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24y/f P1L1, FT LSCS due to placenta previa on 20-04-2018.1 unit of blood transfusion done post operatively. Patient developed erythematous lesions over loin spreading toward abdomen and back bilaterally. C/o mild

a 39 year old male pt with c/o weight gain, frequent lri,multiple joint pain,hair fall for 4to 5 years . what should be the further management.inv enclosed.

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50 year old Male presenting with Palpatations and Breathlessness...

A 65 yr old male pt came with complaints of double vision fatigue which worse on evening time and repeated work on examination bilateral ptosis present . what is diagnosis and management?

Verified response The most likely diagnosis. is myestenia gravis u can do The ice pack test and the Tensilon ( edrophonium ) which are considered an extension of the neurologic examination rather than laboratory tests can do mmunologic and/or electrophysiologic testing to confirm. Once the diagnosis of myasthenia gravis has been established, a chest CT or MRI scan should be performed to look for a possible associated thymoma. MANAGEMENT the treatment of MG is highly individualized for each patient. Treatment choices depend on the age of the patient, the severity of the disease, particularly the presence of bulbar or respiratory symptoms, and the pace of progression. The initial step in most adult patients with mild or moderate disease is symptomatic therapy in the form of pyridostigmine bromide. Those with severe disease, or rapidly worsening disease, should be treated much like those in myasthenic crisis using rapid therapies (ie, intravenous immunoglobulin or plasmapheresis) followed by longer-acting immunotherapies such as glucocorticoids, azathioprine , mycophenolate mofetil, or cyclosporine .
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Verified response Given the clinical scenario presented : ▪SBP [Spontaneous Bacterial Peritonitis] is always a risk in Alcoholics with Portal Hypertension & ASCITES....symptoms nonspecific. Recommend: Abdominal Ultrasound to start & peritoneal tap[ultrasound guided or even marked location per sono exam] IF ASCITES PRESENT; & send ascitic fluid for cell counts, chemistries[glu, LDH, ADA, protein] cytology & cultures[bacterial, AFB, Fungal]. Sonogram will also evaluate gallbladder/hepatic pancreatoduodenal bed [if later not obscured via gas] ▪Additionally, no mention made of CBC/DIFF & general labs [lytes, RENAL function, LFTS?] ▪Further, Serum AMYLASE & LIPASE should be checked to evaluate for acute/chronic pancreatitis... ▪FURTHER, must evaluate APPENDIX[via Ultrasound] as acute Appendicitis can be the masquerader --- even with BENIGN EXAMS ▪Lastly, Never forget that CARDIAC ISCHEMIA & acute Pneumonia can present themselves As ABDOMINAL symptomology --- therefore, add EKG 12 LEAD &Troponin-T with PA/LAT CXR. I also send 2 sets Blood Cultures when considering any infectious etiology. ▪In my experience, Alcoholics tend to present atypically with TYPICAL maladies --- therefore, MAINTAIN SUSPICION during Workup.
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There you are --- would obtain ABDOMINAL CT scan & ask GENERAL SURGERY to consult on patient....in MEANTIME... keep NPO; IV PPIs, IVF maintenance; Needs COMPLETE electrolytes [SMA-6, CA+2, phosphate, Mg+2;] BUN/CR; LFTS, & AMYLASE & LIPASE; CBC/DIFF, & SEND 2 SETS BC....WILL NEED better clarification of LOCULATED PERITONEAL COLLECTION, as may be from COLONIC PERFORATION--- THEREFORE: CT SCAN necessary. WOULD Also Start BROAD SPECTRUM antibiotics to cover Gram neg ENTEROBACTERIACEAE & Anaerobes[IV CEFTRIAXONE & METRONIDAZOLE great to START AFTER BLOOD CULTURES SENT]
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23y/f (P1L1) presented to casualty with h/o sudden unresponsiveness. Patient opens eyes voluntarily, blink reflex response. Delivered term male baby 3 months ago through elective LSCS, baby is alive & healthy,

ecg

Mr. 47 years old Looking for drug use With shivering

Verified response Granted, EKG presented reveals NSR @80; NAD, NRWPAP; no intervsls; no chamber hypertrophy nor ischemic chgs. ●HOWEVER, this gentleman's Chief COMPLAINT merits the main ATTENTION --- ie: HIS ADDICTIVE DISEASE. He is clearly experiencing probable OPIOID WITHDRAWAL SYMPTOMS given his shivering -- in fact we use the OWS[Opioid Withdrawal Scale] in determining degree of WD prior to initiating BUPRENORPHINE[SUBOXONE with Naloxone SL tab vs Film] therapy to AVERT ACTIVE Withdrawal in these patients; initiating Rx once MODERATE WD symptoms present. BY AVERTING & Stopping OPIOID Withdrawal symptoms--- the Recovering person can then BETTER FOCUS upon their disease & its remedy via REHAB/participation in 12 Step programs/NA/AA fellowships. ▪BUPRENORPHINE is a MU-OPIOID receptor AGONIST with Strong Affinity for, & long dissociation from, the Mu opioid receptor, which also possess a CEILING effect circa 24mg/day dosing--- thusly protecting the patient from RESPIRATORY DEPRESSION, which exists as a significant problem with METHADONE RX/maintenance in rxing OPIOID USE DISORDER. Further, Given BUPRENORPHINE's 'favorable' BIOAVAILABILITY profile by its POOR ORAL/GI mucosal absorption[<50%], & long biological T1/2 of 37 hrs; along with its attendant ceiling effect upon CNS Mu opioid receptors --- makes for safest OPIOID AGONIST Rx in Opioid Use Disorder(OUD). DATA has shown that over 90% of Opioid dependent patients RELAPSE within their First year of attempted sobiety, with majority within first 3 months following entering Recovery --- however, this statistic improves considerably on BUPRENORPHINE maintenance Rx(Along with continued Psychosocial Support & CBT-related Addiction Counseling) --- which can be dose adjusted individually & tapered over time. The PsychoSocialBiologic Reason behind POOR EARLY SOBRIETY maintenance in those with OUD involves the OPIOID ABSTINENCE SYNDROME; & its associated ANHEDONIA/Depression which is very disabling to the newly Sober individual.
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8yrs old girl presents with itchy rash on neck and around both elbow joints.

Verified response to rule out atopic dermatitis if there is recurrence of such lesion since childhood, h/o asthma, ask for family history of asthma and atopy.
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Verified response CKD is a compelling indication for using ACE inhibitors/ ARB's as the first line as an antihypertensive medications.This drugs have a protection for the kidneys.You can use loop diuretics and calcium channel blockers as the second line
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angiotensin converting enzyme inhibitors and angiotensin receptor blockers are the initial treatment options...
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