Wednesday, April 26, 2017
Tuesday, April 25, 2017
Exam Prep Hacks -Tips for a lazy person
The Basics : Deviated Nasal Septum
Deviated Nasal Septum - "Abnormal and asymmetrical alignment of the nasal septum that results in acute nasal obstruction and other symptoms of upper respiratory tract."
AETIOLOGY -
1. Trauma : Abnormal pressure ( lateral or frontal ) applied to nasal septum results in its deviation to one side or another.
- The lateral blow may cause displacement of septal cartilage from the vomerine groove and maxillary crest.
Groove on which septal cartilage sits ( encircled ) - lateral view Diagram by IkaN. |
- Frontal blow causes crushing injuries to the nose, usually occurs in sportspersons especially the boxers.
2. Developmental anomalies : Palate forms the base of nasal septum. Highly arched palate, cleft palate or lip, and dental abnormalities can all lead to deviation of the septum.
3. Racial factors : Caucasians have more incidence of DNS.
4. Hereditary : Familial predisposition.
TYPES of DNS -
1. Anterior dislocation : dislocation of nasal septum into one of the chambers. ( unilateral nasal obstruction )
2. C - shaped dislocation : simple curve to one side with compensatory hypertrophy of turbinates in other side. It causes unilateral nasal obstruction.
3. S - shaped deformity : causes bilateral nasal obstruction
4. Spurs : shelf - like projections may lead to headache and epistaxis. ( unilateral obstruction )
5. Thickening : due to septal hematoma
CLINICAL FEATURES of DNS mnemonic
TREATMENT - Only required if the symptoms are severe. The procedures are to be done once the patient is more than 17 years old.
- Septoplasty : The most deviated parts of nasal septum are removed and rest of the parts are surgically corrected and repositioned.
- Submucous resection ( SMR ) : Mucoperiosteal and mucoperichondral flaps that overlie one side of the septum are lifted. Most of the septum is removed and flaps repositioned.
Thats all
Hope this helped :)
- Jaskunwar Singh
External Carotid Artery branches mnemonic
External Carotid Artery branches mnemonic - Seven Angry Ladies Fighting Over PMS
Cranial nerve III damage (Oculomotor nerve damage mnemonic)
The CN III has both motor (central) and parasympathetic (peripheral) components.
Which fibers get affected in diabetes?
Which would lead to loss of pupillary light reflex?
Which fibers are compressed first?
Which would cause the down and out pupil?
Don't know? Check the video out!
Mnemonic : Deviated Nasal Septum clinical features
The clinical features ( s/s ) that are presented by a patient with DNS are : NOSE MASH
NO - Nasal Obstruction
S - Septal cartilage and bone deformity
E - Epistaxis
M - Middle Ear infection
A - Anosmia
S - Sinusitis
H - Headache
- Jaskunwar Singh
C Peptide levels : An Overview
Hello everyone!So I ended up uttering 'C peptide' recently in my Medicine Viva and my professor screwed me over it.
(Clearly I didn't C it through :'D )
So I thought of doing a brief summary on it.
Here goes.
1. What is C peptide ?
- When pro- insulin is cleaved , it gives insulin and C peptide.
- C peptide in general has a longer half life than insulin and is easier to detect.
- The pathway is something like this :
Pre proinsulin produced in Rough Endoplasmic Reticulum of Pancreas --> Transported to the Golgi apparatus and cleaved to form Proinsulin --> Packed into secretory granules --> In these granules proinsulin is converted to : Insulin and C peptide.
- Traditionally it is said to have no intrinsic activity but recent studies say it might have anti oxidant and anti inflammatory properties.
2. What does it indicate ?
- So , its presence indicates presence of Insulin in the body in a proportionate amount.
- Hence in a case of Hypoglycemia if C peptide levels are high, it's likely to be due to increased endogenous Insulin levels.
3. C peptide levels increased in -
- Insulinoma
- Sulfonylurea induced Hypoglycemia ( As they are Insulin Secretagogues)
- Type 2 Diabetes Mellitus ( Hyperinsulinism due to resistance)
- Insulin Resistance states like Obesity , PCOS , Cushing's.
4. C peptide levels reduced in -
- Type 1 Diabetes as Insulin secretion is reduced
- Latent Autoimmune Diabetes of Adult (LADA )
- Factitious hypoglycemia - Due to excess exogenous Insulin administration.
- Hypoglycemia due IGF secreting tumors.
So if you get a patient with Hypoglycemia with elevated insulin levels , C peptide levels help you decide if due to exogenous Insulin , or Endogenous Insulin ( Sulfonylurea induced or Insulinoma).
Hope this helped !
Stay awesome.
Happy studying!
~ A.P Burkholderia.
Monday, April 24, 2017
The Basics : Middle Ear
In this post, I will be talking about the middle ear structures and its relations with its neighbors ( just a summary ).
The Middle Ear is an air filled and bilaterally compressed/ concaved cavity lined by mucous membrane located in between the external and internal parts of ear. It is divided into:
- Epitympanum or the Attic ( 6mm ) - lies above pars tensa and medial to pars flaccida
- Mesotympanum ( 2mm ) - lies opposite to pars tensa
- Hypotympanum ( 4mm ) - lies below the level of pars tensa
BOUNDARIES of the middle ear ( homologous to structure of a cube ) :-
Roof : Tegmen tympani - a thin bony plate that is a part of petrous part of temporal bone, separates the middle ear cleft from middle cranial fossa.
- Infection in the middle ear may spread superiorly and lead to formation of abscess in the meninges ( especially Extradural abscess ), meningitis or if severe, it may even lead to abscess formation in the temporal lobe.
Floor : Jugular bulb - The middle ear cavity is separated from jugular bulb by a thin piece of bone that if deficient may lead to formation of a layer of fibrotic tissue and mucous membrane in between. The contents of jugular bulb are:
- Internal Jugular vein
- Glossopharyngeal nerve ( IX )
- Vagus ( X )
- Accessory nerve ( XI )
The tympanic branch of glossopharyngeal nerve enters the middle ear at the junction of the floor and medial wall to play an important role in formation of tympanic plexus.
Anterior wall : The upper part of the narrow anterior wall has two openings or tunnels for - ( mnemonic : TEA )
- Canal for Tensor tympani muscle
- Pharyngotympanic ( or Eustachian ) tube
The lower part of anterior wall is separated from the Internal Carotid Artery by a thin plate of bone. The ICA is surrounded by a plexus of sympathetic nerves that enter middle ear through openings in this bony plate to form tympanic plexus.
Posterior wall : Posteriorly, it is related to middle ear cleft ( Aditus, Antrum and mastoid air cells )
- Infection in this region may spread posteriorly into the sigmoid sinus ( in posterior cranial fossa ) and cause thrombophlebitis !!
Medial wall : Medially the middle ear cavity is related to the promontory, oval and round window
Lateral wall : Tympanic membrane separates the middle ear from the external ear.
A brief about the functions of middle ear:
On the incoming of sound waves, the tympanic membrane oscillates and these oscillations are sensed by the strongly attached and faithful middle ear ossicle, the Malleus. The sound energy is transmitted as such by the ossicles ( Malleus - Incus - Stapes ) to the internal ear for further processing.
The major function of these ossicles is amplification of sound waves - Tympanic membrane is 17 times larger than the oval window - So that means the sound energy is picked up by the larger area ( TM ) and impinged over a much smaller area ( oval window ) thus amplifying it 17 times.
In addition, the lever action of the ossicular chain is approx. 1.3 units. Thus the intensity ( force ) of sound waves/ vibrations changes ( increased by ~20 times ) and not the frequency !! If the sound waves are not amplified ( in case OC is removed ), the Air Conduction would be lost. So BC > AC and thus hearing would then be poor.
Thats all
Hope this helped :)
Stay Awesome!
- Jaskunwar Singh
Craniopharyngioma mnemonic
The C's of Craniopharyngioma
Children
Calcification
Cholesterol crystals
Cyst formation
Central diabetes insipidus
Compresses chiasm, can't C (see, because butemporal hemianopia)
CR: CRAniopharyngioma RAthkes pouch remnant
Yup. That's all!
-IkaN