The document summarizes a case presentation of a 22-year-old male college student admitted with nausea and vomiting. Laboratory tests revealed a positive Lyme titer and western blot showed two positive bands, suggesting acute Lyme disease as the cause. The document also discusses the diagnostic criteria and interpretation of Lyme disease serology tests, noting the potential for false positives.
This document discusses three cases of neurotoxicity:
1) A man experiencing anticholinergic toxicity from hydrocodone cough syrup who was found yelling that he was Jesus.
2) A confused and agitated woman found to have acetaminophen-induced liver failure.
3) A man who drank insecticide in a suicide attempt and was experiencing symptoms of organophosphate poisoning such as excessive salivation, sweating, and incontinence.
The document also briefly covers other causes of anticholinergic toxicity like jimson weed and mushrooms as well as mercury poisoning.
The document provides an overview of Kelly McDonough's shift as an EMT, describing two medical calls - the first involving a man experiencing agitation and chest pain due to cocaine use, and the second an overdose of a woman who had ingested tricyclic antidepressants. Key details are provided on the patient assessments and treatments for cocaine intoxication and tricyclic antidepressant overdose.
A 4-month-old boy presented with 3 days of fever and 1 day of lethargy and food refusal. On examination, he had a high fever and bulging of the anterior fontanelle. Laboratory tests showed elevated white blood cell count in CSF. Gram stain of CSF did not find any bacteria. Salmonella was later grown from CSF and blood cultures. The diagnosis was bacterial meningitis caused by Salmonella. Treatment included cefotaxime, ciprofloxacin, and IV fluids. The antibiotics would be continued for 28 days to treat the Salmonella meningitis.
Hemolytic Disease of the Fetus and Newborn (HDFN) occurs when maternal IgG antibodies coat fetal red blood cells, causing their destruction both before and after birth. The severity can range from asymptomatic to fetal death. Anti-D is the most common cause but other antibodies like anti-c and anti-K1 can also induce HDFN. Maternal immunization occurs through fetal-maternal hemorrhage during pregnancy events or blood transfusions. Prenatal screening and monitoring of maternal antibody titers and fetal well-being is important. Intrauterine transfusions may be required to treat severe cases. ABO incompatibility is also a major cause of HDFN though it is usually milder since sensitization is not
Group C Hemolytic Disease of the Newborn (HDN) is caused by IgG antibodies produced by the mother that destroy the fetus or newborn's red blood cells. It can be caused by Rh, ABO, or other blood group incompatibilities. The antibodies cross the placenta and coat the fetus's red blood cells, which are then destroyed by the spleen and liver. This leads to anemia, liver and spleen enlargement, jaundice, and in severe cases hydrops fetalis or kernicterus. Diagnosis and management involves blood group testing of mother and baby, antibody screening and identification, amniocentesis to assess fetal anemia, and treatments like intrauterine transfusions, plasma
Central and Peripheral Nerve Lesions - Neel Golwalabcooper876
This document provides a summary of a presentation on central and peripheral nerve disorders. It includes 6 case studies presented to illustrate different conditions:
1) A 35-year-old woman with transverse myelitis presenting with numbness ascending from her feet to thighs and difficulty emptying her bladder.
2) A 39-year-old man with an epidural abscess presenting with bilateral upper and lower extremity weakness and neck pain.
3) A 60-year-old man with tabes dorsalis, a late manifestation of neurosyphilis, presenting with numbness, difficulty walking, vision changes, and urinary issues.
4) An 18-year-old woman with Guillain-Barré syndrome presenting
This document contains a series of case studies involving EKG interpretations. Case 7 involves a teenager who ate oleander leaves and presented with tachycardia and an irregular pulse on EKG. The EKG shows paroxysmal atrial tachycardia with block, indicating digoxin toxicity from the oleander ingestion. Case 8 describes an elderly patient with an unresponsive episode who is found to have a widened QRS complex on EKG due to life-threatening hyperkalemia. The document emphasizes interpreting EKGs in the context of patient presentations and histories to identify toxic ingestions, electrolyte abnormalities, and underlying cardiac conditions.
This document discusses haemolytic disease of the fetus and newborn (HDFN), specifically Rh disease. It provides details on the pathophysiology, classification, antenatal assessment and management of Rh HDFN. Key points include that Rh HDFN is caused by maternal IgG antibodies crossing the placenta and destroying Rh+ fetal red blood cells. It can be prevented through administration of RhIg to Rh- mothers. Management may involve procedures like amniocentesis, intrauterine transfusions or exchange transfusions in the fetus or newborn if severe haemolysis is detected or predicted.
This document discusses three cases of neurotoxicity:
1) A man experiencing anticholinergic toxicity from hydrocodone cough syrup who was found yelling that he was Jesus.
2) A confused and agitated woman found to have acetaminophen-induced liver failure.
3) A man who drank insecticide in a suicide attempt and was experiencing symptoms of organophosphate poisoning such as excessive salivation, sweating, and incontinence.
The document also briefly covers other causes of anticholinergic toxicity like jimson weed and mushrooms as well as mercury poisoning.
The document provides an overview of Kelly McDonough's shift as an EMT, describing two medical calls - the first involving a man experiencing agitation and chest pain due to cocaine use, and the second an overdose of a woman who had ingested tricyclic antidepressants. Key details are provided on the patient assessments and treatments for cocaine intoxication and tricyclic antidepressant overdose.
A 4-month-old boy presented with 3 days of fever and 1 day of lethargy and food refusal. On examination, he had a high fever and bulging of the anterior fontanelle. Laboratory tests showed elevated white blood cell count in CSF. Gram stain of CSF did not find any bacteria. Salmonella was later grown from CSF and blood cultures. The diagnosis was bacterial meningitis caused by Salmonella. Treatment included cefotaxime, ciprofloxacin, and IV fluids. The antibiotics would be continued for 28 days to treat the Salmonella meningitis.
Hemolytic Disease of the Fetus and Newborn (HDFN) occurs when maternal IgG antibodies coat fetal red blood cells, causing their destruction both before and after birth. The severity can range from asymptomatic to fetal death. Anti-D is the most common cause but other antibodies like anti-c and anti-K1 can also induce HDFN. Maternal immunization occurs through fetal-maternal hemorrhage during pregnancy events or blood transfusions. Prenatal screening and monitoring of maternal antibody titers and fetal well-being is important. Intrauterine transfusions may be required to treat severe cases. ABO incompatibility is also a major cause of HDFN though it is usually milder since sensitization is not
Group C Hemolytic Disease of the Newborn (HDN) is caused by IgG antibodies produced by the mother that destroy the fetus or newborn's red blood cells. It can be caused by Rh, ABO, or other blood group incompatibilities. The antibodies cross the placenta and coat the fetus's red blood cells, which are then destroyed by the spleen and liver. This leads to anemia, liver and spleen enlargement, jaundice, and in severe cases hydrops fetalis or kernicterus. Diagnosis and management involves blood group testing of mother and baby, antibody screening and identification, amniocentesis to assess fetal anemia, and treatments like intrauterine transfusions, plasma
Central and Peripheral Nerve Lesions - Neel Golwalabcooper876
This document provides a summary of a presentation on central and peripheral nerve disorders. It includes 6 case studies presented to illustrate different conditions:
1) A 35-year-old woman with transverse myelitis presenting with numbness ascending from her feet to thighs and difficulty emptying her bladder.
2) A 39-year-old man with an epidural abscess presenting with bilateral upper and lower extremity weakness and neck pain.
3) A 60-year-old man with tabes dorsalis, a late manifestation of neurosyphilis, presenting with numbness, difficulty walking, vision changes, and urinary issues.
4) An 18-year-old woman with Guillain-Barré syndrome presenting
This document contains a series of case studies involving EKG interpretations. Case 7 involves a teenager who ate oleander leaves and presented with tachycardia and an irregular pulse on EKG. The EKG shows paroxysmal atrial tachycardia with block, indicating digoxin toxicity from the oleander ingestion. Case 8 describes an elderly patient with an unresponsive episode who is found to have a widened QRS complex on EKG due to life-threatening hyperkalemia. The document emphasizes interpreting EKGs in the context of patient presentations and histories to identify toxic ingestions, electrolyte abnormalities, and underlying cardiac conditions.
This document discusses haemolytic disease of the fetus and newborn (HDFN), specifically Rh disease. It provides details on the pathophysiology, classification, antenatal assessment and management of Rh HDFN. Key points include that Rh HDFN is caused by maternal IgG antibodies crossing the placenta and destroying Rh+ fetal red blood cells. It can be prevented through administration of RhIg to Rh- mothers. Management may involve procedures like amniocentesis, intrauterine transfusions or exchange transfusions in the fetus or newborn if severe haemolysis is detected or predicted.
Japanese encephalitis is a vaccine-preventable, but fatal encephalitis. I will present two case of Japanese encephalitis, and they had some neurologic deficit on language, motor function and even brainstem function. Though Low clinical illness rate, but high disability or mortality rate developed in these patients
1. A 35-year-old man presented with acute onset of breathlessness and was found to have pulmonary thromboembolism and deficiencies in protein C and protein S without evidence of deep vein thrombosis.
2. He was treated with supportive measures, heparin, acenocoumarol, and supplements but developed massive hemoptysis and succumbed to his illness despite intensive care.
3. The case report discusses evaluation, treatment, and long-term management of venous thromboembolism and highlights complications that can arise.
This document presents three case studies. Case Study 1 involves a 38-year-old woman with double vision and headaches that are worse when looking left. Examination finds failure of left eye adduction. Case Study 2 is a 32-year-old woman with blurred vision, leg weakness, and urinary incontinence. Case Study 3 is a 45-year-old man with shortness of breath, fevers, weight loss, fatigue, unsteady gait, and memory problems.
This document provides guidance on evaluating and managing ill-appearing neonates in the emergency department. Key points include:
1) Treat all ill-appearing neonates for sepsis initially with antibiotics such as ampicillin and gentamicin until infection is ruled out. Perform diagnostic tests including blood cultures and lumbar puncture if stable.
2) Check bedside glucose in all ill-appearing neonates and treat hypoglycemia.
3) Consider various differential diagnoses remembered by the acronym "NEO SECRETS" including infections, inborn errors of metabolism, electrolyte abnormalities, etc.
4) Neonates presenting with bilious emesis require workup to rule out volvulus
Epilepsy and other seizure brain disorders were discussed. Generalized seizures are caused by near simultaneous activation of the entire cerebral cortex from an electrical discharge originating deep in the brain. Partial seizures are due to electrical discharges beginning in a localized brain region. Status epilepticus refers to prolonged seizure activity lasting more than 5 minutes or multiple seizures without regaining consciousness. Seizures have various types and presentations depending on their origin and spread in the brain. Physical examination, history, and diagnostic workup are important for evaluating patients presenting with seizures.
A 25-year-old female presented with severe shortness of breath that began suddenly. She had a normal vaginal delivery one week prior and mild shortness of breath for three days after. On examination, she was tachycardic, tachypneic, and hypoxic. Echocardiogram showed right ventricular dysfunction. She was diagnosed with pulmonary embolism but died after a few hours despite treatment. The case presentation discusses a young female diagnosed with pulmonary embolism after childbirth who died despite emergency treatment.
A 38-year-old man presented with seizures and was diagnosed with cortical venous thrombosis. He had multiple risk factors including diabetes, hyperhomocysteinemia, and dyslipidemia. He was treated with anticoagulation but continued having seizures. Imaging later revealed a venous infarct. His symptoms gradually improved with treatment but he was discharged with some residual neurological deficits. Cortical venous thrombosis can be challenging to diagnose but outcomes have improved with prompt diagnosis and treatment. Hyperhomocysteinemia is an increasingly recognized risk factor.
1) The document summarizes a clinical meeting presentation about conjoined twin infants born at 35 weeks gestation who were attached at the head.
2) On examination, the twins were generally healthy and developing appropriately except for being jaundiced and experiencing intermittent low urine output.
3) Over the course of their hospital stay, their jaundice and urine output were monitored and treated conservatively with phototherapy and IV fluids respectively. Electrolyte abnormalities were also corrected.
A male infant was delivered via elective C-section at 36 weeks and 5 days gestation due to the mother's history of two previous C-sections. The infant presented with hypoglycemia which is common in infants of diabetic mothers. The infant was admitted to the NICU for monitoring and treatment of hypoglycemia, including intravenous fluids and corticosteroids. After several days of blood sugar monitoring and treatment, the infant's blood sugars stabilized and he was discharged.
HYPERTENSIVE DISORDERS OF PREGNANCY.pptxssuser52ada61
This document discusses hypertensive disorders of pregnancy, including gestational hypertension, preeclampsia, chronic hypertension, and preeclampsia superimposed on chronic hypertension. It covers classification, risk factors, pathogenesis, clinical features, investigations, management including antihypertensive treatment and timing of delivery, complications, and key takeaways on reducing morbidity and mortality through timely identification and management.
This document discusses pregnancy induced hypertension (PIH), also known as preeclampsia. PIH is a multisystem disorder of unknown etiology that can lead to increased maternal and fetal morbidity and mortality if left untreated. It is characterized by new onset hypertension and proteinuria after 20 weeks of gestation. The document covers the classification, signs, symptoms, risk factors, pathophysiology, diagnosis and management of the different types of PIH, including chronic hypertension, gestational hypertension, preeclampsia, and eclampsia. Treatment involves blood pressure control with antihypertensives, magnesium sulfate to prevent seizures, and timely delivery once the fetus is mature.
This document discusses pregnancy induced hypertension (PIH), including definitions, classifications, risk factors, pathophysiology, diagnosis, and management. PIH is a multisystem disorder characterized by new onset hypertension after 20 weeks of gestation. It includes gestational hypertension, preeclampsia, and eclampsia. Management involves monitoring for signs of worsening disease and delivering after 37 weeks if mild or earlier if severe to prevent maternal and fetal morbidity and mortality. Treatment includes antihypertensives, magnesium sulfate to prevent seizures, and delivery.
1) A 1.5 month boy presented with fever and pancytopenia. Examination found pallor. Blood tests found normocytic anemia, leukopenia, thrombocytopenia.
2) Bone marrow aspiration found erythroid dysplasia and megaloblastosis. Chromosomal breakage study and karyotyping were normal.
3) Flow cytometry found B cell immune deficiency. The pancytopenia and symptoms improved with supportive care.
4) Genetic testing in Germany found a MYSM1 mutation, which has been associated with bone marrow failure and immunodeficiency. The patient will require long term supportive care including transfusions, immunoglobulins and G
1. This case presents a 1.5 month old boy with pancytopenia, fever, and respiratory symptoms.
2. Initial workup showed normocytic anemia, leukopenia, thrombocytopenia, and low corrected reticulocyte count. Bone marrow aspiration found erythroid dysplasia and megaloblastic changes.
3. Further testing found B cell immune deficiency. The patient was eventually diagnosed with MYSM1 mutation, a rare cause of congenital sideroblastic anemia and immunodeficiency. He requires supportive care including transfusions and immunoglobulin therapy.
This document provides an overview of preeclampsia and eclampsia. It begins with definitions of preeclampsia, classifications, risk factors and pathophysiology. It then discusses specific conditions like HELLP syndrome and eclampsia in more detail, providing their definitions, symptoms, management and complications. The document concludes with introducing topics that will be covered in more depth, including prediction and prevention of preeclampsia, investigations and management approaches for non-severe and severe preeclampsia.
This document provides information on a case of hypertensive disorders of pregnancy. It describes a 29-year-old female patient who is 36 weeks and 1 day pregnant presenting with amenorrhea and headaches for the past 3 weeks. Her blood pressure was found to be elevated. On examination, her vitals were normal aside from elevated blood pressure, and the fetal presentation was normal. The patient's history included similar symptoms in her previous pregnancy. The document provides questions and answers on the classification, risk factors, diagnosis, pathogenesis, complications, management, and anesthesia considerations for hypertensive disorders of pregnancy like preeclampsia.
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.
This 2-year old female dog presented with a 2 day history of hind limb lameness and a 3-4 week history of progressive skin nodules. Physical examination revealed multiple small skin nodules, joint effusions, and enlarged lymph nodes. Testing showed a mild non-regenerative anemia, hyperglobulinemia, and positive results for Leishmania on blood PCR. The dog was diagnosed with leishmaniasis based on clinical signs and test results. Treatment was started with miltefosine and allopurinol.
Rh negative pregnancies can lead to isoimmunization of the mother if she has a Rh positive baby. This occurs due to a fetomaternal hemorrhage which allows the fetus's Rh positive blood cells to enter the mother's circulation and trigger an immune response. Testing for isoimmunization involves indirect Coombs testing of the mother. Unsensitized Rh negative mothers receive anti-D immunoglobulin injections to prevent isoimmunization. Sensitized pregnancies require careful monitoring and may involve amniocentesis, intrauterine transfusions or early delivery to prevent fetal complications like hydrops fetalis. The baby may also require treatments like phototherapy or exchange transfusion if affected by hemolytic anemia or
Pregnancy Induced Hypertension - Pre eclampsiaomar143
This document provides information about a 33-year-old pregnant woman admitted to the hospital with mild preeclampsia at 36 weeks of gestation. It includes her medical history, symptoms, physical exam findings, lab results, diagnosis, and notes on preeclampsia and its management. The key details are that she presented with swelling in her lower limbs and a history of amenorrhea for 8 months, and was found to have elevated blood pressure and mild preeclampsia at 36 weeks of pregnancy.
NAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdfRahul Sen
Time-lapse embryo monitoring is an advanced imaging technique used in IVF to continuously observe embryo development. It captures high-resolution images at regular intervals, allowing embryologists to select the most viable embryos for transfer based on detailed growth patterns. This technology enhances embryo selection, potentially increasing pregnancy success rates.
Japanese encephalitis is a vaccine-preventable, but fatal encephalitis. I will present two case of Japanese encephalitis, and they had some neurologic deficit on language, motor function and even brainstem function. Though Low clinical illness rate, but high disability or mortality rate developed in these patients
1. A 35-year-old man presented with acute onset of breathlessness and was found to have pulmonary thromboembolism and deficiencies in protein C and protein S without evidence of deep vein thrombosis.
2. He was treated with supportive measures, heparin, acenocoumarol, and supplements but developed massive hemoptysis and succumbed to his illness despite intensive care.
3. The case report discusses evaluation, treatment, and long-term management of venous thromboembolism and highlights complications that can arise.
This document presents three case studies. Case Study 1 involves a 38-year-old woman with double vision and headaches that are worse when looking left. Examination finds failure of left eye adduction. Case Study 2 is a 32-year-old woman with blurred vision, leg weakness, and urinary incontinence. Case Study 3 is a 45-year-old man with shortness of breath, fevers, weight loss, fatigue, unsteady gait, and memory problems.
This document provides guidance on evaluating and managing ill-appearing neonates in the emergency department. Key points include:
1) Treat all ill-appearing neonates for sepsis initially with antibiotics such as ampicillin and gentamicin until infection is ruled out. Perform diagnostic tests including blood cultures and lumbar puncture if stable.
2) Check bedside glucose in all ill-appearing neonates and treat hypoglycemia.
3) Consider various differential diagnoses remembered by the acronym "NEO SECRETS" including infections, inborn errors of metabolism, electrolyte abnormalities, etc.
4) Neonates presenting with bilious emesis require workup to rule out volvulus
Epilepsy and other seizure brain disorders were discussed. Generalized seizures are caused by near simultaneous activation of the entire cerebral cortex from an electrical discharge originating deep in the brain. Partial seizures are due to electrical discharges beginning in a localized brain region. Status epilepticus refers to prolonged seizure activity lasting more than 5 minutes or multiple seizures without regaining consciousness. Seizures have various types and presentations depending on their origin and spread in the brain. Physical examination, history, and diagnostic workup are important for evaluating patients presenting with seizures.
A 25-year-old female presented with severe shortness of breath that began suddenly. She had a normal vaginal delivery one week prior and mild shortness of breath for three days after. On examination, she was tachycardic, tachypneic, and hypoxic. Echocardiogram showed right ventricular dysfunction. She was diagnosed with pulmonary embolism but died after a few hours despite treatment. The case presentation discusses a young female diagnosed with pulmonary embolism after childbirth who died despite emergency treatment.
A 38-year-old man presented with seizures and was diagnosed with cortical venous thrombosis. He had multiple risk factors including diabetes, hyperhomocysteinemia, and dyslipidemia. He was treated with anticoagulation but continued having seizures. Imaging later revealed a venous infarct. His symptoms gradually improved with treatment but he was discharged with some residual neurological deficits. Cortical venous thrombosis can be challenging to diagnose but outcomes have improved with prompt diagnosis and treatment. Hyperhomocysteinemia is an increasingly recognized risk factor.
1) The document summarizes a clinical meeting presentation about conjoined twin infants born at 35 weeks gestation who were attached at the head.
2) On examination, the twins were generally healthy and developing appropriately except for being jaundiced and experiencing intermittent low urine output.
3) Over the course of their hospital stay, their jaundice and urine output were monitored and treated conservatively with phototherapy and IV fluids respectively. Electrolyte abnormalities were also corrected.
A male infant was delivered via elective C-section at 36 weeks and 5 days gestation due to the mother's history of two previous C-sections. The infant presented with hypoglycemia which is common in infants of diabetic mothers. The infant was admitted to the NICU for monitoring and treatment of hypoglycemia, including intravenous fluids and corticosteroids. After several days of blood sugar monitoring and treatment, the infant's blood sugars stabilized and he was discharged.
HYPERTENSIVE DISORDERS OF PREGNANCY.pptxssuser52ada61
This document discusses hypertensive disorders of pregnancy, including gestational hypertension, preeclampsia, chronic hypertension, and preeclampsia superimposed on chronic hypertension. It covers classification, risk factors, pathogenesis, clinical features, investigations, management including antihypertensive treatment and timing of delivery, complications, and key takeaways on reducing morbidity and mortality through timely identification and management.
This document discusses pregnancy induced hypertension (PIH), also known as preeclampsia. PIH is a multisystem disorder of unknown etiology that can lead to increased maternal and fetal morbidity and mortality if left untreated. It is characterized by new onset hypertension and proteinuria after 20 weeks of gestation. The document covers the classification, signs, symptoms, risk factors, pathophysiology, diagnosis and management of the different types of PIH, including chronic hypertension, gestational hypertension, preeclampsia, and eclampsia. Treatment involves blood pressure control with antihypertensives, magnesium sulfate to prevent seizures, and timely delivery once the fetus is mature.
This document discusses pregnancy induced hypertension (PIH), including definitions, classifications, risk factors, pathophysiology, diagnosis, and management. PIH is a multisystem disorder characterized by new onset hypertension after 20 weeks of gestation. It includes gestational hypertension, preeclampsia, and eclampsia. Management involves monitoring for signs of worsening disease and delivering after 37 weeks if mild or earlier if severe to prevent maternal and fetal morbidity and mortality. Treatment includes antihypertensives, magnesium sulfate to prevent seizures, and delivery.
1) A 1.5 month boy presented with fever and pancytopenia. Examination found pallor. Blood tests found normocytic anemia, leukopenia, thrombocytopenia.
2) Bone marrow aspiration found erythroid dysplasia and megaloblastosis. Chromosomal breakage study and karyotyping were normal.
3) Flow cytometry found B cell immune deficiency. The pancytopenia and symptoms improved with supportive care.
4) Genetic testing in Germany found a MYSM1 mutation, which has been associated with bone marrow failure and immunodeficiency. The patient will require long term supportive care including transfusions, immunoglobulins and G
1. This case presents a 1.5 month old boy with pancytopenia, fever, and respiratory symptoms.
2. Initial workup showed normocytic anemia, leukopenia, thrombocytopenia, and low corrected reticulocyte count. Bone marrow aspiration found erythroid dysplasia and megaloblastic changes.
3. Further testing found B cell immune deficiency. The patient was eventually diagnosed with MYSM1 mutation, a rare cause of congenital sideroblastic anemia and immunodeficiency. He requires supportive care including transfusions and immunoglobulin therapy.
This document provides an overview of preeclampsia and eclampsia. It begins with definitions of preeclampsia, classifications, risk factors and pathophysiology. It then discusses specific conditions like HELLP syndrome and eclampsia in more detail, providing their definitions, symptoms, management and complications. The document concludes with introducing topics that will be covered in more depth, including prediction and prevention of preeclampsia, investigations and management approaches for non-severe and severe preeclampsia.
This document provides information on a case of hypertensive disorders of pregnancy. It describes a 29-year-old female patient who is 36 weeks and 1 day pregnant presenting with amenorrhea and headaches for the past 3 weeks. Her blood pressure was found to be elevated. On examination, her vitals were normal aside from elevated blood pressure, and the fetal presentation was normal. The patient's history included similar symptoms in her previous pregnancy. The document provides questions and answers on the classification, risk factors, diagnosis, pathogenesis, complications, management, and anesthesia considerations for hypertensive disorders of pregnancy like preeclampsia.
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.
This 2-year old female dog presented with a 2 day history of hind limb lameness and a 3-4 week history of progressive skin nodules. Physical examination revealed multiple small skin nodules, joint effusions, and enlarged lymph nodes. Testing showed a mild non-regenerative anemia, hyperglobulinemia, and positive results for Leishmania on blood PCR. The dog was diagnosed with leishmaniasis based on clinical signs and test results. Treatment was started with miltefosine and allopurinol.
Rh negative pregnancies can lead to isoimmunization of the mother if she has a Rh positive baby. This occurs due to a fetomaternal hemorrhage which allows the fetus's Rh positive blood cells to enter the mother's circulation and trigger an immune response. Testing for isoimmunization involves indirect Coombs testing of the mother. Unsensitized Rh negative mothers receive anti-D immunoglobulin injections to prevent isoimmunization. Sensitized pregnancies require careful monitoring and may involve amniocentesis, intrauterine transfusions or early delivery to prevent fetal complications like hydrops fetalis. The baby may also require treatments like phototherapy or exchange transfusion if affected by hemolytic anemia or
Pregnancy Induced Hypertension - Pre eclampsiaomar143
This document provides information about a 33-year-old pregnant woman admitted to the hospital with mild preeclampsia at 36 weeks of gestation. It includes her medical history, symptoms, physical exam findings, lab results, diagnosis, and notes on preeclampsia and its management. The key details are that she presented with swelling in her lower limbs and a history of amenorrhea for 8 months, and was found to have elevated blood pressure and mild preeclampsia at 36 weeks of pregnancy.
NAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdfRahul Sen
Time-lapse embryo monitoring is an advanced imaging technique used in IVF to continuously observe embryo development. It captures high-resolution images at regular intervals, allowing embryologists to select the most viable embryos for transfer based on detailed growth patterns. This technology enhances embryo selection, potentially increasing pregnancy success rates.
The biomechanics of running involves the study of the mechanical principles underlying running movements. It includes the analysis of the running gait cycle, which consists of the stance phase (foot contact to push-off) and the swing phase (foot lift-off to next contact). Key aspects include kinematics (joint angles and movements, stride length and frequency) and kinetics (forces involved in running, including ground reaction and muscle forces). Understanding these factors helps in improving running performance, optimizing technique, and preventing injuries.
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.
“Psychiatry and the Humanities”: An Innovative Course at the University of Mo...Université de Montréal
“Psychiatry and the Humanities”: An Innovative Course at the University of Montreal Expanding the medical model to embrace the humanities. Link: https://www.psychiatrictimes.com/view/-psychiatry-and-the-humanities-an-innovative-course-at-the-university-of-montreal
Pictorial and detailed description of patellar instability with sign and symptoms and how to diagnose , what investigations you should go with and how to approach with treatment options . I have presented this slide in my 2nd year junior residency in orthopedics at LLRM medical college Meerut and got good reviews for it
After getting it read you will definitely understand the topic.
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
2. CASE 1
22 yo M , college student
CC: Nausea / Vomiting
PMH: ADHD/ Anxiety
Meds: Adderall
HPI: 3 day hx of N/V, this is his third visit for same
Thursday, May 17, 12
3. CASE 1- N/V
Vitals: 152/81, P 103, RR 16, T 97.5, Sat 100% RA
Pt seen two other times for same and sent home
IVF, Zofran IV, Compazine PR, CT head neg, K+ was 3.0
Rash on back noted by RN, did not look like Erythema chronicum migrans
“bullseye”
Maybe there for several months according to the ID consult
Lyme titer added to labs
Thursday, May 17, 12
4. WORKUP
Admitted to medicine for workup
CT abdomen was neg
ID consulted for positive Lyme titer ( ELISA)
Western blot added (confirmatory test)
Thursday, May 17, 12
5. ECM RASH
Note “bullseye pattern” typical for Lyme Disease
Thursday, May 17, 12
6. LAB TESTS
Laboratory blood tests are helpful if used correctly and
performed with validated methods. Laboratory tests are
not recommended for patients who do not have
symptoms typical of Lyme disease. Just as it is
important to correctly diagnose Lyme disease when a
patient has it, it is important to avoid misdiagnosis and
treatment of Lyme disease when the true cause of the
illness is something else.
Source: cdc.gov
Thursday, May 17, 12
7. LYME TITER
http://www.cdc.gov/lyme/diagnosistreatment/
LabTest/TwoStep/
Thursday, May 17, 12
8. WESTERN BLOT
The confirmatory test for a positive Lyme titer
Many false positives occur with with the Lyme titer
This clarifies equivocal or positive tests
Western Blot sub-fractionates the IgG and IgM
Thursday, May 17, 12
9. WESTERN BLOT
For Positive Results you must have:
An lgG Western Blot must have five or more of these bands: 18, 21,28, 30, 39, 41,,45, 58, 66 and
93 kDa.
An lgM Western Blot must have two or more these three bands: 23, 39, 41
Source: www.whatislyme.com
Thursday, May 17, 12
10. OUR PATIENT’S WB
IgG - Negative
overall
only 2 bands pos
Prob no chronic
infection
IgM- 2 of 3 are
positive
presumes acute
infection
Thursday, May 17, 12
12. SUMMARY
False positives on the initial Lyme titer and Western
blot can occur
Routine testing without actual symptoms causes
unnecessary concern, further testing and treatments
Much controversy exists on the actual interpretation
of Western blot
Thursday, May 17, 12
13. WESTERN BLOT
False-positive reactions may occur with patients
with other spirochetal diseases (syphilis, yaws,
pinta, relapsing fever, or leptospirosis), influenza,
autoimmune disorders, multiple sclerosis, or
amyotrophic lateral sclerosis.
http://www.mayomedicallaboratories.com/
interpretive-guide
Thursday, May 17, 12
14. CASE 2
22yo F Status post delivery of twins 6 days ago
CC: Headache/ HTN since yesterday
Pain 6/10
PMH: Asthma, Migraine, Pre ecclampsia (RN note)
Arrival 1414hrs, PA time 1448 hrs in FT
BP:144/69 in triage
Thursday, May 17, 12
15. MD NOTE
2 days of HA
Hx migraines, this was “more severe”
BP running high, repeat in ER at 1651 hrs at 175/99, 1705 hrs Gyn consulted
1739hrs at 189/114
1740 hrs Labetalol 10mg IV
1849hrs Hydralazine ordered IV ? in MD note, not RN
1911 Magnesium IV ordered 4 grams over 15 mins
Thursday, May 17, 12
17. HTN IN PREGNANCY
Gestational HTN: found late in pregnancy, no other
findings for preeclampsia, “transient” , clears by post
partum week 12
Chronic HTN Preceding Pregnancy- ≥140/90, before
20 wks, persists beyond 12 weeks
Chronic HTN with PIH ( preeclamsia or eclampsia)
highest risk
Thursday, May 17, 12
18. PREGNANCY INDUCED
HTN
Preeclampsia- mild/ BP ≥ 140/90, > 20 wks
gestation, no end organ damage, >300mg protein/
24hrs.
Severe Preeclampsia- SBP ≥160/110, proteinuria >
5gr/ 24hr, Headache, Epigastric pain, Low PLT,
Oligouria < 400mg/ 24hr, Pulmonary edema
Thursday, May 17, 12
19. PREECLAMPSIA RISK
FACTORS
Nulliparity
Previous gestational hypertensive disorders
Diabetes
Malnutrition
Hydatiform mole
Low social status
Chronic Nephritis
Thursday, May 17, 12
20. PREECLAMPSIA SIGNS &
SYMPTOMS
CNS: Headache, visual disturbances, altered mental
status, blindness, weakness & malaise
Edema
Epigastric Pain
Dyspnea
Seizures- on top of the criteria for preeclampsia
define Eclampsia
Thursday, May 17, 12
21. MANAGEMENT
Delivery is the only “cure”
HTN management
Hydralazine/ Labetalol IV/ Sodium nitroprusside
IV Magnesium - seizure prevention “eclampsia”
IV Fluids, patients are intravascularly depleted
Thursday, May 17, 12
22. HELLP SYNDROME
H- Hemolysis
EL- Elevated Liver Enzymes
LP- Low platelets
Occurs in 10-20% of women with Preeclampsia or
Ecclampsia
Women usually have HTN/ Preeclampsia before
HELLP syndrome is noted.
Thursday, May 17, 12
24. LABS
All women with new onset HTN: CBC, AST/ALT,
BMP, Uric acid, LDH, Indirect Bilirubin, PT/PTT
HELLP: check Spot Protein (prot/creat ratio) > 0.3,
Proteinuria > 300mg/ 24hr, Uric Acid> 5.6, Creat> 1.2
Also for HELLP: PLT < 100k, Elevated PT/ PTT,
Decreased Fibrinogen, Hemolysis markers
( peripheral smear, Indirect Bili > 1.2, LDH>600)
Thursday, May 17, 12
25. OUR CASE
Pt was seen in triage. BP was144/69, RN noted home
BP of 170/110
Pt had Headache, got Reglan (no note of vomiting on
chart), had leg edema
Sent to Fast Track
MD involved after PA presentation
Thursday, May 17, 12
26. PREECLAMPSIA
Lessons learned.......
Thursday, May 17, 12
27. LACTIC ACIDOSIS
The product of anaerobic metabolism
Number one cause of metabolic acidosis
Causes anion gap
AG= Na⁺ - (Cl⁻ + HCO3⁻)
Bicarb (HCO3⁻) will be low
Lactate above 4meq/L is abnormal
Thursday, May 17, 12
29. METABOLIC ACIDOSIS
MUDPILES
Methanol- metabolized to Formic Acid via liver enzymes, cellular hypoxia, blindness
Uremia- increased bicarb wasting leads to acidosis
DKA- ketone formation in the absence of insulin from fatty acid breakdown
Paraldehyde- sedative no longer in use
INH- inhibits lactate dehydrogenase
Lactic Acidosis- type A ( hypoperfusion) and type B ( DM, toxins,
Ethylene glycol- antifreeze degradation produces glycolic acid and oxalate
Salicylates- ie ASA overdose
Thursday, May 17, 12
30. METABOLIC ACIDOSIS
Anion gap- associated with an unmeasured anion
produced or gained
Thursday, May 17, 12
31. TYPES OF LACTIC
ACIDOSIS
Type A: from tissue hypoperfusion/ hypoxia
Type B- Drugs, DM, Liver disease, malignancy,
inborn errors of metabolism
Thursday, May 17, 12
32. LACTIC ACIDOSIS
When to order?
Think of the situation.
Hypoxia- asthma, COPD, CHF
Increased Metabolic Activity- seizure, exercise,
shivering ( doesn’t change management)
Sepsis- dead bowel, overwhelming infection, fever
Thursday, May 17, 12
33. SEPSIS
SIRS definition- Systemic Inflammatory Response
Syndrome
Essentially a cytokine storm with abnormal
Thursday, May 17, 12
34. SEPSIS
SIRS due to an infection is SEPSIS
Non Sepsis Causes- trauma, burns, pancreatitis,
ischemia and hemorrhage
Also- anaphylaxis, tamponade, PE, Adrenal insuff.,
complications of surgery, Overdoses
Complications- organ failure
Thursday, May 17, 12