These two lesions occuring in relation with shoulder dislocation can stump someone if asked in an MCQ as to which lesion is specifically related to which structure.
Remember the sentence-
" Sacks of money are deposited in a bank"
In a similar way, the head of humerus is 'deposited' (articulates within) the glenoid cavity.
Thus,
Hill Sach's lesion occurs on the humeral head.
Bankart's lesion occurs on the anterior glenoid labrum.
Now, how to remember whether is it the anterior or the posterior labrum?
Remember that anterior dislocation of the humeral head is the commonest occurence. That will leave no confusion.
That's all!
-Sushrut Dongargaonkar
Hello everybody, so today's post will be a little long so kindly bear with me.
I hope that this post helps you and makes interpretation of an x-ray less daunting and more fun.
So let's get started.
Step 1:
Always place the x-ray in a such a way so that it seems you are facing the patient.
So naturally this is only possible with AP(Anteroposterior) and PA (Posteroanterior) views.
The technicians mark the X-ray indicating the side but chest x-rays are sort of independent of side markers due to the position of the left ventricle and the aortic knuckle.
Step 2:
To interpret a chest x-ray you need to think in layers as in from outside-in or from inside-out, with one type of structure at a time.
Do a targeted search rather than just staring at the radiograph, an abnormality is unlikely to strike unless you look for it in a planned manner.
Your eyes should scan each part of the film and one should always look twice in the regions where mistakes are more likely, like the Apices in a PA view and the region over the spine in a lateral view.
Step 3:
Scan the whole radiograph in a sequence:
Identify AP or PA view.
Check for side markers.
Radiographic exposure.
Check for integrity of bony cage.
Begin with lung Apices.
Upper middle and lower zones.
Check the Cardiophrenic angles.
Mediastinal structures.
Soft tissues.
Step 4:
Then Detect the lesion : Where is the lesion and what structures are affected by it. Starting with
Trachea and Bronchi:
Position,shift and deviation.
Mediastinal Lines:
Paratracheal stripes: visible or lost.
Aortopulmonary Window: Fullness or normal.
Paraspinal Lines: bulging or normal.
Hilum and Cardiac prominences, and see cardiogenic or mediastinal cause for the prominence.
Lungs :
Check for the Lung Volumes, Right or left lung densities,Diffuse lung abnormalities.
Whether the lesion is Pulmonary or Extrapulmonary. If pulmonary whether it is focal or diffuse.
Pleura and Fissures : Check for pleural effusion and pleural based masses.
Bones :
Focal injuries
Rib fractures, Notching.
Shoulder girdle and clavicles .
Step 5:
Directed search in an apparently normal chest x-ray.
Lungs :
See the Hidden lung areas like retrocardiac and retroclavicular areas.
Also check for Pulmonary Embolism.
Mediastinum : Check for the Posterior mediastinal masses and hilar masses.
Step 6:
Describe the Lesion :
Location and Extent of the lesion.
Characteristics in the form of :
Shape
Homogeneity
Calcification
Necrosis
Associated features of trachea, lungs fissures etc.
Step 7:
In the end.
Put up a provisional diagnosis.
Differentiate from the closer/similar diagnoses.
Put up a final diagnosis.
A breif description on the Management.
Viola! We are through our way describing a chest x-ray!
Reading any radiograph has its learning curve and the more we see the more we learn.
Try and describe all the radiographs you see hence forth in the manner mentioned above or anyway you like it but follow a definite protocol and don't miss any important points.
I hope this post was helpful.
Let's Learn Together!
-Medha.
Hello everybody!
So today let's learn a bit about how our brain circuits work.
Some people hate cheese. Like seriously?
How can you miss the warm fussy feeling you get while eating warm molten cheese in a Fondue!
Well some people might not feel any bit of it and rather feel disgusted when presented with cheese.( I feel bad for them )
Anyway let's see how these things work.
Why aversive to cheese per say?
Cheese is the food that most frequently triggers aversion.
Among those with an aversion to cheese, 20% say they are intolerant to lactose. In 50% of cases, at least one of their family members does not like cheese either. These stats suggested that there is a genetic origin to this aversion, which might be related to lactose intolerance.
To find out what happens in the brain, people who like cheese and who do not were selected and participated in a functional magnetic resonance imaging (fMRI) study.
They observed that the ventral pallidum which is activated in people who are hungry was totally inactive in people who had an aversion to cheese but was active for all other food types. Also the Globus Pallidus and Substantia Nigra part ( the reward circuit) was more active in people who had aversion to cheese than in those who do.
So in conclusion, the areas of reward centres of our brain the Globus Pallidus and Substantia Nigra have two types of neurons with complementary activity , one relating to the rewarding aspect of food and other to it's aversive nature.
So now we have a breif idea as to how the brains are wired differently and how we all our special in our own ways!
Let's learn Together!
-Medha.
One can get confused on hours end as to what fracture is related to what bone. Hope this mnemonic comes in handy!
1. MUFC( Manchester united fan club)
- Monteggia upper ulnar fracture
With radial head dislocation
2. GFR low(Glomerular filtration rate)
- Galeazzi fracture radial, lower
With distal radio ulnar subluxation
That's all!
-Sushrut Dongargaonkar
Hi.
Like the title suggests, this post is on treatment of erythema migrans in early Lymes disease.
For non pregnant adults and children ≥8 years of age with early Lyme disease: Doxycycline, amoxicillin, or cefuroxime axetil.
Why is doxycycline preferred for most patients with early localized Lyme disease?
Because it is effective against both Lyme disease and human granulocytic anaplasmosis.
Children <8 years of age or pregnant women with early localized Lyme disease: Amoxicillin or cefuroxime axetil.
Doxycycline is not recommended for children under the age of eight years or for pregnant or lactating women.
Why?
Because of severe adverse effects, including teratogenicity, permanent yellowish-brown teeth discoloration after in utero exposure and in children under 8 years of age and more rarely fatal hepatotoxicity reported in pregnant women.
That's all!
-IkaN
Hey guys, Ikan posted a clinical vignette based on this differentiation. So I did a little digging.
Both Akathisia and RLS can be caused due to antipsychotics, Akathisia goes more with typical ones and RLS with atypical ones.
Besides RLS has some other characteristic features:
1. Associated with dysesthesia originating in legs whereas in case of akathisia patient feels like it's originating in the central core of the body.
2. RLS has evening-predominance, it disturbs sleep of the patient as the patient jerks his legs during sleep which might be noted by his gf or wife.
3. There is positive family history in RLS.
4. RLS can be induced by other centrally acting drugs like Diphenhydramine, Citalopram, Clonazepam etc if there is a positive family history.
Treatment:
First intervention should always be reduction of dose of antipsychotics.
While RLS responds well to dopamine agonists like Pramipexol and Ropinirole, Akathisia responds well to Mirtazapine, a tetracyclic antidepressant. Although withdrawing the causative drug works the best.
According to latest clinical trial reports, The first line treatment of akathisia is propranolol, second line is Benztropine and if these doesn't work we resort to benzodiazepines.
That's all! You never stop learning.
-VM
