The Dexamethasone Suppression Test (DST) is based on the principle of negative feedback exerted by steroids on pituitary gland’s ACTH secretion. Negative feedback with exogenous steroid works if the cause is excessive ACTH secretion from pituitary: 1. Cushing’s disease (pituitary ACTH dependent Cushing’s syndrome): Excessive ACTH secretion by pituitary adenoma…
Tag: Internal medicine
Clinical Skills and Approaches 
Milkmaid’s grip in Chorea
Milkmaid’s Grip Milk maids grip is appreciated as an alternating squeezing and releasing of the finger like a milking motion, when asked to maintain a constant, firm grip of examiner’s fingers. This may reflect a combination of Chorea and Motor impersistence. As a result of poor grip, patients often involuntarily…
Clinical Skills and Approaches 
Ascitic Paracentesis : Practical Essentials
Absolute contraindications to Ascitic Tapping (Paracentesis) While some authors have claimed ascitic paracentesis to be free from absolute contraindications, others have listed following as absolute contraindications: Clinically evident fibrinolysis Disseminated Intravascular Coagulation (DIC) Clinically apparent oozing from needle sticks Acute abdomen requiring surgery Relative contraindications to Blind Paracentesis Ultrasound guided…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Difference between Sarcoidosis and Tuberculosis
Sarcoidosis and tuberculosis are both granulomatous disease with similar constitutional symptoms, respiratory symptoms and multiple organ involvement with hilar and mediastinal lymph node involvement. Hence, the diagnosis of one from the other may pose significant difficulties. Sarcoidosis vs Tuberculosis (TB) IFN-gamma release assays (IGRA)Tuberculosis can be reliably excluded if both…
Clinical Skills and Approaches 
Prescribing Opioids for Chronic Pain
Recommendations for Prescribing Opioid in Chronic pain 1. 1st line of therapy in chronic pain outside of active cancer, palliative or end of life care must be nonpharmacologic therapy and nonopioid pharmacologic. Consider opioid therapy in combination with nonpharmacologic or nonopioid pharmacologic therapy if benefits outweighs risk. 2. Ordinarily 2…
Emergency Medicine 
Supraventricular Tachycardia vs Sinus Tachycardia
Yesterday, I had encountered a tachycardic patient with heart rate 160/min. Somewhere in medical school, I was taught that the sinus tachycardia with heart rate >160/min must be considered as a Supraventricular tachycardia (SVT). With such misinformation, it was easier for me to overlook the fact that the patient was…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Steroid Induced Leukocytosis
Mechanism of Steroid Induced Leukocytosis There are 3 major mechanisms responsible for corticosteroid induced granulocytosis: 1. Demargination of neutrophils from endothelial cells (60% of the rise): Recall the leukocyte adhesion cascade in the chapter of inflammation. L-selectins are present in leukocytes that mediates their rolling on the endothelial lining of…
Case Reports 
Extensive Small Cell Lung Cancer
Short Case Summary 74 years old smoker, male patient presented with significant weight loss, productive cough and abdominal discomfort of short duration. Patient was icteric with stable vitals. On examination of chest, there was decreased air entry over right lung field. On examination of abdomen, liver was palpable with hard,…