Peripheral neuropathy or polyneuropathy-diffuse peripheral lesion, often symmetrical
Onset-
Childhood-CMT
Adult-diabetes
Older adult- paraproteinemia
Acute onset-AIDP, porphyria, toxic, vasculitis,tick paralysis, diphtheria
Chronic-B 12 def, paraproteinemia, diabetes.
Symptom-
Motor-distal weakness predominates.
Sensory-tingling (positive), numbness (negative)
Autonomic-orthostatic lightheadedness, gastroparesis, sweating abnormalities
Diff diagnosis by pattern
Pattern 1 : symmetrical ,prox and distal weakness + sensory loss
CIDP, vasculitis
Pattern 2 : symmetrical distal weakness +sensory loss
DM, drug and toxin, hereditary neuropathies, amyloidosis , paraproteinemia
Pattern 3: Asymmertical distal weakness and numbness
Infectious neurpathy, multifocal trauma, entrapment, vasculitic
Pattern 4: asymmetrical distal or prox weakness without sensory loss
Multifocal motor neuropathy, motor neuron disease, inclusion body myolitis
Pattern 5: asymmetric prox and distal weakness with sensory loss
Malignant infiltration, polyradiculopathy, HNPP
Pattern 6: symmetric small fibre sensory neuropathy without weakness
DM, amyloid, HIV
Pattern 7 marked proprioception loss
HIV, B6 toxicity, sjogren, paraneoplastic
Pattern 8: Neuropathywith cranial nerve involve
HIV,lyme, AIDP, sarcoidosis, malignant infiltration,antiGd1b neuropathy
Acute neuropathies
Guillain barre
Vasculitic neuropathic
Acute intermittent porphyria
Diphteria
Heavy metal
Tick paralysis
Chronic:
Mononeuropathic –trauma entrapment’
Multiple mononeuropathic- vasculitic
Polyarteritis nodosa
Sjogren
Wegener grnulomatosis
HNPP
Multifocal motor neuropathic
Polyneuropathic
DM,
Nutritional eg B12, B6, B1 def ,
Alcoholic
CIDP
Paraneoplstic
Paraproteinemia
Infectious-HIV, CMV, lyme, leprosy
Sarcoid
Metabolic- renal, hepatic or hypothyroid
Heavy metal- arsenic, lead, mercury
Drug- vincristine, flagyl, sisplatin , amiodarone,
Showing posts with label review. Show all posts
Showing posts with label review. Show all posts
Wednesday, September 07, 2011
Monday, September 05, 2011
Support my blog
Recently i had updated my blog but sadly people just read my blog but without showing support.
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writing summary blog is quite taxing! you should spend minimum time by clicking the ad sense after finish every article. Who knows! YOU LEARN SOMETHING BY CLICKING IT! iF YOU worried about deviation just right click to open in other page!
Gout
Gout
Gout is a disease characterized by an abnormal metabolism of uric acid, resulting in an excess of uric acid in the tissues and blood.
People with gout either produce too much uric acid (10%), or more commonly or have problem in removing it (90%).
acute and chronic goutyarthritis, kidney stones, and local deposits of uric acid (tophi) in the skin and other tissues.
Gout may occur alone (primary gout) or may be associated with other medical conditions or medications (secondary gout).
Gouty arthritis characterised by sudden onset of a painful, hot, red, swollen joint, particularly in the foot at the big toe. Commonest inflammatory arthritis in men over the age of 40.
Diagnosed by detecting uric acid (monosodium urate) crystals in Joint aspiration which is negative birefringence.
uric acid level should be done but cannot be rule out by normal uric acid!
joint radiograph to see joint destruction.
Genetics (our inherited genes), gender, and nutrition(alcoholism, obesity) play key roles in the development of gout.
20% development of gout if parents got gout
Diets rich in red meats, internal organs, yeast, and oily fish increase the risk for gout.
Attacks of gouty arthritis can be precipitated when there is a sudden change in uric acid levels, which may be caused by
• overindulgence in alcohol and red meats,
• trauma,
• starvation and dehydration,
• IV contrast dyes,
• chemotherapy,
• medications,
o diuretics and some other anti-hypertensive medications,
o aspirin (Bayer, Ecotrin),
o nicotinic acid (B-3-50, B3-500-Gr, Niacin SR, Niacor, Niaspan ER, Slo-Niacin),
o cyclosporin A,
o allopurinol (Zyloprim) and probenecid (Benemid),
o others.
Kidney stones are more frequent in people with gout.
Uric acid crystals can form outside joints.- tophi, can be found in the earlobe, elbow, and Achilles tendon (back of the ankle), or in other tissues.
tophi are not painful but can be a valuable clue for the diagnosis as the crystals that form them can be removed with a small needle for microscopic examination.\
treatment
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
o Examples include indomethacin(Indocin), ibuprofen (Advil), andnaproxen (Aleve). Newer drugs such ascelecoxib (Celebrex) can also be used.Aspirin should not be used
o High doses of anti-inflammatory medications are needed to control the inflammation and can be tapered off within a couple of weeks.
o The primary complications of these medications include upset stomach, bleeding ulcers, and decreased kidney function.
• Colchicine (Colcrys)
o This medication is given in two different ways, either to treat the acute attack of arthritis or to prevent recurring attacks.
o To treat the hot, swollen joint, colchicine is given rapidly (generally, two tablets at once followed by another tablet an hour later).
o To help prevent an attack from coming back, colchicine can be given once or twice a day. While the chronic use of colchicine can reduce the attacks of gout, it does not prevent the accumulation of uric acid that can lead to joint damage even without attacks of hot, swollen joints.
o caution for pt with kidney or liver function.
• Corticosteroids
o Corticosteroids such as prednisone (Meticorten, Sterapred, Sterapred DS) are generally given when your doctor feels this is a safer approach than using NSAIDs.
o When given by mouth, high-dose corticosteroids are used initially and tapered off within a couple of weeks. It is important to take these medications as prescribed to avoid problems.
o Some complications with the short-term use of corticosteroids include altered mood, elevated blood pressure, and problems with control of glucose in patients with diabetes.
o Corticosteroids can also be injected into the swollen joint. Resting the joint temporarily, after it is injected with steroids, can be helpful.
• Probenecid (Benemid)
o This medication helps the body eliminate excess uric acid through the kidneys and into the urine.
drink at least 2 liters of fluid a day while taking this medication (to help prevent uric acid kidney stones from forming).
• Allopurinol
o This medication decreases the formation of uric acid by the body and is a very reliable way to lower the blood uric acid level. Allopurinol is currently the gold standard of maintenance therapy.
o Allopurinol can be still used, but the dose may need to be adjusted for kidney problem pt.
o Common side effects include stomach pain, headache, diarrhea, and rash.
• Febuxostat (Uloric)
o Febuxostat is first new medication developed specifically for the control of gout in over 40 years.
o Febuxostat decreases the formation of uric acid by the body and is a very reliable way to lower the blood uric acid level.
o Febuxostat can be used in patients with mild to moderate kidney impairment.
o Febuxostat should not be taken with 6-mercaptopurine (6-MP), or azathioprine.
It is important to understand that these maintenance medications are used to lower the uric acid well below normal to prevent recurrent gouty arthritis attacks. Generally, doctors want the blood uric acid level to be below 6.0 mg/dL. This level of uric acid is referred to as the "target level" or "goal" of therapy.
IT is not available in Malaysia.
Malaysian candidates only got to uses allopurinol.
for acute attack only can used steroid, colchicine and NSAID!
Support my blog by clicking adsense at side or below. THIS is the inspiration for me to continue on provide summary daily!
Gout is a disease characterized by an abnormal metabolism of uric acid, resulting in an excess of uric acid in the tissues and blood.
People with gout either produce too much uric acid (10%), or more commonly or have problem in removing it (90%).
acute and chronic goutyarthritis, kidney stones, and local deposits of uric acid (tophi) in the skin and other tissues.
Gout may occur alone (primary gout) or may be associated with other medical conditions or medications (secondary gout).
Gouty arthritis characterised by sudden onset of a painful, hot, red, swollen joint, particularly in the foot at the big toe. Commonest inflammatory arthritis in men over the age of 40.
Diagnosed by detecting uric acid (monosodium urate) crystals in Joint aspiration which is negative birefringence.
uric acid level should be done but cannot be rule out by normal uric acid!
joint radiograph to see joint destruction.
Genetics (our inherited genes), gender, and nutrition(alcoholism, obesity) play key roles in the development of gout.
20% development of gout if parents got gout
Diets rich in red meats, internal organs, yeast, and oily fish increase the risk for gout.
Attacks of gouty arthritis can be precipitated when there is a sudden change in uric acid levels, which may be caused by
• overindulgence in alcohol and red meats,
• trauma,
• starvation and dehydration,
• IV contrast dyes,
• chemotherapy,
• medications,
o diuretics and some other anti-hypertensive medications,
o aspirin (Bayer, Ecotrin),
o nicotinic acid (B-3-50, B3-500-Gr, Niacin SR, Niacor, Niaspan ER, Slo-Niacin),
o cyclosporin A,
o allopurinol (Zyloprim) and probenecid (Benemid),
o others.
Kidney stones are more frequent in people with gout.
Uric acid crystals can form outside joints.- tophi, can be found in the earlobe, elbow, and Achilles tendon (back of the ankle), or in other tissues.
tophi are not painful but can be a valuable clue for the diagnosis as the crystals that form them can be removed with a small needle for microscopic examination.\
treatment
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
o Examples include indomethacin(Indocin), ibuprofen (Advil), andnaproxen (Aleve). Newer drugs such ascelecoxib (Celebrex) can also be used.Aspirin should not be used
o High doses of anti-inflammatory medications are needed to control the inflammation and can be tapered off within a couple of weeks.
o The primary complications of these medications include upset stomach, bleeding ulcers, and decreased kidney function.
• Colchicine (Colcrys)
o This medication is given in two different ways, either to treat the acute attack of arthritis or to prevent recurring attacks.
o To treat the hot, swollen joint, colchicine is given rapidly (generally, two tablets at once followed by another tablet an hour later).
o To help prevent an attack from coming back, colchicine can be given once or twice a day. While the chronic use of colchicine can reduce the attacks of gout, it does not prevent the accumulation of uric acid that can lead to joint damage even without attacks of hot, swollen joints.
o caution for pt with kidney or liver function.
• Corticosteroids
o Corticosteroids such as prednisone (Meticorten, Sterapred, Sterapred DS) are generally given when your doctor feels this is a safer approach than using NSAIDs.
o When given by mouth, high-dose corticosteroids are used initially and tapered off within a couple of weeks. It is important to take these medications as prescribed to avoid problems.
o Some complications with the short-term use of corticosteroids include altered mood, elevated blood pressure, and problems with control of glucose in patients with diabetes.
o Corticosteroids can also be injected into the swollen joint. Resting the joint temporarily, after it is injected with steroids, can be helpful.
• Probenecid (Benemid)
o This medication helps the body eliminate excess uric acid through the kidneys and into the urine.
drink at least 2 liters of fluid a day while taking this medication (to help prevent uric acid kidney stones from forming).
• Allopurinol
o This medication decreases the formation of uric acid by the body and is a very reliable way to lower the blood uric acid level. Allopurinol is currently the gold standard of maintenance therapy.
o Allopurinol can be still used, but the dose may need to be adjusted for kidney problem pt.
o Common side effects include stomach pain, headache, diarrhea, and rash.
• Febuxostat (Uloric)
o Febuxostat is first new medication developed specifically for the control of gout in over 40 years.
o Febuxostat decreases the formation of uric acid by the body and is a very reliable way to lower the blood uric acid level.
o Febuxostat can be used in patients with mild to moderate kidney impairment.
o Febuxostat should not be taken with 6-mercaptopurine (6-MP), or azathioprine.
It is important to understand that these maintenance medications are used to lower the uric acid well below normal to prevent recurrent gouty arthritis attacks. Generally, doctors want the blood uric acid level to be below 6.0 mg/dL. This level of uric acid is referred to as the "target level" or "goal" of therapy.
IT is not available in Malaysia.
Malaysian candidates only got to uses allopurinol.
for acute attack only can used steroid, colchicine and NSAID!
Support my blog by clicking adsense at side or below. THIS is the inspiration for me to continue on provide summary daily!
Sunday, September 04, 2011
Causes of thrombocytopenia
Medical always related with your normal life even for causes for thrombocytopenia.
It is just like economic-supply and demand
In thrombocytopenia- if destruction excess or reduced production
Impaied production-
1) drugs=eg cytotoxic
2) virus infection-dengue, HIV
3) infection-leptospirosis
4)megaloblastic
5)MDS
6)leukemia,Myelofibrosis, aplastic anemia
7)solid tumour
summary-drug, infection , blood dyscrasia-MDS, leukemia and solid tumour infiltration to marrow
excessive dest
Immune mediated
ITP
drug induced-penicillins, Grp IIB-IIIa inhibitors
secondary immune-SLE, CLL, heparin)
post tranfusion purpura
DIVC
TTP
sequestration
splenomegaly
diluional
massive tranfusion
It is just like economic-supply and demand
In thrombocytopenia- if destruction excess or reduced production
Impaied production-
1) drugs=eg cytotoxic
2) virus infection-dengue, HIV
3) infection-leptospirosis
4)megaloblastic
5)MDS
6)leukemia,Myelofibrosis, aplastic anemia
7)solid tumour
summary-drug, infection , blood dyscrasia-MDS, leukemia and solid tumour infiltration to marrow
excessive dest
Immune mediated
ITP
drug induced-penicillins, Grp IIB-IIIa inhibitors
secondary immune-SLE, CLL, heparin)
post tranfusion purpura
DIVC
TTP
sequestration
splenomegaly
diluional
massive tranfusion
ITP
ITP (Immune thrombocytopenia purpura) is due to immune destruction of platlelet.
Ab coated plt removed following binding to Fc receptors on macrophages
ITP in children – acute, history of recent viral infection-varicella, measles
ITP adult- less acute, seen in women, may be asso with autoimmune disorders such as SLE, thyroid diseases
CLL and solid tumours
Infections with virus- HIV
Clinical- major bleed rare, easy bruising
Inv-FBC, bone marrow-increased megakaryocytes
Treatment-Plt> 30x 109 no urgent trt
First line- steroid 1mg/kg body wt
IV igG is effective if needed rapid rise
Second line-splenectomy
Third line –failed both then danazol, other immunosuppressive such as azathioprine,ciclosporin , mycophenolate mofetil
Ab coated plt removed following binding to Fc receptors on macrophages
ITP in children – acute, history of recent viral infection-varicella, measles
ITP adult- less acute, seen in women, may be asso with autoimmune disorders such as SLE, thyroid diseases
CLL and solid tumours
Infections with virus- HIV
Clinical- major bleed rare, easy bruising
Inv-FBC, bone marrow-increased megakaryocytes
Treatment-Plt> 30x 109 no urgent trt
First line- steroid 1mg/kg body wt
IV igG is effective if needed rapid rise
Second line-splenectomy
Third line –failed both then danazol, other immunosuppressive such as azathioprine,ciclosporin , mycophenolate mofetil
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