Medical pearls{high yield facts}

1. Increased Reid Index is pathognomic for?

• multiple myeloma free light chains (either kappa or lambda) & Waldenstrom's macroglobinemia
• primary Syphilis
• Alcoholism and relatively normal with age and obesity
• chronic bronchitis.

ans:Reid Index Increased is pathognomic for chronic bronchitis.

REID INDEX, CHRONIC BRONCHITIS - Chronic bronchitis causes enlargement of mucous secreting glands in the trachea and bronchi. The ratio of the thickness of the mucous gland layer to the thickness of the wall between the epithelium and cartilage is known as the Reid Index. A normal Reid index is less than 0.4 and is increased in chronic bronchitis.

2.Hard Chancre is pathognomic for?

• primary Syphilis
• Haemophilus ducreyi
• rheumatoid arthritis
• membranous glomerulonephritis

ans:Hard Chancre is pathognomic for primary Syphilis.

here we have to discuss an important aspect on chancre.

chancre is an ulcerative lesion which is of 2 types:

• hard chancre{primary lesion in syphilis}
• soft chancre(chancroid){causedby Hemophilus ducreyi}

Hard chancre	Chancroid
1.characteristic lesions of primary syphilis	1.Chancroid is caused by Haemophilus ducreyi
It often has an indurated hard raised border	The chancroid lacks induration and is referred to as a soft chancre.
They are painless	In contrast to the syphilis chancre, the chancroid is extremely painful
"punched out" appearance	nonindurated with ragged undermined scalloped margins, a foul-smelling yellow-gray exudative covering and surrounding erythema.more superficial, more numerous

3.Anitschkow cells are pathognomic for:

ans-rheumatic fever.

During acute rheumatic fever,focal inflammatory lesions are found in various tissues.they are most distinctive within the heart,where they are called aschoff bodies.

aschoff bodies:they consist of foci of swollen eosinophillic collagen surrounded by lymphocytes{primarily T-lymphocytes},occasionally plasma cells & plump macrophages called anitschkow cells.

anitschkow cells:They are also called caterpillar cells, as these cells have a large amount of clear cytoplasm surrounding a rod-shaped nucleus that to some resembles a caterpillar.

aschoff cells:Larger Anitschkow cells may coalesce to form multinucleated Aschoff giant cells.

4.Rokitansky-Aschoff sinuses are:

ans:they are small outpouchings of gallbladder mucosa that extend through the muscularis layer.

may be congenital
a/w adenomyomatosis of gallbladder ,chronic cholecystitis

5.Chvostek's Sign seen in:

ans:one of the signs of hypocalcemia.

CHVOSTEKíS SIGN
Elicitation:
Tapping on the face at a point just anterior to the ear and just below the zygomatic bone
Postitive response:Twitching of the ipsilateral facial muscles, suggestive of neuromuscular excitability caused by hypocalcemia.

another sign of hypocalcemia:trousseau's sign.

TROUSSEAUíS SIGN
Elicitation:
Inflating a sphygmomanometer cuff above systolic blood pressure for several minutes
Postitive response:Muscular contraction including flexion of the wrist and metacarpophalangeal joints,hyperextension of the fingers, and flexion of the thumb on the palm, suggestive of neuromuscular excitability caused by hypocalcemia.

note:Trousseau-von Bonsdorff Test-
The Trousseau-von Bonsdorff test has been correlated with the presence of Trousseauís sign.
The Trousseau-von Bonsdorff test is performed immediately after deflating the sphygmomanometer. The patient is instructed to breathe deeply at a rate of 40breaths/min and is then observed for the previously described carpopedal spasm. One study found the Trousseau-von Bonsdorff test to be a useful adjunct to Trousseauís sign.

In the current age of medicine, the utility of Chvostekís sign and Trousseauís sign has diminished with the development of technology that is able to assess serum calcium values. However, the signs may still be helpful as crude determinations of the neuromuscular excitability that occurs in patients with hypocalcemia.
Trousseauís sign is likely to be a more specific indicator
of hypocalcemia than Chvostekís sign, but both signs
are diagnostically useful, and attempts to both perform
and interpret the signs are an interesting challenge to
physicians and students of medicine.

-------------------------THE END-----------------------

in every post i will post 5 new medical pearls which would be useful as mcqs in usmle & pg exam in India.