Acute and Chronic Diseases: Specific Symptomatology

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Acute and Chronic Diseases: Specific Symptomatology

25 Apr, 3:30 PM

[Music] welcomes you all it's very happy to uh see you all in the same platform right now and uh here comes our greatest speaker dr tushar shah he's a consultant physician in advanced multi-speciality hospital mumbai as we know like there is no much requirement of any interaction because it's a great personality already there are quite important and good lectures he has given the metrics itself because in the symptomology so it's very nice to see you like you are here thank you thank you so much uh so uh we have an unusual uh mode of presentation today what we're going to talk about is uh specific symptomatology in both acute and chronic diseases uh basically i want you to know that even a few words from a patient even one or two sentences from a patient can sometimes give you a diagnosis uh and uh as william oscar had said listen to the patient he said to the patient he's telling you the diagnosis so uh this is uh a to z of specific is which disease has exertional exertional chest pain and exertional sympathy as its principal manifestation of a cardiovascular system yeah there is only one heart disease which causes exertional syndrome because when the patient walks the output falls even further and patient has a synthetic so exercise explained is knowing many diseases is exertional syncope is uncommon and it is an outlet obstruction it can happen in hocm hypertrophy obstructive cardiomyopathy myopathy and in aortic stenosis so aortic synthesis one important message here is if you diagnose your dysgnosis based on any one or more of these symptoms by doing an echocardiogram remember symptomatic aortic stenosis has a very limited life two and a half years maximum for a patient to survive as soon as symptoms start in your distance system you have to have the patient undergo investigations and invasive procedure it could be a aortic vial replacement surgical what we call sour surgical aortic valve replacement or tower tower which is translucent aortic valve replacement so that is a correct answer i don't know who gave the correct answer is the correct answer was it lakshman no points there then i'll go to the second question uh this was a for neonic stories remember the next question the answer starts with the letter b and it will be in sequence from a to z all the answers will be in a sequence so your question question number two which disease has obstructive symptoms and irritating symptoms of the hosts to is score yes so the obstructive symptoms and irritative symptoms happen in bph benign prostatic hypertrophy very important that luts lups stands for lower urinary tract symptoms luts are defined uh well in history taking because no uroflometry no euro dynamic study no ultrasound is going to give you as much information as simple history is going to give you in lower united signals thus if the patient has irritative symptoms like frequency which is an irritative symptom like urgency this frequency of urgency can occur in an overactive bladder need not be an obstruction over active batteries where the detrusor muscle is over active that's a different disease but if the patient has irritative symptoms with obstructive symptoms meaning the patient has hesitancy in starting urination has a poor stream cannot extreme as of thin stream and cannot reach far these obstructive symptoms the patient has acute urinary tension sometimes when obstructive symptoms and irritation occur together you know that there is an outlet obstruction bladder outlet obstruction the commonest form of bladder outward obstruction is bph we're going to the next and this is uh bleeding after vaginal intercostal bleeding after coitus vaginal bleeding after coitus classic symptoms now this is one thing that you cannot miss leaving after coitus uh if a patient tells you or your own inquiry if the patient gives your answer to your question you have to suspect cervix carcinoma because this is one carcinoma that can be cured you know in in gynecology there are three important cancers cancer of the uterus cancer of the cervix cancer of the ovary cancer the uterus if you diagnose a little late does not matter it still will still be curable cancer the ori is very difficult diagnosis early and you will be very very lucky to diagnose it in a curative stage but cancer of the cervix you must diagnose early and this is one important the other symptom of cancer the cervix is a foul smelling vaginal discharge okay we go ahead with the next and this is b acute fever myalgias and eyeshadow yeah thank you ordering is a very um obvious answer here my suggestion to you is you have to become experts in dengue i say dengue because in english they call it dengue in hindi and gujarati my mother dingo so yeah you can call it whatever you like but you have to learn dengue like you know the back of your hand is extremely important and because this monsoon you will probably see more dengue than you have seen last year or the year before last you have to become extremely good at dengue we have discussed in acute viewers but i would prefer that we have one dedicated lecture on dengue because this is one disease where you can save lives and one disease where you can kill a person the commonest cause of dengue as i've always said the commonest cause of death in dengue is the treating physician dengue cannot die only we can kill a patient so take care of dengue uh we go to the next remember all these are i'm claiming are specifics of dermatology so the differential diagnosis if at all is very very little tenesmus or diarrhea during or just before menstruation very peculiar symptom of this you have to catch patient female patient during menses every menses every period she has either urge to defecate without successful education which is called christmas or she has diarrhea during or just before menstruation what is the diagnosis endometriosis dr narayanam uh has and alakazam also have written endometriosis endometriosis is a very peculiar disease it's a mimic it can mimic other diseases as you know endometriosis is basically deposition of endometrial tissue outside the uterus meaning it should be inside the uterus but the gluteal tissue is elsewhere this issue elsewhere we bleed during menstruation so if there is bleeding of a piece of endometrial tissue above lying above the rectum then it can cause irritation and diarrhea it can cause an urge to difficult like an sms without uh without passage of stool if there is a tissue of endometrial sitting over the urinary bladder you can have urinary frequency irritative symptoms during menstruation a very peculiar disease is [Music] endometriosis we go to the next one hand or voice tremor that improves after alcohol intake [Music] no [Music] generally essential tremors essential tremors will improve excellent excellent uh essential tremor or f for familial tremor so there is essential grammar familial tremor idiopathic name or all other names given to this tremor i just explained this a little bit to you if you don't know the condition idiopathic meaning it is no ideology occasionally it is inherited as an autosomal dominant trait with variable penetrance so you your father may have males commoner than females so father may have and then the sun will have a tremor so this tremor is an action level action tremor where you out stretch your hand like this and you get a tremor like this this is an action tremor there are three areas where tremors can occur limbs feet and hands so twice some people get voice chamber and then there is head trimmer someone like this or something like this more commonly like this intuition or head tremor voice tremor limb travel can all occur in familial orientation why is it called idiopathic or essential tremor because sometimes there is no genetic history and you get tremor the onset of this trauma is usually a young age maybe a person in twenties or thirties onset later age is unusual commonly mistaken as the beginning of parkinsonism do remember parkinsonian dreamer is a resting trouble patient is resting his hands on the table and they have this rolling tremor etc that tremor is completely different from the action trimmer or postural tremor of um familial or essential tremor so that is alcohol drinking alcohol incidentally if the patient notices that my after drinking alcohol i can sign the papers better suppose he has a very important document to sign and his hand is trembling you can have a drink of alcohol and sign your papers before an exam for example not recommended as a therapist the correct treatment is the the treatment of choice is be the blockers there are four groups of drugs given beta blockers there is an anti epileptic [Music] what is the name given to this first mtp joint is there a name this is again a very easy diagnosis of course there is differential here you can get acute swelling due to cellulite is a nail fold infection for example you can get it due to a trauma fracture of the distal phalanx or possible pharynx of the grade 2 but here if the patient has no history of trauma and the patient does not describe any yellow discoloration of the skin vision is just pain and swelling and redness a sense of inflammation ask the pain one thing important is is the onset at night if it is at night more likely to be out ask the patient the answer is after a binge or alcohol or a very heavy purine containing meal like alcohol and this happens late in the night then you have a diagnosis even the telephone very easy to diagnose doubt so what is the first thing we tell the patient to do if the patient has gout what is the first home remedy that they can take [Music] with water ice ice the joint if the patient can touch the joint with eyes it is difficult because the exquisitely tender area but if the patient can touch the joint ice pack is the first treatment of course anti-inflammatory there are three painkillers used in acute blood nsaids colchicine and steroids there are three what is the most effective what is the most effective in one the most important the most effective therapy is intra articular steroid injection that is the most effective scene then of course that is photo steroids oral and cells like naproxen or inner mechanism and consciousness great dr divya got it right uh g for doubt we had now we come to h anxiety hyperventilation anaesthesia and tonic spasm of hands what hyperventilation what happens to the patient hypocrisy i'm sure you know this but i will explain this a little bit biochemically too what happens is the patient is tense say before going to the exam or inside the exam hall they see the question paper and they panic and when they panic they hyperventilate when they hyperventilate what happens respiratory alkalosis right you are losing carbon dioxide you get respiratory alkalosis respiratory alkalosis means that you will get decreasing ionic calcium whenever there is alkalinization of blood ionic calcium is reduced ionic calcium is the active form of calcium so you have now hypocalcemia hypocalcemia of the ionic variety and that causes tetanese these patients will present with severe panic they will present with uh parasthesia sometimes around the mouth sometimes in the hands and a frank or poop needle spasm and how do you treat this okay how do you treat this by rebreathing around the nose around the mouth and keep breathing into the back what will happen carbon dioxide will be rebreathed in and so the hypo carbic acapnea hypocapnia will be corrected uh pco2 will normalize and hence the ionic calcium will normalize in the behavior many people used to give intervenors calcium uh don't give insurgents calcium this this is good enough to feed the patient of course these people are very anxious so you may give some antennas that if you like known as a pam uh i don't like alphazolam but some people give alphas and the patient would see better with these things so that is h for hypocalcemic technique wonderful iron deficiency craving for ice is called pago some people call it the icon pika that is incorrect what are the difference between pika and pago fuji anybody what is spiker you know spiker p-i-c-a is a food item or not a food is ice a food item it is right it is a food anchor you have it ice eating cannot be called micro non food item like clay right so he is non-food and that uh is spica so iron deficiency causes pagophile not what is the commonest cause of pica psychiatric disorders is the commonest cause for fighter right so vego fatigue is a pathognomonic symptom of you know what the meaning of pathognomonic other morning symptoms means that this symptom does not occur in any other disease except iron deficiency is pathognomonic symptom of iron deficiency what is the pathogramic sign of iron deficiency a sign that doesn't occur in any other disease clinical sign on general examination wonderful a spoon shaped shepherd speaker pylonica does not occur in any disease except iron deficiency so yeah so this is your eye for iron deficiency we go on to what is the pattern mnemonic mandibular symptom of temporal artery medication sorry you said j4 jock claudication is the correct answer a photographer temporal arteries is also known as jain cell arteritis giant cell art right yes [Music] is basically pain occurring while chewing food pain in the jaw well if the temporal lateral is unilateral the jaw on that side the absolute jaw will be pain not the whole lower jaw and this is where we shall jaw it is a lower jaw that means in tempo like arthritis what is the uh okay we'll come to the other association of temporal arthritis later how do you diagnose temporal arteries anybody how do you confirm temple like radiation uh region may pick up inflammation in the temporal lobes once you diagnose temple later it is what is the first thing you do [Music] treatment wise steroids yeah you have to immediately start steroids for what reason to prevent the blindness of actually wonderful to prevent blindness blindness is a devastating complication of temporal arteritis and steroids will prevent blindness wonderful go to the next and epigastric pain vomiting and uncontrolled diabetes in a young patient what are you looking at ketosis diabetic ketosis um this might be type one uncontrolled any diabetic patient coming with vomiting and significant epic acid or abdominal discomfort you have to first think of ketoacidosis this patient will have to go into the hospital be admitted probably in the icu for management of ketoacidosis which uh so in diabetes there are two or three things which you must realize are very very important your diabetes comes with fever and rigors what do you what is your first thought sir sorry kitten us we were with rigers [Music] you can get cardiovascular manifestations cutaneous manifestations gi manifestations within gi manifestations you have upper ga manifestation which is in the form of what what is the upper ga manifestation of diabetic order maybe gastroparesis is sometimes nocturnal diarrhea right okay we go on to 12 pocket of the band paracetamol patient says where my pocket is in the trousers that is the area where i get tingling of burning pocket of the pant region anaesthesia classic pathognomonic symptom of bridge disease is [Music] ligament and if it is entrapped below the inguinal ligament for any reason the region can be pregnancy the reason can be recent weight again the reason can be a tight belt bone all the time if the latter remains now so it gets interrupt patient is parasthesia they will tell you that it is as if a phone is on silent and is buzzing in my hand pocket so that that is a beautiful symptom of malaria basically is a very very benign condition it's not as troublesome as carpal tunnel syndrome is and you can leave it alone just advise the patient to not wear a very tight waistband and you can ask the patient to lose weight uh so it's not a very very uh troublesome disease but very easy to diagnose very satisfying to diagnose vertigo many as united or bilateral what is what do you think is the first symptom of all these four first one or two symbols which come before their fearfulness for your fullness earfulness vertigo often perceive tinnitus and deafness uh what what kind of diet do you advise these questions so often the patient says that my vertigo is not all the time but it will come you often after a significant salted meal that is sometimes an association that you can find vertigo occurring after the salted meat can uh mean many years but all fullness is a very important symptom you know what is the meaning of phrase not that without which if you do not have oral fullness you should not diagnose meniere's disease without oral fullness so oral fullness is sometimes called the [Music] no you weren't right is uh the me the meaning of the phrase is that this has to be present to be able to diagnose uh the disease so that is menial disease and we should know how to diagnose vertigo perfectly i just very briefly i don't know how much time i'm taking and whether i'm on target for the 26 questions i am uh three causes of vertigo in the opening three common causes are bppv and one rare cause is for serious circulation questions precious is vestibular neuronics or and these causes can be separated simply on symptomatology and that is why fascinating area for those who can take a good history okay let us go to the next crowd of dementia urinary incontinence uh dementia is mild first of all not very rapidly progressive urinary incontinence is very common it taxes very common now how do you go about diagnosing nph first of all of course you do a scan imaging on scan you can make out what you can make out that there is a hydrogen on a ct scan and the cerebral atrophy is not enough supposed to explain the hydrocephalus so this is not it's a disproportionate hydrocephalus uh in circulatory the hydrocarbons that you get is called what what is the name and are there any imaging techniques that tell you that this is uh this is uh nph such as events indexer is a better choice index more than 0.70 the index i think it is the velocity of the of the csf flow and that i'm not sure of the the values but yeah you can make out and the other test that is commonly done is a therapeutic or a diagnostic csf tab where they remove fluid from the csf and from the spinal cap and if the patient's ataxia improves then it is strongly suggestive that we may be able to treat the nph with what shunting uh [Music] because of dementia for example okay so that is about in place we go on to the next one urge urinary incontinence i have given up so the patient i tell you what the patient comes to you with the patient comes to you with the need and the urgent need to go to the washroom for urination every hour two hours in the daytime and in the night time remember bpx causes more nighttime frequency and the stream is good forceful the patient does not feel that there is residual urine staying behind does not have a need to evacuate within 10 minutes of your activity that can happen in bph it is a complete full forceful evacuation and the volume of evacuation is not large it's a small volume evacuation wonderful bladder is the name yeah the disease anybody knows what is the cause of the disease it is of course a parasympathetic hyperactivity uh and the truezer muscle hyper contractility and the stimulus of the dentures and muscle contractility is the filling of the bladder a small feeling 200 ml 150 ml feeling of the bladder will cause an urge no etiology patients are usually middle aged and older [Music] female more common than male you can occur in males also um how do you diagnose it genetically are you sorry clearly you suspected it how do you diagnose it europe from middle flow dynamic statistics your symmetry it is much much more simpler than that uh [Music] you don't need aerodynamic studies you don't need urophilamentary you just have a diagnosis what is the treatment what are the treatment you said parasympathetic hyperactivity so you have anti muscular agents yeah your anticholinergic agents what are they called pterodeen oxybutynin solifenosin that is an acid real drugs that are commonly used in oracle these are symptomatic drugs there is no cure the drug therapy is lifelong that is your own activity the next one shoulder pain hip girdle pain back pain in the older person with gel tell you what the gel phenomenon is l phenomena is where the patient after being inactive for a long time when the patient has to become active they find it difficult to move from their position it's like they are very exciting got that right polymer romantica is uncommon is an uncommon disease it's a disease of the older person rarely seen below the age of 55 uh women more common than men and with which other is it often associated we have already spoken temporal vessel vascularities romantic unfortunately has no diagnostic test what is the diagnostic test here imagine what is the elevated uh inflammatory markers and it's a more of a diagnosis of exclusion with other associations scoring uh i'm not sure of any diagnostic scoring method but esr and crp arranged as you correctly said the way to diagnose pmr is to give steroids you give half mg per kg of pregnancy loan you get a dramatic response to steroids in body materials and that corroborates your clinical diagnosis with clinical diagnosis with high markers next cue asymmetric throat pain or dinophysia halitosis fever and voice change you have a hot potato in your mouth your voice is horse and will be very gorgeous and it is amazing [Music] yeah it is a very unusual voice or hot potato wise the patient may complain of halitosis the relatives may come in halitosis and may they'll be free or of course some very high grade fever pain during degradation and voice change that is your cue for quincy we're going to the r one is he feeling in the lower limbs relieved immediately on standing or walking restlessness leg syndrome now one of the most common fallacies uh uh of uh above grassland syndrome is that it is a painful syndrome it is not painful there is no lower limb pain people who diagnose this less lexington based on history of pain at night in the lower limb scrams at night in the low limbs cramps and pain are not a feature of restless legs at all restlessness is a feature of less like restless leg syndrome so that is very important to understand patient feels restless a very uneasy feeling that they have difficulty even describing and this restlessness will make them stand up and walk about which will immediately review restlessness but as soon as they lie down again to sleep they will not be able to sleep because of that uh can restlessness this leg syndrome occur in upper limbs it's called legs and drums can occur in opponents since i'm asking the question it is disorder [Music] [Music] come on catch question what is now i ask you another way what are the causes of restless legacy sexy is a secondary cause the most important cause of course is idiopathic secondary causes what is the most important cause iron deficiency never forget iron deficiency as a cause of risklessness iron deficiency is the curable cause of restless leg syndrome yeah you must you must remember this any patient who comes with symptoms of restless leg syndrome your first job is to test for iron deficiency correct behind deficiency patient will not need your dopaminergic drugs right how how do you diagnose iron deficiency what blood test do you ask for we will ask for an iron iron and tibc and ferritin levels so you will ask for serum and more sensitive ferritin ideally uh transparent saturation will be a better one can also be falsely elevated in inflammatory conditions less than 15 percent saturation is considered a feature of of significant iron deficiency ferritin as you said is very very specific very specific more specific than anything else but because it eliminates in acute inflammatory disorders it is not very sensitive it will not be always low in a patient with uh iron deficiency right and the drugs used in idiopathic rls uh are of course your drugs called dopamine energy drugs you don't use in dopa or that is you don't use uh carburetor combination why don't you use because single part can cause augmentation there's a condition called augmentation augmentation means worsening of rls after a few weeks or months of therapy you use parametric soul and propylene oil but they also cause augmentation worsening after a few months so now us fda has said that the first choice should be regardless rather than the dopamine energy drugs i have never used those recovering government yet uh but this is the current recommendation okay i think we are deviating from simple symptoms a but all in good faith we go to s night time snoring and snorting day times normal lungs can you mimic snoring for me mimic snoring some people will do step by step as you saw is that is nodding why snorting occurs when the patient's attract is completely obstructed and that that will cause a patient to you know kind of force their breath in and snorting will wake the patient up snoring will make the partner up snorting will wake the patient up and um um so snorting and of course data and formula datum sounds you have to specify what kind of sunlight and snoring your specify what degree of snowing snoring which is heard outside the wall of the room or the patient is considered as the significant snoring and somnolence is when the patient is actually not sitting idle but when the patient is talking to somebody or driving a car and falls asleep that is a significant surveillance that can mean sleep apnea right it's difficult uh answer tell me dragon energy a more common maxillary mandibular or authentic division i'm actually very mindful of mandelbrot i thought it was nicely can you check okay somebody check mandible is more common i think my sleeve is more carbon but anyway we will check that the least common of course is the authentic division or getting uh uh what is the frequency of neuralgia what are the duration you know that is tapping pain sharp shooting pain shooting pain how many times [Music] a day or once a few days to 100 times a day it can be extremely variable it can be torturous for the patient can be so frequent and there are some precipitating factors for example cold last of air shaving doing chewing chewing food chewing chewing chewing chewing food kissing all these are precipitants of of ridicule fascinating disease maxillary or mandibular give me a give me an answer whenever you can uh yeah so that is how do you diagnose is there a diagnostic test like is there an imaging or a you know no conduction study which will tell you that this is which is not always a vascular impingement of the nerve can be there on an mri may be there but that that is not a very specific finding you don't find it always so what is the specific diagnostic test called specific treatment again treatment like we said in pmr you treat with steroids you get a response temporal artery disease you get a response here no it's too far away you have to just give carbohydrate or ox carbohydrate you give ox carbohydrate carbohydrate in two days or three days the pain nearly disappears it's a beautiful response to carbon speech almost 70 to 80 percent patient will respond very quickly to carbohydrate and if that happens your diagnosis is made then you don't think of tm joint arthritis dental pain etcetera etcetera you know now that your diagnosis is strategic okay that is t now we go on to you track off of more than eight weeks with rhinorrhea this is a little tricky but yeah let me somebody's found out that uh mandel of mandibular branch uh is is the correct brand as much said i rectify my mistake mandibular more than maxillary okay dry cough nobody you upper airway cough syndrome now this is an unusual and new terminology or a very simple thing the simple thing was post nasal grip post nasal drip has been now given a fanciful term upper airway cough syndrome as as you know i don't know whether we have discussed this before but there are four or five important causes of chronic dry cough with a normal x-ray chest can you give me some causes dry cough earlier eight weeks grd1 drd then one already fine finite post-diesel trip due to rhinitis two dry cough more than eight weeks normal exercise [Music] is so unusual for that third would be hyperactive disease wonderful cough variant asthma of as a presentation and as the soul presentation notice here move is only cough of variant asthma fourth ace inhibitors that you know very well right ac is and fifth a post viral of syndrome as you know in covert we have seen so many patients where especially omicron where cough has persisted far beyond the acute illness these are the five causes of chronic more than eight weeks off with uh rack off with a normal exercise yeah that was you for you [Music] [Music] in which condition that causes you get a sudden aversion to smoking viral hepatitis a very big peculiar symptom of viral hepatitis you know fever you know vomiting you know something upper brain pain while hepatitis can cause aversion [Music] young non-alcoholic adult with cirrhosis and asymmetric tremor wilson's disease from w well since this is a very peculiar uh situation any young patient comes with acute hepatitis with neurological symptoms think of medicines and how do you diagnose this what are the three tests that you use cellular plasmid levels and uh serum copper levels [Music] 24 hours urinary urinary copper serum fundus examination for carefree and examination it's not fungus i think it's lamborghini so that is wilson's disease for you and patient inhale tried problem with lipstick stains on her front teeth why i'm so sorry i have framed the uh question grammatically wrong patient on third trophy inhalations has lipstick stains on her front teeth why and this is this letter what is the letter what is the letter x and it's always difficult to find the quiz question they wanted to set the lips up so every time when they do that the lipstick in the front loops will be sticking to the can you normally the lipstick from the teeth is washed off by saliva by the tongue or the saliva on the tongue here if there's a completely dry mouth then you don't get that washing off what is that opium anticoagulant any anticholinergic drug can cause this any anticoagulant for example the drugs used in overactive bladder for example antidepressants of the tricyclic variety all of them can cause antiqual energy side effects and dryness of the mouth kindness is called xerostomia second last on why cut equations on big oxygen complain of changing color vision what change easy again [Music] which is a more common cause of yellow color especially nuclear characteristics cause that what causes blue color [Music] sildenafil children causes blue color you know i think causes halos especially at nighttime with an oncoming light of a car they get halos uh around the uh eyes so aren't they like therefore amygdalin patients should not ideally be driving it much and they get it because of i think they get corneal micro deposits uh almost all patients on long term memory have corneal micro deposits diagnosed on slit lamp right uh bilirubin deposits don't press three rhini says that there is deposit in the cornea due to digitalis i didn't know that thank you uh we go on to z a woman on sleep medicines has a car accident in the middle of the night next morning when asked why did she drive at night she cannot remember she's on sleep medicines this may not be very easy because you have to specifically know a side effect of a medicine it is z so that is a clue [Music] these drugs can cause sleep talking sleep walking sleep driving a very dangerous side effect of these drugs and if sometimes when they drive cars of course they will cause accidents uh so one important thing about zolpidem which is the commonest drug used here so i'll put them is that in women the maximum dose is 5 milligrams because 10 million causes a lot of sleep talking sleepwalking problem and in men you can go up to 10 milligrams okay so uh i think we end here anybody any questions we can keep it open to the to the audience now i don't know 2 or 26 obviously conditions discussed so if you have any specific questions or if you can give me suggestions on our next talk that will be very helpful let me see the let me see the answers or comments okay okay no real comments people have just been answering because they have a fairly rapid fire session yeah uh thank you lakshman ankit i would like to know the scores if you have been kept and uh and netflix is going to send you gift vouchers from both amazon and flipkart and maybe from other companies okay anybody somebody's raised hands yeah okay sorry in the scorecard uh i would say dr lakshman is leading followed by dr vathul and dr atul uh dr ankit uh there were many questions which were answered by all so four questions were answered by all at the same time zero points kind of a thing and so in the yeah okay so uh uh thank you so much for everybody for attending the two people raising their hands uh dr shivani gender and they wanted good evening sir so thanks a lot for your valuable information answer we keep on listening to your videos and they are just so much valuable and so they help in the patient uh treatment answer just wanted to ask you that uh the supply dose that we use uh in patients of in the tremors essential tremors what is the ideal dose that we should give to these patients so you must remember that most essential tremor patients start young and first question to ask the patient is do you think you require treatment many patients will tell you that their tremor is manageable and they don't need treatment and therefore you don't need to give people to every essential tremor some patients will tell you that okay they have an exam coming up they have to write a paper and you can give them temporarily a beta blocker that is the first thing decide whether treatment is to be given or not and if you want to give a proper role which is ideally the first first choice drug check the blood pressure of the patient often a young person will have blood pressure as low as 90 by 60 110 by 70 so you will start low you start with 10 and i'm beating in a patient who is not a hypertensive and step up in a patient is already a hypotenuse [Music] is 80 milligram so the range is 10 20 okay so actually the patient which is started it's 20 mg in the morning and 10 mg in the evening but what happened the heart rate is of the patient is 66 so should i in vp is 100 by 70 should i increase the dose of siplara should i means but the tremendous is not improving on 30 mg so the lowest heart rate that you can go to is 55 don't worry at 67 68 heart rate the lowest bp that you can go i will go to 90 by 16 in a standing position so if they're standing between 1960 i would not mind you can increase but if you think that there is not [Music] maximum is 75 milligram you should familiarize yourself with the side effects of the pyramids the most important side effect is knee stones so if a patient has had kidney stones or recurrent kidney stones you should not be programmed [Music] good evening thank you wonderful question sir uh sir i would like to ask uh i've seen a lot of cases uh presenting with first metatars inflammation it's better after mission we diagnose them as gout but most of the time the uric acid is normal and again they come after six seven months and again the same symptom but uric acid is normal and i've seen that in many cases so how to treat so first thing you must learn is that more than fifty percent of cases of acute growth will have a normal uric acid that is the most important thing to learn uric acid needs not be high in fact uh a uric acid that goes from up to down can as much cause as the uric acid goes from down to up any change massive change in uric acid levels can cause so low uric acid no problem that is why in fact when you see a high uric acid and you start xyloric or fabulous system uh you will cause a patient on uric acid lowering therapy unit lowering therapy with aloperinol or fabulous diet can actually precipitate by suddenly changing the blood level of uric acid lower level so okay low uric acid is not does not rule out gout the mole chemical okay okay and if [Music] the most correct test is aspiration of joint fluid looking for unity crystals nobody likes crystals yes nobody does that nobody does that so how do you diagnose though you again do a therapeutic diagnosis anybody can tell me how do you diagnose without my therapeutic manual if arthritis it won't relieve any other anxieties except doubt or maybe showdown it [Music] give me a correct dosing schedule the tablet available is in india 0.5 in the us 0.6 0.5 mg two tablet stack one after one hour and then one tds that is the dosing very specific dosing two start one after one hour and then tedious that is the standard dosing of earth now sorry okay thank you sir was one after one hour and then tedious it on [Music] yes those are the questions i think yeah is there any specific reasons would you like to start doses like that why why is there a specific reason to give one basically they have chosen a dosing schedule which will cause less side effects while ensuring relief you know when i was a student i was in my mbps the dosing what are the dosing do you know the dosing was one tablet every hour till diary occurs or vomiting occurs or the patient gets released that was the reason that harrison's textbook mentioned that in my addition in my the 13th or 12th edition that was island that was then we realized that such a high dose such a frequent dose causes a lot of vomiting in the area so they probably by trial and error came to a dose which was security meaning uh therapeutic as well as not very uh adverse the patient and still at this those also we get a lot of patients with diet not much vomiting but that that's a very great uh session sir actually we liked a lot and we enjoyed a lot seeing further participation thanks to great yes sir i would like to thank netflix for giving such a good opportunity for the young residents like us with a great eminent faculty like you it's a very good thing thank you all the best thank you so much


Acute diseases are characterised by a rapid onset and progression. Chronic conditions, on the other hand, are long-term and develop over time. Because of the fundamental distinction between the two, these diseases have distinctive symptoms. Let us watch Dr. Tushar Shah describe the distinctions in symptomatology between acute and chronic diseases, and how we may use this information to assist diagnose patients in our practice.


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