The condition where 'day blindness' is present is a cataract at the nodal point. Nodal point of the eye is where the rays of light pass through the lens without any refraction, usually at the centre of the lens. Thus, during the day, especially when out in the sun, the pupil contracts and the light has to pass through the cataractous area, causing diminution of vision.
Thursday, June 22, 2017
Immunotherapy for Prostate cancer
Immunotherapy is now an emerging and much promising intervention in the treatment of prostate cancer, apart from the traditional cancer treatments - chemotherapy, radiation and surgery.
Wednesday, June 21, 2017
Research Update - The Multitasking Brain.
And you hear the Pinggg!!!
Aha.. GOTHAM needs you!! You shift your focus from the task of studying to the task of on your cellphone,and simultaneously thinking about how good you are at multitasking!
Hematuria: A clinical pearl
Hematuria (blood in urine) may be microscopic or macroscopic/ gross.
The American Urological Association (AUA) defines microscopic hematuria as 3 red blood cells/ high - power field on microscopic examination of the centrifuged urine specimen in two of the three freshly voided, clean- catch, midstream urine samples.
Gross/ visible hematuria can result from as little as 1mL of blood in 1L of urine, and therefore, the color of urine does not necessarily reflect the degree of blood loss.
Now lets have a brief review of the clinical presentation of hematuria on the basis of its source -
- A glomerular source of bleeding (nephronal/ glomerular hematuria) usually results in persistent microscopic hematuria that may be with/ without intermittent periods of gross hematuria.
- Total hematuria (present throughout the void) indicates bleeding of bladder/ upper tract origin.
- If renal sources of hematuria are present, the blood is equally dispersed throughout the urine stream and does not clot.
In cases of clotting, its localisation is a must to evaluate the underlying cause:
- Hematuria/ clots at the beginning of the urine stream ( initial hematuria ) is a symptom of a urethral cause.
Terminal hematuria occurring at the end of stream may be caused due to either prostatic, bladder, or trigonal source of bleeding.
Thats all
- Jaskunwar Singh
Grossing the thyroid and differentials to be considered
The following key factors should be described of the received specimen:
1. Type of the specimen
2. Dimensions of all the lobes
3. Size- If enlargement seen, is it diffuse or focal
4. Colour- Brown ( Normal); yellowish white/ beefy red/ mahogany brown
5. Consistency of the lesion - cystic ( single or multiple; bilateral or unilateral lobe involvement); solid; solid- cystic
6. Relation of the lesion to the adjacent thyroid
7. Surface of the thyroid - Smooth/ infiltrated - hemorrhagic irregular areas
8. Whether received intact or in pieces due to extensive extrathyroidal adhesions ( Reidel thyroiditis)
Serotonin receptor agonist and antagonist notes
mPFC activation in depression: The Associations
I had talked about how people with neuroticism also have an advantage of being creative in a previous post.
Lets now know the basis of this in brief -
Tuesday, June 20, 2017
Sinus of Morgagni- Contents
Contents- (mnemonic PLATE)
1. Palatine branch of ascending pharyngeal artery
2. Levator palati muscle
3. Ascending palatine artery
4. Tensor vetli palatini
5. Eustatian tube
- 1) Conductive deafness
- 2) Ipsilateral immobility of the soft palate
- 3) Trigeminal Neuralgia
- Hope that helped!
- Ashita Kohli
Zenker's Diverticulum
Killian's Dehiscence is a potential gap between the oblique and transverse fibres of the inferior constrictor muscle. It is also known as the gateway of tears as it is a potential site of perforation during oesophagoscopy.
Zenker's diverticulum occurs due to the outpouching of the pharyngeal mucosa at the site of Killian's dehiscence.
There is incoordination between the descending peristaltic wave and the cricopharyngeus muscle at the upper oesophageal spincter which leades to high intra luminal pressure and the mucosal herniation through the weak area of Killian's Dehiscence.
It is not a true diverticulum as it has just the herniation of the pharyngeal mucosa. ( A true diverticulum has all the layers of the oesophageal wall)
It is usually seen in elderly above the age of 60.
Symptoms-
1. The most common symptom is Dysphagia, which is intermittent initially and later becomes progressive.
2. Halitosis ( ie. bad breath, well ofcourse because food can get trapped in this pouch)
3. Regurgitation of food and cough.
4. There maybe regurgling sounds in the neck, gurgling sensation on palpation is known as Boyce sign.
Malignancies may develop in 0.5-1% cases.
Diagnosis- Barium Swallow and videofluoroscopy
Treatment-
1. Endoscopic stapling of the diverticulo esophageal sphincter.
2. In patients not fit for major surgeries, Dohlman's surgery may be done.
Hope that helped!
Ashita Kohli
Waldeyer's Ring
The ring is bounded by-
1. Palatine Tonsils ( also called as Faucial Tonsil)- Situated in between the anterior and posterior pillars on each side of oropharynx
2. Adenoids (aka Lushka's Tonsil)- Lies at the junction of roof and posterior wall of nasopharynx
3. Tubal Tonsils ( aka Gerlach's Tonsil)- Lies in the fossa of rosenmuller behind the eustatian tube opening
4. Lateral Pharyngeal Band and Nodules
Hope that helped!
Ashita Kohli
Rhinolalia Aperta
The defect is seen in the failure of the nasopharynx to cut off from oropharynx.
Some fibres of palatopharyngeus muscle make the posterior pillar, go posteriorly in the posterior wall of nasopharynx and along with the lower fibres of the superior constrictor muscle forms a ridge known as the Passavant's Ridge.
During swallowing and speaking the passavant's ridge closes the nasopharyngeal isthmus.
When this doesn't happen (eg- cleft lip, paralysis of palate) it leads to nasal regurgitation of food and nasal tone in speech known as Rhinolalia Aperta.
Treatment-
1. In children with cleft palate, special exercises can help in strengthening the muscles so as to reduce the nasality in voice.
2. Surgery- Posterior Pharyngeal Flap
Sphincter Pharyngeoplasty
Hope this helps!
Ashita Kohli
Differentials of lower limb ulceration: Venous, arterial or neuropathic?
Authors diary: Tip for solving multiple choice questions
Monday, June 19, 2017
Baclofen for treatment of alcohol dependence
Hello!
Recent evidence suggest that the gamma-aminobutyric acid-B receptor agonist baclofen is a promising agent for the treatment of alcoholism.
Yep!
Baclofen produces an effortless decrease or suppression of alcohol craving. It decreases alcohol consumption including in those with poor motivation. The drug causes few side effects and does not add to the intoxication effect of alcohol.
It benefits patients with alcohol dependence (even those who are still in precontemplation stage of motivation!)
Research has shown that baclofen reduces withdrawal symptoms of alcohol and is safe in those with liver impairment.
Although further studies that compare long-term alcohol-related outcome of baclofen with established drugs such as naltrexone and disulfiram are needed.
Interesting, isn't it?
-IkaN
More than what you know about vitamins!
Q. Which vitamin deficiency is related with lowering of seizure threshold?
Ans. Pyridoxine Vitamin B6.
Q. Why laropiprant (20mg) + Niacin (1g) is used in combination?
Ans. Nicotinic acid (a derivative) results in flushing of face.
Q. In hyperemesis gravidarum, what do you give for associated Wernicke's encephalopathy following hyperemesis?
Ans. I thought of anti-emetics at first but the answer is vitamin B1. (Wernicke's encephalopathy doesn't always result from alcohol :P )
That's for today.
Take care. :)
-Upasana Y.
Lacunar infarction notes + mnemonic
Lacunar infarcts are small (0.2 to 15 mm in diameter) noncortical infarcts caused by occlusion of a single penetrating branch of a large cerebral artery.
Pathophysiology:
Lipohyalinosis of the penetrating arteries. (Mnemonic: L for Lipohyalinosis, L for Lacunar)
Microatheroma of the origin of the penetrating arteries.
Lacunar stroke is usually related to a chronic vasculopathy associated with systemic hypertension.
Clinical features:
Penetrating artery occlusions usually cause symptoms that develop over a short period of time, typically minutes to hours. However, a stuttering course may ensue, as with large artery thrombosis, and symptoms sometimes evolve over several days.
As a general rule, lacunar syndromes lack findings such as aphasia, agnosia, neglect, apraxia, or hemianopsia (so-called "cortical" signs). Monoplegia, stupor, coma, loss of consciousness, and seizures also are typically absent.
These syndromes are common :
● Pure motor hemiparesis
● Pure sensory stroke
● Ataxic hemiparesis
● Sensorimotor stroke
● Dysarthria-clumsy hand syndrome
Pure motor hemiparesis: Characterized by weakness involving the face, arm, and leg on one side of the body in the absence of "cortical" signs (aphasia, agnosia, neglect, apraxia, or hemianopsia) or sensory deficit.
Artery / structure involved: Posterior limb of the internal capsule.
Mnemonic: PM - Pure Motor, Posterior limb of internal capsule.
Pure sensory stroke: Numbness of the face, arm, and leg on one side of the body in the absence of motor deficit or "cortical" signs.
Artery / structure involved: Thalamogeniculate branches of the posterior cerebral artery (Ventral posterolateral and ventral posteromedial nuclei)
Mnemonic: MIST
Motor - Internal capsule
Sensory - Thalamus
Ataxic hemiparesis: Ipsilateral weakness and limb ataxia that is out of proportion to the motor deficit. Some patients may exhibit dysarthria, nystagmus, and gait deviation towards the affected side. As with other lacunar syndromes, the above-mentioned "cortical" signs are absent.
Artery / structure involved: Fibres of the fronto-ponto-cerebellar system in the internal capsule / corona radiata.
Sensorimotor stroke: Characterized by weakness and numbness of the face, arm, and leg on one side of the body in the absence of the aforementioned "cortical" signs.
Artery / structure involved: Sensorimotor strokes arise from infarcts involving the posterolateral thalamus and posterior limb of the internal capsule. The exact vascular anatomy is debated.
Dysarthria-clumsy hand syndrome: Facial weakness, dysarthria, dysphagia, and slight weakness and clumsiness of one hand are characteristic. There are no sensory deficits or "cortical" signs.
Artery / structure involved: Lacunar infarctions of the anterior limb of the internal capsule, genu of the internal capsule, or corona radiata.
Treatment:
Intravenous alteplase (recombinant tissue-type plasminogen activator or rt-PA) improves outcomes for patients with ischemic stroke in general if administered within 4.5 hours of symptom onset. The available evidence suggests that intravenous thrombolysis is beneficial for patients with lacunar stroke. Most patients with acute ischemic stroke who are not eligible for thrombolytic therapy should be treated with aspirin.
That's all!
-IkaN
Sunday, June 18, 2017
Changes in glomerular dynamics mnemonic
If you forgot the afferent - efferent stuff from step 1, I have a mnemonic.
Remember ACE ID, PDA ANC.
Step 2 CK: Management of thromboembolic stroke
Drugs used to lower BP acutely in severe preeclampsia mnemonic
Drugs used to lower blood pressure acutely in severe preeclampsia (Maternal hypertensive crisis) mnemonic
"Lower Hypertension Now"
Labetalol iv preferred (Avoid in bradycardia)
Hydralazine iv
Nifedipine oral
That's all!
-IkaN
Micturition and Neurological diseases
Here, presenting you a detailed description of Pathologies of Bladder in Neurology. I believe this is the best resource on this topic available online for free. :)
Diaphragmatic hernia : Mnemonic and Review
Here's a short post on the key points about Congenital Diaphragmatic Hernia.
So there's deficiency in the diaphragm during development causing abdominal contents to budge into the Thorax.
There are 2 main types -->
1. Bochdalek.
2. Morgagni.
Now out of these 2, Bochdalek is commoner.
(It's hard to remember the word Bochdalek. I struggle with it every day. )
You can memorize it by realising that it rhymes with ' Scotch da Lake '
(Which means a lake of scotch in Punjabi)
Key points about Bochdalek -
BBBB
- Back - Located posteriorly
- Big - Bigger than the Morgagni form
- Bad - Poor prognosis
- Bag and Mask Contra indicated.
Also realise - Bochdalek
So it's got an L in it. L = Left. So it's more common on the left side. These hernia classically cause a scaphoid abdomen and Mediastinal shift to the opposite side.
Morgagni can be remembered by the opposite of the BBB
So it's
- Not on the back - Anteriorly
- Not Big - Small sized.
- Not as Bad - Prognosis is alright.
Also realise - Morgagni
It's got an R in it = Right. So it's more common on the right side. And it contains the Transverse colon generally.
So that's all !
Happy studying!
Stay awesome !
~ A.P.Burkholderia