STENCILDENT

                        LUDWIG ANGINA STUDENTS CORNER : HI !my dear stencildent family ,today we will be discussing about a very important topic ,yes its about Ludwig angina here we given a sample as to how you can present this answer when asked first of all do start by listing out table of content ,then move on to describing the surgical anatomy ,reason for Ludwig angina existence and how it gets precipitated ,pathology ,clinical features ,management -surgery point of view and conclude with complications.                         TABLE OF CONTENT : INTRODUCTION SURGICAL ANATOMY ETIOLOGY PRECIPITATAING FACTOR PATHOLOGY CLINICAL FEATURES MANAGEMENT  SURGERY COMPLICATION INTRODUCTIO N: Ludwig angina refers to serious ,potentially life threatening polymicrobial cellulitis of submental ,submandibular region combined with inflammatory edema of mouth Organism commonly isolated : STAPHYLOCOCUS AUREUS ,STREPTOCOCUS VIRIDAN ANEROBE :Fusiform bacilli,diptheroid  Cellulitis:  Diffuse inflammation

      REACTIONARY HEMORRHAGE  INTRODUCTION: The term hemorrhage refers to excess loss of blood due to rupture of blood vessel STUDENTS CORNER : Start your answer by giving a short introduction to the topic followed by table of contents ,it can be visa versa to ,under the table of content mention etiology ,precipitating factors, pathophysiology ,clinical features and end it with treatment plan . Now let me give you a mnemonic that I used while preparing in order to remember etiology remember HTC MTC where: H-HYDROCELE SURGERY   T-THYROID SURGERY   C-CHOLECYSTECTOMY  M-MAJOR ABDOMINAL SURGERIES T-TONSILLECTOMY  C-CIRCUMSICION .  To remember precipitating factors the mnemonic as:   PBS ,CVS P(SILENT )  B- BLOOD PRESSURE  S-STRAING   C-CLOT DISLODGEMENT   V- VOMITING  S - SLIPPING OF LIGATURE . Clinical feature CDC TROPHY   C-CYANOSIS  D-DRY FACE,DRY MOUTH   C-COLD CLAMMY SKIN   T- TACHYPNEA,TACHYCARDIA  R- RAPID THREADY PULSE  O-OLIGURIA  P-PALLOR  H- HYPOTENSION  Y (SILENT )  Hope thes

  CLAUDICATION PAIN IN LEG WHILE WALKING  INTRODUCTION: Claudio means to limp (Latin word) Crampy pain in muscle seen in limbs  Site of pain depends on site of arterial occlusion Due to arterial occlusion Metabolites -lactic acid Substance p accumulate in muscle and cause pain common site -calf muscle Pain in foot - block in lower tibial and plantar vessel Pain in calf-block in femoropopliteal site Pain in thigh - block in superficial femoral artery  Pain in buttocks'-block in common iliac - LERICHE SYNDROME Pain commonly develops when muscles are exercising  During exercise: increase perfusion and increased opening of collateral wash the metabolites away BOYD CLASSIFICATION: GRADE 1: Pain after walking distance which pain develop CLAUDICATION DISTANCE  If patient continues to walk pain subsides -metabolites causing pain are washed away in the circulation due to increased blood flow in muscle and also opening of collateral GRADE2: Pain still persist on continuing walk ,but can walk

                   RAYNAUD DISEASE  INTRODUCTION: Raynaud phenomenon:  Vascular disease characterized by intermittent arteriolar vasospasm of the digits Etiology :Cold temperature /stress Features: Exaggerated vasoconstriction of digital arteries and arterioles Pain Pallor Cyanosis Hyperemia Symptoms present with characteristic changing of hands from white to blue to red PRIMARY RAYNAUD PHENOMENON: Also known as RAYMAUD DISEASE Less severe than secondary  Its seen in females Usually bilateral Occur :upper limb and normal peripheral pulses Etiology :abnormal sensitivity to cold that result in upper limb (hand ) arteriolar spasm Symptoms can be precipitated Observed by placing hands in cold water DIFFERENCE BETWEEN RAYNAUD PHENOMENON AND SECONDARY RAYNAUD PHENOMENON PRIMARY RAYNAUD PHENOMENON: Also known as Raynaud disease Less severe than secondary  Vasospasm is not associated with ischemic injury or an underlying associated disease Sex:women Age: <30 years Involves all fingers symme

                       NECROTISING FASCITIS  INTRODUCTION: It is a spreading ,destructive ,invasive infection of skin and soft tissue including deep fascia with relative sparing of muscle Common sites:  Lower extremities Genitalia Groin Lower abdomen  Similar to melaneys gangrene CAUSATIVE ORGANISM : MONOMICROBIAL : Group A BETA hemolytic streptococci Type 2 necrotizing fasciitis  POLYMICROBIAL : Synergistic combination anaerobe +coliform /non-group A streptococci  Type 1 necrotizing fasciitis  No history of injury when it occurs in lower limbs RISK FACTORS FOR TYPE 1 NECROTISING FASCITIS : Diabetic mellitus Malnutrition Obesity Corticosteroid Immune deficiency  CLINICAL FEATURES: Affected area: sudden pain, gross swelling of the limbs part: swollen red, erythematous ,edematous skip lesion of necrosis ,ulceration skin changes : Bronze hue Brawney induration Blebs /crepitus High degree fever ,jaundice ,renal failure a)TYPE 2 SPECIFIC FEATURE: Caused by streptococcus pyogens Occur in you

                        PRESSURE SORE: INTRODUCTION: PRESSURE SORE IS ALSO KNOWN AS:  BED SORE/DECUBITUS ULCER   Trophic ulcer with underlying bone as base Non -mobile ,deep ,punched out ulcer Common in : Old age Tetanus Diabetic  Comatose patient Anemia Emaciated patient BED RIDDEN INDIVIDUAL  SITES: Occiput Heel  Sacrum Scapula Elbow Buttock PREDISPOSING FACTOR: Malnutrition Anemia Excessive sweating Edema Incontinence-skin moist, septic Friction due to foreign body, bed sheet  Superficial bed sore 75%common  Deep bed sore is painless and covered with slough TREATMENT: Change of position in bed Use of water bed ,ripple bed Bed-smooth, free from wrinkles Skin-dry, clean, washed with soap Ripple bed-alternate pressure point pad under bottom sheet of ordinary mattress Urinary incontinence- specialized silicone bed clothes Good nursing ,regular dressing  Good nutrition is necessary Antibiotics ,blood transfusion are very essential as per need Excision of dead tissue followed by skin graf

                          TRACHEOSTOMY INTRODUCTION: Tracheostomy is making an opening in anterior wall of trachea and covering it into stoma on skin surface Types:  Emergency tracheostomy, Elective tracheostomy Permanent tracheostomy Mid tracheostomy ideal, commonly used through 2nd and 3rd rings behind isthmus Tracheostomy tubes are made of plastic ,soft ,least irritant and disposable  They have inflatable cuff, should be deflated at regular interval to prevent -tracheal necrosis due to pressure FUNCTIONS: Respiration through alternative pathway in case of obstruction above the stoma Protection of airway from: aspiration of pharyngeal secretion in comatose patient  Blood due to injuries in pharynx ,larynx INDICATION: RESPIRATORY OBSTRUCTION: Infection- Ludwig angina, Peritonsillar infection Tumor Trauma to larynx, trachea RETAINED SECRETION: (Inability to cough) Comatose patient Painful cough -trauma to chest RESPIRATORY INSUFFICIENCY: Chronic lung conditions: Emphyema bronchiectasis

                                    BIOPSY   Biopsy is the removal of tissue from the living organism for the purpose of microscopic examination and diagnosis . Lets first split the word biopsy into 2 halves ,first half BIO- means life/tissue ,second half OPSY -Vision /microscopy. STUDENT CORNER : First lets us understand how to attempt this question better to score maximum marks possible ,so in order to achieve that we need to present our answer also in that order ,draw the table of contents as such below starting with a small introduction to what biopsy is  all about followed by enlisting all the types of biopsy ,highlight all methods available to perform biopsy following which do mention any 2 methods in detail ,for example here I have mentioned about FNAC and TRUCUT biopsy you could also do the same or mention about any other 2 methods  . Coming back to our topic let us now discuss various types of biopsy : TYPES : INCISION BIOPSY EXCISION BIOPSY FNAC TRUCUT PUNCH BIOPSY  PAP SMEAR

                    HYPERKALEMIA FAQ(MOST FREQUENTLY ASKED QUESTION): HYPERKALEMIA also referred to as over potassium in blood . When do we call it over potassium in blood? When potassium levels are as high above 5.5 milliequivalent/liter  . Normally where does this potassium gets stored in our blood ? It gets divided into two components :  a) Intracellular (98%) b)Extracellular (2%):  INTRAVASCULAR SPACE :Between blood vessel and lymphatic  INTERSTITIAL SPACE :Between cell and outside cell. Internal potassium balance:  Is maintained by sodium potassium pump ,for every 3 sodium ions out,2 potassium ions enters into be more precise electrochemical radiant maintains the overall internal balance         Sets resting membrane potential                                👇 Needed for contraction of muscle which includes cardiac muscle,skeletal muscle and smooth muscle . EXTERNAL POTASSIUM BALANCE : When a Dietary intake of 50-150 milli equivalent/liter ,our kidney the most vital organ plays a