DIETARY MANAGEMENT OF HIGH CHOLESTEROL

And lots of cholesterol! 😬

πŸ‘‰ Most Patients that present with high cholesterol (hyperlipidemia) have dietary or lifestyle indiscretion.

πŸ‘‰ Diets rich in cholesterol or saturated fat tend to increase blood LDL (bad) cholesterol levels while carbohydrates or alcohol increases blood VLDL triglycerides.

πŸ‘‰ Patients with diabetes or hyperthyroidism tend to present with hyperlipidemia, in which case the former has to be controlled first to which the latter would respond slowly.

Dietary Management:

πŸ₯— A modified fat diet should be given for 3-6 months before considering drug therapy.

πŸ₯— Dietary management should aim to decrease the intake of red meat, dairy produce and refined sugar.

πŸ₯— Simultaneously, it should significantly increase the intake of vegetables, fruits and pulses.

πŸ₯— Other sources of protein such as fish should be encouraged, particularly oily fish such as mackerel, salmon or trout. (Fact: Omega 3 poly unsaturated fats really help!)

πŸ₯— Increased physical activity should be encouraged, this will improve glucose, blood pressure and lipid profiles.

πŸ₯— Avoidance of cigarette smoking is absolutely essential in these patients.

Discrete Methods:

⭐ Reduce energy intake to achieve ideal body weight.

⭐ Increase dietary fibre intake.

⭐ Reduce saturated fat intake to provide 30% of total fat intake.

⭐ Reduce total fat intake to provide 30% of energy intake.

⭐ Moderate alcohol intake.

⭐ Increase consumption of oily fish.

⭐ Eat greater than or equal to five portions of fresh fruit or vegetables per day.

SOURCE: Davidson’s Principles and Practices of Medicine (19th edition)


Sunantha πŸ“–

TEETH JEWELLERY

Sparkle your smile! 😁✨

Tooth Jewellery Bonding Procedure:

πŸ’Ž Firstly, the tooth is cleaned with a fluoride free polishing paste, dried and isolated.

πŸ’Ž To increase the surface area for bonding it is etched with an acid etchant for 20 to 30 seconds.

πŸ’Ž The surface is thoroughly rinsed with water and blow dried. A light-curing bonding agent is applied and left on the tooth for a maximum of 20 seconds.

πŸ’Ž The tooth is light-cured and a small amount of flow composite is applied to its surface.

πŸ’Ž Using a jewel handler, the jewel is pressed into the center of the composite.

πŸ’Ž With the light-curing lamp the composite is cured from all sides.

Features of Tooth Jewellery:



🌟 The procedure is non-invasive and painless.

🌟 It does not require extra maintenance.

🌟 It can be removed or replaced anytime and has no effect on the tooth
enamel once the jewel is removed or replaced.

🌟 It involves a procedure that only takes about 10 – 15 minutes and is completely reversible.

🌟 It is stain resistant.

🌟 It does not obstruct regular brushing habits even if using an electric toothbrush nor
restrict you from visiting your dentist or dental hygienist.


~Sunantha ✨

COMMONLY USED ANALGESICS IN DENTISTRY

Worry not! Your common analgesics are here at the rescue!🦸

STUDY NOTES βš•οΈ

1️⃣ For mild to moderate pain with little inflammation:

πŸ’Š Paracetamol ~ 500-650 mg QID

πŸ’Š Low dose ibuprofen ~ 400-600 mg (5-10mg/kg) TDS

2️⃣ Postextraction or similar acute but short-lasting pain:

πŸ’Š Keterolac ~ 15-30 Mg IV or IM; Orally, 10-20mg QID

πŸ’Š Diclofenac ~ 50 mg TDS, then BD orally, (75mg deep IM)

πŸ’Š Nimesulide ~ 100 Mg BD

πŸ’Š Aspirin ~ 350-650mg TDS OR QID (Maximal 1000mg)

~Sunantha πŸ–‹οΈ

MOTOR NEURON DISEASE

Stephen Hawking was diagnosed with Amyotrophic Lateral Sclerosis (ALS), a Motor Neuron Disease. But it never stopped him from becoming the greatest physicist of his time!

This is a progressive disease of unknown origin in which there is degeneration of motor neurons of the spinal cord and cranial nerve nuclei and of pyramidal neurons in the motor cortex.

CAUSES:

πŸ‘‰ 95% of the cases – Viral infection, trauma, exposure to toxins and electric shock. (Though no Strong evidence exists)

πŸ‘‰ 5% of the cases – Familial showing autosomal dominant inheritance. Defect lies in Chromosome 21 on the enzyme SOD1 (Superoxide dismutase)

CLINICAL FEATURES:

πŸ‘©β€βš•οΈ Usually affects people above 50 years of age. Very uncommon before 30.

πŸ‘¨β€βš•οΈ Male predominance.

πŸ‘©β€βš•οΈ Dysarthria and Dysphagia.

πŸ‘¨β€βš•οΈ Wasting and fasciculation of muscles.

πŸ‘©β€βš•οΈ Weakness of tongue, face, palate and limb muscles.

πŸ‘¨β€βš•οΈ Spasticity, extensor plantar reflexes and excessive tendon reflexes are seen in case of pyramidal tract involvement.

πŸ‘©β€βš•οΈ External ocular muscles and sphincters usually remain intact.

πŸ‘¨β€βš•οΈ No sensory deficit objectively seen.

πŸ‘©β€βš•οΈ Intellectual impairment is not seen in most cases.

INVESTIGATIONS:

🧐 Differential diagnosis: diabetic amyotrophy, multifocal neuron disease, spinal disorders should be excluded.

🧐 Electromyography – helps confirm fasciculation and denervation.

🧐 Spinal imaging and brain scanning – to exclude focal spinal or cerebral disease.

🧐 A slightly elevated protein concentration is seen in the CSF examination sometimes.

MANAGEMENT:

πŸ’Š Riluzole 100 Mg per day appears to be modestly effective in prolonging the life of the patient.

πŸ’Š Helps the Quality of life of patients: Psychological and physical support, speech therapist, physiotherapist.

πŸ’Š Mechanical aids: Splints, wheelchairs, walking aids, communication devices.

PROGNOSIS:

⚠️ Motor Neuron Disease is progressive; the mean time from diagnosis to death is 1 year.

⚠️ Most patients die within 3-5 years after the onset of symptoms.

⚠️ Death is usually from respiratory infection and failure, and the complications of immobility.

SOURCE: Davidson’s Principles and Practice of Medicine (19th edition)


~Sunantha✍️

POISONS AND ANTIDOTES

Holds good for Antidotes too! Prof. Snape is right ALWAYS! πŸ–€

Antidotes available for the treatment of specific poisonings:

☠️ Anticoagulants – πŸ’Š Vitamin K, Fresh frozen plasma

☠️ Beta-blockers – πŸ’Š Glucagon, Adrenaline

☠️ Calcium channel blockers – πŸ’Š Calcium gluconate

☠️ Cyanide – πŸ’Š Oxygen, Dicobalt edetate, nitrites, sodium thiosulphate, hydroxocobalamin

☠️ Ethylene glycol/Methanol – πŸ’Š Ethanol, 4-methylpyrazole

☠️ Lead – πŸ’Š DMSA (2,3-dimercaptosuccinic acid), disodium calcium edetate

☠️ Mercury – πŸ’Š DMPS (2,3-dimercapto-1-propane sulphonate)

☠️ Iron salts – πŸ’Š Desferroxamine

☠️ Opioids – πŸ’Š Naloxane

☠️ Organophosphorus insecticides, nerve agents – πŸ’Š Atropine, pralidoxime (P2S)

☠️ Paracetamol – πŸ’Š N-acetylcysteine, methionine

☠️ Cardiac glycosides – πŸ’Š Digoxin-specific antibody fragments

REFERENCE:

Professor Severus Snape πŸ–€

Davidson’s Principles and Practice of Medicine (19th edition)


~Sunantha✍️

AIMS OF MEDICINE

The ultimate aim is to not become like him! πŸ˜‚

STUDY NOTES βš•οΈ

1️⃣ History Taking:

History taking is an important aspect of Medicine.

One should learn to take a complete and thorough history of the patient.

2️⃣ Physical Examination:

The Clinician should know all the techniques of physical examination.

The positive and negative physical signs should be examined and noted so as to come to some conclusion at the end of the examination.

3️⃣ Terminology:

The exact terminology used in medical science should be used and followed.

That in itself is a key to diagnosis of various diseases.

4️⃣ Skill:

The Clinician should be able use the laboratory instruments as well as the therapeutic aspects judiciously.

One has to learn the skill in the most sophisticated application of laboratory technology or use of the latest therapeutic modality.

5️⃣ Art of Medicine:

In a variety of symptoms the patient presents with, the doctor should have an intuition as to follow which sign/symptom/laboratory finding and to know what to ignore, ultimately excelling at the art of ‘decision-making’.

This kind of strong and methodical intuitive nature of the Clinician is expected.

6️⃣ Patient-Doctor Relationship:

Students should not treat patients as just ‘cases’ or ‘diseases’ but as people undergoing suffering and should be treated with empathy.

At the same time, the doctor should also be careful as to not pay utmost attention to the most exaggerating patients.

There should be a mutual trust between the patient and the doctor.

A healthy professional relationship with the doctor makes the patient feel at ease and helps in the patient co-operation and recovery.

SOURCE: Textbook of Clinical Medicine by Chugh (5th edition)


~Sunantha✍️

CLINICAL PRESENTATION OF PULMONARY TUBERCULOSIS

Phew! πŸ˜‚

STUDY NOTES βš•οΈ

Clinical Presentation:

πŸ‘©β€βš•οΈ Chronic cough often with hemoptysis.

πŸ‘¨β€βš•οΈ Pyrexia of unknown origin.

πŸ‘©β€βš•οΈ Unresolved Pneumonia.

πŸ‘¨β€βš•οΈ Exudative pleural effusion.

πŸ‘©β€βš•οΈ Asymptomatic (diagnosis on chest radiograph)

πŸ‘¨β€βš•οΈ Weight loss, general debility.

πŸ‘©β€βš•οΈ Spontaneous Pneumonia.

Time from infection and Manifestations:

πŸ•— 3 – 8 weeks ➑️ Primary Complex, Positive tuberculin skin test.

πŸ•• 3 – 6 months ➑️ Meningeal, miliary and pleural disease.

πŸ•’ Upto 3 years ➑️ Gastrointestinal, bone and joint and lymph node disease.

πŸ•£ Around 8 years ➑️ Renal tract disease.

πŸ•ž From 3 years onwards ➑️ Post primary disease due to reactivation or reinfection.

SOURCE: Davidson’s Principles and Practice of Medicine (19th edition)


~Sunantha✍️

CANCRUM ORIS

Don’t let Cancrum Oris take your pretty cheeks away! Stay nourished! πŸ˜‚

STUDY NOTES βš•οΈ

Cancrum oris is a special type of gangrene.

Causes:

πŸ” Malnourishment.

πŸ” Major diseases like diptheria, Whooping cough, measles, kala azar, typhoid, etc.

πŸ” These factors lead to invasion of opportunistic organisms like the Vincent’s organisms – Borrelia vincentii and fusiforms causing ulcerations, erosions and eventually fibrosis.

Clinical Presentation:

πŸ‘©β€βš•οΈ It is an extensive ulcerative disease of the cheek mucosa usually occuring in malnourished children.

πŸ‘¨β€βš•οΈ As the disease progresses, there may be complete reduction of the cheek thickness.

Treatment:

πŸ’Š Ryle’s tube feeding.

πŸ’Š Improve the nutrition.

πŸ’Š Appropriate antibiotics: Metronidazole 400mg thrice daily for 7-10 days.

πŸ’Š Surgical reconstruction of the cheek.

Complications:

⚠️ Fibrosis leading to restricted movement of the jaw.

⚠️ Sepsis, toxaemia and death.

SOURCE: Manipal Manual of Surgery (3rd edition)


~Sunantha✍️

GLASSGOW COMA SCALE

Assess and then decide! πŸ˜‚

STUDY NOTES βš•οΈ

Glassgow Coma Score is used to assess the level of consciousness properly instead of using vague terms like semi-conscious, obtundant, etc.

Hence it is widely used thereby avoiding observer errors in the observation patients.

NEUROLOGICAL ASSESSMENT USING GLASSGOW COMA SCALE:

1️⃣ Eyes Open:

Spontaneously – 4

To speech – 3

To pain – 2

None – 1

2️⃣ Best Verbal Response:

Oriented – 5

Confused – 4

Inappropriate words – 3

Incomprehensible sounds – 2

None – 1

3️⃣ Best Motor Response:

Obeys commands – 6

Localises pain – 5

Withdrawal to pain – 4

Flexion to pain – 3

Extension to pain – 2 (due to raised intracranial pressure)

None – 1

~*~

⭐ Maximum score is 15.

⭐ Minimum score is 3.

⚠️ If a patient has a score of 7 or less than 7, then he/she is said to be in coma.

SOURCE: Manipal Manual of Surgery (3rd edition)


~Sunantha✍️

LUDWIG’S ANGINA

I’m still a medical emergency though! πŸ˜‚

STUDY NOTES βš•οΈ

It refers to the cellulitis of the submandibular and submental regions combined with inflammatory oedema.

Causes:

πŸ” Streptococcal organisms are responsible for the infection around the submandibular region.

πŸ” Anaerobes also play a major role.

Clinical Features:

πŸ‘©β€βš•οΈ Elderly patients who present with a diffuse swelling in the submandibular and submental regions (brawny oedema).

πŸ‘¨β€βš•οΈ Oedema of the floor of the mouth is seen which causes elevation of the tongue that in turn results in difficulty in swallowing.

πŸ‘©β€βš•οΈ High grade fever with toxicity.

πŸ‘¨β€βš•οΈ Putrid halitosis is also characteristic of Ludwig’s angina.

Treatment:

πŸ’Š Rest and hospitalization

πŸ’Š Appropriate antibiotics should be given.

πŸ’Š Intravenous fluids to correct dehydration and Ryle’s tube feeding.

πŸ’Š If conservative management is not responsive in the patient, then surgery is preferred.

Surgery:

βœ‚οΈ Under General Anaesthesia, a 5-6 cm curved incision is made below the mandible in the submandibular region and over the most prominent part of the swelling.

βœ‚οΈ The submandibular gland is mobilised, mylohyoid muscle is divided, and the pus is drained.

βœ‚οΈ Even if there’s no pus, the oedematous fluid comes out which in itself will improve the patient condition greatly.

βœ‚οΈ The wound is closed by loose sutures, after cleansing the cavity with antiseptics and a drainage tube is inserted.

Complications:

⚠️ Mediastinitis and Septicaemia.

⚠️ Oedema of the glottis which is caused due to the spread of the cellulitis via a tunnel connecting stylohyoid muscle and submucosa of the glottis.

SOURCE: Manipal Manual of Surgery (3rd edition)


~Sunantha✍️