Daily Dose of Medicine

🚑 You’re the Doctor: A 25-year-old marathon runner collapses at the finish line. Bystanders say he was confused and agitated before collapsing. On arrival: •BP: 88/60 mmHg •HR: 145 bpm •Temp: 41°C (105.8°F) •RR: 30/min •Skin: Hot, dry, no sweating. What’s your next step? 🩺 A. IV fluids and antipyretics 🌡️ B. Rapid sequence intubation 🛏️ C. Ice-water immersion 🧊 D. Administer adrenaline 💉 E. CT brain to rule out stroke 🧠 👇 Comment your answer & reasoning! #MedTwitter #FOAMed #EmergencyMedicine #MedicalEducation #MedStudentTwitter #DoctorLife #HeatStroke #CriticalCare

80-year-old diabetic woman with a history of atrial fibrillation is transferred to your emergency department (ED) from the local nursing home with a note from the facility stating that she was complaining of abdominal pain and vomited once. Her vital signs in the ED are blood pressure (BP) 105/75 mm Hg, heart rate (HR) 95 beats/minute, respiratory rate (RR) 18 breaths/minute, and temperature 100.1°F . The patient appears very uncomfortable and has not stopped moaning in pain since arriving to the ED. You are surprised to find that her abdomen is soft and nontender on palpation. Which of the following diagnostic tests is most likely to reveal the cause of her symptoms? a. Capsule endoscopy b. Colonoscopy c. Computed tomography (CT) angiography of the abdomen d. Ultrasound e. Abdominal radiograph

reference: uptodate

🌟 Gottron’s sign over extensor surfaces of knees 🌟

@rahul_volgs biopsy of temporal artery biopsy is diagnostic test for GCA 😇if the clinical diagnosis is suspected then biopsy should be delayed any further meanwhile treatment is started immediately without delay.

@MRCEMPREP e

⭐ Gold standard Diagnostic test for Giant cell arteritis ? A-ultrasound B-Angiography C-Biopsy of Artery D-Ct head E-Explain the answer

C-Biopsy of Artery ◦ Temporal artery biopsy (TAB) is currently the gold standard method for the diagnosis of giant cell arteritis (GCA), with a specificity of 98% to 100% when histopathology demonstrates active necrotizing arteritis, characterized by a predominance of mononuclear cell infiltrates or a granulomatous process with multinucleated giant cells. Other features include narrowing and occlusion of the arterial lumen, intimal proliferation, rupture of the internal elastic layer, and lumen thrombosis. ◦ However TAB has a sensitivity of 77% and its false-negative rate ranges from 9% to 61%. ◦ False negatives may be due to the timing of biopsy, the length of the specimen, or the presence of segmental “skipping lesions” (observed in 12%‒28% of cases). ◦ It is also estimated that 25% of TAB for GCA are reported as “healed arteritis”, defined as fibrosis, attenuation and/or neovascularization of the media, irregular intimal proliferation, multifocal to complete loss of internal elastic lamina, adventitial fibrosis, and absence of ongoing chronic medial inflammation. The presence of “healed arteritis” is more often associated with prior history of polymyalgia rheumatica and longer corticosteroid use before TAB. 📸 Histopathological findings in biopsy-proven giant cell arteritis: (A) Temporal artery with narrowed lumen, atrophic media, interrupted elastic lamina, and granulomatous inflammation consistent with the diagnosis of giant cell arteritis (H&E, x50). (B) Typical area of granulomatous inflammation with multiple giant cells (black arrows) in the interrupted elastic lamina (H&E, x400). (C) Similar findings in another temporal artery biopsy with interrupted elastic lamina (black arrow), granulomatous inflammation, and giant cell formation (H&E, x200). (D) A clearer area of interrupted elastic lamina (red arrowhead) after special staining (Elastin, x200). *Source: Alkatan, Hind M et al. “Giant cell temporal arteritis: a clinicopathological study with emphasis on unnecessary biopsy.” Frontiers in Ophthalmology vol. 3 1327420. 2023 🔗doi.org/10.3389/fopht.…

@IhabFathiSulima Top 2 DDs goes Parotid gland tumor Lymphoma

What is the description or diagnosis or Differential?

@PediatricsC_1 @IhabFathiSulima @hemo_shk @jkbjb1 @MoarSahitoPTI @neoskinhealer @ritafattal @DrBassemKurdi @mohammadalmogbi @Dr_Alhatlani @DrOptomistic07 tracheo oesophageal fistula we see clearly contrast enhanced dye seeping into Right lung 🫁

6 months old girl get choking with almost every feed. What could be? @IhabFathiSulima #MEDHTM @hemo_shk @Jkbjb1 #TooCloseToDiagnose @MoarSahitoPTI @MRCEMPREP @neoskinhealer @ritafattal @DrBassemKurdi @mohammadalmogbi @Dr_Alhatlani @DrOptomistic07

Answer E: Vancomycin, ceftriaxone are effective against major pathogens in bacterial meningitis (Strep pneumoniae, Neisseria meningitidis, and H influenza). Patients at extremes of age, Listeria monocytogenes becomes more prevalent and requires specific therapy with ampicillin.

A 72-year-old female presents with fever, stiff neck, and headache. You strongly suspect bacterial meningitis. Which of the following is the most appropriate treatment strategy? A. Dexamethasone B. Vancomycin and ceftriaxone C. Ampicillin D. A and B E. A, B, and C

@IhabFathiSulima strychnine poisoning can cause tetnosapsm similar like tetnus

What type of poison can cause the devil posture?

A woman presents with a long history of dysphagia for both liquids & solids. Chest X-ray reveals a dilated lower oesophagus with a fluid level behind the heart choice of treatment? A. Atenolol b-Nifedipine c-Ramipril d-Propranolol e-Doxazosin

acanthosis nigricans is a sign for insulin resistance in body

A 45-year-old male with fatigue, weight gain, and cold intolerance. On examination, his skin is dry, and he has a slow heart rate. TSH: Elevated Free T4: Low ❓ likely diagnosis? A) Hyperthyroidism B) Hypothyroidism C) Addison’s disease D) Cushing’s syndrome

Persistence of fetal circulatory pattern of right to left shunt through PDA and foramen ovale after birth is due to high pulmonary vascular resistance occur in which of the following. a. PPHN (Persistent Pulmonary Hypertension of the Newborn) b. Sepsis c. TTN d. CHD e. Pneumothorax

Hypoxic –ischemic encephalopathy(HIE) is an important cause of permanent damage to CNS tissue that may result in neonatal death or manifest as cerebral palsy. Which of the following is the characteristic of stage 1. a. Baby dull and lethargic b. Weak primitive reflexes c. Contricted pupils d. Puplis unequal in size e. Normal reactive pupils

A term baby weighing 3.6kg delivered by c-section has tachypnea and acrocyanosis. Apgar scores were 7 and 8 at 1 and 5 minutes, respectively. Vitals and systemic examination are normal with the exception of a respiratory rate of 84b/m and slight subcostal retractions. What diagnosis you will consider in this baby. a. Congental diaghpramatic hernia b. Pneumothorax c. Cyanotic congenital heart disease d. Transient tachypnea of newborn e. Sepsis

@IhabFathiSulima he must be having dandruff seborric dermatitis on face. difficult to treat thought

What is the diagnosis ⁉️