Hill’s criteria in Aortic Regurgitation

Hey Awesomites

Normally, the lower limbs systolic blood pressure ( measured on popliteal artery by indirect method, using sphygmomanometer ) is 10-20 mmHg higher than that of upper limbs ( brachial artery ).

This is because:

1. The lower limb vessels are more muscular than the upper limb vessels.

2. Lower limb vessels are in direct continuation of the Aorta, whereas the upper limb vessels form an angle of 90°.

3. The increased blood pressure is the result of summation effects of reflected pressure waves.

As a result, the pressure waves are transmitted at a higher speed in the wall of lower limb vessels which then get reflected at the end to increase further with the incoming wave.

In Aortic Regurgitation, the greater amplitude of pressure waves results in exaggerated increase in systolic blood pressure of lower limbs vessels compared to that of upper limbs.

The grading of severity of aortic regurgitation based on Hill’s criteria is as follows :
Mild - difference of 20-40 mmHg
Moderate - difference of 40-60 mmHg
Severe - difference of >60 mmHg.

Thats all
Hope that helped :)
- Jaskunwar Singh

Image based MCQ on pediatric infections

Hey Awesomites

Yesterday we posted an MCQ on a pediatric infection with characteristic appearance of rash on face, involving both cheeks.

Image Based MCQ on Fracture

Hello awesomites!
Yesterday we posted an Image based MCQ on Fracture of forearm bones and here's the answer for it.
Q. The X-ray of forearm in AP and Lateral views as shown in the image is diagnostic of

A. Galeazzi fracture-dislocation
B. Barton fracture
C. Monteggia fracture-dislocation
D. Colles fracture

Ans: c) Monteggia fracture-dislocation

Monteggia fracture-dislocations is defined as fracture of the ulnar shaft along with concomitant dislocation of the radial head.

Mechanism: Monteggia fracture-dislocations occur as the result of a fall onto an outstretched hand (FOOSH).

Classification: The Bado classification is used to subdivide the Fracture dislocation into four types.

Type I: anterior dislocation of radial head (Most common)
Type II: posterior dislocation of radial head
Type III: lateral dislocation of radial head
Type IV: anterior radial head dislocation as well as proximal third ulnar and radial shaft fractures

That's all!
Thanks for your active participation.

MD Mobarak Hussain (Maahii)

Causes of chemosis mnemonic

Chemosis is known as oedema of conjunctiva.

Reason:due to exudation from the abnormal capillaries.This retained exudate gives a swollen and gelatinous appearance.

Regions: loosely attached areas of the bulbar conjunctiva and fornices.

Causes: ABC

A: Acute inflammations like gonococcal conjunctivitis, panophthalmitis, dacryocystitis, periostitis, orbital cellulitis.

B: Blood conditions (abnormal) like anaemia, urticaria, angioneurotic oedema, lymphocytic infiltration.

C: Circulatory obstruction in conditions like pulsating exophthalmos or due to pressure of an orbital tumour which may interfere with the lymph and blood drainage.

Thanks for reading.

Madhuri

Causes of hematuria mnemonic

Hey Awesomites

Some common Glomerular causes of Hematuria:
( mnemonic: GH )
- Glomerulonephritis ( post infectious, membranoproliferative, rapid progressive, IgA nephropathy )
- Henoch- Schonlein nephritis

Non - glomerular causes of hematuria :
( mnemonic : HEMATURIa )
- Hemorrhage ( cystitis, PCKD )
- Allergic reaction ( interstitial nephritis )
- Trauma or Tumors
- Urinary tract infections / increased Urinary calcium 

Thats all

- Jaskunwar Singh 

Renal colic : Important points

Hey Awesomites

Some important points to be noted regarding renal colic:

Tay Sachs Disease

Hello Awesomites!
Here's a Blog on Tay Sachs Disease and some common questions related to it.

Tay-Sachs disease

It is a genetic disorder that results in the destruction of nerve cells in the brain and spinal cord. Tay–Sachs disease is caused by a genetic mutation in the HEXA genes on chromosome 15. It is inherited from a person's parents in an autosomal recessive manner. The mutation results in problems with an enzyme called beta-hexosamidase A ,located on lysosomes,which results in the build up of the toxin GM2 ganglioside within cells. The most common type, known as infantile Tay–Sachs disease, becomes apparent around three to six months of age with the baby losing the ability to turn over, sit, or crawl. This is then followed by seizures, hearing loss, and inability to move. An eye abnormality called a cherry-red spot, which can be identified with an eye examination, is characteristic of this disorder. Death usually occurs in early childhood. Less commonly the disease may occur in later childhood or adulthood. These forms are generally milder in nature.Diagnosis is by measuring the blood hexosaminidase A level or genetic testing.

Frequently asked questions -

The substance which accumulates in Tay Sach’s disease is Ganglioside.
Deficiency of enzyme Hexosaminidase-A causes Tay Sach’s disease.
Cherry red spot at macula may be seen in Tay Sach’s disease.

That's all!
Thank you.

MD Mobarak Hussain (Maahii)

Myopathies series - Part 6

Hello :)

Now we will discuss individual myopathies in detail.

We have discussed the association between metabolic disorder and myopathies.
Metabolic myopathies Intro
Metabolic myopathies (differential diagnosis)
In this part, we will discuss the association between structure of cell (myocytes) and myopathy. Look at the diagrams below :-

Q.IDENTIFY THE GIVEN MUSCULAR DYSTROPHIES (Comment below)

In the next post, I will explain the pictures in detail.
I hope it helped.
-Upasana Y. :)

Fact of the day : Neurovascular knockout

Hey Awesomites

Stimulation of trigeminal nerve in the face, vagus nerve, or carotid sinus in the neck may cause a reflex drop in heart rate, dilatation of peripheral blood vessels, and constriction of cerebral blood vessels, which leads to a sudden loss of brain perfusion and unconsciousness. This type of knockout is called "neurovascular knockout".

Blow to the eyesocket, as during boxing may cause a similar knockout, called the oculocardiac reflex due to stimulation of trigeminal nerve ( ophthalmic branch ) and vagus nerve.

- Jaskunwar Singh

Image Based MCQ on ENT instruments

Hello guys!

Yesterday we posted an Image based MCQ on ENT instruments.
And here's the answer for it.

#ENT
#Instruments

Q. The instrument shown in the above image is used in?

A. Thyroidectomy
B. Adenoidectomy
C. Tonsillectomy
D. Parathyroidectomy

Ans: c) Tonsillectomy

The instrument shown in the above image is Eve’s Tonsillar Snare, used in tonsillectomy.

Identification of the Instrument:

It consists of a long, thin, hollow tube with a stainless steel wire loop at one end which has Ratchet action. The other end has three large rings. These three rings allow the instrument to be operated using three fingers.

Uses:

It is used to snare the lower pole of Tonsil at the end of dissection. Advantage of using the snare to resect the tonsil is to minimize the bleeding by crushing the vascular pedicle, not cutting unlike scissors.

Procedure:

The instrument is held by inserting the forefinger and the middle finger into two rings on either side of the snare.The thumb is placed in the single ring at the back. This ring is actually located at the end of the plunger. Pulling the plunger with the thumb draws out the wire loop while it can be pulled back in by pressing the plunger with the thumb. The wire loop is first threaded over the Denis Browne tonsil holding forceps. The dissected tonsil is then held with the forceps and the wire loop moved over it until it surrounds the pedicle of the tonsil. The thumb is then pressed down to draw back the loop. The pedicle of the tonsil is crushedby this movement.

That's all!
Thank you.

MD Mobarak Hussain (Maahii)

Asthma + Eosinophilia

Let us suppose that a patient has the classic signs & symptoms of Asthma and with that she has eosinophilia ( Absolute eosinophil count above 500/mm3).

The next step should be to look at the serum IgE levels.

If it is also elevated-

1. Do a stool examination and serological testing for strongyloidiasis.

2. Do Aspergillus-skin testing and check for aspergillus specific IgE.

If you have got a positive result for one of the above two, you have your diagnosis.

But what if both of the above results come out to be negative.

Then consider Churg Strauss syndrome or Eosinophilic granulomatosis with polyangiitis.

That's it!

-VM

Subpleural opacities and Ground Glass Opacities

Hey guys!

I saw a patient today, a 37 year old female patient with chief complaints of cough and shortness of breath. She has a history of allergic rhinitis and migraine. She is also obese with an BMI of 31.

As you must have guessed already she was diagnosed with Bronchial asthma. On the spirometry report done 4 months back,  there was an obstructive pattern and after giving bronchodilators her FEV1 increased by 22% (>12%) and FEV1 vol increased by 300ml (>200ml). These findings also strongly support the diagnosis of asthma.

She was started on Albuterol as needed and Salmeterol-fluticasone MDI. She didn't show good response in the first 4 weeks, so she was also started on Montelukast and Tiotropium inhaler.

Now after 4 months, she still had cough and shortness of breath. She had bilateral polyphonic wheezes. A chest X Ray was done which came out to be normal. On pulse oximetry, SaO2 was 97% while breathing ambient air. On chest CT we found two attributes:
Subpleural opacities and Ground glass opacities.

So based on the CT scan findings, differential diagnosis:

Subpleural opacities:
1. Eosinophilic granulomatosis with polyangiitis( previously called Churg Strauss).

2. Organizing pneumonia

3. Pulmonary embolism with resultant subpleural pulmonary infarction

4. Allergic bronchopulmonary aspergillosis ( well, not really, actually in this case, there is peripheral air space opacification which looks identical to subpleural opacities)

Now Ground glass opacities:

1. Atypical pneumonia

2. Hypersensitivity pneumonia

3. Several ILDs

4. Sarcoidosis

5. Pulm Edema

6. Pulm Haemorrhage

That's all!

-VM

Cutaneous manifestations of Streptococcus

Hello awesomites!
Here's a collection of Cutaneous infections/diseases caused by Streptococcus pyogenes

Direct infections of skin or subcutaneous tissue-

1. Cellulitis
2. Impetigo
3.Ecthyma,Erysipelas
4. Vulvovaginitis
5. Perianal infection
6. Streptococcal ulcers
7. Blistering distal dactylitis
8. Necrotizing fasciitis

Secondary infection-

Eczema, infestations, ulcers, etc.

Tissue damage from circulating toxins-

1. Scarlet fever
2. Toxic‐shock‐like syndrome
3. Recurrent toxin‐mediated perineal erythema

Skin lesions due to allergic hypersensitivity to Streptococcal antigens

1. Erythema nodosum
2. Vasculitis

Skin disease provoked or influenced by Streptococcal infection (mechanism uncertain)-

1. Psoriasis, especially guttate forms.
2. Kawasaki disease.

That's all!

MD Mobarak Hussain (Maahii)

Gross specimen description

Description of gross specimens is a compulsory exercise in almost all exams.

So, what should you describe about a specimen?

Is it an entire tissue/ organ and which one? And then describe the organ from the capsule to the parenchyma if it is a solid organ or from inside out - mucosa to the serosa if it is an intestine and from the intima to the externa if it is a vessel!

And don't forget the code "C2S2".....
Describe the consistency, the colour and the shape and the size...

So, for eg- description of a fatty liver would be
" A slice of a liver, enlarged in size with rounded borders, capsule not thickened, parenchyma yellowish and greasy, soft in consistency- probably fatty liver"

Is it a bit simple now?

Masks and Respirators (Respiratory type of PPE)

Hello :)

Have you ever seen people wearing those mask like thing during certain infections?

I used to consider it some kind of fashion or trend. But now I got to know what those masks are for?

Those are the RESPIRATORY types of the PPE (Personal protective equipment).

RESPIRATORS:-

It protect against multiple airborne contaminants. 

These are different from surgical masks.

INDICATION:-

It is used in emergencies like influenza epidemic. Here you need protection from air-borne transmissible diseases.

AIR-BORNE TRANSMISSIBLE DISEASES:-

-TB

-Pandemic Flu outbreak

-Avian Flu

-SARS

-Small pox

TYPES OF RESPIRATORS SELECTED:-

-N95 (means the respirator blocks at least 95% of very small (0.3 micron) test particles.)

-High efficiency particulate air (HEPA)

-Powered air purifying respirators (PAPRs)

N95 limitation:-

-they leak 

-Risk reduced but not eliminated

-facial hair compromises seal

-Don't work for Oxygen deficient conditions

-Breathing resistance increases overtime.

SURGICAL MASKS:-

The surgical masks are the main barriers to protect the patient against possible infection or contamination of exhaled organism by medical personnel, and in turn are barrier to surgical personnel against possible splashing fluids.

For more details, Click the link below :

https://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/GeneralHospitalDevicesandSupplies/PersonalProtectiveEquipment/ucm055977.htm

It is important for prevention of the community. 

Although the main reason for sudden spread and increased mortality are:-

-Delay in reporting to health care centre 

-Further delay in diagnosing the disease and referral services.

 Studies have been done to compare the effectiveness of surgical masks and respirators during Respiratory infection emergency.

1. AMONG HEALTH CARE WORKERS

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4868605/
2. AMONG THE PATIENTS  
https://www.ncbi.nlm.nih.gov/pubmed/23505369/

That's all for today.

:D

-Upasana Y.  :)

Flexion Tear Drop Fracture

Hello guys!

Here's a short description on Flexion Tear Drop Fracture and its radiological findings.

It typically occurs from severe flexion and compression forces, most commonly at C5-C6 (diving head first, motor vehicle collision deceleration).

Radiographic features -

1. Sagittal fracture through the vertebral body.
2. Fracture of the anteroinferior vertebral body (Tear Drop Sign)
3. Loss of anterior height of the vertebral body -Cervical kyphosis.
4. Posterior cervical displacement above the level of injury.
5. Widening of interspinous processes.
6. Intervertebral disc space narrowing.
7. Disruption of the spinolaminar line.
8. Vertebral body rotation with an AP diameter that appears smaller than on other levels.
9. Anterior dislocation of the facet joints.

That's all! 

Thank you.

MD Mobarak Hussain (Maahii) 

Image Based MCQ on Shoulder Dystocia

Hello awesomites!
Yesterday we posted an Image based MCQ on Shoulder Dystocia.
And as promised here is the answer.

#Obs_Gynae
Q. The image given below represents:

A. Mc Roberts maneuver
B. Woods corkscrew maneuver
C. Cleidotomy
D. Zavanelli maneuver

The correct answer is A.

The given image shows Mc Roberts maneuver.

All of the above mentioned maneuvers are used for management of shoulder dystocia.

Mc Roberts maneuver:
In this maneuver, legs of the mother will be abducted and flexed against the abdomen. It causes cephalic rotation of the pelvis. Along with this gentle suprapubic pressure is applied by the assistant.

MD Mobarak Hussain  (Maahii)

Image Based MCQ on Health Programs

Hello awesomites!
Yesterday we posted an Image based MCQ on Health Programs.
And as promised here is the answer to the question.

Image Based MCQ
#PSM
#Community_Medicine
Q. The following image represents:
A. Rashtriya swasthya bima yojana
B. Mid day meal program
C. Integrated child development service
D. Mission Indradhanush

The correct answer is B. Mid day meal program.

Option A-

Option C-

Option D-

Thank you. 

MD Mobarak Hussain (Maahii) 

Sequence of appearance of papilledema

The optic disc margins start to blur in the following order in papilledema-

1. Superior
2. Inferior
3. Nasal
4. Temporal

Blurring first occurs where the nerve fibre density is the highest.The optic disc being ovoid in shape, with taperings superiorly and inferiorly, the nerve fibre density is higher there. Hence such a sequence.

That's all!

-Sushrut Dongargaonkar

Question on larynx

So here is answer of our previous questions.
#Anatomy
Sensory supply of larynx, below the vocal cord-
A) Superior laryngeal nerve
B) Inferior laryngeal nerve
C) Recurrent laryngeal nerve
D)Internal laryngeal nerve

Ans is "C" Recurrent laryngeal nerve.


Things must be know.
All intrinsic muscles of larynx are supplied by recurrent laryngeal nerve except cricothyroid. Cricothyroid is supplied by external laryngeal nerve. 

By ojas gite

Image Based MCQ on Blood Agar

Hello awesomites!

Yesterday, we posted an Image based MCQ - And as promised, here is the answer!

#Microbiology
Q. Which organism shows the below depicted phenomenon when incubated with staphylococcus aureus on blood agar:

A. Clostridium perfringens
B. Bacillus anthracis
C. Haemophilus influenzae
D. Corynebacterium diphtheria

The correct answer is C. Haemophilus influenzae.

The given image shows the phenomenon of satellitism which is exhibited by Haemophilus influenzae when incubated on blood agar along with Staphylococcus. Factor V produced by Staph aureus helps in growth of Haemophilus. Haemophilus   colonies will be larger and well developed alongside the streak of staphylococcus aureus since V factor diffuses into surrounding medium. This is known as satellitism.

MD Mobarak Hussain (Maahii)