Friday, 19 February 2016

Eye Muscles


Longest extraocular muscle of eye - superior oblique

Shortest extraocular muscle of eye - inferior oblique

Longest among extraocular rectus muscles of eye - medial rectus

Shortest  among extraocular rectus muscles of eye - lateral rectus

Embryologically 1st  extraocular muscle - lateral rectus

Extraocular muscle with 2 origins - lateral rectus

Extraocular muscle with only 1 muscular artery - lateral rectus

muscle not originating from apex of orbit INFERIOR OBLIQUE

muscle not affecting in retro orbital block SUPERIOR OBLIQUE

In isolated eyeball  EOM helps to recognise side of eyeball-IO

in isolated eyeball which EOM helps to recognise side of eyeball -IO

Wednesday, 17 February 2016

Death Stages

The seven stages of death
1. Pallor Mortis - post mortem paleness which happens in those with light/white skin almost instantly (in the 15–25 minutes after the death) because of a lack of capillary circulation throughout the body.
2. Algor mortis - reduction in body temperature following death. This is generally a steady decline until matching ambient temperature. The Glaister equation estimates the hours elapsed since death as a linear function of the rectal temperature: (98.4°F - rectal temperature in Fahrenheit)/1.5
3. Rigor mortis - one of the recognizable signs of death, caused by chemical changes in the muscles after death, causing the limbs of the corpse to become stiff and difficult to move or manipulate.
In humans, it commences after about three to four hours, reaches maximum stiffness after 12 hours, and gradually dissipates until approximately 48 to 60 hours after death.
4. Livor mortis - settling of the blood in the lower (dependent) portion of the body, causing a purplish red discoloration of the skin. When the heart stops functioning and is no longer agitating the blood, heavy red blood cells sink through the serum by action of gravity. It starts twenty minutes after death and reaches its maximum within 6-12 hours.
5. Putrefaction - decomposition of proteins in a process that results in the eventual breakdown of cohesion between tissues and the liquefaction of most organs. The exact rate of putrefaction is dependent upon many factors such as weather, exposure and location. Thus, refrigeration at a morgue or funeral home can retard the process, allowing for burial in three days or so following death without embalming. The rate increases dramatically in tropical climates.
6. Decomposition - process by which organic substances are broken down into simpler forms of matter. Various sciences study the decomposition of bodies under the general rubric of forensics because the usual motive for such studies is to determine the time and cause of death for legal purposes.
7. Skeletonization - the last vestiges of the soft tissues of a corpse or carcass have decayed or dried to the point that the bones of the skeleton are exposed. By the end of the skeletonization process, all soft tissue will have been eliminated, leaving only disarticulated bones....

By Dr. Piya Gupta

Tuesday, 16 February 2016

Broadman Areas

Brodmann areas for human

Areas 3, 1 & 2 - Primary Somatosensory Cortex (frequently referred to as Areas 3, 1, 2 by convention)
Area 4 - Primary Motor Cortex
Area 5 - Somatosensory Association Cortex
Area 6 - Premotor cortex and Supplementary Motor Cortex (Secondary Motor Cortex)(Supplementary motor area)
Area 7 - Somatosensory Association Cortex
Area 8 - Includes Frontal eye fields
Area 9 - Dorsolateral prefrontal cortex
Area 10 - Anterior prefrontal cortex (most rostral part of superior and middle frontal gyri)
Area 11 - Orbitofrontal area (orbital and rectus gyri, plus part of the rostral part of the superior frontal gyrus)
Area 12 - Orbitofrontal area (used to be part of BA11, refers to the area between the superior frontal gyrus and the inferior rostral sulcus)
Area 13 and Area 14* - Insular cortex
Area 15* - Anterior Temporal Lobe
Area 17 - Primary visual cortex (V1)
Area 18 - Secondary visual cortex (V2)
Area 19 - Associative visual cortex (V3,V4,V5)
Area 20 - Inferior temporal gyrus
Area 21 - Middle temporal gyrus
Area 22 - Superior temporal gyrus, of which the caudal part is usually considered to contain the Wernicke's area
Area 23 - Ventral Posterior cingulate cortex
Area 24 - Ventral Anterior cingulate cortex.
Area 25 - Subgenual cortex (part of the Ventromedial prefrontal cortex)
Area 26 - Ectosplenial portion of the retrosplenial region of the cerebral cortex
Area 27 - Piriform cortex
Area 28 - Posterior Entorhinal Cortex
Area 29 - Retrosplenial cingulate cortex
Area 30 - Part of cingulate cortex
Area 31 - Dorsal Posterior cingulate cortex
Area 32 - Dorsal anterior cingulate cortex
Area 33 - Part of anterior cingulate cortex
Area 34 - Anterior Entorhinal Cortex (on the Parahippocampal gyrus)
Area 35 - Perirhinal cortex (on the Parahippocampal gyrus)
Area 36 - Parahippocampal cortex (on the Parahippocampal gyrus)
Area 37 - Fusiform gyrus
Area 38 - Temporopolar area (most rostral part of the superior and middle temporal gyri)
Area 39 - Angular gyrus, considered by some to be part of Wernicke's area
Area 40 - Supramarginal gyrus considered by some to be part of Wernicke's area
Areas 41 & 42 - Primary and Auditory Association Cortex
Area 43 - Primary gustatory cortex
Area 44 - pars opercularis, part of Broca's area
Area 45 - pars triangularis Broca's area
Area 46 - Dorsolateral prefrontal cortex
Area 47 - Inferior prefontal gyrus
Area 48 - Retrosubicular area (a small part of the medial surface of the temporal lobe)
Area 49 - Parasubiculum area in a rodent
Area 52 - Parainsular area (at the junction of the temporal lobe and the insula)

Thursday, 11 February 2016

Alcoholism Classificarion

Alpha alcoholism: the earliest stage of the disease, manifesting the purely psychological continual dependence on the effects of alcohol to relieve bodily or emotional pain. This is the "problem drinker", whose drinking creates social and personal problems. Whilst there are significant social and personal problems, these people can stop if they really want to; thus, argued Jellinek, they have not lost control, and as a consequence, do not have a "disease".

Beta alcoholism: polyneuropathy, orcirrhosis of the liver from alcohol without physical or psychological dependence. These are the heavy drinkers that drink a lot, almost every day. They do not have physicaladdiction and do not suffer withdrawalsymptoms. This group do not have a "disease".

Gamma alcoholism: involving acquired tissue tolerance, physical dependence, and loss of control. This is the AA alcoholic, who is very much out of control, and does, by Jellinek's classification, have a "disease".

Delta alcoholism: as in Gamma alcoholism, but with inability to abstain, instead of loss of control.

Epsilon alcoholism: the most advanced stage of the disease, manifesting asdipsomania, or periodic alcoholism.

Criteria & classifications

Criteria & classifications

Agatson score : CAD

Austin - kartush classification - middle ear risk index ( MERI)

Alanzolej classification : chloledochal cyst

Amsel's criteria: bacterial vaginosis

Ann Arbours staging: Hodgkin's lymphoma & Non Hodgkin's lymphoma

Ashbury criteria : GBS

Astler collar:colorectal cancer

Belthazar scoring : acute pancreatitis

Bent criteria : allergic fungal sinusitis

Butcher's criteria: Mesothelioma

Berlin's criteria : ARDS

Bismuth classification: tumors of hepatic ductal system

Bosniak classification : renal cyst

Broca's index : Ht in cms-100

Boreman classification : Gastric carcinoma

Child's Turcott pug score/MELD/PELD- Cirrhosis of liver

Chang staging: Medulloblastoma

cierney & millar classification : chronic osteomyelitis

Corpulence index : Actual wt/desired wt

Cottle's classification --> nasal septum

De meester criteria : GERD

Duke staging : colorectal cancer

Duke's criteria: Endocarditis/Heart failure

Durie salmon system of staging: Multiple myeloma

Epworth's criteria : Sleep apnea

Enneking's staging : Bone tumors

Evan's stagng: Neuroblastoma

Forrest classification: peptic ulcer bleed

Framminghams criteria/Boston's criteria: CHF

FAB: Leukemias

Fisch - glomus tumor

Glisson's staging: Prostrate

Gartland's classification: Supracondylar # Humerus

Glasgow Blatch ford score : Upper GI bleed for medical intervention

GOLD's criteria :COPD

Glassgow scale/Ransons criteria/APACHE score: Pancreatitis

Hess & Hunt Scale: subarachnoid hemorrhage

Hall's criteria : Down's syndrome

Harvard criteria : brainstem death

Jackson's staging:Penile Carcinoma

jones criteria.- Rheumatic fever

killip classification-MI with HF

LEEFORDT's classification : facial #

Light's criteria: pleural effusion

Lauren's classification: Gastric Ca

Levenson's criteria :- also in congenital cholesteatoma and malignant otitis externa

Mac afee protocol : Placenta previa

Mallampati scoring: for intubation

Milan's crjteria: for liver transplant in HCC

Mantrles criteria/Alvarado score: Appendicitis

Mayers n cottons grading system: Subglottic stenosis

Manson's classification: Radial head #

MASAOKA -Thymoma

MELD Criteria- model for end stage liver disease

Mc Donald's criteria: Multiple Sclerosis

MIDAS score : migraine

morry & peterson criteria -acute osteomyelitis

Neer's classification: supracondylar# femur

NADA's criteria: ASD assesment of child for heart disease

Nazer's Index: Wilsons disz

OKUDA staging : HCC

Oschner sherren regime : Appendicular Mass

Paget's Index : Abruptio placentae

paalman criteria  : Ectopic pregnancy

Pretext -Hepatoblastoma

Ponderal Index: ht in cm/cube root of body wt in kgs

Quetlet index: BMI -wt in kg/ht in meter square

Quintero staging -TTTS

Quebeck's grading: severity of reflex

Reese Ellsworth - retinoblastoma (exam q)

Richertson bloom scoring : Breast ca.
1.tubule formation
2.Mitotic index
3.Cell size(nuclear pleomorphism)

Robson's staging : RCC

Rye classification: Hodgkin's lymphoma

Rotterdam's criteria : Polycystic ovarian syndrome

Rockall scoring: adverse out come after GI bleed

Rule of wallace/Rule of 9: Burns

Seddon's classification: Nerve injury n regeneration

sernath staging -Hypoxic ischaemic encephalopathy

Stanford classification: Aortic dissection

SPIGELBREG criteria= OVARIAN ectopic

STUDDIFORD criteria= ABDOMINAL ectopic (pain)

Spalding's criteria: abdominal pregnancy

Todeni classification : chloledochal cyst

Van Nuys prognostic index : DCIS

Waterson criteria : TEF

Well's criteria: pulmonary embolism

Monday, 8 February 2016


Gridiron's incision(Mc Burney's incision)
Described in 1894 by McBurney, used for appendectomy. An oblique incision made in the right
lower quadrant of the abdomen, classically used for appendectomy Incision is placed perpendicular to the spinoumblical line at McBurney's point, i.e. at the junction of lateral one-third and medial two-third of spino-umblical line.

Kocher’s incision
An oblique incision made in the right upper quadrant of the abdomen, classially used for open cholecystectomy . Named after Emil Theodor Kocher . It is appropriate for certain operations on the liver , gallbladder and biliary tract .This shares a name with the Kocher incision used for thyroid surgery: a transverse, slightly curved incision about 2 cm above the sternoclavicular joints;

Sunday, 7 February 2016

Cartilage lessons

Info - Benign Cartilagenous lesions :
Central -
Chondromyxoid fibroma

Peripheral -

laryngeal endoscopic cordectomies

A classification of laryngeal endoscopic cordectomies was first proposed by European laryngology
society in 2000.The classification described 8 types of cordectomies, as follows:

Type I: Subepithelial cordectomy, which is the resection of vocal cord epithelium passing through the
superficial layer of lamina propria .
Type II: Subligamental cordectomy, which is resection of epithelium, or Reinke’s space and vocal ligament.
Type III: Transmuscular cordectomy, which proceeds through vocalis muscle.
Type IV: Total cordectomy, which extends from vocal process to the anterior commissure.
Type Va: Extended cordectomy encompassing the contralateral vocal fold.
Type Vb: Extended cordectomy encompassing the arytenoids.
Type Vc: Extended cordectomy encompassing the ventricular fold.
Type Vd: Extended cordectomy encompassing the subglottis.


RansonRanson’s Criteria on Admission :
age greater than 55 years
a white blood cell count of > 16,000/µL
blood glucose > 11 mmol/L (>200 mg/dL)
serum LDH > 350 IU/L
serum AST >250 IU/L

Ranson’s Criteria after 48 hours of admission :
fall in hematocrit by more than 10 percent
fluid sequestration of > 6 L
hypocalcemia (serum calcium < 2.0 mmol/L (<8.0 mg/dL))
hypoxemia (PO2 < 60 mmHg)
increase in BUN to >1.98 mmol/L (>5 mg/dL) after IV fluid hydration base deficit of >4 mmol/L

The prognostic implications of Ranson’s criteria are as follows :
Score 0 to 2 : 2% mortality
Score 3 to 4 : 15% mortality
Score 5 to 6 : 40% mortality
Score 7 to 8 : 100% mortality

“Acute Physiology And Chronic Health Evaluation” (APACHE II) score > 8
points predicts 11% to 18% mortality
Hemorrhagic peritoneal fluid
Indicators of organ failure
Hypotension (SBP <90 mmHG) or tachycardia > 130 beat/min
PO2 <60 mmHg
Oliguria (<50 mL/h) or increasing BUN and creatinine
Serum calcium < 1.90 mmol/L (<8.0 mg/dL) or serum albumin <33 g/L

Balthazar Scoring for the Grading of Acute Pancreatitis
Grade A – normal CT
Grade B – focal or diffuse enlargement of the pancreas
Grade C – pancreatic gland abnormalities and peripancreatic inflammation
Grade D – fluid collection in a single location
Grade E – two or more collections and/or gas bubbles in or adjacent to pancreas