Prostate-Specific Antigen (PSA) Test

• Total PSA (tPSA):

o Measures overall PSA levels in the blood.

o Used as the primary screening test.

• Free PSA (fPSA): 

o Measures unbound PSA.

o Lower free PSA percentage suggests a higher cancer risk.

• PSA Density (PSAD): 

o Adjusts PSA levels based on prostate volume

o Helps differentiate BPH from cancer.

• PSA Velocity (PSAV): 

o Tracks PSA level changes over time.

o Rapid increase may indicate aggressive cancer.

• PSA Doubling Time (PSADT): 

o Measures how quickly PSA levels double.

o Faster doubling suggests more aggressive cancer.

• Pro-PSA & Prostate Health Index (PHI): 

o Includes p2PSA, total PSA, & free PSA

o To improve cancer detection & reduce unnecessary biopsies.

• 4Kscore Test: 

o Evaluates four PSA-related proteins along with clinical factors.

o To estimate the risk of high-grade cancer.

• PCA3 Test: 

o Urine-based genetic test detecting PCA3 mRNA.

o Highly specific to prostate cancer.

• IsoPSA Test: 

o Analyzes PSA structural changes to distinguish benign conditions from cancer.

 

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SIRS vs Sepsis

 

Systemic Inflammatory Response Syndrome (SIRS)

• Non-specific (infections vs non-infectious)

• ≥2 of the following:

o Temp >38°C or <36°C

o HR >90 bpm

o RR >20 or PaCO₂ <32 mmHg

o WBC >12,000/mm³, <4,000/mm³, or >10% bands

Sepsis

• Organ dysfunction due to dysregulated host response to infection.

• SOFA score increases by ≥2.

• qSOFA (≥2 indicates high risk):

o Altered mental status (GCS <15)

o RR ≥22/min

o SBP ≤100 mmHg

Severe Sepsis (Obsolete Term in Sepsis-3, 2016)

• Sepsis + tissue hypoperfusion/organ dysfunction.

Septic Shock

• Sepsis + circulatory failure

o Hypotension requiring vasopressors (MAP <65 mmHg).

o Lactate >2 mmol/L 

Management (Surviving Sepsis Campaign Guidelines)

• Early recognition & treatment (within 1 hour)

• IV fluids (30 mL/kg crystalloid in 1st 3 hours)

• Broad-spectrum antibiotics ASAP

• Vasopressors (norepinephrine) if MAP <65 mmHg

• Source control (drain abscesses, remove infected devices)

• Supportive care (oxygenation, ventilation, glycemic control, DVT/stress ulcer prophylaxis)

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Guillain–Barré syndrome (GBS)

(aka: Landry–Guillain–Barré–Strohl syndrome:

• Most common cause of acute flaccid paralysis
• Rapidly progressive ascending paralysis & areflexia
• Autonomic dysfunction, CSF albumin-cytologic dissociation.
• The sensory and motor systems may be equally affected. 
• The paralysis moves rapidly from lower to upper areas.

Differential diagnosis:

• Myasthenia gravis: Intermittent & worsened by exertion.
• Multiple Sclerosis: CNS demyelination, hyperreflexia, multiple lesions on MRI, oligoclonal bands in CSF.
• Botulism: Descending weakness fixed dilated pupils, food/wound toxin exposure & prominent cranial nerve dysfunction with normal sensation.
• Tick paralysis: Ascending paralysis but spares sensation.
• West Nile virus: Headache, fever, & asymmetric flaccid paralysis but spares sensation.
• Transverse myelitis: Pain, weakness, abnormal sensation, urinary dysfunction, sensory level, hyperreflexia, spinal cord lesion on MRI.
• CIDP: Chronic progression, relapses, requires long-term immunotherapy.
• Spinal Cord Compression: Hyperreflexia, sensory level, MRI shows mass or compression.

 

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Lower extremity edema

Lower extremity edema is a multifaceted clinical presentation characterized by the abnormal accumulation

 of interstitial fluid within the subcutaneous tissues of the lower limbs. This phenomenon often manifests

 as visible swelling, which may be pitting or non-pitting in nature, contingent upon its underlying etiology.

 The pathophysiology involves an intricate interplay of increased capillary hydrostatic pressure, reduced

 oncotic pressure, lymphatic obstruction, or enhanced capillary permeability. Etiologies are diverse,

 spanning systemic conditions such as congestive heart failure, chronic kidney disease, and hepatic

 dysfunction, to localized factors like venous insufficiency, lymphedema, or trauma. A meticulous history

 and physical examination, supplemented by diagnostic adjuncts including duplex ultrasonography or

 laboratory investigations, are imperative to delineate the causative mechanism and guide targeted

 intervention.

 

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Palm Rashes

Common features and patterns:

• Color:

1. Red or erythematous: Common in inflammatory or allergic reactions.
2. Purple or purpuric: May suggest vascular or hematologic issues, such as small blood vessel inflammation (vasculitis).
3. White or hypopigmented: Seen in fungal infections or depigmentation disorders.
4. Brown or hyperpigmented: May occur in chronic skin conditions or post-inflammatory hyperpigmentation.

• Texture:

1. Flat (macular): Rash appears as flat, discolored spots.
2. Raised (papular or nodular): Bumps that may be small or large.
3. Scaly or flaky: Seen in psoriasis or fungal infections.
4. Smooth or shiny: Can occur in viral rashes or early dermatitis.

• Moisture:

1. Dry and cracked: Common in eczema or chronic irritation.
2. Moist or oozing: May suggest infection, blistering, or acute contact dermatitis.

• Distribution:

1. Symmetrical: Seen in systemic causes like eczema, psoriasis, or drug reactions.
2. Localized: Often indicates contact dermatitis or insect bites.
3. Peripheral patterns: Rashes that concentrate around the edges of the palms can be seen in certain fungal infections.

• Associated Symptoms:

1. Itching: Common in eczema, scabies, or allergic reactions.
2. Pain or burning: Suggests irritation, infection, or vascular issues.
3. Blisters: Seen in contact dermatitis, hand-foot-and-mouth disease, or bullous skin conditions.
4. Peeling or desquamation: Seen after infections (e.g., scarlet fever) or in conditions like Kawasaki disease.

• Causes & Features:

1. Contact Dermatitis: Red, itchy patches, sometimes with vesicles or blisters.
2. Atopic Dermatitis: Chronic, itchy, scaly rash; may worsen with exposure to irritants.
3. Psoriasis: Thick, scaly, silvery patches, often with well-defined edges.
4. Hand-Foot-and-Mouth Disease: Small, red spots or blisters on palms, soles, and sometimes around the mouth.
5. Fungal Infections (Tinea Manuum): Asymmetric scaling and redness, often with peeling.
6. Scabies: Small, red papules with linear burrows, typically between fingers.
7. Drug Reactions: Diffuse rash that can affect the palms, often accompanied by systemic symptoms.

 

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