A 45 year old man, known to inject drugs, and currently living in homeless hostels, presents to the Emergency Department complaining of malaise, fever, rigors and arthralgia. On auscultation he has a new pansystolic murmur heard loudest over the left sternal edge. What is the
@supportbrain1
While the bifid zygomaticus major muscle is a key anatomical feature in natural dimple formation, the buccinator muscle is often targeted in surgical procedures to create dimples.
@drkeithsiau
Postcholecystectomy diarrhea (PCD) is a recognized complication following gallbladder removal. The pathophysiology primarily involves bile acid malabsorption due to the continuous release of bile acids into the intestine, which can overwhelm the absorptive capacity of the ileum
@IhabFathiSulima
Infections in this area can potentially spread intracranially, leading to serious complications such as cavernous sinus thrombosis, meningitis, or brain abscess. The lack of valves in the facial veins allows for retrograde flow, facilitating the spread of pathogens from
A 84 year old care home resident is brought into the Emergency Department by his carers. They report 48 hours of increased confusion and agitation on a background of dementia. His observations are recorded as:
Heart rate: 93 beats/minute
Blood pressure: 147/95 mmHg
Respiratory
@EM_RESUS
Ignoring chest pain until your heart decides to take a permanent coffee break 🧐. ED physicians will be far less bothered if you bother them sooner
@IhabFathiSulima
Diamond ring sign. The yolk sac represents the “ring” and the embryo represents the “diamond” in this earliest sign of embryonic development on ultrasound
A 29 year old man presents to the Emergency Department with a painful, swollen left eye. He complains of visual disturbance, headache and painful eye movements. On examination he has a mild fever and you note eyelid oedema and erythema. His visual acuity is reduced in the
A 3 year old child is brought into ED by his parents with a widespread itchy rash. The patient is otherwise generally well, other than a mild temperature and irritability secondary to scratching and poor sleep.
The parents explain that the rash started as pink spots which became
@IhabFathiSulima
According to the American Association for the Study of Liver Diseases (AASLD), there is no strict upper limit for the volume of ascitic fluid that can be removed in a single session, provided that appropriate albumin replacement is administered. Specifically, the AASLD recommends
@supportbrain1
Kiesselbach's plexus, also known as Little's area, is a highly vascularized region located on the anterior part of the nasal septum. This area is clinically significant because it is the most common site for anterior epistaxis (nosebleeds). The plexus is formed by the anastomosis
@drkeithsiau
While both omeprazole and dexlansoprazole are effective PPIs, dexlansoprazole's dual delayed-release formulation provides extended acid suppression, which can be advantageous in managing conditions like NAB and GERD. Both PPIs can interact with clopidogrel, but dexlansoprazole
@DrMedica_13
Sucking blisters, also known as friction blisters or suck callouses, are benign lesions that typically appear on the lips of newborns. These blisters are caused by the repetitive friction and suction forces exerted during breastfeeding or bottle-feeding. The pathophysiology
@modernHealthMe
Hutchinson's triad is a clinical manifestation of late congenital syphilis, characterized by three specific findings: interstitial keratitis, eighth nerve deafness, and Hutchinson's teeth.
1. Interstitial keratitis: This refers to inflammation of the cornea, which can lead to
A baby is delivered in the Emergency Department at 42 weeks gestation with thick meconium-stained fluid. The baby is hypotonic, cyanotic, apnoeic, and bradycardic. What is the first management step for this baby?
a) Warming, drying, and stimulation
b) Administer adrenaline
A 20 month old boy is brought to the Emergency Department by his mother. He has a past medical history of eczema which is normally well controlled. Over the previous 2 days he has developed a new rash around his mouth. He is off his food and is febrile. How should this
@OGdukeneurosurg
A seat belt mark on the chest, also known as the "seat belt mark" (SBM) sign, is a skin bruise that corresponds to the site of the seat belt during a motor vehicle collision. This mark is indicative of the force exerted by the seat belt on the body during the crash. The presence
A 34 year old man presents to the Emergency Department with a 3 day history of abdominal pain. On examination palpation of the left lower quadrant increases pain felt in the right lower quadrant. What name is given to this clinical finding?
A) Psoas sign
B) Obturator sign
C)
@supportbrain1
Plantar fasciitis is a common cause of heel pain, affecting approximately 10% of people at some point in their lives. It is characterized by stabbing, nonradiating pain in the proximal medioplantar surface of the foot, particularly noticeable with the first steps in the morning
@modernHealthMe
In infants, the typical response is dorsiflexion of the great toe, often accompanied by fanning of the other toes. This response is considered normal in infants up to approximately 1 year of age due to the immaturity of the corticospinal tract. The presence of the Babinski sign
@Doctors__squad
For adults, the American Heart Association (AHA) recommends a C:V ratio of 30:2 for both single-rescuer and two-rescuer CPR. For children, the guidelines are slightly different. The AHA recommends a C:V ratio of 30:2 for single-rescuer however, for two-rescuer CPR, the
A 19 year old man presents to the Emergency Department with a 2 day history of penile ulcers.
You suspect genital herpes. Which of the following herpes viruses is most likely responsible for the patient's symptoms?
#MedX
#FOAMed
@supportbrain1
Caplan syndrome, also known as rheumatoid pneumoconiosis, is a rare condition characterized by the presence of rheumatoid arthritis (RA) in conjunction with a specific form of pneumoconiosis. This syndrome typically occurs in individuals with a history of occupational exposure to
You are called urgently to the waiting room by a receptionist. A 23-year-old woman who presented with chest pain has collapsed. She is 32 weeks pregnant. You find no signs of life and a nurse has started chest compressions. A maternal cardiac arrest call is made. What action
@supportbrain1
A horseshoe kidney is the most common renal fusion anomaly, occurring in approximately 1 in 500 individuals in the general population. This congenital condition is characterized by the fusion of the lower poles of the kidneys across the midline, forming a U-shaped structure. The
@modernHealthMe
Angioedema associated with angiotensin-converting enzyme inhibitors (ACEIs) is a potentially serious adverse effect characterized by localized swelling, typically involving the face, lips, tongue, and upper airway structures. This condition occurs due to the accumulation of
@IhabFathiSulima
The "rugger jersey" spine pattern on X-ray is most commonly associated with hyperparathyroidism, particularly secondary hyperparathyroidism due to chronic kidney disease. This radiographic finding is characterized by alternating bands of sclerosis and lucency at the vertebral
@MoarSahitoPTI
Omeprazole is a proton pump inhibitor (PPI) used primarily for the treatment of various acid-related gastrointestinal disorders. It works by inhibiting the H+,K+-adenosinetriphosphatase enzyme in gastric parietal cells, leading to a potent and long-lasting reduction in gastric
@MoarSahitoPTI
B>A . Spironolactone is a potassium-sparing diuretic and aldosterone antagonist. It is used in the management of heart failure with reduced ejection fraction (HFrEF). The American College of Cardiology and the American Heart Association recommend its use in patients with NYHA
@md1talk
The triad of ataxia, encephalopathy, and ophthalmoplegia is classically associated with Wernicke's encephalopathy (WE). This condition is primarily due to a deficiency of thiamine (vitamin B1) and is often seen in patients with chronic alcoholism, malnutrition, or other
@modernHealthMe
Panic attack leading to hyperventilation resulting in respiratory alkalosis. Alkalosis leads to binding of Ca to Albumin resulting in signs of Tetany
An 18-year-old male patient presents with pyrexia, a productive cough characterized by hemoptysis, and expiratory wheezing. His medical history includes recurrent lower respiratory tract infections during his pediatric and adolescent periods. Findings?
Source :
@LITFLblog
@IhabFathiSulima
Acne keloidalis nuchae (AKN), also known as folliculitis keloidalis nuchae (FKN), is a chronic, scarring folliculitis predominantly affecting men of African descent. It typically presents as keloid-like papules, pustules, and plaques on the occipital scalp and posterior neck. The
@drkeithsiau
Spontaneous bacterial peritonitis (SBP) is a bacterial infection of ascitic fluid that occurs in patients with cirrhosis and ascites, without any evident intra-abdominal surgically treatable source of infection. The condition is primarily caused by the translocation of enteric
@modernHealthMe
Corynebacterium diphtheriae is a Gram-positive, non-spore forming, non-motile, pleomorphic rod that belongs to the genus Corynebacterium and the actinomycete group of organisms. It is the causative agent of diphtheria, a potentially fatal infectious disease. The pathogenicity of
@modernHealthMe
An episiotomy is a surgical incision made in the perineum—the area between the vaginal opening and the anus—during the second stage of labor to enlarge the vaginal opening and facilitate childbirth. This procedure is typically performed to prevent severe perineal tears, expedite
@IhabFathiSulima
Neuroretinitis is an inflammatory disorder of the eye characterized by optic disc edema and the subsequent development of a macular star. The condition can be classified into idiopathic, infectious, and recurrent forms. Infectious causes include cat scratch disease, Lyme disease,
@Doctors__squad
Dog-mediated rabies
Rabies is a vaccine-preventable, zoonotic, viral disease affecting the central nervous system. In up to 99% of the human rabies cases, dogs are responsible for virus transmission. Children between the age of 5 and 14 years are frequent victims.
Rabies infects
@modernHealthMe
Tuberous sclerosis complex (TSC) is a rare multisystem autosomal dominant genetic diseasethat causes non-cancerous tumours to grow in the brain and on other vital organs such as the kidneys, heart, liver, eyes, lungs and skin. A combination of symptoms may include seizures,
A 32 year old man presents to the Emergency Department with a 12 hour history of right sided abdominal pain. Labs show:
- Haemoglobin 13.2 g/dl
- White blood cells 8.4 × 10^9/L
- Platelets 345 × 10^9/L
- Sodium 132 mmol/L
- Potassium 4.6 mmol/L
- Urea 6.5 mmol/L
- Creatinine 150
@Gazelle6849
Delays in epinephrine administration are associated with increased morbidity and mortality. Adrenaline(epinephrine) is the cornerstone of anaphylaxis management. It should be administered immediately upon recognition of anaphylaxis to prevent progression to severe or fatal
@simplify_drugs
Metformin is associated with vitamin B12 deficiency. This association has been well-documented in multiple studies and clinical trials. The mechanism is thought to involve interference with the calcium-dependent binding of the intrinsic factor-vitamin B12 complex to the cubam
A 12 year old boy is brought to the Emergency Department by his parents.
They describe weight loss over the last month, associated with increased thirst and abdominal pain in the last 2 days. His blood results show a metabolic acidosis with a raised blood glucose. His initial
@Neuromed_
Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disorder of the central nervous system, often following an infection such as pharyngitis. The primary treatment for ADEM involves high-dose corticosteroids. Intravenous methylprednisolone is typically
@DrMedica_13
Amiodarone is an antiarrhythmic drug known to cause pigmentation changes in the skin. This pigmentation typically presents as a slate-gray or blue-gray discoloration, particularly in areas exposed to light. The pigmentation is due to the accumulation of amiodarone and its
@IhabFathiSulima
Rose gardener’s disease
Sporotrichosis is a subacute or chronic fungal infection caused by the dimorphic fungus Sporothrix schenckii and related species within the Sporothrix genus. This infection is typically acquired through traumatic inoculation of the fungus into the skin or
@DrMedica_13
The triad of recurrent sinusitis, infertility, and bronchiectasis is characteristic of Kartagener's syndrome, which is a subset of primary ciliary dyskinesia (PCD). Kartagener's syndrome specifically includes situs inversus totalis along with the aforementioned symptoms.
The
A 39 year old man presents to ED complaining of syncopal episodes. He is concerned as his father died suddenly and unexpectedly when he was 42. What is the most likely diagnosis?
A) Long QT syndrome
B) Hypertrophic obstructive cardiomyopathy
C) Wellens syndrome
D) Brugada
A 40 year old man presents with a 5 day history of a sharp, central chest pain. He describes the pain as "worst on breathing in". He has no significant past medical history but has had a recent episode of sinusitis. What is the most likely diagnosis?
A) Community acquired
A 31 year old man presents to the Emergency Department with a painful, swollen ankle after falling heavily whilst playing in a football match. He is not able to weight bear. What can be seen in this x-ray?
A) Fracture of the medial malleolus
B) Fracture of the lateral malleolus
@Prince_Fynnd
Acne is caused by a combination of increased sebum production, follicular hyperkeratinization, microbial colonization, inflammation, hormonal influences, genetic predisposition, and lifestyle factors
@DrMedica_13
Micrognathia, characterized by mandibular hypoplasia, is often associated with various syndromic conditions that can include cardiac abnormalities. One notable association is with Pierre Robin sequence, which can present with ventricular septal defects to more complex structural
@Gazelle6849
Most commonly used drugs for migraine prophylaxis are propranolol, metoprolol, timolol, topiramate, valproic acid. Second-line treatments include venlafaxine, gabapentin, naproxen, and supplements like magnesium and riboflavin. These are considered when first-line agents are
A 28 year old woman presents to the Emergency Department complaining of tingling and numbness around her mouth for the past week. Occasionally, she also develops painful carpal spasm. She has a past medical history of Graves disease for which she underwent a subtotal
A 73 year old man presents to ED complaining of severe central chest pain radiating to his left arm. His ECG is shown.
Which of the following coronary arteries is most likely affected?
A) Left coronary artery (LCA)
B) Right coronary artery (RCA)
C) Left circumflex artery (LCx)
D)
A 65-year-old man presents to the Emergency Department with a 10-hour history of chest pain and shortness of breath. He has no past medical history. On examination, you note his chest is clear and a chest x-ray is normal. His observations are recorded as:
- Heart rate: 95 beats
@supportbrain1
An umbilical hernia is a condition characterized by the protrusion of intra-abdominal contents through a weakness or incomplete closure at the umbilical ring. This defect is common in both pediatric and adult populations, though the etiology and management may differ between
@Gazelle6849
Paronychia with abscess, an inflammation and infection of the nail folds, can be classified as either acute or chronic, and the treatment approach varies accordingly. Warm soaks with or without Burow solution or 1% acetic acid are recommended as first-line treatment. If warm
@supportbrain1
The butterfly rash, also known as a malar rash, is a characteristic cutaneous manifestation of systemic lupus erythematosus (SLE). This rash typically presents as an erythematous, flat or raised rash that spans the bridge of the nose and extends symmetrically over the cheeks,
@MoarSahitoPTI
Hydrocortisone sodium succinate (Solu-Cortef) is a glucocorticoid used in various clinical settings, particularly when oral therapy is not feasible. Its uses include:
1. Allergic States: It is indicated for the control of severe or incapacitating allergic conditions that are
🚨 Medical Mystery Alert 🚨
A mother rushes her newborn to the ER, 16 hours post-home birth. The baby, increasingly jaundiced, has a heart rate of 154 bpm, respiratory rate of 30, and a temp of 36.9°C.
🔬 Neonatal team finds Heinz bodies in the blood film.
What's the
A 5 week old baby boy is brought to the Emergency Department by his mother. She is worried as he seems constantly hungry and is losing weight. She describes frequent non-bilious vomiting occurring about half an hour after formula feeding. On examination you are able to palpate a
@MoarSahitoPTI
The American College of Cardiology (ACC), American Heart Association (AHA), and Heart Rhythm Society (HRS) recommend the use of warfarin (target INR 2.0 to 3.0) or non-vitamin K antagonist oral anticoagulants (NOACs) such as dabigatran, rivaroxaban, apixaban, and edoxaban for
@supportbrain1
Gout in the big toe, also known as podagra, is a form of inflammatory arthritis characterized by the deposition of monosodium urate (MSU) crystals in the joint. This condition is primarily caused by hyperuricemia, where elevated levels of uric acid in the blood lead to the
@MoarSahitoPTI
Ondansetron is a selective serotonin 5-HT3 receptor antagonist primarily used as an antiemetic to prevent nausea and vomiting associated with cancer chemotherapy, radiotherapy, and postoperative procedures
@OGdukeneurosurg
The Hoffman sign is a neurological examination finding used to assess the presence of upper motor neuron lesions, particularly in the context of cervical myelopathy. It is elicited by flicking the distal phalanx of the middle finger and observing for involuntary flexion of the
@md1talk
ST elevation in leads V1-V4, I, and aVL, along with ST depression in leads II, III, and aVF, is indicative of an extensive anterior wall myocardial infarction (MI), likely due to occlusion of the proximal portion of the left anterior descending (LAD) coronary artery
@OGdukeneurosurg
Mumps is an acute viral illness caused by the mumps virus, characterized by several key symptoms. The most classic presentation is parotitis, which is the acute onset of unilateral or bilateral tender swelling of the parotid or other salivary glands, typically lasting about 5
What is the anatomical basis for the formation of natural dimples in humans?
A) Hyperactivity of the orbicularis oris muscle
B) Presence of subcutaneous fat deposits in the buccal region
C) Bifurcation or shortened structure of the zygomaticus major muscle
D) Hypertrophy
@radRounds
Distal Radial Physeal Stress Syndrome, it is the most common manifestation, characterized by stress injuries to the distal radial growth plate. Chronic stress can lead to physeal arrest and subsequent growth disturbances. Gymnast's wrist is the wider term used to describe a
A 32-year-old factory worker presents to the Emergency Department with a 2-day history of pain in the right eye. He has no past medical history and cannot recall a history of trauma.
What is the most likely diagnosis?
a) Allergic conjunctivitis
b) Anterior uveitis
c)
@supportbrain1
Gradenigo syndrome is a rare but serious complication of otitis media characterized by a classic clinical triad: ipsilateral abducens nerve (cranial nerve VI) palsy, retro-orbital pain (trigeminal ganglionitis), and chronic otorrhea (otitis media). The underlying etiology is
@OGdukeneurosurg
Cutis Verticis Gyrata (CVG) is a rare dermatological condition characterized by the formation of convoluted folds and deep furrows on the scalp, resembling the gyri of the brain cortex. CVG can be classified into primary and secondary forms.
Primary CVG is further divided into:
A 65 year old man presents to ED with worsening shortness of breath over the past week. He has a past medical history of hypertension and diabetes mellitus. On examination, he is pale and sweaty and breathless. His observations are: HR 115, BP 150/90, RR 28, Sp02 90%. What is the
@supportbrain1
Ehlers-Danlos syndrome (EDS) is a group of heritable connective tissue disorders characterized by joint hypermobility, skin hyperextensibility, and tissue fragility. The clinical manifestations of EDS can vary widely, ranging from mild skin and joint hyperlaxity to severe
@Neuromed_
Horner's syndrome is a neurological disorder characterized by a classic triad of ptosis (drooping of the upper eyelid), miosis (constricted pupil), and anhidrosis (absence of sweating) on the affected side of the face. This condition results from an interruption of the
@DrMedica_13
A vestigial tail in humans is a rare congenital anomaly characterized by a protruding structure from the lumbosacrococcygeal region. This structure is a remnant of the embryonic tail that typically regresses during fetal development. Vestigial tails can be classified into two
You are assessing a 29-year-old woman who presents to the Emergency Department with wheeze and shortness of breath. She is known to suffer from asthma. On examination, you note widespread wheeze. The patient has an increased work of breathing and is unable to talk in full
@supportbrain1
Anencephaly is a severe congenital malformation of the central nervous system characterized by the absence of a major portion of the brain, skull, and scalp. This condition arises due to the failure of the neural tube to close properly during the first few weeks of embryonic
@Doctors__squad
The simple interrupted suture is a versatile technique used for wound closure in a wide range of clinical scenarios. It involves placing individual stitches at regular intervals along the length of the wound. Each suture consists of a knot at the skin’s surface.
@supportbrain1
A vasectomy is a surgical procedure for permanent male contraception. It involves the disruption and occlusion of the vas deferens, the ducts that transport sperm from the testicles to the urethra. By interrupting sperm transport, vasectomy effectively prevents sperm from being
@DrMedica_13
The presentation of unilateral facial weakness with an inability to close the eye or raise the eyebrow is most consistent with Bell's palsy.
Remember Bell's palsy is diagnosed by exclusion, and a systematic evaluation is essential to rule out other potential causes of facial
A 55 year old man presents to the Emergency Department complaining of difficulty swallowing over the previous 3 days. He has no significant past medical history. On examination you note bilateral facial weakness, ptosis and slurred speech. His pupils are dilated and barely
A 5 year old child with fever and sore throat for the last couple of days and a generalised red sandpaper-like rash that erupted in the last few hours, starting on chest and spreading to limbs.
A) Rubella
B) Measles
C) Fifth disease
D) Scarlet fever
E) Roseola infantum
#MRCEM
A 65 year old man is sent to the Emergency Department by his General Practitioner (GP) with profuse watery diarrhoea. A stool sample taken by the GP has demonstrated C. difficile cytotoxin. The patient has recently completed an extended course of antibiotics. Which of the