Diseases of the Inner Ear: A Clinical, Radiologic, and Pathologic Atlas – March 2010 Edition

This book is a comprehensive atlas of the clinical conditions that commonly involve the inner ear and lateral skull base. Each disorder or disease is meticulously and beautifully illustrated, with accompanying informative text. An important feature of the book is that no disorder is described from a single point of view. Instead, the clinical features are linked with both radiologic and pathologic findings to provide an all-encompassing picture of the condition in question. This is feasible because the book is the result of years of intense collaborative teamwork between departments at the University of Toronto and the Tehran University of Medical Sciences, and includes many clinical and pathologic images that could only be acquired in major referral units. It is anticipated that this atlas will assist greatly in improving collaboration between clinicians and surgeons in the diagnostic, therapeutic, and surgical management of disorders in this challenging area.

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USMLE ALGORITHMS-SURGERY: CHEST TRAUMA

This ten minute clip talks about Chest Trauma including discussion of the following topics:
-Rib Fracture
-Traumatic Rupture of the trachea or bronchus
-Flail Chest
-Pulmonary Contusion
-Myocardial Contusion
-Traumatic Rupture of the Aorta

Written and narrated by a USMLE Expert. ENJOY!!

Thoracic ultrasound for pneumothorax

instructional video discussing the use of thoracic ultrasound for pneumothorax

Tracheal Stenosis

Endoscopic view of stenosis
Resected segment of trachea
3-D CT reconstruction of trachea showing stenosis at mid level

Tracheal stenosis is a narrowing or scarring of the inside of the trachea can produce difficulty breathing;
treatment may be surgical excision, dilation, or stenting.

USMLE ALGORITHMS: MENINGITIS

This algorithm is everything you need to know for the diagnosis and management of Meningitis for your exam. It is written and narrated by a USMLE Expert, and is to the point. All of Meningitis in less than 5 minutes.

Laparoscopic Hysterectomy

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Laparoscopic hysterectomy is a surgical removal of the uterus,Laparoscopic hysterectomy is alternative to abdominal hysterectomy.Hysterectomy is the second most common major operation performed in the United States today, second only to cesarian section.The first laparoscopic hysterectomy (LH) was performed in January 1988 by Harry Reich in Pennsylvania.The indications for laparoscopic hysterectomy are similar to the generally accepted indications for hysterectomy.
The contraindications for laparoscopic hysterectomy include postpartum hysterectomy and adnexal masses which cannot be removed with an endobag. The size of the uterus and access to it also limit the scope of the procedure depending on the experience of the surgeon.Hysterectomy is usually performed for problems with the uterus itself or problems with the entire female reproductive complex. Some of the conditions treated by hysterectomy include uterine fibroids (myomas), endometriosis (growth of menstrual tissue outside of the uterine cavity), adenomyosis (a more severe form of endometriosis, where the uterine lining has grown into and sometimes through the uterine wall), several forms of vaginal prolapse, heavy or abnormal menstrual bleeding, and at least three forms of cancer (uterine, advanced cervical, ovarian). Hysterectomy is also a surgical last resort in uncontrollable postpartum obstetrical haemorrhage.Tags,laparoscopic hysterectomy recovery,laparoscopic vaginal hysterectomy

Rotator cuff muscles

"The SITS muscles":
· Clockwise from top:

• Supraspinatus.................
  
  Read more...............>>
  
 

Advanced Practice in Critical Care: A Case Study Approach – May 2010 Edition

Advanced Practice in Critical Care provides experienced critical care nurses with a clear and distinct evidence base for contemporary critical care practice. Central to the book is the application of research and evidence to practice and therefore, case studies and key critical care clinical situations are used throughout to guide the reader through the patient care trajectory.
Each chapter introduces an initial patient scenario and as the chapter progresses, the patient scenario develops with the theoretical perspectives and application. In this way, it is evident how multi-organ dysfunction develops, impacting upon and influencing other body systems, demonstrating the multi-organ impact that is often experienced by the critically ill patient. In this way, consequences of critical illness such as acute renal failure, haemostatic failure and liver dysfunction are explored. Throughout the text, key research findings and critical care treatment strategies are referred to, applied and evaluated in the context of the given patient case study. Advanced assessment techniques are explained and the underlying pathophysiology is discussed in depth. Advanced Practice in Critical Care is an essential resource for experienced practitioners within critical care whom primarily care for patients requiring high dependency or intensive care.
This key new book provides in-depth rationales for contemporary critical care practice in an effort to increase the depth of knowledge of nurses who care for the critically ill patient, so that they can truly evaluate their care interventions in view of underlying pathophysiology and evidence. Each chapter introduces a patient scenario, which is developed and explored throughout the course of the chapter.

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How to identify Hematoma in Mammography ??

In this article We will show WELL-CIRCUMSCRIBED and ILL-DEFINED HEMATOMA as seen in Mammogaphy...

WELL-CIRCUMSCRIBED HEMATOMA:
Most commonly caused by blunt or surgical trauma, although hematomas may develop in patients who are anticoagulated or have clotting abnormalities. The combination of hemorrhage and edema more commonly results in an ill-defined mass or a diffuse area of increased density. Although the mammographic findings simulate carcinoma, a history of trauma suggests a conservative approach. Follow-up examinations show gradual decrease in size or even disappearance of the lesion. An organized hematoma may occasionally persist as a more sharply defined mass.

Imaging Findings:

Medium to high-density mass, often having slightly irregular margins. Overlying skin edema is usually present in the acute stage if the hematoma is secondary to trauma.

Hematoma. (A) Mammogram of a firm, palpable mass that arose at a recent biopsy site shows a dense lesion associated with skin thickening (arrows). (B) Three months later, there has been almost complete resolution of the hematoma with only minimal residual architectural distortion (arrows).

ILL-DEFINED HEMATOMA

Overlying skin thickening from edema and bruising may simulate carcinoma. Hematomas tend to resolve within 3 to 4 weeks.

Imaging Findings:

May appear as an ill-defined lesion (more commonly a relatively well-defined mass or a diffuse increase in density).

Hematoma. Ill-defined area of increased density (arrows) in the area of a lumpectomy performed 2 weeks previously.

Algorithm for neonatal resuscitation

Though neonatal resuscitation shares the foundation concepts of airway, breathing, and circulation with adult and pediatric resuscitation, the neonatal algorithm incorporates other concepts central to the care of the newly born infant (e.g. thermal control), emphasizes the importance of establishing adequate lung expansion and ventilation, and dictates key variations in practice resulting from anatomic and developmental differences between neonatal and older pediatric patients.
The algorithm for neonatal resuscitation begins with rapid assessment and the initial steps of resuscitation, then continues through positive-pressure ventilation (including intubation), chest compressions, medications, and special considerations.

This figure shows The algorithm for neonatal resuscitation that begins with a rapid assessment of the infant and continues through the initial steps of resuscitation, positive-pressure ventilation, chest compressions, and medications. Endotracheal intubation may be considered at several steps during resuscitation.

A case of Pityriasis Rosea

A 26-year-old female presents with this rash. She states the rash is minimally pruritic and developed over the last week. She has had some virus-like symptoms and reports the rash began as a large salmon-colored patch on her chest area. The most likely diagnosis is ??

A) tinea versicolor

B) pityriasis rosea

C) varicella

D) psoriasis

E) cocciodiomycosis

The answer is B. (Pityriasis rosea)
Pityriasis rosea is a self-limited, exanthematous skin disease that develops acutely and is characterized by the appearance of slightly inflammatory, oval, papulosquamous lesions on the trunk and proximal areas of the extremities. Pityriasis rosea is largely a disease of older children and young adults. It is more common in women than men.
A prodrome of headache, malaise, and pharyngitis may occur in a small number of cases, but except for itching, the condition is usually asymptomatic. The eruption commonly begins with a “herald patch”: a single round or oval, sharply demarcated pink or salmon-colored lesion on the chest, neck, or back, 2 to 5 cm in diameter. The lesion soon becomes scaly and begins to clear centrally, leaving the free edge of the scaly lesion directed inwards toward the center. A few days or a week or two later, oval lesions similar in appearance to the herald patch, but smaller, appear in crops on the trunk and proximal areas of the extremities The long axes of these oval lesions tend to be oriented along the lines of cleavage of the skin. This characteristic Christmas-tree pattern is most evident on the back, where it is emphasized by the oblique direction of the cleavage lines in that location.

Most cases of pityriasis rosea need no treatment other than reassurance and proper patient education. Topical steroids with moderate potency are helpful in the control of itching. They can be applied to the pruritic areas two or three times daily. Topical antipruritic lotions such as prax, pramagel, or sarna may also be helpful.

The 5 Ts of Right to left shunt

The 5 Ts

1. Truncus arteriosus (1 vessel)
2. Transposition of great arteries (2 vessels transposed)
3. Tricuspid atresia (3 =Tri)
4. Tetralogy of fallot (4 =Tetra)
5. Total anomalous pulmonary venous return (5 =5 words)

Higher Healthcare Costs in 2011

WASHINGTON :- The amount employers spend on their workers' healthcare costs will reach a 5-year high in 2011, and employees will also face larger out-of-pocket costs for their medical care next year, according to a forecast released Monday by the consulting group Hewitt Associates.

Because of higher medical claim costs, an aging population, and changes under the new healthcare reform law, employers can expect to pay nearly 9% more toward their employees' healthcare costs than they did in 2010.

The findings are in line with a recent survey by the National Business Group on Health that asked large employers what they expected to pay for their workers' medical costs in 2011. The answer: about 9% more than in 2010.

The average total healthcare premium per employee working at a large firm will be $9,821 in 2011 -- up from $9,028 in 2010.

Employees will contribute, on average, $2,209, or 22.5% of the total premium, which is a few hundred dollars more than in 2010, when the average employee at a large firm paid 21.8% of their total premium, to total slightly less than $2,000. Once out-of-pocket costs for co-pays and deductibles are factored in, employees can expect to pay about $486 more than they paid toward their medical costs in 2010.

The authors of the Hewitt report say that the new figures mean that healthcare premiums have more than doubled in the past decade and employees' share of their medical costs will have more than tripled.

The high 2011 cost projections are based on a number of factors, the study authors said. For one, employers haven't hired many new employees in recent years, which has resulted in a slightly older work force that is more prone to expensive medical conditions.

Certain insurance market reforms contained in the Affordable Care Act (ACA) -- such as covering dependents until age 26 and eliminating lifetime and annual limits -- contributed to about 1% to 2% to the 9% increase in what employers are likely to pay in 2011.

"After 18 months of waiting for healthcare reform to play out, employers find themselves in a very challenging cost position for 2011," said Ken Sperling, Hewitt's healthcare practice leader, in a press release. "Reform creates opportunities for meaningful change in how healthcare is delivered in the U.S., but most of these positive effects won't be felt for a few years. In the meantime, employers continue to struggle to balance the significant healthcare needs of an aging work force with the economic realities of a difficult business environment."

Hewitt's data came from a database with detailed census, cost, and plan design information for 350 large U.S. employers representing 14.4 million participants and $51.9 billion in 2010 healthcare spending.

Take care of Depression among medical students!!

Medical students with moderate to severe depression more frequently endorsed several depression stigma attitudes than nondepressed students and had a higher rate of suicidal thoughts, according to a study in the September 15 issue of JAMA, a theme issue on medical education.

"Medical students experience depression, burnout, and mental illness at a higher rate than the general population, with mental health deteriorating over the course of medical training. Medical students have a higher risk of suicidal ideation and suicide, higher rates of burnout, and a lower quality of life than age-matched populations," the authors write. They add that medical students are less likely than the general population to receive appropriate treatment, perhaps because of the stigma associated with depression. "Students may worry that revealing their depression will make them less competitive for residency training positions or compromise their education, and physicians may be reluctant to disclose their diagnosis on licensure and medical staff applications."

Thomas L. Schwenk, M.D., of the University of Michigan, Ann Arbor, and colleagues conducted a study to assess the prevalence of self-reported depression and suicidal ideation among medical students and to assess the perceptions of depression stigma by both depressed and nondepressed students. In September-November 2009, the researchers surveyed all students enrolled at the University of Michigan Medical School (n = 769). The survey response rate was 65.7 percent (505 of 769).

Emergencies in Urology

Emergencies in Urology
Publisher: Springer | ISBN: 3540486038 | edition 2007 | PDF | 679 pages | 41,5 mb



Emergencies in Urology is a comprehensive textbook covering one of the few remaining white spots on the map of urological literature. To date only a small number of publications have been dedicated to the topic of urgent and emergent problems in urology – important as these are in our daily clinical life.Therefore the editors, both of them internationally recognized urological experts, have taken the effort to present an in-depth study into virtually every possible urgent urological situation with which a urologist may be confronted today. Consequently, the book includes chapters on topics such as urological trauma, urosepsis, urinary obstruction, oncological emergencies, intra- and postoperative complications, acute problems in children, and many more.To obtain the best possible expertise in such a wide field, renowned expert authors have contributed their experience to this book. They did so not only by writing the regular book chapters but also by delivering short stories about urgent situations they encountered in their own professional life. These vignettes are one of the rare opportunities where experience can be relayed without restriction from one urological generation to the next.Much work has gone into the illustrations for the book. Foremost in this respect is the art of Stephan Spitzer, one of the leading medical illustrators of today.The result is a comprehensive, well-organized text, in which state-of-the-art know-how, didactic algorithms, personal experience and detailed illustrations are combined into a unique guide of how to manage urological emergencies.

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Gallblader Ultrasound - Cholecystitis

Histopathology Lung--Bronchiectasis

Endoscopic Anterior Skull Base Resection by RRC

An endoscopic anterior skull base resection may be necessary in select neoplasms. Obviating the need for any external incisions, this approach has become increasingly valuable to address a number of sinonasal neoplasms affecting the anterior skull base, through a minimally invasive technique. This video reviews the endoscopic anterior skull base approach for a typical esthesioneuroblastoma. It also touches on the reconstructive technique using a free alloderm graft, which has been in use by us for over 10 years, and has yielded consistent results, with no CSF leaks.

Skin Prick Testing

This test measures specific IgE attached to Mast cells in the skin

Allergen solutions for skin prick testing: PONI F

• Positive control (histamine)
• Occupational allergens (ammonium persulphate, platinum salts, antibiotics, and latex)
• Negative control (diluent)
• Inhaled allergens (house dust mite (HDM), grass pollen, cat dander, dog hair)
• Food allergens

Disadvantages of skin prick test: FISH

• Food allergens (less standardized), less reliable than inhaled allergens
• Itching
• Skin conditions (eczema or dermatographism) interfere with interpretation
• Histamine antagonists (antihistamines) suppress skin reaction

Mitral Valve Prolapse and Mitral Regurgitation

Mitral valve prolapse and consequent mitral valve regurgitation is seen during TEE examination in a patient undergoing mitral valve repair. The P2 scallop of the posterior mitral leaflet is seen as prolapsed with a flail chord. Color Doppler shows a mitral regurgitant jet.

Increased Medical Student Debt

The average medical school debt today, according to the Association of American Medical Colleges(AAMC), is $156,456. USA is the only country in the world were future doctors have to bear such a financial burden of their education. That places significant strain on any relationship involving an American medical student.
Student debt statistics
•  $156,456 – According to the Association of American Medical Colleges (AAMC), the average educational debt of indebted graduates of the class of 2009.
•  79 percent of graduates have debt of at least $100,000.
•  58 precent of graduates have debt of at least $150,000.
Why medical education debt has increased
Medical education debt is driven by rising tuition. AAMC data show that median private medical school tuition and fees increased by 50 percent (in real dollars) in the 20 years between 1984 and 2004. Median public medical school tuition and fees increased by 133 percent over the same time period. Other recent 20-year periods show similar trends. Tuition is just one source of increasing debt burdens. Other causes include:
•  Interest accrued on loans over time significantly adds to the total cost of student debt.
•  Students are now entering medical school with more education debt from undergraduate education.
•  Increasing numbers of “non-traditional” students who have children to support.

Diagnostic Criteria for Transverse Myelitis

The term “transverse myelitis” describes a heterogeneous group of inflammatory disorders that are characterized by acute or subacute motor, sensory, and autonomic (bladder, bowel, and sexual) spinal cord dysfunction (Table above).
The clinical signs are caused by an interruption in ..........

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1st movie by Doctors Gate :D

Excisional biopsy in melanoma

A 42-year-old female presents with the lesion (shown below) on the back of her calf. She has no significant medical problems and otherwise feels well. The lesion has not bled, but seems to have grown over the last few months. Appropriate initial management of this skin lesion should be??

• A) observation and removal if bleeding or further change occurs
• B) complete excision with normal margins
• C) complete excision with wide margins
• D) shave biopsy
• E) electrodessication and curettage

The answer is B. (Complete excision with normal margins) Even in the hands of experienced dermatologists, there is an approximately 15% false negative rate in determining the presence of melanoma based on examination alone; therefore, histologic confirmation is essential for both tumor diagnosis and staging. A complete excision with normal skin margins is preferable when possible as the first diagnostic step (e.g., excisional biopsy).
An incisional biopsy can be performed for larger lesions when complete excision is not practical and when the suspicion of melanoma is low; incisional biopsy does not adversely affect survival. Shave biopsies should be avoided because they may not provide enough tissue for diagnosis and do not allow for accurate depth measurement. All biopsies of lesions suspected of being melanomas should provide a piece of full-thickness skin extending to the subcutaneous fat.

When considering the diagnosis of melanoma, shave biopsies should be avoided because they may not provide enough tissue for diagnosis and do not allow for accurate depth measurement. All biopsies of lesions suspected of being melanomas should provide a piece of full-thickness skin extending to the subcutaneous fat.

Little Black Book of Emergency Medicine

Steven E. Diaz, "Little Black Book of Emergency Medicine"
Jones & Bartlett Pub 2006 | ISBN-10: 076373456X | 507 Pages | CHM | 2,2 MB



Thoroughly revised and updated, the second edition of this pocket-sized handbook provides comprehensive, concise, evidence-based information on diagnosing and treating illness and injury in the emergency setting. The Little Black Book of Emergency Medicine is a convenient resource offering quick access to vital information and makes a great reference for solving pressing problems on the ward or in the clinic.

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Musculoskeletal System &Lumbar Spine Examination

Rectal bezoars in children

A bezoar is a solid mass formed in the gastrointestinal tract as a result of the consumption of indigestible or poorly digestible substances. Bezoars most commonly form in the stomach, but can occur in the small intestine and, rarely, in the colon or rectum. They are usually classified according to the material of which they are derived, for example, trichobezoars (hair), lactobezoars (milk curd), phytobezoars (plant fibre) and medication bezoars. The term originates from the Arabic term badzehar, meaning "antidote," a reference to historical medicinal use of these concretions found in animal gastrointestinal tracts in the treatment of human poisonings.

See this case of a previously well 8 year-old boy was brought to the emergency department with a three-day history of constipation. He had consumed three handfuls of flavoured unshelled sunflower seeds four days previously. His mother had unsuccessfully tried several sodium biphosphate and sodium phosphate enemas at home, as well as the use of bran to aid defecation. On examination, the patient’s abdomen was soft and nontender with normal bowel sounds. A bolus of stool mixed with unshelled sunflower seeds was visible at the anus.

A radiograph of the abdomen showed stool extending from the descending colon down to the rectum, which contained a large mass . Oral phosphate soda and a mineral oil enema were ineffective. The patient was taken to the operating room for digital and instrumental extraction under general anesthesia. He was monitored in hospital for 24 hours and discharged when he was taking liquids and passing soft stool.

Although small rectal bezoars may pass spontaneously, options for the care of patients presenting to clincians with symptomatic rectal bezoars include the use of enemas and extractions with conscious sedation or general anesthesia. Formation of bezoars from sunflower seeds may be more likely in children or preteens who are unable or unwilling to spit out the shells, particularly with flavoured shells.

Oxyhemoglobin dissociation curve

Current Indications for Tonsillectomies

Tonsillectomy-strong indications

1. Carcinoma of the tonsil. The best technique for optimal results from biopsy and staging requires complete removal of the tonsil.
2. Peritonsillar abscess (PTA) . A bacterial abscess, PTA is most often caused by anaerobic organisms. Incision and drainage is mandatory. Recurrent abscess rate is 10% and recurrent abscess may be fatal. Therefore, the tonsil should be removed. This may be done at the time of the initial PTA presentation or may be done electively 6 weeks later.
3. Congestive heart failure. Failure of the right-side of the heart can be caused in young children by a constant upper airway obstruction (SDB/OSA). This is reversed by tonsillectomy.
4. Tonsillitis causing respiratory difficulties, dysphagia, and requiring hospitalization. Any episode of tonsillitis causing respiratory embarrassment, or so severe that hospitalization is required, is best treated by elective tonsillectomy 6 weeks after the episode.

Tonsillectomy-philosophic indications

1. Recurrent tonsillitis. It is currently believed by most otolaryngologists that a patient having four or more episodes of tonsillitis a year for at least 2 years that necessitates their missing 10 or more days a year of school or work will benefit from a tonsillectomy.
2. Sleep disturbances. Sleep disordered breathing/obstructive sleep apnea, and snoring can be caused by upper respiratory tract lymphoid tissues that prolapse into and obstruct the airway during sleep. In these cases, tonsillectomy, adenoidectomy, and even partial palatectomy with uvulectomy (UP3) may improve the airway.

differential diagnosis of inflammatory neck mass

Algorithm for differential diagnosis of inflammatory neck mass. Dx = diagnosis; CT = computed tomography; CBC = complete blood cell count; PT = patient; Bx = biopsy; WBC = white neck mass. Dx = diagnosis; CT = computed tomography; CBC = complete blood cell count; PT = patient, Bx = biopsy; WBC = white blood cell count.

American Diabetes Association Complete Guide to Diabetes

American Diabetes Association | English | 2005-08-15 | ISBN: 1580402372 | 554 pages | PDF | 3,3 MB

The ADA's bestselling resource on living with and managing diabetes
The organization's flagship book on diabetes care, and American Diabetes Association Complete Guide to Diabetes is the quintessential sourcebook for people who want to take charge of their disease for a lifetime. Containing detailed explanations and step-by-step instructions on self-managing diabetes, this definitive guide arms readers with hundreds of effective self-care techniques to solve scores of common diabetes-related problems─safely and easily.


This completely revised fourth edition is filled with the latest information about:
• Insulin and oral diabetes medications
• Tools and techniques for managing diabetes
• Meal Planning, including sample meal plans
This mega-volume also includes chapters on gestational diabetes, glucose control, health care professionals, the ins and outs of insulin, healthy eating, diabetes tools, health insurance and hospital stays, and much more.

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Epley maneuver for Vertigo

The manuever starts sitting upright . This maneuver should be done by a doctor or physical therapist both for safety (you may be dizzy) and to observe the eye movements.


This maneuver is done with the assistance of a doctor or physical therapist. A single 10- to 15-minute session usually is all that is needed. When your head is firmly moved into different positions, the crystal debris (canaliths) causing vertigo will move freely and no longer cause symptoms.

The Epley maneuver is also called the particle repositioning or canalith repositioning procedure. It was invented by Dr. John Epley.
It involves sequential movement of the head into four positions, staying in each position for roughly 30 seconds. The recurrence rate for BPPV( Benign Paroxysmal Positional Vertigo ) after these maneuvers is about 30 percent at one year, and in some instances a second treatment may be necessary.

When performing the Epley maneuver, caution is advised should neurological symptoms (for example, weakness, numbness, visual changes other than vertigo) occur. Occasionally such symptoms are caused by compression of the vertebral arteries ), and if one persists for a long time, a stroke could occur.

Carpal Tunnel Choices

This 3D medical animation depicts carpal tunnel syndrome and carpal tunnel release. Carpal tunnel syndrome is a nerve disorder of the hand caused by compression of the median nerve.2 different types of carpal tunnel release are animated, an open carpal tunnel procedure and the endoscopic approach.

Physical Examination of Respiratory System

part I


part II

Imaging findings in Bladder Rupture

-Diagnostic evaluation of bladder rupture includes voiding cystourethrography (VCUG) or CT scan

* VCUG
o Voiding cystourethrography historically been preferred contrast enhanced
study for diagnosis of bladder rupture
o Bladder needs to be fully distended and evaluation of a post-voiding
film essential
* Plain film:
o "Pear-shaped" bladder
o Paralytic ileus
o Upward displacement of ileal loops
o Flame-shaped contrast extravasation into perivesical fat
+ Best seen on postvoid films
+ May extend into thigh / anterior abdominal wall

One image from an IVU shows a flame-shaped density adjacent to

right lateral wall of bladder representing extra-peritoneal contrast from a bladder rupture

* US
o "Bladder within a bladder" = bladder surrounded by fluid collection

Is Evidence-Based Medicine a Barrier to Cost-Effective Care?

August 29, 2007 presentation by Alan Garber for the Stanford School of Medicine Medcast lecture series.

Alan Garber, MD, PhD, professor of medicine and the director of the Center for Health Policy and of the Center for Primary Care and Outcomes Research at Stanford University, discusses the importance of distinguishing between a treatment's effectiveness and its value, and in turn what role evidence-based medicine should play in today's coverage decisions.

Lower lobe predominance mnemonic

BADAS

* B: Bronchiectasis
* A: Aspiration pneumonia
* D: Drugs, Desquamative interstitial pneumonia
* A: Asbestosis
* S: Scleroderma and other Collagen vascular diseases

C.I.A.

* C: Collagen vascular disease
* I: Idiopathic pulmonary fibrosis
* A: Asbestosis

Scleroderma

diopathic pulmonary fibrosis

Algorithm for determining the cause of the Hypernatremia

Hypernatremia is defined as a serum sodium > 145 mEq/L

- hypernatremia can be due to:-

* net loss of water and sodium from the body with inadequate water replacement (commonest cause)
* inadequate water intake................

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Disorders of the Parathyroid, Pituitary, and Pancreas: MEN 1

Multiple endocrine neoplasia type 1(MEN 1):It is a relatively uncommon "1 person in every 30,000 people" inherited "autosomal dominant disorder, but it may also occur sporadically as a result of new mutations" disease described by Wermer In 1954 .

Parathyroid tumors

Hyperparathyroidism is the most common manifestation of MEN 1.Clinical manifestations include urolithiasis, bone abnormalities, and, in severe cases, generalized weakness and mental or cognitive dysfunction.
Hyperparathyroidism in MEN 1 differs from sporadic cases by earlier age at presentation, involvement of multiple glands, and high recurrence rate postoperatively (50% by 8-12 y after surgery).

Enteropancreatic tumors

Pancreatic islet cell tumors represent the second most common manifestation of MEN 1 and occur in 80% of patients.
Nonfunctioning pancreatic endocrine tumors are the most common pancreatic tumors, occurring in 80-100% of cases
Gastrinomas are the most common cause of symptomatic disease and are found in approximately 60% of patients with MEN 1. Compared with the sporadic form of gastrinomas in Zollinger-Ellison syndrome (ZES), tumors in MEN 1 are more often duodenal, small, and multicentric, thus diminishing the probability of surgical cure. The features predictive of poor prognosis include pancreatic location of lesions, metastases, ectopic Cushing syndrome, and height of gastrin levels. Development of gastrinomas is preceded by multifocal hyperplasia of the gastrin-producing cells. Long-standing MEN 1/ZES may lead to development of gastric carcinoid tumors that might be aggressive.
Insulinomas account for approximately 20-35% of functional pancreatic islet cell tumors. Similar to gastrinomas, they can be multicentric (10-20%), where 25% metastasize either to regional lymph nodes or to the liver.
Glucagonomas occur in 3% of patients with MEN 1 and are silent or present with hyperglycemia. Only a few patients show the typical skin lesions known as necrolytic migratory erythema.

The occurrence of the watery diarrhea, hypokalemia, hypochlorhydria, and acidosis (WDHA) syndrome (incidence approximately 1%) may be due either to either a pancreatic islet cell or to a carcinoid tumor.

Pituitary tumors

These often-multicentric tumors occur in more than 50% of patients and are clinically apparent in up to 20% of patients. These tumors tend to be larger and more aggressive than those not associated with MEN 1.

Prolactinomas are the most common pituitary tumor in patients with MEN 1.

Growth hormone–producing tumors account for 25% of these adenomas. Growth hormone levels rise due to autonomous secretion from the pituitary tumor or, less commonly, by production of growth hormone–releasing factor by a pancreatic or other endocrine tumor.

A pituitary tumor or carcinoid tumor that produces corticotropin can cause Cushing syndrome in patients with MEN 1. Ectopic production of corticotropin-releasing factor from a pancreatic islet cell tumor also has been described.

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Neuroscience at a Glance

This third edition of one of the most popular titles in the at a Glance series contains essential integrated information on anatomy, biochemistry, physiology and pharmacology to provide a review of the structure and function of the nervous system. Neuroscience at a Glance is the perfect introduction and revision aid to this notoriously difficult subject area and features:

* New chapters on consciousness, memory, emotion and drug addiction, and imaging the nervous system
* Highly visual presentation with full-colour illustrations and the inclusion of high-quality CT and other neurological scans
* Self-assessment case studies to make revision more rewarding
* A companion website at www.medicalneuroscience.com with self-assessment, case studies, a glossary, further reading and other useful information.

Neuroscience at a Glance will appeal to medical students, biomedical science students and junior doctors. In addition, the text is a suitable companion for nurses and other students of allied health

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Antrochoanal Polyp

Antrochoanal polyps, are solitary polyps arising from the maxillary antrum. They were first described by Killian in 1906. Although their etiology remains unknown, allergy has been implicated........

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Endoscopic photograph of right nasal cavity showing an antrochoanal polyp arising from the middle meatus and blocking the right posterior choana.

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Diabetes-Related Atherosclerosis

WHAT IS LITHOTRIPSY

Melatonin and it`s uses

Melatonin is a hormone secreted by the pineal gland in the brain. It helps regulate other hormones and maintains the body's circadian rhythm. The circadian rhythm is .................

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Vascular invasion: way to follicular thyroid carcinoma

There are 4 types of thyroid carcinoma: papillary, follicular, medullary, and anaplastic carcinoma. One of these types, follicular thyroid carcinoma, can look very much like a benign thyroid adenoma. Both follicular carcinoma and thyroid adenoma are composed of follicles (resembling normal thyroid follicles).

The only way to tell apart follicular thyroid carcinoma (which is malignant) from thyroid adenoma (which is benign) is to take out the entire nodule and examine the entire thing very carefully. If you see tumor cells invading the capsule, or if you see them within vessels (as in the photo above), that means it’s follicular carcinoma. Malignant tumor cells invade; benign ones do not.

Classification of Wound by Sterility

The Centers for Disease Control and Prevention (CDC) “Guidelines for prevention of surgical site infection” identifies four surgical wound classifications.

CLASS I: CLEAN WOUNDS

* an uninfected surgical wound in which no inflammation is encountered and the respiratory, alimentary, genital, or uninfected urinary tracts are not entered.
* clean wounds are primarily closed and, if necessary, drained with closed drainage.
* Surgical wound incisions that are made after nonpenetrating (ie, blunt) trauma should be included in this category if they meet the criteria.

CLASS II: CLEAN-CONTAMINATED WOUNDS

* a surgical wound in which the respiratory, alimentary, genital, or urinary tracts are entered under controlled conditions and without unusual contamination.
* Specifically, surgical procedures involving the biliary tract, appendix, vagina, and oropharynx are included in this category, provided no evidence of infection is encountered and no major break in technique occurs.

CLASS III: CONTAMINATED WOUNDS

* open, fresh, accidental wounds.
* surgical procedures in which a major break in sterile technique occurs (eg, open cardiac massage) or there is gross spillage from the gastrointestinal tract and incisions in which acute, nonpurulent inflammation is encountered are included in this category.

CLASS IV: DIRTY OR INFECTED WOUNDS

* old traumatic wounds with retained or devitalized tissue and those that involve existing clinical infection or perforated viscera.
* This definition suggests that the organisms causing postoperative infection were present in the wound before the surgical procedure.

A 41-year-old woman presents with amenorrhea for 9 mo.She is found to have a prolactin secreting pituitary adenoma. Laboratory data reveals a serum calcium level of 12.0 mg/dL and hypoglycemia (serum glucose of 49 mg/dL). Which of the following is the most likely diagnosis?

• a.MEN 1 syndrome
• b.MEN 2A syndrome
• c.MEN 2B syndrome
• d.Sipple syndrome

The answer is (a).  The patient most likely has multiple endocrine neoplasia or MEN 1(Wermer syndrome), an autosomal dominant disorder, consisting of tumors of the Pancreas, Pituitary, and Parathyroid gland (PPP).
MEN 2A(Sipple syndrome) consists of Pheochromocytoma, hyperParathyroidism, and medullary carcinoma of the Thyroid (PPT). Patients with MEN 2B syndrome present with Pheochromocytoma, Neuromas, and medullary carcinoma of the Thyroid (PNT).

AMC Handbook of Clinical Assessment

This book provides unique problem-based self-learning exercises to aid preparation for clinical assessment.

Self-test clinical competency tasks with performance guidelines and commentaries cover all domains and disciplines for the medical graduate about to enter internship.
The publication covers:
*Communication Skills
*Clinical consulting skills
*Ethics & The Law
*More that 150 self-assessment tasks and performance guidelines
*8 complete trial examinations for self-testing

GET IT HERE

Connective Tissue Histology

Shave and Punch Skin Biopsy

Erythema Marginatum Pic in rheumatic

Erythema marginatum is described as the presence of pink rings on the trunk and inner surfaces of the arms and legs which come and go for as long as several months. The rings are barely raised and are non-pruritic. The face is generally spared.

It occurs in less than 5% of patients with rheumatic fever and sometimes called erythema marginatum rheumatica , but is considered a major Jones criterion when it does occur.

It is an early feature of rheumatic fever and may be associated with mild carditis.

Epidemiology

In developed countries, rheumatic fever has become very rare and this rash occurs in no more than 2 to 5% of cases of rheumatic fever. However, rheumatic fever has become as common in New Zealand as in some developing countries, especially amongst the Maori children. In the 1990s there appeared to be a resurgence of rheumatic fever in the USA. Erythema marginatum was uncommon in patients with rheumatic fever reported in a large series from Pittsburgh.

Pediatric Bone Marrow Aspiration

Algorithm for the diagnosis of Hyperkalemia

Causes of hyperkalemia:
Pseudohyperkalemia

* tight tourniquets and/or fist clenching
* small needle and/or venous sampling in a high vacuum tube
* over-vigorous centrifugation of the blood specimen and/or ....................

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Angioneurotic Edema

Angioedema: is the development of large welts below the surface of the skin, especially around ...........

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Infant CPR

Hormonal and Other Changes in Patients with Hypothalamic Amenorrhea.

In patients with hypothalamic amenorrhea, there are alterations of hormones and other factors that affect the secretion of gonadotropin-releasing hormone (GnRH), including :
# low levels of leptin and
# high levels of both ghrelin and neuropeptide Y (NPY).
β-endorphin, corticotropin-releasing hormone (CRH), dopamine, and γ-aminobutyric acid (GABA) are factors that negatively influence GnRH secretion. Some of these factors may also serve as hunger signals from the peripheral to the central nervous system and as links between nutrition and reproduction.
Hallmark findings in adolescents and young women with hypothalamic amenorrhea include overactivity of the hypothalamic–pituitary–adrenal axis, suppression of the hypothalamic–pituitary–ovarian axis, and alterations in thyroid hormone regulation. FSH denotes follicle-stimulating hormone, LH luteinizing hormone, TSH thyrotropin, and T3 triiodothyronine.

“Cotton Wool” Appearance of Paget's Disease

A 63-year-old man presented with a long-standing history of sinusitis and 3 weeks of frontal headache. The physical examination was unremarkable.
The alkaline phosphatase level was elevated at 434 IU per liter (upper limit of the normal range, 129). The serum calcium level was within normal limits.

Radiography of the skull (Panel A) showed thickening of the outer and inner tables of the cranial bones, widening of the diploë, and a “cotton wool” appearance caused by irregular areas of sclerosis (arrows). Computed tomography of the skull (Panel B) confirmed bony expansion, cortical bone thickening, and irregular areas of sclerosis (arrows). These imaging findings reflect the mixed osteolytic and osteoblastic phases of Paget's disease, resulting in accelerated bone turnover with bone deposition and expansion.
The patient was treated with alendronate, which resulted in improvement in frontal headache.

Palate of pipes smokers :Nicotine Stomatitis

Description: The classic form of this disease occurs in the palate of those who smoke pipes. The palatal mucosa is white and criss-crossed by fissures, giving the appearance of a dried creekbed.............
 

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Practical Paediatric Problems: A Textbook for MRCPCH

The problem based approach of the book presents the reader with a slightly different perspective from that found in the traditional system based textbook. Junior doctors deal with and learn from dealing with children with problems – so this textbook with its alternative approach will be a useful additional source of advice and help to many starting off their careers in paediatrics.

This innovative text, modelled on the current RCPCH syllabus for paediatric training, provides all the information that the senior house officer and specialist registrar in paediatrics will need during training and when preparing for the MRCPCH examination. A series of chapters discussing general principles in paediatric medicine is followed by a section covering the problems associated with the major body systems. Each chapter within this latter section is divided into three elements. Element A covers the background basic science to the particular problems being discussed in the chapter, including basic embryology and anatomy, biology and physiology. A description of the techniques involved in investigation where these will be critical to the diagnoses that follow is also included here; Element B presents the core system problems for the chapter. Tables are provided to summarise the different causes, classifications and differential diagnoses, clinical features, key investigations, therapeutic options and outcomes. Concise supporting text provides more detailed information where appropriate. Selected short case histories are also included to highlight the key issues covered in the chapter. Element C is a concise bibliography, incorporating a short series of key primary papers and review articles and suggestions for further reading. Subjects covered under general principles include developmental paediatrics, behavioural issues and learning difficulties, community paediatrics and clinical pharmacology. Clinical chapters include the respiratory, cardiovascular, endocrine and all other body systems. Haematology, oncology, psychiatry, surgical problems and tropical paediatric medicine are also covered here. All chapters contain up-to-date and appropriate information written by practising paediatricians who are each acknowledged specialists in their own field. Thistextbook will fast become an indispensable guide to the specialty for all trainee paediatricians in preparation for the MRCPCH examination and beyond.







http://hotfile.com/dl/65452286/d43a012/MRCPCH.pdf.html

Yearbook of Intensive Care and Emergency Medicine - Febuary 2010 Edition

The Yearbook compiles the most recent developments in experimental and clinical research and practice in one comprehensive reference book. The chapters are written by well recognized experts in the field of intensive care and emergency medicine. It is addressed to everyone involved in internal medicine, anesthesia, surgery, pediatrics, intensive care and emergency medicine.





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