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Monday, April 30, 2018

New born rashes : ref AAP

Cutis marmorata
Harlequin colour change
Neonatal Acne
Erythema toxicum
Pustular Melanosis
Milia
Miliaria Crystallina
Miliaria rubra
Seborrheic dermatitis
atopic dermatitis

Sunday, April 29, 2018

DSD

Denys Drash
Phenotypic female or male
46xy
Female internal organs with streak ovaries(as MIF is missing)(WT1 suppressor defect)
Plus syndrome findings wilms,renal failure,ambiguous genitals.
Abdominal mass is a rare presenting symptom, they re actually treated as atypical nephrotics ;)
Because genitalia may be virilized to be male looking with labial fusions. If male type true genitals,then cryptorchidism.,but still female internal organs present(obviously has MIF was not there so internal organs will form).

WAGR
phenotypic male but with cryptorchdism and hypospadias.
46 XY
Wilms,aniridia,GU abnor,retard mental
Defect in chromosome 11.

If the patient has all features of..... DenysDrash,but wilms tunor is not there(oops), then look for developing Gonadoblastoma in streak gonads,its Frasier syndrome.

Now theres a female,
Who has failed to achieve menarche,
But there is thelarche,
Genitals female type,
Ultrasound reveals that there are no internal female organs, and along tract,instead, testes are seen.
Means MIF worked, so no internal organs, testosterons didnot work thats why female external organs. Thats androgen insensitivity syndrome.
Her karyoype will be 46xy.,and normal testosterone...that converts to estradiol,and so thelarche is there.

Now, after this patient,
Another female comes :)
She has failed to achieve menarche, but his patient, also doesnt have thelarche,
The genitals are true female type,
And ultrasound reveals, internal female organs n gonads....oppps!  Wait n see???
No.
Get Karyotype.
.
46xy
.
Get testosterone.
.
Low.
.
.thats defective SRY gene,
46,xy but no SRY, means No MIF, means female genitals will form,
No SRY means no testosterone,
Which means no male ductal system or testes and so female genitals.
Its Swyer syndrome.

Friday, April 27, 2018

Self

*Imam Ibn al-Qayyim* (rahimahullah):

A friend will not (literally) share your struggles, and a loved one cannot physically take away your pain, and a close one will not stay up the night on your behalf. So look after yourself, protect yourself, nurture yourself and don't give life's events more than what they are really worth.

Know for certain that when you break no one will heal you except you, and when you are defeated no one will give you victory except your determination. Your ability to stand up again and carry on is your responsibility.

Do not look for your self worth in the eyes of people; look for your worth from within your conscious. If your conscious is at peace then you will ascend high and if you truly know yourself then what is said about you won't harm you .

Do not carry the worries of this life because this is for Allah. And do not carry the worries of sustenance because it is from Allah. And do not carry the anxiety for the future because it is in the Hands of Allah.

Carry one thing: How to Please Allah. Because if you please Him, He pleases you, fulfils you and enriches you like.

Do not weep from a life that made your heart weep. Just say, "Oh Allah compensate me with good in this life and the HEREAFTER."

Sadness departs with a Sajdah. Happiness comes with a sincere Du'a. Allah does not forget the good you do. Nor does he forget the good you did to others and the pain you relieved them from. Nor will He forget the eye which was about to cry but you made it laugh.

Live your life with this principle:

*Be good even if you don't receive good, not because of others' sake but because Allah loves those who do good*

Monday, April 9, 2018

Long case history

Long case history ---- points,else- chich history

Pt Name                                                                     (add one sided space for D/D based on P/C )
Father Name
Age/Gender
DOA
TOA
MOA
Address
Source of History:

Ki masla ay tay kao to masla ay ? (now give 3 minutes to mother to speak)

P/C
HOPI
SYS Review
Ix Now
T/M now
Progress Now

Past Hx/Actual History:
--p/c back then
--hopi back then
--sys review
--past hx
--Ix
--T/M
--Progressions?

CCHAM BVEND SKIFS





For any symptom as :

OD PARA
Onset
Duration

Progression
Aggravating factors
Relieving factors
Associations



CCHAM   BVEND   SKIFS


Compliance(who gives,buys,skipped meds?)/Complications/FollowUp(where/how often/ anygrowth parameters chked/any tests done/any meds added or changed ?/
Hospitalizations(how many where,duration?/what were P/C )
ADL(DEATH: Dressing, Eating, Ambulation, Toileting, Hygiene)
Monitoring at home(as in Nephrotic Syndrome, urinary protein., BP in ckd, bsr in DM)

Birth Hx
Vaccination
Exercise/Physiotherapy
Nutrition/Feeding Hx(calories: past 24 hours)
Development (may begin by asking about schooling)

Screening(Family)
Knowledge(about disease)
Impact(On Parents, Patient, Sibling,Schooling,Social Life and Activities)
Family History(consanguinity)hwo many siblings?siblings deaths/?
Social history (own home?rooms?families in home?members?earning? fridge-bike?/water for drinking?/sanitation/ eating red meat?

Remember :
** You must give 3 minutes to the attendant to speak.
** Before you ask about presenting complaints make a margin on the paper on its right side and write a heading differential diagnosis a second heading diagnosis and third heading issues.
Now,
Once you have asked about presenting complaints a differential diagnosis must come to your mind against which you have to complete your history of presenting illness and finally at the end of history of presenting illness and systemic review you must understand that what is the diagnosis here.
** at the end of history taking and physical examination save five minutes in which you have to make case summary.

Good luck.

Saturday, April 7, 2018

Worthy few

Our lives continue to be smooth as calmly flowing rivers because of worthy people around us, whom we can trust, and who are strong and brave enough to utter truths,or share their true prospects with us,worthy few!
We must not desire such truthfulness or sharings from every one, but, those who do come closer, and those who fully do,they re the closest and later inseparable.