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Med G

a Medical doctor who graduated in 2018 and I graduated my studies in Japan. I like sharing medical education.I hope you like my page. Contact: pagemedg@gmail.com

All contents are copyrighted. I am a clinical and public health doctor. Disclaimer:
The information provided is for educational and informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Do not self-medicate or use any prescription drugs without proper evaluation and prescription by a licensed healthcare professional. Always consult your physician or qualified healthcare provider before starting, stopping, or changing any medication or treatment plan.

05/12/2025

A 12-year-old boy presents with a 2-day history of a painful swelling on the lower eyelid. His mother reports that the lesion started as mild redness but has now become a tender, warm, localized bump. He denies fever, vision changes, or pain with eye movements.

On examination, there is a small, erythematous, tender nodule on the eyelid margin, with a tiny yellow point suggesting a superficial abscess. Extraocular movements are normal, and there is no eyelid edema extending beyond the local area.

❓ Question: What is the most likely diagnosis?

A. Chalazion
B. External hordeolum (stye)
C. Dacryocystitis
D. Orbital cellulitis

05/12/2025

🔍 How to listen
• Move the stethoscope from top (apices) to bottom (bases) of the lungs.
• Always compare left with right at the same level.

🌬️ Asthma
Lung sounds:
• Diffuse wheezing (especially on expiration)
• Sometimes fine crackles
Other clues:
• History of asthma or allergies
• Uses inhalers/bronchodilators
• “Silent chest” = very severe obstruction → emergency

🌬️ Acute Bronchitis
Lung sounds:
• Wheezing
• Crackles that change or clear with coughing
Other clues:
• Recent viral respiratory infection
• Often smoker or recent cold
• Persistent cough, usually days–weeks

💧 Congestive Heart Failure (CHF)
Lung sounds:
• Crackles at the bases (fluid)
• Sometimes wheezing (“cardiac asthma”)
Other clues:
• Pedal edema, raised JVP
• Orthopnea, paroxysmal nocturnal dyspnea
• Often on diuretics

🌫️ COPD / Emphysema
Lung sounds:
• Decreased breath sounds
• Wheezing
• Rhonchi if lots of secretions
Other clues:
• Long smoking history, barrel chest
• Prolonged expiration
• May be on oxygen and multiple inhalers

🚫 Foreign Body Obstruction
Lung sounds:
• Stridor (loud, harsh sound in upper airway)
• Localized wheeze over the blocked area
Other clues:
• Sudden onset choking episode
• Worse when agitated
• Common in children

🦠 Pneumonia
Lung sounds:
• Localized crackles
• Bronchial breath sounds over consolidation
• Possible wheeze, especially in children
Other clues:
• Fever, pleuritic chest pain
• Brown/green/yellow sputum
• Signs of consolidation: increased vocal fremitus, dull percussion

💨 Pneumothorax
• Lung sounds:
• Absent or markedly decreased on the affected side
• Other clues:
• Sudden pleuritic chest pain and dyspnea
• Hyperresonant percussion
• Tracheal deviation (late sign in tension pneumothorax)

💦 Pleural Effusion (important modern addition)
Lung sounds:
• Decreased or absent over the effusion
Other clues:
• Dullness to percussion
• Decreased vocal fremitus
• Can be due to CHF, infection, malignancy

🩸 Pulmonary Embolism (PE) (often missed)
Lung sounds:
• Often normal or near normal
Other clues:
• Sudden dyspnea, pleuritic chest pain
• Tachycardia, hypoxia
• Risk factors: immobility, surgery, pregnancy, OCPs, cancer

05/12/2025

⭐ Acute Pericarditis (ECG Interpretation)

• Diffuse ST elevation → think pericarditis.
• PR depression → strong sign of pericarditis.
• PR elevation in aVR → supports pericarditis but is not exclusive.
• ST depression only in aVR/V1 → okay in pericarditis.
• ST depression in other leads → think MI.

Diffuse ST-segment elevation is seen on the ECG. This makes us think of several possible conditions:
• Acute pericarditis
• Large myocardial infarction (MI)
• Ventricular aneurysm
• Early repolarization (ER)
• Coronary vasospasm

⭐ Key clue for pericarditis:

PR-segment depression, especially in the inferior leads (II, III, aVF), is very suggestive of acute pericarditis.

⭐ Additional supportive clue:

PR-segment elevation in lead aVR also supports pericarditis.
But be careful: this finding alone does NOT rule out MI, because PR elevation in aVR can also appear in acute MI.

⭐ Important point:
• In acute pericarditis, ST depression may appear in aVR and V1 — this is normal for pericarditis.
• BUT ST-segment depression in any other leads (not aVR or V1) is highly suggestive of acute MI, because those represent true reciprocal changes.

05/12/2025

A 17-year-old boy is brought to the emergency department with a 3-day history of fever, sore throat, and burning eyes, followed by the sudden appearance of painful red macules on his face and trunk. These lesions have begun to coalesce and form irregular dusky patches. His lips are crusted with hemorrhagic erosions, and he has purulent conjunctivitis causing difficulty opening his eyes.

He started lamotrigine for epilepsy 2 weeks ago. On examination, Nikolsky sign is mildly positive. No full-thickness skin detachment is seen yet.

❓ Question: What is the most likely diagnosis?

A. Erythema multiforme major
B. Stevens–Johnson syndrome (SJS)
C. Toxic epidermal necrolysis (TEN)
D. Acute herpetic gingivostomatitis

05/12/2025

Pulmonary Function Tests
Obstruction = “Air can’t get OUT”
• Asthma (reversible)
• COPD (not reversible)
• Emphysema → ↓ DLCO
• Chronic bronchitis → Normal DLCO

Restriction = “Lungs can’t EXPAND”
• ILD → ↓ DLCO
• Chest wall/obesity → Normal DLCO
• Neuromuscular → Normal/↑ DLCO

04/12/2025

Diabetic eye disease

The exact pathogenesis is incompletely understood, but is thought to occur as sequelae to microvascular retinal disease. This in turn causes retinal ischaemia and new vessel formation (probably driven by vascular endothelial growth factor (VEGF) production).

Diabetic eye disease is the most common cause of blindness in developed nations.

04/12/2025

A 38-year-old male farmer from a rural village presents with a slowly progressive swelling of his right foot for the past 2 years. He reports multiple nodules, some of which drain pus through sinus tracts, occasionally containing “grains.” The condition began after he frequently walked barefoot in the fields.

On examination, the foot shows large, firm swelling, multiple subcutaneous nodules, and sinuses discharging purulent material. There is no fever. He reports progressive difficulty walking due to deformity.

❓ Question: What is the most likely diagnosis?

A. Cutaneous tuberculosis
B. Leprosy (lepromatous)
C. Mycetoma (Madura foot)
D. Sporotrichosis

03/12/2025

A 19-year-old university student presents with a painful and intensely pruritic linear rash on his right leg. The eruption began immediately after swimming at a beach earlier in the day. He recalls feeling a sudden burning sensation while in the water.

On examination, you see multiple erythematous, whip-like, linear and curvilinear streaks with clustered papules along the lines of contact. There is no fever, no systemic symptoms, and no vesicles or necrosis.

He has no known allergies and has never experienced similar lesions before.

❓ Question: What is the most likely diagnosis?

A. Allergic contact dermatitis
B. Jellyfish envenomation
C. Phytophotodermatitis
D. Cutaneous larva migrans

03/12/2025

Gallstones (Cholelithiasis)
Gallstones form when bile becomes imbalanced:
✔ Too much cholesterol
—> cholesterol stones
✔ Too much unconjugated bilirubin
—> pigment stones
✔ Poor gallbladder emptying
—> stones sit and grow
⚠️ Complications (High-Yield)
• Acute cholecystitis (gallbladder inflammation)
• Choledocholithiasis → jaundice
• Cholangitis → fever + jaundice + abdominal pain (Charcot triad)
• Pancreatitis

03/12/2025

Endocrine System
• Hormones = chemical messengers.
• Endocrine glands secrete into blood; exocrine glands use ducts.
• Peptide = fast, membrane receptors.
• Steroid = slow, intracellular receptors.
• Thyroxine = peptide hormone acting like steroid.
• Many non-endocrine organs now recognized as hormone-producing (heart, kidney, fat).
• Hormones regulated mainly by negative feedback loops.

03/12/2025

A 28-year-old office worker presents with a 2-week history of intensely itchy eruptions on both palms. He describes sudden flare-ups where small, deep-seated fluid-filled vesicles appear, followed by redness and peeling. The vesicles are extremely itchy, especially at night.

He reports increased stress recently and frequent handwashing. No fever, no mucosal lesions, and no history of psoriasis. On examination, his palms show multiple erythematous patches with circular clusters of tiny vesicles, giving a “tapioca pudding” appearance.

❓ Question: What is the most likely diagnosis?

A. Dyshidrotic eczema (Pompholyx)
B. Tinea manuum
C. Secondary syphilis
D. Allergic contact dermatitis

02/12/2025

A 7-year-old boy is brought to the emergency department with severe muscle spasms and stiffness. His parents report that 10 days ago he stepped on a rusty nail while playing outside; the wound was cleaned at home but no medical care was sought. He has not received routine childhood vaccinations.

Today, he developed trismus (lockjaw), difficulty swallowing, and painful spasms triggered by loud sounds. On examination, he is lying in bed with a rigid, arched posture, with his back hyperextended and heels and head touching the bed while the torso is elevated.

Vital signs show tachycardia and low-grade fever.

❓ Question: What is the most likely diagnosis?

A. Hypocalcemic tetany
B. Tetanus (Clostridium tetani infection)
C. Dystonic reaction
D. Seizure disorder

住所

Hiroshima, Hiroshima