Property:Explanation
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This is a property of type Text.
W
The patient retains the right to make the decision regarding his treatment but the physician can make recommendations that would be in the best interest of the patient and his partner. The physician should recommend that the patient informs the sexual partner for work-up and treatment, but the physician may not violate the right to patient's confidentiality. Although the patient is a minor, parental consent is not required in treating sexually transmitted infections. The physician cannot notify his parents because of his patient’s rights to privacy and confidentiality, unless he is incapacitated and is not able to make decisions for himself, then confidential medical information could be disclosed to relatives.<br/>
'''Educational Objective:''' The patient retains the right to make the decision regarding his treatment but the physician can make recommendations that would be in the best interest of the patient and his partner. The physician should recommend that the patient informs the sexual partner for work-up and treatment, but the physician may not violate the right to patient's confidentiality. Although the patient is a minor, parental consent is not required in treating sexually transmitted infections.<br/>
'''References:''' First Aid 2015 page 58. +
Duchenne Muscular Dystrophy (DMD) is an X-linked recessive disorder caused by frameshift mutation due to deletion of segments of the dystrophin gene. The mutation results in the acceleration of muscle breakdown. Clinical manifestations of DMD typically start at early age before 5 years of age and include proximal muscle weakness, calf pseudohypertrophy, and positive gower's sign (patients walk up their own body and use both hands and feet to stand up from a squatting position).<br/>
'''Educational Objective:''' Duchenne Muscular Dystrophy (DMD) is an X-linked frameshift mutation caused by the deletion of segments of the dystrophin gene.<br/>
'''References:''' First Aid 2015 page 84. +
Confidentiality is a core principle in medical care. By upholding confidentiality and personal privacy, physicians encourage patients to seek medical care and discuss their problems more openly without fear of sharing such information. Confidentiality also circumvents any discrimination based on their medical condition. Patient's informed consent is required before the release of any medical information; nevertheless, confidentiality is not absolute. It may be revoked in cases where a patient's confidentiality poses a threat to other individuals, or the public, or in cases where the law requires it. There are certain circumstances in which a physician may disclose patient information. However, disclosure should be made in specific circumstances in a manner that minimizes harm to the patient:<br>
* When law enforcement members obtain a warrant allowing them to access an individual's medical information.
* When a court of law requests information regarding a patient.
* When withholding information about a disease that may be a threat to other individuals or the public.<br/>
'''Educational Objective:''' Confidentiality may be revoked in cases where a patient's confidentiality poses a threat to other individuals or the public or in cases where the law requires it. Law enforcement officers require a valid court issued warrant that should be presented to the physician in order to justify disclosing confidential patient information.<br/>
'''References:''' Snyder L. American College of Physicians Ethics Manual: sixth edition. Ann Intern Med. 2012;156(1 Pt 2):73-104. +
Amiodarone-induced hypothyroidism (AIH) is believed to result from the inability of the thyroid to escape from the Wolff-Chaikoff effect. Amiodarone is a benzofuranic-derivative iodine-rich drug, the large amount of iodide released during the metabolism of amiodarone leads to an adaptive blockage of further thyroidal iodide uptake and thyroid hormone biosynthesis, the so-called Wolff-Chaikoff effect.
The reported incidence of AIH varies widely, ranging from 6% in countries with low iodine intake to 13% in countries with a high dietary iodine intake.
The risk of developing hypothyroidism is independent of the daily or cumulative dose of amiodarone. However, the risk is greater in the elderly and in female patients, probably as a result of a higher prevalence of underlying thyroid abnormality. The relative risk of developing AIH was found to be 13-fold higher in female patients with positive thyroid microsomal or thyroglobulin antibodies, as compared with men without thyroid antibodies.
'''Reference''':
*"Effects of amiodarone on thyroid function.", journal = Ann Intern Med, volume = 126, issue = 1, month = Jan, year = 1997, PMID = 8992925
*"Amiodarone and the thyroid: a practical guide to the management of thyroid dysfunction induced by amiodarone therapy.", journal = Heart, volume = 79, issue = 2, month = Feb, year = 1998, PMID = 9538302 .
*"Incidence, predictability, and pathogenesis of amiodarone-induced thyrotoxicosis and hypothyroidism.", journal, volume = 91, issue = 5, month = Nov, year = 1991, PMID = 1951413<br/>
'''Educational Objective:''' <br/>
'''References:''' +
Amiodarone-induced hypothyroidism (AIH) is believed to result from the inability of the thyroid to escape from the Wolff-Chaikoff effect. Amiodarone is a benzofuranic-derivative iodine-rich drug, the large amount of iodide released during the metabolism of amiodarone leads to an adaptive blockage of further thyroidal iodide uptake and thyroid hormone biosynthesis, the so-called Wolff-Chaikoff effect.
The reported incidence of AIH varies widely, ranging from 6% in countries with low iodine intake to 13% in countries with a high dietary iodine intake.
The risk of developing hypothyroidism is independent of the daily or cumulative dose of amiodarone. However, the risk is greater in the elderly and in female patients, probably as a result of a higher prevalence of underlying thyroid abnormality. The relative risk of developing AIH was found to be 13-fold higher in female patients with positive thyroid microsomal or thyroglobulin antibodies, as compared with men without thyroid antibodies.
'''Reference'''
*"Effects of amiodarone on thyroid function.",journal = Ann Intern Med, volume = 126, issue = 1, month = Jan, year = 1997,PMID = 8992925.
*"Amiodarone and the thyroid: a practical guide to the management of thyroid dysfunction induced by amiodarone therapy.", journal = Heart, volume = 79, issue = 2, month = Feb, year = 1998,PMID = 9538302.
*"Incidence, predictability, and pathogenesis of amiodarone-induced thyrotoxicosis and hypothyroidism.",journal = Am J Med, volume = 91, issue = 5, month = Nov, year = 1991, PMID = 1951413.<br/>
'''Educational Objective:''' <br/>
'''References:''' +
Amiodarone-induced thyrotoxicosis (AIT) occurs in 2–12% of patients on chronic amiodarone treatment.
In patients with pre-existing thyroid abnormalities, thyrotoxicosis is believed to result from:
*Type I AIT is believed to result from iodine-induced excessive thyroid hormone synthesis.
*Type II AIT results from glandular damage with consequent release of preformed thyroid hormones into the circulation. It is usually self-limiting, which may be explained by the dose-dependent cytotoxic effect of amiodarone.
'''Reference''':
*"Effects of amiodarone on thyroid function.",journal = Ann Intern Med, volume = 126, issue = 1, month = Jan, year = 1997, PMID = 8992925.
*"Amiodarone and the thyroid: a practical guide to the management of thyroid dysfunction induced by amiodarone therapy.", journal = Heart, volume = 79, issue = 2, month = Feb, year = 1998, PMID = 9538302.<br/>
'''Educational Objective:''' <br/>
'''References:''' +
This is a case of aortic dissection complicated by cardiac tamponade. The triad of hypotension, tachycardia and muffled (distant) heart sound, referred to as Beck’s triad, makes cardiac tamponade a high differential. Cases of cardiac tamponade caused by aortic dissection or rupture often requires urgent open surgical repair. Pericardiocentesis is advised prior to repair for immediate symptomatic relief.
Educational Objective: Always suspect cardiac tamponade whenever you observe a triad of hypotension, tachycardia and muffled (distant) heart sound, referred to as Beck’s triad. Pericardiocentesis is done to provide immediate symptomatic relief to the patient in preparation for the surgical repair.
Reference: http://www.wikidoc.org/index.php/Cardiac_tamponade_resident_survival_guide<br/>
'''Educational Objective:''' <br/>
'''References:''' +
Croup, also known as laryngotracheitis or laryngo-tracheo-bronchitis (LTB), is characterized by laryngeal inflammation leading to hoarseness, a barking cough. The child is typically less than 3 years of age, and the most common agent is Parainfluenza virus. Croup is usually a clinical diagnosis. Lateral neck x-rays show subglottic narrowing
Croup commonly presents in children and is caused by Parainfluenza virus.<br/>
'''Educational Objective:''' Croup commonly presents in children and is caused by Parainfluenza virus.<br/>
'''References:''' First Aid USMLE 2CK +
'''Educational Objective:'''
Tensilon test is the first bed site test to evaluate a myasthenia gravis.
'''References''': First Aid for STEP 2 2013, Rheumatology Chapter.<br/>
'''Educational Objective:''' <br/>
'''References:''' +
'''Educational Objective:'''
Myasthenia gravis is associated with rheumatoid arthritis. Typically the Ocular myasthenia involves both eyes symmetrically.<br/>
'''Educational Objective:''' <br/>
'''References:''' +
'''Educational Objective:''' Solitary lung mass with high index of suspicion of lung cancer<br/>
'''Educational Objective:''' <br/>
'''References:''' +
D: Change hypertension medication
In a presentation of worsening asthma, looking for triggers of patient symptoms in the history is essential to avoid additional treatment, cost and harm to the patient. Knowing drug interactions with asthma medications and change medication accordingly is the best approach.
Beta blockers exacerbate bronchospastic diseases and shouldn't be used in hypertensive patients with asthma as a general rule. However, metoprolol can be used in case of failure or intolerance of other antihypertensives, and the doses should be lowered with bronchdilators administered concomitantly.<br/>
'''Educational Objective:''' Beta blockers antihypertensives are not used in patients with bronchspastic diseases in general, and other alternatives should be used in the management of hypertension.<br/>
'''References:''' Lopressor FDA label'"`UNIQ--ref-00000001-QINU`"' +
This is subacute case of Infective endocarditis; it is diagnosed according to the Duke clinical criteria. Streptococcus bovis is associated with colonic pathology, and a colonoscopy should be done to eliminate the source of infection.<br/>
'''Educational Objective:''' Infective endocarditis caused by streptococcus bovis is usually associated with colonic pathology, and a colonoscopy should be done to eliminate the source of infection.<br/>
'''References:''' +
The patient has hyponatremia, which can lead to increased water shifting into the brain, resulting in cerebral edema.<br/>
'''Educational Objective:''' Severe hyponatremia may cause osmotic shift of water from the plasma into the brain cells. Typical symptoms include nausea, vomiting, headache and malaise. As the hyponatremia worsens, confusion, diminished reflexes, convulsions, stupor or coma may occur.<br/>
'''References:''' http://www.wikidoc.org/index.php/Hyponatremia +