welcome good evening everyone I am working with and I welcome you all on behalf of Team Netflix it's a very special learning session tonight that we have the Dr tusharsha uh he's a Consulting physician and Advanced multi-specialty Hospital Mumbai and today the Superstar of Netflix turns into The Grandmaster for this quiz on symptomatology um so before we get started a couple of instructions for the quiz which are going to be slightly different from the regular instructions that you have uh when the quiz is on uh you will not be able to use the comment feature so if you want to put in your questions or doubt uh you can uh do it in between the questions uh this quiz is slightly different from the one that we had when we played the Wizards of medicine um so in this uh we do have three rounds uh each round has five questions uh we do not have any um image based around nor do we have any case based round um and do uh so when you have the question you have four options uh um select the option and don't forget to hit submit only then will the um answer be recorded uh you have a plus four for every right answer and you have a minus one a negative marking for every wrong answer at the end of round one uh your round one scores will be seen on your screen and the time taken and only the top 10 winners or their score will be displayed on the screen along with their Rank and their score their Rank and the time taken by them um and I think uh we can get started yeah and after every question because this the basic idea or the aim of this session is for learning so after every question after the answer is put out uh so it's going to explain the question and he'll explain the answers and in case you all have any doubts or you all can use the common features in between the questions and very important to hit submit okay I think we can get started with the round one and in case there are uh so every option can either have if it's a true or false question it has only true false answer otherwise all other questions have four options if you all can't see all the four options swipe on the screen so you can scroll and see all that that's it from my answer over to you we'll get started with it yeah yeah so let's start with the first question and hello everybody good evening and I think this is going to be a very easy quiz so all the best I will not read out every time the question but um yeah males affected much more than females in which one of these causes of headache just click on the answer that you think is right A B C or D yep most of you have got it right just a headaches are much much more common in males than in females the ratio has been written as six is to one five is two one or nine is to one depending on what literature you follow and it is said that the made to female ratio that used to be say a couple of decades ago has now reduced uh and uh more females are now being noticed to have cluster headaches but predominantly predominantly it Still Remains a disease of the young male uh migraine as you know is commoner in women temporal arthritis is marginally common in women and cerebral aneurysm rupture which is most commonly due to a very annual Zoo rupture is probably equally distributed between males and females so question addict uh suspected more in males than in females as you know clusterity typically has a unilateral very orbital ache with autonomic symptoms like rhinoria from the same side or lacrimation from the same side comes in clusters multiple episodes come together over a few weeks or months then a long Hiatus of no headache and then another cluster coming up very classical presentation is uh Western remember that a drug used in prevention of cluster Verapamil is almost never used in migraine prevention so a big difference between the preventive use preventive drug choice in both yeah we can go to the next question um just a second so the thumb Mission technical issue I'll just restart meanwhile uh I think most of you know I'm reading about an important thing is if operation does get a severe cluster headache and you want to relieve the headache one of the better ways to relieve the headache is to give a very high flow 50 liters or more through an nrbm or even a high flow nasal oxygen equipment so yeah that might relieve the headache much faster than anything else yeah and go to the next question so I'll just be at the back end if anything or I'll just pop up again sure yeah so which one which one of these infections is most likely to present with both upper and lower gastrointestinal symptoms this probably is a simpler question uh and we have amoebic dysentery entering fewer bacillary dysentery and grdrs which one of these four is more common to present with both upper and lower GI okay so many of you did not get this very easily remember that and I'll explain everything to you so grds is now it is called Giardia intestinalis zero intestinalis is a disease where the it may be the parasites colonize the duodenum and the uh proximal ilium and the symptoms can be both upper and lower the upper GSM doesn't include nausea easy satiety uh belching and burping especially sulfurous belches bloating and of course lower GI which are the predominant symptoms you can get acute barrier or chronic diarrhea fever of course comes with upper GI symptoms also but in general entry fever has constipation and diarrhea constipation the first three or four days due to the enlargement of prayer patches and diarrhea after three or four days of fever when the pair patches start slapping stuffing off so interview I would say is less likely to give both symptoms geods is more likely to be both symptoms remember gids is is in the whole world the commonest communist parasitic infection of the GI tract more common than amoebiasis since it is more difficult to diagnose gids by stool test we we often will not suspect it and also because the treatment is essentially similar of the RDS and amoebiases but do keep a track of grds is because if it is left untreated you can cause a long term IBS like syndrome or a long term uh empirically if they have if they are presenting with diarrhea plus some upper GI simulation yeah uh basically disagree of course you know that comes with lower GI symptoms and so does I may be recently I don't know if if somebody here is already yeah so somebody's asking I'll take the questions by while the back end is being sorted um role in cluster headache it is useful uh unfortunately a subcutaneous injections are not currently available I think at least in Mumbai they are not available and kryptons are useful in the asteretics even if not sublingual you can give a order done oh and somebody said IBT reactive Arthur I decided over the question there is so that is about the second question waiting for the conductor of the back end to tell me if yes we have the third question right thank you we of course take your question questions again in the end if you have anything we have some time to discuss yes and in case anybody is facing any issues submitting the answer just put in the comments and someone from the tech team will be in touch with you okay my third question is coming up let me uh talk a bit more about JLS who has uh that's okay we have another question which of the following statements is incorrect there is only one incorrect statement out of these four foreign is a classic symptom in in fact there is no other disease which causes craving for ice cream for ice pagophagia is not Pica as we have already discussed before Pica is craving for non-food substances like mud chalk Etc uh vitamin B1 deficiency can cause edema and breathlessness uh some of you got that wrong because probably I did not say that vitamin B1 deficiency causes wet very very that would have made it very clear but B1 is thymine wet berry berry uh will obviously cause dilated cardiomyopathy and that dilated cardiomyopathy will present as edema and breathlessness yeah can we go to the next question please foreign system and you have to tell me which one causes menorrhagia is most likely to cause Malaysia so again uh maximum boards go for the correct answer hypothyroidism so remember this hypo causes hyper bleeding hypothyroidism causes more common than oligominoria or amenorrhea hyperthyrogen more commonly causes oligominoria amenorrhea can cause menorrhagia but more commonly hypo I mean a minority hyperpolactinemia as you well know if serum production goes High you have you have what is what is called galactorrhea immunoria combination so again it is immunoria oligominoria and some good viral thyroiditis does not affect the the menstrual cycles so this is the features ah would point to just tell you is that always in a patient who come with menourgia always think of two things which are which can be missed one is do the TSH and second is inquire about Dom peridone or similar drugs as you know number one can cause hyper prolactoneer electronemia and many patients take drugs like pantocid with down stall combination without the knowledge of the doctor for months to years and these patients can get galactorrhea immunoria so if they have immunorium then you think of hyperpolactidemicia then you think of hypothyroidism thank you we'll do the next question yeah before the next question comes uh Dr why are you asking what can cause Pica that is non-food substance the commonest cause of Pica is uh Psychiatric so most commonly psychiatric diseases anxiety uh psychosis they cause Pica one of the well-known forms of Pica is uh eating hair your own hair you pluck it out and you eat it they call it trichotillomania and they of course cause a Reservoir in the stomach a ball of hair in the stone a well-known entity uh yeah can we have the next question please which one of these is least likely to cause a dry mouth least likely to cause a dry mouth foreign touching the correct answer questions related to any of the questions that have come so far then we can use the Rays and feature later but right now just through submit foreign ergic side effects it's a tricyclic antidepressant and it causes a dry mouth it is said that not reptiling a related drug causes less dry mouth than amitriptyline Leo salvatamol is an innocent drug as far as dryness of mouth is concerned the principal side effects of leucosalamol are tachycardia Tremors and hypokalemia as an inhaler or as a nebulized drug moxonidine as you know is a centrally acting anti-hypertensive drug the only Indian and moxonidine are related clonidine causes more dryness of mouths yeah more virus of mouth than moxonidine so if you have somebody on clonidine getting a lot of dryness you may consider switching to maximity a protropium as you know is an anticholinergic drug used for COPD and a protropium antiotropium both cause a significant dryness amounts we can go to the next question so we'll have the score for the first round uh so these are okay top 10 winners of the first round with their uh score and timing given on the right hand side uh so congratulations and they will go on to the second round so after round two also we'll have for the winners and at the end of round three we will get the winners of the quiz these are the top 10 or the first round if there are 15 questions and we have divided into three rounds to five each round and yeah we can go to the next question please yes uh so these are two statements um yeah I will just read out question uh there are two statements and you have to tell me whether both are true or both are false you cannot have one two one false here so both are both false the first statement is knee swelling appears more rapidly in ligament injury than in meniscus injury true or false and causes of myasthenia gravis tends to improve on application of Eye of eyes to the upper eyelid true or false do we have the choices here where they can click so these are the options to a false ligament injury causes swelling faster than meniscus injury and ptosis of Myasthenia improves an application of ice to the upper eyelid either both are true or both are false okay majority again got it right both statements are true ligament injury causes very quick or rapid swelling so if an injury occurs in a football player or Cricket player and you get swelling almost immediately think of Letterman injury a lot of patients of Myasthenia present with ocular Myasthenia rather than a generalized Myasthenia and oculomycine gravis has the principal symptom of ptosis two or three things about ptosis is that ice application improves the process of Myasthenia and secondly is that the ptosis increases as you ask the patient to raise it I I I eyelids up and keep them in the upward State and the affected side if it is unilateral onset which is usually unateral onset the affected side will start having pauses on that strain so yeah that is about winning uh question number six and we can move seven this is the second question the second now this is about an investigation that can lead to a diagnosis that can to treatment which can be life-saving ultra sound can become life-saving uh which can be very simple in times represents into again the majority correct uh 68 of you said ruptured ectopic pregnancy this is not very difficult two or three things here aortic stenosis causes symptoms will cause a syncope which is typically exertional when you walk you get Syncopy you don't need an ultrasound to diagnose it could be uh to diagonal aortic stenosis you'd need of course an echocardiogram which is acute pancreatitis does not present with sin committee typically and of course it is life-threatening of course it is sometimes diagnosed on ultrasound and upside ectopic pregnancy of course uh the whatever the scientific show the ultrasound will show uh the blood in the pelvic cavity or in the peritoneum so there is a hemoperitoneum in a ruptured ectopic pregnancy and which you will see on our sound which will make you immediately operate the patient the patient represented single picture any young a female who's in the age group of pregnancy any young female the child bearing age you and are married or unmarried if the patient has syncopal episode and you get an emergency call the first thing that you have to think of is 100 sound uh room do the sonography and fluid then take her into the OT directly acute appendicitis does not again present with uh with syncope you can have the next question please again an easy question foreign Ty of special senses occurs in 90 of patients of Parkinson's disease this 90 figure uh seems to be an authoritative figure but some Publications also give a figure as a lesser number of patients or Parkinson's but um majority of Parkinson's inspiration have this uh problem with their one of their special senses and again a majority of you have it correct loss of smell or fracture can proceed Parkinson's Disease by up to eight years so if an elderly gentleman uh says that he has lost his or her smell uh then you may think of the possibility that this person will become Parkinson's what do you do about it you can't do anything about it do you tell the patient you can't tell the patient so I'm just telling you that this is something acute loss of smell with acute fever without stuff feeling stuffiness of the nose I'll repeat no stuffiness of the nose as you already know so uh that of course is different from this loss of infection we can have the next question please yes [Music] again two statements both false or both true the cough of low flow syndrome persists for a longer duration then the cough of tropical pulmonary eosinophilia true or false I'll repeat the cough of low flow syndrome remember low floss is due to Hell means like roundworm and hookworm the core of nuclear syndrome persists for a longer duration than the cough of PPE which is due to file areases and the second statement sigmoid diverticulitis is more likely to cause diarrhea than constipation true or false those are two or motor faults first question was useless syndrome more long symptoms than tropical Journey while we're using Julia second was diverticulitis more common right side than on the left true or false foreign where you get cough occasionally wheeze usually no fever due to the passage of larvae of roundworm Bookworm helmets to the lungs remember this that these larvae come to the lungs not to reside in the lungs not to get stuck in the lungs they make their way into the bronchial tree Ascend climb up the trachea broccoli tree go up to the pharynx go down the esophagus and go into the GI tract that is the paths that they take therefore they are parked through the lungs low flood syndrome is short transient hence the cough caused by loafers is self-limiting sometimes the patient will not even have symptoms or if the patient has symptoms they won't even report it because they are transient symptoms you will never come to know so low fuel syndrome often uh not present does not come to you in your clinic whereas tropical pulmonary eosinophilia which is due to filarial larvae what happens there the filarial land we are released by the adult worm which is residing in the lymphatics these released larvae are being are hoping to be picked up in the blood from the bloodstream by mosquitoes because that's how they will reproduce they have to get into mosquitoes the intermediate host and the those that are not picked up by mosquitoes they die and how do they die they enter the lung uh they enter the lung capillaries in the lung capillaries they get stuck they have nowhere to go and in the lung capillaries they die and this causes significant uh of significant vs fever sometimes with chills and these symptoms can persist for some time till when will they persist till usually either you are treated or the reaction to these larvae dies down remember you must diagnose tropical and treat it well because if you don't treat it with say diethyl carbozine if you don't eat it correctly then some patients can develop long-standing interstitial lung disease tropical pulmonary eugenophilia is a cause of chronic fibrosis orientation lung disease in India and therefore you must treat it correctly the correct treatment is 21 days at least some authors for example has recommended 28 base treatment in India to treat tropical pulmonary eosinophilia remember the treatment of filariasis of the of the Cisco term or the lower limb is 14 days the treatment of tropical pulmonary using neogenophilia is 21 days and you know the drug b e c is 6 mg per kg per day and this is for 21 days to 28 days in three divided doses yeah maybe you have the next uh slide please [Music] of course you know the diode is commonly in the sigmoid colon okay so the time has started here uh you can scroll the options and don't forget to hit submit only then uh the answers getting recorded [Applause] oh okay okay so yeah many of you got that right 20 at least got that right uh others did not which are one of these is not a symptom of gravity autonomy neuropathy diabetic autonomic neuropathy is a thing that you must suspect in anybody who's had long-standing diabetes especially long-standing uncontrolled diabetes and there are some symptoms which warn you that there is a development of autonomic neuropathy that is sympathetic and parasympic nervous system are being affected GI autonomic neuropathy upper GI is uh gastric a Tony or gastroparesis and this presents with bloating easy satiety uh post mood bloating especially the lower GI autonomic neuropathy present typically with nocturnal diarrhea and of course diarrhea in diabetics can have more than one cause metformin for example is a cause but otherwise diarrhea in an uncontrolled long-standing diabetes you must think of autonomic neuropathy especially if the diarrhea is more at night neuropathy can cause palpitations but most importantly it can cause postural greediness so all long-standing diabetic patients whether or not they complain of greediness you must check both their supine blood pressure and standing blood pressure because autoimmiopathy can be a problem and if the supine is 170 by 70 and the standing is 120 by 70 ignore the 170 systolic in the Supine position do not increase the medicines because of the superint blood pressure because the standing blood pressure 120 by 70 is a significant fall and the patient will have syncopal episodes if you increase the BP medicine further in fact there might be a case sometimes of reducing the between uh paresthesia of hands and feet are of course features of peripheral sensory motor neuropathy and not autonomic neuropathy we'll go to the next question okay yeah so that's end of round two and we have now the score sheet uh Dr Kumar Dr venkates well done all of you and we go ahead with the third round I don't know why you call it Wipeout and to just name the rounds and actually round three he saw in Wizards of medicine there was a complete change in the because of round three so let's see if this is also it's more um I mean the negative marking does not increase in this round so no worry about it everything Remains the Same it's still stuffing well everybody starts reading the questions so there's one question uh if you want to take that because there's some issue so we'll just have to wait for a couple of seconds before we take your get the next question on so why early Society early Society uh remember gastroparesis means there is no no resistances or weak when it starts in the stomach so this gastric emptying is delayed so previous meal also might be still inside the stomach therefore because of the previous residue if a person eats a little bit now he feels full she feels full so that is probably the reason why you get early satis due to uh due to gastroparesis I think about gastrosis traditionally we have been taught that erythromycin can be used in gastroparesis it is no more used what can be used now is the Commerce indicated drug is metoclopramide metoclopramide can be used as a symptomatic drug overall of course a 10 milligram three times a day as a symptomatic drug for gastroporosis other prokinetics may also be used like etopride muscle Pride but I think the drug of choice seems to be metachloramide all right yeah the next question I have tried to include multiple diseases in each McQ so that we have a little more discussion on each question okay this might turn out to be the easiest of the lot let's see it is the easiest of the lot 82 percent of you got it right you need at your shoulder pain that radiates down the album distribution of the Upper Limb so as you know cervical this disease can easily cause that uh C5 C6 this collapse would be the Communist location of this collab causing this herpes zoster of course can come with a single print the pain often precedes the rash so anybody who comes with a radical pain or a dermatomal pain radical pain on your dermatode say in the thoracic dermato or abdominal dermatome or the lower limb atom any patient who comes with a dermatomal pain even if there is no rash think of herpes roster of course check for the rash front and back but if there is no rash tell the patient or relative or both that look for the rash running evening and let me tell you this that if you think that the patient has a dermatomal discomfort and the skin sorry and there is burning over the skin and if there is an uncomfortable sensation when you touch the skin in that burmito even if there is no rash you are justified in starting to another cycle of your farm cyclovironment the antiviral drugs because the earlier you start the antiviral drugs the Lesser is not only the severity of the herpes roster the Lesser is the severity of post therapeutic neuralgia sorry and as you know Pancoast tumor is a name given to tumor of the upper lobe of the lung compressing the brachial plexus that is your bank posture uh it can be histologically of any tumor need not be just one type of tumor X chromosome carcinoma but it's usually a peripheral tumor in the in the upper lobe yeah we can go to the next slide which follow these statements is false this is all about night time symptoms all three hmm again a majority gets this right uh so I'll take this one by one carpal tunnel syndrome classically whereas thesis are more at night and uh pain of IBS never wakes a person up at night so if a patient complains to abdominal pain which say diarrhea since three four months the one question that you cannot miss asking before you label the person is IBS is has the pain ever woken you up at night if there is no such instance only then should you think of IBS if the pain has woken the patient up at night then IBS is ruled out so that is a very important symptom to know and the third of course is good or questions so there are four coughs four causes of cough that are more at night time gastroesophageal reflux disease post nasal grip uh peroxisible nocturnal Disney and due to cardiac failure and late night so depending on what time you get that cough sometimes you can add a clue to the diagnosis oh God will occur almost immediately online supine sometimes even before the patient has slept off posters will rip a little later after the patient has gone supine as you know pnd middle of the night wakes the patient up say 2 am 3 m blumen makes the patient up why does it occur so late because it takes the edema fluid of congestive cardiac failure to get redistributed into the venous circulatory system and kind of flood the lungs at night at 2 30 am 3 m when the patient wakes up with coffin breathlessness and Asthma of course is an early morning very early morning disease 4 AM 5 m the patient can wake up due to cough and wheezing yeah we can take the next question again a bedroom some technology question foreign again most of you where oxycle is here we just discussed a patient that has to wake up uh mid middle of the night and go to a window that is a classic description open the window and uh they gasped for air uh restless legs in Rome classically patient has to get up and walk about and one of the diagnostic symptoms of restless leg syndrome is almost immediate relief on standing up and walking about morning stiffness arthritis you must remember that morning stiffness any any inflammatory disorder is relieved by movement in a degenerative disorder is aggravated by movement joint diseases so morning stiffness Road arthritis are when you stay in bed there will be more stiff than when they move about use their hands they gradually become restive is gout the mono article pain of photogram what is the definition of photograph means gout of the first metatarso phalangeal joint that is a great joint that photograph is uh the pain is not dependent on whether you are in bed or out of bed so there is no relief on getting out of bed you can take the next question please thank you uh there are four options in this so you'll have to scroll and see all the options and then hit submit foreign so which one of these is not a red flag symptom remember this that in a chronic smoker even a speck of blood in the scooter Speck of blood can mean malignancy so you must investigate a chronic smoker with blood immediately for malignancy typically first thing is to do a CT scan with contrast see it is kind of a lungs with contrast another thing about smoking smokers cough uh is a cough that occurs typically early in the morning stays for a few minutes smoker's cough is easily identified by the patient themselves as insignificant meaning they know that this is the cough they had due to smoking if any change occurs in the nature of the cough meaning the cough becomes different in its character or becomes different in its expectoration cough becomes different in its duration if the smoker's cough changes character then malignancy becomes a strong possibility and the other possibility is COPD development of COPD becomes a possibility it's changing smokers cough is an important symptom to elicit uh vomiting an epigastric pain in a type 1 diabetic of course you will immediately think of diabetic ketoacidosis as the cause of these two symptoms need to take in deep breaths in a young student with restlessness as you know again we have discussed this before uh acute discomfort in breathing they are they are extremely Restless when there is an anxiety attack a panic attack kind of thing the typical breathing is as if they are hungry for air but very deep breaths and inconsistent Rhythm the rhythm is not always and if you ask them to stop breathing for a second hold your breath you might even be able to hold your breath for a second which operations are having problem edema for example will not be able to hold their breath so uh these patients will of course as you know because of deep breathing they'll get ionic hypocalcemia serum ionic calcium will fall and they will get tetany because of these so and the treatment as you know already is rebreathing into a plastic or paper bag and the Sim could be uh in the main case of aortic stenosis now three symptoms of aortic sterosis mean that you have to operate you know this again I'll repeat this for you excerpts to syncope exertional dyspnea in exertional chest pain that is angina all three are symptoms of aortic circles where if you do not operate the patient will probably die within a two or three years two or three years is the maximum lifespan of a symptomatic aortic stenosis patient unless intervention occurs and ventilation can occur in the form of either a Tavi or a sour that is a surgical aortic wall replacement or a trans um transcathedral aortic wall replacement so that is um that is the audit services for you we go to the second last question of this quiz or is it the last the last question on this because we are last question okay this question stresses the importance of asking for aggravating and relieving features in any patient who presents with pain again most of you got that right pain of acute pancreatitis is uh relieved by bending forwards and pain of pericarditis is similarly relieved by bending forwards both these pains aggravate on lying supine don't improve online so mine and the pain of acute appendicitis was worsens or any job any jerks uh say while traveling in a basic Shore car on bad roads the pain will versus so that is one question you must ask anybody who presents with acute a girl pain remember appendicit is the initial pain is very umbilical or just among the umbilical super umbilical and therefore you will not immediately think of equilibernosis but if there is if there is worsening of pain due to jerks one possible cause is acute amendocitis yeah I think that ends the question we may have the scores yeah so first we'll see the scoreboard for the third round so these are the top 10 winners this is just the third round scoring mode the total scoring so and then uh the next board that is seen will be the final score round so this is the final score round so we have Dr n.k Kumar who is stood first with a score of 52 and we have Dr suyash ambedkar with 48 and we have Dr Shivam chandok at 47 uh Dr shibanu at 43 Dr harshita at 42 those are the top five uh then we have Dr Neil Lemay 42 he was one of the winners from the previous wizards of Medicine Dr Arun at 42 Dr Mall SRI at 42 Dr Puja at 42 and Dr Laila Abdu at 38. congratulations everyone excellent timings I can see that they are amazing yeah yeah so this was great and if there are any questions that you would like clarification on you can now use the reason feature or use the comments and put on your questions there so we have Dr pranali Who's asked what is the best stock for migraine what is the best drug for acute uh relief of migraine or pleasure for preventive migraine so there are two therapy pharmacotherapies for migraine one is for relieving the headache when it occurs and only so prevention of headaches so for release of headache when you want to give a prescribed a drug remember ask the patient what leaves you best migraine patients know better than Physicians as to what relieves them so if the patient is having migraine for some time they usually know okay are a simple tablet of classical 500 milligram treats here at about 250 milligrams of Naproxen released my headache very quickly so whatever the patient chooses it's your choice if if the patient does not choose has not chosen already then you have three steps uh first step is to decide whether you want to treat just the headache or you want to treat headache with vomiting so the patient has both headache and vomiting this and then your treatment might be different so if a patient has headache and vomiting what I would give for example is give naproxen 250 or 500 milligram with one stable tablet five milligram that would be my combination of choice for treatment or food addict uh if the patient has very mild headache I would say just take paracetamol and see how you feel with that I know the question is extremely severe headache and comes to my clinic with that bad headache I might I might give an injectable diclofenac to the patient or an injectable like a good injectable stem until the patient which sometimes can release both relieve both the headache and the vomiting but remember this when you give a patient an SOS medication for headaches in migraine the most important thing is not what to give which drug to give the most important thing is to tell the patient please take the medicine as soon as the headache starts take it while the headache is mined don't shake it anymore don't allow the patient to have a delay in the medicine intake so that is the most important message not which drug but what time of uh the headache so that is for acute headache there are many choices that are trans uh Etc and the other thing is about prophylaxis prophylaxis first line prophylactic drugs are I think three or four are considered first line drugs for prevention of migraine one is propranolol the second isodium valproate that is topiram meat these are the three most commonly used drugs for prevention first prevention most evidenced based drug and there are of course many fluidizing is there and supported it is there and amitriptyline is there Etc but these are three properly sodium rice and to prevent and remembering that child bearing age group is the most common age group for migraine and you must not give sodium valproate in the child wearing age group unless the patient is very sure of will be a contraceptive use or you're very sure that the patient is not going to get pregnant we have Dr manasri Who's asked what is the reason of hypothyroidism causing menorrhia oh I don't know I don't know because the mechanism by which hypothyroidism causes I I don't know the cause and if anybody here can help me by telling giving the correct answer please do so but I would have to read that up [Music] so we have Dr P K Mina who's asked uh what are the different types of Tremors and how to establish a perfect diagnosis ah Xbox three types of travels one is resting drama like in Parkinson best thing ever means the patient is resting not moving the hands are still for example and operation the resting drama it goes like this I'm just putting my hand here so that you can see it the resting February resting parkinsonism the hand is moving like this the typical pre-rolling movement of the index finger and thumb and the movement of the interfaryngeal metacarpopharyngeal wrist joint all at rest right so this is called the resting River uh then we have what is called the action grammar action rimmer is also known as postural River patient is asked to keep their hands in a particular posture and if you get the Tremor like this this travel is a postural Tremor and this partial framer of course is elicited by making the patient to this classic cause of tremor is uh in what is called as familial trim or essential tremor and this this partial trimmer uh also occurs in thyroid toxic causes for example alcohol withdrawal for example so uh ashutramum very easy to diagnose and the third type of frame will described the variety of problem described is intention tremor where you make the patient safe for example do a finger nose finger test or ask them to go and fetch a thing from the table and at the end of the movement is uh the Tremor and that trimmer is classically described in cerebellar disease yeah tremors are relatively easy to feed this may we have the next question yes we have Dr nikhil Who's asked what is the dose of cephism ceph examine typhoid is it 1200 in divided doses ceph exam is 20 mg per kg per day so in a 60 kg person it's 1200 milligrams per day in divided doses so for example you can use cefixime without traveling it because carbonate is not necessary in entry fever 400 milligrams three times a day typical duration is 7 days given the answer of why does hypothyroidism cause memorizia she says it causes an ovulatory a uterine bleeding so yeah so an ovulation is the cause she says of pillow regia thank you uh we have Dr Shivam who's asked can a young man with restlessness and deep breathing be a case of asthmatic attack uh deep breathing in Asthma as you it is not deep inspiration it is more a prolonged expression they will uh prolonged expiration so uh long experience and in the anxiety one they have a um so that is and of course the wheezing sound automatically used calculation so now very difficult but if it's diagnosis thank you sir and then we have Dr suesh Who's asked how does one diagnose lockless sir syndrome diagnosis of retrospective nature meaning as I said the patient almost never present to you when they have symptoms and therefore when you look at a CBC and you see using Ophelia then you should say okay the patient may have almonds or worms um so what we do when we find using affiliate on CBC often speed doctors give heterozan empirically don't give ever heterozan empirically in in an asymptomatic equation with using Ophelia unless the usual count is 3000 plus uh at least two thousand absolutely so if you have a 10 percent user feels out of seven thousand total WBC count meaning the absolute use in account is 700 another question does not give any history of the cause of user if you have meaning the patient doesn't have atopic diseases like eczema like aw right then you think of this patient as having helmet gases if such a patient says okay I did have some cough uh say a couple of weeks back then that cough was low floods so it doesn't matter whether the patient had cough or not cough then you will give and the help in the treatment in the form of albendazole or whatever you like so you you must you must consider giving an anti-aging thick not give atrazan in such a patient whether using Ophelia is not very high and symptoms are not there yep thank you so I think around the same question that we have for another question what are the diagnostic criteria for tpe ah so I think the rest of that publication don't remember the criteria but this is the broad criteria one second but total costs second Criterion is absolute reasonable count of three thousand or more uh please don't know more is the classic definition some people do say that if there are symptoms and you get an absolute count of 2000 you should consider it as DP uh TP is almost never diagnosed easily by doing a blood collection for my profile area yeah it's almost always absent there are of course anti-microfilarial IGM or anti I think IGM is available uh which can be which can be tested for uh in the X-ray of the chest you will find infiltrates uh in PPE which you don't find in low blood syndrome so you may find those on the CT scan or an x-ray chest so these would be the broad reasons for diagnosing TP uh I think we are at the end of the questions here um and I think we've already exceeded the one hour timeline so I think so we'll call it oh thank you so much thank you sir we enjoyed the quiz and learned a lot from it thank you I hope so I hope so thank you all thank you very much for attending thank you sir
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After the 'Wizards of Medicine' comes the quiz on symptomatology with Dr. Tushar Shah. Join us for a really fascinating session when knowledge is put to the test and new ideas are learned all at once!
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