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NIMS(Nepal Index Of Medical Specialities) has been design to provide information on drugs that are marketed in Nepal by Pharma company from around the world .

NIMS DRUGS DIRECTORY

NIMS(Nepal Index Of Medical Specialities) has been design to provide information on drugs that are marketed in Nepal by Pharma company from around the world .

NIMS DRUGS DIRECTORY

NIMS(Nepal Index Of Medical Specialities) has been design to provide information on drugs that are marketed in Nepal by Pharma company from around the world .

NIMS DRUGS DIRECTORY

NIMS(Nepal Index Of Medical Specialities) has been design to provide information on drugs that are marketed in Nepal by Pharma company from around the world .

NIMS DRUGS DIRECTORY

NIMS(Nepal Index Of Medical Specialities) has been design to provide information on drugs that are marketed in Nepal by Pharma company from around the world .

Sunday, May 1, 2016

Every seizure are nor simple seizure neither epilepsy -DrSudeepKC

A 3-month-old boy exhibits nystagmus and limb tremors unassociated with seizures. Over the next few years, he develops optic atrophy, choreoathetotic limb movements, seizures, and gait ataxia. 


picture of 3 month boy having nystagmus and limb moments


He dies during status epilepticus and at autopsy is found to have widespread myelin breakdown with myelin preservation in islands about the blood vessels.


The pathologist diagnoses a sudanophilic leukodystrophy to describe the pattern of staining observed on slides prepared to look for myelin breakdown products.


a. Neuromyelitis optica (Devic’s disease)
b. Central pontine myelinolysis
c. Marchiafava-Bignami disease
d. Acute disseminated encephalomyelitis
e. Pelizaeus-Merzbacher disease


The answer is e. Pelizaeus-Merzbacher disease is a demyelinating disorder that belongs to a group of degenerative diseases known as sudanophilic leukodystrophies. 

Leukodystrophy refers to the disturbance of white matter, and sudanophilic refers to the Sudan staining
characteristics of the involved white matter. Children with PelizaeusMerzbacher disease typically become symptomatic during the first months of life, but survival may extend into the third decade of life. Most affected
persons are male.

Tuesday, April 26, 2016

57-year-old female presented

A 57-year-old female presented with a 3-month history of weight loss, lethargy, shortness of breath and pleuritic left-sided pain. She has never smoked. On examination, she was apyrexial, breathless and in pain.

Questions
1. What does the first CXR show?
2. What does the second CXR show?
3. What is the most likely diagnosis given the history and CXR appearances?


Answers
1. A large left-sided pleural effusion.
2. A trace of fl uid remains. In addition, there is extensive
consolidation of the basal segments of the left
upper lobe ( circle Image 3) partly obscuring the left
heart border.
3. Bronchioloalveolar cell carcinoma.


The relatively long history of lethargy and weight loss together with the lack of signs of sepsis suggest malignancy. This degree of consolidation if due to infection would be accompanied by a shorter history and the patient would be clinically septic. CT showed a rind of pleural thickening consistent with pleural metastases explaining her pleural effusion and pleuritic pain ( single arrows Images 4a, b).


This scan was performed following pleural drain insertion, hence the air within the soft tissues. Note the pleural thickening extends along the mediastinal contour ( double arrow Image 4a) and is associated with volume loss, both signs are highly suggestive of malignancy.
In addition, there is posterior bulging of the oblique fi ssure ( arrow Image 4c) which is in favour of
bronchioloalveolar cell carcinoma  . The incidence of bronchioloalveolar cell carcinoma
(a form of adenocarcinoma) is increasing particularly as the incidence of smoking is decreasing. It is the form of lung cancer most commonly seen in nonsmokers. 

Saturday, April 23, 2016

answer of MCQ

1.The following features are true for Tetralogy of Fallot, except:
a. Ventricular septal defect
b. Right ventricular hypertrophy
c. Atrial septal defect
d. Pulmonary stenosis.
Answer-c)

2. The most common retrobulbar orbital mass in adults is:
a. Neurofibroma b. Meningioma
c. Cavernous haemangioma
d. Schwannoma
Answer-c)

3. Expanisle type osseous metastases are characteristic of primary malignancy of:
a. Kidney b. Bronchus
c. Breast d. Prostate
Answer-a)

4. Which is the objective sign of identifying pulmonary plethora in a chest radiograph?
a. Diameter of the main pulmonary/ artery> 16mm.
b. Diameter of the left pulmonary artery > 16mm
c. Diameter of the descending right pulmonary artery> 16mm
d. Diameter of the descending left pulmonary artery > 16 mm
Answer-c)

5. The most accurate investigation for assessing ventricular function is:
a. Multislice CT
b. Echocardiography
c. Nuclear scan
d. MRI
Answer-d)

6.The most important sign of significance of renal artery stenosis on an angiogram is:
a. A percentage diameter stenosis> 70%
b. Presence of collaterals
c. A systolic pressure gradient> 20 mm Hg across the lesion
d. Post stenotic dilatation of the renal artery
Answer-b)

7. The MR imaging in multiple sclerosis will show lesion in:
a. White matter b. Grey matter c. Thalamus d. Basal ganglia
Answer-a)

8. The most common location of hypertensive intracranial haemorrhage is:
a. Subarachnoid space
b. Basal ganglia
c. Cerebellum
d. Brainstem
Answer-b) 


9. Which of the following causes rib- notching on the chest radiography?
a. Bidirectional Glem shunt
b. Modified Blalock- Taussing shunt
c. IVC occlusion
d. Coarctation of aorta
Answer-d)

10. The most sensitive imaging modality to detect early renal tuberculosis is:
a. Intravenous urography
b. Computed tomography
c. Ultrasound
d. Magnetic Resonance imaging
Answer-a)

11. All of them use non- ionizing radiation, except:
a. Ultrasonography
b. Thermography
c. MRI
d. Radiography
Answer-d)

12. The most radiosensitive tumor among the following is:
a. Bronchogenic carcinoma
b. Carcinoma parotid
c. Dysgerminoma
d. Osteogenic sarcoma
Answer-c

13. All of the following modalites can be used for in – situ ablation of liver secondaries, except:
a. Ultrasonic waves
b. Cryotherapy
c. Alcohol
d. Radiofrequency
Answer-c)

14. All of the following radioisotopes are used as systemic radionucleide, except:
a. Phosphorus- 32 b. Strontium – 89
c. Iridium- 192 d. Samarium – 153
Answer-c)

15. Phosphorous – 32 emits:
a. Beta particles b. Alfa particles
c. Neutrons d. X- rays
Answer-a)

16. Which of the following is used in the treatment of differentiated thyroid cancer:
a. 131I b. 99mTc
c. 32P d. 131I-MIBG
Answer-a)

17. Which one of the following imaging techniques gives maximum radiation exposure to the patient?
a. Chest X-ray b. MRI
c. CT scan d. Bone scan
Answer-d)

18. Which one of the following has the maximum ionization potential ?
a. Electron b. Proton
c. Helium ion
d. Gamma (y)-Photon
Answer-c)

19. Typically bilateral inferior lens subluxation of the lens is seen in:
a. Marfan’s syndrome
b. Homocystinuria
c. Hyperlysinaemia
d. Ocular trauma
Answer-b)


20. The procedure of choice for the evaluation of an aneurysm is:
a. Ultrasonography
b. Computed tomography
c.Magnetic resonance imaging
d. Arteriography
Answer-d)

21. The common cause of subarachnoid hemorrhage is:
a. Arterio- venous malformation
b. Cavenous angioma
c. Aneurysm
d. Hypertension
Answer-c)

22. Spalding’s sign occurs after:
a. Birth of live foetus
b. Death of foetus in uterus
c. Rigor mortis of infant
d. Cadaveric spasm.
Answer-b)

23. Renal artery stenosis may occur in all of the following, except:
a. Atherosclerosis
b. Fibromuscular dysplasia
c. Takayasu’s arteritis
d. Polyarteritis nodosa
Answer-d)

24. Which one of the following congenital malformation of the fetus can be diagnosed in first trimester by ultrasound?
a. Anencephaly
b. Inencephaly
c. Microcephaly
d. Holoprosencephaly
Answer-a)

25. Which of the following conditions is least likely to present as an acentric osteolytic lesion:
a. Aneurysmal bone cyst
b. Giant cell tumor
c. Fibrous cortical defect
d. Simple bone cyst
Answer-d)

26. “Rugger Jersey Spine” is seen in :
a. Fluorosis
b. Achondroplasia
c. Renal Osteodytrophy
d. Marfan’s Syndrome
Answer-c)

27. Brown tumours are seen in:
a. Hyperparathyroidism
b. Pigmented villonodular synovitis
c. Osteomalacia
d. Neurofibromatosis
Answer-a)

28. Which of the following malignant tumours is radioresistant?
a. Ewing’s sarcoma
b. Retinoblastoma
c. Osteosarcoma
d. Neuroblastoma
Answer-c)

Sunday, April 17, 2016

is a keratotic follicular eruption-DrSudeepKC

This disorder primarily involves the skin and eyes. Phrynoderma, the name applied to the cutaneous eruption of vitamin A deficiency, is a keratotic follicular eruption that initially appears on the proximal extremities. 
Phrynoderma (follicular hyperkeratosis)


It eventually extends to the trunk, back, abdomen, buttocks, and neck. Although phrynoderma is widely accepted as being specific for vitamin A deficiency, it has recently been suggested that it may be a manifestation of severe malnutrition associated with deficiencies of multiple critical vitamins and essential fatty acids. 

Facial lesions may resemble large comedones of acne. Eye symptoms include nyctalopia (delayed dark adaptation, the earliest finding), night blindness, and xerophthalmia.

Objective findings are Bitot’s spots, which are areas of shed corneal epithelium, and in severe disease, keratomalacia. Vitamin A deficiency is most commonly caused by malabsorption disorders.

Phrynoderma is a type of follicular hyperkeratosis located on the extensor surfaces of the extremities whose main cause is vitamin A deficiency. The simultaneous occurrence of phrynoderma and ocular symptoms secondary to hypovitaminosis A after bariatric surgery is exceptional.

Friday, April 15, 2016

The following antihypertensive combination is irrational, and therefore should not be used:

The following antihypertensive combination is irrational, and therefore should not be used:


A. Nifedipine + hydralazine
B. Amlodipine + atenolol
C. Enalapril + clonidine
D. Enalapril + hydrochlorothiazide



ANS IS : A. Nifedipine + hydralazine

Thursday, March 31, 2016

BP lowering in hypertensive urgency


ans is 
B. Inability to control the rate and extent of fall in BP
C. Reports of adverse/fatal outcome
D. Both 'B' and 'C'

thank you;

Wednesday, March 23, 2016

sore throat.-DrSudeepKC

A 22-year-old woman complains of a sore throat. On examination she has mild jaundice and an enlarged liver and spleen.
Examination of Throat


a. Anaerobic bacteria
b. Chlamydia psittaci
c. Corynebacterium diphtheriae
d. Epstein–Barr virus


D.Epstein–Barr virus right answer

EBV infects B cells of the immune system and epithelial cells. Once EBV's initial lytic infection is brought under control, EBV latency persists in the individual's B cells for the rest of the individual's life.

It is best known as the cause of infectious mononucleosis (glandular fever). It is also associated with particular forms of cancer, such as Hodgkin's lymphomaBurkitt's lymphomagastric cancer,nasopharyngeal carcinoma, and conditions associated with human immunodeficiency virus (HIV), such as hairy leukoplakia and central nervous system lymphomas.There is evidence that infection with EBV is associated with a higher risk of certain autoimmune diseases,especiallydermatomyositissystemic lupus erythematosusrheumatoid arthritisSjögren's syndrome,and multiple sclerosis.Some 200,000 cancer cases per year are thought to be attributable to EBV.

Symptoms
The infection develops slowly with such mild symptoms that it may initially be indistinguishable from a cold or the flu. As the condition progresses the symptoms may include:
  • sore throat that lasts two weeks or more
  • Swollen lymph nodes in the neck, armpits, and groin
  • A persistent fever (usually about 102 degrees F)
  • fatigue
  • malaise (a vague feeling of discomfort)
These symptoms can be mild or so severe that throat pain impedes swallowing and fever reaches 105 degrees F. Some people also experience a rash, eye painphotophobia (discomfort with bright light), a swollen spleen or liver infection.
Although the symptoms of infectious mononucleosis usually resolve in one or two months, the EBV remains dormant in cells in the throat and blood for the rest of the person's life. Periodically, the virus can reactivate and can be found in the saliva of infected persons. This reactivation usually occurs without symptoms of illness. EBV also establishes a lifelong dormant infection in some cells of the body's immune system.
Diagnosis
Diagnosis is suggested on the basis of the clinical symptoms of fever, sore throat, swollen lymph glands and the age of the patient. A physical examination may reveal an enlarged liver and/or enlarged spleen. The liver and spleen may also be tender. Laboratory tests may be needed for confirmation.
Blood findings with infectious mononucleosis may include an elevated white blood cell count, an increased percentage of certain white blood cells and a positive reaction to a "monospot test." The monospot test relies on clumping of horse red blood cells by mononucleosis antibodies presumed to be in a person's serum.
antibody tests for EBV measure the presence and/or the concentration of specific EBV antibodies. Different laboratory tests can measure specific EBV antibodies. Some of these tests can be performed on a single sample of blood, while others compare different samples of blood over a period of time.
Treatment
In most cases of mononucleosis, no specific treatment is necessary. The illness is usually self-limited. Since it is a viral infection and viruses do not respond to antibiotics, they are ineffective against mono. Doctors will recommend bedrest and drinking plenty of fluids.
When the patient's temperature returns to normal, he or she may gradually resume normal activities as strength returns. However, mono can be accompanied by a streptococcal infection of the throat, in which case an antibiotic will be prescribed to treat that condition.
In severe cases, corticosteroid drugs that reduce swelling are prescribed. If the spleen is swollen, the doctor may recommend avoiding strenuous activities, such as lifting and pushing, as well as any contact sports, which may cause sudden rupture of the spleen. Hospitalization is necessary if there is a serious complication, such as rupture of the spleen.

Thursday, March 17, 2016

Guidelines for the use of a statin in hypertension; DrSudeepKC


Guidelines for the use of a statin in hypertension include the following, except:



A. Following a stroke
B. Type 2 diabetic diagnosed 11 years previously
C. Primary prevention with a CVD risk of 25%
D. Target levels of LDL <2 mmol/L and total cholesterol <4 mmol/L
E. Primary prevention in an 80-year-old


STATIN GUIDELINES
ANSWER : E. Statins should be used in all cases of secondary prevention in patients with hypertension, with target levels of LDL <2 mmol/L and total cholesterol <4 mmol/L or a 30% reduction. The primary prevention benefit of statins has been shown in trials of hypertensive patients down to a CVD risk level of 6%.

This is not financially feasible; therefore the recommendation is for statin use if the CVD risk is ≥20% or established type 2 diabetes for more than 10 years. There is little evidence for the treatment of patients over 80 years old with statins.

Monday, March 14, 2016

Captopril produces greater fall in blood pressure in:




Correct ans is  : A. Diuretic treated patients
https://www.facebook.com/nims.nepal/

Sunday, March 13, 2016

rate limiting enzyme-DrSudeepKC



A. Renin is the correct answer

Saturday, March 12, 2016

absorbed from the stomach: -DrSudeepKC


ANSWER IS B DICLOFENAC 


Diclofenac sodium is a benzeneacetic acid derivative, designated chemically as 2-[(2,6-dichlorophenyl)amino] benzeneacetic acid, monosodium salt. The structural formula is:

             Structure Image
soluble in methanol, soluble in ethanol, sparingly soluble in water and practically insoluble in chloroform and in dilute acid. The n-octanol/water partition coefficient is 13.4 at pH 7.4 and 1545 at pH 5.2. Diclofenac sodium has a dissociation constant (pKa) of 4.0 ± 0.2 at 25°C in water.
Each enteric-coated tablet for oral administration contains 25 mg, 50 mg, or 75 mg of diclofenac sodium. In addition, each tablet contains the following inactive ingredients. Inactive ingredients: Black iron oxide, croscarmellose sodium, hydroxypropyl cellulose, hydroxypropyl methylcellulose, lactose (monohydrate), magnesium stearate, methacrylic acid copolymer, microcrystalline cellulose, polyethylene glycol, povidone, red iron oxide, and titanium dioxide. The 25 mg also contains: D and C Yellow #10 Aluminum Lake and pharmaceutical glaze shellac. The 50 mg also contains: Pharmaceutical glaze shellac and yellow iron oxide. The 75 mg also contains: carnauba wax, glycerol monostearate, shellac, and yellow iron oxide.

Diclofenac sodium delayed-release tablets are a nonsteroidal anti-inflammatory drug (NSAID) that exhibits anti-inflammatory, analgesic, and antipyretic activities in animal models. The mechanism of action of diclofenac sodium delayed-release tablets, like that of other NSAIDs, is not completely understood but may be related to prostaglandin synthetase inhibition.
Diclofenac is 100% absorbed after oral administration compared to IV administration as measured by urine recovery. However, due to first-pass metabolism, only about 50% of the absorbed dose is systemically available. Food has no significant effect on the extent of diclofenac absorption. However, there is usually a delay in the onset of absorption of 1 to 4.5 hours and a reduction in peak plasma levels of less than 20%.

The apparent volume of distribution (V/F) of diclofenac sodium is 1.4 L/kg.
Diclofenac is more than 99% bound to human serum proteins, primarily to albumin. Serum protein binding is constant over the concentration range (0.15-105 µg/mL) achieved with recommended doses.
Diclofenac diffuses into and out of the synovial fluid. Diffusion into the joint occurs when plasma levels are higher than those in the synovial fluid, after which the process reverses and synovial fluid levels are higher than plasma levels. It is not known whether diffusion into the joint plays a role in the effectiveness of diclofenac.
Five diclofenac metabolites have been identified in human plasma and urine. The metabolites include 4’-hydroxy-, 5-hydroxy-, 3’-hydroxy-, 4’,5-dihydroxy- and 3’-hydroxy-4’-methoxy diclofenac. In patients with renal dysfunction, peak concentrations of metabolites 4’-hydroxy- and 5-hydroxy-diclofenac were approximately 50% and 4% of the parent compound after single oral dosing compared to 27% and 1% in normal healthy subjects. However, diclofenac metabolites undergo further glucuronidation and sulfation followed by biliary excretion.
One diclofenac metabolite 4’-hydroxy-diclofenac has very weak pharmacologic activity.
Diclofenac is eliminated through metabolism and subsequent urinary and biliary excretion of the glucuronide and the sulfate conjugates of the metabolites. Little or no free unchanged diclofenac is excreted in the urine. Approximately 65% of the dose is excreted in the urine and approximately 35% in the bile as conjugates of unchanged diclofenac plus metabolites. Because renal elimination is not a significant pathway of elimination for unchanged diclofenac, dosing adjustment in patients with mild to moderate renal dysfunction is not necessary. The terminal half-life of unchanged diclofenac is approximately 2 hours.
The pharmacokinetics of diclofenac sodium delayed-release tablets has not been investigated in pediatric patients.
Pharmacokinetics differences due to race have not been identified.
Hepatic metabolism accounts for almost 100% of diclofenac sodium delayed-release tablets elimination, so patients with hepatic disease may require reduced doses of diclofenac sodium delayed-release tablets compared to patients with normal hepatic function.
Diclofenac pharmacokinetics has been investigated in subjects with renal insufficiency. No differences in the pharmacokinetics of diclofenac have been detected in studies of patients with renal impairment. In patients with renal impairment (inulin clearance 60-90, 30-60, and less than 30 mL/min; N=6 in each group), AUC values and elimination rate were comparable to those in healthy subjects.

Monday, March 7, 2016

In the typical patient who is poisoned by iron::DrSudeepKC

In the typical patient who is poisoned by iron:


iron tonic


a. Hypoglycemia initially occurs then hyperglycemia secondary to pancreatitis.
b. Gastrointestinal hemorrhage is commonly seen secondary to liver dysfunction and coagulation abnormalities.
c. Lactic acidosis is rarely seen in the toxic patient.
d. Strictures may develop late in poisoning causing gastric outlet obstruction or bowel obstruction.
e. The iron accumulates in the bone and may cause pathologic fractures.


The answer is d. Direct caustic effects on the bowel by iron can result in early gastric and small bowel hemorrhage, which can result in hypovolemia and shock.

Late strictures may present as gastric outlet or bowel obstruction. As toxic amounts of iron enter the mitochondria and disrupt oxidative phosphorylation, lactic acidosis occurs.

Hyperglycemia is often seen early, but later hepatic failure results in hypoglycemia. Iron does not accumulate in the bone.

Sunday, March 6, 2016

Conjunctivitis is commonly associated with:-DrSudeepKC

Conjunctivitis is commonly associated with:

a. Hand-foot-and-mouth disease.
b. Fifth disease.
c. Rubeola (measles).
d. Mononucleosis.
e. Reye’s syndrome.


The answer is c. Viruses are the most frequent cause of conjunctivitis and adenovirus is the most frequent virus implicated. Other diseases may present with conjunctivitis as part of their clinical syndrome.

These include Kawasaki disease, measles (rubeola), and seasonal allergies. Measles, caused by a paramyxovirus, begins with a prodrome of gradually increasing fevers and URI symptoms (cough, coryza, conjunctivitis).

The prodrome is followed 2–4 days later with the appearance of a maculopapular rash that appears first on the head and spreads inferiorly to the trunk and extremities (including the palms and soles). Koplik spots, white papules on an erythematous base, on the buccal mucosa are pathognomonic.

Monday, February 29, 2016

depressed mood for 4 months-DrSudeepKC

A 32-year-old woman is seen in an outpatient psychiatric clinic for the chief complaint of a depressed mood for 4 months. During the interview, she gives very long, complicated explanations and many unnecessary details before finally answering the original questions.

Which of the following psychiatric findings best describes this style of train of thought?

a. Loose association
b. Circumstantiality
c. Neologism
d. Perseveration
e. Flight of ideas

The answer is b.  Circumstantiality indicates the loss of a goal-directed thought process: the patient brings in many irrelevant details and comments, but eventually will get back to the point. In loose associations, the thought process has also lost its goal-directedness;

however, the patient never gets back to the original point and there is no clear connection between sentences. A neologism is a fabricated word made up by the patient, which is usually a combination of existing words.

Perseveration, often associated with cognitive disorders, refers to a response that persists even after a new stimulus has been introduced—for example, a patient asked to repeat the phrase “no ifs, and, or buts” responds by saying, “no ifs, ifs, ifs, ifs.” Flight of ideas is a disorder of thinking in which the patient expresses thoughts very rapidly, with constant shifting from one idea to another, though the ideas are often connected.

Wednesday, February 24, 2016

history of difficulty breathing during feeding-DrSudeepKC

A 2-week-old full-term infant is brought to the ED with a history of difficulty breathing during feeding.
Examination reveals a noncyanotic, tachypneic infant. The heart rate is 140/min, and you can easily hear a widely radiating systolic murmur.

Chest radiography shows cardiomegaly and pulmonary congestion. The child most likely has:
a. Patent ductus arteriosus.
b. Hypoplastic left ventricle.
c. Coarctation of the aorta.
d. Transposition of the great vessels.
e. Ventricular septal defect.


The answer is c. The first step in evaluating heart disease in the infant is to establish whether it is cyanotic or acyanotic. In the infant with heart failure, the diagnosis is aided by knowledge of the time course. Immediately after birth, congestive heart failure (CHF) is most often caused by noncardiac diseases such as hypoxia, hypoglycemia, hypocalcemia, acidosis, and sepsis.

Patent ductus arteriosus is the most common cause of CHF in premature infants, but hypoplastic left ventricle is the most common cause of CHF in the term infant’s first week. Coarctation commonly presents as acute CHF in the second week.

Transposition of the great vessels usually occurs in the first 3 days with cyanosis and failure. CHF due to a ventricular septal defect usually presents approximately 1 month after birth. After 3 months, CHF is most likely due to acquired diseases like myocarditis, anemia, and rheumatic
fever.

Monday, February 22, 2016

२ दिन देखी पेट दुखाई सहन नसक्नु हुदै गयो -डा .सुदिप के सी

A 58-year-old man has a long history of dyspepsia for which he frequently takes over the counter antacids.

For the past 2 days his epigastric pain is worse and is constant.

Vital signs: oral temperature 99.0◦F,
heart rate 110/min,
blood pressure 158/90 mmHg.
His abdomen is rigid and you note decreased bowel sounds.
The x-ray showed in Figure  was obtained. Your next step would be to:


a. Perform an immediate paracentesis.
b. Consult surgery for perforated hollow viscus.
c. Give oral contrast and take to CT scan for further evaluation.
d. Start a proton pump inhibitor and refer to a gastroenterologist.
e. Begin high-dose somatostatin therapy and consult gastroenterology.


The answer is b: This upright chest x-ray shows free air under the diaphragms, consistent with perforated peptic ulcer. PUD is common in the United States but only 7% experience perforation. Ninety-five percent of these patients will require emergent operative intervention. The upright chest x-ray is approximately 70% sensitive for detecting perforation from peptic ulcer disease. Although, instillation of 500 mL of air, or lateral decubitus films may help improve the sensitivity, CT abdomen (either no contrast or with oral contrast) is the next best test if perforation is suspected and the initial x-ray is negative.

Friday, February 19, 2016

Time onset of Echo detection after MI ? -DrSudeepKC

How long after coronary artery occlusion can echocardiography detect wall-motion abnormalities?


(A) Within a few heartbeats
(B) 5 to 10 min
(C) 30 min
(D) 1 h
(E) 2 to 4 h

The answer is A. Soon after the onset of myocardial ischemia, muscle contraction is impaired. This may manifest on echocardiography as a wall-motion abnormality.

Experimentally, hypokinesis, akinesis, or dyskinesis can be seen within a few heartbeats after coronary occlusion. In selected patients in the critical care unit, echocardiography has a sensitivity greater than 70 percent in AMI.

 In studies of ED patients, where prevalence of AMI is lower and prevalence of coronary artery disease is higher, echo has been shown to be sensitive but not specific.

Echocardiography is most useful in patients with cardiogenic shock to diagnose anatomic complications that may be amenable to surgical correction (i.e., septal or mitral ruptures).

Sunday, February 14, 2016

जीका भाईरस (zika virus) : DrSudeepKC

जीका भाईरस (zika virus)   


 
डा. सुदिप के .सी. MD
मानिसमा जीका भाइरस संक्रमित एडिस (ades) लामखुट्टेको टोकाइले सर्ने गर्छ ! यो लामखुटेले राती भन्दा दिनमा टोक्ने गर्छ ! यो भाइरस नेपाल बाहिर को मुलुक जस्तै अफ्रिकी मुलुक , अमेरिका , हाईटि र ब्राजिलमा देखा परिसकेको छ हालै चीनमा पनि देखिएको आशंका गरिएको छ !   नेपालमा अहिले सम्म देखा नपरेपनि फैलन सक्ने सम्भावना र फैलिएमा महामारीको रुप लिन सक्ने अनुमान गरिएको छ   !
 

कसरी सर्छ जीका ?
1.       लामखुट्टेको टोकाइले
2.       पहिले नै संक्रमित रक्तदान गर्दा
3.       शारिरिक सम्पर्क गर्दा
4.       गर्भवती आमाबाट पेटको बच्चामा
5.       बच्चालाई दुध खुवाउदा

रोगका लक्षणहरु
·         लक्षणहरु मुख्य रुपमा लामखुट्टेले टोकेको २ देखि १२ दिन मा देखिन्छ !
·         बिरामीलाई रोग लागेको थाहा नहुन सक्छ जसलाई असिमटोमेटिक(asymptomatic) भनिन्छ!
·         तल उल्लेखित २ वा २ भन्दा बडी लक्षणहरु रहेमा बिरामी जीका भाइरस संक्रमित भन्न सकिन्छ !
o   हल्का ज्वरो आउने
o   शरिरमा बिबिरा आउने
o   मासपेसी दुखने
o   टाउको दुख्ने
o   आखा पछाडिको भाग दुख्ने
o   पेट दुख्ने
o   पातलो दिसा ३ पटक भन्दा बडी हुने
o   वाकवाक लाग्ने
o   मुखको छालाहरु खोल्सिदै जाने
o   शरिर चिलाउने
o   माथिका लक्षणहरु २ देखी ७ दिन मा हराएर जाने
रोग लागेपछि के के खराब गर्छ  ?
·         बच्चाको टाउको सानो हुने जसलाई माइक्रोसिफेली  (microcephaly) भनिन्छ !
·         आँखा भित्र रहेको नसा सुकेर हेर्न नसक्ने हुने !
·          खुट्टा कम्जोर भई बिस्तारै माथी सर्दै पुरा शरिर कम्जोर भई स्वास फेर्न नसक्ने र मृत्यु हुने !

 के-के जाचहरु गरेर पत्ता लाग्छ त जीका लागेको ?
·         नेपालमा र धेरै प्रमुख देशहरुमा अजै पनि टेस्ट उपलब्ध हुन सकेको छैन !
·         तर  अमेरीकी हेल्थ ओर्गनैजेशन ,WHO, CDC ,अर्बो भाईरस डाईगोनोस्टिक ल्याब र स्टेट हेल्थ ल्याब  अहिले सम्मका जाच गर्ने यी मात्र ठाउँहरु हुन् जहाँ जीका टेस्ट गर्न सकिन्छ !  
·         लक्षण भएको  ७ दिन भित्र रगत आर टि पी सि आर (RT-PCR) मध्यम बाट जाच गर्न सकिने !
·         जीका भाइरस सेरोलोजिकल नै प्रमाणित जाच हो (CONFIRMATORY) !
·         ७ दिन पछि आउने बिरामीलाई दुवै  आर टि पी सि आर र सेरोलोजिकल गर्नु पर्ने !
पेटमा बच्चा हुदा महिलाको जाच
यदि महिला लाई जीका संक्रमित भएमा अर्थात् माथि लेखिएका लक्षण देखिएमा
·         संक्रमित भएको  २ देखी १२ हप्ता भित्र ल्याब जाच
·         जचमा केही थाहा नभएमा वा नेगेटिव भएमा बच्चा बसेको ठाउँ (साल) र बच्चाको जाच गर्नु पर्ने !
·         भिडियो X-रेय गरि बच्चाको सानो टाउको वा गिदीमा सेतोपदार्थ (क्याल्सिफिकेसन) भएको अवस्था पत्ता लगाउने !
·         यदी बच्चाको टाउको सानो भएमा र गिदीमा सेतोपदार्थ (क्याल्सिफिकेसन )भएमा बच्चा बसेको सालको
परिक्षणहरु गर्ने !

यदि महिला लाई जीका संक्रमित नभएमा अर्थात् माथीलेखिएका लक्षण नदेखिएमा
·         संक्रमित नभएको महिलाको ल्याब जाच गर्न नपर्ने 
·         जचमा केही थाहा नभएमा वा नेगेटिव बच्चा बसेको ठाउँ र बच्चाको जाच गर्नु पर्ने
·         भिडियो X-रेय ३-४ हप्तामा  गरि बच्चाको टाउको वा गिदीको  अवस्था पत्ता लगाउने !
·         यदी बच्चाको टाउको सानो भएको  र गिदीमा सेतोपदार्थ (क्याल्सिफिकेसन )भएको शंका लागेमा  बच्चा बसेको सालको परिक्षणहरु गर्ने !
बच्चा भैसकेकोमा कसरी जीका संक्रमित छ छैन पत्ता लगाउने ?
·         बच्चा ६ महिना पुगेपछि बच्चाले कान सुन्छ कि सुन्दैन जाच गर्ने !
·         बच्चालाई नजिकको स्वस्थ चौकी वा डाक्टरकोमा लगी बच्चाको सुन्ने शक्तिको जाच गर्ने !
·         अरू बच्चाको तुलनामा आफ्नो बच्चा हुर्केको अवस्थाको ख्याल गर्ने र बच्चाको टाउकोको गोलाई पहिलो वर्ष सम्म नाप्ने !
उपचार कसरी गर्ने ?
·         पहिले लक्षणहरूको अवस्था र अवस्था अनुरूप औषधी दिने !
·         ज्वरो आएमा आराम गर्ने , झोल पदार्थ र सिटामोल दिने !
·         एसप्रिन र ब्रुफेंन जस्ता औषधी नदिने जब सम्म डेंगु ज्वरो भएको नभएको थाहा हुदैन !
रोकथाम कसरी  गर्ने ?
गर्भवती महिला जीका भाइरस संक्रमित भूभागमा नजाने !
अहिले सम्म कुनै पनि भ्याक्सिन छैन तर भारतीय कम्पनी बायोटेकले २ वोटा भ्याक्सिन भएको दाबी गर्दै आएको छ तर अहिले सम्म त्यसको असर र कुनै पनि अध्ययन भएको छैन र अहिले सम्म मान्छेमा प्रयोग गरिएको छैन  !
लामखुटटे  को टोकाइबाट बच्नेनै मुख्य रोग हुनु बाट जोगिनु हो !
घरमा जाली ढोका र सुत्दा जाली प्रयोग गर्ने लामखुटटेबाट बच्ने मल्हम पनि प्रयोग गर्न सकिन्छ !
कुनैपनि कपडा फोहोरो र शंका लागेमा लामखुटटे मार्ने स्प्रे प्रयोग गर्न सकिन्छ !
बच्चालाई शरिर पुरा छोप्ने लुगा लगाउने र लामखुटटे  भएको ठाउँमा जान वा खेल्न नदिने !