Thursday, 31 October 2013

Lumbar Stenosis

Lumbar Stenosis

Stenosis, the narrowing of the bony canal that protects the spinal cord and its branching nerves, in the lower back is often characterized by radiating pain in the buttocks and legs.
Signs & Symptoms
Frequently people afflicted with lumbar stenosis have varying degrees of low back discomfort. The pain typically occurs most often during activities and is relieved by resting, sitting or bending forward. In some cases, the pain is centralized in the lower legs and feet. In severe cases, it also can impact continence and sexual function.
Diagnosis
Doctors use two kinds of tests to diagnose spinal stenosis. Some of the tests are aimed at making sure there isn’t another cause producing the symptoms. Others can indicate that the vertebral narrowing has occurred. After asking you questions about your symptoms, your doctor probably will check your reflexes, gait and other indicators of spinal problems.
Tests include:
  • X-ray– High-energy radiation is used to take pictures of the spine.
  • Magnetic Resonance Imaging (MRI)– An MRI provides detailed pictures of the spine that are produced with a powerful magnet linked to a computer.
  • Computed Tomography (CT) Scan– A CT scan uses a thin X-ray beam that rotates around the spine area. A computer processes data to construct a three-dimensional, cross-sectional image.
  • Myelogram– This is an X-ray of your spine taken after a special dye has been injected into the spinal column. It can show pressure on the spinal cord or problems with discs or vertebrae.
  • Bone Scan– This test detects areas of increased or decreased bone metabolism, which can indicate a problem in the bone such as a fracture or infection.
Treatment
The initial treatment for stenosis is to treat the symptoms rather than the condition itself. These treatments include:
  • Medication such as aspirin or ibuprofen to relieve inflammation and pain
  • Rest
  • Physical therapy
  • Posture changes such as lying with the knees drawn up to the chest or leaning forward while walking may relieve the pressure on the nerves
  • Losing weight
  • Epidural corticosteroid injections to reduce inflammation and relieve pain
If several months of treatment haven’t improved the symptoms, and if the stenosis is severe, surgery to widen the spinal canal may be necessary. Because bone continues to deteriorate, additional treatment may be needed several years after even successful surgery. Operations used to treat stenosis include:
  • Decompressive Laminectomy– The roof of the vertebrae, called the lamina, is surgically removed. The procedure also may include removing part of the disc or fusing the vertebrae (spinal fusion).
  • Foramenotomy– The area where nerve roots leave the spinal canal, called the foramen, is removed.
  • Laminoplasty– The covering over the upper spine is elevated but not removed to allow decompression of the spinal cord and minimize the development of instability and deformity.
  • Laminotomy– Only a small portion of the lamina is removed.
  • Medial Facetectomy– Part of the spinal joints, called the facet, is partially removed to relieve pressure on the nerve roots passing underneath it.

Cervical Stenosis

Cervical Stenosis

Stenosis in the neck, also called the cervical spine, affects the upper part of the body including the arms and hands. Stenosis is the narrowing of the bony canal that protects the spinal cord and its branching nerves to the point where it injures the spinal cord or nerves. This may be caused by a number of conditions including bone spurs or rupture of the spinal discs, the spongy pads of tissue that keep the vertebrae from grinding against each other when you bend your back.
Signs & Symptoms
Cervical stenosis may even cause pain, numbness, or weakness in the legs. The pain may move from one part of the body to another but is often most noticeable in the neck.
Diagnosis
Doctors use two kinds of tests to diagnose spinal stenosis. Some of the tests are aimed at making sure there isn’t another cause producing the symptoms. Others can indicate that the vertebral narrowing has occurred. After asking you questions about your symptoms, your doctor probably will check your reflexes, gait and other indicators of spinal problems.
Tests include:
  • X-ray — High-energy radiation is used to take pictures of the spine.
  • Magnetic Resonance Imaging (MRI) — An MRI provides detailed pictures of the spine that are produced with a powerful magnet linked to a computer.
  • Computed Tomography (CT) Scan — A CT scan uses a thin X-ray beam that rotates around the spine area. A computer processes data to construct a three-dimensional, cross-sectional image.
  • Myelogram — This is an X-ray of your spine taken after a special dye has been injected into the spinal column. It can show pressure on the spinal cord or problems with discs or vertebrae.
Treatment
  • The initial treatment for stenosis is to treat the symptoms rather than the condition itself. These treatments include:
  • Medication such as aspirin or ibuprofen to relieve inflammation and pain
  • Rest
  • Physical therapy
  • Posture changes, such as lying with the knees drawn up to the chest or leaning forward while walking, may relieve the pressure on the nerves
  • Losing weight
  • Corticosteroid injections to reduce inflammation and relieve pain
  • A cervical collar
If several months of treatment have not improved the symptoms, and if the stenosis is severe, surgery to widen the spinal canal may be necessary. Because bone continues to deteriorate, additional treatment may be needed several years after even successful surgery. Operations used to treat stenosis include:
  • Anterior Cervical Discectomy and Fusion– A small incision in the front of the neck is used to access the upper spine. The ruptured or herniated disc is removed and replaced with a small bone plug, which eventually grows to connect the two adjacent vertebrae.
  • Cervical Corpectomy– Part of the vertebra and discs are removed and replaced with a bone graft or a metal plate and screws to support the spine.
  • Decompressive Laminectory– The roof of the vertebrae, called the lamina, is surgically removed. The procedure also may include removing part of the disc or fusing the vertebrae (spinal fusion).
  • Foramenotomy– The area where nerve roots leave the spinal canal, called the foramen, is removed. This procedure can be performed using a minimally invasive approach with an endoscope, an instrument that allows the surgeon to see inside the body through a tiny incision. The surgeon can then use other tiny incisions to perform the surgery, avoiding the discomfort and muscle atrophy associated with the traditional open technique that uses a large incision.
  • Laminoplasty– The compressive bone in the back of the neck is gently lifted off of the spinal cord creating a new “roof” over the spinal cord and nerve roots. This procedure effectively decompresses the spinal cord over multiple segments without the need for fusion or hardware. It also minimizes the chance of spinal instability or deformity that may result from the traditional laminectomy procedure.
  • Laminotomy– Only a small portion of the lamina is removed.
  • Medial Facetectomy– Part of the bone structure in the spinal canal, called the facet, is removed.
  • Cervical Disc Replacement– A new technology that will be undergoing clinical trials at UCSF Medical Center. Instead of fusing the affected area, the natural disc material is replaced with a metal and plastic prosthesis that maintains or restores the motion segment. This will hopefully prevent degeneration of the next disc level

Thoracic Disc Herniation

Thoracic Disc Herniation

The thoracic spine consists of the 12 vertebrae between your neck and lower back. The ends of your ribs, although not attached to the spine, rest in indentations in the thoracic vertebrae that help support the ribs. This arrangement also makes the thoracic vertebrae more stable than other vertebrae. Disc herniation in the thoracic spine is relatively rare compared to the lumbar vertebrae in the lower back and the cervical vertebrae in the neck. Thoracic disc herniations account for less than 1 percent of all protruded discs.
Signs & Symptoms
  • Pain in the upper back
  • Numbness, pain or tingling from the upper back and around the chest
  • Leg weakness
  • Chest pain
Diagnosis
Your doctor will examine your movements, strength and reflexes. He or she also may recommend the following tests:
  • Magnetic Resonance Imaging (MRI) — An MRI provides detailed pictures of the spine that are produced with a powerful magnet linked to a computer.
  • Computed Tomography (CT) Scan — A CT scan uses a thin X-ray beam that rotates around the spine area. A computer processes data to construct a three-dimensional, cross-sectional image.
  • Myelogram — This is an X-ray of your spine taken after a special dye has been injected into the spinal column. It can show pressure on the spinal cord or problems with discs or vertebrae.
Treatment
Most often, thoracic disc herniation is treated with bed rest and pain medication. However, surgery may be recommended if the condition doesn’t respond to conservative treatment or if the disc is impinging on the spinal cord and causing symptoms or signs of spinal cord dysfunction.
Surgical treatment consists of removing the damaged disc or discs, a procedure called a discectomy. It also may include removing the lamina, the upper part of the vertebrae, to give the spinal cord more room. In the past, discectomy was usually a major surgery done through a large incision. Today, it is more likely to be performed using small incisions, miniature instruments and a viewing instrument called an endoscope.

Lumbar Disc Herniation

Lumbar Disc Herniation

The lumbar spine consists of the five vertebrae in the lower part of the spine, each separated by a disc, also called a lumbar disc. The discs in this part of the spine can be injured by certain movements, bad posture, being overweight and disc dehydration that occurs with age. Although the lumbar vertebrae are the biggest and strongest of the spinal bones, risk of lumbar injury increases with each vertebrae down the spinal column because this part of the back has to support more weight and stress than the upper spinal bones. The lumbar disc is the most frequent site of injury in several sports including gymnastics, weightlifting, swimming and golf, although athletes in general have a reduced risk of disc herniation and back problems.
Signs & Symptoms
Symptoms of disc herniation in the lower back are slightly different from symptoms in the cervical or thoracic parts of the spine. The spinal cord ends near the top lumbar vertebrae but the lumbar and sacral nerve roots continue through these spinal bones. A lumbar disc herniation may cause:
  • Lower back pain
  • Pain, weakness or tingling in the legs, buttocks and feet
  • Difficulty moving your lower back
  • Problems with bowel, bladder or erectile function, in severe cases
Diagnosis
Initial diagnosis of lumbar herniation generally is based on the symptoms of lower back pain. Your doctor will examine your sensation, reflexes, gait and strength. Your doctor also may suggest the following tests:
  • X-ray — High-energy radiation is used to take pictures of the spine.
  • Magnetic Resonance Imaging (MRI) — An MRI provides detailed pictures of the spine that are produced with a powerful magnet linked to a computer.
  • Computed Tomography (CT) Scan — A CT scan uses a thin X-ray beam that rotates around the spine area. A computer processes data to construct a three-dimensional, cross-sectional image.
  • Electromyography — This test measures muscle response to nervous stimulation.
Treatment
Conservative treatment of lower disc pain usually is successful over time. It includes:
  • Pain medication or pain therapies such as ultrasound, massage or transcutaneous electrical nerve stimulation
  • Anti-inflammatory medication such as aspirin, ibuprofen and acetaminophen
  • Physical therapy
  • Steroid injections
  • Education in proper stretching and posture
  • Rest
However, if your pain doesn’t respond to conservative treatment in two to four weeks, your condition affects your bowel or bladder function, or if it threatens permanent nerve damage, your doctor may suggest surgery. Modern methods of surgery allow some spine operations to be performed through tiny incisions using miniature instruments while a microimaging instrument called an endoscope is used to view the surgery site.
The surgery usually includes removing the part of the disc that has squeezed outside its proper place, called a discectomy. The surgeon also may want to remove the back part of the vertebrae, called the lamina, in a laminectomy; or to surgically open the foramen, the holes on the side of the vertebrae through which the nerves exit, in a foramenotomy. Only about 10 percent of adult lumbar disc patients require surgery and even fewer children and adolescents.
UCSF Spine Center orthopedic surgeons also are investigating the effectiveness of an implant that may replace damaged lower back discs.

Cervical Disc Herniation

Cervical Disc Herniation

The cervical spine consists of the top seven bones, called vertebrae, in your spine located between the skull and chest. The first symptom of cervical disc herniation is usually neck pain. Others symptoms may include:
  • Pain in one arm or in both arms
  • Limited head and neck motion, especially turning to the side of the herniated disc
  • Hyperactive reflexes
  • Spasticity
  • Loss of bladder or bowel control, erectile dysfunction
Signs & Symptoms
The cervical spine consists of the top seven bones, called vertebrae, in your spine located between the skull and chest. The first symptom of cervical disc herniation is usually neck pain. Others symptoms may include:
  • Pain in one arm or in both arms
  • Limited head and neck motion, especially turning to the side of the herniated disc
  • Hyperactive reflexes
  • Spasticity
  • Loss of bladder or bowel control, erectile dysfunction
Diagnosis
Your doctor will check your range of motion in your arms, shoulders and neck. Other tests may include:
  • X-ray — High-energy radiation is used to take pictures of the spine.
  • Magnetic Resonance Imaging (MRI) — An MRI provides detailed pictures of the spine that are produced with a powerful magnet linked to a computer.
  • Computed Tomography (CT) Scan — A CT scan uses a thin X-ray beam that rotates around the spine area. A computer processes data to construct a three-dimensional, cross-sectional image.
  • Myelogram — This is an X-ray of your spine taken after a special dye has been injected into the spinal column. It can show pressure on the spinal cord or problems with discs or vertebrae.
  • Discography — This test is sometimes used to evaluate back pain in preparation for surgery.
Treatment
Conservative treatment for cervical disc herniation includes:
  • Rest
  • A cervical collar or neck brace
  • Anti-inflammatory medication
  • Steroid medication
  • Physical therapy that may include cervical traction
Only about 10 percent of cervical herniation patients require surgery. Various surgical procedures are available depending on the severity of herniation. They include:
  • Microdiscectomy or removal of the herniated part of the disc
  • Anterior cervical decompression and fusion in which the disc is removed and the vertebrae are fused together by means of a dowel bone graft, which comes from cadaver bone, between the vertebrae
  • Cervical endoscopic foramenotomy, with or without discectomy, is a minimally invasive procedure in which the herniated disc material is removed using tiny incisions

Scoliosis

Scoliosis

Everyone’s spine has natural curves. These curves round our shoulders and make the lower back curve slightly inward. But some people have spines that also curve from side to side, a common condition called scoliosis. On an X-ray, a spine with scoliosis looks more like an “S” or a “C” than a straight line. Some of the bones in a scoliotic spine also may have rotated slightly, making the person’s waist or shoulders appear uneven.
Scoliosis affects about 2 percent of the population, including children and adults, and tends to run in families. If someone in a family has scoliosis, the likelihood of another family member having it is much higher – about 20 percent.
As the population ages, adult degenerative scoliosis is becoming more common, with the condition typically developing at between age 50 to 70. The condition can have devastating effects on a person’s life in later years. Treatment in this older population presents particular changels due to other back conditions, such as osteoporosis. But significant advances – including minimally invasive surgery, new neuro-monitoring techniques and 3-dimensional imaging – allows older patients to receive limited doses of anesthesia and benefit from quicker recovery.
Scoliosis is defined as curvature of the spine greater than 10 degrees, as measured on an X-ray. Anything less is simply due to normal variation.
Signs & Symptoms
Scoliosis may be divided into five types:
  • Congenital Scoliosis– Congenital means that a person is “born with” scoliosis. Congenital scoliosis is caused by an abnormality of one or more vertebrae where they fail to form properly. This can be seen on X-ray and directly in the operating room.
  • Idiopathic Scoliosis– This is the most common form of scoliosis. The name idiopathic means “the cause is unknown.” Those with this type of scoliosis are otherwise healthy and normal. The spine shows no abnormality of the bones themselves on X-rays or by looking at it directly in the operating room. While the overall incidence is equal in females and males, progressive or severe idiopathic scoliosis is about six to seven times more frequent in females.
  • Neuromuscular Scoliosis– This type of scoliosis occurs in people who have a disease of the nervous system, such as cerebral palsy.
  • Postural Scoliosis– Also known as “hysterical scoliosis,” postural scoliosis may be a result of pain, as a patient tilts to relieve the pain. It can be reversed by relieving the pain or by having the patient lie flat. X-rays don’t show any abnormality of the vertebrae.
  • Syndromic Scoliosis– This type of scoliosis occurs in people with a syndrome, such as Marfan syndrome or one of the skeletal dysplasias such as achondroplasia.
Progressive, severe scoliosis can produce three major problems:
  • If the part of the spine in the chest, called the thoracic spine, curves more than 60 degrees, the volume of the chest can be reduced, potentially compromising the function of the heart and lungs. For example, the heart may have to work harder to pump the normal volume of blood or the affected individual may have shortness of breath.
  • Severe curvature of the lower half of the spine that connects the chest with the pelvis, known as the lumbar spine, may push the contents of the abdomen against the chest and interfere indirectly with heart and lung function. Curvature of the lumbar spine also may alter sitting balance and posture.
  • Severe curvature of either the thoracic (upper) or the lumbar (lower) spine, or both, eventually becomes visible to others. The resulting tilting and twisting of the back, shoulders and pelvis may produce an appearance that the individual finds unacceptable. If idiopathic scoliosis affects a girl around the time of puberty, when body image is developing hand-in-hand with self-esteem, the condition can pose significant psychological and emotional challenges.
Idiopathic scoliosis may also involve pain, which is more common in adults with scoliosis.
Diagnosis
Uneven ribs and shoulders may be the first noticeable signs of scoliosis. The diagnosis is based upon an X-ray of the spine.
Other tests may be necessary if an underlying disease is suspected as the cause of scoliosis. Symptoms of a possible underlying disease include:
  • Deformities of the foot, such as an abnormally high arch that could cause imbalance.
  • Discolored skin spots or pigmented birthmarks that could be a sign of neurofibromatosis, a genetically inherited disease in which nerve tissue grows tumors. Neurofibromas may be harmless or may cause skeletal or neurological problems, including pressure on spinal nerves.
  • Significant pain, which typically is not a symptom of scoliosis. Patients who tilt to relieve pain can develop scoliosis.
Certain types of scoliosis are associated with other diseases, such as kidney disease. If an underlying disease is suspected, additional tests – such as an ultrasound to look for kidney disease and a magnetic resonance imaging (MRI) scan to look for a possible neurological disorder – may be performed.
Treatment
Scoliosis treatment is based on the degree of curvature of the spine, viewed from the front or back by X-ray. The following are general guidelines for treatment.
Less Than 10 Degrees
This is not scoliosis. Scoliosis is defined as spinal curvature greater than 10 degrees. Curvature under 10 degrees is considered a normal variation, just as there is a normal range for weight and for height.
10 Degrees to 30 Degrees
In this range, scoliosis is observed to see if it progresses.
30 Degrees to 50 Degrees
In this range, bracing is the standard of care in the United States. The scoliosis brace is known as a TLSO, which stands for thoraco-lumbar spinal orthotic. The idea behind bracing is to stop or slow progression of the curve so that it stays under 50 degrees. The two principal types of braces used are the Milwaukee brace, developed by Dr. Walter Blount of Milwaukee, and the Boston brace, developed by Dr. John Hall of Boston. Brace treatment successfully stops curve progression in about 80 percent of children.
More Than 50 Degrees
Beyond 50 degrees, the spine loses its ability to compensate and progression becomes inevitable even after the child is mature. The only way to stop progression at this stage is a surgery called spinal fusion. Think of the vertebrae as beads on a string. The spine bends between the vertebrae as a string bends between the beads, causing the beads to move. The way to stop the beads from moving is to stick them together. Spinal fusion surgery joins the vertebrae.
There is no clear evidence that untreated scoliosis or scoliosis treated with bracing or spinal fusion will increase the risk of back pain or arthritis in the long term. The younger a child is when diagnosed with scoliosis – or the more the child has to grow – the greater the risk of scoliosis progressing.
After puberty, curves under 50 degrees are not likely to get worse. For this reason, the goal of scoliosis mangement is to keep curves under 50 degrees until the child has matured. Children with curves under 50 degrees typically grow up into adults with no significant problems related to scoliosis.
Medication, Physical Therapy
In most cases, treatment for adults begins with a combination of non-surgical treatments administered from several weeks to months. These include:
  • Anti-inflammatories, such as ibuprofen and mild narcotics to relieve pain
  • Epidural steroid injections to relieve leg pain
  • Physical therapy to stablize the spine
Minimally Invasive Surgery
UCSF Medical Center is one of the few medical centers in Northern California to offer advanced minimally invasive spinal fusion surgery. These include XLIF (eXtreme Lasteral Interbody Fusion) or DLIF (Direct Lateral Interbody Fusion) procedures that limit the dose of anesthesia and effectively restore quality of life.
During these procedures, a surgeon creates a small portal in a patient’s side, between the ribs and hip, minimizing muscle stripping while allowing access to the spine. The procedures enable surgeons to correct the side-to-side curvature of the spine and restore spinal balance or alignment so the spine is not pitched forward.
Potential Complications
A potential complication of spine surgery is damage to the nerves running along the psoas muscle, one of the body’s major muscles responsible for stabilizing the base of the spine and allowing the spine to flex and rotate the hip joint. To limit potential nerve injuries, doctors at UCSF Medical Center use neuromonitoring during spine surgery, which allows surgeons to stimulate and test nerves during surgery.
Our doctors also use 3-dimensional imaging techniques during surgery to see the spine more clearly, increase accuracy when placing spinal instruments and improve patient safety.
Treatment for Children
Most spine curves in children with scoliosis will remain small and need only to be watched by an orthopedist for any sign of progression. If a curve does progress, an orthopedic brace can be used to prevent it from getting worse. Children undergoing treatment with orthopedic braces can continue to participate in a full range of physical and social activities.
If the curve of the spine is severe when first seen, or if treatment with a brace does not control the curve, surgery may be necessary.

Kyphosis

Kyphosis

Kyphosis describes the exaggerated curve of the spine that results in a rounded or hunched back. Kyphosis may develop for several reasons. Postural kyphosis in children and adolescents may be related to habit and posture rather than underlying spinal deformity. In contrast, structural kyphosis refers to a round-back posture that is not reversible by paying attention to your posture and making an effort to sit and stand up straight. In adolescents, structural kyphosis may be caused by initial spine development with a rounded shape that is made worse by further growth. In the elderly, compression fractures characteristically result in loss of height and kyphotic deformity.
Signs & Symptoms
  • Back pain
  • Difficulty standing with an upright posture
  • Early fatigue to the back and legs
Diagnosis
The diagnosis of kyphosis is based on physical examination of the spine and X-rays. Your doctor may ask you to bend forward so that he or she can evaluate the spine in the position of maximal extension to assess the flexibility of the spine and the structural nature of the deformity.
Treatment
Treatment depends on the severity of the deformity. In patients with a flexible deformity, physical therapy and attention to posture may result in significant improvement. In patients with rigid deformity of the spine, surgery may be needed.
Surgery for kyphosis involves extending the rounded spine, fusing vertebrae together and using braces to maintain correction. In older patients with kyphosis that is related to compression fractures and osteoporosis, kyphosis may be corrected with a minimally invasive procedure called a balloon kyphoplasty. During this procedure a small balloon is inserted, through a small incision, into the collapsed bone to restore its shape. It is then filled with a substance that hardens and helps the bone expand.

Spondylolisthesis

Spondylolisthesis

Spondylolisthesis is a condition in which one vertebra slips forward on the one below it. In children, spondylolisthesis may occur as the result of a birth defect that affects the back of the spine or be caused by stress fractures within the back part of the spine. Spondylolisthesis is the most common cause of low back pain in adolescent athletes. In older people, the most common cause is degeneration of the discs between the vertebrae. With aging, the discs lose moisture, dry out and flatten, bringing the bones on either side closer together to the point where one slips forward on the other.
Signs & Symptoms
Typical symptoms of spondylolisthesis include pain across the lower back and legs, which occurs when the slipped vertebra irritates the nerves around it. However, a person can have the condition and not have pain.
Diagnosis
A number of test may be used to aid in the diagnosis of spondylolisthesis and to locate the affected bone, including:
  • X-ray — High-energy radiation is used to take pictures of the spine.
  • Magnetic Resonance Imaging (MRI) Scan– An MRI provides detailed pictures of the spine that are produced with a powerful magnet linked to a computer.
  • Computed Tomography (CT) Scan — A CT scan uses a thin X-ray beam that rotates around the spine area. A computer processes data to construct a three-dimensional, cross-sectional image.
Treatment
Most often, treatment for spondylolisthesis includes:
  • Physical therapy to strengthen the back muscles
  • Pain medication
  • Bed rest
  • Wearing a back brace or corset
Children and adolescents whose spines have slippage greater than 30 percent to 50 percent may be candidates for spinal fusion surgery. Children and adults who have persistent pain despite non-operative care also may be considered for surgery.
Surgery for spondylolisthesis may involve decompression of the nerve roots by removing bone and/or intervertebral disc material, followed by fusion of the vertebrae with or without bracing.

Anklosing Spondylitis

Anklosing Spondylitis

Ankylosing spondylitis is an inflammatory condition that involves the spine and skeleton of the head and trunk. The disorder causes inflammation and pain in joints in the spine, pelvis and other parts of the skeleton. In addition, parts of the spine, the sacroiliac joints where the hips join the lower back, or the hips may fuse, or grow, together.
Signs & Symptoms
Pain Stiffness, especially in the morning, Functional limitation, When the disorder affects the spine, it also may result in progressive deformity including curvature of the back, called kyphosis, and the inability to stand up straight.
Diagnosis
The first clue in diagnosing ankylosing spondylitis is the presence of symptoms, especially back pain. In addition, X-rays are taken to look for signs of the disorder, such as fused joints. A blood test for the HLA-B27 gene, which is found in about 90 percent of the people with ankylosing spondylitis, also may be performed. However, only 10 percent to 15 percent of people who inherit the gene develop ankylosing spondylitis.
Treatment
Ankylosing spondylitis usually is treated with:
  • Pain or anti-inflammatory medications
  • Antirheumatic drugs
  • Exercise
  • Physical therapy
Doctors in the UCSF Spine Center are currently working with new medications that inhibit immune-system cells, called cytokines, which appear to cause some of the symptoms of ankylosing spondylitis.
Joint replacement surgery, most commonly of the hips and shoulders, may be an option for severely affected patients. In addition, spinal reconstruction and internal bracing may be necessary to treat severe spine deformities associated with ankylosing spondylitis.

Cervical Spine Injury Management Guidelines


Guidelines for the Treatment of Cervical Fractures with or without Spinal Cord Injury

1. Admission Guidelines:
All patients with the following clinical conditions MUST be admitted to the ICU for close respiratory and neurological monitoring. The pre-printed Spinal Cord Injury Orders will be used on all patients.
  • Radiographic evidence of unstable cervical fracture or dislocation (i.e. atlantococciptal dislocation, bilateral subaxial facet dislocation,..) and/or
  • Clinical or radiographic evidence of spinal cord injury

All field collars should be changed out to a permanent rigid collar (Aspen or Miami-J) within 6 hours of admission.
Admission location and monitoring criteria for patients with documented cervical fractures without radiographic evidence of dislocation (i.e. transverse foramen fractures, spinous process fractures,.. ) and without clinical or radiographic evidence of spinal cord injury is left to the discretion of the admitting Attending Physician.

2. Immobilization Guidelines:
Unstable Cervical Fracture or Dislocation, with/without Spinal Cord Injury:
  • All patients will be maintained in a rigid cervical collar with strict cervical and log roll precautions until temporary stabilization using halo traction or halo vest is applied (Note: If the patient will be maintained in halo traction for >24 hours he/she should be placed on a rotorest bed to promote respiratory toileting, to be discontinued after surgical fixation)
  • Definitive operative stabilization of such fracture dislocations should occur within the first 24-48 hours of hospitalization

Stable Cervical Fracture without Dislocation, without Spinal Cord Injury:
  • All patients will be maintained in a rigid cervical collar, unless otherwise determined by the Attending Physician.
  • Log roll precautions, operative intervention and length of collar use to be determined by the Attending Physician.

3. Neurological Examination:
  • Every 1-2 hours until definitive stabilization is achieved and for at least 24 hours post-operatively, unless otherwise determined by the Attending Physician.
  • After 24 hours, the frequency of neurological examination may be progressively weaned as determined by the Attending Physician.
  • Evaluation should be based upon the ASIA scoring system, unless otherwise determined by the Attending Physcian.

4. Steroids Administration:
  • Steroids can be administered in all patients with evidence of spinal cord injury (excluding penetrating injury and/or nerve root injury) unless contraindicated by co-morbidities or injuries as determined by the Attending Physician.
  • Load: Methylprednisolone 30mg/kg IV over 15 minutes
  • Infusion: (Begin 45 minutes after bolus)
    • Within 0-3 hours of injury: Methylprednisolone 5.4mg/kg/hr IV for 23 hours
    • Within 3-8 hours of injury: Methylprednisolone 5.4mg/kg/hr IV for 47 hours
  • All patients receiving steroids must also have the following ordered
    • Pepcid 20mg IV/PO/FT Q12 or Prevacid 30mg PO/FT Daily
    • Routine finger stick blood sugar monitoring with institution of and insulin sliding scale or insulin gtt for BS >140

5. Blood Pressure Management:
  • To promote spinal cord perfusion MAPs will be maintained >85 mm Hg for 7 days post injury
  • Pressures should be maintained using the following:
    • Dopamine 2-10 mcg/kg/min IV
    • Phenylephrine 5-200mcg/min IV
    • When able to take PO’s institute one of the following oral agents and begin weaning gtt
      • Ephedrine 25mg PO Q6 (maximum dose 150mg/24 hours)
      • NaCl tablets 1-2gms PO TID (maximum dose 4gms TID
      • Florinef 0.2mg PO Daily (maximum 1mg/24 hours)
      • Midodrine 10mg 30 min before sitting up or TID (do not use in combination with ephedrine)
  • Institute abdominal binding and elastic (ACE) bandages to lower extremities when placed in the sitting position or cleared for OOB activity

6. Respiratory Management:
  • All patients must receive continuous oxygen saturation monitoring (Maintain a low threshold for intubation in high cervical injury C5 or above)
  • Initiate quad cough and suctioning Q2 hours when appropriate
  • Incentive spirometer Q2 hours when appropriate
  • Albuterol 2.5mg in 3cc NS per nebulizer, every 6 hours in the intubated and high cervical (C5 or above) non-intubated patient

7. DVT Prophylaxis:
  • Upon admit all patients will received SCS with antiembolic stockings unless contraindicated by lower extremity injuries
  • Non-operative cases will receive enoxaparin 30mg SQ BID within 48 hours of admission, unless otherwise determined by the Attending Physician.
  • Operative cases will have enoxaparin 30mg SQ BID started within 48 hours of surgery regardless of drain placement.
  • DVT prophylaxis in patients with traumatic brain injury, in addition to their spinal injury, will be evaluated on a case by case basis by the Attending Neurosurgeon.

8. Additional Treatment Guidelines:
  • All patients not on a rotorest bed will be turned every 2 hours
  • All patients will initially receive an indwelling foley catheter with Q2 I&O Monitoring
    • The patient will intitally be allowed an attempt at self evacuation, this will be followed up with a bladder scan or straight catheterization if results provide proof of retention (> 100cc unless history significant for BPH then may liberalize to 150cc) a routine catheterization program will be instituted
    • I&0 catherterization will begin once urine output is <2 liters in 24 hours and will be ordered in the following manner
      • I&O cathererization Q6 hours if >400cc change frequency to Q4 hours
  • All patients will have the following consults within 48 hours of admission unless contraindicated secondary to instability (emphasis on early mobilization
    • Physical Therapy
    • Occupational Therapy
    • Speech Therapy for Swallow evaluation
      • If unable to pass or participate in swallow evaluation; a feeding tube will be placed and nutritional support initiated within 48 hours of admission
    • Physical Medicine and Rehabilitation
  • All patients with evidence of altered rectal tone, pernineal sensation, or with evidence of lack of bowel function will be started on the following bowel regimen within 24-48 hours of admission
    • Colace 100mg PO/FT BID
    • Bisacodyl Suppository 10mg PR with digital stimulation administered at the same time daily






Sunday, 27 October 2013

Paediatrics MCQs with key

1.An eight year old boy presented to the casualty with high fever, pruritic erythematous rash, joint pain and lymph node enlargement. There is a history of upper respiratory tract infection for which he was on cefaclor – 8 days completed of a 10 day course. The most likely diagnosis is?
A. Serum sickness like illness
B. HSP
C. Type III hypersensitivity
D. Kawasaki disease

Correct answer : A. Serum sickness like illness
Serum sickness like reaction can occur following the use of certain drugs, especially cefaclor in children. It presents with an urticarial / purpuric rash, arthritis, lymphadenopathy and fever. But unlike true serum sickness (a type III hypersensitivity response), it is not caused by circulating immune complexes.



2.A one year old child presented to the OPD with the history of short stature, tiredness and constipation. Examination revealed a palpable goitre. Serum T4 was decreased and TSH levels were increased. Which is the most probable diagnosis?
A. Thyroid dysgenesis
B. Thyroid Dyshormonogenesis
C. TSH receptor blocking antibody
D. Central hypothyroidism

Correct answer : B. Thyroid Dyshormonogenesis
Among the options given, only Thyroid Dyshormonogenesis presents with a palpable goitre.
 
 
3.Most common tumour associated with Neurofibromatosis I in children is?
A. AML
B. CML
C. ALL
D. JMML (Juvenile myelomonocytic leukemia)

Correct answer :  D. JMML (Juvenile myelomonocytic leukemia)
Children with NF1 have a 200-500 times increased incidence of JMML.

 
4.The protective effects of breast milk are known to be associated with:
A. IgM antibodies
B. Lysozyme
C. Mast cells
D. IgA antibodies


Correct answer : D. IgA antibodies
Although breast milk contains both breast milk and antibodies; antibodies play the major role in providing immunity. Breast fed babies have lower incidence of diarrhoea, otitis media, pneumonia, bacteremia and meningitis.


5.All of the following therapies may be required in a 1 hour old infant with severe birth asphyxia except:
A. Glucose
B. Dexamethasone
C. Calcium gluconate
D. Normal saline


Correct answer : B. Dexamethasone
Steroids should not be used in management of infants with asphyxia



GRIP Book 1 & 2 For Title Page Book 1 GRIP FOR FINAL YEAR Medicine 1 Medicine 2 Paedetric MedicineSolved SEQ papers form 2007-2013, MCQs with key, Solved Model papers, TOS, Syllabus, Most important Topics & repeated questions Q Bank University questions according to UHS pattern (University of health sciences, Lahore) By Dr Hafiz Bashir Ahmad Noor (SMC)

Title Page Book 1 GRIP FOR FINAL YEAR
Medicine 1
Medicine 2
Paedetric Medicine

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Title Page Book 2 GRIP FOR FINAL YEAR
GENERAL SURGERY
SPECIAL SURGERY
GYNAECOLOGY
OBSTETRICS

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price : Rs 400 only
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Copies: 1000

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GRIP Book 1 & 2 For Solved SEQ papers form 2007-2013, MCQs with key,
Solved Model papers, TOS, Syllabus, Most important Topics & repeated questions
Q Bank University questions according to UHS pattern
(University of health sciences, Lahore) By Dr Hafiz Bashir Ahmad Noor (SMC)





Saturday, 26 October 2013

The secret to success is to do common things uncommonly well...

The secret to success is to do
common things uncommonly well.

On The Edge: 10 Tips To Fight Stress by Shannon Clark

If it's a top-heavy number like 8 or 9, don't be ashamed. You're in the company of many high-level achievers—you know, the types whose hard work keeps everyone around them from having to experience that degree of stress. Even a mid-level number like 5-7 is nothing to sneeze at. That range, to me, signifies a dull roar of background chaos punctuated with occasional 8 or 9-level crises.
It's too easy to attribute your stress to a single source like "it's my job," "relationship troubles," or just "money." The truth is that if you're a 5 or above, you probably have multiple stressors heaped up on your aching shoulders—or your neck, or wherever your body seems to "carry it." Unfortunately, for every acute headache and neck crick, there may be a host of other silent, long-term health problems to which your stress is contributing. These can include depression, anxiety, heart disease and stroke, weight gain, chronic migraines, gastrointestinal problems, and an increased rate of aging.
You might not be able to cut out all stress in your life. You probably wouldn't even want to. But that's no reason not to take a stand against chronic stress and look for easy ways to turn the battle in your favor. Here are 10 time-tested stress-busters.

1
Keep a Journal

You could call this a "stress journal," but if that feels a little too negative—like it's the place you go to vent your rage and plot revenge against all the people who bug you—then just calling it a "journal" will suffice. Whatever the name, it is one of the best tools to combat daily stress.
Here's what most people don't tell you about journals: You don't have to write page after page like a stereotypical sullen teenager to see the benefit. A simple sentence or two here or there can do wonders. Just like acknowledging that you're at an 8 or 9 level of stress can help you realize that something needs to be done. Labeling your stressors for what they are can help give you the perspective to finally combat them. Just write what's happening and what you're feeling. That's enough.
The simple act of writing can serve as a fantastic emotional release and can help you temporarily put whatever stresses you out of mind, so you can deal with other issues and return to it later. Revisit it the next time you reach for the journal, and maybe you'll be better able to think up a productive solution.

2
Change Your Perspective

Remember, nothing in life is by nature stressful. Stress is simply a mental state coloring how you perceive an event or circumstance. That doesn't mean it's not real, but it does mean that you can shift the way you look at the event. Psychologists call this "cognitive reframing," and it's been shown to be effective for an incredible range of people and problems.
There are many ways to reframe. You can open yourself to more possibilities in what you thought was a simple either/or situation. You could look at a supposed weakness and see the strength it's causing you to develop. Think about how someone from another business, industry, or country would react in your shoes. There are many different ways to do it, but what they all share is creating possibilities you didn't know existed and bringing them to light.

3
Don't Forget Your Mg!

Magnesium helps lower the levels of cortisol in the body, which is the primary hormone released during a stressful situation, and the one linked to the most health concerns. If your cortisol levels are chronically high, you're also at an increased risk of muscle loss, sleep disruption, depression, moodiness, and general feeling-like-crappiness. Not so coincidentally, these are also some of the symptoms of magnesium deficiency, which more than half of us suffer from.
An easy way to get your magnesium during the day is to snack on nuts. Pretty much any variety will do, but some of the best include the Brazil nut (107 mg per oz.), almond (76 mg), cashew (74 mg), peanut (50 mg) and walnut (45 mg). Each of these also provides a heaping helping of essential fatty acids, potassium, protein, and other macro- and micronutrients.

4
Cook Up Some Oatmeal

If you wake up stressed about the busy day ahead, set aside a few minutes to eat something hot and filling prior to battle. Oatmeal is packed with complex carbohydrates to provide sustained energy over the course of the morning. Those slow-burning carbs also help release the neurotransmitter serotonin in your body, which can help induce a natural feeling of calmness.

5
Cut Simple Sugars

Not all carbohydrates are great for reducing your stress level. The simple carbs found in foods high in white flour, refined sugar, and most highly processed foods and drinks are going to cause an instant blood glucose spike followed by a crash. This can just leave you with a massive energy low, making stress feel even more unbearable and solutions even farther from your grasp.
This rapid fluctuation in blood sugar levels also places a significant amount of stress on the body in general, so avoid it as much as possible. Stick to complex carbohydrates along with fruits and vegetables instead.
"Stick to complex carbohydrates along with fruits and vegetables instead of simple sugars."

6
Practice Deep Breathing

Sometimes stress sneaks up on you. Other times, you can feel it coming over you in a wave of panic. When this happens, the physiological response is almost always to breathe more shallowly—which is the exact wrong course of action. The next time you feel that awful feeling, take only deep belly-breaths for a full minute. This will increase oxygen flow into the body and the brain, producing a calming sensation to help you regain control over your emotions.
Deep breathing is so effective that once you try it, you'll wonder why you don't do it all the time. Well, you should! Research has shown that many people breath shallowly all the time without even realizing it. Don't be one of them. This simple change can drastically improve how you feel.

7
Go for a Brisk Walk

Exercise is great for stress. You probably know that already. But it doesn't have to be intense, sweaty, or take place in a gym in order to help you clear your head. Sometimes the best way to combat stress is to simply go for a quick walk. Even just 10 minutes of brisk walking is often enough for most people to feel more relaxed when they return to their desk or house. Step away from the screen, get that inbox out of your head, and move your body.
"Even just 10 minutes of brisk walking is often enough for most people to feel more relaxed when they return to their desk or house."
Walk a few times each and every day and see if you can rope in your coworkers. Why should smokers be the only ones who get to go outside?

8
Indulge in Dark Chocolate

Cutting down on sugar is harder for some of us than others. The key for people who simply can't imagine life without chocolate is to be strategic about indulgences. So listen up: Chocolate can help you combat stress, but not any chocolate will do! You have to go dark or go home!
Chocolate contains a number of different compounds that help release endorphins in the body, but these compounds are found in the cocoa part of the chocolate, not the other stuff like milk, sugar, or stabilizing agents. A good rule is to buy chocolate with as high a cocoa percentage as you can handle.
"Black and green teas balance caffeine content with the amino acid theanine."

9
Drink Tea

If you were to make a cartoon drawing of a stressed out person, he or she would probably have a cup of cheap coffee sitting right next to a huge stack of paperwork. Sound about right? You may think a steady stream of coffee is crucial for getting through the day, but it's also known to increase cortisol levels and boost production of adrenalin—the hormone behind the "fight or flight" response. Stretch that out over months and years and it can begin to fatigue your adrenal glands, which can lead to fatigue, anxiety, and mood swings. Long story short: Coffee leads to more stress, more problems, and less energy.
Black and green teas balance caffeine content with the amino acid theanine. If you don't know this compound yet, you should. It has been known for decades for its ability to reduce physical and mental stress, improve mood and cognitive performance, and raise the overall levels of the calming neurotransmitters GABA and dopamine. Sure, tea varieties generally contain less caffeine than your venti Americano, but they also have been shown in studies to decrease cortisol more effectively than a placebo. Sip them throughout the day without worry.

10
Get a Hobby

When you have obligations building up all around you, it can feel like the only way you'll ever be happy again is to struggle with them nonstop until they're out of your life. But, you need to have corners of your life that belong to you alone, where you can get lost in a state of "flow" and not have to worry about anything else.
These activities should be totally consuming while you do them, and they shouldn't be burdened with guilt or shame. A social component helps; regular social engagements have been shown to increase your happiness level on par with making more money at work. But a hobby doesn't have to be social in order to be great. It just has to clear out your worries and make you feel good.
May I suggest ... working out?



Anatomy MCQs Set3 with key

1.Paralysis of 3rd, 4th and 6th cranial nerves with involvement of ophthalmic division of trigeminal, localizes the lesion to:
A. Cavernous sinus
B. Apex of orbit
C. Brainstem
D. Base of skull
Correct answer : A. Cavernous sinus
3,4,5 cranial nerves pass in relation to the lateral wall of cavernous sinus. 6th cranial nerve passes through the cavernous sinus.
 
 
 
2.All of the following are branches of the external carotid artery except:
A. Superior thyroid artery
B. Anterior Ethmoidal artery
C. Occipital artery
D. Posterior auricular artery
Correct answer : B. Anterior Ethmoidal artery
Anterior ethmoidal artery arises from ophthalmic branch of internal carotid artery.
 
 
 
3.In an adult male, on per rectal examination, the following structures can be felt anteriorly except:
A. Internal iliac lymph nodes
B. Bulb of the penis
C. Prostate
D. Seminal vesicle when enlarged
Correct answer : A. Internal iliac lymph nodes
Internal iliac lymph nodes can be palpated laterally when they are enlarged, not anteriorly.
 
 
 
 
4.The following group of lymph nodes receives lymphatics from the uterus except:
A. External iliac
B. Internal iliac
C. Superficial inguinal
D. Deep inguinal
Correct answer : D. Deep inguinal
 
 
 
5.All of the following statements regarding vas deferens are true except:
A. The terminal part is dilated to form ampulla
B. It crosses ureter in the region of ischial spine
C. lt passes lateral to inferior epigastric artery at deep inguinal ring
D. It is separated from the base of bladder by the peritoneum
Correct answer : D. It is separated from the base of bladder by the peritoneum
There is no peritoneal layer between vas deferens and the bladder.
 
 
 
6.The Prostatic urethra is characterized by all of the following features, except that it:
A. ls the widest and most dilatable part
B. Presents a concavity posteriorly
C. Lies closer to anterior surface of prostate
D. Receives Prostatic ductules along its posterior wall
Correct answer : B. Presents a concavity posteriorly
Prostatic urethra is concave anteriorly.
 
 
7.Benign Prostatic hypertrophy results in obstruction of the urinary tract. The specific condition is associated with enlargement of the:
A. Entire prostate gland
B. Lateral lobes
C. Median lobe
D. Posterior lobes
Correct answer : C. Median lobe
Median lobe of prostate is prone to development of BPH.
Posterior lobe of prostate is prone to development of malignancy.
 
 
8.In which of the following a reduction in arterial oxygen tension occurs?
A. Anaemia
B. CO poisoning
C. Moderate exercise
D. Hypoventilation
Correct answer : D. Hypoventilation
Reduction in arterial oxygen tension occurs in respiratory failure – Type 1 (decreased oxygenation) or Type 2 (defective ventillation).
 
 
9.While doing thoracocentesis, it is advisable to introduce needle along:
A. Upper border of the rib
B. Lower border of the rib
C. In the center of the intercostal space
D. In the anterior part of the intercostal space
Correct answer : A. Upper border of the rib
The intercostal neurovascular bundle lies along the lower boder of the rib. Hence we should introduce the needle along the upper border of rib to prevent damage to the neurovascular bundle.
 
 
10.The femoral ring is bounded by the following structures except:
A. Femoral vein
B. Inguinal ligament
C. Femoral artery
D. Lacunar ligament
Correct answer : C. Femoral artery
Boundaries of femoral ring:
Anterior – Inguinal ligament
Medial – Lacunar ligament
Posterior – Pectineus and covering fascia
Lateral – Septum separating it from femoral vein





Anatomy MCQs Set2 with key

1.The intricately and prodigiously looped system of veins and arteries that lie on the surface of the epididymis is known as :
A. Choroid plexus
B. Tuberal plexus
C. Pampiniform plexus
D. Pectiniform septum
Correct answer : C. Pampiniform plexus


2.Infection / inflammation of all of the following causes, enlarged superficial inguinal lymph nodes except :
A. Isthmus of uterine tube
B. Inferior part of anal canal
C. Big toe
D. Penile urethra
Correct answer : D. Penile urethra
Lymphatic drainage of urethra
Penile urethra – deep inguinal lymph nodes
Prostatic urethra and membranous urethra  - Internal iliac nodes
Entire female urethra – Internal iliac nodes
 
 
3.While exposing the kidney from behind, all of the following nerves are liable to injury except:
A. Lateral cutaneous nerve of thigh
B. Ilioinguinal nerve
C. Subcostal nerve
D. Iliohypogastric nerve


Correct answer : A. Lateral cutaneous nerve of thigh
Posterior relations of the kidney:
Diaphragm
Medial and lateral arcuate ligaments
Muscles:
Psoas major
Quadratus lumborum
Transversus abdominis
Subcostal vessels
Nerves:
Subcostal nerve
Iliohypogastric nerve
Ilioinguinal nerve
12th rib (11th rib and 12th ribs in left kidney)
 
 
 
4.An inhaled foreign body is likely to lodge in the right lung due to all of the following features except:
A. Right lung is shorter and wider than left lung
B. Right principal bronchus is more vertical than the left bronchus
C. Tracheal bifurcation directs the foreign body to the right lung
D. Right inferior lobar bronchus is in continuation with the principal bronchus
Correct answer : A. Right lung is shorter and wider than left lung
An foreign body is more likely to get lodged in the right lung as the right bronchus is wider, …
 
 
5.After radical mastectomy there was injury to the long thoracic nerve. The integrity of the nerve can be tested at the bedside by asking the patient to :
A. Shrug the shoulders
B. Raise the arm above the head on the affected side
C. Touch the opposite shoulder
D. Lift a heavy object from the ground
Correct answer : B. Raise the arm above the head on the affected side
Long thoracic nerve (Nerve of Bell) supplies the serratus anterior muscle
Serratus anterior rotates the inferior angle of scapula laterally during abduction of the arm above the …
 
 
6.Barr body is found in the following phase of the cell cycle:
A. lnterphase
B. Metaphase
C. G1 phase
D. Telophase
Correct answer : A. lnterphase
 
 
7.All of the following physiological processes occur during the growth at the epiphyseal plate except:
A. Proliferation and hypertrophy
B. Calcification and ossification
C. Vasculogenesis and erosion
D. Replacement of red bone marrow with yellow marrow
Correct answer : D. Replacement of red bone marrow with yellow marrow
 
 
 
8.The type of joint between the sacrum and the coccyx is a
A. Symphysis
B. Synostosis
C. Synchondrosis
D. Syndesmosis
Correct answer : A. Symphysis
 
 
9.The following statements concerning chorda tympani nerve are true except that it:
A. Carries secretomotor fibers to submandibular gland
B. Joins lingual nerve in infratemporal fossa
C. ls a brach of facial nerve
D. Contains postganglionic parasympathetic fibers
Correct answer : D. Contains postganglionic parasympathetic fibers
Chorda tympani nerve contains preganglionic parasympathetic fibers. It synapses in the submandibular ganglion.
 
 
10.The superior oblique muscle is supplied by:
A. 3th cranial nerve
B. 4th cranial nerve
C. 5th cranial nerve
D. 6th cranial nerve


Correct answer : B. 4th cranial nerve (Trochlear nerve)





Anatomy MCQs part 1 with key

1.Which of the following gives rise to the muscular component of dorsal aorta?
A. Intermediate mesoderm
B. Lateral plate mesoderm
C. Axial mesoderm
D. Paraxial mesoderm

Correct answer : B. Lateral plate mesoderm
Vascular smooth muscle cells are thought to arise from splanchnic layer of paraxial mesoderm. But recent studies have shown that the aortic smooth muscle cells arise from the lateral plate mesoderm.


2.Toynbee’s muscle is?
A. Levator ani
B. Tensor tympani
C. Stapedius
D. Scalenus minimus

Correct answer : B. Tensor tympani


3.Deepest layer of scalp is:
a) Connective tissue
b) Aponeurosis (Epicranial Aponeurosis)
c) Loose areolar tissue (Danger area of scalp)
d) None of these
Correct answer: d) None of these
From superficial to deep, the layers of scalp are (mnemonic: SCALP)
  1. S – Skin
  2. C – Connective tissue (fibrofatty)
  3. A – Aponeurosis (Epicranial Aponeurosis)
  4. L – Loose areolar tissue (Danger area of scalp)
  5. P – Periosteum


4.Which of the following movements will not be affected by involvement of the L5 Nerve root?
A. Thigh adduction
B. Knee Flexion
C. Knee Extension
D. Toe Extension

Answer : A. Thigh adduction
Thigh adduction is performed by adductor muscles (magnus, longus, brevis) with gracilis and pectineus acting as accessory muscles. None of them are supplied by L5 nerve root.


5.The Couinaud’s segmental nomenclature is based on the position of the :
A. Hepatic veins and portal vein
B. Hepatic veins and biliary ducts
C. Portal vein and biliary ducts
D. Portal vein and hepatic artery

Correct answer : A. Hepatic veins and portal vein
Couinaud’s segmental nomenclature is based on position of hepatic veins and portal vein. It is the French system.

Monday, 7 October 2013

Saturday, 5 October 2013

Understanding your body...Stress Management

Everyone experiences stress at some point in life. Hans Selye, a scientist who popularized the concept of stress, said, “Stress as a scientific concept suffers the misfortune of being too widely known and too poorly understood.”
Despite the fact that stress is one of the most common human experiences, it is surprisingly difficult to define. Scientists say that stress is a force or event that impairs normal stability, balance or functioning.
The following example may make stress easier to understand. The stress of a strong wind might alter the balance of a suspension bridge so that the bridge swings from side to side. Usually people do not even notice the gentle swaying as they drive across the bridge.
When the wind increases, the swaying of the bridge becomes obvious to everyone. Although this swaying might make someone uncomfortable or anxious, it is actually the way that the bridge copes with stress. If the bridge did not sway at all, it would be brittle and more likely to be damaged by the stress of the wind. If the strength of the wind increased dramatically, so that the limits of the bridge were exceeded, the bridge could actually collapse.
Stress in our lives is like that wind. Although stress is often present, it usually goes unnoticed. Sometimes the stress that people experience makes them feel shaky or frightened, as if they, like that bridge, were at risk of collapse. Usually this fear is unrealistic, and people’s foundations are much sturdier than they think. Occasionally, one truly is at risk of collapse; it is critically important to recognize this risk. Most often, however, the real risk that comes from stress is that, over many years, it will damage people’s health and detract from their quality of life.
Medical research can explain the dramatic effects that stress has on one’s body and health.
Stress is really one of the ways that the body protects itself. When danger threatens, the body produces chemical substances called “hormones” that prepare people for action. These hormones, such as adrenaline, are released into the bloodstream and pumped throughout the entire body. They increase the tone in the muscles, preparing a person to jump into motion. They raise the heart rate, so that blood flows more rapidly throughout the tissues. They signal respiration to become more rapid, so that an ample amount of oxygen is available to supply the entire body in a crisis. They even increase the speed of thoughts, helping individuals to plan and think their way out of trouble.
These physical and psychological changes are helpful when people are actually threatened by danger. They are not so helpful if people experience them all day, every day. It is difficult for the body to remain in a state of “red alert” all of the time. If this occurs, people become tired, anxious or depressed.