Lesion located in the right parietal lobe (non dominant lobe).
Friday, June 30, 2017
Hemineglect mnemonic + clock drawing
Lesion located in the right parietal lobe (non dominant lobe).
Torn meniscus and inability to extend the knee
Doubt: Why does torn meniscus present with inability to extend the knee? I don't understand the anatomy correlation.
If there is complete tear, the meniscus (a piece of it) gets dislodged. It gets stuck in the knee joint.
This causes:
Inability to extend the knee.
Pain on extension of the knee.
Why is it called "bucket handle"?
A bucket handle meniscus tear represents a complete tear of the mensicus support or the ligament that holds the meniscus in place. This allows the meniscus to flop over like the handle on a bucket. When the meniscus flips over it becomes stuck in the middle of the knee joint, you lose the ability to fully straighten the knee then you have a “locked knee”.
Explained by Dr. Mustufa Poonawala
The meaning of valgus (with doubt + mnemonic)
Meaning of valgus: A deformity involving oblique displacement of part of a limb away from the midline.
Doubt: Why is genu valgum knock knees? The knees (genu) are displaced towards the midline!
Answer: It's not the knees we consider during the deformity... It's the relationship of distal part with the proximal part at a joint.
Mnemonic: L in vaLgum is for Lateral displacement.
(Conversely, varuM is medial displacement.)
That's all!
Hate the inaccurate naming.
-IkaN
Study group discussion: Queckenstedt Sign
Suppose there is an obstruction to cerebral venous drainage in the left side, and u r doing an LP with manometry. If u occlude the left internal jugular vein, there will be no change in pressure but if u do it on the right side, there will be increase in csf pressure.
Response of Vagus to Systemic Injury.
Hello!
Let's learn/revise.
The vagus nerve exerts several homeostatic influences, including enhancing gut motility, reducing heart rate, and regulating inflammation.
Central to this pathway is the understanding of neurally controlled anti-inflammatory pathways of the vagus nerve.
This neurally mediated anti-inflammatory pathway allows for a rapid response to inflammatory stimuli and also for the potential regulation of early proinflammatory mediator release, specifically tumor necrosis factor (TNF).
Vagus nerve activity in the presence of systemic inflammation may inhibit cytokine activity and reduce injury from disease processes such as pancreatitis, ischemia and reperfusion, and hemorrhagic shock.
This activity is primarily mediated through nicotinic acetylcholine receptors on immune mediator cells such as tissue macrophages.
Furthermore, enhanced inflammatory profiles are observed after vagotomy, during stress conditions.
Let's learn Together!
-Medha.
Thursday, June 29, 2017
Greenish discoloration of Urine
The common causes of greenish discolouration of urine are :
(1) Phenol containing compounds: Promethazine, Propofol, Thymol,
(2) Dyes: Indigo-blue, Indigo carmine, Carbolic acid, Flavin derivatives,
(3 Biliverdin (in cases of long standing obstructive jaundice),
(4) Amitryptyline (anti-depressant),
(5) Pseudomonas infection,
(6) Cemetidine,
(7) Indomethacin,
(8) Methylene blue (bluish )
Monday, June 26, 2017
Hilton's law
The nerve which supplies a muscle of a joint, will also supply the joint and the overlying skin.
Conversely, any nerve that is innervating a joint will also supply the muscles of the joint and the overlying skin.
In humans, we find only 2 exceptions to this general rule:
1) Buccal branch of Mandibular nerve as we all know, pierces the Buccinator muscle. But it doesn't supply the muscle. The innervation of Buccinator is by the Buccal branch of Facial nerve.
2) Sciatic nerve in the Gluteal region....is very closely related to the Pyriformis muscle.... And may occasionally send a fibre that pierces the muscle. But it doesn't supply it. Pyriformis is supplied directly by the sacral plexus(the nerve to pyriformis).
Mithil Jagannath.
Medicowesome 2017.
Sunday, June 25, 2017
Vasculitis Classification : A way out
Here's my way out of the necrotising vasculitis. Pan intended ;;).
So depending on the size of the vessel involved you can classify it as -
1. Large Vessel Vasculitis
2. Medium Vessel Vasculitis
3. Small Vessel Vasculitis
For the first two Remember :
TT PK
So Large vessel = TT
Takayasu Arteritis
Temporal Arteritis (Giant cell Arteritis)
And Medium Vessel = PK
Polyarteritis Nodosa
Kawasaki disease
Now Small Vessel Vasculitis can be classified further. It can be positive for a particular antibody called ANCA or it can be negative. This antibody is purely an association and not a causative one.
ANCA Negative : HCC
H - Henoch Schonlein Purpura
C - Cryoglobulinemia related
C - Cutaneous Leukocyto-angiitis
(Think of crying babies.
Cry = Cryoglobulinemia related Vasculitis
And another baby related Vasculitis is HSP).
Now ANCA positive Vasculitis can be either c-ANCA or p-ANCA depending on what part it stains.
Remember - WC
(Like Western commode)
Wegner's is c-ANCA.
Remember - PCM
p-ANCA in Churg Strauss and Microscopic Poly-angiitis.
Please note - The names of Wegner's and Churg Strauss have been changed to Granulomatosis with Polyangiitis , and Eosniophilic GPA respectively. This is said to be because the scientist Wegener had been discovered to be possibly related to some Nazi war time activities and this opportunity was made the most of to also take a step towards a more pathology-specific name-calling by altering the honorific name given to the disease.
That's all!
Happy studying.
And Stay Awesome !
~ A.P.Burkholderia.
Pills of knowledge in Ophthalm- Retinal haemorrhages
1. Flame shaped haemorrhages are seen when they occur in the superficial layers of the retina because the blood can spread as tight junctions are not present there.
2.Dots and blots show up into the deeper layers because the space to spread for the blood is relatively lesser.
That's all!
Sushrut Dongargaonkar
Saturday, June 24, 2017
Step 2 CK: The algorithm to Management of Ventricular Tachycardia
Well, we did too. So, we are going to post some algorithms in subsequent posts, which will make it easier and save you some time in the preparation. They will guide your thoughts during those timed multiple choice questions.
Ventricular Tachycardia: It's a type of ventricular arrhythmia. The EKG is a must have diagnostic test. Look for wide-QRS-complexes. If the EKG is inconclusive--> telemetry monitoring should be done. If the questions asks, what is the most accurate test to diagnose this patient with V.Tach--> its Electrophysiologic studies.
Now, read very carefully the last line of the question as to what the question is demanding; it could be the next step in management or the test for a definite diagnosis.
The next (VERY IMPORTANT) step is to look at the vital signs and understand if the patient is hemodynamically unstable
(LOOK FOR :
*IS THE B.P. LOW?
*IS THERE CHEST PAIN?
*CHECK THE Respiratory Rate- does the patient complain of shortness of breath/dyspnea,
*LOOK FOR HIS MENTAL STATUS- is the patient confused/has altered mental status? *LOOK FOR SIGNS/SYMPTOMS OF CHF.
If any of these are present--categorize the patient as Hemodynamically Unstable.
And then, follow the chart below for management questions.
We all wanna help others; but do we help ourselves?
{This might be quite a descriptive post. So read this if you don't have exams upcoming recently}
As a Medical student, or a doctor we all are opting for a profession of care for people. But often we forget that the people who need care includes ourselves too.
How should we take care of ourselves.
1. One should take care of one's self.
2. One should take care of one's colleagues.
Do you eat well? Do you sleep enough? Are you spending time with your family? All these fall into such a level about taking care of your ownself.
As medical students we have long weeks and short sleeps. Let's admit, still we don't have enough time.
1. First of all, don't forget to,
EAT WELL. Food is essential for your sustenance. Eat nutritious food. Not just starch and sugary food. Opt for some fruits, yoghurt and more veges.
Our professor said it is better to get yourself a multivitamin complex if you feel like you are running out of enough nutritious food.
SLEEP WELL. Sleep is one of the most important aspects of your daily life. You probably cant sleep 6hrs straight. But get some decent sleep at least for 4hrs. And if you are taking a powernap, try taking it in multiplies of 90mins. I saw it recently in an article 90mins(180/270 etc) of nap improves your ability to wake up fresh as it is appox 1 sleep cycle.
EXERCISE WELL. You dont have hop into University gym and run on those treadmills for your dear life, but obvio try taking a stroll with your friends in the ground, or get a brisk walk to market instead of getting a taxi or riding there.
RELAX WELL. We surely don't have time to sit on a sedan chair and reflect on life or get a bikini/short picnic to the nearest beach when we have an Internal Medicine exam 3 days away. But surely you have time to go grab a coffee and enjoy it without looking at your jumbled up notes. (They aren't much readable anyways 😜jk...), Sit on a short wall and swing your legs like you remember all the drug regimes of the world. Look at the sky from the terrace and try to find a constellation or two that you learned in Grade school. Listen to a song that uplifts you or soothe you depending on your mood. Sketch something (personal secret : I sketch my crushes when I'm stressed 😜). Do something that makes you feel good. Meditation or yoga or something are good too. If spa, manicure pedicure, massage works for you, by all means go for it too.
CHECK-UPS. What is the last time you checked if you have enough Hgb count? Get your personal body checkups. You are only riding that Car, don't forget to check the oil and water levels too. Even a Benz or a BMW can wreck havoc if they don't have enough care. Get yourself done a teethscaling.
ENVIRONMENT. Look at your desk. Does it look like that you just performed an exocism there? 😂 Clean it up yo! Clean your desk. Your room. Keep some airfreshners, keep stuff that motivate you surrounding you. Not things that make you feel like "I'll rather live in the library!". 😜 Get enough Oxygen into your place and for all the love for Zeus, don't get into a room without enough ventilation.
MENTAL HEALTH. Almost every university provides free mental health counselling to its students. What was the last time you used it? Last time I had stress issues with my Neurology final exams, I went to meet a guidance counsellor. She totally listened to me and made me feel good. And another time when I felt like I'm losing my interest and the passion, I talked to my psychiatry professor.I think you should talk to someone qualified about it. And never think talking to a psychiatrist or a counsellor is a bad thing. In the long run it will help you heaps.
2. How to take care of your colleagues.
Ok we don't even have time for ourselves. I agree. But please don't leave those who are around you.
We all are in the same journey. Look out for them. Check if they ate their meals. If they forgot their attendance. Check if they are okay. If their relationships are going well. If they are performing fine in exam. Look out for people around you. Close friends are the first people are recognize depression and anxiety in a person before it attains to clinical levels. If you notice a difference talk to them. Or lead them to talk to someone qualified about it.
If someone is losing marks and failing exams offer to help them. If they ask for support never refuse.
Be a good person to others, this way you will be a good doctor too.
That's it for now folks. Enjoy and always take care of yourselves and others around you.
With love,
Jay
Mnemonico diagnostico: Opacities that may be confused with renal calculus
Mnemonic for opacities on a plain abdominal radiograph that may be confused with renal calculus:
TOP GAME
Tubercular calcified lesions in the kidney
Ossified tip of 12th rib
Phleboliths (calcifications in the wall of pelvic veins)
Gall stones
Appendicular/ Adrenal gland concretions
Mesenteric lymph node calcifications
External (foreign) bodies in alimentary canal (ex., cyclopenthiazide)
Thats all
- Jaskunwar Singh
Answer is not always antibiotics!
Clinical vignette:
Young, non smoker, female comes with complaints of sore throath, dry cough, nasal congestion for 10 days. Now, she feels better however she coughs out yellowish expectoration.
There are scattered wheezes and crackles that clear with coughing.
You've ordered relevant labs and meanwhile the patient asks you if she would need antibiotics. What would your next step be?
Answer: Symptomatic management.
Reason: Since there is a history of preceding viral infection and her current situation indicated Acute Bronchitis, the expectant management would be fairly Symptomatic!
Infact, there are articles that state that giving antibiotics could worsen the patient condition! Also, judicious use of antibiotics can help prevent antibiotic resistance.
Let's fight antibiotic resistance!
Stay awesome!
-Rippie
FENO in asthma: routine clinical testing
One of the additional tests for determining the present status of airways in asthmatics is the measurement of Fraction of Nitric Oxide in Expired air (FENO).
The levels of Nitric oxide are elevated in the presence of inflammation in the airways, that is eosinophilic in nature.
In children <12 years, normal FENO is usually less than 36 ppb. However, in case of allergic inflammation of airways, the levels rise to >50 ppb.
Note that FENO is not diagnostic, but a test for independent prediction of exacerbations in asthmatic patients and is now done routinely in clinical practice, as approved by US- FDA.
Thats all
- Jaskunwar Singh
Friday, June 23, 2017
My Elective experience
Hey guys,
I was off blogging for a while for obvious reasons and I apologise for that. But, hey! Let me share the reason behind it :D
I was off to the States for my Clinical Electives at Mayo Clinic and Cleveland Clinic, so I'm going to briefly write about Electives in this post.
Overview of US Clinical Experience:
A) HANDS-ON Clinical Experience:
- One to one patient contact, can elicit history, perform physical examinations, write notes, suggest plan of care, have full access to patient records
- Considered better as what can be better than hands-on!
- Can be done only before a Medical Student graduates. ( Therefore, you can't do electives if you're already a Doctor -_-)
1. Sub-Internship equivalent to a 4th year US Medical Student
2. Clinical electives are equivalent to a 3rd year US Medical Student
3. Clerkship (This typically is for US Medical students; not applicable to IMGs)
4. Externships
B) NOT HANDS-ON Clinical Experience:
- You only get to observe (hence, Limited role in patient care)
- Can be done while you're a Medical Student or even after you graduate
- Controversial if it can be considered as USCE?
C) RESEARCH ELECTIVE:
- Usually, longer the elective, the better it is! (Increases yield of getting a fruitful publication out of it.
- No outlined criteria, eligibility varies from place to place.
Now,
I typically like to classify Clinical Electives into: (Although, others may classify them based on different criteria, I believe, classifying this way is logical in terms of expenses majorly)
1. USMLE Step 1 required
2. USMLE Step 1 NOT required
[I shall soon write a separate blog on this, pre requisites for elective application and rough expenses soon, so stay tuned as always :D]
About my elective experience:
I had given my USMLE Step 1 while I was in Third year. So, when I got into Fourth year I applied to Universities that had USMLE Step 1 criteria.
As now a days, getting electives is becoming more and more competitive, along with my friends, I applied to IMG friendly elective places well in advance (about 10 months prior for a few places). This also meant that we had to wait for a long time to get our acceptances as they don't send out acceptances until 3-1 month prior to your elective start date.
Fortunately, I got accepted at Mayo Clinic, Rochester for Infectious Diseases elective and at Cleveland Clinic, Ohio for Endocrinology elective! Yippie!! (Big thank you to Ikan for guiding me with the application process)
Both, Mayo Clinic and Cleveland Clinic are amazing places to work at! (And if you don't already know, Mayo Clinic has been ranked no.1 and Cleveland Clinic has been ranked no.2 on U.S. News and World Report's Honor Roll :D)
What to do while you're there?
- Be professional, dress professionally, follow code and conduct of your Hospital or Clinic.
- Take histories, perform physical examinations as required, write patient notes, suggest plan of action and so on...
- Volunteer for case presentations/ talks
- If you find an interesting case while you're rotating there, discuss with your residents/ fellows/ attendings if you can submit it to a journal or present it at any conference.
- If you're interested in research, talk to your attending and try to get involved in one.
- Most importantly, As an IMG, it is crucial for us to get A Strong Letter of Recommendation. If you've been working hard, I am sure, most attendings would agree to write you a Strong LoR! Hurray!
Also, once you are done with your elective, in the following week or so, it is good to write your attendings a courtesy/ Thank you email, so that they know you really learnt during your elective!
Stay awesome!
-Rippie
Lymphedema - High yeild Information.
Hello there!
So today in the surgery OPD I happened to see a case of Lymphedema feet ,and hence thought of reviewing some important points on same.
So, Congenital lymphedema may involve a single lower extremity, multiple limbs, the genitalia, or the face.
The edema typically develops before 2 years of age and may be associated with specific hereditary syndromes -Turner syndrome,Milroy syndrome, Klippel-Trenaunay-Weber syndrome.
Lymphedema praecox is the most common form of primary lymphedema, accounting for 94% of cases.
Lymphedema praecox is far more common in women, with the gender ratio favoring women 10:1.
The onset is during childhood or the teenage years, and the swelling involves the foot and calf.
Lymphedema tarda is uncommon, accounting for <10% of cases of primary lymphedema. The onset of edema is after 35 years of age.
Secondary lymphedema is far more common than primary lymphedema. Secondary lymphedema develops as a result of lymphatic obstruction or disruption.
Other causes of secondary lymphedema include radiation therapy, trauma, infection, and malignancy.
Globally, filariasis (caused by Wuchereria bancrofti, Brugia malayi, and Brugia timori) is the most common cause of secondary lymphedema.
Hope It helps.
Let's Learn Together!
-Medha.
Thursday, June 22, 2017
Pathophysiology and Radiologic patterns of Atelectasis
Pills of knowledge in Ophthalm- Nodal cataract
The condition where 'day blindness' is present is a cataract at the nodal point. Nodal point of the eye is where the rays of light pass through the lens without any refraction, usually at the centre of the lens. Thus, during the day, especially when out in the sun, the pupil contracts and the light has to pass through the cataractous area, causing diminution of vision.
Immunotherapy for Prostate cancer
Immunotherapy is now an emerging and much promising intervention in the treatment of prostate cancer, apart from the traditional cancer treatments - chemotherapy, radiation and surgery.
Wednesday, June 21, 2017
Research Update - The Multitasking Brain.
And you hear the Pinggg!!!
Aha.. GOTHAM needs you!! You shift your focus from the task of studying to the task of on your cellphone,and simultaneously thinking about how good you are at multitasking!
Hematuria: A clinical pearl
Hematuria (blood in urine) may be microscopic or macroscopic/ gross.
The American Urological Association (AUA) defines microscopic hematuria as 3 red blood cells/ high - power field on microscopic examination of the centrifuged urine specimen in two of the three freshly voided, clean- catch, midstream urine samples.
Gross/ visible hematuria can result from as little as 1mL of blood in 1L of urine, and therefore, the color of urine does not necessarily reflect the degree of blood loss.
Now lets have a brief review of the clinical presentation of hematuria on the basis of its source -
- A glomerular source of bleeding (nephronal/ glomerular hematuria) usually results in persistent microscopic hematuria that may be with/ without intermittent periods of gross hematuria.
- Total hematuria (present throughout the void) indicates bleeding of bladder/ upper tract origin.
- If renal sources of hematuria are present, the blood is equally dispersed throughout the urine stream and does not clot.
In cases of clotting, its localisation is a must to evaluate the underlying cause:
- Hematuria/ clots at the beginning of the urine stream ( initial hematuria ) is a symptom of a urethral cause.
Terminal hematuria occurring at the end of stream may be caused due to either prostatic, bladder, or trigonal source of bleeding.
Thats all
- Jaskunwar Singh
Grossing the thyroid and differentials to be considered
The following key factors should be described of the received specimen:
1. Type of the specimen
2. Dimensions of all the lobes
3. Size- If enlargement seen, is it diffuse or focal
4. Colour- Brown ( Normal); yellowish white/ beefy red/ mahogany brown
5. Consistency of the lesion - cystic ( single or multiple; bilateral or unilateral lobe involvement); solid; solid- cystic
6. Relation of the lesion to the adjacent thyroid
7. Surface of the thyroid - Smooth/ infiltrated - hemorrhagic irregular areas
8. Whether received intact or in pieces due to extensive extrathyroidal adhesions ( Reidel thyroiditis)
Serotonin receptor agonist and antagonist notes
mPFC activation in depression: The Associations
I had talked about how people with neuroticism also have an advantage of being creative in a previous post.
Lets now know the basis of this in brief -
Tuesday, June 20, 2017
Sinus of Morgagni- Contents
Contents- (mnemonic PLATE)
1. Palatine branch of ascending pharyngeal artery
2. Levator palati muscle
3. Ascending palatine artery
4. Tensor vetli palatini
5. Eustatian tube
- 1) Conductive deafness
- 2) Ipsilateral immobility of the soft palate
- 3) Trigeminal Neuralgia
- Hope that helped!
- Ashita Kohli
Zenker's Diverticulum
Killian's Dehiscence is a potential gap between the oblique and transverse fibres of the inferior constrictor muscle. It is also known as the gateway of tears as it is a potential site of perforation during oesophagoscopy.
Zenker's diverticulum occurs due to the outpouching of the pharyngeal mucosa at the site of Killian's dehiscence.
There is incoordination between the descending peristaltic wave and the cricopharyngeus muscle at the upper oesophageal spincter which leades to high intra luminal pressure and the mucosal herniation through the weak area of Killian's Dehiscence.
It is not a true diverticulum as it has just the herniation of the pharyngeal mucosa. ( A true diverticulum has all the layers of the oesophageal wall)
It is usually seen in elderly above the age of 60.
Symptoms-
1. The most common symptom is Dysphagia, which is intermittent initially and later becomes progressive.
2. Halitosis ( ie. bad breath, well ofcourse because food can get trapped in this pouch)
3. Regurgitation of food and cough.
4. There maybe regurgling sounds in the neck, gurgling sensation on palpation is known as Boyce sign.
Malignancies may develop in 0.5-1% cases.
Diagnosis- Barium Swallow and videofluoroscopy
Treatment-
1. Endoscopic stapling of the diverticulo esophageal sphincter.
2. In patients not fit for major surgeries, Dohlman's surgery may be done.
Hope that helped!
Ashita Kohli
Waldeyer's Ring
The ring is bounded by-
1. Palatine Tonsils ( also called as Faucial Tonsil)- Situated in between the anterior and posterior pillars on each side of oropharynx
2. Adenoids (aka Lushka's Tonsil)- Lies at the junction of roof and posterior wall of nasopharynx
3. Tubal Tonsils ( aka Gerlach's Tonsil)- Lies in the fossa of rosenmuller behind the eustatian tube opening
4. Lateral Pharyngeal Band and Nodules
Hope that helped!
Ashita Kohli
Rhinolalia Aperta
The defect is seen in the failure of the nasopharynx to cut off from oropharynx.
Some fibres of palatopharyngeus muscle make the posterior pillar, go posteriorly in the posterior wall of nasopharynx and along with the lower fibres of the superior constrictor muscle forms a ridge known as the Passavant's Ridge.
During swallowing and speaking the passavant's ridge closes the nasopharyngeal isthmus.
When this doesn't happen (eg- cleft lip, paralysis of palate) it leads to nasal regurgitation of food and nasal tone in speech known as Rhinolalia Aperta.
Treatment-
1. In children with cleft palate, special exercises can help in strengthening the muscles so as to reduce the nasality in voice.
2. Surgery- Posterior Pharyngeal Flap
Sphincter Pharyngeoplasty
Hope this helps!
Ashita Kohli
Differentials of lower limb ulceration: Venous, arterial or neuropathic?
Authors diary: Tip for solving multiple choice questions
Monday, June 19, 2017
Baclofen for treatment of alcohol dependence
Hello!
Recent evidence suggest that the gamma-aminobutyric acid-B receptor agonist baclofen is a promising agent for the treatment of alcoholism.
Yep!
Baclofen produces an effortless decrease or suppression of alcohol craving. It decreases alcohol consumption including in those with poor motivation. The drug causes few side effects and does not add to the intoxication effect of alcohol.
It benefits patients with alcohol dependence (even those who are still in precontemplation stage of motivation!)
Research has shown that baclofen reduces withdrawal symptoms of alcohol and is safe in those with liver impairment.
Although further studies that compare long-term alcohol-related outcome of baclofen with established drugs such as naltrexone and disulfiram are needed.
Interesting, isn't it?
-IkaN
More than what you know about vitamins!
Q. Which vitamin deficiency is related with lowering of seizure threshold?
Ans. Pyridoxine Vitamin B6.
Q. Why laropiprant (20mg) + Niacin (1g) is used in combination?
Ans. Nicotinic acid (a derivative) results in flushing of face.
Q. In hyperemesis gravidarum, what do you give for associated Wernicke's encephalopathy following hyperemesis?
Ans. I thought of anti-emetics at first but the answer is vitamin B1. (Wernicke's encephalopathy doesn't always result from alcohol :P )
That's for today.
Take care. :)
-Upasana Y.
Lacunar infarction notes + mnemonic
Lacunar infarcts are small (0.2 to 15 mm in diameter) noncortical infarcts caused by occlusion of a single penetrating branch of a large cerebral artery.
Pathophysiology:
Lipohyalinosis of the penetrating arteries. (Mnemonic: L for Lipohyalinosis, L for Lacunar)
Microatheroma of the origin of the penetrating arteries.
Lacunar stroke is usually related to a chronic vasculopathy associated with systemic hypertension.
Clinical features:
Penetrating artery occlusions usually cause symptoms that develop over a short period of time, typically minutes to hours. However, a stuttering course may ensue, as with large artery thrombosis, and symptoms sometimes evolve over several days.
As a general rule, lacunar syndromes lack findings such as aphasia, agnosia, neglect, apraxia, or hemianopsia (so-called "cortical" signs). Monoplegia, stupor, coma, loss of consciousness, and seizures also are typically absent.
These syndromes are common :
● Pure motor hemiparesis
● Pure sensory stroke
● Ataxic hemiparesis
● Sensorimotor stroke
● Dysarthria-clumsy hand syndrome
Pure motor hemiparesis: Characterized by weakness involving the face, arm, and leg on one side of the body in the absence of "cortical" signs (aphasia, agnosia, neglect, apraxia, or hemianopsia) or sensory deficit.
Artery / structure involved: Posterior limb of the internal capsule.
Mnemonic: PM - Pure Motor, Posterior limb of internal capsule.
Pure sensory stroke: Numbness of the face, arm, and leg on one side of the body in the absence of motor deficit or "cortical" signs.
Artery / structure involved: Thalamogeniculate branches of the posterior cerebral artery (Ventral posterolateral and ventral posteromedial nuclei)
Mnemonic: MIST
Motor - Internal capsule
Sensory - Thalamus
Ataxic hemiparesis: Ipsilateral weakness and limb ataxia that is out of proportion to the motor deficit. Some patients may exhibit dysarthria, nystagmus, and gait deviation towards the affected side. As with other lacunar syndromes, the above-mentioned "cortical" signs are absent.
Artery / structure involved: Fibres of the fronto-ponto-cerebellar system in the internal capsule / corona radiata.
Sensorimotor stroke: Characterized by weakness and numbness of the face, arm, and leg on one side of the body in the absence of the aforementioned "cortical" signs.
Artery / structure involved: Sensorimotor strokes arise from infarcts involving the posterolateral thalamus and posterior limb of the internal capsule. The exact vascular anatomy is debated.
Dysarthria-clumsy hand syndrome: Facial weakness, dysarthria, dysphagia, and slight weakness and clumsiness of one hand are characteristic. There are no sensory deficits or "cortical" signs.
Artery / structure involved: Lacunar infarctions of the anterior limb of the internal capsule, genu of the internal capsule, or corona radiata.
Treatment:
Intravenous alteplase (recombinant tissue-type plasminogen activator or rt-PA) improves outcomes for patients with ischemic stroke in general if administered within 4.5 hours of symptom onset. The available evidence suggests that intravenous thrombolysis is beneficial for patients with lacunar stroke. Most patients with acute ischemic stroke who are not eligible for thrombolytic therapy should be treated with aspirin.
That's all!
-IkaN
Sunday, June 18, 2017
Changes in glomerular dynamics mnemonic
If you forgot the afferent - efferent stuff from step 1, I have a mnemonic.
Remember ACE ID, PDA ANC.
Step 2 CK: Management of thromboembolic stroke
Drugs used to lower BP acutely in severe preeclampsia mnemonic
Drugs used to lower blood pressure acutely in severe preeclampsia (Maternal hypertensive crisis) mnemonic
"Lower Hypertension Now"
Labetalol iv preferred (Avoid in bradycardia)
Hydralazine iv
Nifedipine oral
That's all!
-IkaN
Micturition and Neurological diseases
Here, presenting you a detailed description of Pathologies of Bladder in Neurology. I believe this is the best resource on this topic available online for free. :)
Diaphragmatic hernia : Mnemonic and Review
Here's a short post on the key points about Congenital Diaphragmatic Hernia.
So there's deficiency in the diaphragm during development causing abdominal contents to budge into the Thorax.
There are 2 main types -->
1. Bochdalek.
2. Morgagni.
Now out of these 2, Bochdalek is commoner.
(It's hard to remember the word Bochdalek. I struggle with it every day. )
You can memorize it by realising that it rhymes with ' Scotch da Lake '
(Which means a lake of scotch in Punjabi)
Key points about Bochdalek -
BBBB
- Back - Located posteriorly
- Big - Bigger than the Morgagni form
- Bad - Poor prognosis
- Bag and Mask Contra indicated.
Also realise - Bochdalek
So it's got an L in it. L = Left. So it's more common on the left side. These hernia classically cause a scaphoid abdomen and Mediastinal shift to the opposite side.
Morgagni can be remembered by the opposite of the BBB
So it's
- Not on the back - Anteriorly
- Not Big - Small sized.
- Not as Bad - Prognosis is alright.
Also realise - Morgagni
It's got an R in it = Right. So it's more common on the right side. And it contains the Transverse colon generally.
So that's all !
Happy studying!
Stay awesome !
~ A.P.Burkholderia
Croup : Review of key points
Here's a short Mnemonic/Review of Important facts about Croup - Acute Tracheobronchitis !
Remember :
CROUPS
C - Common respiratory disease
R - Respiratory viruses like Parainfluenza
O - Oxygen Treatment (Humidified)
U - Ugly Cough - Barking / Seal like cough
P - Prodrome of illness followed by Inspiratory Stridor
S - Steeple sign on X Ray
It's helpful to remember Acute EPIGLOTTITIS as the complete opposite of CROUPS using similar ideas.
- Not as common.
- Caused by Bacteria generally (Strep , Hib)
- Oxygen Therapy + AntiBiotics
- Ugly - Sniffing dog like position + Drooling
- Prodrome not particularly, but Stormy acute onset.
- Shows Thumb print appearance on X Ray.
Hope this helped !
Happy Studying !
Stay awesome.
~ A.P.Burkholderia
CMS neurology form 2: Question on numbness, tingling and decreased grip strength
Differentiating C8 radiculopathy from ulnar neuropathy
Hello. This is a very short post (because I am super busy studying)
It's on differentiating C8 radiculopathy from Ulnar neuropathy based on a question I solved the other day. How would you differentiate the two in clinical practice?
C8 radiculopathy:
- Thumb abduction weakness: abductor pollicis brevis (C8, T1)
- Triceps affected (C6, C7, C8)
- Radiculopathies are often painful.
Ulnar neuropathy:
- Hand intrinsics (C8, T1) affected:
Palmar and dorsal interossei
Lumbricals III & IV
Abductor/opponens/flexor digiti minimi
- Basically, all hand intrinsics except for the median-supplied "LOAF" muscles (lumbricals I & II, opponens/ abductor/flexor pollicis brevis)
- Triceps not affected.
- Focal neuropathies aren't painful.
Conclusion: The ulnar nerve innervates all intrinsic hand muscles, except the abductor and flexor pollicis brevis, opponens pollicis, and lateral two lumbricals, which are innervated by C8 and T1 via the median nerve which helps differentiating the ulnar neuropathy from C8 radiculopathy.
That's all!
-IkaN
Saturday, June 17, 2017
Pills of knowledge in Ophthalm- Anterior ciliary artery
The point where the anterior ciliary artery pierces the sclera is often marked by a pigment. This is of particular importance while cauterization as in a bid to make everything look neat and shiny, the pigmented part shouldn't be cauterized as it will cause necrosis of the structures supplied by the artery.
Effects of Angiotensin-II on GFR
So this is a highly confusing topic. No matter how many times you read it, some amount of doubt is always there in your mind. So an advice to the readers, bookmark this post because you will be needing to read it more than once to get the drift.
First of all, let us review the effects of Angiotensin II on Glomerulus.
It constricts both the afferent and efferent arterioles but preferentially increases efferent resistance. Why? 3 reasons:
1. Efferent arterioles have a smaller diameter in their basal state.
2. Ang II stimulates the release of vasodilator NO from the afferent arteriole.
3. Ang II minimizes vasoconstriction at the afferent arteriole via the stimulation of Ang II type 2 (AT-2) receptors, which result in vasodilatation through a CYP450 dependent pathway.
The net effect of preferential rise in efferent arteriolar resistance is that the glomerular pressure is increased or stabilized(in hypoperfusion states), which helps to maintain or increase GFR. But in the long run, lots of fluid have been filtered out leaving behind the proteins which raise the colloid osmotic pressure, eventually enough to overrule the hydrostatic pressure and hence it leads to decrease in GFR.
Ang II also reduces GFR by causing constriction of the mesangial cells which reduces the effective surface area for filtration.
-VM
Pills of knowledge in Ophthalmology- Squint and refractive errors
1.A refractive error should be thoroughly assessed prior to surgical squint correction or the squint may recur.
2. Divergent squint occurs in myopes as the divergent system of muscles is more active during far vision. So, the far vision in myopes being hampered, the eyes try to diverge more.
3. Same goes for hypermetropes. They end up with a convergent squint if left uncorrected.
-That's all!
Sushrut Dongargaonkar
Differentiating peroneal neuropathy, sciatic nerve injury and L5 radiculopathy
Peroneal nerve supplies the dorsiflexors and evertors of the foot. There will be no weakness in plantar flexion and inversion in peroneal nerve injury.
- Acute foot drop (difficulty dorsiflexing the foot against resistance or gravity).
- Patients describe the foot as limp; there is a tendency to trip over it unless they compensate by flexing the hip higher when walking, producing what is called a "steppage" gait.
- Patients may also complain of paresthesias and/or sensory loss over the dorsum of the foot and lateral shin.
- Examination typically reveals weakness in foot dorsiflexion and foot eversion (deep and superficial peroneal nerve-innervated, respectively), with normal inversion and plantar flexion (posterior tibial nerve).
- Sensory disturbance is confined to the dorsum of the foot, including the web space between digits 1 and 2 and the lateral shin.
- Reflexes are normal.
- Weakness affecting most of the lower leg musculature, including the hamstrings.
- Hip flexion, extension, abduction and adduction, and knee extension are normal.
- Sensory loss involves the entire peroneal, tibial, and sural territories.
- In the lower leg, however, the medial calf and arch of the foot may be spared secondary to innervation by the preserved saphenous nerve (a branch of the femoral nerve). Sensation is also spared above the knee both anteriorly and posteriorly.
- The knee jerk is normal, but the ankle jerk is unobtainable.
- Back pain that radiates down the lateral aspect of the leg into the foot.
- On examination, strength can be reduced in foot dorsiflexion, toe extension, foot inversion, and foot eversion.
- Mild weakness in leg abduction may also be evident in severe cases due to involvement of gluteus minimus and medius. Atrophy may be subtle; it is most readily observed in extensor digitorum brevis.
- Sensory loss is confined to the lateral shin and dorsum of the foot.
- Reflexes are generally normal.
-IkaN
Friday, June 16, 2017
Alvarado Score Parameters Mnemonic ; For Appendicitis
Anorexia or ketones in urine - 1
Leukocytosis >10,000 -2
Vomiting/Nausea -1
migrAtory pain to right iliac fossa -1
Rebound tenderness -1
temperAture above 37.3 celsius -1
tenDerness in right iliac fossa -2
neutrOphilia >70% -1
Of these the second parameter from above and second parameter from below have 2 points credited for each. Every other parameter is credited with 1 point each.
The overall aggregate comes out of 10, which the highest possible score for Alvarado score.
If, the aggregate is,
<3 - Low risk for appendicitis
4-6 - Mid risk for appedicitis
>=7 - High risk for appendicitis
In some hospitals where a differential count is difficult to find, use a modified score with 9.
That's all guys, if you find any mistake let me know.
With love,
Jay~
P.S. - yayyy.....missed me much awesomites? I was away from the blog for the last 6 months from posting, because I had very disastrous scores for surgery in my university and I didn't feel worthy enough to write for you guys. (So my activity was largely concentrated in the Whatsapp Medicowesome groups, and the Author's page.) Anyways, I had to take a remedial exam for Surgery 2 weeks ago. And BAAM!!!!.....the results were released today, and yayyyyy.....I passed surgery! :)
I must thank all my Medicowesome admin/author collegues for tolerating my rants and, help me to push through the hellish scary time together. Thanks everyone. Finally I'm through it, and I'm back to writing for you all guys. So thought to start the first post after returning, with a General Surgery Diagnosing score with the help of Schwartz Textbook of Surgery.
See ya soon peepz! :)
Thursday, June 15, 2017
Pills of knowledge in Ophthalm- Posterior staphyloma
A posterior staphyloma is common because the durability of the layers of the eye where the optic nerve enters the eye is lesser in comparison.
-That's all!
Sushrut Dongargaonkar
Pills of knowledge in Ophthalm- Moxifloxacin
Moxifloxacin is the preferred antibiotic in Ophthalmic surgeries and pathologies because it gets concentrated into the anterior chamber and the aqueous.
That's all!
-Sushrut Dongargaonkar
EMG and NCS - Review
Hello there!
Today we'll see some important points on Electromyography (EMG) and Nerve conduction studies (NCS).
EMG evaluates abnormal electrical activity in muscles, and NCS investigates how electricity flows through a nerve.
They help to locate and determine the causes of diseases that affect muscles and peripheral nerves.
Procedure:
In EMG, a small needle is inserted into a muscle, to measure its electrical activity. In NCS, electrodes are placed on the skin overlying a nerve, and other recording electrodes are attached at a different point over the same nerve and a small shock is applied, and the electrical impulse is recorded.
Understanding the terminologies and results of these tests-
Amplitude: The electrical signal is represented as a wave, and the amplitude is its height.
ConductionVelocity (CV): The conduction velocity describes the speed at which the electrical impulse travels along the nerve.D
Duration This describes the width of an electrical wave.
ConductionBlock: The diminution of signal across an anatomical region such as the wrist. This suggests nerve entrapment.
So when a nerve stimulates a muscle to contract, there is a brief burst of electrical activity called a motor unit action potential (MUP).
Some of the abnormal responses seen are:
1)Fibrillations & positive sharp waves on the monitor seen in diseases of peripheral nerves.
Muscles sometimes start having spontaneous activity on their own.
2)Fasciculations: Sometimes the abnormality causes visible muscle twitches.
3)Abnormally large MUPS : These are seen If a nerve has been injured and then regrows.
On regeneration the nerve tends to branch out to include a wider area of the muscle and hence we get large motor unit potentials on the screen.
4) Abnormally small MUPS: When they're abnormally small or brief it suggests the presence of a disease of a muscle (a myopathy) where the muscle is unable to contract to and fails to provide the normal amplitude of the wave.
5)"Recruitment pattern": As a muscle is contracted, nerve fibers signal more and more bits of muscle (called motor units) to join in and help.
In a neuropathic disorder, the amplitude of different motor units is strong, but there are fewer of them because the nerve is unable to connect to as many units.
In myopathies, the number of motor units is normal, but the amplitude is smaller
You may never come across an actual EMG for an interpretation,but it is always good to know the investigation.
The interpretation of EMG and NCSs is not always straightforward and may not always lead to just one possible diagnosis — but the tests can reduce the number of diagnostic possibilities.
Hope this was helpful!
Let's Learn Together!
-Medha.
New TB Risk Factor
People with low levels of vitamin A who live with individuals who were sick with tuberculosis were 10 times more likely to develop the disease than people with high levels of the nutrient, according to research led by investigators at Harvard Medical School.
Vit A rich foods: Liver, fish, hard-boiled egg(not omelette), cheese, butter, cheddar etc
And now some vegetables: Sweet potato, Carrot, Squash, Spinach, Lettuce
Some fruits: Mango, Papaya, Guava, Watermelon, Apricot, Passion fruit
Another reason to love Mango!
-VM
Research update: Statins may increase risk of Parkinsons' disease
A new research by neuroscientists has updated our knowledge about the association between high cholesterol levels in people and prevalence of neurodegenerative diseases such as the Parkinson's.