Medicine Hack

Tapping the patellar tendon elicits the knee jerk (L 2,3, 4), a stretch reflex of the quadriceps femoris muscle, because the tap on the tendon stretches the muscle. A similar contraction is observed if the quadriceps is stretched manually. When a skeletal muscle with an intact nerve supply is stretched suddenly, it contracts. This response is called the stretch reflex . It is a type of monosynaptic reflex. The knee jerk reflex is an example of a deep tendon reflex (DTR) in a neurological exam and is graded on the following scale: 0 (absent), 1+ (hypoactive), 2+ (brisk, normal), 3+ (hyperactive without clonus), 4+ (hyperactive with mild clonus), and 5+ (hyperactive with sustained clonus). Absence of the knee jerk can signify an abnormality anywhere within the reflex arc, including the muscle spindle, the Ia afferent nerve fibers, or the motor neurons to the quadriceps muscle. In general the afferent loop is much more critical for reflex function than the efferent l

The Richter hernia occurs when only the antimesenteric border of the bowel herniates through the fascial defect. The Richter hernia involves only a portion of the circumference of the bowel. As such, the bowel may not be obstructed, even if the hernia is incarcerated or strangulated, and the patient may not present with vomiting. The Richter hernia can occur with any of the various abdominal hernias and is particularly dangerous, as a portion of strangulated bowel may be reduced unknowingly into the abdominal cavity, leading to perforation and peritonitis.

The most characteristic finding is increased amplitude of the QRS complex. R waves in leads facing the left ventricle (i.e., leads I, aVL, V 5 , and V 6 ) are taller than normal, whereas S waves in leads overlying the right ventricle (i.e., V 1 and V 2 ) are deeper than normal. In many patients, the ST segment is depressed and followed by an inverted T wave. In most cases, the ST segment slopes downward from a depressed J point and the T wave is asymmetrically inverted (formerly called a “strain” pattern). A widening of the QRS complex may be there i.e. more than 110 ms and also the QRS complex may be notched. Common diagnostic criteria include: 1) Sokolow - Lyon index : SV 1 + (RV 5 or RV 6 ) > 3.5 mV                                        : RaVL > 1.1 mV 2) Cornell voltage criteria : SV 3 + SaVL ≥ 2.8 mV (for men)                                        : SV 3 + SaVL ≥ 2.0 mV (for women)

1) Increase dietary potassium intake 2) Limit dietary sodium intake to < 2.4 gm/day 3) Increase physical activity 4) Weight loss 5) All antihypertensive medications and combinations are effective 6) Multiple drug combinations may be required to achieve control 7) Angiotensin-converting enzyme (ACE) inhibitors and beta blockers as monotherapy may be less effective but should be used when indicated (e.g., renal disease, heart failure, post–myocardial infarction) 8) Thiazide diuretics and calcium channel blockers may have greater blood pressure–lowering efficacy 9) A higher incidence of angioedema occurs when using ACE inhibitors

In this condition there is exaggerated vagal discharge following carotid sinus stimulation when doing simple tasks like shaving or buttoning a tight shirt collar or even head rotation. There is reflex vasodilation and decrease in the pulse. These may combine to reduce blood pressure and cerebral perfusion in some elderly patients, causing loss of consciousness. Carotid sinus hypersensitivity is diagnosed by applying gentle pressure over the carotid pulsation just below the angle of the jaw, where the carotid bifurcation is located. Pressure should be applied for 5 to 10 seconds. It should be done in both supine and upright position. A normal response to carotid sinus massage is a transient decrease in the sinus rate, slowing of atrioventricular (AV) conduction, or both. Carotid sinus hypersensitivity is defined as a sinus pause longer than 3 seconds in duration and a fall in systolic blood pressure of 50 mmHg or more.

This is caused by autonomic overactivity, usually provoked by emotional or painful stimuli, less commonly by coughing or micturition. It is also called as neurocardiogenic syncope. The mechanism is that directly or indirectly, the nucleus tractus solitarius is activated by the triggering stimuli and this leads to increased parasympathetic tone and decreased sympathetic tone. The vagal parasympathetic tone leads to negative chronotropic and negative inotropic effects. This causes a slowing in the heart rate and decreased contractility that leads to a drop in the cardiac output. The decreased sympathetic tone on the other hand leads to vasodilation which leads to a decrease in the total peripheral resistance. Both cause a decrease of blood pressure significant enough to lead to loss of consciousness. 'Malignant' vasovagal syndrome is a rare condition where syncopal attacks so frequent that they are significantly disabling . Recovery is rapid if the patient lies down.

The word 'patient' is derived from the Latin patiens , meaning sufferance or forbearance. The overall purpose of medical practice is to relieve suffering. It is important to make a diagnosis, to know how to approach treatment, and to design an appropriate scheme of management for each patient. It is therefore essential to understand each person as fully as possible, whatever their social class or ethnic and cultural background.