Brainstem lesions
4 more scenarios for Peter Gates Brainstem Rule of 4. Neurological lesion identification and neuro examination quiz
Coma and small pupils
You are asked to review a 65 year-old man who is comatose (GCS 3) with small pupils (2 mm bilaterally). He has a history of diabetes mellitus and bipolar disorder. He was discharged from hospital yesterday, following a surgical procedure.
Refractory Shock in Trauma
Refractory shock in trauma is still most likely due to occult ongoing haemorrhage; shock may be due to the underlying cause of trauma e.g. MI leading to car crash
Paediatric Trauma Patient
Apply ATLS/APLS protocol: primary survey to exclude life-threatening injuries, secondary survey, re-evaluation and definitive care.
HIV brain mass
Consider a 45 year-old HIV positive male with right hemiparesis and fluctuating conscious state. His CT head is shown below.
Cyanide Poisoning
Cyanide is a potentially lethal toxic agent that can be found in liquid and gaseous form. First discovered in 1786 by Scheele, who extracted it from the dye Prussian blue - and promptly died from exposure to the vapours
Salicylate Poisoning
Salicylate poisoning: mechanisms of toxicity: acid-base disturbance, uncoupling of oxidative phosphorylation, disordered glucose metabolism
Standardised Mortality Ratio
Standardised Mortality Ratio SMR is the ratio of the observed or actual hospital mortality and the predicted hospital mortality for a specified time period.
Diaphragmatic Palsy
Diaphragmatic Palsy: unilateral can be asymptomatic depending on patients underlying respiratory reserve; bilateral -> most mechanical ventilation dependent
Palmar erythema DDx
Palmar erythema is a non-specific finding characterised by a redness of the palmar skin.
SVC Obstruction DDx
Obstruction of the superior vena cava results from mediastinal mass lesions. Features include a plethoric and cyanosed face with periorbital oedema, exophthalmos, conjunctival injection, and venous dilatation in the fundi, distended non-pulsatile neck veins and a positive Pemberton sign.
Clubbing DDx
Clubbing is an abnormality of the fingertips with following features: beaked nails; loss of angle between nail bed and finger; increased AP width of finger tip; sponginess of proximal nail bed