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Common Clinical Questions

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Admin:
1.What are the causes of muscle tenderness and thick nerve?
Thick Nerve ??? ??? Elaborate on this question more!

2.What is the difference between  anterograde and retrograde amnesia?
In Anterograde amnesia, new events contained in the immediate memory are not transferred to the permanent as long-term memory. The sufferer will not be able to remember anything that occurs after the onset of this type of amnesia for more than a brief period following the event.
Retrograde amnesia is the inability to recall some memory or memories of the past, beyond ordinary forgetfulness.
The terms are used to categorize patterns of symptoms, rather than to indicate a particular cause or etiology. Both categories of amnesia can occur together in the same patient, and commonly result from drug effects or damage to the brain regions most closely associated with episodic/declarative memory: the medial temporal lobes and especially the hippocampus.
An example of mixed retrograde and anterograde amnesia may be a motorcyclist unable to recall driving his motorbike prior to his head injury (retrograde amnesia), nor can he recall the hospital ward where he is told he had conversations with family over the next two days (anterograde amnesia).

3.What  are the  causes of the persistent headache?
1-Extradural hematoma
2-Preeclampsia
3-Subdural hematoma
4-Concussion
5-Brain abscess
6-Temporal arteritis
7-Infectious Mononucleosis
Advice: IF you are having persistent headache, check your blood pressure
Dr.Mahdi

Diagnostic:
Other common clinical questions during rotations
What is the normal urine output for an adult?
1/2 cc/kg/hr
children:
1 cc/kg/hr
What are the 5 Ws of post-operative fever?
Wind, Water, Wound, Walking, Wonder drugs
What are the 4 Fs seen in a typical cholecystitis patient?
Fat, female, forty, fertile
What are the reasons a fistula may not close?
Malnutrition, malignancy, high output, epithelialization of the tract
What's the blood supply to the stomach?
Gastric aa (L+R), Gastroepiploic aa (L+R), Short gastrics
What's the Parkland formula?
% burned x 4 x weight in kg = fluids for first 24 hours (use rule of 9s to get % burned)
What are 5 indications (AEIOU) for dialysis?
Acidosis, electrolytes, ingestions, overload, uremia
What are causes of anion gap/non-anion gap metabolic acidosis?
MUDPILES - methanol, uremia, DKA, paraldehyde, INH, lactic acidosis, ethanol, salicylates (all for anion gap acidosis, i forgot the ones for non-gap)
What's the treatment of hyperkalemia?
Sodium kayexalate, albuterol, insulin + D5, calcium gluconate
What are the rule of 10's for pheochromocytoma?
10% bilateral
10% malignant
10% extra-adrenal
Most common causes of aseptic meningitis?
Enteroviruses, HSV, HIV, Crypto, Blasto, Toxo
Triad of mediastinitis?
Fever, SOB, chest pain
What are the signs of placental separation?
Cord lengthening
Gush of Blood
Uterus takes on a globular shape and becomes palpable anteriorly
Diagnostic

Dr.Mohamed:
1.WHAT ARE THE CAUSES OF SYSTOLIC AND DIASTOLIC MURMURS  OVER THE APEX?
2.WHAT ARE THE CAUSES OF CHEST PAIN, HAEMOPTYSIS,JAUNDICE IN CARDIAC CASE?
3.HOW CAN YOU DIFFERENTIATE CLINICALLY BETWEEN THE RHEUMATIC FEVER AND INFECTIVE ENDOCARDITIS
4.WHAT IS THE DEFINITION OF DYSPNEA,ORTHOPNEA AND PAROXYSMAL NOCTURNAL DYSPNEA?
5.WHAT ARE THE CAUSES OF LOW CARDIAC OUTPUT?

Sumaya:
I am a nurse but thought give it a try.

WHAT ARE THE CAUSES OF CHEST PAIN
-Acute MI's, acute bronchitis, pericarditis, pericardial effusion, pneumonia, TB, valvular stenosis, acid reflux

4.WHAT IS THE DEFINITION OF DYSPNEA,ORTHOPNEA AND PAROXYSMAL NOCTURNAL DYSPNEA?
Dyspnea: Breathlessness, difficulty breathing, shorness of breath--usually subjective symptom.
Orthopnea: Dyspnea brought up by lying down flat, can be relieved by using multiple pillows or sitting up.
Paroxysmal nocturnal dyspnea (pnd). Severe of form of orthopnea in which the person awakens from sleep during night and gasps for air. Pnd is usually common in left ventricular failure and is caused by pulmonary congestion d/t redistribution of body fluid while the person is lying down.

5.WHAT ARE THE CAUSES OF LOW CARDIAC OUTPUT? i'll list what i remember
-hypovolema- loss of fluid/blood.
-Cardiogenic- decreased cardiac output  with evidence of adequate intravascular volume, can result from heart failure, MI's, arrhythmias, heart valve disorders, pulmonary embolus.
- Neurogenic :  massive vasodilation caused by increased parasympathetic stimulation or decreased sympathetic stimulation leading to decreased cardiac output.
Anaphylactic shock: Low cardiac output caused my vasodilation as in neurogenic but caused by hypersensitivity reaction such as allergic reaction.

Dr.Mohamed:
thank you so much sumaya for your answers,but still i want answers for other questions which are:-
1.what are the causes of systolic and diastolic murmurs over the apex?
2.how can you differentiate clinically between rheumatic fever  and infective endocarditis?
3.what are the causes of haemoptysis , jaundice in  cardiac case?.

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