GOUT PIC

Gout of the Right Great Toe: Diffuse swelling and redness centered at the right MTP joint, but extending
over much of the foot.


Gout of the Left Great Toe: Diffuse swelling and redness centered at the left MTP joint.

Case of gross hematuria following a game of soccer

A 37 year old male complains of gross hematuria following a game of soccer with his friends at work. He could not recall any particularly severe trauma. On examination both kidneys were enlarged and easy palpable. His blood pressure was raised. A likely diagnosis is :

a) polycystic disease of the kidneys
b) Berger's nephritis
c) systemic lupus erythematosus
d) renal vein thrombosis
e) Goodpasture's syndrome

The correct answer is...................... A

Explanation
In polycystic disease of the kidneys the symptoms or signs first occur between the third and fourth decades of life. These include microscopic and gross hematuria, flank pain and hypertension. The polycystic condition is not confined to the kidneys. Hepatic cysts, usually identified incidentally by sonography, help in making the diagnosis of DPK. These cysts are more likely to be found in adults than in children. Approximately 10% to 40% of patients have berry aneurysms, and approximately 9% of these patients die because of subarachnoid hemorrhages

Mapping the Atrioventricular Node

A 75-year-old woman presented with dyspnea, an awareness of rapid heart action, and permanent atrial fibrillation with a rapid ventricular response that had been resistant to treatment with beta-blockers, calcium-channel blockers, digoxin, and multiple cardioversions. For severe rheumatic aortic and mitral stenosis, she had undergone replacement of the aortic and mitral valves with Starr–Edwards devices in 1970, as seen on chest radiography on admission (Panels A and B, arrows). In 2006, a pacemaker had been implanted for the treatment of bradycardia.

To control the rapid ventricular response to atrial fibrillation, the patient underwent ablation of the atrioventricular node, located just below the aortic valve, where the ablation catheter was positioned (Panel C). Whereas ablation sites are often identified with the use of computerized systems for "electroanatomical mapping," the patient's atrioventricular node was identified on the basis of simple anatomical landmarks, the aortic and mitral valves. The atrioventricular node may be injured by operations or infections because of its proximity to these valves.

After ablation, the patient's condition immediately improved. Atrioventricular-node blocking agents were discontinued, and the only cardiac medications she continued to receive were warfarin and furosemide. Six months after the procedure, the patient remained free of heart-failure symptoms.

Procedures to open obstructed airway

#The tongue is the single most common cause of an airway obstruction. In most cases, the airway can be cleared by simply using the head-tilt/chin-lift technique. This action pulls the tongue away from the air passage in the throat ,See this video:

Head tilt chin lift Technique

#The head-tilt/chin-lift is an important procedure in opening the airway; however, use extreme care because excess force in performing this maneuver may cause further spinal injury. In a casualty with a suspected neck injury or severe head trauma, the safest approach to opening the airway is the jaw-thrust technique because in most cases it can be accomplished without extending the neck.See it:

Jaw Thrust Technique

Differences between sutures and fractures in skull x-ray

Linear fracture results from low-energy blunt trauma over a wide surface area of the skull. It runs through the entire thickness of the bone and, by itself, is of little significance except when it runs through a vascular channel, venous sinus groove, or a suture. In these situations, it may cause epidural hematoma, venous sinus thrombosis and occlusion, and sutural diastasis, respectively. Differences between sutures and fractures are summarized in this Table

Click here for enlargment

Algorithm of the cause of Hypokalaemia

A history of vomiting, diarrhoea, or use of medications such as diuretics can be helpful in determining the cause of hypokalaemia. However, in some cases, the cause of hypokalaemia is not readily apparent. In these cases, measurements of BP and urinary potassium excretion, and assessment of acid-base balance are often helpful.

Serum potassium concentrations:
There is no strict correlation between the serum potassium concentration and total body potassium stores. In chronic hypokalaemia, a potassium deficit of 200 to 400 mmol (200 to 400 mEq) is required to lower the serum potassium concentration by 1 mmol/L (1 mEq/L). These estimates are good provided there is no concurrent acid-base abnormality (e.g., for diabetic ketoacidosis or severe non-ketotic hyperglycaemia).

In diabetic ketoacidosis patients may have a normal or even elevated serum potassium concentration at presentation, despite having a marked potassium deficit due to urinary and GI losses.

Spurious hypokalaemia can occur when blood with a high WBC count is left at room temperature due to extraction of potassium by the WBCs. It is therefore important to consider repeating the test for confirmation.

Medical Terminolog: An Illustrated Guide

Medical Terminolog: An Illustrated Guide
Publisher: Lippincott Williams & Wilkins | ISBN: 078174976X | edition 2003 | PDF | 744 pages | 14,1 mb

This product contains a student access code for courses that have adopted the Blackboard or WebCT online course for Cohen: Medical Terminology: An Illustrated Guide, Fourth Edition.

For Free Download:

HERE

About corneal injuries

Which of the following statements is true regarding corneal injuries?

• A) Patients should have the affected eye patched for 24 hours.
• B) Topical antibiotics are recommended to prevent superinfection.
• C) Foreign bodies should not be removed because of potential further injury to the cornea.
• D) Topical anesthetics should be g...iven to treat the discomfort.
• E) None of the above.

Answer and Discussion

The answer is B.
Controlled studies have not found patching to improve the rate of healing or comfort in patients with traumatic or foreign body abrasions. Patients should be treated with topical antibiotics to prevent superinfection. If a corneal foreign body is detected, an attempt can be made to remove it by irrigation. Topical anesthetics should never be administered or prescribed for pain relief because they delay corneal epithelial healing.