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

Head transplant

Recently during surfing on net ,i came across very interesting topic of surgery -Head transplant ,would like to share with you all people
World's 1st attempt to transplant a human head was launched in year 2015 at a surgical conference in united states.
Procedure was 1st put forward by Sergio canavero -an Italian neurosurgeon.
The actual procedure will be as followed :

Two teams will work in concert making deep incisions on patient's neck exposing vital arteries, veins and nerves ,next step is the most crucial step of cutting spinal cord using $200,000 diamond nanoblade !.
Head is than moved on to donors body and spinal cord can be fused together using polyethylene glycol to encourage the fat in cell membrane to mesh out once the neck is transplanted
and then patient would then be placed into a coma for about a month to prevent movement and to allow healing procedure
while implanted electrodes provide regular electrical stimulation to spinal cord finally when patients wakes up from coma he will be able to see his face and speak !!!! But will need a physiotherapy for 1 year to begin walking .
Dr sergio canavero said that surgery would be ready in 2017 probably .
A computer scientist Spiridonov with Werdnig-Hoffman disease has volunteered to offer his head to study as he is suffering from incurable spinal muscular atrophy and has decided to give one final shot to have a new body !

~Ojas

Tongue depressor and bipod stand

Boyle- davis tongue depressor

This instrument is used to lower down the tongue and hold it while the Davis mouth gag serves to hold the mouth open during tonsillectomy and other oral procedures. it comes in various sizes and used depending upon the age of patient.

The mouth gag is held in position by using the Draffin bipod stand which consists of two rods.

Thats all
- Jaskunwar Singh

Tonsil holding forceps

Denis Browne's tonsil holding forceps

Used in tonsillectomy to grasp the tonsils and pull medially. (dissection method)

The shaft is bent at an angle towards the handle. Ends of this instrument are cup- shaped with holes.



Thats all
- Jaskunwar Singh

Killian's nasal speculum

Killian's long bladed self- retaining nasal speculum

Used in Submucous resection (SMR) and septoplasty procedures.

It helps keep mucoperichondrial flaps away to make space for proper access and vision to the interior of nose and perform surgery efficiently.

IMPORTANT: In septoplasty, the flap is raised only on one side while in SMR, both sides flaps are raised. So due to cosmetic reasons and high risk of septal complications, septoplasty is preferred over the submucous resection.


Thats all
- Jaskunwar Singh

Direct Laryngoscope

As the name suggests, this instrument is used for direct visualization of larynx and hypopharynx. 

Diamond blackfan anemia notes and mnemonic

Diamond blackfan anemia

It is congenital pure red cell aplasia.

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
.
.
.
.
.
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