Neuromuscular Blocking Agents

Classification of NSAIDs

DIAGNOSTIC CRITERIA OF MULTIPLE MYELOMA

DIAGNOSTIC CRITERIA OF MULTIPLE MYELOMA :

Major:
1.PLasmacytoma
2.Bone marrow plasmacytosis >30% of plasma cells
3.Monoclonal globin spike IgG > 35/L, or IgA >20g/L
4. Light chain excretion on urine electrophoresis > 1g/24hours

Minor:
1.Bone marrow plasmacytosis, 10-30% plasma cells
2.Monoclonal globulin spike, IgG < 35 g/l or IgA <20g/L
3. Lytic bine leaions
4. NOrmal IgM < 500mg/L, IgA < 1g/L or IgG < 6g/l

Criteria 
1. 1 major and 1 minor
or 
2. 3 minor that should include 1 and 2 of minor criteria.

Reference: Harrison's Principles of Internal Medicine 18th Edition

Differential diagnosis of dementia

Flow diagram for the differential diagnosis of dementia.



The percentage contributions of various diagnoses
are approximate. *The list of secondary causes of dementia
is not exhaustive.
CNS = central nervous system;
CSF = cerebrospinal
fluid;
MR = magnetic resonance imaging.

 

Framingham Criteria for Congestive Heart Failure

Framingham Criteria for Congestive Heart Failure

Diagnosis of CHF requires the simultaneous presence of at least 2 major criteria or 1 major criterion in conjunction with 2 minor criteria.

Major criteria:

·        Paroxysmal nocturnal dyspnea

·        Neck vein distention

·        Rales

·        Radiographic cardiomegaly (increasing heart size on chest radiography)

·        Acute pulmonary edema

·        S3 gallop

·        Increased central venous pressure (>16 cm H2O at right atrium)

·        Hepatojugular reflux

·        Weight loss  >4.5 kg in 5 days in response to treatment

Minor criteria:

·        Bilateral ankle edema

·        Nocturnal cough

·        Dyspnea on ordinary exertion

·        Hepatomegaly

·        Pleural effusion

·        Decrease in vital capacity by one third from maximum recorded

·        Tachycardia (heart rate>120 beats/min.)

Minor criteria are acceptable only if they can not be attributed to another medical condition (such as pulmonary hypertension, chronic lung disease, cirrhosis, ascites, or the nephrotic syndrome).

The Framingham Heart Study criteria are 100% sensitive and 78% specific for identifying persons with definite congestive heart failure.

Reference:

1. McKee PA, Castelli WP, McNamara PM, Kannel WB. The natural history of congestive heart failure: theFramingham study. N Engl J Med. 1971 Dec 23;285(26):1441-6. [Medline]

Reid index

The Reid index is a pathological measurement of mucosal gland proliferetion in chronic bronchitis.

Assessed by comparing the thickness of the mucous glandular tissue verses the distance from epithelium to the level of cartilage.

An index of < 0.4 is considered to be within normal limits.

A greater value is the most pathognomonic indicator of chronic bronchitis.

Stomach cell types and substance secreted

SYNTHESIS OF CATECHOLAMINES

ANATOMY OF THE EYE

Bone within Bone appearance

Bone within Bone appearance: Sickle cell anemia, Osteopetrosis.

Courtesy: DAMS 

CHROMOSOMES AND ASSOCIATED DISORDERS

Chromosome 1: Rh system / neuroblastoma
Chromosome 2: Cystinuria/hypobetalipoproteinemia
Chromosome 3: RCC/ALKAPTONURIA
Chromosome 4: Huntingtons chorea/achondroplasia/parkinsons disease 
Chromosome 5: FAP/colorectal carcinoma/cri-du-chat syndrome
Chromosome 6: HLA system(short arm) /MHA antigen/DM
Chromosome 7: Cystic fibrosis
Chromosome 8: Osteoporosis
Chromosome 9: ABO blood group / friedreich’s ataxia
Chromosome 10: Apert syndrome Charcot-Marie-Tooth disease Charcot-Marie-Tooth disease, type 1 Charcot-Marie-Tooth disease, type 4 Cockayne syndrome congenital erythropoietic porphyria Cowden syndrome Crouzon syndrome Hirschprung disease multiple endocrine neoplasia type 2 Pfeiffer syndrome porphyri Usher syndrome Usher syndrome type I Wolman syndrome
Chromosome 11: Sickle cell anaemia/beta thallasemia/wilms tumour/MEN -1/ataxia telengiectasia/human insulin gene/PTH gene
Chromosome 12: PKU/vWF/CA testes
Chromosome 13: Retinoblastoma/osteosarcoma/wilsons ds
Chromosome 14: Familial HOCM/ alpha 1 antitripsin deficiency
Chromosome 15: Marfan’s syndrome/albinism/pradder willi syndrome/angelman syndrome
Chromosome 16: Alpha thallasemia/adult PKD
chromosome 17: Carninoma breast(BRCA1)/medulloblastoma/neurofibromatosis-1/ovarian tumour/ P 53 gene
Chromosome 18: Erythropoietic protoporphyria hereditary hemorrhagic telangiectasia Niemann-Pick disease/Type C porphyria Selective Mutism Edwards syndrome (Trisomy 18)
Chromosome 19: Myotonia dystrophica/gene for insulin receptor
Chromosome 20: MODY type 1 DM/prions disease
Chromosome 21: Homocystinuria/amyloidosis…folic acid transport..
Chromosome 22: Meningioma/acoustic neuroma/NF -2/Di-George syndrome
Chromosome Xq: Gene for androgen insensitivity syndrome/ fragile X syndrome/ Testicular feminisation/ X-SCID/ X linked agaamaglobulinemia/ Fabry ds/ Lesch- Nyhan/ Hemophilia B/ Hemophilia A/ Hunter syndrome/ G6PD deficiency
Chromosome Xp – Ocular albinism/ Chr Granulomatous Ds/ DMD/ Menkes syndrome

Image Courtesy: topnews.in

DINNER FOR MEDICAL STUDENTS!

Pseudogout

The xanthine oxidase inhibitor allopurinol

The xanthine oxidase inhibitor allopurinol is by far the most commonly used hypouricemic agent and is the best drug to lower serum urate in overproducers, urate stone formers, and patients with renal disease. It can be given in a single morning dose, 100–300 mg initially and increasing up to 800 mg if needed. In patients with chronic renal disease, the initial allopurinol dose should be lower and adjusted depending on the serum creatinine concentration.

Musculoskeletal Manifestations of Crystal-Induced Arthritis

Funny but True :'(

Lung Carcinoma Overview- Click to get Bigger image

http://www.lung-cancer.com

IHS diagnostic criteria for Migraine

In 1988 the International Headache Society published criteria for the diagnosis of a number of different headache types . Those for some of the common headaches are reproduced below for migraine with and without aura, cluster headache, tension-type headache, and cervicogenic headache.

11 Health Benefits of Pomegranate Juice~

1)Fights Breast Cancer
Studies in Israel show that pomegranate juice destroys breast cancer cells while leaving healthy cells alone. It may also prevent breast cancer cells from forming.

2) Lung Cancer Prevention
Studies in mice show that pomegranate juice may inhibit the development of lung cancer.

3) Slows Prostate Cancer
It slowed the growth of prostate cancer in mice.

4) Keeps PSA Levels Stable
In a study of 50 men who had undergone treatment for prostate cancer, 8 ounces of pomegranate juice per day kept PSA levels stable, reducing the need for further treatment

5) Protects the Neonatal Brain
Studies show that maternal consumption of pomegranate juice may protect the neonatal brain from damage after injury.

6) Prevention of Osteoarthritis
Several studies indicate that pomegranate juice may prevent cartilage deterioration.

7) Protects the Arteries
It prevents plaque from building up in the arteries and may reverse previous plaque buildup.

8) Alzheimer's Disease Prevention It may prevent and slow Alzheimer's disease. In one study, mice bred to develop Alzheimer's disease were given pomegranate juice. They accumulated significantly less amyloid plaque than control mice and they performed mental tasks better.

9)Lowers Cholesterol
It lowers LDL (bad cholesterol) and raises HDL (good cholesterol).

10) Lowers Blood Pressure
One study showed that drinking 1.7 ounces of pomegranate juice per day lowered systolic blood pressure by as much as 5 percent.

11) Dental Protection
Research suggests that drinking pomegranate juice may be a natural way to prevent dental plaque.

Common Antibodies and Their Disease Associations

Duchenne Muscular Dystrophy (DMD) V/S Becker's Muscular Dystrophy- Differences between DMD and BMD

Just for Fun

ECG CHANGES IN CHAMBER HYPERTROPHIES/ENLARGEMENTS

CHAMBER HYPERTROPHIES/ENLARGEMENTS ::

LEFT ATRIAL ENLARGEMENT
-- Left atrium forms the later part of the P wave. Hence enlargement of left atrium will produce an increase in the duration of the P wave, as well as delayed depolarization leading to "Double peaks" in P wave
-- Also called " P - mitrale "
-- This is evident very clearly in Chest leads 
-- P wave is generally > 120 ms

Image : LAE ... typical "bipeaked " P mitrale

 

RIGHT ATRIAL ENLARGEMENT
-- Right atrium forms the initial part of the p wave... hence Right atrial enlargement will produce Peaked/Tall P wave, and not widen the duration of P wave.
-- Refered to as P - pulmonale
-- Tall peaked P wave is seen in lead II and many leads (especially in right precordial leads) 
-- P wave is Pointed
-- Usually > 2.5 mm

Normal CT Scan:

Normal CT Scan:

It is worth spending a few minutes familiarising yourself with the appearances of a normal CT scan. It is much easier to detect abnormalities once you are accustomed to normal appearances. The scan below is a slice through the human brain and you should imagine that you are viewing it as if looking up from the patient's feet. Therefore, the patient's left is to the right of the screen. The shape of the ventricles is quite distinctive and they are shown outlined in green and orange. The presence of the third ventricle in the midline is one of the first things to look for. If the third ventricle is either not visible, or shows signs of shift away from the midline, this suggests that there is an abnormality. The basal cisterns is the fluid filled space around the back of the midbrain outlined here in purple. Blood clots, or swelling of the brain may cause this to become narrowed, or not visible altogether. Note in this scan, that the frontal horns of the lateral ventricles are symmetrical, with the septum between them in the midline.