• Acquired pendular nystagmus: multiple sclerosis (2-4% patients) ○ Rare: chronic toluene encephalopathy ○ Described as a cerebellar tremor • Special variants: ○ See-saw nystagmus: Parasellar mass, usually a craniopharyngioma
• The onset of RA is episodic in a few patients, with one to several joint areas being affected sequentially for hours to days, alternating with symptom-free periods that may last from days to months; this episodic pattern is referred to as "palindromic rheumatism." • A response among patients with palindromic rheumatism to hydroxychloroquine, which is also used for the treatment of RA, further supports the possibility that palindromic rheumatism can be a presenting feature of RA.
5. Higoumenakis' sign (HS): Right sternoclavicular joint involvement
8. Patient with CKD and rising creatinine, steps to control
a. Control DM/ HTN b. Restrict dietary protein, but don't allow catabolism i. Historical: Bull's regime (only carbohydrate – disadvantage: catabolism) ii. Gio vanity diet: 0.6 g/ kg protein c. Restrict dietary K+ (e.g. in fruits – watermelon, tomato) d. Evaluate drugs and drug interactions that increase K+ levels
9. Dictum is to not give glucose in cerebral edema
• Treating cerebral edema: head-end elevation, decompressive craniotomy • Administering mannitol must be cautious: heart, kidney and rest physiological functions must be intact
• Involuntary synchronous spasms of one side of the face, usually beginning around the eye • Etiology: compression of the facial nerve that exits the brainstem by an ectatic or aberrant artery. The typical aberrant arterial anomalies leading to facial nerve root compression are the branches of the anterior inferior cerebellar artery, posterior inferior cerebellar artery, and vestibular artery, among others.
12. Crocodile tears: misdirected autonomic fibers, a salivary stimulus may result in excess lacrimation, the syndrome of "crocodile tears." (differentiate from Frey's syndrome)
13. Marcus Gunn phenomenon versus Marin-Amat syndrome
• Aberrant innervation of the levator muscle by the mandibular branch of the trigeminal nerve (Marcus Gunn jaw winking) causing eyelid retraction when the patient contracts the pterygoid muscle during the acts of sucking, jaw opening, or lateral jaw movement • Marin Amat syndrome is a rarely reported synkinesis in which eyelids close upon full opening of the jaw or movement of the jaw laterally. • In inverse Marcus Gunn phenomenon the upper lid falls to cover the eye with movements of mastication. This is more commonly seen as an acquired rather than congenital anomaly in central nervous system (CNS) disease.
14. 3 KW's in medicine
• Keith, Wagner, and Barker's (KWB) classification of hypertensive retinopathy • Kimmelstiel-Wilson (KW) lesions of DM • Katz-Wachtel phenomenon: Tall diphasic QRS complexes (>50 mm in height) in the mid-precordial leads (leads V2, V3 or V4) typically associated with Biventricular Hypertrophy (BVH).
15. All extrampyramidal manifestations disappear during sleep.
○ Except tardive dyskinesia
16. Maximum doses and Glargine
• Glimperide: 6 - 8 mg/ day • Metformin: 2 g/ 2.5 g per day • Lantus: Insulin glargine
17. NCPF – non-cirrhotic portal fibrosis
• The Asian Pacific Association for the Study of the Liver (APASL) Working Party on Portal Hypertension ○ NCPF/IPH is a disease of uncertain etiology characterized by periportal fibrosis and involvement of small and medium branches of the portal vein, resulting in the development of portal hypertension. The liver functions and structure primarily remain normal. ○ Diagnostic features: ▪ Presence of moderate to massive splenomegaly ▪ Evidence of portal hypertension, varices, and/or collaterals ▪ Patent spleno-portal axis and hepatic veins on ultrasound Doppler ▪ Test results indicating normal or near-normal liver functions ▪ Normal or near-normal hepatic venous pressure gradient, and ▪ Liver histology—no evidence of cirrhosis or parenchymal injury. ○ Other features: ▪ Absence of signs of chronic liver disease ▪ No decompensation after variceal bleed except occasional transient ascites ▪ Absence of serum markers of hepatitis B or C virus infection ▪ No known etiology of liver disease ▪ Imaging with ultrasound or other imaging techniques showing dilated and thickened portal vein with peripheral pruning and periportal hyperechoic areas. • Normal portal vein size: 8 mm to 11 mm (12 mm is borderline, 13 mm is reported as dilated)
18. Central causes of paraparesis
19. Females develop alcoholic liver disease at lower concentrations of alcohol
• Males under age 65: >14/ week or >4/ any day • Females (all ages) and males over 65: >7/ week or >3/ any day ○ Due to polymorphisms of alcohol and aldehyde dehrogenase
20. Liver transplantation eligibility in alcoholic liver disease:
a. 6-months of abstinence is required b. Recidivism is a contra-indication c. Concept of auxiliary liver transplant
21. Non-typhoidal salmonella: poultry, eggs, reptiles such as lizard (falling on someone/ water tanks) - excreta/ gut of reptiles contains NTS Species: ○ Salmonella typhimurium ○ Salmonella enteridus ○ Salmonella choleraesuis
22. COVID – Pangolins may have spread the disease to humans
23. Modified ATT in:
a. Drug-induced liver injury i. ALE regimen b. Renal modification i. Pyrazinamide and ethmabutol: half dose OD or full dose alternate day ii. Rifampicin, isoniazid: same dose is safe
Download Full Congestive Heart Failure and Cardiac Transplantation Clinical Pathology Imaging and Molecular Profiles 1st Edition Daniel J. Garry PDF All Chapters
Complete Download Rule outs in small animal medicine Problem oriented assessment of problems in physical examination and clinical pathology Second Edition,New Edition,Second Edition Katrin Hartmann PDF All Chapters
