Pictures of Tympanic membrane perforation with corresponding causes

Picture of a central left tympanic membrane perforation.

In general, such perforations are caused by chronic suppurative otitis media. In addition to hearing loss, patients present with purulent drainage that .................

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What is Blepharophimosis

Ptosis and inverted epicanthal folds in blepharophimosis.
The patient has bilateral ptosis with reduced lid size.There are inverted epicanthal folds, telecanthus. The nasal bridge is flat and there is hypoplastic orbital rim. Other examination:

• there may be strabismus and sometimes nystagmus
• the condition is autosomal dominant and therefore ask to see family member. However, other members may have had surgery. Look for lid scars in the family members.

velvet palm as a paraneoplastic sign

A 54-year-old woman who had a 34-pack-year smoking history presented with a 5-month history of changes in palmar skin texture associated with a 15-kg weight loss and left hip pain waking her at night.

On physical examination, cachexia was noted, along with a rugated, velvety appearance of the palms (Panel A), acanthosis nigricans, and left hip pain on rotation.

Laboratory evaluation revealed neutrophil leukocytosis (white-cell count, 42,300 per cubic millimeter), thrombocytosis (platelet count, 1.17 million per cubic millimeter), and hypercalcemia (calcium corrected for albumin, 4.5 mmol per liter [18 mg per deciliter]).

Chest computed tomography (CT) revealed nodules (Panel B, arrow), and bone scintigraphy showed increased uptake in the left hip. Both these radiographic findings suggest metastasis. CT-guided fine-needle aspiration of a lung nodule revealed cells consistent with non–small-cell carcinoma of the lung.

The palmar changes represent a cutaneous paraneoplastic sign known as tripe or velvet palm. It is highly associated with cancer (94% in some reports), most frequently with gastric adenocarcinoma or bronchogenic carcinoma. The patient was referred to oncology for chemotherapy but died a few weeks later of metastatic lung cancer.