Important features of Rickettsia and Rickettsial Diseases Obligate intracellular parasites like Chlamydia – can survive only in host cells Cannot produce their own ATP, so they utilize the ATP of a host cell Gram negative coccobacillia, and short bacilli that grow strictly in eukaryotic cells (unable to grow in cell…
Tag: Internal medicine
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Thoracocentesis : Practical Essentials
Absolute contraindications of thoracocentesis There are no absolute contraindications to diagnostic thoracocentesis. If clinical judgement dictates that the information gained from the pleural fluid analysis may help in diagnosis and therapy, thoracocentesis should be performed. Necessity of an immediate alternative procedure such as open thoracostomy or thoracotomy is the only…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Gastrinoma (Passaro’s) triangle
Boundaries of Gastrinoma Triangle It is an imaginary triangle formed by 3 points in upper abdomen: Apex: Cystic duct-CBD junction Inferior point: 2nd part duodenum-3rd part duodenum junction Left lateral point: Pancreatic neck-body junction This area is located to the right of Superior Mesenteric Artery (SMA) i.e. Proximal duodenum and…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
MEN syndrome : Mnemonics
MEN syndrome is an autosomal dominant (AD) predisposition to developing multiple endocrine tumors. Mnemonic: MEN are Dominant. Points to remember: MEN I or MEN 1 (Wermer’s syndrome) Mnemonic: 3 X P’s MEN IIA or MEN 2A (Sipple’s syndrome) Mnemonic: 3 X C’s MEN IIB or 2B (MEN III) Mnemonic: 2C 2M…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Rib Notching
Normal Rib Notching A small notch near the costo-vertebral joint is normal, so pathologic rib notching is more likely if the notching is more lateral. Types of Pathological Rib Notching 1. Superior rib notching 2. Inferior rib notching (more common) Inferior Rib Notching (Roesler’s sign) Mechanism: Enlargement of one or…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Ascitic Fluid Analysis : How to come to diagnosis?
We have already discussed about the practical essentials about Ascitic Paracentesis including absolute contraindications, site of needle entry and appropriate volume replacement. Laboratory analysis of ascitic fluid may provide answers to important clinical questions, as its composition varies depending on the underlying cause. Gross Special test WBC (/mm³) – most useful PMN…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Hemolytic Anemia – Quick review
Although, we classify as intravascular and extravascular hemolysis, “diseases” don’t read the book. These disorders may be described as causing extravascular hemolysis, but your case may be the uncommon exception with intravascular hemolysis that was not mentioned. Diseases may cause anemia by both intravascular and extravascular hemolysis. Extravascular hemolysis typically…
Clinical Skills and Approaches 
Percussion of Spleen
Traube’s semilunar space Borders: Superiorly: Left 6th rib superiorly Laterally: Left midaxillary line or Left anterior axillary line Inferiorly: Left costal margin Method: Patient’s position: supine with left arm slightly abducted. Percuss: from medial to lateral Interpretation: Resonance (Normal) and Dullness (Splenomegaly) Also: Pleural effusion or mass in stomach may…