Monday, December 6, 2010

Corneal Abrasion:What to do and What not to do!

The patient may complain of eye pain or a foreign body sensation after being poked in the eye with a finger or twig. The patient may have abraded the cornea inserting or .................

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PreTest Self-Assessment And Review

"Medicine: PreTest Self-Assessment And Review" by Steven Berk
Mc G - H | 356 pages | English | 2006, 11 edition | ISBN: 0071455531 | PDF | 1,7 MB

PreTest is the closest you can get to seeing the test before you take it. Great for course review and clinical rotations, too! Medicine: PreTest asks the right questions so you'll know the right answers.

This one-of-a-kind test prep guide helps you:
* Get to know material on the medicine shelf exam and the USMLE Step 2
* Practice with 500 clinical vignette-style questions and referenced answers
* Learn why answers are right and wrong
* Review key facts for exam success
* Build confidence, skills, and knowledge

There are plenty of answers out there. But only PreTest delivers the right questions.

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Differential Diagnosis of bile duct dilatation

Whenever there is bile duct dilatation, the first priority is to look for obstruction.

If there is an obstruction, we first look for gallstones in the bile duct. If there are no gallstones involved, we then look for strictures.
The differential diagnosis for a stricture is based on the location.

* A distal stricture is most likely the result of a distal cholangiocarcinoma, pancreatic carcinoma or pancreatitis.
* A stricture within the liver is likely due to gallbladder carcinoma or inflammatory strictures like PSC (Primary Sclerosing Cholangitis) or AIDS cholangiopathy.
* Metastatic disease can occur anywhere within the bilairy system.

No Obstruction
Once we have excluded obstruction, we have to think about nonobstructive biliary diseases like:

* Caroli disease
* Choledochal cyst
* Recurrent pyogenic cholangitis
* Primary sclerosing cholangitis


Mucocutaneous Manifestations of Necrolytic Migratory Erythema

Necrolytic migratory erythema is a rare inflammatory dermatosis.which occurs in 70% of patients with the glucagonoma syndrome.
Its clinical features are polymorphic mucocutaneous manifestations, encompassing multiple annular erythematous scaling and crusting patches with hyperpigmentation. These lesions can affect the entire body with a predilection for the perineum, buttocks, groin, abdomen, and limbs — in other words, areas that are subject to increased pressure and friction. The only two reported oral findings are angular cheilitis and atrophic glossitis.
This Figure shows Mucocutaneous Manifestations of Necrolytic Migratory Erythema.
Bullous, erosive oral mucositis with areas having lichenoid features are visible on the tongue and the upper and lower lips (Panel A) and inside the right cheek (Panel B). The patient's entire body, including the back, is covered with purplish, confluent erythematopapulous scaling and crusting lesions with a keratotic surface (Panel C). Histologic analysis of the skin (Panel D, left) shows hyperparakeratosis and spongiosis, accompanied by the presence of necrotic keratinocytes, and vascular proliferation. Histologic analysis of the oral mucosa (Panel D, right) shows a prominent neutrophilic, eosinophilic, and plasmacellular infiltrate (hematoxylin and eosin).

The patient's nutritional status was normal. Routine hematologic tests revealed mild hyperglycemia, hypoalbuminemia, a glucagon level of 73 pg per milliliter (normal range, 25 to 250), and a zinc level of 134 μg per deciliter (normal range, 60 to 250). Tumor markers showed a CA-125 level of 232 U per milliliter (normal range, 0 to 35) and a β2-microglobulin level of 2924 ng per milliliter (normal range, 600 to 2600). Total-body computed tomography revealed the presence of an ovoid mass measuring 40 mm in diameter in the upper lobe of the right lung, with prominent striae hooking the apical and costal homolateral pleura. No evidence of a pancreatic tumor was detected. Needle biopsy of the lung with ultrasonographic guidance revealed a small-cell lung cancer. A diagnosis of nonglucagonoma-associated necrolytic migratory erythema was made. The patient died 2 months later.

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How is Neuroblastoma Clinically Presentating ?

Neuroblastoma is a childhood cancer that is diagnosed at a median age of about 17 months. Tumors can arise anywhere along the sympathetic nervous system, with the majority occurring in the adrenal medulla. Primary tumors in the neck or upper chest can cause Horner's syndrome (ptosis, miosis, and anhidrosis)............

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Fluorescent thyroid scan in thyroiditis

Fluorescent thyroid scan in thyroiditis. The normal thyroid scan (left) allows identification of a thyroid with normal stable (127I) stores throughout both lobes. A marked reduction in 127I content is apparent throughout the entire gland involved with Hashimoto's thyroiditis (right).

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