infectious mononucleosis

this week i managed to see a patient with this disease. a 4y 7m old boy with hx of fever and runny nose for 6 days. following then the mother noticed presence of lumps on bilateral part of the neck.

upon physical exanination, other LNs were also palpable; axillary, inguinal. per abd revealed hepatosplenomegaly.

differentials : cmv, malignancy ( leukemia/lymphoma), leptospirosis

infectious mono is a clinical diagnosis!

ivx : fbc to look for leukocytosis with lymphocytosis.
monospot test

tx : symptomatic / supportive tx. antiviral is not proven to be beneficial clinically!

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Pretibial Myxedema

Pretibial Myxedema can occur in both hypo / hyperthyroidism.

If patient has  thyrotoxicosis + Pretibial Myxedema, then think of GRAVE'S DISEASE! this is absent in TMNG.

Aortic Regurgitation : Collapsing Pulse

The most common confusion for this sign is : 


collapsing pulse positive = no pulse felt when raising the hand up. correct, no?


Answer : false! collapsing pulse is positive if we feel a "knocking" sensation on our palm. that means, in normal healthy patient, there will be no knocking sensation.


Method : 


1. locate for radial pulse
2. place our palm over it
3. ensure that patient has no problem to lift the arm. who knows the patient has fracture. 
4. while still placing palm on it, quickly raise the patient's hand above his head. 
5. look for the sensation!

Pulmonary Embolism :

I just read an article from BMJ Learning regarding the topic.


Interesting facts :


1. Mortality of Pulmonary Embolism depends on :
- the haemodynamic status of patients
- presence of Right Ventricular Failure rather than embolic size!
- cardiogenic shock


2. Risk factors of PE include
- previous thromboembolic disease
- immobilisation
- morbid obesity
- malignancy
- cardiac failure
- pregnancy
- recent surgery


2. Thrombolytic agents (e.g STK) do not actually have mortality advantage over heparin, do not result in no change in disease recurrence as well as do not reduce risk of major haemorrhage. However, Thrombolytic agent is beneficial in patients with PE & Cardiopulmonary arrest. those without cardiac compromise, no need to add thrombolytic agent. 


3. no prove that any thrombolytic agent is superior than one another in PE. however, in case of patients with circulatory compromise, STK is asscociated with worsening hypotension. 


4. route of administration of Thrombolytic agents do not matter; either via pulmonary artery catheter or peripheral administration. IV or infusion? doesnt matter which. sama saja. 


5. complication of thrombolytic agent is : HAEMORRHAGE!


6. Alternative to thrombolytic therapy : surgical embolectomy and pulmonary catheterisation


Other notes to PE :


Ivx : 
1. D dimer test - if negative, can already rule out PE. if positive, doesnt confirm PE. find  other causes of increase D-Dimer! i.e infection / inflammation


2. ECG (S1Q3T3), but the most common finding is SINUS TACHYCARDIA!


3. CXR (normally normal finding) - wedge shaped infarct - Dilatation of pulmonary vessels proximal to embolism along with collapse of distal vessels, often with a sharp cut of. Hampton's hump a pleural-based wedge shaped area of increased opacity

4. ventilation/perfusion scan - the limit is in eg COPD patient. cannot differentiate since COPD patients will have mismatch anyway. so, ct angio is better for this kind of patient!

5. CT pulmonary angiogram - gold standard!


References : 
http://www.e-radiography.net/radpath/p/pe.htm
bmj learning

still not too late!

Hello All. 


Welcome to my blog. 


Yes, that's a very typical "welcome" speech. How else can i say it? 


Well, the ultimate reason why i decided to open my 2nd blog is simply to use this as my learning notes. 


As you can see, being a medical student requires you to remember a hell lotta points. 


But as a young adult who also wants to enjoy life, i experience the "short-term memory syndrome". 


Hence, i am hoping this blog can improve me on that and at the same time, reducing the usage of papers!

"ROCK ON!"