Carotid Echocardiogram (right carotid artery plaque)

Patient is having a plaque in his right carotid artery 

How to approach USMLE questions ? ( Lesch–Nyhan syndrome )

Thyrotoxicosis with low radioactive iodine

The most important cause of thyrotoxicosis with low radioactive iodine uptake include:

1.Subacute painless thyroiditis
2.subacute granulomatous thyroiditis
3.iodine induced thyroid toxicosis
4.levothyroxine overdose
5.Struma ovarii

Vascular and immunologic manifestations of infective endocarditis

Vascular & immunologic manifestations of infective endocarditis:

Duke Criteria

Vascular phenomena:

• Systemic arterial emboli (focal neurologic deficits, renal or splenic infarcts)
• Septic pulmonary infarcts
• Mycotic aneurysm
• Conjunctival hemorrhages
• Janeway lesions- Macular, erythematous, non-tender lesions on the palms and soles.

Immunologic phenomena:

• Osler's nodes- Painful, violaceous nodules seen on the fingertips & toes.
• Roth spots- Edematous and hemorrhagic lesions of the retina.
• Glomerulonephritis
• Arthritis or positive rheumatoid factor.

Osteosarcoma

The most common primary bone tumor affecting children and young adults. Boys between ages 13 and 16 years are at higher risk. In children, the tumor occurs most frequently at the metaphyses of long bones such as the distal femur, proximal tibia and proximal humerus
Constitutional symptoms such as fever, weight loss, and malaise are usually absent. On physical examination, the most important finding is a tender soft-tissue mass. Characteristics x-ray findings include a spiculated ''sunburst'' pattern and periosteal elevation known as Codman triangle.
Alkaline phosphatase and lactate dehydrogenase are elevated from turnover of damaged osteocytes; high levels may correlate with adverse prognosis. Increased ESR rate is a non-specific marker of inflammation.

Treatment :

includes tumor excision and chemotherapy

Cor-pulmonale

Cor-pulmonale is a term for right-sided heart failure most commonly due to pulmonary disease. Signs of right-sided heart failure include

• JVD
• right sided S3
• right ventricular heave
• hepatomegaly
• Ascites 
• Dependent edema

Alcohol Abuse

Alcohol Abuse : CAGE

Have you ever felt you should Cut down on your drinking?

Have people Annoyed you by criticizing your drinking ?

Have you ever felt bad or Guilty about your drinking?

Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover (Eye opener)?