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Eczema discoid

This photo for male patient 54 years old with Eczema discoid (Typical coin shaped lesions of discoid eczema )

Morphology: Excoriation

These are typical lesions of discoid eczema.It is commonly seen in the elderly.
The lesions often weep and become secondarily infected with Staphylococci requiring both antibiotics and topical steroids.

Crohn's disease PIC and x-ray

Synonyms: regional ileitis, terminal ileitis, regional enteritis or granulomatous enteritis.

Crohn's disease causes inflammation in the small intestine. Crohn's disease usually occurs in the lower part of the small intestine, called the ileum, but it can affect any part of the digestive tract, from the mouth to the anus. The inflammation extends deep into the lining of the affected organ. The inflammation can cause pain and can make the intestines empty frequently, resulting in diarrhea.

Crohn's Disease, X-Ray
This lower abdominal X-ray shows narrowing (stenosis) of the end of the small intestine (ileum)with loss of mucosal pattern and bowel wall thickening. Crohn's disease typically affects the small intestine. A solution containing a dye (barium), was swallowed by the patient. When it passed into the small intestines, this X-ray was taken (lower GI series).

For more information: WATCH THE VIDEO

Clinical Surgery Lectures - 02 Pain

Alpha1 Autonomic Receptor Mnemonic

Alpha 1 Adrenergic Autonomic Receptor of the Sympathetic Nervous System presented in a pictorial mnemonic format. Key Point: Alpha1 Constricts. For Medical learning.

Endolymphatic Shunt Operation

The endolymphatic shunt operation consists of opening the mastoid bone and identifying the endolymphatic sac which is located in the posterior fossa dura.
To find the sac, the sigmoid sinus is denuded of its bony cover except for a small rectangle of thin bone named Bill's Island, after Dr. William House. The sigmoid sinus is then collapsed with gentle pressure and the sac exposed behind the posterior semicircular canal.
The sac is then incised and a shunt tube is inserted. The picture shows a Huang-Gibson tube with a one-way valve that allows fluid to seep out but not back into the sac. This procedure decreases the endolymphatic fluid pressure

3 Exercises to lose weight fast

It is not difficult to lose your weight when you have the right information, at the right time, and the right tools to put it to use. If you will do these 3 best popular exercises on a consistent basis, week in and week out, then combined with a good diet, you will lose weight fast.

1. Interval running: Running has the potential to burn more calories per amount of time worked than any other exercise there is. No, I don’t mean jogging. Although you can use walking, then jogging as a way to prepare yourself to be able to run in the future. Interval running is just running with short breaks in between. For example: run for 30 seconds, then take a 30 second break then repeat.

2. Rowing: I love it, Rowing is a complete body workout and can be done outside on a lake, in the comfort of your own home, or at a gym. It burns a lot of calories and builds lean muscle.

3. Squat Presses: This exercise is well known to trainers and athletes alike, but not to the mainstream. It is simply taking a dumbbell or a barbell, then doing a squat. As you come to the top of your squat, you press the dumbbells (or barbell) above your head and then bring it back down and repeat. This exercise works every large muscle in the body and if done with short rest periods can be a good cardio workout (gets the heart rate up).

If you really want to lose weight, and want to do it fast, then you will have to use exercise. If you do these exercises 3-5 times per week (and be sure to mix it up), then you will reach your weight loss goals.

Localized osteoporosis in Inflammatory disease

Localized osteoporosis often is the first (though nonspecific) radiographic manifestation of inflammatory diseases such as osteomyelitis, tuberculosis, and rheumatoid arthritis.
In pyogenic infections, bone destruction typically precedes osteoporosis, whereas in tuberculosis the reverse is true.
Periarticular demineralization is a classic early sign of rheumatoid arthritis.

Staphylococcal osteomyelitis. (A) Initial film of the first metatarsophalangeal joint shows soft-tissue swelling and periarticular demineralization due to hyperemia. (B) Several weeks later, there is severe bony destruction about the metatarsophalangeal joint.

Retinal Hemangioblastoma in von Hippel–Lindau Disease

An 18-year-old woman presented with a 2-month history of visual loss in the right eye. Visual acuity was 20/100 in the affected eye and 20/20 in the left eye.
Ophthalmoscopy revealed an orange–yellow tumor (Panel A, arrow) with tortuous feeding vessels and optic-disk edema (Panel A, arrowhead), indicating retinal hemangioblastoma. The patient underwent ruthenium plaque radiotherapy, cryotherapy, and photodynamic therapy, which induced complete tumor regression and sclerosis of the dilated vessels (Panel B).

After treatment, the visual acuity improved, to 20/70. A systemic evaluation, including magnetic resonance imaging of the brain, computed tomography of the abdomen, and measurement of urinary vanillylmandelic acid levels, was unremarkable. However, genetic studies revealed a mutation in the von Hippel–Lindau tumor-suppressor gene VHL, confirming von Hippel–Lindau disease.

Visual disturbance caused by exudation or retinal detachment due to retinal hemangioblastoma may be the initial symptom of von Hippel–Lindau disease. Thorough, systemic evaluation is important to detect potential tumors of the central nervous system, adrenal glands, kidneys, and pancreas early enough to permit treatment.

Securing A Chest Tube

Oasis Dry Suction Chest Drain

Phimosis Vs Balanitis

While examining the male genitalia, you are unable to retract the foreskin of an uncircumcised patient. There is no evidence of erythema. Which of the following is

the most likely diagnosis?

  • a.Balanitis
  • b.Phimosis
  • c.Escutcheon
  • d.Smegma
  • e.Priapism

The answer is (b).

refers to the inability to retract the distal foreskin over the glans penis.

Physiologic phimosis occurs naturally in newborn males. Pathologic phimosis defines an inability to retract the foreskin after it was previously retractible or after puberty in an uncircumcised patient, may be secondary to distal scarring of the foreskin. this may occur normally in the first 6 years of life.

Phimosis is usually congenital but may be due to recurrent infections or balanoposthitis (inflammation of the glans penis and prepuce).

Balanitis is inflammation of the glans penis and occurs only in uncircumcised persons. Escutcheon is the hair pattern associated with genitalia. Smegma is a white, cheeselike material that collects around the glans penis in an uncircumcised man. Priapism is a painful, prolonged penile erection, which most often occurs in patients with sickle cell disease, sickle cell trait, or leukemia.

To see Balanitis :- click here

Adenoma Sebaceum of Nose & Bourneville's syndrome

What is adenoma sebaceum?
Adenoma sebaceum is a hamartoma on the face, composed of fibrovascular tissue and appearing as an aggregation of red or yellow papules that may be associated with tuberous sclerosis, also called Bourneville 's syndrome or Bourneville-Pringle's disease.

Bourneville's syndrome consists of epilepsy, severe mental retardation associated with adenoma sebaceum (overgrowth of the sebaceous glands) of the face, cerebral cortical tubers (hence the name "tuberous sclerosis") and hamartomatous tumours of the heart and kidney. It is heredofamilial and usually manifests itself early in life. Females are more often affected. Incomplete forms of the syndrome occur. Transmitted as an autosomal dominant trait with variable expressivity.

Adenoma sebaceum of the nose and face in tuberous sclerosis (Bourneville's syndrome)

When man becomes Reddish !!

What is Red man syndrome??
It is an infusion-related reaction peculiar to vancomycin.Typically it consists of pruritus, an erythematous rash that involves the face, neck, and upper torso.
Less frequently, hypotension and angioedema can occur. Patients commonly complain of diffuse burning and itching and of generalized discomfort. They can rapidly become dizzy and agitated, and can develop headache, chills, fever, and paresthesia around the mouth.
In severe cases, patients complain of chest pain and dyspnea. In many patients, the syndrome is a mild, evanescent pruritus at the end of the infusion that goes unreported.

It would appear about 4–10 min after an infusion started or may begin soon after its completion.
Vancomycin can cause two types of hypersensitivity reactions, the red man syndrome and anaphylaxis. Red man syndrome has often been associated with rapid infusion of the first dose of the drug and was initially attributed to impurities found in vancomycin preparations. Even after improvement in vancomycin's purity, however, reports of the syndrome persist.

Other antibiotics (e.g. ciprofloxacin, amphotericinB, rifampicin and teicoplanin) or other drugs that stimulate histamine release can result in red man syndrome.

Discontinuation of the vancomycin infusion and administration of diphenhydramine can abort most of the reactions. Slow intravenous administration of vancomycin should minimize the risk of infusion-related adverse effects.

Laparoscopic Cholecystectomy Procedure

Hutch diverticula of Bladder

A 73-year-old man presented to the emergency department after having intermittent fevers for 2 weeks. He had a history of recurrent urinary tract infections, parkinsonism, and a compression fracture at the L2 vertebra that was the result of a fall 2 years before presentation.
In addition, he had paraparesis and a neurogenic bladder, also subsequent to the fall. The results of physical and laboratory evaluation were notable for the identification of Pseudomonas aeruginosa in a blood culture and for a urinalysis showing more than 100 white cells per high-power field. He was treated with empirical antibiotics.

Intravenous urography showed no obstructive uropathy, but symmetric diverticula could be seen near both ureteral orifices (arrows). These lesions, known as Hutch diverticula, are usually congenital rather than occurring as a result of a neurogenic bladder or an infection or obstruction. They represented a new finding in this patient. Hutch diverticula are more commonly seen in men and boys and are usually unilateral and asymptomatic. After treatment with antibiotics, the patient's fever and pyuria subsided.
He declined any further evaluation or intervention. During the year after diagnosis, two more urinary tract infections developed.

Aphakic bullous keratopathy

Following intracapsular cataract surgery with vitreous loss, this eye struggled with bullous keratopathy. The photo shows a huge ruptured bulla involving the cornea superiorly.The light reflex lies in the inferior bed of the ruptured bulla.

The edge of the bulla can be seen superiorly from 11:00 o'clock to 1:00 o'clock. This was a major complication of cataract surgery in 1965 when this photo was taken. The loss of vitreous was a dreaded subject since the approach to its loss was extremely primitive compared to the wonderful techniques now employed by vitreous surgeons.

Laparoscopic mesh repair of an epigastric hernia

The repair of a large epigastric (ventral) hernia using a laproscopic or keyhole surgery technique.

Facts about Insomnia

Primary insomnia is usually associated with

  • A) sleep apnea
  • B) restless legs syndrome
  • C) periodic limb movements
  • D) circadian rhythm sleep disorders
  • E) none of the above

Answer and Discussion

Insomnia is defined as inadequate or poor-quality sleep characterized by one or more of the following: difficulty falling asleep, difficulty maintaining sleep, waking up too early in the morning, or sleep that is not refreshing. Insomnia also involves daytime consequences such as fatigue, difficulty concentrating, and irritability.

Periods of insomnia lasting between 1 night and a few weeks are defined as acute insomnia. Chronic insomnia refers to sleep difficulty occurring at least 3 nights per week for 1 month or more.

Insomnia may be associated with specific sleep disorders, including restless legs syndrome, periodic limb movement disorder, sleep apnea, and circadian rhythm sleep disorders. Restless legs syndrome is characterized by unpleasant sensations in the legs or feet that are temporarily relieved by movement. Symptoms are worse in the evening, especially when a person is lying down and remaining still. The sensations cause difficulty falling asleep and are often accompanied by periodic limb movements. Periodic limb movement disorder is characterized by bilateral repeated and rhythmic, small-amplitude jerking or twitching movements in the lower extremities and, less frequently, in the arms. These movements occur every 20 to 90 seconds and can lead to awakenings, which are usually not noticed by the patient. Often the patient reports that sleep is not refreshing. In many cases, the bed partner is more likely to report the movement problem. Obstructive sleep apnea is most commonly associated with snoring, daytime sleepiness and obesity but occasionally presents with insomnia. Circadian rhythm sleep disorders including sleep-work insomnia are characterized by an inability to sleep because of a disturbance between the circadian sleep rhythm and the desired or required sleep schedule.

Primary insomnia occurs in the absence of the previously mentioned conditions . When the insomnia persists beyond 1 or 2 nights or becomes predictable, treatment should be considered. Pharmacologic treatment is usually effective, especially short-acting hypnotics.

Sleep hygiene measures may also be useful. Chronic insomnia may be more difficult to treat. Because chronic insomnia is often multifactorial in etiology, a patient may need multiple treatment modalities, including medication (antidepressants, antihistamines, melatonin) and behavioral therapy. If an underlying medical or psychiatric condition is identified, this condition should be treated first. The answer is E.

Actinic keratosis Animation

Actinic Keratosis Actinic keratosis (AK), or solar keratosis, or senile keratosis is a precancerous skin condition that develops in the skin when exposed to sun, hydrocarbons, and arsenicals and is more common in light-skinned people When the human skin is exposed to the sun, the UV-B rays from the sun damage the dermis and epidermis. The epidermis is thinned and damaged cells calls fibroblasts cause synthesis of abnormal dermal elastic fibers within the superficial dermis that give the characteristic appearance of actinic keratosis. Actinic keratoses are small, noticeable, red-brown patches that don't fade away and have a characteristic rough texture accompanied by itching and burning. The lesions are generally 1-3mm in size, occur in clusters, and generally occur in sun exposed areas like the face, neck, and hands.Actinic keratosis has physical characteristics that allow dermatologists to visually identify them. If there is any indication of the possibility of cancer, a skin biopsy is recommended.There are several options to treat AK, the decision on treatment methodology is based on the nature of the lesion, age and health.Actinin keratosis can be treated by:CryosurgeryCurettage and Electro dissectionSurgical ExcisionDermabrasionTopical medicationsActinic keratosis can be prevented by avoiding prolonged exposure to the sun, wearing protective clothing, using sunscreen lotion and sun glasses and regular skin self-examination.

Appearance of Cricopharyngeal achalasia in X-ray

It appeares as :Hemispherical or horizontal, shelflike protrusion on the posterior aspect of the esophagus at approximately the C5-C6 level.

Short Comment.......It is Failure of the upper esophageal sphincter to relax. Can result in dysphagia by obstructing the passage of a swallowed bolus. In severe disease, can cause aspiration and pneumonia.

Local Anesthetic Injection Techniques

Demonstrates on the skull and on a patient, various injection techniques. It also describes the basic dental chair position for injections.

Basic Medical Pathology: Neoplasis I

Hemostasis Lecture

A concise lecture on basics of hemostasis; the triggers of the development of the hemostatic plugs (primary) and (secondary). The differences between Hemostasis and Thrombosis.
Clinical presentation and importance are also discussed.

Aortic Dissection

* 3:1 male to female predominance
* Over the age of 40
* Hemorrhage in the media (at vasa vasorum) leading to either
  1. Hemorrhage in the wall (less common)
  2. Hemorrhage separate media from adventitia

· Predisposing factors
o Hypertension (most commonly)
o Atherosclerosis
o Cystic medial necrosis
o Coarctation of the aorta
o Aortic stenosis
o S/P prosthetic aortic valve
o Trauma (rare)
o Pregnancy (rare)

· Aneurysm defined by size criteria
o In general, ascending aorta > 5 cm
o Descending aorta > 4 cm

· Vessels involved with dissection
o Any artery can be occluded
o Usually the right coronary and three arch vessels are involved with arch
o Right pulmonary artery and left-sided pulmonary veins may be occluded

· Types
o DeBakey Type I...............................................Involves entire aorta
o DeBakey Type II "Least common"...............Ascending aorta only
o DeBakey Type III "Most common"...............Descending aorta only
o Stanford Type A................................................Ascending aorta involved
----- Over half develop aortic regurgitation
o Stanford Type B.................................................Ascending aorta NOT involved
· Most dissections arise either just distal to the aortic valve or just distal to aortic isthmus

o Sharp, tearing, intractable chest pain

o Murmur or bruit of aortic regurgitation

o Previously hypertensive, now possible shock

o Asymmetric peripheral pulses

o Pulmonary edema

· Imaging Findings
o Chest films
  • - Mediastinal widening
  • - Left paraspinal stripe
  • - Displacement of intimal calcifications
  • - Apical pleural cap
  • - Left pleural effusion
  • - Displacement of endotracheal tube or nasogastric tube

  • - Intimal flap
  • - Slow flow or clot in false lumen

o CT
  • - Intimal flap
  • - Displacement of intimal calcification
  • - Differential contrast enhancement of true versus false lumen

CT of abdominal aorta shows intimal flap (dark line -red arrow)
with true lumen anteriorly and false lumen posteriorly

o Angiography
  • - Intimal flap
  • - Double lumen
  • - Compression of true lumen by false channel
  • - Increase in aortic wall thickness > 10 mm
  • - Obstruction of branch vessels

Phototherapy in Hyperbilirubinemic baby

You are called to see an infant in the newborn nursery. The child was delivered 60 hours prior to your visit. The child appears jaundiced but otherwise healthy. A total serum bilirubin level is measured at 18 mg/dL. Appropriate treatment includes

  • A) observation
  • B) stop breast feeding and switch to formula feedings
  • C) begin phototherapy
  • D) perform a septic workup
  • E) start IV hydration

Answer and Discussion

Hyperbilirubinemia is very common in term newborns. Current recommendations include the following: phototherapy should be instituted when the total serum bilirubin level is >=15 mg/dL (257 آµmol/L) in infants 25 to 48 hours old, 18 mg/dL (308 آµmol / L) in infants 49 to 72 hours old, and 20 mg/dL (342 آµmol/L) in infants older than 72 hours.

It is unlikely that term newborns with hyperbilirubinemia have serious underlying pathology. Physiologic jaundice peaks on the third or fourth day and declines over the first week following birth. Infants who are breast fed are more likely to develop physiologic jaundice because of relative caloric deprivation in the first few days of life. If jaundice occurs in breast-fed infants, feedings should be increased to more than ten times/day.In some cases formula supplementation may be necessary.

Pathologic jaundice occurs if it presents within the first 24 hours after birth, the total serum bilirubin level rises by >5 mg/dL (86 آµmol/L) per day or is >17 mg/dL (290 آµmol/L), or an infant has signs and symptoms suggestive of serious illness. The management consists of excluding pathologic causes of hyperbilirubinemia and initiating treatment to prevent harmful neurotoxicity.The answer is C.

Subdermal Interrupted Suturing

Acute angular meibomitis

Diagnosis: acute angular meibomitis ( meibomianitis ) with marked chemosis, lid edema, and pain OS

Acute meibomitis causes increasing subjective and objective symptoms as the outer canthus is approached by the involved meibomian gland. The reason for this is that there is a confluence of nerves and bloodvessls at the outer angle. In addition, the tissues are more taut and less giving. A pressure is built up in the area with resultant pressure on the nerves and pressure on the bloodvessels. The former pressure gives pain, the latter gives edema of the more easily distended bulbar conjunctiva and skin of the lids. At times there may be collateral edema of the lids of the other eye.

There is exquisite tenderness to finger pressure over the area just above the outer canthus. There is lid edema. There is marked chemosis .

All About Surgical Suturing

APML LEUKEMIA Bone Marrow Aspirate

Oculocutaneous albinism

This 7 year-old boy was referred because of reduced poor vision. Examination revealed the vision to be 6/60 in both eyes with the typical facial appearance of oculocutaenous albinism: fair skin, blonde hair, bilateral pink iris and pendular nystagmus. Fundoscopy did not show any optic disc or macular hypoplasia. Cycloplegic refraction showed significant astigmatism of 3.00D in both eyes and glasses were prescribed.
Typical appearance of oculocutaneous albinism

Age-related Maculopathy with Angiogram

This photo shows age-related Maculopathy AMD, Classic Choroidal Neovasculariz.

Note that in an area of slight depigmentation (presumably a previous RPE detachment) is a darkly pigmented spot surrounded by a slim ring of subretinal blood.

With Angiogram:
#In the arterial phase the cartwheel of new choroidal vessels becomes immediately visible (together with the choroidal flush). A slight window defect is in the area of hypopigmentation.

#In mid-angiogram the neovascularization becomes prominent. The ring of surrounding blood blocks fluorescence.

#Late angiogram with diffuse leakage from the new vessels even into some of the blood.

Dupuytren's contracture Pic and shape of incision

The most commonly affected digits are the ulnar digits (ring and small fingers).

Dupuytren's contracture is a thickening of the fibrous tissue layer underneath the skin of the palm and fingers. Although painless, the thickening and tightening (contracture) of this fibrous tissue can cause the fingers to curl (flex).

It is more common in men than in women.

The cause of Dupuytren's contracture is not known. It is not caused by an injury or heavy hand use.

Dupuytren's contracture symptoms usually occur very gradually.

1-Nodules. One or more small, tender lumps (nodules) form in the palm. Over time, the tenderness usually goes away.

2-Bands of tissue. The nodules may thicken and contract, forming tough bands of tissue under the skin.

3-Curled fingers. One or more fingers bend (flex) toward the palm. The ring and little fingers are most commonly affected, but any or all fingers can be involved. As the bend in the finger increases, it may be hard to straighten your finger. Grasping large objects and putting your hand in a pocket becomes difficult.

**Nonsurgical Treatment:

-Steroid injection. If a lump is painful, an injection of corticosteroid - a powerful anti-inflammatory medication - may help relieve the pain. In some cases, it may prevent the progression of contracture. Several injections may be needed for a lasting effect.

-Splints. Splinting does not prevent increased bend in the finger. Forceful stretching of the contracted finger will not help either, and may speed the progression of contracture.
The intralesional enzyme, collagenase clostridium histolyticum, was approved by the FDA in February 2010.

**Surgical Treatment:

Surgery is recommended when joint contracture exceeds 30°, or when nodules are painful and interfere with hand function.

Surgical procedure. Surgery for Dupuytren's contracture divides or removes the thickened bands to help restore finger motion. Sometimes the wound is left open and allowed to heal gradually. Skin grafting may be needed.


Achondroplasia is a type of genetic disorder that is a common cause of dwarfism. People with this condition have short stature, usually reaching a full adult height of around 4'0" (1.2 meters).

Incidence and Prevalence
This condition occurs at a frequency of about 1 in 25,000 to 1 in 40,000 births. Achondroplasia also occurs in all races with equal frequency in males and females.

Clinical Features

Clinical features of the disease:

* nonproportional dwarfism (short stature)
* shortening of the proximal limbs (termed rhizomelic shortening)
* short fingers and toes
* a large head with prominent forehead
* small mid-face with a flattened nasal bridge
* spinal kyphosis (convex curvature) or lordosis (concave curvature)
* varus (bowleg) or valgus (knock knee) deformities
* frequently have ear infections (due to Eustachian tube blockages), sleep apnea (which can be central or obstructive), and hydrocephalus


The disorder is a result of an autosomal dominant mutation in the fibroblast growth factor receptor gene 3 (FGFR3), which causes an abnormality of cartilage formation. FGFR3 normally has a negative regulatory effect on bone growth. In achondroplasia, the mutated form of the receptor is constitutively active and this leads to severely shortened bones.

People with achondroplasia have one normal copy of the fibroblast growth factor receptor 3 gene and one mutant copy. Two copies of the mutant gene are invariably fatal before, or shortly after birth. Only one copy of the gene needs to be present for the disorder to occur. Therefore, a person with achondroplasia has a 50% chance of passing on the gene to their offspring, meaning that there will be a 50% chance that each child will have achondroplasia. Since two copies are fatal, if two people with achondroplasia have a child, there's a 25% chance of it dying shortly after birth, a 50% chance the child will have achondroplasia, and a 25% chance the child will have a normal phenotype. However, in 3 out of 4 cases, people with achondroplasia are born to parents who don't have the condition. This is the result of a new mutation.

New gene mutations are associated with increasing paternal age (over 35 years). Studies have demonstrated that new gene mutations are exclusively inherited from the father and occur during spermatogenesis (as opposed to resulting from a gonadal mosaicism). More than 99% of achondroplasia is caused by two different mutations in the fibroblast growth factor receptor 3 (FGFR3). In about 98% of cases, a G to A point mutation at nucleotide 1138 of the FGFR3 gene causes a glycine to arginine substitution (Bellus et al 1995, Shiang et al 1994, Rousseau et al 1996). About 1% of cases are caused by a G to C point mutation at nucleotide 1138.

There are two other syndromes with a genetic basis similar to achondroplasia: hypochondroplasia and thanatophoric dysplasia. Both of these disorders are also caused by a genetic mutation in the FGFR3 gene.


Achondroplasia can be detected before birth by the use of prenatal ultrasound. A DNA test can be performed before birth to detect homozygosity, where two copies of the mutant gene are inherited, a condition which is lethal and leads to stillbirths.

Radiologic Findings CLICK HERE

A skeletal survey is useful to confirm the diagnosis of achondroplasia. Skull films demonstrate a large skull with a narrow foramen magnum, and relatively small skull base. The vertebral bodies are short and cuboidal, and there is congenitally narrowed spinal canal. The iliac wings are small and squared, with a narrow sciatic notch. The tubular bones are short and thick with metaphyseal cupping and flaring and irregular growth plates. Fibular overgrowth is present. The hand is broad with short metacarpals and phalanges, and a trident configuration. The ribs are short with cupped anterior ends. If the radiographic features are not classic, a search for a different diagnosis should be entertained.

The diagnosis can be made on by fetal ultrasound by progressive discordance between the femur length and biparietal diameter by age. The trident hand configuration can be seen if the fingers are fully extended.


Growth hormone (GH) therapy has been proposed as a possible treatment for the short stature of achondroplasia. However, the people who participated in the studies on the subject have not yet reached adult size, so this type of therapy has unknown results.

Early experience with surgical limb lengthening procedures resulted in a high incidence of complications, but recent experiences have improved results considerably.

New animal studies have demonstrated efficacy of parathyroid hormone-related peptide (PTHrP) replacement.

Pictures of Tympanic membrane perforation with corresponding causes

Picture of a central left tympanic membrane perforation.
In general, such perforations are caused by chronic suppurative otitis media. In addition to hearing loss, patients present with purulent drainage that subsides on antibiotic treatment. The perforation is then patched with a temporalis fascia graft

Picture of left tympanic membrane perforation
This dry perforation in the posteroinferior quadrant has ragged edges and to a certain extent, resembles traumatic perforations. The fragment of skin hanging in the center of the perforation was pulled out of the middle ear, where it was forming a cholesteatoma sac.

Picture of right inferior tympanic membrane perforation.

What is Blepharophimosis

Ptosis and inverted epicanthal folds in blepharophimosis.
The patient has bilateral ptosis with reduced lid size.There are inverted epicanthal folds, telecanthus. The nasal bridge is flat and there is hypoplastic orbital rim. Other examination:

  • there may be strabismus and sometimes nystagmus
  • the condition is autosomal dominant and therefore ask to see family member. However, other members may have had surgery. Look for lid scars in the family members.

velvet palm as a paraneoplastic sign

A 54-year-old woman who had a 34-pack-year smoking history presented with a 5-month history of changes in palmar skin texture associated with a 15-kg weight loss and left hip pain waking her at night.

On physical examination, cachexia was noted, along with a rugated, velvety appearance of the palms (Panel A), acanthosis nigricans, and left hip pain on rotation.

Laboratory evaluation
revealed neutrophil leukocytosis (white-cell count, 42,300 per cubic millimeter), thrombocytosis (platelet count, 1.17 million per cubic millimeter), and hypercalcemia (calcium corrected for albumin, 4.5 mmol per liter [18 mg per deciliter]).

Chest computed tomography (CT) revealed nodules (Panel B, arrow), and bone scintigraphy showed increased uptake in the left hip. Both these radiographic findings suggest metastasis. CT-guided fine-needle aspiration of a lung nodule revealed cells consistent with non–small-cell carcinoma of the lung.

The palmar changes represent a cutaneous paraneoplastic sign known as tripe or velvet palm. It is highly associated with cancer (94% in some reports), most frequently with gastric adenocarcinoma or bronchogenic carcinoma. The patient was referred to oncology for chemotherapy but died a few weeks later of metastatic lung cancer.

Bullous Erythema Exsudativum Multiforme

Pathology: Conjunctiva -> Bullous Disease of Skin and Mucous Membranes -> Erythema Multiforme

Late phase with extensive scarring of the conjunctiva (symblepharon) which has led to obstruction of the accessory tear glands and tear retention cysts.

Diagnosis:late Phase of Bullous Erythema Exsudativum Multiforme, Stevens-Johnson Syndrome.

Answered case

The patient shown below most likely has:

a. A large left pleural effusion

A large right pneumothorax

Atelectasis of the left lung

Pneumonia in the left lung

Unilateral pulmonary edema

The correct answer :

Pneumonia in the left lung



There is opacification of the left hemithorax. There is no shift of the heart and mediastinal structures (i.e. the trachea). This eliminates pleural effusion and atelectasis as possibilities. A tension pneumothorax would displace the heart and mediastinal structures away from the side of the pneumothorax and would not cause complete opacification of the opposite lung. In addition, there should be no lung markings visible in the hemithorax which contains the pneumothorax. Either pneumonia or pulmonary edema could cause the findings shown, but pneumonia is a much more common cause.

Coal workers pneumoconiosis - stage II

This chest x-ray shows stage II coal worker's pneumoconiosis (CWP). There are diffuse, small light areas on both sides of the lungs. Other diseases that may explain these x-ray findings include simple silicosis, disseminated tuberculosis, metastatic lung cancer, and other diffuse, infiltrative pulmonary diseases.


Description: red linear erosion with surrounding scale

This 62-year-old woman who wore glasses for years developed an erosion on the retroauricular fold of her right ear. The erosion is easily observed when she raises her ear.

Acanthoma fissuratum cutis is a common cutaneous lesion induced by chronic mechanical trauma. Most cases are caused by poorly fitting spectacle frames. The main differential diagnosis is basal cell carcinoma.

Dealing with Primary Dysmenorrhea

Which of the following is considered first-line therapy for primary dysmenorrhea?Dealing with Primary Dysmenorrhea
A) Nonsteroidal anti-inflammatories (NSAIDs)
B) Selective serotonin receptor inhibitors (SSRIs)
C) Antiestrogens
D) Acupuncture
E) Tricyclic antidepressants

Answer and Discussion
Primary dysmenorrhea is associated with cramping pain in the lower abdomen occurring just before and/or during menstruation, in the absence of other conditions such as endometriosis. The initial presentation of primary dysmenorrhea typically occurs in adolescence.
The condition is associated with increased production of endometrial prostaglandin, resulting in increased uterine tone and stronger, more frequent uterine contractions. A diagnostic evaluation is unnecessary in women with typical symptoms and in the absence of risk factors for secondary causes.

NSAIDs are the most effective treatment, with the addition of oral contraceptive pills when necessary. About 10% of affected women do not respond to these measures. In these cases it is important to consider secondary causes of dysmenorrhea in women affected. Acupuncture is also used as an alternative treatment.The answer is A.

Abdominal-Wall Abscess Related to Gallbladder Adenocarcinoma.

An 83-year-old man with hypertension presented with a 3-month history of a painful, progressively enlarging mass in the right subcostal region. He reported no associated constitutional symptoms and no history of abdominal surgery. Local examination revealed a tender, erythematous, fluctuant mass, 3 cm by 2 cm, with clinically significant surrounding induration and an underlying fixed mass (Panel A). Computed tomography revealed that the mass was communicating with a large gall bladder mass (Panel B, arrow). Ultrasonography-guided needle biopsy, along with histologic and immunocytochemical examinations, confirmed that the mass was an adenocarcinoma of the gall bladder. The patient did not agree to any further evaluation or treatment. He was discharged with plans for palliative care and died 5 weeks later.

Chloroquine-Induced Hair Hypopigmentation

A 16-year-old, blonde-haired patient was evaluated for a new band of lighter-colored hair located approximately 3 cm from the scalp. The patient first noted the change in hair color 1 week after returning from a 2-week vacation in Costa Rica, during which she took chloroquine phosphate for malaria prophylaxis.

Instead of taking 500 mg weekly, the recommended dose for prophylaxis, the patient took 500 mg of chloroquine phosphate daily, starting 1 week before the trip, during the 2 weeks in Costa Rica, and for 1 week after returning home. She had taken the first dose 3.5 months before presentation. Hair hypopigmentation is a rare but reversible side effect of chloroquine.
Although most cases occur after 3 consecutive months of treatment with daily doses of more than 500 mg of the drug, rapid onset is also possible.

blast from Europe's medieval medical past are medicinal leeches

Miichael Palin experiments with a traditional Russian health therapy in Estonian capital Tallinn by allowing a doctor to cover him in sucking leeches. Fascinating video that is definitely not for the faint hearted! Taken from BBC travel documentary, Palin's New Europe.

In modern medicine, however, leeches are used in reconstructive surgery to provide a vacuum effect that helps stimulate blood circulation. This process is crucial to help kick start blood flow into, for example, a reattached finger.

Osteogenesis imperfecta and it`s subtypes

Krish 5 Year old boy brought to the hospital by his mother because she has noticed that her child did not have appropriate height for his age and having Mild limb deformity.This child has a previous Hx of Right tibial fracture when the child was 3years old.

Osteogenesis imperfecta
Osteogenesis imperfecta also known as Brittle Bone Disease or Lobstein syndrome
It is a group of diseases where there is an increased fragility of bone with frequent fractures.
They are all associated with type I collagen mutations.It is a genetic disorder with autosomal dominant inheritance

Mainly there are four subtypes of Osteogenesis imperfecta
Type I mild disease(Collagen is of normal quality but is produced in insufficient quantities)

1. Blue sclerae
2. Slight protrusion of the eyes
3. Mild prepubertal bone fragility
4. Little or no deformity or Slight spinal curvature
5. Loose joints
6. Mild short stature
7. Poor muscle tone
8. Hearing loss in about 50% of adults
9. Bruises easily
10. Dentinogenesis imperfecta may be absentin 1A and present in 1B

Type II perinatal lethal(Collagen is not of a sufficient quality or quantity)

1. Most cases die within the first year of life due to respiratory failure or intracerebral hemorrhage
2. blue sclerae
3. In utero fractures
4. Micromelia
5. Marked long bone deformity
6. Platyspondyly
7. Lethal in the perinatal period
8. Broad but poorly mineralized skull

Type III progressive deforming(Collagen quantity is sufficient but is not of a high enough quality)

1. Blue then white sclerae
2. Progressing deforming of the long bones and spine secondary to fractures and gravity
3. Relative macrocephaly and triangular faces
4. Extremely short stature and barrel-shaped rib cage
5. Respiratory problems
6. Poor muscle tone and Loose joints

IV moderately severe disease(Collagen quantity is sufficient but is not of a high enough quality)

1. White sclerae
2. Moderate fragility and mild to moderate bowing of long bones especially before puberty
3. Variable short stature
4. Dentinogenesis imperfecta absent in IVA and present in IVB

circulacion fetal animacion

adherent leukoma

The history of this eye: A corneal ulcer formed. The ulcer produced a minute perforation of the cornea. The aqueous humor rushed towards the site of perforation and carried the iris with it.
The iris plugged the perforation and became incorporated with the scar issue healing process. Notice the iris pigment that is incorporated in the corneal scar -evidence of iris involvement and thus, an adherent leukoma.

Fortunately, this eye recovered from this potentially catastrophic situation. Other eyes might have gone on to staphyloma, glaucoma,endophthalmitis, panophthalmitis and / or phthisis bulbi from the same initial corneal ulcer.

Antimalarial medications overdose

A woman on antimalarial medications takes an overdose .
Which of the following is the most consistent feature of antimalarial overdose?
  • a) ventricular arrhythmias
  • b) hypokalemia
  • c) methaemoglobinaemia
  • d) Thrombocytosis
  • e) blindness

The correct answer is B

Quinoline derivatives, particularly quinine and chloroquine, are highly toxic in overdose. The toxic effects are related to their quinidine-like actions on the heart and include circulatory arrest, cardiogenic shock, conduction disturbances and ventricular arrhythmias.

Additional clinical features are obnubilation, coma, convulsions, respiratory depression. Blindness is a frequent complication in quinine overdose.
Hypokalaemia is consistently present, although apparently self-correcting, in severe chloroquine poisoning and is a good index of severity. Recent toxicokinetic studies of quinine and chloroquine showed good correlations between dose ingested, serum concentrations and clinical features, and confirmed the inefficacy of haemodialysis, haemoperfusion and peritoneal dialysis for enhancing drug removal. The other quinoline derivatives appear to be less toxic. Amodiaquine may induce side effects such as gastrointestinal symptoms, agranulocytosis and hepatitis.
The main feature of primaquine overdose is methaemoglobinaemia. No cases of mefloquine and piperaquine overdose have been reported. Overdose with quinacrine, an acridine derivative, may result in nausea, vomiting, confusion, convulsion and acute psychosis. The dehydrofolate reductase inhibitors used in malaria treatment are sulfadoxine, dapsone, proguanil (chloroguanide), trimethoprim and pyrimethamine. Most of these drugs are given in combination. Proguanil is one of the safest antimalarials. Convulsion, coma and blindness have been reported in pyrimethamine overdose. Sulfadoxine can induce Lyell and Stevens-Johnson syndromes.

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