Kronig's isthmus and Traube's space

Kronig's Isthmus is a band of resonance representing lung apex. It may also be remembered as the supraclavicular region.
Boundaries: Medially: Scalene
                    Laterally: Acromion process
                    Anteriorly: Clavicle
                    Posteriorly: Trapezius

Impaired dullness: Fibrosis, Upper Lobe Collapse and Mass
Hyperresonant: Emphysema, Hydropneumothorax

Traube's Space boundaries:
Superiorly: 6th rib
Laterally: Mid axillary line
Medially: Left costal margin

Dullness: Splenomegaly, Full stomach, Left Pleural Effusion, Carcinoma involving gastric fundus, Enlarged left lobe of liver, Achalasia cardia

Percussion myokymia

In a chronically wasted individual as in pulmonary tuberculosis, a percussion stroke close to sternum on the front of the chest, may cause a transient twitching of the muscle which is more marked on the side of the pulmoary affection.

Coin Test

Coin test:
Ask an assistant to put a coin on the anterior chest wall and strike the coin by another coin. Simultaneously auscultate using your stethoscope on the posterior chest wall. If you hear a bell like sound, it's due to pneumothorax.

Youtube video here.

A day to learn

I am currently on my medicine rotation and we have a fixed routine. Every morning we have a case discussion by first year residents, then ward rounds and then an evening class where we take a case by rotation. There are many things that I have learnt in these past two weeks and my recent posts have been about what I have gained from these classes and not found in textbooks. It's like my personal way of bookmarking and access it from wherever I want to and you guys can benefit from it too.

Today, instead of the usual history taking and examination we just looked at some findings in different patients, We finally palpated a liver and a spleen and again a liver (but this time by dipping method). It just bounces right back at your fingers. YES!

We also palpated a supraclavicular lymph node. And we saw swan neck deformity. And. And. We saw spider nevi. It's not as big as it looks in the books. It looked like a small red papule.

Today was one of the days where I wanted to see more. Feel more. Know more. Not read. But experience. Aah! I love such days.

Barrel Chest Anatomy/ Features

What are the features of a barrel shaped chest?

AP:Transverse :: 1:1

Anteriorly:

• Supraclavicular fossa is prominent
• Angle of Louis is prominent
• Cricosternal distance is reduced
• Obtuse subcostal angle  (due to horizontal placement of ribs)

Posteriorly: Kyphosis

Laterally:

• Ribs are horizontal
• Intercostal space widen
• Intercostal indrawing

SLE Mnemonic

@MD SOPHARINA

Malar Rash
Discoid Rash
Serositis (Pleuritis and Pericarditis seen as rub and effusion)
Oral Ulcer
Photosentitivity
Hematological (Hemolytic anemia, Leukopenia <4000/uL, Lymphopenia <1000/uL, Thrombocytopenia <100000/uL)
ANA
Renal (Proteinuria >0.5g/day or 3+ in dipstick)
Immunological (Anti ds DNA, Anti Sm Antibodies)
Neurological (Seizures, Psychosis without any other cause)
Arthritis (2 or more peripheral joints)

Additional features:
Raynaud's phenomenon
Jaccoud arthropathy
Livedo reticularis

Cranial Nerve Nuclei Mnemonic

CeMi Pons Medu
2   2   4       4

Cerebellum   Cranial nerves 1, 2 lie in the cerebellum
Midbrain       CN 3, 4
Pons              CN 5, 6, 7, 8
Medulla        CN 9, 10, 11, 12

I know this wasn't exactly a mnemonic. In case this didn't help you, here's a bonus link: Brainstem Rules of 4 (for the gunners)

Upper Motor Neuron Lesion Mnemonic

In UMN lesion, there is hypertonia. The tone is increased in the extensors of lower limbs and flexors of upper limbs.

LEG: Legs Extensors Greater tone

Uremia Symptoms Mnemonic

NAWAB PEG
Nausea/ Vomiting
Anorexia
Weakness/ Fatigue
Acidosis
Bleeding

Pruritus
Encephalopathy
Gastritis

Mitral Stenosis X- Ray Findings

Radiological signs seen in mitral stenosis are:

§  Backward displacement of esophagus by enlarged left atrium (in lateral view X-ray). Also the earliest sign.

§  Straightening of left heart border due to enlarged left atrium.

§  Double shadow due to enlarged left atrium. Dense right atrial shadow superimposed within fainter left atrial shadow that touches the diaphragm.

§  Splaying of carina (The left main bronchus is lifted up by the enlarged left atrium)

§  Prominent upper zone pulmonary veins (Inverted moustache sign /  Antler’s horn sign / Cephalisation pulmonary of blood flow)

§  Enlarged pulmonary trunk (This occurs following the development of pulmonary hypertension)

§  Kerley B lines (indicating fluid collection in the interlobular septa. 1-2 cm in length lines in lung peripheries perpendicular to and extend out to pleural surfaces.)


NOTE: Here is a chest radiograph exhibiting classic findings of chronic mitral stenosis.

Are you interested in knowing the Peripheral signs in Aortic Regurgitation? Click here.

Causes of Cyanotic Heart Disease

Causes of Cyanotic Heart Disease: the five "terrible T's" and one "S"
1. Transposition of the great vessels
2. Total anomalous pulmonary venous return
3. Tetralogy of Fallot
4. Truncus arteriosus
5. Tricuspid atresia
6. Severe pulmonic stenosis

Causes of common drops

Wrist drop : Radial Nerve
Foot drop : Common Peroneal nerve
Eyelid Drop : Trigeminal nerve
Uvula drop : Vagus nerve
Shoulder drop/ upper limb (whole) drop : Brachial Plexus Injury
Lower limb drop (whole) : Sciatic nerve injury

Ectopia lentis

Ectopia lentis (Dislocation of lens) is seen in Marfans syndrome & Homocystinuria , but in one the dislocation is up (and outward) while in the other it goes down (and inward).
Remember that " urine goes down and into closet ". So lens get displaced down and inward in Homocysteinuria. And lens get displaced up and outward in Marfans syndrome (Opposite of above).

Blood disorders: Male vs Female

HE (male) gets:
HEmophilia (X-linked)
HEinz bodies (G6PD deficiency, causing HEmolytic anemia: X-linked)
HEmochromatosis ­ (male predominance)
HEart attacks (male predominance)
HEnoch-Schonlein purpura (male predominance)

SHE (female) gets:
SHEehan's syndrome

Bronchiectasis: Causes

A SICK AIRWAY

Airway lesion (chronic obstruction)
Sequestration
Infection, Inflammation
Cystic fibrosis
Kartagener's syndrome
Allergic bronchopulmonary aspergillosis
Immunodeficiencies (myeloma, lymphoma, hypogammaglobinemia)
Reflux inhalation injury
Williams Campbell Syndrome
Aspiration
Young's Syndrome

Alzheimer's disease: Features

RONALD (In memory of Ronald Readen, former US president. who was victim of AD)

Reduction of acetylcholine
Old Age
Navigational difficulties, Neurofibrillary tangles
Atrophy of cerebral cortex
Language impairment
Dementia

Android M.B.B.S. Apps

As a medical student 15 years ago, the student's "peripheral brain" consisted of fat textbooks sitting on office bookshelves or smaller, spiral-bound references stuffed into the bulging pockets of their lab coat. These were then replaced with programs loaded onto PDAs. Today, smartphone apps allow health professionals at all levels to access the most up-to-date medical resources such as drug references, disease-risk calculators, and clinical guidelines—anytime, anywhere.

If you don't have an Iphone. Well, you don't have an Iphone.

But,I have an android. :D Catching up with the android rage, I tried many android apps on my Samsung Galaxy. I got some  free apps for medical students , which I personally found to be useful in some context or the other.

1.  Dorland's Medical Dictionary

It is the most comprehensive dictionary containing approximately 40,000 entries and 350 illustrations and provides authoritative, concise definitions for a wide range of terms used in the health sciences. Though the free app is a trial version, you can uninstall and re-install the app after the 7 days of trial period.

2. Medscape

It is a great drug reference app and also a mini-textbook packed with protocols for disease pathology, great for a quick reference and refreshing you medical knowledge. The application contains 7,000+ drug references, 3,500+ disease clinical references, 2,500+ clinical images and procedure videos, robust drug interaction tool checker, CME activities, and more. I am in love with this app. It's the best and a must have!

3. Eponyms
These are the people who discovered a disease, pioneered a treatment, or invented a test, and later had their work named after them. In offline mode, a little info about the eponym is given. If you have data connectivity, you can look up details in google or wikipedia.

4.Skyscape

It is an all-in-one high-quality app, available on all Android OS versions. For users of older Android versions, skyscape is a fair replacement for Medscape. RxDrugs, Archimedes (Medical Calculator), Outlines in Clinical Medicine and MedAlert are available for free.

5. Evernote

It is a great organization tool which allows you to access and read your PDF documents on the go. Adding pictures to notes is an additional amazing feature which can help keep track of notes for future reference. Above all, you can sync these notes across computers and other devices you use.

6. Med Mnemonics Lite
The free version contains mnemonics of Anatomy, Pharmacology, Internal Medicine and Cardiology. I'm not sure if the paid app is worth the price though.

7. Wikidroid
I don't care what the health information librarians say, wiki is still an easy and quick way to look up answers. User friendly interface- quick and easy navigation. Save page for offline viewing feature.

Edit: For people like me who absolutely need mnemonics to remember certain things you could try using scrabble word finder to quickly make up the mnemonic. I enter the first alphabet of the points I need to remember and then select the word I am familiar with out of the given options. Obviously, this helps more when you have more vowels. Now you can save your precious time at least a few times!

If you have any other app that you find useful, leave a comment below and help others!