_ _ _ _ _ n CT, an x-ray source and x-ray detector housed in a doughnut-shaped assembly move circularly around a patient who lies on a motorized table that is moved through the machine. Usually, multidetector scanners with 4 to 64 or more rows of detectors are used because more detectors allow quicker scanning […]
_ _ _ _ _ Share This Continuing improvements in radiologic imaging make it increasingly useful in diagnostic evaluation. Primary care and referring physicians work with radiologists who specialize in diagnostic imaging to choose the best imaging test for each evaluation. Many imaging tests use ionizing radiation (x-rays and radionuclides) and radiographic contrast agents; the […]
_ _ _ _ Exercise stimulates tissue change and adaptation (eg, increase in muscle mass and strength, cardiovascular endurance), whereas rest and recovery allow such change and adaptation to occur. Recovery from exercise is as important as the exercise stimulus. Regular physical activity reduces the likelihood of medical illness, decreases the incidence of the major […]
_ _ _ _ Some people who use drugs use large enough amounts often enough and long enough to become dependent. Definitions A single definition for drug dependence is elusive. Concepts that aid in defining drug dependence are tolerance and psychologic and physical dependence. Tolerance describes the need to progressively increase the drug dose to […]
_ _ _ _ _ On Happiness foreverIs happiness forever desirable? it is not.happiness can only be understood in the context of sadness and without sadness happiness is a disease process leading to complications ..A paper describes happiness forever as a medical diseaseBut all this later Today in an entertaining talk on happiness forever by […]
_ _ _ _ Receptors are macromolecules involved in chemical signaling between and within cells; they may be located on the cell surface membrane or within the cytoplasm (see Table 1: Pharmacodynamics: Some Types of Physiologic and Drug–Receptor Proteins). Activated receptors directly or indirectly regulate cellular biochemical processes (eg, ion conductance, protein phosphorylation, DNA transcription, […]
_ _ _ _ _ _ Receptors are macromolecules involved in chemical signaling between and within cells; they may be located on the cell surface membrane or within the cytoplasm (see Table 1: Pharmacodynamics: Some Types of Physiologic and Drug-Receptor Proteins). Activated receptors directly or indirectly regulate cellular biochemical processes (eg, ion conductance, protein phosphorylation, […]
_ _ _ _ _ Headache is pain in any part of the head, including the scalp, face (including the orbitotemporal area), and interior of the head. Headache is one of the most common reasons patients seek medical attention. Pathophysiology Headache is due to activation of pain-sensitive structures in or around the brain, skull, face, […]
_ _ _ _ _ _ _ _ (Huntington’s Chorea; Chronic Progressive Chorea; Hereditary Chorea) Huntington’s disease is an autosomal dominant disorder characterized by chorea and progressive cognitive deterioration, usually beginning in middle age. Diagnosis is by genetic testing. Treatment is supportive. First-degree relatives are encouraged to have genetic testing. Huntington’s disease affects both sexes […]
_ Fragile X–associated tremor/ataxia syndrome (FXTAS) is a genetic disorder affecting mostly men and causing tremor, ataxia, and dementia. FXTAS affects about 1/3000 men. A premutation (an increased number of CGG repeats) occurs in the fragile X mental retardation (FMR1) gene on the X chromosome; if the mutation is full, > 200 repeats occur, causing […]
_ _ _ Chorea is nonrhythmic, jerky, rapid, nonsuppressible involuntary movements, mostly of distal muscles or the face; movements may merge imperceptibly into purposeful or semipurposeful acts that mask the involuntary movements. Athetosis is nonrhythmic, slow, writhing, sinuous movements predominantly in distal muscles, often alternating with postures of the proximal limbs to produce a continuous, […]
_ _ Voluntary movement requires interaction of the corticospinal (pyramidal) tracts, basal ganglia, and cerebellum (the center for motor coordination). The pyramidal tracts pass through the medullary pyramids to connect the cerebral cortex to lower motor centers of the brain stem and spinal cord. The basal ganglia (caudate nucleus, putamen, globus pallidus, subthalamic nucleus, and […]
Myelin sheaths cover many nerve fibers in the central and peripheral nervous system; they accelerate axonal transmission of neural impulses. Disorders that affect myelin interrupt nerve transmission; symptoms may reflect deficits in any part of the nervous system. Myelin formed by oligodendroglia in the CNS differs chemically and immunologically from that formed by Schwann cells […]
Weakness is one of the most common reasons patients present to primary care clinicians. Weakness is loss of muscle strength, although many patients also use the term when they feel generally fatigued or have functional limitations (eg, due to pain or limited joint motion) even though muscle strength is normal. Weakness may affect a few […]
_ _ _ _ Memory loss is a common complaint in the primary care setting. It is particularly common among the elderly but also may be reported by younger people. Sometimes family members rather than the patient report the memory loss (typically in an elderly person, often one with dementia). Clinicians and patients are often […]
_ Brief psychotic disorder consists of delusions, hallucinations, or other psychotic symptoms for at least 1 day but < 1 mo, with eventual return to normal premorbid functioning. It is typically caused by severe stress in susceptible people. Brief psychotic disorder is uncommon. Preexisting personality disorders (eg, paranoid, histrionic, narcissistic, schizotypal, borderline) predispose to its […]
_ _ _ Schizoaffective disorder is characterized by significant mood symptoms, psychosis, and other symptoms of schizophrenia. It is differentiated from schizophrenia by occurrence of ≥ 1 episodes of depressive or manic symptoms. Schizoaffective disorder is considered when a psychotic patient also demonstrates mood symptoms. The diagnosis requires that significant mood symptoms (depressive or manic) […]
Differential Diagnosis of Psychotic Symptoms: Medical “Mimics” By Oliver Freudenreich, MD | December 3, 2012 For a pdf of the original article (Psychiatr Times. 2010;27[12]:52-61) and Dr Freudenreich’s bio and financial disclosure, please click here. Crude exogenous organic damage of the most varying kind can produce acute psychotic clinical pictures of a basically uniform kind. […]
Do not be distracted, especially by technology. Do not jog with your iPod because attackers are looking for easy, distracted individuals who look-like they are not paying attention to surroundings. The same can be said for talking on your cell phone. But, on the other hand, if you feel someone is following you, pull out […]
29 December 2012 14:41:34 Dr Harish Shetty A review of 35 academic studies by Dr Aric Sigman of the British Psychological Society has revealed the top 15 ways in which long hours before the telly can affect children’s health as they grow 1 Obesity: a result of little exercise 2 Disrupted hormones: light from televisions […]
f you discover eye drops such as I CURE / I CUL in anybody’s belongings than the person is surely taking addictive drugs Harish Shetty When Ms Ghorpade found eye drops in the bag of her teenage son she was surprised. She did not recollect any visit to the eye doctor or any problem with […]
_ _ _ _ Hypothyroidism (Myxedema) Share This view related topics in this manual Hypothyroidism is thyroid hormone deficiency. It is diagnosed by clinical features such as a typical facies, hoarse slow speech, and dry skin and by low levels of thyroid hormones. Management includes treatment of the cause and administration of thyroxine. Hypothyroidism occurs […]
_ _ Erectile dysfunction (ED) is the inability to attain or sustain an erection satisfactory for sexual intercourse. Most erectile dysfunction is related to vascular, neurologic, psychologic, and hormonal disorders; drug use can also be a cause. Evaluation typically includes screening for underlying disorders and measuring testosterone levels. Treatment options include oral phosphodiesterase inhibitors or […]
Drug interactions are changes in a drug’s effects due to recent or concurrent use of another drug or drugs (drug-drug interactions) or due to ingestion of food (drug-nutrient interactions—see Nutrition: General Considerations: Nutrient-Drug Interactions). A drug interaction may increase or decrease the effects of one or both drugs. Clinically significant interactions are often predictable and […]
Lipids are fats that are either absorbed from food or synthesized by the liver. Triglycerides (TGs) and cholesterol contribute most to disease, although all lipids are physiologically important. The primary function of TGs is to store energy in adipocytes and muscle cells; cholesterol is a ubiquitous constituent of cell membranes, steroids, bile acids, and signaling […]
Share This Hypoglycemia unrelated to exogenous insulin therapy is an uncommon clinical syndrome characterized by low plasma glucose level, symptomatic sympathetic nervous system stimulation, and CNS dysfunction. Many drugs and disorders cause it. Diagnosis requires blood tests done at the time of symptoms or during a 72-h fast. Treatment is provision of glucose combined with […]
_ _ _ Diabetes mellitus (DM) is impaired insulin secretion and variable degrees of peripheral insulin resistance leading to hyperglycemia. Early symptoms are related to hyperglycemia and include polydipsia, polyphagia, and polyuria. Later complications include vascular disease, peripheral neuropathy, and predisposition to infection. Diagnosis is by measuring plasma glucose. Treatment is diet, exercise, and drugs […]
Hyponatremia is decrease in serum Na concentration < 136 mEq/L caused by an excess of water relative to solute. Common causes include diuretic use, diarrhea, heart failure, and renal disease. Clinical manifestations are primarily neurologic (due to an osmotic shift of water into brain cells causing edema), especially in acute hyponatremia, and include headache, confusion, […]
Rehabilitation after stroke aims to preserve or improve range of motion, muscle strength, bowel and bladder function, and functional and cognitive abilities. Specific programs are based on the patient’s social situation (eg, prospects of returning to home or work), ability to participate in a rehabilitation program supervised by nurses and therapists, learning ability, motivation, and […]
Genetics has advanced understanding of many disorders, sometimes allowing them to be reclassified. For example, classification of many spinocerebellar ataxias has been changed from one based on clinical criteria to one based on genetic criteria (see Movement and Cerebellar Disorders: Hereditary ataxias). The Online Mendelian Inheritance in Man (OMIM) database is a searchable catalog of […]
_Patients who are experiencing severe changes in mood, thoughts, or behavior or severe, potentially life-threatening drug adverse effects need urgent assessment and treatment. Nonspecialists are often the first care providers for outpatients and inpatients on medical units, but whenever possible, such cases should also be evaluated by a psychiatrist. When a patient’s mood, thoughts, or […]
Medical assessment of patients with mental symptoms seeks to identify 2 things: Physical disorders mimicking mental disorders Physical disorders accompanying mental disorders Numerous physical disorders cause symptoms mimicking specific mental disorders (see Table 3: Approach to the Patient With Mental Symptoms: Selected Mental Symptoms Due to Physical Disorders). Other physical disorders may not mimic specific […]
Some drug categories (eg, analgesics, anticoagulants, antihypertensives, antiparkinsonian drugs, diuretics, hypoglycemic drugs, psychoactive drugs) pose special risks for elderly patients. Some, although reasonable for use in younger adults, are so risky as to be considered inappropriate for the elderly. The Beers Criteria are most commonly used to identify such inappropriate drugs (see Table 5: Drug […]
Drug-related problems include Adverse effects Ineffectiveness Adverse drug effects are effects that are unwanted, uncomfortable, or dangerous. Common examples are oversedation, confusion, hallucinations, falls, and bleeding. Among ambulatory people ≥ 65, adverse drug effects occur at a rate of about 50 events per 1000 person-years. Hospitalization rates due to adverse drug effects are 4 times […]
Pharmacodynamics is defined as what the drug does to the body or the response of the body to the drug; it is affected by receptor binding, postreceptor effects, and chemical interactions (see Pharmacodynamics: Drug-Receptor Interactions). In the elderly, the effects of similar drug concentrations at the site of action (sensitivity) may be greater or smaller […]
Pharmacokinetics (see Pharmacokinetics) is best defined as what the body does to the drug; it includes absorption, distribution across body compartments, metabolism, and excretion. With aging, the metabolism and excretion of many drugs decrease, requiring that doses of some drugs be adjusted. Toxicity may develop slowly because levels of chronically used drugs tend to increase […]
Neuromyelitis optica affects only the eyes and spinal cord. It causes acute optic neuritis, sometimes bilateral, plus demyelination of the cervical or thoracic spinal cord. Neuromyelitis optica was previously considered to be a variant of multiple sclerosis (MS) but is now recognized as a different disorder. Symptoms include visual loss, paraparesis or quadriparesis, and incontinence. […]
Multiple sclerosis (MS) is characterized by disseminated patches of demyelination in the brain and spinal cord. Common symptoms include visual and oculomotor abnormalities, paresthesias, weakness, spasticity, urinary dysfunction, and mild cognitive impairment. Typically, neurologic deficits are multiple, with remissions and exacerbations gradually producing disability. Diagnosis is by history of remissions and exacerbations plus clinical signs, […]
Myelin sheaths cover many nerve fibers in the central and peripheral nervous system; they accelerate axonal transmission of neural impulses. Disorders that affect myelin interrupt nerve transmission; symptoms may reflect deficits in any part of the nervous system. Myelin formed by oligodendroglia in the CNS differs chemically and immunologically from that formed by Schwann cells […]
Cerebellar disorders have numerous causes, including congenital malformations, hereditary ataxias, and acquired conditions. Symptoms vary with the cause but typically include ataxia (impaired muscle coordination). Diagnosis is clinical and often by imaging and sometimes genetic testing. Treatment is usually supportive unless the cause is acquired and reversible. The cerebellum has 3 parts: Archicerebellum (vestibulocerebellum): It […]
Tremors are involuntary, rhythmic, alternating, or oscillatory movements of interrelated muscle groups. They typically involve the hands, head, facial structures, vocal cords, trunk, or legs. Tremors can be characterized by Frequency of oscillation (rapid or slow) Amplitude of movement (fine or coarse) Movements or postures that evoke them (eg, rest, action, certain positions) Pathophysiology Tremors […]
Parkinson’s disease is an idiopathic, slowly progressive, degenerative CNS disorder characterized by resting tremor, muscular rigidity, slow and decreased movement, and postural instability. Diagnosis is clinical. Treatment is with levodopa plus carbidopa, other drugs, and, for refractory symptoms, surgery. Parkinson’s disease affects about 0.4% of people > 40 yr, 1% of people ≥ 65 yr, […]
Myoclonus is a brief, shocklike contraction of a muscle or group of muscles. Diagnosis is clinical and by selective testing. Treatment includes correction of reversible causes and sometimes oral drugs (eg, clonazepam, valproate). Physiologic myoclonus may occur as a person falls asleep (nocturnal myoclonus). Myoclonus can result from other disorders and certain drugs (see Table […]
Huntington’s disease is an autosomal dominant disorder characterized by chorea and progressive cognitive deterioration, usually beginning in middle age. Diagnosis is by genetic testing. Treatment is supportive. First-degree relatives are encouraged to have genetic testing. Huntington’s disease affects both sexes equally. The caudate nucleus atrophies, the inhibitory medium spiny neurons in the corpus striatum degenerate, […]
Fragile X–associated tremor/ataxia syndrome (FXTAS) is a genetic disorder affecting mostly men and causing tremor, ataxia, and dementia. FXTAS affects about 1/3000 men. A premutation (an increased number of CGG repeats) occurs in the fragile X mental retardation (FMR1) gene on the X chromosome; if the mutation is full, > 200 repeats occur, causing fragile […]
Dystonias are sustained involuntary muscle contractions, often distorting body posture. Dystonias can be primary or secondary, and they can be generalized, focal, or segmental. Diagnosis is clinical. Treatment of generalized dystonia is often with a combination of anticholinergic drugs, muscle relaxants, and benzodiazepines. Treatment of focal or segmental dystonias is often with botulinum toxin; more […]
Chorea is nonrhythmic, jerky, rapid, nonsuppressible involuntary movements, mostly of distal muscles or the face; movements may merge imperceptibly into purposeful or semipurposeful acts that mask the involuntary movements. Athetosis is nonrhythmic, slow, writhing, sinuous movements predominantly in distal muscles, often alternating with postures of the proximal limbs to produce a continuous, flowing stream of […]
Voluntary movement requires interaction of the corticospinal (pyramidal) tracts, basal ganglia, and cerebellum (the center for motor coordination). The pyramidal tracts pass through the medullary pyramids to connect the cerebral cortex to lower motor centers of the brain stem and spinal cord. The basal ganglia (caudate nucleus, putamen, globus pallidus, subthalamic nucleus, and substantia nigra) […]
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