Factors that predispose to development of pneumonia are:

Smoking
Alcohol
Upper respiratory tract infections
Recent influenza infection
Corticosteroid therapy
Old age
Pre existing lung disease

Cerebral angiography can be done through various routes

Transfemoral – most common
trans axillary – rarely used
trans carotid – rarely used

Why direct puncture of carotid artery is not used?

Any local complications like hematoma and pseudoaneurysm may be life threatening
Atherosclerotic plaques in the cartoid may dislodge during wall puncture and cause stroke\

Why is the axillary artery not used?

Difficult to approach
Difficult to manouvre the catheter into the carotid artery

Why is transfemoral route preferred?

Easy and fast access
Even if local complication arise, they are not life threatening

Ophthalmoplegic migraine was previously considered as a subtype of migraine.
Now it is classified as a cranial neuralgia.
It is characterised by recurrent attacks of migranous type headache associated with paresis of one or more ocular cranial nerves.
Oculomotor palsy is the most common.
But abducent and trochlear nerves can also be involved.
There is no visual loss.
It usually occurs in children less than 10 years old.
An inflammatory etiology is proposed.
The prognosis is generally good.
The headache is usually relieved within 1 week.
But the ophthalmologic abnormalities may take days or weeks to resolve.

Ref : Pediatric neurology: a …

Mnemonic for Day of appearance of rash in a febrile patient is : Very Sick Person Must Take Double Tablets
Very – Varicella (day 1)
Sick – Scarlet fever (day 2)
Person – Pox – small pox (day 3)
Must – Measles (day 4)
Take – Typhus (day 5)
Double – Dengue (day 6)
Tablets – Typhoid (day 7)

Clinical features of Factor XIII deficiency

History of prolonged bleeding from umbilical stump
Delayed bleeding
Recurrent abortions

Diagnosis (Investigations)

Prothrombin time and Activated partial thromboplastin time are normal

Factor XIII is needed for stabilization of fibrin clot
Intrinsic and extrinsic pathways are not affected

Clot stability in 5M urea – qualitative test

Normal clot remains stable in 5M urea
But in cases of Factor XIII deficiency, the clot dissolves
But it becomes positive only in very severe deficiency

Quantitative factor XIII assay – using photometry

It starts in early adolescence
Bilateral myoclonic jerks are seen
Mostly in the morning
Precipitated by sleep deprivation
The patient usually remains conscious during the episode
Associated with absence seizures and generalised tonic clonic seizures
Benign condition
Complete remission is uncommon
Positive family history may be present
Responds well to anticonvulsants
Drug of choice – Valproate

Barium carbonate is a whitish powder
It is used as a rodenticide
Symptoms develop within half an hour of poison ingestion
Fatal dose is 0.8g

Symptoms of barium carbonate poisoning:

Gastrointestinal

Diarrhoea
Vomiting
Abdominal pain

Cardiac

Arrhythmia
Hypertension
Heart failure

Areflexia, tetraplegia, flaccid paralysis

First you can review the Mechanism of normal split in second heart sound
In case of small ventricular septal defect, the blood flow through it is not large enough to cause a significant increase in right ventricular ejection time
Hence there is a normal split
But in case of large VSD, both the right ventricle and left ventricle act as a single chamber
The blood flow from both the ventricle occur for the same duration
Also because of the presence of pulmonary hypertension, hangout interval becomes negligible
Hence there is a single second heart sound with absent …

First you can review the Mechanism of normal split in second heart sound
In severe right heart failure, the right ventricle takes a longer time to eject the blood – hence the wide split
Also since it cannot accomodate the increased blood flow during inspiration, there is no increase in the split during inspiration

If you couldn’t grasp the rationale behind it, here’s an example:

Imagine the right ventricle to be a plane with 100 seats (seats referring to the capacity)
Lets first take the case of a normal right ventricle
Imagine that during the weekdays (expiration) …

First you can review the Mechanism of normal split in second heart sound
In case of atrial septal defect, the right atrium receives blood from the left atrium in addition to the normal venous return
Due to the increased amount of blood reaching the right ventricle, it takes a longer time to eject the blood
Hence the pulmonary valve takes longer to close and we appreciate a wide split (In both inspiration and expiration)

So, why does it cause a wide fixed split instead of a wide variable split?

During inspiration, the blood flow through …