Six causes of hypoglycaemia

(mnemonic)

The mother of a 14-year-old type 1 diabetic boy phones the GP's surgery asking for advice. Her son has a chest infection and is not eating. She is worried about his blood sugar levels

Management?

A 28-year-old woman presents with a solitary 3-cm freely mobile painless nodule. She also complains of a serous nipple discharge and axillary lymphadenopathy

F. Breast cancer

Axillary lymphadenopathy is indicative of malignancy.

A 36-year-old woman presents with multiple and bilateral cystic breast swellings which are noted to be particularly painful and tender premenstrually. She states that during pregnancy the symptoms improved

What is the likely diagnosis?

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A 50-year-old woman presents with an eczematous appearance to her nipple and areola. It is associated with a discrete nodule that is attached to the overlying skin

Likely diagnosis

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Paget's disease.

Paget's disease or intraductal carcinoma is associated with eczema of the nipple, especially in the presence of a firm nodule suggestive of more than simple eczema.

A 30-year-old woman post-appendectomy develops high fever of 42°C, hypotension and mottled cyanosis in the recovery room. She received halothane inhalational gas in surgery. She was noted to have trismus during intubation.

Diagnosis and management?

Malignant hyperthermia may be precipitated by halothane or suxamethonium.

Intravenous dantrolene sodium

A 40-year-old man complains of circumoral numbness following thyroidectomy. Tapping over his preauricular region elicits facial twitching.

What is this sign? Initial management?

Chvostek's sign is a sign of hypocalcaemia, which may occur after thyroidectomy and injury to the parathyroid glands.

IV calcium gluconate

• Metabolic abnormalities:
• diabetes, renal glycosuria, or glycogen storage disease
• Dietary conditions:
• starvation, fasting, high protein, or low carbohydrate diets, prolonged vomiting, and anorexia
• Conditions in which metabolism is increased:
• hyperthyroidism, fever, pregnancy or lactation

Also known as Stiffperson's Syndrome or Moersch-Woltman Condition)

 rare neurologic disorder of unknown etiology characterized by progressive rigidity and stiffness, primarily of the axial musculature, that is superimposed by spasms, resulting in postural deformities.^[1] There are also sub-variants: Stiff Baby Syndrome and Stiff Limb Syndrome.^[2] Other forms or types of the disease include focal SPS, jerking SPS, and progressive encephalomyelitis with rigidity and myoclonus.^[

Vascular system

Mondor's disease (also known as "Mondor's syndrome of superficial thrombophlebitis") is a rare condition which involves thrombophlebitis of the superficial veins of the breast and anterior chest wall. It sometimes occurs in the arm or penis.

Patients with this disease often have abrupt onset of superficial pain, with possible swelling and redness of a limited area of their anterior chest wall or breast. There is usually a lump present, which may be somewhat linear and tender. Because of the possibility of the lump being from another cause, patients are often referred for mammogram and/or breast ultrasound.

Mondor's disease is self limiting and generally benign. A cause is often not identified, but when found include trauma, surgery, or inflammation such as infection. There have been occasional cases of associated malignancy.Management is with warm compresses and pain relievers, most commonly NSAIDS such as ibuprofen.

It is named after Henri Mondor (1885-1962), a surgeon in Paris, France who first described the disease in 1939.

the Direct Coombs test, is used to test for autoimmune hemolytic anemia

In certain diseases or conditions an individual's blood may contain IgG antibodies that can specifically bind to antigens on the red blood cell (RBC) surface membrane, and their circulating red blood cells (RBCs) can become coated with IgG alloantibodies and/or IgG autoantibodies. Complement proteins may subsequently bind to the bound antibodies. The direct Coombs test is used to detect these antibodies or complement proteins that are bound to the surface of red blood cells; a blood sample is taken and the RBCs are washed (removing the patient's own plasma) and then incubated with antihuman globulin (also known as "Coombs reagent"). If this produces agglutination of RBCs, the direct Coombs test is positive, a visual indication that antibodies (and/or complement proteins) are bound to the surface of red blood cells.

The indirect Coombs test is used in testing what group of patients?

prenatal testing of pregnant women, and in testing blood prior to a blood transfusion

It detects antibodies against RBCs that are present unbound in the patient's serum. In this case, serum is extracted from the blood, and the serum is incubated with RBCs of known antigenicity. If agglutination occurs, the indirect Coombs test is positive

Where would a Cystosarcoma phyllodes tumor be found?

 is a rare, predominantly benign tumor that occurs almost exclusively in the female breast.Its name is derived from the Greek words sarcoma, meaning fleshy tumor, and phyllo, meaning leaf. Grossly, the tumor displays characteristics of a large, malignant sarcoma, takes on a leaflike appearance when sectioned, and displays epithelial, cystlike spaces when viewed histologically (hence the name). Because most tumors are benign, the name may be misleading. Thus, the favored terminology is now phyllodes tumor.

 almost exclusively in the female breast

rare, predominantly benign tumor

Its name is derived from the Greek words sarcoma, meaning fleshy tumor, and phyllo, meaning leaf. Grossly, the tumor displays characteristics of a large, malignant sarcoma, takes on a leaflike appearance when sectioned, and displays epithelial, cystlike spaces when viewed histologically (hence the name). Because most tumors are benign, the name may be misleading. Thus, the favored terminology is now phyllodes tumor.