“PILL” Esophagitis.

Hello!

Let's review a very common preventable condition of pill/drug induced esophagitis. 

It is occurs due to prolonged contact of the esophageal mucosa with a medication, which acts like the damaging agent.

Medications implicated in
“pill”esophagitis are :
Tetracycline
Potassium chloride
Ferrous sulfate
Nonsteroidal antiinflammatory drugs
Alendronate. 

Most often the offending tablet is ingested at bedtime with inadequate  water, this leads to prolonged contact  u of the drug with the esophageal mucosa leading to focal damage and esophagitis.

This causes acute discomfort followed  by progressive retrosternal pain,  odynophagia, and dysphagia.

Endoscopy reveals a focal lesion localized to one of the anatomic narrowed regions of the esophagus or an unsuspected pathologic narrowing. 

Treatment is supportive.
Antacids, topical anesthetics, bland or  liquid diets are often used.

Let's Learn Together!
-Medha.

Flow volume loop notes and mnemonics

Here are my notes on the flow volume loops!

Flow volume loop explanation video and mnemonic

Hello!

I explain the flow volume loops seen in obstructive lung diseases, restrictive lung diseases, intrathoracic and extrathoracic - fixed variable obstruction in this video with mnemonics! :)

Chest X-ray - Right Lung!

Hello everybody!
So today let's go through the Right lung segments as seen on a Chest x-ray with the help of images.

This will help us identify the exact location of the pathology and the possible etiology for the same.

So the Right lung has 3 lobes.
Upper
Middle
Lower.

Let's start with the right UPPER LOBE.
It has 3 segments.

Now moving to the MIDDLE LOBE .
It has 2 segments Medial and Lateral.

Moving to the LOWER LOBES.

It has 5 segments.

Superior Basal

Lateral Basal

Antero Basal

Medial Basal

Posterior Basal.

(3D CT Images courtesy - CU medicine Hong Kong)

So well I hope this helps to correlate the various Bronchopulmonary segments while interpreting a Chest x-ray!

Let's Learn Together!

-Medha.

Difference between cauda equina syndrome and conus medullaris (with mnemonics)

Let's differentiate Cauda equina syndrome (CES) from conus medullaris today!
With mnemonics because they make life easier! (And because it is the IkaN style of doing things)

Ischioanal fossa (Fun Mnemonic Diagrams)

Hello Everyone,
Lets discuss Ischioanal fossa. I remember it as a Rocket!!
How to draw it?

Draw a rocket

Add 2 wings !!

Draw 2 snakes underneath the wings

                                             

Color it up.

And Label it.

That's all,

Thank you,

Chaitanya Inge

Methamphetamine intoxication mnemonic

Hello!

This post is about crystal meth.

Aortic stenosis murmur explained

In this video I talk about:

The systolic crescendo decrescendo murmur of AS
Early vs late systolic murmur - Which is more severe?
Why there is a soft S2 and paradoxical splitting of the second heart sound in AS?

And mnemonics! Yaay! :D

Cortisol and eosinophils

Today, I forgot the relationship between cortisol and esosinophils. Completely screwed up a practice question because I couldn't remember it.

Now I made a mnemonic to remember this :D

Mnemonic: In hypERcortisolism, Eosinophils Reduce.

Why do corticosteroids cause eosionopenia? Why does hypocortisolism cause an increase in eosinophil count?

Bankart's and Hill Sach's lesion mnemonic

These two lesions occuring in relation with shoulder dislocation can stump someone if asked in an MCQ as to which lesion is specifically related to which structure.

Remember the sentence-

" Sacks of money are deposited in a bank"

In a similar way, the head of humerus is 'deposited' (articulates within) the glenoid cavity.

Thus,
Hill Sach's lesion occurs on the humeral head.
Bankart's lesion occurs on the anterior glenoid labrum.

Now, how to remember whether is it the anterior or the posterior labrum?
Remember that anterior dislocation of the humeral head is the commonest occurence. That will leave no confusion.

That's all!

-Sushrut Dongargaonkar

How to interpret a Chest X-ray.

Hello everybody, so today's post will be a little long so kindly bear with me.

I hope that this post helps you and makes interpretation of an x-ray less daunting and more fun.

So let's get started.
Step 1:
Always place the x-ray in a such a way so that it seems you are facing the patient.

So naturally this is only possible with AP(Anteroposterior) and PA (Posteroanterior) views.

The technicians mark the X-ray indicating the side but chest x-rays are sort of independent of side markers due to the position of the left ventricle and the aortic knuckle.

Step 2:
To interpret a chest x-ray you need to think in layers as in from outside-in or from inside-out, with one type of structure at a time.
Do a targeted search rather than just staring at the radiograph, an abnormality is unlikely to strike unless you look for it in a planned manner.
Your eyes should scan each part of the film and one should always look twice in the regions where mistakes are more likely, like the Apices in a PA view and the region over the spine in a lateral view.

Step 3:
Scan the whole radiograph in a sequence:

Identify AP or PA view.
Check for side markers.
Radiographic exposure.
Check for integrity of bony cage.
Begin with lung Apices.
Upper middle and lower zones.
Check the Cardiophrenic angles.
Mediastinal structures.
Soft tissues.

Step 4:

Then Detect the lesion : Where is the lesion and what structures are affected by it. Starting with

Trachea and Bronchi:
Position,shift and deviation.

Mediastinal Lines:
Paratracheal stripes: visible or lost.
Aortopulmonary Window: Fullness or normal.
Paraspinal Lines: bulging or normal.

Hilum and Cardiac prominences, and see cardiogenic or mediastinal cause for the prominence.

Lungs :
Check for the Lung Volumes, Right or left lung densities,Diffuse lung abnormalities.
Whether the lesion is Pulmonary or Extrapulmonary. If pulmonary whether it is focal or diffuse.

Pleura and Fissures : Check for pleural effusion and pleural based masses.

Bones :
Focal injuries
Rib fractures, Notching.
Shoulder girdle and clavicles .

Step 5:
Directed search in an apparently normal chest x-ray.

Lungs :
See the Hidden lung areas like retrocardiac and retroclavicular areas.
Also check for Pulmonary Embolism.

Mediastinum :  Check for the Posterior mediastinal masses and hilar masses.

Step 6:
Describe the Lesion :
Location and Extent of the lesion.
Characteristics in the form of :
Shape
Homogeneity
Calcification
Necrosis
Associated features of trachea, lungs fissures etc.

Step 7:
In the end.
Put up a provisional diagnosis.
Differentiate from the closer/similar diagnoses.
Put up a final diagnosis.
A breif description on the Management.

Viola! We are through our way describing a chest x-ray!

Reading any radiograph has its learning curve and the more we see the more we learn.

Try and describe all the radiographs you see hence forth in the manner mentioned above or anyway you like it but follow a definite protocol and don't miss any important points.

I hope this post was helpful.

Let's Learn Together!
-Medha.

A neonate with cyanotic heart disease (Case #2)

A 3 day old new born is found to have cyanosis. On examination, a II/IV holosystolic murmur is heard. CXR shows decreased pulmonary vascular markings and cardiomegaly. ECG shows tall P waves and left axis deviation. Diagnosis?

Similar to the case we discussed last time (A neonate with cyanotic heart disease #1), let's narrow our differential.

Step 2 CK: Immunization schedule in the US mnemonic

Hey!

I did not create the mnemonic, I just created the table to put it all together for quick revision :)