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Dina Amjad
@dinaamjad1998
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Newly graduate doctor Aiming for General Surgery
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eye
Thyroid Eye Signs Lid Signs Dalrymple’s Sign: Lid Retraction. Von Graefe’s Sign: Lid lag of the upper eyelid on downward gaze. Vigoroux Sign: Eyelid fullness/swelling. (Figure 1) Grove Sign: Resistance to pulling down the retracted upper lid. Rosenbach's Sign: Fine tremors of the eyelids when closed. Gifford’s Sign: Difficulty in everting upper lid. • Enroth Sign: Edema of lower lid. (Figure 1) Boston’s Sign: jerky irregular movement of upper lid on downward gaze. Kocher’s Sign: Increased lid retraction with visual fixation (staring look). (Figure 2) Abadie Sign: Spasm of the levator palpebrae superioris muscle with retraction of the upper lid. Riesman's sign: Bruit heard over the closed eye with a stethoscope. Facial Signs Stellwag Sign: Incomplete and infrequent blinking (staring look). Joffroy Sign: Absent creases in the forehead on superior gaze. (Figure 3) Jellinek's Sign: Hyperpigmentation of the superior eye folds. Hertoge’s Sign: Loss of the lateral third of eyebrows. Sainton’s sign: Delayed forehead wrinkling on up gaze. Extra-Ocular Muscle Signs Möbius Sign: Inability to converge. (Figure 4) Ballet Sign: Restriction of one or more extraocular muscles. Jendrassik's Sign: Limitation of abduction and rotation of eyeballs. Suker’s Sign: Poor fixation on abduction. Pupillary Signs Cowen’s Sign: Jerky pupillary constriction to light. Lowy’s Sign: Mydriasis with instillation of lower concentration of adrenaline. Knies’s sign: Unequal dilatation of pupil in dim light. Others Goldzeiher’s Sign: Deep injection of the bulbar conjunctiva. (Figure 5) Payne Trouseau Sign: Globe luxation. Sattler Sign: Increased intra-ocular pressure in upgaze. #THYROID #EYE #SIGNS #EPONYMS #ENDOCRINOLOGY #OPHTHALMOLOGY #clinical #ophthalmopathy
Differential diagnosis of schistocytes / fragmentation hemolysis: • Thrombotic microangiopathies (TMA) - TTP - Shiga toxin-mediated hemolytic-uremic syndrome (ST-HUS) - Complement-mediated TMA (formerly known as atypical HUS) - Drug-induced thrombotic microangiopathy (DITMA) - TMA after solid organ or stem cell transplant • DIC / Trousseau's • Malignant hypertension • Scleroderma renal crisis • Severe B12 deficiency • Mechanical hemolysis/"macroangiopathic hemolytic anemia" • HELLP syndrome • Catastrophic APLS BCM IM Residency @BCM_InternalMed #schistocytes #differential #diagnosis #hematology #hemolysis
Hypertensive Crisis Algorithm - Hypertensive Urgency and Hypertensive Emergency Blood Pressure Reduction Goals: • lower BP up to 25% in first 1 hr • then < 160/100 mmHg in next 2-6 hrs • then to baseline over next 2 days Matthew Ho, MD PhD @MatthewHoMD #Hypertensive #Crisis #Algorithm #Urgency #Emergency #management #algorithm #cardiology
Granular & “Muddy Brown” Casts on Urine Microscopy A. Finely granular cast B. slightly coarser granular cast C. “urine poker quads” showing a fine (f), coarse (c) and muddy brown (mb) granular cast accompanied by a waxy (wx) cast D. “Muddiness” of mb granular casts is better appreciated at low power field compared to high power field (inset). #Granular #MuddyBrown #Casts #Urine #Microscopy #Clinical #Nephrology #Sediment
Mixed Cellular Casts on Urine Microscopy Degenerating mixed cellular cast - brightfield, unstained - from patient with pneumococcal sepsis and AKI Dr. Jay R. Seltzer @jrseltzer #Cellular #Casts #clinical #Urine #Microscopy
Atlas of Urine Microscopy Findings • Epithelial cells - Normal • Renal tubular cells - Acute tubular injury • Nondysmorphic red - cells Non-glomerular bleeding from anywhere in the urinary tract • Dysmorphic red cells - Glomerular disease, but can also be seen if urine sample is not fresh at time of microscopy • Red cell casts - Diagnostic of glomerular disease • Leukocytes - Up to 3 per high-power field = normal; >3 per high-power field = inflammation in urinary tract • White cell casts - Renal infection • Hyaline casts - Any type of renal disease • Granular casts - More significant renal disease • “Muddy brown cast” - Necrotic tubular cells aggregated with tamm horsfall protein indicating acute tubular injury • Crystals - Some crystals can be found in healthy individuals; “abnormal” crystals may indicate metabolic disorders or excreted medications • Bacteria - Urinary tract infection; contamination #Urine #Microscopy #Atlas #key #diagnosis #nephrology #casts
Waxy Casts on Urine Microscopy Dr. Telma Lemos @TELMALEMOS10 #Waxy #Casts #Urine #Microscopy #clinical #nephrology
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RBC Casts on Urine Microscopy Dr. Telma Lemos @TELMALEMOS10 #RBC #Casts #Urine #Microscopy #clinical #nephrology
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Urinary Casts in the setting of renal disease #Clinical #Nephro #Urine #Microscopy #Casts #Comparison #Chart #ATN #AIN #Pyelonephritis
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