Concentric layers of Granuloma There are 4 concentric layers in a granuloma, however the clear distinction is difficult in reality due to overlapping. From inside to out: 1. Necrosis Caseating necrosis: Tuberculosis, Leprosy Coagulative necrosis: Buruli ulcer (M.ulcerans), Gumma containing central blood vessels (Syphilis) Fibrinoid necrosis: Aschoff bodies (Rheumatic granuloma),…
Author: Epomedicine
Clinical Skills and Approaches
Milkmaid’s grip in Chorea
Milkmaid’s Grip Milk maids grip is appreciated as an alternating squeezing and releasing of the finger like a milking motion, when asked to maintain a constant, firm grip of examiner’s fingers. This may reflect a combination of Chorea and Motor impersistence. As a result of poor grip, patients often involuntarily…
PGMEE, MRCS, USMLE, MBBS, MD/MS
Tissue Specific and Named Macrophages
Subtle differences in the morphology and functions of macrophages develop as a result of the influence of a particular microenvironment. Appearance of macrophages to histologists have been described as a kind of mythological Proteus, “a creature who had the power of changing his appearance at will”. The life-span of these fixed…
Clinical Skills and Approaches
Ascitic Paracentesis : Practical Essentials
Absolute contraindications to Ascitic Tapping (Paracentesis) While some authors have claimed ascitic paracentesis to be free from absolute contraindications, others have listed following as absolute contraindications: Clinically evident fibrinolysis Disseminated Intravascular Coagulation (DIC) Clinically apparent oozing from needle sticks Acute abdomen requiring surgery Relative contraindications to Blind Paracentesis Ultrasound guided…
PGMEE, MRCS, USMLE, MBBS, MD/MS
Difference between Sarcoidosis and Tuberculosis
Sarcoidosis and tuberculosis are both granulomatous disease with similar constitutional symptoms, respiratory symptoms and multiple organ involvement with hilar and mediastinal lymph node involvement. Hence, the diagnosis of one from the other may pose significant difficulties. Sarcoidosis vs Tuberculosis (TB) IFN-gamma release assays (IGRA)Tuberculosis can be reliably excluded if both…
Clinical Skills and Approaches
Prescribing Opioids for Chronic Pain
Recommendations for Prescribing Opioid in Chronic pain 1. 1st line of therapy in chronic pain outside of active cancer, palliative or end of life care must be nonpharmacologic therapy and nonopioid pharmacologic. Consider opioid therapy in combination with nonpharmacologic or nonopioid pharmacologic therapy if benefits outweighs risk. 2. Ordinarily 2…
Emergency Medicine
NSTEMI : Early Medical Management Pearls
Antiplatelet therapy Aspirin 2-4 non-enteric coated chewable baby aspirins (81 mg each) – buccal absorption is the fastest for platelet inhibition. Initial dose: 150 mg – 325 mg Daily dose: <150 mg For patients unable to take oral medications: Rectal suppository 325 mg Avoid in acute MI: Enteric coated preparations…
PGMEE, MRCS, USMLE, MBBS, MD/MS
Apoptosis (Caspases and Genes) : Mnemonics
Caspases (Pro-apoptotics) Initiator caspases: Executioner caspases: 3 and 7 Pro-apoptotic genes Mnemonic: “B” followed by a vowel Anti-apoptotic genes Mnemonic: Contains “L” or “XL” Other: Inhibitor of Apoptosis (XIAP) How all these genes and molecules work together to complete apoptosis? Find it here.