Some of the helpful well created Mnemonics Submitted in our Facebook page .

Easy Pharmacology Mnemonics

ST elevation causes in ECG:- remember “ELEVATION”: -

• E:Electrolytes,
• L:-LBBB,
• E:-Early repolarization,
• V:-Ventricular hypertrophy,
• A:- Aneurysm,
• T:- Treatment (eg pericardiocentesis)
• I:- Injury (AMI, contusion),
• O:-Osborne waves (hypothermia),
• N:-Non-occlusive vasospasm

Morphine: side-effects MORPHINE:

• M:-Myosis,
• O:-Out of it (sedation),
• R:- Respiratory depression,
• P:- Pneumonia (aspiration),
• H:- Hypotension,
• I:- Infrequency (constipation, urinary retention) ,
• N:-Nausea,
• E:- Emesis

The simple way to read a “CHEST FILM”:- remember the phrase “ABCDEFGHI”

• A:(airway):- see the position of trachea(is it in centre or shifted either side)..!!.
• B:(bony skeleton):-see the clavicles,sternum,ribs(normal or any # line and presence of cervical rib)..!!
• C:cardiac silhouetee):-see the borders of heart n large blood vessels..!!
• D:-(diaphragm):compare left n rt one/air bubbles under lt diaphragm n presence of hemidiaphragm).
• E:-(effusion and/or empty space):-see the costophrenic n costocardiac margins…!!
• F:-(fields..i.e. lung fields):-small airways n vascular margins..,cavity,air bronchogram,local or descrete lesion,consolidation,etc…!!
• G:(gass bubbles):-presence or absence under left diaphragm..!!
• H:(hilar reason):-see any lymphadenopathy n all..!!
• I:(inspiratory effort):-look for either patient has inspired enough.normaly incase of normal quite respiration 1o anterior ribs should be visible.look also for the position of patient..i.e. either patient is rotated?? coz incase of rotation usualy mediastinum n hilar shadows r altered….!!

SUBMITTED BY: Dr. Santosh Kumar Bhagat

On Our Face Book Page

Upper and Lower Motor Neurons

All the neurons contributing to the pyramidal and extrapyramidal systems should be called upper motor neurons (UMN).
The anterior horn cells and the related neurons in the motor nuclei of some cranial nerves are called lower motor neurons (LMN). Axons of these cells give rise to the peripheral motor nerves. These are lowest in position in the motor system and recieve all the inputs from higher centers like medulla, pons, mid-brain and cerebral cortex and transmit the same to the target organs. All impulses for motor activity are to be funelled into them and these are also called final common pathway.

Signs of Upper Motor Neuron Lesions (UMNL)

1. Paralysis or weakness of movements of the affected side but gross movements may be produced. No muscle atrophy is seen initially but later on some disuse atrophy may occur.

2. Babinski sign is present: The great toe becomes dorsiflexed and the other toes fan outward in response to sensory stimulation along the lateral aspect of the sole of the foot. The normal response is plantar flexion of all the toes.

Babinski Reflex

3. Loss of performance of fine-skilled voluntary movements especially at the distal end of the limbs.

4. Superficial abdominal reflexes and cremasteric reflex are absent.

5. Spasticity or hypertonicity of the muscles.

6. Clasp-knife reaction: initial higher resistance to movement is followed by a lesser resistance

7. Exaggerated deep tendon reflexes and clonus may be present.

Signs of Lower Motor Neuron Lesions (LMNL)

1. Flaccid paralysis of muscles supplied.

2. Atrophy of muscles supplied.

3. Loss of reflexes of muscles supplied.

4. Muscles fasciculation (contraction of a group of fibers) due to irritation of the motor neurons – seen with naked eye.

5. Muscle fibrillation (contraction of individual fibers) – detected only by EMG

6. Muscle contracture (shortening of paralyzed muscles)

7. Presence of muscle wasting

8. Reaction of degeneration: When the LMN is cut, a muscle will no longer respond to interrupted electrical stimulation 7 days after nerve section, although it will still respond to direct current. After 10 days, response to direct current also ceases.

Mnemonic for Medical Students

Upper Motor Neuron Lesion vs Lower Motor Neuron Lesion : Difference or comparison between upper motor neuron lesion (UMNL) and lower motor neuron lesion (LMNL)

Mnemonic for basis of difference: STORM Baby
Also remember: In a Lower motor neuron lesion everything lowers

Case Of Tree man

The man’s condition started when he cut himself at the age of 15 and the unchecked proliferation of the lesions has baffled local medical specialists who have tried drugs and surgery with no success.
“This warts began to grow and slowly radiate after my knee being scratch in an accident when i was a teenager.” Dede said, citated from Discovery Channel, Friday (16/11/2007).

After having laboratory test on Dede’s disease, Anthony Gaspari, he found that is was caused by HPV (Human Papiloma Virus) the virus which causes wart in Normal people.
Deficiency of white blood cells, which are crucial in fighting infections, and his weakened immune system couldn’t fight the HPV. The virus hijacked his skin cells, causing it to produce massive amounts of keratin, a protein found in hair and fingernails. The warts sprouted into dense growths known medically as “cutaneous horns” on his hands and feet.

Source: CNN, discovery websites

Opioids are among the commonly misused substance by drug abusers around the world. Opioids come in various forms – Heroin , Morphine, Methadone, Coedine, Pethidine, Dihydrocoedeine.

Opioids are a class of drugs derived from the extracts of plant- opium poppy. Used as Analgesics but  most opiates give a feeling of euphoria and a degree of sedation. These side effects are the cause of Abuse of Opioids.

Opioid overdose can be lethal

Clinical Features Of Opiod Intake in body are-
Rapid, intensely presurable experience
Heightened sexual arousal
Increase dose required for same experience within weeks

Withdrawl Symptoms include-
Intense craving , Rhinorrhea, Lacrimation, Yawning, Perspiration, Shivering, Piloerection, Vomiting and diarrhea, abdominal cramps.
Tachycardia, hypertension, mydriasis ( dilation of Pupil ) and facial flushing.

Hallmark Of Opioid Poisoning are-
Respiratory depression – may lead to death
Pin-point Pupil
CNS depression- decresed level of consciousness.
Signs of IV drug misuse like needle tract marks, tattoo.

Severe –
Respiratory depression
Hypotension
Non-cardiogenic pulmonary edema
Hypothermia
Death due to Respiratory arrest and Gastric aspiration
Others- Ventricular Arrhythmia, Conduction defects and heart blocks

Lab Diagnosis Criteria ( CDC)

• Biologic: A case in which opioids are detected in urine, as determined by hospital or commercial laboratory tests. Fentanyl derivatives and certain other synthetic opioids (e.g., oxycodone) might not be detected by routine toxicologic screens.

- OR-

• Environmental: Detection of opioids in environmental samples, as determined by FDA

Management-
1. Clear Airway and provide Respiratory support
2. Supplement increase flow Oxygen administration
- Severe cases Endotrachel intubation may be required.
3. Antidote- Naloxone is the anti-dote for Opioids. Naloxone is given in dose of 0.8-2 mg bolus IV and repeated every 2 minutes until pupil dilates. Opioid overdose is a challenging condition that requires a difficult balancing act between over and under treatment with naloxone. Nalorphine is an alternative. Literature : Naloxone in Opioid Overdose
4. O2 saturation must be monitored .
5. Management of Hypotension.
6. CPAP/ PEEP for ventilator support.

SAY NO TO DRUGS- Medchrome Against Drug Abuse
Warning- Do not take drug without physician’s prescription.

Syndrome in which hepatic encephalopathy , characterized by mental changes progressing from confusion to stupor and coma, results from a sudden severe impairment of hepatic function. According to emedicine/medscape.com Acute liver failure is a broad term and encompasses both fulminant hepatic failure  and subfulminant hepatic failure.

Fulminant hepatic failure (FHF)  which is  defined as the severe impairment of hepatic functions or severe necrosis of hepatocytes in the absence of preexisting liver disease.( encephalopathy within 8 weeks of the onset of symptoms in a previously healthy liver).

Defined originally further as-

• occurring withion 8 weeks of onset of precipitating illness.
• In the absence of evidence of pre-existing liver disease

Classified as-

1. Hyperacute – occurring in less than 7 days. Cerebral edema is common. Commonly caused by viral hepatitis and paracetamol poisoning .

2. Acute- Occuring between 1 week to 4 weeks. Cerebral edema is common.  Follows Drug toxicity and cryptogenic causes.

3. Sub-acute- Occuring between 4 weeks to 12 weeks. Cerebral edema is uncommon. Cryptogenic causes and drugs are main causes.

   
   
   Causes Of Acute liver Failure-
   Enlarge the picture

Causes of acute liver failure

Clinical Assessment-

• Mild episodic symptoms may progress up to hepatic encephalopathy later causing severe cerebral disturbances.
• Reduced alertness, poor concentration
• Behavioural changes- aggressive and restless.
• Altered sensorium
• Flapping tremor or Asterexis
• Fetor hepaticus ( typical smell breath in liver disease)
• Abnormal pupilary reaction
• Hypertension, Bradycardia, hyperventilation
• Profuse sweating, Myoclonus, focal fits, decerebrate posturing and late- Papilloedema

General Symptoms are-

Weakness, nausea and vomiting, right hypochondrial discomfort

Examination may reveal-Jaundice, Reye’s Syndrome

• Fetor hepaticus
• Hepatomegaly is unusual
• Sudden onset ascites
• Normal spleen size

Investigation useful for assessing the problem are-

1. Toxicology Screen of blood and urine for drugs and toxins
2. Hepatitis Virus Antibody screening and test to detect CMV, EBV, HSV etc
3. Liver function test
4. Serum Caeruloplasmin level,  Serum copper, Urinary copper, Slit lamp eye examination to rule out Wilson’s Disease
5. Auto-antibodies like ANF, ASMA, LKM
6. Utrasonography – Liver and Doppler of Hepatic veins

Management-

1. Patient is critical and need ICU care
2. Monitor – Neurological, Cardiorespiratory functions
3. Fluid balance- maintainance and input/output charting
4. Blood Analysis- Arterial Blood Gas Analysis, Peripheral blood count, Electrolytes,Glucose-2 hourly
5. Kidney function test
6. Prothrombin time
7. Infection Survillence-
8. Culture Blood, urie throat, sputum, cannula sites
9. Chest x-ray

Treatment-

1. Conservative treatrment is Dialysis for removal of toxins and drugs
2. Paracetamol Poisoning-NAC (Read Paracetamol poisoning in children)
3. Liver transplant

Monitor the adverse prognostic criteria.

Complications – ( HERMIM – Mnemonic)

• Hypoglycemia
• Encephalopathy and cerebral edema
• Renal failure
• Metabolic acidosis
• Infection
• MODS

Survival – 1 yr =60%

Studying Online

Pathology is an interesting subject but it is as difficult as any other subjects in medical science like anatomy, physiology, pharmacology, etc. We all are made differently and we all have different way of learning or studying. The method that I use to study may or may not be suitable to you. Lectures, books, pictures and slides are the common sources of learning. Using online resources to learn may be very helpful to many of us.

It is a vast subject and its knowledge is always expanding. So, it is more important that the pathology learnt in the undergraduate curriculum (like MBBS Basic Science) is basic and relevant, emphasizing the understanding of mechanisms and principles rather than detailed facts. As students continue their medical education into PG trainee years, more detailed systemic pathology will become more relevant and more appropriately learnt at that time.

Site home: http://medicalschoolpathology.com

Medical School Pathology is a resourceful medical website designed to assist self learner medical students for learning pathology. It provides online access to lecture notes and videos of all 29 chapters based on Robbin’s Pathology. Besides, it also provides medics with online laboratory for learning histopathology. This site probably won’t be useful to lay person because the description are mostly medical and includes medical jargons.

Chapters

GENERAL PATHOLOGY

1. Cellular Adaptations, Cell Injury, and Cell Death
2. Acute and Chronic Inflammation
3. Tissue Repair: Cellular Growth, Fibrosis, and Wound Healing
4. Hemodynamic Disorders, Thrombosis, and Shock

Textbook for pathology

5. Genetic Disorders
6. Diseases of Immunity
7. Neoplasia
8. Infectious Diseases
9. Environmental and Nutritional Pathology
10. Diseases of Infancy and Childhood

DISEASES OF ORGAN SYSTEMS

11. Blood Vessels
12. The Heart
13. Red Cells and Bleeding Disorders
14. White Cells, Lymph Nodes, Spleen, and Thymus
15. The Lung
16. Head and Neck
17. The Gastrointestinal Tract
18. The Liver and Biliary Tract
19. The Pancreas
20. The Kidney
21. The Lower Urinary Tract and the Male Genital Tract
22. The Female Genital Tract
23. The Breast
24. The Endocrine System
25. The Skin
26. Bones, Joints, and Soft Tissue Tumors
27. Peripheral Nerve and Skeletal Muscle
28. The Central Nervous System
29. The Eye

Online Resources For Self-Learning

Download Lecture notes in Powerpoint
Watch and Download Lecture videos of General Pathology
Watch and Download Lecture videos of Systemic Pathology
Watch and Download Histopathology Videos
Online Access to Rock Lab for Independent Study
Shotgun Histology

Tips for Skin care in Pregnancy-

SKIN IN PREGANCY: gentle cleansing specially glycerine based and rinse off.moisture and apply sun screen with SPF 30 (morning)

Care of Skin in Pregnancy

Make up during pregnancy:

1. less the better .
2. Foundation that’s works as well as concelar.
3. Undereye circle must be tackled with foundation. moisturiser and sunscreen and water proof mascara.

SKIN PROBLEM IN PREGANCY:

Stretch mark:

1. during its formation use of olive oil in the area is helpful.
2. Later retinoids can be used ( Not to be used in pregnancy)
3. Dermabrassion.
4. Pulsed dye laser in some cases.

Melasma:

1. Bleaching agent (hydroquione 4%) may cause irritation so use with hydrocortisone 1% .
2. superfical  chemical bleach and microdermabrassion.
3. Topical agent (azelaic acid)

Acne:

1. oily skin and hormonal imbalance cause it.
2. Antibacterial and antibiotic agent(clindamycin ,benzyl peroxide )
3. oral antibiotics ,
4. sometime laser later.
5. Retinoid is helpful but contraindicated

Advice:- Do not take any medication without physicians or dermatologist’s precription.
Specially during pregnancy which is a critical period for child and mother.
Medchrome.com

Article By: Dr. Akriti Sharma

Peurperium

Puerperium is a period following child birth during which body tissues especially the pelvic organs revert back approximately to pre-pregnant state both anatomically and physiologically. Normally, it lasts for 6 weeks after delivery.

What is puerperal pyrexia?

also called childbed fever, is a  rise of temperature reaching 100.4 degree Fahrenheit  or 38 degree celcius measured orally on 2 separate occasions at 24 hours apart ( excluding first 24 hours) within first 10 days following delivery is called puerperal pyrexia.

Causes of fever during Peurperium

Puerperal Sepsis : Most common cause. It is an infection of genital tract which occurs as a complication of delivery. Peuperal pyrexia is considered to be due to genital tract infection unless proved otherwise.

Urinary tract infection

• Cystitis
• pyelonephritis

Mastitis : breast infection

Infection of cesarean section wound

Pulmonary infection

Septic pelvic thrombophlebitis

Recrudescence of malaria or pulmonary tuberculosis

Unknown causes

Conjoined twins

Interesting Cases Gallery

Facing strange cases are a regular part of Medical life. Here are some interesting pictures clicked in the Hospital, shared for educational purpose to all interested readers.

Gallery Of the Interesting cases:

1. Intrauterine Fetal death , still Birth
2. Conjoined Siamese twins
3. Third degree external hemorrhoid prepared for hemorrhoidectomy
4. Excised huge Sebaceous cyst( Initially  it was diagnosed as pleomorphic Adenoma with potential malignancy and biopsy was sent)

Submitted By :- Dr. Bibek KC

Mosquito is a vector of malaria

Introduction

Malaria is a communicable disease transmitted from one person to another through mosquito bite. 2 species of plasmodium has been identified to cause this disease at present in Nepal:
a. Plasmodium falciparum
b. Plasmodium vivax
Among these two, plasmodium falciparum is more dangerous which is the primary cause of death due to malaria.

How is malaria transmitted?

When an infected female anopheles mosquito bites a healthy person, plasmodium enters circulation along with its saliva. Hence, prevention from mosquito bite is the best way of preventing malaria.

What are the signs and Symptoms?

• Relapsing fever
• Amnesia
• If infected and untreated for long, spleen is enlarged
• Headache
• Vomitting
• Fainting
• If not treated on time may lead to death

Where to go if malaria is suspected?

Immediately reach to the nearest health post or health personnel and the blood test is performed for malaria on suspected person. Receive free antimalarial medicines made available by government and take it as suggested by the health personnel.

How to prevent malaria?

Prevent mosquito bite:

• Use bed-nets on bed while sleeping
• Use nets in windows and doors of house
• Use mosquito repellents
• Use mosquito repellent creams when going out

Destroy mosquitoes:

• Cooperate with government personnel to spray insecticides around your home
• Mosquitoes usually die within 3 to 6 months due to effect of insecticide
• Such walls should not be painted atleast for 3 months

Reduce mosquito habitats:

• Prevent stagnant water by filling unnecessary ditches, clearing bushes around ponds.
• Make still drainage (water) to flow
• Planting water absorbing trees like simal, jamoon, etc. is effective in areas where water is not necessary

Destroy offsprings of mosquitoes

• Kill the larve by immediately filling the ditches
• Use carnovorous fishes like gambusia which feeds on mosquito larvae

Destroy the parasites

• As soon as fever is observed, immediately perform blood test and take medications.

Slogan by Government in Nepali

औलोको परजीवी नास गरि लामखुट्टे भए पनि औलोबाट छुटकारा पाउ |

घर वरिपरी सफा र स्वच्छ राखौ

पनि जम्ने खाल्ड खुल्दी पुरू

औलो रोग बाट बचौं र बचाऔन् |

Source

Government of Nepal
Ministry of Health and Population
National Health Education, Information and Communication Center
Teku, Kathmandu