Serotonin Syndrome vs NMS

Article from: http://uuhsc.utah.edu/poison/healthpros/utox/Vol4_No4.pdf

This article quotes some interesting facts about serotonin syndrome. As you know, NMS (I forgot the whole name, but it's written there and is caused by dopamine antagonist effect) can have certain common features in terms of the clinical presentation. Therefore I would like to bring a certain attention over this matter.

Feature: Serotonin Syndrome
Mechanism: Serotonin excess
Onset of Symptoms: Minutes to hours
Resolution of symptoms: Less than 24 hours
Neuromuscular: Myoclonus, hyperreflexia
Rhabdomyolysis: Rare
Metabolic acidosis: Rare
Elevated transaminases: Rare


Feature: Neuroleptic Malignant Syndrome
Mechanism: Dopamine antagonism
Onset of Symptoms: Days to weeks
Resolution of symptoms: 5-14 days
Neuromuscular: “lead pipe” rigidity
Rhabdomyolysis: Common
Metabolic acidosis: Common
Elevated transaminases: Common



Anyways, this is from table 3 in the article. I finally found the answer to this mystery to me^^

Some USMLE Prep

I come across this website: http://en.wikibooks.org/wiki/USMLE_Step_1_Review

Okay, it listed out some website I think it is useful to those students who are preparing for the boards exam.

1) http://www.learnerstv.com
2) http://www.stepprep.com
3) http://www.clinicalreview.com/welcome/

I have doubts on the third site, but the top two sites, I think, are quite good. Since it's free, why not just give a try? I seriously don't have much time to waste. Next Thursday will be my exam. Hope everything goes well and hope that all the questions which appear during the exam are all of which I had done them before or know the answer, somehow. Pray hard...

4 random names of syndromes

1. Gradenigo syndrome

Triad: abducens nerve palsy, pain in distribution of trigeminal nerve, otitis media.

The syndrome must be suspected in patients with suppurative otitis media presents with orbital or retro-orbital pain and or cranial nerve palsy. This syndrome normally presents as a complication of another disease, i.e. acute suppurative otitis media. It takes time to develop before it really cause serious major complication. Treatment has to be started immediately.

2. Vernet syndrome

Paresis of 9th–11th (with or without 12th) cranial nerves together.

Also known as jugular foramen syndrome. Make sense. If you love long articles, like me, do read this. Read this also: http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T06-4SF9CFC-1&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&_docanchor=&view=c&_searchStrId=993765207&_rerunOrigin=google&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=9e52d751ce6f397a23719b0a362ac454.

3. Villaret syndrome

This syndrome is characterized by an ipsilateral paralysis of cranial nerves numbers IX ,X, XI, XII, and sometimes cranial nerve number VII, and it can also involve the cervical ganglia of the sympathetic trunk. Paralysis is caused by a lesion in the posterior retroparotid space, e.g. glomus tumors (most frequently).

P/S: Looks like the V syndromes concern more on the jugular foramen nerve thingy...

4. Foix-Jefferson syndrome ( also known as Also known as: Godtfredsen's disease, Foix’ syndrome II)

Syndrome of trigeminal neuralgia, oculomotor paralysis, XIIth nerve paralysis and ophthalmoplegia, due to invasion of nasopharyngeal tumours into the base of the skull and adjacent structures, and compression of the hypoglossal nerve by enlarged retropharyngeal lymph nodes. Generally similar to the Jacod’s syndrome (retrosphenoidal syndrome). From http://www.whonamedit.com/synd.cfm/1525.html

Foix-Jefferson syndrome: Formation of a blood clot composed of platelets and fibrin in the CAVERNOUS SINUS of the brain. Infections of the paranasal sinuses and adjacent structures, CRANIOCEREBRAL TRAUMA, and THROMBOPHILIA are associated conditions. Clinical manifestations include dysfunction of cranial nerves III, IV, V, and VI, marked periorbital swelling, chemosis, fever, and visual loss. (From Adams et al., Principles of Neurology, 6th ed, p711)

Sounds like: cavernous sinus thrombosis? http://www.wrongdiagnosis.com/medical/foix_jefferson_syndrome.htm

So that's all for the weirdo names. One thing interesting are that they concern on neurology. Though some names can be quite confusing.

Atrioventricular Septal Defect

Two types, namely partial and complete. Important point here is that this condition is most related to Down syndrome.

Partial: Primum atrial septal defect combined with cleft mitral valve. I can't find any good source related to this, but I do find this.

http://www.med.yale.edu/intmed/cardio/chd/e_cleft_mv/index.html

Well, I can't differentiate which is what. (where the hell is the cleft mitral valve? ==) I found this from: http://www.mayoclinic.org/atrial-septal-defect/types.html

A mitral valve cleft is a slit-like or elongated hole in one of the leaflets (anterior leaflet) that form the mitral valve.

Check out some cool pictures from there ya?

Complete: Common atrioventricular canal. How about this in http://en.wikipedia.org/wiki/Atrioventricular_septal_defect Look at the picture there. I think it's self explanatory.

Short cases for MRCP

http://www.mrcophth.com/commonshortcases/commonshortcasesindex1.html

I was looking at this part of the case: http://www.mrcophth.com/ptosis/ptosiscommoncases.html#mgjw

Maybe I didn't tell everything. Lolz. I was checking out the "down-and-out" phenomenon of the CN III palsy. http://www.mrcophth.com/ptosis/thirdnerveplasy.html

Play odds. What is the cause of CN III palsy? Uncal herniation...(lolz, play odds)