Photo of Acute tonsillitis in Infectious Mononucleosis

Acute Tonsillitis:
This is a common condition which is usually caused by gram positive bacteria (may be the organism is Streptococcal Pyrogenesis , there is a risk of developing Rheumatic Fever ). Often multiple different bacteria exists in the tonsillar crypts, which can be ...............

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A White Hand Vs Red Hand

A 14-year-old girl presented for evaluation of 3 years of intermittent episodes of acute pain in the hands and feet. She had no other medical history. These episodes of pain were frequently triggered by physical exercise and bathing.

During physical examination, movement of the patient's right hand triggered burning pain, and the hand became acutely erythematous. Immersion of the right hand in warm water triggered the same kind of pain and erythema. The patient's presentation was typical of erythromelalgia, in which an increase in temperature triggers attacks of acute pain and red, swollen hands and feet. In some patients, pain and redness can extend beyond the distal extremities. Symptoms are relieved by exposure to cold.

Erythromelalgia can be seen in association with myeloproliferative disorders, connective-tissue disorders, vasculitis, diabetes, gout, multiple sclerosis, thrombotic thrombocytopenic purpura, and the use of certain drugs. Cases of erythromelalgia that are associated with myeloproliferative disorders usually respond to aspirin. Otherwise, treatment is difficult, although attendance at a pain rehabilitation center can be beneficial. The patient had no underlying disease, and no medical treatment was effective. She manages the erythromelalgia by avoiding triggering factors.

Donald School Textbook of Ultrasound in Obstetrics & Gynecology

Featuring more than 650 color illustrations, this definitive volume provides comprehensive and expert coverage on the practical applications of ultrasound. The text is divided into three parts: general aspects, obstetrics, and gynecology. It includes recent technological breakthroughs in diagnostic ultrasound, including the advent of color Doppler, power Doppler, and three-dimensional and four-dimensional imaging. All contributors are either present or former teachers at the 8 branches of the Ian Donald school. A comprehensive text with state-of-the-art images, the book is of value to obstetricians, gynecologist, and medical ultrasonographers.

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Suturing technique

Gastric Volvulus and X-Ray

Gastric volvulus is a rare clinical entity defined as an abnormal rotation of the stomach of more than 180°, creating a closed loop obstruction that can result in incarceration and strangulation.

Etiology:
Type 1

* This type comprises 2/3 of cases and is presumably due to abnormal laxity of the gastrosplenic, gastroduodenal, gastrophrenic, and gastrohepatic ligaments. This allows approximation of the cardia and pylorus when the stomach is full, predisposing to volvulus.
* This type is more common in adults but has been reported in children.

Type 2

* This type is found in 1/3 of patients and is usually associated with congenital or acquired abnormalities that result in abnormal mobility of the stomach.
* Congenital defects as:
-Diaphragmatic defects - 43%
-Gastric ligaments - 32%
-Abnormal attachments, adhesions, or bands - 9%
-Asplenism - 5%
-Small and large bowel malformations - 4%
-Pyloric stenosis - 2%
-Colonic distension - 1%
-Rectal atresia - 1%
The most common causes of gastric volvulus in adults are diaphragmatic defects. In cases of paraesophageal hernias, the gastroesophageal junction remains in the abdomen, while the stomach ascends adjacent to the esophagus, resulting in an upside-down stomach. Gastric volvulus is the most common complication of paraesophageal hernias.

Imaging findings

* Massively dilated stomach in LUQ(left upper quadrant) possibly extending into chest
* Inability of barium to pass into stomach (when obstructed)

Frontal radiograph from an upper GI examination shows the stomach
located in the lower chest in a large hiatal hernia. The greater curvature
of the stomach lies superior to the lesser curvature in an organoaxial twist.
Note that the stomach is not obstructed.

Organoaxial and Mesenteroaxial types:
#Organoaxial type:Twist occurs along a line connecting the cardia and the pylorus--the luminal (long) axis of the stomach.



#Mesenteroaxial type:Twist occurs around a plane perpendicular to the luminal (long) axis of the stomach from lesser to greater curvature.

Preparation for Studying the USMLE

It is not important to know every think bout medicine to pass The USMLE test, but there are some advices and helpful techniques to be ready for it. here some :

1- Mora and more Sample questions:
the most effective way to study for the USMLE is by using professionally developed question banks (like KAPLAN question bank).These question banks focus on the important, tested topics, and are pretty good at identifying distractors (those "wrong" answers that sound pretty believable).

2- Concentrate on your weaknesses:
The USMLE is broken down by topics. That means you have to perform in all the areas to do well on the test as a whole. You know you're weak in an area when you've done poorly in a course - but if you've done well on a school-specific test or in a pass-fail course you can't tell how you'll perform on the USMLE.

3- Study for the USMLE as you study your medical school course:
This seems like a trivial answer, but its not always implemented. Some medical schools use board-exam like tests in their courses, but some are pass-fail. If you're in a pass-fail course its important to realize that you're preparing for the USMLE - and study that way.

Musculoskeletal Examination

Musculoskeletal Examination is a user-friendly textbook designed for students, physical therapists and physicians. It is uniquely multidisciplinary in its approach, being written by a physiatrist, physical therapist and orthopedist. With tables and boxed features to emphasize and summarize key concepts, and ’sample examination’ boxes to highlight and test difficult areas, it is ideal for teaching introductory courses yet detailed enough for professional reference within clinical practice. It includes an easy-to-follow examination process for all the joints and spine, as well as combining biomechanics with physical examination to enhance understanding of function.
This third edition includes more and better anatomy illustrations; over 850 illustrations, x-rays and MRIs are perfect as a quick reference guide, while the detailed descriptions and clinically relevant examples of frequently encountered conditions will help out even the most novice practitioner.
The chapter on basic science, the brief overview of anatomy, and the introductory remarks at the start of each chapter that provide a biomechanical overview of the region featured, all ensure Musculoskeletal Examination will help you gain the understanding necessary to make a correct diagnosis and determine a successful treatment plan for your patients.
Musculoskeletal Examination is ideal for physiotherapists, physiatrists, orthopedists, medical students, practitioners and all those involved in sports medicine and clinical massage.


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