Past Pointing Mnemonic

Hi everyone !
So this is another short post about 'Past pointing'. I hope you don't consider it pointless to discuss this. (I know, play along.)

There are a few tests called 'Finger-Nose-Finger' test and 'Finger-Nose' test. These detect how controlled and precise your movements are.
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.

2 important lesions where you get this are :
1. Cerebellar
2. Vestibular

So, in a Cerebellar lesion things are very straight forward.
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

The Vestibular System defects are slightly more complex and also very controversial. So irrespective of which side you try, you'd get Bilateral past pointing in a Vestibular lesion.
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).

Hope this helps. Let me know how I can improve it!
Happy studying ! :)

~A.P.Burkholderia

Symptomatic variations in cough

Hey Awesomites!

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 ! :)

How to apply for USMLE exams: ECFMG certification using IWA in detail

This is a continuation of the main post, How to apply for USMLE exams (http://www.medicowesome.com/2016/12/how-to-apply-for-usmle-exams.html)

Step 3 is elaborated in detail here:

Medipicsowesome: Thanatophoric dysplasia

Hello!

First post of Medipicsowesome. Yaay!

Thanatophoric dysplasia (TD) is a lethal skeletal dysplasia. It is the 2nd most common lethal skeletal dysplasia after osteogenesis imperfecta type II.

It is characterized by extremely short limbs and folds of extra (redundant) skin on the arms and legs.

Other features of this condition include a narrow chest, short ribs, underdeveloped lungs, and an enlarged head with a large forehead and prominent, wide-spaced eyes.

Type I thanatophoric dysplasia is distinguished by the presence of curved thigh bones and flattened bones of the spine (platyspondyly).

Type II thanatophoric dysplasia is characterized by straight thigh bones and a moderate to severe skull abnormality called a cloverleaf skull.

This baby seems to have type II thanatophoric dysplasia.

The condition is uniformly fatal within a few hours of birth either from respiratory failure or from brainstem compression from a narrow foramen magnum.

This baby died a few hours after birth.

Cool fact: The term thanatophoric derives from the Greek words "thanatos" meaning "death" and "foros" meaning "bearing/carrying/bringing".

That's all!
-IkaN

Medipicsowesome: An introduction

Hello!

The Medicowesome family has decided to create a library of medical pictures. Excited? =)

We are going to label all these posts as Medipicsowesome.

It'll contain pictures of specimens, diseases, instruments, etc.

Since we wish to avoid copyright issues, we will be taking permission for most pictures / giving credits from which they're taken. If a picture belongs to you and you do not wish to see it uploaded on the site, email us at medicowesome@gmail.com and we will take it down immediately.

I have taken permission from the patients for pictures clicked in my wards, explaining they'll be uploaded on the blog for medical students to learn. Only after their permission, I have uploaded the pictures. To maintain confidentiality, I will blur eyes / faces too.

If you want to share cases you've seen on Medipicsowesome, we'll be happy to upload it. Just email us the picture with a description and make sure you have the permission of the patient!
Email: medicowesome@gmail.com
Subject: Medipicsowesome submission

That's all!
The idea was come up by all authors, especially, Sakkan. Thanks for the encouragement everyone else! < 3
-IkaN

Median nerve

Median nerve
Root value :C5-T1
IMP points
1)Median nerve is most medial content of Cubital fossa
In Cubital fossa it gives 3
Branches to flexor muscles
Remember this mnemonics
Feel Climate (in) Rajasthan,Days (in) Singapore (in) PLs
Flexor carpi radialis  .(FELL CLIMATE -Rajasthan)
Flexor digitorum superficials(Days
in -Singapore) 
Palmaris Longus (PLs) .
In forearm it gives Anterior interosseous branch which supplies:-
1)Lateral half of flexor digitorum profundus (Well,medial half is supplies by ulnar nerve)
2)Pronator quadratus(my Fav!)
3)Flexor policies Longus(Extensor policies Longus and brevis both supplied by radial  nerve)
In palm ,median nerve supplies 5 muscles !
3 thenar muscles ,(Abductor pollicis brevis ,flexor pollicies brevis  ,opponens pollicis )
Lateral 2 lumbricals!
Clinical anatomy:
1)Known as labourers nerve /eye of hand
2)Pointing index finger occurs due to paralysis of long flexors of digit .
3)Ape or monkey thumb deformity if thenar muscles are paralysed
4)Must know carpal tunnel syndrome(Happens when median nerve is trapped )REMEMBER Skin over the thenar eminence is not affected as the branch of median nerve supplying it arises from forearm
5)FROMENT's.sign/Book holding test &paper holding test is done to test median nerve .
6) Complete claw hand when Ulnar and median nerves are paralysed.

~Ojas

Hyperplasia - Physiologic or Pathologic?

Hyperplasia means increase in the cell number.

It tends to occur only in organs where the cells retain the ability to divide. It can be physiologic or pathologic.

The morphology of the organ on gross or the cells on microscopy does not differ in physiologic or pathologic hyperplasia. What differentiates the two is the inciting stimulus.

for eg- Breast/ Endometrial hyperplasia is a feature of pregnancy as well as in certain hormone producing tumors of the ovary. The tissue microscopically, only shows increased number of mature cells. However, the hyperplasia that occurs due to pregnancy (physiologic) process is labelled as "Physiologic" while that which occurs due to ANY pathologic process is labelled as
"Pathologic" hyperplasia.
 

An AIDS patient with abnormal CT scan

Hey! Here's a case kinda thingy that I made up.

An HIV positive male presents with loss of recent memory and left sided paralysis. A CT scan is done. What are the differentials based on the CT findings given below?

1. Multiple ring enhancing lesions
2. Single, periventricular ring enhancing lesion
3. Cerebral atrophy with secondary ventricular involvement
4. Multiple non enhancing white matter lesions

Answers given below
.
.
.
.
.

1. Multiple ring enhancing lesions - Toxoplasmosis. TMP SMX for prevention!

2. Single, periventricular ring enhancing lesion - CNS lymphoma. Usually, positive for EBV.

3. Cerebral atrophy with secondary ventricular involvement - AIDS dementia complex. Though paralysis would not be a feature. Only defects in short term memory and executive function is seen.

4. Multiple non enhancing white matter lesions - Demyelination of subcortical white matter suggestive of progressive multifocal leukoencephalopathy is caused by JC virus.

That's all!
-IkaN

ALS and Riluzole mnemonic

Riluzole is a glutamate inhibitor which is used in Amyotrophic laterla sclerosis.

How to remember this?

Unnecessary mnemonic #521

Rilu glues all.
Rilu - Riluzole
Glues - Glutamate inhibitor
Al - ALS

That's all!

I'm sorry, that was a terrible mnemonic. Forget ice bucket, I'd win the pathetic mnemonic bucket challenge :P

-IkaN

CSF rhinorrhea and meningitis treatment

Today I was asked a question in ENT viva that- in a patient of CSF rhinorrhea due to traumatic aetiology, what measures will you take to prevent the onset of meningitis and how will you manage the condition?

Cyber knife

This new technique in radiotherapy is revolutionising the world of treatment in oncology. The technique is largely unheard and my intention of writing the post is to share it with a maximum number of people.

Invented by John R Adler, Peter and Russell Schönberg in 1990, 'CK' is about targetting radiation with a high accuracy to neoplastic tissues.

A linear accelerator of 6MV delivers X ray radiation of 6-800cGy while a  robotic arm maneuvers the 'linac' around the body of the patient so that most of the neoplastic cells are irradiated. An accuracy of 0.5 mm is maintained during the process.

For ensuring such level of accuracy, tissue tracking is needed. There are different methods of tracking for bones, lungs and viscera. For soft tissues like pancreas, gold fiducials(hair like implants) are inserted so that the movement of the tissues as the patient breathes can be identified accurately.

About 1-5 sessions are needed depending upon the pathology. There's no anaesthesia and long treatment hours involved, unlike surgery. Plus, the procedure is significantly cheaper than say, Whipple's pancreaticoduodenectomy!

-Thats all!

Causes of Acute Pancreatitis

Hi guys,

I have an exam soon and I was struggling with this, so, I made this up!

To remember causes of Acute Pancreatitis, you need to think of none other than your nursery school days! :P

So, here we go- ABCDEFGHI, (oh wait did I just say "HI" :P)

Now going a little off track, but, when I was small I used to do a lot of gardening, so I remember rest of the causes as Me POT.

Alcohol ingestion  (acute or chronic)
Biliary calculus
Connective tissue diseases- SLE, TTP,  PAN
Drugs- diuretics- frusemide, thiazide. (Others are anti retroviral drugs, sulphomamides, tetracycline, tamoxifen, etc)
Endoscopic procedures
Familial/ Genetic
Hereditary Pancreatitis/ Hyperparathyroidism/ hypercalcemia/ Hypertrigylceridemia
Infections- viral

Metabolic conditions - renal failure,
Penetrating Peptic Ulcer
OPC poisoning
Trauma to abdomen

Phew, a long list. Isn't it?

Hope it helps!!
That's it!

-Rippie