A 63 year old man comes to the emergency room with back pain, weakness and shortness of breath. On examination, he has an aneurysm of the abdominal aorta at the aortic hiatus of the diaphragm. Which of the following pairs of structures would most likely be compressed?

A.) Vagus nerve and azygos vein
B.) Esophagus and vagus nerve
C.) Azygos vein and thoracic duct
D.) Thoracic duct and vagus nerve
E.) Inferior vena cava and phrenic nerve.

It’s C.) Azygous vein and thoracic duct.

The aortic hiatus transmits the azygous vein and the thoracic duct. The vagus passes through the esophageal hiatus with the esophagus and the right phrenic nerve comes through the diaphragm with the vena cava.

Mnemonic in regards to this problem? The aorta is found between a duck and a goose (thoracic duct and azygous vein).

(via White-Coat)

white-coat:

A 63 year old man comes to the emergency room with back pain, weakness and shortness of breath. On examination, he has an aneurysm of the abdominal aorta at the aortic hiatus of the diaphragm. Which of the following pairs of structures would most likely be compressed?

A.) Vagus nerve and azygos vein
B.) Esophagus and vagus nerve
C.) Azygos vein and thoracic duct
D.) Thoracic duct and vagus nerve
E.) Inferior vena cava and phrenic nerve.

What do you think?

\o/

What is Cancer?

A 3D Animation which depicts the growth of a tumor.

When it comes to health, men often take better care of their cars or roofs than their own bodies. “If they spot a leak in their roof, they want to fix it before it damages the whole house,” says Dr. Jean Bonhomme of the Men’s Health Network. “The slightest funny noise in their car will send men to the garage. If they could only do that with their own bodies.”

In fact, a possible reason for men’s higher mortality from major illnesses such as heart disease, cancer, stroke and diabetes is their unwillingness to seek medical help as often as women do. Perhaps young men can get away with ignoring various aches and pains, but in middle age, these can be signs of something that might get worse over time.

Indeed, there are some symptoms that a man should always take seriously, whatever his age. If you have one or more of them, stop, think and call a doctor.

1. Chest pain

This is the holy grail of symptoms. If you feel as if an elephant is sitting on your chest, head for the nearest ER. (Call an ambulance or have somebody drive you.) Often, however, signs of a heart attack are less obvious, involving left-arm pain, jaw pain, sweating and shortness of breath. Chest pain that catches you after exertion, lasts a few minutes and then goes away could mean your heart is not getting enough blood (a condition called angina). Yes, sometimes chest pain is only heartburn, but why take a chance?

2. Shortness of breath

Being a little short of breath after running or a game of pickup basketball is not a big deal. But if you feel short of breath lying in bed at night, after walking a block or two or climbing one flight of stairs, you should see your doctor at once. These may be signs that your heart is getting weak—also called congestive heart failure.

3. Unintended weight loss

Many Americans are trying to lose weight. But what if you’re losing weight without even trying? If your pants are suddenly too loose, something else may be going on. It may be something relatively benign, like an overactive thyroid gland, but sometimes it’s the first hint of cancer.

4. Blood in the urine or stool

True, some people don’t even want to look. But they should. The bottom line is: There shouldn’t be any blood in your urine or stool.

Urine travels from the kidneys to the bladder in special pipes called ureters, and then to the urethra before it leaves the body. Any disruption along the way from cysts, stones, infection or inflammation can introduce blood in the urine. So can cancer of the kidneys or bladder.

Blood in the stool may be trickier to see. If you see bright red blood, it’s a no- brainer. But sometimes blood in the stool may make your bowel movement look dark and tarry. Don’t assume it’s hemorrhoids. When there’s blood in the stool, colon cancer must be ruled out, usually by a colonoscopy. (Blood in the stool also can be related to a bleeding ulcer or a condition called diverticulitis.)

5. Changes in urination

Getting up too many times at night to visit the bathroom, a weak stream, having difficulty passing urine or getting urine started can all be signs of an enlarged prostate. The walnut-sized gland that surrounds the urethra grows as men age and can cause a common condition called benign prostatic hyperplasia (BPH). It’s not life-threatening, but it can have a profound effect on quality of life. Identify it early, and you can prevent its progression. Prostate cancer—a life-threatening condition—has similar symptoms. A physical exam and a PSA blood test can often tell the difference between the two. Increased visits to the bathroom also can be a symptom of other conditions, including diabetes—a serious illness that may lead to heart and kidney disease.

6. Leg swelling

When fluid accumulates in your feet, ankles or legs, don’t ignore it. The swelling, also called edema, may be a warning of heart, kidney or liver disease. While there are medications (diuretics, or “water pills”) that can help reduce the swelling, it is critical to find the underlying cause: Is the heart not pumping effectively? Are the kidneys not filtering all the fluid they’re supposed to? Is the liver congested? A battery of tests is likely to reveal the reason and get you started on the right course of treatment.

7. Skin lesions that don’t go away

Many people ignore skin wounds, especially when they are not on the face. Skin ulcers, particularly on the legs and feet, that don’t heal after a few days should raise a red flag. They may be a tip-off that something is wrong with the circulation. Nonhealing wounds also can be the first clue of diabetes. A skin lesion anywhere on the body that doesn’t go away, becomes larger or changes color and shape can suggest skin cancer. Don’t brush it off. If caught early, the chances of a full recovery are great.

Source: Health & Fitness

Answer of the image challenge C - Cocaine

Why?

Perforation of the nasal septum and palate are well recognized complications of intranasal cocaine use.

Source: The New England Journal of Medicine

Which one of the following drugs of abuse is most typically associated with the illustrated complication?

A- Ketamine

B- Heroin

C- Cocaine

D- Phencyclidine

E- Mescaline

Chose your answer?

The Amazing Human Body Exhibition

Is an educational exhibit that is intended to provide audiences with a unique and visually-informative perspective on the inner working of the human body by viewing real human specimens, preserved through a method called plastination

During the process of plastination, all the water in the body (water comprises about 70 percent of all cells) is replaced by polymers such as silicone rubber or polyester resin that retain all tissue structure via a special vacuum process. The technique can take up to 5,000 hours for a full-body plastinate.

The Amazing Human Body exhibition presents approximately 400 real human specimens, including 18 whole bodies and aims to inspire the general public to learn more about how the human body functions and how lifestyle choices affect the body.

More Information

Answer of the image challenge A- Palsy of the long thoracic nerve

Why?

Weakness or paralysis of the serratus anterior due to palsy of the long thoracic nerve is a common cause of a winged scapula.

Source: New England Journal of Medicine

This 9-year-old boy presented with a two-day history of right shoulder pain after an upper respiratory tract infection. What is the cause of the abnormality demonstrated?

A- Palsy of the long thoracic nerve

B- Subcutaneous emphysema

C- Neuralgic amyotrophy

D- Pleural prolapse

E- Scapular subluxation

Chose your answer?

Fig.1: Examples of primary and secondary causes of male hypogonadism. Klinefelter’s syndrome results from the 46,XXY karyotypic abnormality present in approximately 1 in 500 male births. The example of Kallmann’s syndrome is rare isolated deficiency of GnRH, resulting in hypogonadotropic hypogonadism associated with olfactory lobe dysgenesis and anosmia. FSH, follicle-stimulating hormone; GnRH, gonadotropin-releasing hormone; LH, luteinizing hormone; T, testosterone.

Fig. 2: Regulation of testicular function. Note that the single decapeptide gonadotropin-releasing hormone (GnRH) stimulates the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Pulsatile GnRH is required. Chronic exposure downregulates the GnRH receptor and causes impaired FSH and LH release, the mechanism whereby pharmacologic GnRH agonists result in chemical castration. Prolactin excess also results in impaired GnRH pulse generator function and hypogonadotropic hypogonadism. Feedback inhibition of LH secretion is a sex steroid–mediated event, whereas FSH secretion has dual feedback regulation involving inhibition by sex steroids and the Sertoli cell product inhibin. Accordingly, a monotropic elevation of the FSH level (normal LH and testosterone levels) may result from deficient Sertoli cell–spermatogenic function. CNS, central nervous system.

Author: Stephen Kemp, MD, PhD, Professor, Department of Pediatrics, Section of Pediatric Endocrinology, University of Arkansas and Arkansas Children’s Hospital

Introduction

Hypogonadism manifests differently in males and in females before and after the onset of puberty. If onset is in prepubertal males and testosterone replacement is not instituted, the individual has features of eunuchoidism, which include sparse body hair, poor development of skeletal muscles, and delay in epiphyseal closure, resulting in long arms and legs. When hypogonadism occurs in postpubertal males, lack of energy and decreased sexual function are the usual concerns. In females with hypogonadism before puberty, failure to progress through puberty or primary amenorrhea is the most common presenting feature. When hypogonadism occurs in postpubertal females, secondary amenorrhea is the usual concern.

Read More» (eMedicine)

Images Source (1 and 2): Cleveland Clinic

Answer of the image challenge D - Hypogonadism

Why?

The man on the right has evidence of central adiposity, preservation of scalp hair, loss of body hair, and gynecomastia compared to his identical brother. These findings are most suggestive of hypogonadism. This patient was diagnosed with a pituicytoma.

It’s Tumblr Tuesday and if you don’t have any blog to recommend, could you  recommend fuckyeahmedicine ?? please… (just click the link)

Thanks everyone!

Wish you all the best.

Source: New England Journal of Medicine

What endocrine diagnosis is affecting the identical twin on the right side of the image?

A- Acromegaly

B- Addison’s disease

C- Cushing’s syndrome

D- Hypogonadism

E- Hypothyroidism

Chose your answer?

Sick sinus syndrome (SSS) is a type of bradycardia in which the sinoatrial (SA), or sinus node is not working as it should. The sinus node is a small cluster of cells in the upper right chamber, or atrium, of the heart. It contains special “pacemaker” cells that generate the electrical signals that regulate the pace and rhythm of the heartbeat. These signals travel from the sinus node to the AV node. From the AV node, the signal is conducted along pathways that spread into the ventricles, causing them to contract and pump blood into the lungs and throughout the body.

Sick sinus syndrome (SSS) is not a specific disease, but a group of signs or symptoms that indicate the SA node is not functioning properly.

Some patients with sick sinus syndrome also have rapid heartbeats (tachycardia). Or the heartbeat alternates between too fast and too slow. This is called bradycardia-tachycardia syndrome. Often there is a long pause (asystole) between heartbeats, especially after an episode of tachycardia.

SSS affects about 3 out of every 10,000 people. It becomes more common as we age.

Types of Sick Sinus Syndrome

Sick sinus syndrome may be due to defects in the heart itself, or it can be related to factors outside the heart.

Some medications prescribed to treat high blood pressure, coronary artery disease and other conditions, for example, are known to cause bradycardia. This generally does not cause problems for most people, and drugs that slow the heart rate are useful treatments for some types of arrhythmias or other heart disorders. But they may cause low heart rates and bring out other symptoms of SSS in some individuals, such as elderly people with age-related degeneration of the SA node.

• Sinoatrial block is a type of SSS in which the electrical signals move too slowly through the sinus node.
• Sinus arrest is when the signal from the SA node has a pause in it’s normal pacemaker activity.

Bradycardia also can result from abnormalities of the atrioventricular (AV) node, the part of the heart’s conduction system that conducts electrical signals from the atria to the ventricles. These problems are commonly called heart block.

Symptoms

Many people with sick sinus syndrome have no symptoms, or the symptoms may not seem serious enough for concern. The condition may not be diagnosed until it is in an advanced stage. Typically, the first sign an individual with SSS notices is a consistently slow heart rate or bradycardia. Often, the rate falls to 40 to 50 beats per minute or less before it is noticed.

For more information about the electrical conduction system of the heart and what can go wrong, go to The Normal Heart.

If you experience any sudden, unexplained episodes of fainting, consult your doctor.

Other symptoms may include:

• Fainting (syncope) can occur when the abnormal heart rhythm affects the heart’s ability to pump a sufficient volume of blood to the brain.
• Fatigue and weakness may be signs that the heart is not pumping as well as it should. When the blood supply is inadequate, the body diverts blood to the most vital organs. This reduces blood flow to the muscles of the arms, legs or other parts of the body and the individual may lack energy or be unable to do normal tasks.
• Shortness of breath, or dyspnea. People with this symptom often describe the sensation of not being able to take in enough air, or say they are “out of breath.”
• Chest pains, or angina, that indicate the heart is not getting enough blood.
• Disturbed sleep. The abnormal rhythm of the heart may interfere with sleep and wake people up repeatedly during the night. Some people have a condition called sleep apnea in which they stop breathing off and on during the night. This condition may contribute to SSS and other heart disorders by reducing oxygen supply to the heart.
• Confusion. When the blood supply to the brain is diminished, people may have trouble understanding what is happening around them or make errors in judgment. They also may seem drowsy, have problems with balance or movement, or appear anxious or agitated.
• Palpitations describe an unusual awareness of the beating of the heart. The heartbeat may seem too fast or slow, or to beat in a chaotic, irregular pattern. People may describe a “pounding” in the chest, as if the heart is beating with unusual force. People with SSS who have episodes of tachycardia (an abnormally rapid heartbeat) often describe them as “palpitations.” 

People with unexplained symptoms that may be early signs of sick sinus syndrome should consult their doctor as soon as possible.

Seeing the Doctor

There are some signs that a doctor may discover during a physical examination that suggest a diagnosis of SSS, such as:

• A pulse that is slower than normal.
• An irregular heart rhythm that can be heard with a stethoscope.
• Sinus “pauses,” or gaps between signals from the SA node, that indicate the heart is not being paced at the normal, steady rate.
• “Escape” rhythms are electrical signals that originate from a part of the heart muscle other than the sinus node. If the SA node stops working or doesn’t work properly, another pacemaker at the center of the heart called the AV node may begin signaling the heart to beat. Less often, the lower chambers of the heart also can generate escape rhythms that take over for the function of the SA node.
• A heart rhythm that alternates between slow and fast.
• Low or low-normal blood pressure.

Article Source: Heart Rhythm Society

Image by Mayo Foundation for Medical Education and Research.

Author: Daniel C Postellon, MD, Clinical Associate Professor, College of Human Medicine, Pediatrics and Human Development, Michigan State University; Consulting Staff, Pediatric Endocrine Clinic, Helen DeVos Children’s Hospital

In 1938, Henry Turner first described Turner syndrome, which is one of the most common chromosomal abnormalities.More than 95% of adult women with Turner syndrome exhibit short stature and infertility.

Read More » (eMedicine)

Image Source: FemaleCare