Hyperkinetic Movement Disorders

Tremor Rhythmic oscillation of a body part due to intermittent muscle contractions Dystonia Involuntary patterned sustained or repeated muscle contractions often associated with twisting movements and abnormal posture. Athetosis Slow, distal, writhing, involuntary movements with a propensity to affect the arms and hands Chorea Rapid, semipurposeful, graceful, dance-like nonpatterned involuntary movements involving distal or proximal muscle groups Myoclonus Sudden, brief (<100 ms), jerk-like, arrhythmic muscle twitches Tic Brief, repeated, stereotyped muscle contractions that are often suppressible. Can be simple and involve a single muscle group or complex and affect a range of motor activities

Guide to NSAID Therapy

No/Low NSAID GI Risk NSAID GI Risk No CV risk (no aspirin) Traditional NSAID Coxib or      Traditional NSAID + PPI or misoprostol     Consider non-NSAID therapy CV risk (consider aspirin) Traditional NSAID + PPI or misoprostol if GI risk warrants gastroprotection A gastroprotective agent must be added if a traditional NSAID is prescribed   Consider non-NSAID therapy Consider non-NSAID therapy

Colorectal Cancer Screening Strategies

Choices/Recommendations  Comments  Average-Risk Patients  Asymptomatic individuals > 50 years of age (>45 years of age for African Americans) Colonoscopy every 10 years*   Preferred cancer prevention strategy   Annual fecal immunochemical test (FIT) for occult bleeding, fecal DNA testing every 3 years Cancer detection strategy; fails to detect many polyps and some cancers   CT colonography every 5 years Evolving technology    Flexible sigmoidoscopy every 5 years Fails to detect proximal colon polyps and cancers   Double-contrast barium enema every 5 years Less sensitive than colonoscopy or CT colonography, misses some rectosigmoid polyps and cancers Personal History of Polyps or Colorectal Cancer  1 or 2 small (<1 cm) adenomas with low-grade dysplasia Repeat colonoscopy in 5 years Assuming complete polyp resection 3 to 9 adenomas, or any adenoma >1 cm or containing high-grade dysplasia or villus features Repeat colonoscopy in 3 years; subsequent colonoscopy based on findings Assuming complete polyp resection >10 adenomas Colonoscopy in <3 years based on clinical judgment Consider evaluation for FAP or HNPCC; see recommendations below Piecemeal removal of a sessile polyp Exam in 2 to 6 months to verify complete removal   Small (<1 cm) hyperplastic polyps of sigmoid and rectum Colonoscopy in 10 years   >2 serrated polyps, or any serrated or hyperplastic polyp >1 cm Repeat colonoscopy in 3 years   Incompletely removed serrated polyp >1 cm Exam in 2 to 6 months to verify complete removal   Colon cancer Evaluate entire colon around the time of resection, then repeat colonoscopy in 3 years   Inflammatory Bowel Disease  Long-standing (>8 years) ulcerative colitis or Crohn's colitis, or left-sided ulcerative colitis of >15 years' duration Colonoscopy with biopsies every 1 to 3 years   Family History of Polyps or Colorectal Cancer  First-degree relatives with only small tubular adenomas Same as average risk   Single first-degree relative with CRC or advanced adenoma at age >60 years Same as average risk   Single first-degree relative with CRC or advanced adenoma at age <60 years, OR two first-degree relatives with CRC or advanced adenomas at any age Colonoscopy every 5 years beginning at age 40 years or 10 years younger than age at diagnosis of the youngest affected relative   FAP Sigmoidoscopy or colonoscopy annually, beginning at age 10–12 years Consider genetic counseling and testing HNPCC Colonoscopy every 2 years beginning at age 20–25 years until age 40, then annually thereafter Consider histologic evaluation for microsatellite instability in tumor specimens of patients who meet Bethesda criteria; consider genetic counseling and testing

Papez circuit

Papez circuit is a complex circuit involved in expression of emotions. It connects the limbic system with hypothalamus and thalamus.

Neck of femur - blood supply

1. Extra capsular arterial ring:

- formed by medial and lateral circumflex femoral arteries.
- chief blood supply of head & neck of femur, formed mainly by medial circumflex.
- it gives retinacular vessels that supply 2/3 rd of head.

2. Artery of Ligamentum teres

- foveal or medial epiphyseal arery.
- branch of obturator artery.
- forms main blood supply in < 8 year.

3. Intraosseous blood supply

- via metaphysis

Carotid artery bifurcation

Common carotid artery bifurcates at the level of upper border of thyroid cartilage, opposite the disc b/w C 3 & C 4 vertebrae.

It is usually palpated against ' Chassaignac tubercle' , ant tubercle on the transverse process of C 6 vertebra.

Heterotaxy Syndromes

Situs ambiguous also known as heterotaxy, is a rare congenital defect in which the major visceral organs are distributed abnormally within the chest and abdomen.

The normal position of the organs is known as situs solitus.

Situs inversus is a condition in which the usual positions of the organs are reversed from left to right as a mirror image of the normal condition. 

If these are the two extreme positions on a continuum of asymmetric thoracic and abdominal organ formation, situs ambiguus covers everything in between.

Situs ambiguus or heterotaxy syndrome refers
to malposition and dysmorphism of thoracic and
abdominal organs associated with indeterminate
atrial arrangement and vascular anomalies.
Azygos or hemiazygos continuation of the IVC with
absence of the hepatic segment is the most frequent associated anomaly.



Right Isomerism or Asplenia or Ivemark's syndrome:

In this condition, bilateral right sidedness occurs. These patients have bilateral right atria, a centrally located liver , an absent spleen and both lungs have 3 lobes. The descending aorta and inferior vena cava are on the same side of the spleen.

Left Isomerism or Polysplenia syndrome:


Here, bilateral left sidedness occurs. These patients have bilateral left atria and multiple spleens, and both lungs have 2 lobes. Interruption of the inferior vena cava with azygous or hemiazygous continuation is often present.

Prostatic urethra

It is the widest and most dilatable part of the male urethra.
On cross-section, it is concavo-convex in shape.

Pancreas- posterior relations

Head is related to:

1. Inferior vena cava.
2. Terminal part of renal veins.
3. Right crus of diaphragm.
4. Common bile duct.

Uncinate process :     Aorta

Neck :          Termination of superior mesenteric vein
                      beginning of portal vein.

Body:

1. Aorta and origin of SMA.
2. Left crus of diaphragm.
3. Splenic vein.
4. Left kidney.
5. Left adrenal gland.
6. Left renal vessels.

Diaphragm- development

Diaphragm develops from the following components:

1. Septum transversum
2. Pleuroperitoneal membranes.
3. Ventral and dorsal mesenteries of esophagus.
4. Mesoderm of body wall.
5. Cervical myotomes.

Brachial Plexus

Branches from Trunk:

1. Suprascapular Nerve ( C5, 6 )
2. N. to subclavius    ( C 5, 6 )

Branches from Roots:

1. Long thoracic nerve ( C 5, 6, 7)
2. Dorsal scapular nerve ( C 5)

Trigeminal nerve- branches

Foetal circulation

Percent saturation of foetal blood vessels

Vertebral Artery- Parts

Vertebral artery is divided into the following four parts:

V 1 : Origin to transverse process of C6

V 2 : Thru f. transversaria of upper 6 cervical vertebrae.

V 3 : Sub- occipital triangle.

V 4 : Passes thru foramen magnum, pierces dura and enters subarachnoid space. 

Divisions of vertebral artery

Foramen magnum

The structures passing through the foramen magnum are:

Anterior Part:      1. Apical ligament of dense.
                            2. Vertical band of cruciate ligament
                            3. Membrana tectoria

Subarachnoid Space:

1. Vertebral artery
2. Ant. Spinal artery
3. Post. Spinal artery
4. Spinal accessory nerve.
5. Sympathetic plexus around vertebral arteries.

Posterior part:  1. Lower part of medulla.
                         2. Meninges.

Nerve supply - lower limb

Testosterone production

malnutrition- indicators

Indicators of malnutrition


Stunting - low height for age = chronic

Wasting - low weight for height = acute


Underweight - low weight for age = both acute and chronic malnutrition
"

'via Blog this'

The Parasympathetic Supply of the Head

Number 10 The Parasympathetic Supply of the Head:

Animated lectures

Hampton's hump- pulmonary embolism

Perineal pouch

 

Neural Crest Derivatives

Connective tissue and bones of the face and skull
Cranial nerve ganglia
C cells of the thyroid gland
Conotruncal septum in the heart

Odontoblasts
Dermis in face and neck

Spinal (dorsal root) ganglia
Sympathetic chain and preaortic ganglia
Parasympathetic ganglia of the gastrointestinal tract
Adrenal medulla

Schwann cells
Glial cells
Arachnoid and pia mater (leptomeninges)
Melanocytes

Cavernous Sinus

Dural venous sinuses