tag:blogger.com,1999:blog-56998929845166498742024-03-18T20:08:23.646-05:00icupearls.org ArchivePearls on Intensive Care Medicine Practice - Project "Critical Care A Day"
Unknownnoreply@blogger.comBlogger4020125tag:blogger.com,1999:blog-5699892984516649874.post-52822871344745975962024-03-18T09:18:00.021-05:002024-03-18T09:18:00.251-05:00SMI and CVD<div><div><b><i><span style="color: #990000;">Q:</span><span style="color: #0c343d;"> Individuals having schizophrenia are twice as likely to die from Cardio Vascular Disease (CVD).</span></i></b></div><div><b><i><span style="color: #0c343d;"><br /></span></i></b></div><div><b><i><span style="color: #0c343d;">A) True</span></i></b></div><div><b><i><span style="color: #0c343d;">B) False</span></i></b></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><b><span style="color: #990000;"><br /></span></b></div><div><b><span style="color: #990000;">Answer:</span><span style="color: #0c343d;"> A</span></b></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><strong style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; margin-bottom: 0pt; margin-top: 0pt;"><span style="color: #0c343d;">Patients with severe mental illness (SMI) usually have a lower lifespan of 15 to 25 years. And the most common cause is CVD. In this regard, schizophrenia has the worst prognosis. People with schizophrenia are twice as likely to die from CVD. The various reasons are drug-induced obesity leading to diabetes, a sedentary lifestyle, high blood pressure, increased tendency to smoke, poor nutrition, drug-induced dyslipidemia, and relatively less recognized QTc prolongation.</span></strong></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>#psychiatry</b></span></div><div><span style="color: #0c343d;"><b>#cardivascular</b></span></div><div><span style="color: #0c343d;"><br /></span></div><div><span style="color: #0c343d;"><br /></span></div><div><span style="color: #0c343d;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">References:</span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">1. Laursen TM, Nordentoft M, Mortensen PB. Excess early mortality in schizophrenia. Annu Rev Clin Psychol 2014; 10:425.</span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">2. Henderson DC, Nguyen DD, Copeland PM, et al. Clozapine, diabetes mellitus, hyperlipidemia, and cardiovascular risks and mortality: results of a 10-year naturalistic study. J Clin Psychiatry 2005; 66:1116.</span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">3. Brown S, Inskip H, Barraclough B. Causes of the excess mortality of schizophrenia. Br J Psychiatry 2000; 177:212.</span></div></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5699892984516649874.post-24193028171547618242024-03-17T08:55:00.005-05:002024-03-17T08:55:00.144-05:00Rhupus<div><b><i><span style="color: #990000;">Q:</span><span style="color: #274e13;"> Which patients usually get labeled as Rhupus?</span></i></b></div><div><b><span style="color: #990000;"><br /></span></b></div><div><b><span style="color: #990000;">Answer:</span><span style="color: #0c343d;"> Patients often have combined or overlapping features of Systemic Lupus Erythematosus (SLE) and Rheumatic Arthritis (RA). There are no objective criteria, either clinically and/or immunologically, to describe it as a distinct disease.</span></b></div><div><b><span style="color: #0c343d;"><br /></span></b></div><div><b><span style="color: #0c343d;">One of the clinical features that characterized these patients is erosive arthropathy, which is unlikely to present in SLE.</span></b></div><div><b><span style="color: #0c343d;"><br /></span></b></div><div><b><span style="color: #0c343d;"><br /></span></b></div><div><b><span style="color: #0c343d;">#rheumatology</span></b></div><div><span style="color: #0c343d;"><br /></span></div><div><span style="color: #0c343d;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">References:</span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">1. Antonini L, Le Mauff B, Marcelli C, Aouba A, de Boysson H. Rhupus: a systematic literature review. Autoimmun Rev. 2020 Sep;19(9):102612. doi: 10.1016/j.autrev.2020.102612. Epub 2020 Jul 12. PMID: 32668290.</span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="font-size: x-small;"><span style="color: #0c343d;">2. Upadhyaya S, Agarwal M, Upadhyaya A, Pathan</span><span style="color: #0c343d;">.</span><span style="color: #0c343d;">ia M, Dhar M. Rhupus Syndrome: A Diagnostic Dilemma. Cureus. 2022 Sep 11;14(9):e29018. doi: 10.7759/cureus.29018. PMID: 36249648; PMCID: PMC9550206.</span></span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">3. Ahsan H. Rhupus: dual rheumatic disease. J Immunoassay Immunochem. 2022 Mar 4;43(2):119-128. doi: 10.1080/15321819.2021.1941096. Epub 2021 Jul 6. PMID: 34228594<br /></span></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5699892984516649874.post-42034192887801465582024-03-16T09:07:00.029-05:002024-03-16T09:07:00.133-05:00ECG in acute pericarditis<div><div><b><i><span style="color: #990000;">Q: </span><span style="color: #274e13;">ST elevation on EKG in acute pericarditis is usually? (select one)</span></i></b></div><div><b><i><span style="color: #274e13;"><br /></span></i></b></div><div><b><i><span style="color: #274e13;">A) concave-up</span></i></b></div><div><b><i><span style="color: #274e13;">B) convex-up</span></i></b></div><div><b><span style="color: #990000;"><br /></span></b></div><div><b><span style="color: #990000;"><br /></span></b></div><div><b><span style="color: #990000;">Answer</span><span style="color: #0c343d;">: A</span></b></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>Although not a confirmed science but a great tool to remember that in acute pericarditis the ST elevation is usually present in all the leads in a concave-up manner. In contrast, ST elevation in myocardial infarction (MI) is usually limited to the affected area in a convex-up manner.</b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>EKG in acute pericarditis mostly evolves through four stages.</b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b><i>Stage 1 (hours to days) </i>- widespread ST elevation (typically concave up) with reciprocal ST depression in leads aVR and V1. There is also frequently an atrial current of injury, reflected by elevation of the PR segment in lead aVR and depression of the PR segment in other limb leads and in the left chest leads, primarily V5 and V6. Thus, the PR and ST segments typically change in opposite directions.<u> PR segment deviation is highly specific, though less sensitive</u>.</b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b><i>Stage 2 (first week)</i> - normalization of the ST and PR segments.</b></span></div><div><span style="color: #0c343d;"><b><i><br /></i></b></span></div><div><span style="color: #0c343d;"><b><i>Stage 3 (afterward)</i> - development of diffuse T-wave inversions.</b></span></div><div><span style="color: #0c343d;"><b><i><br /></i></b></span></div><div><span style="color: #0c343d;"><b><i>Stage 4 </i>- normalization of the EKG.</b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>#cardiology</b></span></div><div><span style="color: #0c343d;"><br /></span></div><div><span style="color: #0c343d;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">References:</span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">1. Sarda AK, Thute P. Importance of ECG in the Diagnosis of Acute Pericarditis and Myocardial Infarction: A Review Article. Cureus. 2022 Oct 24;14(10):e30633. doi: 10.7759/cureus.30633. PMID: 36426313; PMCID: PMC9683083.</span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">2. Liu YL, Lin CS, Cheng CC, Lin C. A Deep Learning Algorithm for Detecting Acute Pericarditis by Electrocardiogram. J Pers Med. 2022 Jul 15;12(7):1150. doi: 10.3390/jpm12071150. PMID: 35887647; PMCID: PMC9324403.</span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">3. Masek KP, Levis JT. ECG diagnosis: acute pericarditis. Perm J. 2013 Fall;17(4):e146. doi: 10.7812/TPP/13-044. PMID: 24361030; PMCID: PMC3854820.</span></div></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5699892984516649874.post-11400943816060471112024-03-11T18:35:00.000-05:002024-03-12T04:12:06.659-05:00Sialorrhea<div><div><b><i><span style="color: #990000;">Q</span><span style="color: #274e13;">: 66 years old male with metastatic lung cancer has been made comfort care in ICU. Patient is struggling with severe Sialorrhea (excess salivation). There is no response to glycopyrrolate. Botulinum toxin A (Botox) injection in salivary gland should be considered?</span></i></b></div><div><b><i><span style="color: #274e13;"><br /></span></i></b></div><div><b><i><span style="color: #274e13;">A) Yes</span></i></b></div><div><b><i><span style="color: #274e13;">B) No</span></i></b></div><div><b><i><span style="color: #274e13;"><br /></span></i></b></div><div><span style="color: #990000;"><b><br /></b></span></div><div><span><b><span style="color: #990000;">Answer:</span><span style="color: #0c343d;"> A</span></b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>Sialorrhea is a common problem with various centrally acting and neurological diseases such as amyotrophic lateral sclerosis (ALS), cerebral palsy, stroke, and Parkinson's disease. Patients with Alzheimer's disease or myasthenia gravis are usually prescribed drugs with reversible cholinesterase inhibitor activity, and develop excess salivation as a side effect.</b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>This can be distressing to patients as well as to the family. Also, it may lead to aspiration pneumonia. A few drugs which can be helpful are glycopyrrolate and scopolamine. In case of resistant sialorrhea intrasalivary gland injection of botulinum toxin A may be helpful. In extremely severe cases radiation to the parotid and submandibular glands could be considered. </b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>In the ICU, a portable suction device can be used.</b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>#palliative care</b></span></div><div><span style="color: #0c343d;"><br /></span></div><div><span style="color: #0c343d;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">References:</span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">1. Hugel H, Ellershaw J, Gambles M. Respiratory Tract Secretions in the Dying Patient: A Comparison between Glycopyrronium and Hyoscine Hydrobromide. J Palliat Med 2006; 9:279.</span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">2. Bennett M, Lucas V, Brennan M, et al. Using anti-muscarinic drugs in the management of death rattle: evidence-based guidelines for palliative care. Palliat Med 2002; 16:369.</span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">3. Hockstein NG, Samadi DS, Gendron K, Handler SD. Sialorrhea: a management challenge. Am Fam Physician 2004; 69:2628.</span></div></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5699892984516649874.post-55013881607777787742024-03-10T16:30:00.000-05:002024-03-12T04:13:25.243-05:00Anti-hypertensive Scleroderma Renal Crisis (SRC)<div><b><i><span style="color: #990000;">Q</span><span style="color: #274e13;">: Which of the following anti-hypertensive is relatively contraindicated in Scleroderma Renal Crisis (SRC)? (select one)</span></i></b></div><div><b><i><span style="color: #274e13;"><br /></span></i></b></div><div><b><i><span style="color: #274e13;">A) Labetalol </span></i></b></div><div><b><i><span style="color: #274e13;">B) Angiotensin-converting enzyme (ACE) inhibitors</span></i></b></div><div><b><i><span style="color: #274e13;">C) calcium channel blockers</span></i></b></div><div><b><span style="color: #990000;"><br /></span></b></div><div><b><span style="color: #990000;"><br /></span></b></div><div><b><span style="color: #990000;">Answer: </span><span style="color: #0c343d;">A</span></b></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>Scleroderma Renal Crisis (SRC) is one of the few rheumatological emergencies where early diagnosis and treatment can significantly affect the outcome. Wrong diagnosis may lead to wrong management pathway and eventually to a very high mortality. SRC is heralded with hypertensive crisis and is associated with acute renal failure. The pearl is to avoid IV Labetalol or nitroprusside and gradually decrease blood pressure with PO angiotensin-converting enzyme (ACE) inhibitors. calcium channel blockers may help. Renal dialysis is a last resort. Another important differential diagnosis is from SLE (renal). It has been suggested that the use of steroids is associated with the onset of scleroderma renal crisis.</b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>Labetalol is known to cause vasospasm at the microcirculatory level.</b></span></div><div><span style="color: #0c343d;"><br /></span></div><div><span style="color: #0c343d;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">References: </span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">1. Hudson M, Ghossein C, Steen V. Scleroderma renal crisis. Presse Med. 2021 Apr;50(1):104063. doi: 10.1016/j.lpm.2021.104063. Epub 2021 Feb 3. PMID: 33548376.</span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">2. Bose N, Chiesa-Vottero A, Chatterjee S. Scleroderma renal crisis. Semin Arthritis Rheum. 2015 Jun;44(6):687-94. doi: 10.1016/j.semarthrit.2014.12.001. Epub 2014 Dec 11. PMID: 25613774.</span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">3. Foocharoen C, Tonsawan P, Pongkulkiat P, Anutrakulchai S, Mahakkanukrauh A, Suwannaroj S. Management review of scleroderma renal crisis: An update with practical pointers. Mod Rheumatol. 2023 Jan 3;33(1):12-20. doi: 10.1093/mr/roac028. PMID: 35349704.</span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">4. Nagaraja V. Management of scleroderma renal crisis. Curr Opin Rheumatol. 2019 May;31(3):223-230. doi: 10.1097/BOR.0000000000000604. PMID: 30870219.<br /></span></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5699892984516649874.post-5512843645399607722024-03-10T13:26:00.034-05:002024-03-10T13:26:00.135-05:00Fournier's Gangrene<b><i><span style="color: #990000;">Q:</span><span style="color: #274e13;"> Which gender is more to get Fournier gangrene? (select one) </span></i></b><div><b><i><span style="color: #274e13;"><br /></span></i></b></div><div><b><i><span style="color: #274e13;">A) Males </span></i></b></div><div><b><i><span style="color: #274e13;">B) Females </span></i></b></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><b><span style="color: #990000;"><br /></span></b></div><div><b><span style="color: #990000;"> Answer: </span><span style="color: #0c343d;">A </span></b></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><p style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; color: #0e101a; margin-bottom: 0pt; margin-top: 0pt;"><strong style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; margin-bottom: 0pt; margin-top: 0pt;">Necrotizing fasciitis of the perineum is called Fournier gangrene. It is vital to know that Fournier gangrene occurs when there is a breach in the integrity of the gastrointestinal (GI) or genital-urethral (GU) mucosa. This basic understanding is essential to comprehend the urgency and polymicrobial nature of the disease. </strong></p><p style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; color: #0e101a; margin-bottom: 0pt; margin-top: 0pt;"><br /></p><p style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; color: #0e101a; margin-bottom: 0pt; margin-top: 0pt;"><strong style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; margin-bottom: 0pt; margin-top: 0pt;">This breach in the mucosa of GI or GU symptomatically begins abruptly with severe pain, usually rapidly reaching the anterior abdominal wall and gluteal muscles. This classic presentation makes life easier for clinicians to keep a low threshold to involve surgical service way early in the process. Men are more commonly affected with scrotal and penile involvement. </strong></p></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>#ID </b></span></div><div><span style="color: #0c343d;"><b>#surgical-critical-care</b></span></div><div><span style="color: #0c343d;"><br /></span></div><div><span style="color: #0c343d;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;"> References: </span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;"> 1. Singh A, Ahmed K, Aydin A, Khan MS, Dasgupta P. Fournier's gangrene. A clinical review. Arch Ital Urol Androl. 2016 Oct 5;88(3):157-164. doi: 10.4081/aiua.2016.3.157. PMID: 27711086. </span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;"> 2. Stephens BJ, Lathrop JC, Rice WT, Gruenberg JC. Fournier's gangrene: historic (1764-1978) versus contemporary (1979-1988) differences in etiology and clinical importance. Am Surg 1993; 59:149. </span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;"> 3. Huayllani MT, Cheema AS, McGuire MJ, Janis JE. Practical Review of the Current Management of Fournier's Gangrene. Plast Reconstr Surg Glob Open. 2022 Mar 14;10(3):e4191. doi: 10.1097/GOX.0000000000004191. PMID: 35295879; PMCID: PMC8920302.</span><div><br /></div></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5699892984516649874.post-10105419264847377292024-03-09T08:17:00.017-06:002024-03-09T08:17:00.127-06:00Characteristic finding of CSF In GBS <div><div><b><i><span style="color: #990000;">Q:</span><span style="color: #274e13;"> What is the characteristic finding in CSF in Guillain–Barré syndrome (GBS)?</span></i></b></div><div><b><span style="color: #990000;"><br /></span></b></div><div><b><span style="color: #990000;"><br /></span></b></div><div><b><span style="color: #990000;">Answer: </span><span style="color: #0c343d;">Albumino-cytological dissociation</span></b></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>In Guillain–Barré syndrome, cerebrospinal fluid (CSF) shows characteristic findings of albumin-cytological dissociation. It is considered as a diagnostic hallmark. In contrast to infectious causes, there is an elevated protein level (100–1000 mg/dl), without pleocytosis. An increased white blood cell count may indicate an alternative diagnosis, probably an infection.</b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>#neurology</b></span></div><div><span style="color: #0c343d;"><b>#procedures</b></span></div><div><span style="color: #0c343d;"><br /></span></div><div><span style="color: #0c343d;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">References:</span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">1. Rath J, Zulehner G, Schober B, Grisold A, Krenn M, Cetin H, Zimprich F. Cerebrospinal fluid analysis in Guillain-Barré syndrome: value of albumin quotients. J Neurol. 2021 Sep;268(9):3294-3300. doi: 10.1007/s00415-021-10479-9. Epub 2021 Mar 2. PMID: 33651153; PMCID: PMC8357680.</span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">2. Vargas-Cañas ES, Galnares-Olalde JA, León-Velasco F, García-Grimshaw M, Gutiérrez A, López-Hernández JC. Prognostic Implications of Early Albuminocytological Dissociation in Guillain-Barré Syndrome. Can J Neurol Sci. 2023 Sep;50(5):745-750. doi: 10.1017/cjn.2022.288. Epub 2022 Aug 18. PMID: 35979659.</span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">3. Illes Z, Blaabjerg M. Cerebrospinal fluid findings in Guillain-Barré syndrome and chronic inflammatory demyelinating polyneuropathies. Handb Clin Neurol. 2017;146:125-138. doi: 10.1016/B978-0-12-804279-3.00009-5. PMID: 29110767.</span></div></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5699892984516649874.post-72200720885429156772024-03-08T06:17:00.001-06:002024-03-08T06:17:00.126-06:00Erythrocytosis and smoking.<div><div><b><i><span style="color: #990000;">Q:</span><span style="color: #274e13;"> Erythrocytosis resolves with the cessation of smoking.</span></i></b></div><div><b><i><span style="color: #274e13;"><br /></span></i></b></div><div><b><i><span style="color: #274e13;">A) Yes</span></i></b></div><div><b><i><span style="color: #274e13;">B) No</span></i></b></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><b><span style="color: #990000;"><br /></span></b></div><div><b><span style="color: #990000;">Answer: </span><span style="color: #0c343d;">A</span></b></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>It is a well-known fact erythrocytosis and consequently, polycythemia is common in smokers. One of the pearls that often get missed in teaching smokers to quit is that one of the benefits of smoking cessation is the resolution of polycythemia and lesser risks from all its associated effects such as stroke other vascular thrombosis like DVT.</b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>#hematology</b></span></div><div><span style="color: #0c343d;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">References:</span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">1. Smith JR, Landaw SA. Smokers' polycythemia. N Engl J Med 1978; 298:6.</span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">2. Aitchison R, Russell N. Smoking--a major cause of polycythaemia. J R Soc Med 1988; 81:89.</span></div></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5699892984516649874.post-35628981293333959822024-03-07T00:30:00.002-06:002024-03-07T09:17:39.798-06:00Adjunct Rx of behavioral effects due to levetiracetam<div><div><i><b><span style="color: #990000;">Q:</span><span style="color: #274e13;"> Which adjuvant treatment may take care of some of the central effects of Levetiracetam?</span></b></i></div><div><b><span style="color: #990000;"><br /></span></b></div><div><b><span style="color: #990000;"><br /></span></b></div><div><b><span style="color: #990000;">Answer: </span><span style="color: #0c343d;">Vitamin B6 (Pyridoxin)</span></b></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>Levetiracetam (Keppra) may have central effects like depression, hallucinations, irritability, anger, suicidal thoughts, seizures, double vision, etc. Pyridoxine (vitamin B6) may curtail some of the central symptoms. These side effects can be particularly pronounced in the elderly population.</b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>#neurology</b></span></div><div><span style="color: #0c343d;"><b>#pharmacology</b></span></div><div><span style="color: #0c343d;"><br /></span></div><div><span style="color: #0c343d;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">References:</span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">1. Dreischmeier E, Zuloaga A, Kotloski RJ, Karasov AO, Gidal BE. Levetiracetam-associated irritability and potential role of vitamin B6 use in veterans with epilepsy. Epilepsy Behav Rep. 2021 May 3;16:100452. doi: 10.1016/j.ebr.2021.100452. PMID: 34142077; PMCID: PMC8188361.</span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">2. Besag FMC, Vasey MJ, Sen A. Current evidence for adjunct pyridoxine (vitamin B6) for the treatment of behavioral adverse effects associated with levetiracetam: A systematic review. Epilepsy Behav. 2023 Mar;140:109065. doi: 10.1016/j.yebeh.2022.109065. Epub 2023 Feb 13. PMID: 36791631.</span></div></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5699892984516649874.post-29919636169699537422024-03-06T08:36:00.024-06:002024-03-06T08:36:00.137-06:00Benzodiazepines as antiemetics<div><div><b><i><span style="color: #990000;">Q:</span><span style="color: #274e13;"> Benzodiazepines are relatively strong antiemetic agents and are less utilized for this purpose.</span></i></b></div><div><b><i><span style="color: #274e13;"><br /></span></i></b></div><div><b><i><span style="color: #274e13;">A) True</span></i></b></div><div><b><i><span style="color: #274e13;">B) False</span></i></b></div><div><b><span style="color: #990000;"><br /></span></b></div><div><b><span style="color: #990000;"><br /></span></b></div><div><b><span style="color: #990000;">Answer: </span><span style="color: #0c343d;">B</span></b></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>The benzodiazepines are weak antiemetic agents. Although it has been used for this purpose, particularly in Chemotherapy-Induced Nausea and Vomiting (CINV), most of its benefits are from reducing anticipatory emesis.</b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>They can be best utilized in combination with other effective anti-emetic dexamethasone and metoclopramide in CINV to reduce anxiety-associated nausea and vomiting.</b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>#GI</b></span></div><div><span style="color: #0c343d;"><b>#pharmacology</b></span></div><div><span style="color: #0c343d;"><br /></span></div><div><span style="color: #0c343d;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">References:</span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">1. Bowcock SJ, Stockdale AD, Bolton JA, et al. Antiemetic prophylaxis with high dose metoclopramide or lorazepam in vomiting induced by chemotherapy. Br Med J (Clin Res Ed) 1984; 288:1879.</span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">2. Kris MG, Gralla RJ, Clark RA, et al. Antiemetic control and prevention of side effects of anti-cancer therapy with lorazepam or diphenhydramine when used in combination with metoclopramide plus dexamethasone. A double-blind, randomized trial. Cancer 1987; 60:2816.</span></div></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5699892984516649874.post-14823017198941107782024-03-05T08:13:00.027-06:002024-03-05T08:13:00.137-06:00Cachexia and sarcopenia<div><div><b><i><span style="color: #990000;">Q</span><span style="color: #274e13;">: What is the difference between sarcopenia and cachexia?</span></i></b></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><b><span style="color: #990000;">Answer:</span></b></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>Cachexia is generally defined as weight loss due to loss of muscle mass. Although it is universally associated with fat loss, it is not required.</b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>Sarcopenia is characterized by loss of muscle mass, strength, and performance. It does not necessarily result in overall weight loss like muscle loss in obesity, known as sarcopenic obesity. By core definition, it is defined as loss of skeletal muscle mass, two standard deviations below sex-specific normal values for young adults. Sarcopenia may occur due to various underlying reasons such as disuse, changing endocrine function, underlying chronic diseases, inflammation, insulin resistance, nutritional deficiencies, and cancer treatment.</b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>#musculoskeletal</b></span></div><div><span style="color: #0c343d;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">References:</span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">1. Baumgartner RN, Koehler KM, Gallagher D, et al. Epidemiology of sarcopenia among the elderly in New Mexico. Am J Epidemiol 1998; 147:755.</span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">2. Kotler DP. Cachexia. Ann Intern Med. 2000 Oct 17;133(8):622-34. doi: 10.7326/0003-4819-133-8-200010170-00015. PMID: 11033592.</span></div></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><span style="color: #0c343d; font-size: x-small;">3. Ardeljan AD, Hurezeanu R. Sarcopenia. 2023 Jul 4. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 32809648.</span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5699892984516649874.post-65838058076055291812024-03-04T09:11:00.019-06:002024-03-04T09:11:00.122-06:00Factors predictive of corticosteroid psychosis in patients with SLE<div><div><b><i><span style="color: #990000;">Q:</span><span style="color: #274e13;"> 34 years old female with a history of lupus and on home steroids is admitted to ICU with severe psychosis. Which of the following is a risk factor for glucocorticoid-induced psychosis in Systemic lupus erythematosus (SLE)? (select one)</span></i></b></div><div><b><i><span style="color: #274e13;"><br /></span></i></b></div><div><b><i><span style="color: #274e13;">A) Hyperalbuminemia</span></i></b></div><div><b><i><span style="color: #274e13;">B) Hypoalbuminemia </span></i></b></div><div><b><span style="color: #990000;"><br /></span></b></div><div><b><span style="color: #990000;"><br /></span></b></div><div><b><span style="color: #990000;">Answer: </span><span style="color: #0c343d;">B</span></b></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>Psychosis in lupus is well-known. The most difficult part is to identify whether this psychosis is a direct manifestation of the disease itself or is due to the high glucocorticoid dose, prevalent for treatment in SLE. One of the underlying factors that may help to identify the cause of psychosis in this patient population is hypoalbuminemia, which may be a risk factor for glucocorticoid-induced psychosis in patients with SLE.</b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>#rheumatology</b></span></div><div><span style="color: #0c343d;"><b>#psychiatry</b></span></div><div><span style="color: #0c343d;"><b>#pharmacology</b></span></div><div><span style="color: #0c343d;"><b>#neurology</b></span></div><div><span style="color: #0c343d;"><br /></span></div><div><span style="color: #0c343d;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">Reference:</span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">Chau SY, Mok CC. Factors predictive of corticosteroid psychosis in patients with systemic lupus erythematosus. Neurology 2003; 61:104.</span></div></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5699892984516649874.post-10949957875133020652024-03-03T02:00:00.000-06:002024-03-03T13:09:54.561-06:00Boas' sign<div><b><i><span style="color: #990000;">Q: </span><span style="color: #274e13;">What is Boas' sign?</span></i></b></div><div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><b><span style="color: #990000;"><br /></span></b></div><div><b><span style="color: #990000;">Answer:</span><span style="color: #0c343d;"> Boas's sign is hyperaesthesia below the right scapula in acute cholecystitis. It has also been described as 'point tenderness' in the region to the right of the 10th to 12th thoracic vertebrae. Boas' sign can also be present in the stomach and duodenal disease.</span></b></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><b style="color: #0c343d;">The objective of asking this question is that clinical signs in acute cholecystitis can be tricky and no single clinical finding (like the famous Murphy's sign) carries sufficient weight to establish or exclude acute cholecystitis without further testing.</b></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>#hepatology</b></span></div><div><span style="color: #0c343d;"><b>#physical-exam</b></span></div><div><br /></div><div><br /></div><div><span style="color: #0c343d; font-size: x-small;">References:</span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">1. Iyer HV. Boas' sign revisited. Ir J Med Sci. 2011 Mar;180(1):301. doi: 10.1007/s11845-010-0640-x. Epub 2010 Nov 18. PMID: 21086060.</span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">2. Gunn A, Keddie N. Some clinical observations on patients with gallstones. Lancet 1972;2:230-241</span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">3. Trowbridge, RL; Rutkowski, NK; Shojania, KG (1 January 2003). "Does this patient have acute cholecystitis?". JAMA. 289 (1): 80–6.</span></div></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5699892984516649874.post-86922903701472330362024-03-02T01:00:00.000-06:002024-03-02T07:59:42.849-06:00CRD<div><span style="font-family: inherit;"><b><i><span style="color: #990000;">Q: </span><span style="color: #274e13;">As per consensus-based guidelines from an academic panel (2004), 'death' is considered a grade in the management of chemotherapy-related diarrhea (CRD).</span></i></b></span></div><div><span style="color: #274e13; font-family: inherit;"><b><i><br /></i></b></span></div><div><span style="color: #274e13; font-family: inherit;"><b><i>A) True</i></b></span></div><div><span style="color: #274e13; font-family: inherit;"><b><i>B) False</i></b></span></div><div><span style="color: #0c343d; font-family: inherit;"><b><br /></b></span></div><div><span style="color: #0c343d; font-family: inherit;"><b><br /></b></span></div><div><span style="font-family: inherit;"><b><span style="color: #990000;">Answer</span><span style="color: #0c343d;">: A</span></b></span></div><div><span style="color: #0c343d; font-family: inherit;"><b><br /></b></span></div><div><span style="color: #0c343d; font-family: inherit;"><b>As per consensus-based guidelines from an academic panel convened to address the management of CRD in 2004, there were five grades of diarrhea.</b></span></div><div><span style="color: #0c343d; font-family: inherit;"><b><br /></b></span></div><div><span style="color: #0c343d; font-family: inherit;"><b>Grade 1<span style="white-space: pre;"> </span>- Increase of <4 stools per day over baseline; mild increase in ostomy output compared with baseline</b></span></div><div><span style="color: #0c343d; font-family: inherit;"><b><br /></b></span></div><div><span style="color: #0c343d; font-family: inherit;"><b>Grade 2<span style="white-space: pre;"> </span>- Increase of four to six stools per day over baseline; moderate increase in ostomy output compared with baseline; limiting instrumental activities of daily living (ADL).</b></span></div><div><span style="color: #0c343d; font-family: inherit;"><b><br /></b></span></div><div><span style="color: #0c343d; font-family: inherit;"><b>Grade 3<span style="white-space: pre;"> </span>- Increase of seven or more stools per day over baseline; hospitalization indicated; severe increase in ostomy output compared with baseline; limiting self-care ADL.</b></span></div><div><span style="color: #0c343d; font-family: inherit;"><b> </b></span></div><div><span style="color: #0c343d; font-family: inherit;"><b>Grade 4 - Life-threatening consequences; urgent intervention indicated<span style="white-space: pre;"> </span></b></span></div><div><span style="color: #0c343d; font-family: inherit;"><b> </b></span></div><div><span style="color: #0c343d; font-family: inherit;"><b>Grade 5 - Death</b></span></div><div><span style="color: #0c343d; font-family: inherit;"><b> </b></span></div><div><b style="color: #0c343d; font-family: inherit;"> It was advised to divide CRD into two categories</b><b style="color: #0c343d; font-family: inherit;"> </b></div><div><ul style="text-align: left;"><li><span style="color: #0c343d; font-family: inherit;"><b> "uncomplicated" (Grade 1 or 2)</b></span></li><li><span style="color: #0c343d; font-family: inherit;"><b> "complicated." - all above grades</b></span><b style="color: #0c343d; font-family: inherit;"> </b></li></ul></div><div><span style="color: #0c343d; font-family: inherit;"><b> </b></span></div><div><span style="color: #0c343d; font-family: inherit;"><b> #GI</b></span></div><div><span style="color: #0c343d; font-family: inherit;"><b> #oncology</b></span></div><div><span style="font-family: inherit;"> </span></div><div><span style="font-family: inherit;"> </span></div><div><span style="font-family: inherit;"> </span></div><div><span style="font-size: small;"><span style="font-family: inherit;">References:</span></span></div><div><span style="font-family: inherit; font-size: x-small;"> </span></div><div><span style="font-size: small;"><span style="font-family: inherit;"> 1. Benson AB 3rd, Ajani JA, Catalano RB, et al. Recommended guidelines for the treatment of cancer treatment-induced diarrhea. J Clin Oncol 2004; 22:2918.</span></span></div><div><span style="font-family: inherit; font-size: x-small;"> </span></div><div><span style="font-family: inherit; font-size: x-small;">2. National Institutes of Health, National Cancer Institute. Available at: <a href="https://ctep.cancer.gov/protocoldevelopment/electronic_applications/docs/CTCAE_v5_Quick_Reference_8.5x11.pdf">https://ctep.cancer.gov/protocoldevelopment/electronic_applications/docs/CTCAE_v5_Quick_Reference_8.5x11.pdf</a> (Accessed February 27, 2024).</span></div><div> <br /></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5699892984516649874.post-9566066777423985562024-03-01T14:00:00.020-06:002024-03-01T14:00:00.135-06:00Asplenia and neutrophils<div><div><b><i><span style="color: #990000;">Q:</span><span style="color: #274e13;"> Asplenia tends to cause? (select one)</span></i></b></div><div><b><i><span style="color: #274e13;"><br /></span></i></b></div><div><b><i><span style="color: #274e13;">A) neutrophilia</span></i></b></div><div><b><i><span style="color: #274e13;">B) neutropenia</span></i></b></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><b><span style="color: #990000;"><br /></span></b></div><div><b><span style="color: #990000;">Answer</span><span style="color: #0c343d;">: A</span></b></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>Asplenia may occur due to various reasons including splenectomy and auto-infarction. Asplenia leads to an exaggerated response to either infection or inflammation which includes both neutrophilia and thrombocytosis. Differential diagnosis can be made by the presence of Howell-Jolly bodies or nucleated red blood cells.</b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>#hematology</b></span></div><div><span style="color: #0c343d;"><b>#surgical-critical-care</b></span></div><div><span style="color: #0c343d;"><br /></span></div><div><span style="color: #0c343d;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">References:</span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">1. McBride JA, Dacie JV, Shapley R. The effect of splenectomy on the leucocyte count. Br J Haematol 1968; 14:225.</span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">2. Tahir N, Zahra F. Neutrophilia. [Updated 2023 Apr 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK570571/</span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">3. Spencer RP, McPhedran P, Finch SC, Morgan WS. Persistent neutrophilic leukocytosis associated with idiopathic functional asplenia. J Nucl Med 1972; 13:224.</span></div></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5699892984516649874.post-19263275109489679642024-02-29T01:30:00.014-06:002024-02-29T01:30:00.125-06:00Adenosine Stress Test<div><div><b><i><span style="color: #990000;">Q: </span><span style="color: #274e13;">What is the mechanism behind using Adenosine for chemical stress test?</span></i></b></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><b><span style="color: #990000;">Answer:</span><span style="color: #0c343d;"> Adenosine causes vasodilation in the small and medium-sized arterioles (less than 100 µm in diameter). When adenosine is administered, it causes a coronary steal phenomenon, where the vessels in healthy tissue dilate as much as the ischemic tissue, and more blood is shunted away from the ischemic tissue that needs it most. This is the principle behind adenosine stress testing.
</span></b></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>Adenosine is quickly broken down by adenosine deaminase, which is present in red cells and the vessel wall.</b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>#cardiolgy</b></span></div><div><span style="color: #0c343d;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">References:</span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">1. Müller-Suur R, Eriksson SV, Strandberg LE, Mesko L. Comparison of adenosine and exercise stress test for quantitative perfusion imaging in patients on beta-blocker therapy. Cardiology. 2001;95(2):112-8. doi: 10.1159/000047356. PMID: 11423717.</span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">2. Alzahrani T, Khiyani N, Zeltser R. Adenosine SPECT Thallium Imaging. 2022 Sep 12. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 30725755.</span></div></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5699892984516649874.post-2427434202487577962024-02-28T08:49:00.000-06:002024-02-28T08:49:00.150-06:00 Adult testicular torsion<div><div><b><i><span style="color: #990000;">Q:</span><span style="color: #274e13;"> 19 years old college student presented to the Emergency Room with acute scrotal pain. The surgical ICU team has been called. Testicular torsion is suspected. In testicular torsion cremasteric reflex would be? (select one)</span></i></b></div><div><b><i><span style="color: #274e13;"><br /></span></i></b></div><div><b><i><span style="color: #274e13;">A) positive</span></i></b></div><div><b><i><span style="color: #274e13;">B) negative</span></i></b></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><b><span style="color: #990000;"><br /></span></b></div><div><b><span style="color: #990000;">Answer</span><span style="color: #0c343d;">: B</span></b></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>The cremasteric reflex is incited by stroking the ipsilateral thigh of the troubled site of the testis. If the testis does not pull up, the test is considered negative, and a presumptive diagnosis of testicular torsion should be made. Another important aspect of a physical exam in testicular torsion is to look for bell clapper deformity with a high-riding testis. Profound testicular swelling is very common. Diagnosis should be confirmed with scrotal ultrasound as soon as possible since testicular torsion is a urologic emergency. </b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>A delay of a few hours may cause testicular nonviability up to the extent that if a surgical route is not available, manual detorsion should be performed.</b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>#urology</b></span></div><div><span style="color: #0c343d;"><b>#surgical-critical-care</b></span></div><div><span style="color: #0c343d;"><br /></span></div><div><span style="color: #0c343d;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">References:</span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">1. Rabinowitz R. The importance of the cremasteric reflex in acute scrotal swelling in children. J Urol 1984; 132:89.</span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">2. Kutikov A, Casale P, White MA, et al. Testicular compartment syndrome: a new approach to conceptualizing and managing testicular torsion. Urology 2008; 72:786.</span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">3. Cummings JM, Boullier JA, Sekhon D, Bose K. Adult testicular torsion. J Urol 2002; 167:2109.</span></div></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5699892984516649874.post-25778808966617075342024-02-26T00:30:00.015-06:002024-02-26T00:30:00.136-06:00Dry purpura and wet purpura.<div><div><span><b><i><span style="color: #990000;">Q: </span><span style="color: #274e13;">Dry purpura is more pathognomonic than wet purpura.</span></i></b></span></div><div><span style="color: #274e13;"><b><i><br /></i></b></span></div><div><span style="color: #274e13;"><b><i>A) True</i></b></span></div><div><span style="color: #274e13;"><b><i>B) False</i></b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span><b><span style="color: #990000;">Answer</span><span style="color: #0c343d;">: B</span></b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>Purpura is defined as coalesced petechiae, which are small, flat, red, and discrete areas of bleeding.</b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>Dry purpura usually means purpura in the skin, and wet purpura means hemorrhagic blisters in mucous membranes. The most common cause is thrombocytopenia. Wet purpura is the most predictive of severe bleeding.</b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>Purpura due to vasculitis is usually palpable and may be pruritic, and the distribution does not follow dependent areas.</b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>#physical-exam</b></span></div><div><span style="color: #0c343d;"><b>#dermatology</b></span></div><div><span style="color: #0c343d;"><b>#hematology</b></span></div><div><span style="color: #0c343d;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">References:</span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">1. Mishra K, Jandial A, Malhotra P, Varma N. Wet purpura: a sinister sign in thrombocytopenia. BMJ Case Rep. 2017 Sep 1;2017:bcr2017222008. doi: 10.1136/bcr-2017-222008. PMID: 28864561; PMCID: PMC5589040.</span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">2. Crosby WH. Editorial: Wet purpura, dry purpura. JAMA. 1975 May 19;232(7):744-5. doi: 10.1001/jama.232.7.744. PMID: 1173178.</span></div></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5699892984516649874.post-50156141830105799342024-02-24T23:30:00.000-06:002024-02-25T08:19:13.703-06:00QTc risk factors<div><b><i><span style="color: #990000;">Q: </span><span style="color: #274e13;">43 years old patient is started in ICU on Quetiapine for possible delirium. The patient is noted to have progressive prolongation of QTc on EKG. Which gender is more prone to have Torsade de pointes (TdP)? (select one)</span></i></b></div><div><b><i><span style="color: #274e13;"><br /></span></i></b></div><div><b><i><span style="color: #274e13;">A) Male</span></i></b></div><div><b><i><span style="color: #274e13;">B) Female</span></i></b></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><b><span style="color: #990000;"><br /></span></b></div><div><b><span style="color: #990000;">Answer:</span><span style="color: #0c343d;"> B</span></b></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>There are multiple risk factors for drug-induced TdP. The more risk factors, the more the chances of prolonged QTc degenerating into TdP. Out of all the risk factors, being a female gender carries the highest risk. Risk factors in line of descent include:</b></span></div><div><ul style="text-align: left;"><li><span style="color: #0c343d;"><b>Female sex </b></span></li><li><span style="color: #0c343d;"><b>History of heart disease </b></span></li><li><span style="color: #0c343d;"><b>Concurrent use of two QT-prolonging drug</b></span></li><li><span style="color: #0c343d;"><b>Hypokalemia</b></span></li><li><span style="color: #0c343d;"><b>High drug dose </b></span></li><li><span style="color: #0c343d;"><b>Prior history of Long QTc </b></span></li></ul></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>#cardiology</b></span></div><div><span style="color: #0c343d;"><br /></span></div><div><span style="color: #0c343d;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">References:</span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">1. Drew BJ, Ackerman MJ, Funk M, et al. Prevention of torsade de pointes in hospital settings: a scientific statement from the American Heart Association and the American College of Cardiology Foundation. Circulation 2010; 121:1047.</span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">2. Drici MD, Knollmann BC, Wang WX, Woosley RL. Cardiac actions of erythromycin: influence of female sex. JAMA 1998; 280:1774.</span></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5699892984516649874.post-83196281725572008402024-02-24T00:30:00.000-06:002024-02-24T00:30:00.239-06:00Nitrates MOA<div><b><i><span style="color: #990000;">Q: </span><span style="color: #274e13;">Anti-anginal effects of nitrates are primarily due to? (select one)</span></i></b></div><div><b><i><span style="color: #274e13;"><br /></span></i></b></div><div><b><i><span style="color: #274e13;">A) coronary vasodilatation</span></i></b></div><div><b><i><span style="color: #274e13;">B) systemic vasodilation </span></i></b></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><b><span style="color: #990000;"><br /></span></b></div><div><b><span style="color: #990000;">Answer: </span><span style="color: #0c343d;">B</span></b></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>Nitrates are probably one of the oldest but still the first line of drugs for the relief of angina pectoris since last more than 150 years.</b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>Although nitrates indeed vasodilate coronaries the primary anti-anginal effect is systemic vasodilation which reduces the left ventricular systolic wall stress. Nitrates are primarily venodilators, and have a modest arteriolar vasodilator effect. </b></span><b style="color: #0c343d;">They have a synergetic effect when used with beta-blockers or calcium channel blockers.</b></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>Clinicians should stay aware that if a patient is hypovolemic, (s)he may have a precipitate drop in blood pressure due to arteriolar vasodilatation.</b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>Nitrates may have some coronary effect by reversing coronary vasospasm, and indirectly improve subendocardial blood flow in synergism with decreased left ventricular end-diastolic pressure due to its systemic venous dilatation. Nitrates may also lower the resistance to collateral vessel blood flow.</b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>It is less known that nitrates also have antiplatelet and antithrombotic characteristics.</b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>#cardiology</b></span></div><div><span style="color: #0c343d;"><b>#pharmacology</b></span></div><div><span style="color: #0c343d;"><br /></span></div><div><span style="color: #0c343d;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">References:</span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">1. Murrell W. Nitro-glycerine as a remedy for angina pectoris. Lancet 1879; 1:80.</span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">2. Gibbons RJ, Abrams J, Chatterjee K, et al. ACC/AHA 2002 guideline update for the management of patients with chronic stable angina www.acc.org/qualityandscience/clinical/statements.htm (Accessed on August 24, 2006).</span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">3. Abrams J. Hemodynamic effects of nitroglycerin and long-acting nitrates. Am Heart J 1985; 110:216.</span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">4. Knight CJ, Panesar M, Wilson DJ, et al. Different effects of calcium antagonists, nitrates, and beta-blockers on platelet function. Possible importance for the treatment of unstable angina. Circulation 1997; 95:125.</span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">5. Loscalzo J. Antiplatelet and antithrombotic effects of organic nitrates. Am J Cardiol 1992; 70:18B.</span></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5699892984516649874.post-89494417681229248522024-02-23T00:30:00.019-06:002024-02-23T00:30:00.132-06:00ETT diameter<div><div><b><i><span style="color: #274e13;">Q; Size of an Endotracheal Tube (ETT) represents? (choose one)</span></i></b></div><div><b><i><span style="color: #274e13;"><br /></span></i></b></div><div><b><i><span style="color: #274e13;">A) Internal diameter of ETT</span></i></b></div><div><b><i><span style="color: #274e13;">B) External diameter of ETT</span></i></b></div><div><b><span style="color: #990000;"><br /></span></b></div><div><b><span style="color: #990000;"><br /></span></b></div><div><b><span style="color: #990000;">Answer: </span><span style="color: #0c343d;">B</span></b></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>The “size” of an ET tube refers to its internal diameter. </b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>A “size 7 ” ET tube, means one with an internal diameter of 7 mm. ET tubes are usually labeled as ID (internal diameter) and OD (outside diameter).</b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>#procedures</b></span></div><div><span style="color: #0c343d;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">References:</span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">1. Haas CF, Eakin RM, Konkle MA, Blank R. Endotracheal tubes: old and new. Respir Care. 2014 Jun;59(6):933-52; discussion 952-5. doi: 10.4187/respcare.02868. PMID: 24891200.</span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">2. Esianor BI, Campbell BR, Casey JD, Du L, Wright A, Steitz B, Semler MW, Gelbard A. Endotracheal Tube Size in Critically Ill Patients. JAMA Otolaryngol Head Neck Surg. 2022 Sep 1;148(9):849-853. doi: 10.1001/jamaoto.2022.1939. PMID: 35900743; PMCID: PMC9335245.</span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">3. Ahmed RA, Boyer TJ. Endotracheal Tube. [Updated 2023 Jul 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539747/</span></div></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5699892984516649874.post-89201417274112346782024-02-22T02:00:00.029-06:002024-02-22T02:00:00.137-06:00calcitonin in severe hypercalcemia<div><b><i><span style="color: #990000;">Q</span><span style="color: #274e13;">: 48 years old male with known metastatic lung cancer is admitted to ICU with severe hypercalcemia of 16.3 mg/dL. The patient appears to be very vasculopath and the patient arrived from the ER with one peripheral IV, which also appears to be infiltrated now. Which route would be more efficacious to administer Calcitonin at this point? (select one)</span></i></b></div><div><b><i><span style="color: #274e13;"><br /></span></i></b></div><div><b><i><span style="color: #274e13;">A) subcutaneous</span></i></b></div><div><b><i><span style="color: #274e13;">B) intra-nasal </span></i></b></div><div><b><span style="color: #990000;"><br /></span></b></div><div><b><span style="color: #990000;"><br /></span></b></div><div><b><span style="color: #990000;">Answer:</span><span style="color: #0c343d;"> A</span></b></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>Intra-nasal Calcitonin is usually not effective. Even if a good IV line is available, the best route to administer calcitonin is either </b></span><b style="color: #0c343d;">intramuscularly (IM) or subcutaneously (SC). The patient can be either calcitonin responsive or not. The initial dose is 4 units/kg. If the patient is responsive, the calcium level should decrease in the next 6 hours by 1 to 2 mg/dL. If the patient is responsive, the total further course is every 12 hours for the next 24 to 48 hours till the calcium level drops to a desirable level. </b></div><div><b style="color: #0c343d;"><br /></b></div><div><b style="color: #0c343d;">If the patient appears unresponsive or partially responsive, the dose can be increased to 8 units/kg every 6 to 12 hours, for the next 24 to 48 hours. Simultaneous standard management of hypercalcemia with IV hydration should be pursued.</b></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>After 48 hours body develops tachyphylaxis due to receptor downregulation. </b></span><b style="color: #0c343d;">The mechanism of action is dual i.e., via renal excretion of calcium and by decreasing bone resorption.</b></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>#electrolytes</b></span></div><div><span style="color: #0c343d;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">References:</span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">1. Chevallier B, Peyron R, Basuyau JP, et al. [Human calcitonin in neoplastic hypercalcemia. Results of a prospective randomized trial]. Presse Med 1988; 17:2375.</span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">2. Kiriakopoulos A, Giannakis P, Menenakos E. Calcitonin: current concepts and differential diagnosis. Ther Adv Endocrinol Metab. 2022 May 21;13:20420188221099344. doi: 10.1177/20420188221099344. PMID: 35614985; PMCID: PMC9125613.</span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">3. Walker MD, Shane E. Hypercalcemia: A Review. JAMA. 2022 Oct 25;328(16):1624-1636. doi: 10.1001/jama.2022.18331. PMID: 36282253.<br /></span></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5699892984516649874.post-25727556529994832272024-02-21T02:00:00.030-06:002024-02-21T02:00:00.136-06:00Asymptomatic candiduria in a renal transplant patients<div><div><b><i><span style="color: #990000;">Q:</span><span style="color: #274e13;"> 46 years old patient with a history of successful kidney transplant about 6 years ago is admitted to ICU with chest pain and EKG changes. The night float intern sent urinalysis due to previous history though the patient did not have any urological complaints. The patient is found to have asymptomatic candiduria. Asymptomatic candiduria in a renal transplant is an absolute indication for the treatment.</span></i></b></div><div><b><i><span style="color: #274e13;"><br /></span></i></b></div><div><b><i><span style="color: #274e13;">A) True</span></i></b></div><div><b><i><span style="color: #274e13;">B) False</span></i></b></div><div><span style="color: #0c343d;"><br /></span></div><div><b><span style="color: #990000;"><br /></span></b></div><div><b><span style="color: #990000;">Answer:</span><span style="color: #0c343d;"> B</span></b></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>Asymptomatic candiduria after renal transplantation is not an absolute indication for treatment, unless there is a high risk for graft involvement or the patient still carries a ureteral stent (like in the early phase of post-transplant).</b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>A clinician may consider continuing management with an ultrasound of the KUB (Kidney, Ureter, Bladder) system to rule out any underlying possibility of fungus balls in high-risk patients like diabetics.</b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>This conservative approach is to prevent resistant Candida infections in the future. A clinician should look for and reduce the risk factors that may be contributing to candiduria. If candiduria persists in the case of chronic bladder catheters or stents, replacement should be considered.</b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>Patients who are required to undergo major surgery or have neutropenia may be considered for treatment at a provider's discretion.</b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>#ID</b></span></div><div><span style="color: #0c343d;"><b>#urology</b></span></div><div><span style="color: #0c343d;"><br /></span></div><div><span style="color: #0c343d;"><br /></span></div><div><span style="color: #0c343d;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">References:</span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">1. Pappas PG, Kauffman CA, Andes DR, et al. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis 2016; 62:e1.</span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">2. Sobel JD, Kauffman CA, McKinsey D, et al. Candiduria: a randomized, double-blind study of treatment with fluconazole and placebo. The National Institute of Allergy and Infectious Diseases (NIAID) Mycoses Study Group. Clin Infect Dis 2000; 30:19.</span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">3. Jacobs DM, Dilworth TJ, Beyda ND, et al. Overtreatment of Asymptomatic Candiduria among Hospitalized Patients: a Multi-institutional Study. Antimicrob Agents Chemother 2018; 62.</span></div></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5699892984516649874.post-37275075453749478962024-02-20T09:34:00.003-06:002024-02-20T09:34:00.124-06:00Diphenhydramine in Palliative Care Patients<div><div><b><i><span style="color: #990000;">Q</span><span style="color: #274e13;">: 74 years old male is converted to hospice care after transfer to ICU due to distant metastases from pancreatic cancer. The patient requested a gentle medicine for proper sleep. Diphenhydramine (Benadryl) is an appropriate choice.</span></i></b></div><div><b><i><span style="color: #274e13;"><br /></span></i></b></div><div><b><i><span style="color: #274e13;">A) True</span></i></b></div><div><b><i><span style="color: #274e13;">B) false</span></i></b></div><div><b><span style="color: #990000;"><br /></span></b></div><div><b><span style="color: #990000;"><br /></span></b></div><div><b><span style="color: #990000;">Answer</span><span style="color: #0c343d;">: B</span></b></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>The above question intends to cover two objectives.</b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>First, noise pollution in ICUs and inpatient wards is still an underestimated issue. Frequent alarms, ventilator noise, and blood draws at odd hours disrupt patients' sleep patterns and increase the rate of delirium in hospitals.</b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>Non-pharmacological interventions always supersede pharmacological interventions.</b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>The second objective is to underline the abuse of Diphenhydramine for insomnia in hospitals. It is conventionally believed that Diphenhydramine is a benign entity as it is easily available over the counter and is a good sedative to use as a sleep aid. Wrong. Although its antihistamine property makes it a sedative its anticholinergic effect decreases cognitive function and may cause delirium.</b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>There is no reliable data on its use or safety particularly in hospice and palliative care patients.</b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>#end-of-life-care</b></span></div><div><span style="color: #0c343d;"><b>#pharmacology</b></span></div><div><span style="color: #0c343d;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">Reference:</span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">1. Nolen A, Dai T. Diphenhydramine Use Disorder and Complicated Withdrawal in a Palliative Care Patient. J Palliat Med. 2020 Sep;23(9):1279-1282. doi: 10.1089/jpm.2019.0308. Epub 2019 Dec 5. PMID: 31808723.</span></div></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5699892984516649874.post-50053335098250189892024-02-19T01:00:00.022-06:002024-02-19T01:00:00.151-06:00singers' emboli<div><div><b><i><span style="color: #990000;">Q: </span><span style="color: #274e13;">What is Singers' emboli?</span></i></b></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><b><span style="color: #990000;"><br /></span></b></div><div><b><span style="color: #990000;">Answer:</span><span style="color: #0c343d;"> Helium gas emboli in singers</span></b></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>An interesting cause of "Helium emboli" (popularly known as Singers' Emboli can occur from inhalation of pressurized helium. Some singers intentionally inhale high-pressure helium to enhance tone or to produce a change in their voice. Inhaled high-pressure gas can produce high trans-pulmonary pressure sufficient to rupture alveoli and surrounding blood vessels, introducing gas into the pulmonary veins and allowing systemic embolization through the left heart; particularly in an upright person!</b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>But the more common cause of "helium emboli" is from IABP. Intra-aortic balloon Pump (IABP) Counter-pulsation utilizes helium gas to inflate its balloon. As Helium is a low density as well as an inert gas, in case of balloon rupture it is easily absorbed into the bloodstream. However, fairly well-numbered incidents of "Helium emboli" after balloon rupture have been described in the literature.</b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>A major clinical sign of helium embolus is a neurological deficit associated with other findings of balloon rupture as blood in the tubing. Treatment is hyperbaric oxygen.</b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b><br /></b></span></div><div><span style="color: #0c343d;"><b>#pulmonary</b></span></div><div><span style="color: #0c343d;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">References:</span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">1. Cerebral and coronary gas embolism from the inhalation of pressurized helium Critical Care Medicine: May 2002 - Volume 30 - Issue 5 - pp 1156-1157</span></div><div><span style="color: #0c343d; font-size: x-small;"><br /></span></div><div><span style="color: #0c343d; font-size: x-small;">2. Cerebral Gas Embolism Resulting From Inhalation of Pressurized Helium - Annals of Emergency Medicine Volume 28, Issue 3, Pages 363-366, September 1996</span></div></div>Unknownnoreply@blogger.com0