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cranial nerves - facts

By Pratyush kumar

Cranial nerves – facts

CN which is the smallest -- olfactory n.
CN which enters cerebrum directly - olfactory nerve

CN with longest intracranial (subarachnoid) course -- trochlear n
CN which emerges posterior to brain stem- trochlear nerve
CN with dorsal exit -- trochlear n.
CN which is the largest and thickest -- trigeminal n.
CN which is largest -- trigeminal nerve
CN with longest extracranial course --vagus n.
CN having longest intraosseous course -- facial nerve
CN with longest ( intradural )course - abducent nerve
CN passing through cavernous sinus -- abducent nerve
CN involved in raised intracranial tension -- abducent nerve 
Abducent nerve has the longest intra-cranial INTRADURAL course!!
Thickest nerve is SCIATIC nerve
Thickest cutaneous nerve is GREATER OCCIPITAL nerve
Labourer’s nerve-median nerve
Dentist’s nerve-inferior alveolar nerve
Alderman’s nerve-auricular branch of vagus nerve
Nerve of laterjet-largest gastric branch of vagus nerve



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RNTCP – DOTS DEFINITIONS

By Pratyush kumar

 RNTCP – DOTS DEFINITION 


Extra Pulmonary tuberculosis
TB of any organ other than the lungs, such as
the pleura (TB pleurisy), lymph nodes, intestines,
genitourinary tract, skin, joints and bones, meninges
of the brain, etc.
Pleurisy is classified as extra pulmonary TB.
A patient diagnosed with both sputum smear
positive pulmonary and extra pulmonary TB should
be classified as pulmonary TB

New
A TB patient who has never had treatment for
tuberculosis or has taken anti-tuberculosis drugs for
less than one month.

Relapse
A TB patient who was declared cured or treatment
completed by a physician, but who reports back to
the health service and is now found to be sputum
smear positive.

Transferred in
A TB patient who has been received for treatment
into a Tuberculosis Unit, after starting treatment in
another unit where s/he has been registered.

Treatment after default
A TB patient who received anti-tuberculosis
treatment for one month or more from any source
and returns to treatment after having defaulted,
i.e., not taken anti-TB drugs consecutively for two
months or more, and is found to be sputum smear
positive.

Failure
Any TB patient who is smear positive at 5 months
or more after starting treatment. Failure also
includes a patient who was treated with Category
III regimen but who becomes smear positive during
treatment.

Chronic
A TB patient who remains smear positive after
completing a re-treatment regimen.

Others
TB patients who do not fit into the above mentioned
types. Reasons for putting a patient in this type
must be specified.

Cured
Initially sputum smear-positive patient who has
completed treatment and had negative sputum
smears, on two occasions, one of which was at the
end of treatment

Treatment completed
Sputum smear-positive patient who has completed
treatment, with negative smears at the end of the
intensive phase but none at the end of treatment.
Or: Sputum smear-negative TB patient who has
received a full course of treatment and has not
become smear-positive during or at the end of
treatment.
Or: Extra-pulmonary TB patient who has received a
full course of treatment and has not become smearpositive
during or at the end of treatment.

Died
Patient who died during the course of treatment
regardless of cause

Failure
Any TB patient who is smear positive at 5 months
or more after starting treatment. Failure also
includes a patient who was treated with Category
III regimen but who becomes smear positive during
treatment.

Defaulted
A patient who has not taken anti-TB drugs for
2 months or more consecutively after starting
treatment.

Transferred out
A patient who has been transferred to another
Tuberculosis Unit/District and his/her treatment

result (outcome) is not known.


plz click this link to read 

latest RNTCP guidelines for diagnosing pulmonary tb

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TEN STEPS TO SUCCESSFUL BREASTFEEDING

By Pratyush kumar

TEN STEPS TO SUCCESSFUL

BREASTFEEDING
Every facility providing maternity services and care for
newborn infants should:
1. Have a written breastfeeding policy that is routinely
communicated to all health care staff.
2. Train all health care staff in skills necessary to
implement this policy.
3. Inform all pregnant women about the benefits and
management of breastfeeding.
4. Help mothers initiate breastfeeding within a halfhour
of birth.
5. Show mothers how to breastfeed, and how to
maintain lactation even if they should be separated
from their infants.
6. Give newborn infants no food or drink other than
breast milk unless medically indicated.
7. Practise rooming in - allow mothers and infants to
remain together - 24 hours a day.
8. Encourage breastfeeding on demand.
9. Give no artificial teats or pacifiers (also called
dummies or soothers) to breastfeeding infants.
10. Foster the establishment of breastfeeding support
groups and refer mothers to them on discharge from
the hospital or clinic.

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IMPORTANT ANNUAL EVENTS FOR DOCTORS

By Pratyush kumar


Annual events

Category:

QID, BID, TID, LATIN MEANING

By Pratyush kumar

q.i.d. (on prescription): Seen on a prescription, q.i.d. (or qid) means 4 times a day (from the Latin quater in die). The abbreviation q.i.d. is also sometimes written without a period in capital letters as "QID". However it is written, it is one of a number of hallowed abbreviations of Latin terms that have been traditionally used in prescriptions to specify the frequency with which medicines should be taken.
Other examples include:
·         q.d. (qd or QD) is once a day; q.d. stands for "quaque die" (which means, in Latin, once a day).

·         b.i.d. (or bid or BID) is two times a day; b.i.d. stands for "bis in die" (in Latin, 2 times a day).

·         t.i.d. (or tid or TID) is three times a day ; t.i.d. stands for "ter in die" (in Latin, 3 times a day).

·         q_h: If a medicine is to be taken every so-many hours, it is written "q_h"; the "q" standing for "quaque" and the "h" indicating the number of hours. So, for example, "2 caps q4h" means "Take 2 capsules every 4 hours."

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Varicose vein {salient clinical points)

By Pratyush kumar

DEF:-these are dilated tortuous veins.
SITE:-seen in lower limb commonly. other places where we can see are hemorrhoids in rectum , esophageal varices , and spermatocele

IMPORTANT HISTORY

h/o occupation:- long standing job
family history:- runs in family , involvement of FOX C-2 gene, klippel-trenaunay syndrome {portwinw stain,varicose vein, local gigantism}
h/o night cramps ,severe pain after walking :- shows deep venous thrombosis
h/o relieve of pain after lying down and raising the limb:- venous claudication {where as in arterial claudication it will aggravate the pain, in neurogenic claudication person stand and bends to relieve pain}
h/o venous ulcer at medial or lateral malleolus, dark hyper-pigmentation , eczema, lipodermatosclerosis

INSPECTION

involvement of great saphenous vein if it extends from dorsum of foot to the thigh, and short saphenous vein if it ends in politeal fossa.
morriseys cough impulse at the sapheno-femoral junction{ it lies 4 cm below and lateral to pubic tubercle, can be identified by asking the patient to flex and abduct,so that adductor longus tendon which gets inserted at pubic tubercle becomes prominent}

PALPATION

thickening of vein

TEST:-
brodie-trendlenburg test :-
empty the vein by raising the limb and tie tourniquet below s-f junction
1 ask the patient to stand up open tourniquet immediately and look for fast filling of blood column .it shows s-f incompetency
2 keep tourniquet as such, wait for 1 minute and look for filling of blood, if it gets filled it shows perforator incompetency
multiple tourniquet test:-
aim is to identify incompetent perforators
tie tourniquets at multiple levels after emptying the vein.
look for filling of blood..where perforators are incompetent vein will become dilated.it can be confirmed by double tourniquet test
modified perthes test:-
NO NEED TO EMPTY THE VEIN, tie tourniquet below s-f junction and ask the patient to walk fo3 minutes, if patient complaints pain then there is DVT, or if it shrinks then no dvt only varicosity.
schwartz test
keep one hand at s-f junction across the course of vein and with other hand tap on the vein below , feel foe the impulse.
fegans test
empty the vein and palpate across the vein , cresentic gaps may be felt it signifies perforator incompetency.
morriseys cough impulse
ask the patient to cough and feel for impulse at saphenofemoral junction ,if felt signifies s-f incompetency

AUSCULTATION

hear for bruit which signifies A-V fistula

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New FIGO 2010 Staging for Carcinoma

By Pratyush kumar

Carcinoma of the Vulva

IA         Tumor confined to the vulva or perineum, ≤ 2cm in size with stromal invasion ≤ 1mm, negative nodes
IB         Tumor confined to the vulva or perineum, > 2cm in size or with stromal invasion > 1mm, negative nodes
II          Tumor of any size with adjacent spread (1/3 lower urethra, 1/3 lower vagina, anus), negative nodes
IIIA      Tumor of any size with positive inguino-femoral lymph nodes
            (i) 1 lymph node metastasis greater than or equal to 5 mm
            (ii) 1-2 lymph node metastasis(es) of less than 5 mm
IIIB      (i) 2 or more lymph nodes metastases greater than or equal to 5 mm
          (ii) 3 or more lymph nodes metastases less than 5 mm
IIIC      Positive node(s) with extracapsular spread
IVA       (i) Tumor invades other regional structures (2/3 upper urethra, 2/3 upper vagina), bladder mucosa, rectal mucosa, or fixed to pelvic bone
            (ii) Fixed or ulcerated inguino-femoral lymph nodes
IVB       Any distant metastasis including pelvic lymph nodes

Carcinoma of the Cervix

IA1       Confined to the cervix, diagnosed only by microscopy with invasion of < 3 mm in depth and lateral spread < 7 mm
IA2       Confined to the cervix, diagnosed with microscopy with invasion of > 3 mm and < 5 mm with lateral spread < 7mm
IB1       Clinically visible lesion or greater than A2, < 4 cm in greatest dimension
IB2       Clinically visible lesion, > 4 cm in greatest dimension
IIA1      Involvement of the upper two-thirds of the vagina, without parametrial invasion, < 4 cm in greatest dimension
IIA2      > 4 cm in greatest dimension
IIB        With parametrial involvement
IIIA/B   Unchanged
IVA/B    Unchanged

Carcinoma of the Endometrium

IA         Tumor confined to the uterus, no or < ½ myometrial invasion
IB         Tumor confined to the uterus, > ½ myometrial invasion
II          Cervical stromal invasion, but not beyond uterus
IIIA      Tumor invades serosa or adnexa
IIIB      Vaginal and/or parametrial involvement
IIIC1    Pelvic node involvement
IIIC2    Para-aortic involvement
IVA       Tumor invasion bladder and/or bowel mucosa
IVB       Distant metastases including abdominal metastases and/or inguinal lymph nodes
Uterine sarcomas were staged previously as endometrial cancers, which did not reflect clinical behavior. Therefore, a new corpus sarcoma staging system was developed based on the criteria used in other soft tissue sarcomas.[2] This is described as a best guess staging system, so data will need to be collected and evaluated for further revision.

Uterine Sarcomas (Leiomyosarcoma, Endometrial Stromal Sarcoma, and Adenosarcoma)

IA         Tumor limited to uterus < 5 cm
IB         Tumor limited to uterus > 5 cm
IIA        Tumor extends to the pelvis, adnexal involvement
IIB        Tumor extends to extra-uterine pelvic tissue
IIIA      Tumor invades abdominal tissues, one site
IIIB      More than one site
IIIC      Metastasis to pelvic and/or para-aortic lymph nodes
IVA       Tumor invades bladder and/or rectum
IVB       Distant metastasis

Adenosarcoma Stage I Differs from Other Uterine Sarcomas

IA         Tumor limited to endometrium/endocervix
IB         Invasion to < ½ myometrium
IB         Invasion to > ½ myometrium

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