Sunday, April 30, 2017
Collier's Sign
Hey guys!
Collier’s sign (“posterior fossa stare,” “tucked lid” sign) is elevation and retraction of the upper eyelids, baring the sclera above the cornea, with the eyes in the primary position or looking upward.
This may be seen with upper dorsal midbrain supranuclear lesions (e.g., Parinaud’s syndrome). There may be accompanying paralysis of vertical gaze (especially upgaze) and light-near pupil-
lary dissociation.
The sign is thought to reflect damage to the posterior commissure levator palpebrae superioris inhibitory fibers; causing overactivity of this muscle.
-VM
Hydatid cyst mnemonic
Here's a mini mnemonic on hydatid cyst. Caused by E. Granulosus.
H - Hepatic cysts common
Y -
D - Dogs are definitive host
A - Albendazole treatment (Remember, anaphylaxis risk if aspirated)
T -
I -
D -
C - Calcification (eggshell calcification)
Y -
S -
T -
That's all!
-IkaN
Phencyclidine intoxication mnemonic
Melanoma marker mnemonic
The immunohistological marker for melanoma is HMB 45.
You can remember it by remembering the gorilla named 'Harambe' (HaraMBe) of Cincinnati zoo who was in the news as he unfortunately had to be put down because a child entered his enclosure.
You can correlate melanoma's black pigment with that of Harambe's black fur.
That's all!
- Sushrut Dongargaonkar
Chronic granulomatous disease mnemonic
Chronic granulomatous disease mnemonic
CGD - GRANULES!
G - chronic Granulomatous disease
R - Rhodamine (Dihydrorhodamine abnormal flow cytometry)
R - ROS, Respiratory burst decreased
A - Abscess / Granulomas
N - Nitroblue tetrazolium dye test
N - NADPH oxidase defective
Catalase positive organisms mnemonic: CATALASE!
Candida
Aspergillus
Tuberculosis
Listeria
Staphylococcus aureus
Serratia
pSeudomonas
E coli
That's all!
-IkaN
Deglutition
Upward into nasopharynx: Prevented by elevation of soft palate.
Forward into larynx: Prevented as follows(Only if you don’t talk while swallowing food :P
- Approximation of vocal cords
- Forward and upward movement of vocal cords
- Backward movements of epiglottis to seal opening of larynx
- This causes Deglutition Apnea
- Pharyngoesophageal sphincter relaxes.
- Also upward movement of larynx stretches opening of oesophagus.
Primary peristaltic contractions
Secondary peristaltic contractions
It undergoes Receptive Relaxation. i.e. it relaxes only upon entry of bolus. Otherwise it is constricted.We have 2 clinical conditions associated with it:
1.Achlasia cardia : Failure of sphincter to relax during swallowing. Causes accumulation of food in oesophagus.
2.Gastroesophageal Reflex disease(GERD): Due to incompetence of LES. Acidic content from stomach regurgitates back into pharynx.
Thank you,
Chaitanya Inge
Saturday, April 29, 2017
Friday, April 28, 2017
Mnemonic for Sulci And Gyri of the cerebrum
Memorising sulci and gyri of the cerebrum consists of two parts:
- Memorising the names of the sulci and gyri
- Memorising the locations
Lets start with Superolateral surface
We have 4 regions on superolateral surface. They are
- Frontal
- Parietal
- Temporal
- Occipital
Frontal
Sulci:
- Precentral
- Superior frontal
- Inferior frontal
- Precentral
- Superior Frontal
- Inferior frontal
- Middle frontal
Sulci:SI Gyri: SMI
Names of Sulci are:
- Superior Temporal
- Inferior Temoral
- Superior Temporal
- Middle Temporal
- Inferior Temporal
Parietal
Sulci: PI Gyri: PSI
- Postcentral
- Intraparietal
- Post central
- Superior Parietal
- Inferior Parietal
SaLLTy C
- Superior and Inferior Polar
- Lunate
- Lateral Occipital
- Transverse Occipital
- Calcarine
- Gyrus descendens
- Inferior Occipital
- Superior Occipital
- Arcus parieto-occipitalis.
- Calcarine
- Callosal
- Cingulate
- Anterior parolfactory
- Posterior Parolfactory
- Parieto-Occipital
- Suprasplenial or subparietal
- Median frontal
- Cuneus
- Cingulate
- Paraterminal
- Paraolfactory
- Paracentral
- Precuneus
- Collateral
- H shaped orbital sulci
- Olfactory
- Occipitotemporal
- Rhinal
Gyri(purpled coloured in mnemonic
- Parahippocampal
- Posterior Orbital
- Lateral orbital
- Anterior Orbital
- Lingual
- Lateral Occipitotemporal
- Gyrus rectus
- Median Occipitotemporal
- Medial Orbital
That's all,
Thankyou,
Chaitanya Inge
Blood Supply And Nerve Supply of the Scalp
Hello Everyone!
Today we will discuss blood supply and nerve supply of the scalp. Just too many nerves and arteries out there. But there is a way out.
- Sensory
- Motor
- Supratrochlear (Opthalmic division)
- Supraorbital (Opthalmic division)
- Zygomaticotemporal (Maxillary division)
- Auriculotemporal (Mandibular division)
- Great Auricular(C2,C3)
- Lesser Occipital(C2)
- Greater Occipital(C2)
- Third Occipital(C3)
- Arterial supply:
- Supratrochlear
- Supraorbital
- Superficial Temporal
- Posterior Auricular
- Occipital
- Venous Drainage: Common, thats simple. Names corresponds to arteries.
- But there's a twist. The superficial temporal along with maxillary vein wants to drain in external as well as internal jugular. So they form retro mandibular vein whose course is pretty clear in diagram.
Thursday, April 27, 2017
How to draw midbrain sections and lesions (Fun mnemonic diagrams)
Hello everyone!
Brain sections are super hard to remember, I imagine them as monsters and this is how I draw them:
Paraneoplastic Dermatoses - Bazex Syndrome.
Hello everybody,
So to continue our series on cutaneous manifestations of internal malignancies
Let's quickly learn about Bazex Syndrome.
Bazex syndrome — acrokeratosis
paraneoplastica is a paraneoplastic phenomenon associated with squamous cell carcinoma of the upper digestive tract.
Presents more commonly in Males and over the age of 40.
Presentation: Erythematous to violaceous psoriasiform plaques predominantly located in acral areas (especially the fingers, toes, nose, and helices).
Nail dystrophy, palmoplantar keratoderma, and alopecia are common.
In most patients, manifestations of Bazex syndrome precede the diagnosis of malignancy or the malignancy is diagnosed concurrently.
The lesions of Bazex syndrome are usually resistant to targeted therapies, but treatment of the neoplasm usually leads to resolution of the cutaneous findings, although not always.
Let's learn together!
-Medha!
Wednesday, April 26, 2017
Tuesday, April 25, 2017
Exam Prep Hacks -Tips for a lazy person
The Basics : Deviated Nasal Septum
Deviated Nasal Septum - "Abnormal and asymmetrical alignment of the nasal septum that results in acute nasal obstruction and other symptoms of upper respiratory tract."
AETIOLOGY -
1. Trauma : Abnormal pressure ( lateral or frontal ) applied to nasal septum results in its deviation to one side or another.
- The lateral blow may cause displacement of septal cartilage from the vomerine groove and maxillary crest.
![]() |
Groove on which septal cartilage sits ( encircled ) - lateral view Diagram by IkaN. |
- Frontal blow causes crushing injuries to the nose, usually occurs in sportspersons especially the boxers.
2. Developmental anomalies : Palate forms the base of nasal septum. Highly arched palate, cleft palate or lip, and dental abnormalities can all lead to deviation of the septum.
3. Racial factors : Caucasians have more incidence of DNS.
4. Hereditary : Familial predisposition.
TYPES of DNS -
1. Anterior dislocation : dislocation of nasal septum into one of the chambers. ( unilateral nasal obstruction )
2. C - shaped dislocation : simple curve to one side with compensatory hypertrophy of turbinates in other side. It causes unilateral nasal obstruction.
3. S - shaped deformity : causes bilateral nasal obstruction
4. Spurs : shelf - like projections may lead to headache and epistaxis. ( unilateral obstruction )
5. Thickening : due to septal hematoma
CLINICAL FEATURES of DNS mnemonic
TREATMENT - Only required if the symptoms are severe. The procedures are to be done once the patient is more than 17 years old.
- Septoplasty : The most deviated parts of nasal septum are removed and rest of the parts are surgically corrected and repositioned.
- Submucous resection ( SMR ) : Mucoperiosteal and mucoperichondral flaps that overlie one side of the septum are lifted. Most of the septum is removed and flaps repositioned.
Thats all
Hope this helped :)
- Jaskunwar Singh
External Carotid Artery branches mnemonic
External Carotid Artery branches mnemonic - Seven Angry Ladies Fighting Over PMS
Cranial nerve III damage (Oculomotor nerve damage mnemonic)
The CN III has both motor (central) and parasympathetic (peripheral) components.
Which fibers get affected in diabetes?
Which would lead to loss of pupillary light reflex?
Which fibers are compressed first?
Which would cause the down and out pupil?
Don't know? Check the video out!
Mnemonic : Deviated Nasal Septum clinical features
The clinical features ( s/s ) that are presented by a patient with DNS are : NOSE MASH
NO - Nasal Obstruction
S - Septal cartilage and bone deformity
E - Epistaxis
M - Middle Ear infection
A - Anosmia
S - Sinusitis
H - Headache
- Jaskunwar Singh
C Peptide levels : An Overview
Hello everyone!So I ended up uttering 'C peptide' recently in my Medicine Viva and my professor screwed me over it.
(Clearly I didn't C it through :'D )
So I thought of doing a brief summary on it.
Here goes.
1. What is C peptide ?
- When pro- insulin is cleaved , it gives insulin and C peptide.
- C peptide in general has a longer half life than insulin and is easier to detect.
- The pathway is something like this :
Pre proinsulin produced in Rough Endoplasmic Reticulum of Pancreas --> Transported to the Golgi apparatus and cleaved to form Proinsulin --> Packed into secretory granules --> In these granules proinsulin is converted to : Insulin and C peptide.
- Traditionally it is said to have no intrinsic activity but recent studies say it might have anti oxidant and anti inflammatory properties.
2. What does it indicate ?
- So , its presence indicates presence of Insulin in the body in a proportionate amount.
- Hence in a case of Hypoglycemia if C peptide levels are high, it's likely to be due to increased endogenous Insulin levels.
3. C peptide levels increased in -
- Insulinoma
- Sulfonylurea induced Hypoglycemia ( As they are Insulin Secretagogues)
- Type 2 Diabetes Mellitus ( Hyperinsulinism due to resistance)
- Insulin Resistance states like Obesity , PCOS , Cushing's.
4. C peptide levels reduced in -
- Type 1 Diabetes as Insulin secretion is reduced
- Latent Autoimmune Diabetes of Adult (LADA )
- Factitious hypoglycemia - Due to excess exogenous Insulin administration.
- Hypoglycemia due IGF secreting tumors.
So if you get a patient with Hypoglycemia with elevated insulin levels , C peptide levels help you decide if due to exogenous Insulin , or Endogenous Insulin ( Sulfonylurea induced or Insulinoma).
Hope this helped !
Stay awesome.
Happy studying!
~ A.P Burkholderia.
Monday, April 24, 2017
The Basics : Middle Ear
In this post, I will be talking about the middle ear structures and its relations with its neighbors ( just a summary ).
The Middle Ear is an air filled and bilaterally compressed/ concaved cavity lined by mucous membrane located in between the external and internal parts of ear. It is divided into:
- Epitympanum or the Attic ( 6mm ) - lies above pars tensa and medial to pars flaccida
- Mesotympanum ( 2mm ) - lies opposite to pars tensa
- Hypotympanum ( 4mm ) - lies below the level of pars tensa
BOUNDARIES of the middle ear ( homologous to structure of a cube ) :-
Roof : Tegmen tympani - a thin bony plate that is a part of petrous part of temporal bone, separates the middle ear cleft from middle cranial fossa.
- Infection in the middle ear may spread superiorly and lead to formation of abscess in the meninges ( especially Extradural abscess ), meningitis or if severe, it may even lead to abscess formation in the temporal lobe.
Floor : Jugular bulb - The middle ear cavity is separated from jugular bulb by a thin piece of bone that if deficient may lead to formation of a layer of fibrotic tissue and mucous membrane in between. The contents of jugular bulb are:
- Internal Jugular vein
- Glossopharyngeal nerve ( IX )
- Vagus ( X )
- Accessory nerve ( XI )
The tympanic branch of glossopharyngeal nerve enters the middle ear at the junction of the floor and medial wall to play an important role in formation of tympanic plexus.
Anterior wall : The upper part of the narrow anterior wall has two openings or tunnels for - ( mnemonic : TEA )
- Canal for Tensor tympani muscle
- Pharyngotympanic ( or Eustachian ) tube
The lower part of anterior wall is separated from the Internal Carotid Artery by a thin plate of bone. The ICA is surrounded by a plexus of sympathetic nerves that enter middle ear through openings in this bony plate to form tympanic plexus.
Posterior wall : Posteriorly, it is related to middle ear cleft ( Aditus, Antrum and mastoid air cells )
- Infection in this region may spread posteriorly into the sigmoid sinus ( in posterior cranial fossa ) and cause thrombophlebitis !!
Medial wall : Medially the middle ear cavity is related to the promontory, oval and round window
Lateral wall : Tympanic membrane separates the middle ear from the external ear.
A brief about the functions of middle ear:
On the incoming of sound waves, the tympanic membrane oscillates and these oscillations are sensed by the strongly attached and faithful middle ear ossicle, the Malleus. The sound energy is transmitted as such by the ossicles ( Malleus - Incus - Stapes ) to the internal ear for further processing.
The major function of these ossicles is amplification of sound waves - Tympanic membrane is 17 times larger than the oval window - So that means the sound energy is picked up by the larger area ( TM ) and impinged over a much smaller area ( oval window ) thus amplifying it 17 times.
In addition, the lever action of the ossicular chain is approx. 1.3 units. Thus the intensity ( force ) of sound waves/ vibrations changes ( increased by ~20 times ) and not the frequency !! If the sound waves are not amplified ( in case OC is removed ), the Air Conduction would be lost. So BC > AC and thus hearing would then be poor.
Thats all
Hope this helped :)
Stay Awesome!
- Jaskunwar Singh
Craniopharyngioma mnemonic
The C's of Craniopharyngioma
Children
Calcification
Cholesterol crystals
Cyst formation
Central diabetes insipidus
Compresses chiasm, can't C (see, because butemporal hemianopia)
CR: CRAniopharyngioma RAthkes pouch remnant
Yup. That's all!
-IkaN
Sunday, April 23, 2017
'A' wave in JVP : Mnemonic and explanation
Hi everyone. So JVP is one of the most theoretical clinical signs I've ever studied. And though parts of it are logical , I find it tedious to memorize all causes for a particular finding.
So I've prepared a Mnemonic for prominent a waves.
Here goes.
The A wave is a positive wave of the JVP.
It represents the Right Atrial pressure during systole.
Causes of a prominent a wave
Remember :
CRePT's
C - Cor Pulmonale
R - Right heart Failure
P - Pulmonary stenosis
T - Tricuspid stenosis
S - The S tells you it's Stenosis for P and T.
The a wave essentially represents the pressure in the Right atrium during systole.
So any condition that causes this pressure to increase would cause a prominent A wave.
Cor Pulmonale and RVF are basically congestion in RV causing elevation of pressure in the RV.
This means the atrium needs to pump with greater force into the Ventricle for the venous return to enter the Ventricle. This increases the RA pressure causing prominent a wave.
Pulmonary Stenosis leads to accumulation of blood in the RV and this follows a similar fate as the above mentioned causes.
Tricuspid stenosis causes obstruction to the flow of blood from RA to RV. Thus accentuating the pressure in the RA.
That's the Prominent a wave for you !
~~~~~~~~~~~
Now there's something called the Cannon a wave.
These represents contraction of the RA against a closed Tricuspid valve.
The causes of this include -
A- V dissociation.
Heart blocks.
Ventricular arrhythmias - V tach , Ventricular premature complexes and Ventricular pacing.
~~~~~~~~~~~
The a wave would be absent in Atrial fibrillation as the atrium is functionally not pumping at all , and just vibrating.
These are the a wave findings for you !
Hope this helped
Stay awesome.
~ A.P. Burkholderia
Number needed to treat and number needed to harm mnemonic
Hello!
Number needed to treat = 1 / Absolute risk reduction
Mnemonic: TARR - Treat Absolute Risk Reduction
Number needed to harm = 1 / Attributable risk
Mnemonic: HARM - Harm Attributable Risk M
That's all
-IkaN
The Basics : Lateral wall of Nasal cavity
Saturday, April 22, 2017
Clubbing : Why it occurs.
This is a short post on why clubbing happens.
So it's simple !
It's cause people like to go out and get drunk.
Just kidding. Here goes.
- It's the bulbous enlargement of the terminal digits and the nail bed.
- Symmetrical clubbing can occur due to a host of causes.
- To summarize :
A. Respiratory
: Lung cancer
: Suppurative lung conditions like
: Pulmonary Fibrosis
B. Cardiac
- Cyanotic heart disease
- Eisenmenger Syndrome
- Infective endocarditis
- Inflammatory bowel disease
- Cirrhosis - esp Biliary
D. Endocrine
- Thyroid Acropachy
- Acromegaly
But what makes sense to me , I want to share with you'll! And it was an absolute pain to find something convincing enough. So just stick with me here ;;)
The most widely accepted theory right now is the megakaryocyte theory.
IBD - especially Crohn disease seen to have thrombocytosis eventually which may aggravate the PDGF.
In cirrhosis of liver , especially biliary , pulmonary arteriovenous shunting is observed. This could result in the megakaryocyte entrapment as explained.
Another theory suggests inflammation triggers a vagal response causing Vasodilator effects. ( Neurogenic).
Other theories -
Hypoxia induced
Reduced ferritin related
Neurogenic
Humoral - various PG's and other humoral molecules.
The most widely accepted theory is the Megakaryocyte theory.
Hope this satisfied you !
Thank you.
Stay awesome.
~A.P.Burkholderia
Preparing for NEET - Part 2
Authors' diary: Homemade cheap DIY alternatives for a smartphone camera stand
In this video, I show how I keep my camera stable while shooting videos of my notes / whiteboard.
I use paper cups and books as my camera stand.
Friday, April 21, 2017
Paraneoplastic Dermatoses - Tripe Palm.
(The palmar ridges are accentuated and resemble to the stomach mucosa of a ruminant-tripe.)
-Medha.
Nail Changes in Medicine : A Summary
Hi everyone. Just a list of changes you can see in the nails in different systemic Diseases. So let's get nailed ;)
1. Clubbing -
Loss of angle between the nail and the nail fold - More soft and bulbous nail.
Typically indicates Cardio Pulmonary function disturbance :
--> Cardiac conditions like Cyanotic heart disease, Infective endocarditis and Atrial myxoma.
--> Respiratory conditions :
Neoplastic like CA lung ( Esp. Squamous cell CA) , Mesothelioma.
Infective like Bronchiectasis , Abscess , Empyema.
(Non cardiorespiratory causes = Inflammatory bowel disease, Biliary Cirrhois.
Thyroid Acropachy , Acromegaly. )
2. Koilonychia -
Spoon shaped nails.
Strongly indicative of Iron Deficiency anemia or Fungal nail infection.
3. Onycholysis -
Destruction of nail.
Seen in Psoriasis , Hyperthyroid and Fungal nail infection.
4. Chronic Paronychia -
Inflammation of nail fold. May have swollen nail and discharge with throbbing pain. May occur due to frequent nail biting.
5. Cyanosis -
Can be looked for in nail bed. We have a post on this already.
6. Beau line -
Transverse furrows from temporary arrest of nail growth due to increased stress.
Nails grow at 0.1 mm/d , so furrow distance from the cuticle can be used to time the attack. Can be seen in Malaria , Typhus , Rheumatic fever , Kawasaki.
7. Mees line -
White transverse bands in Arsenic poisoning / Renal failure.
8. Muerhcke's line -
White parallel lines without furrowing on the nail.
Seen in Hypoalbuminemia.
9. Terry's nails -
Proximal portion of nail is white / pink , tip is reddish brown.
Seen in cirrhosis , CRF
10. Splinter hemorrhage -
Longitudinal Hemorrhage streaks under the nail seen in Infective endocarditis.
What a fun way to get nailed down 😂 Happy studying !
Stay awesome.
~ A.P.Burkholderia.