·
lowered CSF glucose: hypoglycorrhachia
·
heroin: a/w wound
botulism
·
crack cocaine:
a/w syphilis
·
Note that isolated
dextrocardia is more likely to have underlying cardiac malformations like VSD...etc.
Here we can see dextrocardia with left-sided liver and right-sided stomach (situs
invertus) in which the heart is usually normal!
·
The combination of diabetes mellitus,
hypertension, obesity, insulin resistance, and dyslipidemia (increased VLDL,
increased triglyceride, and decreased HDL) is called syndrome X or Coronary artery disease, Hypertension,
Atherosclerosis, Obesity, and Stroke (CHAOS).
·
Physicians should be able to calculate different cholesterol levels (mg/dL) using the
following simple formulas:
1. Total
cholesterol = HDL + VLDL + LDL
2. VLDL =
Triglycerides/5
3. LDL = Total
cholesterol -HDL -[Triglycerides/5]
·
Patients with peripheral vascular disease should
be evaluated with a penile/brachial index.
An index <0.06 suggests vascular impotence. Endocrine ED may be due to
testicular failure (rare) or prolactinomas
·
The differential diagnosis for microcytic
hypochromic anemia is TICS (Thalassemia,
Iron deficiency, Chronic disease, and Sideroblastic).
·
Tangier disease
is a rare inherited disorder of lipoprotein metabolism. Patients present with a
low serum cholesterol level, virtually no HDL
cholesterol, a normal or elevated triglyceride level, orange-colored tonsils,
corneal opacities, and a relapsing polyneuropathy. The disorder
does not lead to premature atherosclerosis and treatment is not required.
·
Dose of Anthracyclines need NOT be modified
in renal failure pts.
·
Blood test that differentiates seizures from
pseudoseizures – Prolactin level (Blood samples must
be drawn within 20 mins of the episode)
In GTCS – Prolactin level
↑
In non-epileptic seizures
– Prolactin level normal
·
MC metastatic tumor causing Diabetes insipidus – Breast Ca
·
Antiarrythmic drug without any direct effect on
heart – Phenylephrine (It terminates
arrhythmia reflexly, via the baroreceptors, in response to a vasopressor
effect)
·
MURMURs
·
Austin Flint
murmur : Austin Flint murmur is a mid-diastolic rumbling audible in
subjects with severe aortic regurgitation that is best heard at the apex with
little radiation. Several theories have been suggested for the origin of the
murmur: (1) vibration of the anterior mitral valve leaflet due to the
regurgitant jet, (2) collision of the jet with mitral inflow, (3) increased
mitral inflow velocity due to narrowing of the valve orifice by the jet, and
(4) vibration from the jet impinging on the myocardial wall. It differs from
mitral stenosis murmur in that ,it occurs in the presence of a murmur of aortic
valve insufficiency and in the absence of the rheumatic, mitral opening snap.
·
Carey Coombs
murmur : Mitral valvulitis associated with acute rheumatic fever may
cause a low-pitched mid-diastolic rumble. It can be differentiated from the
diastolic murmur of Mitral stenosis by the absence of (1)an opening snap,
(2)presystolic accentuation & (3)loud first heart sound.
·
Cruveilhier-Baumgarten
murmur : Venous hum heard in epigastric region (on examination by
stethoscope) due to collateral connections between portal system and the
remnant of the umbilical vein in portal hypertension.
·
Duroziez's murmur
: Its a to & fro murmur heard over the femoral artery during both
systole& diastole. It is elicited by applying gradual arterial compression
with the diaphragm of the steth. This compression not only produces systolic
murmur(which is the normal result of arterial compression) but also a diastolic
murmur(which is pathologic & suggestive of aortic
regurgitation).Sensitivity of 58-100%.False positives occur in high output
states. In high output states the double murmur is due to forward flow. In Ar
one murmur is due to forward flow& the other due to reverse flow.The two
can be differnetiated by applying pressure first on the more cephalad edge of
the diaphragm & then on its more caudal edge. The murmur of forward flow is
enhanced by compressing the cephalad edge. Conversely the reverese flow murmur
is enhanced by compressing the caudad edge.
·
Gibson murmur
:The typical continuous "machinery-like" murmur of patent ductus
arteriosus.train in tunnel murmur
·
Graham Steell's
murmur : Due to pulmonary regurgitation in patients with pulmonary
hypertension and mitral stenosis. It is a high pitched early diastolic murmur
heard best at the left sternal edge in the second intercostal space with the
patient in full inspiration.
The murmur is
heard due to a high velocity regurgitant flow across the pulmonary valve; this
is usually a consequence of pulmonary hypertension. The Graham Steell murmur is
often heard in patients with chronic cor pulmonale as a result of chronic
obstructive pulmonary disease.
·
Means-Lerman
"scratch" murmur: Increased flow across the pulmonary
valve in Thyrotoxicosis may be associated with ejection systolic murmur.The
ejection systolic murmur owing to hyperthyroidism may have a scratchy quality
(Means-Lerman scratch), and, frequently, the intensity of P2 is increased
because of mild to moderate pulmonary hypertension.
·
Roger's Murmur:
A loud pansystolic murmur caused by interventricular septal defect of the
heart; maximal at the left sternal border.
·
Seagull murmur:
a raucous murmur with musical qualities, such as that heard occasionally in
aortic insufficiency.A "seagull’s cry murmur" is defined as a murmur
imitating the cooing sound of a seagull. This type of murmur is typically
characterized by a musical timbre and a high frequency, and may occur as a result
of various valve diseases. It is usually described as a sign of tight calcific
aortic stenosis, when the murmur’s high frequency components are transmitted to
the lower left sternal border and the cardiac apex during most of systole
(Gallavardin’s phenomenon). In this condition, the typical harsh timbre of the
ejective murmur tends to assume a musical high pitched quality, resembling that
of mitral regurgitation, which may be reminiscent of the cry of a seagull. A
protodiastolic murmur with similar characteristics, typically in decrescendo,
may occur in severe aortic valve regurgitation, particularly when the
regurgitant flow presents high velocities. However, a seagull’s cry murmur may
also be the sign of mitral regurgitation or prolapse. Similarly, the musical
and holosystolic sound reflects the presence of high frequency components due
to high velocities of reflow.
·
Still's murmur:
An innocent musical murmur resembling the noise produced by a twanging string;
almost exclusively in young children, of uncertain origin and ultimately
disappearing.{There are five innocent murmurs of infancy and childhood: (i)
pulmonary flow murmur, (ii) Still's murmur, (iii) venous hum, (iv) carotid
bruit, (v) physiologic pulmonary branch stenosis murmur of neonate}
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