• sticky

November 26, 2015 11:03 pm

প্রকাশকঃ

Answers mostly Assembled from the participants’ Answer
PLATFORM CME Contest:1

Identify NAMED FACIES:
(All contest photographs are taken from Davidson/Macleod/Hutchisons/Abdullah text book)

1

1a

1b
1 FLAT FACE:
Flat nasal bridge and protruded tongue with Opened small mouth, almond shaped eyes(due to epicanthal folds), and upward slanting eyes(seen in 1a), light-colored spots in their eyes (called Brushfield spots),low set small ears, hypertelorism(increased distance between two orbits), high arched palate with small teeth, idiotic look.

1a was a clue for diagnosis, i.e other than facial features, single palmar crease (also known as Simian crease-মজার ব্যাপার হচ্ছে এটা বলা যাবে না, কারণ মানুষের হাতে সাধারণত তিনটা রেখা থাকে, বানর গোত্রীয় প্রাণীদের হাতে একটা রেখা থাকে, Simian crease এর বদলে single palmar crease বলতে হবে, বিজ্ঞান বিবর্তনবাদের বানর থেকে মানুষ প্রমাণ করে দিচ্ছে অথচ Simian crease বলাটা অপমানজনক মনে করছে)। Widely separated 1st and 2nd toe is also diagnostic.

Diagnosis: Down’s Syndrome

{Down’s Syndrome is important for 1st prof Anatomy Written(Genetics+Embryology), 2nd Prof Pathology Written(Again Genetics), Final Prof(Medicine+Pediatrics), FCPS part 1 MCQ(all subject Basic part), MRCP part 1(Clinical Science section),MD residency/M.phil admission test MCQ(Basic part), খাঁটি বাংলায় বাবা না পড়ে যাবা কই, না পড়লে কোথাও না কোথাও ডাউন সিন্ড্রোম ডাউন দিবে :P}

2

2a
2 MONGOLOID FACE:
Frontal bossing, depressed bridge of the nose, hypertelorism, malar prominence, dental malocclusion, mild icterus, pallor. It is also called Chimpunk Facies.
Diagnosis: Hereditary Haemolytic Anemia(Beta-Thalassaemia Major)

{Thalassaemia Major is important for 1st Prof Physiology Viva (Hematology), 2nd prof Pathology Viva (Hematology), Final Prof *Medicine (SAQ-Clinical Scenario,Long Case,Short Case-Splenomegally), Pediatrics (SAQ-Clinical Scenario), both Under grad+Post grad-Genetic Counseling OSCE}

*Confusion Breaker: Thalassaemia ছাড়াও Down Syndrome এর Face কেও MONGOLOID FACE বলা হয়, যাঁদের বা যে অসুখের কারণে চোখে Epicanthal Fold থাকে তাঁদের সবাইকেই MONGOLOID FACE বলে। চাইনিজ/থাই/জাপানিজ এদের সবারই MONGOLOID FACE।

3
3 FACIES LEONINA:
Lion like appearance, prominent ridges and furrows of forehead and cheeks. Widespread nodule and infiltration with loss of eye brows and early collapse of nose.
Diagnosis: Advanced Lepromatous leprosy

{Leprosy is important for 2nd Prof Microbiology Written, Final Prof Medicine Written+Viva}

4
4 MASKED FACE:
Mask like expressionless face with less blinks of the eye, fixed and apathetic look(Stare look/Serpentine stare) dribbling of saliva.

Serpentine Stare-এ অসুখে চোখের পলক ফেলা স্বাভাবিকের চেয়ে এত কমে আসে যে মনে হয় রোগীর চোখের পাতাই নেই (সাপের চোখের পাতা থাকে না)। মানুষ সাধারণত মিনিটে গড়ে দশ বার বা প্রতি ২-৮ সেকেন্ডে একবার পলক ফেলে, Parkinson’s Disease এ চোখের পলকের হার কমে, আবার SCIZOPHRENIA তে বাড়ে। একটা স্ন্যাপ দেখে MASKED FACE বলা কঠিন তাই Parkinson’s Diseaseএর সবচেয়ে বিখ্যাত রোগী বক্সার মোহাম্মদ আলীর বিভিন্ন সময় তোলা কিছু স্ন্যাপ গুগল থেকে দেয়া হলো। 4e (1)

4e (1)

4e (2)

4e (3)

4e (4)

Diagnosis: Parkinson’s Disease {Parkinson’s Disease is important for 2nd Prof Pharmacology Written, Final Prof Medicine Viva(Neurology)}

5

5a
5 MALAR RASH(LUPUS FACIES)
Butterfly distribution of Rashes
Diagnosis: Systemic Lupus Erythematosus

SLE নিয়ে অনেক মিথ চালু আছে, ক্ল্যাসিকাল Sign Symptoms এর বাইরেও যে কোন অস্বাভাবিক FEATURE নিয়ে Present করতে পারে। ল্যাটিন শব্দ LUPUS এর মানে নেকড়ে, “Erythro” মানে লাল, নেকড়ের কামড়ে লাল? ফ্রান্সের মহিলারা এই Rash ঢাকতে যে মুখোশ ব্যবহার করতো তার নাম ছিল “Loup” ফ্রেঞ্চ ভাষায় যার মানেও নেকড়েই। নেকড়ে না প্রজাপতি নিয়ে আমরা যেরকম confused, Postgraduation এ মেডিসিনের কোন রোগীর ডায়াগনসিস নিয়ে কোন কনফিউশন হলে SLE ধরে চিকিৎসা শুরু করা হয়। 5b

{SLE is important for Final Prof Medicine SAQ-Clinical Scenario, Viva}
5c
*** Confusion Breaker: Mitral Facies/Malar Rash Vs Butterfly Rash Rosy Coloration of cheeks(duo to vascular stasis) with bluish tinge(duo to arteriovenous anastomosis). Though its seen in Mitral Stenosis patients but its not Pathognomonic may be seen in normal person and other diseased conditions e.g. Hypothyroidism, Polycythemia and PH(photograph given)

6

6a

6b
6 SCLERODERMA FACE (Bird beak face/”Mauskopf”-mousehead facies):
Smooth,shiny,tight face with beaking of nose(Sharp nose),salt and pepper appearence, Microstomia(narrow mouth opening),Lips thin and pursed,pinched nose,loss of wrinkling of forehead.
Diagnosis: Systemic sclerosis

7

7a
7 MYXEDEMATOUS FACE:
Puffy face with peri-orbital swelling,baggy eye lid and malar flush with loss of outer one third of eye brow. Its Also known as Torpid face.
Diagnosis: Hypothyroidism

{Hypothyroidism is important for 1st Prof Physiology Written+Viva,1st Prof Biochemistry Written,2nd Prof Pathology Written+Viva,2nd Prof Pharmacology(for Concept),Final Prof Medicine Viva+Thyroid Examination Short Case,Surgery(ENT) Viva+Thyroid Examination Short Case,Post Graduation all Subject part 1 test তাই খাঁটি বাংলায় থায়রয়েডে একবার হাইপো হয়ে(মাথায় কনসেপ্ট না ঢুকলে) গেলে সারা জীবন টিউব লাইট হয়ে থাকতে হবে}
n.b: রোগীর সাথে ফোনে ১০ সেকেন্ড পালসে কথা বলে আর ৫ সেকেন্ডে হ্যান্ড শেক করে এ রোগ ডায়াগনসিস করতে শার্লক হোমস বা ডাঃ বিধান চন্দ্র হতে হবে না, বলেন তো কেনো?

8
8 CRETINIC FACE:
Idiotic look,large head,sparse hair,broad flat nose with big nostril,widely set eyes( hypertelorism), thick everted lip with macroglosssia(so large protruding tongue), jaundice.

Diagnosis: CRETINISM (Congenital Hypothyroidism)

9

9a

9b

9c
9 AGITATED/TERROR FACE:
Bilateral Exophthalmos with periorbital Oedema/Graves Opthalmopathy- due to Graves disease with Lid Lag(Von Graefe’s sign) and Lid Retraction(Dalrymple’s sign)
Diagnosis: Thyrotoxicosis/Graves Disease

10

10a

10b

10c

10d
10 ACROMEGALIC FACE:
Prominent orbital ridges, large nose,thick greasy skin with Large coarse Facies (thick bones,protruding supraciliary areas,Enlarged Skull,prominent lower jaw/mandible(Prognathism),separation of the lower teeth) and thickening of the lips, spade like fleshy hands.

Diagnosis: Acromegaly

{Acromegaly is important for 1st Prof Physiology Written, Final Prof Medicine Written, MRCP Part 1}

11

11a

11b
11 MOON FACE:
Plethoric puffy round face oily, ruddy, acne, alopecia, increase in facial hair(Hirsutism)

Diagnosis: Cushing’s syndrome.

{Cushing’s Syndrome is Important for 1st Prof Physiology Written+Viva, 2nd Prof Pathology Written, 2nd Prof Pharmacology (for Concept), Final Prof Medicine Written, All post graduation part 1 test)

12
12 RACOON’S EYE (PANDA SIGN)
Periorbital bruises

Diagnosis: Head Injury (Base of the Skull Fracture)

Other important face (Photograph not available in mentioned textbooks)

13 Tabetic face
ptosis with wrinkling of the forehead, unequal small and irregular pupils, sad face`
Tabes dorsalis

14 Congential syphilitic face
saddle nose, rhagades, interstitial keratitis
Congenital syphilis
15 Hepatic facies
shrunken eyes, hollowed temporal fossa, parched lips, muddy complexion of skin, dry face, icterus
Cirrhosis of liver

Collection of Different Facies:
16 Adenoid Facies: Adenoid Hypertrophy
17 Ashen Gray Facies: Myocardial Infarction
18 Bird Facies: Pierre Robin Malformation
19 Bovine Facies: Cranio-Facial Dysostosis
20 Cockayne Facies: Cockayne Syndrome
21 Coarse Facies: Inborn Metabolism Errors
22 Elfin Facies: Wiliam’s Syndrome
23 Frog like Facies: Intranasal Disease
24 Gargoyle Facies: Hurler’s Syndrome
25 Hippocratic Facies: Close to death after prolong Disease
26 Hatchet Facies: Myotonia Atrophica
27 Marshal Halls Facies: Hydrocephalus
28 Monkey Facies: Marasmus
29 Mouse Facies: Chronic Renal Failure
30 Pagetic Facies: Paget’s Disease
31 Potter Facies: Oligohydramnios
32 Plethoric Facies: Polycythemia
33 Ricketic Facies: Rickets
34 Snarling Facies: Myasthenia Gravis
35 Uremic Facies: Uremia

*****Winners of THE PLATFORM CME CONTEST 1
FIRST POSITION JOINTLY: এস এম ফরহাদ (PMC-4),Tashnova Jahan(CMC-54), Anindita Barshan (DJMC-15), Fahim Uddin(KMC-22)
SECOND POISTION JOINTLY: Syed Hasinul Haque (Rahin)(DMC-k65), Afsana Afreen(DMC-k70) Mohammad Forhad Rumi(RMC-51) Sakhawat Sajib(CMC-53)
THIRD POSITION JOINTLY: Zarin Tasnim(MMC-M48), Nasreen Poly(CMC-54)

Special thanks M. A.Hashem (Bangladesh Medical Colllege,BM-25), Tasnuva Ashraf (RpMC-29)

On Behalf Of THE PLATFORM CME CONTEST 1,
Collection, Presentation, Result Supervision: Dr Mohib Nirob,
Resident, BSMMU

Join Our SOCIAL MEDIA: www.facebook.com/Platform.med.bd/ for Next THE PLATFORM CME CONTEST 2 next week.
Platform is only open for BANGLADESHI DOCTORS AND MEDICAL STUDENTS ALL AROUND THE WORLD, Any query please Contact [email protected]

Disclaimer: All the photographs and Medical information mentioned here is strictly for academic purpose not for any kind of treatment or patient management and it is subject to change with improvement of Medical Science.

*****PLATFORM WEBSITE has a vision to enrich medical knowledge based web content for BANGLADESH.

শেয়ার করুনঃ Facebook Google LinkedIn Print Email
পোষ্টট্যাগঃ CME CONTEST 1,

পাঠকদের মন্তব্যঃ ( 0)




Time limit is exhausted. Please reload the CAPTCHA.

Advertisement
Advertisement
.