Fact of the day : Easier approach shot to the pouch of Douglas

Hey Awesomites

The posterior fornix of the vagina is separated from the peritoneal cavity by a single layer of peritoneum and the posterior vaginal wall. Therefore, vaginal approach from its posterior aspect for evacuation of pus in the pouch of Douglas can be done without much difficulty.

On the other hand, approach to uterovesical pouch ( anterior relation ) is much more difficult from the vaginal route and consists of a series of steps :
- Incise the vagina
- separate bladder from cervix
- Traverse the vesicocervical space ( till the uterovesical fold of peritoneum is reached )

This difference is due to the normal physiological position of the uterus that is anteverted and anteflexed; the direction of external os being downwards and backwards.


That's all
- Jaskunwar Singh

Basic modalities of Transitional Zone

Hey Awesomites

Squamocolumnar junction ( the transitional zone ) is a junction formed by merging of squamous epithelium of the vagina with the columnar epithelium of endocervix.

Squamous non keratinized epithelium lining the vaginal mucosa has three distinct layers -
- Basal layer of cuboidal cells
- Middle layer of prickle cells
- Superficial layer of cornified cells

Embryologically, the junction consists of columnar epithelium that spreads over the external os and only the basal and middle layer of squamous epithelium lining the vaginal mucosa.

After attaining puberty, hormonal effects of oestrogen and progesterone induce metaplastic changes in columnar epithelium. Therefore, the squamous epithelium comes in close vicinity to the external os.

During reproductive age, growth of uterus, hypertrophy of cervical cells and associated hormonal changes and in females exposed to DES in utero, the transitional zone extrudes well out of the external os.

Due to high cellular activity and sensitivity to certain irritants and mutagens, there is high risk of dysplastic changes in the squamocolumnar epithelium and eventually carcinoma cervix. So, scrapings for PAP smear are done without difficulty from this exposed area to screen the patients.

In menopausal women, the atrophy of cervix leads to in drawing of SCJ into the canal. Hence the junction is not easily accessible and this ill exposure is the reason for high rates of false negative findings in PAP smear in older women! Hormonal therapy in such patients improves the positivity of results.


That's all
Jaskunwar Singh

Types of tympanic membrane perforation

Hello Awesomites ! :D

There are different types of perforation of tympanic membrane. We name it on the basis of :-

1. Size of perforation

2. Site of perforation

So, let us begin.

ACCORDING TO SIZE OF PERFORATION,

1. Pinhole :- 1-2 mm in size.

2. Small :- Area involving one quadrant or <10% of pars tensa.

3. Medium :- Area involving 2-3 quadrant or 10-40% of pars tensa.

4. Subtotal :- Area involving the pars tensa >75% and does not involve the annulus.

5. Total :- A total perforation is present in tympanic membrane. Tympanic membrane is essentially absent and involve annulus also. 

ACCORDING TO SITE OF PERFORATION,

1. Anterior 

2.Posterior

3.Inferior

4.Central

OR,

1.Central :- A simple perforation in pars tensa with intact annulus. 

                   Perforation is surrounded all around by pars tensa.

2. Marginal :- Perforation in the pars tensa surrounded partly by pars tensa and partly by bone.

3. Attic :- Perforation in pars flaccida.

I found this topic very confusing in my exams.

I hope it helped. :D

Have a great day ahead.
-Upasana Y. :) 

Corpus Callosum - Let's connect

Hey Awesomites
Jas here
I am back :)

Let's talk about the largest connective pathway in the brain, the Corpus Callosum that is made up of more than 200 million nerve fibres, connecting our left brain to the right.

Rotator Cuff muscles and their actions (mnemonic)

To remember the actions of Rotator Cuff muscles ( Supraspinatus, Infraspinatus, Teres Minor and Subscapularis), just remember the following:

1- The mnemonic for the muscles is: SITS
2- We will start with ABDuction and finish with ADDuction
3- The vowels in English can be remembered by AEEIou ( shout to remember better :P )
4- Now just match letters from the 2 mnemonics in the same order they are written in
 as you can see in the table:

So S goes with A...I goes with E...T goes with E and the last S goes with I.

Never forget the action of Rotator Cuff muscles again :)

-Murad

Echinocandins: Mechanism of action, side effects and orgranisms affected (mnemonic)

To easily remember anything related to Echinocandins (eg: Caspofungin, Micafungin) , just think of the letters "C, A and N"  => CAN :D

=> EchinoCANdins.
=> Inhibit synthesis of B-gluCAN. 
=> Used in CANdida and a thing that CAN invade your body (invasive aspergillosis).
=> CAN make you flush ( due to histamine release).

-Murad

Joll's triangle in thyroidectomy

Hello friends,

This post is about the importance of Joll's triangle in thyroidectomy.

Joll's triangle is used to identify external laryngeal nerve during thyroidectomy.

Boundaries of this triangle are :
Laterally: Upper pole of thyroid gland and superior thyroid vessels.
Superiorly: Attachment of strap muscles and deep investing layer of fascia to hyoid.
Medially: Midline of neck.
Floor: Cricothyroid muscle.

This triangle contains superior laryngeal nerve which gives rise to external laryngeal nerve.

Given below is the diagram of this triangle:

Mnemonics for Modified Jones Criteria

Modified Jones Criteria is used  for diagnosis of Acute Rheumatic Fever.

Mnemonic - "JONES CAFE PAL"

MAJOR CRITERIA :-
Joint involvement (polyarthritis)
O 'O' looks like a heart - myocarditis
Nodules subcutaneous
Erythema Marginatum
Sydenham Chorea

MINOR CRITERIA :-
CRP elevated
Arthalgia
Fever
ESR elevated

Prolong PR interval
Anamnesia of Rheumatism
L eukocytosis

Presence of  either
- 2 major criterias or
- 1 major criteria + 2 minor criteria

Is considered to diagnose patient positive.

Written by,
Pratheek Prabhu

SIADH vs Diabetes Insipidus, Osmolarity and Sodium levels in urine and serum in both (mnemonic)

Serum and urine findings in SIADH and  Diabetes Insipidus can really mess up our brains :S

A nice mnemonic to memorize SIADH is to recall the letters as  :
 "S"odium "I"s "A"lways "D"own "H"ere (by here: I mean serum) =>
so in SIADH:
=> low Na in serum
=> high Na in Urine & high Urine Osmolarity

Now ...just think of the opposite and you ll get Diabetes Insipidus
so in DI:
=> high Na in serum /high serum osmolarity
=> low Na in Urine

-Murad

Chronic Renal Failure : Indications for dialysis.

Hello guys!

In this post I am going to list down the Indications for dialysis in patients of Chronic Renal Failure.

Absolute Indications :
1. Volume overload not responding to medication.
2. Refractory hypertension.
3. Hyperkalemia unresponsive to medications.
4. Severe metabolic acidosis unresponsive to medications.
5. Uremic pericarditis
6. Neurological signs and symptoms of Uremia.
7. Plasma creatinine more than 1060 umol/l or BUN more than 36 mmol/l

Relative Indications :
1. Anorexia
2. Severe anemia unresponsive to erythropoietin.
3. Persistent severe pruritus.
4. Restless legs syndrome.

That's all.
Thank you

MD Mobarak Hussain (Maahii)

Some thalamic nuclei and their function (mnemonic)

Thalamic nuclei can really cause a headache if no mnemonics are used while studying them :O

The following mnemonics may be used to associate the nuclei with their functions:

1- Ventral Postero-Lateral nuclues  (VPL) => Very Painful Leg
This nucleus has input (pain, temperature, pressure, touch, vibration and proprioception) from Spinothalamic and dorsal columns/medial lemniscus ( Lower Limbs and Upper Limbs).

2- Ventral Postero-Medial nucleus (VPM) => Very Painful Mouth
This nucleus has input (face sensastion and taste) from trigeminal and gustatory pathway).

3- Lateral Geniculate Nucleus  (LGN) => Looking Good Naked :O
This nucleus has input (part of the visual pathway) from the optic nerve.

4- Medial Geniculate Nucleus (MGN) => Making Good Noise
This nucleus has input (part of the hearing pathway) from superior olive and inferior colliculus of tectum.

& that's it! :)

-Murad

Relation between Type I, Type II errors and Null hypothesis (mnemonic)

Biostatistics can really be dry and hard to engulf sometimes. 

One of the things that always confused me was when to accept and when to reject the null hypothesis. 

Since  mnemonics are one of the best things ever, here you go:

Type ONE error:
You use a verb with ONE consonant => reJect => so you reJect Null hypothesis

Type TWO error:
You use a verb with TWO consonants => aCCept => so you aCCept Null hypothesis

& that's it! :)

-Murad

Bacterial exotoxins that work via overactivating Adenylate Cyclase, a mnemonic

There are many bugs which have many exotoxins - to memorize those that have an exotoxin which work through overactivating Adenylate Cyclase therefore increasing cyclic AMP (+ cAMP) => just remember the letters of the word: CAMP

=> the bugs are:
Cholera (Vibrio Cholera)
Anthrax (Bacillus Anthracis)
Moctezuma's revenge (a fancy name of heat labile entertotoxigenic E.coli, ETEC)
Pertussis (Bordetella Pertussis)

-Murad