Tuesday, October 25, 2016

A 42 Year old Woman With a Suspected Melanoma.

A 42-year-old woman presents with the lesion (shown above) on the back of her calf. She has no significant medical problems and otherwise feels well. The lesion has not bled, but seems to have grown over the last few months. Appropriate initial management of this skin lesion should be
A) Observation and removal if bleeding or further change occurs
B) Complete excision with normal margins
C) Complete excision with wide margins
D) Shave biopsy
E) Electrodesiccation and curettage

Answer And Discussion:

A Brief Discussion On Heart Murmurs

Heart murmurs are the sounds other than the normal heart sounds produced that is loud enough to be heard with a stethoscope and is caused by turbulence of blood flow across the ehart valves. 
A normal heartbeat makes two sounds like "lub-DUP", which are the normal sounds of the heart valves closing.

The objective of this article is to help the reader understand:
  • Taking history and examining a patient with a heart murmur.
  • Differential diagnosis for the cause of heart murmur
  • Appropriate investigations for a patient presenting with a heart murmur. 
Heart murmurs can be present at birth (congenital) or develop later in life. A heart murmur isn't a disease by itself but the presence of  murmurs may indicate an underlying heart problem. Some murmurs may be benign and are due to conditions outside the heart. These are known as innocent, functional or physiologic murmurs and does not need any treatment. 

Clinical Features: A patient with a heart murmur may present with the symptoms of the underlying heart condition that is causing the murmur. The doctor my detect the presence of the murmur while doing the physical examination. 

Causes: While taking the clinical history it is important to keep in mind the different etiologies that can cause a heart murmur. These may include: 

- Physiologic causes: 
  • Anemia
  • High blood pressure
  • Overactive thyroid
  • Fever
  • Pregnancy
- Abnormal Heart Murmurs: 
  • Septal defects
  • Cardiac shunts
  • Heart valve abnormalities. 
  • Endocarditis 
  • Rheumatic fever

Monday, October 24, 2016

A Brief Discussion On Clotting Disorders

Disorders of clotting may be congenital or acquired.
Clotting disorder is a condition in which the blood's ability to coagulate (form clots) is impaired. This can cause a tendency toward prolonged or excessive bleeding which may occur spontaneously or following an injury or medical and dental procedures. 

hemarthroses in a patient with hemophillia



  • Hemophillia
  • von Willebrand's disease. 
  • Vitamin K deficiency.
                - Hemorrhagic disease of the newborn
                - Obstructive jaundice
                - Fat malabsorption
  • Liver disease
  • Disseminated intravascular coagulation
  • Autoimmune disease e.g SLE
  • Massive transfusion
  • Drugs
               - Heparin
               - Warfarin
               - Thrombolytic therapy. 

Clinical History: 

1. Onset and Duration: The duration of symptoms and age of presentation is very useful in determining the underlying etiology.

Sunday, October 23, 2016

Scoliosis- Case Study.

A 12 year old boy is seeing you for a physical examination required for junior high school sports. You plan to evaluate him for scoliosis.

Q 1. Which screening method is the most sensitive for detecting scoliosis?

Answer: The "Forward Bending Test" which is accomplished by having the patient bend at the waist with feet together and hands hanging free. Observe the patient (with shirt off) from behind and note any elevation of the ribs or paravertebral muscle mass on one side. The elevation should be measured in degrees (inclinometers are available), and an inclination of 5 degrees or more should be evaluated further.

Q 2. Define Scoliosis?

Answer: Scoliosis is a lateral curvature of the spine, usually accompanied by rotation and generally occurring in the thoracic or lumbar areas. It can occur with excessive kyphosis (posteriorly convex curvature) or lordosis (anteriorly convex curvature).

Q 3. On forward bending test, you find slight elevation of the left paravertebral muscles mass, which you estimate to be 7 degrees. The remainder of the examination is normal. You decide to obtain radiographs that show 12 degrees of angulation (Cobb angle).
This patient’s scoliosis is most likely:
A) Congenital.
B) Idiopathic.
C) Related to a tumor.
D) Secondary to infection.

Answer and Discussion

Saturday, October 22, 2016

Disorders Of The Nails

Examining the nails is an important part of physical examination and certain features may point to the underlying medical disorder. In some cases the nails may have local disease causing a disorder or abnormal findings.
Here we try to give a brief description of some of the nail disorders along with pictures for a better understanding.

1. Absent part: also known as Anonychia . It may be congenital or secondary to severe infection or allergic reaction. It is also seen in self inflicted trauma or in people who have a habit of nail biting.

Partial Anonychia 

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 Congenital Anonychia 

2. Nail Pitting: characterized by depressions on the surface of the nail is seen in conditions like psoriasis and connective tissue disorders like alopecia aerata and sarcoidosis. Nail pitting in one or two finger nails may be due to local trauma.

First Aid Management Of Heat Stroke -- Charts