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chest x-ray, bronchiectasis

Laparoscopic appendectomy surgery.

Coronary Angiography (Cardiac Catheterization)

USMLE step 1

This is part of series of online courses from We have courses prepared by teachers who specialize in online medical teaching. Hundreds of students have taken the courses and passed in their respective exams with flying colors. We have courses for both undergraduate and postgraduate subjects like Physiology, Pathology, Biochemistry, Medicine, Surgery etc. The postgraduate courses are most beneficial for exams like USMLE, AMC, etc.
We have both recorded and live streaming courses.

"USMLE STEP 1 Reality" by Dr Brian Bolante

Croup (acute laryngotracheobronchitis) on X-ray with steeple sign

Croup, also called acute laryngotracheobronchitis is caused by viral infection of the upper airway usually parainfluenza virus or respiratory syncytial virus (RSV). It is common and has a peak incidence before the age of 1 year (typically between 3 and 6 months of age).

It is presented Clinically by protracted barking cough and inspiratory stridor due to tracheal narrowing that is caused by mucosal oedema .

X-ray finding :

On Plain film

The diagnosis of acute laryngotracheobronchitis or Croup is usually made clinically

and no need for doing may do it just for excluding other causes of same presentation like:

- foreign body aspiration.........tracheal or oesophageal.

- angioneurotic edema

- epiglottitis and epiglottic-cysts

- congenital subglottic stenosis

However there are some typical radiographic findings :

1- steeple sign (the image above): seen on AP radiographs of the neck or chest and neck demonstrates uniform narrowing of the subglottic airway

But What is steeple sign ??

The steeple sign refers to superior tapering of the trachea on a frontal chest radiograph. It is remaniscient of a church steeple and is suggestive of croup.

2- distension of the hypopharynx is also seen due to the patient's attempt at decreasing airway resistance (the image below)

What is the USMLE?

USMLE represents The United States Medical Licensing Examination,it is a three-part licensing examination that is required in order to receive a license to practice medicine within the United States.
This exam is designed by the Federation of State Medical Boards and the National Board of Medical Examiners to determine whether or not an individual understands and can apply the knowledge necessary to practice medicine safely and intelligently. The USMLE is actually comprised of 3 different exams that are referred to as steps, which examine the individual's knowledge of specific topics related to the field of medicine like basic science, medical knowledge, medical skills, clinical science, and the application of all of these skills and areas of knowledge in the medical field.

All three steps of the USMLE include a series of computerized multiple-choice questions (MCQs), but the format of the exam and the information covered in each multiple-choice section is different for each step of the USMLE. The USMLE Step II also has a clinical skills portion that examines an individual's ability to work with real patients and the USMLE Step III has a computerized patient simulation portion in addition to the multiple-choice section of the exam. In order for an individual to receive a license to practice medicine, the individual must pass all three steps of the USMLE.

Automated Breast Ultrasound

U-Systems has developed an Automated Breast Ultrasound System that is FDA 510k approved for diagnostic imaging

What is the Whipple Procedure?

In this video, Washington University surgeon William Hawkins, MD, explains the Whipple procedure, which is performed to remove cancer from the head of the pancreas. Hawkins and his colleagues complete about 125 Whipples a year, making the Siteman Cancer Center one of the highest-volume centers for this type of surgery nationwide. These surgeons pioneered a modification to the Whipple procedure that has resulted in the lowest fistula rate any large group (1.5 percent compared to 15 percent).

Money-Driven Medicine

Money-Driven Medicine provides the essential introduction Americans need to become knowledgeable and vigorous participants in healthcare reform.

Cornual pregnancy

B mode 2D image :

This UltraSonography image of the uterus can show us a gestation sac of 6 weeks 4 days age, in the right cornu of the uterus. 3-D image of the uterus further confirms the findings. These ultrasound images are diagnostic of cornual pregnancy (Which is a type of ectopic pregnancy).

3D image:

Endoscopy of Acute Bleeding from a Peptic Ulcer :important implications for health care costs

Acute upper gastrointestinal hemorrhage, which is defined as bleeding proximal to the ligament of Treitz, is a prevalent and clinically significant condition with important implications for health care costs worldwide. Negative outcomes include rebleeding and death, and many of the deaths are associated with decompensation of coexisting medical conditions precipitated by the acute bleeding event. This video focuses specifically on endoscopic management of acute bleeding from a peptic ulcer.

Corrective Surgery: Microvascular Decompression

Microvascular decompression actually treats the vessel causing the cranial nerve disorder, it potentially provides a long-term solution to the problem.

Penetrating Keratoplasty

PK is a corneal transplant with replacement of all layers of the cornea, but retaining the peripheral cornea.

Anatomy of Hip Adductors

Sympathetic Nervous System - Draw it to Know it - Neuroanatomy Tutorial

In this tutorial, we will draw the neuroanatomy of the thoracolumbar sympathetic nervous system.

Serial Abdominal Closure of a Laparostomy

A technique for abdominal closure after laparostomy is presented

First Aid : Nose bleeding

Beta-blockers: side effects

BBC Viewers !!!
"BBC Loses Viewers In Rochedale":

  • Bradycardia
  • Bronchoconstriction
  • Claudication
  • Lipids
  • Vivid dreams & nightmares
  • -ve Inotropic action
  • Reduced sensitivity to hypoglycaemia

Medicare enrollment problems,Medicare payments

A 3-physician, family medicine practice in Lexington, Va., recently found itself with roughly $40,000 in unpaid Medicare claims -- practice revenue that was in limbo because of a cascade of blunders in Medicare's physician enrollment process.

Brenda Harlow, office manager for Lexington Family Practice since 1981 and, thus, no newcomer to the Medicare game, commented she'd never seen anything like the mess in which the practice found itself recently.

The nightmare started with the completion of Medicare enrollment forms in January. A series of events, including Medicare contractor mailroom mishaps and a lack of clarity about what information the contractor needed from the practice, stretched on for nearly two months, according to Harlow.

Then the hammer came down.
"Payments from Medicare were stopped on March 12," said Harlow. Subsequently, the practice was notified that, as of May 25, all three physicians in the practice could be "barred from Medicare for a year."

Robert Pickral, M.D., has been serving Medicare patients at the Lexington practice since 1981. "What is the message to the physicians of America when this kind of disruption happens?" he asked.
"We operate a small practice in a small community. Revenue is way down, and federal quarterly taxes are due," said Pickral, adding that Medicare patients account for nearly 25 percent of the practice's patient panel.

As of June 2, the practice still had no resolution regarding the Medicare enrollment problems, and it still has not received any Medicare payments.

According to Kent Moore, the AAFP's manager of health care financing and delivery systems, there is no way to know for sure how many other Academy members are experiencing similar problems with Medicare. But "I do know that Pickral's practice is not alone," he said.

"I have exchanged e-mails and phone calls with other AAFP members who have run afoul of Medicare's physician enrollment process," said Moore, adding "in some cases, physicians have had their Medicare billing privileges revoked as a consequence."

Avoiding Medicare Mishaps
Medicare's Provider Enrollment, Chain and Ownership System, or PECOS, may be the source of many problems, including those experienced by Pickral's practice, according to Cynthia Hughes, C.P.C., an AAFP coding expert who works with Moore in the AAFP's Practice Support Division.

The Internet-based PECOS was established in 2003, and physicians who have not submitted an enrollment application since it went operational need to re-enroll, said Hughes.

She also cited physician revalidation rules laid out in the Medicare Program Integrity Manual (275-page PDF; About PDFs). According to the manual, Medicare providers and suppliers "must resubmit and recertify the accuracy of their enrollment information every five years in order to maintain Medicare billing privileges."

According to Hughes and Moore, physicians can be proactive to prevent problems with Medicare. For example, physicians should

* log in to PECOS to see if they are registered there and to ensure that their information is complete and accurate;
* respond to Medicare requests for revalidation of enrollment in a timely manner, so if issues crop up, there is ample time to resolve them; and
* report any provider changes, such as a change of address, promptly.

"Physicians may think Medicare is picking on them, but the real issue is that there are lots of new rules that everyone is trying to follow," said Hughes.

She suggested that physicians who are rushing to beat a Medicare enrollment deadline and who are not already established in PECOS should submit a paper application. "Approval for PECOS registration can take some time," said Hughes.

Prosthetic-Valve Dehiscence

A 33-year-old man with rheumatic heart disease presented with an acute onset of chest pain. Five years earlier, the patient had undergone replacement of the mitral and aortic valves (Medtronic Hall and ATS Medical, respectively).

On physical examination, he had diaphoresis with normal vital signs and without evidence of congestive heart failure, acute aortic regurgitation, or abnormal prosthetic heart sounds. Electrocardiography that was performed 4 hours after the onset of pain showed ST elevation in left-sided leads V8 and V9, which was suggestive of inferoposterior myocardial injury. Laboratory evaluation revealed an elevated international normalized ratio (>12; normal range, 2.5 to 3.5), a creatine kinase level of 39 U per liter (normal range, 0 to 150), a creatine kinase MB level of 5.5 U per liter (normal range, 0.6 to 6.3), and a troponin I level of 0.24 ng per milliliter (normal range, 0.01 to 0.03).

Cardiac catheterization showed that the prosthetic aortic valve was significantly displaced with each heartbeat (Panels A and B, arrows); no abnormality of the mitral valve was observed. The patient underwent urgent excision and replacement of the dehisced aortic valve, which was found to be infected with Staphylococcus aureus, with associated vasculitis; the mitral valve was not affected. The patient had postoperative mediastinal bleeding and died from irreversible shock 24 hours later.

Male Intermittent Self-Catheterization

Peritoneal Mesothelioma

View this mesothelioma resource as presented at the International Symposium on Malignant Mesothelioma 2008, hosted by the Mesothelioma Applied Research Foundation. Presentation by Dr. James F. Pingpank, Head of the Surgical Metabolism Section of the Surgery Branch of the NCI, in Bethesda Maryland.

Intradermal and Subcutaneous Injections

Academy of Health Sciences (Army), Fort Sam Houston, TX. Shows the proper method for administering a subcutaneous and intradermal injection, including selection and preparation of the site and disposal of used equipment. From the EMT video, group three series.

Anatomy of the perineum

Brief lesson on anatomy of the perineum.

Medicine In 3 Minutes

Central line placement

Delirium Mnemonics

Here is a simple mnemonics for delirium: DELIRIUM(S)

D Drugs, Drugs, Drugs
E Eyes, ears
L Low O2 (MI, ARDS, PE, CHF, COPD) **
I Infection
R Retention (of urine or stool), Restraints
I Ictal
U Underhydration/Undernutrition
M Metabolic
(S) Subdural, Sleep deprivation

Delirium is one of the most hidden and deadly enemy in ICU. It increases mortality, it cost money and its hard to recognise.

**"Low O2 states" does NOT necessarily mean hypoxia, rather it is a reminder that patients with a hypoxic insult (e.g. Ml, stroke, PE) may present with mental status changes with or without other typical symptoms/signs of these diagnoses.

Transsphenoidal Surgery

Transsphenoidal surgery is a procedure used to remove pituitary tumors from the brain. The surgeon works through a small opening (ostium) at the back of the nose (septum) that leads to an air pocket called the sphenoid sinus. To access the pituitary tumor, the surgeon goes through the sphenoid sinus and cuts through the tissue covering the pituitary gland. The tumor is removed with small instruments called curets. A small scope inserted through the sphenoid sinus helps the surgeon to visualize the tumor. A large tumor may need to be cut into smaller pieces before it's removed.

Cells of Immune response

The main cell of the specific immune response is the small lymphocyte.


1) B and T lymphocytes constantly enter the blood stream from the peripheral lymphatic tissue via the lymphatics and the thoracic duct and circulate around the body. '

2) They reenter the lymphoid tissue at another site.

3) Lymphocytes form 20 - 40% of the circulating white blood cell Circulating lymphocytes are mainly T cells with a few B cells.

Immune response & elimination of antigen

1) Antigens can enter the body through the mucosa or skin.

2) Meeting the mucosa associated lymphoid tissue or the cutaneous lymphoid tissue.

3) The antigens are carried to the regional lymph nodes via lymphatics

4) If the antigen enters the blood stream it will be filtered by the spleen.

5) Lymphocyte recirculation ensures that B and T lymphocytes are constantly patrolling the body looking for antigen.

6) Antigen will meet the corresponding lymphocytes specific for the antigen →immune response (activation, proliferation and differentiation of lymphocytes)

7) The immune response takes place in the PERIPHERAL LYMPHOID TISSUE(rich in macrophages and dendritic cells).

* At the mucosal or skin surface immune response takes place in the MALT or cutaneous immune system.

* o The immune response to tissue antigens takes place in the lymph node.

* o The immune response to circulating antigens takes place in the spleen.

8) Antibodies from B cells or effector T cells go to the site of infection and eliminate the antigen.

9) The memory cells remain in the lymphoid tissue.

10) The second time the antigen enters there are a large number of antigen specific lymphocytes (memory cells) in the lymphoid organs so the secondary response is faster and greater than the primary response.


1) Cytokines are small soluble proteins that act as multipurpose chemical messengers,secreted by a cell, and act on itself or another cell to change the activity of that cell.

2) They play an important role in both non-specific and specific immunity.

3) cytokines Can be produced by a wide variety of cells such as endothelial cells etc.

4) Some cytokines act on the bone marrow to increase cell proliferation and differentiation.

* eg. colony stimulating factors include GM-CSF, G-CSF, M-CSF.

Feature of cytokines

1) ONE cytokine can ACT on many different cells.

* e.g. TNF acts on the liver to produce acute phase proteins and on the Neutrophils to activate it.

2) DIFFERENT cytokines can have the SAME action.

* e.g. TNF from macrophages and lymphotoxin from T cells have the same actions.

3) Cytokines can act on the same cell that produced it (AUTOCRINE ACTION), on nearby cells (PARACRINE ACTION) or on distant cells (ENDOCRINE ACTION).

lawyers opinion :risky business tweeting the symptoms of social media

"To date there are at least 540 hospitals in the United States utilizing social media tools: Hospitals account for 247 YouTube channels, 316 Facebook pages, 419 Twitter accounts, and 67 blogs.

The number of individual and independent medbloggers is in the thousands.

In December of 2009, a hospital employee was forced to resign because of a single tweet.

On October 29, 2008, a patient provided what is believed to be the first live tweet from the operating room. “Bad bad stick. Ow ow ow ow ow.”

In response to online physician rating websites, like Yelp, RateMD, and others, a company now offers physicians an antidefamation service, including contract provisions restricting a patient’s right to make negative comments on rating websites.

There are a number of other scenarios that could lead to liability. For example, what happens if an “off-duty” physician responds to a health question by a neighbor while doing yard work? Suppose the same exchange occurs through online “messages” between a physician and one of the physician’s “friends” on Facebook, creating an electronic record of the exchange that could potentially support the existence of a physician-patient relationship, thereby creating certain liability arising therefrom (e.g., HIPAA, medical malpractice, patient abandonment, etc.).

The authors of a National Law Journal article warn that bosses who “friend” are begging to be sued."

Peritoneal Mesothelioma

View this mesothelioma resource as presented at the International Symposium on Malignant Mesothelioma 2008, hosted by the Mesothelioma Applied Research Foundation. Presentation by Dr. James F. Pingpank, Head of the Surgical Metabolism Section of the Surgery Branch of the NCI, in Bethesda Maryland.

Nasal reconstruction using median forehead flap

Cardiac Ultrasound - Subxiphoid View : Case Study

This video details the use of bedside ultrasound imaging to evaluate cardiac structures and health, especially when attempting to identify cardiomyopathy, pericardial effusion, and pericardial tamponade. The subxiphoid view of the heart provides physicians with a great deal of information regarding a patient's condition.

Answer this case of Acute Chest Pain

A 42-year-old man found vomiting in the street is brought to the ED by emergency medical services (EMS). He has a known history of alcohol abuse with multiple presentations for intoxication.

Today, the patient complains of acute onset and persistent chest pain associated with dysphagia and pain upon flexing his neck. His blood pressure is 115/70 mm Hg, heart rate of 101 beats per minute, respiratory rate 18 breaths per minute, and oxygen saturation of 97% on room air. As you listen to his heart, you hear a crunching sound. His abdomen is soft with mild epigastric tenderness. The ECG is sinus tachycardia without ST-T wave abnormalities. On chest x-ray, there is air in the mediastinum.

What is the most likely diagnosis?

a.Acute coronary syndrome (ACS)


c.Alcoholic ketoacidosis

d.Esophageal perforation

e.Aortic dissection

The right answer is D


Esophageal perforation is

potentially life-threatening conditions that can result from any valsalva-like maneuver, including childbirth, cough, and heavy lifting. Alcoholics are at risk due to their frequent vomiting. The most common cause of esophageal perforation is from iatrogenic causes such as a complication from upper endoscopy. The classic physical exam finding is mediastinal or cervical emphysema. This is noted on palpation of the chest wall or by a crunching sound heard on auscultation, also known as Hamman’s sign.

(a) The patient has no ST-T wave abnormalities on ECG. The history and physical exam are not consistent with ACS. (b)Alcoholics have a high incidence of pancreatitis and can present with epigastric tenderness, however they usually don’t have mediastinal air on radiography. (c) Alcohol ketoacidosis usually occurs in a heavy alcohol user who has temporarily stopped drinking and eating. Aortic dissection (e) usually occurs in patients with chronic hypertension or connective tissue disorders. They

should not have Hamman’s sign.

BP is facing a bill of up to $34bn from the Gulf of Mexico disaster

BP is facing a bill of up to $34bn from the Gulf of Mexico disaster after US senators demanded the oil company deposited $20bn into a ring-fenced account to meet escalating compensation costs.

The sum dwarfs many analysts' previous estimates, shared by BP, that put the cost of the clean-up effort and payment of damages to affected communities, such as fishermen, closer to a total of $5bn.

Shares in BP nose-dived by more than nine per cent today as investors took fright at the demand by the 54 Democratic senators, who represent a majority in the US upper house. The company is now worth almost half what it was before the accident of just under two months ago.

BP already faces up to $14bn in civil penalties, payable under US environmental law, assuming the leak is plugged in August. These punitive damages are directly linked to the size of the spill – already estimated at being up to eight times worse than the Exxon Valdez disaster in 1989 – with BP liable for up to $4,300 for each barrel-worth spilt.

Senate leaders insisted the $20bn ring-fenced account should be exclusively for "payment of economic damages and clean-up costs" and should not be seen as a cap on BP's other legal liabilities. With punitive damages pending too, the theoretical total of $34bn is equivalent to more than half the corporation tax paid by all British companies last year.

Tony Hayward, chief executive of BP, and other directors of the company, will meet Barack Obama at the White House on Wednesday prepared to offer concessions in the hope of taking the sting out of mounting political attacks on the company.

BP will be in "listening mode", willing to cut its next dividend, worth about $2.5bn, possibly paying the cash into the clean-up fund. It will also reiterate its commitment to paying all legitimate claims arising from the disaster. But the company does not believe that the demand by the senators to stump up $20bn is justified.

Executives were also alarmed by the White House's insistence last week that BP must pay the wages of rig workers laid off by other firms because of the six-month moratorium on deepwater drilling in the gulf. If pursued, the company fears it would be exposed to potentially limitless claims from anyone affected by the disaster, which would eventually bankrupt the company. The company hopes that President Obama's statement, following the meeting with BP, will draw back from the demand.
Hayward, who was in Houston today overseeing the spill response, hosted a conference call with his board to discuss BP's next move. The company had indicated that it would wait as usual until close to its next results announcement, on 27 July, to decide whether or not to pay its next quarterly dividend. But it is now set to announce its intentions sooner, perhaps as early as Thursday. It is understood BP could use the dividend as a bargaining chip in its talks with the White House.

Obama today risked the wrath of families of 9/11 victims by comparing the gulf spill to the 2001 terrorist attacks, as pressure intensified on the White House to show greater urgency over the crisis.

Ahead of a trip to Louisiana and a televised address to the nation tomorrow, Obama said the spill, the worst environmental disaster in US history, would, like the 2001 terror plots, continue to influence the country for decades to come. Some people who lost relatives in the 9/11 attacks rejected the comparison. "I think he's off-base," said Jim Riches, a former New York fire department deputy chief, whose son died at the World Trade Centre. "These were 9/11 murders … not something caused by people trying to make money."

Laparoscopic Uterine Suspension Procedure

Some Occupational Lung Diseases and Their Causes

* Asbestosis, caused by exposure to asbestos particles. Often found among people who worked in shipyards, asbestos mines, and factories that refined or used asbestos to manufacture products.
* Black lung (Coalworker's pneumoconiosis) which affects coal workers
* Chronic Beryllium disease (CBD), which affects workers in a variety of metallurgical occupations
* Byssinosis (brown lung disease), often occurs in cotton and textile workers when bacteria released from cotton or other materials is inhaled and grows with the lungs. This is often associated with poor ventilation systems.
* Hypersensitivity pneumonitis, this can affect people who work in office buildings whose air-conditioning systems are contaminated by certain fungi and bacteria.
* Occupational asthma, can affect people who work with a variety of materials. This includes animals (dander), carbamates (urethanes), dyes, epoxy resins and enzymes used in detergent, leather goods, latex, and automotive paints
* Silicosis often developed by people who worked with clay, sand and stone dust including miners, stone cutters and sandblasters.

Bad aspects in American health care system

1. Most physicians do not set their own fees. Medicare, Medicaid, and private health plans set these fees, which often have little to do with the costs of doing business.

2. Congress each year sets Medicare fees through a formula called SGR (Sustainable Growth Rate), which this year calls for a 20% reduction in overall physician fees.

3. If SGR were to go through as to proposed, surveys indicate at many at 30% of physicians will not accept new Medicare patients because new Medicare fees will not cover expenses.

4. The next political crisis will be limited access to doctors; this is already occurring in Boston, where waiting times to see doctors are 2 to 3 times the national average for comparable cities.

5. Medicare on average pays 80% of what it costs to provide care: hospitals and doctors make up the difference by negotiating higher payments from the much maligned private plans.

6. An estimated 10% of health costs are due to the practice of “defensive medicine,” whereby doctors order extra tests and procedures in anticipation of defending themselves again future malpractice lawsuits.

7. Passing federal laws permitting patients to enroll in plans and “portability” of plans across state lines would make a public option unnecessary and would render private plans “competitive.”

8. Ending “community ratings,” which force the young to pay the same premiums as older individuals, and reducing “standard benefit plans, “ which often include unnecessary benefits, would reduce premiums for the young and decrease the number of uninsured.

9. The primary care shortage is real and growing because medical students are smart and are not choosing to work twice as long as specialists at 1/2 the pay; doubling Medicare pay for primary office visits would be a good start for relieving the crisis.

10. The surest way to reduce costs is having patients spend more of their own money and making them more responsible for their health, which is the premise of lower-premium health savings accounts and high deductible plans.

Radiological images of Morgagni's Hernia

A 41-year-old woman was evaluated for a 5-month history of dyspnea and cardiac arrhythmia. Chest radiography revealed an enlarged right mediastinum with air content on the right side (Panel A, arrow; and Panel B, lateral view). Thoracic computed tomographic (CT) scans showed a Morgagni's hernia, characterized by an anteromedial diaphragmatic defect, with herniation of the transverse colon and part of the omentum into the thorax (Panels C and D).

CT scans also showed that the bowel contents were compressing the right side of the heart.
Morgagni's hernias are secondary to congenital defects in the anterior diaphragm. The hernia sac frequently contains the transverse colon with the omentum; more rarely, the stomach, small bowel, or liver is involved. The patient's hernia was laparoscopically reduced , and the diaphragmatic defect was repaired with a composite mesh. Postoperatively, the patient's symptoms resolved. Follow-up thoracic CT confirmed the absence of bowel contents in the thorax.

Ultrasound guided Femoral Nerve stimulating Catheter

Insertion of continuous stimulating femoral nerve catheter

job hazards in Lung Cancer

As we know cigarettes are the most important cause of lung cancer,But chemicals and other on-the-job hazards "play a remarkable role" in lung cancer risk.

5% of lung cancers in men are job-related. Men in the known to be risky occupations were 74% more likely to have been diagnosed with lung cancer.

The strongest associations were seen for ceramic and pottery jobs and brick manufacturing, as well as for those working in manufacturing of non-iron metals.

A Chest X-Ray shows a right upper lobe (RUL) mass due to lung cancer.

What is Absence of the Septum Pellucidum?

The septum pellucidum (SP) is a thin membrane located at the midline of the brain. Children who are born without this membraine and also have other abnormalities--pituitary deficiencies and abnormal development of the optic disk--have a disorder known as septo-optic dysplasia.

Is there any treatment?
Absence of the SP alone is not a disorder but is instead a characteristic noted in children with septo-optic dysplasia.

SO,What is Septo-Optic Dysplasia?

Septo-optic dysplasia (SOD) is a rare disorder characterized by abnormal development of the optic disk, pituitary deficiencies, and often agenesis (absence) of the septum pellucidum (the part of the brain that separates the anterior horns or the lateral ventricles of the brain). Symptoms may include blindness in one or both eyes, pupil dilation in response to light, nystagmus (a rapid, involuntary to-and-fro movement of the eyes), inward and outward deviation of the eyes, hypotonia , and hormonal problems. Seizures may also occur.
In a few cases, jaundice may occur at birth. Intellectual problems vary in severity among individuals. While some children with SOD have normal intelligence, others have learning disabilities and mental retardation. Most, however, are developmentally delayed due to vision impairment or neurological problems.

This Figure shows severity of classical triad of SOD
(i) optic nerve hypoplasia, (ii) pituitary hormone abnormalities and (iii) midline brain defects

How to take a History of hand & wrist joint

When taking the history of a hand problem, consider:

* pain:

o pain from the hand may be felt in the fingers or palm

o a diffuse ache may be referred from the neck, shoulder or mediastinum

* deformity:

o as well as providing function the hand is also of great cosmetic importance

o deformity may occur acutely e.g. due to tendon rupture, or slowly due to bone or joint pathology

* swelling:

o symmetry and pattern of joint involvement may be diagnostic

* function:

o the patient may be unable to grasp doorknobs, turn keys or do buttons up

The history of the wrist joint should cover the following areas:


* often well localised in the wrist indicating particular disorders


* may be noticed only when severe


* either of the joint or tendon sheaths


* except in trauma, this is usually a late symptom

Easy carpal bones mnemonic:

Toronto Notes Atlas CD

An excellent software CD accompanying the Toronto Notes Books.
This CD contains 16 different Chapters (Anesthesia and Peri-operative medicine, Cardiac & Vascular Surgery, Dermatology, Endocrinology, Gastroenterology, Geriatric Medicine, Gynecology, Hematology, Infectious Diseases, Nephrology, Neurosurgery, Ophthalmology, Otolaryngology, Pediatrics, Plastic Surgery and Rheuatology).
There is no need to install this CD. Just download it with the given links below and it will open in your browser. Along with this, an extremely helpful Functional Neuroanatomy software is also included that installs quickly and provides great audio-visual knowledge (No need of CD ROM).

For Download :
Part 1.......Here
Part 2.......Here
Part 3.......Here
Part 4.......Here

SPSS 10.0 for Windows Student Version

For use in any course where use of a statistical software package is desired. SPSS brings affordable, professional statistical analysis and modeling tools right to a student’s own PC. Based on the professional version of one of the world’s leading desktop statistical software packages, SPSS 10.0 for Windows Student Version includes an easy-to-use interface and comprehensive on-line help that enables students to learn statistics, not software. An arsenal of robust features, including time series, allows for even the most complex analysis. System Requirements –Microsoft Windows 95/98 or NT 4.0 –586DX or better IBM-compatible PC –68MB hard disk space –32MB RAM minimum –32MB virtual memory –SVGA monitor –Windows-compatible mouse.
To Get It :

Small-Bowel Intussusception

A previously healthy 22-year-old man presented with a 3-month history of intermittent abdominal pain and hypochromic microcytic anemia, with a hemoglobin level of 5.1 g per deciliter and a mean corpuscular volume of 75 µm3.

Initial endoscopy of the upper and lower gastrointestinal tract was unremarkable, despite a positive test for fecal occult blood. Further investigation with video-capsule enteroscopy showed an intraluminal bulge within the proximal jejunum 77 minutes after ingestion of the capsule. Six days later, the patient presented with abdominal pain, nausea, and vomiting. Computed tomography showed the presence of an intussusception (arrow).

On emergency laparotomy, a proximal jejunojejunal intussusception was found and resected. Pathological examination revealed that the leading edge of the intussusception was a pedunculated benign lipomatous polyp. At a follow-up visit 2 months later, the patient was free of pain and had no further signs of bleeding.

18% tax on pizza and soda can decrease U.S adult`s weight by 5 bounds(2 kg)/year

From Reuters:

With two-thirds of Americans either overweight or obese, policymakers are increasingly looking at taxing as a way to address obesity on a population level.

"Sadly, we are currently subsidizing the wrong things including the product of corn, which makes the corn syrup in sweetened beverages so inexpensive."

Instead, the agricultural subsidies should be used to make healthful foods such as locally grown vegetables, fruits and whole grains less expensive.

Why does a CT scan cost so much in USA? (billions dollars on Defensive Medicine)

It started as a simple stomach ache, but Alexandra Varipapa, a sophomore at the University of Richmond, decided to go to the emergency room.

There, doctors ordered a full CT scan, a radiation imaging test, which found a harmless ovarian cyst. She never questioned the CT scan, CBS News correspondent Wyatt Andrews reports.

But her father did - when he got the $8,500 bill, $6,500 of which was that CT scan.

“I was pretty flabbergasted,” said Robert Varipapa, himself a physician.

Varipapa says his daughter's pain could have been diagnosed far more easily and cheaply with a $1,400 ultrasound.

“A history, a pelvic examination and probably an ultrasound,” he said. And he would have started with the ultrasound.

But the hospital defends the CT scan, saying an ultrasound might have missed something more serious.

“It would not have ruled out appendicitis obviously, it would not have ruled, necessarily, out a kidney stone,” said Dr. Bob Powell, ER medical director of Bon Secours St. Mary’s Hospital.

Varipapa agrees, but asks why not start simple - and do the CT scan only if necessary?

“Well it's my opinion this is defensive medicine,” Varipapa said.

Defensive medicine is what happens when doctors order too many tests because they are afraid of missing a diagnosis and later losing a multi-million dollar lawsuit for malpractice. Defensive medicine these days is so pervasive, some estimate its yearly cost at more than $100 billion.

Dr. Kevin Pho runs the popular medical blog, Kevin M.D., where doctors routinely confess exactly how they run up costs by practicing defensive medicine.

“Defensive medicine is bad medicine,” Pho said.

In a post, one ER doctor says he's just admitted two patients to the hospital - when he was sure "neither was having cardiac (problems), but what am I to do?"

Another admits that in his practice, “every patient with a headache gets a (CT) scan.”

“It's much easier to defend the fact that you ordered a test than it is to not order the test at all,” Pho said.

And the costs of defensive medicine today are increasingly paid by patients, even those with insurance - because of rising deductibles and co-payments.

“There’s no doubt in my mind this is a significant driver in health care costs today,” Pho said.

Source : CBS News

Not the Best, Only the Most Expensive

Money-Driven Medicine provides the essential introduction you need to become knowledgeable and vigorous participants in healthcare reform.Americans spend two times more per capita for healthcare than the average rich country, one-sixth of the GDP.
"Money-Driven Medicine" reveals that the profit-driven "medical-industrial complex" has over-built the healthcare sector producing a powerful, distorting incentive for billions of dollars of pointless, even risky, tests, prescriptions and surgeries. This pay-per-service system drives doctors into lucrative specialities, while primary care physicians have become an endangered species. Million dollar diagnostic machines stand idle while emergency rooms overflow.

Causes of Calcified Liver Masses on CT

1- Inflammatory hepatic lesions

oMost common cause of calcified hepatic lesions

. Inflammatory conditions

  • For example, granulomatous diseases (tuberculosis).
  • Calcification involves entire lesion
  • Appears as a dense mass
. May produce artifacts on CT scans

o Echinococcus cysts have curvilinear or ring calcification

. Central water density in cyst

2- Benign neoplasms

o Hemangiomas, especially large ones, may contain large, coarse calcifications; may be seen at CT in 20% of cases or radiography in 10%

3- Malignant liver neoplasms

o Hepatocellular adenoma

. Calcifications may be solitary or multiple

. Usually located eccentrically within complex heterogeneous mass.

o Fibrolamellar carcinoma

. Calcifications reported in 15%-25% of cases at CT

. Occurs in many patterns

o Intrahepatic cholangiocarcinoma

. Calcifications are typically accompanied by a desmoplastic reaction

. Visible at CT in about 18% of cases.

o Calcified hepatic metastases

. Most frequently associated with mucin-producing neoplasms such as colon, or less likely ovarian, carcinoma

Calcified liver and peritoneal metastases from ovarian carcinoma

Medical malpractice from both a doctor and lawyer perspective,and Payment receiving

Medical malpractice is a major issue that divides doctors and lawyers — with patients often left in the middle. reform is sorely needed, mainly to help injured patients be compensated more quickly and fairly than they currently are:

Researchers from the New England Journal of Medicine found that nearly one in six cases involving patients injured from medical errors received no payment. For patients who did receive compensation, they waited an average of five years before their case was decided, with one-third of claims requiring six years or more to resolve. These are long waits for patients and their families, who are forced to endure the uncertainty of whether they will be compensated or not.

And with 54 cents of every dollar injured patients receive used to pay legal and administrative fees, the overhead costs clearly do not justify this level of inefficiency.

In this clip, perspectives from both sides are given, and it’s easy to see why this contentious issue isn’t going to be resolved anytime soon.

Appendicitis in CT

Specific CT scan findings of appendicitis include enlargement of the appendix ( more than 6 mm in the outer diameter), enhancement of the appendiceal wall, lack of opacification in an enlarged appendix, fat stranding in the periappendiceal region, and the presence of an appendicolith within the appendix.

Funny medical photos 1

Carpal bones mnemonic

Some Lovers Try Positions That They Can't Handle

  • S - Scaphoid
  • L - Lunate
  • T - Triquetral
  • P - Pisiform
  • T - Trapezium
  • T - Trapezoid
  • C - Capitate
  • H - Hamate

Proximal: A=Scaphoid, B=Lunate, C=Triquetral, D=Pisiform
Distal: E=Trapezium, F=Trapezoid, G=Capitate, H=Hamate

Burkett's lymphoma pic

Differential Diagnosis of bile duct dilatation

Whenever there is bile duct dilatation, the first priority is to look for obstruction.


If there is an obstruction, we first look for gallstones in the bile duct. If there are no gallstones involved, we then look for strictures.

The differential diagnosis for a stricture is based on the location.

* A distal stricture is most likely the result of a distal cholangiocarcinoma, pancreatic carcinoma or pancreatitis.

* A stricture within the liver is likely due to gallbladder carcinoma or inflammatory strictures like PSC (Primary Sclerosing Cholangitis) or AIDS cholangiopathy.

* Metastatic disease can occur anywhere within the bilairy system.

No Obstruction

Once we have excluded obstruction, we have to think about nonobstructive biliary diseases like:

* Caroli disease

* Choledochal cyst

* Recurrent pyogenic cholangitis

* Primary sclerosing cholangitis

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