Sunday, April 23, 2017
The Basics : Lateral wall of Nasal cavity
Thursday, April 13, 2017
Laryngomalacia vs tracheomalacia mnemonic
Tracheomalacia causes expiratory stridor.
Friday, February 24, 2017
Aminoglycoside mnemonic
Hello all, let me slip in a quick mnemonic on Neomycin and Amikacin
1.Highest nephrotoxic drug-
Neomycin
2.Highest auditory toxicity is with-
Amikacin
N for N and A for A. Easy one to remember for the MCQs!
That's all!
-Sushrut
Wednesday, December 28, 2016
ENT instruments contents page
Here's the mini contents page for ENT instruments, this post is linked to the main contents page :)
Tuesday, December 20, 2016
Past Pointing Mnemonic
So this is another short post about 'Past pointing'. I hope you don't consider it pointless to discuss this. (I know, play along.)
Say, for example , I ask a patient to touch my finger (which I place directly in front of him), then touch his own nose and touch my finger once again.
A normal person should be able to do this correctly and accurately.
However, in lesions of at least 2 structures of our body , the patient's finger overshoots the examiner's or can't seem to reach it correctly.
This is called 'Past Pointing' , as the patient shoots past the destination point.
1. Cerebellar
2. Vestibular
You'd get pastpointing only on the side of the lesion as only that side has become stripped from the cerebellar control. The other side has intact Cerebellar control.
Cerebellum = Same side Past Pointing.
Cerebellum is Single and Lonely
However,
Such a pastpointing is generally more prominent on the side of the Slow Component of the nystagmus produced (Whatt?). Yeah. Also, the Slow side of nystagmus and the side of past pointing are also the same as the side to which you'd lose your balance in a Vestibular disorder !
So Remember :
My SLOW Vestibular friend FALLS to pointy end but can Swing BOTH ways .
So Slow Component of nystagmus , and Falling during gait testing would be present and Pointing would be towards the same side too.
But Past Pointing can Bilateral (Swings both ways).
Happy studying ! :)
Symptomatic variations in cough
Cough is a common symptom that may be associated with an infection of upper respiratory tract, which if not given attention to can progress to a life- threatening chronic disease! Normally, its just a common reflex that helps clear mucus off from the throat and the upper airways. But there are certain variations in the presence and progression of cough. So what is your cough trying to tell you about your health? Let's know about this...
Vestibular Apparatus Mnemonic
Hi everyone. This is just a short post to help you remember the functions of the Vestibular System. Memorising this always gives me a vertigo. ;)
The Vestibular System has 2 components :
1. Semicircular canals
2. Utricle and Saccule.
So the Vestibular System detects the following :
Angular Acceleration/Rotational movements.
Linear Acceleration.
Gravity.
Position of Head in space.
So the Semi circular canals are concerned with Angular Acceleration. You can remember that as :
Circle = Rotates ; So SCC detect Rotational movements or Angular Acceleration
The rest are functions of Utricle and Saccule.
Remember : GPL - Girls Premiere League.
For : Gravity, Position of Head and Linear acceleration.
Now remember :
Saccule - NOT Sleeping line. So Vertical movements.
And
Utricle - Horizontal (since sleeping line was not Saccule it will be Utricle)
Another way would be "UHH' Utricle for Horizontal.
Hope this helped you.
Happy studying ! :)
Friday, December 16, 2016
CSF rhinorrhea and meningitis treatment
Thursday, December 15, 2016
Tongue depressor and bipod stand
This instrument is used to lower down the tongue and hold it while the Davis mouth gag serves to hold the mouth open during tonsillectomy and other oral procedures. it comes in various sizes and used depending upon the age of patient.
The mouth gag is held in position by using the Draffin bipod stand which consists of two rods.
Thats all
- Jaskunwar Singh
Tonsil holding forceps
Used in tonsillectomy to grasp the tonsils and pull medially. (dissection method)
The shaft is bent at an angle towards the handle. Ends of this instrument are cup- shaped with holes.
Thats all
- Jaskunwar Singh
Killian's nasal speculum
Used in Submucous resection (SMR) and septoplasty procedures.
It helps keep mucoperichondrial flaps away to make space for proper access and vision to the interior of nose and perform surgery efficiently.
IMPORTANT: In septoplasty, the flap is raised only on one side while in SMR, both sides flaps are raised. So due to cosmetic reasons and high risk of septal complications, septoplasty is preferred over the submucous resection.
Thats all
- Jaskunwar Singh
Direct Laryngoscope
Wednesday, December 14, 2016
Walsham's forceps
Uses: to correct lateral deviation of fractured nose and disimpaction
and repositioning of bony fragments.
Most students get confused between Walsham's forceps and Asch's forceps. The difference is in the structure of the instruments itself.
Walsham's forceps: paired instrument used for reduction of nasal bone fractures. One nasal blade is placed externally while the other blade goes into the nose and supports the nasal bone.
Also, the blades are not elevated in walsham's forceps as in the case of asch's.
Asch's forceps: unpaired instrument used for reduction of nasal septum and vomer fractures. It is used along with Walsham's forceps for the reduction procedures. The blades are elevated. (ASCh = Ascending)
Thats all
- Jaskunwar Singh
Trousseau's tracheal dilator
Used to widen the tracheal incision to aid in the insertion of
tracheostomy tube.
Remember: It is curved at its ends so that it doesn't block the field of vision of the surgeon while making the incision and insertion of the tube.
Thats all
- Jaskunwar Singh
Toynbee's ear speculum
Uses: Examination of external ear and tympanic membrane
In operative procedures like myringoplasty, myringotomy.
Removal of wax, foreign body, otomycosis, ear discharge.
Different sizes for patients according to age.
Thats all
- Jaskunwar Singh
Tonsil artery forceps
Straight forceps (Birkitt's tonsil artery forceps) used to catch the bleeding point. (in tonsillar fossa) following tonsillectomy.
Birkitt's first tonsillar artery forceps |
Wilson's second artery forceps |
Thats all
- Jaskunwar Singh
Asch's forceps
Used for reducing procedures in cases of nasal septum fractures. (Reduction Rhinoplasty)
The septum is grasped with the blades of this instrument and straightened to make proper alignment.
The blades are elevated. Remember ASCh- Ascending.
The instrument is often confused with Walsham's fracture. Both are used in reduction procedures of fractures of nasal septum.
To know about differentiating features, click here.
Thats all
- Jaskunwar Singh
Thudicum's nasal speculum
Used to examine external nose.
Light is focused at different sites to examine antero- inferior part of nasal septum, roof, floor, and lateral wall by tilting patient's head in various directions.
There's a specific technique to hold this instrument during examination of the patient. Its really simple but if you don't practice to hold it, you will forget it for sure.
Keep your ring finger beneath one arm of the speculum and index finger in between the two arms. Press the other arm with middle finger such that the two lower ends meet.
Here's the picture of the right way to hold it.-
Luc's forceps
Monday, December 5, 2016
Brain abscess notes
Brain abscess notes
Here's what I studied =)
Causes
- Direct spread (Paranasal sinusitis, otitis media, mastoiditis, dental infection)
- Head trauma or surgical procedure
- Hematogenous spread (Pneumonia, endocarditis)
Organisms:
- Streptococci
- Bacteroides
- Pseudomonas
- Hemophilus
- Enterobacteriaceae
- MRSA (Head trauma, neurosurgical procedure)
Symptoms:
- Headache > 75% patients
- Fever only in 50% patients (Important: Absence of fever should not exclude the diagnosis)
- Focal neurologic deficits > 60% patients
- Other symptoms - Papilledema, nausea, vomiting, drowsiness, confusion
Hemiparesis - Frontal lobe abscess
Dysphasia - Temporal lobe abscess
Nystagmus, ataxia - Cerebellar abscess
Neuroimaging:
- MRI is better than CT.
- Ring enhancing lesion with surrounding edema on neuro imaging studies is seen.
- Most accurate: Brain biopsy
High yield: Biopsy is essential to distinguish brain abscess from cancer and also to determine the precise organism.
Don'ts: Do NOT do a LP. CSF analysis doesn't contribute to diagnosis or therapy. Increases the risk of herniation.
Extra: Abscesses due to Listeria have blood culture positive > 85% of the time.
Differentials:
- Meningitis
- Meningoencephalitis
- Brain tumors (Cancer can give fever)
Treatment:
- Empirical antibiotics should be modified after results of gram stain and culture.
- Surgical drainage.
- Prophylactic anticonvulsant therapy (High risk [>35%] of seizures)
- Glucocorticoids are reserved for substantial periabscess edema and mass effect due to increased ICP.
- Serial MRI or CT scan monthly to document resolution of abscess.
That's all!
-IkaN