tag:blogger.com,1999:blog-10967761805628764732024-02-20T02:09:28.421-08:00Doctors Gatesall you need to enjoy medicine. Daily medical Videos,Cases,Diagrams, Animation,Articles,Free medical books and news.dr_toxichttp://www.blogger.com/profile/09498540693366676689noreply@blogger.comBlogger1133125tag:blogger.com,1999:blog-1096776180562876473.post-77080658650573340282019-08-10T15:10:00.000-07:002019-08-10T15:10:16.027-07:00The 5 W's of post-operative fever<span style="background-color: white; color: blue; font-family: Arial; font-size: medium;">W</span><span style="background-color: white; color: #333333; font-family: Arial; font-size: 14px;">ind</span><span style="background-color: white; color: red; font-family: Arial;">---</span><span style="background-color: white; color: #333333; font-family: Arial; font-size: 14px;">pneumonia, atelectasis at 1st 24- 48 hours</span><br style="background-color: white; color: #333333; font-family: Arial;" /><span style="background-color: white; color: blue; font-family: Arial; font-size: medium;">W</span><span style="background-color: white; color: #333333; font-family: Arial; font-size: 14px;">ater</span><span style="background-color: white; color: red; font-family: Arial;">---</span><span style="background-color: white; color: #333333; font-family: Arial; font-size: 14px;">urinary tract infection at Anytime after post op day 3</span><br style="background-color: white; color: #333333; font-family: Arial;" /><span style="background-color: white; color: blue; font-family: Arial; font-size: medium;">W</span><span style="background-color: white; color: #333333; font-family: Arial; font-size: 14px;">ound</span><span style="background-color: white; color: red; font-family: Arial;">---</span><span style="background-color: white; color: #333333; font-family: Arial; font-size: 14px;">wound infections at Anytime after post op day 5</span><br style="background-color: white; color: #333333; font-family: Arial;" /><span style="background-color: white; color: blue; font-family: Arial; font-size: medium;">W</span><span style="background-color: white; color: #333333; font-family: Arial; font-size: 14px;">onderdrugs</span><span style="background-color: white; color: red; font-family: Arial;">---</span><span style="background-color: white; color: #333333; font-family: Arial; font-size: 14px;">especially anesthesia </span><br style="background-color: white; color: #333333; font-family: Arial;" /><span style="background-color: white; color: blue; font-family: Arial; font-size: medium;">W</span><span style="background-color: white; color: #333333; font-family: Arial; font-size: 14px;">alking</span><span style="background-color: white; color: red; font-family: Arial;">---</span><span style="background-color: white; color: #333333; font-family: Arial; font-size: 14px;">walking can help reduce deep vein thromboses and pulmonary embolus usually occures at Day 7-10</span>dr_toxichttp://www.blogger.com/profile/09498540693366676689noreply@blogger.comtag:blogger.com,1999:blog-1096776180562876473.post-49734391982720305312011-10-20T15:15:00.000-07:002011-10-20T15:15:25.499-07:00 Lewy body dementia when compared to Alzheimer's dementiaWhich of the following is more commonly seen in patients with Lewy body dementia when compared to Alzheimer's dementia?<br />
<ul><li><b style="color: red;">A)</b> Hallucinations</li>
<li><b style="color: red;">B)</b> Lip smacking</li>
<li><b style="color: red;">C) </b>Tremor</li>
<li><b style="color: red;">D)</b> Emotional lability</li>
<li><b style="color: red;">E)</b> Repetitive behavior</li>
</ul><br />
<div style="color: blue;"><span style="font-size: large;">The answer is A. </span></div>Although difficult to know for sure, Lewy body dementia may be the second most common dementia after Alzheimer's disease. <br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiFpBpL1hpKCzdOzjZuG3r2K-xpiPLmtDgqyKsliXyjGvlUEawDbwRPoiXrTwM_Ygy7FlkaToWxW6nQgffaBEDTcnhtoWOdH26dZQ3bCK7Pp5lT3mqepCKIY4RJtbR-8nT-EksHuTDB6Zrq/s1600/lewy-body.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="160" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiFpBpL1hpKCzdOzjZuG3r2K-xpiPLmtDgqyKsliXyjGvlUEawDbwRPoiXrTwM_Ygy7FlkaToWxW6nQgffaBEDTcnhtoWOdH26dZQ3bCK7Pp5lT3mqepCKIY4RJtbR-8nT-EksHuTDB6Zrq/s200/lewy-body.jpg" width="200" /></a></div>Lewy bodies are hallmark lesions of degenerating neurons in Parkinson's disease<i> "deposits of the protein alpha-synuclein inside nerve cells in the brain"</i> and occur in dementia with or without features of Parkinson's disease. In Lewy body dementia, Lewy bodies may predominate markedly or be intermixed with classic pathologic changes of Alzheimer's disease. Symptoms, signs, and course of Lewy body dementia resemble those of Alzheimer's disease, except hallucinations (mainly visual) are more common and patients appear to have an exquisite sensitivity to antipsychotic-induced extrapyramidal adverse effects.dr_toxichttp://www.blogger.com/profile/09498540693366676689noreply@blogger.comtag:blogger.com,1999:blog-1096776180562876473.post-3555973439030846772011-10-18T08:40:00.000-07:002011-10-18T08:40:56.874-07:00 Essentials of Neuroimaging for Clinical Practice<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiUXFTG8XGdu0aT3ckAStSRIyQMVnceh9F491gQg9-WLzZBXD0mVGXwSfY2O34xF4n0hwfJM6pD8KPDW9IsAzHnDs6cLeWK1g6UWwT2wM5Pe5Wy7q4cU0OMmfruTtKwQrqzZkStTQZQTtY9/s1600/Essentials+of+Neuroimaging+for+Clinical+Practice.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiUXFTG8XGdu0aT3ckAStSRIyQMVnceh9F491gQg9-WLzZBXD0mVGXwSfY2O34xF4n0hwfJM6pD8KPDW9IsAzHnDs6cLeWK1g6UWwT2wM5Pe5Wy7q4cU0OMmfruTtKwQrqzZkStTQZQTtY9/s1600/Essentials+of+Neuroimaging+for+Clinical+Practice.jpg" /></a></div>The use of neuroimaging studies in psychiatry is explodingAand offers tremendous potential for practicing clinicians. Yet if you’re like many psychiatrists, you’re sometimes uncertain about which studies to use in specific situations. Until now, you’ve had to sort through the only information availableAtechnical reviews in the literatureAfor guidance. But no more. Essentials of Neuroimaging for Clinical Practice is an all-in-one resource that explains how to use these powerful techniques to improve outcomes. It demystifies neuroimaging with clear, concise, and practical advice on using today’s most advanced applications in the diagnostic workup of patients. This practical clinical guide will help you achieve a solid understanding of the full range of neuroimaging modalities: -Structural techniques such as computed tomography (CT) and magnetic resonance imaging (MRI) -Functional techniques such as positron emission tomography (PET), single photon emission computed tomography (SPECT), functional magnetic resonance imaging (fMRI), and magnetic resonance spectroscopy (MRS) -Other techniques such as electroencephalography (EEG)Aincluding quantitative EEG and event-related potentialsAand magnetoencephalography. For each modality, you’ll find: -A basic review of the techniqueAtrace the development of each modality, and become familiar with its underlying technology. -Guidance on when to use itAlearn which techniques are best to use in specific clinical situations. -Tips for ordering studiesAdiscover how to write up orders to obtain the most accurate and detailed information from each study, including when to use contrast and how to determine the best acquisition parameters. -A look at its future potential in practice and researchAexplore the current capabilities of each modality and the most promising strategies for improving diagnostic results. Filled with examples of real-life imaging studies, Essentials of Neuroimaging for Clinical Practice is a must-have tool for all practicing psychiatrists and psychologists. In addition, it will serve as an excellent clinical guide for residentsAand an outstanding text for courses in clinical neuroimaging for psychiatrists.<br />
<div style="text-align: center;"><span style="font-size: large;"><a href="http://www.filesonic.com/file/2585981941/Essentials_of_Neuroimaging_for_Clinical_Practice.pdf">HERE </a></span></div>dr_toxichttp://www.blogger.com/profile/09498540693366676689noreply@blogger.comtag:blogger.com,1999:blog-1096776180562876473.post-30075138846141500132011-10-13T00:42:00.000-07:002011-12-19T12:03:57.753-08:00 Tongue`s surface in Prolonged antibiotic use<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEivaogOOPjbwvlGPcn2ikasROR9yp-O4CbAK2-juRdi7FVPgcHEjcFHZYw79VsrRn5RtAtBwCuDGE47qwPUNKKyWPqIKDon6Pi16CBSVPPCZ2Pn-zszrdlcoDYUUR0wAKysBEgPkvcG991-/s1600/303239_10150340961399041_373970904040_8078617_1337105558_n.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEivaogOOPjbwvlGPcn2ikasROR9yp-O4CbAK2-juRdi7FVPgcHEjcFHZYw79VsrRn5RtAtBwCuDGE47qwPUNKKyWPqIKDon6Pi16CBSVPPCZ2Pn-zszrdlcoDYUUR0wAKysBEgPkvcG991-/s1600/303239_10150340961399041_373970904040_8078617_1337105558_n.jpg" /></a></div>Which of the following conditions is the skin finding shown in the picture associated with?<br />
<br />
<ul><li><b style="color: red;">A)</b> Prolonged antibiotic use</li>
<li><b style="color: red;">B)</b> Sjögren's syndrome</li>
<li><b style="color: red;">C)</b> Addison's disease</li>
<li><b style="color: red;">D)</b> Chronic gastroesophageal reflux</li>
<li><b style="color: red;">E)</b> Malignant melanoma</li>
</ul><br />
<br />
<div style="color: blue;"><span style="font-size: large;">The answer is A. </span></div>(Black tongue) Black hairy tongue results from hyperplasia of the filiform papillae with deposition of keratin on the surface. The condition causes the tongue to have ..............<br />
<br />
<div style="color: red;"><a href="http://mediphotos.blogspot.com/2011/12/tongues-surface-in-prolonged-antibiotic.html"><u><b>READ MORE...................>></b></u></a></div>dr_toxichttp://www.blogger.com/profile/09498540693366676689noreply@blogger.comtag:blogger.com,1999:blog-1096776180562876473.post-62029528423125188842011-10-11T09:38:00.000-07:002011-10-11T09:38:18.276-07:00 The Barber's Itch<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjEwJkotiVtoFa02WEF2r-6OIbpTJRW0HP6Z_DTuBYCCGzpUH2PzUD3PDnG_pWBbgYNPif1OR-XZRgwBIPDmemHv1hYfjmx1TDGEIc5wuaZocs1m68vz_VNoEvcYBXR4Wgo4ySXbx_Z1OFc/s1600/Folliculitis_MRSA_004.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="208" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjEwJkotiVtoFa02WEF2r-6OIbpTJRW0HP6Z_DTuBYCCGzpUH2PzUD3PDnG_pWBbgYNPif1OR-XZRgwBIPDmemHv1hYfjmx1TDGEIc5wuaZocs1m68vz_VNoEvcYBXR4Wgo4ySXbx_Z1OFc/s320/Folliculitis_MRSA_004.jpg" width="320" /></a></div>Barber's itch is a type of Folliculitis "an inflammation of one or more hair follicles".<br />
It is an infectious skin disease which arises on bearded area of the face and upper lip. The condition takes place when the hair follicles get damaged by constant friction with clothing and it may even take place due to blockage and shaving<br />
<br />
The disease develops and the first signs of the condition are the appearance of painful pimples that develop at the hair follicles along the beard, these pimples can grow either superficial or may occur in the deeper layers of the skin associated with some common symptoms as rash, itching, and pimples or pustules near a hair follicle in the neck, groin, or genital zone.<br />
<br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjgkl2EQkBFVGXR5FGmtwkqSG38Dfw7isPA_jL5pDSYNV0CBODMpHVuD6NUfeJvwiVS17OMz_LXlkwV_jqjw9cf_ZBnwOv78IiDEhCeSCXH9qHC4pUBfNT7opB_GcEbuFGtGXQVIyk89IGZ/s1600/folliculitis.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjgkl2EQkBFVGXR5FGmtwkqSG38Dfw7isPA_jL5pDSYNV0CBODMpHVuD6NUfeJvwiVS17OMz_LXlkwV_jqjw9cf_ZBnwOv78IiDEhCeSCXH9qHC4pUBfNT7opB_GcEbuFGtGXQVIyk89IGZ/s1600/folliculitis.jpg" /></a></div>The cause that responsible for Barber`s folliculitis may be either a bacterial or a fungal infection :<br />
- Mustache hair is usually affected by the bacteria; staphylococci.<br />
- Bearded hair on the cheeks and the chin is commonly affected by the fungus.<br />
<br />
#The condition is aggravated by shaving ,On the other hand <span>the sh<span id="dtx-highlighting-item">a</span>ring of towels<span id="dtx-highlighting-item"> a</span>nd r<span id="dtx-highlighting-item">a</span><span>z<span id="dtx-highlighting-item">or</span>s p</span><span id="dtx-highlighting-item">a</span>sses on the highly cont<span id="dtx-highlighting-item">a</span>gious fung<span id="dtx-highlighting-item">a</span>l infection</span>dr_toxichttp://www.blogger.com/profile/09498540693366676689noreply@blogger.comtag:blogger.com,1999:blog-1096776180562876473.post-1496456805372830272011-10-10T16:31:00.000-07:002011-10-10T16:31:00.357-07:00 Menstrual Cycle explanationThis animation video explains the biological processes of Menstruation and the physiology of Menstrual Cycle<br />
<iframe width="420" height="315" src="http://www.youtube.com/embed/zjcKW8ifpak?rel=0" frameborder="0" allowfullscreen></iframe>dr_toxichttp://www.blogger.com/profile/09498540693366676689noreply@blogger.comtag:blogger.com,1999:blog-1096776180562876473.post-29773418552435968972011-10-05T02:31:00.000-07:002011-10-05T02:31:19.693-07:00malignant external otitis A 72-year-old patient withlong-standing Type 2 diabetes mellitus presents with complaints of pain in his right ear with purulent drainage. On physical exam, the patient is afebrile. The pinna of the left ear is tender, and the external auditory canal is swollen and edematous. The peripheral white blood cell count is normal. The organism most likely to grow from the purulent drainage is :<br />
<ul><li><b style="color: red;">a</b>. Pseudomonas aeruginosa</li>
<li><b style="color: red;">b</b>. Staphylococcus aureus</li>
<li><b style="color: red;">c</b>. Candida albicans</li>
<li><b style="color: red;">d</b>. Haemophilus influenzae</li>
<li><b style="color: red;">e</b>. Moraxella catarrhalis</li>
</ul><br />
<div style="color: blue;"><span style="font-size: large;"><u> The answer is a.</u></span></div>Ear pain and drainage in an elderly diabetic patient must raise concern about malignant external otitis. Presence of swelling and inflammation of the external auditory meatus strongly suggests this diagnosis. This infection usually occurs in older diabetics and is almost always caused by organism Pseudomonas aeruginosa.<br />
<br />
Haemophilus influenzae and Moraxella catarrhalis frequently cause otitis media but not external otitis.<br />
<br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiDh0rM8GoZ7KzF0s5N3RFd5oP8-MJo1OEqZzorCQjKFTqzTev7fL0gNYp4xYzX-Juv5tgD63PLwFF7y2axphyphenhyphenFuHxL9f6TWuxxTILWTT8p_E6-6_f2126B-43bEdsOusVWLLcPpTYLg0By/s1600/afp20061101p1510-f1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiDh0rM8GoZ7KzF0s5N3RFd5oP8-MJo1OEqZzorCQjKFTqzTev7fL0gNYp4xYzX-Juv5tgD63PLwFF7y2axphyphenhyphenFuHxL9f6TWuxxTILWTT8p_E6-6_f2126B-43bEdsOusVWLLcPpTYLg0By/s1600/afp20061101p1510-f1.jpg" /></a></div><div style="color: #3d85c6; font-family: Times,"Times New Roman",serif; text-align: center;"><i>Acute otitis externa with the canal somewhat narrowed from edema and obstructed by desquamating epithelium, soft cerumen, and purulent discharge; this must be removed to visualize the tympanic membrane and to allow ototopical therapy to penetrate to all the superficially infected areas of the canal skin.</i></div>dr_toxichttp://www.blogger.com/profile/09498540693366676689noreply@blogger.comtag:blogger.com,1999:blog-1096776180562876473.post-10522742993683422282011-10-04T07:24:00.000-07:002011-10-04T07:24:00.160-07:00 Types of Hypospadias<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhCaj1rf6XT09UjJBZVUpXwOWJKYuV_ngZkwxIFPmsQbDNYWVCF_3VWgPEsfjGxb70Mn-8pZe3F-aXkywGmnAXT-A5SHWmihiDJpfs-Vr2AJguzXXcvun6mSq8k3PbvmJ9fpYSFVJDmHDSX/s1600/Hypospadias-lg.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="216" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhCaj1rf6XT09UjJBZVUpXwOWJKYuV_ngZkwxIFPmsQbDNYWVCF_3VWgPEsfjGxb70Mn-8pZe3F-aXkywGmnAXT-A5SHWmihiDJpfs-Vr2AJguzXXcvun6mSq8k3PbvmJ9fpYSFVJDmHDSX/s400/Hypospadias-lg.jpg" width="400" /></a></div><br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhCaj1rf6XT09UjJBZVUpXwOWJKYuV_ngZkwxIFPmsQbDNYWVCF_3VWgPEsfjGxb70Mn-8pZe3F-aXkywGmnAXT-A5SHWmihiDJpfs-Vr2AJguzXXcvun6mSq8k3PbvmJ9fpYSFVJDmHDSX/s1600/Hypospadias-lg.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><br />
</a></div>Hypospadias is one of the most frequent male congenital malformations and may be part of the testicular dysgenesis syndrome, It occures 1-2 of 100 boys. Hypospadias is a birth defect found in boys in which the urinary tract opening is not at the tip of the penis. Bending of the penis on erection may be associated and is as chordee.<br />
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<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEikIkCmy5hQQfnXv5BgX5E2LFhdxXlXO1O51pu4a3G08RgoZYAogvExfMv3FPN1pIKu3oOnw9LuLJUbHLFlzH9D2rYQfUQDO5pCnhTVxL4lEsHbZZXFtIXkstSbkGBsAV_7DEiOK8RY_mVn/s1600/1014760-1015227-1324.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEikIkCmy5hQQfnXv5BgX5E2LFhdxXlXO1O51pu4a3G08RgoZYAogvExfMv3FPN1pIKu3oOnw9LuLJUbHLFlzH9D2rYQfUQDO5pCnhTVxL4lEsHbZZXFtIXkstSbkGBsAV_7DEiOK8RY_mVn/s320/1014760-1015227-1324.jpg" width="211" /></a></div><br />
This picture shows Proximal shaft hypospadias . Note the deficient ventral foreskin, blind urethral pit at the glanular level, and lighter pigmented urethral plate extending to the true meatus at the proximal shaft level. <br />
<br />
The location of the urethral meatus was described if visible, and hypospadias was graded as glandular, coronal, penile, penoscrotal, scrotal, or perineal according to the anatomical position <br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhVjEKdiLbEUAlSl9-4X5dTJUQUi6jTHi_iNO3cC3rbuwjTgO7OcdKbkrvdUEeDYW62vcxJA7g7OcIveAp8rOKyhHRVYIbHqrqRxXgdlXCgVsD8ATKuf7BUnJyXOaj0pBGfqLS6oyptnUtB/s1600/F1.medium.gif" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhVjEKdiLbEUAlSl9-4X5dTJUQUi6jTHi_iNO3cC3rbuwjTgO7OcdKbkrvdUEeDYW62vcxJA7g7OcIveAp8rOKyhHRVYIbHqrqRxXgdlXCgVsD8ATKuf7BUnJyXOaj0pBGfqLS6oyptnUtB/s400/F1.medium.gif" width="175" /></a></div><br />
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<div style="color: #e06666; text-align: center;"><i>Types of hypospadias classified by the anatomical position of the urethral meatus. <b style="color: black;">1</b>, Glandular; <b><span style="color: black;">2</span></b>, coronal; <b style="color: black;">3</b>, penile; <b><span style="color: black;">4</span></b>, penoscrotal; <b><span style="color: black;">5</span></b>, scrotal; <b style="color: black;">6</b>, perineal. </i></div><br />
On examination :A dorsal hood of foreskin and glanular groove are evident, but, upon closer inspection, the prepuce is incomplete ventrally and the urethral meatus is noted in a proximally ectopic position. Rarely, the foreskin may be complete, and the hypospadias is revealed at the time of circumcision. If hypospadias is encountered during neonatal circumcision, after the dorsal slit has been performed, the procedure should be halted, and the patient should be referred for urologic evaluation.<br />
<b style="color: #3d85c6;">The most simple classification of Hypospadias</b> is mild, moderate and severe, which can also be called first, second and third degrees of severity. This classification system is based on the location of the external opening for urine and semen (the urethral meatus). In mild or first degree hypospadias, the opening is on the underside of the head of the penis or where the head and the shaft meet. This accounts for about <b style="color: red;">80%</b> of the cases of hypospadias.<br />
<br />
Moderate or second degree hypospadias <b><span style="color: red;">(15%)</span></b> occurs when the hole is actually on the shaft of the penis, somewhere between the junction of head and shaft, and the lower part of the shaft. Severe or third degree hypospadias occurs when the hole is located on the lower part of the shaft just in front of the testicles or is located behind the testicles, between them and the anus.dr_toxichttp://www.blogger.com/profile/09498540693366676689noreply@blogger.comtag:blogger.com,1999:blog-1096776180562876473.post-33779250958569380342011-09-16T06:47:00.000-07:002011-09-16T06:47:25.251-07:00About Visual fields A patient presents with a bilateral homonymous quadranopsia involving the right upper visual field. Which of the following represents the MOST likely anatomic location of the abnormality?<br />
<ul><li><b>(A)</b> Prechiasmal, right side</li>
<li><b>(B)</b> Optic chiasm</li>
<li><b>(C)</b> Postchiasmal, prethalamic, left side</li>
<li><b>(</b><b>D)</b> Occipital lobe, right side</li>
<li><b>(E)</b> Occipital lobe, left side</li>
</ul><br />
<div style="color: blue;"><u><b>The answer is E.</b></u></div>Homonymous visual field cuts imply a postchiasmal location of the abnormality because this is the first point where fibers from the same visual field of both eyes join. Fibers further divide between the thalamus and occipital lobe into upper and lower quadrant visual fields. The most common location for quadranopsia defects is the occiptal lobe. Stroke, tumor, and atypical migraine may present with quadranopsia.<br />
Visual fields are named from the perspective of the patient, i.e., the right visual field corresponds to the left side of the retina. Therefore, a right-sided visual field cut involves the left-sided neurologic tracks.dr_toxichttp://www.blogger.com/profile/09498540693366676689noreply@blogger.comtag:blogger.com,1999:blog-1096776180562876473.post-8345828088221651402011-09-06T02:32:00.000-07:002011-09-06T02:32:15.338-07:00 Preoperative dose of antibiotic<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgKkMpw__-pOSXv38_76BMS7vwXLHr4Tax1XWIejMscVliAUMC2SV60nt_kuOsIsDIB1c5zhgVslHY7Ja3IV0BR10bm7KAH1uwRC0sJSIFTHGUaoLgTQ2bzA6CmTt1X9m5MjlrWOBS_mmJG/s1600/Operating_Liau.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="210" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgKkMpw__-pOSXv38_76BMS7vwXLHr4Tax1XWIejMscVliAUMC2SV60nt_kuOsIsDIB1c5zhgVslHY7Ja3IV0BR10bm7KAH1uwRC0sJSIFTHGUaoLgTQ2bzA6CmTt1X9m5MjlrWOBS_mmJG/s320/Operating_Liau.jpg" width="320" /></a></div>When vancomycin is used as a preoperative prophylactic antibiotic, it should be administered within ______ minutes of the start of surgery.<br />
<br />
<b style="color: red;">A)</b> 15<br />
<b style="color: red;">B)</b> 30<br />
<b style="color: red;">C)</b> 60<br />
<b style="color: red;">D)</b> 120<br />
<b style="color: red;">E)</b> At the time of incision<br />
<br />
<div style="color: blue; text-align: left;"><u>Answer and Discussion</u></div>The answer is D.<br />
Ideally, a preoperative dose of antibiotic should provide a sufficient antibiotic serum level throughout the surgery to combat organisms most likely to cause a site infection. It is recommended that the first dose be timed to occur within 60 minutes before the surgical incision is made. If a fluoroquinolone or vancomycin is chosen for prophylaxis, the first dose should be administered within 120 minutes of the start of surgery. If the surgery involves the use of a tourniquet (e.g., hip or knee arthroplasty), the antibiotic infusion should be completed before inflation of the tourniquet. For most surgeries, it is recommended that use of prophylactic antibiotics end within 24 hours after surgery.dr_toxichttp://www.blogger.com/profile/09498540693366676689noreply@blogger.comtag:blogger.com,1999:blog-1096776180562876473.post-56805325984240340172011-09-05T17:26:00.000-07:002011-09-05T17:26:07.845-07:00 Mindmap for Appendicitis<i><b>Revise appendicitis faster with this mindmap!</b></i><br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgNzr5gpWGjvHyVsDSGDPNDFPdYLa37Nmni7V7zdacI6ZmiGE6-RxNyqDscCgtM5lDWFFSrgRJf1keOr8HEEXBwLgCl-ek68q9telaKt5Otz5MVEA5YKvCk8Q5s2Jvv4J3In-zsNVlo4yi7/s1600/apx.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="207" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgNzr5gpWGjvHyVsDSGDPNDFPdYLa37Nmni7V7zdacI6ZmiGE6-RxNyqDscCgtM5lDWFFSrgRJf1keOr8HEEXBwLgCl-ek68q9telaKt5Otz5MVEA5YKvCk8Q5s2Jvv4J3In-zsNVlo4yi7/s400/apx.jpg" width="400" /></a></div><br />
<div style="color: #3d85c6; text-align: center;"><i><b>Click here for enlargment</b></i></div><br />
dr_toxichttp://www.blogger.com/profile/09498540693366676689noreply@blogger.comtag:blogger.com,1999:blog-1096776180562876473.post-66609529562430604482011-08-23T16:20:00.000-07:002011-08-23T16:20:39.251-07:00 Acanthosis nigricans in diabetes mellitus<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgMMdFEGZjMlYXAeo5tQQd01qOFEcbTTn2AH_ZbqaUTtZiNr625UOV8wZ4kXs8XSCstwe-DtL0GjiC1fnFvgXFRae-NikGpyPoiiDpgQeY8qMH1eziW0MM0DdIKh2SW2YPVjczdtSspZL5M/s1600/untitled.bmp" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgMMdFEGZjMlYXAeo5tQQd01qOFEcbTTn2AH_ZbqaUTtZiNr625UOV8wZ4kXs8XSCstwe-DtL0GjiC1fnFvgXFRae-NikGpyPoiiDpgQeY8qMH1eziW0MM0DdIKh2SW2YPVjczdtSspZL5M/s320/untitled.bmp" width="227" /></a></div>You note the shown skin disorder during a general medical evaluation. You explain to the patient they are at risk for the development of:<br />
<br />
<b style="color: red;">A)</b> Alzheimer's disease<br />
<br />
<b style="color: red;">B)</b> tuberculosis<br />
<br />
<b style="color: red;">C)</b> diabetes mellitus<br />
<br />
<b><span style="color: red;">D)</span></b> Grave's disease<br />
<br />
<b style="color: red;">E)</b> melanoma<br />
<br />
<br />
<br />
<span style="font-size: large;"><i> <span style="color: blue;">The answer is C. </span></i></span><span style="color: blue;"><b>(Diabetes mellitus)</b> </span><br />
Although the majority of cases of acanthosis nigricans are benign and associated with obesity, the disease can represent the onset of malignancy as well as a variety of conditions related to insulin resistance.<br />
Acanthosis nigricans has been reported in association with a number of malignancies, particular gastrointestinal cancers <u><i>(e.g., gastric, hepatocellular) and lung cancer</i></u>. The suspicion for malignancy increases in patients with extensive or rapidly progressive lesions, when there is mucous membrane involvement, or when there is prominent sole and palm disease.<br />
<br />
The common finding in all non-malignancy associated cases of acanthosis nigricans is <b>insulin resistance</b>. This explains the relationship between this skin disorder and diseases such as diabetes mellitus, Cushing's syndrome, and hypothyroidism (most likely due to weight gain and subsequent insulin resistance), and with obesity.<br />
<br />
<br />
dr_toxichttp://www.blogger.com/profile/09498540693366676689noreply@blogger.comtag:blogger.com,1999:blog-1096776180562876473.post-16372456915992176992011-08-23T04:16:00.000-07:002011-08-23T04:16:00.383-07:00 Photos of Melanosis coli "Pseudomelanosis coli"<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiLHFTVHVHkH7VKAl9mXwCadT3mFlWjkSy7AvtB7fKJFtcgtvzlc3Vfe50KH9a-fjfQwdqbL4hVaze2FU1lKPpmGWrrSuY5cvUkmXhzjNfyWQKqldFV48kPABXiOiy2yNZsO-W2kd_atMTZ/s1600/Melanosisx2.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="150" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiLHFTVHVHkH7VKAl9mXwCadT3mFlWjkSy7AvtB7fKJFtcgtvzlc3Vfe50KH9a-fjfQwdqbL4hVaze2FU1lKPpmGWrrSuY5cvUkmXhzjNfyWQKqldFV48kPABXiOiy2yNZsO-W2kd_atMTZ/s200/Melanosisx2.jpg" width="200" /></a></div>Melanosis coli, also pseudomelanosis coli, is a disorder of pigmentation of the wall of the colon, often identified at the time of colonoscopy.<br />
The most common cause of melanosis coli is the <b><i>extended use of laxatives</i></b>,<span style="font-size: small;"> this darkening of the colonic mucosa caused by the accumulation of lipofuscin particles within the macrophages of the lamina propria of the colonic mucosa as a result of long term exposure to anthraquinone-containing laxatives as Senna and other plant glycosides. However, other causes are identified</span>, including an increase in colonic epithelial apoptosis.<br />
<br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg-co7vkBCJkzApkjbLGXMihjtAKRn0eVVZNFbCoXOb8FYpkDzU5tAXw3DL_u1TiffX1k_HupEkshJScrIGb20O3IvotvCt2gnSV1u5N51JLoRq2rLbyRsmPYKQT9HxbK644ssKUOKn6ebv/s1600/melanosiscoli.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="239" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg-co7vkBCJkzApkjbLGXMihjtAKRn0eVVZNFbCoXOb8FYpkDzU5tAXw3DL_u1TiffX1k_HupEkshJScrIGb20O3IvotvCt2gnSV1u5N51JLoRq2rLbyRsmPYKQT9HxbK644ssKUOKn6ebv/s320/melanosiscoli.jpg" width="320" /></a></div><div style="color: #e06666; text-align: center;"><i><span style="font-family: Verdana,Arial,Helvetica,sans-serif; font-size: x-small;"><span>This is the photograph of the colon, and there is an extremely dark appearance to the wall of the colon. This is seen in patients who have taken laxatives over many years and the pigment from the laxative gets deposited in the wall of the bowel giving an extremely dark appearance to it. This is a benign condition, not cancerous, and does not become cancerous, but often it is quite obvious.</span></span></i></div><br />
<b style="color: red;">-</b> Melanosis coli is a <u>misnomer</u>, as the pigmentation is due to lipofuscin-laden macrophages - not melanin pigment. Pseudomelanosis coli is a more appropriate descriptor, but not in common usage.<br />
<br />
The differential diagnosis of brown pigmentation of the colon is:<br />
<br />
* Pseudomelanosis coli.<br />
* Hemosiderin-laden macrophages (old haemorrhage).<br />
* Melanin (rare).dr_toxichttp://www.blogger.com/profile/09498540693366676689noreply@blogger.comtag:blogger.com,1999:blog-1096776180562876473.post-71465013695902729312011-08-20T09:50:00.001-07:002011-08-20T09:50:55.848-07:00 Vacuum Assisted Delivery: A Brief Summary of Key Principles<iframe width="420" height="345" src="http://www.youtube.com/embed/HCO249A0e2Q?rel=0" frameborder="0" allowfullscreen></iframe>dr_toxichttp://www.blogger.com/profile/09498540693366676689noreply@blogger.comtag:blogger.com,1999:blog-1096776180562876473.post-80402069179796567802011-08-19T17:45:00.000-07:002011-08-19T17:45:53.742-07:00 Decompression sickness "divers' disease"A 55-year-old male diver begins complaining of back pain and urinary retention 1 h after a dive. What is the MOST likely diagnosis?<br />
<ul><li><b style="color: red;">(A)</b>Barotrauma to the bladder</li>
<li><b style="color: red;">(B)</b>Lumbar strain</li>
<li><b style="color: red;">(C)</b>Neurotoxin from a marine envenomation</li>
<li><b style="color: red;">(D)</b>Nitrogen narcosis</li>
<li><b style="color: red;">(E)</b>Decompression sickness</li>
</ul><br />
<div style="color: blue;"><span style="font-size: large;">The answer is E.</span></div>Barotrauma is the most common affliction of divers and usually affects the ears, sinuses, lungs, and, rarely, the gastrointestinal tract. The bladder is not involved.<br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjkoqHG4e3zXlve9U1Qjhbe552fi-08Z7aa0MCIpsyNlXrIbJ2O-DcQCyDPRv1sP8y2PTZuPwJ-OTgyA1e_Q9JC2JkQOJm5CDX2RYQ8eEj6Q1EyQEpSdKA89QW9eLW0ZiNAHBfMuz4tzh09/s1600/dscuk889501000_diving_sb10069547cf-001.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjkoqHG4e3zXlve9U1Qjhbe552fi-08Z7aa0MCIpsyNlXrIbJ2O-DcQCyDPRv1sP8y2PTZuPwJ-OTgyA1e_Q9JC2JkQOJm5CDX2RYQ8eEj6Q1EyQEpSdKA89QW9eLW0ZiNAHBfMuz4tzh09/s1600/dscuk889501000_diving_sb10069547cf-001.jpg" /></a></div><i><b>Decompression sickness (DCS)</b></i>,also known as divers' disease, the bends or caisson disease, is caused by formation of gas bubbles in tissues after ascent from a dive and results in vascular occlusion, usually in the venous circulation. DCS may have cutaneous manifestations including rash and pruritus. It classically causes joint and back pain and may be associated with neurologic symptoms secondary to spinal cord involvement.<br />
<br />
Patients with neurologic or other severe forms of DCS should be referred for hyperbaric oxygen therapy. Nitrogen narcosis is due to the anesthetic effects of breathing nitrogen at high partial pressures and causes divers to become altered on deep dives.<br />
<br />
dr_toxichttp://www.blogger.com/profile/09498540693366676689noreply@blogger.comtag:blogger.com,1999:blog-1096776180562876473.post-12831387265126923392011-08-19T09:27:00.000-07:002011-08-19T09:27:28.178-07:00 Superior vena cava syndrome<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjgwQVfoPg9ODbqRm_u4idaU29OcyeKnEGmLlgzMDdnhFMIfcpInL1flVsGlQ7gLOl_kMQlHQiWczs9ar0NdxuEgSZMeAU11vhL2VJY7BQUt7Imr34m_rr8HVtUShssGTsAm92NOiyigora/s1600/hand.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="167" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjgwQVfoPg9ODbqRm_u4idaU29OcyeKnEGmLlgzMDdnhFMIfcpInL1flVsGlQ7gLOl_kMQlHQiWczs9ar0NdxuEgSZMeAU11vhL2VJY7BQUt7Imr34m_rr8HVtUShssGTsAm92NOiyigora/s200/hand.JPG" width="200" /></a></div>A 72-year-old man who was overweight and had a history of hypertension and heavy smoking presented with a swollen neck. He had no dysphagia. He reported that he had experienced increased snoring and daytime sleepiness during the previous 3 weeks.<br />
An otolaryngologic examination was unremarkable except for an unusually narrow upper airway. On inspection, the patient's hands were swollen and showed signs of pitting edema <i><span style="color: red;">(Figure 1A)</span></i>. Inflammatory parameters and complete blood count were normal.<br />
<br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgibRaC_9oHzfgqTE7bDSIt9Sj7Pv2df3liTNcUQd0Mk-BC5rH61YgDcF9l8WEqdDSoSW8TxmP8ati6dcTzQdSOaH6phXqH2VEGEYDpKwq9xPk-h5dhGsMMB-JAjgrFnr4Z1wEhj3ubiEEh/s1600/CT.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="182" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgibRaC_9oHzfgqTE7bDSIt9Sj7Pv2df3liTNcUQd0Mk-BC5rH61YgDcF9l8WEqdDSoSW8TxmP8ati6dcTzQdSOaH6phXqH2VEGEYDpKwq9xPk-h5dhGsMMB-JAjgrFnr4Z1wEhj3ubiEEh/s400/CT.JPG" width="400" /></a></div><br />
Contrast-enhanced computed tomography scans of the neck and chest revealed an enlarged retropharyngeal space <i style="color: red;">(Figure 1B)</i> and a mass compressing the superior vena cava <i style="color: red;">(Figure 1C)</i>. A transthoracic needle biopsy showed a non–small-cell carcinoma. Radiotherapy resulted in clinical improvement and a rapid reduction in compression of the superior vena cava. <br />
<br />
The exact incidence of superior vena cava syndrome remains unknown, It has mainly malignant causes. <br />
Nonmalignant causes can include aneurysm of the aorta, thromboses after implanted intravascular catheters or fibrosing mediastinitis. <br />
<br />
<i style="color: blue;"><b>Classically</b></i>, compression of the superior vena cava leads to visible swelling and venous distension in the face, neck, chest and upper limbs. Other symptoms of varying severity can occur, from cough, hoarseness and dyspnea to headache, confusion and visual symptoms. In patients who are overweight, swelling of the neck may go unnoticed, and signs such as obstructive sleep apnea or edema of the upper limb may point to the diagnosis. dr_toxichttp://www.blogger.com/profile/09498540693366676689noreply@blogger.comtag:blogger.com,1999:blog-1096776180562876473.post-12968986272182328942011-08-15T17:56:00.000-07:002011-08-15T18:00:49.089-07:00 Characteristic shape of Molluscum contagiosum infection<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjsqFoKjXy1eA-NHrszsfXqaxdN8MUzLyUI1PgAa3czCvO-5X-oWOBKSPx505jLWIZrADKy8IYL2DmDIiYKOy4t3DeD1viEhsqVuMH7I02fAzJiiI3MbqXtePudxT1oiG-2DootMpcT68N4/s1600/226078_10150278857139041_373970904040_7641292_5117956_n.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjsqFoKjXy1eA-NHrszsfXqaxdN8MUzLyUI1PgAa3czCvO-5X-oWOBKSPx505jLWIZrADKy8IYL2DmDIiYKOy4t3DeD1viEhsqVuMH7I02fAzJiiI3MbqXtePudxT1oiG-2DootMpcT68N4/s1600/226078_10150278857139041_373970904040_7641292_5117956_n.jpg" /></a></div>A 4-year-old preschooler presents with the skin lesions shown here. The area affected is just below the chin on the child's right side. The lesions have been present over the last month, and the child has reported no symptoms associated with them. The most likely diagnosis is<br />
<br />
<ul><li><b style="color: red;">A)</b> varicella</li>
<li><b style="color: red;">B)</b> herpes zoster</li>
<li><b style="color: red;">C)</b> Rhus dermatitis</li>
<li><b style="color: red;">D)</b> molluscum contagiosum</li>
<li><b style="color: red;">E)</b> scabies</li>
</ul><br />
<div style="text-align: center;"> <b style="color: blue;">The answer is D. (Molluscum contagiosum) </b></div>Molluscum contagiosum is a common, superficial viral infection of the skin that typically occurs in infants and preschoolers. The incidence decreases after the age of 6 to 7 years. The condition can be spread via sexual contact in young adults.<br />
<u><i>The lesions are</i></u> dome-shaped, waxy, or pearly-white papules with a central white core and are 1 to 3 mm in diameter. Frequently, groups of lesions are found. The lesions may resolve spontaneously. Treatment involves removal with a sharp needle or curette, application of liquid nitrogen, antiwart preparations, electrodessication and curettage, or trichloroacetic peels for extensive areas. Typically, infants or young preschool-age children should not be treated aggressively.<br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjpIvb3M66hWLF28eG5wy_7doquYUezAVl9MWkf8kFtkHWf_1gbBQ8GhKfGms6o5Bysy4pirMkH56U0Otq7wuXWTv5Jem4HB17DuNlEMCxk5z5EPnwrR2HfdiZht2WUGpL4aM-cajim2RzJ/s1600/Molluscaklein.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="293" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjpIvb3M66hWLF28eG5wy_7doquYUezAVl9MWkf8kFtkHWf_1gbBQ8GhKfGms6o5Bysy4pirMkH56U0Otq7wuXWTv5Jem4HB17DuNlEMCxk5z5EPnwrR2HfdiZht2WUGpL4aM-cajim2RzJ/s400/Molluscaklein.jpg" width="400" /></a></div><div style="color: magenta; text-align: center;"><i>Typical flesh-colored, dome-shaped and pearly lesions</i></div><br />
dr_toxichttp://www.blogger.com/profile/09498540693366676689noreply@blogger.comtag:blogger.com,1999:blog-1096776180562876473.post-73834963997607927742011-08-12T15:57:00.000-07:002011-08-12T15:57:45.010-07:00 Illustration of Vaginal Delivery on a model <iframe allowfullscreen="" frameborder="0" height="250" src="http://www.medicanalife.com/player/embed_player.php?vid=8&width=300&height=250&autoplay=" width="300"></iframe>dr_toxichttp://www.blogger.com/profile/09498540693366676689noreply@blogger.comtag:blogger.com,1999:blog-1096776180562876473.post-92161419621399413732011-08-11T01:44:00.000-07:002011-08-11T01:44:40.616-07:00 Synthesis and metabolism of vitamin D in the regulation of calcium, phosphorus, and bone metabolism.<div style="text-align: center;">Click for photo enlargement</div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiHKMidSbRiVA5ilQFBW-Y_BlQyzjwnITppLoto66Yw027mFIRA9OUKknHNjZfZUJ-W52JcqUh6aZZd_w2qqqwyFWWkUa5WdxdgZ9qTN-1zrprJmdBWHn3k3vzItBtCvL8PwamXJdDyZ5Vc/s1600/F1.large.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiHKMidSbRiVA5ilQFBW-Y_BlQyzjwnITppLoto66Yw027mFIRA9OUKknHNjZfZUJ-W52JcqUh6aZZd_w2qqqwyFWWkUa5WdxdgZ9qTN-1zrprJmdBWHn3k3vzItBtCvL8PwamXJdDyZ5Vc/s320/F1.large.jpg" width="264" /></a></div>During exposure to solar UVB radiation, <span style="color: red;">7-dehydrocholesterol</span> in the skin is converted to <span style="color: red;">previtamin D3</span>, which is immediately converted to <span style="color: red;">vitamin D3</span> in a heat-dependent process. Excessive exposure to sunlight degrades previtamin D3 and vitamin D3 into inactive photoproducts. Vitamin D2 and vitamin D3 from dietary sources are incorporated into chylomicrons and transported by the lymphatic system into the venous circulation. Vitamin D (hereafter, “D” represents D2 or D3) made in the skin or ingested in the diet can be stored in and then released from fat cells.<br />
Vitamin D in the circulation is bound to the <span style="color: orange;">vitamin D–binding protein</span>, which transports it to the liver, where vitamin D is converted by vitamin D-25-hydroxylase to 25(OH)D. This is the major circulating form of vitamin D that is used by clinicians to determine vitamin D status.<i> (Although most laboratories report the normal range to be 20 to 100 ng/mL [50 to 250 nmol/L], the preferred range is 30 to 60 ng/mL [75 to 150 nmol/L].)</i> This form of vitamin D is biologically inactive and must be converted in the kidneys by <span style="color: orange;"><span style="color: red;">25-hydroxyvitamin D</span>-1α-hydroxylase</span> (1-OHase) to the biologically active form <span style="color: red;">1,25(OH)2D</span>.<br />
<b><i>Serum phosphorus, calcium, fibroblast growth factor 23 (FGF-23)</i></b>, and other factors can either increase (+) or decrease (−) the renal production of 1,25(OH)2D. 1,25(OH)2D decreases its own synthesis through negative feedback and decreases the synthesis and secretion of <span style="color: red;">PTH </span>by the parathyroid glands. 1,25(OH)2D increases the expression of 25-hydroxyvitamin D-24-hydroxylase (24-OHase) to catabolize 1,25(OH)2D to the water-solubl biologically inactive <span style="color: red;">calcitroic acid</span>, which is excreted in the bile.<br />
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1,25(OH)2D enhances intestinal calcium absorption in the small intestine by interacting with the vitamin D receptor–retinoic acid x-receptor complex <b>(VDR-RXR)</b> to enhance the expression of the epithelial calcium channel (transient receptor potential cation channel, subfamily V, member 6 [TRPV6]) and calbindin 9K, a calcium-binding protein (CaBP). 1,25(OH)2D is recognized by its receptor in osteoblasts, causing an increase in the expression of the receptor activator of RANKL.<br />
RANK, the receptor for RANKL on preosteoclasts, binds RANKL, which induces preosteoclasts to become mature osteoclasts. Mature osteoclasts remove calcium and phosphorus from the bone, maintaining calcium and phosphorus levels in the blood. Adequate Ca2+ and phosphorus (HPO42−) levels promote the mineralization of the skeleton. dr_toxichttp://www.blogger.com/profile/09498540693366676689noreply@blogger.comtag:blogger.com,1999:blog-1096776180562876473.post-90630007931040920072011-08-09T17:12:00.000-07:002011-08-09T17:12:25.462-07:00 8 clinical criteria predict management in an ICU<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjAufY8eu5uWafnOIX7LOMKMXPf3HDEGWtvUqg0kVR_Vbobac_vSWiuKojEA16NoWNuabfyBWhsQsxhXAo3V0KHVn-NvMl-ZJmH82JsxCUgu3UG6jf2-lHyBOn7d-_5efegddfezXIGErCB/s1600/059_intensive_care_unit_nurse.ju.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="150" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjAufY8eu5uWafnOIX7LOMKMXPf3HDEGWtvUqg0kVR_Vbobac_vSWiuKojEA16NoWNuabfyBWhsQsxhXAo3V0KHVn-NvMl-ZJmH82JsxCUgu3UG6jf2-lHyBOn7d-_5efegddfezXIGErCB/s200/059_intensive_care_unit_nurse.ju.jpg" width="200" /></a></div>Which of the following would indicate the patient must be monitored in an intensive care unit setting following an overdose?<br />
<br />
<ul><li><b style="color: red;">A)</b> PaCO2 >45 mmHg</li>
<li><b style="color: red;">B)</b> Seizures</li>
<li><b style="color: red;">C)</b> QRS duration ≥ 0.12 seconds</li>
<li><b style="color: red;">D)</b> Second- or third-degree atrioventricular block</li>
<li><b style="color: red;">E)</b> All of the above</li>
</ul><br />
<span style="font-size: large;">Answer and Discussion</span><br />
<span style="color: #0b5394; font-size: large;">The answer is E.</span><br />
The presence of any of eight clinical criteria predict a complicated hospital course that could be best managed in an ICU:<br />
<br />
<b><i>1-</i></b> PaCO2 >45 mmHg <br />
<b><i>2-</i></b> A need for emergency intubation <br />
<i><b>3-</b></i> The presence of postingestion seizures <br />
<i><b>4-</b></i> Unresponsiveness to verbal stimuli <br />
<i><b>5-</b></i> A non-sinus cardiac rhythm <br />
<i><b>6-</b></i> Second- or third-degree atrioventricular block <br />
<i><b>7-</b></i> Systolic blood pressure <80 mmHg <br />
<i><b>8-</b></i> QRS duration ≥ 0.12 seconds<br />
<br />
dr_toxichttp://www.blogger.com/profile/09498540693366676689noreply@blogger.comtag:blogger.com,1999:blog-1096776180562876473.post-22423101054669057162011-08-09T04:53:00.000-07:002011-08-09T04:53:46.118-07:00 Heparin . . . The forgotten hero in myocardial infarction <iframe width="425" height="349" src="http://www.youtube.com/embed/23ge2qlSjJg?rel=0" frameborder="0" allowfullscreen></iframe>dr_toxichttp://www.blogger.com/profile/09498540693366676689noreply@blogger.comtag:blogger.com,1999:blog-1096776180562876473.post-44008494766932018212011-08-05T05:23:00.000-07:002011-08-05T05:23:55.097-07:00 Description of Hallux Malleus "hammer toe"-Hallux for the big toe<br />
-Malleus for a hammer<br />
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<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiIfq42R64p3FtJHeLPnlrid1ghMdRGhZ2fgNpMBSA_wpF7vdUnKWvR2LIv2oyi__f4o3NwQofnmxMgjg26aZtEQ892ucG9Z_tQnziuDJxto64W5tyxnXoRMwOPZJkuRWioToRDq4KS5jek/s1600/higharch.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiIfq42R64p3FtJHeLPnlrid1ghMdRGhZ2fgNpMBSA_wpF7vdUnKWvR2LIv2oyi__f4o3NwQofnmxMgjg26aZtEQ892ucG9Z_tQnziuDJxto64W5tyxnXoRMwOPZJkuRWioToRDq4KS5jek/s1600/higharch.jpg" /></a></div>Hallux malleus is a deformity of the great toe. This deformity can be very stiff or flexible. The joint in the great toe becomes contracted in a flexed or downward position. <br />
This deformity usually occurs due to an imbalance of the tendons that insert on the top and the bottom of the great toe. When the tendon on the bottom of the toe (the tendon that causes the toe to flex down) over powers the tendon that causes the toe to bend up, this deformity occurs.<br />
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Usually patients will develop a callus and even an ulcer on the tip of the great toe. This deformity is often seen in conjunction with hammer toes. High arched feet are typically the most affected by this deformity.<br />
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This deformity is treat initially with padding techniques to prevent sores from developing at the tip of the toe. Custom, soft, accommodative orthoses are sometimes prescribed for the patient to provide cushioning and also to prevent worsening of the deformity.<br />
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If conservative treatment fails, surgery is indicated. Surgery usually consists of performing a <b><i>bone fusion</i></b> of the 2 bones in the great toe. This can be done with screws, staples, or wire fixation.dr_toxichttp://www.blogger.com/profile/09498540693366676689noreply@blogger.comtag:blogger.com,1999:blog-1096776180562876473.post-7071886789783636232011-08-04T13:33:00.000-07:002011-08-04T13:33:48.451-07:00About Retinal Detachments<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhf9PCLxPjKcUOu5mJqhjkLQc_OigWu-ofby6CzByOda2S24aqyjZMWiJlr3Hn9nuoqZfSr2x2MfV5tXuuUovdsGXX1g36rZGamuRJDu3hjpAZRzO6GOxdX99Me5xLhfH4XQyChaSJPNBpz/s1600/RetinalDetachment.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhf9PCLxPjKcUOu5mJqhjkLQc_OigWu-ofby6CzByOda2S24aqyjZMWiJlr3Hn9nuoqZfSr2x2MfV5tXuuUovdsGXX1g36rZGamuRJDu3hjpAZRzO6GOxdX99Me5xLhfH4XQyChaSJPNBpz/s1600/RetinalDetachment.jpg" /></a></div>Which of the following statements is TRUE regarding acute traumatic retinal detachments?<br />
<ul><li><b style="color: red;">(A)</b> Most detachments can be visualized on standard fundoscopy</li>
<li><b style="color: red;">(B)</b> Eighty percent of detachments occur within 24 h of the traumatic event</li>
<li><b style="color: red;">(C)</b> Most detachments originate in the inferotemporal quadrant</li>
<li><b style="color: red;">(D)</b> Visual outcome depends on the extent of involvement of the optic disc</li>
<li><b style="color: red;">(E)</b> Sudden onset of pain is a prominent feature</li>
</ul><br />
<div style="color: #3d85c6;"><u><span style="font-size: large;">The answer is C. </span></u></div>The typical retinal detachment is heralded by painless flashes of light, floaters, and a shade across the visual field. Interestingly, most detachments follow a latent period, up to 8 months posttrauma in 50 percent of cases.<br />
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Detachments begin as small tears in the ora serrata (called dialysis), most frequently affecting the inferotemporal quadrant, followed by the superonasal quadrant. Because most detachments are very peripherally situated on the retina, standard fundoscopy is typically inadequate for visualization. Although a number of techniques have been developed to correct the detachment, visual outcome remains largely determined by the degree of macular involvement.dr_toxichttp://www.blogger.com/profile/09498540693366676689noreply@blogger.comtag:blogger.com,1999:blog-1096776180562876473.post-3644954513612341292011-08-03T09:29:00.000-07:002011-08-03T09:29:19.390-07:00 Prostate diseases in relation to Prostate zonesMost cancer lesions occur in the peripheral zone of the gland, fewer occur in the transition zone and almost none arise in the central zone. Most benign prostate hyperplasia (BPH) lesions develop in the transition zone, which might enlarge considerably beyond what is shown.<br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi99D5gB2n8d-IdOxevOvOC2drOy3BdkKC7duxKF4v6BfQUdaCYgLxtoCb_cTlxXg-wcK_8hvZB1eLtLDx4tbUQenZunMIF9ZMy7HorCeZzgWzHZaj9x2hEUW9PV2OVYxaSBkYnZ1f08Fr2/s1600/nrc2090-f1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi99D5gB2n8d-IdOxevOvOC2drOy3BdkKC7duxKF4v6BfQUdaCYgLxtoCb_cTlxXg-wcK_8hvZB1eLtLDx4tbUQenZunMIF9ZMy7HorCeZzgWzHZaj9x2hEUW9PV2OVYxaSBkYnZ1f08Fr2/s640/nrc2090-f1.jpg" width="492" /></a></div><br />
The inflammation found in the transition zone is associated with BPH nodules and atrophy, and the latter is often present in and around the BPH nodules. Acute inflammation can be prominent in both the peripheral and transition zones, but is quite variable.<br />
The inflammation in the peripheral zone occurs in association with atrophy in most cases.<br />
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<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi0i5yloV1YOTQlknMl80AQGhbBEgaX6wBhCumIFDeqQnshjtQaDT0QngrzR6dV49PEs82IrCip-dBSVxQXe6eEFMZSV3q576gDxtfdWtegVC5WWKQ72KZhEJfCu4apwm2VGLBX4E7LCDPq/s1600/untitled.bmp" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="192" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi0i5yloV1YOTQlknMl80AQGhbBEgaX6wBhCumIFDeqQnshjtQaDT0QngrzR6dV49PEs82IrCip-dBSVxQXe6eEFMZSV3q576gDxtfdWtegVC5WWKQ72KZhEJfCu4apwm2VGLBX4E7LCDPq/s640/untitled.bmp" width="640" /></a></div>Although carcinoma might involve the central zone, small carcinoma lesions are virtually never found here in isolation, strongly suggesting that prostatic intraepithelial neoplasia (PIN) lesions do not readily progress to carcinoma in this zone. Both small and large carcinomas in the peripheral zone are often found in association with high-grade PIN, whereas carcinoma in the transition zone tends to be of lower grade and is more often associated with atypical adenomatous hyperplasia or adenosis, and less often associated with high-grade PIN. The various patterns of prostate atrophy, some of which frequently merge directly with PIN and at times with small carcinoma lesions, are also much more prevalent in the peripheral zone, with fewer occurring in the transition zone and very few occurring in the central zone.dr_toxichttp://www.blogger.com/profile/09498540693366676689noreply@blogger.comtag:blogger.com,1999:blog-1096776180562876473.post-66608447384826848742011-07-30T02:59:00.000-07:002011-07-30T02:59:08.129-07:00Local anesthesia for a complex lower lip laceration (Mental nerve block)A 20-year-old male kick boxer sustains a lower lip laceration during a practice match. The wound is complex and crosses the vermilion border. Which is the best way to achieve anesthesia?<br />
<ul><li><b style="color: red;">(A)</b> Local infiltration with 1 percent lidocaine</li>
<li><b style="color: red;">(B)</b> Local infiltration with 1 percent lidocaine with epinephrine</li>
<li><b style="color: red;">(C)</b> Inferior alveolar nerve block</li>
<li><b style="color: red;">(D)</b> Lingular nerve block</li>
<li><b style="color: red;">(E)</b> Mental nerve block</li>
</ul><br />
<div style="color: blue;"><u><span style="font-size: large;">answer is E. </span></u></div><br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi24RVJtBhF504o0xcjohyGpaI1yKjBDAd1W19IBR8cZVeK2rMsWvxn74mmysQfZBswQhHOBDLPfWjYaF6GH0pUPaufK65s6tzI8hxbTXnDQJO5ee8N2S0UdHNoNe8Wvn8N9kAkQe_jVdMf/s1600/mnb.gif" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi24RVJtBhF504o0xcjohyGpaI1yKjBDAd1W19IBR8cZVeK2rMsWvxn74mmysQfZBswQhHOBDLPfWjYaF6GH0pUPaufK65s6tzI8hxbTXnDQJO5ee8N2S0UdHNoNe8Wvn8N9kAkQe_jVdMf/s1600/mnb.gif" /></a></div>A regional block is preferred for a complex lower lip laceration <i><u>because it preserves tissue planes and landmarks, facilitating anatomically correct repair. </u></i><br />
The mental nerve supplies the skin and mucus membranes of the lower lip. The mental foramen is located inside the lower lip at its junction with the lower gum, just posterior to the first premolar tooth.<br />
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To avoid nerve injury, 1 percent lidocaine with epinephrine is injected close to, but not into, the mental foramen. The inferior alveolar and lingular nerves do not supply the lower lip and thus would not be effective in this patient.dr_toxichttp://www.blogger.com/profile/09498540693366676689noreply@blogger.com