Lost Your Password?
You have reached of 163 points, ( %)
Vegetative-vascular dysfunction is also referred to as Somatoform autonomic dysfunction. This is a clinical syndrome that includes disorders of human systems and organs with various origin and manifestations. The vegetative (autonomous) nervous system that has two main branches, the sympathetic branch and the parasympathetic system, provides innervation of internal organs. These systems produce an opposite effect on a human body. Normal systems are balanced, whereas the somatoform autonomic dysfunction disturbs the balance and the effect of either sympathetic or parasympathetic system predominates.
In the case of rheumatism, the heart valves will be affected with an underlying streptococcal infection. The appearance of no changes in cardiac borders on percussion rules out the option of carditis.
Stage 1: Renal hypertrophy and hyperfiltration – glomerular filtration rate may be increased 20 - 40%
Stage 2: Is clinically ‘silent’ but hyperfiltration persists and is correlated with mild hyperglycemia
Stage 3: Microalbuminuria is present
Stage 4: Overt nephropathy with proteinuria, hypertension and progressive renal failure
Stage 5: End-stage renal failure develops
Notice that this patient has scarlet fever which is characterised by the presented symptoms; fever, difficulty swallowing, hyperemic soft palate/ tongue, skin rash on flexors and folds, pale nasolabial triangle. This disease is as a result of a Group A streptococcal or streptococcus pyogenes infection. For its treatment an antibiotic regimen should be followed; the preferred choice of antibiotics is Penicillin or Amoxicillin.
The key point here is ‘ Insulin and infusion of isotonic solutions of sodium chloride and glucose eliminated these problems’ which confirms this patient has a type 1 diabetes mellitus ( insulin dependent). Recall that type 1 insulin diabetes mellitus is usually noticed at a young age whereas type 2 ( non- insulin dependent) is observed at the latter ages of life as well as in obesed individuals. Renal glucosuria is seen when the kidney excretes glucose with urine in individuals with normal or low blood glucose level. Diabetes insipidus is related to the antidiuretic hormone also called vasopressin. In this case, the individual excretes large volumes of urine.
Acute hematogenous osteomyelitis is an infection of the bone usually caused by a bacteria and common in children less than 5 years; typically affects the metaphysis of long tubular bones. Children present with fever, localized pain, swelling, and rarely erythema around a long bone, limited range of motion, and limping or refusal to bear weight or use an extremity (pseudoparalysis). Brodie's abscess is a sub-acute form of osteomyelitis, presenting as a collection of pus in bone. Classically, this may present after progression to a draining abscess extending from the tibia out through the skin.
From observation, this patient presents with an enlarged thyroid gland,exophthalmos ( eyeballs bulging out), tachycardia. These are characteristic findings in a patient with hyperthyroidism ( thyrotoxicosis- excess circulating thyroid hormone). Tremors, weight loss and fatigue are other vital signs that can be seen in such patients. Hypothyroidism will present with the exact opposite symptoms ie., weight gain, slow metabolic rate, bradycardia etc. The parathyroid gland produces parathormone; a hormone responsible for regulating blood calcium and phosphorus level.
Note that this baby is actually experiencing Erythema toxicum neonatorum (ETN); an erythemic process usually seen in full term infants. It starts on the first day after birth and usually fades away within a week. Erythema nodosum is a type of skin inflammation that is located in a part of the fatty layer of skin. Erythema nodosum results in reddish, painful, tender lumps most commonly located in the front of the legs below the knees. The tender lumps, or nodules, of erythema nodosum range in size. Transient erythema occurs as a result of loss of hair ( maybe due to exposure to radiation) and neurological changes.
By definition cerebral edema is the excess accumulation of water in the intra-and/or extracellular spaces of the brain. The most rapid and effective means of decreasing tissue water and brain bulk is osmotherapy. Osmotic therapy is intended to draw water out of the brain by an osmotic gradient and to decrease blood viscosity. These changes would decrease ICP and increase cerebral blood flow (CBF). Mannitol is the most popular osmotic agent. However, prolonged administration of Mannitol results in an electrolyte imbalance that may override its benefits and that must be carefully monitored. Nursing care of the patient receiving Mannitol requires vigilant monitoring of electrolytes and overall fluid balance and observation for the development of cardiopulmonary complications in addition to neurological assessment.
Dejerine Klumpke’s palsy occurs when there is a traction or tear of the lower trunk: C8-TH1 roots. In infants, it is caused as a result of upward force on the arm during delivery while in adults it occurs after trauma. This condition affects the intrinsic hand muscles ( lumbricals, interossei, thenar and hypothenar). This condition is characterised by a total claw hand ( see image ) because the lumbrical muscles normally flex the metacarpophalangeal joints and extend the Distal and proximal interphalangeal joints. In Duchenne Erb’s palsy ( waiter’s tip hand), there is a traction or tear to the upper trunk: C5-C6 roots. It is caused by the lateral traction of the neck during the delivery of infants. It affects the deltoid (abduction), Infraspinatus ( lateral rotation) and biceps brachii ( flexion and supination). Horner’s syndrome is characterised by Ptosis ( slight drooping of the eyelid), Anhidrosis ( absence of sweating) and Miosis ( pupil constriction)
Kehr’s sign- pain in the left shoulder ( due to irritation of the under surface of the diaphragm). Murphy’s sign pain during inspiration while palpating the right subcostal region. Ortner\'s sign painfulness at the easy pushing on the right costal arch by the edge of the palm. These signs are positive in conditions related to the gallbladder eg cholecystitis, cholelithiasis etc.Chronic cholecystitis refers to a long term inflammation of the gallbladder. It is characterised by flatulence, abdominal distension and discomfort, nausea and fat intolerance. Diagnosed with the help of ultrasound. Acute Pancreatitis will be accompanied by epigastric or central abdominal pain that radiates to the back and is relieved when sitting forward. Periumbilical bruising ( Cullen’s sign) or on the flanks ( Grey turner’s sign) are key findings in this pathology.
Note that acute bronchiolitis and Acute bronchitis are very similar and basically present with almost the same symptoms. One key difference is the age range of people affected ; Bronchitis is found in individuals of all age ranges although mostly seen in older children and adults while bronchiolitis is only found in younger children especially below 2 years. From analysis, we hear vesicular tympanic sound and bubbling rales / crackles - these can be found in both diseases; but the key difference here is the age of the child (3 months).
Chiefly, we can notice a trend of allergic diseases running in the family tree. Parental history of allergic conditions are strong risk factors for atopic dermatitis in the child. Atopic dermatitis is an inflammatory skin disease that is characterised by itching, redness, and scaling of the skin, predominantly in the skin creases. This patient is allergic to citrus fruits. Atopic dermatitis is a systemic chronic allergic disease that occurs in people with an inherited predisposition to atopy and characterized by typical morphological changes of the skin with itching, lesions of the central and autonomic nervous system, endocrine and immune systems with hyper IgE. Essential criteria for diagnosis: itch, rash elements`, typical morphology and localization (flexor surface of extremities in adults (lichenification), extensor surfaces and face in children (eczema)), chronic recurrent course, atopic diseases in personal and family anamnesis (bronchial asthma, allergic rhinitis).
Atopic dermatitis is a chronic disease that affects the skin. The word "dermatitis" means inflammation of the skin. "Atopic" refers to a form of allergy in which a hypersensitivity reaction such as eczema or asthma may occur in a part of the body not in contact with the allergen. In atopic dermatitis, the skin becomes extremely itchy and inflamed, causing redness, swelling, cracking, weeping, crusting, and scaling. For allergy related diseases, total IgE is increased in blood. Recall That these diseases are classified under Type 1 hypersensitivity reaction ( IgE mediated). IgM indicates a recent infection while IgG is seen in chronic phases of an infection.
Juvenile rheumatoid arthritis is the most common cause of arthritis in children. The most common features of JRA are: joint inflammation, joint contracture (stiff, bent joint), joint damage and/or alteration or change in growth. Other symptoms include joint stiffness following rest or decreased activity level (also referred to morning stiffness or gelling), and weakness in muscles and other soft tissues around involved joints. Coupled with the presented signs, the age of the patient helps us put the diagnosis of juvenile rheumatoid arthritis. Reactive arthritis is an autoimmune condition that develops in response to an infection in another part of the body. Coming into contact with bacteria and developing an infection can trigger reactive arthritis. It has symptoms similar to various other conditions collectively known as "arthritis,".
Notice that the patient above experiences abnormal blood discharge with no reproductive organ ( recto-abdominal) pathology; this indicates a case of Dysfunctional Uterine bleeding ( juvenile form- since it occurs at child age and in period of pubescence). A dysfunctional uterine bleeding (DUB) is the bleeding, not associated with organic diseases of women’s genitals, interrupted pregnancy or systemic diseases of the organism. Adenomyosis is a condition in which the inner lining of the uterus (the endometrium) breaks through the muscle wall of the uterus (the myometrium). Adenomyosis can cause menstrual cramps, lower abdominal pressure, and bloating before menstrual periods and can result in heavy periods. Werlhof’s disease is also known as immune thrombocytopenic purpura.
The term ‘quinsy’ also known as peritonsillar abscess refers to an inflammation of the throat, especially an abscess ( pus filled cavity) in the region of the tonsils. Notice that results from Mesopharyngoscopy shows hyperemia and bulging of the posterior wall of the oropharynx. One major complication of Quinsy is Retropharyngeal abscess which refers to the accumulation of pus behind the pharynx (as seen from the Mesopharyngoscopy ). Other possible complications include sepsis, pneumonitis etc.
The above symptoms manifested i.e dyspnea, barking cough, stenotic respiration is a sign of croup that is manifested in Laryngotracheitis, which itself is one of the complications of Measles. Bronchitis will present with productive cough, along with wheezing sound during respiration Pneumonia- for the above question they didn’t mention any characteristic symptoms involving lower respiratory tract like dyspnea on exertion, sputum with green or yellow colour/ rusty sputum Quinsy : comes with throat pain, trouble opening mouth, change of voice but not with barking cough or dyspnea normally.
Recall that the normal ejection fraction ranges from about 50-70%. A diastolic heart failure usually occurs due to the stiffness of the Left ventricle and its inability to relax properly. In this type of HF, the ejection fraction is usually preserved as opposed to a systolic heart failure which has a reduced ejection fraction due to the inability of the left ventricle to contract properly. Note that Systolic Heart failure is also referred to as Heart failure with reduced ejection fraction (HFrEF) while the diastolic form is also referred to as Heart Failure with preserved ejection Fraction ( HFpEF).
The term subarachnoid hemorrhage (SAH) refers to extravasation of blood into the subarachnoid space i.e. the space between the pia and arachnoid membranes. The subarachnoid space is the space where the cerebrospinal fluid (CSF) circulates, therefore, hemorrhage into this space will result in bloody CSF as mentioned in the question or CSF liquor with high content of erythrocytes. The CSF is responsible for protecting your brain from injury by serving as a cushion. A hemorrhage in this space can cause a coma, paralysis, and even death. It is often characterized by a severe headache in adults (often referred to as ‘worst headache of my life’). In newborns, subarachnoid hemorrhages can result from either birth trauma (excessive mechanical force on the baby during birth) or hypoxic-ischemic injury - HIE, (lack of oxygenated blood flow to the brain). The former (birth trauma) is a more common cause in term infants, and the latter (HIE) in preterm infants. Recall that Cerebrospinal fluid is produced by the ependymal cells in the choroid plexus of the third, fourth and lateral ventricles in the brain. It occupies the subarachnoid space i.e., the space between the arachnoid mater and the pia mater; including the ventricular system of the brain and spinal cord.
Nikolsky’s sign is a skin finding in which the top layers of the skin slips away from the top layers when rubbed. It is usually positive in Pemphigus Vulgaris, Scalded skin syndrome (Ritter’s exfoliative dermatitis, lyell’s disease), impetigo neonatorum and erythema multi form.
Opioids, sometimes called narcotics, are a type of drug. They include strong prescription pain relievers, such as oxycodone, hydrocodone, fentanyl, and tramadol. The illegal drug heroin is also an opioid. They are commonly used to treat moderate to severe or refractory pain. Examples of opioids include:
-Full agonist: Morphine, Heroin, Meperidine, Methadone, Codeine, Fentanyl
-Partial agonists: Buprenorphine
-Mixed agonist/antagonist: Pentazocine-Antagonist: Naloxone, Naltrexone
Treat toxicity with Naloxone (competitive opioid receptor antagonist) and prevent relapse with Naltrexone. The risks of using prescription opioids include dependence and addiction. Dependence means feeling withdrawal symptoms when not taking the drug. Addiction is a chronic brain disease that causes a person to compulsively seek out drugs, even though they cause harm. Common Signs of Opioid Addiction: The inability to control opioid use; Uncontrollable cravings; Drowsiness; Frequent flu-like symptoms; Isolation from family or friends; Stealing from family, friends or businesses; New financial difficulties. This patient has injection marks on the forearms and cravings for Tramadol in addition to showing signs of opioid withdrawal - sweating, dilated pupils, rhinorrhea, lacrimation, nausea, stomach cramps, diarrhea (“flu-like” symptoms), piloerection (“cold turkey”). Flu-like symptoms here include - malaise, chills, runny nose, aching muscles and joints. Even though Solpadein contains both Paracetamol and Caffeine which are Pain killers, the best choice here is Opioid addiction due to the signs of withdrawal manifested by this patient.
Sepsis is a medical condition caused by the body’s reaction to an infection. Neonatal sepsis can be caused by organisms such as E. coli, listeria, Group B streptococcus, Herpes simplex virus etc. Conditions that increase the risk of neonatal sepsis include: Preterm birth, early rupture of membrane, chorioamnionitis etc.Key signs include: Fever, vomiting, diarrhea, pale skin with yellow and white tint ( jaundice), irritability, difficulty in breathing and feeding etc. Hemorrhagic disease of newborn occurs as a result of deficiency in vitamin K or essential blood clotting factors, trauma. It is characterised by excessive bleeding. Hemolytic disease of newborn occurs due to ABO incompatibility or Rhesus Incompatibility between mother and child ( mother -ve, child +ve).
Propranolol (Obsidan) is a drug indicated for the treatment of high blood pressure, a number of types of irregular heart rate, thyrotoxicosis, capillary hemangiomas, performance anxiety, and essential tremors. It is classified as a beta blocker (non- selective); weak indirect α1-adrenoceptor agonist in addition to potent β-adrenoceptor antagonist. Procainamide and lidocaine are Na channel blockers used to treat Acute ventricular arrhythmias especially Post Myocardial Infarction.
By definition cerebral edema is the excess accumulation of water in the intra-and/or extracellular spaces of the brain. The most rapid and effective means of decreasing tissue water and brain bulk is osmotherapy. Osmotic therapy is intended to draw water out of the brain by an osmotic gradient and to decrease blood viscosity. These changes would decrease ICP and increase cerebral blood flow (CBF). Mannitol is the most popular osmotic agent. However, prolonged administration of Mannitol results in an electrolyte imbalance that may override its benefits and that must be carefully monitored. Nursing care of the patient receiving Mannitol requires vigilant monitoring of electrolytes and overall fluid balance and observation for the development of cardiopulmonary complications in addition to neurological assessment. Therefore, the best choice is to go for diuretics to prevent some of the complications associated with Mannitol. Furosemide is a loop diuretic with a strong osmotic effect. It has been shown to prolong the reversal of blood brain osmotic gradient established with the osmotic agents by preferentially excreting water over solute. Furosemide is a strong diuretic and acts fast.
It is recommended that diphtheria, tetanus, and acellular pertussis vaccination be administered across the lifespan. Children younger than 7 years of age receive DTaP or DT, while older children and adults receive Td. D- Diphtheria; T- Tetanus; P- Pertussis (Whooping cough); aP- acellular pertussis vaccine.
Give adolescents a single dose of Tdap, preferably at 11 to 12 years of age.
Give pregnant women a single dose of Tdap during every pregnancy, preferably during the early part of gestational weeks 27 through 36.
Give adults who have never received Tdap a single dose of Tdap. This can be given at any time, regardless of when they last got Td. This should be followed by either a Td booster every 10 years.
Rickets (Rachitis) is a metabolic disease of growing bone that is unique to children (especially of the first 2 years) and adolescents often associated with Vitamin D deficiency. Vitamin D deficiency results in Rickets in Children and Osteomalacia in adults. Apart from the decreased bone mineralization in Rickets, there are also some non specific symptoms commonly found in patients with this condition.
Occipital Alopecia: occurs in about 30%.
Muscular Hypotonia: generalized muscular hypotonia; “floppy baby syndrome” or “slinky baby”
Neurologic abnormalities: observed in all cases and revealed at initial period of disease as irritability, interrupted sleep, sweating.
Rachitic rosary; Craniotabes; occipital alopecia and enlargement of the wrists were four most common physical examination findings for the age group 0 - 6 months.
Under the influence of maternal hormones during pregnancy a newborn may exhibit signs of hormone exposure after birth. Hormones from the mother (maternal hormones) are some of the chemicals that pass through the placenta into the baby's blood during pregnancy. These hormones can affect the baby. For example, pregnant women produce high levels of the hormone estrogen. This causes breast enlargement in the mother. By the third day after birth, breast swelling may also be seen in newborn boys and girls. Such newborn breast swelling does not last, but it is a common concern among new parents. The breast swelling should go away by the second week after birth as the hormones leave the newborn's body. Hormones from the mother may also cause some fluid to leak from the infant's nipples. This is called witch's milk. It is common and most often goes away within 2 weeks. Newborn girls may also have temporary changes in the vaginal area.
The skin tissue around the vaginal area, called the labia, may look puffy as a result of estrogen exposure.
There may be a white fluid (discharge) from the vagina. This is called physiologic leukorrhea.
There may also be a small amount of bleeding from the vagina.
These changes are common and should slowly go away without any intervention.
Shoulder dystocia refers to a situation where, after delivery of the head, the anterior shoulder of the fetus becomes impacted on the maternal pubic symphysis, or (less commonly) the posterior shoulder becomes impacted on the sacral promontory. One major complication of this state is an injury to the brachial plexus. The brachial plexus is a network of nerves made up the anterior rami of the lowest four cervical nerves and the first thoracic nerve ( C5-C8 & Th1). The brachial plexus provides nerve supply to the skin and muscles of the arms ( except the trapezius and an area close to the axilla ; an injury to the brachial plexus affects the sensation and movement of different parts of the arm. The Moro reflex is an infantile reflex that develops between 28–32 weeks of gestation and disappears between 3–6 months of age. It is a response to a sudden loss of support and involves three distinct components.: spreading out the arms (abduction), pulling the arms in (adduction), crying (usually).
Notice that this reflex is absent coupled with flaccid paresis of the upper extremities- these are key signs that indicate an injury to the brachial plexus ( C5-TH1).
Many babies born with a small ventricular septal defect (VSD) won't need surgery to close the hole. After birth, the doctor may want to observe the baby and treat symptoms while waiting to see if the defect closes on its own. Babies who need surgical repair often have the procedure in their first year. Children and adults who have a medium or large ventricular septal defect or one that's causing significant symptoms may need surgery to close the defect. With this 5 year old boy already having exertional dyspnea, fatigability and in the sub compensation stage, it is an indication for Surgery in order to close the defect. Surgical treatment for ventricular septal defects involves plugging or patching the abnormal opening between the ventricles.
In the sub compensation stage and with the child already showing symptoms of dyspnea, conservative treatment is no longer indicated. Indomethacin is used in the case of patent ductus arteriosus due to its inhibitory effect on Prostaglandin E2 which helps in closing the ductus arteriosus immediately after birth.
A physiological third heart sound (S3) is common in youth but allegedly very rare after the age of 40 years. A physiological third heart sound (S3) can be heard in practically all healthy children and adolescents but rarely in individuals after the age of 40 years. After age 40, a third heart sound is usually abnormal and correlates with dysfunction or volume overload of the ventricles. The third heart sound (S3) is a low-frequency, brief vibration occurring in early diastole at the end of the rapid diastolic filling period of the right or left ventricle. It is physiologic because it is not related to any pathology at any age before 40 years. Patient is 17years, has no health problems, murmurs are absent and ECG shows no pathological changes. There is no physiologic S4 and all other options listed are signs of different heart pathologies.
Absence or Petit mal seizures are a form of generalised seizures usually less than 15 seconds in duration and commonly seen in children. It is characterised by sudden lapses of consciousness which involves an absence of motion and a state of forgetfulness.
Obnubilation is a state of clouding of consciousness and stupor.
fugue state or psychogenic fugue, is a dissociative disorder and a rare psychiatric disorder characterized by reversible amnesia for personal identity, including the memories, personality, and other identifying characteristics of individuality.
Glomerulonephritis is a group of Disorders where damage to the glomerular filtration apparatus causes a leak of protein +/- blood into urine depending on the disease. Patients may be asymptomatic or present with hematuria, proteinuria, edemas, hypertension etc.
This patient has a post streptococcal form of glomerulonephritis. Notice That fews days ago, he suffered from Quinsy also known as peritonsillar abscess, a condition mostly caused by streptococcal infection. A deposition of the immune formed complex (between the streptococcal antigen and antibodies ) on the kidney’s glomerular membrane leads to its inflammation ( glomerulonephritis) .
Chronic Glomerulonephritis involves long term inflammation and scarring of the glomeruli. This condition progresses over the years.
Acute Pyelonephritis is an inflammation of the Renal pelvis due to an infection. High fever, rigor, vomiting, pain and tenderness of the lumbar region are key findings.
In acute renal failure, there is a significant decrease in renal function that occurs over hours or days. This manifests as an abrupt and sustained rise in serum urea and creatinine levels coupled with oliguria / anuria.
Apart from the endocrine function of the pancreas ( production of hormones such as insulin, glucagon, somatostatin etc), the Pancreas also possess exocrine function ie, it produces enzymes that aid in in food digestion eg amylase for the digestion of carbohydrate, lipase for the breakdown of fats and trypsin and chymotrypsin for proteins, elastase. Notice that this patient has an issue with digestion revealed by the presence of bloating, liquid, gray and smelly stool.
Pancreatic fecal elastase-1 (FE-1) has become the first-line test of pancreatic function. FE-1 is well documented in quantitative studies to be stable during intestinal transit and studies demonstrate significant correlation between fecal elastase and levels of other pancreatic enzymes such as duodenal lipase, amylase, trypsin, and bicarbonate concentration. Fecal elastase is concentrated in human feces compared with pancreatic juice and is a simple, non-invasive and inexpensive test.
The Spearman's Rank Correlation Coefficient is used to discover the strength of a link between two sets of data. This example looks at the strength of the link between the immunization rate of children and measles incidence rate by district.
Correlation is a bivariate analysis that measures the strength of association between two variables and the direction of the relationship. In terms of the strength of relationship, the value of the correlation coefficient varies between +1 and -1. A value of ± 1 indicates a perfect degree of association between the two variables. As the correlation coefficient value goes towards 0, the relationship between the two variables will be weaker. A correlation coefficient of zero indicates that no relationship exists between the variables. The direction of the relationship is indicated by the sign of the coefficient; a + sign indicates a positive relationship and a – sign indicates a negative relationship.
An inverse correlation, also known as negative correlation, is a contrary relationship between two variables such that when the value of one variable is high then the value of the other variable is probably low.
In this case, it is expected that as the immunization rate increases, measles incidence should decrease.
Osteoarthritis (OA): mechanical wear and tear - it’s a degenerative joint disease.
Associated with Pain in weight bearing joints commonly experienced after use (i.e. at the end of the day), and the pain improves with rest. The pain associated with OA could also be precipitated by trauma.
Joint findings: joint space narrowing; osteophytes (bone spurs); subchondral sclerosis and cysts.
Involves distal interphalangeal joints on the hands (heberden nodes) and Proximal interphalangeal joints (Bouchard nodes); does not affect Metacarpophalangeal joints. Rheumatoid Arthritis: autoimmune which erodes articulated cartilage and bone. The inflammatory cells and cytokines then induce pannus (proliferative granulation tissue) formation, deep usurations.
Associated with pain, swelling and morning stiffness, lasting >1hr and the pain improves with use.
A doppler echocardiography is a diagnostic method for heart related issues. It is a combination of an echocardiogram (which uses sound waves to create an image of the heart) and a doppler technology ( which shows the velocity ie, speed and direction of blood flow in cardiac tissues). An Electrocardiography shows the electrical activity of the heart. In patients with cystic fibrosis (CF), continuous pulmonary infection and inflammation with thickened secretions cause airways obstruction and hyperinflation. As the disease progresses, these patients develop disabling lung disease and eventually respiratory failure and pulmonary hypertension (PH). PH is considered to be a consequence of several mechanisms that either raise the pressure downstream of the pulmonary capillaries, induce vasoconstriction, increase blood flow to the lung, or obstruct the pulmonary vessels either by embolism or in situ fibrosis. The echocardiogram is an integral part of the evaluation of a patient with PH. Common echocardiographic findings in PH includes right atrial and right ventricular (RV) enlargement, reduced RV function, displacement of the intraventricular septum to the left, and tricuspid regurgitation that permits the estimation of the pulmonary artery systolic pressure (PASP). Therefore, Doppler echocardiography will be the best choice to evaluate a patient with a chronic pulmonary heart disease.
Frostbite is an injury of the skin and underlying tissues that occur due to exposure to cold ( low temperature). There are 4 degrees of frostbite: I Degree: lasts for about 5-7 days; after warming, paleness changes to hyperemia (redness). Edema of tissues progresses for about 2 days and then it decreases to 6-7 days when shelling (peeling) of epidermis appears. Tactile and pain sensitiveness (sensation) are preserved but sometimes with disorders. Pain in injured areas could be severe, itching also could be. II Degree: characterised by the spreading of edema, appearance of bullaes. The bottom of the opened bullaes are covered with fibrin. Cyanotic skin and difficulty of movement of phalanges. Necrosis of keratic and granular layers. N/B growth layer of the skin is not lost and regeneration appears after 2 weeks. Scars are not formed. III Degree: Necrosis of all skin layers or even fatty tissue appears. Inflammation develops: firstly aseptic and then on 5th- 7th day purulent . Bullas contain blood . Decrease of tactile and temperature sensation. Edema of tissues spreads on the proximal areas. Firstly skin has cyanotic color then dark brown and black crusts are formed. IV Degree: Necrosis of all skin, fat tissue and even bones and joints. Results in amputation of the affected area.
Ejection fraction refers to how much blood the heart ( left ventricle) pumps at a single contraction. It ranges from 55%-75%. Heart failure is observed when the heart is unable to meet up with the body's blood and oxygen demand. This is either due to inadequate contraction of the heart (weak heart muscles) or not enough filling of the heart during relaxation majorly as a result of stiffness of the walls. Heart failure due to weak heart muscles ( reduced contractility power) is referred to heart failure with reduced ejection fraction. Heart failure due to inadequate filling of the ventricle during relaxation but with normal heart contraction is referred to as a Heart failure with preserved ejection fraction.
The symptom of delayed fontanelle closure and tooth eruption indicates the 9 month old baby has issues in relation to reduced calcium levels ( calcium is responsible for formation/modelling of bones and teeth). In relation to vitamins, vitamin D is responsible for the intestinal absorption of elements like calcium, magnesium etc. In humans, vit D₃- cholecalciferol and D₂- ergocalciferol are the most important. Deficiency of vitamin D will lead to Rickets (in children) and osteoporosis(in adults). Vitamin C deficiency will lead to scurvy characterised by bleeding gums, petechial bleeding ( small hemorrhages) Vitamin B1 deficiency leads to Beri-Beri, Vit A deficiency results in night blindness.
Norms; gestation period- 280 days or 40 weeks up to 42 weeks birth weight- 3-3.5kg (3000-3500g) Body length- 45-55cm the baby in question underwent a full term gestation period (41 weeks) but is underweight ( 2500g). This underweight is due to complications that occurred during gestation as stated “The pregnancy was complicated with severe gestosis of the second semester”. We can therefore conclude that the baby who had a full term gestation had some intrauterine growth restrictions. A premature infant is one which is born before 37 weeks of gestation. A post mature infant is one born after 42 weeks of gestation.
Rabies is a viral disease humans get via an infected dog’s bite. For its remedy, the anti rabies vaccine is used. It is a recombinant vaccine.
Septic shock is a type of distributive shock, caused by generalized reaction of the organism to microorganisms and their toxins. Its etiology can be connected with gram positive and gram negative bacteria, rickettsia or fungi and any mucosa can be their entrance (intestine, abdominal cavity, urinary tracts, wound surface). When the toxins get to the blood flow tissue macrophages answer their appearance with production of cytokines. Cytokines are mediators of systemic inflammatory response; they trigger a whole number of immune reactions (both humoral and cellular immune response). This leads to circulation and microcirculation disorders and thus to tissue hypoperfusion and tissue anoxemia.
Duchenne-Erb's palsy is a form of brachial plexus palsy. Erb's palsy leads to a weakness of a newborn baby's arm. It is caused by a stretch injury to the brachial plexus ( C5-C6). The brachial plexus is a network of nerves near the neck that give rise to all the nerves of the arm. These nerves provide movement and feeling to the arm, hand, and fingers (note that - Spontaneous movements are absent in the shoulder and elbow joints, passive movements are painless). Klumpke paralysis (C7-8, T1) results in weakness of the intrinsic muscles of the hand; grasp reflex is absent. If cervical sympathetic fibers of the first thoracic spinal nerve are involved, Horner syndrome is present.
The patient presents with symptoms of croup also called laryngotracheobronchitis; classic symptoms include barking cough, noisy breathing (stridor), intercostal retraction (hoover’s sign). This can be caused by a virus ( parainfluenza, influenza A or B) or bacteria (corynebacterium diphtheriae, staph. Aureus, strep pneumonia etc). It is most commonly seen in children aged 6 months- 5years.
Rheumatoid Arthritis is an autoimmune form of inflammation and is different from osteoarthritis which is due to mechanical wear and tear ( continuous use ). N/B in RA, the inflammation is always symmetrical ( on both sides of the body) and the patient always presents with the complaint of joint stiffness in the morning that lasts for more than an hour.
Nephrotic Syndrome - Massive proteinuria (> 3.5g/ day) with hypoalbuminemia, edema (due to decrease in oncotic pressure). Occurs due to podocyte damage, focal segmental glomerulosclerosis, membranous nephropathy, amyloidosis or diabetic glomerulonephropathy. Nephritic Syndrome- usually due to glomerular inflammation which further damages the glomerular basement membrane, loss of rbc into urine leading to hematuria. Occurs in acute post streptococcal glomerulonephritis, rapidly progressive glomerulonephritis, IgA nephropathy, Alport syndrome, membranoproliferative glomerulonephritis. Observe that the patient loses about 7.1g of protein per litre of urine daily (> 3.5g/ day) and also presents with edema which indicates a nephrotic syndrome.
Cystic fibrosis is an autosomal recessive defect in CFTR gene ( Cystic Fibrosis Transmembrane Regulator ). This gene encodes an ATP gated Cl ion channel that secretes Cl in lungs and GI tract and reabsorbs Cl in sweat glands. The hallmarks of cystic fibrosis are salty tasting skin, normal appetite but poor growth and poor weight gain, excess mucus production, and coughing/shortness of breath……..
Alanine Transaminase (ALT) is a transaminase enzyme primarily found in the liver and kidneys. An Elevation in ALT (liver function test) levels is used in diagnosing liver pathologies such as cirrhosis, hepatitis, liver cancer etc.
The symptoms of Bronchial Asthma are as a result of bronchoconstriction - expiratory dyspnea, wheezing, shortness of breath etc. Salbutamol is a short-acting beta 2 agonist (another example is Albuterol) commonly used in clinical practice as an emergency antiasthmatic agent because of its fast acting quality. Beta 2 receptors are found in the bronchioles of lungs and the arteries of skeletal muscles. This drug dilates (opens up) the bronchi (bronchodilation). Short acting beta agonists are the same medications as those in your quick-acting inhaler. Other medications that can be used to treat emergency asthma attacks are Oral corticosteroids, Ipratropium, Oxygen. Cromolyn sodium is a mast cell stabilizer, it prevents the release of Histamine and other inflammatory mediators. Dexamethasone is a glucocorticoid, it has anti inflammatory, immunosuppressive and antipyretic effects.
An increased content of Erythrocytes in CSF findings indicates “ intracranial hemorrhage”. Presence of protein and low glucose in CSF are not specific and can indicate pathologies such as an infarct, meningitis, sepsis etc. Hypertonia and depressed consciousness are also general signs and can be found in any of the above pathology.
Testicular Feminization syndrome also called Complete androgen insensitivity syndrome is a genetic anomaly in which an XY fetus has a defect in androgen receptors leading to a feminine appearance. Usually presents with an absent uterus and fallopian tubes, a rudimentary vagina, scanty or no pubic hair growth, normal and functioning testes etc Genotype 46XY. Mayer-Rokitansky-Kuster-Hauser syndrome is also called Mullerian Agenesis. A failure in the development of the mullerian duct which leads to uterus, cervix agenesis and vaginal hypoplasia. Secondary sexual characteristics are normal in such individuals because Ovaries do not develop from the mullerian duct.
“A round moon-like Face” is a term used to describe an individual with Cushing’s syndrome. Occurs when the body produces an increased amount of cortisol ( a hormone produced from the zona fasciculata of the adrenal cortex). Symptoms include; abdominal obesity but with thin arms and legs, reddish stretch marks, a round red face, a fat lump between the shoulders ( buffalo hump), weak muscles, weak bones, acne, hirsutism.
Pyelonephritis is a Urinary tract infection mostly caused by bacteria and leads to an inflammatory process in the kidneys. Can be caused by E.coli, klebsiella, pseudomonas and is being accompanied by symptoms such as fever, frequent urination and pain during urination etc. In the patient described above, for confirmation of the causative agent, a sample of the patient’s urine is collected; a bacteria specimen is obtained from it ( unknown bacteria). It is then introduced into a culture ( inoculation) where they can grow and multiply. N/B various microorganisms have specific culture mediums.
An apgar score is a test used in assessment of the health of a newborn child. In this test, the skin colour, pulse rate, irritability, muscle tone and respiration are checked and scored individually between 0-2. A score of 7 and above means the baby is normal, 4-6 is fairly low, 3 below refers to a critical condition; immediate actions to restore the child’s health should be taken. For a baby with normal response, he/she should be taken immediately to the mother to be breastfed.
Due to the inability of the fetal liver to conjugate and quickly excrete the increased amount of bilirubin after birth, a buildup of bilirubin in the blood takes place in the newborn. These accumulated products are deposited in areas like mucous membrane, eyes, skin and in complicated cases- brain. This process is termed ‘Physiological Jaundice’; it occurs within the first 24hrs of birth and resolves without treatment in 1-2 weeks. Hemolytic disease of the newborn due to Rh incompatibility occurs when an Rh- mother presents with an Rh+ fetus. In the first pregnancy, the mother is exposed to fetal blood and forms a maternal anti-D IgG. In subsequent pregnancies, the anti-D IgG crosses the placenta, attacks fetal RBCs and leads to hemolysis in the fetus. Hemolytic disease of the newborn due to ABO incompatibility occurs when a type O mother presents with a type A or type B fetus. Pre-existing maternal anti-A or anti-B IgG antibodies cross the placenta leading to hemolysis in the fetus.
Newborns are at a high risk of developing encephalopathy caused by hyperbilirubinemia due to the fact that soon after birth, the infant’s liver gets busy in fetal hemoglobin breakdown (which is later replaced by the adult form) and as a result, the conjugation process of bilirubin is slowed down leading to an accumulation of unconjugated bilirubin in the blood. Coupled with a not too developed blood brain barrier, the accumulated bilirubin easily goes across the barrier leading to encephalopathy.
Menarche refers to the first menstrual cycle. Painful menstruation (dysmenorrhea) expresses as cramping pain in the abdomen, it is most times associated with symptoms such as lower back pain, nausea, diarrhea, and headaches. These muscle cramps occur as a result of increased prostaglandin levels produced from the uterus. These prostaglandins cause the uterus to continuously tighten and relax, leading to cramps. For treatment, the patient can be given NSAIDs - for pain and anti-inflammatory effect; Antispasmodics- for relaxation of muscles and antiprostaglandin therapy- to reduce the amount and effect of prostaglandins produced.
The patient has a history of purulent otitis ( a purulent inflammation of the middle ear) mostly as a result of an infection (confirmed by the increased temperature). From the description above, we can draw out that the patient has an infection around the knee joint ( knee joint is thickened, hyperemic, with localized fever). Osteomyelitis ( a rare infection of the bone) is the best possible choice.
An agenesis is the failure of an organ to develop. From the above analysis, we observe an undetected right kidney on palpation; an absent contrast on the right during excretory urography indicates no organ located ( supported by an incomplete bladder trigone) - coupled with the patient’s age, we can conclude that development of the right kidney never took place. A compensatory hypertrophy/ hyperplasia of the left kidney occured in order to meet the body’s requirement.
Notice that from the above analysis, the platelet level is relatively low (150 − 400 · 109/L is the normal). This is confirmed in the result of the duke test being 9 minutes - prolonged ( normal is 2-5 ). The Duke test is done to check the bleeding time , it is a platelet function test. An abnormality indicates diseases such as von wilirend,thrombocytopenia, DIC etc. Recall that platelets originate from large bone marrow cells and a bone marrow biopsy will be most helpful in analysis amongst all the above listed.
pseudofurunculosis, is observed in neonates and infants. The disease begins with the appearance of superficial pustules in the ostium of sweat glands (periporitis). Caused by staphylococcus aureus, which penetrates in the depth of the sweat gland and causes the forming of deep indurated painful nodules. The nodules are very similar to furuncles, but they have not got core in the center (hence the name pseudofurunculosis). Vesiculopustulosis is a widespread purulent disease, which appears in the first years of life. In the ostium of the sweat glands numerous pustules appear, filled with white yellow matter, the size of a pin head to a small pea, they do not merge with each other and are surrounded by bright edematous circles.
Notice that the patient presents with a history of vulvitis ( inflammation of the vulva) and a urinary tract infection. The more common mode of UTIs is through the ascending pathway, where fecal flora gain access to the urinary tract via colonization of the urethra. Descending infections are the result of hematogenous spread of bacteria from a primary source located elsewhere in the body.
Tetralogy of fallot is a combination of four congenital heart defects; they include- pulmonary valve stenosis, ventricular septal defect, hypertrophy of the right ventricle and an overriding aorta. Symptoms include; a heart murmur, clubbing of the fingers (drumstick fingers), cyanosis, prolonged crying, poor weight gain etc ; majority of which are seen in the described patient…………..
Notice that the result from the echocardiogram shows the accumulation of fluid in the pericardium thereby indicating a pericardial effusion. As a result of this, the intrapericardial pressure will be increased leading to an adverse effect on the heart. In order to remove the accumulated fluid, a Pericardiocentesis (pericardial puncture) is carried out. This is a medical procedure in which a needle is used in aspirating (removing) the excess pericardial fluid.
The patient is diagnosed with coarctation of the aorta which refers to the narrowing of the aorta leading to reduced blood flow to various parts of the body. Treatment approaches usually consist of surgery or a procedure called balloon angioplasty or stent placement. The various types of surgery include; Bypass graft repair, Subclavian flap aortoplasty. Resection with end-to-end anastomosis etc. Medication/ conservative treatment isn't used to repair coarctation of the aorta, but it might be used to control blood pressure before and after stent or surgery.
Osteosarcomas are primary malignant tumors of bone that are characterized by the production of osteoid or immature bone by the malignant cells. Characteristics of osteogenic sarcoma include; the presence of osteoid-producing cells ( malignant osteoblasts), present as painful enlarging mass . A major sign seen on x-ray is the Codman triangle ( a subperiosteal lesion), in some literature, it is described as ‘resembling melting sugar’ or ‘sunburst pattern’.
For specific prevention of Measles, the MMR vaccine is used (measles, mumps and rubella). It is a live/attenuated vaccine administered at the age of 12 months, Revaccination at 4 to 6 years or at 10 to 11 years.After contact with measles, unvaccinated persons under 30 years of age without a history of measles or any contraindication for vaccination should be vaccinated with measles vaccine not later than 72 hours after the contact. Recall that the patient has no previous record of measles vaccination and due to the outbreak of measles, she should immediately be vaccinated ( or within the next 72 hours)
A minimum interval is the shortest time between two doses in a vaccination series. The Hepatitis B vaccination is given in a three dose series; First dose at birth, second Between 1-2 months and the third dose is given between the 6th-15th month. Examples of the hepatitis B vaccines are Engerix-B and Recombivax HB; the minimum interval between the first and second doses is 4 weeks. An adult taking the Hepatitis B vaccine will take 3 doses one month apart. For example, as an adult, if you take the first dose 1st March, next dose will be 1st April and the last dose will be 1st May.
There are a variety of reasons behind vaccine opposition. Some people have to forgo different vaccinations due to a high risk of potential allergic reactions, religious beliefs, mistrust of pharmaceutical companies, post vaccination complications such as autism. As a medical personnel, it is important to explain to these individuals the risk of staying unvaccinated stressing on the fact that these individuals risk exposure and stay unprotected to a wide range of diseases which in a long run will cause more damages (lethal consequences).
Anaphylactic shock is a medical emergency that may require resuscitation measures such as airway management, supplemental oxygen, large volumes of intravenous fluids, and close monitoring. Administration of epinephrine is the treatment of choice with antihistamines and steroids often used as adjuncts. It is recommended that an epinephrine solution be given intramuscularly into the mid anterolateral thigh as soon as the diagnosis is suspected. The injection may be repeated every 5 to 15 minutes if there is insufficient response. A second dose is needed in 16-35% of episodes. with more than two doses rarely required. The intramuscular route is preferred over subcutaneous administration because the latter may have delayed absorption. Minor adverse effects from epinephrine include tremors, anxiety, headaches, and palpitations.
The boy has not been vaccinated therefore, the most rational decision will be to vaccinate him after convincing his parents to carry out the procedure, MMR vaccine is a combined vaccine usually administered at the age of 12 months.
Hyaline membrane disease is observed in Respiratory distress disorder. Usually found in premature infants, a membrane made up of proteins and dead cells lines the alveoli, making gas exchange difficult.
One of the forms of stomach dyskinesia of hypertonic type is pylorospasm. It is observed mainly in babies, especially in the first weeks and months of life. Pylorospasm in children is caused by functional disturbances of the nervous- muscular system of the stomach pyloric part. Pylorospasm is marked by weak development of muscles in cardial part of the stomach and its more expressed development in the area of the pylorus. It promotes development of vomiting and eructation. Symptomatically, the major difference between pylorospasm and pyloric stenosis is the presence of Projectile vomiting in stenosis. In esophageal achalasia, the lower esophageal sphincter fails to open during swallowing leading to the build up food in the esophagus.
Pseudomonas aeruginosa , an encapsulated, Gram-negative, rod-shaped bacterium is resistant to a wide range of antibiotics; from the listed drugs, Ciprofloxacin ( a quinolone) is the best choice. Other possible drugs include gentamicin, carbenicillin, carbapenems etc.
On ECG, hyperkalemia is characterised by a tall, peaked T wave, ST segment depression, shortened QT interval, widening of QRS. For Hypokalemia, we observe; flat or inverted T wave,prolongation of QT interval, appearance of a U wave in some cases ets. Patients with blood calcium level changes will experience a change in heart rate; Tachychardia in Hypercalcemia and Bradycardia in hypocalcemia.
Disseminated intravascular coagulation is a pathology that involves the widespread activation of clotting factors leading to a deficiency in clotting factors and a bleeding state. Notice that the newborn experiences hypocoagulation, thrombocytopenia, and hypothrombinemia which are classical signs found in DIC. This pathology can be triggered by sepsis, acute pancreatitis etc. thrombocytopenic purpura is a clinical syndrome in which a decreased number of circulating platelets (thrombocytopenia) present as a bleeding tendency, easy bruising (purpura), or extravasation of blood from capillaries into skin and mucous membranes (petechiae)
Lordosis, kyphosis, and scoliosis refer to curvatures of the spine. Lordosis refers to the normal inward curvatures of the spine at the cervical and lumbar regions, while kyphosis refers to the normal outward curvature of the spine specifically at the thoracic region. Scoliosis which always refers to the abnormal sideways curves of the spine.
An opening should be created on the foreskin in order to evacuate the urine. A urine bladder catheterization is used to evacuate urine in cases of bladder pathologies.
Neonatal impetigo (Impetigo Neonatorum), also known as neonatal Pemphigus (Pemphigus Neonatorum), occurred in a newborn as a suppurative acute infectious skin disease, rapid onset, infectious intensity. Primary lessons are bullae which progress into blisters, rupture and cause erosions.......
An echocardiography is a procedure used in checking the live images of the heart. Information from this procedure shows: Changes in your heart size, Pumping strength, Damage to the heart muscle, Valve problems, Heart defects. An electrocardiography is a procedure that records electrical signals of the heart. It provides information about the heart rate, rhythm, Inadequate blood and oxygen supply to the heart, Heart attack and some structural abnormalities. A phonocardiography is the recording of the sounds from the heart.
Candidal vulvovaginitis is also known as vaginal thrush or vaginal yeast infection. It is characterised by very severe vaginal itching, burning sensation while urinating, pain during sex, hyperemic vagina and a thick white vaginal discharge. It occurs due to excessive growth of vaginal candida. Note that Trichomoniasis secretion is usually yellowish-green in colour.
From ultrasound, we observe the reduction in size of the right kidney; this may be due to a reduction in blood flow or a chronic infection ( as earlier stated, she previously had a case of pyelonephritis). Due to the constriction of the renal artery, the kidney releases Renin (from juxtaglomerular cells). This renin converts angiotensinogen (produced in the liver) to angiotensin I; Angiotensin I is then converted to angiotensin II by angiotensin converting enzyme, ACE ( an enzyme produced in the vascular endothelial cells of the lungs). Angiotensin II then stimulates the secretion of aldosterone from the adrenal cortex. In this system, angiotensin II is a potent vasoconstrictor that assists in the Increase of blood pressure.
Enterovirus infections (ECНO and Coxsackie’s infections) a group of an acute diseases caused by ECНO and Coxsackie’s enteroviruses, that are characterized by the variety of clinical displays from the mild fever and simple carrying of virus to protracted meningoencephalitis, myocarditis, myalgia and other. Notice that the cell count in the CSF is 90% lymphocytes which indicates a viral cause; for bacterial origin, the cell count will be mainly neutrophils. Enterovirus is the only viral cause amongst the listed agents.
ErbDuchenne palsy is the paralysis of the arm caused by the injury to the nerves C5-C6. Paradoxical respiration is a term used to refer to distressed breathing. Notice that this patient's left lung lags behind during respiration and respiration is also weakened on this side; a paresis ( muscular weakness due to nerve damage) of the diaphragm (the main respiratory muscle) can lead to this situation. No changes in CBC rules out the option of an infection ( congenital pneumonia) and respiratory distress is often seen in preterm babies with lack of sufficient surfactant.
Pay attention to the Hemogram and notice that the lymphoblast level is highly elevated. Leukemia is a cancer of the marrow and blood. The major forms of leukemia are divided into four categories. The terms myelogenous or lymphocytic denote the cell type involved. Myelogenous and lymphocytic leukemia each have an acute or chronic form. Thus, the four major types of leukemia are acute or chronic myelogenous and acute or chronic lymphocytic leukemia.Acute leukemia is a rapidly progressing disease that affects mostly cells that are unformed or immature (Blast cells). These immature cells cannot carry out their normal functions. Chronic leukemia progresses slowly and permits the growth of greater numbers of more developed cells. Blast cells are immature WBC. Presence of 70% of Blast cells in the analysis indicates an acute form of leukemia. Less than 10% of blast cells will indicate a chronic form. In thrombocytopenic purpura there will be a decreased number of circulating platelets (thrombocytopenia), easy bruising (purpura), or extravasation of blood from capillaries into skin and mucous membranes (petechiae). Note that Atypical lymphocytes are mostly associated with Infectious Mononucleosis, an infection obtained from the epstein barr virus (EBV).
From anamnesis, we see that the patient experienced a prolonged Menstrual cycle characterized by profuse blood discharge; the current state of the patient (pale skin, fatigue etc) is due to the amount of blood already lost. A post hemorrhagic anemia is a condition in which a person loses lots of hemoglobin and RBCs due to blood loss. It is usually seen in cases of trauma, severe injuries etc. In Somatoform Autonomic dysfunction, the symptoms are presented by the patient as if they were due to a physical disorder of a system or organ that is largely or completely under autonomic innervation and control, i.e. the cardiovascular, gastrointestinal, respiratory, and urogenital systems.
Congestive heart failure can cause peripheral (lower extremity edema), pulmonary and abdominal edema (ascites). This is because the heart is too weak to pump blood around the body properly, so the blood accumulates in other parts of the body before getting to the heart. Because of this, and due to the increased blood pressure in the veins, fluid seeps out into the surrounding tissue. This may cause swelling in the legs or a build-up of fluid in the abdomen. A rasping systolic murmur also indicates an organic heart pathology. Edema due to cardiac origin are commonly seen after stressful activities (physical exertion) or in the evening after the day’s work. This is because the heart has been overworked and cannot perform its normal duty of pumping blood around the body effectively. Cardiac edema generally resolves with rest. Nephrotic syndrome also leads to edema but will be characterised by severe proteinuria and an increased depletion in albumin levels. Also it is characterized by generalized edema commonly seen in the morning when the patient wakes up in contrast to cardiac edema. Angioneurotic edema is seen in individuals with deficiency in C1 esterase inhibitor deficiency. It is also referred to as quinke’s edema. Edema as a result of hepatocirhosis will be seen in an individual with a chronic alcohol abuse history or one with a liver related pathology and associated with ascites, esophageal varices, caput medusa and rectal varices.
Although the Rh groups of the mother and child are different, the presence of normal erythrocyte and hemoglobin levels from the blood test rules out the option of hemolytic disease of the newborn. A cephalohematoma is a traumatic subperiosteal hematoma that occurs in the periosteum of an infant’s skull bone underneath the skin. Occurs mostly because of increased friction between infants cranium and maternal pelvis or forceps ( during assisted delivery). Infants with cephalohematoma are also at a heightened risk for developing jaundice, because as the blood breaks down, the levels of bilirubin increase. In these instances, and if the bilirubin is excessively high, treatment may include phototherapy.
Autoimmune thyroiditis (hashimoto’s thyroiditis) is a chronic disease in which the body creates antibodies which destroy the thyroid gland; it is characterised by symptoms of hypothyroidism ( bradycardia, increase in weight constipation etc). Notice that a year ago, she had a diffuse enlargement of the thyroid relatively due to a lymphocyte infiltration of the stroma. Diffuse toxic Goiter ( grave’s disease) also presents with an enlarged thyroid but is characterised by signs of hyperthyroidism. Recall that a person with a cancer related issue in anamnesis, will present with an unexplained loss of weight within a short period.
Transesophageal fistula (TEF) is an abnormal connection between the esophagus and the trachea ie, the tube that leads to the stomach and that which leads to the lungs. It is characterised by continuous effusion of saliva from the mouth, choking and vomiting with first feeding. Due to this abnormal connection, contents going to the stomach can easily get into the respiratory tract Mucoviscidosis ( cystic fibrosis of the pancreas) is a genetic disorder that occurs due to the mutation in CFTR gene. It is characterised by the production of thick and sticky mucus that can clog the lungs and obstruct the pancreas.
The key finding here is from the sputum ‘thick, viscous and difficult to expectorate’. This is characteristic of the disease cystic fibrosis ( pulmonary mucoviscidosis) which refers to a form of genetic disorder that affects the CFTR gene. It basically affects the cells that produce mucus, sweat and digestive juices ( the reason for the thick and viscous sputum); people with this pathology also encounter persistent lung infections. Note that drumstick fingers ( also known as clubbing of the nails) are seen in individuals with cardiovascular diseases and lung pathologies. These lung diseases include; lung cancer, lung infections, interstitial lung disease and cystic fibrosis. In recurring bronchitis (chronic bronchitis), the individual experiences productive cough for about three months recurring in the space of two consecutive years. Bronchial Asthma is an allergic disease, a chronic obstructive pulmonary disease ( COPD) characterised by the swelling and narrowing of the airway and also the increased production of mucus.
Exogenic ( external cause) obesity is a form of obesity caused by the consumption of food more than one's capacity. Notice that all examinations done on the child were found to have no pathologies ( carbohydrate tolerance, level of 17-ketosteroids, blood electrolytes etc ) this rules out the possibility of an underlying cause of the obesity such as conn’s disease, type 2 diabetes etc. to correct this disorder, diet changes should be made, patient should also undergo regular exercise to lose the weight already gained.
Bacterial gastroenteritis is caused by a variety of organisms, including Campylobacter, Salmonella, Shigella, Yersinia, Vibrio cholerae, Staphylococcus aureus, diarrheagenic Escherichia coli, Clostridium difficile, Clostridium perfringens, and non cholera Vibrio species. Shigellosis is also known as bacillary dysentery caused by the infection of the shiga toxin. It is characterised by High-fever, tenesmus,Profuse inflammatory, mucoid-bloody diarrhea and basically affects the large intestine. This patient experiences pain in the sigmoid colon accompanied by profuse diarrhea ( mixed with mucus)
84. The extensive statistical indicator is used to determine a structure of a disease ( in this case, how many percent ( the proportion) of the total diseased fall under cardiovascular cases) ie., it shows, what part from the general number of all diseases is made with this or that disease which enters into total.
Bronchial asthma is a medical condition classified under type 1 hypersensitivity ( IgE mediated); it is a chronic inflammatory pulmonary disease that is characterized by periodic cough, wheezing, tachypnea, dyspnea, hypoxemia, increased production of mucus which blocks the airways. Triggers include stress, allergens, viral upper respiratory infections …… add morphology, talk about charcot layd. Cells , cush. Spirals etc
Ileocaecal invagination is also termed ileocaecal intussusception which makes up more than 70% of cases of intussusception in children. Note that the tumour-like formation is in the right iliac area ( the ileocaecal angle - the point at which the ileum and caecum meet). Intussusception is a medical condition in which one section of the intestine gets enclosed or enveloped by another part. Symptoms include, vomiting, abdominal pain, and rectal bleeding (red jelly-like stools).
Wilms tumor is also called nephroblastoma and is a rare tumor that occurs in children, also presents with abdominal pain, anorexia, vomiting, malaise but does not show any signs of rectal bleeding.
Excretory Urography is also known as intravenous Pyelogram. It is an x-ray procedure that involves the intravenous administration of contrast material inorder to verify and localize upper urinary tract diseases. Retrograde pyelogram also uses a contrast agent for better visualization of the ureters and kidneys but note that: In intravenous pyelogram, the contrast dye is injected into a vein while in retrograde pyelogram, it is injected directly into the ureters. Retrograde pyelogram is mostly done in cases where excretory urography does not give a clear image of the pathological area.