- Medical treatment of hydrocephalus.

Medical treatment of hydrocephalus

*Aim:-

Medical treatment is used to delay surgical intervention.

*Medical treatment is not effective in long-term treatment of chronic hydrocephalus. It may induce metabolic consequences and thus should be used only as a temporizing measure.

*Lines of TTT:- "Fair"

• Furosemide:1mg/kg/day.(Decreasing CSF secretion).
• Acetazolamide 5mg/kg/day.(Decreasing CSF secretion).
• Isosorbide (Increasing CSF reabsorption).
• Restriction of water and salts.

Dr Ibrahim

- Skull causes of macrocephaly.

Skull causes of Macrocephaly.

"Oscar"

Osteogenesis imperfecta.
Secondaries especially neuroblastoma.
Chronic hemolytic anemia.
Achondroplasia.
Rickets.

Dr Ibrahim

-Guillain Barr� syndrome.

Guillain Barr� syndrome

Aetiology(theories):-

• Postinfection:50% of cases have preceding respiratory or GIT viral infection.
• Post vaccination:following vaccination against swine flu virus.
• Lymphoma.
• Autoimmune theory.

Clinical Picture:-
1-Initial febrile illness.
2-Motor affection:-

• Bilateral symmetrical ascending affection of both lower limbs,trunk,upper limbs,Bulbar muscles,facial muscles then diphragm and respiratory muscles.
• The Affection is proximal more than distal in adult.
• The Affection is proximal more than distal in infant and childrens.
• Weakness is associated with hypotonia and areflexia.
  

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-Lambert-Eaton syndrome.

Lambert-Eaton syndrome
or
Myasthenic-myopayhic syndrome.

*Pathophysiology:-

• a myasthenic syndrome due to autoimmune orocess targeting the mechanism of releasing A.CH from nerve terminals.
• It often associated with bronchogenic carcinoma or other malignancies.

*Clinical picture:-
Proximal weakness,wasting and fatigue but with less common ocular and bulbar affection than Myasthenia.

*Diagnosis:-

• EMG:- shows paradoxical increase  in successive muscle contractions.
• No significant response to prostigmine,but respond to guanidine HCL 20 mg/Kg/day or prednisolone+imuran.
• No acetylecholine receptor antibodies.
• CXR to determine if associated with bronchogenic carcinoma or not.

*Treatment:-

• Treatment of the underlying neoplasm.
• Plasmapheresis.
• Immunosuppression.

Dr Ibrahim

Return to list of medical syndromes here

-Poisons with charachteristic odour.

Poisons with charachteristic odour

"Phenol"

Phenol,Phosphorus.

Hydrocarbons.
Hydrocyanic acid(Bitter almond).
Hydrogen sulphide(Rotten egg).

Ethanol and methanol.
Nicotine.

Opium.
Organophosphorus,arsenic (Garlic odour).

Liquid of salicylate"oil of winter green".

Dr Ibrahim

-Indications of heamodialysis.

Indications of heamodialysis
"Unstable"

Uraemia.
No response to conventional therapy.
Salicylates.
Theophylline.
Alcohols,Acetaminophen.
Boric acid,Barbiturates.
lithium.
Ethylene glycol.

Dr Ibrahim

-Substances not adsorbed by Activated Charcoal.

Substances not adsorbed by Activated Charcoal
"Phials"

Pesticide,potassuim
Hydrocarbons.
Iron,Insecticide.
Acids,Alkali,Alcohols.
Lithium.
Solvents.

Dr Ibrahim

-Common radiopaque medications.

Common radiopaque medications which appear in X-ray
"Cheap bit"

Chloral hydrate,Cocaine,Ca.
Heavy metals.
Enteric coated tablets.
Antihistamines,Arsenic.
Phenothiazines,potassium.

Barium.
Iodide,Iron.
Tricyclic antidepressants.

Dr Ibrahim

-Don't soil scorpion sting.

Don't soil(????)scorpion sting

(Don't perform the following in scorpion sting):-

Suction of the wound.
Over treat by hypnotics (over sedation).
Immersion of injured extremity in ice.
Local incision.

Dr Ibrahim

-Vircow's triad.

Vircow's triad is the aetiology of thrombosis which is composed of :-

1-Damage of vascular endothelium(Vascular trauma):-
this damage expose the endothelial collagen which is rough surface to which platelets can stick firmly and release thromboxane A2 that help more platelet aggregation.

2-Slowing(Reduced)in the blood flow (stasis):-
these changes help thrombosis by allowing the platelets to deviate from the axial stream and cross the peripheral plasmatic zone to stick to the vascular endothelium.

3-Change in blood composition(Increased coagulability ):-
a-Increase number of blood elements.
-Increase platelets so become more sticky and agglutinate in small masses and adhere to vascular endothelium.
-Increase WBCs and RBCs increase viscosity of blood and stasis.
b-Biochemical changes that cause systemic activation of the cloting system.

"VIR chow"

Vascular trauma
Increased coagulability
Reduced blood flow (stasis)

Dr Ibrahim

Return to other triads here.

-Types of laxatives.

Types of laxatives

"Boss"

Bulk laxatives.
Osmotic laxatives.
Stimulant(irritant)laxatives.
Stool Softeners.

Or "Bios"

Bulk laxatives.
irritant(Stimulant)laxatives.
Osmotic laxatives.
Stool Softeners.

Dr Ibrahim

-Poisoning severity grading.

Poisoning severity grading

Grade 0(none):no symptoms or signs or vague symptoms not related to the poison.

Grade 1(Minor):Mild,transient and spontanously resolving symptoms.

Grade 2(Moderate):pronounced or prolonged symptoms.

Grade 3(sever): sever or life threatening symptoms.

Dr Ibrahim

Return to list of medical grades (click here) 

-Drugs causing constipation.

Drugs causing constipation

"Coma"

Calcium channel blockers.
Opioids.
Muscle relaxants.
Antacids,Anticholinergics,Abuse of laxatives.

Dr Ibrahim

-Treatment of urticaria.

Treatment of urticaria

"Scar"

Systemic steroids(sever cases resistant to treatment).
Soothing lotions locally.

Ca gluconate.

Adrenaline.
Antihistamines.

Removal of the cause.

Dr Ibrahim

-Local causes of Miosis.

Local causes of Miosis (Constriction of the pupil)
"Path"

Puncture of anterior chamber.
Acute iritis.
Traumatic Miosis.
Hypermetropia.

Dr Ibrahim

-Risk factors of cerebral infarction.

Risk factors of cerebral infarction

A)Non-modifiable risk factors:- "Maps"
Male gender.
African-American.
Age(Old age).
Positive family history.
Prior Stroke.

B)Modifiable risk factors by medical treatment:- "Third"
Transient ischemic attacks.
Heart diseases.
Increase Blood pressure(HTN).
Raised Hematocrite.
Diabetes Mellitus.

C)Modifiable risk factors by changing lifestyle:- "chops"
Cigarette smoking.
Hyperlipidemia.
Obesity.
Physical inactivity.
Stressful life.

Dr Ibrahim

-Grades for quantitative assessment of muscle power.

Grades for quantitative assessment of muscle power

Grade(0):-Total paralysis.
Grade(1):-Visible or palpable flicker of contraction but no movement of joint or limb.
Grade(2):-contraction of the muscle  only when the effect of gravity is eliminated.
Grade(3):-Normal movement against gravity but not against additional resistance.
Grade(4):-Normal movement against gravity and additional resistance but not in full range.
Grade(5):-Intact(Normal) muscle power.

Dr Ibrahim

Return to list of medical grades (click here) 

-Mechanical causes of Impotence.

Mechanical causes of Impotence
"Hope"

Huge bilateral hydrocele or inguinal hernia.
Morbid Obesity.
Penile carcinoma.
Peyrone's disease(fibrotic scar of tunica alibuginea surrounding corpora cavernosa resulting in curvature of penis in erection)
Elephantiasis of penis or scrotum.

Dr Ibrahim

-Predisposing factors of genital candidosis in female.

Predisposing factors of genital candidosis in female

"Charge"

Chemotherapeutics(Antibiotics or immunosuppressive drugs).
Hormonal effect(e.g steroids,contraceptive pills and pregnancy)
Severe Anaemia or other debilitating diseases.
Reinfection from an infected male.
Glucosuria(Diabetes mellitus and pregnancy).
Excessive humidity (wearing of nylon tights).

Dr Ibrahim