Important Triads in Medicine

►TRIAD OF ALPORT'S SYNDROME --
• SENSORINEURAL DEAFNESS,
• PROGRESSIVE RENAL FAILURE,
• OCULAR ANOMALIES
►TRIAD OF BEHCET'S SYNDROME --
• RECURRENT ORAL ULCERS,
• GENITAL ULCERS,
• IRIDOCYCLITIS.
►BECK'S TRIAD --
• MUFFLED HEART SOUND,
• DISTENDED NECK VEINS,
• HYPOTENSION.
►CHARCOT'S TRIAD --
• PAIN+FEVER+JAUNDICE
►GRADENIGO'S TRIAD -
• SIXTH CRANIAL N. PALSY,
• PERSISTANT EAR DISCHARGE,
• DEEP SEATED RETRO-ORBITAL PAIN
►Triad Of Hypernephroma --
• pain+
• hematuria+
• renal Mass.
►Triad of Wilm's tumor:
• Fever +
• Mass +
• Hematuria
►Hutchinson's Triad ---
• Hutchison's Teeth,
• Interstitial Keratitis,
• Nerve Deafness.
►Triad Of Kwashiorkar-
• Growth Retardation,
• Mental Changes,
• Edema.
►Saint's Triad ---
• Gall Stones,
• Diverticulosis,
• Hiatus Hernia.
►Trotter's Triad --
• Conductive Deafness,
• Immobility Of Homolateral Soft Palate,
• Trigeminal Neuralgia.
Mnemonic: NPC- neuralgia, palatal paralysis, conductive deafness
►VIRCHOW'S TRIAD --
• STASIS+
• HYPERCOAGULABILTY+
• VESSEL INJURY.
►SAMTER'S TRIAD --
• ASPIRIN SENSITIVITY,
• BRONCHIAL ASTHMA,
• NASAL POLYP.
►Grancher's triad--
• lessened vesicular quality of breathing,
• skodaic resonance, and
• increased vocal fremitus; seen in early pulmonary tuberculosis.
►Osler's triad--
• telangiectasis,
• capillary fragility, and
• hereditary hemorrhagic diathesis seen in hereditary hemorrhagic telangiectasia.
►BARTTER'S SYNDROME -
• METABOLIC ALKALOSIS,
• HYPOKALEMIA,
• NORMAL OR DECREASED BP.
►Weil's Disease--
• Hepatorenal Damage,
• Bleeding Diathesis,
• Pyrexia.
►Meniere's Disease --
• Vertigo,
• Tinnitus,
• Sensorineural Hearing Loss.
►Melkersson Rosenthal Syndrome--
•recurrent Facial Palsy,
•Plication Of Tongue,
•Facial Edema.
►Parkinsonism--
•Rigidity,
•Tremor
•Hypokinasia
►Cushing's traid --
•Bradycardia,
•hypertension &
•irregular respirations in increased intracranial
pressure.
►Kartagener’s Syndrome--
•bronchiectasis,
•Recurrent sinusitis, and
•Situs inversus.
►Hemobilia(Triad of Sandblom)--
•Malena,
•Obstructive jaundice,
•Biliary colic.
►Murphy's triad(in order)-
•Pain,
•Vomitting,
•Fever.
►WHIPPLE'S TRIAD Of INSULINOMA--
•HYPOGLYCAEMIA DURING ATTACKS,
•S.GLUCOSE <40 mg%,
•PROMPT RELIEF ON GLUCOSE ADMINISTRATION.
►Triad of HUS
•hemolytic anemia +
•acute renal failure +
•thrombocytopenia
►Triad of alkaptonuria
•Homogentistic aciduria
• Black pigmentation of cartilage and collagenous tissue
•Ochronotic arthritis
►Classic triad of Chronic mercury poisoning
•Excessive salivation and gingivitis
•Tremors
•Neuropsychiatric changes
►Adams triad or Hakim's triad for Normal Pressure •Hydrocephalus
•urinary incontinence,
•gait disturbance, and dementia
►Bezold's triad: Three symptomatic indications of otosclerosis:
•diminished aural perception of low frequency tones,
• retarded bone conduction,
• negative Rinne test
►Hand-Schüller-Christian disease triad of
•exophthalmos,
•lytic bone lesions (often in the skull), and
•diabetes insipidus
►UNHAPPY TRIAD
An unhappy triad (or terrible triad, "horrible triangle", O'Donoghue's triad or a "blown knee") is an injury to the anterior cruciate ligament, medial collateral ligament, and the meniscus. The triad refers to a complete or partial tear of the anterior cruciate ligament, medial collateral ligament, and the meniscus.
►Dieulafoy's triad:
•hyperesthesia of the skin,
•exquisite tenderness and
•guarding over McBurney's point, considered a classic sign of acute appendicitis
►Vogt Triad of tuberus sclerosis: Mental Retardation Adenoma Sebaceum Seizures
►Miller fisher syndrome:Variant of GBS. It usually affects the eye muscles first and presents with the triad of •ophthalmoplegia, •ataxia, and •areflexia.
►Classic triad of Wernicke encephalopathy are •encephalopathy, •ataxic gait, •ophthalmoplegia!
►Carney Triad :::
•gastric epithelioid leiomyosarcoma (these are now known to actually be malignant gastrointestinal stromal tumors),
• pulmonary chondroma, and
•extra-adrenal paraganglioma. .
►Atta's triad of bilharzial dysentery:-.
•Bleeding per rectum.
•Polyposis.
•Clubbing of fingers
►Loeys-Dietz syndrome is phenotypically distinct from Marfan syndrome... Loeys-Dietz syndrome is an aggressive, autosomal dominant condition that is distinguished by the triad of
•arterial tortuosity and aneurysms,
•hypertelorism (widely spaced eyes), and
•bifid uvula or cleft palate.
►Classic triad in Gardner's Syndrome:
colonic polyps
bone tumors
soft tissue tumors
►Borchardt's triad
epigastric pain, nausea, inability to pass nasogastric tube.. seen in gastric volvulus
►Triad of shaken baby syndrome:
•subdural
•hematoma , retinal hemorrhage , and
•cerebral oedema.
►Beck's cognitive triad is a triad of types of negative thought present in depression:
•The self (i.e., self is worthless)
•The world/environment (i.e., world is unfair), and
•The future (i.e., future is hopeless).
►Felty triad
•Neutropenia
•RA
•SPlenomegaly
►Behcet's syndrome
The clinical triad of uveitis with recurrent oral and genital ulcers--
►Macdonald triad
The Macdonald triad is a set of three behavioral characteristics which are associated with sociopathic behavior. These behavioral characteristics are found in the childhood histories of individuals with sociopathic behavior:
•Enuresis (bedwetting)
•Firesetting
•Torturing small animals
►MARSHALL'S TRIAD, when considering the pathology of
trauma of bomb explosions. The triad includes
•punctate-bruises,
•abrasions and
•small punctate lacerations all of which are typically found in an explosive bomb blast. Although many similarities exist between injury patterns seen in lightning and concussive injuries, Marshall's Triad findings are not typically found in lightning strike injuries.
►Van der Hoeve syndrome presents with the triad of •osteogenesis imperfecta,
•otosclerosis and
•blue sclera.
►Classical triad of Aortic stenosis(valvular dx)-
• dyspnea,
• angina and
• syncope.
►the classic Rigler's triad of gallstone ileus:
• pneumobilia;
• small bowel obstruction; and
• an ectopic gallstone
►VIRchow’s triad for venous thrombosis:
Vascular trauma
Increased coagulability
Reduced blood flow
►Mackler's triad which includes
• chest pain,
• vomiting and
• subcutaneous emphysema,
while classical, is only present in 14% of
people with Boerhaave syndrome .
►Ohashi triad:
• Neoplasms with mucin hyper— production,
• dilatation of the duct of Wirsung, and
• protruding papilla (the Ohashi triad)
►Abnormalities in Congenital Rubella: Triad of Gregg :
• cataract,
• deafness, and
• heart defect
►Currarino syndrome (or triad) is defined as a partial sacral agenesis associated with a presacral mass and ano-rectal malformation.
►Triad of alkaptonuria
• Homogentistic aciduria
• Black pigmentation of cartilage and collagenous tissue
• Ochronotic arthritis
►Dieulafoy's triad::
• Hypersensitivity of the skin,
• tenderness and
• muscular contraction at McBurney's point in acute appendicitis.
►Triad of somatostatinoma
• Diabetes mellitus
• Steatorrhoea
• Cholecystolithiasis

SINOATRIAL BLOCK ::

First Degree SA block
-- Delay between impulse generation and transmission to the atrium.

Second Degree SA block, Type I (Wenckebach)
-- Progressive lengthening of the interval between impulse generation and transmission, culminating in failure of transmission.

Second Degree SA block, Type II
-- Intermittent dropped P waves with a constant interval between impulse generation and atrial depolarisation

Third Degree SA Block
= None of the sinus impulses are conducted to the right atrium.

AV NODAL RE - ENTRANT TACHYCARDIA (AVNRT)

FAST SLOW AVNRT 

-- Accounts for 10% of AVNRT

--Associated with Fast AV nodal pathway for anterograde conduction and Slow AV nodal pathway for retrograde conduction.

-- Due to the relatively long ventriculo-atrial interval, the retrograde P wave is more likely to be visible after the corresponding QRS.

ECG FINDINGS ::

-->QRS-P-T complexes.
-->Retrograde P waves are visible between the QRS and T wave.

ECG image ::

Narrow complex tachycardia ~ 120 bpm.
Retrograde P waves are visible after each QRS complex — most evident in V2-3.

BRUGADA SYNDROME

BRUGADA SYNDROME :: 

Type 1 (Coved ST segment elevation >2mm in >1 of V1-V3 followed by a negative T wave) is the only ECG abnormality that is potentially diagnostic. This has been referred to as Brugada sign.

Type 2 has >2mm of saddleback shaped ST elevation.

Brugada type 3 can be the morphology of either type 1 or type 2, but with <2mm of ST segment elevation.

Diagnostic Tests for Valvular heart disease.

The best initial test for all valvular heart disease is the echocardiogram.
Transesophageal echo is generally both more sensitive and more specific than transthoracic echo.

Catheterization is the most accurate test. Catheterization allows the most precise measurement of valvular diameter, as well as the exact pressure gradient across the valve.

There is nothing specific about the EKG in those with valvular heart disease. The EKG is expected to show hypertrophy of chambers, but you cannot confirm a diagnosis of valvular heart disease from an EKG alone.

Acute Rheumatic fever

Acute Rheumatic fever:

►RHD is the most common cause of heart disease in children in developing countries

►ARF is mainly a disease of children aged 5–14 years. Initial episodes become less common in older adolescents and young adults and are rare in persons aged >30 years. By contrast, recurrent episodes of ARF remain relatively common in adolescents and young adults. 

►The most common clinical presentation of ARF is polyarthritis and fever. Polyarthritis is present in 60–75% of cases and carditis in 50–60%. 

►Heart Involvement:
Up to 60% of patients with ARF progress to RHD. The endocardium, pericardium, or myocardium may be affected. Valvular damage is the hallmark of rheumatic carditis. 
MC in Acute cases: MR
MC in Chronic cases: MS
MC overall: MR

►ARF almost always affects the large joints—most commonly the knees, ankles, hips, and elbows—and is asymmetric. 

►Sydenham's chorea commonly occurs in the absence of other manifestations, follows a prolonged latent period after group A streptococcal infection, and is found mainly in females. 
Clinical triad of:
Chorea
Hypotonia/weakness
Emotional lability / OCD / ADHD

►Skin Manifestations: The classic rash of ARF is erythema marginatum, It occurs usually on the trunk, sometimes on the limbs, but almost never on the face.

►The most common serologic tests are the anti-streptolysin O (ASO) and anti-DNase B (ADB) titers.

►The mainstay of primary prevention for ARF remains primary prophylaxis (i.e., the timely and complete treatment of group A streptococcal sore throat with antibiotics). If commenced within 9 days of sore throat onset, a course of penicillin (as outlined above for treatment of ARF) will prevent almost all cases of ARF that would otherwise have developed.

Must know about Rheumatoid arthritis (RA)

►Rheumatoid arthritis (RA) is the most common form of chronic inflammatory arthritis and often results in joint damage and physical disability.

►Pleural disease, the most common pulmonary manifestation of RA, may produce pleuritic chest pain and dyspnea, as well as a pleural friction rub and effusion. 

►The earliest involved joints are typically the small joints of the hands and feet. The initial pattern of joint involvement may be monoarticular, oligoarticular (4 joints), or polyarticular (>5 joints), usually in a symmetric distribution. 

►Once the disease process of RA is established, the wrists, metacarpophalangeal (MCP), and proximal interphalangeal (PIP) joints stand out as the most frequently involved joints 

►Inflammation about the ulnar styloid and tenosynovitis of the extensor carpi ulnaris may cause subluxation of the distal ulna, resulting in a "piano-key movement" of the ulnar styloid. 

►Flatfoot deformity is by far the most common hindfoot deformity in rheumatoid arthritis

►One of the most common manifestations of RA in the
hands is tenosynovitis in flexor tendon sheaths; this can
be a major cause of hand weakness.

►The atlantoaxial joint is
prone to subluxation in several directions and is summarized
later.
• The atlas can move: anteriorly on the axis (most
common). > Posteriorly > Vertically
•The earliest and most common symptom of cervical subluxation
is pain radiating up into the occiput.

►RA can be associated with generalized osteopenia
and osteoporosis owing to the effects of drugs
The fibula is the most common fracture site.

►The most frequent site of cardiac involvement in RA is the pericardium. 
Mitral regurgitation is the most common valvular abnormality in RA.

►Rheumatoid vasculitis is seen most commonly in patients with long-standing disease, a positive test for serum RF, and hypocomplementemia; the overall incidence is quite rare, occurring in no more than 1% of cases.

►The most frequently recognized skin lesion in RA is the
rheumatoid nodule. They occur most often on extensor surfaces or pressure points, such as the olecranon process and the proximal ulna, as well as on tendons.
They are subcutaneous and vary in consistency from a soft,
amorphous, entirely mobile mass to a hard, rubbery mass
attached firmly to the periosteum.

►Ocular Keratoconjunctivitis sicca is the most common ophthalmic manifestation of rheumatoid arthritis, with a reported prevalence of 15–25%.

►The most common flexor tendon to rupture in rheumatoid arthritis is FPL rupture, caused by scaphotrapezial synovitis. 

►A normochromic, normocytic anemia often develops in patients with RA and is the most common hematologic abnormality. 

►Felty's syndrome is defined by the clinical triad of neutropenia, splenomegaly, and nodular RA and is seen in less than 1% of patients.

►The most common histopathologic type of lymphoma is a diffuse large B-cell lymphoma.

►The overall mortality rate in RA is two times greater than the general population, with ischemic heart disease being the most common cause of death followed by infection. 

►IgM, IgG, and IgA isotypes of RF occur in sera from patients with RA, although the IgM isotype is the one most frequently measured by commercial laboratories.

►Muscle: In biopsy specimens, atrophy of type II fibers is most
common.

►AZA is most commonly used as a substitute
for MTX when there are contraindications or intolerance
to MTX