Hill’s criteria in Aortic Regurgitation

Hey Awesomites

Normally, the lower limbs systolic blood pressure ( measured on popliteal artery by indirect method, using sphygmomanometer ) is 10-20 mmHg higher than that of upper limbs ( brachial artery ).

This is because:

1. The lower limb vessels are more muscular than the upper limb vessels.

2. Lower limb vessels are in direct continuation of the Aorta, whereas the upper limb vessels form an angle of 90°.

3. The increased blood pressure is the result of summation effects of reflected pressure waves.

As a result, the pressure waves are transmitted at a higher speed in the wall of lower limb vessels which then get reflected at the end to increase further with the incoming wave.

In Aortic Regurgitation, the greater amplitude of pressure waves results in exaggerated increase in systolic blood pressure of lower limbs vessels compared to that of upper limbs.

The grading of severity of aortic regurgitation based on Hill’s criteria is as follows :
Mild - difference of 20-40 mmHg
Moderate - difference of 40-60 mmHg
Severe - difference of >60 mmHg.

Thats all
Hope that helped :)
- Jaskunwar Singh

Image based MCQ on pediatric infections

Hey Awesomites

Yesterday we posted an MCQ on a pediatric infection with characteristic appearance of rash on face, involving both cheeks.

Image Based MCQ on Fracture

Hello awesomites!
Yesterday we posted an Image based MCQ on Fracture of forearm bones and here's the answer for it.
Q. The X-ray of forearm in AP and Lateral views as shown in the image is diagnostic of

A. Galeazzi fracture-dislocation
B. Barton fracture
C. Monteggia fracture-dislocation
D. Colles fracture

Ans: c) Monteggia fracture-dislocation

Monteggia fracture-dislocations is defined as fracture of the ulnar shaft along with concomitant dislocation of the radial head.

Mechanism: Monteggia fracture-dislocations occur as the result of a fall onto an outstretched hand (FOOSH).

Classification: The Bado classification is used to subdivide the Fracture dislocation into four types.

Type I: anterior dislocation of radial head (Most common)
Type II: posterior dislocation of radial head
Type III: lateral dislocation of radial head
Type IV: anterior radial head dislocation as well as proximal third ulnar and radial shaft fractures

That's all!
Thanks for your active participation.

MD Mobarak Hussain (Maahii)

Causes of chemosis mnemonic

Chemosis is known as oedema of conjunctiva.

Reason:due to exudation from the abnormal capillaries.This retained exudate gives a swollen and gelatinous appearance.

Regions: loosely attached areas of the bulbar conjunctiva and fornices.

Causes: ABC

A: Acute inflammations like gonococcal conjunctivitis, panophthalmitis, dacryocystitis, periostitis, orbital cellulitis.

B: Blood conditions (abnormal) like anaemia, urticaria, angioneurotic oedema, lymphocytic infiltration.

C: Circulatory obstruction in conditions like pulsating exophthalmos or due to pressure of an orbital tumour which may interfere with the lymph and blood drainage.

Thanks for reading.

Madhuri

Causes of hematuria mnemonic

Hey Awesomites

Some common Glomerular causes of Hematuria:
( mnemonic: GH )
- Glomerulonephritis ( post infectious, membranoproliferative, rapid progressive, IgA nephropathy )
- Henoch- Schonlein nephritis

Non - glomerular causes of hematuria :
( mnemonic : HEMATURIa )
- Hemorrhage ( cystitis, PCKD )
- Allergic reaction ( interstitial nephritis )
- Trauma or Tumors
- Urinary tract infections / increased Urinary calcium 

Thats all

- Jaskunwar Singh 

Renal colic : Important points

Hey Awesomites

Some important points to be noted regarding renal colic:

Tay Sachs Disease

Hello Awesomites!
Here's a Blog on Tay Sachs Disease and some common questions related to it.

Tay-Sachs disease

It is a genetic disorder that results in the destruction of nerve cells in the brain and spinal cord. Tay–Sachs disease is caused by a genetic mutation in the HEXA genes on chromosome 15. It is inherited from a person's parents in an autosomal recessive manner. The mutation results in problems with an enzyme called beta-hexosamidase A ,located on lysosomes,which results in the build up of the toxin GM2 ganglioside within cells. The most common type, known as infantile Tay–Sachs disease, becomes apparent around three to six months of age with the baby losing the ability to turn over, sit, or crawl. This is then followed by seizures, hearing loss, and inability to move. An eye abnormality called a cherry-red spot, which can be identified with an eye examination, is characteristic of this disorder. Death usually occurs in early childhood. Less commonly the disease may occur in later childhood or adulthood. These forms are generally milder in nature.Diagnosis is by measuring the blood hexosaminidase A level or genetic testing.

Frequently asked questions -

The substance which accumulates in Tay Sach’s disease is Ganglioside.
Deficiency of enzyme Hexosaminidase-A causes Tay Sach’s disease.
Cherry red spot at macula may be seen in Tay Sach’s disease.

That's all!
Thank you.

MD Mobarak Hussain (Maahii)

Myopathies series - Part 6

Hello :)

Now we will discuss individual myopathies in detail.

We have discussed the association between metabolic disorder and myopathies.
Metabolic myopathies Intro
Metabolic myopathies (differential diagnosis)
In this part, we will discuss the association between structure of cell (myocytes) and myopathy. Look at the diagrams below :-

Q.IDENTIFY THE GIVEN MUSCULAR DYSTROPHIES (Comment below)

In the next post, I will explain the pictures in detail.
I hope it helped.
-Upasana Y. :)

Fact of the day : Neurovascular knockout

Hey Awesomites

Stimulation of trigeminal nerve in the face, vagus nerve, or carotid sinus in the neck may cause a reflex drop in heart rate, dilatation of peripheral blood vessels, and constriction of cerebral blood vessels, which leads to a sudden loss of brain perfusion and unconsciousness. This type of knockout is called "neurovascular knockout".

Blow to the eyesocket, as during boxing may cause a similar knockout, called the oculocardiac reflex due to stimulation of trigeminal nerve ( ophthalmic branch ) and vagus nerve.

- Jaskunwar Singh

Image Based MCQ on ENT instruments

Hello guys!

Yesterday we posted an Image based MCQ on ENT instruments.
And here's the answer for it.

#ENT
#Instruments

Q. The instrument shown in the above image is used in?

A. Thyroidectomy
B. Adenoidectomy
C. Tonsillectomy
D. Parathyroidectomy

Ans: c) Tonsillectomy

The instrument shown in the above image is Eve’s Tonsillar Snare, used in tonsillectomy.

Identification of the Instrument:

It consists of a long, thin, hollow tube with a stainless steel wire loop at one end which has Ratchet action. The other end has three large rings. These three rings allow the instrument to be operated using three fingers.

Uses:

It is used to snare the lower pole of Tonsil at the end of dissection. Advantage of using the snare to resect the tonsil is to minimize the bleeding by crushing the vascular pedicle, not cutting unlike scissors.

Procedure:

The instrument is held by inserting the forefinger and the middle finger into two rings on either side of the snare.The thumb is placed in the single ring at the back. This ring is actually located at the end of the plunger. Pulling the plunger with the thumb draws out the wire loop while it can be pulled back in by pressing the plunger with the thumb. The wire loop is first threaded over the Denis Browne tonsil holding forceps. The dissected tonsil is then held with the forceps and the wire loop moved over it until it surrounds the pedicle of the tonsil. The thumb is then pressed down to draw back the loop. The pedicle of the tonsil is crushedby this movement.

That's all!
Thank you.

MD Mobarak Hussain (Maahii)

Asthma + Eosinophilia

Let us suppose that a patient has the classic signs & symptoms of Asthma and with that she has eosinophilia ( Absolute eosinophil count above 500/mm3).

The next step should be to look at the serum IgE levels.

If it is also elevated-

1. Do a stool examination and serological testing for strongyloidiasis.

2. Do Aspergillus-skin testing and check for aspergillus specific IgE.

If you have got a positive result for one of the above two, you have your diagnosis.

But what if both of the above results come out to be negative.

Then consider Churg Strauss syndrome or Eosinophilic granulomatosis with polyangiitis.

That's it!

-VM

Subpleural opacities and Ground Glass Opacities

Hey guys!

I saw a patient today, a 37 year old female patient with chief complaints of cough and shortness of breath. She has a history of allergic rhinitis and migraine. She is also obese with an BMI of 31.

As you must have guessed already she was diagnosed with Bronchial asthma. On the spirometry report done 4 months back,  there was an obstructive pattern and after giving bronchodilators her FEV1 increased by 22% (>12%) and FEV1 vol increased by 300ml (>200ml). These findings also strongly support the diagnosis of asthma.

She was started on Albuterol as needed and Salmeterol-fluticasone MDI. She didn't show good response in the first 4 weeks, so she was also started on Montelukast and Tiotropium inhaler.

Now after 4 months, she still had cough and shortness of breath. She had bilateral polyphonic wheezes. A chest X Ray was done which came out to be normal. On pulse oximetry, SaO2 was 97% while breathing ambient air. On chest CT we found two attributes:
Subpleural opacities and Ground glass opacities.

So based on the CT scan findings, differential diagnosis:

Subpleural opacities:
1. Eosinophilic granulomatosis with polyangiitis( previously called Churg Strauss).

2. Organizing pneumonia

3. Pulmonary embolism with resultant subpleural pulmonary infarction

4. Allergic bronchopulmonary aspergillosis ( well, not really, actually in this case, there is peripheral air space opacification which looks identical to subpleural opacities)

Now Ground glass opacities:

1. Atypical pneumonia

2. Hypersensitivity pneumonia

3. Several ILDs

4. Sarcoidosis

5. Pulm Edema

6. Pulm Haemorrhage

That's all!

-VM

Cutaneous manifestations of Streptococcus

Hello awesomites!
Here's a collection of Cutaneous infections/diseases caused by Streptococcus pyogenes

Direct infections of skin or subcutaneous tissue-

1. Cellulitis
2. Impetigo
3.Ecthyma,Erysipelas
4. Vulvovaginitis
5. Perianal infection
6. Streptococcal ulcers
7. Blistering distal dactylitis
8. Necrotizing fasciitis

Secondary infection-

Eczema, infestations, ulcers, etc.

Tissue damage from circulating toxins-

1. Scarlet fever
2. Toxic‐shock‐like syndrome
3. Recurrent toxin‐mediated perineal erythema

Skin lesions due to allergic hypersensitivity to Streptococcal antigens

1. Erythema nodosum
2. Vasculitis

Skin disease provoked or influenced by Streptococcal infection (mechanism uncertain)-

1. Psoriasis, especially guttate forms.
2. Kawasaki disease.

That's all!

MD Mobarak Hussain (Maahii)