Friday, November 19, 2010

Glasgow Coma Scale

A 29-year-old woman was an unbelted passenger in a motor vehicle accident. On arrival to the hospital, the paramedics inform you that she opens her eyes in response to verbal stimuli. She is incoherent and withdraws from painful stimuli. Which of the following is the patient’s calculated Glasgow Coma Scale (GCS)?
  • a.15
  • b.3
  • c.9
  • d.5
  • e.12

The answer is (C). The Glasgow Coma Scale (GCS) is often used to quantify consciousness and assess cerebral cortex and brain stem function by assessing the patient’s verbal response, motor response, and eye opening response to stimuli.
It may be repeated at intervals to detect improvement or deterioration and is now widely used in coma assessment. The minimum score is 3 and the maximum score is 15.
Three behaviors are assessed in the GCS:

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Presentation of  Atrophic vaginitis

A 64 y old woman presents with vaginal bleeding similar to “spotting” that has occurred daily for 1 mo. Her last menses was at age 50 and she has been healthy her entire life. She denies fever,weight loss, or abdominal pain.Physical examination is normal.
the most likely diagnosis is?
  • a.Atrophic vaginitis
  • b.Endometriosis
  • c.Uterine leiomyoma
  • d.Endometrial carcinoma
  • e.Polycystic ovarian syndrome

The answer is ( a ).
The most commoncause of postmenopausal vaginal bleeding is atrophic vaginitis (with or without trauma).
Endometriosis is the most common cause of infertility;patients present with dyspareunia (painful intercourse), abnormal vaginal bleeding, and pelvic pain. Uterine leiomyomas (uterine fibroids) change in size with the menstrual cycle but regress in size during menopause. Often the fibroid is palpable on pelvic examination. Polycystic ovarian syndrome (Stein-Leventhal syndrome) affects younger women (15–30). The etiology of polycystic ovary syndrome is unknown; patients present with amenorrhea, obesity, hirsutism, and infertility. All postmenopausal women with vaginal bleeding require a biopsy to rule out endometrial carcinoma.

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Pachyderma due to scabies

A 65-year-old white man with a history of multiple myeloma presented with thick, leathery, gray skin of the torso and extremities. Panel A shows the left axilla. The patient reported intense pruritus and thickening of his skin during the previous 6 months, despite treatment with oral and topical corticosteroids. Because of chronic immunosuppression due to his underlying malignant condition, a specimen obtained from scrapings of the skin was prepared and examined. It showed scabies mites, eggs, and scybala (fecal pellets) (Panel B), which confirmed a diagnosis of crusted scabies.

The patient was treated with oral ivermectin and topical permethrin, with noticeable improvement within 1 month; subsequently, the patient was lost to follow-up.
Crusted scabies is a rare variant of scabies and occurs most commonly in immunosuppressed patients.
It presents as: erythematous or gray hyperkeratotic patches or plaques that can resemble the hide of a pachyderm (elephant, rhinoceros, or hippopotamus); “pachyderma” refers to thick skin, like that of a pachyderm. Patients with crusted scabies have a very high burden of mites and are extremely infectious. Thus, a prompt diagnosis is needed to avoid transmission to others. No such transmission was documented in this case.

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Atlas of Procedures in Surgical Oncology With Critical, Evidence-based Commentary Notes

Riccardo A. Audisio, "Atlas of Procedures in Surgical Oncology With Critical, Evidence-based Commentary Notes"
World Scientific Publishing Company | 2009 | ISBN: 9812832939 | 300 pages | PDF | 38,2 MB

This unique book presents a series of concisely written technical notes on common procedures in surgical oncology. Each operation is illustrated with pictures framing precise technical points. The book is accompanied by a CD-ROM that includes video clips of the procedures. Written by top European experts, this volume will provide an invaluable resource for young surgical oncologists to familiarize with technical details, develop a critical approach and expand their surgical skills. It will also be a useful source of reference for medical oncologists, radiologists, radiotherapists and nurses, as well as final-year medical students.


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A popliteal cyst, also called a Baker's cyst, is a soft, often painless bump that develops on the back of the knee. A cyst is usually nothing more than a bag of fluid. These cysts occur most often when the knee is damaged due to arthritis, gout, injury, or inflammation in the lining of the knee joint. Surgical treatment may be successful when the actual cause of the cyst is addressed. Otherwise, the cyst can come back again.

Symptoms :
The symptoms caused by a popliteal cyst are usually mild. You may have aching or tenderness with exercise or your knee may feel unsteady, as though it's going to give out. You may feel pain from the underlying cause of the cyst, such as arthritis, an injury, or a mechanical problem with the knee, for instance a tear in the meniscus. Along with these symptoms, you may also see or feel a bulge on the back of your knee. Anything that causes the knee to swell and more fluid to fill the joint can make the cyst larger. It is common for a popliteal cyst to swell and shrink over time.

Sometimes a cyst will suddenly burst underneath the skin, causing pain and swelling in the calf. A ruptured popliteal cyst gives symptoms just like those of a blood clot in the leg, called thrombophlebitis. For this reason, it is important to determine right away the cause of the pain and swelling in the calf. Once the cyst ruptures, the fluid inside the cyst simply leaks into the calf and is absorbed by the body. In this case, you will no longer be able to see or feel the cyst. However, the cyst will probably return in a short time.


Suturing Workshop

A discussion and demonstration of suturing techniques with Lee Dresang, MD from the University of Wisconsin Department of Family Medicine.

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Babinski Response

Babinski Response: Note upgoing great toe upon stimulation of lateral foot in patient with
upper motor neuron lesion.

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