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Tuesday, June 17, 2008

Classical medical findings

1.Curschmann's spirals seen in:

ans:asthma

Curschmann's Spirals refer to the desquamated epithelium seen in biopsies from asthmatic patients.

asthma7

Curschmann's spiral: This very large spiral was found in lavage fluid from an asthmatic patient being evaluated for a lung mass. Many of these structures were present. The Papanicolaou stain gives a reddish core with a fuzzy margin to which many cells are attached secondarily.

These spirals, composed of a mucosubstance, may be seen in sputum, as well as lavage fluid. They can occasionally be found in histologic sections of mucus in conditions other than asthma. Although first described in respiratory secretions of asthmatics, they also occur unrelated to asthma in vaginal secretions, and rarely in pleural and peritoneal effusions.



2.Brushfield spots seen in:

ans:Down's syndrome

  • Brushfield spots are focal areas of iris stromal hyperplasia, surrounded by relative hypoplasia.
  • The spots are more common in patients with lightly pigmented irides.
  • they appear as tiny grey-white areas of depigmentation seen in a ring around the pupil of individuals with Down's syndrome.
  • They may, rarely, be found in people who do not have Down's syndrome.

Brushfield spots

3.the "BOOT SHAPED HEART" is a characteristic chest radiograph finding in:boot shaped heart

ans: Tetralogy of Fallot.

The most likely diagnosis is tetralogy of Fallot, a congenital condition of the heart, characterised by four features:

  • Ventricular septal defect, communication between the two ventricles
  • Pulmonary stenosis, narrowing at the pulmonary valve or at the level of right ventricular infundibulum, which lies just below the pulmonary valve
  • Over-riding of the aorta, the aorta being positioned over the ventricular septal defect instead of in the left ventricle
  • Right ventricular hypertrophy.

note:

a)Trilogy Of Fallot:

  • pulmonary valve stenosis
  • atrial septal defect
  • with right ventricular hypertrophy.

b)Fallot's pentalogy

The four characteristics of Fallot's tetralogy syndrome, plus a patent foramen ovale or atrial septal defect.

important points-

  • Tetralogy of Fallot is the second most common congenital cyanotic heart disease, after transposition of the great arteries
  • Also tetralogy of Fallot is the commonest cardiac malformation responsible for cyanosis after one year of age
  • comprises a complex of anatomical abnormalities arising because of the abnormal development of bulbar septum, which separates the ascending aorta from the pulmonary artery and which normally fuses with the outflow part of the interventricular septum.
  • Echocardiography is the most important investigation to confirm the diagnosis.
  • Definitive treatment - This is open heart surgery with patch closure of the ventricular septal defect and of the overriding of aorta and the resection of the infundibular obstruction. This is usually done in the third year of life and ideally before the child reaches school age.

4.Kimmelstiel-Wilson nodules are characteristic of :

Kimmelstiel-Wilson nodules

ans:Diabetic nephropathy.

This is nodular glomerulosclerosis (the Kimmelstiel-Wilson lesion) of diabetes mellitus. Nodules of pink hyaline material form in regions of glomerular capillary loops in the glomerulus. This is due to a marked increase in mesangial matrix from damage as a result of non-enzymatic glycosylation of proteins.

note:

  • Diabetic nephropathy is a clinical syndrome characterized by
  1. persistent albuminuria (>300 mg/d or >200 mcg/min) that is confirmed on at least 2 occasions 3-6 months apart,
  2. a relentless decline in the glomerular filtration rate (GFR),
  3. and elevated arterial blood pressure.
  • The glomeruli and kidneys are typically normal or increased in size initially, thus distinguishing diabetic nephropathy from most other forms of chronic renal insufficiency, wherein renal size is reduced (except renal amyloidosis and polycystic kidney disease).
  • Three major histologic changes occur in the glomeruli of persons with diabetic nephropathy.
  1. First, mesangial expansion is directly induced by hyperglycemia, perhaps via increased matrix production or glycosylation of matrix proteins.
  2. Second, GBM thickening occurs.
  3. Third, glomerular sclerosis is caused by intraglomerular hypertension (induced by renal vasodilatation or from ischemic injury induced by hyaline narrowing of the vessels supplying the glomeruli).

pathophysiology of diabetic nephropathy-from emedicine

diabetes pathophysiology

Diabetic nephropathy. Screening for and prevention of the progression of microalbuminuria in diabetes mellitus, in which ACE-I is angiotensin-converting enzyme inhibitor:

diabetes

Stages in the development of diabetic nephropathy:

diabetic nephropathy


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