Body Oddities

Ever wonder why your eye suddenly starts twitching or why you start hiccupping uncontrollably in public and simply can't stop? Or how about pondering the medical reason behind yawning or getting a brain freeze immediately after eating ice cream? Well, according to experts there are medical reasons for such oddities and what you're about to read may surprise you.

Sneezing
Achewww! Known as sternutation, the act of sneezing removes an irritant from the nose. When a particle or cluster of particles pass through nasal hairs and reach the nasal mucosa, they trigger histamine production. This reaches nerve cells in the nose which signals to the brain to initiate a sneeze. Particles such as dust may irritate the nose and result in a sneeze. Sneezing is more common for people with allergies when they're exposed to various allergens like animal dander and pollen.

Hiccups
Hiccups are the result of a spasm in the diaphragm, which contracts to pull air into the lungs causing a sudden rush of inhaled air. According to Dr. Michael Farber, Director, Executive Health Program, Hackensack University Medical Center, "This sets off a chain reaction causing the airway opening to close quickly which in turn halts the flow of air thus causing the vocal cords to react by closing quickly, creating the characteristic hic." Hiccups may be the result of eating a big meal, swallowing air, drinking carbonated beverages, tobacco use or sudden emotional excitement. He explains, "Hiccups may improve through basic maneuvers such as relaxation or distraction, eating and drinking, or techniques of altered breathing."

Blushing
Awwww, you're blushing. Turning red in the face is caused by the dilation of blood vessels in the face. In fact, this normal physiologic response allows the transfer of heat from our bodies to the skin's surface. Dr. Yael Halaas, board-certified facial plastic surgeon in New York explains, "Several factors cause blushing such as a change of temperature, spicy foods, emotional responses and alcohol. Some medical conditions can also cause blushing such as Acne Rosacea." In this condition, there is an increase of vasculature and enlargement of blood vessels in the face. This condition can be treated by a dermatologist or qualified physician.

Brain Freeze
This almost instantaneous headache is a reaction to a cold substance coming into the roof of the mouth. Better known as brain freeze, Dr. Michael Farber says, "Typical onset is within seconds of exposure to a cold precipitant, as the body reacts by initially reducing blood flow to the region to conserve heat followed by enhanced blood flow return to the region." Nerves within the area sense this and transmit the sensation back to the nerve base as pain. His advice -- relieve pain by pressing the tongue against the roof of the mouth to warm the area.

Eye Twitch
According to experts, eye twitching is essentially a spontaneous spasm of muscles surrounding the eye. The involuntary twitching of an eyelid muscle may last less than a minute, although twitching may occur in one eye or the other, in both or underneath the eye. Some experts attribute it to fatigue, stress or caffeine. If spasms persist a doctor should be consulted.

Yawning
Known as the act of opening the mouth by taking a deep breath, yawning is a reflex often associated with fatigue, stress or boredom. Some experts say the real reason why we yawn is a result of low oxygen levels in our lungs. As such, when we're resting we don't use our entire lung capacity and just use air sacs at the bottom of our lungs. If the air sacs don't get fresh air, they partially collapse and as a result our brain prompts the body to yawn or possibly sigh to get more air into the lungs.

Leg Cramps
Although painful sensations caused by contracting or over shortening of muscles, better known as leg cramps, may occur infrequently they may also be a sign of medical disorders. For instance, in a young athlete leg cramping may be associated with dehydration, especially after intense exercise. According to Dr. Sean McCance, Orthopedic and Spine Surgeon, Mount Sinai Hospital and Lenox Hill Hospital, in the elderly population leg cramps is a common symptom of a condition called spinal stenosis. "Spinal stenosis is a narrowing of the spinal canal, which leads to compression of the nerves in the lower back. When people stand up and walk, the compression gets worse and that causes vague aching, cramping and sometimes pain and numbness in the legs." Plus, he says in general leg cramping can be a sign of poor blood supply to the legs. Typically when a patient complains of leg cramping; both a spinal exam and a vascular exam are performed.

Double Jointedness
Double-jointedness, or the ability to have flexible joints that bend in unusual ways, is also known as hypermobility. Basically, joints and surrounding structures such as ligaments and tendons are abnormally flexible which enables people to bend or rotate them in various ways. For instance, if people can bend their thumbs backwards to their wrists, this is the result of misaligned joints, abnormally shaped ends of one or more bones at a joint. Essentially, joints that stretch more than what is considered normal. The extreme flexibility signifies a wide range of movement between the bones as the result of a shallow socket, extra stretchy ligaments or bone ends that are smoother than normal.

Pins & Needles
Oooh, ahhhh, owww....when it comes to the pins and needles sensation in your legs, there could be a variety of reasons why it's occurring. Dr. Sean McCance explains, "When pins and needles is in one leg only, it is more likely related to a mechanical problem, whereas if it is in both legs, it is more likely related to a metabolic problem such as a vitamin deficiency, excessive alcohol use, or diabetes." In the setting of lower back pain he says it could be a sign of a herniated disc. This could cause symptoms including pins and needles and numbness in the leg, as well as pain and weakness. He adds, "That is best assessed by physical examination by a spinal specialist followed by an MRI."
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--Vicki Salami/ AOL Body

Signs & Symptoms & Syndromes

1. Amenorrhea- Primary: absence of menses by age 16.
Secondary: absence of menses for 6 months in a female with previously normal menstruation, or absence of menses for 3 normal intervals with a history of oligomenorrhea.
2. Anuria- <100 ml urine/day Foley catheter.
3. Asterixis- Flapping with wrists hyperextended.
4. Babinski's sign- stroke sole of foot, & toes dorsiflex if pyramidal track lesion.
5. Battle's sign- Ecchymoses of mastoid process; basilar skull fracture.
6. Brudzinki's Sign- Neck flexion causes hip & knee flexion.
7. Carnett's Sign- Disappearance of tenderness when abdominal muscles are contracted, indicates intra-abdominal pain.
8. Chadwick's sign- cervix & vaginal cyanosis.
9. Chandelier Sign- Cervical motion tenderness.
10. Charcot's Sign/Triad-upper quadrant pain, jaundice, fever; gallstones.
11. Cheilosis- cracked lips; Riboflavin deficiency.
12. Cheyne Stokes respiration- Periodic breathing with periods of apnea (Elevated Intracranial Pressure)
13. Chvostek's sign- Tapping cheek results in facial spasm; hypocalcemia.
14. Colon cutoff sign- Spasm of splenic flexure with no distal colonic gas. (Abdominal X-ray).
15. Courvoiser's Sign- Palpable non-tender gallbladder with jaundice; pancreatic or biliary malignancy.
16. Cullen's Sign- Bluish periumbilical discoloration; peritoneal hemorrhage.
17. Cushing's Triad- Bradycardia, hypertension, abnormal respirations, ascending weakness.
18. Decerebration- Extension of legs & arms; wrists & fingers flex with midbrain & pons functioning.
19. Decortication- Noxious stimuli causes flexion of arms, wrists & fingers with leg extension, indicates damage to contralateral hemisphere above midbrain.
20. Dupuytren's contracture- Fibrotic palmar ridge to ring finger/ Palmar contracture; cirrhosis.
21. Egophony- E to A changes.
22. Fetor Hepaticas- Odor of breath & urine caused by Mercaptans.
23. Fever of Unknown Origin (FUO)- >/= 38.3*C,(>/=101*F), undiagnosed after 1 week of evaluation & extensive studies.
24. Free Air Under Diaphragm- Ruptured Viscus (CXR).
25. Glossitis- B12, folate deficiency.
26. Grey Turner's Sign- Flank ecchymoses; retroperitoneal hemorrhage.
27. Hegar's sign- Softening of uterine isthmus.
28. Hepatic angle sign- Loss of lower margin of right, lateral, liver angle (X-ray).
29. Homan's Sign- Dorsiflexion of foot elicits calf tenderness.
30. Horner's syndrome- eyelid ptosis, miosis, & anhydrosis.
31. Iliopsoas Sign- Elevation of legs against examiners hand causes pain; retrocecal appendicitis.
32. Jugular venous distention- (at 45* measure perpendicular distance from the sternal angle to top of column of blood= jugular venous pressure in cm H2O.
33. Kayser-Fleischer rings- Bronze Corneal pigmentation; Wilsons disease.
34. Kernig's Sign- Flexing hip & extending knee elicits resistance.
35. Kussmaul respirations- Deep sighing breathing
36. Levine's Sign - Patient describes pain with clenched fist over the sternum.
37. L4- S1 range or in the C5 to C7 disks- Most herniation occurs.
38. Meniere's disease: inner ear disorder involving a triad of symptoms of vertigo, tinnitus, and hearing loss.
39. Mercedes Benz Sign- Gallstones appearing as radiolucent clefts (Abdominal X-ray).
40. Moliminial symptoms- Mid-cycle ovulatory pain; premenstrual, increased discharge; breast tenderness, water retention, dysmenorrhea.
41. Muerkhe Lines- Narrow, arc-shaped bands of pallor in nail beds; hypoalbuminemia.
42. Murphy's Sign- Right Upper Quadrant Tenderness & Arrest of respiration secondary to pain/ Inspiratory arrest upon RUQ palpation; cholecystitis.
43. Myxedema- condition resulting from advanced hypothyroidism or thyroxine deficiency.
44. Normal CVP: approximately 4 to 10 cm.
45. Normal Intra Ocular Pressure: 13 to 22 mmHg
46. Normal PCWP: 4 to 13 mmHg.
47. Obtundation- Awake but not alert.
48. Obturator Sign- Flexion of right thigh & external rotation of leg causes pain in pelvic appendicitis.
49. Oculocephalic reflex- Dolls eyes maneuver, observation of eye movements in response to lateral rotation of head, no eye movements or loose movements occurs in bihemispheric (diencephalons) lesion.
50. Oculovestibular reflex- Cold caloric maneuver, raise head 60 degrees & irrigate ear with cold water, causes tonic deviation of eyes to irrigated ear if intact brain stem (midbrain); If conscious, causes nystagmus, vertigo, emesis.
51. Oliguria - <20 ml/h, 400-500 ml urine/day
52. Osler's Maneuver- Inflate cuff above systolic. If the radial artery pulse remains palpable, the true blood pressure may be 53. pH of expectorated blood- alkaline= pulmonary; acidic= GI.
54. Plummers nails- Distal onycholysis, separation of fingernail from nail bed.
55. Puddle Sign- Examiner flicks over lower abdomen while auscultating for dullness with patient on all fours; detects greater than or equal to 120 ml.
56. Pulsus paradoxus- Inspiratory drop in systolic blood pressure; >18= severe attack.
57. Racoon's eyes- Periorbital ecchymoses; skull fracture.
58. Raynaud's Syndrome- Red, blue or numb hands when exposed to cold.
59. Renal Bruits- high- pitched systolic & diastolic bruit just below costal margin lateral to midline; renal artery stenosis.
60. Rhonchi- fine, high-pitched, end-inspiratory crackles.
61. Rinne test- Air conduction last longer than bone conduction when tuning fork is placed on mastoid process.
62. Rovsing's Sign- Pressure to left colon causes referred pain at McBurneys point (RLQ); appendicitis.
63. Sentinel loop- Spasm of transverse colon (Abdominal X-ray).
64. SGOT/AST: Serum glutamic-oxaloacetic transaminase; peaks in 24 to 36 hours in MI.
65. SGPT/ ALT: Serum glutamic pyruvic transaminase.
66. Sister Joseph's Nodule- Umbilical nodule; carcinoma metastasis.
67. Spider angiomas- Arterioles with stellate red capillaries.
68. Stigmata of Liver Disease- Umbilical venous collaterals (Caput Medusae), jaundice, spider angiomas, palmar erythema.
69. Stupor- Unconscious but awakeable with vigorous stimulation.
70. Tactile fremitus- Increase vocal conduction when patient says 99.
71. Terry's nails- White proximal nail beds; cirrhosis.
72. Thumb Printing- Edema & gas of intestinal wall. (Abdominal X-ray).
73. Trousseau's sign- sign for hypercalcemia in which carpal spasm can be elicited by compressing the upper arm and causing ischemia to the nerves distally.
74. TSH- T3, T3RU, T4.
75. Virchow's Triad- Immobilization, trauma, malignancy
76. Weber test- lateralization of sound when tuning fork is placed on top of head.
77. Whispered pectoriloquy- Decreased loudness of whisper during auscultation

Listening for the Sounds of Heart Failure

Recognizing Heart Murmurs on Auscultation:

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Here's the last part of the Lesson--
Lesson XXI

Health Bits

Pediatricians to FDA: No cold meds to children under 6 (CNN)---Cold and cough medicines given to infants and toddlers work no better than dummy pills and can be dangerous, pediatricians seeking to curb their use told government health advisers Thursday.

The doctors told the Food and Drug Administration advisers that the over-the-counter medicines shouldn't be given to children younger than 6 because they don't help them and aren't safe. Such a prohibition would go beyond last week's drug industry move to eliminate sales of the nonprescription drugs targeted at children under 2.

The group petitioned the FDA...


Wyeth Philippines, Inc.(ABS- CBNNews) on Thursday filed a formal notice and voluntary product withdrawal plan with the Bureau of Food and Drugs (BFAD) and Department of Health (DOH), saying it will voluntarily withdraw Dimetapp Oral Drops, the company's medicine for treatment of colds in infants. Click here for
more


Experts: Drug-resistant staph deaths may surpass AIDS toll(AP)

More than 90,000 Americans get potentially deadly infections each year from a drug-resistant staph "superbug," the government reported Tuesday in its first overall estimate of invasive disease caused by the germ.

Deaths tied to these infections may exceed those caused by AIDS, said one public health expert commenting on the new study. The report shows just how far one form of the staph germ has spread beyond its traditional hospital setting.

The overall incidence rate was about 32 invasive infections per 100,000 people. That's an "astounding" figure, said an editorial in Wednesday's Journal of the American Medical Association, which published the study.

Most drug-resistant staph cases are mild skin infections. But this study focused on invasive infections --click here




Study shows no language effects from vaccines (Reuters)--
A mercury-based vaccine preservative did not appear to affect language or other similar brain functions in children, U.S. researchers said on Wednesday in the first of a series of studies meant to lay to rest the controversy over thimerosal. More on this story


Landmark malaria vaccine clears another hurdle in tests on infants (AFP)--The most ambitious attempt to engineer a vaccine against malaria has cleared another key hurdle, with tests among African babies showing the prototype to be safe and highly protective, a study released on Wednesday said.

Known by its lab name of RTS,S the prototype is raising high hopes of the first vaccine shield against a disease that claims more than a million lives a year -- 800,000 of them African children aged under five -- and sickens hundreds of millions more.More..

Guide to Complete History Taking & Physical Examination

HISTORY IDENTIFYING DATA:
Patients name, age, race, sex; referring physician or clinic.

SOURCE AND RELIABILITY:
Name and reliability of informant (patient, old chart, relative).

HISTORY OF PRESENT ILLNESS (HPI):
Describe the course of the patients illness, including when it began, character of the symptoms; location where the symptoms began; aggravating or alleviating factors; pertinent positives and negatives, other related diseases; past illnesses or surgeries, past diagnostic testing.

PAST MEDICAL HISTORY (PMH): Past diseases, surgeries, hospitalizations; significant medical problems; history of diabetes, hypertension, peptic ulcer disease, asthma, COPD, MI, Cancer, TB. In children include birth history, prenatal history, immunizations, type of feedings.

MEDICATIONS:

ALLERGIES:
Penicillin?

FAMILY HISTORY:
Medical problems in relatives; specifically ask about problems similar to patients illness. Asthma, MI, heart failure, hypertension, CA, TB, diabetes, kidney diseases, hemophilia.

SOCIAL HISTORY:
Alcohol, smoking, drug usage. Marital status and children; employment and home situations; exposure to carcinogens or environmental agents. In children include: Sleep, play habits, grade in school.

REVIEW OF SYSTEMS (ROS):
General:
Weight gain or loss, appetite loss, fever, chills, fatigue, night sweats.

Skin:
Rashes, bruising, skin discolorations.

Head:
Headaches, dizziness, tenderness, lumps or masses; history of seizures, head trauma.

Eyes:
Visual changes, visual acuity, visual field deficits, diplopia, inflammation.

Ears:
Tinnitus, vertigo, pain, discharge.

Nose:
Nose bleeds, discharge, sinus diseases.

Mouth & Throat:
Dental diseases, hoarseness, sore throat, pain.

Respiratory:
Cough, shortness of breath, sputum (color, amount), chest pain; history of PTB; vaccination for influenza or pneumococcus. Positive Purified Protein Derivative (PPD Testing).

Cardiovascular:
Chest pain, orthopnea, paroxysmal nocturnal dysonea; dyspnea on exertion, claudication, extremity edema.

Gastrointestinal:
Odynophagia, dysphagia, abdominal pain, nausea, vomiting, hematemesis, diarrhea, melena, hematochezia, constipation, bloody stool, change in bowel habits, jaundice.

Genitourinary:
Dysuria, frequency, hesitancy, hematuria, polyuria, discharge, impotence, testicular masses, penile discharge.

Gynecological:
Gravida/para, abortions, LMP (frequency, duration), age of menarche, menopause; dysmenorrhea, contraception, vaginal bleeding; last pelvic exam and pap smear, breast masses, self-examination, mammography.

Endocrine:
Polyuria, polydipsia, polyphagia, skin or hair changes, cold or heat intolerance, hormonal therapy.

Musculoskeletal:
Joint pain or swelling, arthritis, myalgias.

Skin:
Easy bruising, bleeding tendencies.

Lymphatics:
Lymphadenopathy.

Neuropsychiatric:
Weakness, seizures, paresthesias, memory changes, emotional depression disturbances.

PHYSICAL EXAMINATION

Vital Signs:
Temperature, heart rate, respiratory rate, blood pressure (right and left arm, sitting and standing height), weight.

Skin:
Rashes, scars, moles; capillary refill (in seconds).

Lymph Nodes:
Cervical, supraclavicular, auxiliary, inguinal nodes; size, mobility, tenderness, consistency.

Head:
Bruising, tenderness. In pediatric patients check fontanelles.

Eyes:
Pupils equal round and react to light and accommodation (PERRLA); extra ocular movement intact (EOMI); visual fields and acuity. Fundoscopy (fundi, papilledema, arteriovenous nicking, hemorrhages, or exudates), conjunctiva; scleral icterus, ptosis.

Ear:
Discharge, acuity, tympanic membranes (dull, shiny, intact, injected, bulging).

Nose:
Discharge, exudates, polyps. Pediatrics: Nasal flaring.

Mouth & Throat:
Mucus membrane color and moisture level; oral lesions, dentitions, tonsils, erythema.

Neck:
Jugular venous distention (JVD), thyromegaly, lymphadenopathy; range of motions, masses, bruits, hepatojugular reflex (HJR).

Chest:
Equal expansion, tactile fremitus, percussion, auscultation, rhonchi, crackles, rubs, breath sounds, egophony, whispered pectoriloquy.

Heart:
Point of maximal impulse (PMI), thrills (palpable tubulance); regular rate & rhythm (RRR), first & second heart sounds (S1 & S2); gallops, murmurs (grade 1-6), pulses (grade 0-2+).

Breast:
Retractions, tenderness, lumps, nipple discharge, dimpling, gynecomastia.

Abdomen:
Contour (flat, scaphoid, obese, distended); scars, bowel sound, tenderness, organomegaly, masses, liver span; splenomegaly, guarding, rebound, bruits; percussion note (tympanic), costovertebral angle tenderness (CVAT), inguinal masses.

Genitourinary:
External lesions, hernias, scrotum, testicles, varicoceles.

Pelvic Exam:
Vaginal mucosa, cervical discharge; uterus size & masses, adnexa, ovaries, suprapubic tenderness.

Extremities:
Joint swelling, range of motions, edema (grade 1-4+); cyanosis, clubbing, edema (CCE);pulses (radial, ulnar, femoral, popliteal, posterior tibial, dorsalis pedis; simultaneous palpation of radial and femoral pulses), Homans sign,; cyanosis, varicosities.

Rectal Exam:
Sphincter tone, masses, hemorrhoids, fissures; guaiac test for occult blood; presence or absence of stool in rectal vault, prostate (nodules, tenderness, size).

Neurological:

Mental status & affect; cranial nerves 1-12; gait, strength (graded 0-5); touch sensation, pressure, pain, position & vertigo; deep tendon reflexes (graded 0-4+) (biceps, triceps, patellar, ankle); Romberg’s test (ability of patient to stand erect with arms outstretched and eyes closed).

Cranial Nerve Exam:

I: Smell
II: Visions & Visual fields;
III, IV, VI: Pupil responses to light; positional & pursuit eye movements, ptosis.
V: Facial sensation, ability to open jaw against resistance, corneal reflex.
VII: Close eyes tightly, smile, shows teeth.
VIII: Watch tick, Weber test; Rinne’s Test.
IX, X: Palette moves in midline when patient says ah, speech.
XI: Shoulder shrug & turns head against resistance.
XII: Stick out tongue in midline. Heel to skin test.

Labs:
Electrolytes (sodium, potassium, bicarbonate, chloride, BUN, creatinine), CBC (hemoglobin, hematocrit, WBC count, platelets, differential); X-rays, ECG, Urine Analysis (UA), liver function tests (LFTs).

MINI-MENTAL STATUS EXAM

Orientation:
What is the year, day of the week, date, month? = 5 points What is barrio, town, city, country, hospital, floor? = 5 points

Registration: Repeat: 3 objects: apple, book, coat = 3 points

Attention/Calculation: Spell WORLD backwards = 5 points

Memory: Recall 3 objects = 3 points

Language: Name a pencil & a watch = 2 points Repeat, No ifs, ands or buts = 1 point

Three stage command:
Take this paper in your right hand, fold it in half, and put it on the floor= 3 points

Written Command:
Close your eyes. = 1 point Write a sentence = 1 point

Visual Spatial:
Copy two overlapping pentagons = 1 point

TOTAL SCORE 30 POINTS

Normal: 25-30
Mild Intellectual Impairment: 20-25
Moderate Intellectual Impairment: 10-20
Severe Intellectual Impairment: 0-10

MD's Notes

Welcome to Medicine Pearls!

Below is what this blog is all about. Feel free to voice your opinions, suggestions, questions, violent reactions, etc.

Subjective:

-- Medical Education and Career Dilemmas

Objective:

--Welfare of the people in the health profession;
--career guides
-- study guides
-- white and green humor
-- true stories
--useful website links

Assessment:

-- Peer and Professional Help in day-to- day activities and practice

Prognosis:

-- Better Medical Professionals