A 14-year-old girl with type 1 diabetes mellitus presented with blurred vision in both eyes for 2 years. Examination found cloudiness in the left lens and an intraocular lens implanted in the right eye from previous cataract surgery. The patient had poor glycemic control with HbA1c of 8.8%. Surgery was performed to remove the cataract in the left eye. Close monitoring of glycemic control and regular ophthalmologic exams are important for managing diabetic complications like cataracts in pediatric patients.
2nd Pediatric On Squares Pediatric Board Review.pdfMEWBORG
This document provides an overview of a pediatric hematology oncology board review presentation covering several topics:
- Pediatric hematology topics include febrile neutropenia, bleeding disorders, treatment of thalassemia and iron overload, sickle cell disease, thrombocytopenia, and anemia in children.
- Pediatric oncology topics include leukemia and lymphomas, solid tumors, and oncology emergencies such as tumor lysis syndrome, superior vena cava syndrome, and mediastinal mass.
- The document also provides example questions that would be discussed during the board review covering topics like febrile neutropenia, hematologic manifestations of COVID-19, diagnoses of anemia
UCMS:Final Integrated medical quiz 2018 Illuminous
The document describes the rules and format for an integrated medical quiz finals round consisting of 12 total questions divided into 2 questions per team. Teams have 1 minute to answer each question they receive before it bounces to the next team, and can pounce within 30 seconds to steal a question. Correct answers earn points while incorrect answers during a pounce result in negative points, with scores announced at the end.
The document provides the details of a quiz competition involving 12 total medical questions that will be divided among teams to answer within time limits, with opportunities to earn or lose points depending on correct or incorrect responses when pouncing to answer another team's question. S
Drs. Lena, Avery, and Davis’s CMC Abdominal Imaging Mastery Project: August C...Sean M. Fox
Dr. Kelsey Lena is an Emergency Medicine Resident and Drs. Michael Avery and Joshua Davis are Surgery Residents at Carolinas Medical Center in Charlotte, NC. They are interested in medical education. With the guidance of Drs. Kyle Cunningham and Michael Gibbs, they aim to help augment our understanding of emergent abdominal imaging. Follow along with the EMGuideWire.com team as they post these monthly educational, self-guided radiology slides. This month’s topics include:
• Splenic Rupture
• Obstructive jaundice
• Ovarian Torsion
A ten-year-old boy is brought to clinic by his mother who stat.docxmakdul
A ten-year-old boy is brought to clinic by his mother who states that the boy has been listless and not eating. She also notes that he has been easily bruising without trauma as he says he is too tired to go out and play. He says his bones hurt sometimes. Mother states the child has had intermittent fevers that respond to acetaminophen. Maternal history negative for pre, intra, or post-partum problems. Child’s past medical history negative and he easily reached developmental milestones. Physical exam reveals a thin, very pale child who has bruises on his arms and legs in no particular pattern. The APRN orders complete blood count (CBC), and complete metabolic profile (CMP). The CBC revealed Hemoglobin of 6.9/dl, hematocrit of 19%, and platelet count of 80,000/mm3. The CMP demonstrated a blood urea nitrogen (BUN) of 34m g/dl and creatinine of 2.9 mg/dl. The APRN recognizes that the patient appears to have acute leukemia and renal failure and immediately refers the patient to the Emergency Room where a pediatric hematologist has been consulted and is waiting for the boy and his mother. The diagnosis of acute lymphoblastic leukemia (ALL) was made after extensive testing.
Question 1 of 2:
What is ALL?
--
QUESTION 2
A ten-year-old boy is brought to clinic by his mother who states that the boy has been listless and not eating. She also notes that he has been easily bruising without trauma as he says he is too tired to go out and play. He says his bones hurt sometimes. Mother states the child has had intermittent fevers that respond to acetaminophen. Maternal history negative for pre, intra, or post-partum problems. Child’s past medical history negative and he easily reached developmental milestones. Physical exam reveals a thin, very pale child who has bruises on his arms and legs in no particular pattern. The APRN orders complete blood count (CBC), and complete metabolic profile (CMP). The CBC revealed Hemoglobin of 6.9/dl, hematocrit of 19%, and platelet count of 80,000/mm3. The CMP demonstrated a blood urea nitrogen (BUN) of 34m g/dl and creatinine of 2.9 mg/dl. The APRN recognizes that the patient appears to have acute leukemia and renal failure and immediately refers the patient to the Emergency Room where a pediatric hematologist has been consulted and is waiting for the boy and his mother. The diagnosis of acute lymphoblastic leukemia (ALL) was made after extensive testing.
Question 2 of 2:
How does renal failure occur in some patients with ALL?
QUESTION 3
A 12-year-old female with known sickle cell disease (SCD) present to the Emergency Room in sickle cell crisis. The patient is crying with pain and states this is the third acute episode she has had in the last nine months. Both parents are present and appear very anxious and teary eyed. A diagnosis of acute sickle cell crisis was made. Appropriate therapeutic interventions were initiated by the APRN and the patient’s pain level decreased, and she was transferre.
The document discusses two conditions: paroxysmal nocturnal hemoglobinuria (PNH) and atypical hemolytic uremic syndrome (aHUS). PNH is a complement-mediated hemolytic anemia treated with the drug eculizumab, a C5a inhibitor. aHUS is a complement-mediated thrombotic microangiopathy that can cause stroke, heart attack, and kidney failure, and is also treated with eculizumab. The document asks the reader to identify PNH, aHUS, and the mode of action of eculizumab.
A much-quoted aphorism in medicine is “Listen to your patient and they are telling you the diagnosis”. Most often, the history reveals the diagnosis and sometimes, it is all that is required to make the diagnosis. Unfortunately, in this age of modern technology-based medicine, many busy clinicians fail to get a proper history and miss important dots in the history that connect to the diagnosis. This is clinically relevant, as a specific diagnosis completely alters the nature of treatment and thereby improves prognosis.
2nd Pediatric On Squares Pediatric Board Review.pdfMEWBORG
This document provides an overview of a pediatric hematology oncology board review presentation covering several topics:
- Pediatric hematology topics include febrile neutropenia, bleeding disorders, treatment of thalassemia and iron overload, sickle cell disease, thrombocytopenia, and anemia in children.
- Pediatric oncology topics include leukemia and lymphomas, solid tumors, and oncology emergencies such as tumor lysis syndrome, superior vena cava syndrome, and mediastinal mass.
- The document also provides example questions that would be discussed during the board review covering topics like febrile neutropenia, hematologic manifestations of COVID-19, diagnoses of anemia
UCMS:Final Integrated medical quiz 2018 Illuminous
The document describes the rules and format for an integrated medical quiz finals round consisting of 12 total questions divided into 2 questions per team. Teams have 1 minute to answer each question they receive before it bounces to the next team, and can pounce within 30 seconds to steal a question. Correct answers earn points while incorrect answers during a pounce result in negative points, with scores announced at the end.
The document provides the details of a quiz competition involving 12 total medical questions that will be divided among teams to answer within time limits, with opportunities to earn or lose points depending on correct or incorrect responses when pouncing to answer another team's question. S
Drs. Lena, Avery, and Davis’s CMC Abdominal Imaging Mastery Project: August C...Sean M. Fox
Dr. Kelsey Lena is an Emergency Medicine Resident and Drs. Michael Avery and Joshua Davis are Surgery Residents at Carolinas Medical Center in Charlotte, NC. They are interested in medical education. With the guidance of Drs. Kyle Cunningham and Michael Gibbs, they aim to help augment our understanding of emergent abdominal imaging. Follow along with the EMGuideWire.com team as they post these monthly educational, self-guided radiology slides. This month’s topics include:
• Splenic Rupture
• Obstructive jaundice
• Ovarian Torsion
A ten-year-old boy is brought to clinic by his mother who stat.docxmakdul
A ten-year-old boy is brought to clinic by his mother who states that the boy has been listless and not eating. She also notes that he has been easily bruising without trauma as he says he is too tired to go out and play. He says his bones hurt sometimes. Mother states the child has had intermittent fevers that respond to acetaminophen. Maternal history negative for pre, intra, or post-partum problems. Child’s past medical history negative and he easily reached developmental milestones. Physical exam reveals a thin, very pale child who has bruises on his arms and legs in no particular pattern. The APRN orders complete blood count (CBC), and complete metabolic profile (CMP). The CBC revealed Hemoglobin of 6.9/dl, hematocrit of 19%, and platelet count of 80,000/mm3. The CMP demonstrated a blood urea nitrogen (BUN) of 34m g/dl and creatinine of 2.9 mg/dl. The APRN recognizes that the patient appears to have acute leukemia and renal failure and immediately refers the patient to the Emergency Room where a pediatric hematologist has been consulted and is waiting for the boy and his mother. The diagnosis of acute lymphoblastic leukemia (ALL) was made after extensive testing.
Question 1 of 2:
What is ALL?
--
QUESTION 2
A ten-year-old boy is brought to clinic by his mother who states that the boy has been listless and not eating. She also notes that he has been easily bruising without trauma as he says he is too tired to go out and play. He says his bones hurt sometimes. Mother states the child has had intermittent fevers that respond to acetaminophen. Maternal history negative for pre, intra, or post-partum problems. Child’s past medical history negative and he easily reached developmental milestones. Physical exam reveals a thin, very pale child who has bruises on his arms and legs in no particular pattern. The APRN orders complete blood count (CBC), and complete metabolic profile (CMP). The CBC revealed Hemoglobin of 6.9/dl, hematocrit of 19%, and platelet count of 80,000/mm3. The CMP demonstrated a blood urea nitrogen (BUN) of 34m g/dl and creatinine of 2.9 mg/dl. The APRN recognizes that the patient appears to have acute leukemia and renal failure and immediately refers the patient to the Emergency Room where a pediatric hematologist has been consulted and is waiting for the boy and his mother. The diagnosis of acute lymphoblastic leukemia (ALL) was made after extensive testing.
Question 2 of 2:
How does renal failure occur in some patients with ALL?
QUESTION 3
A 12-year-old female with known sickle cell disease (SCD) present to the Emergency Room in sickle cell crisis. The patient is crying with pain and states this is the third acute episode she has had in the last nine months. Both parents are present and appear very anxious and teary eyed. A diagnosis of acute sickle cell crisis was made. Appropriate therapeutic interventions were initiated by the APRN and the patient’s pain level decreased, and she was transferre.
The document discusses two conditions: paroxysmal nocturnal hemoglobinuria (PNH) and atypical hemolytic uremic syndrome (aHUS). PNH is a complement-mediated hemolytic anemia treated with the drug eculizumab, a C5a inhibitor. aHUS is a complement-mediated thrombotic microangiopathy that can cause stroke, heart attack, and kidney failure, and is also treated with eculizumab. The document asks the reader to identify PNH, aHUS, and the mode of action of eculizumab.
A much-quoted aphorism in medicine is “Listen to your patient and they are telling you the diagnosis”. Most often, the history reveals the diagnosis and sometimes, it is all that is required to make the diagnosis. Unfortunately, in this age of modern technology-based medicine, many busy clinicians fail to get a proper history and miss important dots in the history that connect to the diagnosis. This is clinically relevant, as a specific diagnosis completely alters the nature of treatment and thereby improves prognosis.
Drs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: July CasesSean M. Fox
Drs. Olson and Jackson are interested in education and Pediatric Emergency Medicine. Follow along with the EMGuideWire.com team and Drs. Nikki Richardson and Michael Gibbs as they post these educational, self-guided radiology slides on Pediatric Emergency Medicine Radiology. This month’s topics include:
• Aortic Aneursym
• Aortic Coarctation
• Aspirated Foreign Body
• Ingested Foreign Body
• VP Shunt Malfunction
• Hemopneumothorax
• COVID-19 pneumonia and pneumothorax
This document summarizes Kawasaki disease, an acute febrile illness that causes vasculitis of medium-sized arteries, especially coronary arteries. It can lead to coronary artery aneurysms and thrombosis. The disease is diagnosed based on clinical criteria in the absence of a confirmatory test. Treatment with intravenous immunoglobulin can reduce the risk of coronary artery lesions from 25% to 3-5%, but infants and incomplete presentations remain at higher risk.
1. The patient is exhibiting signs and symptoms consistent with Kawasaki disease, including prolonged fever, oral ulcers, conjunctivitis, rash, lymphadenopathy, and extremity changes.
2. Kawasaki disease does occur in Egypt, with an estimated 280 cases diagnosed annually.
3. Treatment for Kawasaki disease involves intravenous immunoglobulin and aspirin to prevent coronary artery aneurysms, which develop in around 25% of untreated patients.
This document discusses three patient cases:
1. A 73-year-old woman presented with blurred vision and was diagnosed with giant cell arteritis after a positive temporal artery biopsy. High-dose steroids were started.
2. A 65-year-old woman with a partial right third nerve palsy was found to have a ruptured posterior communicating artery aneurysm on imaging.
3. A 22-year-old woman with weight loss after bariatric surgery developed ataxia, confusion, and abnormal eye movements. She was initially diagnosed with variant Creutzfeldt-Jakob disease but autopsy found Wernicke's encephalopathy due to thiamine deficiency.
This document contains a knowledge check for a nursing course. It includes 14 scenarios covering various medical conditions and asks questions related to each scenario. The scenarios cover topics like acute lymphoblastic leukemia, sickle cell disease, hemophilia, myelomeningocele, patent ductus arteriosus, lead poisoning, sudden infant death syndrome, Kawasaki disease, asthma, cystic fibrosis, idiopathic scoliosis, hemolytic uremic syndrome, pituitary dwarfism, and osteogenesis imperfecta. For each scenario, students are asked 1-2 questions testing their understanding of the condition's presentation, pathophysiology, diagnosis, or management. Responses of at least 2-4 sentences in length are required.
This document presents a case study of a 2-year-old female infant diagnosed with Kawasaki disease based on symptoms of fever, swollen lips, and ankle swelling. The patient was treated with intravenous immunoglobulin and aspirin, showed improvement, and was discharged with a final diagnosis of incomplete Kawasaki disease. The document then provides a brief overview of Kawasaki disease, including epidemiology, pathophysiology, diagnostic criteria, treatment, and potential complications like coronary artery aneurysms and long-term cardiac issues.
This document presents a case report of a female infant diagnosed with Seckel syndrome. Key details:
- The 19-day-old infant presented with vomiting, lethargy, no urine output, and no weight gain. Exam found microcephaly, beaked nose, and clubbed feet.
- Differential diagnosis included Seckel syndrome and two types of Microcephalic osteodysplastic dwarfism (MCODD).
- Features like proportionate dwarfism, severe microcephaly, "bird-headed" appearance supported diagnosis of Seckel syndrome, a rare autosomal recessive genetic disorder caused by mutations in the ATR gene.
- Management focused on treatment
Diplopia Caused by Salmonella enteritidis Infectioniosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This document discusses HIV-associated wasting and gastrointestinal opportunistic infections. It begins with an index case of a 28-year-old female diagnosed with HIV two weeks prior who presents with weight loss, diarrhea, cough, and oral thrush. The document then reviews the epidemiology, etiology, clinical presentation, diagnosis, and treatment of HIV-associated wasting and common GI opportunistic infections like candidiasis, cytomegalovirus, and Pneumocystis jirovecii pneumonia. Key findings from the patient's history, exam, and labs are also presented, assessing her for conditions like anemia, candidiasis, and likely PJP.
The document discusses pediatric hyperglycemia and diabetic ketoacidosis (DKA). It notes that DKA is the most common cause of death in children with diabetes globally due to lack of access to insulin or improper insulin use. Risk factors for DKA include young age, poor diabetes control, missed insulin injections, and infection. The document outlines the pathophysiology of hyperglycemia and DKA and provides guidelines for assessment, management, complications, education, and resources regarding pediatric patients presenting with these conditions.
Epilepsy and other seizure brain disorders were discussed. Generalized seizures are caused by near simultaneous activation of the entire cerebral cortex from an electrical discharge originating deep in the brain. Partial seizures are due to electrical discharges beginning in a localized brain region. Status epilepticus refers to prolonged seizure activity lasting more than 5 minutes or multiple seizures without regaining consciousness. Seizures have various types and presentations depending on their origin and spread in the brain. Physical examination, history, and diagnostic workup are important for evaluating patients presenting with seizures.
1
Diabetes SOAP Note
Name xxxx
United State University
Course ::xxxx
Professor xxxx
Date xxxx
Diabetes SOAP Note
ID:
Client's Initial: N.L. Age: 50; Race: Caucasian; Gender: Male; Date of Birth: Jan 1, 1972. He is unaccompanied and seems to be a reliable historian.
Subjective
CC: "I have been experiencing frequent urination, and fatigue"
HPI: Patient is a 50-year-old man who arrives at the clinic complaining of frequent urination. Aside from the increased frequency of urination, other symptoms include thirst, hunger, and tiredness. He reports that the symptoms have been going on for about two months. He has a past medical history of hypertension, which was diagnosed last year 2021. He reports he has not had any other long-term illnesses or allergies. He also reports that he has not taken any medication that have made his condition worse or helped. He reports drinking alcohol occasionally about 2 bottles of beer in a week. He denies any burning or pain while urinating, denies fever or chills.
Past Medical History:
· Medical Problem: Hypertension
· Surgeries: none
· Allergies: No known allergies
· Immunization: Fully immunized
· Current Medications: Lisinopril 10 mg po daily for Blood pressure
Family History:
Mother, age 78, has diabetes
Father, age 80, diseased, with history of hypertension
Brother, age 60, has diabetes
Social History
Living situation: He lives with his wife and 3 grandchildren in a safe environment.
Occupation: He is a high school teacher
Tobacco or marijuana use: Denies
Alcohol use: Drinks 5 bottles of beer in a week.
Diet: Vegan
Exercise: Rare physical activity
Review of System
Constitutional: The patient reports fatigue. Denies chills or fever.
Skin: Denies skin rashes, bruises, color changes, or lesions.
HEENT: Head: No previous head injury reported.
Eyes: Denies use of corrective lenses. No eye irritation, color blindness, dryness, or copious tears
were reported.
Ear: Denies experiencing hearing difficulties, ear pain, ear ringing, discharges, or hearing loss.
Nose: No nosebleed, loss of smell, nasal congestion, or pain reported.
Months/ throat: No bleeding gums or mouth wounds were reported. No sore throat and hoarseness were reported.
Respiratory: Denies difficulties in breathing, wheezing, or coughing.
Cardio: Denies chest pains but reports episodic heart palpitations
Endocrine: Reports an increase in appetite and thirst.
Musculoskeletal: Denies having joint pain, muscle pain, or swelling.
Genitourinary: Denies discomforts when urination. Reports an increase in urination more often during the night.
Neuro: Denies tremors, headaches, or dizziness.
Psychiatric: Denies sleep disturbances or ideas of hurting himself, such as suicidal thoughts. Denies depression and anxiety
Objective
Vital Signs:
Blood Pressure 138/89, Resp: 18, Heart rate: 88, Temperature 98.6 F, SpO2 100
Height 5'3" Weight 158lbs BMI 28.2.
Physical Exam:
General appearance: The patient is a nice looking 50-year-old Caucasian man who is
...
Acute Leukemia Initial Presentation as Acute Appendicitis - Case Reportasclepiuspdfs
Appendicitis represents a real, everyday working problem for the primary physician and those who care for children. Acute appendicitis can be initial manifestation of leukemia or relapse. However, such cases have only been reported in adults. Very few cases are reported in pediatric population. Here, we report a 5-year-old girl who presented with clinical features suggestive of acute appendicitis. The clinical findings were supported with radiological findings. On further investigations, found to have acute leukemia. Acute appendicitis was treated conservatively. The parents were reluctant to accept the clinical diagnosis. The parents were keen to get more and more second opinion in this regard before accepting final diagnosis.
J.F. is a 50-year-old woman admitted with recurrent endocarditis, nausea, vomiting and renal failure. She has a history of autoimmune deficiency, heart valve infections, malnutrition and heart issues. On admission, she has signs of decreased cardiac output like edema and murmurs. Lab results show renal failure and anemia. She requires long-term IV antibiotics and nutrition support to treat her current endocarditis infection and underlying conditions.
The guidelines provide new diagnostic criteria for coeliac disease (CD) based on recent scientific and technical developments. Two groups of patients are defined with different diagnostic approaches: 1) children with symptoms suggestive of CD and 2) asymptomatic children at increased risk.
For group 1, the diagnosis is based on symptoms, positive serology, and compatible histology. If anti-tissue transglutaminase antibody titers are >10 times the upper limit of normal, CD can be diagnosed without biopsies by applying further testing.
For group 2, the diagnosis is based on positive serology and histology. HLA testing for HLA-DQ2 and HLA-DQ8 is valuable to exclude CD if both haplotypes
Krok 2 - 2012 Question Paper (General Medicine)Eneutron
This document contains a series of multiple choice questions related to medicine. Question 1 asks about the most likely cause of hypertension in a child with bronchial asthma. Question 2 presents an administrative dilemma regarding dismissing a senior nurse. Question 3 asks about diseases that cannot cause purulent mediastinitis.
Mrs. Monowara, a 65-year-old female, presented with gradually reduced vision in both eyes over the past 3 months. She complained of eye pain, headaches, and vomiting for a year. Examination found primary angle closure glaucoma in the right eye and suspected primary angle closure in the left eye, with cataracts present in both eyes. She underwent combined cataract extraction and trabeculectomy in the right eye and was scheduled for laser peripheral iridotomy in the left eye, along with medical management including eye drops and oral medications.
CIRCULAT in Chronic Ischemic Heart Disease - 20 Pat, Diabetic Foot and Gene E...ISCHEMIC CARDIOPATHY
The document discusses a study on the effects of a complex herbal formulation called CIRCULAT in treating chronic ischemic heart disease. The study found that 85% of the initial 20 patients showed good responses to CIRCULAT therapy as measured by imaging and stress tests over periods of 6 months to 1 year. The treatment was associated with reductions in perfusion damage percentages on imaging and increases in functional capacity on stress tests for most patients.
This study prospectively examined the frequency of severe hypoglycemia over 12 months in 60 patients with type 1 diabetes - 29 with impaired awareness of hypoglycemia and 31 with normal awareness. Patients were matched for demographic and clinical characteristics. The results showed that patients with impaired awareness had over twice as many episodes of severe hypoglycemia (2.8 vs 0.5 episodes per patient per year) and were more likely to experience an episode (66% vs 26%) compared to those with normal awareness. Most episodes in those with impaired awareness occurred during waking hours, particularly in the evening, while those with normal awareness had more episodes in the early morning. The study demonstrated that impaired awareness of hypoglycemia significantly increases the risk of severe
Clinical profile of paediatric patients with rheumatic heart disease at moi t...Alexander Decker
This document summarizes a study on the clinical profile of pediatric patients with rheumatic heart disease at Moi Teaching and Referral Hospital in Eldoret, Kenya. The study found that the most common symptoms in new patients were dyspnea, easy fatigability, palpitations, cough and orthopnea. The most common signs were systolic murmurs, thrills and tachycardia. Most new patients presented with severe disease in NYHA class 3 or 4. Mitral regurgitation alone or combined with aortic regurgitation were the most common valve lesions. The results suggest that most new patients have advanced valvular disease and complications due to late presentation, highlighting the need for early detection
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kol...rightmanforbloodline
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Versio
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Drs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: July CasesSean M. Fox
Drs. Olson and Jackson are interested in education and Pediatric Emergency Medicine. Follow along with the EMGuideWire.com team and Drs. Nikki Richardson and Michael Gibbs as they post these educational, self-guided radiology slides on Pediatric Emergency Medicine Radiology. This month’s topics include:
• Aortic Aneursym
• Aortic Coarctation
• Aspirated Foreign Body
• Ingested Foreign Body
• VP Shunt Malfunction
• Hemopneumothorax
• COVID-19 pneumonia and pneumothorax
This document summarizes Kawasaki disease, an acute febrile illness that causes vasculitis of medium-sized arteries, especially coronary arteries. It can lead to coronary artery aneurysms and thrombosis. The disease is diagnosed based on clinical criteria in the absence of a confirmatory test. Treatment with intravenous immunoglobulin can reduce the risk of coronary artery lesions from 25% to 3-5%, but infants and incomplete presentations remain at higher risk.
1. The patient is exhibiting signs and symptoms consistent with Kawasaki disease, including prolonged fever, oral ulcers, conjunctivitis, rash, lymphadenopathy, and extremity changes.
2. Kawasaki disease does occur in Egypt, with an estimated 280 cases diagnosed annually.
3. Treatment for Kawasaki disease involves intravenous immunoglobulin and aspirin to prevent coronary artery aneurysms, which develop in around 25% of untreated patients.
This document discusses three patient cases:
1. A 73-year-old woman presented with blurred vision and was diagnosed with giant cell arteritis after a positive temporal artery biopsy. High-dose steroids were started.
2. A 65-year-old woman with a partial right third nerve palsy was found to have a ruptured posterior communicating artery aneurysm on imaging.
3. A 22-year-old woman with weight loss after bariatric surgery developed ataxia, confusion, and abnormal eye movements. She was initially diagnosed with variant Creutzfeldt-Jakob disease but autopsy found Wernicke's encephalopathy due to thiamine deficiency.
This document contains a knowledge check for a nursing course. It includes 14 scenarios covering various medical conditions and asks questions related to each scenario. The scenarios cover topics like acute lymphoblastic leukemia, sickle cell disease, hemophilia, myelomeningocele, patent ductus arteriosus, lead poisoning, sudden infant death syndrome, Kawasaki disease, asthma, cystic fibrosis, idiopathic scoliosis, hemolytic uremic syndrome, pituitary dwarfism, and osteogenesis imperfecta. For each scenario, students are asked 1-2 questions testing their understanding of the condition's presentation, pathophysiology, diagnosis, or management. Responses of at least 2-4 sentences in length are required.
This document presents a case study of a 2-year-old female infant diagnosed with Kawasaki disease based on symptoms of fever, swollen lips, and ankle swelling. The patient was treated with intravenous immunoglobulin and aspirin, showed improvement, and was discharged with a final diagnosis of incomplete Kawasaki disease. The document then provides a brief overview of Kawasaki disease, including epidemiology, pathophysiology, diagnostic criteria, treatment, and potential complications like coronary artery aneurysms and long-term cardiac issues.
This document presents a case report of a female infant diagnosed with Seckel syndrome. Key details:
- The 19-day-old infant presented with vomiting, lethargy, no urine output, and no weight gain. Exam found microcephaly, beaked nose, and clubbed feet.
- Differential diagnosis included Seckel syndrome and two types of Microcephalic osteodysplastic dwarfism (MCODD).
- Features like proportionate dwarfism, severe microcephaly, "bird-headed" appearance supported diagnosis of Seckel syndrome, a rare autosomal recessive genetic disorder caused by mutations in the ATR gene.
- Management focused on treatment
Diplopia Caused by Salmonella enteritidis Infectioniosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This document discusses HIV-associated wasting and gastrointestinal opportunistic infections. It begins with an index case of a 28-year-old female diagnosed with HIV two weeks prior who presents with weight loss, diarrhea, cough, and oral thrush. The document then reviews the epidemiology, etiology, clinical presentation, diagnosis, and treatment of HIV-associated wasting and common GI opportunistic infections like candidiasis, cytomegalovirus, and Pneumocystis jirovecii pneumonia. Key findings from the patient's history, exam, and labs are also presented, assessing her for conditions like anemia, candidiasis, and likely PJP.
The document discusses pediatric hyperglycemia and diabetic ketoacidosis (DKA). It notes that DKA is the most common cause of death in children with diabetes globally due to lack of access to insulin or improper insulin use. Risk factors for DKA include young age, poor diabetes control, missed insulin injections, and infection. The document outlines the pathophysiology of hyperglycemia and DKA and provides guidelines for assessment, management, complications, education, and resources regarding pediatric patients presenting with these conditions.
Epilepsy and other seizure brain disorders were discussed. Generalized seizures are caused by near simultaneous activation of the entire cerebral cortex from an electrical discharge originating deep in the brain. Partial seizures are due to electrical discharges beginning in a localized brain region. Status epilepticus refers to prolonged seizure activity lasting more than 5 minutes or multiple seizures without regaining consciousness. Seizures have various types and presentations depending on their origin and spread in the brain. Physical examination, history, and diagnostic workup are important for evaluating patients presenting with seizures.
1
Diabetes SOAP Note
Name xxxx
United State University
Course ::xxxx
Professor xxxx
Date xxxx
Diabetes SOAP Note
ID:
Client's Initial: N.L. Age: 50; Race: Caucasian; Gender: Male; Date of Birth: Jan 1, 1972. He is unaccompanied and seems to be a reliable historian.
Subjective
CC: "I have been experiencing frequent urination, and fatigue"
HPI: Patient is a 50-year-old man who arrives at the clinic complaining of frequent urination. Aside from the increased frequency of urination, other symptoms include thirst, hunger, and tiredness. He reports that the symptoms have been going on for about two months. He has a past medical history of hypertension, which was diagnosed last year 2021. He reports he has not had any other long-term illnesses or allergies. He also reports that he has not taken any medication that have made his condition worse or helped. He reports drinking alcohol occasionally about 2 bottles of beer in a week. He denies any burning or pain while urinating, denies fever or chills.
Past Medical History:
· Medical Problem: Hypertension
· Surgeries: none
· Allergies: No known allergies
· Immunization: Fully immunized
· Current Medications: Lisinopril 10 mg po daily for Blood pressure
Family History:
Mother, age 78, has diabetes
Father, age 80, diseased, with history of hypertension
Brother, age 60, has diabetes
Social History
Living situation: He lives with his wife and 3 grandchildren in a safe environment.
Occupation: He is a high school teacher
Tobacco or marijuana use: Denies
Alcohol use: Drinks 5 bottles of beer in a week.
Diet: Vegan
Exercise: Rare physical activity
Review of System
Constitutional: The patient reports fatigue. Denies chills or fever.
Skin: Denies skin rashes, bruises, color changes, or lesions.
HEENT: Head: No previous head injury reported.
Eyes: Denies use of corrective lenses. No eye irritation, color blindness, dryness, or copious tears
were reported.
Ear: Denies experiencing hearing difficulties, ear pain, ear ringing, discharges, or hearing loss.
Nose: No nosebleed, loss of smell, nasal congestion, or pain reported.
Months/ throat: No bleeding gums or mouth wounds were reported. No sore throat and hoarseness were reported.
Respiratory: Denies difficulties in breathing, wheezing, or coughing.
Cardio: Denies chest pains but reports episodic heart palpitations
Endocrine: Reports an increase in appetite and thirst.
Musculoskeletal: Denies having joint pain, muscle pain, or swelling.
Genitourinary: Denies discomforts when urination. Reports an increase in urination more often during the night.
Neuro: Denies tremors, headaches, or dizziness.
Psychiatric: Denies sleep disturbances or ideas of hurting himself, such as suicidal thoughts. Denies depression and anxiety
Objective
Vital Signs:
Blood Pressure 138/89, Resp: 18, Heart rate: 88, Temperature 98.6 F, SpO2 100
Height 5'3" Weight 158lbs BMI 28.2.
Physical Exam:
General appearance: The patient is a nice looking 50-year-old Caucasian man who is
...
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For group 2, the diagnosis is based on positive serology and histology. HLA testing for HLA-DQ2 and HLA-DQ8 is valuable to exclude CD if both haplotypes
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The document discusses a study on the effects of a complex herbal formulation called CIRCULAT in treating chronic ischemic heart disease. The study found that 85% of the initial 20 patients showed good responses to CIRCULAT therapy as measured by imaging and stress tests over periods of 6 months to 1 year. The treatment was associated with reductions in perfusion damage percentages on imaging and increases in functional capacity on stress tests for most patients.
This study prospectively examined the frequency of severe hypoglycemia over 12 months in 60 patients with type 1 diabetes - 29 with impaired awareness of hypoglycemia and 31 with normal awareness. Patients were matched for demographic and clinical characteristics. The results showed that patients with impaired awareness had over twice as many episodes of severe hypoglycemia (2.8 vs 0.5 episodes per patient per year) and were more likely to experience an episode (66% vs 26%) compared to those with normal awareness. Most episodes in those with impaired awareness occurred during waking hours, particularly in the evening, while those with normal awareness had more episodes in the early morning. The study demonstrated that impaired awareness of hypoglycemia significantly increases the risk of severe
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TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kol...rightmanforbloodline
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8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
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share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
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1. A FOURTEEN YEARS OLD GIRL WITH TYPE 1
DIABETES MELLITUS WITH CATARACT
PRESENTED BY:
Kirnia Tri Wulandari, MD
SUPERVISOR:
Harjoedi Aji Cahyono, MD, PAED (C), Ph.D
Irfan Agus Salim, MD, PAED, M.Biomed
Fadilah Mutaqin, MD, PAED, M.Biomed
PEDIATRIC DEPARTMENT
FACULTY OF MEDICINE BRAWIJAYA UNIVERSITY, DR. SAIFUL ANWAR MALANG GENERAL HOSPITAL
C A S E R E P O R T
2. LIST OF ABBREVIATIONS
T1DM : Type 1 Diabetes Mellitus
BMI : Body Mass Index
HbA1c : Hemoglobin A1c
NADPH : Nikotinamid Adenin Dinukleotida Phosfat
NADH : Nicotinamide Adenine Dinucleotide (NAD) + hydrogen (H)
ROS : Reactive oxygen species
IOL : Intra Ocular Lens
ADA : American Diabetes Association
ISPAD : International Society for Pediatric and Adolescent Diabetes
NVG : Neo Vascular Glaucoma
anti-VEGF: Anti-Vascular Endothelial Growth Factor
PEDIATRIC DEPARTMENT
FACULTY OF MEDICINE BRAWIJAYA UNIVERSITY, DR. SAIFUL ANWAR MALANG GENERAL HOSPITAL
3. Introduction
In the world
Half a million children have type 1 diabetes
mellitus (T1DM)
With an estimation of 80,000 new cases
every year
In the pediatric population
Cataract is a rare manifestation of ocular
complication at an early phase of T1DM
The prevalence of early diabetic cataract
varies between 0.7 and 3.4%
The pathophysiological mechanism of early
diabetic cataract has not been fully
understood
There are many theories about the possible
etiology including osmotic damage, polyol
pathway, and oxidative stress
PEDIATRIC DEPARTMENT
FACULTY OF MEDICINE BRAWIJAYA UNIVERSITY, DR. SAIFUL ANWAR MALANG GENERAL HOSPITAL
M. M. Geloneck, B. J. Forbes, J. Shaffer, G. Ying, and G. Binenbaum, “Ocular complications in children with diabetes mellitus,” Ophthalmology, vol. 122, no. 12, pp. 2457–2464, 2020
M. E. Wilson, A. V. Levin, R. H. Trivedi et al., “Cataract associated with type-1 diabetes mellitus in the pediatric population,” Journal of American Association for Pediatric Ophthalmology and Strabismus, vol. 11, no. 2, pp. 162–165, 2020
5. Chief Complaint
Blurred foggy vision in the both eyes since 2 years ago
History of Present Illness
- Weakness since the last few days
- Feelings of hunger and thirst
- Numbness in both legs
Past Medical History
- A year-long history of polydipsia and polyuria
- Diagnosed with type 1 diabetes since 2017
D/Girl/14 years old/38 kg
6. Family History
Diabetes mellitus type 2 was found in her grandfather of the biological maternal line
History of Immunization
The patient completed the immunization
History of growth & development
Growth and developemnt was in accordance to the age
History of Childbirth
- She was born via sectio caesare at 37-48 weeks of gestation
- The birth weight was 2100 grams
- There was no cyanosis, tightness, and icteric at birth
7. History of Treatment
Novorapid 11-11-11
Levemir 0-0.13-0
History of Surgical
The patient underwent a surgical treatment for her catarract of the right eye in
Islamic Hospital at September 15th 2022
History of nutrition
Complete breast milk nutrition for 2 years
History of Social
The patient was the first child
8. • Weight 38 kg (P5)
• Height 149 cm (<P5) ~ 11
years old
• Head Circumference 50 cm
(-2SD to Mean)
• Mid-Upper Arm
Circumference 18 cm (P5-
P10)
• BMI 17,1 kg/m2 (P10-P25)
Antropometric
status
9. PHYSICAL EXAMINATION
General Appearance : Looked mild ill, compos mentis , spontaneous breathing
Vital Sign
HR : 110 times/ minute RR : 20 times/ minute
Axillary Temperature : 36,7º C SaO2 : 99% with room air
Head/Neck :
Normocephal, lymph node enlargement (-)
Anemia -/-, Ikterus -/-, Cyanosis-/-, conjunctival injection -/-, pericorneal injection -/-
Thorax:
Symmetrical, deep subcostal retraction (-), abdominal breathing
Heart/ single S1, normal S2, murmur (-), gallop (-)
Lung/ ves/ves, Rh -/-, Wh -/-
Abdomen:
Slightly distended (-), meteorismus (-), normal Bowel Sound (+), tenderness (-)
Liver and Spleen are not palpable
Extremities :
Warm acrals, CRT <2”, edema (-)
11. Laboratoric examination
Hemoglobin 12.7 g/dL
Level of insulis 17.8
Vitamin D serum 7.43 ng/L
Fasting blood glucose level 150 mg/dl
HbA1c 8.8%
Total cholesterol 207 mg/dL
Urinary glucose level 1+
Protein level 1+
Urinary ketone level Negatif
Electrolyte levels
Normal
Kidney function
Liver function
Blood gas analysis Normal without acidosis or alkalosis
12. Ophthalmiological examination
Intermittent blurred vision
Visual acuity was more than 2/60 in both eyes
No anemic conjunctiva is found
The posterior segment shows results within normal limits
An intraocular lens (IOL on place) in the right eye as she got cataract
surgical treatment previously
The lens of left eye was coudy uneven
The intraocular pressure was found higher on the both eye as 17.3
mmHg
13. Figure. The Funduscopy examination.
A. there was a redness in the right eye; B. There was an
intraocular lens (IOL on place) in the right eye as she
got cataract surgical treatment previously; C. The lens of
left eye was coudy uneven.
A B
Figure. The clinical appearance of patient eyes.
A. there was a redness in the right eye; B. There was an
intraocular lens (IOL on place) in the right eye as she
got cataract surgical treatment previously; C. The lens of
left eye was coudy uneven.
B
A
C
14. Funduscopy examination
Funduscopy Right eye Left eye
FR + +
FR media Clear Clear
PN II Round shape with orange
coulour
Round shape with orange
coulour
C/D ratio of PN II 0.3 0.3
SV of PN II >7 >7
Vasa A/V 2, No scle, no Cross 3. No scle, no Cross
Retina No exudate, no
haemmorhage
No exudate, no
haemmorhage
RF of Macula + +
15. Diagnosis & Therapy
Diagnosis Therapy
- Type 1 Diabetes mellitus
- cataract of the left eye
• Novorapid 15-15-15
• Levemir 0-0-20
• Vitamin D 5000 IU once daily
• Vitamin B Complex once daily
• A drop of Levocin Eye drop
• Vosama Eye Drop six time a day on
the right eye
17. According report data from type 1
diabetes registries across nineteen
countries in Australasia, Europe
and North America (n = 324,501)
reported that 84% of patients
exhibited HbA1c above target
The laboratorium result in
this patient, fasting
blood glucose level
examination was found to
be high at 150 mg/dL
with an HbA1c level of
8.8%.
Glycaemic control and
achieving normal
glycated haemoglobin
(HbA1c ≤ 7.0% or 53
mmol/mol)
M. Craig, C. Jefferies, D. Dabelea et al., “Definition, epidemiology, and classification of diabetes in children and adolescents,” Pediatric Diabetes, vol. 15, no. S20, pp. 4–17, 2020
Type 1 Diabetes Mellitus
18. The risk factors for cataract
development are the duration
of symptoms of type 1 diabetes
mellitus prior to the diagnosis,
poor metabolic control, high
glycosylated hemoglobin,
diabetic ketoacidosis, genetic
factors, and treatment with
glucocorticoids
In this patient we found blurred
foggy vision in the both eyes since
2 years ago. There were not pain
and redness in the eyes. She had a
family history with diabetes mellitus
type 2 was found in her grandfather
of the biological maternal line.
There is no family history with the
same complaints
M. Phillip, D. Ludwick, K. Armour, and M. Preslan, “Transient subcapsular cataract formation in a child with diabetes,” Clinical Pediatrics, vol. 32, no. 11, pp. 684-685, 2021
Type 1 Diabetes Mellitus with Cataract Diabeticum
19. Ehrlich et al. described a patient
who developed cataract within 3
weeks of a type 1 diabetes mellitus
diagnosis
Pakhetra et al. described bilateral cataract
development at the time of diagnosis of type
1 diabetes mellitus in a young girl and
development of juvenile diabetic cataract
within a few months of type 1 diabetes
mellitus diagnosis in an another patient
In this patient a 14-year old girl presented with
blurred foggy vision in the both eyes since 2 years
ago. The patient was previously diagnosed with
type 1 diabetes since 2017
E. L. Montgomery and J. A. Batch, “Cataracts in insulindependent diabetes
mellitus: sixteen years’ experience in children and adolescents,”Journal of
Paediatrics and Child Health, vol. 34, no. 2, pp. 179–182, 2022
20. American Diabetes Association
(ADA) and the International Society
for Pediatric and Adolescent
Diabetes (ISPAD) as two major
associations of pediatric
diabetologists. Phacoemulsification is
the most common technique of
cataract extraction in the developed
world. Types of surgery differentiate
between younger and older children.
Attributable to soft cataract in
younger children, use of
phacoemulsification is not mandatory
In this patient, at September 15th 2022,
the patient underwent a surgical treatment
for her catarract of the right eye in Islamic
Hospital.
Y. Y. Jin, K. Huang, C. C. Zou, L. Liang, X. M. Wang, and J. Jin, “Reversible cataract as the presenting sign of diabetes mellitus : report of two cases and
literature review,” Iranian Journal of Pediatrics, vol. 22, no. 1, pp. 125–128, 2019.
A. Falck and L. Laatikainen, “Diabetic cataract in children,” Acta Ophthalmologica Scandinavica, vol. 76, no. 2, pp. 238– 240, 2021
Surgical treatment
21. She found an ophthalmiological
examination during the initial
hospitalization revealed intermittent
blurred vision. Her visual acuity was
more than 2/60 in both eyes. No
anemic conjunctiva is found.
Examination of the posterior segment
shows results within normal limits.
There was an intraocular lens (IOL on
place) in the right eye. While the lens
of left eye was cloudy uneven. The
intraocular pressure was found higher
on the both eye as 17.3 mmHg The
patient was conscious with no
headache, abdominal pain, or other
symptoms.
Randomized controlled study in 27
children aged between 4 and 14 years
who underwent the intervention of
cataract surgery with or without PPC
(primary posterior capsulorhexis) and
AV (anterior vitrectomy) demonstrated
better visual acuity and significantly
less PCO in the group that undergone
cataract surgery with PPC and AV.
Elkin et al. revised the incidence of
PCO in all age groups of pediatric
cataract patients who underwent
cataract extraction followed by IOL
implantation without PPC and AV and
found occurrence of PCO up to 90%.
C. Costagliola, G. Iuliano, M. Menzione, A. Nesti, F. Simonelli, and E. Rinaldi, “Systemic human diseases as oxidative risk factors in cataractogenesis. I. Diabetes,” Ophthalmic Research, vol. 20, no. 5, pp. 308–316, 2021.
I. G. Obrosova, S. S. Chung, and P. F. Kador, “Diabetic cataracts: mechanisms and management,” Diabetes/Metabolism Research and Reviews, vol. 26, no. 3, pp. 172–180, 2020.
POST SURGICAL
22. Treatment for intraoperative and
postoperative complications
In patients with neovascular
glaucoma (NVG) Anti-
VEGF agents such as
bevacizumab intraocular
pressure reduction and
regression of
neovascularization
Cataract surgery after
administering anti-VEGF
agents should be done with or
without vitrectomy as early as
possible to enable treatment
of the posterior segment
M. C. Ventura, V. V. Sampaio, B. V. Ventura, L. O. Ventura, and W. Nosé, “Congenital cataract surgery with intraocular lens implantation in microphthalmic eyes: visual outcomes and complications,” Arquivos Brasileiros de Oftalmologia, vol. 76, no. 4, pp. 240–243, 2018
S. K. Khokhar, G. Pillay, E. Agarwal, and M. Mahabir, “Innovations in pediatric cataract surgery,” Indian Journal of Ophthalmology, vol. 65, no. 3, pp. 210–216, 2019
23. Jin et al. reported two cases of
reversible cataract that gradually
disappeared over several months with
good glycemic control.
Prognosis
Y. Y. Jin, K. Huang, C. C. Zou, L. Liang, X. M. Wang, and J. Jin, “Reversible cataract as the
presenting sign of diabetes mellitus : report of two cases and literature review,” Iranian Journal of
Pediatrics, vol. 22, no. 1, pp. 125–128, 2019.
24. Conclusion
Routine examination of the lens and retina for diabetic adolescents and
children who have diabetic ketosis or high levels of HbA1c
The patient with cataract, postoperative retinoscopy should be routinely
performed, and regular follow-up visits are advised
If abnormalities are identified, it is encouraged that patients are immediately
referred to an ophthalmologist for further evaluation