Dermatomyositis is a connective tissue disorder characterized by chronic inflammation of voluntary muscles and skin. It is more common in women and the age of onset is 50-70 years. A) Heliotrope Rash: It is a macular, confluent, purple or purple/red rash over both eyelids and periorbital tissue present with or…
Tag: Internal medicine
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Chest X-ray: Alveolar vs Interstitial Disease
Interstitium is the scaffolding that supports the alveolar walls and surrounds both the alveoli and the terminal bronchioles. Neither alveoli nor interstitium is visible on a chest X-ray when normal. It is necessary to analyze whether the pattern of diffuse opacification in the lung field is alveolar or interstitial. Terms:…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Systematic Approach to Frontal Chest X-ray
To make an appropriate diagnosis through a chest radiograph, it must be analyzed in a systematic manner. One of the common mistakes that students do is to miss the regions that needs to be looked for – commonest being the rib fractures. A mnemonic has been devised for this purpose:…
Clinical Skills and Approaches 
Pathological reflexes – Variations of Babinski
Normally, the pathological reflexes are not evident because they are suppressed by cerebrum at brainstem or spinal cord level by 6 months of age. Importance: Up-going (dorsiflexion) toe can be elicited at various sites and all indicated Upper Motor Neuron (UMN) lesion. Use a blunt-pointed object like fingernail or tip…
Clinical Skills and Approaches 
Hematological Signs – Angular Stomatitis and Atrophic Glossitis
ANGULAR STOMATITIS/CHEILITIS Definition: Maculopapular and vesicular lesions grouped on the skin at the corners (or ‘angles’) of the mouth and the mucocutaneous junction. It is made worse by licking the lips. Causes: 1. Oral candidiasis 2. Poorly fitting dentures 3. Bacterial infection 4. Less common Nutritional deficiencies (especially riboflavin, iron and pyridoxine) Iron…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Cutaneous manifestation in thyroid disorders
Skin – Systemic Disease Connection “When a man has on the skin of his body a swelling or an eruption… and the disease appears to be deeper than the skin it is a leprous disease.” – Leviticus 13: 2-3 In ancient times changes in skin were taken to indicate the…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Respiratory Examination – Dyspnea
Definition: Breathlessness inappropriate to the level of physical exertion or even occurring at rest (subjective and not a sign) Mechanisms: Chemoreceptors: Peripheral: Carotid and aortic bodies (to pO2, pCO2 and H+) Central: Medulla (to pCO2, not pO2, change in pH of CSF) a. Increased work of breathing: Airflow obstruction: Bronchial…
Clinical Skills and Approaches 
Examination of Hands
History: Hand dominance and occupation? Injury? Pain? Paresthesia? Impaired function? Swelling? Position: Place the patient’s hands on pillow Look: SEATS a. Shape or Deformity: – Wrist: Radial deviation: RA Ulnar deviation and flexion deformity: Spastic hemiplegia (CP) Wrist drop (also finger drop): Radial nerve injury Prominent dorsal ulnar and radial…