We'll review some uncommon clinical scenarios...not so uncommonly covered, by the medical boards.
Q: What does a WIDENED MEDIASTINUM most commonly imply?
A: 1. Dissecting Thoracic Aneurysm
2. Inhalational Anthrax
3. Improper patient positioning during CXR (this is most common).
Q: What does finding of CALCIUM OXALATE in urinalysis imply?
A: 1. Ethylene Glycol Poisoning
2. IBD (Crohn's Disease)
Q: What are BURTON'S LINES?
A: Bluish discoloartion along the gingival margins of teeth...in CHRONIC LEAD POISONING.
Not seen in edentulous persons. It is a highly suggestive sign!
Q: What is a PINGUECULA?
A: It is a harmless, yellow-while collagen (jelly-like) depostion on the corneal surface.
Can be removed for bothersome-cosmetic reasons.
Q: What are MEES' LINES?
A: A whitish transverse discoloration of the fingernails...seen in ARSENIC or LEAD poisoning.
We'll continue soon!
Sunday, March 25, 2012
Saturday, March 3, 2012
HEMATOLOGICAL EMERGENCIES...
We'll continue with interesting topics in hematology, specifically disorders that need quick diagnosis and management.
1. WHAT IS TTP (Thrombotic Thrombocytopenic Purpura)?
A: TTP is an uncommon but not infrequent blood dyscrasia, that primarily affects
platelets. As the name implies, platelet numbers are very diminished causing
cutaneous purpura. This is primarily a disease of ADULTS.
The PENTAD for diagnosing TTP are:
1. Thrombocytepenia
2. Purpura
3. Confusion (mental status changes)
4. Renal Insufficiency/failure
5. Fever
Usually not all 5 charactersitic findings are present. To make the diagnosis, besides the low
plateletet count and reactive purpura...the presence of an additional finding, will do.
2. WHAT IS THE TREATMENT FOR TTP?
A: Emergent PLASMA EXCHANGE, as well as meticulous supportive care.
3. WHAT IS ITP (Idiopathic Thrombocytopenic Purpura)?
A: ITP predominately affects CHILDREN in about 90% of cases, due to immune phenomenon.
Generally occurs as after a recent VIRAL EXANTHEM, UPPER RESPIRATORY
INFECTION, INFECTIOUS MONONUCLEOSIS,etc. Clinically, similar to TTP above.
4. WHAT IS THE TREATMENT OF ITP?
A: Medical treatment for ACUTE TTP, with active bleeding consist of GLUCOCORTICOIDS.
If steroids are unhelpful...IVIG (Intravenous Immunoglobulin) infusion is recommended.
Emergency SPLENECTOMY is reserved for severe ITP.
5. WHAT IS POST (PLATELET) TRANSFUSION PURPURA?
A: Occurence of LOW PLATELET COUNT 7-10 DAYS, after platelet transfusion.
Patients usually present with bleeding from gums, purpura and severe thrombocytopenia.
It is due to presence of an ANTIGEN called...HPA-/a.
6. WHAT IS THE TREATMENT?
A: IVIG or PLASMAPHERESIS.
Thanks for your time!
1. WHAT IS TTP (Thrombotic Thrombocytopenic Purpura)?
A: TTP is an uncommon but not infrequent blood dyscrasia, that primarily affects
platelets. As the name implies, platelet numbers are very diminished causing
cutaneous purpura. This is primarily a disease of ADULTS.
The PENTAD for diagnosing TTP are:
1. Thrombocytepenia
2. Purpura
3. Confusion (mental status changes)
4. Renal Insufficiency/failure
5. Fever
Usually not all 5 charactersitic findings are present. To make the diagnosis, besides the low
plateletet count and reactive purpura...the presence of an additional finding, will do.
2. WHAT IS THE TREATMENT FOR TTP?
A: Emergent PLASMA EXCHANGE, as well as meticulous supportive care.
3. WHAT IS ITP (Idiopathic Thrombocytopenic Purpura)?
A: ITP predominately affects CHILDREN in about 90% of cases, due to immune phenomenon.
Generally occurs as after a recent VIRAL EXANTHEM, UPPER RESPIRATORY
INFECTION, INFECTIOUS MONONUCLEOSIS,etc. Clinically, similar to TTP above.
4. WHAT IS THE TREATMENT OF ITP?
A: Medical treatment for ACUTE TTP, with active bleeding consist of GLUCOCORTICOIDS.
If steroids are unhelpful...IVIG (Intravenous Immunoglobulin) infusion is recommended.
Emergency SPLENECTOMY is reserved for severe ITP.
5. WHAT IS POST (PLATELET) TRANSFUSION PURPURA?
A: Occurence of LOW PLATELET COUNT 7-10 DAYS, after platelet transfusion.
Patients usually present with bleeding from gums, purpura and severe thrombocytopenia.
It is due to presence of an ANTIGEN called...HPA-/a.
6. WHAT IS THE TREATMENT?
A: IVIG or PLASMAPHERESIS.
Thanks for your time!
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