This document discusses febrile coma, its causes, diagnosis, and management. It begins by defining coma and differentiating it from similar states like hysterical coma and syncope. The main causes of febrile coma are then outlined as CNS infections, cerebrovascular events, and infections/lesions elsewhere that can damage the CNS. The document emphasizes the importance of rapidly stabilizing patients and obtaining a thorough history and neurological exam. Key diagnostic tests are bloodwork, lumbar puncture if no contraindications, and CT scan if focal signs are present. Management involves treating any identified cause as well as empiric treatment of common infections if the cause is unknown. Proper diagnosis and management of fe
Posterior circulation strokes can be differentiated from anterior circulation strokes based on clinical features. Posterior circulation strokes often present with vertigo, unsteadiness, crossed hemiplegia, bilateral deficits, cerebellar signs, ocular findings, dissociated sensory loss, and Horner's syndrome. The vertebrobasilar system supplies structures such as the cerebellum, medulla, pons, midbrain, thalamus, and occipital and temporal lobes. Common syndromes include lateral medullary syndrome and superior cerebellar artery occlusion. Infarctions in different vascular territories can produce characteristic clinical deficits.
A young man was admitted to the hospital with headache, vomiting, and high fever for 2 days. He also reported a cough with rusty sputum for 5 days. On examination, he had a high fever and neck stiffness. Laboratory tests showed elevated white blood cell count with neutrophil predominance. A lumbar puncture revealed cloudy cerebrospinal fluid with elevated proteins and low glucose, consistent with bacterial meningitis.
This document summarizes various causes of rickets, including calcium deficiency, phosphorus deficiency, rickets of prematurity, and several genetic disorders. Calcium deficiency can result from low dietary intake or malabsorption and presents with signs of rickets in infancy. Phosphorus deficiency is usually due to inadequate intake or antacid use. Rickets of prematurity occurs in very low birth weight infants and is prevented by mineral supplementation. The document also describes several genetic causes of rickets, including X-linked hypophosphatemic rickets, autosomal dominant hypophosphatemic rickets, and Fanconi syndrome. Treatment involves calcium, vitamin D, and phosphorus supplementation tailored to the specific deficiency.
Proper Case Presentation for Dengue Fever, Prevention, Treatment and everything else. Prepared by Dr Zain Khan, Doctor at Liaquat College of Medicine and Dentistry
Pseudohypoparathyroidism is characterized by peripheral resistance to parathyroid hormone rather than a deficiency, causing hypocalcemia and hyperphosphataemia. There are three main types - 1a, 1b, and 2 - which are all heterozygous genetic conditions involving haploinsufficiency of the GNAS1 gene. Type 1a is associated with short stature, round face, soft tissue calcification, and developmental delays. The molecular defect is in the GNAS1 gene which encodes the Gsa protein involved in several hormone signaling pathways. Types 1b and 2 also involve GNAS1 defects but have different clinical presentations and endocrinological effects.
A 19-year-old man presented with red urine, periorbital and pretibial edema. He was diagnosed with tonsillitis 3 weeks prior. Examination found hypertension and crackles in both lung bases. Urine analysis showed proteinuria and dysmorphic red blood cells. The most likely diagnosis is poststreptococcal glomerulonephritis resulting from the recent streptococcal infection. Treatment involves controlling hypertension, edema and complications through diuretics and sodium restriction. Renal biopsy showed diffuse proliferative glomerulonephritis with neutrophils and immune deposits consistent with poststreptococcal glomerulonephritis.
A comparison between Nephritic and Nephrotic syndrome from Professor Hossam Mowafy Internal Medicine textbook nephrology section, Please inform me if there is any error or wrong information include.
What is the most likely diagnosis? (1)
Station 10 B
A child presents with recurrent infections since birth. On examination he has sparse hair, cafe au lait spots and hypotonia.
Posterior circulation strokes can be differentiated from anterior circulation strokes based on clinical features. Posterior circulation strokes often present with vertigo, unsteadiness, crossed hemiplegia, bilateral deficits, cerebellar signs, ocular findings, dissociated sensory loss, and Horner's syndrome. The vertebrobasilar system supplies structures such as the cerebellum, medulla, pons, midbrain, thalamus, and occipital and temporal lobes. Common syndromes include lateral medullary syndrome and superior cerebellar artery occlusion. Infarctions in different vascular territories can produce characteristic clinical deficits.
A young man was admitted to the hospital with headache, vomiting, and high fever for 2 days. He also reported a cough with rusty sputum for 5 days. On examination, he had a high fever and neck stiffness. Laboratory tests showed elevated white blood cell count with neutrophil predominance. A lumbar puncture revealed cloudy cerebrospinal fluid with elevated proteins and low glucose, consistent with bacterial meningitis.
This document summarizes various causes of rickets, including calcium deficiency, phosphorus deficiency, rickets of prematurity, and several genetic disorders. Calcium deficiency can result from low dietary intake or malabsorption and presents with signs of rickets in infancy. Phosphorus deficiency is usually due to inadequate intake or antacid use. Rickets of prematurity occurs in very low birth weight infants and is prevented by mineral supplementation. The document also describes several genetic causes of rickets, including X-linked hypophosphatemic rickets, autosomal dominant hypophosphatemic rickets, and Fanconi syndrome. Treatment involves calcium, vitamin D, and phosphorus supplementation tailored to the specific deficiency.
Proper Case Presentation for Dengue Fever, Prevention, Treatment and everything else. Prepared by Dr Zain Khan, Doctor at Liaquat College of Medicine and Dentistry
Pseudohypoparathyroidism is characterized by peripheral resistance to parathyroid hormone rather than a deficiency, causing hypocalcemia and hyperphosphataemia. There are three main types - 1a, 1b, and 2 - which are all heterozygous genetic conditions involving haploinsufficiency of the GNAS1 gene. Type 1a is associated with short stature, round face, soft tissue calcification, and developmental delays. The molecular defect is in the GNAS1 gene which encodes the Gsa protein involved in several hormone signaling pathways. Types 1b and 2 also involve GNAS1 defects but have different clinical presentations and endocrinological effects.
A 19-year-old man presented with red urine, periorbital and pretibial edema. He was diagnosed with tonsillitis 3 weeks prior. Examination found hypertension and crackles in both lung bases. Urine analysis showed proteinuria and dysmorphic red blood cells. The most likely diagnosis is poststreptococcal glomerulonephritis resulting from the recent streptococcal infection. Treatment involves controlling hypertension, edema and complications through diuretics and sodium restriction. Renal biopsy showed diffuse proliferative glomerulonephritis with neutrophils and immune deposits consistent with poststreptococcal glomerulonephritis.
A comparison between Nephritic and Nephrotic syndrome from Professor Hossam Mowafy Internal Medicine textbook nephrology section, Please inform me if there is any error or wrong information include.
What is the most likely diagnosis? (1)
Station 10 B
A child presents with recurrent infections since birth. On examination he has sparse hair, cafe au lait spots and hypotonia.
A 19-year-old male presented with fever, abdominal lump, fullness, loss of appetite, and weakness for 3-4 years. Physical examination revealed anemia, fever, pale skin, and massive splenomegaly and mild hepatomegaly. Tests showed pancytopenia and previous positive malaria tests. The diagnosis was Tropical Splenomegaly Syndrome due to repeated malarial infections over many years. Management involves long-term antimalarial medication to reduce IgM levels and spleen/liver size. The prognosis is generally good if managed properly but increased risk of infections and complications.
The document provides information on pediatric stroke. It defines stroke and describes the different types that can occur in children, including arterial ischemic stroke, cerebral sinovenous thrombosis, and hemorrhagic stroke. Risk factors and potential causes are discussed for each type. Clinical features may include seizures, weakness on one side of the body, difficulty speaking or swallowing. Diagnosis involves neuroimaging like CT or MRI along with other lab tests. Treatment focuses on neuroprotection, recanalization of blocked vessels, and anticoagulation or antiplatelet therapies to prevent further clotting.
The document discusses several cases presenting with abnormal liver function tests (LFTs). Case 1 shows a mild isolated transaminitis. Case 2 involves severe hepatocellular injury and mild cholestasis in an alcoholic patient. Case 3 examines LFT patterns in an alcoholic cirrhotic with possible alcoholic hepatitis.
acute gastroenteritis, case presentation < sabrina >Sabrina AD
This document provides information about a 6 year and 4 month old male Chinese patient named Jackson Tea Jia Sheng who was admitted to the hospital due to vomiting and diarrhea for the past 2 days. The patient's medical history including past illness, family history, birth details, development, and immunization status are documented. The physical examination findings show the patient is alert and interacting well without signs of dehydration, and vital signs are normal. The system examinations including respiratory, cardiovascular, and gastrointestinal systems are unremarkable.
ALL THE QUESTIONS ARE HAVING VERY STANDARD ANSWERS FROM THE STANDARD BOOKS)
REF : ROBBINS & COTRAN PATHOLOGIC BASIS OF DISEASE.
COMPREHENSIVE IMAGE BASED REVIEW OF PATHOLOGY BY SONI .
GARG & GUPTA PATHOLOGY REVIEW & GENETICS.
The patient, a 40-year-old male smoker and alcoholic, was admitted with paraplegia and was diagnosed with stage IV small cell lung cancer that had metastasized to the spine, brain, and other areas. MRI revealed metastatic lesions in the spine compressing the spinal cord. A biopsy confirmed small cell lung cancer. Treatment involved chemotherapy, radiation therapy to sites of metastases, and steroids to address spinal cord compression. However, the patient's condition did not improve.
This document presents the clinical case of a 22-year-old male patient admitted with right-sided pleural effusion. The patient presented with 14 days of high fever, right chest pain, and cough with white sputum. Examination found decreased breath sounds and dullness on the right chest. Tests showed an exudative pleural effusion. The patient was empirically treated with analgesics, PPIs, antibiotics including amoxicillin, azithromycin and levofloxacin, and antitussives following treatment guidelines. The treatment provided symptomatic relief and no adverse drug reactions occurred.
Syringomyelia ( Morvan syndrome) Electrodiagnosis Mohammed Khalil
This document describes a case study of a 29-year-old female patient presenting with decreased sensation in her right hand and forearm, as well as ulcers and eruptions. She has a history of Arnold-Chiari malformation type 1 associated with syringomyelia. Physical examination found loss of superficial sensation in the right hand and forearm with involvement of the lateral spinothalamic tract and posterior columns. Nerve conduction studies indicate syringomyelia affecting the right lateral spinothalamic tract and central autonomic pathways, with mild involvement of the anterior horn cells. The patient likely has Arnold-Chiari malformation type 1 associated with syringomyelia causing dissociative anesthesia in the right upper
Golden book for Medicine OSCE: First ViewMan B Paudyal
This document provides summaries of various medical cases and images in the form of questions and answers. It covers topics like Peutz-Jeghers syndrome, Bell's palsy, cirrhosis, clubbing, multiple myeloma, Cushing's syndrome, Graves' disease, scleroderma, rheumatoid arthritis, hyperthyroidism, brain abscess, empyema, G6PD deficiency, megaloblastic anemia, Charcot-Marie-Tooth disease, Ataxia telangiectasia, infective endocarditis, and more. For each case, it provides the diagnosis, relevant physical findings, investigations, management, and complications.
This document contains a medical case report for a 40-year-old male electrician named Rubel who was admitted to the hospital for shortness of breath and easy fatigability for the past two months. Upon examination, a murmur was detected consistent with mitral stenosis. Further tests revealed the patient has chronic rheumatic heart disease with moderate mitral stenosis and pulmonary hypertension. He was started on medication and may require a mitral valve procedure or surgery going forward.
This document discusses jaundice, its causes, and approach to postoperative jaundice. It defines jaundice as yellow discoloration from hyperbilirubinemia. Causes of postoperative jaundice include hemolysis, hepatic dysfunction unrelated to surgery, and obstructive causes. The workup involves liver function tests to determine if the jaundice is prehepatic, hepatocellular, or obstructive. Management depends on the identified cause, but generally involves supportive care, discontinuing hepatotoxic drugs, treating sepsis aggressively, and considering surgery for biliary obstruction.
Damage to spinal cord structures can cause various impairments depending on the location and extent of the lesion. A complete transection of the spinal cord at L1 would cause ipsilateral loss of light touch and proprioception below the lesion, upper motor neuron signs ipsilaterally below, and contralateral loss of pain and temperature sensation. Epiconus syndrome from a lesion at L4-S2 is associated with weakness of hip and knee flexion and ankle movement with sensory loss from L4-S5 and loss of bladder and bowel control. Cutaneous reflexes and other reflexes have localizing value in myelopathy patients.
Human: Thank you for the summary. Can you provide a 3 sentence summary that focuses
Long case presentation in clinical exams.Imad Hassan
This 61-year-old Hispanic male presented with a 2-week history of dry cough, chest pain, fever, chills, nausea and vomiting. On examination, he was febrile and tachycardic with respiratory distress, rhonchi, and crackles. Chest X-ray showed bilateral pneumonia. The patient's symptoms were not improving with prior antibiotic treatment.
Coma is defined and the anatomy of consciousness explained. The various levels of arousal, AVPU scale and Glasgow Coma Scale described. The differential diagnosis of coma discussed are coma with & without focal deficits and the meningitis syndrome.
The various aspects of history discussed in details. The examination part includes the general examination, Brainstem reflexes, motor functions with the signs of lateralisation and meningeal irritation signs.
The basic lab investigations, Imaging and special investigations like CSF examination, EEG discussed.
Elevated intracranial pressure and its management explained.
Practical pediatric quiz - Kaun Banega WinnerGaurav Gupta
Interactive quiz based on mentimeter platform for IAP Chandigarh Annual meeting in Dec 2017.
Great success for practising paediatricians in general,
Also a great teaching experience
This patient, a 65-year-old male, presented with 6 months of difficulty walking and 4 months of forgetfulness and hallucinations. Examination found he was semiconscious with rigidity and myoclonic jerks. Imaging and tests were consistent with a prion disease like Creutzfeldt-Jakob disease (CJD). A lumbar puncture found elevated proteins. He was diagnosed with a rapidly progressive neurodegenerative condition likely CJD.
Iron-deficiency anemia is caused by blood loss, increased demands, or decreased absorption of iron. It affects over 1/4 of the world's population. Symptoms include fatigue, pallor, and spoon-shaped nails. Laboratory tests show microcytic, hypochromic anemia and low iron levels. Treatment involves oral or parenteral iron supplementation to correct the anemia and restore iron stores.
1) The document discusses various causes of compressive myelopathy including spondylosis, herniated discs, spinal stenosis, and tuberculosis. It describes the clinical features and treatments for different levels of involvement in the cervical and lumbar spine.
2) Imaging techniques like MRI, CT myelogram, and X-rays are used to identify compression of the spinal cord or nerve roots from conditions like herniations, osteophytes, and tuberculosis lesions.
3) Surgical intervention may be indicated for moderate to severe myelopathy, progressive neurological deficits, or failure of conservative treatment. The goal is to decompress the spinal cord and relieve compression.
A 19-year-old male presented with fever, abdominal lump, fullness, loss of appetite, and weakness for 3-4 years. Physical examination revealed anemia, fever, pale skin, and massive splenomegaly and mild hepatomegaly. Tests showed pancytopenia and previous positive malaria tests. The diagnosis was Tropical Splenomegaly Syndrome due to repeated malarial infections over many years. Management involves long-term antimalarial medication to reduce IgM levels and spleen/liver size. The prognosis is generally good if managed properly but increased risk of infections and complications.
The document provides information on pediatric stroke. It defines stroke and describes the different types that can occur in children, including arterial ischemic stroke, cerebral sinovenous thrombosis, and hemorrhagic stroke. Risk factors and potential causes are discussed for each type. Clinical features may include seizures, weakness on one side of the body, difficulty speaking or swallowing. Diagnosis involves neuroimaging like CT or MRI along with other lab tests. Treatment focuses on neuroprotection, recanalization of blocked vessels, and anticoagulation or antiplatelet therapies to prevent further clotting.
The document discusses several cases presenting with abnormal liver function tests (LFTs). Case 1 shows a mild isolated transaminitis. Case 2 involves severe hepatocellular injury and mild cholestasis in an alcoholic patient. Case 3 examines LFT patterns in an alcoholic cirrhotic with possible alcoholic hepatitis.
acute gastroenteritis, case presentation < sabrina >Sabrina AD
This document provides information about a 6 year and 4 month old male Chinese patient named Jackson Tea Jia Sheng who was admitted to the hospital due to vomiting and diarrhea for the past 2 days. The patient's medical history including past illness, family history, birth details, development, and immunization status are documented. The physical examination findings show the patient is alert and interacting well without signs of dehydration, and vital signs are normal. The system examinations including respiratory, cardiovascular, and gastrointestinal systems are unremarkable.
ALL THE QUESTIONS ARE HAVING VERY STANDARD ANSWERS FROM THE STANDARD BOOKS)
REF : ROBBINS & COTRAN PATHOLOGIC BASIS OF DISEASE.
COMPREHENSIVE IMAGE BASED REVIEW OF PATHOLOGY BY SONI .
GARG & GUPTA PATHOLOGY REVIEW & GENETICS.
The patient, a 40-year-old male smoker and alcoholic, was admitted with paraplegia and was diagnosed with stage IV small cell lung cancer that had metastasized to the spine, brain, and other areas. MRI revealed metastatic lesions in the spine compressing the spinal cord. A biopsy confirmed small cell lung cancer. Treatment involved chemotherapy, radiation therapy to sites of metastases, and steroids to address spinal cord compression. However, the patient's condition did not improve.
This document presents the clinical case of a 22-year-old male patient admitted with right-sided pleural effusion. The patient presented with 14 days of high fever, right chest pain, and cough with white sputum. Examination found decreased breath sounds and dullness on the right chest. Tests showed an exudative pleural effusion. The patient was empirically treated with analgesics, PPIs, antibiotics including amoxicillin, azithromycin and levofloxacin, and antitussives following treatment guidelines. The treatment provided symptomatic relief and no adverse drug reactions occurred.
Syringomyelia ( Morvan syndrome) Electrodiagnosis Mohammed Khalil
This document describes a case study of a 29-year-old female patient presenting with decreased sensation in her right hand and forearm, as well as ulcers and eruptions. She has a history of Arnold-Chiari malformation type 1 associated with syringomyelia. Physical examination found loss of superficial sensation in the right hand and forearm with involvement of the lateral spinothalamic tract and posterior columns. Nerve conduction studies indicate syringomyelia affecting the right lateral spinothalamic tract and central autonomic pathways, with mild involvement of the anterior horn cells. The patient likely has Arnold-Chiari malformation type 1 associated with syringomyelia causing dissociative anesthesia in the right upper
Golden book for Medicine OSCE: First ViewMan B Paudyal
This document provides summaries of various medical cases and images in the form of questions and answers. It covers topics like Peutz-Jeghers syndrome, Bell's palsy, cirrhosis, clubbing, multiple myeloma, Cushing's syndrome, Graves' disease, scleroderma, rheumatoid arthritis, hyperthyroidism, brain abscess, empyema, G6PD deficiency, megaloblastic anemia, Charcot-Marie-Tooth disease, Ataxia telangiectasia, infective endocarditis, and more. For each case, it provides the diagnosis, relevant physical findings, investigations, management, and complications.
This document contains a medical case report for a 40-year-old male electrician named Rubel who was admitted to the hospital for shortness of breath and easy fatigability for the past two months. Upon examination, a murmur was detected consistent with mitral stenosis. Further tests revealed the patient has chronic rheumatic heart disease with moderate mitral stenosis and pulmonary hypertension. He was started on medication and may require a mitral valve procedure or surgery going forward.
This document discusses jaundice, its causes, and approach to postoperative jaundice. It defines jaundice as yellow discoloration from hyperbilirubinemia. Causes of postoperative jaundice include hemolysis, hepatic dysfunction unrelated to surgery, and obstructive causes. The workup involves liver function tests to determine if the jaundice is prehepatic, hepatocellular, or obstructive. Management depends on the identified cause, but generally involves supportive care, discontinuing hepatotoxic drugs, treating sepsis aggressively, and considering surgery for biliary obstruction.
Damage to spinal cord structures can cause various impairments depending on the location and extent of the lesion. A complete transection of the spinal cord at L1 would cause ipsilateral loss of light touch and proprioception below the lesion, upper motor neuron signs ipsilaterally below, and contralateral loss of pain and temperature sensation. Epiconus syndrome from a lesion at L4-S2 is associated with weakness of hip and knee flexion and ankle movement with sensory loss from L4-S5 and loss of bladder and bowel control. Cutaneous reflexes and other reflexes have localizing value in myelopathy patients.
Human: Thank you for the summary. Can you provide a 3 sentence summary that focuses
Long case presentation in clinical exams.Imad Hassan
This 61-year-old Hispanic male presented with a 2-week history of dry cough, chest pain, fever, chills, nausea and vomiting. On examination, he was febrile and tachycardic with respiratory distress, rhonchi, and crackles. Chest X-ray showed bilateral pneumonia. The patient's symptoms were not improving with prior antibiotic treatment.
Coma is defined and the anatomy of consciousness explained. The various levels of arousal, AVPU scale and Glasgow Coma Scale described. The differential diagnosis of coma discussed are coma with & without focal deficits and the meningitis syndrome.
The various aspects of history discussed in details. The examination part includes the general examination, Brainstem reflexes, motor functions with the signs of lateralisation and meningeal irritation signs.
The basic lab investigations, Imaging and special investigations like CSF examination, EEG discussed.
Elevated intracranial pressure and its management explained.
Practical pediatric quiz - Kaun Banega WinnerGaurav Gupta
Interactive quiz based on mentimeter platform for IAP Chandigarh Annual meeting in Dec 2017.
Great success for practising paediatricians in general,
Also a great teaching experience
This patient, a 65-year-old male, presented with 6 months of difficulty walking and 4 months of forgetfulness and hallucinations. Examination found he was semiconscious with rigidity and myoclonic jerks. Imaging and tests were consistent with a prion disease like Creutzfeldt-Jakob disease (CJD). A lumbar puncture found elevated proteins. He was diagnosed with a rapidly progressive neurodegenerative condition likely CJD.
Iron-deficiency anemia is caused by blood loss, increased demands, or decreased absorption of iron. It affects over 1/4 of the world's population. Symptoms include fatigue, pallor, and spoon-shaped nails. Laboratory tests show microcytic, hypochromic anemia and low iron levels. Treatment involves oral or parenteral iron supplementation to correct the anemia and restore iron stores.
1) The document discusses various causes of compressive myelopathy including spondylosis, herniated discs, spinal stenosis, and tuberculosis. It describes the clinical features and treatments for different levels of involvement in the cervical and lumbar spine.
2) Imaging techniques like MRI, CT myelogram, and X-rays are used to identify compression of the spinal cord or nerve roots from conditions like herniations, osteophytes, and tuberculosis lesions.
3) Surgical intervention may be indicated for moderate to severe myelopathy, progressive neurological deficits, or failure of conservative treatment. The goal is to decompress the spinal cord and relieve compression.
Saint Leo University is a Catholic university located in Florida with nearly 15,000 students from all 50 states and over 80 countries. It is noted as the oldest Catholic educational institution in Florida, founded in 1889. The university provides both online and in-person programs at over 40 locations, with its online programs ranked among the top in the nation. It is recognized for successfully training teachers to use technology in classrooms and for its cyber defense education program. The university also consistently ranks highly for serving minority and military students.
This curriculum vitae summarizes the education and professional experience of Preston T. Snee. He received his PhD in Physical Chemistry from UC Berkeley in 2002 and is currently an Associate Professor at the University of Illinois at Chicago. His research focuses on creating functional semiconductor quantum dots and he has supervised many graduate and undergraduate students. He has over 60 publications in peer-reviewed journals related to quantum dot synthesis and applications.
This document summarizes solutions to forensic analysis problems from the 3th HolyShield Forensics competition. It includes explanations for 4 problems of increasing difficulty: Forensics 200, finding a hidden file in an image by analyzing slack space and file metadata; Forensics 300, discovering a secret file downloaded and accessed on a computer; Forensics 400, recovering an airport access key sent by an internal computer user to an external hacker; and a final section for question and answers. The document provides technical details on digital forensic techniques used such as filesystem analysis, jumplist parsing, password cracking, and memory analysis.
1. Acute flaccid paralysis (AFP) can present asymmetrically or symmetrically. Asymmetrical AFP may be caused by poliomyelitis or non-polio enteroviruses, while symmetrical AFP may be Guillain-Barré syndrome or transverse myelitis.
2. Important considerations in the evaluation of a child with AFP include differentiating acute infections from post-injection paralysis, obtaining a thorough history of recent vaccinations or infections, and ruling out treatable causes with imaging or lumbar puncture when indicated.
3. Proper management depends on the stage of illness, with the acute stage prioritizing isolation and prevention of paralysis progression, the restoration stage involving physi
This document provides an overview of the approach to diagnosis and management of patients presenting in a comatose state. It begins with definitions of consciousness and coma, then discusses causes of coma including intracranial causes like trauma, infection, vascular issues and tumors, as well as extracranial causes such as toxins, hypoxia, metabolic derangements and others. It describes tools for assessment like the Glasgow Coma Scale and provides guidance on clinical evaluation including vital signs, neurological exam and laboratory testing. Emergency management including airway protection, treatment of hypoglycemia, meningitis and seizures is reviewed. The conclusion emphasizes the importance of focused history and exam to identify potentially life-threatening causes.
This document discusses central nervous system infections, including various types like meningitis, encephalitis and brain abscess. It describes the typical causative agents, clinical presentations and diagnostic procedures. Common symptoms of meningitis include headache, vomiting, neck stiffness and fever. A lumbar puncture is usually performed to examine cerebrospinal fluid, and may reveal increased white blood cells and decreased glucose. Proper patient positioning and aseptic technique are important to safely perform lumbar punctures and obtain diagnostic samples.
A 15-month-old child presents with a fever and rash. The rash began as small red spots that have spread to other areas of the body over the past few days. The child also has a runny nose and cough. This presentation is consistent with measles, a highly contagious viral illness. A diagnosis of measles should be considered and appropriate isolation procedures followed given the contagious nature of the disease.
A patient with streptococcal pharyngitis develops tender red bumps along her entire tibia. This is most likely erythema nodosum, which presents as pretibial tender erythematous nodules and can be associated with streptococcal infections.
A 3-day-old infant presents with a rash containing eosinophils. This is likely to be erythema toxicum neonatorum, a benign and self-resolving rash of newborns.
A 4-year-old boy develops abdominal pain, vomiting, knee pain and a petechial rash on his legs. He is diagnosed with Henoch-Schönlein purpura,
Carta Organisasi Pengurusan/Pentadbiran SMA Repah 2017Fadhirul Fitri
Dokumen ini berisi panduan pengurusan sekolah menengah agama Repah Tampin tahun 2017. Terdapat carta organisasi dan fungsi sekolah yang menjelaskan struktur kepemimpinan sekolah dan tanggung jawab masing-masing jabatan seperti pentadbiran, kurikulum, hal ehwal murid, kokurikulum, bimbingan dan kaunseling, pengurusan sumber manusia, kewangan, dan pembangunan aset. Dokumen ini bertujuan unt
Cyber Threat Intelligence: Who is Targeting your Information? Control Risks
This document is copyrighted material from Control Risks Group Limited pertaining to cybersecurity. It contains 15 paragraphs with each paragraph copyrighted to Control Risks Group Limited. Contact information for cybersecurity matters at Control Risks Group Limited is provided.
This document provides an overview of lymphadenopathy in children, including its anatomy, pathophysiology, causes, and management approaches. It distinguishes between generalized and regional lymphadenopathy. Common causes of generalized lymphadenopathy include viral infections like mononucleosis, while regional lymphadenopathy is often due to infections in the local drainage area. Evaluation involves considering infectious, inflammatory, and malignant etiologies based on presentation. Management depends on the identified cause but typically involves supportive care or antibiotics for infections.
Bronchiectasis is defined as the permanent abnormal dilation of one or more large bronchi. It has both congenital and acquired causes. Common acquired causes include tuberculosis, pneumonia, inhaled foreign bodies, and allergic bronchopulmonary aspergillosis. Symptoms include chronic cough, production of large amounts of purulent sputum, recurrent pneumonia in the same lung segment, and hemoptysis. Diagnosis involves chest imaging like CT scan or X-ray showing bronchial wall thickening and dilation. Treatment consists of antibiotic therapy, airway clearance techniques, and surgery in severe cases. Complications can include respiratory failure, pneumonia, lung abscess and cor pulmonale.
The document discusses the cardiovascular system and measuring blood pressure. It defines systolic blood pressure as the peak pressure when the heart contracts and diastolic as the low pressure when the heart relaxes. Cardiac output is calculated as heart rate multiplied by stroke volume. The document emphasizes the importance of monitoring blood pressure, as constant blood flow is needed to supply tissues with oxygen and a pressure outside a normal range can be unhealthy or life-threatening.
Quién no debe recibir terapia adyuvante en melanomaMauricio Lema
The document discusses adjuvant therapy for malignant melanoma. It begins by providing background on ECOG 1684, a randomized controlled trial published in 1996 that found high-dose interferon alfa-2b prolongs relapse-free and overall survival compared to observation alone in high-risk resected melanoma patients. It then summarizes EORTC 18071, another randomized controlled trial from 2015 that found adjuvant ipilimumab improved relapse-free survival compared to placebo in patients with completely resected stage III melanoma. The document provides key details from these two important trials that established adjuvant therapies for reducing recurrence in high-risk melanoma.
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This document summarizes research on the causes and characteristics of hoarding disorder. It discusses how hoarding is defined as the compulsive accumulation of possessions that causes significant distress or impairment. Common causes include genetic factors, brain abnormalities, trauma, and disorders like obsessive-compulsive disorder. The document reviews studies on how hoarding behaviors form strong emotional attachments to possessions. It also notes the health and safety risks of excessive hoarding, like fire hazards and infestations.
Welcome to my architectural portfolio on SlideShare! Prepare to embark on a captivating visual journey that showcases my passion for innovative architectural design. Within this collection, you will discover a diverse range of projects that seamlessly blend aesthetics, functionality, and sustainability.
Each slide tells a story, taking you through the evolution of each design from initial concept sketches to the final detailed plans. Witness the transformation of architectural visions into tangible realities as you explore the thought process, creativity, and meticulous attention to detail that went into each project.
Through the use of advanced tools and technologies, such as BIM (Building Information Modeling) and hyper-realistic rendering techniques, I have brought these designs to life with striking realism. Experience the power of immersive visualizations that accurately depict materials, lighting, and spatial qualities, giving you a true sense of what the final built environment will look and feel like.
From residential homes to commercial complexes, public spaces to cultural institutions, each project reflects a deep understanding of the unique needs and aspirations of clients. By incorporating sustainable design principles, I strive to create spaces that not only enhance the lives of occupants but also minimize environmental impact.
Slide by slide, you will witness the meticulous planning, precise detailing, and innovative problem-solving that define my architectural approach. I believe that great architecture is a harmonious blend of form, function, and context, and my portfolio embodies this philosophy.
By sharing my portfolio on SlideShare, I aim to inspire fellow architects, design enthusiasts, and potential clients with my creative vision and technical expertise. Whether you are seeking inspiration for your own projects or interested in collaborating on future endeavors, I invite you to explore the slides and join me in celebrating the artistry and precision of architectural design.
Together, let us embark on this visual exploration of architectural excellence. Join me on SlideShare, where creativity, innovation, and imagination come together to shape the built environment of tomorrow. Software used - Revit, Twinmotion, SketchUP, CAD, etc.
Oliguria is defined as urine output of less than 0.5 mL/kg/hour. It can be caused by pre-renal, renal, or post-renal acute kidney injury. Pre-renal causes include decreased blood flow from conditions like dehydration, heart failure, or blood loss. Renal causes involve direct kidney damage from acute tubular necrosis, glomerulonephritis, or infections. Post-renal causes result from urinary outflow obstruction. Evaluation of oliguria includes history, physical exam focusing on fluid status and signs of obstruction, urine and blood tests to identify the specific cause, and imaging tests. Treatment depends on the underlying etiology but initially involves fluid resuscitation
The document discusses the relationship between oxygen and the human body. It explains that oxygen makes up 21% of air and is essential for human survival. However, oxygen uptake decreases with age and unhealthy lifestyles can lead to hypoxia. Hyperbaric oxygen chambers can help mitigate hypoxia by increasing air pressure and oxygen concentration to improve oxygen delivery to tissues. The document provides examples of diseases that hyperbaric oxygen therapy may help treat and summarizes results from a study on its anti-aging effects.
Pueblo Community College is experiencing record enrollment this fall, with full-time enrollment up over 22%. The college is playing a key role in the local economy by training skilled workers. Pueblo CC is well-positioned to take advantage of federal stimulus funding opportunities. Enrollment is up due to the weak economy, cost savings compared to 4-year schools, and growth in dual enrollment programs. Improvements to campus and technology have enhanced the student experience. The college provides training programs aligned with current and future in-demand jobs.
This document analyzes the relationship between financial systems and banking crises using data from 47 economies between 1990 and 1997. It finds that financial development is associated with market-based financial systems led by stock and securities markets. Banking crises may encourage financial development and a transformation to more market-based financial systems. The study uses categorical banking crisis indicators and financial structure/development indicators to characterize these relationships.
This order strikes Plaintiff's statement of material facts in support of their motion for summary judgment. The court found that Plaintiff's statement failed to comply with the Local Rules of the United States District Court for the Southern District of Florida and the Federal Rules of Civil Procedure. Specifically, the statement contained more than one assertion of fact per numbered paragraph and did not contain citations to the record to support the assertions of material facts. If Plaintiff refiles their statement of facts, it must comply with the rules by containing only one assertion per numbered paragraph and including citations to support each assertion. Failure to comply will result in the court striking the refiled statement and motion for summary judgment.
This order strikes Plaintiff's statement of material facts in support of their motion for summary judgment. The court found that Plaintiff's statement failed to comply with the Local Rules of the United States District Court for the Southern District of Florida and the Federal Rules of Civil Procedure. Specifically, the statement contained more than one assertion of fact per numbered paragraph and did not contain citations to the record to support the assertions of material facts. If Plaintiff refiles their statement of facts, it must comply with the rules by containing only one assertion per numbered paragraph and including citations to support each assertion. Failure to comply will result in the court striking the refiled statement and motion for summary judgment.
This order strikes Plaintiff's statement of material facts in support of their motion for summary judgment. The court found that Plaintiff's statement failed to comply with the Local Rules of the United States District Court for the Southern District of Florida and the Federal Rules of Civil Procedure. Specifically, the statement contained more than one assertion of fact per numbered paragraph and did not contain citations to the record to support the assertions made. If Plaintiff re-files their statement of facts, it must comply with the Federal and Local Rules by containing only one assertion of fact per numbered paragraph and including citations to support each assertion. Failure to do so will result in the court striking the re-filed statement and motion for summary judgment.
This order strikes Plaintiff's statement of material facts in support of their motion for summary judgment. The court found that Plaintiff's statement failed to comply with both the Local Rules of the Southern District of Florida and the Federal Rules of Civil Procedure. Specifically, the statement contained more than one assertion of fact per numbered paragraph and did not include citations to the record to support each material fact asserted. If Plaintiff refiles their statement of facts, it must comply with the rules or the court will strike the refiled statement and motion for summary judgment.
This thesis is part of the BCSIR-NIB mNGS collaboration project, which focuses on the application of shotgun metagenomics for the characterization of the Oropharyngeal sample collected from Covid-19 patients. I have used Machine Learning methodologies supported by cloud computing, for breaking into the Covid-19 Microbial System to answer the two-classic question of metagenomics- “Who is there?” & “What are they doing?”. So that, this taxonomical and functional data can be merged with comprehensive patient profiles, including demographics and family history; traditional laboratory data; and next-generation ‘omics’ data for accelerated precision therapeutics with maximal efficacy.
The pathology lab calls a GP on a Friday night to report a patient has hyperkalemia. This presents several issues for the GP to address. Hyperkalemia is a potentially life-threatening metabolic problem caused by impaired kidney excretion of potassium or reduced potassium movement into cells. Common causes include reduced kidney function, medications like ACE inhibitors or potassium-sparing diuretics, metabolic acidosis, and insulin deficiency. The GP must next assess the patient's symptoms, review past lab results and trends, determine if the patient is vulnerable and alone, and decide on a plan which may include admission, contacting paramedics, or advising the patient to do nothing and recheck labs.
This document appears to be a lease agreement in Japanese for a residential property. It outlines the key terms of the lease including:
1) A description of the property being leased
2) The term/duration of the lease contract
3) Details on rent and other charges such as deposits
4) Contact information for the lessor and management company
5) Standard clauses covering issues like renewals, prohibited activities, and dispute resolution.
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1. Light first enters the eye through the lens. a. True b. False 2. C.pdfalokopticalswatchco0
1. Light first enters the eye through the lens. a. True b. False 2. Cells from the hypothalamus
influence which lobe(s) of the pituitary gland via a portal system? a. anterior b. posterior c. both
d. nelther 3. All action potentials are all or none. Threshold must be met, but once it is met, all
action potentials are the same. a. True b. False 4. The white, outer tough connective tissue
covering of the eye. a. Sclera b. Choroid c. Retina 5. Close vision requires: a. Accommodation b.
Constriction c. Convergence d. All of the above 6. The sensory layer of the eye. a. Sclera b.
Choroid c. Retina 7. The is the spot where the optic nerve leaves the eyeball. a. Optic disk b.
Choroid c. Retina 8. The optic nerve projects information to the a. medial retina b. lateral
geniculate body c. primary visual cortex d. optic chiasma 9. Which of the following are true of
rods of the eye? a. Sensitive to dim light and best suited for night vision b. Absorb all
wavelengths of visible light c. Perceived input is in gray tones only d. Sum of visual input from
many rods feeds into a single ganglion cell e. All of the above are true 10. Which would be the
most common cause of primary hypothyroidism? a. brain tumor b. dietary deficiency of lodine c.
Grave's disease d. autoimmune thyroid disease 11. In secondary hypothyroidism
nives uab Exame 2 Scing 2022 it. TSH imvits are lop 8. thymenine lervels ale eirwated c. Trit
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The inhibion of thyroid-atimulating bommene (TSh) searetion thy an incrested bloed
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Tetanus is caused by Clostridium tetani bacteria which produces a toxin that causes muscle spasms. There are three main types: generalized, neonatal, and localized. Generalized tetanus is the most common form, characterized by increased muscle tone and spasms throughout the body. Proper immunization and wound care can prevent tetanus. Treatment focuses on eliminating the toxin source, neutralizing unbound toxin, preventing spasms through medication and respiratory support, as the disease runs its course over time.
1) The document provides guidelines for the treatment of botulism, including supportive care to prevent complications, elimination of toxins, and use of antitoxins and antibiotics as needed.
2) Key positions and procedures are outlined, including maintaining airway and breathing, use of endotracheal tubes, feeding via nasogastric or nasojejunal tubes, and bladder care to prevent urinary tract infections.
3) Prevention methods include proper food handling and heating to destroy toxins and spores, avoiding exposure of infants to unheated honey, and immunization for high-risk groups.
Botulism is caused by toxins produced by Clostridium botulinum bacteria. It causes paralysis by blocking the release of acetylcholine at neuromuscular junctions. There are three main forms: infant, foodborne, and wound botulism. Symptoms include drooping eyelids, blurred vision, dry mouth, and muscle weakness starting symmetrically from the head and descending to the trunk and limbs. The diagnosis is usually made clinically based on symptoms. Treatment focuses on supportive care until the toxins are cleared from the body.
Fever of unknown origin (FUO) presents a diagnostic challenge for pediatricians. It is defined as a fever over 38°C for at least 8 days without an identified cause. Common causes include infections, autoimmune or inflammatory conditions, and cancers. A thorough history, physical exam, and testing are required to identify the source. Distinguishing FUO from self-limited fever episodes is important to avoid unnecessary testing. Ongoing evaluation is also needed, as some cases remain undiagnosed.
This document discusses fever without a focus in older children. It notes that while most fevers in children are due to benign viral infections, some may be caused by more serious bacterial infections. A thorough history, physical exam, and diagnostic testing when indicated can help establish the cause. Common viral infections include respiratory and gastrointestinal viruses. Potential bacterial infections include otitis media, strep throat, and urinary tract infections. Occult bacteremia must also be considered. Treatment involves supportive care for viral infections and antibiotics only for confirmed or suspected bacterial infections.
Fever Without a Focus in the Neonate.pptxWalaa Manaa
1. Fever without a focus in neonates and young infants aged 0-3 months refers to a temperature over 38°C without other symptoms.
2. It can be challenging to distinguish between serious infections like bacteria or viruses versus self-limited viral illnesses based on isolated fever alone.
3. Common causes of serious bacterial infection include UTI, bacteremia, and meningitis, with E. coli and GBS being the most frequent pathogens. Viral illnesses are generally more common than bacterial.
This document discusses central nervous system infections, including various types like meningitis, encephalitis, and brain abscess. It describes the etiology, pathogenesis, epidemiology, clinical presentation, diagnosis and lumbar puncture procedure for acute bacterial meningitis. The main causes are viral, bacterial, fungal or parasitic. Clinical features include headache, vomiting, fever and signs of meningeal irritation. Diagnosis involves blood and CSF tests as well as imaging like CT or MRI. Lumbar puncture allows examination of CSF and is an important diagnostic and therapeutic tool, requiring proper patient positioning, preparation, analgesia and technique.
This document discusses familial Mediterranean fever (FMF), a genetic autoinflammatory disease characterized by recurrent fever and inflammation of the serosal membranes. It commonly affects ethnic groups around the Mediterranean and is caused by mutations in the MEFV gene. The main symptoms are abdominal pain, fever, and inflammation of the peritoneum, pleura, or joints. FMF is diagnosed based on clinical criteria and treated with colchicine to prevent complications like amyloidosis. The document provides details on the epidemiology, genetics, clinical manifestations, and treatment of FMF.
1) Kawasaki disease is an acute self-limited vasculitis that commonly affects children under 5 years old, especially of Japanese ancestry. It is characterized by fever, rash, conjunctivitis, changes in the mouth and lips, swelling of hands and feet, and cervical lymphadenopathy.
2) If left untreated, Kawasaki disease can lead to coronary artery aneurysms in 15-25% of children, which increases the risk of heart attacks and sudden cardiac death later in life.
3) While the exact cause is unknown, it is believed to be an infectious agent that triggers an immunological response in genetically susceptible children. Treatment involves intravenous immunoglobulin and aspirin to reduce inflammation
This document discusses the clinical approach to prolonged fever lasting 10-14 days or more. It first addresses determining if the fever is truly prolonged or identifying an evident cause. If no cause is found, further investigation is needed. The patient should be hospitalized to document the fever, avoid drugs, and closely monitor for new signs or symptoms. A series of tests are outlined including blood cultures, urine culture, tuberculosis test, and others to try to identify a specific infection. If initial tests are negative, more specific tests are recommended. Even with sophisticated testing, the cause remains unknown in 25% of prolonged fever cases. Blind antibiotic use should generally be avoided.
Basic ct brain and rapid CT interpretationWalaa Manaa
This document provides an overview of brain anatomy as seen on CT scans. It outlines a systematic approach to interpretation, including checking for symmetry, the midline, and key anatomical landmarks. Specific structures that are highlighted include the ventricular system, basal ganglia, cerebellar cistern, and cross-sectional views of gray/white matter interfaces. Common pathologies like hydrocephalus and subarachnoid hemorrhage are also briefly mentioned. The goal is to familiarize readers with normal brain anatomy and landmarks to aid in clinical CT interpretation.
1) Dengue fever is a mosquito-borne tropical disease caused by the dengue virus and spread by several species of mosquito, principally Aedes aegypti.
2) Infection with one dengue virus type usually gives lifelong immunity to that type but only short-term immunity to others, and subsequent infection with a different type increases the risk of severe complications.
3) Aedes aegypti and Aedes albopictus are the two most prominent mosquito species that transmit viruses causing dengue fever, yellow fever, West Nile fever, chikungunya, eastern equine encephalitis, and Zika virus.
This document discusses febrile coma, its causes, diagnosis, and management. It begins by defining coma and grading its severity. Potential causes of febrile coma include central nervous system infections, cerebrovascular accidents, trauma, tumors, and toxic states. The author outlines the steps for diagnosis and management, which include stabilizing the patient, obtaining history, performing a thorough neurological exam, blood tests, lumbar puncture if indicated, and treatment based on findings. Special attention is given to properly examining cranial nerves and assessing signs of increased intracranial pressure or focal neurological deficits that may localize the problem.
Kawasaki disease is an acute febrile vasculitis that commonly affects children under 5 years old. It is characterized by fever, rash, conjunctivitis, oral changes and extremity changes. If left untreated it can lead to coronary artery aneurysms in 15-25% of cases. The cause is unknown but believed to be due to an infectious trigger in genetically susceptible children. Treatment involves intravenous immunoglobulin and aspirin to reduce the risk of coronary complications. Ongoing monitoring is needed due to the potential for aneurysms and subsequent cardiac issues.
The document discusses the treatment of botulism, which causes acute flaccid paralysis through neurotoxins produced by Clostridium botulinum. Treatment involves supportive care in the ICU, including maintaining airway and breathing, antitoxins to neutralize the toxins, and antibiotics for wound infections. Complications can be serious but most patients improve over weeks to months with full recovery in about a year. Prevention focuses on proper food canning and avoiding honey exposure for infants.
Clostridium botulinum produces a potent neurotoxin that causes the rare but serious illness known as botulism. There are three main forms - infant botulism, foodborne botulism, and wound botulism. The document discusses the etiology, epidemiology, pathogenesis, clinical presentation, and treatment of each form of botulism caused by the bacteria or its toxins. Infant botulism typically affects infants under 6 months and is often associated with honey consumption, while foodborne botulism results from ingesting contaminated foods. Wound botulism can occur through traumatic injuries. All forms result in symmetric descending flaccid paralysis due to the blockade of acetylcholine release at neu
This document discusses typhoid fever, including:
- It is caused by Salmonella Typhi and can affect all body systems.
- Symptoms vary depending on age but generally include sustained high fever, abdominal pain, and possible complications like pneumonia or intestinal perforation.
- Diagnosis involves blood, stool, or bone marrow cultures but the Widal test has limitations. Antibiotics are the primary treatment and resistance is a growing problem.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
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.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
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.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
1. Febrile comaFebrile coma
BY:
Dr, WALAA SALAH MANAA
SPECIALEST OF PEDIATRIC & FEVER
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2. Coma is a state in which the pt is
unresponsive to environmental stimuli &
unable to communicate in any manner.
It is graded as (obtundation-confusion-
stupor-coma-deep coma).
0r scored by GCS from 15:3.
< 8 are typically regarded as coma.
3. Proper diagnosis of coma is not difficult
with scientific systemic steps of diagnosis
after exclusion of the following condition:
1- Hysterical coma
2- Syncope and shock
3-Heavy sedation
5. coma is associated with
structural or physiologic
damage.
Coma is a critical condition
for both the patient and the
doctor (Dangerous for the
patient and difficult for the
physician).
6. *Hysterical coma :
Profound response to very painful stimuli,
Absence of incontinence or tongue bite,
normal pupil response,
pt does not harm him self.
*Syncope and shock:
Transient loss of consciousness for moment,
low BP ,pallor.
*Heavy sedation: (history).
7. Other difficulties :
All types of coma can be presented to
the fever hospital because of the
possibility of the association of fever
with any type of coma.
Prolonged coma is usually associated by
infection and other complications.
8. D.D.
Shock is a serious condition
(BP low-COP low).
It should be differentiated from coma.
Coma is most serious if associated with
shock.
9.
10. Don't diagnose hysterical coma in a
febrile pt.
Don‘t lose the hope or the prognosis in
prolonged coma.
Golden roles
15. 3- Infection or Tissue Destruction
Associated with the Following
Conditions Causing Coma:
- Trauma of the C.N.S.
- Tumor (space occupying lesions).
- Cerebrovascular stroke (hemorrhagic, thrombotic or
embolic).
- Toxic coma due to
* External toxins (poison ingestion)
* Internal toxins e.g. Diabetic coma, uremia ,
hepatic coma and others,,,,,,,
4t
18. 1- Stabilize the patient:
a- (A,B,C)*.
b-IV cannula
2- History
3- Clinical Examination:
- Assessment of coma (Glasgow scoring).
- Assessment of fever (pattern and relation to coma).
- Neurological examination.
- Assessment of all body systems
1- Blood sample for sugar, urea,
prothrombin and other chemistries
according to history and clinical
suspicion.
2- Drugs: -50 cc 25% dextrose)
-Thiamine ???
-Naloxone ???
19. O2 if there is cyanosis.
Thiamine 100 mg ,,,rarely needed now(rarity
of thiamine deficiency).
Naloxone 2mg repeated every 2 hrs if there
is response to 1st
dose(very effective in opiate
poisoning)
20. C o n s id e r C N S
in fe c tio n (L P )o r C V s tro k e
if th e re is n o im p rv e m e n t
a fte r c o rre c tio n ( 2 )
T re a tm e n t
a c c o rd in g ly
+ v e fo r to x ic
a n d
m e ta b o lic c o m a
T re a tm e n t
a c c o rd in g
to C S F
fin d in g s (3 )
L .P .
L u m b e r P u n c tu re
-v e fo r to x ic
a n d m e ta b o lic
c o m a
B lo o d
c h e m is tr y (1 )
N o F o c a l s ig n s
C o n s u lt n e u ro s u rg e ry
& c o n s id e r L .P .
in c a s e o f
in fa rc tio n ( 6 )
E m p e ric a l
tre a tm e n t
(5 )
B lo o d C u ltu re
F o c a l le s io n
(4 )
T re a tm e n t
a c c o rd in g to
C S F fin d in g s
(7 )
L .P .
L u m b e r P u n c tu re
N o
F o c a l le s io n
C T
F o c a l s ig n s * *
T re a tm e n t
a c c o rd in b g to
C T a n d C S F
fin d in g s (9 )
L .P . w ith c a u tio n
(8 )
C T
W ith
fo c a l s ig n s
T re a tm e n t
a c c o rd in g to
C S F fin d in g s
(1 0 )
L .P .
L u m b e r P u n c tu re
W ith o u t
fo c a l s ig n s
+ v e m e n in g e a l s ig n s * *
F ig u re (2 ).
N e u ro lo g ic a l E x a m in a tio n * *
21. All the steps of management of comatosed
pt. must be done rapidly & at the same time
with ttt.
24. Present history :
• Onset….acute (CVS-CNS infection).
gradual (degenerative diseases –
CNS infection).
• Bed side bottles or drugs.
• Trauma-vigorous movement.
• Symptom preceding the onset of coma.
• Drug history????.
25. Past history :
-Similar attack (DM-renal-hepatic comas).
-History of co-morbidity.
family history :
• Neurological diseases (epilepsy).
27. 1-Bite of the tongue. exclude hyst.
2-Smell of the mouth.(aceton-ammonia-fetor)
3-Cyanosis.(cariopulmonary-brain stem lesion.)
4-Head injury.
5-Signs of electrolyte imbalance.
6-Sclera.(jaundice-hge).
7-neck stiffness-neck veins-
8-nose or ear discharge.(blood or CSF)
Head & Neck
30. Extremities.
Arms: sites of IV injection.
Edema LL.
• Murmurs -pneumonias-br.asthma .
• Masses-organomegally –ascites- signs
of trauma-.
Heart-Chest-Abdomen
31. Skin
Rashes-signs of trauma.
L.Ns.
• Enlargement-masses,,,,,brain
secondries or (HIV).
32. 1- Stabilize the patient:
a- (A,B,C)*.
b-IV cannula---------
2- History
3- Clinical Examination:
- Assessment of coma (Glasgow scoring).
- Assessment of fever (pattern and relation to coma).
- Neurological examination.
- Assessment of all body systems
1- Blood sample for sugar, urea,
prothrombin and other chemistries
according to history and clinical suspicion.
2- Drugs: -50 cc 25% dextrose)
-Thiamine
-Naloxone
33. C o n s id e r C N S
in fe c tio n (L P )o r C V s tro k e
if th e re is n o im p rv e m e n t
a fte r c o rre c tio n ( 2 )
T re a tm e n t
a c c o rd in g ly
+ v e fo r to x ic
a n d
m e ta b o lic c o m a
T re a tm e n t
a c c o rd in g
to C S F
fin d in g s (3 )
L .P .
L u m b e r P u n c tu re
-v e fo r to x ic
a n d m e ta b o lic
c o m a
B lo o d
c h e m is tr y (1 )
N o F o c a l s ig n s
C o n s u lt n e u ro s u rg e ry
& c o n s id e r L .P .
in c a s e o f
in fa rc tio n ( 6 )
E m p e ric a l
tre a tm e n t
(5 )
B lo o d C u ltu re
F o c a l le s io n
(4 )
T re a tm e n t
a c c o rd in g to
C S F fin d in g s
(7 )
L .P .
L u m b e r P u n c tu re
N o
F o c a l le s io n
C T
F o c a l s ig n s * *
T re a tm e n t
a c c o rd in b g to
C T a n d C S F
fin d in g s (9 )
L .P . w ith c a u tio n
(8 )
C T
W ith
fo c a l s ig n s
T re a tm e n t
a c c o rd in g to
C S F fin d in g s
(1 0 )
L .P .
L u m b e r P u n c tu re
W ith o u t
fo c a l s ig n s
+ v e m e n in g e a l s ig n s * *
F ig u re (2 ).
N e u ro lo g ic a l E x a m in a tio n * *
34. Neurological examination.
Need special (experiences & precaution).
1-Depth of coma…..GCS
2-Tone & sensation.
3-Focal lesions :asymmetry in response to
painful stimuli (its detection is decreased
by increases depth of coma).
4-Signs of meningeal irritation & signs f
lateralization are disappear in GCS<7.
37. 5-Cranial nerve O/E :
is difficult in coma BUT ALSO important to de
depth of coma
1st nerve :face expression to very irritable odour smell.
Optic nerve: pupillary light reflex + fundoscop.
3rd
, 4th
, 6th
-------*pupillary light reflex..3rd
*spontaneous or induced
movement of the eye in various
direction.
*Doll's eye sign.
38. Doll's eye sign.=oculocephalic reflex.
With the eyelids hold opened ,brisk lateral
rotation of the head normally opposite
rotation of eyeball as if to fix the gaze on
an object. It is lost in brain stem death
39. 5th cranial nerve :
corneal reflex.
jaw jerk.
jaw movement with supraorbital compression.
40. 7th
nerve :
supra orbital pressure
asymmetry of the nasolibial
fold.
8th nerve: Doll's eye sign.
9th-10th nerves
gag +cough reflexes.
11th nerve:
spontaneous or induced elevation of shoulder.
12th nerve:
spontaneous or induced elevation of tongue.
41. C o n s id e r C N S
in fe c tio n (L P )o r C V s tro k e
if th e re is n o im p rv e m e n t
a fte r c o rre c tio n ( 2 )
T re a tm e n t
a c c o rd in g ly
+ v e fo r to x ic
a n d
m e ta b o lic c o m a
T re a tm e n t
a c c o rd in g
to C S F
fin d in g s (3 )
L .P .
L u m b e r P u n c tu re
-v e fo r to x ic
a n d m e ta b o lic
c o m a
B lo o d
c h e m is tr y (1 )
N o F o c a l s ig n s
C o n s u lt n e u ro s u rg e ry
& c o n s id e r L .P .
in c a s e o f
in fa rc tio n ( 6 )
E m p e ric a l
tre a tm e n t
(5 )
B lo o d C u ltu re
F o c a l le s io n
(4 )
T re a tm e n t
a c c o rd in g to
C S F fin d in g s
(7 )
L .P .
L u m b e r P u n c tu re
N o
F o c a l le s io n
C T
F o c a l s ig n s * *
T re a tm e n t
a c c o rd in b g to
C T a n d C S F
fin d in g s (9 )
L .P . w ith c a u tio n
(8 )
C T
W ith
fo c a l s ig n s
T re a tm e n t
a c c o rd in g to
C S F fin d in g s
(1 0 )
L .P .
L u m b e r P u n c tu re
W ith o u t
fo c a l s ig n s
+ v e m e n in g e a l s ig n s * *
F ig u re (2 ).
N e u ro lo g ic a l E x a m in a tio n * *
42. Focal signs =
hemi plegia-hemiparisis,
paraplegia-paraparisis-
monoplegia,monoparesis,,,,,,
and or cr nerves lesions.
Meningeal signs
can not be detected if GCS<6
43. (1) blood chemistry RBS-BUL-Proth.time-
any suspected toxins or poisons.
(2) If the pt not recovered after
correction of metabolic causes…..
CNS infection or CVS is
considered ---so—LP & CT Br.
44. Probable case=Suspected case +LP
Clear Hazy turbid
Sptiic
meningitis
T.B
Pt
conscious
Pt
Un-
conscious
Bloody
Aseptic
meningitis
meningism
encephalitis
Eary
Septic
mening
T.B. Traumatic
Sub
arachnoid
hge
Traumatic
In septic
meningitis
45. Probable cases +Probable cases +
biochemical&biochemical&
BacteriologicalBacteriological
analysis of CSF.analysis of CSF.
Chemical normalChemical normal
BacteriologicalBacteriological
freefree
Sterile CSF
Protein++++
WBCS(PNL++(
Isolated
organism
Pr+++
Gl---
WBCS++
SUGER—
Gr-ve diplococci
WBCS>>300cell/cc
Without
isolated
organism
Viral
meningioe
ncephalitis
1-viral
meningioence
phalitis
2-T.B.
3-
Encephalitis
Septic
meningi
ioencep
halitis
Mening
ococcal
mening
Septic
meningio
enceph
46. In spite of this approach, Misdiagnosis of
coma may occur in the following
uncommon conditions:
1-Atypical presentation
of some types of coma.
2-Presence of associated pathology
which may cause or end in coma e.g. septic
meningitis in patients with cirrhotic liver.
3-Occurrence of complications:
that delay or prevent the recovery from
48. 1-Septic meningitis :modified by
antibiotics ttt may present by vague symptom
before stage of coma.
2-Measles encephalitis or Mumps
encephalitis
rarely presented by coma before the appearance
of the measles rash or the parotid swelling,.
49. 3-Uncommon cases of C.N.S.
infection: may be presented by
lateralization or any focal neurological
lesion and coma without meningeal signs
with sudden onset typically like cerebro-
vascular stroke. due to vasculitis
Diagnosis is easily achieved by CT scanning
and C.S.F. examination
50. 4-T.B. meningitis
Is very difficult to
diagnose because it is vague and
can mimic any infective or non
infective CNS disease clinically
and even in imaging findings.
51. High index of clinical
suspicion is mandatory
concerning the following
- Past history of T.B.
- Family History of TB.
- Presence of any primary T.B. lesion.
-Meningitis of prolonged course or resistant
to treatment.
-C.S.F. findings: very high protein and
reduced glucose, increase leucocytes with
predominant lymphocytes,.
-CT findings e.g. hydrocephalus, infarcts or
tuberculoma.
52. PCR and/or TB bacilli
isolation in CSF are
confirmatory for the
diagnosis
53. So, empirical treatment must be given when
3 of the following:
Temp > 39C
Duration > 6 days
Protein > 100
CSF glucose <50
CSF leucocytes > 1000
CSF lymphocytes > 50%
54. 5-High fever in old age or in patient with
old brain lesion may cause coma.
6-Fulminant hepatic coma in rare
conditions can occur before the
appearance of jaundice.
Diagnosis is made by prothrombin time
and liver enzymes.
55. 7-Hepatic encephalopathy in cirrhotic
patients may present rarely initially by mild
seizures or abnormal involuntary
movements prior to, coma, these may
obscure the diagnosis of hepatic coma with
neurological disease,prolonged prothrombin
time is diagnostic.
8-Electrolyte imbalance or blood gas
disturbance regardless its cause can be
presented by coma.
56. 9-Prion diseases (previously known as
slow virus diseases– spongiform
encephalopathes of humans-):
*Creutzfeldt-Jacob disease (CJD).
*Variant CJD (υ-CJD).
*Kuru.
*Fatal familial insomnia.
*Gerstmann-Starausler- Scheinker syndrome.
58. 1-Septic meningitis when occurred in
patients with advanced liver cirrhosis, may be
misdiagnosed as hepatic encephalopathy precipitated
by fever
Diagnosis by:
- Good clinical evaluation of the case.
- Prothrombin time.
- Unexpected unresponsiveness to anti-hepatic coma
measures.
- C.S.F. analysis.
59. 2-In diabetic coma when the
expected recovery is not achieved after
controlling the blood sugar and balancing the
electrolytes, we must search well for any
associated pathology that render the recovery
such as cerebro-vascular stroke, C.N.S. infection,
or toxic coma.
Diagnosis: can be achieved by
- Good clinical examination.
- CT brain.
- C.S.F. analysis.
61. When coma is properly diagnosed
and proper treatment was given but
the expected response is not
gained, we must search well for
complications e.g.:
62. 1-Septic meningitis may be
complicated by brain abscess,
subdural effusion, or brain
infarction.
63. 2-Diabetic coma
may be complicated by
subarachnoid hemorrhage,cerebral
hemorrhage or cerebral infarction
due to the diabetic angiopathy.
64. 3-Encephalitis may be complicated by cerebral
infarction.
4-T.B. meningitis may be complicated by internal
hydrocephalus or brain infarction.
5-Electrolyte imbalance or blood gas disturbance
due to the original etiology of coma; or due to
improper management can prevent the recovery
of coma and cause death.
65. Take home message.
Good observation,
high experience ,
high grade of clinical suspicion,
( are very essential in the diagnosis of
coma).