Tuesday, 10 July 2018

DEMENTIA

Dementia + sensory Ataxia + PNP(polyneuropathy) + UMN(babinski's sign) = B12 deficiency

Dementia + cerebellar ataxia + ophtalmoplegia = B1 def (Wernicke's syndrome)

Dementia + high cholesterol = hypothyroidism

Dementia + myoclonus = Creutzfeldt-Jakob disease

Dementia + gait apraxia + urinary incontinence = NPH (non-pressure hydrocephalus)

Dementia with stepwise progression + pseudobulbar palsy(PBP) = Binswanger's disease (vascular dementia)

Dementia + PBP + gaze abnormality + torticollis = PSP (progressive supranuclear palsy)

Dementia + chorea= Huntington's disease

Dementia + Parkinsonism + syncopal attack = Shy-Drager syndrome (multiple system atrophy)

Dementia that is fluctuating + Parkinsonism= Lewy body dementia

Dementia with sparing visuospatial skills + personality change = Frontotemporal dementia

WOUND

Definition
A wound occurs when the integrity of any tissue is compromised (e.g. skin breaks, muscle tears, burns, or bone fractures). A wound may be caused by an act, such as a gunshot, fall, or surgical procedure; by an infectious disease; or by an underlying condition.

Surgical Wound classification

Class I
Clean
An uninfected operative wound in which no inflammation is encountered and the respiratory, alimentary, genital, or uninfected urinary tract is not entered. In addition, clean wounds are primarily closed and, if necessary, drained with closed drainage. Operative incisional wounds that follow nonpenetrating (blunt) trauma should be included in this category if they meet the criteria.

Class II
Clean-contaminated
An operative wound in which the respiratory, alimentary, genital, or urinary tracts are entered under controlled conditions and without unusual contamination. Specifically, operations involving the biliary tract, appendix, vagina, and oropharynx are included in this category, provided no evidence of infection or major break in technique is encountered.

Class III
Contaminated
Open, fresh, accidental wounds. In addition, operations with major breaks in sterile technique (e.g., open cardiac massage) or gross spillage from the gastrointestinal tract, and incisions in which acute, nonpurulent inflammation is encountered are included in this category.

Class IV
Dirty-infected
Old traumatic wounds with retained devitalized tissue and those that involve existing clinical infection or perforated viscera. This definition suggests that the organisms causing postoperative infection were present in the operative field before the operation.

Friday, 22 June 2018

Signs in ENT


BATTLE SIGN- Bruising behind earat mastoid region, due to petroustemporal bone# (middle fossa #).

BOCCA'S SIGN - Absence of postcricoid crackle(Muir's crackle) inCarcinoma post. cricoid.

BROWN SIGN - blanching of rednesson increasing pressure more thansystemic pressure see in glomusjugulare.

BOYCE SIGN - Laryngocoele-Gurgling sound on compression ofexternal laryngocoele with reductionof swelling.

DODD’S SIGN/CRESCENT SIGN - X-ray finding-Crescent of air betweenthe mass and posterior pharyngealwall. positive in AC ployp. Negativein Angiofibroma

FURSTENBERGERSSIGN-This is seenwhen nasopharyngeal cyst is communicating intracranially,there isenlargement of the cyst on crying and upon compression of jugularvein.

HITSELBERGER'SSIGN - In Acousticneuroma- loss of sensation in theear canal suppllied by Arnold'snerve( branch of Vagus nerve to ear )

HOLMAN MILLER SIGN, ANTRALSIGN-it is seen in angiofibroma,thetumor pushes forward on theposterior wall of the maxillarysinus..

HONDOUSA SIGN--X-ray finding inAngiofibroma, indicatinginfratemporal fossa involvementcharacterised by widening of gapbetween ramus of mandible andmaxillary body.

HENNEBERT SIGN- false fistula sign( cong.syphilis, Meniere's,)
🎈*IRWIN MOORE’S SIGN-------- positivesqueeze test in chronic tonsillitis
🎈*LIGHT HOUSE SIGN--- seeping outof secretions in acute OTITIS media
🎈*LYRE'S SIGN - splaying of carotidvessels in carotid body tumor
🎈*MILIAN’S EAR SIGN- Erysipelas canspread to pinna(cuticularaffection),where as cellulitis cannot.
🎈*PHELP'S SIGN - loss of crust of bonebetween carotid canal and jugularcanal in glomus jugulare
🎈*RACOON SIGN-Indicate subgalealhemorrhage,and not necessarly baseof skull #
🎈*STEEPLE SIGN- X-ray finding inAcute Laryngo tracheo bronchitis
🎈*STANKIEWICK'S SIGN - indicateorbital injury during FESS. fatprotrudes into nasal cavity oncompression of eye ball from ouside
🎈*THUMB SIGN --X-ray finding A/cepiglottitis
🎈*TRAGUS SIGN- EXTERNAL OTITIS ,Pain on pressing Tragus
🎈*TEA POT SIGN is seen in CSFrhinorrhoea..
🎈*WOODS SIGN----- palpable jugulodigastric lymphnode

Tuesday, 12 June 2018

Tetralogy of Fallot, demystified


Tetralogy of Fallot is a fairly common heart defect. In fact, it's the most common cyanotic heart defect (meaning that if a baby is born with cyanosis - markedly decreased oxygen saturation - and the cause is determined to be a congenital heart defect, the most likely culprit is tetralogy of Fallot).

From the name, it’s obviously composed of four parts. But how to remember what those parts are? You could just memorize them using brute force, but there's actually one thing that ties them all together - so if you can remember this one thing, then the four things make sense. I love this, because when you find you've forgotten one of the four things (which you probably will), you can actually reason it out. Hurray!

Here's the one thing to remember, and it's actually the thing that causes the whole disease. When the interventricular septum is forming, the top portion is pushed up and towards the right ventricle. The official name for this is anterosuperior displacement of the infundibular septum, but it's easier to just remember "up and towards the right," I think.








Check out this image of tetralogy of Fallot. See the red asterisk? That's the top of the interventricular septum. The black asterisk marks the bottom of the interventricular septum. Those parts are supposed to be connected...but obviously they're not. And the reason they're not is that the top part of the septum has moved up (creating a hole in the septum) and to the right (smushing the pulmonary artery outflow tract).

So what happens as a result?

One of the main problems is that it's now very hard for the blood to get out of the right ventricle and into the pulmonary artery (and lungs). That's because the pulmonary outflow tract (fancy name for the beginning of the pulmonary artery) is compressed, and there's less room for blood to flow through. This is called pulmonary stenosis. This is what causes the baby to be cyanotic! If you can't get enough blood out into the lungs, the blood isn't going to be oxygenated very well, and the baby's skin will be bluish. The right ventricle has to work hard to push blood through that compressed pulmonary artery - so the right heart becomes hypertrophied (bigger).

A couple other things happen too, as a result of this displacement of the septum. As the top part of the septum moves upwards, it separates from the bottom part, creating a hole in the septum (this is called a ventricular septal defect). This is actually kind of a good thing, in this case, because it relieves a little of the pressure on the right side of the heart. If the septum was intact, then the only place for the right ventricular blood to go would be through the compressed pulmonary artery...and the right ventricle would have to work incredibly hard to empty itself with each cardiac cycle.

Finally, as the top part of the septum moves to the right, it pulls the aortic valve along with it, repositioning it so that it sits pretty much right over the ventricular septal defect. This is called an overriding aorta, and it doesn't have much clinical consequence.  

So to summarize: the top of the septum moves up and to the right, causing:
1. Pulmonary stenosis 
2. Right ventricular hypertrophy 
3. A ventricular septal defect
4. An over-riding aorta  

Sunday, 27 May 2018

Fistula test Interpretation

How are the results of Fistula test interpreted?
1. In fistula over the dome of the lateral semicircular canal: Increase pressure causes conjugate horizontal deviation of the eyes towards the normal side. As pressure is maintained, jerk nystagmus develops with fast component towards the affected ear. As pressure is released, eyes return to normal
2. Fistula of the lateral semicircular canal (anterior to the ampulla) causes deviation of eyes, to the affected side
3. Vestibular erosion causes rotatory horizontal nystagmus towards the diseased ear
4. Fistula of the posterior semicircular canal causes vertical movement of eyes.

https://youtu.be/4gEM17yTl5k

Tuesday, 22 May 2018

Drowning

Drowning
Drowning is a major cause in head injuries and death
• Initial peak
– Toddler age group
• Second peak
– Male adolescents
• Children younger than 1 year of age
– Often drown in bathtubs, buckets, and toilets
• Children 1–4 years of age
– Likely drown in swimming pools where they haveb beenunsupervised temporarily (usually for < 5 min)
– Typical incidents involve a toddler left unattendedt temporarilyor under the supervision of an older sibling
• Adolescent and young adult age groups (ages 15–24 years)
– Most incidents occur in natural water
• Approximately 90 % of drowning occur within 10 yardso ofsafety
• Parent should be within an arm’s length of a swimmingc hild (anticipatory guidance)
Mechanism of injury
• Initial swallowing of water
• Laryngospasm
• Loss of consciousness
• Hypoxia
• Loss of circulation
• Ischemia
• CNS injury (the most common cause of death)
• Acute respiratory distress syndrome (ARDS) may develop
• Salt water drowning classically associated with:
– Hypernatremia
– Hemoconcentration
– Fluid shifts and electrolyte disturbances are rarely seenc linically
• Fresh water drowning classically associated with:
– Hyponatremia and hemodilution
– Hyperkalemia
– Hemoglobinuria and renal tubular damage
• Management of drowning and near drowning
– Cardiopulmonary resuscitation (CPR) at the scene
– Admit regardless of clinical status
– All children with submersion should be monitoredi inthe hospital for 6–8 h
– If no symptoms develop can be discharged safely
– 100 % oxygen with bag and mask immediately
– Nasogastric tube for gastric decompression
– Cervical spine immobilization if suspected cervicali injuries
– Positive end expiratory pressure (PEEP) and positivep ressure ventilations in case of respiratory arrest
– Continuous cardiac monitoring
– Bolus of normal saline or Ringer’s lactate
– Vasopressors
– Defibrillation if indicated

Monday, 12 February 2018

Mnemonics in Dermatology

Generalized Skin Hyperpigmentation

"With generalized, none of the skin is SPARED"

Sunlight

Pregnancy

Addison's disease

Renal failure

Excess iron (haemochromatosis)

Drugs (e.g. amiodarone, minocycline)

Painful Cutaneous Nodules

BENGAL CO.

Blue rubber bleb nevus

Eccrine spiradenoma

Neurilemmoma/Neuroma

Glomus tumor

Angiolipoma/Angioleiomyoma/Angiosarcoma

Leiomyoma

Cutaneous endometriosis/Calcinosis cutis

Osteoma cutis

White Patch of Skin

"Vitiligo PATCH"

Vitiligo

Pityriasis alba/Post-inflammatory hypopigmentation

Age related hypopigmentation (e.g. idiopathic guttate hypomelanosis)

Tinea versicolor, Tuberous sclerosis (ash-leaf macules)

Congenital birthmark (e.g. Hypomelanosis of Ito)

Hansen's disease (leprosy)

Common Causes of Leukocytoclastic Vasculitis

VASCULITIS

Viral (e.g. Hepatitis B and C)

Autoimmune (Systemic Lupus Erythematosus, Sjögren's syndrome, rheumatoid arthritis)

Streptococci, Staphylococci, Henoch-Schönlein purpura

Cryoglobulins, Cryofibrinogens, Churg Strauss/Wegener's granulomatosis

Ulcerative colitis, urticarial vasculitis

Lymphoproliferative disease (hairy cell leukemia)

Infectious (endocarditis, meningococcemia, gonococcemia, Rocky Mountain spotted fever)

Thiazides, phenothiazines, and other drugs

Immune complex reactions, iodides, idiopathic

Sulfa drugs (septra), penicillin, and other antibiotics

Non-scarring alopecia

TOP HAT

Telogen effluvium, Tinea capitis

Out of iron, zinc

Physical-trichotillomania, traction alopecia

Hormonal-hypothyroidism, androgenic

Autoimmune-alopecia areata, anagen effluvium

Toxins-heavy metals, chemotherapy

Erythema Nodosum

NODOSUM5

NO cause is found in 60% of cases

Drug (iodides, bromides, sulfonamides)

Oral contraceptives

Sarcoidosis or. Löfgren's syndrome

Ulcerative colitis, Crohn's disease, Behçet's

Microbiology: any chronic infection (bacterial, viral, yersinia, tuberculosis, leprosy, deep fungal)

Behcet's syndrome: Diagnostic Criteria

PROSE

Pathergy test

Recurrent genital ulceration

Oral ulceration (recurrent)

Skin lesions (e.g. erythema nodosum, subcutaneous throm-bophlebitis, cutaneous hypersensitivity)

Eye lesions (e.g. iridocyclitis, chorioretinitis)

• Oral ulceration is central criterion, plus any 2 others

Focal Dermal Hypoplasia Syndrome/Goltz syndrome

FOCAL

Female sex (85-90%)6

Osteopathia striata

Coloboma

Absent ecto-, meso-, and neuro-dermis elements

Lobster claw deformity

SLE (Systemic Lupus Erythematosus) Diagnosis

SOAP BRAIN MD

Serositis

Oral/nasal ulcers

Arthritis

Photosensitivity

Blood (cytopenia)

Renal involvement

ANA

Immune (typical antibodies e.g. dsDNA, anti-Sm)

Neurologic (e.g. seizures, stroke)

Malar rash

Discoid rash

• 4 out of 11 criteria needed for diagnosis

Henoch-Schonlein purpura: signs and symptoms

NAPA

Nephritis

Arthritis, arthralgias

Purpura , palpable (especially on lower extremities)

Abdominal pain (intussusception to be ruled out)