Medicine Hack

 INTRODUCTION  Romberg's test is done to assess the integrity of the dorsal columns of the spinal cord. It is not a test to assess the cerebellar function. The test was first described by Moritz Heinrich von Romberg who found that patients with tabes dorsalis (neurosyphilis) often complained of increased unsteadiness in the dark. The test should be performed in all patients who complain of dizziness, imbalance or falls to rule out sensory ataxia.  HOW TO DO THE TEST?  The test is done by requesting the patient to keep his feet firmly together, arms by the side and the eyes open at first. The balance of the patient is noted. Now the patient is asked to close both eyes and the balance is now noted for around 1 minute. The physician should stand in front of the patient with his arms extended on either side of the patient but not touching him. This is done as the latter may fall.  INTERPRETATION  1) If with the eyes open, the balance is not ...

Retropharyngeal abscess is a rare condition presenting in infants (<1 year of age). Clinical symptoms include fever and drooling.  As a result of the swelling within the posterior pharyngeal wall causing upper airway obstruction, the child will typically hold their neck in extension to assist breathing.  A lateral soft tissue neck radiograph taken with the neck held in extension is indicated if a retropharyngeal abscess is suspected. If it is positive, it will demonstrate air within the swollen retropharyngeal tissues, as shown by the x-ray above. A contrast enhanced computerized  tomography (CT) examination will confirm the diagnosis.

Persons with factitious disorder fake illness. They simulate, induce, or aggravate illness. They also often inflict painful and even life-threatening injury on themselves or those under their care. Unlike malingerers who have material goals, such as monetary gain or avoidance of duties, patients with factitious disorder bear the sufferings primarily to gain the emotional care and attention that comes with playing the role of the patient. The disorders have a compulsive quality, but the behaviors are considered voluntary in that they are deliberate and purposeful, even if they cannot be controlled.

PCI consists of balloon angioplasty followed by stenting. Balloon angioplasty expands the coronary lumen by stretching and tearing the atherosclerotic plaque and vessel wall. The atherosclerotic plaque is also redistributed a little along its longitudinal axis. Elastic recoil of the stretched vessel wall generally leaves a 30 to 35 percent residual diameter stenosis. Although stand-alone balloon angioplasty is rarely used other than for very small (<2.25 mm) vessels, balloon angioplasty remains integral to PCI for predilating lesions before stent placement, deploying coronary stents, and further expanding stents after deployment. Coronary stents are currently used in more than 90 percent of PCI procedures worldwide. Coronary stents lowers the incidence of vessel closure. Restenosis after coronary stent placement occurs in some patients due to excessive intimal hyperplasia within the stent. While bare metal coronary stents reduce the incidence of angiographic and clinica...

Above is an electrophoresis of a patient suspected to have sickle cell disease. A blood sample was taken from him and the erythrocytes were separated. After lysis of the RBCs, hemoglobin was released and it was run on a polyacryamide gel. Electrophoresis was carried out and Western blot was performed to located the hemoglobin. The principle of electrophoresis is that the the more negatively charged particles move towards the positive pole and vice versa. In the case of sickle cell disease, glutamate is substituted by valine at the 6th position of the beta chain. This removes a negative charge from the chain and thus in the electric field the mutated chain will not move as far towards the positive pole as does the non-mutated chain. The interpretation is as follows: 1) X is a band that represents the mutated HbS. 2) Y is the normal Hb. 3) 1 is a carrier of HbS i.e. having one normal and one mutated chain. 4) 2 is a person who does not carry any mutant alleles. 5) 3 is a per...

The shoulder joint is a synovial multi-axial spheroidal joint. It occurs between the roughly hemispherical head of the humerus and the shallow glenoid fossa of the scapula. Since there is no major bony constraint, the joint has 3 degrees of freedom. It is the most mobile joint of the body and allows all the movements shown above. The stability of the joint depends on the surrounding muscular and soft tissue envelope. It is one of the most frequently dislocated joints in the body.

The neck has 4 major compartments. 1) Vertebral compartment which is contains the cervical vertebrae and associated muscles of posture, 2) Visceral compartment which contains the thyroid, thymus and parathyroid as well as the esophagus and larynx, 3) 2 vascular compartments on both sides and these contain the major blood vessels and vagus nerve.