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.

5:32 PM

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

3:05 PM

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%

usually due to staphylococus arious

oral herpes hsv1

genital herpes hsv2

There are two types of the herpes simplex virus. HSV-1, also known as oral herpes, can cause cold sores and fever blisters around the mouth and on the face. HSV-2 is generally responsible for genital herpes outbreaks.

polymyositis

immunologically mediated conevtive tissue disorder

inflamtion of the muscledificulty in climbing stair , rising from chair

femoral hernia is the most common hernia that cause to strangulation.

sliding oesophagial hernia never get strangulate,.. but paraoesophageal hiayus hernia may strangulate

gas gangren d6e to clostridial myonecrosis

If BP unusual recheck the cup size

serum sodium 120mmol/ml means decresed extracelluler osmolality

Repression

Explanations > Behaviours > Coping > Repression

Description | Example | Discussion | So what?

 

Description

Repression involves placing uncomfortable thoughts in relatively inaccessible areas of the subconscious mind. Thus when things occur that we are unable to cope with now, we push them away, either planning to deal with them at another time or hoping that they will fade away on their own accord.

Labyrinthitis is an inflammatory disorder of the inner ear, or labyrinth. Clinically, this condition produces disturbances of balance and hearing to varying degrees and may affect one or both ears

Vestibular neuronitis may be described as acute, sustained dysfunction of the peripheral vestibular system with secondary nausea, vomiting, and vertigo

Vestibular neuronitis is unlikely if any of the following findings are present. The following symptoms should be absent:

Multidirectional, nonfatiguing nystagmus suggesting vertigo of central origin

Hearing loss

Other cranial nerve deficits

Truncal ataxia (suggests cerebellar disease or another CNS process)

Inflamed tympanic membrane

Mastoid tenderness

High fever

Nuchal rigidity

Ménière disease is a disorder of the inner ear that is also known as idiopathic endolymphatic hydrops. Endolymphatic hydrops refers to a condition of increased hydraulic pressure within the inner ear endolymphatic system. Excess pressure accumulation in the endolymph can cause a tetrad of symptoms: (1) fluctuating hearing loss, (2) occasional episodic vertigo (usually a spinning sensation, sometimes violent), (3) tinnitus or ringing in the ears (usually low-tone roaring), and (4) aural fullness (eg, pressure, discomfort, fullness sensation in the ears).

Absolute contraindications for ERCP include patient refusal to undergo the procedure; unstable cardiopulmonary, neurologic, or cardiovascular status; and existing bowel perforation.

post ERCP

Patients at higher risk for development of PEP, the most common serious complication associated with this procedure, include patient-related factors, procedure-related factors, operator-dependent factors, and underlying disease or indication for performing ERCP.

Persons who inject illegal drugs with nonsterile needles or who snort cocaine with shared straws are at highest risk for HCV infection. In developed countries, most new HCV infections are related to intravenous drug abuse (IVDA).

Hereditary spherocytosis (HS) is a familial hemolytic disorder associated with a variety of mutations that lead to defects in red blood cell (RBC) membrane proteins. The morphologic hallmark of HS is the microspherocyte, which is caused by loss of RBC membrane surface area and has abnormal osmotic fragility in vitro.

pediatric cases, splenectomy ideally should not be performed until a child is older than 6 years because of the increased incidence of postsplenectomy infections with encapsulated organisms such as S pneumoniae and H influenzae in young children.

Symptoms

 Collapse Section

Symptoms has been expanded.

Damage to the basal ganglia cells may cause problems with one's ability to control speech, movement, and posture. This combination of symptoms is called parkinsonism.

A person with basal ganglia dysfunction may have difficulty starting, stopping, or sustaining movement. Depending on which area is affected, there may also be problems with memory and other thought processes.

In general, symptoms vary and may include:

Movement changes, such as involuntary or slowed movements

Increased muscle tone

Muscle spasms and muscle rigidity

Problems finding words

Tremor

Uncontrollable, repeated movements, speech, or cries (tics)

Walking difficulty

Huntington's Disease

Huntington's disease is a hereditary disease that causes defects in behavior, cognition, and uncontrolled rapid, jerky movements. Evidence shows that the basal ganglias in patients with Huntington's Disease show a decrease in activity of the mitochondrial pathway

meningitis lumbar puncture - Google Search

Neurofibromatosis type 1 (NF1)

This affects 1 in 3000 live births. It is an autosomal dominant, highly penetrant condition. One-third have new mutations.

In order to make the diagnosis, two or more of these criteria need to be present:

Six or more café-au-lait spots >5 mm in size before puberty, >15 mm after puberty (Fig. 27.18)

More than one neurofibroma, an unsightly firm nodular overgrowth of any nerve

Axillary freckles (Fig. 27.18)

Optic glioma which may cause visual impairment

One Lisch nodule, a hamartoma of the iris seen on slit-lamp examination

Bony lesions from sphenoid dysplasia, which can cause eye protrusion

A first-degree relative with NF1.

BCC

BCC typically found sun expose are,, but can see in other ares too,

 but SCC can only see sun expose area

melanoma good prognosis less than 7mm

BCC AND MALIGNENET MELANOMA rarely involve in lips..

usually Scc in the lip

herpeas simples leasions are painful self limiting within a week

cold sore=herpes simples eruptions

adipose dolorosa( dercum disease)

diffusely paifil subcutemious fat deposision

 focal discrete lump

 middle age women

 specially in abdomen and thigh

desmoid tumour.  or epidemoid cyst

locally agressive , well differentiated, firm ovwrgroth  of fibrous tissue

locally agressive

commnly arise from rectus abdomonalis muscle

hx of trauma or sx in 1of4

ingrowing toe nail() and paranoichia are diffrent

ingrowing toe nai(onchocriptosis)

ingrowing toe nail - Google Search

amauosis fugus (fleeting transient visual loss)

thytoidbcs

1,papilary...common in young adult

2.medullary..folliculer,,dificult to diffentiate from benign adenoma.. bone mets+... bld spread..pathological fractures

3.medullary..least common,,part of the MEN

Central Retinal Artery Occlusion

Treatment

Medical Care

Immediate lowering of intraocular pressure includes acetazolamide 500 mg IV or 500 mg PO once.

Topical medications are used to lower intraocular pressure.

Further treatments are as follows:

Some physicians recommend carbogen therapy (5% CO 2, 95% O 2): CO 2 dilates retinal arterioles, and O 2 increases oxygen delivery to ischemic tissues. Perform for 10 minutes every 2 hours for 48 hours. There is no Level 1 scientific evidence that is effective however.

Hyperbaric oxygen therapy (HBOT) may be beneficial if begun within 2-12 hours of symptom onset. Institute treatment with other interventions first, as transport to a chamber may usurp precious time. There is no Level 1 evidence that the improvement noted after hyperbaric oxygen therapy is sustainable however.

Retinal Artery Occlusion

Treatment

Prehospital Care

No specific prehospital treatment is available for retinal artery occlusion. The prognosis for visual recovery is related directly to the promptness in treatment; thus, rapid transport to the ED is essential.

Emergency Department Care

The 2 phases of ED care must occur. The first phase involves rapid detection and treatment of visual loss. The second phase involves a thorough investigation for the cause of visual loss.

No randomized controlled trials to support one treatment modality over any others are underway, but anecdotal reports and case series have suggested many modalities of treatment.

Immediate lowering of IOP to a target pressure of 15 mm Hg using medical management, ocular massage, and anterior chamber paracentesis

Ocular massage

Apply direct pressure for 5-15 seconds, then release. Repeat several times.

Increased IOP causes a reflexive dilation of retinal arterioles by 16%.

A sudden drop in IOP with release increases the volume of flow by 86%.

Ocular massage dislodges the embolus to a point further down the arterial circulation and improves retinal perfusion.

Anterior chamber paracentesis

Advocated when visual loss has been present for less than 24 hours

Early paracentesis is associated with increased visual recovery.

Slit-lamp removal of 0.1-0.4 mL of aqueous humor via tuberculin syringe and a 27-gauge needle may decrease IOP to 3 mm Hg.

Decrease in IOP is thought to allow greater perfusion, pushing emboli further down the vascular tree.

Other treatments

See Medication for details and mechanisms of action for medications.

Start timolol early in the treatment of CRAO, as this is readily available in most emergency departments. Acetazolamide and mannitol should also be used when CRAO is suspected because there are few downsides to starting these medications early.

In carbogen therapy (5% carbon dioxide, 95% oxygen), carbon dioxide dilates retinal arterioles, and oxygen increases oxygen delivery to ischemic tissues.

Thrombolytics may be useful if initiated within 4-6 hours of visual loss, but they may not be much help if the embolus is cholesterol, talc, or calcific. Thrombolytics are introduced via the proximal ophthalmic artery, delivering increased concentrations directly to the retinal artery and minimizing systemic complications.[3] Results of noncontrolled retrospective studies have been mixed. As of 2007, a European controlled study is underway.[4]

Hyperbaric oxygen (HBO) therapy may be beneficial if initiated within 2-12 hours of onset of symptoms. Institute treatment with other interventions first; transport to a chamber may usurp precious time. Results from noncontrolled studies have been mixed. A 2001 controlled study in Israel showed a benefit in the treatment group.[5] In this study, all patients were treated within 8 hours of symptom onset.

Treatment with IV thrombolytics as with cerebral infarction has been discussed[6, 7, 8] but currently is not the standard of care.

Brown-Sequard syndrome

is caused by damage to one half of the spinal cord, resulting in paralysis and loss of proprioception on the same (or ipsilateral) side as the injury or lesion, and loss of pain and temperature sensation on the opposite (or contralateral) side as the lesion.

- Wikipedia, the free encyclopedia

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