- Eye signs of thyrotoxicosis.

Eye signs of thyrotoxicosis.

"DR Joffroy may validate symptoms"

• Dalrymple sign:- rim of sclera is seen all around the cornea, on looking straight forward.
• Rosenbach's sign:- fine tremor of the upper eyelids on slight closure of the eye.
• Joffroy's sign:-lack of wrinkling of the forehead when a patient looks upward.
• Moebius sign:- lack of convergence on looking to near object.
• Von Graefe's sign (lid lag sign):-lagging of the upper eyelid on looking downward without movinh the head.
• Stellwag's sign:-staring look with infrequent blinking.

Dr Ibrahim,,

- Causes of gynecomastia.

Causes of gynecomastia.
Gynecomastia.

• Genetic : klinefelter syndrome.
• Young boy (puberty): due to transient increase of plasma estradiol.
• Neonate: due to persistent maternal or placental lactogens.
• Estrogen and estrogen like drugs (e.g. digitalis).
• Cirrohosis,Cimetidine,Cytotoxic drugs.
• Old age(due to conversion of androgen to estrogen in extra glandular tissue),Overactive thyroid (Hyperthyroidism)
• Myxedema,Marijuana.
• Acromrgally.
• Spironolactone,Steroids.
• Tumour (e.g. testis,adrenal,bronchogenic carcinoma).
• INH,Iron deposition in testis.
• Alcoholism.

- Adrenergic manifestations of Hypoglycemia.

Adrenergic manifestations of Hypoglycemia

(warning signs of hypoglycemic coma).

Due to release of catecholamines when blood sugar less than 50mg%.

"chat Msn"

Coldness, Clamminess
Hunger pain.
Anxiety
Tachycardia,Tremors.


Mydriasis (Dilated pupils).
Sweating.
Nervousness

enjoy,,

Dr Ibrahim

- Side effects of antithyroid drugs.

Side effects of antithyroid drugs.

"Charge"

Cholestatic jaundice.
Hypothyroidism.
Allergy,Agranulocytosis.
Relapse on sudden stoppage.
Goiter,Git upsets.
Exophthalmos increase.

enjoy,,

Dr Ibrahim

- Wagner Grading System for Diabetic Foot Infections.

Wagner Grading System for Diabetic Foot Infections

• Grade 0 :- Intact Skin,but high risky foot.
• Grade 1 :- Superficial ulcer of skin or subcutaneous tissue.
• Grade 2 :- Deep Ulcers but no abscess nor bone involvement.
• Grade 3 :- Deep ulcer with osteomyelitis, or abscess.
• Grade 4 : -Gangrene of toes,heel or forefoot (localized).
• Grade 5 :- Gangrene of whole foot.

 Dr Ibrahim
Return to list of medical grades (click here) 

-Iatrogenic endocrinal diseases.

Iatrogenic endocrinal diseases
"TV as Milk"

Thyroxin therapy lead to thyrotoxicosis.
Vit D lead to hypercalcaemia.

Amiodarone lead to thyroid dysfunction.
ACEIs lead to hypoaldosteronism.
Sympathomimetics lead to picture like thyrotoxicosis.
Steroid therapy lead to DM and cushing syndrome.

Metoclopramide lead to hyperprolactinaemia.
Iodide lead to hyperthyrodism.
Insulin and oral hypoglycemic lead to hypoglycemia.
Lithium lead to hypothyrodism.
Ketoconazole lead to hypoadrenalism.

Dr Ibrahim

-Factors affecting human linear growth.

Factors affecting human linear growth.

• Age
• Sex
• Race.
• Hereditary factors:- Children of two short parents will probably be short and vice versa.
• Endocrinal factors e.g Growth Hormone which is responsible for stimulation of body growth in humans.
• Nutritional factors:- Adequate nutrients must be available for normal growth.
• General health:- Any serious systemic disease in childhood is likely to reduce growth (e.g. chronic kidney disease or chronic infection).
• Intrauterine growth retardation (small birth weight):-These infants often growpoorly in the long term.
• Emotional deprivation and psychological factors:- These can impair growth by complex, poorly understood mechanisms.
• Chromosomal abnormalities.
• Skeletal maturity.

Dr Ibrahim

- Kallmann syndrome.

 Kallmann syndrome

- Def :- It is a rare X-linked recessive genetic disease which characterized by delayed or absent puberty and an impaired sense of smell, also referred as olfactogenital dysplasia.

- Kallmann syndrome is a form of secondary hypogonadism, reflecting that the primary cause of the defect in sex-hormone production lies within the pituitary and hypothalamus rather than a physical defect of the testes or ovaries.

- Kallmann syndrome was described in 1944 by Franz Josef Kallmann, a German-American geneticist.(1)(2)

- Incidence:-

It affects primarily males at an incidence of 1 out of 10,000 in a study of French conscripts.(3)
The male-to-female ratio ranges from 4:1 to 5:1.

- Cause:-

Mutations in the KAL1, FGFR1, PROKR2, and PROK2 genes cause Kallmann syndrome.
These genes play a role in the development of certain areas of the brain before birth. Although some of their specific functions are unclear, these genes appear to be involved in the formation and movement (migration) of a group of nerve cells that are specialized to process smells (olfactory neurons).(4)

- Synonyms:-

• de Morsier’s syndrome II.
• Morsier-Gauthier syndrome.
• Kallmann-de Morsier syndrome.
• Maestre-Kallmann-de Morsier syndrome.
• Maestre de San Juan-Kallmann syndrome.
• Maestre de San Juan-Kallmann-de Morsier syndrome.
• anosmic hypogonadism.
• anosmic idiopathic hypogonadotropic hypogonadism.
• hypogonadotropic hypogonadism and anosmia.
• hypogonadotropic hypogonadism-anosmia syndrome.
  
  

- Pickwickian syndrome.

Pickwickian syndrome

-Def :- It is a condition in which severely overweight people fail to breathe rapidly enough or deeply enough, resulting in low blood oxygen levels and high blood carbon dioxide (CO2) levels.

-Synonyms:- Obesity hypoventilation syndrome(OHS).
-In 1836, Charles Dickens drew in his novel "The posthumous paper of the Pickwick Club" what would be, certainly, the best characterization of an obese subject with respiratory disorders(1).