Surgery MCQ – Renal Calculi in proteus infection

Which of the following renal calculi is seen associated with proteus infection?
A. Calcium Oxalate
B. Triple Phosphate
C. Xanthine
D. Uric Acid
 
Correct answer : B. Triple Phosphate
High ammonia concentration leads to the formation of triple phosphate stones. This arises when urine is infected with urea splitting organisms like Proteus.

Read More

Case Report 5 :: Chest X-ray in Heart Failure

Congestive Heart Failure Intro

 Results from any structural or functional abnormality that impairs the ability of the ventricle to eject blood (Systolic Heart Failure) or to fill with blood (Diastolic Heart Failure).

Chest X-ray in Heart Failure

•  Cardiomegaly
•  Cephalization of the pulmonary vessels
•  Kerley B-lines
•  Pleural effusions

Kerley B-lines

 Pulmonary Edema due to Heart Failure

Pulmonary vessel congestion

 Cardiomegaly

Read More

Sinus X-Rays Are Worthless

Oftentimes, patients come in with sinus x-rays with this or that finding. What many patients as well as physicians may not realize is that sinus x-rays are notoriously unreliable in determining whether sinus infectionis present or not. Indeed, most of the doctors NEVER order a sinus x-ray. Just how unreliable are sinus x-rays?

It may be literally a flip of the coin whether the sinus x-ray is providing a correct diagnosis compared with the gold standard CT sinus.

Depending on what study you look at, the specificity of a sinus x-ray hovers around 50% (how often it correctly states normal sinuses). Sensitivity is a little better at around 80% (how often it correctly detects actual sinusitis).

Several studies have concluded that sinus plain film x-rays are unreliable and no longer routinely indicated for the evaluation of nasal and paranasal sinus disease. When radiographic evaluation is indicated a limited CT series provides superior information.

Take home message?

Do not order a sinus x-ray when evaluating for sinus disease/sinusitis!!! Why bother ordering a test that is going to be wrong almost half the time?

(If a CT sinus comes back normal, the patient most definitely does NOT have acute or chronic sinusitis.)

Reference:
Radiographic evaluation for nasal dysfunction: computed tomography versus plain films.Head Neck. 11 (5), 405-9. 1989

Comparison of sinus x-rays with computed tomography scans in acute sinusitis. Acad Emerg Med. 1 (3), 235-9. 1994

Read More

Happy Independence Day

Never forget their sacrifice
Thousands laid down their lives so
that our country is breathing this day
Never forget their sacrifice...

Happy Independence Day


Martein Kyun Ho Bewafa Sanam Key Liyea
Zara Mar Key Dikhaoo Aapne Watan Key Liyea
Mar Mitoo Gye Desh Key Liye Tooh .
Sanam Bhi Utaar De Gi Apna Dupatta
Tumhare Kafan Key Liyee

Join me to celebrate this day.

This is the day,
We stand up high, as We
All start to cry
That Our nation sings
This is the day
That the liberty bell starts to ring
This is the day to remember
What we stand for
And to celebrate our Independence Day

Read More

Life Support - Humor

Try That for Resusitation

Read More

Advances in Transfusion Medicine

Blood transfusions are an important part of hematologic care. Transfusion is the transfer of blood, its components, or products from one person (donor) into another person’s bloodstream (recipient). Every year in the U.S., more than 20 million units of red blood cells, platelets, and plasma are transfused to treat hematologic conditions such as severe anemia, leukemia, and sickle cell disease. Transfusions have long been associated with some risk to patients. The HIV epidemic during the 1980s was a major cause of fear; regular transfusions, especially of clotting factor concentrates, spread the virus quickly and nearly undetected. That outbreak prompted the development of biovigilance or hemovigilance: tracing and tracking transfusion-related adverse events and incidents, both infectious and non-infectious, that affect blood donors and recipients. Another of the most significant issues complicating transfusion safety has been bacterial contamination of blood products, particularly of platelets. However, steps have been taken in the last decade to avoid, detect, and eliminate this complication through improved donor selection, specialized preparation of the arm before needle insertion, and special screening techniques.

Despite ongoing improvements in the collection, processing, testing, delivery, and monitoring of transfusions during the past several decades, concerns over the safety of these therapies and the process in general continue today.

Historically, there was concern about transmitting infectious diseases from a donor to a recipient. Now blood is regularly tested for infectious disease transmission, particularly for viruses such as Hepatitis B and C, HIV, and West Nile Virus. Traditionally, serum has been tested to look for the body’s response to past infectious exposure, but many serum tests have been replaced by molecular testing called nucleic acid amplification testing (NAT), which finds active viruses in the donor’s blood to determine infection risk. If an active virus is found, the donor unit is discarded. Experts anticipate that new methods, including new molecular and microarray testing, which can identify many infectious agents rapidly and accurately, will replace or augment serum studies and NAT in the near future. Blood transfusion has never been safer from known infectious risk than it is today.

In addition to infectious disease risks, doctors must also manage other risks, such as post-transfusion reactions. These include transfusion-related lung injury (TRALI), during which the donor’s immune antibodies cause breathing problems in the recipient; transfusion associated cardiac overload (TACO), which is swelling caused by the increased blood volume; and post-transfusion iron overload, which is a buildup of iron in the body, usually caused by multiple or regular transfusions.

Source ::  http://www.hematology.org

This article was published in December 2008 as part of the special ASH anniversary brochure

Read More

Happy Ramadan ! رمضان كريم

The holly month of Ramadan is here! I'd like to wish a blessed and peaceful month to muslim foreros on WR
and to all muslims around the world
  
رمضان كريم
أعاده الله على الجميع بالخير والبركة

كل سنة وإحنا طيبين

Read More

Structures passing through foramina of skull

The internal surface of the cranial base can be divided into 3 cranial fossae, the anterior, middle, and posterior. The anterior and middle fossae are separated by the lesser wing of sphenoid bone, and the middle and posterior fossae are separated by petrous part of temporal bone.

Various structures (nerves, arteries, veins) passing through various foramina of skull are listed below:

Foramen Ovale:

Mnemonic: MALE
1. Mandibular Nerve (CN V3)
2. Accessory meningeal nerve
3. Lesser petrosal nerve
4. Emissary vein (Cavernous sinus to pterygoid plexus)
5. Occasionally anterior trunk of middle meningeal artery

Foramen Spinosum

Mnemonic: MEN
1. Middle meningeal artery and vein (posterior trunk)
2. Emissay vein
3. Nervus spinosus (Meningeal branch of mandibular nerve)

Foramen Lacerum:

Mnemonic: MEIG
Structures passing whole length:
1. Meningeal branch of Ascending pharyngeal artery
2. Emissary vein
Other structures partially traversing:
3. Internal carotid artery
4. Greater petrosal nerve

Carotid Canal:

Internal carotid artery (ICA) and venous and sympathetic plexus around it

Foramen Rotundum:

Maxillary nerve (CN V2)

Stylomastoid Foramen:

1. Facial nerve (CN VII)
2. Posterior Auricular artery (Stylomastoid branch)

Internal Acoustic Meatus:

1. Facial nerve (CN VII)
2. Vestibulo-cochlear nerve (CN VIII)
3. Nerves intermedius or pars intermedia of wrisberg
4. Labyrinthe vessels

Hypoglossal canal:

1. Hypoglossal nerve
2. Meningeal branch of Hypoglossal nerve
3. Meningeal branch of Ascending Pharyngeal artery
4. Emissary vein (Sigmoid sinus to internal jugular vein)

Jugular Foramen:

1. Anterior part: Inferior Petrosal Sinus

2. Middle part: 9,10,11 MAP

a. CN IX (Glossopharyngeal nerve)
b. CN X (Vagus nerve)
c. CN XI (Accesory nerve)
d. Meningeal branch of Ascending Pharyngeal Artery

3. Posterior part:

a. Internal Jugular vein (IJV) – Sigmoid sinus junction
b. Emissary vein (Sigmoid sinus to occipital vein)
c. Occipital artery

Mastoid canaliculus (entry) and Tympanomastoid fissure (exit):

Auricular branch of vagus nerve
Tympanic Canaliculus
Tympanic branch of CN IX (Glossopharyngeal nerve)

Incisive Foramen

1. Greater palatine vessels
2. Nasopalatine nerves

Greater Palatine Foramen:

Mnemonic: GAP (Greater and Anterior Palatine Vessels)
1. Greater Palatine vessels
2. Anterior Palatine vessels

Lesser Palatine Foramen:

Middle and Posterior Palatine nerve

Superior Orbital Fissure

1. Lacrimal nerve
2. Frontal nerve
3. Trochlear nerve
4. Occulomotor nerve
5. Nasociliary nerve
6. Abducent nerve
7. Superior ophthalmic vein

Foramen magnum

Mnemonic: MAVer
1. Medulla oblongata
2. Ascending parts of spinal accessory nerves
3. Vertebral arteries

Tags: carotid canal, cranial fossa, foramina of skull, jugular foramen

Source :: Medchrome

Read More