A 7 year old with hyperextensible joints

A 7 year old boy is brought to you. He is intellectually disabled. On examination, you notice hyperextensible joints. Large hands, large feet, protruding ears, elongated face are also seen. The patients testes are large in size compared to his age. Diagnosis?

Marfans syndrome
Ehler Danlos syndrome
Fragile X syndrome
Friedreichs Ataxia
Homocystinuria

Answer below
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It's Fragile X syndrome. Why isn't it's Marfans? Because Marfans has normal IQ.

Here are my notes + mnemonic for Fragile X syndrome.

Did you know?
Fragile X is the most common cause of inherited mental retardation.
It was the first trinucleotide repeat disorder to be recognized.

That's all!
-IkaN

Walsham's forceps

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

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

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

This instrument is of two types: straight and curved.

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

Curved forceps used as replacement forceps before tying a ligature to the bleeding points following tonsillectomy. (also called Second tonsillar artery forceps)


Thats all
- Jaskunwar Singh

Asch's forceps

Asch's septum 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

Lets start with instruments used in surgical procedures of Otorhinolaryngology..

Firstly, lets talk about Luc's forceps.

This instrument has a fenestrated tip with sharp blades to hold

and grasp a tissue and cut it. So basically it is used for cutting.

Uses:

1. As the name suggests, it is used in Caldwell- Luc's operation (Anterior antrostomy) for removing antral mucosa. 

2. Submucosal Resection of nasal septum. (to remove bone or cartilage from the septum required for a graft)

3. Polypectomy  

4. Turbinectomy

Thats all

- Jaskunwar Singh

A tip for confusing things

many of us have this tendency and inner hunger to know everything, but not all of us are prodigies now are we?

hence a typical example.

types of thyroplasty

type1- medialization of cord

type2- lateralization

type3- shortening

type4- lengthening

no many how many times i have read it, i am bound to get confused. i will remember that type 1 and type 2 had to do with changing the position of the cord from midline, but i am totally going to forget whether medialization was first or not. 

The examiners exploit this very weakness. some sadist i tell you! 

anyways not always will you be able to get your hands on mnemonics that will save your neck..and yes sometimes it is even really tough to remember the mnemonics themselves during exams -_-

my tip is 

just remember

type1- medialization

type3- shortening

hell with everything else..this attitude will save your neck more than you can imagine. use this with eveything confusing. 

just dont give your brain the chance to be confused..read and have a visual image of only the very core of the answer. and trust yourself that when push comes to shove you will be able to answer the question correctly 

-sakkan

Primary Health Care

Hey Awesomites

Today its a short post ( a mnemonic actually ;p )  on the principles and elements of primary health care. (I was asked in SPM viva a few days back. ;p )
As a rule, always find a mnemonic in the name itself, I took care of it and made it in the easiest way possible. So here it is ..

C- Community participation
A- Approach (multi- sectorial)
R- Right technology (appropriate)
E- Equitable distribution of health services.

Elements of primary health care: MI NEEDS
- MCH and family planning
- Immunization
- Nutrition
- Education
- Endemic and common diseases
- Drugs provision
- Sanitation.

Thats all
Happy Medicowesome :)

- Jaskunwar Singh

Caput v/s Cephalhematoma - Ways to remember.

Though simple, takes time in the exam if confused.

So here's a way to save the time meanwhile being sure of the answer for the topic.

Langerhans cell histiocytosis notes and mnemonic

Hey!

I'm clearly doing a lot of notes + mnemonic posts. Here's another one on Langerhans cell histiocytosis!

Langerhans lingers
L - Lytic lesion of bones
I - Diabetes Insipidus
N - Nil
G - Eosinophilic Granulomas
E - Exophthalmos
R - Rrrrr.... :P
S - Skin rash

From study group:

Any mnemonic for Hand Schuller Christian disease?

Mnemonic by IkaN: Hands LIE
Lytic bone lesions
Insipidus (Diabetes Insipidus)
Exophthalmos

Mnemonic by Dev: CDE
Calavarial skull defect
Diabetes insipidus
Exophthalmos

Disclaimer: It's a morbid mnemonic. If you are sensitive and religious, don't read it.
Mnemonic by Vinayak: Jesus CHRIST was killed by hammering nails into his HAND, he DIed, his hands' bone got LYSED and we celebrate EXmas:
For calvarial skull defects, you know, wood was also hammered into his head. DI is diabetes insipidus. EX is exophthalmos.

That's all!
-IkaN

Study group discussion: Skeletal resistance to PTH in CRF

Hi guys! So the question that was asked in the study group is- Why is there skeletal resistance to PTH in Chronic Kidney Disease?

Answer-

Skeletal Resistance to PTH has a multifaceted pathogenesis; the most imp factor being uraemia which screws with the PTH receptor's intracellular G-protein signaling mechanism in the Osteoblasts.

Dialysis in these patients increase the levels of Osteoprotegerin, which is a decoy molecule antagonizing the action of RANKL in promoting osteoclastogenesis; further intereference with the action of PTH.

Hyperphosphatemia and Hypocalcemia in CKD patients cause excessive release of PTH which leads to downregulation of its receptors on osteoblasts. 

Decreased levels of calcitriol screws in a special way, it makes the parathyroid gland think that the normal calcium level range is above the actual normal value, making the gland work overtime. For this we use calcimimetics like cinacalcet to decrease the set point back to the real normal value. And also without Calcitriol to assist, PTH's job becomes a lot more difficult. 

Earlier the most common CKD-related osteodystrophy was osteitis fibrosa cystica which was due to very high PTH levels causing pathologically increased bone turnover.

But now since we have developed drugs to tackle increased PTH levels, Adynamic Bone Disease has become the most common osteodystrophy because in the body of a CKD patient, it is already very difficult for PTH to carry out its function and if we are pharmacologically decreasing its values, we are ensuring that it works negligibly. 

That's enough Nephrology for one day! :)

  

-VM