GLOBAL NETWORK OF PASSIONATE DOCTORS & MEDICAL STUDENTS

TURP (Transurethral Resection of the Prostate)

2009-12-01T16:52:00.001+05:00

Heart Rhythm Abnormalities (Part 1)

2009-12-01T16:32:00.005+05:00

Heart Rhythm Abnormalities (Part 2)

2009-12-01T16:32:00.003+05:00

Free Books of Medicine

2009-12-01T16:17:00.000+05:00

Following are the links for downloading some of the best books on the subject of medicine . . they are easily downloadable and absolutely free . . . we will keep adding the links of other valuable books from time to time

EMERGENCY - An Introduction to Clinical Emergency Medicine.pdf
http://www.4shared.com/file/54365050/ae282b7b/EMERGENCY_-_An_Introduction_to.html?s=1

Davidson s Principles and Practice of Medicine 2006 20ed.pdf
http://www.4shared.com/file/151612297/201b4921/Davidson_s_Principles_and_Prac.html?s=1

Harrison's Principles of Internal Medicine 16th Edition.PDF
http://www.4shared.com/file/159794073/57d9fd07/Harrisons_Principles_of_Intern.html?s=1

oxford_handbook_of_clinical_medicine.rar
http://www.4shared.com/file/29579765/3add877e/oxford_handbook_of_clinical_me.html?s=1

Kumar & Clark - Clinical Medicine 6E.rar
http://www.4shared.com/file/48884345/a35e13c1/Kumar__Clark_-_Clinical_Medici.html?s=1

Color Atlas and Text of Clinical Medicine 2nd ed Forbes Jackson.rar
http://www.4shared.com/file/60988259/4271219b/Color_Atlas_and_Text_of_Clinic.html?s=1

pathophysiology of disease An Introduction to Clinical Medicine, 5th Edition.rar
http://www.4shared.com/file/74042386/d3055050/pathophysiology_of_disease_An_.html?s=1

Mayo Clinic Internal Medicine 8th.pdf
http://www.4shared.com/file/77562622/33a96666/Mayo_Clinic_Internal_Medicine_.html?s=1

Differential Diagnosis in Internal Medicine (2007).pdf
http://www.4shared.com/file/94805682/432d5884/Differential_Diagnosis_in_Inte.html?s=1

Lange Q&A - Internal Medicine, 4th Ed.pdf in zip
http://www.4shared.com/file/83661552/c7e0a507/Lange_QA_-_Internal_Medicine_4.html?s=1

Lumbar Fusion Surgery

2009-11-30T22:31:00.001+05:00

Heart Surgery 101, with Dr. Oz

2009-11-25T01:36:00.001+05:00

An insight into Radiotherapy

2009-11-25T01:30:00.001+05:00

2009-11-24T10:13:00.000+05:00

|USMLE Help| is our unique upcoming series in which we will include help from General overview of this Exam , Tips to preapre & perform well all the way to Review questions for step 1 and 2 . . . . . all comming soon ( 10th december)

2009-11-24T10:10:00.000+05:00

This Blog Page has been Officially Launched on Test Basis From 23rd November 2009
Data is being fastly arranged and uploaded to the site . .

SILS/LESS EndoEye Laparoscopic Camera

2009-11-20T20:55:00.001+05:00

Lap Band Surgery

2009-11-18T22:53:00.001+05:00

2009-11-18T11:30:00.000+05:00

What is the MRCP(UK) Examination

The three Royal Colleges of Physicians of the United Kingdom share a common membership examination in general medicine: this is the examination for the Diploma of Membership of the Royal Colleges of Physicians of the United Kingdom. Successful candidates are eligible to apply for the award of the MRCP(UK) Diploma. Read more about the place of the MRCP(UK) Examination in medical training, you can also read more about the history of the MRCP(UK) Examination.

What is the Specialty Certificate Examination

The Federation of Royal Colleges of Physicians of the UK, in association with the Specialist Societies, has developed a programme to deliver Specialty Certificate Examinations within the new specialist training structure. The aim of these national assessments, which will complement workplace-based assessments, is to ensure that trainees have sufficient knowledge of their specialty to practice safely and competently as consultants.

The MRCP(UK) Examination provides information on candidates’ core medical knowledge, basic clinical problem solving skills and the management of common and important medical emergencies. The core medical knowledge and skills tested in the MRCP(UK) Examination provide the very basis that equips doctors to proceed to focus on individual specialties, secure in their grounding in other systems. In recognition that the rate of acquisition of core medical knowledge and practical clinical skills may differ the MRCP(UK) Management Board decided that the MRCP(UK) Part 2 Written and Part 2 Clinical (PACES) Examinations may, from 2009, be taken in any order. In addition, to ease the time pressures on trainees, the MRCP(UK) Part 1 Examination has been made available sooner and the "18 month rule" revised to allow examination entry once 12 months have elapsed after graduation.

The changes in respect to eligibility for and entry to the MRCP(UK) Examination will be applicable to UK and International candidates

Tenth Case: Could it be easier ?

2009-11-12T14:55:00.000+05:00

One day as you were looking having a boring shot at your ED job, a 24-year-old male with no significant medical history presented to the you complaining of several hours of substernal chest pain after using cocaine daily for the preceding six days. His last cocaine use was 24 hours prior to presentation He described the chest pain as central,pressure-like,constant and non-radiating. He also reported associated palpitations shortness of breath and diaphoresis, as well as several days of insomnia and anorexia. He had been drinking tequila for the past 24 hours in an effort to “calm himselfdown.”you performed the PE and found :

GENERAL APPEARANCE: appeared well developed and well nourished, anxious and diaphoretic, and in no acute discomfort.

VITAL SIGNS
Temperature 99.1 F(37.3 C)
Pulse 132 beats/minute
Blood pressure 150/92 mmHg
Respirations 24 breaths/minute
Oxygen saturation 98% on room air

Head Eyes & ENT: PERRL, EOMI, dry mucousmembranes.

NECK: Supple, nojugular venous distension.

CARDIOVASCULAR: Tachycardic rate, regular rhythm without rubs,murmurs or gallops.

LUNGS: Clear to auscultation bilaterally.

ABDOMEN: Soft, nontender,nondistended.

EXTREMITIES: No clubbing, cyanosis or edema, brisk radial and dorsalis pedis pulses.

SKIN: Warm and moist,no rashes.

NEUROLOGIC: Nonfocal.
you place the patient on the cardiac monitor, a peripheralintravenous line was placed and blood was drawn and sent for laboratory testing.A 12-lead ECG was obtained(Figure given).

tell the differentials diagnosis and your style of proceeding to treat the guy

Ninth Case : Back to the Swing

2009-11-12T14:37:00.000+05:00

After getting such a long and unexpected respite you were fresh and ready for some new fun at the job . you hadn't seen a child patient lately and the pediatrician inside you was longing for some satisfaction . That's when a patient answers your call in the form of a 6-year-old female with no significant medical history pre-senting with one day of weakness and inability to move her left arm. She denied trauma to the arm, pain or numbness. On examination, her left arm was completely flaccid (strength 0/5) with intact sensation and a normal radial pulse.Radiographs of the left arm and a non contrast CT of the brain were obtained. Both tests were normal, and the patient was admitted to the pediatric service. On hospital 2nd day an MRI of the neck was obtained, which was again normal. By this time, the patient had regained most of the strength in her left arm, that's when you discharged her home with the diagnosis of left brachial plexitis (ahh your brain waves). Eight days following discharge,the patient again presented to the ED, now with the chief complaint of left leg weakness (now what . . . ? ), plus there was worsening weakness in her left arm. Sh ewas having difficulty walking secondary to the leg weakness. She denied pain or numbness to the arm, and her parents denied recent trauma,fevers, illnesses,travel or sick contacts. Again you go for PE and find the following out :

GENERAL APPEARANCE: well nourished, well hydrated, nontoxicand in no acute discomfort.

VITALS
Temperature 98.2 F
Pulse 95 beats/minute
Blood pressure 100/60 mmHg
Respirations 20 breaths/minute
Oxygen saturation 100% on room air

Head Eyes & ENT: PERRL,EOMI, oropharynxpink and moist.

NECK: Supple, no midline tenderness,no meningeal signs.

CARDIOVASCULAR: Regular rate and rhythm without rubs, murmurs or gallops.
(Check out the Figure ) Coronal views of MRI of the brain (FLAIR image,panel A; T2-weighted image, panel B) from a 6-year-old female with left arm and leg weakness.

LUNGS: Clear to auscultation bilaterally.

ABDOMEN: Soft, nontender,nondistended.

EXTREMITIES: No clubbing, cyanosis or edema; strong and equal peripheral pulses,upperand lower extremities.

NEUROLOGIC: Alert and oriented to person, place and time; cranial nerves II–XII grossly intact. Right upper and lower extremity strength 5/5 proximal and distal, left upper extremity strength 3/5, left lower extremity strength 2/5. Bilateral knee, ankle and biceps reflexes 2+. Patient could ambulate but witha slow, wide-based gait.

you drew the blood and sample was sent for laboratory testing, and MRI of the brain was obtaine(Figure).Laboratory tests,including a complete blood count, electrolytes, creatinine, glucose and INR, were within normal limits.

what are the differentials , probable diagnosis and how do you wish to to proceed ??

Eighth Case : Back to the Easy Life

2009-11-12T14:35:00.000+05:00

Yet again the neuroconsultant episode turned out to be nothing more than nightmare and next day you found yourself at the same old job with unfathomable gratitude and relief (neuro was such a hell ) Today , A 72-year-old female came to you complainng of general body weakness and fatigue worsening over several months, as well as intermittent, bitemporal headaches. Recently, the patient reported increased difficulty getting out of bed in the morning because of her weakness. She had a past medical history significant for hypertension and depression She denied chest pain,shortness of breath,abdominal pain,fevers or chills, dysuria, focal weakness, visual changes and blood tinged or dark stools. The patient did report a decreased appetite as well as occasional nausea over the past several weeks. Her medications include paroxetine, venlafaxine, hydrochlorothiazide and verapamil.
She also denied tobacco or alcohol use,and told you that she lived alone.

You performed the PE and found the following :

GENERAL APPEARANCE: fatigued, dehydrated,awake and alert, and in no acute discomfort.

VITAL SIGNS
Temperature 98.1 F(36.7 C)
Pulse 80 beats/minute
Blood pressure 80/40 mmHg
Respirations 18 breaths/minute
Oxygen saturation 98% on room air

Head ,Eyes & ENT: PERRL,EOMI, visual fields intact, oropharynx dry.

NECK: Supple, no jugular venous distension.

CARDIOVASCULAR: Regular rate and rhythm with murmurs or gallops.

LUNGS: Clear to auscultation bilaterally.

ABDOMEN: Soft, nontender, nondistended, hypoactive bowel sounds noted.

RECTAL: Normal tone, brown stool,hemoccult negative.

EXTREMITIES: Warm, well-perfused without clubbing, cyanosis or edema.

NEUROLOGIC: Alert and oriented to person, place and time; upper extremity and lower extremity strength 5/5 proximal and distal;sensation grosslyi ntact;delayed biceps and patellar reflexes bilaterally.

You placed the patient on the cardiac monitor, placed a peripheral intravenous line , and blood was drawn and sent for laboratory testing. A 12-lead ECG was obtained (Figure),and a1-liter intravenous bolus of normal saline was infused. The blood pressure improved to 90/50 at completion of the NS infusion. A chest radiograph demonstrated
no infiltrate, effusion or cardiomegaly. A noncontrast CT of the brain showed only age-related atrophy without evidence of hemorrhage.

Tell your differentials & suggested diagnosis . . also tell how will you proceed and confirmation of diagnosis and treatment

Seventh Case : Hard Nut to Crack

2009-11-12T14:31:00.001+05:00

Somehow you have managed to get out of that ED job and become a consultant in neuromedicine but before you could really start to enjoy it , you were referred an extemely tough case . It was a 51-year-old man whose misery started some eight months ago when he developed paresthesias of both feet. This was followed within weeks by early satiety, postprandial vomiting of undigested food, and reduced frequency of bowel movements. He became completely unable to eat and lost 60 Ib. A J-tube was placed. He had a 21 packyear cigarette habit, naturally Doctors suspected some carcinoma but extensive studies for malignancy were negative. In the subsequent weeks, your patient developed dry mouth, orthostatic hypotension, lower extremity loss of sweating, and impotence d. Medical therapy failed to improve the gastrointestinal dysmotility. Eleven months into this illness, refractory simple partial and secondary generalized seizures developed, with postictal aphasia, headaches, short-term memory loss, depression, and night sweats.These are the circumstances when he comes to you

On Examination you found :
The pupillary light reflex was normal. Other findings included a mild reduction in short-term memory and asymmetric loss of pin and temperature sensations in a stocking distribution. His feet were dry. Measurement of blood pressure with the patient standing revealed orthostatic hypotension.

After aa series of investigations you came to know that his Autonomic studies documented orthostatic hypotension and a blunted heart rate response to a Valsalva maneuver. Sweating was reduced in the legs. Gastroparesis and delayed small-bowel transit time were demonstrated. At presentation, serum type 1 antineuronal nuclear autoantibody (ANNA-1) was detected (1:15, 360). Cranial magnetic resonance imaging (MRI) showed mild atrophy and increased fluid attenuation inversion recovery (FLAIR) signal in the left mesial temporal, insular, and opercular cortices (Figure). The results of an exploratory mediastinoscopy and a video-assisted thoracic surgery procedure were negative. Computed tomographic (CT) scans of the chest at 3-month intervals and positron emission tomographic (PET) scans were uninformative.

Now you have his MRI and reports on your table and you have to diagnose and treat this poor fellow

Sixth Case : No Picture to Confuse

2009-11-12T14:29:00.001+05:00

Today, you were in particularly bad mood due to my trickery in the last case and in office at your usual job, you really wanted to make some real show of brains . Cases were coming but none gave you the margin to show your talents. That's exactly when a 16-year-old boy presented to to you complaining of suprapubic pain radiating to the right testicle, dysuria, urgency and frequency for eight days. The patient was seen one week prior to this visit by his primary care provider (PCP), at which time he described the previous complaints as well as subjective fevers. At that time, the patient’s temperature was 99.2 F (37.3 C). He was noted to be well appearing and in no acute discomfort. The abdominal examination revealed mild suprapubic tenderness to palpation but without the presence of rebound or guarding, there was no costovertebral angle tenderness (CVAT) and his genitourinary (GU) examination was normal. A urinalysis was negative for infection and the patient was diagnosed with a viral syndrome. Three days prior to today's visit, the patient reported a temperature of 103 F (39.4 C) and severe suprapubic pain. The following day, the intensity of his pain diminshed some what and hisf ever resolved.In the ED,thepatient continued to complain of crampy abdominal pain at a level of 6 (on a scale of 0 to 10), with associated dysuria, urgency and frequency. He denied nausea,vomiting,diarrhea,constipation orpenile discharge, and was tolerating oral liquids.As is becoming your second nature now , you did the PE and found :

GENERAL APPEARANCE: lying supine on the gurney, appeared comfortable and in no acute discomfort.

VITAL SIGNS
Temperature 98.7 F(37.1 C)
Pulse 88 beats/minute
Blood pressure 120/80 mmHg
Respirations 20 breaths /minute
Oxygen saturation 100% on room air
Head , Eyes & ENT: PERRL, EOMI, oropharynx moist and rest unremarkable.

NECK: Supple.no abnormality whatsoever

CARDIOVASCULAR: Regular rate and rhythm without rubs,murmurs or gallops.

LUNGS: Clear to auscultation bilaterally.

ABDOMEN: Soft, nondistended; suprapubic, periumbilical and right lowerquadrant tenderness to palpation without rebound or guarding . No CVAT.

RECTAL: Normal tone, brown stool,hemoccult negative.

GENITOURINARY: Circumcised, no penile discharge, testes descended bilaterally, no testicular swelling or tenderness, no hernias.

EXTREMITIES: No clubbing,cyanosis or edema.

NEUROLOGIC: Nonfocal.

A peripheral intravenous line was placed by you, and blood was drawn and sent for laboratory testing. Laboratory tests revealed a leukocyte count of 16 K/µL with 84% neutrophils ; electrolytes, creatinine, glucose and urinalysis were within normal imits.

This is what you've got . . now you have to work out differentials , declare one as your suggested diagnosis and confirm it by minimum further investigations and then to treat the peatient considering your suggested diagnosis is right

Fifth Case : At Last a Young Man

2009-11-12T14:24:00.000+05:00

After solving the last case you woke up to find that whole peads thing was nothing but a dream and you are still working in ED . Feeling a mixture of emotions you set out for the Hospital and another boring day starts . . but something remarkable happens near lunch break. A 32-year-old man comes to you with a real mind twister. You take the history and learn that two weeks before coming to you, our patient awoke with discomfort in his right shoulder. Within a few days, the pain worsened significantly and involved both shoulders. He noted winging of the right scapula (figure). The pain was worse at night and was associated with a feeling of neck stiffness. Four days before evaluation, he noted a painful rash across his left shoulder. Because of superficial tenderness of the affected area, he avoided contact of the area by clothing. You also learn he had a past history of Crohn's disease.Now again you go for a PE

what you learn is this :

VITAL SIGNS
Temperature 99 F
Pulse 73 beats/minute
Blood pressure 128/82 mmHg
Respirations 17 breaths/minute
Oxygen saturation 98% on room air

Head Eyes & ENT:PERRL, EOMI , normal mucous membranes

NECK: Supple, nothing abnormal.

CARDIOVASCULAR: normal HR, regular rhythm without
rubs,murmurs or gallops.

LUNGS: Clear to auscultation bilaterally.

ABDOMEN: Soft, nontender,nondistended.

EXTREMITIES: No clubbing,cyanosis or edema.

NEUROLOGIC: The neurologic examination demonstrated only winging of the right scapula (Figure). There was a rash on an red base overlying the left scapula.

You go for investigations and find that the results of nerve conduction studies are normal. There were spontaneous fibrillation potentials but no motor unit potentials under voluntary control in the right serratus anterior muscle. Cerebrospinal fluid analysis showed five nucleated cells per microliter (85% lymphocytes, 9% mononuclear cells, 3% neutrophils, and 3% macrophages), increased protein concentration and a normal glucose level. Culture of the vesicular lesion came negative for herpes simplex and varicella-zoster virus (VZV).

Now whats your diagnosis?

How are you goin to proceed with everything?

Fourth Case : Another Toddler in a Different World

2009-11-12T14:22:00.001+05:00

One morning you woke up to discover that the world had changed and somehow you had become a peads consultant . you were still pondering over the implications of this new life in your office when a 24-month-old boy presented to you with no speech, unsteadiness when standing, and a history of seizures since 12 months of age. He was the product of a normal pregnancy, labor, and delivery. He had no speech or syllables, made poor eye contact, and had poor social interactions. He sat at 10 months of age, was able to pull to stand at 17 months, but was unable to walk. He was unsteady in his movements. The seizures occurred when he came out of sleep with jerk-like movements of the arms and then generalized shaking. The seizures were unresponsive to various anticonvulsant agents. He would sleep for only 4 to 6 hours per day and was often awake for much of the night.

As your usual way in the past life, you performed the PE and found :
The head circumference was at the 5th percentile and had decreased from the 50th percentile at birth; height and weight were at the 75th percentile. He had poor eye contact, small optic nerves, central hypotonia with peripherally increased tone, decreased but present deep tendon reflexes, down-going plantar responses, and truncal and appendicular ataxia. who else to turn to except the Lab ?

Investigations gave you the following:
The blood glucose level was 70 mg/dL , and the initial lactate level was 6.1 mmol/L (Ouch . . it's high). The lactate measurement was repeated several more times, and the mean level was 4.2 mmol/L; the mean pyruvate level was 0.18 mmol/L . Measurement of serum amino acids showed an increased level of alanine. Ammonia, chromosomes (46 XY), urine organic acids, acylcarnitines, very long chain fatty acids, phytanic acid, and screening tests for Smith-Lemli-Opitz syndrome were all normal.
you went for muscle biopsy and found results were also normal, including special studies for enzymes of the electron transport chain. Mitochondrial DNA analysis was normal. Electroencephalography showed multifocal spikes and generalized spike-and-wave activity. Findings on magnetic resonance imaging of the head were normal. A skin biopsy specimen failed to show any cytoplasmic inclusions. The electroretinogram was abnormal.

You kept thinking what additional investigation to perform . . at last brain wave tells you to go for southern blot and the only thing that comes as result is abnormal methylation pattern.

Now tell the differentials and suspected diagnosis ?

(don't tell me he's got autism cause i already know)

How are you going to proceed?

Third Case : An Extra Stimulant

2009-11-12T14:20:00.000+05:00

Another day with the same boring series of cases at your job in Emergency is taking its toll on you , you have started to feel the monotony of the affair and go out for a while to fix yourself with a hot steaming cup of cream coffee and a little fresh air to stimulate you up . On your return you find a nice young couple waiting for you with their 22 -month-old baby which seems to be a male .The mother explains that the reason of family's arrival happens to be several episodes of vomiting in baby that began in the middle of the night.The baby had been having intermittent bouts of vomiting beginning two weeks earlier.He had been seen on three separate occasions, diagnosed with acute gastroenteritis. The parents reported that between the bouts of vomiting, their son maintained a very poor appetite and had experienced some weight loss.On this visit,the parents reported the first episode of emesis beginning10 hours prior to their arrival,followed by three more episodes. The patient had refused to take fluids during this period. The family denied recent travel or sick contacts, and the child had not experienced fevers, cough, congestion or diarrhea.
His medical history is significant for a similar episode occurring three months earlier and lasting approximately one week. The patient had no other medical problems and had
been prescribed Phenergan suppositories and Zantac for his symptoms;no Phenergan was given prior to this visit. As usual you proceed with PE

GENERAL APPEARANCE: awake, making good eye contact, but appearing listless and very fatigued.

VITAL SIGNS
Temperature 98.9 F(37.2 C)
Pulse 64 beats/minute
Blood pressure 110/60 mmHg
Respirations 24 breaths/minute
Oxygen saturation 100% on room air
Head Eyes & ENT: Atraumatic, normocephalic, PERRL, EOMI, oropharynx moist.

NECK: fine , no meningeal signs.

CARDIOVASCULAR: Bradycardic,regular rate and rhythm without rubs,murmurs or gallops.

LUNGS: Clear to auscultation bilaterally.

ABDOMEN: Soft, nontender,nondistended,active bowel sounds present.

EXTREMITIES: No clubbing, cyanosis or edema, capillary refill less than 2 sec.

NEUROLOGIC: Awake, following commands, moving all extremities.

An ECG plus chest and abdominal radiograph is obtained.
The ECG demonstrated sinus bradycardia, otherwise normal for age. The combined chest and abdominal radiograph is shown in Figure . A peripheral intravenous line was placed, and blood was drawn and sent for laboratory testing. A 20 mL/ kg bolus of normal saline IV was administered.Now you were hoping something useful from the Lab but the tests, including a complete blood count, electrolytes, glucose, creatinine and urinalysis,are all so normal.

You admit him for observation. Approximately nine hours after admission, the patient had a witnessed tonic clonic seizure that resolved with intravenous lorazepam. you also note that vomitting bouts worsen around midnight to morning time

Now again , What's your suspected diagnosis?

and how are you going to proceed ??

Second Case : An Old Lady Answers your Dreams

2009-11-12T14:18:00.000+05:00

You are still working at Emergency and today you're in a great mood to solve some real though case. obviously inspired by House, M.D's latest episode you watched last night .That's exactly when an 81-year-old female presents to the you complaining of one day of intermittent, diffuse abdominal pain with a medical history of coronary artery disease, remote history of coronary bypass surgery, and successful endovascular stent placement for abdominal aortic aneurysm (AAA) three months earlier. The patient denied associated nausea or vomiting, fevers, dysuria, chest pain or shortness of breath. She reported a normal bowel movement earlier in the day without blood or black stool. Her episodes of abdominal pain were reported to occur approximately every 20 minutes, with complete resolution of her pain between episodes. The patient had undergone an abdominal CT one month earlier, which demonstrated a stable AAA with stent in place.this coming and going of pain quite baffled you up but before getting totally freaked out you knew one last thing to do , you performed PE :

GENERALAPPEARANCE: An elderly female who
appeared well hydrated and in no acute discomfort.

VITAL SIGNS
Temperature 98.1 F(36.7 C)
Pulse 76 beats per minute
Blood pressure 128/60 mmHg
Respirations 16 breathsper minute
Oxygen saturation 97% onroom air

Head Eyes & ENT: PERRL, EOMI, no scleral icterus, oropharynx pink and moist.

NECK: Smooth, no jugular venousdistension.

CARDIOVASCULAR: Regular rate and rhythm without rubs, murmurs or gallops.

LUNGS: Clear to auscultation bilaterally.

ABDOMEN: Soft,mildly distended with increased tympany and hypoactive bowel sounds present.Nontender without a pulsatile mass.

RECTAL: Normal tone, soft,brown stool,hemoccult negative.

EXTREMITIES: Well perfused without clubbing, cyanosis or edema.

NEUROLOGIC: Nonfocal.

You palced an IV line, blood was drawn and sent for laboratory testing. Laboratory tests, including a complete blood count, electrolytes, creatinine, glucose, serum lactate and urinalysis, were all within normal limits. During the patient’s stay, she was observed to have several intermittent bouts of severe abdominal pain,occurring approximately every 30 minutes.

You get a brain wave and a CT of abdomen & pelvis with oral and intravenous contrast is obtained
(figure given).

Now what's your diagnosis?

How do you think you're going to treat this wonderful old lady?

The First Case On an Unlucky Day

2009-11-12T14:16:00.001+05:00

One fateful morning you find yourself in the Emegergency as the duty MO and by further push of luck the first patient you encounter is A 76-year-old female with a medical history significant for hypertension, hypothyroidism, hyperlipidemia and chronic renal insufficiency presented to the ED after fainting while hopping. She reported feeling light headed and dizzy while walking in a grocery store, at which time she experienced a brief loss of consciousness. She fell to the floor, bystanders called emergency services but she quickly regained consciousness. She denied head trauma or neck pain after the fall. She also denied chest pain but had been experiencing some shortness of breath with exertion over the past several weeks, as well as low back pain and bilateral thigh pain worse in the morning. She also noted gradually worsening vision in her right eye over the past week, increasing redness to that eye,and a mild, right-sided headache; her vision prior to this had been normal. Upon presentation to the ED, she could perceive light and vague shapes with the right eye. Her medcations included metoprolol, hydrochlorothiazide, Cozaar,evothyroxine, lovastatin and ibuprofen 400 mg orally twicedaily for low back pain.She denied tobacco use,drank alcoholoccasionally, lived alone and drove a car for transportation. You opt for PE and get the following information:

GENERAL APPEARANCE: The patient appeared well hydrated
and well nourished,and in no acute discomfort.

VITAL SIGNS
Temperature 98 F(36.6 C)
Pulse 54 beats/minute
Blood pressure 138/53 mmHg
Respirations 22 breaths/minute
Oxygen saturation 98% on room air
Visualacuity OS 20/50
OD light perception and hand
motion only (unable to count fingers)

Head Eyes & ENT: A traumatic, normocephalic,no afferent pupillary defect. Sclera of the right eye red and injected, no discharge. Tenderness to palpation over right forehead.No facial lesions or asymmetry noted.

NECK: Supple, no jugular venous distension.

CARDIOVASCULAR: Bradycardic rate, regular rhythm without
rubs,murmurs or gallops.

LUNGS: Clear to auscultation bilaterally.

ABDOMEN: Soft, nontender,nondistended.

RECTAL: Normal tone, brown stool,hemoccult negative.

EXTREMITIES: No clubbing,cyanosis or edema.

NEUROLOGIC: Visual acuity deficit of right eye (cranial nerve
II) as described;remaining neurologic examination nonfocal.

A peripheral intravenous line was placed and blood was drawn and sent forl aboratory testing. A12-lead ECG demonstrated sinus bradycardia ,rate56, without the presence of ST- T wave changes. A noncontrast CT of the brain was obtained (Figure given). Laboratory tests were significant for a leukocyte count of 12.6 K/µL with 81% neutrophils , hematocrit of 27% , creatinine of 1.7 mg/dL , (ESR) of 120 mm/hr and C-reactive protein (CRP) of 18.2 mg/dL

The electrolytes, glucose and troponin Iwere within normal limits ,and a urinalysis did not show signs
of infection.

What is your diagnosis ?

How are you going to manage it futher ?

About This blog

2009-11-08T11:03:00.002+05:00

THIS NETWORK FOR DOCTORS WAS CREATED WITH THE AIM OF BUILDING A UNIQUE DISCUSSION FORUM OR AN INTERNATIONAL COMMUNITY FOR ALL THE MEDICAL STUDENTS , PHYSICIANS, SURGEONS, DENTISTS, RNs (NURSES) ,GENERAL PRACTITIONERS AND SPECIALISTS ALIKE INCLUDING ALL OTHER PEOPLE RELATED TO HEALTH SCEINCES IN ANY POSSIBLE WAY . . . FOR ALL OF THOSE WHO REALLY REALLY LOVE WHAT THEY ARE DOING . . !

WE AIM TO CREATE A UNIQUE FORUM WHERE EVERY MEDICAL STUDENT , DOCTOR OR ANY HEALTH PRO CAN:

1. FIND A CHANCE TO SHARE THIER EXPERIENCES IN MEDICAL WORLD WITH FOREIGN COLLEAGUES

2. ASK FOR ACADEMIC HELP FROM THOSE WHO ARE SENIOR & HELP THOSE WHO ARE NEWER IN FIELD

3.LEARN ABOUT BEST MEDICAL SCHOOLS & CLINICAL SETTINGS FROM AROUND THE WORLD

4.REMAIN UPDATED ABOUT THE NEW DEVOLPMENTS & PRACTICES IN HEALTH SCEINCES

5. SHARE THE FUTURE PROSPECTS & JOB OPPERTUNITIES AROUND THE GLOBE.

6. COLLABORATE PROFESSIONALLY THROUGH EXCHANGE OF MEDICAL INFORMATION THROUGH CLINICAL CASE DISCUSSIONS , MEDICAL KNOWLEDGE & SURGURY VIDEO SHARING

7. PLAN ABOUT JOINT ACTIVITIES PERTAINING TO SOCIAL & CHARITY WORK.

8. FIND STUDY PARTNERS FOR MORE EFFICIENT PREPARATION OF VARIOUS EXAMINATION LIKE USLME , MRCP , AMC , MRCS , MRCPH , PLAB, MRCOG

9. DISCUSS ABOUT THE POSSIBITILES OF POST GRADUATION IN FOREIGN UNIVERSITIES OF INTERNATIONAL REPUTE

10. SEEK FOREIGN FRIENDS RELATED TO THEIR OWN PROFESSION.

11.SEEK MENTORSHIP , SEARCH FOR ROOM MATE OR LIVING PLACE IF THEY ARE MEDICAL STUDENTS IN A FOREIGN COUNTRY.

12. AND SIMPLY STAY IN TOUCH AND INTERACT WITH FELLOWS AND COLLEAGUES :-)

THIS GROUP AIMS TO BE THE HOME OF ALL THE DOCTORS FOR WHOM NOTHING IS MORE FUN THAN SUCCESSFULLY TREATING A LETHAL CONDITION , NOTHING MORE ADVENTUROUS THAN CARRYING OUT A SUCCESSFUL , SMOOTH & CLEAN SURGURY , NOTHING MORE RELISHING THAN MAKING AN INTELLIGENT DIAGNOSIS OR PACING UP A DYING HEART. . .

AND ALSO FOR ALL THOSE MEDICAL STUDENTS TOO WHOSE WORLDS ROCK WHEN THEY SEE A SUFFERING HUMAN CURED . . GET TO LEARN A NEW CONCEPT OF MEDICINE , A NEW SKILL AT SURGURY . . WHO LOVE TO DREAM OF BEING A GREAT PRACTITIONER OF MEDICINE OR SURGURY

LET US ALL BE TOGETHER AT ONE PLACE TO SHARE OUR EXPERIENCES AND KNOWLEDGE . . . ALL OF US LUCKY SOULS ENDOWED WITH THE MAGNIFICENT ART OF HEALING

WELCOME TO THE PREMIUM INTERNATIOANAL COMMUNITY FOR DOCTORS AND MEDICAL STUDENTS FROM AROUND THE WORLD