Any thing to improve Mr VD?

51yom Mr VD a carpenter from Jaggarajupeta sustained injury at his neck due to falling from a 3 feet height in a drunken state on 17^th April now admitted for further management.

MRI Scan of Cervical Spine dated 19^th April revealing mild disc bulge indenting the thecal sac at C3-4 and C4-5 level,intramedullary altered signal intensity extending from C3to C6 levels suggestive of Cord oedema andsome early cervical spondylosis.

Mr VD admitted as he has weakness of both upper and lower limbs, incontinence of bladder and he is not able to perform daily activities of life.He is thin built and seen in supine lying position having trunk in midline with shoulders raised and elbows slightly flexed, hips flexed , knees extended and ankle plantar flexed.

Motor Examination: Modified Asworth scale UpperLimb: Biceps on Rt side is1 and on Lt 1+, Wrist 1+on both sides. Lower Limb:Qudriceps on Rt side 1+ and on Lt 2 Dorsiflexors 3 on both sides

Sensory Examination:Superficial Sensation in Abdominals(T8-T12) is absent on bothsides and Plantars on both sides Extensor. All Deep Sensations are normal. Cranial Nerves are normal.

Deep Tendon Reflexes like Biceps Jerks,Triceps Jerks and Knee Jerks on both sides elicited 3+ and. Ankle Jerks 2+.

The person is completely dependent with Berg Balance Scale of 0/56.

So how will you manage?

• Electical stimulation of all 4 limbs.Group stimulation with Faradic and Galvanic
• Acive ROM exercises
• Passive ROM exercises
• Finger grip exercises
• Positioning of limbs in antispastic positions
• Wheel chair exercises like pull ups,push ups,weight shifting exercises
• Breathing exercises
• Ankle toe movements and Tendoachilles stretching
• Inhibitory techniques to spastic muscles
• Weight bearing exercises and irradiation tecniques
• Chest physiotherapy(Rib springing)
• Swallowing exercises(Chin Trunk position)
• Rolling over bed, turning prone on hands and elbows
• Training in parralel bars with biofeedback
• Orthotic support andbracrs

A 45 year old woman with a long history of rheumatoid arthritis complains of severe and recurrent respiratory tract infections.-Medical MCQs (PLAB, MRCP, USMLE, FRCR, MRCS, GRE , all with answers ) Medical Cases

A 45 year old woman with a long history of rheumatoid arthritis complains of severe and recurrent respiratory tract infections.-Medical MCQs (PLAB, MRCP, USMLE, FRCR, MRCS, GRE , all with answers ) Medical Cases
Correct Answer:A
Explanation:Felty's syndrome is a triad of rheumatoid arthritis, splenomegaly, and neutropenia. This is secondary to immunoglobulin directed toward neutrophils. Patients with Felty's syndrome respond to splenectomy with an increase in their neutrophil count. Splenomegaly with peripheral trapping and destruction of neutrophils is also seen in lysosomal storage diseases and in portal hypertension.

A post-partum woman presents with swelling her right lower limb-Medical MCQs (PLAB, MRCP, USMLE, FRCR, MRCS, GRE , all with answers ) Medical Cases

A post-partum woman presents with swelling her right lower limb-Medical MCQs (PLAB, MRCP, USMLE, FRCR, MRCS, GRE , all with answers ) Medical Cases
               E) LMWH
scintigraphy is for confirmation of pulmonary embolism & LMWH is given for its treatment 

A 12 year old girl has fever, rash and joint pain. On investigation she is found to have hematuria-Medical MCQs (PLAB, MRCP, USMLE, FRCR, MRCS, GRE , all with answers ) Medical Cases

A 12 year old girl has fever, rash and joint pain. On investigation she is found to have hematuria-Medical MCQs (PLAB, MRCP, USMLE, FRCR, MRCS, GRE , all with answers ) Medical Cases
               SLE, which can be associated with hypocomplementaemic urticarial vasculitis (HUV), seems to be the likely diagnosis in this case. HUV causes urticaria-like rashes & glomerulonephritis amongst other things, so would account for this girl's symptoms...

What is the diagnosis?-Medical OSCES

Dirofilaria Repens

What is the diagnosis?-Medical OSCES
        

Dirofilaria repens is a zoonotic filarial nematode transmitted by mosquitoes.

Commonly affected organs in the human include the skin, lung, eyes, female breast, and male genitals.

Unlike cases of ocular loiasis, in which the Loa loa worm is the infective parasite, there is typically no need for systemic antifilarial medication.

SJS

SJS

           25YOM SJS is always laughing with full of optimism with scintillating eyes not believing what had happened to him on 11th March of this year all of a sudden when an auto fell on his back severely injuring his dorsal spine. He developed paraplegia with loss of all sensations below umbilicus. X-Ray of Dorsolumbar spine revealing wedge compression fracture ofD12 vertebral body.MRI Scan of Dorsolumbar spine revealing complete cord injury.On physical examinaion his vitals normal.Motor power in both lower limbs and all sensatins below the level of umbilicus are absent.Now I wonder if there is any thing we can do to alleviate his condition apart from wheel chair life.I request if any body can help by suggesting specific physical exercises and any other management to help this person to stand and to do daily activities of life.

So what else to be expected for further evaluation and management?

           KSN,50 YOM has been evaluated for bleeding from anal region.C/O breathlessness distention of abdomen,loss of weight,extreme weakness since one month.O/E yellow conjunctiva,ascites. HB 7.6gm%,ESR 56,Platelet count 1.62lakhs,Serum Creatinine1.2,Total Bilirubin 0.63,Direct Bilirubin0.1, SGPT16,SGOT 24,S.Alkaline posphatase 185.UGI Endoscopy revealing Grade1 esophageal varices.Ultra Sound Abdomen revealing Hepatosplenomegaly with prominent splenoportal  venous with ascites.Multiple lymphnodal masses at portohepatis and paraaortic suggesting further evaluation.CTscan of Abdomen suggesting Hepatosplenomegaly with features of portal hypertension.Extensive retroperitoneal,mesentric.pelvic,bilateral inguinal and right cardiophrenic lymphadenopathy.FNAC of left cervical lymhnode revealing proliferative lymphadenopathy and preesnce of discrete large hystioid cells.

KSN

KSN with ascites

            The person is currently managed with compatible blood transfusion of O+ve blood to improve his general condition., As the facilities are limited here,we are thinking of referring to a higher center.So what else to be expected for further evaluation and management?