Melanonychia: hyperpigmented longitudinal streaks

This 20-year old boy man had presented with slowly progressing brown colored longitudinal streaking of the finger nails for over three years.

Melanonychia descriped as brown or black linear pigmentation of the nail unit. Melanonychia commonly presents as pigmented band arranged lengthwise along the nail unit, and this presentation is known as longitudinal  melanonychia (LM) or melanonychia striata.
The most important cause of melanonychia is subungual melanoma, but a variety of other causes includes :physiologic longitudinal melanonychia, systemic disorders, trauma, inflammatory disorders, fungal infections, drugs, and benign melanocytic hyperplasias.

Tubular Diskectomy

A video showing the procedure of Tubular Diskectomy of a herniated disk.

How is difficult to diagnose Chronic fatigue syndrome

Chronic fatigue syndrome is a common chronic pain disorder that causes severe fatigue that does not improve with rest. Chronic fatigue syndrome tends to get worse after exercise or mental activity. Severe or untreated chronic fatigue syndrome can lead to serious disruptions of work, school, relationships, and social activities. Chronic fatigue syndrome can also result in disability and severely impact a person's quality of life.

the causes of chronic fatigue syndrome are not known . One theory is that it develops out of a combination of factors, such as viral infection, stress, and exposure to toxins. Chronic fatigue syndrome can run in families, so genetic factors may increase the risk of developing the disorder. The prevalence of chronic fatigue syndrome is higher among adults 30–39 years old than among those over 60 and women > men.

There is no specific test to detect it.so,it is difficult to diagnosed.Diagnosing chronic fatigue syndrome requires running many tests to rule-out other diseases and disorders that have similar symptoms. Making a diagnosis of chronic fatigue syndrome includes performing a complete evaluation that includes a medical history, including symptoms, and physical examination.

Lisch Nodules

 Lisch nodules are melanocytic hamartomas, usually clear yellow to brown, that appear as well defined, dome shaped elevations projecting from the surface of the iris. They may be seen without magnification but a slit lamp examination may be necessary to distinguish them from naevi on the iris which present as flat or minimally elevated, densely pigmented lesions with blurred margins. The nodules are thought not to cause any ophthalmologic complication.

Lisch nodules are the most common clinical finding in adults over 20 years of age with type I neurofibromatosis (NF-1). Unlike cafe au lait spots, multiple nodules are specific for peripheral neurofibromatosis - Von Recklinghausen disease. They may occur in segmental neurofibromatosis which is due to a somatic mutation of the NF-1 gene but are generally absent in central neurofibromatosis. In children, nodules are a more likely finding than neurofibromas. This is an example of an ocular manifestation of a genetic disease. NF-1 has been mapped to a gene defect in chromosome 17.

Tracheal Stenosis

Endoscopic view of stenosis 

Resected segment of trachea 

3-D CT reconstruction of trachea showing stenosis at mid level

Tracheal stenosis is a narrowing or scarring of the inside of the trachea can produce difficulty breathing;
treatment may be surgical excision, dilation, or stenting.

History and Examination at a Glance

History and Examination At a Glance provides a concise, readily accessible introduction and revision guide designed in accordance with current teaching practice. The book follows the easy-to-use At a Glance format of double page spreads composed of clear memorable diagrams that support accompanying key facts and essential information.
For ease of understanding, the book has a four-part approach. Section I introduces students to key history taking and communication skills including relationships with patients, family history, functional enquiry and more. Section II covers the history and examination of the systems as well as the principles and presentation of a history and examination. Section III and IV cover all the common clinical presentations and system based conditions, how they present and how to make a diagnosis. These include topics from chest pain, headache, unconscious patient, attempted suicide and trauma to aortic aneurysm, renal failure, asthma, stroke and much more.
History and Examination At a Glance will be an essential resource for all medical students as well as students in other health professions. It is ideal for clinical training, for the run up to OSCE as well as other clinical examinations and it will be an absolute cornerstone to anyone’s clinical attachments! The book is designed to fit into the reading time as well as the budget of students and trainees.

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Clinical Emergency Medicine Casebook

Emergency Medicine is not divided into specific areas of practice. Emergency room visitors come in all shapes and sizes, at any time of day or night, with a wide range of maladies. Emergency physicians need to become experts in diverse areas of medicine and to be able to make quick and informed decisions about patient care. A cornerstone of emergency medicine training is the constant drilling and re-drilling of simulated cases and clinical scenarios. This book offers a unique yet underutilized strategy for learning: a case-based approach from real patients and actual events. Each case provides the opportunity for learning essential clinical concepts. Focused exclusively on the needs of in-training emergency physicians and nurses, the book covers more than 100 common and unusual cases in emergency medicine. The procedures have been class-tested by the Stanford/Kaiser Emergency Medicine Residency Program.

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