Geographic Tongue

Geographic tongue is a benign, chronic condition of unknown cause. It is present in around 13% of the population and is more common in females.

As the name suggests in this condition there is a map-like appearance on the upper surface and sides of the tongue. It may occur in other areas of the mouth, as well.

Although geographic tongue may look alarming, it doesn't cause health problems and isn't associated with infection or cancer.

Clinical Features

• Erythematous areas with a white grey border (the irregular, smooth red areas are said to look like the outline of a map).
• The patches may vary in size, shape, and color.
• These patches come and go or change very quickly in days, weeks, or months
• Some patients report burning after eating certain food.
• Many people with geographic tongue have no symptoms.

A 60 year old woman with a h/o Rheumatic heart disease and recently being treated for heart failure...

This ECG was recorded from a 60-year-old woman with rheumatic heart disease. She had been in heart failure, but this had been treated and she was no longer breathless.

What does the ECG show and what question might you ask her?

The ECG shows:
• Atrial fibrillation with a ventricular rate of 60-65/min
• Normal axis
• Normal QRS complexes
• Prominent U wave in lead V2
• Downward-sloping ST segments, best seen in leads V5-V6

Clinical interpretation
The downward-sloping ST segments (the 'reverse tick') indicate that digoxin has been given. The
ventricular rate seems well-controlled. The prominent U waves in lead V2 could indicate hypokalaemia.

An 18-year-old woman presents to your office complaining of tender nodules that have developed on the lower extremities.

An 18-year-old woman presents to your office complaining of tender nodules that have developed on the lower extremities.

She has no other symptoms. She continues with her oral contraceptives but has not started any new medications. She denies any fevers and has no history of recent trauma.

The likely diagnosis is
A) Erythema multiforme
B) Erythema nodosum
C) Lyme disease
D) Pyoderma gangrenosum
E) Rheumatoid arthritis

Answer:

Left Posterior Fascicular Block - ECG

ECG Findings
• QRS complex widening to 90 to 120 ms.
• Right axis deviation must be beyond 100 degrees and must have no other cause (such as lateral myocardial infarction).
• Small R wave and large S wave in the high lateral leads, I and aVL.
• Slurred S wave in V5 and V6.
• This example also contains unrelated ST changes.

 Clinical Pearls
1. The signal exiting the AV node is carried rapidly to the upper aspect of the LV and all of the RV through the intact left anterior fascicle and right bundle, where depolarization is rapid. However, conduction to the inferior portion of the left ventricle is slower and must proceed cell-to-cell
due to the blocked left posterior fascicle. Therefore, the latter portion of the QRS depolarizes toward the inferior myocardium, manifesting as strong right axis deviation.

Meconium Aspiration Syndrome - X ray Chest

This X ray is of a one day old baby who had difficulty breathing.

X-ray chest shows right upper lobe consolidation and rest of the lungs show patchy to streaky areas suggesting meconium aspiration syndrome

Explanation: In meconium aspiration syndrome (MAS) the newborn breathes a mixture of meconium and amniotic fluid into the lungs around the time of delivery.
Meconium is the early feces passed by a newborn soon after birth, in some cases; the baby passes meconium while still inside the uterus. This usually happens due to lack of enough blood and oxygen.
Once the meconium has passed into the amniotic fluid, the baby may breathe meconium into the lungs. This condition is called MAS. It causes breathing difficulty due to inflammation in the lungs after birth.
Meconium aspiration syndrome is a leading cause of severe illness and death in newborns. However, in most cases, the outlook is excellent and there are no long-term health effects provided the infant is placed in newborn intensive care unit for close observation and treatment

Traumatic Cataract

Introduction: 
Any trauma to the eye that disrupts the normal architecture of the lens may result in the development of a traumatic cataract—a lens opacity.
The mechanism behind cataract formation involves fluid infiltration into the normally avascular and acellular lens stroma. The lens may be observed to swell with fluid and become cloudy and opacified. The time course is usually weeks to months following the original insult. Cataracts that are large enough may be observed by the naked eye. Those that are within the central visual field may cause blurring of vision or distortion of light around objects (eg, halos).

               This acute traumatic cataract is seen as a milky cornea at the time of injury

Clinical Pearls: 
1. Traumatic cataracts are frequent sequelae of lightning injury. Advise all victims of lightning strike of this possibility.
2. Cataracts may also occur as a result of electric current injury to the vicinity of the cranial vault.
3. Leukocoria results from a dense cataract, which causes loss of the red reflex.
4. If a cataract develops sufficient size and “swells” the lens, the trabecular meshwork may become blocked, producing glaucoma.