Nose Bleed
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This 55-year-old Hispanic woman with a history of Wegener's granulomatosis presented with a nosebleed. She had bruising on her arms and legs over the past 1.5 months and bleeding gums. Lab work showed thrombocytopenia. A bone marrow biopsy showed orderly trilineage maturation with adequate megakaryocytes. She was diagnosed with idiopathic thrombocytopenic purpura (ITP) rather than thrombocytopenia related to her Wegener's. Treatment options for ITP include corticosteroids, IVIG, anti-D immunoglobulin, and splenectomy.
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Endometrial hyperplasia is an increased proliferation of endometrial glands relative to the stroma that can progress to endometrial carcinoma. It occurs most often in peri-menopausal women with elevated estrogen levels and is caused by prolonged, unopposed estrogen stimulation. Endometrial hyperplasia is classified as simple, complex, or atypical depending on architectural and cytological abnormalities. Endometrial carcinoma is the most common cancer of the female reproductive system, occurring most often in post-menopausal women. It is broadly classified into Type I and Type II tumors based on clinical and molecular characteristics and risk factors. Surgery is the primary treatment for early-stage disease while radiation and chemotherapy may be used
epistaxis
The document summarizes the causes, evaluation, and management of epistaxis (nosebleeds). Key points include:
- The most common causes are local trauma, dry air, and hypertension. Weather has a proven association with incidence.
- Evaluation involves examination of the nasal cavity to identify the bleeding site. Imaging and labs may be needed to investigate underlying causes.
- Management begins with first aid and may involve cautery, nasal packing, medications, or surgery to control active bleeding and address its cause. Continued or severe bleeding may require embolization or ligation of arteries supplying the nasal cavity.
Irritable Bowel Syndrome Haitham Ahmed
This document summarizes a case presentation of a 33-year-old male complaining of abdominal pain and diarrhea episodes. His symptoms meet the diagnostic criteria for irritable bowel syndrome. Through blood tests and modifying his poor diet and lifestyle, his symptoms improved significantly. The literature discussed notes IBS is a functional gastrointestinal disorder diagnosed through symptom criteria. Management involves addressing stressors and dietary triggers through diet modification and medication.
SPINAL TUBERCULOSIS / POTS' DISEASE- CASE-PRESENTATION- At-Shaheed-Suhraward...
SPINAL TUBERCULOSIS / POTS' DISEASE- CASE-PRESENTATION- At-Shaheed-Suhraward...Shaheed Suhrawardy Medical College
SPINAL-TUBERCULOSIS-POTT-S-DISEASE- CASE-PRESENTATION-At-Shaheed-Suhrawardy-Medical-College-Hospital-Dhaka-Bangladesh (1)First aid in hotel industry
Sunil Kumar is a research scholar and faculty member at the Institute of Hotel and Tourism Management at Maharshi Dayanand University in Rohtak, Haryana, India. The document provides information on first aid, including the principles of first aid, common injuries and situations like burns, cuts, nosebleeds, fractures, and muscle injuries. It also lists the contents of a first aid box.
Case Presentation UTH EM Aug 27 JSEBooth
A 23-year-old woman presents to the emergency department with abdominal pain in her right lower quadrant and suprapubic region that began 12 hours ago. Her physical exam reveals tenderness in the right lower quadrant and suprapubic areas. Imaging and labs are ordered which ultimately reveal a ruptured corpus luteum cyst.
Basic first aid
1. Basic first aid involves assessing safety hazards, activating emergency services, and following the ABCs of airway, breathing, circulation.
2. Universal precautions like gloves and masks should be used to prevent disease transmission when treating injuries. Signs, symptoms, and patient history should be noted.
3. First aid for various injuries and emergencies includes controlling bleeding, treating shock, applying dressings, immobilizing fractures, and calling for emergency help.
Maxillary sinus carcinoma
The maxillary sinus is the largest and most commonly involved sinus in malignancies. Maxillary sinus carcinoma arises from the sinus lining and spreads locally through bone destruction and invasion of surrounding structures. Distant metastases occasionally occur in the lungs. Diagnosis involves radiography, CT scan, and biopsy. Treatment depends on tumor stage and may involve surgery, radiation therapy, or chemoradiation. Prognosis diminishes with increased stage, with a 5-year survival rate of 40-50% even with advances in multimodal therapy.
Thyroid Carcinoma Presentation
Thyroid carcinoma is the most common endocrine malignancy, with an annual incidence of 3.5 per 100,000 in the UK. Differentiated thyroid carcinomas have high 10-year survival rates of 80-90% for middle-aged adults, but recurrence rates of 10-15% are possible. Diagnosis is usually via fine needle aspiration biopsy of thyroid nodules, with surgery the main treatment depending on tumor size, involvement of lymph nodes, and histological subtype. Long-term monitoring of serum thyroglobulin levels and thyroid-stimulating hormone levels is important for screening for recurrence.
First Aid and Sport Injuries
This document provides information on first aid, including defining it as initial assistance given before emergency help arrives. It aims to preserve life, prevent worsening conditions, and promote recovery. The steps of first aid are to protect, call for help, and provide aid. It also discusses unconsciousness, recovery position, CPR, sports injuries, bone injuries like fractures and dislocations, muscular injuries like strains and tears, ligament sprains, tendonitis, and the contents of a first aid kit.
Sports injury
This document provides information on many common sports injuries organized by body part. It describes the most frequent ankle injuries like ankle sprains and Achilles tendon ruptures. It also covers knee injuries, injuries to the thigh, hip, lower back, shoulders and injuries associated with the elbow, wrist, hand and fingers. For each injury, it lists symptoms and potential treatments.
Basic First Aid (Bleeding)
This document provides information on basic first aid for bleeding. It discusses the different types of bleeding (capillary, venous, arterial), common causes of bleeding (trauma, medical conditions, medicines), and treatment for severe bleeding. The treatment section outlines steps to address severe bleeding such as applying direct pressure to stop the bleeding, elevating the injured body part, and seeking emergency medical help when bleeding is under control or continuing to wait for assistance. Military and civilian first aid approaches are also briefly mentioned.
Common ENT emergencies
Common ENT emergencies include foreign bodies, trauma, and complications of infections in the ear, nose, and throat. Foreign bodies in the ear can cause discomfort and infection if not removed. Epistaxis (nosebleeds) may be caused by trauma, dry air, or medical issues and are typically managed first by applying pressure and then treatments like cauterization if needed. Infections of the sinuses can lead to orbital or intracranial complications requiring intravenous antibiotics or surgery. Deep neck infections like peritonsillar abscesses or Ludwig's angina require needle aspiration, drainage, or tracheostomy. Airway obstruction emergencies are treated by securing the airway through maneuvers like Heimlich
Heat Stroke
A brief yet comprehensive description of a very common problem faced in KSA especially during hajj season. It is meant to enhance the awareness among ER and ICU physicians.
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Mri in diagnosis of acute appendicitis during pregnancy
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Case report myelofibrosis
1. A 74-year-old man presented with continuous left upper abdominal pain for 3 days that worsened when lying on his left side. He had been fatigued for a year and was diagnosed with anemia.
2. On examination, he had pale conjunctiva and tenderness in his left hypochondriac region with splenomegaly. Laboratory tests found hemoglobin of 7.8 g/dL and normocytic normochromic anemia.
3. Abdominal ultrasound revealed splenomegaly. He was assessed as having normocytic normochromic anemia suspected to be due to a myeloproliferative disorder.
cerebrovenous thrombosis
A 24-year-old woman presented with headache and left-sided weakness. Imaging showed cerebral venous thrombosis involving the superior sagittal sinus and draining veins. She was diagnosed with antiphospholipid syndrome based on recurrent pregnancy loss and positive lupus anticoagulant. She was treated with anticoagulation and anticonvulsants and showed gradual improvement over 10 days with residual mild weakness. Her long-term management plan includes lifelong anticoagulation and screening for recurrent thrombosis.
Clinical ScenarioREASON FOR CONSULTATION Desaturation to 64.docx
Clinical Scenario:
REASON FOR CONSULTATION:
Desaturation to 64% on room air 1 hours ago with associated shortness of breath.
HISTORY OF PRESENT ILLNESS:
Mrs. X is 73-year-old Caucasian female who was admitted to the general surgery service 3 days ago for a leaking j-tube which was surgically replaced 2 days ago and is now working properly. This morning at 07:30, the RN reported that the patient was sleeping and doing fine, then the CNA made rounds at 0900 and Mrs. X was found be mildly dyspneic. Vital signs were checked at that time and were; temperature 38.6, pulse 120, respirations 22, blood pressure 138/38. O2 sat was 64% on room air. The general surgeon was notified by the nursing staff of the hypoxia, an order for a chest x-ray and oxygen therapy were given to the RN. The O2 sat is maintaining at 91% on 4L NC. The patient was seen and examined at 10:10 a.m. She reports that she has been having mild dyspnea for 2 days that has progressively gotten worse. She does not use oxygen at home. Her respiratory rate at the time of visit was 22 and she feels short of breath. She has felt this way in the past when she had pneumonia. She is currently undergoing radiation treatment for laryngeal cancer and her last treatment was 1 to 2 weeks ago. She reports that she has 2 to 3 treatments left. She denies any chest pain at this time and denies any previous history of CHF. Review of her vital signs show that she has been having intermittent fevers since yesterday morning. Of note, she was admitted to the hospital 3 weeks ago for an atrial fibrillation with RVR for which she was cardioverted and has not had any further problems. The cardiologist at that time said that she did not need any anticoagulation unless she reverted back into A-fib.
REVIEW OF SYSTEMS:
Constitutional:
Negative for diaphoresis and chills.
Positive for fever and fatigue.
HEENT:
Negative for hearing loss, ear pain, nose bleeds, tinnitus.
Positive for throat pain secondary to her laryngeal cancer.
Eyes:
Negative for blurred vision, double vision, photophobia, discharge or redness.
Respiratory:
Positive for cough and shortness of breath
. Negative for hemoptysis and wheezing.
Cardiovascular:
Negative for chest pain, palpitations, orthopnea, leg swelling or PND.
Gastrointestinal:
Negative for heartburn, nausea, vomiting, abdominal pain, diarrhea, constipation, blood in stool or melena.
Genitourinary:
Negative for dysuria, urgency, frequency, hematuria and flank pain.
Musculoskeletal:
Negative for myalgias, back pain and falls.
Skin:
Negative for itching and rash.
Neurological:
Negative for dizziness, tingling, tremors, sensory changes, speech changes.
Endocrine/hematologic/allergies:
Negative for environmental allergies or polydipsia. Does not bruise or bleed easily.
Psychiatric:
Negative for depression, hallucinations and memory loss.
PAST MEDICAL HISTORY:
Diabetes mellitus that was diagnosed 12 years ago with neuropathy. This resolved after gastric.
Right sided valve infective endocarditis by dr adeel
This document describes the case of a 24-year-old intravenous drug user who presented with a 15-day history of fever, malaise, and shortness of breath for 7 days. On examination, he was found to be pale with a heart murmur. Investigations showed anemia, hepatitis C, and HIV positivity. Echocardiography revealed vegetation on the tricuspid valve. He was diagnosed with right-sided infective endocarditis and treated with antibiotics.
Hyperviscosity syndrome CPC
This document presents the case of a 40-year-old man admitted with altered consciousness for 3 days. His history revealed generalized aches, low back pain, decreased urine output, and weight loss over the past few months. Initial workup showed anemia, renal failure, and hypercalcemia. Imaging found an enlarged liver and vertebral fractures. Further testing identified a monoclonal band and plasma cells in bone marrow, leading to a diagnosis of multiple myeloma with hyperviscosity syndrome. He received rehydration, antibiotics, plasmapheresis, and chemotherapy.
Celiac common presentation of a uncommon disease saved with date
A 38-year-old female presented with abdominal distention, leg edema, and loose motions for 4-6 months. Her history revealed multiple hospital admissions for anemia. Testing showed liver cirrhosis, hypothyroidism, and iron deficiency anemia. Upper endoscopy found flattened duodenal folds and villous atrophy. Biopsy revealed celiac disease. She was started on a gluten-free diet with improvement in symptoms. Celiac disease causes villous atrophy and malabsorption from intolerance to gluten, presenting variably from anemia to osteoporosis. Diagnosis requires biopsy showing villous atrophy after gluten exposure.
Endocrinology Unit Case Presentation.pptx.pdf
A 24-year-old male student with known sickle cell anemia presented with 4 days of generalized body pain, 2 days of fever, and 1 day of loss of consciousness. On examination, he was unconscious and tachycardic. Investigations showed anemia, leukocytosis, and thrombocytopenia. He was admitted to the ICU and treated for possible vaso-occlusive crisis or chest syndrome based on his history and exam findings. Brain CT was normal. He received blood transfusions and IV fluids and antibiotics, and was evaluated by neurology with no focal deficits found.
Endocrinology Unit Case Presentation.pptx.pdf
A 24-year-old male student with known sickle cell anemia presented with 4 days of generalized body pain, 2 days of fever, and 1 day of loss of consciousness. On examination, he was unconscious and tachycardic. Investigations showed anemia, leukocytosis, and thrombocytopenia. He received blood transfusions and antibiotics. Brain CT was normal but he remained hypotonic on one side. The differential diagnosis included acute stroke versus chest syndrome complications.
Endocrinology Unit Case Presentation.pptx.pdf
A 24-year-old male student with known sickle cell anemia presented with 4 days of generalized body pain, 2 days of fever, and 1 day of loss of consciousness. On examination, he was unconscious and tachycardic. Investigations showed anemia, leukocytosis, and thrombocytopenia. He received blood transfusions and antibiotics. Brain CT was normal but he remained confused. The differential diagnosis included vaso-occlusive crisis, sepsis, or stroke in the setting of sickle cell anemia.
Interesting Case of Rowells syndrome
Kshamendra, a 22-year-old male, presented with fever, rash, joint pains, fatigue, and cough for several weeks. He was initially diagnosed with typhoid fever but developed a drug reaction. Examination found a vesicular rash, joint pain, and pneumonia. Tests showed pancytopenia, positive ANA and anti-Ro/La antibodies. A diagnosis of Rowell's syndrome was made based on meeting the criteria of lupus erythematosus, ANA positivity, erythema multiforme-like lesions, and a positive anti-Ro antibody.
approach to a bleeding child with blood disorders.pptx
This document describes the approach to three cases of bleeding in children. Case 1 involves a 5-month-old male with intracranial bleeding and seizures who was found to have a subdural hematoma requiring surgery. Despite resuscitation efforts, the child did not survive the surgery. Case 2 is a 2-year-old male with bruising and a very low platelet count, consistent with thrombocytopenia. Case 3 involves a 1-year-old male with knee swelling and fever, who was found to have a low platelet count, consistent with disseminated intravascular coagulation. The document provides definitions of types of bleeding, the stages of hemostasis, differential diagnoses, and management strategies for bleeding
Case pesentation dr.esam
A 25-year-old female presented with swelling of both lower limbs and puffiness of the eyelids for one month. She has a history of anemia managed with blood transfusions and steroids, but stopped treatment herself after one month. On examination, she had massive edema of the lower limbs and abdomen. Laboratory tests showed persistent anemia and protein in the urine. A renal biopsy was planned but the patient developed seizures before the procedure. She is now being treated with steroids, immunosuppressants, and other medications.
N334 ACR Hammond
This document provides an analysis of a 65-year-old male with chronic hepatitis C and cirrhosis who presented for follow up of anemia. He has a history of multiple failed hepatitis C treatments and complications of cirrhosis including ascites, encephalopathy, and esophageal varices. His current medications and management plan are outlined, focusing on preventing further liver damage and complications through lifestyle changes, medication adherence, screening for hepatocellular carcinoma, and treatment of ascites and encephalopathy. Economic and ethical considerations related to his condition are also discussed.
Crisis in acromegaly
A case presentation of a patient of acromegaly who eventually developed panhypopituitarism and visual field defect along with subacute apoplexy.
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This case presentation describes a 49-year-old female patient who presented with a 3-year history of flank pain associated with dysuria and hematuria. Imaging and lab results showed poorly functioning left kidney secondary to xanthogranulomatous pyelonephritis, and obstructive uropathy of the right kidney due to pelviolithiasis. The patient was diagnosed with xanthogranulomatous pyelonephritis of the left kidney, pelviolithiasis of the right kidney, and diabetes mellitus type 2. She was admitted and managed conservatively with IV fluids and pain medication. The treatment plan includes a left nephrectomy, left flank exploration, cystoscopy, and right
SLE Case Presentation
A 30-year-old female presented with a 2-week history of fever, loss of appetite, weight loss, and fatigue. On examination, she was febrile and pale with cervical lymphadenopathy. Investigations revealed pancytopenia, elevated ESR and CRP, positive ANA and anti-DS DNA antibodies, low complement levels, and a positive bone marrow TB PCR. A lymph node biopsy showed necrotizing lymphadenitis. She developed hepatitis after starting anti-tuberculosis treatment, which was withdrawn. A Quantiferon test was ordered to further evaluate for tuberculosis. She is being started on treatment for systemic lupus erythematosus with isoniazid cover pending the Quant
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This document summarizes the case report of a 20-year-old primigravida woman at 32 weeks of gestation who presented with severe anemia, breathlessness, giddiness and urinary tract infection. Her hemoglobin level was 3.3 g/dL. She was diagnosed with vitamin B12 deficiency induced pancytopenia and urinary tract infection. She received blood transfusions, intravenous vitamin B12 injections and antibiotics. Her condition improved with treatment and her hemoglobin rose to 7.9 g/dL.
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A 71-year-old male presented with 2 months of fever, headaches, and weight loss. Initial workup revealed anemia, elevated liver enzymes and inflammatory markers. He was treated for enteric fever but did not improve. Further testing showed pancytopenia, a weakly positive ANA, and a bone marrow biopsy suggestive of granulomas. He developed cough and hypoxemia. Imaging found pleural effusions and lung consolidation. The working diagnosis shifted to tuberculosis given suggestive bone marrow findings. Treatment with antitubercular therapy and steroids was started.Hemophagocytic Lymphohistiocytosis - HLH
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A Case of Antiphospholipid Antibody Syndrome
This document summarizes the case of a 19-year old male patient who presented with breathlessness, fever, and pain and discoloration of the toes. After examination and investigation, he was diagnosed with reactivated central nervous system tuberculosis, rheumatoid-related interstitial lung disease, bronchiectasis, and secondary antiphospholipid syndrome. Antiphospholipid syndrome is an autoimmune condition characterized by vascular thrombosis and/or pregnancy complications associated with antiphospholipid antibodies. It can occur primarily or secondary to other autoimmune diseases.
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Organization
Academy of Oriental Medicine at Austin
Academy of Oriental Medicine at Austin
Academy of Oriental Medicine at Austin
About AOMA: The Academy of Oriental Medicine at Austin offers a masters-level graduate program in acupuncture and Oriental medicine, preparing its students for careers as skilled, professional practitioners. AOMA is known for its internationally recognized faculty, award-winning student clinical internship program, and herbal medicine program. Since its founding in 1993, AOMA has grown rapidly in size and reputation, drawing students from around the nation and faculty from around the world. AOMA also conducts more than 20,000 patient visits annually in its student and professional clinics. AOMA collaborates with Western healthcare institutions including the Seton Family of Hospitals, and gives back to the community through partnerships with nonprofit organizations and by providing free and reduced price treatments to people who cannot afford them. The Academy of Oriental Medicine at Austin is located at 2700 West Anderson Lane. AOMA also serves patients and retail customers at its south Austin location, 4701 West Gate Blvd. For more information see www.aoma.edu or call 512-492-303434.
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Breast cancer: Post menopausal endocrine therapy
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
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