December, 2010 | Master Of Medicine

Monthly Archives: December 2010

Guillain Barre syndrome and variants

Guillain Barre Syndrome

  1. Ascending Areflexic paralysis
  2. Minimal or no sensory loss
  3. Preceded by infection with Campylobacter Jejuni(MC),CMV,Mycoplasma
  4. Autoantibodies against gangliosides usually anti GM1.
  5. IVIg is the treatment of choice,plasmapheresis also done.

GBS variants

AIDP

  1. Seen in adults
  2. Demyelinating disorder
  3. Anti GM1 antibodies
  4. Rapid recovery

AMAN

  1. Mainly affects children
  2. Axonal disease
  3. Anti GD1A antibodies
  4. Rapid recovery

AMSAN

  1. Adults
  2. Axonal disease
  3. Slow recovery
  4. Similar to AMAN

Miller Fisher

  1. Characterised by Opthalmoplegia,ataxia,Areflexia
  2. Anti GQ1b antibodies
  3. Demyelinating disorder.

Mosquitoes and their eggs

Anopheles Eggs- In flowing water,with lateral floats ,laid singly.

Culex eggs- Raft shaped,in groups

Aedes- Cigar shaped,in groups

Mansoni -Star shaped,beneath around water plants.

Anopheles larvae- Free living lie parallel to surface.

Adult anopheles sits at an angle to the surface.

All other larvae lie at an angle and require siphons for breathing.

Trinucleotide repeats in diseases

GAA- Friederichs AtAxia

CAG- Spino Cerebellar Ataxia

CAG- Kennedy’s disease(tip:Cennedy’s disease)

CAG- Huntingtons disease(Chorea)

CAG- DRPLA

CTG- Myotonic dystrophy

CGG- Fragile X syndrome

Corticosteroids

  • Zona Glomerulosa-Mineralocorticoids
  • Zona Fasciculata-Glucocorticoids
  • Zona Reticularis-Sex corticoids
  • GFR from outside to inside.

Points to remember

  1. Maximum glucocorticoid activity- Dexamethasone
  2. Maximum mineralocorticoid activity- Aldosterone
  3. Glucocorticoid with maximum mineralocorticoid action-Hydrocortisone
  4. Least potent Glucocorticoid- Cortisone
  5. Most potent Glucocorticoid- Betamethasone
  6. Selective mineralocorticoid action(zero glucocorticoid action)- DOCA
  7. Selective glucocorticoid action(Zero mineralocorticoid action)- Methyl prednisolone,triamcinolone,paramethasone,dexamethasone,betamethasone
  8. Steroid with maximum topical activity- Triamcinolone acetonide

Hyponatremia

Osmolality

All conditions causing hyponatremia are hypo osmolar except

Pseudohyponatremia

  • hyperlipidemia
  • hypoproteinemia
  • Hyperglycemia

ECF volume

Normal in SIADH,Adrenal insufficiency,Hypothyroidism

Increased in Secondary hyperaldosteronism,CHF,Nephrotic syndrome,Cirrhosis

Urine Sodium>20mmol/L

Hypoaldosteronism,saltwasting nephropathy,recent diuretics

SIADH

  1. Primary watergain followed by secondary Sodium gain
  2. Urine Osmolarity higher
  3. Uricosuria- Hypouricemia
  4. Euvolemia

Secondary Hyperaldosteronism

Primary sodium gain exceeded by secondary water gain.

Renal Tubular acidosis

Type I RTA

DCT- H+ secretion Low

Urine pH cannot be reduced<5.5 even by NH4Cl

Type II RTA

PCT –  HCO3 reabsorption Low

Fanconis syndrome-Swan neck PCT

Type III RTA

Autosomal recessive

Carbonic Anhydrase defect

Type IV RTA

DCT- H+/K+

Hyperkalemic Acidosis

Causes of Reversible Dementia

  • Wernickes Encephalopathy
  • Hypothyroidism
  • Cushings syndrome
  • Organ failure
  • Neurosyphilis
  • Whipples disease
  • Chronic Subdural hematoma
  • Normal pressure hydrocephalus
  • Drugs,medications,Narcotics
  • Depression(pseudo dementia)
  • Schizophrenia
  • Vasculitis
  • Acute intermittent porphyria
  • Recurrent non convulsive seizures

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