Types of respiratory pattern of breathing

A 55-year-old man with emphysema will have which kind of respiratory pattern of breathing?

• a.Biot respiration
• b.Apneustic breathing
• c.Cheyne-Stokes respiration
• d.Rapid and shallow breathing
• e.Kussmaul breathing

The answer is d.

In emphysema, there is destruction of alveolar septa and reduced elastic recoil. This causes collapse of the small airways and prolongs the expiratory phase of respiration.
During the prolonged expiration, patients will “purse” their lips to avoid collapse of the small airways. The respiratory rate is increased by having a markedly shortened inspiratory interval.

Kussmaul respirations are slow and deep respirations to increase the tidal volume in patients with diabetic ketoacidosis. Biot respirations are seen in patients with increased intracranial pressure. These are irregular, unpredictable periods of apnea alternating with periods of noisy hyperventilation. Cheynes-Stokes respirationis a rhythmic, gradually changing pattern of apnea and hyperpnea that is cardiac or neurologic in origin. Apneustic breathing is characterized by a long period of inspiration or gasping with almost no expiratory phase.

A case of Necrolytic migratory erythema due to glucagonoma.

This 63-year-old woman with a 4 1/2-year history of diabetes mellitus presented with an ulcerating rash, primarily on the shins, groin, and face (Panel A); cheilitis (Panel B); and glossitis.
Her symptoms had been worsening for 4 years despite specialized wound care. In addition, she noted concurrent weight loss, depression, abdominal pain, and intractable nausea. She was taking 500 mg of metformin daily. Given her history of diabetes mellitus and the skin findings, abdominal computed tomography was performed, and glucagon levels were measured.

An enhancing, lobulated mass measuring 7 cm in diameter was found in the tail of the pancreas, and the patient's fasting glucagon level was elevated, at 890 pg per milliliter (normal range, 0 to 80). The mass was resected, and pathological examination of the specimen confirmed a diagnosis of glucagonoma.

Glucagonomas are rare neuroendocrine tumors that can cause diabetes and a rash known as necrolytic migratory erythema, which has a characteristic annular pattern of erythema with central crusting and bullae. The prognosis correlates with the stage of tumor development and the potential for resection. In this patient, 1 day after resection, the rash had faded significantly. Four weeks after discharge, the patient had normal glucose levels (while taking no medication), and the necrolytic migratory erythema had completely resolved.

Video demonstrates Actions of the ocular muscles

This short video demonstrates how the eye muscles work together to move the eye illustrated by simple animation

Management of a case of scrotal pain and swelling testis

A 5 year old presents to your office complaining of scrotal pain and you note swelling of the left testis. Appropriate management at this time includes

• A) continued observation
• B) elevation of the scrotum and ice therapy
• C) ultrasound evaluation
• D) doppler stethoscope evaluation
• E) CT scan of the pelvis

The answer is C. 

Testicular torsion should be suspected in patients who complain of acute scrotal pain and swelling. Torsion of the testis is a surgical emergency because the likelihood of testicular damage increases as the duration of torsion increases.

Associated conditions that may resemble testicular torsion, such as torsion of a testicular appendage, epididymitis, trauma, hernia, hydrocele, varicocele, and Henoch-Sch?nlein purpura, in general do not require immediate surgical intervention. Testicular torsion is most common in neonates and postpubertal boys, although it can occur in males of any age. Henoch-Schonlein purpura and torsion of a testicular appendage typically occur in prepubertal boys, whereas epididymitis most often develops in postpubertal boys.

The cause of an acute scrotum can usually be made based on a careful history, a thorough physical examination and appropriate diagnostic tests. The onset, character, and severity of symptoms must be determined. The physical examination should include inspection and palpation of the abdomen, testis, epididymis, scrotum, and inguinal region. Urinalysis should always be performed. Scrotal imaging with Doppler color flow ultrasound is necessary when the diagnosis remains unclear. Once the correct diagnosis is established, prompt surgical evaluation should be performed.

A “spectacle” view of both testes with colour Doppler ultrasound