Sunday, September 19, 2010

USMLE ALGORITHMS: Bacterial Skin Infections

USMLE Step 3 Bacterial Skin Infections Algorithm with Voice explanation from USMLE Expert.

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Principle of Rhinoplasty

Operative Obstetrics

The ten years since the first edition of Operative Obstetrics have witnessed considerable changes in obstetric practice. There has been a continued increase in the rate of cesarean delivery, and the use of minimally-invasive surgery has rapidly gained popularity. Social changes affecting practice have also been significant, prompting a reevaluation of the appropriateness of certain types of operations during pregnancy. This fully-updated edition includes chapters on cesarean delivery, birth injury, ectopic pregnancy, and common surgical complications. It features a new discussion of surgical procedures performed by non-physicians and an updated treatment of fetal surgery. The text also considers complicated and controversial subjects such as cervical insufficiency,pregnancy termination, instrumental delivery, and shoulder dystocia. Each of the four sections includes an in-depth analysis of the important ethical and legal issues underlying practice for the area in question. An expanded appendix reviews legal concepts pertinent to practitioners in the field of obstetrics.

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Funny Medical Photos 2

Gallstone Ileus in CTand Rigler’s Triad

A 65-year-old female presents with mild abdominal distention, nausea, and vomiting. A KUB indicates pneumobilia and paucity of air in the colon. What is the most likely diagnosis ?

Gallstone Ileus is Impaction of gallstone in ileum after passing through a biliary-enteric fistula,It is Unusual complication of chronic cholecystitis

· 60% are cholecystoduodenal fistulae; others are cholecystocolonic and cholecystogastric fistulae

· Average age of patient is 70 years old

· Delay in diagnosis-------- Mortality of 15-20%

** Rigler’s Triad
  • Pneumobilia
  • SBO (Small-Bowel Obstruction)
  • Impacted gallstone-usually in the terminal ileum at ileocecal valve

Two axial images from a contrast-enhanced CT of the abdomen show air in the gall bladder (red arrow) and air in the common bile duct (blue arrow) representing pneumobilia, the gallstone in the small bowel lumen (yellow arrow) and dilated and fluid-filled loops of small bowel from small bowel obstruction (green arrow)

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Aspiration of the Knee

Knee Examamination

Traumatic Ulcer

An ulcer by definition is a localized area on the skin or mucosa in which the surface epithelium has been destroyed. The shape and size of traumatic ulcers are so variable as to defy a simple description. They are usually painful and of short duration.

This photo descriped as Erythematous area surrounding a central yellow fibrinopurulent membrane located in right lateral border of tongue

Etiology: Common causes of traumatic ulcers include: denture irritation, biting injuries, hard foods, chemicals, toothbrush and dry cotton rolls.

Treatment: The treatment is to remove the cause if it is known. Relief of pain can be achieved with topical anesthetics such as Orabase with Benzocaine.
Prognosis: The ulcer should heal if the cause is removed. An ulcer which does not heal within two to three weeks should be biopsied to rule out malignancy.

Differential diagnosis:
Traumatic ulcers must be differentiated from squamous carcinoma and ulcerative mucosal diseases such as lichen planus.

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