laly1
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there in the mini cases : 65 yo F presents with intermittent right temporal headache ,fever,blurred vision in her right eye and pain in her jaw when jewing.
my question is why carotid artery dissection is one of the differential diagnosis and why LP is not included in the workup . can someone please explain thanks
Edited by laly1 on 04/19/08 - 04:27 PM
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| supra
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carotid artery dissection is INCLUDED in the DD for headache .IN PAGE 63 OF FA coz' headache with visual disturbancesis one of the presenting feature in carotid artery dissection .The clinical picture of carotid artery dissection varies from mild cerebral and/or cranial nerve dysfunction to a completed stroke.Clinical appearance is primarily characterized by local signs such as headache or facial pain, visual obscurations ,Horner's syndrome, lower cranial nerve palsies, and pulsatile tinnitus, followed a few hours or days later by signs of cerebral or retinal ischemia.Headache is one of the most common symptoms.It is usually diagnosed late since the symptoms may be attributed to migraine especially with transient symptoms resembling migraine with aura.
LP is not included in the workup coz if RAISED INTRACRANIAL PRESSURE +ve,IT MIGHT lead to herniation of the brain and worsening of symptoms.
Supra
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| bioguy
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wow, supra, you are genius!!!! i admire you!
laly, please keep asking more questions. i am at the same stage of preparation in FA and it never occured to me to ask this question. i now realize what i am missing.
I appreciate it.
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| laly1
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Wow Supra that is amazing ,wonderfull and to the point thank you for responding .
bioguy yea I will keep doing FA and hopefully we can benefit from question I also appreciate your question
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.[96:1-5] Read! In the name of your Lord who created - Created the human from something which clings. Read! And your Lord is Most Bountiful - He who taught (the use of) the Pen, Taught the human that which he knew not.
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| supra
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bioguy,n laly ,thanks, i m being flattered,
hey.......i was wondering........... what if in the exam the SP says,'Hey DOC,i admire u /hair style /u r very nice".
Do U say[font style="background-color: #ccffff"],"Thank you Mr SP,BUT my focus is on u n ur problem,can we talk about dat?ISNT DIS RUDE?[/font] 
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| bioguy
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I'd try "thank you very much for your compliments, Mr.US. now coming back to your problem, do you.. blah blah"
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??/??/CS pass/??/4USlors/Need Visa - ok, i also need a good USMLE score !
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| laly1
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agree withyou bioguy ,thank the patirnt and redirect him or her to the encounter.
I have another FA inquiry on page 72 the mini case : 55 yo M with tingling and numbness in hands and feet (glove and stocking distribution) over the past twomonth .He has a history of diabetes ,hypertentionand alcoholism there is decreased soft touch,vibratory and position sense in the feet.
in DD Hyperventilation ,Paraprotienemia/Myeloma can some one explain why??.
also can someone explain the Tensilon test
thanks
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.[96:1-5] Read! In the name of your Lord who created - Created the human from something which clings. Read! And your Lord is Most Bountiful - He who taught (the use of) the Pen, Taught the human that which he knew not.
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| tompat
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hi all, which editin of first aid u people are talking about? please tell me. i m also at the same stage
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| tompat
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in myeloma cases aberrant production of antibodies can explain some of the peripheral neuropathies.
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| supra
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Hey LALY,tensilon test is done for myasthenia graevis,
In myasthenia graevis patients,there are antibodies2 Acetyl choline receptors,so no ACh,therefore early fatigue.EDROPHOBIUM CHLORIDE (tensilon)is an anti -cholinesterase drug, ,n this causes less destruction of ACh and thus improves the muscle strength FOR A BRIEF PERIOD if given in myasthenic patients but not in other cases of muscle weakness.IT ALSO HELPS DIFFERENTIATE BETWEEN MYASTHENIC CRISIS N CHOLINERGIC CRISIS,IN myasthenic crisis,there is brief improvement of muscle strenth,but in chinergic crisis ,there is worsening of muscle weakness. This test is not done anymore coz,in either case the treatment is withdrawal of the anticholinergic drugs,n then plamapheresis,respiratory support.
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| laly1
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 on top of it supra ,thanks very informative .
tompat i think mine is the 2nd edition I just bought it a couple of weeks ago from Barnes and Noble so I'm asuming its the latest edition .
What about hyperventilation!!
please for those who are doing FA can we share our Q here
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.[96:1-5] Read! In the name of your Lord who created - Created the human from something which clings. Read! And your Lord is Most Bountiful - He who taught (the use of) the Pen, Taught the human that which he knew not.
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| champo
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. HYPERVENTILATTION,,,,,,,,,,Causes respiratory alkalosis ,,that increases pH that further increases the affinity of albumin to bind to calcium ,as a result ca bound to albumin increaes ,,,causing a decrease in ca present in ionized form which is the active form of calcium in body ,so as a result u get neurological manifestations of hypocalcemia like numbness n paresthesia.
MULTIPLE MYELOMA,,,,,,,,, known as disease of plasma cells causes bone destruction ,including vertebral compression ,causing radiculopathy n neurological manifestations .
regarding TENSILON TEST..........FOREMOST IMP THING IS THAT ITS OBSELETE NOW
it was used to differentiate b/w cholinergic crisis[overtreatment with cholinergic drugs resulting in overstimulation n fasciculayion n paralysis] AND mysthenic crisis[where pt has severe symptoms of mysthenia presenting with paralysis[esp respiratory paralysis]
so tensilon [edrophonium] wa given to differentiate these 2,which is a chinesterase inhibitor increasing the availability of ach to the neuromuscular junction.
but b coz treatemet of mysthenic crisis or cholinergic crisis,is same ,so tensilon test lost its significance n is no longer performed.
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| champo
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Though peripheral neuropathies r not common IN MULTIPLE MYELOMA n most neurologocal manifestations r coz of spinal cord compression ,, BUT YES,,if this has to be a peripheral neuropathy ,amyloidosis [primary or immunocytic amyloidosis]or hyperviscosity or bort can be cause.
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| laly1
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OMG I thought i had the last edition ,but then i checked again amzaon and everywhere else but thats the only copy i found .
I also checked the FA web site and they listed on edition which is the 2nd edition published 2006 .
http://www.mhprofessional.com/product.php?isbn=00...
Tompat can you please tell where did you get your 4th edition and is itvery different than the 2nd one .
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.[96:1-5] Read! In the name of your Lord who created - Created the human from something which clings. Read! And your Lord is Most Bountiful - He who taught (the use of) the Pen, Taught the human that which he knew not.
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| tompat
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hey laly1, i m so sorry for the confusion, ur right it's the 2 nd edition only, my bad.
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| tompat
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hypercalcemia causes peripheral neuropathies , i dont know the why?
but if u think of hyperventilation then that shud coz respi. alkolosis, which shud be compensated by body by developing metabolic acidosis. this shud lower albumin's affinity for Ca. we need more light on this.
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| tompat
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as far as my step 1 knowledge goes, hyper ca shud decrease Na entry in nerve cells, which is necessary for nerve conduction, so shud b there alteration of nerve function.
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| champo
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Respiratory alkalosis is compensated in the body by loss of HCO3, body tries to react to these increased hco3 by loss ,trying to bring body back to neutral ,,though it hardly succeeds in bring hco3 to normal ,, BUT FOR SURE IT CAN T over-COMPENSATE IN A WAY WHERE IT WILL DECREASE BICARBONATES TO AN EXTENT THAT DISORDER WILL MOVE FROM RESPIRATORY ALKALOSIS TO METABOLIC ACIDOSIS.
KEEP ASKING IF U HAV MORE QUERIES ,,THANX
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| laly1
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In a case of RLQ abdominal pain weare not supposed to repeat painfull maneuver ,in the physical we should start with Inspection ,auscultaion, percussion ,paplation when we do palpation superficial then deep the patient might show pain should we proceed with palpation of deep organs and do rebound , because in both we will have to go to the RLQ again
my question is how should we proceed with the rest of the palpation
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.[96:1-5] Read! In the name of your Lord who created - Created the human from something which clings. Read! And your Lord is Most Bountiful - He who taught (the use of) the Pen, Taught the human that which he knew not.
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| tompat
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thanks champo
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