1. ....."Hi...how are you? Grow up!" ..... This was in the context of a patient presenting with a decreased level of consciousness. kind of a tough one. He is referring to a Hygroma - namely, a pocket of cerebrospinal fluid (CSF) in the subdural space. Large hygromas can cause focal neurologic deficits and mental status changes. They can result from head trauma. CT showing a subdural hygroma below.
2. ....."The result of any mass on the cortex...What do soldiers and scouts do? They march."....He is referring to a Jacksonian March - where seizure activity spreads through the primary motor cortex, resulting in the clonic activity of the corresponding area of the homunculus. This often starts on the hands and moves more proximally.
3. ...."Flappy hands...you're going to flap again"....This was mentioned in the context of Hepatitis C infection. He is referring to Asterixis, commonly seen in hepatic encephalopathy, uremic encephalopathy, and hypercarbia.
4. ...."Does our patient have respiratory distress?....did you bring your purse?".....Referring to pursed lip breathing - one of the physical signs of respiratory distress. Other signs to look for include positioning (sitting up, leaning forward, 'tripoding'), nasal flaring, use of accessory muscles (intercostal retraction, use of trapezius and sternocleidomastoids), and paradoxical breathing - the inward movement of the diaphragm on inspiration.
5. ...."He has hypotension and tachycardia, and he sounds sick. What is going on? Think of something...ummmmm....seppie."..... Okay, this is not the hardest one, but I thought it was funny. He is referring to sepsis. I just liked the use of the word "seppie".
Some helpful links to the case we discussed:
- An approach to decreased level of consciousness can be found here.
- An approach to Acid-Base issues can be found here.
- Stigmata of chronic liver disease can be found here.