Image Based MCQ on Instruments

Hello awesomites!
Yesterday we posted an Image based MCQ on Instruments and here is the answer to the question.
#Image_based
#Instruments
Q. What is the inner diameter of the device shown in the picture if it is to be used in adults?

A. 2-3 mm
B. 8-9 mm
C. 12-15 mm
D. 21-23 mm
The correct answer is B. 8-9 mm. The image given shows an Endotracheal tube that is available in different sizes for different age groups.
Internal diameter 3mm - 6mm is used for Paediatric cases.
Typically, an 8.0 or 8.5 mm for adult men and 7.5 to 8.0 mm for adult women is an ideal choice.

Thanks for your active participation in the question.

MD Mobarak Hussain (Maahii)

Cushing Vs Curling Ulcer

Hello!

Its time to differentiate between two confusing ulcers - Cushing and Curling.

What is Cushing Reflex?
It is a triad of Bradycardia, Hypertension and altered respiration following Head injury.

What is Cushing Ulcer?
Stress Ulcer following Head injury.
Most common site - Acid producing area of Stomach.

What is Curling Ulcer?
Stress Ulcer following Burn.
Thomas Blizzard Curling.
Reduced plasma volume leads to ischemia and cell necrosis of the mucosa.
Most common site - 1st part of Duodenum.
cURling = bURn

This may help you to remember the difference between these two.

Thanks

MD Mobarak Hussain (Maahii)

Latanoprost and Pilocarpine never go together

Latanoprost increases the uveoscleral outflow of the aqueous humor. Pilocarpine has a constrictive effect on the ciliary body as a whole. Hence, when the two are used together, their effects end up getting nullified with the physician bungling to achieve the target IOP.

That's all!

-Sushrut Dongargaonkar

Medicollabowesome: ENT Manifestations of HIV Infection

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Medicollabowesome: Neurological Diseases in HIV patients

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Medicollabowesome: HIV Infections - Clinical categories

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Medicollabowesome: The increased burden of HIV and AIDS

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Introducing Medicollabowesome

Hello everyone!

We, the Medicowesome authors, decided to do something new this month and bring to you - Medicollabowesome.

The idea originated from wanting to see how different people present information uniquely on the same topic. 

The Medicowesome authors decided that most of us will (try) to write on one particular topic every month. 

Hopefully, we will learn so much together :D

The topic for the month of August: HIV & AIDS. 

We've already begun writing (:

I invite readers to participate in Medicollabowesome too by emailing your article to us! 

Email the title, post and author name to medicowesome@gmail.com with "Medicollabowesome" in the subject line. 

This is so exciting! 

-IkaN 

Medicollabowesome: CD4 and Cavitatory lesions in HIV

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Medicollabowesome: HIV-IRIS

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Medicollabowesome: Ocular HIV

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Medicollabowesome: AIDS - Symptomatic phase association with CD4 count

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Medicollabowesome : HIV Fact sheet

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Drug of choice : Dermatology

Hello everyone!
Here's a collection of Drugs of choice (DOC) for some Dermatology conditions. These are some of the most commonly asked questions in Post Graduation entrance exams.

1. DOC for severe erythrodermic psoriasis?
Cyclosporin

2. DOC for erythrodermic psoriasis?Methotrexate

3. DOC  for pustular psoriasis?
Acitretin

4. 2nd choice for pustular psoriasis?Methotrexate

5. DOC  for arthritis mutilans?
Etanercept

6. DOC for impetigo herpetiformis?
Systemic steroids

7. DOC for psoriatic arthritis?
Methotrexate

8. DOC for psoriatic erythroderma in pregnancy?
Systemic steroid

-Md Mobarak Hussain (Maahii)

Role of Mastoid cells

Role of Mastoid air cells.

Clubbing

CLUBBING:

Bulbous enlargement of the distal portion of the digits due to increased subungual soft tissue.
It is also known as the "Hippocratic fingers", as it is believed that perhaps Hippocrates was the first to document clubbing as a sign of disease.

Grades of clubbing-
Grade I- presence of fluctuation test °
Grade II- obliteration of Lovibond angle*
Grade III- parrot beak or drumstick appearance
Grade IV- hypertrophic osteoarthropathy (HOA)

*Refer the diagram
°Refer the video clipping

Theories of clubbing-
1. Neurogenic theory- vagal stimulation via neural reflexes can lead to proliferation of connective tissue at the distal extremities resulting in clubbing.

2.Humoral theory- Normally lungs throws out all the soluble substances by inactivation. But in case of lung problems, these systems reach the systemic circulation in active state and stimulate the changes seen in HOA (growth hormone, PTH, bradikynin, prostaglandin, ferritin)

3.Hypoxic theory- Hypoxia is suggested to be a stimulus for HOA. It leads to opening of deep arteriovenous shunts and fistulae which increase blood flow to the extremities and leads to hypertrophy.

4.Platelets derived growth factor- Normally megakaryocytes and large platelets get destroyed in the lungs. But in lung pathology they escape the lung and reach the distal extremities. Here they interact with the endothelial cells and release platelet derives growth factor (PDGF) post activation. PDGF and other mediators then activate the fibroblasts and transforming growth factor beta which lead to collagen production and connective tissue laying down ultimately giving rise to clubbing and HOA.
This is the latest accepted theory.

Causes of clubbing-

'CLUBBING'

C - cyanotic heart diseases, chron's disease
L - lung causes (lung abscess, emphysema, interstitial lung disease, bronchogenic carcinoma, tuberculosis)
U - ulcerative colitis
B - biliary cirrhosis
B - benign mesothelioma
I - infective endocarditis, idiopathic, inherited
N - neurogenic tumors
G - graves disease

Shivani Mangalgi
Medicowesome 2017

Courtesy YouTube

Hypergraphia - An intriguing brain anomaly

HYPERGRAPHIA
It is a condition in which an individual feels the driving compulsion to write; the overwhelming urge to write.

Hypergraphia has also been called 'midnight disease'.
Well based on how we perceive it, the "disease" could either be all about writing or writer's block.

Neurologically-
This unstoppable drive to write can be triggered by temporal lobe epilepsy(hippocampus and Wernicke's area in specific), intolerant mood disorders or dopamine.

What is very fascinating about this condition is that there are NO other vicious symptoms (other than a little irritability-which is quiet expected) and the fact that the patient can go on writing on anything from toilet papers to wall to even roads.

And what is more fascinating to know is that many famous authors and poets like Sylvia Plath, Stephen King and Leo Tolstoy (that's how the world got "War and Peace") suffered from hypergraphia.

Ingenious result from a brain defect.

Now a question might arise..if the quality of writing in these patients is any good?
To answer this, it is important to know that patient with hypergraphia exhibit wide variety of writing style and content.  To elucidate this statement, let's go through few accounts:

1. Alice Flaherty (Harvard Medical school neurologist) gets episodes of hypergraphia following any grief incidences that have grave affect on her brain.
She has started her 4th book and is doing research to help explain how the muse comes and goes.
​
2. Mendez- He felt the unreasonable compulsion to write poetry even though the patient had no previous history of being a poet.

3. Patient who wrote everything backwards!

4. Patients writing same word over and over again but with differing calligraphy.

5. Patients' writing consists of sheer scribbling and frantic random thoughts.

 Therefore on a lighter note, if you have the wrong brain defect but fall under the right category...then voilà...YOU shall be famous!


Shivani Mangalgi
Medicowesome 2017

Leucocoria

Leucocoria:

Also known as the white pupillary reflex, is an abnormal white reflection from the retina of the eye.
Pathologically it's the absence of the red reflex.

Clinically the pupils appear white rather than the usual black color.

Mnemonic for causes of leukocoria- 

'CREAM PIGMENT'

C - Coats disease/ Coloboma/ Cataract
R - Retinoblastoma/ Retinal dysplasia/ ROP/ Retinal         fold
E - Endophthalmitis
A - Astrocytic hamartoma/ Anisometropia
M - Myelinated retinal nerve fiber layer

P - Persistent fetal vasculature/ PHPV
I - Incontinentia pigmenti/ Inflammation (uveitis)
G - Granuloma
M - Melanoma/ Medulloepithelioma
E - Familial exudative vitreoretinopathy (FEVR)
N - Norrie
T - Trauma/ Toxocariasis

Go ahead and add more causes to make your own list!

Shivani Mangalgi
Medicowesome 2017

Post operative ileus ( mechanical obstruction vs paralytic )

Hey Awesomites

Under normal circumstances, bowel movements usually do not appear till 72 hours after a certain abdominal or non - abdominal surgery, with a characteristic pattern of initiation of small bowel movements within 24 hours, stomach within 48 and colonic ( proximal to distal ) within 72 hours after surgery.

The assessment of gastrointestinal recovery is done with consideration to certain factors like the time taken to ingestion of first solid food, and time to either bowel movements or the first flatus passed, whichever occurs later.

Prolonged post operative paralytic ileus means:
- No return of bowel movements ( on auscultation ) after 72 hours
- Absence of flatus or stool on day 6 after surgery
- Feeling of discomfort, nausea or vomiting on oral intake, thus requiring i.v. support, NG tube placement by PO day 5.
- Partial return of bowel movements after PO day 5.

On the other hand, post operative ileus due to mechanical obstruction, inspite of sharing many signs and symptoms, is an important differential to exclude. Most of the patients with PO mechanical obstruction in the bowel ( due to herniation, adhesions, stomas, masses, etc. ) have an initial return of bowel function that may be partial/ complete, and oral intake, after a physiological period of 72 hours post operatively. 

It is then followed by intermittent episodes of nausea, feculent vomiting abdominal intense cramping pain and distension, that is often paroxysmal and rapidly progressing..

Also, patient with mechanical bowel obstruction after surgery may have other signs suggestive of ischemia of bowel loop distal to the obstruction, such as localised tenderness, fever, tachycardia, and peritoneal signs, which would mean immediate surgical intervention so as to prevent further complications !!
( Refer to UpToDate)

Thats all
Hope this helps :)

- Jaskunwar Singh

Causative microbes in acute osteomyelitis

 

Hello Awesomites!
Let's discuss some facts about Common microbes involved in Acute Osteomyelitis.

Staphylococcus aureus is the most common infecting organism found in older children and adults with osteomyelitis.

Gram negative bacteria - vertebral body infections in adults.

Pseudomonas  - intravenous drug abusers.

Fungal osteomyelitis - chronically ill patients receiving long-term intravenous therapy or parenteral nutrition.

Salmonella osteomyelitis - Sickle cell hemoglobinopathies - tends to be diaphyseal.

Infants -S. aureus (most common),group B streptococcus & gram-negative coliforms . 
Group B streptococcus - otherwise healthy infants 2 to 4 weeks of age.

Animal Bite - Pasteurella

Human Bite - Eikinella

That's all!
Thank you.

MD Mobarak Hussain (Maahii)

Mnemonico diagnostico : SLE revised 2012 diagnostic criteria

Hey Awesomites

SLICC classification criteria for Systemic Lupus Eryhtematosus mnemonic :