#হাবিজাবি_৩১৩
মেডিসিনের গুরুত্বপূর্ণ কিছু clinical Triad, Tetrad ও Pentad.
abdominal pain,
diarrhoea,
urticaria.
Think of: Strongyloides stercoralis.
(GI tract এ parasitic infestation হলে urticaria হয়)
loin pain,
fever,
tenderness over the kidneys (Renal angle tenderness).
Think of: Acute pyelonephritis (infection of the kidney)
haematuria,
a loin mass.
Think of: RCC (Renal cell carcinoma)
তবে এই triad মাত্র 10% ক্ষেত্রে পাওয়া যায়।
Children are more liable to develop tetany than adults and present with a characteristic triad of
carpopedal spasm,
stridor,
convulsions.
Think of: Tetany due to hypocalcemia
কিন্তু এই symptoms গুলো বাচ্চাদের বেশি পাওয়া যায়, বড়দের মেইনলি carpopadal spasm পাওয়া যায়।
Whipple’s triad:
Symptoms of hypoglycemia,
low glucose on measurement at that time,
symptoms resolve after the correction of hypoglycemia.
Think of: Hypoglycemia due to any cause, specially insulin secreting tumor যেমন insulinoma. একটা রোগী পেয়েছিলাম আমরা। Endoscopic USG kore tiny insulinoma পাওয়া যায়, আমাদের কাছে এসেছিল hypoglycaemic shock & multiple basal ganglia infarct নিয়ে। পরে ডায়াগনোসিস হয়, অপারেশন হয়।
• hyperglycaemia (blood glucose >11.1 mmol/L (200 mg/dL)) or known diabetes,
• hyperketonaemia (≥3.0 mmol/L on fingerprick testing) or ketonuria (more than 2+ on urine dipstick testing),
• metabolic acidosis (venous bicarbonate <15 mmol/L and/or venous pH <7.3 (H+ > 50 nmol/L)
Think of: DKA (Diabetic ketoacidosis)
ophthalmoplegia,
ataxia,
confusion.
Think of: Wernicke encephalopathy due to Vit B1 deficiency. It may progress to permanent Korsakoff psychosis. One of the important causes of Vit B1 deficiency is chronic Alcoholism.
ophthalmoplegia,
ataxia,
areflexia.
Think of: Miller Fisher syndrome (a variety of GBS)
Charcot’s triad:
jaundice,
right upper quadrant pain,
fever.
Think of: Cholangitis
Electromyography shows:
• spontaneous fibrillation
• short-duration action potentials in a polyphasic disorganised outline
• repetitive bouts of high-voltage oscillations on needle contact with diseased muscle.
Think of: myopathy or inflammatory myositis.
skin lesions (purpura or nodules),
asymmetric mononeuritis multiplex,
eosinophilia.
Think of: EGPA (Eosinophilic granulomatosis with polyangitis)/Churg-Strauss syndrome
learning disability,
epilepsy,
skin lesions.
Think of: Tuberous sclerosis
On brain histopathology:
cortical spongiform change,
neuronal cell loss,
gliosis.
Think of: Human prion diseases
gait apraxia,
dementia,
urinary incontinence.
Think of: NPH (Normal pressure hydrocephalus)
The negative cognitive triad:
. Negative view of self ‘I am no good’
. Negative view of current life experiences 'The world is an awful place’
. Negative view of the future 'The future is hopeless’
Think of: major depressive illness
On chest radiology:
mild bronchiectasis concentrated in the right middle lobe and lingula,
a ‘tree-in-bud’ pattern,
randomly scattered (+/− cavitated) nodules 1–2 cm in diameter.
Think of: Mycobacterium avium intracellulare complex
Beck's triad:
low arterial blood pressure,
high venous pressure,
absent apex beat.
Think of: cardiac tamponade
ataxia,
atonia,
asthenia.
Think of: cerebellar disease
anorexia,
asthenia,
anaemia.
Think of: malignancy
Steinberg's triad:
incontinence of bladder,
impotence,
constipation.
Think of: MS (Multiple sclerosis)
Charcot's neurologic triad:
Intention tremor,
nystagmus,
scanning speech.
Think of: cerebellar symptoms a part of MS (multiple sclerosis)
neurofibroma,
café-au-lait spots,
lisch nodules.
Think of: neurofibromatosis
facial palsy,
recurrent facial oedema,
plication of the tongue (Hygiea).
Think of: Melkersson–Rosenthal syndrome
rheumatoid arthritis (RA),
splenomegaly,
leucopenia.
Think of: Felty's syndrome
fever,
oligoarticular arthritis,
an evanescent salmon-coloured rash (which typically appears with the fever spikes).
Think of: Still's disease
pseudoxanthoma elasticum,
angioid streaks,
vascular abnormalities.
Think of: Groenblad–Strandberg syndrome
retinitis pigmentosa,
progressive external ophthalmoplegia,
heart block.
Think of: Kearns–Sayre syndrome
Virchow’s triad:
• changes in blood flow (stasis or turbulence)
• vessel wall dysfunction
• changes in blood components, leading to hypercoagulability
Think of: Thrombosis
rash,
fever,
peripheral eosinophilia.
Think of: AIN (Acute interstitial nephritis)
headache,
neck stiffness,
fever.
Think of: Meningitic syndrome
undulant fever,
sweating,
migratory arthralgia or myalgia.
Think of: brucellosis in endemic regions like middle east
unholy triad:
hypothermia,
acidosis,
coagulopathy.
Think of: metabolic response to injury, particularly in major trauma.
severe cystic acne,
cellulitis of the scalp,
hidradenitis suppurativa.
Think of: Follicular occlusion type of Acne
thickened & slow-growing yellow nails,
pulmonary manifestations (cough, bronchiectasis, pleural effusion),
lower limb lymphoedema.
Think of: Yellow-nail syndrome
• polyuria due to the osmotic diuresis that results when blood glucose levels exceed the renal threshold
• thirst and polydipsia due to the resulting loss of fluid and electrolytes
• weight loss due to fluid depletion and accelerated breakdown of fat and muscle secondary to insulin deficiency
Think of: DM (diabetes mellitus)
eye symptoms:
redness,
pain,
photophobia.
Think of: Anterior uveitis (iritis)
pulmonary haemorrhage,
glomerulonephritis,
the presence of circulating antibodies directed against an antigen intrinsic to the basement membrane of both kidney and lung.
Think of: Anti-glomerular basement membrane (anti-GBM) disease
dermatitis,
diarrhoea,
dementia.
Think of: Niacin (Vit B3) deficiency
bronze skin pigmentation (due to melanin deposition),
hepatomegaly,
Think of: gross iron overload (Hemochromatosis)
hyperthermia,
neurological symptoms,
heat exposure or strenuous exercise.
Think of: Heat stroke
Tetrad:
• a characteristic petechial rash typically affecting buttocks and lower legs
• abdominal pain due to vasculitis involving the gastrointestinal tract
• arthralgia
• renal disease characterised by visible or non-visible haematuria, with or without proteinuria.
Think of: Henoch–Schönlein purpura (HSP)/IgA vasculitis
বাচ্চাদের বেশি হয়।
Tetrad:
Excessive daytime sleepiness,
Cataplexy,
Hypnagogic/hypnopompic hallucinations,
Sleep paralysis.
Think of: Narcolepsy and cataplexy
Pentad:
• thrombocytopenia
• microangiopathic haemolytic anaemia
• neurological sequelae
• fever
• renal impairment
Think of: TTP (Thrombotic thrombocytopenic purpura)
Triad:
presence of red cell fragments on a peripheral blood smear, thrombocytopenia,
high lactate dehydrogenase (LDH) levels.
Think of: TTP (Thrombotic thrombocytopenic purpura)
পড়ার জন্য ধন্যবাদ।
কাওসার
কে-৬৫