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Sign of the day
DOI’S SIGN
This is specific to
LAMBERT EATON MYASTHENIC SYNDROME ,
an autoimmune disorder affecting neuromuscular junction.
THE MANEUVER.
Deep tendon reflexes ( knee or Ankle) are initially assessed & found to be absent or markedly diminished.
The Pt is then asked to maximally contract the relevant muscle for a short period ( Vigorously pushing against resistance)
RESULT
immediately following this maximal contraction, repeating the reflex test will cause the previously absent deep tendon reflexes to successfully appear or significantly strengthen.
THE MECHANISM
The temporary surge in calcium at the nerve terminal during sustained contraction overcomes the synaptic block characteristic of LAMBERT EATON MYASTHENIC SYNDROME.
60% of LEMS is associated with malignancy, most commonly SMALL CELL CARCINOMA OF LUNG
Nerve conduction study shows INCREMENTAL RESPONSE when a nerve repeatedly stimulated.
Blood test-to detect Anti VGCC antibodies
Named after Edward H Lambert & Lee Eaton from Mayo clinic who first described in 1956.
Dr. Prabhakar K
Prof of Medicine
SDUMC, kolar.
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Pals, we’ve started drawing up the #BTBF Plan (Bamboozle The Bath Fairy Plan) inspired by Lems the Golden @haunted_mars 🐾🧚🏻🛁🐶 Inviting feedback from pals, espeshally Pawyers 💖🐕🦜 luv Rocky & Syd 🩵🐩🐤 #saltywavedog #dogsofx
ALT Playful cartoon‑style drawing of Rocket and Syd plotting their Bamboozle The Bath Fairy Plan with a blackboard and map showing the steps they plan to follow. Created with Microsoft Pilot using prompts by the hoo best fren and photos of Rocket & Syd.
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🎵🎶💖🐤 Thank you Lems 🌸🦜🌼🎶🎵 Sending beak-to-boop kisses to you too 🩵🐦🌿 Luv Syd 😘❤️
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Aroooo Lems 💖🐕 Thank you for the compliment 🩵🌼🐶 I think you have star quality handsome good looks pal 🧡🐩 Have a happy weekend ☀️🌴 🐾Luv Rocky & Syd 😍❤️🦜🐶
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Manuel retweeted
May 17
Lems is sooo hot, sexy and perfect sucking that cock and getting cum allover her face 😍💦😘🥵
DRILL FROM FRONT
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Jun 13
早速LEMSさんへ🎶
目的はラーメ…🍜
いやいや🤭MORIZO RRイジり✨
①低ダストブレーキパッド
まだ2回しか乗ってないのにホイールは既にまっ茶💦
帰宅後確認しましたが全くついていませんでした😊
②ブラックエンブレム フロント
めっちゃカッコいい✨
今日もありがとうございました🙇
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Jun 13
Mengawali malam minggu dgn bahagia trs tbtb aku masuk angin dan pusing trs skrg lems🫠
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