papillary CA of thyroid usualy give LN mets. spread via  LN mets

papillary ca of thyroid spred to midline pretracheL and prelaryngeal node where in front of thyroid membrain(DELPIC AND ORACULAR NODES)

also spread the deep cervical chain of nodes following superior anc middle thyroid veins  also inferior thryroid vei

Amaurosis fugax

comonest cause is ipsilateral carotid atery lesion , oftem stenosis or ulceration og atherosclerolic plaque,

Myasthenia gravis  is tested by tensilone test

treatment for actue glucoma

1.carbonic anhydrase inhibiter.. acetaazolamide

2.alpa adrenergic agonist, cholinergic agents.. pilocarpine

3.beta blocker..timilol

4,presteglandine

atropine worst the condition.. so dont use it to dialate and visualize the pupils

if stapidedius affect in bells palsy pt may complain hyperacusis

if cordatympany goes.. loss of ipsilateral taste sensation anterior

polymyositis

afect proximal muscle groups initialy

 sensation remain normal

 deep tendon reflexux normal

Hereditory sensory motor neuropathy(Charcot marine tooth syndrome)

heriditoty

both sensory and motor peripherL nerve affect

feet and hand affect due to distal muscle weekness

diabetic amyotropy..

neuropathy of proximal nerve trunk or plexus

vestibuler neuriyis is unilateral and does not affect to hearing

meniere disease

nystagmus is present during attack

benign paroxysmal positional vertigo

older patents

Attacks with schanging the head

Destruction to the inferior parietal lobule of the dominant hemisphere results in Gerstmann's syndrome.

Gerstmann syndrome is characterized by four primary symptoms:

Dysgraphia/agraphia: deficiency in the ability to write[2][3]

Dyscalculia/acalculia: difficulty in learning or comprehending mathematics[2][3]

Finger agnosia: inability to distinguish the fingers on the hand[2][3]

Left-right disorientatio

Gerstmann syndrome is a neuropsychological disorder that is characterized by a constellation of symptoms that suggests the presence of a lesion in a particular area of the brain

Considerations in Specific Patient Subgroups

Pregnant women

Higher HPV infection rates have been reported in pregnant women. If condyloma develops, rapid growth can be observed. Factors responsible include suppression of immunity during pregnancy and hormonal changes.[47] Small asymptomatic lesions need not be treated; larger lesions can be treated with keratolytics or cryotherapy.[68] Occasionally, condylomata in pregnant women become large and macerated, requiring surgical excision after the first trimester. Interferon, podophyllin, and 5-fluorouracil (5-FU) should not be used in pregnancy.

The risk of perinatal HPV transmission to the oropharyngeal mucosa of the neonate is low for mothers with latent infections or genital warts.

Microphallus, or micropenis, is defined as a stretched penile length of less than 2.5 standard deviations (SDs) below the mean for age. Traditionally, the term micropenis refers to a penis that is otherwise normally formed, and the term microphallus has been used when associated hypospadia is present.

The mean stretched penile length in a full-term newborn male is 3.5 cm. Measurements of less than 2-2.5 cm

Although micropenis can be considered a form of ambiguous genitalia, the presence of a normal scrotum and palpable testes indicates a high probability of a normal male karyotype. If the testes are not palpable and/or the penile urethra is absent, the examination is better described as ambiguous, and an evaluation and counseling for disorders of sex development should be performed.

Microphallus

Workup

Laboratory Studies

A karyotype is recommended to confirm chromosomal sex.

In situations of genital ambiguity, pelvic ultrasonography is often helpful. The presence of a uterus and ovaries strongly suggests a virilized female (46,XX) infant.

When hypopituitarism is suspected, an MRI of the head should be obtained to evaluate the hypothalamic and pituitary areas. In Kallmann syndrome, abnormalities of the olfactory system may be seen.

Testosterone therapy in the form of 3 monthly intramuscular (IM) injections has been used to increase penis size in infants and children.

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Ano-genital warts or condyloma acuminata are caused by the human papilloma virus (HPV).

Approximately 75% of all pancreatic carcinomas occur within the head or neck of the pancreas

The most active single agents for pancreatic cancer have been 5-fluorouracil (5-FU) and gemcitabine. Gemcitabine appears to be slightly more active than 5-FU. Objective responses, meaning actual regression of tumor, have been 20% or less

According to the American Cancer Society, for all stages of pancreatic cancer combined, the one-year relative survival rate is 20%, and the five-year rate is 6%.

Alzheimer disease (AD) is the most common neurodegenerative disease responsible for dementia. About half of dementia cases result from AD;[

As with many neurodegenerative diseases, both rare autosomal-dominant forms of AD and more common sporadic forms with genetic risk factors without causative mutations exist

Autosomal-dominant forms of AD tend to be more severe and occur at a younger age than sporadic AD but are relatively rare. Sporadic AD accounts for the vast majority of AD cases.

AD is characterized grossly by progressive atrophy and gliosis, first of the hippocampus and mesial temporal lobe, followed by other association cortices (frontal and parietal lobes), and finally by primary motor or sensory cortex (occipital lobe).

Vascular brain injury (VBI) is widely recognized as a common cause of cognitive impairment (vascular cognitive impairment) culminating in vascular dementia. Most vascular dementia cases are sporadic and share risk factors with peripheral vascular disease. A widely used method for the clinical diagnosis of vascular dementia in life is the Hachinski Ischemic Score, which is assessed by determining whether the individual has experienced an abrupt onset or stepwise progressive course of specific signs and symptoms and the presence of vascular risk factors.[

Capture Mar 13, 2016

Infarction of this artery due to thrombosis or a stroke leads to posterior inferior cerebellar artery syndrome (PICA syndrome), also known as lateral medullary syndrome, or Wallenberg syndrome. Severe occlusion of this or vertebral arteries could lead to Horner's Syndrome as well.

It is the clinical manifestation resulting from occlusion of the posterior inferior cerebellar artery (PICA) or one of its branches or of the vertebral artery, in which the lateral part of the medulla oblongata infarcts, resulting in a typical pattern. The most commonly affected artery is the vertebral artery, followed by the PICA, superior middle and inferior medullary arteries.

absence of dolls eye responce in brain death patient

caloric tesr.. 8 cranial nerve. put hot water

streptomycine cause neurotoxicity

chyeny

cheyne stroke breathing kiya ne suwaseta

tardy ulner palsy

due to incsease carring angle amd chronic stretch

pancoast syndrome is pain in the shoulder and arm due to entrapment of c8 t1 due to upper lobe carcinoma

wasting of small muscle of hand is a early  fx of syringomyelia

benign essential tremor or exagerated physiological tremor

atosomal dominent typenof family hx but genetic base unknown

abonomal cereibeller actititybin functional immaging

 but no organic causs

age of onset bimodel at 2nd decaed and 5th decadewoest with advancing age

brain mets

commonest brain mets is lung CA .specially small cell ca

 then

 melanoma

renal cel ca

 breast ca

most common primary t of brain is glioblastoma multiforme

its also most malignent

cerebral infarction is wedge shape defects

most important thing of qudripagicbptb mx is

 mx of neurogenic bladder

diabetic proximal neuropathy=diabetic amyotrophy

herpes zoster =3 %  gets motor weakness due to spead of virus from dosal root to anterior root

meralgia paraesthetica due to obtrution of

ateral cutenious nerve of thigh atbgroin..

 pt wil complain numbness of lateral tjigh

thisnisndue to gross asitice

also obse patient and army training guysbmay affect

aortic bification syndrom

thrombous at aortic b7fication

bilateral buttock clodicatio and  impotence

alcoholic peripheral neuropathy is gl8ve and stocking type

Budd chiari syndrome is due to hepatic vein thrombosis resulting , hepTonspleno megaly, ascitis,jaumdice, portal htn

ischemic rest pain

burning type peririperies

reduce with legs hangin down

pain due to chronic venous insufficiency

fx of sking pigmentation

agreavated by walking

 realive by recumbency

nocternql muscle cramps

tx

strech exercise of ankle extension

quinine sulphate 300mg nocte

RA cause spontaneous rupture of tendons of finger extenser

de quervain tenosynovitis - Google Search

de quervain tenosynovitis - Google Search

De Quervain's tenosynovitis (dih-kwer-VAINS ten-oh-sine-oh-VIE-tis) is a painful condition affecting the tendons on the thumb side of your wrist. If you have de Quervain's tenosynovitis, it will probably hurt when you turn your wrist, grasp anything or make a fist.

Kienböck disease is the eponymous name given to avascular necrosis (aseptic necrosis) involving the lunate.

aseptic avasculer necrosis of lunate bone

Monday, March 14, 2016

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mallet deformaty of finger is usually  due to  ruptuere of the extenser tendon of distal interphalangel joint of finger..

fast ball allanna yanakota benava

fracture of clavical cause to elevation of proximal fragment, depressed of distal fragment ànd drop the level of afected shoulder

acromial claviculer joint dislocation

you can see step d3formity

Achilles (uh-KILL-eez) tendon rupture is an injury that affects the back of your lower leg. It most commonly occurs in people playing recreational sports. The Achilles tendon is a strong fibrous cord that connects the muscles in the back of your calf to your heel bone.

recu4rent anterior dislocation of shoulder can relocated at ED with analgisia

OA suported stick usually on unaffected side

osteoporosis ans osteopenia of male patient should be evluate always b4 say idiopathic

radiation can caise hypogonadism and it can cause for osteoporosis

 multiple myloma can causemalignat letions

septic ateritis  shoild cover with stap aureus.treated with flucloxacillin

polysteritis nodosa is multi systemic

ateritis cause gangrean foot, multiple joint pain, fever  high esr

 muscle bx  should be done

bx shows nectotising vasculitis in small vescles

inflamatory vasculitis, giant cell ateritis, syphilitic aotitis , Takauasu ateritis are risk factors gor aortic dissection

also marfen syndrome in younger ages

for uncomplicate intermittent clodication

 pentoxifylline can be used..

verapamil shoud never use fornwide complex tachycardia

risk factors for AF

hypertention20%