Alexander Mendieta, M.D
@mendietaalex1
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Statuses
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GOD is my guide🙏🏿|🇩🇴|Physician😷|Researcher🥼|Tweets are my own |Likes, RTs and comments = Do not necessarily imply endorsement
Joined March 2015
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Pinned Tweet
61 years old patient comes with hematuria,
Can you comment the diagnosis❓
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HIV patient + fever. What is the diagnosis ?
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1K
@drkeithsiau
PORTAL HYPERTENSION
🌐is the most frequent cause of hospitalization, variceal bleed, liver transplantation, and death in patients with cirrhosis
🌐cirrhosis is the most prevalent cause
🌐⬇️albumin⬆️PT time/liver enzymes
🌐patients show hypercoagulable state needing anticoagulants
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This smoker patient has a chronic diarrhea history,
Do you know the diagnosis?
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731
There is an organ that may look as chocolate if it gets sicked....
Do you recognize the organ?
What is the disease?
🍫🍫 🍫👁️
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@drkeithsiau
MONONUCLEOSIS
🌐classically presents with fever, lymphadenopathy, and tonsillar pharyngitis
🌐EBV, Adenovirus, Hepatitis A, HIV, Rubella and Toxoplasmosis are potential causes
🌐maculopapular rash is evident most commonly
🌐treatment is supportive
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@drkeithsiau
FOVEOLAR GASTRIC ADENOMA
🌐may be caused by H. Pylori
🌐Persistent infection of the stomach with H. pylori (HP) leads to chronic atrophic gastritis and eventually causes gastric cancer
🌐polyps have to be removed to prevent gastric cancer
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@drkeithsiau
CHAGAS DISEASE
🌐is a zoonotic disease caused by the parasite Trypanosoma cruzi.This is a vector-borne illness spread by the triatomine bug
🌐Chronic infections can last for years
🌐Gastrointestinal (GI) disease: megacolon and megaesophagus due to fibrosis and “Achalasia” as seen
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Wow!!! 🤯
Can you recognize this disease❓
Best drug to treat it?
He is been like this since a child…👀👀
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Yes!! this is an esophagus!!!
Do you know the diagnosis and how to treat it? 👀
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20 years female that has never menstruated,
BUT since adolescence has monthly lower abdominal pain and cramping,
Do you know the diagnosis❓
Interesting‼️👁️
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@farmacotips
CORTICOESTEROIDES
🌐el síndrome de Cushing es una enfermedad rara provocada por un exceso de la hormona cortisol en el cuerpo
🌐La causa más común de este síndrome se debe a la exposición frecuente a medicación que contenga glucocorticoides
🌐 Los hallazgos cutáneos⬇️⬇️
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- Weight loss
- Migratory arthritis
- Pancytopenia
- Low C3 and C4
- Proteinuria
Do you know the disease ?👀👀👀👀
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Newborn with no abdominal sounds
Do you know the diagnosis?
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@BrownJHM
PHLEGMASIA CERULEA DOLENS
🌐associated with deep vein thrombosis of the lower extremity
🌐may progress to critical limb ischemia and potentially limb loss
🌐etiology unknown in 10% of cases
🌐PE is another clinical manifestation of phlegmasia
🌐Supportive measures 1st line tx
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-Bone pain
-Infections
-Hypercalcemia
-Constipation
-Renal failure
-Anemia
Please comment the diagnosis……🧐
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This can be formed in young women….
What is the diagnosis❓
Why does it have human appearance❓
👹
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@unblogmedico
"Signo del ómnibus de Fournier"
🌐También llamado signo de la retina Ana y de Hertoghe
🌐Suele asociarse a hipotiroidismo o a dermatitis atópica (por el rascado repetido)
🌐 También en ciertos casos de lepra precoz, en la sífilis secundaria y en la intoxicación por talio
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Baby with blue discoloration on skin
Do you know the diagnosis?
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This female patient has been receiving treatment for Breast Cancer,
Do you know the diagnosis?
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@farmacotips
IMPÉTIGO
🌐Tratado con Mupirocina tópica
🌐Las infecciones bacterianas más frecuentes en el niño son las piodermitis o enfermedades causadas por microorganismos piógenos, estreptococos y estafilococos, que pueden localizarse en la parte superficial de la piel (impétigo)
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@BrownJHM
MELANOMA OF THE NAIL
🌐Subungual melanoma is a distinct subtype of cutaneous malignant melanoma arising from structures within the nail apparatus
🌐The pigment extends beyond the nail and into the adjacent skin ("Hutchinson sign")
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60 years old female patient with a mobile mass that translluminates with a penlight,
Do you know the diagnosis ?
Treatment?
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-Garlic odor
-Watery diarrhea
-QT prolongation
What is the diagnosis and treatment ❓
🤓🤓
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This patient has hearing issues and lack of balance while walking,
Do you know the diagnosis?
#MedEd
#MedTwitter
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@BrownJHM
@grepmeded
WINGING OF SCAPULA
🌐 The most common etiology of a winged scapula is usually due to damage or impaired innervation to the serratus anterior muscle (innervated by thoracic nerve).
🌐 Some patients may also complain of an inability to raise the affected arm above their head.
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This patient was present on the ER with ⬇️Blood pressure
Do you know the diagnosis? 👁️
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@drkeithsiau
Lupus Pernio associated to Sarcoidosis
🌐Patients with lupus pernio have a higher risk for pulmonary disease
🌐 Exposure to metals such as beryllium, zirconium, and aluminum is associated with the development of granulomas that are similar to sarcoid granulomas
🌐It can cause ⬇️
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Patient with arrhythmia history,
Do you know the diagnosis?
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@BrownJHM
CULLEN SIGN IN ACUTE PANCREATITIS
🌐 Cutaneous manifestations of pancreatitis include Cullen sign, Grey Turner sign, and pancreatic fat necrosis
🌐Cullen sign is a hemorrhagic discoloration of the umbilical area due to intraperitoneal hemorrhage from any cause
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59 years old woman comes with abdominal distention, she works at a construction 🚧 company,
Do you know the diagnosis?
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@drkeithsiau
Chylous Ascites
is defined as a milky appearing, triglyceride-rich peritoneal fluid in the abdominal cavity
occurs due to trauma, rupture of the lymphatics secondary to obstruction, or an increase in the peritoneal lymphatic pressure
High mortality rate (70%)
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@farmacotips
El síndrome de crup o “Crup”
🌐Se denomina también laringotraqueobronquitis y puede ser vírica o bacteriana
🌐Está causada por diversos virus, si bien los más habituales son los virus parainfluenza tipo 1, 2 y 3, y afecta más a los niños que a las niñas
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@farmacotips
RUBÉOLA CONGÉNITA
🎯Toda persona que no esté vacunada contra la rubéola está en riesgo de contraer la enfermedad
🎯Las mujeres embarazadas que contraen rubéola están en riesgo de sufrir un aborto espontáneo o un nacimiento sin vida, y sus bebés en gestación corren el riesgo de⤵️
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What is the treatment of choice for a pregnant women with hyperthyroidism in the first trimester?
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@BrownJHM
SWEET SYNDROME
🌐 The diagnosis is made by identifying the typical features and the histology of the erythematous plaques.
🌐 First-line option is systemic corticosteroids, or if lesions are limited, topical corticosteroids.
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@OGdukeneurosurg
LYMPHATIC FILARIASIS
🌐Lymphatic filariasis impairs the lymphatic system and can lead to the abnormal enlargement of body parts, causing pain, severe disability and social stigma
🌐Diethylcarbamazine (DEC) is the drug of choice
🌐 There are 3 types of filarial worms:
⬇️⬇️
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This patient has also hypertension,
Do you know the etiology?
How can it be diagnosed and managed ?
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This patient has an aneurysm;
Do you know the diagnosis?
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75 years old female Gardener presents with axilar lymphadenopathy and these hand lesions⬇️
What is the diagnosis ?
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@farmacotips
DERMATITIS SEBORREICA
🌐Se puede tratar con Ketoconazol
🌐El invierno es la época del año que exacerba enfermedades como dermatitis atópica, psoriasis y dermatitis seborreica
🌐En pacientes con síndrome de inmunodeficiencia
adquirida (SIDA), la disminución de CD4=⬆️Malassezia sp
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55 years male patient that used to work in a mining company,
Do you know the diagnosis?
#MedEd
#MedTwitter
#XMed
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@drkeithsiau
IgA VASCULITIS
🌐 Henoch-Schönlein purpura is a vasculitis involving the small vessels of the joints, kidneys, gastrointestinal tract, and skin
🌐can also involve the central nervous system (CNS) and the lungs
🌐is typically self-limited and managed with supportive care
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@BrownJHM
@Radiopaedia
COFFEE BEAN SIGN
🌐It is used to describe the twisting of the sigmoid colon about its mesenteric axis, mimicking the picture of a coffee bean
🌐Plain radiograph in left-sided position revealed dilated colon loops with air-fluid level
🌐Laparotomy indicated.
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@BrownJHM
Vitamin A Deficiency
🌐Vitamin A deficiency-associated ocular symptoms have been shown to develop at concentrations less than 10 micrograms/dL
🌐The most common cause is the chronic inflammation from regular gastrointestinal (GI) infections
🌐Zinc is coadministered for VitA abs.
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64 years old male patient with chronic diabetes mellitus,
Do you know the diagnosis?
#XMed
#MedEd
#MedTwitter
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👁️👁️👁️👁️👁️👁️👁️👁️
Can you recognize the congenital defect❓
Any syndrome associated ❓
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61 years old man started with this pruritic skin lesions 2 weeks ago,
What is the diagnosis❓
What is the best treatment to cure it❓
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68 years old man, he thought smoking would NOT be that bad,
Do you know the diagnosis ❓
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@drkeithsiau
FILARIASIS
🌐Chronic infection can lead to swelling of the extremities, hydroceles, and testicular masses
🌐second cause of deformity after leprosy
🌐grade lV is non reversible (also called as elefantiasis)
🌐Diethylcarbamazine and Ivermectine are the main drugs used
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Parents from this child of almost 2 years are worried because he does not walk yet,
Do you know the diagnosis?
#XMed
#MedEd
#MedTwitter
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This patient has a severe respiratory depression after an infection that caused him a bloody diarrhea;
Do you know the diagnosis?
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39 years male patient with these hand lesions,
What is the causing etiology❓
He said father had a stroke in his 40s....
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@drkeithsiau
Alpha-Gal syndrome
🌐antibodies against the galactose α-1, 3-galactose are evident
🌐reaction may be present 3-6 hrs after eating meat
🌐⬆️IgE
🌐hydrocortisone, hydroxyzine and fexofenadine
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15 years old male practices basketball 🏀 regularly,
Orthopedist was in charge of checking him…
Do you know the diagnosis❓
What is the muscle affected❓
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This patients has extremely painful great toe, he also has hypertension, DM, hyperlipidemia….
What is the diagnosis?
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Patient with hypertension, muscle weakness and low renin levels,
What diagnosis do you think is it ?👀👀👀👀
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@farmacotips
SÍNDROME GRIS
es una afección peligrosa que se presenta en recién nacidos (especialmente en bebés prematuros)si se le administra cloramfenicol para combatir una infección bacteriana
el cloranfenicol se metaboliza en el hígado, cuyas enzimas hepáticas no están bien desarrolladas
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Can you recognize the affection❓❓
👁️👁️👁️👁️
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What is the best treatment you would use in Atrial Fibrillation?
👁️👁️👁️
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@BrownJHM
ACHENBACH SYNDROME
🌐Painful blue finger or paroxysmal finger hematoma, is a rare clinical condition, which results in the sudden onset of bruising along with burning pain, mostly on the volar aspects of fingers
🌐The third finger of the right hand is the most common injured
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Easy easy‼️
Genetic disease….
Diagnosis❓
What organ else can they affect❓
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@BrownJHM
MELANOMA OF THE NAIL
🌐Subungual melanoma is a distinct subtype of cutaneous malignant melanoma arising from structures within the nail apparatus
🌐The pigment extends beyond the nail and into the adjacent skin ("Hutchinson sign")
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This patient has a very severe status:
- Cyclic fevers
- Headache 🤕
- Anemia
- Splenomegaly
- “Hypoglycemia”
Visited to Brazil 🇧🇷
What do you think is the diagnosis❓
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@BrownJHM
EXUDATIVE TONSILLITIS
🌐S. pyogenes group A beta-hemolytic is the most important Bacterial cause
🌐Adenovirus is the most important viral cause
🌐Fever associated with group A beta-hemolytic strep. tonsillitis responded to penicillin
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@BrownJHM
PAGET SCHROETTER
🌐 Effort-induced thrombosis of the axillary and subclavian veins associated with compression of the subclavian vein at the thoracic outlet.
🌐 It is more commonly encountered on the right side.
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@farmacotips
ESCHERICHIA COLI
🌐es el pathogenic más frecuente de las infecciones del aparato GI y vías urinarias
🌐es un bacilo gram negativo, productora de lactosa.
🌐Puede producir diarrea hemorragica debido a la toxina de Shiga (serotipo más virulento)
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@drkeithsiau
Spindle Cell Sarcoma of the tongue 👅
🌐rarely happens in the tongue
🌐mostly affects men
🌐Smoking, alcohol consumption, and previous irradiation of the head and neck region ⬆️risk
🌐has an aggressive behavior
🌐surgery improves the prognosis
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@GesconsEduca
ENFERMEDAD DE CROHN
Afecta principalmente los intestinos, pero puede afectar desde la boca hasta el ano.
Otros síntomas pueden incluir dolor anal o secreción, lesiones de la piel, abscesos rectales, fisuras y dolor de articulaciones (artritis)
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45 years male pale patient, non-smoker, came to the office because left quadrant abdominal pain,
Do you know the diagnosis ❓
How can we cure it❓
Complications associated ❓ 👀
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What is the best combination to treat Helicobacter Pylori infection?
👁️👁️👁️
41
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This little child’s mother did not agree to his vaccinations,
Do you imagine the disease❓
What to do as a doctor when this is present❓👀
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@unblogmedico
Ribete de Burton
Se asocia a intoxicación por Plomo
Afecta fundamentalmente a la población laboralmente expuesta, pero también a la población general, sobre todo como intoxicación alimentaria por conducciones de agua en tuberías de plomo, vinos a granel o⬇️⬇️
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@BrownJHM
Battle Sign (also called Battle's Sign)
🌐It is retroauricular or mastoid ecchymosis that is typically the result of head trauma.
🌐It takes 1 to -2 days for the sign to appear.
🌐 Battle sign is prominent when there is a fracture of the petrous temporal bone.
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This is your liver when eat a lot of junk food!!
What is the diagnosis?
Comment other risk factors….
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@BrownJHM
Blueberry Muffin Syndrome
skin shows diffuse, dark blue to violaceous purpuric macules and papules
Toxoplasmosis, Other, Rubella, Cytomegalovirus and HSV. These entities should be ruled out
Histiocytosis, neuroblastoma, leukemia cutis, myeloproliferative disorder, mastocytosis
3
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@drkeithsiau
PICA
🌐is defined as eating nonnutritive, nonfood substances over a period of at least one month
🌐Iron deficiency anemia, pregnancy , epilepsy and esquizofrenia have been associated
🌐main target of treatment is to identify the causing risk factor and resolve complications
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@BrownJHM
LICHTENBERG FIGURES
🌐Lichtenberg figures are nonburn skin injuries that are pathognomonic for lightning exposure
🌐Other clues suggestive of lightning injury include arrhythmias and rhabdomyolysis
🌐Lesions appear up to 1h after exposure and stay up to 48h
2
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@BrownJHM
Diabetic Foot Ulcer
🌐is usually the result of poor glycemic control, underlying neuropathy, peripheral vascular disease, or poor foot care
🌐is also one of the common cause for osteomyelitis of the foot and amputation of lower extremities
🌐 Staphylococcus is the most common spp
2
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Newborn was found with just 1 visible testicle‼️‼️
What is the diagnosis ❓👀
If corrected… What is a complication in the long term ❓✅
37
15
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@BrownJHM
@Radiopaedia
MASSIVE FECAL IMPACTION
often seen as an acute complication of severe or untreated chronic constipation. When an individual is constipated, stool remains in the large intestine for longer than usual, giving the intestine more time to absorb water from the fecal matter
1
22
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@drkeithsiau
ADDISON DISEASE
🌐is an acquired primary adrenal insuf.
🌐results from bilateral adrenal cortex destruction leading to decreased adrenocortical hormones, which may include cortisol, aldosterone, and androgens
🌐hyperpigmentation due to ⬆️ACTH and MSH
🌐tx ⬆️glucose/cortisol
2
22
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@BrownJHM
FLAIL CHEST
🌐The primary cause of a flail chest is blunt thoracic trauma, or chest trauma, which is an injury caused by a forceful impact with a dull object or surface
🌐Complications May be Atelectasis, refractory hypoxemia, Pneumonia, Pneumothorax and ARDS….
1
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This patient has 4 months with dyspnea, there is no pathological past history,
Do you know the diagnosis?
#XMed
#MedTwitter
#MedEd
41
30
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@drkeithsiau
BEAU’S LINES
🌐caused by infections, inflammatory diseases, Stevens–Johnson syndrome or Kawasaki disease, acrodermatitis enterohepatica and some drugs
🌐myocardial infarction, local trauma and renal failure may be associated
🌐HIV is been associated
🌐clinically diagnosed
3
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30 years old male patient comes to consultation with ataxia and hemangioblastoma,
Do you know the diagnosis?
23
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@docxusofficial
🌐Diagnosis is Superior Vena Cava Obstruction
🌐Pemberton's sign involves bilateral arm elevation, and a positive sign results in facial engorgement
0
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@BrownJHM
@IhabFathiSulima
@grepmeded
🌐Beevor sign is an abnormal upward (cephalad) umbilicus movement upon truncal flexion while the patient is in a supine position
🌐 It becomes diagnostic to certain diseases such as facioscapulohumeral muscular dystrophy (FSHD), particularly when accompanied by⬇️⬇️⬇️
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Patient comes to the office with this ball that DOES NOT transilluminate with a penlight🔦
Do you know the diagnosis❓
How can she be cured❓
53
15
149
@BrownJHM
GENERALIZED OSTRACEOUS PSORIASIS
🌐Lesions like oyster shell-appearance
🌐 Lithium has been implicated in the exacerbation of pre-existing psoriasis
🌐 Corticosteroids are the first line topical treatment for psoriasis in all age groups
1
18
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@farmacotips
SÍNDROME DEL HOMBRE ROJO ASOCIADO A VANCOMICINA
🌐se caracteriza por enrojecimiento de la parte superior del cuerpo, prurito, sensación de ardor y, ocasionalmente, hipotensión.
🌐ciprofloxacina, anfotericina B, rifampicina y teicoplanina son algunas de sus causas
🌐¿infusión ?
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