Monday, June 19, 2017

Neonatal Dermatoses - Different Types Explained with Pictures For Better Understanding.

Skin disorders are one of the most common problems in pediatrics. Never underestimate parental concerns about their child’s skin. Unlike many disease processes, the skin is visible and noticeable to parents and others. Examination of the skin requires observation and palpation of the entire skin surface under good light. Do not forget to look at the eyes and mouth for mucous membrane involvement. Examination should include onset, duration, and inspection of a primary lesion. It is also important to note secondary changes, morphology, and distribution of the lesions.

Neonatal Dermatoses

1. Cutis Marmorata

  • Transient, blanchable, reticulated mottling occurs on the skin exposed to a cool environment.
  • No treatment is necessary; the condition generally resolves by 1 year of age.
  • If it persists, consider hypothyroidism, heart disease, or other associated abnormalities.
2. Erythema Toxicum Neonatorum

  • Scattered erythematous papules and pustules may occur anywhere on the body .
  • This self-limited condition generally appears in the first week of life and resolves within 1 month.

Ruptured Liver Abscess.

A 50-year-old male presented to the Emergency Room with shock and a four-day history of a febrile illness. He required intubation and was started on inotropes.
His Chest X ray is shown below:

Case Discussion: It is important to look at the “blind areas” of the Chest X ray in order not to miss important clues. These areas are under the diaphragm, behind the heart, the hilum, and the soft tissues. This Chest X ray shows a lucency over the liver density. The lucency does not conform to the usual bowel configuration. In this clinical context, an important differential diagnosis to be considered is a ruptured liver abscess. This can be confirmed either by bedside ultrasound or CT,

A CT scan was done in this patient which is shown below:

Left Ventricular Hypertrophy (LVH) - ECG Study

ECG criteria of LVH (voltage criteria):
• S wave in V1 + R wave  in V6 or V5 is > 35 mm (S V1 + R V6 > 35 mm).
(This criteria is applicable only above 25 years of age).

Other criteria of LVH:
• R in V5 (or V6) > 26 mm.
• R in aVL > 11 mm (or 13 mm).
• R in aVF > 20 mm (also in LII and LIII).
• R in LI + S in LIII > 25 mm.
• R in LI > 15 mm.
• R in V6 is equal to or greater than R in V5 (normally R in V5 is taller than R in V6).
• S in V1 or V2 > 25 mm.
• Sum of all QRS in all 12 leads > 175 mm.
• Left axis deviation (QRS between –30° and –90°).

                                         Left ventricular hypertrophy with strain

It is important to note that: In young and thin person, this voltage criteria is not diagnostic (in younger person, S in V1 + R in V5 or V6 should be greater than 40 mm).

Q. How to confirm the diagnosis of LVH?
Ans. By echocardiography (M-mode).

Q. What are the causes of LVH?
Ans. As follows:

Friday, June 16, 2017

Drug Induced Lupus Erythematosus

Drug-induced lupus erythematosus is a disorder that is brought on by a reaction to a medicine. In drug induced lupus not all the typical features of systemic lupus erythematosus are seen, with renal and nervous system involvement being unusual. It usually resolves on stopping the drug.

The most common medicines known to cause drug-induced lupus erythematosus are:
  • Isoniazid
  • Hydralazine
  • Procainamide
Other less common drugs may also cause the condition. These may include:
  • Anti-seizure medications
  • Capoten
  • Chlorpromazine
  • Tumor-necrosis factor (TNF) alpha inhibitors (such as etanercept, infliximab and adalimumab)
  • Methyldopa
  • Minocycline
  • Penicillamine
  • Quinidine
  • Sulfasalazine
Symptoms tend to occur after taking the drug for at least 3 to 6 months.

Thursday, June 15, 2017

Case Study - Complete 3rd Degree Heart Block

An 80-year-old woman, who had previously had a few attacks of dizziness, fell and broke her hip. She is  found to have a slow pulse, and her ECG is shown below. The surgeons want to operate as soon as possible but the anesthetist is unhappy.

What does the ECG show and what should be done?

The ECG shows:
• Complete heart block
• Ventricular rate 45/min

Clinical interpretation
In complete heart block there is no relationship between the P waves (here with a rate of 70/min)
and the QRS complexes.
The ventricular 'escape' rhythm has wide QRS complexes and abnormal T waves.

What to do

A sexually active 24-year-old woman presents to your office complaining of vaginal discharge.

A sexually active 24-year-old woman presents to your office complaining of vaginal discharge. Findings from a wet prep are pictured here.

The most likely diagnosis is
A) Yeast vaginitis
B) Gardnerella infection
C) Trichomonas infection
D) Gonorrhea
E) Chlamydia

Answer is