Intravenous dreams

You know you have done too many blood collections when you say stuff like, "Dreams are collapsible, like a vein. So make sure you put needle in a good one."

Study group discussion: Dua's membrane

Cool fact: A new layer of cornea is discovered. It's called the Dua's membrane.

The Dua's Layer lies between the stroma and the descmets.

It's said to be acellular.

It was discovered last year by an Indian opthalmologist, Dr. Harminder Singh Dua.

Related post: Layers of the cornea mnemonic

Study group discussion: Pleural tap

Which muscles are pierced in midaxillary line during pleural tap?
Answer:
- Serratus anterior
- External intercostals
- Internal intercostals
- Intercostalis muscle

What are the boundaries of the safety area that we chose for pleural tap?

Answer:
Anterior - Lateral border of pectoralis major
Lateral - Lateral border of trapezius
Inferior - 5th intercostal space
Superior - Base of axilla

It's also called safe triangle.

Related post: Why is atropine given before procedures like drainage of pleural effusion aka pleural tap?

Staghorn calculus mnemonic

Staghorn calculus mnemonic

I remember the word, "MAPS"

M: Magnesium Ammonium Phosphate Struvite stones

A: Alkaline pH (AlkAline has 2 A's, Acid has just 1 A.)

P: Proteus

S: Splitting organisms (Urea splitting, urease producing organisms)

Staghorn calculus

Study group discussion: Vitamins and renal stones

Question: Which vitamin is indicated in treatment of calcium stones?

Answer: Pyridoxine

And which vitamin is avoided in a patient with history of calcium stones?

Answer: Vitamin C, it will worsen calcium stones.

Why?

Answer: Vitamin C increases oxalate in body. Pyridoxine decreases oxalate level in body.

Extra: Vitamin A deficiency too causes stones. The desquamated epithelium in tubules acts as a nidus for stone formation.

Study group discussion: Signs in acute appendicitis

Most commonly asked appendicitis signs

Aaron’s sign: A referred pain or feeling of distress in the epigastrium or precordial region, on continuous firm pressure over McBurney’s point, in acute appendicitis.

Dieulafoy’s triad: Tenderness, muscular contraction and skin hyperaesthesia at McBurney’s point in appendicitis.

Obturator sign: It refers to presence of hypogastric pain on stretching the obturator internus due to its irritation in the pelvis. This test is performed by passive internal rotation of the flexed rightthigh with the patient supine.

Bastedo’s sign : Pain and tenderness in the right iliac fossa on inflation of the colon with air, in cases of chronic appendicitis.

Psoas sign  : It is positive in retrocecal appendicitis. In this, irritation of the of the psoas muscle gives rise to pain when the patient’s right thigh is extended from the flexed position.

Rovsing’s sign  : Pain at McBurney’s point induced in cases of appendicitis, by pressure exerted over the descending colon

That's a good summary. Thanks!

Study link! Clinical features of acute appendicitis mnemonic
http://medicowesome.blogspot.ae/2014/11/clinical-features-of-acute-appendicitis.html

Study group discussion: Vitamin K overdose and deficiency

What's the adverse effect of excess dose of vitamin K, if given in new born?

Answer: Neonates - In infants (particularly premature babies), excessive doses of vitamin K analogs during the first few days of life may cause severe hemolytic anemia; this in turn may result in  hyperbilirubinemia, kernicterus, leading to brain damage or even death.

Study group discussion: Serial interval and communicable period

What is the difference bw serial interval and communicable period?

Communicable period is the one in which the disease is transmitted from one case to another. (Also known as infectivity.)
The patient might have the disease but may not be infectious because of latent phase.

Serial interval is the time period in which the disease manifests from one case to another.

It's different from communicable period because the disease doesn't manifest immediately, so the case might present to you late.

Serial interval = Latent period + communicable period (Roughly)

Study group discussion: Temporal arteritis

A 60 year old male presents with headache, scalp tenderness, painful temples, pain on chewing & visual disturbances.. Diagnosis?

Answer: Temporal arteritis

What tests you would do to confirm the diagnosis?

Answer: Raised ESR, temporal artery biopsy

Treatment?

Answer: High dose steroids like prednisolone!

Temporal artery branch of?

Answer: ECA, the external carotid artery!

Study group experience #15

Structures that pass through the diaphragm mnemonic
Purtscher's retinopathy

Biliverdin
Largest protein and the smallest protein in the human body

Hemolytic disease of new born
Evening rise of temperature in tuberculosis and malaria
Causes of edema

Chloroquine and Behcets disease
Drugs contraindicated in myasthenia gravis
Drugs used in the treatment of Alzheimers disease

Smoking and hernia
Eponymous terms in hernia and mnemonics

Correct order of clinical assessment of the abdomen

More information on the study group

It's amazing studying with you guys, I wish I could update - discuss more often, but internship is really draining me. Trying my best to catch up. Love you all! :)

-IkaN

Study group discussion: Correct order of clinical assessment of the abdomen

Question: During clinical examination of abdomen what is the correct sequence of the following events?
Palpation - inspection - auscultation - percussion.

Answer: You first need to auscultate in abdominal examinations because bowel sounds increase after palpation. So it would be inspection -  auscultation -  palpation - percussion.

When assessing most body systems, the appropriate order is inspection, palpation, percussion, and auscultation. However, with the abdominal assessment, auscultate before you manipulate the abdomen with palpation and percussion. The rationale for this is that manipulation of the abdomen with palpation and percussion may stimulate peristalsis and thereby alter your examination findings. So the appropriate order for the abdominal examination is inspection, then auscultation, followed by palpation and percussion.

Research paper: http://www.ncbi.nlm.nih.gov/books/NBK420/

Extra tips: You wanna ask the patient whether it hurts somewhere and palpate that area last.

While examining abdomen always expose the patient from nipples to midthigh. Also one more important thing is that, abdominal examination is never complete without examination of external genitalia.

Organ of Zuckerkandl.

There are several extradrenal sites where pheochromocytoma occurs, and this, the 'organ of Zuckerkandl' is one interesting site.

It actually is a cluster of bodies,located either at the bifurcation of the abdominal aorta or at the origin of the inferior mesentric artery and they contain chromaffin cells derived from the neural crest.

These are also known as 'paraortic bodies' but differ from 'corpora aortica'(also a chromaffin body)which lies near to the thoracic aorta.

The organ of Zuckerkandl is said to be responsible for secreting catecholamines and other vasoactive substances. It has a function of supplying catecholamines to the fetus especially in the first trimester of pregnancy and regresses usually in the third trimester.



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Study group discussion: Largest protein and the smallest protein in the human body

How many amino acids make up a protein ?

>100 ~ proteins
10-100 ~ polypeptide
<10 ~ peptide

Which protein is smallest in the human body?

Thyroid releasing hormone or TRH should be the smallest protein in the human body, with 234 amino acids. (> 100 amino acids is a protein.)

Smallest polypeptide in the human body should be insulin, with 54 amino acids. (10-100 amino acids is a polypeptide.)

Smallest peptide in the human body should be glutathione, with 3 amino acids. (<10 amino acids is a peptide.)

I concluded these on what I found on Google. Correct me if I'm wrong.

Largest protein is titin in the human body!

Interesting virology fact:-
The largest viruses as Poxviruses measuring 300nm are as large as the smallest bacteria (mycoplasma). The smallest viruses as Parvovirus measuring about 20nm are nearly as small as one of the largest protein molecule, hemocyanin.