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The diagnosis is Myasthenia Gravis. The curtain sign (enhanced ptosis) is characteristically seen in myasthenia gravis. #IM

A 23-year-old man presented with a 1-month history of double vision and right eyelid drooping that worsened at the end of the day. On examination, manual raising of the ptotic right eyelid resulted in dropping of the left eyelid. What is the most likely diagnosis?

The lethal triad in trauma is an indication to limit initial trauma surgery to damage control only. The return to ICU for more resuscitation. It consist of acidosis, hypothermia and coagulopathy. #Surgery #Trauma

Management of Stroke #Neurology

Tests to order in hepatomegaly: - Blood tests: Full blood count Urea and electrolytes Liver function tests Clotting Inflammatory markers Blood film Full liver screen - Ultrasound abdomen #Inx #GIT #Clinical

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Causes of massive splenomegaly: - Myelofibrosis - CML - Malaria - Visceral leishmaniasis Causes of moderate splenomegaly: - Other myeloproliferative diseases (not CML and myelofibrosis) - Portal hypertension - Thalassaemia - Glycogen storage disorders Causes of mild splenomegaly: - Polycythaemia - Haemolytic anaemias - Infection - Infiltration - Connnective tissue diseases #DDx

Gastrointestinal cause of clubbing: Hepatic cirrhosis Coeliac disease Ulcerative colitis Crohn’s disease GI lymphoma #IM #GIT #DDx

Treatment of early neonatal infection (within 6 days) is with ampicillin and gentamicin. Treatment of late neonatal infection (7-90 days) is β-lactamase resistant antibiotic and a 3rd generation cephalsporin (e.g., cefotaxime) #Pediatrics

DDx of tachypnea in an infant of a diabetic mother: ~ hypoglycemia ~ respiratory distress syndrome ~ hypertrophic cardiomyopathy ~ hypocalcemia ~ polycythemia ~ clavicle fracture #Pediatrics #DDx

Brachial cleft cysts occur anterior to the sternocleidomastoid muscle. #Surgery

Manifest tetany occurs with calcium levels < 7 mg/dL. It presents with muscle spams in the hands and feet. Latent tetany occurs with calcium levels between 7 - 9 mg/dL. It presents with muscle spasms only with stress. #Surgery #Electrolytes

The 3 P's of Pinealoma: - Paralysis of upward gaze (Parinaud syndrome) - Ptosis - Precocious puberty #Pediatrics

Types of cerebral palsy #Pediatrics

Use of Macrolides (especially Erythromycin) in infants < 2 weeks is associated with pyloric stenosis. Use of sulfamethoxazole-trimethoprim in infants < 2 months is associated with kernicterus. #Pediatrics

Treat Multidrug-resistant TB with (pyrazinamide or ethamabutol) + a fluoroquinolone (levofloxacin or moxifloxacin) + an injectable agent (amikacin, kanamycin, capreomycin or streptomycin) #Infectious

TB treatment terminology 1 . Relapse is defined as a patient who develops active tuberculosis (by culture, clinical or radiological deterioration) after completion of Anti-TB therapy. 2. Default is defined as interruptions in therapy of longer than 2 months. 3. Failure is defined as continued or recurrent positive cultures after 4 months of treatment in patients with assured adherence to the prescribed anti-tuberculous regimen. 4. Multidrug-resistant (MDR)-TB: TB caused by strains that are resistant to in vitro to rifampicin and isoniazid. 5. Extensively drug-resistant (XDR)-TB: TB caused by strains that are resistant to in vitro to isoniazid, rifampicin and at least one injectable agent (i.e., amikacin, kanamycin or capreomycin) and any of the fluoroquinolones. 6. Monoresistant TB: TB caused by strains of that are resistant to just one anti-TB drug. 7. Polyresistant TB: TB caused by strains that are resistant to more than one drug, but not isoniazid and rifampicin together. #Infectious

First and second line drugs to treat TB PRIEST & KTR FACEPaC mnemonic #Infectious

Measles (Rubeola) vs Rubella (German measles) - The rash in measles in confluent in some areas. The rash in rubella is not. - Measles also causes Cough, Coryza, Conjunctivitis, and Koplik spots (Grey-white papules with an erythemtaous base) - Rubella causes sore throat, posterior cervical lymphadenopathy, and Forchheimer spots (pinpoint or larger petechial rash on the soft palate) #Pediatrics

Pneumocystis pneumonia is treated with Trimethoprim-Sulfamethoxazole. Add steroids if PaO2 < 70 mmHg or A-a gradient ≥ 35 mmHg. If the patient has a sulfa drug allergy, alternative drugs such as Pentamidine, Atovaquone, or Dapsone can be used. #Infectious