DOCTORS GATE.

2011-05-10T14:14:00.001-07:00

ECG: Digitalis Effect

Gross and Microscopic picture of Renal Infarction

2011-04-03T12:19:00.001-07:00

1- Gross specimen of Renal infarction:

The kidney is cut in half along its longitudinal axis, exposing :
(A.) the cortex
(B.) the medulla
(C.) a minor calyx .
The pyramidal shaped infarct is pale as compared to the adjacent normal cortex. Why? as the wedge shape of this zone of coagulative necrosis resulting from loss of blood supply with resultant tissue ischemia that produces the pale infarct.
The arrow points to a line of hyperemia that represents the interface between normal and necrotic tissue.

2- Microscopic section of Renal infarction:

* The thick arrow points to glomerulus in an area of coagulation (ischemic) necrosis.
* The thin arrow points to a glomerulus which is in the interface between necrotic and normal kidney.

Pearls of the Minimally Invasive Infrapubic Penile Implant

2011-01-17T10:02:00.000-08:00

Arterial Blood Gases for OSCEs

2011-01-17T07:10:00.000-08:00

Basosquamous Carcinoma in the Temple

2011-01-14T21:47:00.000-08:00

This photo shows large, crusted tumor on the temple that has clinical features of both squamous cell carcinoma (scaly crust), and basal cell carcinoma (translucency in some areas)........

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Wolfflin Spots

2011-01-11T09:24:00.000-08:00

Wolfflin spots are the whitish clumps of connective fibers found in some irides (mostly blue) near the periphery. These are somewhat distinct from Brushfield spots.............

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How to appreciate Traumatic exophthalmos

2011-01-07T09:35:00.000-08:00

Traumatic exophthalmos develops as a retrobulbar hematoma that pushes the eyeball globe outward. Patient presents with periorbital edema, ecchymosis, a marked decrease in visual acuity, and an afferent pupillary defect in the involved eye.
Sometimes the exophthalmos may be obscured by ..........

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Bone Marrow Aspiration

2011-01-07T01:59:00.000-08:00

How to get a jersey finger !!

2011-01-06T21:42:00.000-08:00

Which finger is most likely to be affected with disruption of the flexor digitorum profundus tendon (also known as a jersey finger)?

A) Thumb
B) Index finger
C) Third finger
D) Ring finger
E) Fifth finger (“pinky”)

Answer and Discussion

The answer is D.

Disruption of the flexor digitorum profundus tendon, also known as jersey finger, commonly occurs when an athlete's finger catches on another player's clothing, usually while playing a tackling sport such as football or rugby.
The injury causes forced extension of the DIP joint during active flexion. The ring finger is the weakest finger and accounts for 75% of jersey finger cases.

Bronchiectasis in High-Resolution CT

2011-01-06T12:23:00.000-08:00

Bronchiectasis is defined as localized, irreversible dilatation of part of the bronchial tree. Involved bronchi are dilated, inflamed, and easily collapsible, resulting in airflow ..............

Types of Coarctation of the aorta

2011-01-06T08:36:00.000-08:00

Infantile type :- aortic stenosis proximal to insertion of ductus arteriosus (preductal).
Adult type :- stenosis is distal to ductus arteriosus (postductal). Associated with notching of the ribs (due to collateral circulation), hypertension in upper extremities, weak pulses in lower extremities,
Associated wilh Turner's syndrome.
Can result in aortic regurgitation.
Check femoral pulses on physical exam.

SO ;

INfantile: IN close to the heart.
ADult: Distal to Ductus. Most commonly associated with bicuspid aortic valve.

Craniotomy for resection of 4th Ventricle Tumor

2011-01-05T18:19:00.000-08:00

Dr. Pakzaban demonstrates the technique of suboccipital craniotomy for access to the posterior cranial fossa using an Aesculap bone scalpel. This approach is used in many different operations including decompression of Chiari malformation. In this case, it is being used for resection of a 4th ventricle tumor known as subependymoma.

Indications for OPG requests

2011-01-05T08:05:00.000-08:00

An OPG or "ORTHOPANTOGRAM", gives a panoramic view of the mandible and teeth.
It is performed using a technique called "tomography". The X-ray tube moves around the head, the x-ray film moves in the opposite direction behind your head. This generates an image slice where the mandible and teeth are in focus, and the other structures are blurred.

Why to get it ?

Dental Disease

* Caries - appear as different shaped areas of ...........

Different arterial pulse waveforms and example causes

2011-01-05T03:46:00.000-08:00

Different arterial pulse waveforms are best assessed at the carotid artery. You are feeling for the speed at which the artery expands and collapses and force with which it does so. It takes some practise to master and it may be useful to imagine a graph such as those shown in the figure below,also Some examples are present:

Aortic stenosis: a slow rising pulse, maybe with a palpable shudder. Sometimes called anacrotic or a plateau phase........

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ABC of Resuscitation (ABC series)

2011-01-04T23:57:00.000-08:00

111 pages
Publisher: BMJ Books; 5 edition (January 7, 2004)
Language: English
ISBN-10: 0727916696
ISBN-13: 978-0727916693

Product Description
This authoritative guide has concise and practical information on all aspects of resuscitation. New guidelines are just one of the changes to the 5th edition of this book as many of the chapters have been completely rewritten,with new material on automated defibrillators, advanced life support including paediatric life support, new drugs plus many new illustrations. . The text has worldwide relevance with particular emphasis on Europe, Australasia, South Africa, South America, Malaysia and the Middle East.

For Download :

CLICK HERE

Le Fort Classification of facial fractures

2011-01-04T16:20:00.000-08:00

In 1901 ;René Le Fort (1869-1951),French surgeon, reported his work on cadaver skulls that were subjected to blunt forces of various magnitudes and directions. He concluded that predictable patterns of fractures follow certain types of injuries. Three predominant types were described.

Le Fort I fractures (horizontal) may result from a force of injury directed low on the maxillary alveolar rim in a downward direction. The fracture extends from the nasal septum to the lateral pyriform rims, travels horizontally above the teeth apices, crosses below the zygomaticomaxillary junction, and traverses the pterygomaxillary junction to interrupt the pterygoid plates.

Le Fort II fractures (pyramidal) may result from a blow to the lower or mid maxilla. Such a fracture has a pyramidal shape and extends from the nasal bridge at or below the nasofrontal suture through the frontal processes of the maxilla, inferolaterally through the lacrimal bones and inferior orbital floor and rim through or near the inferior orbital foramen, and inferiorly through the anterior wall of the maxillary sinus; it then travels under the zygoma, across the pterygomaxillary fissure, and through the pterygoid plates.

Le Fort III fractures (transverse), also termed craniofacial dysjunctions, may follow impact to the nasal bridge or upper maxilla. These fractures start at the nasofrontal and frontomaxillary sutures and extend posteriorly along the medial wall of the orbit through the nasolacrimal groove and ethmoid bones. The thicker sphenoid bone posteriorly usually prevents continuation of the fracture into the optic canal. Instead, the fracture continues along the floor of the orbit along the inferior orbital fissure and continues superolaterally through the lateral orbital wall, through the zygomaticofrontal junction and the zygomatic arch. Intranasally, a branch of the fracture extends through the base of the perpendicular plate of the ethmoid, through the vomer, and through the interface of the pterygoid plates to the base of the sphenoid.

USMLE Pass Program Video Lectures (2010) - Pediatrics

2011-01-04T08:16:00.000-08:00

About the PASS Program:

The PASS Program was created in 1988 and officially opened for business in the year 2000. This program is different from any other program in this country. It teaches integrated thinking so that a medical student can answer any question asked at any level. It does not, and should not, matter whether a student is taking the USMLE 1, USMLE 2, or USMLE3. The information that is covered in this program is ...........

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Synthesis & Transport of Thyroid Hormones

2011-01-04T03:04:00.000-08:00

The thyroid secretes 2 iodine-containing hormones: thyroxine (T4 ) and triiodothyronine (T3). The iodine necessary for the synthesis of these molecules comes from food or iodide supplements. Iodide ion is actively taken up by and highly concentrated in the thyroid gland, where it is converted to elemental iodine by thyroidal peroxidase ( See the Figure ).
The protein thyroglobulin serves as a scaffold for thyroid hormone synthesis. Tyrosine residues in thyroglobulin are iodinated to form monoiodotyrosine (MIT) or diiodotyrosine (DIT) in a process known as iodineorganification........

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This figure also show Sites of action of some antithyroid drugs. I–, iodide ion; I°, elemental iodine. Not shown: radioactive iodine (131I), which destroys the gland through radiation.

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Inspecting a skin lesion

2011-01-03T23:59:00.000-08:00

# Inspect each lesion carefully and note¦
-Grouped or solitary? Pattern if grouped .
-Distribution/location:

Symmetrical/asymmetrical?
Peripheral?
In only light exposed areas?
Dermatomal?

-Colour.
-Shape.
-Size.
-Surface.
-Edge.
-Nature of the surrounding skin.

Histopathology of Osteosarcoma

2011-01-03T20:58:00.000-08:00

The staging evaluation of Esophageal Cancer

2011-01-03T05:33:00.000-08:00

After establishing a diagnosis of esophageal cancer, adequate staging is required, because staging is the most important step in choosing appropriate therapy. More than 50% of patients have unresectable or metastatic disease at the time of presentation. For the others, survival is closely related to the stage of the disease.

The staging evaluation allows patients to be ...................

Port wine stains and Associations

2011-01-03T02:57:00.000-08:00

Port wine stains (PWS) are almost always evident at birth and are a capillary malformation. They are usually sporadic, although some occur in families in an apparently autosomal dominant inheritance. They are initially pink or red, and grow in proportion to infant growth. Although they may appear to lighten in the first few months, they generally darken after this.

They can be associated with other skin anomalies such as extensive mongolian spots. An important association is Sturge-Weber syndrome ( PWS+mental retardation ): PWS involving the forehead (V1 area of the trigeminal nerve), eye abnormalities (choroidal vascular abnormalities, glaucoma), and leptomeningeal and brain abnormalities (vascular malformations, calcification, or cerebral atrophy). Another association is Klippel-Trenaunay syndrome, with a capillary malformation and overgrowth of the soft tissue and bone of the affected limb.

Treatment of PWS is possible using a laser, although improvement rather than complete resolution is most common.

Chronic Gouty Tophi

2011-01-02T23:34:00.000-08:00

After years of gouty attacks, patients will develop a chronic arthritis resulting in bone and cartilage destruction and deformity. Uric acid crystals deposit within and surrounding the joint causing a chronic destructive inflammatory process. X-rays characteristically show well demarcated "punched out" erosions.

Tophi at helix of ear.

Tophi or deposits of uric acid crystals are often found around joints, in the olecranon bursa or at the pinna of the ear.

X-ray showing soft tissue swelling and erosion of 2nd PIP.

Pneumocephalus

2011-01-02T20:03:00.001-08:00

X-ray showing nasal and orbital fractures and pneumocephalus

Pneumocephalus is the presence of air in the cranial vault. It is usually associated with neurosurgery, barotrauma, basilar skull fractures, sinus fractures, nasopharyngeal tumor invasion and meningitis..........

Supraspinatus Pathology by Ultrasound

2011-01-02T09:31:00.001-08:00

This video details the complex structures of the human shoulder and how proper and careful ultrasound scanning techniques can identify tendon and rotator cuff tears, as well as avoid false positive and false negative tear diagnoses.