Hope that helps!
Monday, June 5, 2017
Step 2 CK: Psychiatry tip for possible depression questions
Hope that helps!
GLP-1 analogues mnemonics
- Increase glucose dependent insulin release
- Decrease glucagon release
Sunday, June 4, 2017
Motor Neurone Disease : Why and How to rule it out.
Hi everyone ! Here's a short post on How and why to rule out Motor Neuron diseases.
Motor Neurone Disease includes a group of conditions where the Motor Neurons of your body begin to degenerate.
If these neurons are located above the level of the Alpha motor neuron of spinal cord , the result is UMN lesions , like Primary Lateral Sclerosis.
If the degeneration occurs in the Alpha motor neurons themselves , the result is LMN type paralysis, like Spinal Muscular Atrophy..
A combination of the two - UMN + LMN features as seen in - Amyotrophic Lateral Sclerosis.
Now a few set of conditions are used as a way to exclude to MND.
MND itself isn't very common , and carries an extremely poor prognosis. Treatment options are extremely limited. So it's important to rule it out whenever you come across a Paraplegia , Quadriplegia, Bulbar or Pseudobulbar palsy patient .
An MND has No COBS.
C - No Cognitive changes
O - No Ocular motility involvement till late.
B - No Bladder bowel involvement till late.
S - No Sensory involvement.
There are a few exceptions to this -
Cognitive changes can be present if it's associated with Fronto temporal dementia. A lot of the familial cases are associated with this.
Behavorial changes can also be seen in a Pseudobulbar palsy patient. (More on that some other day !)
Sensory involvement may be seen in Hereditary spastic paraplegia - a variant of MND.
So that's all !
Happy studying !
Stay awesome !
~ A.P.Burkholderia.
Clonus - A review.
Hello everybody!
Let's review Clonus breifly today.
So what is it?
It is a series of rhythmic involuntary muscular contractions induced by the sudden passive stretching of a muscle or tendon.
Clonus occurs most frequently at the ankle, knee, and wrist, occasionally elsewhere.
The important Clonus that we all frequently examine is the Ankle Clonus so let's see that in detail here.
Ankle clonus is a series of rhythmic alternating flexions and extensions of the ankle.
How to do it?
The leg and foot should be well relaxed, the knee and ankle in moderate flexion, and the foot slightly everted.
The examiner supports the leg, with one hand under the knee or the calf, grasps the foot from below with the other hand, and quickly dorsiflexes the foot while maintaining slight pressure on the sole at the end of the movement.
A single tap on the tendon to elicit the ankle jerk may occasionally provoke clonus.
Unsustained clonus fades away after a few beats; sustained clonus persists as long as the examiner continues to hold slight dorsiflexion pressure on the foot.
Unsustained (transient) symmetric ankle clonus may occur in normal individuals with physiologically fast Deep Tendon Reflexes. Nonorganic clonus occurs rarely. False clonus (pseudoclonus) in psychogenic disorders is poorly sustained and irregular in rate, rhythm, and excursion.
Sustained clonus is never normal. In severe spasticity, clonus may occur spontaneously or with the slightest stimulus. At the ankle, true clonus can usually be stopped by sharp passive plantar flexion of the foot or the great toe; false clonus is not altered by such a maneuver
Mechanism:
Part one - For ankle clonus, the sudden stretch of the gastrosoleus muscle elicits a contraction essentially analogous to a stretch reflex that causes a contraction with resultant plantar flexion of the foot. The foot goes down.
Part two - This contraction increases tension in the Golgi tendon organs in the gastrosoleus tendon, sending a volley of impulses via the Ib fibers that then inhibit the contraction of the gastrosoleus and facilitate contraction of its antagonist, the tibialis anterior muscle. The foot goes up.
This in turn passively stretches the gastrosoleus, and the cycle is repeated.
A simpler explanation is alternating stretch reflexes.
A few other Clonus' seen are :
1) Patellar clonus :
It consists of a series of rhythmic up-and-down movements of the patella. It may be elicited if the examiner grasps the patella between index finger and thumb and executes a sudden, sharp, downward thrust, holding downward pressure at the end of the movement.
The leg should be extended and relaxed. Patellar clonus may appear when eliciting the patellar or suprapatellar reflex.
2) Wrist Clonus :
It is produced by a sudden passive extension of the wrist or fingers.
3) Jaw Clonus occurs occasionally.
So that's all about clonus.
Hope it was helpful!
Let's learn Together!
-Medha!
Alternate methods of Eliciting Toe Dorsiflexion in Corticospinal tract lesions.
Hello!
Let's review few minor signs of eliciting toe dorsiflexion when we are suspecting a Corticospinal tract lesion.
Gordon’s sign :
Squeezing of calf muscles.
Schaefer’s sign :
Deep pressure on Achilles tendon.
Bing’s sign :
Pricking dorsum of foot with a pin.
Moniz’ sign :
Forceful passive plantar flexion at ankle.
Throckmorton’s sign :
Percussing over dorsal aspect of metatarsophalangeal joint of great toe just medial to Extensor Hallucis Longus tendon.
Marie Foix sign :
Squeezing the toes or strongly plantar flexing toes or foot.
Gonda (Allen) :
Forceful downward stretching or snapping of second, third, or fourth toe; if response is difficult to obtain, flex toe slowly, press on nail, twist the toe, and hold it for a few seconds.
Stransky :
Small toe forcibly abducted, then released.
Allen and Cleckley :
Sharp upward flick of second toe or pressure applied to ball of toe.
Strümpell’s phenomenon :
Forceful pressure over anterior tibial region.
Cornell response :
Scratching dorsum of foot along inner side of Extensor Hallucis Longus tendon.
All the above signs may not be always seen and sometimes these may be the Only signs present and hence it is necessary for us as students to screen as many patients as we can and increase our understanding and clinical acumen, cause the eyes can't see what the brain doesn't know.
Let's learn Together!
-Medha.
Tetralogy of fallot mnemonic
Hello!
Here is a short note on tetralogy of fallot. Tetralogy of fallot is a congenital disorder of heart. It shows four signs, as indicated in it's name (tetra).
Mnemonic for it is - PRVO virus ( parvo virus )
1. Pulmonary stenosis
2. Right ventricular hypertrophy
3. Ventricular septal defect
4. Overriding of aorta.
That's all :)
H@Mid.
Saturday, June 3, 2017
Ano-Rectal anatomy: Above and below pectinate line
Friday, June 2, 2017
Examination of Subtle Hemiparesis - Barré's Sign.
Normally patient should hold this position for at least 20 to 30 seconds and the palms will remain straight with the elbows straight, and the limbs horizontal.
Let's learn Together!
-Medha.
Thursday, June 1, 2017
Pathophysiology of anorexia in chronic kidney disease
What happens in CKD?