Thursday, May 18, 2017
Theophylline toxicity mnemonic
Chest x-ray - Left Lung.
Lingula : The tongue like extension and the alleged counterpart of the middle lobe has 2 parts to it : Superior and Inferior.
Basal lobe has 4 segments namely : Superior, Posterior, Medial, Lateral.
Basal Lobe:
Wednesday, May 17, 2017
“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 explanation video and mnemonic
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.
Tuesday, May 16, 2017
Difference between cauda equina syndrome and conus medullaris (with mnemonics)
With mnemonics because they make life easier! (And because it is the IkaN style of doing things)
Aortic stenosis murmur explained
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
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.
Monday, May 15, 2017
A neonate with cyanotic heart disease (Case #2)
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
I did not create the mnemonic, I just created the table to put it all together for quick revision :)
Sunday, May 14, 2017
Why some people hate cheese!
Hello everybody!
So today let's learn a bit about how our brain circuits work.
Some people hate cheese. Like seriously?
How can you miss the warm fussy feeling you get while eating warm molten cheese in a Fondue!
Well some people might not feel any bit of it and rather feel disgusted when presented with cheese.( I feel bad for them )
Anyway let's see how these things work.
Why aversive to cheese per say?
Cheese is the food that most frequently triggers aversion.
Among those with an aversion to cheese, 20% say they are intolerant to lactose. In 50% of cases, at least one of their family members does not like cheese either. These stats suggested that there is a genetic origin to this aversion, which might be related to lactose intolerance.
To find out what happens in the brain, people who like cheese and who do not were selected and participated in a functional magnetic resonance imaging (fMRI) study.
They observed that the ventral pallidum which is activated in people who are hungry was totally inactive in people who had an aversion to cheese but was active for all other food types. Also the Globus Pallidus and Substantia Nigra part ( the reward circuit) was more active in people who had aversion to cheese than in those who do.
So in conclusion, the areas of reward centres of our brain the Globus Pallidus and Substantia Nigra have two types of neurons with complementary activity , one relating to the rewarding aspect of food and other to it's aversive nature.
So now we have a breif idea as to how the brains are wired differently and how we all our special in our own ways!
Let's learn Together!
-Medha.
Femoral Nerve Mnemonic
Lets discuss Femoral nerve today. Doesn't femoral nerve sound feminine? Also I am writing this post on Mothers Day, what a coincidence!
Root value: L2-L4
(Ladies work 24 hours.)
Motor innervation:
It innervates following muscles:
- Anterior division branches innervates
- Sartorius
- Illiacus
- Pectineus
- Posterior division branches (innervates Quadriceps femoris)
- Rectus femoris
- Vastus medialis
- Vastus lateralis
- Vastus intermedius
How to remember it? @_@
Queens hardly get time to SIP coffee ^_^
Sensory innervation:
Anterior division branches provides sensation to anteromedial asepct of the thigh, consists of 2 branches:
- Medial cutaneous nerve of thigh
- Intermediate cutaneous nerve
Posterior division:
- Saphenous nerve : provides sensation to anteromedial aspect of lower leg.
- Infrapatellar branches to knee :pierces the sartorius and fasica lata medial to the knee, and provides cutaneous innervation to the skin anteriorly over the patella.
Monteggia and Galeazzi fracture mnemonic
One can get confused on hours end as to what fracture is related to what bone. Hope this mnemonic comes in handy!
1. MUFC( Manchester united fan club)
- Monteggia upper ulnar fracture
With radial head dislocation
2. GFR low(Glomerular filtration rate)
- Galeazzi fracture radial, lower
With distal radio ulnar subluxation
That's all!
-Sushrut Dongargaonkar
Laughter Disorders - It might not be funny!
ranging from genuine and spontaneous to simulated (fake), stimulated (tickling), induced (by drugs) or even pathological.
Saturday, May 13, 2017
Fact of the day : Loss of Olfaction is a prodrome of neurodegeneration
Loss of the sense of smell is one of the first warning signs of neurodegenerative diseases such as Alzheimer's, Parkinson's and other diseases associated with dementia.
One of the common link evidenced in some studies is the damage to neurotransmitter and neuromodulator receptors ( particularly acetylcholine ) in the frontal part of brain.
Also, one of the pathogenic hallmarks of AD, the Neurofibrillary Tangles ( NFTs ) have been found in olfactory bulb, olfactory tract, the transentorhinal and entorhinal cortex, anterior olfactory nuclei and amygdale. The number of NFTs within these areas have been positively correlated with the disease progression.
Thus, olfactory testing at the 'right time' is essential to detect the presence of disease process in its 'preclinical phase' itself. It could help in the differential diagnosis of several neurodegenerative diseases. Early diagnostic interventions such as smell testing, brain imaging procedures like functional MRI and PET scan, olfactory epithelium biopsy, using radioactive neurochemicals help in evaluation.
The anosmic symptoms are much more common in old patients of more than 65 years of age.
Thats all
- Jaskunwar Singh
Research update : Genetic locus of Anorexia nervosa revealed
A Research landmark study led by UN school of medicine has found the first genetic locus for the perplexing illness, anorexia nervosa. Previously it was known that this eating disorder runs in families with genetic and environmental factors both playing their role and there is ten - fold risk in first -degree relatives, but no particular association with a genetic locus was provided.
Thought to be associated with psychiatric disorders like neuroticism and schizophrenia, it has also been positively correlated with underlying metabolic abnormalities including body - mass index (BMI) and insulin - glucose metabolism. Genome - wide association studies ( GWAS ) have revealed a significant locus for anorexia nervosa on chromosome 12, in a region previously shown to be associated with type -1 diabetes mellitus and autoimmune disorders. This means that this eating disorder shares common roots with metabolic and psychiatric traits !!
These results may help in reconceptualizing the underlying aetiology and pathogenesis of such a lethal disorder and also coming up with new treatment interventions to cure the disease.
Thats all
- Jaskunwar Singh