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Marfan's syndrome mnemonics and clinical features

noreply@blogger.com (Unknown) — Fri, 31 Aug 2012 08:36:00 +0000

Very easy and good Marfan's Syndrome mnemnics

MARFAN'S syndrome
M

Micro fibrillin protein [ Fibrillin 1 ]
Mitral valve prolapse
Mental retardation is not present *
Myopia due to upward dislocation of Lense [ B/L ectopic lentis ]

A = Aortic root dilatation [ Can cause aortic dissection & aneurysm ]
Aortic regurgitation
R = Retinal detachment
F = Fibrillin 1 gene
Fifteen [ Chromosome 15 is involved ]
Flat feet
[P= Pectus excavatum ]
[H= High arched palate, Hammer toes ] [ Remember as MARPHANS Instead of MARFAN'S ]
A = Arachnodactyly
Astigmatism
Air in lungs [ Pneumothorax ]-> Pain, SOB, Cyanosis
N = Nitroprusside test -Negative **
Nearsightedness
S = Subluxation of Lens [ Upward dislocation of Lense or Superotemporal dislocation] ***
Scoliosis
Speech disorders due to High arched palate & small jaws
Sleep apnea
Spinal Cord= Dural ectasia [ Widening of ballooning of dural sac surrounding the spinal cord ]

Note:
Differentiate from Homocysteinuria

* = Mental retardation is present in Homocysteinuria
** = Urine Cyanide Nitruprusside test positive in Homocysnteinuria
*** = Downward dislocation of Lense in Homocysteinuria [ Inferonasal dislocation ]

Causes of Eosinophilia mnemonics

noreply@blogger.com (Unknown) — Sat, 28 Jul 2012 17:50:00 +0000

Eosinophilic CHINA

C - Cholesterol Embolism

- Connective tissue disease:

Rheumatic arthritis
SLE
Churg strauss vasculitis
Eosinophilic fascitis
Coccidiodomycosis infection
Periarteritis nodosa
Eosinophilia myalgia syndrome

H- Helmenthics (i.e. parasitic) infection:

Ascariasis
Lymphatic filariasis
Hookworm ( Ancylostoma duodenale
Echinococcosis
Schistosomiasis
Strongyloidosis
Trichinosis
Visceral larvae migrans
Fasciolosis (aka Fascioliasis or liver rot caused by Trematodes fasciola hepatica)
Toxocariasis

I- Idiopathic hypereosiphilic syndrome (Hyperimmunoglobulin E. syndrome)

- Interstitial nephropathy

- Inflammatory bowel disease (IBD): Crohn's disease, Ulcerative colitis

- Irradiation

N- Neoplasm:

Lymphoma ( Hodgkin's and some forms of Non-Hodgkin's lymphoma )
Gastric or Lung carcinoma e.g. paraneoplastic eosinophilia
Ovarian carcinoma
Leukemia: Chronic myelogenous leukemia, Adult T-cell leukemia/lymphoma (ATLL), Eosinophilic leukemia
Human T-cell lymphotropic virus I (HTLV-I)

A- Addison's disease

-Allergic conditions:

Asthma
Allergic skin conditions: Atopic dermatitis(eczema), Urticaria, Phemphigus, dermatitis herpetiformis, erythema multiforme
Drugs allergies or hypersensitivity: e.g. penicillin, streptomycin, sulphonamides, carbamazepine
Allergic rhinitis ( Hay fever )
Angioneurotic oedema
Loeffler's syndrome, loeffler's endocarditis
Allergic bronchopulmonary aspergillosis

Others:

Post splenectomy

If you know more than above listed please comment below

Catalase positive microorganisms mnemonics

noreply@blogger.com (Unknown) — Sat, 19 May 2012 17:04:00 +0000

Mnemonics for catalase positive bacteria and fungus:
CATaLaSE

C- Corynbacterium/ Cryptococcus
A- Aspergillus
T- Tuberculosis [Mycobacterium tuberculosis ]
L- Listeria monocytogenes / Legionella pneumoniae
S- Staphylococcus species
E- Enterobacteriacae / Enterobacter

Others: Nocardia, Bacillus, Moraxella, Proteus mirabilis, Pseudomonas

Gram positive bacilli mnemonics

noreply@blogger.com (Unknown) — Sat, 19 May 2012 16:46:00 +0000

Mnemonics for gram positive bacilli bacteria:

BACCiLLEN [Modified version of bacillus ]

B - Bacilli / Bacillus [ B. anthracis, B. cereus, B. stereothermophilus ]
A- Actinomyces
C- Clostridium
C- Corynbacterium
L- Listeria
L- Lactobacillus
E- Erysipelothrix
N- Nocardia

[ Remember: Endospore or Spore forming bacteria are Bacillus and clostridium ]

Oxidase positive bacteria mnemonics

noreply@blogger.com (Unknown) — Sat, 19 May 2012 16:26:00 +0000

Good mnemonics for oxidase positive microorganisms:

Vice Presidenet CHeNey Most Leads Oxidation

V - Vibrio cholerae
P- Pseudomonas aeruginosa
C- Campylobactor
H- Helicobactor
Ne- Nesseria
Mo- Moraxela
Le- Legionella

Obligate anaerobes bacteria mnemonics

noreply@blogger.com (Unknown) — Sat, 19 May 2012 12:50:00 +0000

Obligate anaerobes bacteria mnemonics:

oBliCATe anerobes [ Remember it as oblicate instead of obligate]

B- Bacteroids [Gm -ve]
C- Clostridium [Gm +ve]
A- Actinomyces [Gm +ve]
T- Treponema [Gm -ve]
Other: Peptostreptococcus [Gm +ve], Fusiform [Gm -ve], Porphyromonas [Gm-ve], Veillonella [Gm -ve]

All Obligate anaerobes are Gm -ve except CAP [Clostridium, Actinomyces, Peptostreptococcus ]

To remember Only most important obligate anaerobes as ABC
A- Actinomyces
B- Bacteroids
C- Clostridium

Urease positive bacteria mnemonics

noreply@blogger.com (Unknown) — Sat, 19 May 2012 11:06:00 +0000

Mnemonics for urease positive bacteria:

PUNCHS Kills Urease positive bacteria

P- Proteus mirabilis
U- Ureaplasma
N- Nocardia
C- Cryptococcus [fungus not bacteria]
H- Helicobactor jejuni
S- Staphylococcus epidermidis
K- Klebisiella

Medicine related links

noreply@blogger.com (Unknown) — Sun, 06 May 2012 11:36:00 +0000

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Fat digestion and absorption

noreply@blogger.com (Unknown) — Wed, 22 Feb 2012 18:02:00 +0000

This tutorials show how fat digestion and absorption occurs in human digestive system.

Click here to see animation

Mother's love

noreply@blogger.com (Unknown) — Wed, 05 Oct 2011 08:43:00 +0000

Read this heart touching story:
A man, suffering from Asthma, left alone to die in the street near GIPMER hospital, Pondicherry, discarded by all of his family members, friends, relatives & even his wife. But see the endless love of his mother trying to save her son. Its shows, the only love that never fades in this world is the love of your mother.

Mom, I love you.

Click image t0 enlarge picture

General Anaesthetics

noreply@blogger.com (Unknown) — Wed, 28 Sep 2011 11:26:00 +0000

Definition of general anesthesia:
It is defined as induction of state of unconsciousness with loss of pain sensation and paralysis of skeletal muscles over the whole body.

Cardinal features of general anesthesia:

Loss of pain sensation ( Analgesia )
Unconsciousness
Amnesia ( Block memory of procedure )
Muscle relaxation and immobility ( motionless )
Reflexes are absent

Stages of Anesthesia:

I, Stage of analgesia

This starts from beginning of anesthetic inhalation.

II, Stage of delirium

It starts from loss of consciousness to beginning of regular respiration.

III, Surgical anesthesia

IV, Medullary paralysis

Local anesthetic MCQ

noreply@blogger.com (Unknown) — Sat, 24 Sep 2011 14:04:00 +0000

All about local anesthetics agents and general...

Antiarrhythmic drugs

noreply@blogger.com (Unknown) — Sat, 24 Sep 2011 08:47:00 +0000

These drugs are used to treat or prevent irregular cardiac rhythm such as impaired conductions or abnormal automaticity.
There are several factors that cause cardiac arrhythmias e.g MI, ischemia, mechanical injury, electrolyts and pH imbalance, drugs and neurogenic influences.

Classification:

Class I : Na+ Channel blockers ( Membrane stabilizing agents )

IA: Lengthen the AP ( right shift )

Qunidine
Disopyramide
Procainamide [ used in WPW syndrome

-Open state Na+ channel blockers
-Suppress AV conduction
-Prolong P-R interval
-Prolong QRS, Q-T and Action potential duration

IB: Shorten the AP ( left shift)

Lignocaine
Mexiletine
Phenytoin

IC: Not significantly affect AP (no shift)

Propafenone
Flecainide
Moricizine [Also have calss III property]

[ Remmbered as: Queen have Pelvic Disease, LMP was More PainFull ]

Class II: B- Blockers ( Antiadrenergic agents )
- They act by blocking Catecholamine at the B- adrenergic receptors => Decrease sympathetic activity on the heart => Decreae AV node conduction.

Propanolol (also have class I property)
Atenolol
Pindolol
Sotalol
Metoprolol / Bisoprolol
Esmolol
Acebutolol
R
Timolol

[ Remembered as Two(II) PAP SMEAR Test ]

Class III: K+ Channel blockers ( AP widening agents)
These drugs block K+ channel => Prolong repolarization and Effective refractory period (ERP). Do not block Na+ channel hence conduction velocity is not decreased => Prevent Re-entrant arrhythmias

Bretylium
Ibutilide
Amiodarone
Sotalol
E-4031
Dofetilide / Dronedarone

[Remembered as Three (III) BIASED AP widening agents.]

Class IV: Ca++ Channel blockers:
Block Ca++ channel=> Decrease AV node conduction and shortens plateau phase of AP => Reduce cardiac contractility. Avoid in heart failure due to decrease cardiac cantractility.

Verapamil
Diltiazem

Class V [ Contraindicated in Ventricular arrhythmias]

Magnesium sulfate [Used in Torsades de Pointe]
Adenosine [Used in Supraventricular tachycardia (SPVT)]
Digoxin [Used in Atrial fibrillation, heart failure]

[ Antiarrhythmic agents mnemonics: One(I) Queen have Pelvic Disease, LMP was More PainFull, two(II) PAP SMEAR Test was done, and three(III) BIASED AP widening agents used are Very Dangerous and MAD]

More related topics:

Antiarrhythmic drugs
Antiarrhythmic drugs used in AF

Lignocaine

noreply@blogger.com (Unknown) — Thu, 22 Sep 2011 16:30:00 +0000

General features of Lignocaine ( lidocaine )

It is most widely used LA
It is amino amide linked of local anesthetics [Other amino amide linked LAs are: Bupivacaine, Dibucaine, Etidocaine, Levobupivacaine, Prilocaine, Ropivacaine]
It blocks nerve conduction within 3 minutes after injection.
Lignocaine is rapid acting local anesthetics used in medical practice.
Nerve block is intermediate duration of efficacy approximately 60-120 minutes.
Adrenaline also used with lignocaine, which is vasocontrictor of arteries that delays the resorption of lignocaine resulting in increase duration of anesthesia almost two folds.
It is used for surface application for itching, burning and pain from superficial surfaces.
It is also used in nerve block, infiltration, epidural, spinal, dental anesthetics and intravenous regional block.
Most side effects are drowsiness, altered taste, tinnitus, mental clouding.
It is also used as antiarrhythmic drugs Class IB [ Na+ Channels blockers ( Membrane stabilizing agents)]. It is used intravenously for the treatment of ventricular arrhythmias.
Concentration used in general practice is usually 0.5% to 2%

Mechanism of action:

Lignocaine blocks nerve conduction by blocking the Fast Voltage gated Na+ channels in the neuronal cell membrane.
Sufficient blocks of neuronal cell membrane results in no depolarization of membrane of postsynaptic neuron and fails to transmit action potential.

Contraindications:

Hypersensitivity reaction to lignocaine
Heart block ( 2nd or 3rd degree )
Severe SA block
Combination with other antiarrhythics drugs: Class I antiarrhythmics drugs [ IA: (Qunidine, Disopyramide, Procainamide), IC: ( Flecainide, Propafenone ) and Class III ( Amiodarone Hcl )
Hypotension
Bradycardia
Pacemaker

Adverse effects of lignocaine:

1, CNS effects: Occurs in lower doses

Convulsions
Nervousness
Tingling, tinnitus, tremore
Dizziness, Depression, Drowsiness
Blurred vision
Muscle twitching
Respiratory depression and arrest or apnea
Loss of consciousness or Coma or Seizures

2, CVS effects: Occurs in higher doses

Cardiac arrhythmias
Hypotension
Bradycardia
Cardiac arrest

- Lognocaine is metabolized in liver by CYP3A4, approximately 95% of metabolites

- Elimination half life is almostly 90-120 minutes.

- Elimination is prolonged in case of hepatic impairment ( 340 min. ) and congestive heart failure ( 135 minutes )

More related topics and videos:

Digital ring block video
Ulnar nerve block video
Epidural anesthesia video
Spinal anesthesia video
Median nerve block video
Radial nerve block video
Ulnar nerve block ( USG guided )
Axillary nerve block ( USG guided )
Forearm nerve block ( USG guided )

Cor pulmonale

noreply@blogger.com (Unknown) — Sun, 11 Sep 2011 17:39:00 +0000

It is defined as right heart failure due to long standing pulmonary hypertension. Which leads to enlargement of the right ventricles and eventually right heart failure ensues.

This disease also known as Pulmonary haert disease.
This disease solely caused by primary disorders of respiratory system
If this disease is chronic then right ventricular hypertrophy develops progressively but in case of acute cor pulmonale right ventricular dilatation may occur due to acute increase pressure instead of hypertrophy.
Right sided ventricular disease caused by a primarily left sided heart disease or congenital heart disease is not considered as cor pulmonale.
Almost any chronic lung disease or condition causing prolonged low oxygen blood flow can lead to cor pulmonale

Causes of cor pulmonale:

Chronic obstructive pulmonary disease ( COPD )***
Primary pulmonary hypertension***
Cystic fibrosis
Interstitial lung disease ( Due to scarring of lung tissue )
Obstructive sleep apnea
Recurrent pulmonary embolism ( Chronic blood clots in the lungs)
Sarcoidosis
Kyphoscoliosis
Pneumoconiosis
Altitude sickness
Sickle cell anemia
Loss of lung tissue following lung trauma or surgery

Acute causes

Acute massive pulmonary embolism***
Acute respiratory distress sysndrome ( ARDS )
Acute exacerbation of cor pulmonale

Mnemonics for causes of Cor pulmonale: PuLmonary HTN
P = Pulmonary vascular disease

Primary pulmonary hypertension
Pulmonary embolism ( Acute massive PE or Chronic recurrent PE )
Pulmonary vasculitis
Sickle cell anemia
ARDS
Parasite infestation

L = Lung disease

COPD
Asthma ( Severe, Chronic)
Bronchiectasis
Cystic fibrosis
Interstitial lung disease
Loss of lung tissue following lung trauma or surgery
Sarcoidosis
Pneumoconiosis

H = Hypoventilation

Obstructive sleep apnea
Cerebrovascular disease
Adenoids enlargements in children

T= Thoracic abnormality

Kyphosis
Scoliosis

N = Neuromuscular disease

Polioymyelitis
Motor neurone disease
Myasthenia gravis

Pathophysiology

1, Pumonary vasoconstriction

Due to respiratory disease and poor lung function can leads to alveolar hypoxia and blood acidemia.
Alveolar hypoxia and blood acidemia can results in vasoconstriction of pulmonary arteries
This mechanism leads to pulmonary hypertension and if not treated cor pulmonale ensues

2, Anatomic changes in pulmonary vascular bed

It occurs secondary to parenchymal lung disease or alveolar lung diseases. e.g Emphysema in COPD, interstitial lung disease, massive pulmonary emobolism, cystic fibrosis.
This causes increased in pulmonary pressure

3, Hyperviscosity of blood

Increased blood viscosity is secondary to polycythemia vera ( secondary), sickle cell anemia, macroglobulinemia

4, Increased blood flow in pulmonary vasculature

5, Idiopathic or primary pulmonary hypertension

All above mechanism finally leads to increased pulmonary hypertension and later develop cor pulmonale

Clinical presentation

Symtpoms:

Shortness of breath ( Initially exertional dyspnea but in severe cases can occurs at rest )
Wheezing
Fatigue and syncopal attack
Chest discomfort with anginal pain due to RV ischemia or pulmonary artery stretching
Chronic wet cough
Hemoptysis
Ascites
Hepatomegaly and hepatic congestion secondary to right heart failure
Anorexia due to hepatic involvement
Right upper quadrant abdominal pain and discomfort due to hepatomegaly and congestion
Abnormal heart sounds
Hoarseness of voice due to compression of left recurrent laryngeal nerve by dilated pulmonary artery ( very rare )

Inspection:

Tachypnea
Laboured respiratory efforts with retractions of respiratory muscles
Enlargement of prominent neck and facial veins
Cyanosis: Bluish dicolouration of face
Jaundice due to hepatomegaly and congestion

Palpation:

Hepatomegaly
Pedal edema

Auscultation:

Wheezing
Splitting P2 sound in early stages
Systolic ejection murmur with sharp ejection click heard in pulmonary area
Diastolic pulmonary regurgitation
S3 or S4 sound may be heard
Systolic murmur of tricuspid regurgitation may be heard

Percussion:

Hyperresonance sound in case of COPD
Dull percussion note or fluid thrill in case of ascites

Jugular Venous Pulse, Pressure and abnormalities

noreply@blogger.com (Unknown) — Sun, 11 Sep 2011 14:01:00 +0000

Jugular Venous Pressure is pressure of right atrium. If pressure of right atrial is high then JVP also increase if right atrial pressure is low JVP also low.

- Therefore JVP is determined by right atrial pressure.

Details illustrations about JVP ( Jugular Venous Pulse )

Click image to enlarge view
a wave = Right atrial contraction ( Atrial systole )
c wave = Transmitted carotid impulse at onset of systole ( Due to bulging of the tricuspid valve ring into the atria during ventricular contraction )
x descent = Right atrial relaxation at ventricular systole ( Onset of atrial relaxation )
v wave= Passive atrial filling during closed tricuspid valve and Venous return
y descent = Passive right ventricular filling at start of ventricular diastole or tricuspid valve opening.

Abnormal JVP waves:

1, Raised JVP with normal waveforms

Right heart failure
Volume overload
Bradycardia

2, Large a wave

Tricuspid valve stenosis
Pulmonary hypertension
Pulmonary valve stenosis

3, Cannon A wave

It is powerful atrial wave due to contraction of the right atrium against closed tricuspid valve.

Supraventricular Tachycardia
Complete heart block without Atrial fibrillation
AV dissociations ( Atria and ventricles are not conducting appropriate rhythm )
Ventricular extra systole
Nodal rhythm
Pulmonary hypertension
Tricuspid stenosis

4, Raised JVP with no pulsation

Superior venacava obstruction

5, Absent a wave

Atrial fibrillation

6, Kussmaul's sign ( Paradoxical JVP ): Physiologically JVP is rise during expiration and fall during inspiration. But in case of Kussmaul's sign JVP is increases during inspiration. Some conditions are:

Constrictive pericarditis***
Pericardial tamponade***
Pericardial effusion***
Restrictive cardiomyopathy**
Tricuspid stenosis
Right heart failure ( Cor pulmonale )
Right ventricular infarction

*** = Most common causes

More related topics:

Portable vein viewer
Vein illumination
Facial vein illumination

Calcium Channel Blockers

noreply@blogger.com (Unknown) — Sun, 14 Aug 2011 16:49:00 +0000

Rate limiting calcium channel blockers ( Slow CCB )

A, Dihydropyridine (Lipophilic): These are the most potent calcium channel blockers

Nifedipine
Amlodipine
Nimodipine
Nitrendipine
Felodipine

B, Phenylalkylamine (Hydrophilic )

Verapamil

C, Benzothiazepine

Diltiazem

Mechanism of Action:

1, Smooth Muscle:

CCB work by blocking Voltage-gated Calcium channels in blood vessels
This leads to decreases intracellular Ca+ influx resulting in muscle contraction also decreased.
Decreased vascular smooth muscle contraction resulting in increased arterial vascular diameter.
CCB markedly dilate arterial smooth muscle but have a mild effect venous smooth muscle.
If vasodilation then decrease peripheral vascular resistance..
CCB are effective against large vessels stiffness which occurs usually in elder patients where there is increased Sytolic BP

2, Heart:

CCB blocks Voltage-gated Calcium channels which results in decrease cardiac contractlity.
Decreases in cardiac contractility leads to decreases in cardiac output.
The 0 phase depolarization in SA and AV nodes is largely Ca+ mediated.
Verapamil and diltiazem slows sinus rate and AV conduction due to delayed membrane depolarization. This leads to depression of pacemaker and conduction activity i.e. positive chronotropic and dromotropic action.
Nifedipine doesn't cause delayed membrane depolarization hence it do not decrease SA and AV conduction that is no negative chronotropic and dromotropic action.

-Dihydropyridine are more selective for smooth vascular muscle and negligible -ve inotropic action.
-Diltiazem causes less depression of contractility than verapamil.

CO= Cardiac Output
PVR= Peripheral Vascular Resistance

Hence,
BP= CO x PVR
If there is Decreased CO and Decreased PVR= Decrease BP.

Mesothelioma

noreply@blogger.com (Unknown) — Sat, 13 Aug 2011 11:13:00 +0000

Definition:
It is very rare form of malignant tumour that develops from the lining of the internal organs known as mesothelium.

Prognosis of mesothelioma is extremely poor.

Causes:
It is mainly caused by exposure to the Asbestos
Most of mesothelioma patients have worked in asbestos exposed jobs. Frequent exposed to asbestos or inhalation of asbestos particles are very high risk to develop malignant mesothelioma.
Most of cases sign and symptoms doesn't appear until many year even more than decades after the asbestos exposed.
If early mesothelioma detected and managed well have good prognosis.

Types of mesothelioma:

A, Based on the location of Mesothelioma Cancer:

1, Pleural mesothelioma ( Most common site, aprox. 70%)

Malignant mesothelioma arises from outer lining of the lungs and internal lining of the chest wall.

2, Peritoneal mesothelioma:

Malignant mesothelioma arises from internal lining of the abdominal cavity.

3, Pericardial mesothelioma

Malignant mesothelioma arises from pericardial lining of the pericardial sac.

4, Testicular mesothelioma

Malignant mesothelioma arises from tunica vaginalis of the testes.

B, Based on the Cell type:

Epitheloid mesothelioma ( Most common cell type, approx. 60%, better prognosis)
Fibrous or Sarcomatoid
Mixed or Biphasic (Both epitheloid and fibrous type)
Desmoplastic ( Very rare )

Diagnosis:

Diagnosis of mesothelioma cancer is very difficult because the symptoms are similar to other medical conditions. It requres qualified mesothelioma doctor. Mesothelioma Doctor start to take all investigation like past medical history, past occupational history like asbestos exposure jobs.
Chest X- ray: May shows pleural thickening
Lung function tests should be performed.
CT scan or MRI should be performed
Thoracentesis or Chest thoracotomy should be done if there is accumulation of fluid in pleural cavity.
If ascites: Ascitic tap or paracentesis should be performed.
If Pericardial: pericardiocentesis should be performed.
Fluid Cytopathology must be done, even with cytopathology it is very difficult to diagnose mesothelioma
Biopsy of the affected site must be done to confirm diagnosis of mesothelioma

Treatment:

Prognosis of mesothelioma Cancer is extremely poor.
Qualified Mesothelioma Doctor can only treat mesothelioma patients.

Recently there is some improvements of treatments by newer chemotherapy or multimodality treatments.

Mesothelima at earlier stage has a better prognosis than late stage.

The mainstay of treatment of mesothelioma is

Surgery: Pneumonectomy, pleurectomy, Decoritcation
Radiation
Chemotherapy: Only treatment has proven to improve survival.
Immunotherapy

-Mesothelioma treatment is very expensive that's why it require insurance like health insurance, medical insurance and life insurance for treatment expense.
-If patients had previous jobs which was exposed to asbestos or asbestos related products then it is very easy to lawsuit through mesothelioma lawyers to related company for compensation.

More Details : Download this File

Atrial Fibrillation with rapid ventricular rate

noreply@blogger.com (Unknown) — Thu, 11 Aug 2011 05:25:00 +0000

Definition:
Atrial fibrillation ( AF ) is defined as abnormal irregularly irregular heart rhythm due to rapid, chaotic, asynchronous and incordinated atrial contraction.

Note: always remember 2 point as given below for AF definition,
1, Abnormal irregularly irregular heart rhythm.
2, Rapid, chaotic, asynchronous and incordinated atrial contraction.

In AF, heart rate maybe over 140 beats per minutes.

Types of Atrial fibrillation:
There are three types of atrial fibrillation:

1, Paroxysmal atrial fibrillation

Rapid heart rate begins suddenly and rapidly and stops spontaneously.
Do not necessaryly requre treatment if symptos subsides itself.
If symptoms are persist or troublesome then can use B-blocker and Antiarrhythimic drugs Class IC e.g. Propafenone, Flecainide ( Potent Na+ Channel blockers )
B-blocker is appropriate if structural heart disease, Hypertension and exertion or stress AF.
Amiodarone is second line drug
Digoxin is not effective in case of paroxysmal AF.
Sometimes radiofrequency ablation may also needed if some forms of paroxysmal AF is not relieved by medications.

2, Persistent Atrial fibrillation

Rate control and cardioversion are both effective.
Electrical cardioversion can restore sinus rhythm in case of early AF that is less than 3 months, young patients and no any underlying structural heart disease.
Frequency of relapse is high i.e. approx. 50% within 1 months and 85% within 1 year.
If AF is lessa than 48 hours, immediate DC cardioversion is suitable after the IV heparin administration.
Intravenous Flecainide infusion is safe alternative to Electrical cardioversion if there is no underlying heart disease.
Anticoagulation should be continued for 6 months or must at least 1 months after cardioversion.
If relapse again cardioversion is appropriate.
Antiarrhythmic drugs B-blockers and Amiodarone can reduce risk of recurrence.

3, Permanent Atrial fibrillation

Rate control is mostly effective treatment.
Drugs used for rate controls are Digoxin, B-blockers, Rate limiting Calcioum antagonists e.g. Verapamil or diltiazem.
Controlling rapid heart rate i.e Fast ventricular rate during exercise can be controlled effectively by B-blocker and rate limiting calcium antagonist rather than Digoxin.
Additional benifits in patients with Hypertension and structural heart disease if treated with B-blocker and rate limiting CCB.
If permanent AF is not controlled by any measure can be treated by inducing complete heart block with transvenous catheter radiofrequency ablation and permanent pacemaker must be implanted at the same time.

Causes of AF:
-Exact causes of atrial fibrillation is unknown.

Mnemonics for atrial fibrillation:
ATRIAL'S CARDIAC

A = Acute coronary syndrome ( Atherosclerosis or Ischemic heart disease or MI )***
Amphetamine
T = Thyrotoxicosis
R = Rheumatic heart disease ( Heart Valve disease)***
I = Idiopathic / Increase BP (HTN)***
A= Alcoholism (Holiday heart)*** / Adrenal disease ( Pheochromocytoma )
L = Lone AF***
Lung disease ( Acute Pulmonary embolism**, Pneumonia, Emphysema, COPD, Asthma)
Lung Cancer
S = Sepsis / Shock / Sick sinus syndrome
Smoking
Sleep apnea

C = Congeintal heart disease*** / Congestive heart failure*** /Cardiomyopathy
A = Atrial myxoma
R = Recent heart surgery or Previous heart surgery
D = Diabetes Mellitus
I = Infections ( sepsis, chest infections )
A = Atrial flutter
C = Carbonmonoxice poisoning / Cocaine / Caffeine

*** = Most Common Causes
Other rare causes:
Mesothelioma Cancer
Injury e,g auto mobile accident, road traffic accident, car accident, bike accident.

Older age get higher risk of developing atrial fibrillation
If younger patients born with congenital heart disease there is high risk of developing of atrial fibrillation

More Details Download Following File:Mo

Which cranial nerves are found in the Midbrain (Mesencephalon)?

noreply@blogger.com (Unknown) — Tue, 12 Jul 2011 16:54:00 +0000

A, Optic nerve

B, Oculomotor nerve

C, Trochlear nerve

D, Abducens nerve

More details about midbrain:
CLICK ME

Midbrain:
- Embryologically midbrain arises from second vesicles known as mesencephalon of the neural tube
- It is located below the cerebral cortex and above the hindbrain
- It is the smallest and most superior part of brainstem.
- It measures only 1.5 cm.
- It is divided anterior and posterior section by the Aqueduct of Sylvious ( Connects 3rd and 4rth Ventricles)
- It comprises:
a) Tectum ( Corpora Quaqrigemina )
b) Tegmentum
c) Substantia nigra ( Associated with motor system pathways of the basal ganglia )
d) Cerebral peduncles
e) Cranial nerves

Oculomotor nerve responsible for Eye movements and Pupil constriction (Parasympathetic activity).
Trochlear nerve comes out from the posterior surface of the midrain just below the inferior colliculus.

RED NUCLEUS

Mnemonics: Structures of the midbrain involves visualizing the mesencephalic cross-section as an upside down bear face:-
"The two red nuclei are the eyes of the bear and the cerebellar peduncles are the ears".

E-book and FIle

noreply@blogger.com (Unknown) — Thu, 07 Jul 2011 07:20:00 +0000

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What is the clinical significance of lower uterine segment?

noreply@blogger.com (Unknown) — Wed, 29 Jun 2011 05:45:00 +0000

It is the part of Uterus important for lower segment Cesarean section ( LSCS or LUSCS ). Clinical significant of this part is:

1, Minimal blood loss during LSCS
2, Excellent healing process
3, Reduced risk of uterine rupture in a subsequent pregnancy

If you know more please write comment below:-

What is the normal position of Uterus?

noreply@blogger.com (Unknown) — Wed, 29 Jun 2011 05:24:00 +0000

What is the normal position of Uterus?
A) Anteverted retroflexed
B) Retroverted antiflexed
C) Anteverted anteflexed
D) Retroverted retroflexed