CPAS

Circumferential pelvic anti-shock sheeting. A. A sheet is placed under the pelvis. B. The ends are brought together anteriorly. C. Hemostats are used to secure the sheet snugly.

* A simple method for obtaining temporary pelvic stabilization when an external fixator cannot be applied is the application of a circumferential pelvic anti-shock sheet (CPAS).
* Advantages of this technique include the fact that it is inexpensive and readily available in all EDs. Special training is not required and the emergency physician can apply the sheet. Lower extremity and abdominal access is maintained after the sheet is placed.
* Caution is required in patients with lateral compression pelvic ring injuries or sacral neuroforaminal fractures. Forceful or aggressive CPAS application could worsen visceral injury or sacral nerve root injury in these instances.

SLUG BAM: Muscarinic effects of Acetylcholine

Acetylcholine acts on two vastly different classes of receptors - nicotinic receptors (with two subtypes, one at the neuromuscular junction of skeletal muscle, the other within ganglia and the CNS), and muscarinic receptors (widely distributed within both peripheral and central nervous systems).

**Muscarinic effects SLUG BAM:

• Salivation/ Secretions/ Sweating
• Lacrimation
• Urination
• Gastrointestinal upset
• Bradycardia/ Bronchoconstriction/ Bowel movement
• Abdominal cramps/ Anorexia
• Miosis

Surface anatomy of the Stomach

The cardiac orifice is opposite the 7th left costal cartilage about 2.5 cm. from the side of the sternum; it corresponds to the level of the tenth thoracic vertebra.
The pyloric orifice is on the transpyloric line about 1 cm. to the right of the middle line, or alternately 5 cm. below the 7th right sternocostal articulation; it is at the level of the first lumbar vertebra.
A curved line, convex downward and to the left, joining these points indicates the lesser curvature. In the left lateral line the fundus of the stomach reaches as high as the 5th interspace or the 6th costal cartilage, a little below the apex of the heart.

To indicate the greater curvature a curved line is drawn from the cardiac orifice to the summit of the fundus, thence downward and to the left, finally turning medialward to the pyloric orifice, but passing, on its way, through the intersection of the left lateral with the transpyloric line. The portion of the stomach which is in contact with the abdominal wall can be represented roughly by a triangular area the base of which is formed by a line drawn from the tip of the 10th left costal cartilage to the tip of the 9th right cartilage, and the sides by two lines drawn from the end of the 8th left costal cartilage to the ends of the base line.

Note That: This measurements given refer to a moderately filled stomach with the body in the supine position !!!  Why we say that.........
As The shape of the stomach is constantly undergoing alteration; it is affected by the particular phase of the process of gastric digestion, by the state of the surrounding viscera, and by the amount and character of its contents. Its position also varies with that of the body.

With the patient in the erect posture.

With the patient lying down.

A case of Scabies

A35-year-old woman presents with a pruritic rash that has been present over the last few weeks. The area affected is in the webs of the fingers, and symptoms are reported to be worse at night. Topical over-the-counter steroids have not been beneficial. The likely diagnosis is:

• A)poison ivy
• B)dyshidrotic eczema
• C)scabies
• D)tinea corporis
• E)psoriasis

The answer is ( C ). (Scabies) 
The condition of scabies is associated with intense pruritus that is noted predominantly at night. The lesions are brownish in color and often form irregular burrow lines that may be marked with scaling at one end and a vesicle at the other end. The lesions are typically found in intertriginous areas and warm, protected areas such as the finger webs, inframammary areas, and axilla. The mite Sarcoptes scabei is responsible. Scrapings of the lesion are treated with 10% potassium hydroxide solution and studied under light microscopy. The mite is often identified. Treatment consists of permethrin cream 5% applied from head to toes and left in place for 12 hours before being washed off. Lindane can also be used as an alternative, but not in infants or in pregnant women.

Diagram for Liver relations

Amniotic band sequence

Amniotic band sequence is a disruption sequence with a broad spectrum of clinical manifestations (The frequency is comprised between 1/1200 to 1/15 000 births) it is ranging from partial amputations to major craniofacial and limb-body wall defects.

This amniotic bands are the result of adhesions between the amnion and embryonic or fetal parts. Their . Amniotic bands cause masive malformations with limb amputations, sever abdominal or cranial wall defects. Two different theories have been proposed: constrictive amniotic bands secondary to early amnion rupture, and vascular disruption events.

The anomalies are characteristically asymmetrical and usually prediposed by:
- familial predisposition
- amniocentesis

Associations:
- short umbilical cord
- early amnion rupture-oligohydramnios disruption (EAROD)
- amniotic deformity-adhesion mutilation (ADAM)

EX: limb anomalies

•  intrauterine amputations
•  limb constriction rings
•  pseudosyndactyly
•  club feet
•  abnormal dermatoglyphs

This term infant was born with foot and finger anomalies resulting from amniotic bands.

The Wonders of Fetal Circulation-Amazing video

Fetal Circulation & Changes After Birth
*The superior vena cava enters the right atrium (not right ventricle as mentioned/labeled)*

CN 3 Palsy (Oculomotor nerve Palsy)

Right CN3 Palsy: Patient's right eye is deviated laterally, there is ptosis of the lid, and the right pupil (the 2nd picture) is more dilated than the left.
FOR MORE INFORMATION: CLICH HERE

Causalgia

DEFINITION: A syndrome of sustained burning pain after a traumatic nerve injury combined with vasomotor and sudomotor dysfunction and later trophic changes.


Causalgias are divided into two forms:
1. Causalgia major involves peripheral nerve injury with electrical "crosstalk" (ephapse) that causes severe hyperactivity of sympathetic system (hyperpathia, vasoconstriction, and movement disorder). The major form is severe, usually caused by injury with high velocity sharp objects (e.g., butcher's knife), vibratory component major trauma (e.g., bullet), or high-voltage nerve lesions (electrocution).

2. Causalgia minor involves the same principle as causalgia major, but milder injury, e.g., injury to the dorsum of hand or foot, nerve root contusion, patient falling from a height on gluteal region resulting in "guillotine" effect, bruising of nerve root caught at the narrowed intervertebral foramen.

SO,The difference between the two categories is a matter of degree and severity. To classify causalgia as an independent illness is artificial, and causalgia is nothing but a sever form of RSD(Reflex Sympathetic Dystrophy ).

In this severe form of RSD, the course of the disease is quite accelerated from stage 1 through 4 in a matter of weeks or months. S. Weir Mitchell in 1872 first reported rapid development of atrophic changes in the skin, nails, and soft tissues of the extremity in a matter of days to weeks.
Whereas in RSD of disuse the extremity is cold, in ephaptic dystrophy the thermography reveals in the distal portion of the extremely cold extremity that there is an isolated hot spot that points to the area of scar formation and ephaptic peripheral nerve dysfunction . In this area the vasoconstrictive capability of the sympathetic nerve is paralyzed, and there is a topical hot spot. This hot spot can be appreciated only by thermograph.

CAUSALGIC PAIN:
- Usually pain occurs after the injury to a nerve trunk.
- The pain is spontaneous, severe, and quite persistent.
- There is a markedly lowered threshold for aggravation of pain. This is the case in all RSD patients, but it is more exaggerated in causalgics. So even a breeze over the skin or the touch of a bed sheet or a change of the environment or a family argument and aggravation can markedly aggravate the pain. This feature of emotional aggravation is common to all RSD patients, and it is nothing but the role of the frontal lobe and the limbic system in aggravation of hyperpathic pain.
- The pain is felt distal to the proximal nerve injury, i.e., in the hand or foot. This is typical but not invariable. The pain does not necessarily have to be a burning type of pain, and can be described in many other hyperpathic forms.

Mallampati test

To try to identify patients who will prove difficult to intubate.The patient sits in front of the anaesthetist and opens the mouth wide.
The patient is assigned a grade according to the best view obtained.

View obtained during Mallampati test:
1. Faucial pillars, soft palate and uvula visualised
2. Faucial pillars and soft palate visualised, but uvula masked by the base of the tongue
3. Only soft palate visualised
4. Soft palate not seen.

Clinically, Grade 1 usually predicts an easy intubation and Grade 3 or 4 suggests a significant chance that the patient will prove difficult to intubate.

The results from this test are influenced by the ability to open the mouth, the size and mobility of the tongue and other intra-oral structures and movement at the craniocervical junction.

Alvarado Score In Appendicitis

Separation Anxiety Disorder: Diagnosis &Treatment

Grading for pressure ulcers

A stage 3 pressure ulcer is best described by which of the following?

• a.The skin is red but not broken
• b.There is damage through the epidermis and dermis
• c.There is damage through to the subcutaneous tissue
• d.The ulcer involves muscle
• e.The ulcer involves bone

The answer is  (C)
The grading for pressure ulcers is as follows:
Stage 1 = The skin is red but not broken

Stage 2 = Damage through the epidermis and dermis

Stage 3 = Damage through to the subcutaneous tissue

Stage 4 = Muscle and possible bone involvement

Acromegaly

Acromegaly 1

Acromegaly 2
Facial changes secondary to elevated growth hormone levels. Note in particular
prominent supra-orbital ridge, jaw, and generally enlarged facial features.

FOR MORE IFORMATION:
CLICK HERE

Caplan Syndrome (Coal worker's)

Posteroanterior radiograph shows a multitude of fairly well-circumscribed nodules and masses ranging in diameter from 1 to 5 cm, scattered randomly throughout both lungs with no notable anatomic predilection. No cavitation is apparent, and there is no evidence of calcification.

This patient, a 56-year-old man, had been a coal miner for many years and in recent years had developed arthralgia, which proved to be due to rheumatoid arthritis. As a means of establishing the nature of the pulmonary nodules, a percutaneous needle aspiration was performed on the large mass situated in the lower portion of the left lung (arrowheads): Several milliliters of inky black fluid were aspirated.

Mnemonic for Causes of Pancreatitis

A common mnemonic for causes of Pancreatitis " I GET SMASHED ",an allusion to heavy drinking(one of the many causes)


-I: idiopathic
-G: gallstone; Gallstones that travel down the common bile duct and which subsequenly get stuck in the Ampulla of Vater can cause obstruction in the outflow of pancreatic juices from the pancreas into the duodenum.The backflow of these digestive juices causes lysis of pancreatic cells and subsequent pancreatitis.
-E: ethanol (alcohol)
-T: trauma
-S: steroids
-M: mumps (paramyxovirus)and other viruses as(Epstein-Barr virus & cytomegalovirus)
-A: autoimmune disease; as polyarteritis nodosa & systemic lupus erythromatosis.
-S: scorpion sting-Tityus Trinitatis-Trinidad / snake bite.
-H: hypercalcemia,hyperlipidemia,hypertriglyceridemia and hypothermia.
-E: ERCP (Endoscopic Retrograde Cholangio Pancreatograpgy)
-D: drugs; (SAND-steroids&sulfonamids,azathioprine,NSAID,diuretics such as furosemide and thiazides & didanosine) and duodenal ulcers

USMLE ALGORITHMS: Upper GI Bleeding

This Video Algorithm is going to discuss Upper GI Bleeding. Topics included:

- Mallory Weiss
- Boerhaave's Syndrome
- Esophageal Varices

We will be discussing the presentation of Upper GI bleeding, as well as the full management.

Paget's disease of the Mandible

A 55-year-old man presented with a 2-year history of painful jaw enlargement and progressively ill-fitting dentures. He had no headaches or visual-field defects and did not have hyperhidrosis, oily skin, glucose intolerance, heart failure, or an increase in glove or shoe size.

The entire mandible was enlarged bilaterally to the angle of the jaw (Panels A and B), with marked misalignment of the upper and lower teeth. The serum level of insulin-like growth factor I was normal at 15.2 nmol per liter (normal range, 9 to 40), but levels of serum alkaline phosphatase and bone-specific alkaline phosphatase were elevated (154 IU per liter [normal level, <120] and 92 IU per liter [normal range, 15 to 41], respectively).

A bone scan revealed increased uptake of radionuclide in the jaw (Panel C); no other bones were involved. A mandibular biopsy confirmed the diagnosis of Paget's disease; there was no evidence of osteosarcoma.

Treatment with a bisphosphonate normalized the serum level of alkaline phosphatase. Earlier diagnosis and treatment might have limited further mandibular hypertrophy and pain, which the patient had for some time.

propofol infusion syndrome: a simple name for a complex syndrome.

It was revealed just recently that Propofol, a short-acting, intravenously administered sedative agent is what might have caused the cardiac arrest of the King of Pop, Michael Jackson.

Propofol infusion syndrome (PRIS) is a rare and often fatal syndrome described in critically ill children undergoing long-term propofol infusion at high doses. Recently several cases have been reported in adults, too.

The main features of the syndrome consist of cardiac failure, rhabdomyolysis, severe metabolic acidosis and renal failure.
To date 21 paediatric cases and 14 adult cases have been described. These latter were mostly patients with acute neurological illnesses or acute inflammatory diseases complicated by severe infections or even sepsis, and receiving catecholamines and/or steroids in addition to propofol. Central nervous system activation with production of catecholamines and glucocorticoids, and systemic inflammation with cytokine production are priming factors for cardiac and peripheral muscle dysfunction. High-dose propofol, but also supportive treatments with catecholamines and corticosteroids, act as triggering factors.

At the subcellular level , propofol impairs free fatty acid utilisation and mitochondrial activity. Imbalance between energy demand and utilisation is a key pathogenetic mechanism, which may lead to cardiac and peripheral muscle necrosis. Propofol infusion syndrome is multifactorial, and propofol, particularly when combined with catecholamines and/or steroids, acts as a triggering factor.
The syndrome can be lethal and we suggest caution when using prolonged (>48 h) propofol sedation at doses higher than 5 mg/kg per h, particularly in patients with acute neurological or inflammatory illnesses. In these cases, alternative sedative agents should be considered. If unsuitable, strict monitoring of signs of myocytolysis is advisable.

USMLE ALGORITHMS: DIABETES MELLITUS Type 1 and 2

This video clip is going to discuss Diabetes Type 1, and Type 2:
-The diagnosis, symptoms, management, complications, and management of complications
Topics that will be covered:
-Symptomology
-Diagnosis
-Treatment
-Long term Management of Disease
-Complications and Management of Complications: - DKA - HONK
-CCS Hits for DKA

Internal Birth Control (IUDs)

Bicipital Groove

The bicipital groove is an osseous groove formed in the humeral head by the medial and lateral tuberosities. It serves to retain the long head of the biceps brachii. In this project, we investigate the relationship between the 3D shape of the bicipital groove and the incidence of pathology of the long biceps tendon.


Bicipital groove segmentation from CT data.


Two views of a humeral head extracted from MRI, with the bicipital groove indicated.

Drugs administered in Status Epilepticus

A 21 year old is brought to your clinic in status epilepticus. What drug should be administered initially?

• A) Lorazepam


• B) Phenytoin


• C) Phenobarbital


• D) Pentobarbital


• E) Fosphenytoin

Answer and Discussion
The answer is A. Lorazepam should be administered intravenously and approximately 1 minute allowed to assess its effect. Diazepam or midazolam may be substituted if lorazepam is not available. If seizures continue at this point, additional doses of lorazepam should be infused and a second intravenous catheter placed in order to begin a concomitant phenytoin (or fosphenytoin) loading infusion. Even if seizures terminate after the initial lorazepam dose, therapy with phenytoin or fosphenytoin is generally indicated to prevent the recurrence of seizures.

Elbow ossification centers mnemonic in a child

CRITOE

• C: Capitellum


• R: Radial head


• I: Internal (medial) epicondyle


• T: Trochlea


• O: Olecranon


• E: External (lateral) epicondyle

* CRITOE is the order in which the ossification centers of the elbow appear.

Note that:- Ossification centers may be mistaken for fractures on x-ray.
Example:
If you see only three accessory bony fragments about an elbow joint, these bony pieces should be in the areas of the capitellum, radial head and the internal (medial) epicondyle. If one of the three bony fragments is in the area where you would expect to see the external epicondyle, then that piece actuallyrepresents an avulsion fracture of the distal, lateral humerus, rather than a normal external epicondyle.

* General rule of thumb for the time of appearance of the ossification centers is "1-3-5-7-9-11," which are the ages in years that the ossification centers appear, corresponding to the CRITOE.

Ear Wash System by Welch Allyn

Designed with safety in mind, the Welch Allyn Ear Wash System includes several built-in features that reduce side effects associated with other ear irrigation devices - including vertigo, nausea, deeper cerumen impaction, perforated ear drums, and other tympanic membrane damage.


What makes the Welch Allyn Ear Wash System truly revolutionary is its built-in Hydrovac Action. This proprietary technology features simultaneous irrigation and suction capabilities, which means all discharge is directed away from you and the patient. And since you can easily control and monitor suction, water temperature, and pressure levels, the Ear Wash System is ideal for patients of all ages. What's more, it comes with over ten feet of clear, heavy-duty plastic tubing that lets you position the patient almost anywhere in the room, as well as visualize the process.

Syringomyelia

Syringomyelia is a disease in which fluid-filled cavities, often referred to as syrinxes, form within the spinal cord. These syrinxes typically persist at abnormally high pressure which causes progressive neurological symptoms as they expand and elongate over time, compressing the surrounding nerve fibres from within. Since the spinal cord connects the brain to nerves in the extremities, this damage may result in :
Typical:– 1) “central cord syndrome” with pain and sensory loss in upper extremities 2) sensory loss to patient feels like a cape has been placed on back of neck, shoulders, and arms
3) arreflexia in upper extremities 4) weakness in upper extremities
5) muscle loss in same distribution as sensory loss
6) bladder/bowel dysfunction 7) spasticity and weakness in legs
8) Horner’s syndrome If associated with Arnold-Chiari malformation
9) cough 10) headache If affects medulla and pons -
11) vocal cord paralysis 12) dysarthria 13) nystagmus
14) recurrent dizziness
15) tongue weakness If affects descending tract of trigeminal nerve -
16) facial numbness and sensory loss
17) and in severe cases, death.

Syringomyelia is comparatively rare with 8.4 cases per 100,000.
It occurs more frequently in men than in women, and it usually appears in the third or fourth decade of life.

About three quarters of all cases occur in combination with an Arnold-Chiari Malformation, an abnormality of the brain, in which the lower part of the cerrebellum protrudes into the upper cervical portion of spinal subarachnoid space, blocking the flow of cerebrospinal fluid (CSF).Severe trauma to the spinal cord often leads to scarring of the surrounding tissues and subsequent syrinx formation, although post-traumatic syringomyelia only accounts for about 10% of all cases.

At present treatment options are limited, with surgical intervention being the most common course of action. The aim is to alleviate the patient's symptoms by reducing the fluid pressure in the spinal cord and in the surrounding subarachnoid space. This is achieved by draining the syrinx, possibly inserting a shunt, and/or removing some of the surrounding bone (either from the vertebrae or the base of the skull, depending on the location of the syrinx).

SYMPTOMS OF MALARIA

Sometimes symptoms of malaria infection are not always dramatic, and can easily be dismissed as unimportant.


Plasmodium falciparum normally take 7 to 14 days to show symptoms while Plasmodium vivax and ovale normally take 8 to 14 days (but in some cases can survive for some months in the human horst) and Plasmodium malariae 7 to 30 days.

Symptoms may appear and disappear in phases and may come and go at various time frames. These cyclic symptoms of malaria are caused by the life cycle of the parasites - as they develop, mature, reproduce and are once again released into the blood stream to infect even more blood and liver cells.

Face Scar Revision Surgery

Skin Tension Lines and how to get it

 Skin Tension Lines (STLs) are series of lines based on the direction of tension as this relaxed skin tension lines run perpendicular to the underlying muscles contraction.
For best results and aesthetic outcome, place skin incisions along skin tension lines. Skin tension lines run parallel to the dermal collagen bundles but at right-angles to the direction of contraction of the muscles underneath it offers:

1.  Best cosmetic result
2.  Most narrow and strongest scar line

 You can find Skin Tension Lines (STLs) by asking the patient to contract his or her facial muscles, use oblique lighting, or pinch the skin. So, STLs have some individual variations based on the underlying muscles of facial expression.

Muscles of facial expression.

Generally, the lines are more discernible in older patients and more obscure in younger patients.

Skin tension lines. Illustrated by Charles Norman.

Note: It is prefered to mark skin tension lines prior to surgery as local anesthetic injection and tissue excision may alter them.

Intraocular Lens Implant

Huntington Disease

An autosomal dominant inherited disease, when the patient begins to exhibit symptoms at 20s and 30s.Initially the patients have a tendency to fidget which over months or years develops into jerky, choreiform movements. HD usually progresses over a 10 to 25 year period. As the disease progresses it leads to dementia and usually death from incurrent infection. There is a high incidence of suicide among patients with Huntington Disease (HD).

Pathology : there is atrophy of certain forebrain structures including the entire cerebral cortex and even more notably of the caudate nucleus and putamen The head of the caudate is reduced to a narrow brownish band of tissue that is flattened or concave. In normal brain the ratio of small neurons to large neurons in the corpus striatum is approximately 160:1 in Huntingtons patients the ratio is reduced to 40:1 with a marked decrease in the number of astrocytes. The gene for this disease has been isolated to the short arm of chromosome 4.

Local anaesthesia technique for Middle ear and Mastoid

Episiotomy during Childbirth Delivery

Principles of Soft Tissue Coverage for Tumor Reconstruction (Hand)

Reconstruction of defects produced after tumor extrication differs significantly from that which is normally encountered in the treatment of traumatic defects. Immediate reconstruction should be anticipated and planned in most instances. The use of two surgical teams is advantageous. This avoids the tendency of the surgeon to compromise the resection or remove less tissue out of concern for maintaining reconstruction options.

Operating room personnel must adhere to strict precautions to prevent cross contamination of operative fields. This includes the use of separate draping, instruments, operative clothing, and personnel. The planning for reconstruction should include the possibility that the margins of resection might be positive.
If a local or rotation flap is to be performed, the potential for spread of the tumor to the donor site must be considered. Groin flaps should be avoided. The use of distant or free tissue transfer increases reconstruction complexity but reduces the risk of donor field contamination and is more frequently used after tumor reconstruction.

Vascularized bone transfer or soft tissue coverage may be particularly beneficial and may improve healing in those patients who need postoperative chemotherapy or radiation.

 Wide excision soft tissue sarcoma from the dorsum of the hand (A,B) with radial forearm flap for soft tissue coverage (C).

May-Thurner syndrome

The May-Thurner syndrome is the symptomatic compression of the left common iliac vein between the right common iliac artery and the lumbar vertebrae.

The normal anatomy is that the artery which runs to the right leg (= right common iliac artery) lies on top of the vein coming from the left leg (= left common iliac vein). This close proximity leads, in some people, to pressure of the artery onto the vein and to varying degrees of narrowing of the vein. This is referred to as "May Thurner syndrome". It is not a disease but a congenital anatomic variant. Mild and moderate degrees of narrowing are typically asymptomatic. More severe degrees can lead to obstruction of blood flow from the leg and thus to leg swelling and pain. The narrowed vein can also clot, resulting in left leg DVT.

The syndrome is named after the authors R. May and J. Thurner, who first described this phenomenon in 1957. It has also been termed the iliac compression syndrome. It is probably the reason why more DVTs occur in the left than in the right leg.

Compression of the iliac vein has been documented in approximately 50% of patients with left iliac vein thrombosis.

Several surgical treatment strategies have been employed in the past:

1. venous bypass surgery of the narrowed area;


2. cutting of the iliac artery and repositioning of the artery behind the iliac vein;


3. construction of a tissue sling or flap to lift it off the iliac vein;

Since 1995 venous stents have been placed into the narrowed area, to pry them open . Unfortunately, there are no large studies that
(a) investigate the long-term success of the procedure, i.e. how often the stents improve symptoms and remain patent.
(b) whether patients should remain on long-term (lifelong) coumadin (warfarin) or not. Stents appear beneficial at least in the short-term improvement of symptoms, within the first 1-2 years of stent placement .

Endoscopic Management of Acute Bleeding from a Peptic Ulcer

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.

Depression: characters of major episode(mnemonic)

Depression: major episode characteristics

SPACE DIGS:

• Sleep disruption
• Psychomotor retardation
• Appetite change
• Concentration loss
• Energy loss
• Depressed mood
• Interest wanes
• Guilt
• Suicidal tendencies

Pathology of Chronic lymphocytic leukemia

About Cognitive therapy

Cognitive therapy involves :

• A) repetition of negative thoughts that eventually dissipate
• B) changing a thought that involves a situation that leads to a change of mood, behavior, or reaction
• C) repeated acts of fearful situations that allow adaptation
• D) negative reinforcement of harmful activities
• E) none of the above

The answer is  : (B).

 
Cognitive therapy is a psychological treatment method that helps patients correct false self-beliefs that contribute to certain moods and behaviors. The basic principle behind cognitive therapy is that a thought precedes a mood, and that both are interrelated with a person's environment, physical reaction, and subsequent behavior.
Therefore, changing a thought that arises in a given situation changes mood, behavior, and physical reaction. Although it is unclear who benefits most from cognitive therapy, motivated patients who have an internal center of control and the capacity for introspection likely would benefit most.

Total Wrist Arthroplasty Surgery

Replacement of the wrist joint with an artificial wrist joint is often needed when a traumatic injuries or severe degenerative affecting the wrist (osteoarthritis and rheumatoid arthritis) occur.

Laparoscopy Surgery Full Video For Gall Stones

Ultrasound use in trauma- the fast exam

Photo of Acute tonsillitis in Infectious Mononucleosis

Acute Tonsillitis:
This is a common condition which is usually caused by gram positive bacteria (may be the organism is Streptococcal Pyrogenesis , there is a risk of developing Rheumatic Fever ). Often multiple different bacteria exists in the tonsillar crypts, which can be difficult to culture. Treatment with antibiotics to prevent Rheumatic Fever or tonsillar abscess formation is usually advisable.

The picture in below shows the appearance of acute tonsillitis due to Infectious Mononucleosis. The patient was a 24 year old male with bilateral 4 cm non-tender jugulo-diagastric (upper neck) lymph nodes. The infection was resistant to antibiotics (as all viral infections are).

A White Hand Vs Red Hand

A 14-year-old girl presented for evaluation of 3 years of intermittent episodes of acute pain in the hands and feet. She had no other medical history. These episodes of pain were frequently triggered by physical exercise and bathing.

During physical examination, movement of the patient's right hand triggered burning pain, and the hand became acutely erythematous. Immersion of the right hand in warm water triggered the same kind of pain and erythema. The patient's presentation was typical of erythromelalgia, in which an increase in temperature triggers attacks of acute pain and red, swollen hands and feet. In some patients, pain and redness can extend beyond the distal extremities. Symptoms are relieved by exposure to cold.

Erythromelalgia can be seen in association with myeloproliferative disorders, connective-tissue disorders, vasculitis, diabetes, gout, multiple sclerosis, thrombotic thrombocytopenic purpura, and the use of certain drugs. Cases of erythromelalgia that are associated with myeloproliferative disorders usually respond to aspirin. Otherwise, treatment is difficult, although attendance at a pain rehabilitation center can be beneficial. The patient had no underlying disease, and no medical treatment was effective. She manages the erythromelalgia by avoiding triggering factors.

Suturing technique

Gastric Volvulus and X-Ray

Gastric volvulus is a rare clinical entity defined as an abnormal rotation of the stomach of more than 180°, creating a closed loop obstruction that can result in incarceration and strangulation.

Etiology:
Type 1

* This type comprises 2/3 of cases and is presumably due to abnormal laxity of the gastrosplenic, gastroduodenal, gastrophrenic, and gastrohepatic ligaments. This allows approximation of the cardia and pylorus when the stomach is full, predisposing to volvulus.
* This type is more common in adults but has been reported in children.

Type 2

* This type is found in 1/3 of patients and is usually associated with congenital or acquired abnormalities that result in abnormal mobility of the stomach.
* Congenital defects as:
-Diaphragmatic defects - 43%
-Gastric ligaments - 32%
-Abnormal attachments, adhesions, or bands - 9%
-Asplenism - 5%
-Small and large bowel malformations - 4%
-Pyloric stenosis - 2%
-Colonic distension - 1%
-Rectal atresia - 1%
The most common causes of gastric volvulus in adults are diaphragmatic defects. In cases of paraesophageal hernias, the gastroesophageal junction remains in the abdomen, while the stomach ascends adjacent to the esophagus, resulting in an upside-down stomach. Gastric volvulus is the most common complication of paraesophageal hernias.

Imaging findings

* Massively dilated stomach in LUQ(left upper quadrant) possibly extending into chest
* Inability of barium to pass into stomach (when obstructed)

Frontal radiograph from an upper GI examination shows the stomach
located in the lower chest in a large hiatal hernia. The greater curvature
of the stomach lies superior to the lesser curvature in an organoaxial twist.
Note that the stomach is not obstructed.

Organoaxial and Mesenteroaxial types:
#Organoaxial type:Twist occurs along a line connecting the cardia and the pylorus--the luminal (long) axis of the stomach.



#Mesenteroaxial type:Twist occurs around a plane perpendicular to the luminal (long) axis of the stomach from lesser to greater curvature.

Preparation for Studying the USMLE

It is not important to know every think bout medicine to pass The USMLE test, but there are some advices and helpful techniques to be ready for it. here some :

1- Mora and more Sample questions:
the most effective way to study for the USMLE is by using professionally developed question banks (like KAPLAN question bank).These question banks focus on the important, tested topics, and are pretty good at identifying distractors (those "wrong" answers that sound pretty believable).

2- Concentrate on your weaknesses:
The USMLE is broken down by topics. That means you have to perform in all the areas to do well on the test as a whole. You know you're weak in an area when you've done poorly in a course - but if you've done well on a school-specific test or in a pass-fail course you can't tell how you'll perform on the USMLE.

3- Study for the USMLE as you study your medical school course:
This seems like a trivial answer, but its not always implemented. Some medical schools use board-exam like tests in their courses, but some are pass-fail. If you're in a pass-fail course its important to realize that you're preparing for the USMLE - and study that way.