HSV Retinitis vs CMV Retinitis

Difference between HSV Retinitis and CMV Retinitis

Bacillary angiomatosis vs Kaposi sarcoma

Bacillary angiomatosis also known as Cat scratch disease

by : Bartonella spp.

Transmission : Cat scratch

Lesions : Red color

bacillary angiomatosis-its a superificial vascular proliferation,biopsy shows neutrophilic inflammation

Kaposi sarcoma : HHV-8

lesions violaceous color

Kaposi's sarcoma(HHV-8)- its the neoplastic proliferation of vasculature, biopsy shows lymphocytic inflammation.

Being a Doctor what do you know about Zika Virus ?

Zika Virus is trasmitted by mosquitos of the Aedes genus

Affected countries : Brazil , Bolivia , paraguay , Ecuador , Colombia , Mexico
Haiti , Dominican Republic , Panama , Costa Rica , El salvador

Clinical features :

Vague last for upto a week

Dx : Serology

Symptoms :

• Fever , Rash , Joint pain , Conjunctivitis , Myalgia , Headaches , Pain behind the eyes and Vomiting
• Only 1 in 4 develop symptoms 
• Mostly seen in pregnant women --- lead to infant microcephaly

Prevention :

• Insect repellent , wear long sleeved , long pants - covered extremities 
• Rest 
• Hydration 
• Antipyretic and analgesics : Tylenol  (acetaminophen)

Extrinsic intrinsic pathway coagulation (Easy to memorize)

Secondary causes of Hypertension

Secondary causes of HTN 

1. Renal : Renal Artery Stenosis
2. Adrenal : Primary Hyperaldosteronism , Cushing syndrome , Pheochromocytoma
3. Thyroid : Hyperthyroidism
4. Parathyroid : Hyperparathyroidism .

Torsade de pointes

Drugs list Torsade de pointes :

• Class 1 Anti-Arrhythmia : Quinidine , Procainamide , Disopyramide
• Class 3 Anti-Arrhythmia : Sotalol , Ibutilide , dofetilide

• Combination of Class 1 and Class 3 : Amiadrone

• Antipsychotic : Haloperidol
• Antidepressants : TCA 

Skin conditions and important associations

Acanthosis nigricans -- Insulin resistance (Polycystic Ovarian Syndrome), Gastrointestinal malignancy

Multiple skin tags   -- Insulin resistance , Pregnancy and Crohn disease (perianal)

Porphyria cutanea tarda
Cutaneous leukocytoclastic vasculitis (palpable purpura) secondary to cryoglobulinemia, Lichen planus --
Hepatitis C

Dermatitis herpetiformis  -- Celiac disease

Sudden-onset severe psoriasis 
Recurrent herpes zoster 
Disseminated molluscum contagiosum   -- HIV infection

Severe seborrheic dermatitis  -- HIV infection and Parkinson disease

Explosive onset of multiple itchy seborrheic keratosis -- GI malignancy

Pyoderma gangrenosum -- IBD (inflammatory bowel disease)

Vitiligo -- other autoimmune conditions such as Celiac disease, Pernicious anemia , autoimmune thyroid disease, type 1 diabetes mellitus, primary adrenal insufficiency, hypopituitarism, and alopecia areata.

Features of constrictive pericarditis

Features of constrictive pericarditis

Etiology 

• Idiopathic or viral pericarditis
• Cardiac surgery or radiation therapy
• Tuberculous pericarditis (in endemic areas)

Clinical presentation

• Fatigue and dyspnea on exertion
• Peripheral edema and ascites
• Increased JVP
• Pericardial knock may be heard
• Pulsus paradoxus
• Kussmaul's sign

Diagnostic findings

• ECG may be nonspecific or show atrial fibrillation or low voltage QRS complex
• Imaging shows pericardial thickening and calcification
• Jugular venous pulse tracing shows prominent x and y decents.

Findings of Cor pulmonale

Characteristic findings of Cor pulmonale

Common etiologies :

• COPD
• Interstitial lung disease
• Pulmonary vascular disease (eg, thromboembolic)
• Obstructive sleep apnea

Symptoms :

• Dyspnea on exertion, fatigue, lethargy
• Exertional syncope (due to decreased CO)
• Exertional angina (due to increased myocardial demand)

Examination : 

1. Peripheral edema
2. Increased Jugular venous pressure with prominent a wave
3. Loud S2
4. Right sided heave
5. Pulsatile liver from congestion
6. Tricuspid regurgitation murmur

Imaging :

• EKG : partial or complete RBBB , right axis deviation, right ventricular hypertrophy right ventricular enlargement

• Echocardiogram : Pulmonary hypertension, dilated right ventricle, tricuspid regurgitation

Right heart catheterization: Gold standard for Dx showing right ventricular dysfunction, pulmonary HTN and no left heart disease.

Difference between Hydrocele and Varicocele

Hydrocele:--Painless enlargement of the Scrotum.
Can be Unilateral or Bilateral.

Diagnosis with Transillumination. However transillumination cannot confirm the diagnosis because it also may indicate hernia.

Ultrasound can be done to confirm the diagnosis.

Varicocele:-Varicocele is a mass of enlarged veins that develops in the spermatic cord.

A varicocele can develop in one testicle or both, but in about 85% of cases it develops in the left
testicle. The left spermatic vein drains into the renal vein .

Highest in men between the ages of 15 and 25.
The sudden appearance of varicocele in an older man
may indicate a renal tumor blocking the spermatic
vein.

S&S:--Asymptomatic or may have:--

• Ache in the testicle
• Feeling of heaviness
• Infertility
• Atrophy of the testicle
• Visible or palpable enlarged vein 

Diagnosis:--Large varicoceles may be seen with the naked eye. Medium-sized varicoceles may be detected during physical examination by palpating--"Bag of Worms

Doppler ultrasonography uses ultrasound echos to detect the characteristic sound of the backflow of
blood through the valve.

Treatment:--Surgical Ligation of the affected Spermatic veins.

Summary :

varicocele is described as a "bag of worms", will not transilluminate
hydrocele is collection of fluid in tunica vaginalis, will feel different depending whether it is communicating or not, will transilluminate

Common Causes of Anion gap metabolic acidosis

Common Causes of Anion gap metabolic acidosis:

1.Lactic acidosis: Hypoxia, poor tissue perfusion, mitochondrial dysfunction

2. Ketoacidosis: Type I diabetes, starvation or alcoholism

3. Methanol ingestion : Formic acid accumulation

4. Ethylene glycol ingestion : Glycolic and oxalic acid accumulation

5. Salicylate poisoning: Causes concomitant respiratory alkalosis

6. Uremia (ESRD): Failure to excrete H+ as NH4+

Indications for Dialysis

INDICATIONS FOR URGENT DIALYSIS

Remember : 

AEIOU

A Acid base disorders : Acidemia

E Electrolyte disturbance : Hyperkalemia

I Intoxication i.e methanol, ethylene glycol, lithium , salicylates

O Overload of Volume

U Uremia : Pericarditis , encephalopathy

Osler Weber Rendu Syndrome

Osler Weber Rendu Syndrome :

Patients with hereditary telengiectasia can develop pulmonary AVMs associated with hemoptysis and right to left shunt physiology. Also with recurrent nose bleeds and oral lesions.

USMLE GUIDE TO HIGH SCORE MORE THAN 250

USMLE  GUIDE TO HIGH SCORE MORE THAN 250 by Mirzadani

How to approach USMLE Questions ?

Difference between kawasaki and scarlet fever

Kawasaki disease include: (mucocutaneous lymph node syndrome)

Definition : Kawasaki disease is a vasculitis of medium-sized arteries that affects very young children (usually 12-24 months of age).

cause is unknown

Features:
1. Fever more than 5 days - even after aspirin
2. Bilateral conjunctivitis
3. Lymphadenopathy
4. Cutaneous involvement
1. Oropharyngeal: Erythema of the palatine mucosa, fissured erythematous lips, “strawberry” tongue
2. Peripheral extremities: Edema of hands and feet, erythema of palms and soles, desquamation of the fingertips (periungual)
3. Generalized rash: Polymorphous (usually urticarial) erythematous rash beginning on the extremities and moving to the trunk (centri petal spread)

Complication: Formation of coronary artery aneurysms is the most serious complication of Kawasaki disease.

Scarlet fever : 

Causes : Streptococcus pyogenes (group A streptococci) --Toxigenic

Features:

scarlet rash with Sand paper like texture ,circumoral pallor.

Tonsillar exudates, Spares the palms and soles

Complication: Septic complications

Aspirin helps to reduce fever , Amoxicillin and throat culture

Similarity : ''Strawberry tongue''

Factors Causing Hyperkalemia and Hypokalemia

Factors Causing Hyperkalemia 

• Acidosis
• ACEI
• Beta-Blockers (Propanolol)
• Digitalis toxicity 
• Succinylcholine
• Renal Failure
• Mineralocorticoid deficiency (Hypoaldosteronism)
• Potassium-Sparing Diuretics (Spironolactone,Triamterene,Amiloride)
• Rhabdomyolysis 

Factors Causing Hypokalemia 

• Loop and Thiazide Diuretics
• Osmotic Diuretics
• Mineralocorticoid (Hyperaldosteronism)
• Alkalosis
• Insulin
• Beta-2 agonists(Albuterol)
• Eating disorder
• Diarrhea, Vomiting
• Laxatives
• ATN - recovery phase
• Elderly patients.

Difference between Esophageal varices and Mallory-Weiss syndrome

• Laceration at the GE junction due to severe prolonged vomiting (MW syndrome)

• Dilated submucosal veins in the lower third of the esophagus ,usually secondary to portal hypertension (EV)

• Most Common Cause : alcoholism in (MW syndrome) , Cirrhosis in (EV)

• Presentation : Mild hematemesis in (MW syndrome) , Massive hematemesis when ruptured in (EV) 

• Complication : Boerhaave syndrome (esophageal rupture) in (MW syndrome) , Potentially fatal hemorrhage in (EV) 

both can possibly lead to death in alcoholics.

What is your Clinical Diagnosis of these images ?

Clinical Diagnosis ???

Clinical Diagnosis ???

Note* : Please give your Answer in the comment's option 

CORONARY ARTERIES

From: Ascending aorta
To: Myocardium 

Right coronary artery. Originates from the anterior (new nomenclature: right) aortic sinus. It passes anteriorly between the pulmonary trunk and the right auricle to reach the atrioventricular sulcus in which it runs down the anterior surface of the right cardiac border and then onto the inferior surface of the heart. It terminates at the junction of the atrioventricular sulcus and the posterior interventricular groove by anastomosing with the circumflex branch of the left coronary artery and giving off the posterior interventricular (posterior descending) artery. It supplies the right atrium and part of the left atrium, the sinuatrial node in 60% of cases, the right ventricle, the posterior part of the inter- ventricular septum and the atrioventricular node in 80% of cases.
Left coronary artery. Arises from the left posterior (new nomenclature: left) aortic sinus. It passes laterally, posterior to the pulmonary trunk and anterior to the left auricle to reach the atrioventricular groove where it divides into an anterior interventricular (formally left anterior descending) artery and circumflex branches.
The circumflex artery runs in the atrio- ventricular sulcus around the left border of the heart to anastornose with the right coronary artery. The anterior inter-ventricular artery descends on the anterior surface of the heart in the anterior interventricular groove and around the apex of the heart into the posterior interven-
tricular groove where it anastomoses with the posterior interventricular branch of the right coronary artery. The left coronary artery supplies the left atrium, left ventricle, anterior interventricular septum, sinuatrial
node in 40% of cases and the atrioven- tricular node in 20%.
Dominance. In approximately 10% of hearts the posterior interventricular artery arises from the circumflex artery (left coronary) and then most of the left ventricle and interventricular septum are supplied by the
left coronary artery. The heart is said to have left cardiac dominance.