Medicine Hack

This scale is used to classify the severity of non-traumatic subarachnoid hemorrhage. It includes : 1- Asymptomatic, mild headache, slight or no neck rigidity. 2- Moderate to severe headache, neck rigidity, no neurologic deficit other than cranial nerve palsy. 3- Drowsiness, confusion, mild focal neurologic deficit. 4- Stupor, moderate to severe deficit, hemiparesis. 5- Coma, decerebrate posturing.

Above is a picture of xanthomas in the tendon and below it xathelasmata in a middle aged woman. Both are clinical features of familial hypercholesterolemia. The latter is an autosomal dominant condition and is associated with marked atherosclerosis that results in ischaemic heart disease, stroke and peripheral vascular disorders. Other clinical features that may be there include: 1) Skin xanthomas and 2) Arcus senilis which sets in at a younger age.

It is a typical peripheral blood smear for an iron deficiency anemia patient showing microcytic hypochromic red blood cells at magnification 50X. In normal conditions, the size (diameter) of an RBC should roughly correspond to that of the nucleus of a lymphocyte. In this slide, it is smaller. The numerous small dots refer to platelets and they are found in a larger number (thrombocytosis), a finding commonly seen in iron deficiency anemia. Differential diagnosis includes: 1) anemia of chronic disorders, 2) thalassemia, 3) sideroblastic anemia.

This is a new classification for abnormal bleeding in a non pregnant woman of reproductive age group. It stands for : P - Polyp A- Adenomyosis L- Leiomyoma M- Malignancy/ Hyperplasia C- Coagulopathy O- Ovulatory dysfunction E- Endometrial causes I- Iatrogenic N- Not classified causes. The classification is as such since the first 4 ones i.e. PALM can be diagnosed and measured directly by inspection or imaging techniques. The other ones need investigations other than imaging in most cases to reach a diagnosis.

The minimum recommended vitamin D level is 30 ng/mL but a range of 40-60 ng/mL has been put to guarantee sufficiency. The vitamin D level actually refers to the level of 25-Hyhroxy-cholecalciferol i.e. 25[OH]D and not that of 1,25-Dihydroxy-cholecalciferol. 25[OH]D is the major storage form of vitamin D. Around 88% of it circulates bound to vitamin D-binding protein, 0.03% is free and rest circulates bound to albumin. It has a half life of around 2-3 weeks. If this level is less than 20 ng/mL, it is considered as vitamin D deficiency.

It is a condition whereby the patient will have well perfused pink upper extremities evident by the pink finger nails while the lower extremities will both have cyanosis and clubbing in the toes, as shown in the picture above. In adults, it is commonly seen in patients of Patent Ductus Arteriosus (PDA) who have Pulmonary Hypertension at the same time. This occurs because venous blood shunts through the ductus and enters the aorta distal to the subclavian arteries.  In newborns, it can also occur in pre-ductal coarctation of aorta along with PDA. 

Class New York Heart Association (NYHA) Functional Classification I Patients with cardiac disease but without resulting limitations of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, dyspnea, or anginal pain. II Patients with cardiac disease resulting in slight limitation of physical activity. They are comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnea, or anginal pain. III Patients with cardiac disease resulting in marked limitation of physical activity. They are comfortable at rest. Less than ordinary physical activity causes fatigue, palpitation, dyspnea, or anginal pain. IV Patients with cardiac disease resulting in inability to carry on any physical activity without discomfort. Symptoms of cardiac insufficiency or of the anginal syndrome may be present even at rest. If any physical activity is undertaken, discomfort is increas