies in the ED are rarely necessary for these patients, although

bedside ultrasound may help identify bladder distention or a clot in the bladder.

Depending on this patient’s renal function and physical status after drainage of his

bladder, he may require admission

Case Study Discussion : 65 years Man unable to urinate for 65 years

A 64-year-old man presents to the  (ED) because of an inability to urinate for the past 24 hours. 

In addition, he complains of an unintentional weight loss of 20 lb over the past 6 months , night sweats, and generalized fatigue. On examination, he is thin and in moderate distress. His BP is 168/92 mm Hg, heart rate is 102 beats per minute, temperature is 37.7°C (98.8°F),

and respiratory rate is 22 breaths per minute. The abdominal examination reveals

a tender mass in the suprapubic area. 

rectal examination, the prostate is firm, nontender, and somewhat irregular.

What is the most likely diagnosis

 How would you confirm the diagnosis

 What is the next step in treatment

 A 64-year-old man presents with an inability to void for the past 24 hours

and a tender mass in the lower abdomen. The patient has signs and symptoms

suggestive of prostate cancer, including unintentional weight loss, night sweats, a

decrease in energy, and an enlarged irregular firm prostate gland.

• Most likely diagnosis: Acute urinary retention likely due to prostate cancer.

• Confirming the diagnosis: Thorough history and physical examination including a rectal examination, urinalysis, electrolytes and renal function tests, along

with bedside ultrasound, if available. Prostate-specific antigen may help in the

diagnosis of neoplastic disease if results will be available in the ED.

• Next steps in treatment: Draining the bladder by inserting a urethral catheter

should relieve the patient’s pain; if not, a suprapubic catheter can be placed.

Treatment of the underlying disease process is also necessary.

Malignant causes of LBP , etiology , Clincal Picture , Diagnostics and Treatment

Aetiology

Common Cause metastatic  breast, prostate, lung 

May also be primary loke multiple myeloma, leukemia, lymphoma

Clinical Symptoms Analysis

Pain lasting longer than 1 month, worse at night, unrelieved by rest; unexplained

weight loss; 

mild tomoderate spinal tenderness

Diagnostic tools

CBC, ESR,

plain x-ray, CT,

MRI

Treatment in Emergency Departement 

intravenous dexamethasone

and  refer for radiation therapy

Spinal Infection , etiology , Clinical Picture , Diagnostics and Treatment

Etiology

Most commonly due

to Staphylococcus.aureus

Risk Factors

intravenous drug use

elderly, immunocompromised, alcoholism, recent bacterial

Signs and Symptoms

infection or back trauma

Back pain (even at rest/

night), fever, midline

cultures, tenderness

along spine.

Focal neurologic deficits as late finding

Diagnostics 

CBC, ESR,

 plain x-ray 

C.T

MRI - preferred

Treatment

Intravenous

antibiotics,

surgical drainage

and

decompression

Red Flag Signs and Symptoms of Low Back Pain LBP

 Patients younger than 18 years old or older than 50 years 

Significant trauma (or mild trauma in patients older than 50 years) 

Chronic steroid use 

Osteoporosis 

History of cancer Recent infection 

Immunocompromise 

History of intravenous drug use 

Pain worse at night, 

lasting longer than 6 weeks,

 or refractory to analgesics and rest 

Associated systemic symptoms (fever, unexplained weight loss, malaise, night sweats, diaphoresis, nausea, syncope) 

Acute onset Use of anticoagulants or coagulopathy 

Abnormal vital signs (including unequal blood pressures or pulse deficits) 

Neurologic deficits (including extremity weakness, numbness, paresthesias, loss of rectal sphincter tone, urinary retention)

Cauda Equina Syndrome Case Study , Cardinal Signs

A 57-year-old man 

  one month history of worsening low back pain 

 radiates down the back of both legs and suddenly increased yesterday.

 For the past 2 days,  have difficulty voiding

 skin around his anus feels numb when he wipes with toilet tissue. 

He denies prior trauma to or surgery on his back. 

- Most likely diagnosis: Cauda equine syndrome

Aetiology Central disk herniation multiple, involving bilateral nerve roots 

  the next diagnostic step MRI

Why Cauda Equina and not other causes of LBP because cardinal signs of Cauda equina syndrome are 

, urinary retention and overflow incontinence, decreased rectal tone, saddle anesthesia 

Past Surgical History in Clinical Examination

 Past surgical history: Date and type of procedure performed, indication, and

outcome. Laparoscopy versus laparotomy should be distinguished. Surgeon

and hospital name/location should be listed. This information should be correlated with the surgical scars on the patient’s body. Any complications should

be delineated including, for example, anesthetic complications and difficult

intubations.

Interpretation of Past History in History Taking and Clinical Examination

 Past medical history:

a. Major illnesses such as hypertension, diabetes, reactive airway disease,

 congestive heart failure, angina, or stroke should be detailed.

 i. Age of onset, severity, end-organ involvement.

 ii. Medications taken for the particular illness including any recent changes

to medications and reason for the change(s).

 iii. Last evaluation of the condition (example: when was the last stress test

or cardiac catheterization performed in the patient with angina?)

 iv. Which physician or clinic is following the patient for the disorder?

b. Minor illnesses such as recent upper respiratory infections.

c. Hospitalizations no matter how trivial should be queried.

1st Line of any Case Presentation include the following

 The first line of any presentation should include age, ethnicity, gender, and chief complaint. Example: A 32-year-old white man complains of lower abdominal pain of 8-hour duration.

Clinical Interpretation ofBasic information in Taking History

 Basic information

a. Age: Some conditions are more common at certain ages; for instance, chest pain in an elderly patient is more worrisome for coronary artery disease than the same complaint in a teenager. 

b. Gender: Some disorders are more common in men such as abdominal aortic aneurysms. In contrast, women more commonly have autoimmune problems such as chronic idiopathic thrombocytopenic purpura or systemic lupus erythematosus. Also, the possibility of pregnancy must be considered in any woman of childbearing age. 

c. Ethnicity: Some disease processes are more common in certain ethnic groups (such as type II diabetes mellitus in the Hispanic population).

Treatment of Paracetamol Toxicity

  Although clinical evidence of hepatotoxicity may be delayed for 24 to 72 hours, NAC therapy is most effective if started within 8 hours of ingestion. Because this patient reported the ingestion within 30 minutes, there is time for a serum APAP level, activated charcoal decontamination, and then NAC therapy. If time is an issue, NAC treatment should be initiated without delay. Emesis should not be induced because of the possible delay in therapy. After medical stabilization, assessment of suicide potential is important. SECTION II: CLINICAL

اعراض و اسباب تسمم الباراسيتامول بانادول بيرال

 

يعد الأسيتامينوفين الباراسيتامول (APAP) أحد المسكنات وخافضات الحرارة الأكثر استخدامًا. وهي متوفرة في مجموعة متنوعة من الأدوية الموصوفة ، والأدوية التي لا تحتاج إلى وصفة طبية ، والأدوية الموصوفة للحمى والبرد والسعال وتسكين الآلام. نتيجة لذلك ، هو كذلك أكثر العوامل التي لا تستلزم وصفة طبية والتي يتم الإبلاغ عنها بشكل عرضي ومتعمد الجرعات الزائدة ، مما يؤدي إلى دخول المستشفى بعد جرعة زائدة أكثر من أي عامل دوائي آخر. يشتبه في التعرض السام لـ APAP عند أكثر من 200 مجم / كجم أو أكثر من 10 جم في جرعة واحدة أو على مدار 24 ساعة. في بالإضافة إلى تناول أكثر من 150 مجم / كجم أو أكثر من 6 جم يوميًا لمدة لا تقل عن يومان متتاليان يحتمل أن يكونا سامين. السمية الكبدية هي الأكثر خطورة على الحياة المضاعفات ، ولكنها قد تكون بطيئة ؛ وبالتالي ، فإن مستوى المصل APAP ووقت محدد يعد الابتلاع مهمًا للتخطيط على مخطط الرسم البياني لتقييم احتمالية السمية.

Paracetamol Toxicity causes, symptoms complications

Acetaminophen (APAP) is one of the most commonly used analgesics and antipyretics. It is available in a variety of prescription, over-the-counter, and combination medications labeled for fever, cold, cough, and pain relief. As a result, it is the most common over-the-counter agent reported in accidental and intentional overdoses, leading to more hospitalizations after overdose than any other pharmaceutical agent. A toxic exposure to APAP is suspected when more than 200 mg/kg or more than 10 g is ingested in a single dose or over the course of 24 hours. In addition, an ingestion of more than 150 mg/kg or more than 6 g per day for at least 2 consecutive days is potentially toxic. Hepatotoxicity is the most life-threatening complication, but may be indolent; thus, serum APAP level and a precise time of ingestion are important to plot on a nomogram to assess likelihood of toxicity.

Differential Diagnosis of Altered Mental Status AMS in Elderly

may be due to the following causes

 Infection like SEPSIS , MENINGITIS , UTI

Electrolyte and Metabolic abnormalities

 Hypogylcemia or Hyperglycemia

 Hyponatremia 

Delirium 

 HYPOXIA

عنوان عيادة دكتور احمد فؤاد ابوطالب استشاري جراحة العظام سموحة الاسكندرية

عنوان عيادة دكتور احمد فؤاد ابو طالب استشاري جراحة العظام سموحة الاسكندرية

https://www.facebook.com/102161161602276/photos/a.102161671602225/102161791602213/?type=3

Major Symptoms in Nervous System

 Major symptoms in nervous system . 

Headache . 

Cognitive disturbance . 

Difficulty of speech (dysphasia/aphasia) 

. Loss of consciousness 

. Difficulty in vision, hearing, swallowing . 

Weakness of extremity . 

Abnormal body movement 

. Bladder or bowel dysfunction (urinary retention or incontinence

/ fecal impaction or incontinence) . 

Abnormal sensory symptom

How to Diagnose Different types of Dyspepsia ?

 Dyspepsia is Substernal burning pain or indigestion 

Clusters of symptoms are used to classify dyspepsia,

   reflux-like dyspepsia (heartburn-predominant dyspepsia),

 ulcer-like dyspepsia (epigastric pain relieved with food or antacids) 

and dysmotility-like dyspepsia (nausea, belching, bloating and earily satiety)

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Generic Drugs بدائل الأدوية غالية الثمن في مصر نفس الكفاءة: بدائل حقن سيفوترياكسون من شركة نوفارتس السويسرية سا...: مادة سيفوترياكسون تعتبر من اهم المضادات الحيوية التي حلت كثير من مشاكل الجهاز التنفسي و العمليات الجرحية و قضت على الكثير من انواع البكتيريا...

اضغط الرابط الأزرق في الأعلى لقراءة المقال من مصدره 

بدائل دواء ديباكين الضار بالحوامل في مصر

Generic Drugs بدائل الأدوية غالية الثمن في مصر نفس الكفاءة: بدائل دواء ديباكين الضار بالحوامل في مصر بعد التحذ...:  تحذيرات واسعة من دواء ديباكين بكل تركيزاته و استخدماته خاصة في السيدات الحوامل و البنات في مرحلة البلوغ و ينتشر الدواء المستخدم لعلاج مرضى ...

اضعط الرابط اعلاه للقراءة من المصدر

Causes of vertigo Etiology

Sudden onset – Acute labyrinthitis, vestibular neuritis 

Vertigo with hearing loss and tinnitus – Meniere’s disease

 

Vertigo (episodic) with position change – benign paroxysmal positional vertigo BPPV

 

Vertigo after trauma – Perilymph fistula 

Vertigo with motion – Motion sickness 

Drug-induced vertigo – Vestibulotoxic drugs like Gentamicin, Salicylate and Quinine 

What is V/Q Scan in Medicine ?

A ventilation–perfusion (VQ) scan or V/Q scan is a scan in which we use radioactive material (radiopharmaceutical) to examine airflow (ventilation) and blood flow (perfusion) in the lungs to look for evidence of any blood clot in the lungs, called pulmonary embolism

How to manage a Patient complaining of Syncope ?

You are in an Emergency Room and Have a patient complaining of Syncope what do you have to do

 1st of all you have to apply ECG 

 if ECG is normal and in young patient with Vasovagal Situation , Orthostatic and no comorbidities  

Discharge with Primary Care follow UP 

 , If Abnormal ECG or age more than 60 or History of Cardiac Disease or CHF or Exeretional syncope ,  Chest Pain or Dysponea 

 you have to apply C.T scan Doppler and lab tests

What is Ludwig 's angina Symptoms , Signs and Causes

Ludwig’s angina is a  skin infection that occurs on the floor of the mouth, underneath the tongue. This bacterial infection often occurs after a tooth abscess, which is a collection of pus in the center of a tooth. It can also follow other mouth infections or injuries. 

This infection is more common in adults 

Symptoms of Ludwig’s angina

\ swelling of the tongue, neck pain, and breathing problems 

• pain or tenderness in the floor of your mouth
• difficulty swallowing
• drooling
• problems with speech
• neck pain
• swelling of the neck
• redness on the neck
• weakness
• fatigue
• an earache
• tongue swelling that causes your tongue to push against your palate
• a fever
• chills
• confusion

 The complications can be life-threatening

The bacteria Streptococcus and Staphylococcus are common causes. 

follows a mouth injury or infection, such as a tooth abscess. 

contribute to developing Ludwig’s angina:

• poor dental hygiene
• trauma or lacerations in the mouth
• a recent tooth extraction