Laryngoscopes

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Laryngoscopes

Curved blade -- MacIntosh
Straight blade -- Miller's

Position -- Extension at Atlanto-Occipital joint.
                 Flexion at neck.
Barking dog / Sniffing the morning air position.

MC damage -- Upper Incisors


Complications:

Adults -- Hypertension , Tachycardia , Arrhythmias

Child -- Bradycardia (MCQ)

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Laryngeal mask airway (LMA)

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Laryngeal mask airway (LMA)

Advantages : 

1. No laryngoscopy or muscle relaxation required
2. Easy to insert

BUT
Does not prevent aspiration of gastric contents.


FAST TRAC / Intubating LMA -- for difficult intubation.

Pro-Seal LMA -- provides Controlled Ventilation. ( Therefore used in elective ventilation. )

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Sodalime

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Q. Major component of Sodalime is ?

a. Calcium hydroxide

b. Sodium hydroxide

c. Potasium hydroxide

d. Barium hydroxide.

ANSWER:

Ans: A (Calcium hydroxide)
Composition of Sodalime
94% Ca(OH)2
5% NaOH
1% KOH

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MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel

Mapleson systems

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In 1954 Mapleson described and analyzed five different semiclosed anesthetic systems, and they are classically referred to as Mapleson systems

Type A - Magill's circuit
Best for Spontaneous Ventilation
Modified A - Lack's circuit

Mnemonic : SMAL

Type B & C - Obsolete

Type D - Bain's Circuit
Best for Controlled Ventilation
Modified D - Fenlon

Mnemonic : BCDF

Type E - k/a Ayre's T piece
Used in neonates

Type F - Jackson-Rees' modification of the Ayre's T-piece
Used in child < 6 year or < 20 Kg

E & F are Valveless

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Zeolite - Oxygen Concentrator

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Zeolites are microporous, aluminosilicate minerals commonly used as commercial adsorbents.

Ambient air is compressed, then passed through zeolite,

1. Aluminium hydroxide lattice -- adsorbs nitrogen, leaving a 95% oxygen mixture at the outlet.
2. Silica used to absorb Water Vapour.

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Drugs stop/continue before/during Surgery

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Drugs to be stopped before surgery.
1. Oral hypoglycemic –

              If Minor surgery – Omit morning dose

              If Major surgery – Switch to insulin 48hrs before , and then omit morning dose of
                                          insulin on day of surgery

2. OCP – Estrogen containing pills to be stooped 4 wks before surgery. (Progesterone only pills
                can be continued)

3. MAO inhibitors – discontinue 3 wks before Surgery

4. Oral Anticoagulant – Stop 1 wk before and switch to low molecular weight heparin (which is
                                       stopped 1 day before surgery)

5. Asprin – stop 48 – 72 hrs before

6. Lithium – stop 48 – 72 hrs before.

7. ACE Inhibitors.


Note: Smoking should be stopped 6wks before surgery. Even if not stopped then, it will still benefit if stopped 12hrs before surgery.



Drugs that can be continued.

1. Levodopa 
2. AntiHypertensive (except ACE inhibitors) 
3. AntiAnginals (except Asprin) 
4. AntiThyroid drugs. 
5. Progesterone only pills 

STEROIDS : If patient took Steroid for > 1wk in last 1year – then intraop steroid replacement is necessary.

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Scottie dog

Q. Which of the following forms the " body " of Scottie dog appearance on Oblique projections of the lumbar spine ?
a. Transverse process
b. Spinous process
c. Superior articular process
d. Inferior articular process

ANSWER:

Ans: B ( Spinous process )
The scotty dog sign refers to the normal appearance of the lumbar spine when seen obliquely.
Transverse process = Head/Nose
Superior articular process = Ear
Inferior articular process = leg

For image explanation : Click here

Congenital Heart Diseases

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Wernicke's & Broca's Areas

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Mnemonic :

"BROKen aphasia" (Broca’s aphasia-broken speech)


"Wordys aphasia" (Wernicke’s aphasia- wordy, but making no sense)

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Hydrocephalus

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 Note : The terms communicating and noncommunicating hydrocephalus are used to indicate extraventricular obstructive hydrocephalus and intraventricular obstructive hydrocephalus, respectively.

Normal CSF : 

• 75 % produced in ventricles (choroid plexus)
• 25% Extrachoroidally in capillary endothelium

Normal Rate of production : 20ml/hr

Normal Volume : 

• 50 ml (infants)
• 150 ml (Adults)

Image courtesy :  DrShiviMudgal. - MedicoNotebook

Non communicating Hydrocephalus = Intraventricular Obstructive.

Causes :

1. Most common - Aqueductal Stenosis (MCQ)
2. Aqueductal gliosis
3. Vein of gallen malformation (Invg: MR-Angio)
4. Arnold Chiari malformation
5. Dandy Walker Malformation

Communicating = Extraventricular obstructive.

i.e - obstruction at basal cistern level

- Has large 4th ventricle.

Causes :

1. TBM - Contrast enhancing Basal exudates on CT
2. Pneumococcal Meningitis
3. Leukaemic Infiltrates
4. Large IVH in preterm

First Sign of increased ICT :

• In children : Sutural seperation
• In Adults : Erosion of posterior clenoid process.

Invg of choice for Hydrocephalus : MRI

Treatment :

• Medical - Furosemide , Acetazolamide

• Surgery - Ventriculoperitoneal shunt (complication - blockage , infection usually by coag. negative Staph epidermidis)

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MedicoNotebook : Founder - DrShiviMudgal , Co-Founder - DrAyushGoel

Mediastinal Nodes

Q. Middle mediastinal nodes drain all except ?
a. Lungs
b. Bronchi
c. Right Heart
d. Visceral Pleura

ANSWER:

Ans: C
Ref: Sutton
The middle mediastinal nodes drain the lungs, bronchi, left heart , the lower trachea and visceral pleura.
Right heart drains to Anterior Mediastinal Nodes.

Leukocytoclastic vasculitis (LCV)

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Leukocytoclastic vasculitis (LCV), also known as hypersensitivity vasculitis and hypersensitivity angiitis, is a histopathologic term commonly used to denote a small-vessel vasculitis.

Fragmentation of neutrophils surrounding blood vessels.

1. Microscopic PAN

2. Wegener's granulomatosis

3. Churg–Strauss

4. HSP

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Mallampati classification

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In anesthesia, the Mallampati score, also Mallampati classification, is used to predict the ease of intubation.

http://www.frca.co.uk/article.aspx?articleid=257

Modified Mallampati Grading :

O - Visualize tip of epiglottis.

I - Uvula with its tip

II - Uvula without tip

III - Only Soft Palate

IV - No Soft Palate

Normal Thyromental Distance  >6.5 cm

Normal Sternomantal Distance > 12.5 cm

The Mallampati classification is a method to assess the tongue size in relation to the size of the oropharynx.  

The test is performed by having the patient sit with their head in the neutral position, and then open their mouth as wide as possible and protrude the tongue as far as possible.  

They should not phonate, as this can elevate the soft palate and alter the view.  

A Class 3 or 4 view may be associated with difficult laryngoscopy.

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ASA grading

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The ASA physical status classification system is a system for assessing the fitness of patients before surgery. In 1963 the American Society of Anesthesiologists (ASA) adopted the five-category physical status classification system; a sixth category was later added. These are: 

1. A normal healthy patient. 

2. A patient with mild systemic disease , with no functional limitations

3. A patient with moderate systemic disease , with functional limitations

4. A patient with severe systemic disease that is a constant threat to life. 

5. A moribund patient who is not expected to survive even with or without the operation. 

6. A declared brain-dead patient whose organs are being removed for donor purposes. 

Drawback of this grading :

1.  Does not take into account the risk of surgery
2. Asymptomatic patient is not taken into account

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Important Disease , Caused By , Vector

Disease	Caused By	Vector
1.       Kala Azar	L.Donovani	Sandfly
2.       Onchocerciasis	Onchocerca volvulus	Black Fly
3.       Chagas dis	Trypanosoma Cruzi	Reduvid bug
4.       Sleeping sickness	T. Brucie	Tse Tse fly
5.       Oraya fever	Bartonella Bacilliformis	Sandfly
6.       Trench fever	Bartonella Quintana	Body Lice

Muscle relaxant

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Q. Muscle relaxant not metabolized in human body ?

a)pancuronium

b)doxacurium

c)vecuronium

d)rocuronium

ANSWER:

B : Doxacurium ,
In vivo data from humans suggest that doxacurium chloride is not metabolized and that the major elimination pathway is excretion of unchanged drug in urine and bile.
At some places the answer to this is given Rocuronium which is wrong. Click Here

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MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel

Physiological and Anatomical closure of Ductus Arteriosus

ref: Langman's Medical Embryology - 9th Edition

ref: Guyton

Submitted by DrShiviMudgal

Headache

1. Which is the most common cause of headache among the following ?
a. Migraine
b. Cluster
c. Idiopathic stabbing
d. Exertional



2. Which is the least common cause of headache among the following ?
a. Migraine
b. Cluster
c. Idiopathic stabbing
d. Exertional

ANSWER:

1. A
2. B

Congenital Heart Defects - syndromes

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Down's Syndrome -- MC 1. Endocardial Cushion defect
                                          2. VSD
                                          3. ASD


Turner's ------------- 1. Bicuspid Aortc Valve
                                   2. Coarctation of Aorta


Noonan's ------------ 1. Valvular Pulmonary Stenosis
                                    2. HOCM


Marfan's -------------- 1. Aortic aneurysm
                                      2. Aortic Disection
                                      3. Left sided regurgitation (AR , MR)


Rubella ---------------- 1. PDA (in term)
                                       2. Peripheral Pulm. Stenosis


Infant of Diabetic Mother - MC anomaly - 1. TGA
                                                                    2. HOCM
                                                                    3. VSD
                                                                    4. Conotruncal anastomosis (Persistent truncus arteriosus)


Pompe's ------------------- 1. Short PR interval
                                             2. Very High volt QRS complexes


Tuberous Sclerosis ----------- Ventricular Rhabdomyomas



Maternal------ Mumps------ Endocardial fibroelastosis
                        Lithium------- Ebstein Anomaly
                        Lupus SLE--- Complete heart block in new born
                        Penicillamine -- Cutis Laxa


William syndrome----------- Supravalvular Aortic Stenosis
                                                HyperCalcemia
                                                Elf like facies

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CXR position

Chest X-Ray taken in the position shown in image will be named ?
a. AP view
b. PA view
c. Left antero oblique view (LAO)
d. Right antero oblique view (RAO)

ANSWER:

Ans : D - Right Anterior oblique.. Here the nomenclature is by the part touching the cassette. (This nomenclature is similar to lateral views i.e Right lateral means Right side of patient touches the cassette )

Cremastric reflex

Cremastric Reflex (L1 ,L2)

                                       Afferent                                                           Efferent

• Femoral Branch of GenitoFemoral N                                      Genital branch of Genitofemoral N
• Ilioinguinal N (L1)