Causes of small intestinal bacterial overgrowth

A. (Due to Hypochlorohydria /Achlorhydria
• Pernicious anemia
• Partial gastrectomy
• Long term PPI therapy

B. Due to impaired intestinal motility
• Scleroderma
• Diabetic autonomic neuropathy
• Chronic intestinal pseudo obstruction

C. Due to structural abnormalities
• Gastric surgery
• Jejunal diverticulosis
• Enterocolic fistula
• Extensive small bowel resection
• Stricture (e.g. Crohn’s disease)

D. Due to impaired immune functions
• Hypogammaglobulinemia

Causes of Protein losing enteropathy

Means: Excessive loss of protein into the gut lumen, sufficient to cause hypoproteinaemia.

1. With mucosal erosion or ulceration
2. Without mucosal erosion or ulceration
3. With lymphatic obstruction

A. With mucosal erosion or ulceration
• Crohn’s disease
• Ulcerative colitis
• Radiation damage
• Oesophageal, gastric or colonic carcinoma
• Lymphoma
B. Without mucosal erosion or ulceration
• Tropical sprue
• Menetrier’s disease
• Bacterial over growth
• Coeliac disease
• Eosinophilic gastroenteritis

3. With lymphatic obstruction
• Intestinal lymphangiactasia
• Constrictive pericarditis
• Lymphoma
• Whipple’s disease

Tongue depressor

Tongue Depressor


Tongue Depressor
Wooden Tongue Depressor
Curved Metallic Tongue Depressor
Curved Metallic Tongue Depressor
  1. Identify the instrument.
    • Tongue depressor
  2. Mention 2 important uses.
    • Examination of mouth
    • Examination of Throat
  3. Name 4 causes of sore throat.
    • The common cold
    • Laryngitis
    • Tonsillitis
    • Mononucleosis
    • Mumps
  4. Name 3 Causes of Macroglossia
    • Vascular malformation
    • Muscular hypertrophy
    • Lymphangioma

Butterfly Rash

Butterfly Rash

 photo sle_zps25657d0a.jpg

 photo SKIN009_zps6c65d79f.jpg


  1.  Describe the clinical finding?
  2. What underlying diseases give rise to this condition?
  3. Name 4 diagnostic criteria for diagnosis of the condition.
  4. Write the modalities of treatment.

Answer Sheet:

  1.  Describe the clinical finding?
    C/F: This is a photograph showing Butterfly Rash,
  2. What underlying diseases give rise to this condition?
    Systemic Lupus Erythematosus (SLE)
  3. Name 4 diagnostic criteria for diagnosis of the condition.
    a. Malar Rash
    b. Discoid Rash
    c. Serositis
    d. Oral ulcer
    e. Arthritis
    f. Photosensitivity
  4. Write the modalities of treatment.
    a. Avoid sun and UV light exposure
    b. Use of high factor sun blocks
    c. Intermittent analgesics.
    d. NSAIDs: In mild disease
    e. Short courses of oral corticosteroid for mild to moderate
    f. For severe : High dose corticosteroid
    g. Other immunosuppressive drugs

Primary Lesions of Skin

Macule: Small spot (Less than 5 mm), different in color from surrounding skin, that is neither elevated nor depressed below the skin surface.

Patch: Large spot (>5mm) different in color from surrounding skin.

Papule: Small (less than 5mm diameter) circumscribed solid elevation on the skin.

Plaque: Large (>5mm) superficial flat lesion, often formed by a confluence of papules

Nodule: Large cirumscribed solid skin elevation .

Pustule: Small circumscribed skin elevation containing purulent material.

Vesicle: Small (<5mm) circumscribed skin blister containing serum.

Bulla: Large(>5mm) vesicle containing free fluid.

Wheal: Irregular elevated edematous skin area, which often changes in size and shape.

Cyst: Enclosed cavity with a membraneous lining which contains liquid or semisolid matter .

Tumor: Large nodule, which may be neoplastic .

Telangiectasia: Dilated superifical blood vessel.

Burrow: A linear or curvilinear papule, caused by a burrowing scabies mite.

Comedone: A plug of keratin and sebum wedged in a dilated pilosebaceous orifice.


CURRENT Medical Diagnosis and Treatment 2014

Currennt Medical Diagnosis & Treatment

Currennt Medical Diagnosis & TreatmentCURRENT Medical Diagnosis & Treatment 2014

Maxine A. Papadakis, Stephen J. McPhee, Eds.
Michael W. Rabow, Associate Ed.

Current Medical Diagnosis & Treatment 2014 (CMDT 2014) is the 53rd edition of this single-source reference for practitioners in both hospital and ambulatory settings. The book emphasizes the practical features of clinical diagnosis and patient management in all fields of internal medicine and in specialties of interest to primary care practitioners and to subspecialists who provide general care.

Intended Audience for CMDT

House officers, medical students, and all other health professions students will find the descriptions of diagnostic and therapeutic modalities, with citations to the current literature, of everyday usefulness in patient care.

Internists, family physicians, hospitalists, nurse practitioners, physicians’ assistants, and all primary care providers will appreciate CMDT as a ready reference and refresher text. Physicians in other specialties, pharmacists, and dentists will find the book a useful basic medical reference text. Nurses, nurse-practitioners, and physicians’ assistants will welcome the format and scope of the book as a means of referencing medical diagnosis and treatment.

Patients and their family members who seek information about the nature of specific diseases and their diagnosis and treatment may also find this book to be a valuable resource.

New in this Edition of CMDT

• Update on the evaluation and treatment of chest pain, including use of CT coronary angioplasty
• New algorithms for the treatment for heart failure and NSTEMI
• Updated table for assessing the need for anticoagulation in patients with atrial fibrillation
• Updated guidelines for the treatment of mitral regurgitation, aortic stenosis, and aortic regurgitation
• Updates on the selection and use of antithrombotic therapy
• USPSTF recommendation for HIV screening of all adolescents and adults ages 15–65
• New tables on preferred initial antiretroviral regimens and fixed dose antiretroviral combinations for HIV infection
• New table for medication management of diabetes mellitus
• Data on controversy about postoperative glucose control in diabetics
• Updates on vaccinations (Tdap and pneumococcal vaccine for adults; hepatitis B vaccine for diabetics; HPV for young men) and the 2013 CDC Recommended Immunization Schedule for Adults
• Update on methicillin-resistant Staphylococcus aureus (MRSA)
• Controversial recommendation for low-dose CT screening for lung cancer
• Newly rewritten section on substance abuse, including prescription drug abuse
• Update on antibiotic therapy for febrile neutropenia
• New information on treatment of chronic fatigue syndrome
• New recommendations for preoperative/perioperative management of oral direct thrombin inhibitors
• Revised treatments for glaucoma, age-related macular degeneration
• Revised table of topical ophthalmic agents
• Updates on treatments of asthma, COPD, bronchiectasis
• Urinary antigen testing in diagnosis of community-acquired pneumonia
• Revised criteria for ICU admission for patients with community-acquired pneumonia
• New section on pulmonary hypertension
• Revised American College of Chest Physicians guidelines for anticoagulation after pulmonary emboli
• New oncology therapeutic drugs, including bosutinib and decitabine for leukemia as well as ibrutinib and brentuximab for lymphoma
• Update on therapy for myelodysplasia
• Indications for use of eltrombopag for thrombocytopenia
• New information on prognostic indices in acute liver failure
• Indications for three-drug treatment of hepatitis C
• Indications for and alternatives to liver biopsy in cirrhosis
• New international classification for severity of acute pancreatitis
• Update on placenta accreta diagnosis and treatment
• Update on NSAID treatment for osteoarthritis, colchicine and febuxostat for gout, and tofacitinib for rheumatoid arthritis, and rituximab vs. cyclophosphamide for granulomatosis with polyangiitis
• New section on treatment of cryoglobulinemic vasculitis
• Diagnosis and treatment of health-care–associated mold and fungal meningitis and epidural abscesses from contaminated corticosteroid injections
• Update on corticosteroid treatment in sepsis and septic shock
• Extensively updated tables outlining systemic oncologic therapeutic choices, dosages, and toxicities
• New section on treatment of pleural mesothelioma
• Updates on treatment options for esophageal, gastric, and rectal cancers; carcinoids; and gastrointestinal stroma tumors
• Update on subclinical hypothyroidism and thyroxine replacement
• New sections on diagnosis and treatment of subacute, postpartum, and silent thyroiditis and amiodarone- and iodine-induced thyrotoxicosis
• New treatments for differentiated thyroid cancers

What is chalazion? Fates of chalazion?

 Chalazion/Hailstone/ Internal hordeolum/ Meibomian cyst/ Tarsal cyst:

A chalazion is a chronic, sterile, granulomatous inflammatory lesion caused by retained sebaceous secretion leaking from the meibomian glands or other sebaceous glands into adjacent stroma.


Chronic granulomatous inflammation of the meibomian gland.


Fate of Chalazion:

  1. Spontaneous resolution.
  2. Complications:
    • Increased size and causing mechanical ptosis.
    • Secondary infection-internal hordeolum (painful chalazion).
    • Burst either through skin/conjunctiva.
    • Malignant change- Meibomian carcinoma.

[Ref: Basak/4th/124-126]

Removal of Chalazion

%d bloggers like this: