March, 2011 | Master Of Medicine

Monthly Archives: March 2011

Hemophilia A vs Von Willebrand Factor deficiency.

Hemophilia A

  1. Inherited as X linked recessiv(more common in boys).
  2. Factor VIIIc decreased.
  3. Clotting disorder.
  4. Ristocetin Cofactor level is normal.
  5. Hemarthoris ++.
  6. Bleeding time is normal.
  7. APTT is prolonged.
  8. PT is normal.
  9. Platelet aggregation in response to Ristocetin is normal.

Von Willebrand Factor deficiency.

  1. Commonly Autosomal Dominant disorder(both girls and boys affected)
  2. Factor VIIIc decreased.
  3. VWF decreased.
  4. Ristocetin cofactor decreased.
  5. Features of bleeding disorder with or without clotting disorder.
  6. Bleeding time is prolonged.
  7. APTT prolonged/normal.
  8. PT normal.
  9. Platelet aggregation in response to Ristocetin is decreased.

X ray appearences in heart diseases.

Imaging of the chest is not only valuable in respiratory disorders, but it also  gives valuable insights into specific disease conditions of heart. Given below are specific appearances that heart diseases make on an X ray film.

  1. Coeur en Sabot /Boot shaped heart –  Tetralogy of Fallot
  2. Pear/Money bag/purse –   Pericardial Effusion
  3. Box shaped heart –   Ebstein’s anomaly
  4. Egg on side –    TGA
  5. Snowman/figure of 8 –   TAPVC
  6. Scimtar sign –    TAPVC.
  7. Wide Vascular Pedicle – Corrected TOGV
  8. Sitting Duck shaped Heart- Persistant Truncus Arteriosus
  9. Flask shaped Heart/Leather bottle with Pulm. Oligemia- Pericardial Effusion
  10. Snowman/Figure of 8/ Cottage leaf of Bread heart- TAPVC
  11. Shaggy Heart – Pertusis
  12. Figure of 3 (CXR)/Reversed E sign(Ba swallow) –   Coarctation of Aorta
  13. Hilar Dance sign(Fluoroscopy) –   ASD
  14. Egg in cup – Constrictive pericarditis.

Find more characteristic findings in masterofmedicine among revision topics

Gait disturbances with their causes.

Festinant gait – Parkinsonism

Reeling/ Ataxic gait – Cerebellar vermis involvement.

Stamping/Tabetic gait – Sensory ataxia.

Steppage/ Equine gait – Foot drop.

Waddling gait/ Trendelenberg gait – Gluteal muscle weakness.

Toppling gait – Vestibular neuronitis, Brainstem strokes.

Apraxic gait, paratonia(Gegenhalten), Bruns ataxia – Frontal lobe involvement.

Circumductive gait – Hemiplegia.

Astasia- Abasia - Hysterical.

Clinical features of Infective endocarditis

Clinical features of Infective endocarditis is one of the favorite questions of examiners. Given below is the clinical features of IE and short explanations.

  1. Oslers nodes- tender nodules in pulp of fingers and sole.
  2. Janeway lesions – Non tender erythematous macules in palms and sole.
  3. Mycotic aneurisms- focal dilatations in arteries due to weakening by infection.
  4. Micro abscesses, hemorrhagic stroke.
  5. Roth’s spots, Glomerulonephritis.
  6. Perivalvular abscesses, MC around aortic valve.
  7. MC cause of death: Heart Failure due to valvular insufficiency.

Named heart murmurs and their causes

  1. Carey Coombs murmur- Mid diastolic murmur, in rheumatic fever
  2. Austin Flint murmur- mid- late diastolic murmur,in  Aortic Regurgitation.
  3. Graham- Steel murmur- high pitched, diastolic, in pulmonary regurgitation.
  4. Rytands murmur - mid diastolic atypical murmur, in Complete heart block.
  5. Docks murmur-diastolic murmur, Left Anterior Descending(LAD) artery stenosis.
  6. Mill wheel murmur- due to air in RV cavity following cardiac catheterization.
  7. Stills murmur- inferior aspect of  lower left sternal border, systolic ejection sound, vibratory/musical quality,in subaortic stenosis, small VSD

Barium study findings in various gastrointestinal diseases.

Barium swallow findings

  1. Bird beak appearance – Achalasia cardia
  2. Rat tail appearance – Achalasia cardia
  3. Corkscrew esophagus – Diffuse esophageal spasm
  4. Curling esophagus – Diffuse esophageal spasm
  5. Nut crackers esophagus – Diffuse esophageal spasm

Barium meal findings

  1. String sign - Congenital hypertrophic pyloric stenosis
  2. Thumb print appearance – Ischaemic colitis
  3. Inverted 3 sign of Frosberg – Ca head of pancreas
  4. Widening of C loop of duodenum/antral pad sign- Ca head of pancreas

Barium enema findings

Ileocaecal TB and incompetant ileocaecal valve

  1. Pulled up caecum
  2. Obtuse ileocaecal angle
  3. Filling defect

Carcinoma Colon

  1. Apple core deformity
  2. Irregular filling defect

Ulcerative Colitis

  1. Lead pipe appearance
  2. Loss of haustrations

Crohn’s disease

  1. String sign of Kantor
  2. Raspberry thorn ulcers

Colonic polyps

  1. Smooth irregular filling defects

Hirschsprung disease

  1. Dilated proximal zone with narrow distal zone of coning

Diverticulosis of colon

  1. Saw tooth appearance
  2. Champagne glass sign

Ischemic colitis

  1. Thumb print appearance

Intussusception

  1. Coiled spring appearance
  2. Claw sign

Volvulus

  1. Bird beak sign
  2. Ace of spades

Common Osteochonditis and their sites

Perthes disease – Femoral head

Panners disease – Capitulum

Keinbock disease – Lunate

Osgood Shattler disease -Tibial tubercle

Severs disease – Calcaneal tuberosity

Kohlers disease – Navicular

Freiberg’s disease – Metatarsal head

Scheurmann’s disease - Ring epiphysis of vertebrae

Calves disease – Central bony nucleus of vertebral body

Sinding Larsen Johansson disease – Lower pole of patella

Iselin’s disease – Traction epiphysis 5th metatarsal base

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