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87

Identifying and Treating All Aspects of Fibromyalgia: A New Look Into a Painful Syndrome - Pain, Depression and Sleep

In this podcast, Drs. Andrew Cutler and Stephen M. Stahl discuss the myriad comorbidities associated with the syndrome of fibromyalgia. Patients often present complaining of fatigue as well as pain. Recent research suggests a link between pain, depression and sleep, which is discussed in this podcast.  
Neuroscience Education Institute
about 9 years ago
29747
3
462

Cerebellar Neuroanatomy

Introduction Examination of the cranial nerves allows one to "view" the brainstem all the way from its rostral to caudal extent. The brainstem can be divided into three levels, the midbrain, the pons and the medulla. The cranial nerves for each of these are: 2 for the midbrain (CN 3 & 4), 4 for the pons (CN 5-8), and 4 for the medulla (CN 9-12). It is important to remember that cranial nerves never cross (except for one exception, the 4th CN) and clinical findings are always on the same side as the cranial nerve involved. Cranial nerve findings when combined with long tract findings (corticospinal and somatosensory) are powerful for localizing lesions in the brainstem. Cranial Nerve 1 Olfaction is the only sensory modality with direct access to cerebral cortex without going through the thalamus. The olfactory tracts project mainly to the uncus of the temporal lobes. Cranial Nerve 2 This cranial nerve has important localizing value because of its "x" axis course from the eye to the occipital cortex. The pattern of a visual field deficit indicates whether an anatomical lesion is pre- or postchiasmal, optic tract, optic radiation or calcarine cortex. Cranial Nerve 3 and 4 These cranial nerves give us a view of the midbrain. The 3rd nerve in particular can give important anatomical localization because it exits the midbrain just medial to the cerebral peduncle. The 3rd nerve controls eye adduction (medial rectus), elevation (superior rectus), depression (inferior rectus), elevation of the eyelid (levator palpebrae superioris), and parasympathetics for the pupil. The 4th CN supplies the superior oblique muscle, which is important to looking down and in (towards the midline). Pontine Level Cranial nerves 5, 6, 7, and 8 are located in the pons and give us a view of this level of the brainstem. Cranial Nerve 6 This cranial nerve innervates the lateral rectus for eye abduction. Remember that cranial nerves 3, 4 and 6 must work in concert for conjugate eye movements; if they don't then diplopia (double vision) results. The medial longitudinal fasciculus (MLF) connects the 6th nerve nucleus to the 3rd nerve nucleus for conjugate movement. Major Oculomotor Gaze Systems Eye movements are controlled by 4 major oculomotor gaze systems, which are tested for on the neurological exam. They are briefly outlined here: Saccadic (frontal gaze center to PPRF (paramedian pontine reticular formation) for rapid eye movements to bring new objects being viewed on to the fovea. Smooth Pursuit (parietal-occipital gaze center via cerebellar and vestibular pathways) for eye movements to keep a moving image centered on the fovea. Vestibulo-ocular (vestibular input) keeps image steady on fovea during head movements. Vergence (optic pathways to oculomotor nuclei) to keep image on fovea predominantly when the viewed object is moved near (near triad- convergence, accommodation and pupillary constriction) Cranial Nerve 5 The entry zone for this cranial nerve is at the mid pons with the motor and main sensory (discriminatory touch) nucleus located at the same level. The axons for the descending tract of the 5th nerve (pain and temperature) descend to the level of the upper cervical spinal cord before they synapse with neurons of the nucleus of the descending tract of the 5th nerve. Second order neurons then cross over and ascend to the VPM of the thalamus. Cranial Nerve 7 This cranial nerve has a motor component for muscles of facial expression (and, don't forget, the strapedius muscle which is important for the acoustic reflex), parasympathetics for tear and salivary glands, and sensory for taste (anterior two-thirds of the tongue). Central (upper motor neuron-UMN) versus Peripheral (lower motor neuron-LMN) 7th nerve weakness- with a peripheral 7th nerve lesion all of the muscles ipsilateral to the affected nerve will be weak whereas with a "central 7th ", only the muscles of the lower half of the face contralateral to the lesion will be weak because the portion of the 7th nerve nucleus that supplies the upper face receives bilateral corticobulbar (UMN) input. Cranial Nerve 8 This nerve is a sensory nerve with two divisions- acoustic and vestibular. The acoustic division is tested by checking auditory acuity and with the Rinne and Weber tests. The vestibular division of this nerve is important for balance. Clinically it be tested with the oculocephalic reflex (Doll's eye maneuver) and oculovestibular reflex (ice water calorics). Medullary Level Cranial nerves 9,10,11, and 12 are located in the medulla and have localizing value for lesions in this most caudal part of the brainstem. Cranial nerves 9 and 10 These two nerves are clinically lumped together. Motor wise, they innervate pharyngeal and laryngeal muscles. Their sensory component is sensation for the pharynx and taste for the posterior one-third of the tongue. Cranial Nerve 11 This nerve is a motor nerve for the sternocleidomastoid and trapezius muscles. The UMN control for the sternocleidomastoid (SCM) is an exception to the rule of the ipsilateral cerebral hemisphere controls the movement of the contralateral side of the body. Because of the crossing then recrossing of the corticobulbar tracts at the high cervical level, the ipsilateral cerebral hemisphere controls the ipsilateral SCM muscle. This makes sense as far as coordinating head movement with body movement if you think about it (remember that the SCM turns the head to the opposite side). So if I want to work with the left side of my body I would want to turn my head to the left so the right SCM would be activated. Cranial Nerve 12 The last of the cranial nerves, CN 12 supplies motor innervation for the tongue. Traps A 6th nerve palsy may be a "false localizing sign". The reason for this is that it has the longest intracranial route of the cranial nerves, therefore it is the most susceptible to pressure that can occur with any cause of increased intracranial pressure.  
Neurologic Exam
over 8 years ago
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3
61

Abdominal Pain in Pregnancy

For Obstetrics and Gynaecology  
Rupali Shah
over 6 years ago
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37

Mechanical Back Pain

 
almostadoctor.com - free medical student revision notes
over 5 years ago
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106

Nociceptors - An Introduction to Pain

http://armandoh.org/ https://www.facebook.com/ArmandoHasudungan Support me: http://www.patreon.com/armando Instagram: http://instagram.com/armandohasudungan ...  
YouTube
over 5 years ago
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3
76

Differential Diagnosis of SI Joint Pain - Everything You Need To Know - Dr. Nabil Ebraheim

Educational video describing differential diagnosis of SI joint pain. Become a friend on facebook: http://www.facebook.com/drebraheim Follow me on twitter: h...  
YouTube
over 5 years ago
Foo20151013 2023 eztttu?1444774181
3
128

Dealing with Personal Illness in Med School

Hey guys! I’m Nicole and I’m a second year medical student at Glasgow University. I’ve decided to start this blog to write about my experiences as a med student and the difficulties I encounter along the way, hopefully giving you something you can relate to. Since June of last year I have been suffering with a personal illness, with symptoms of persistent nausea, gastric pain and lethargy. At first I thought it was just a bug that would pass on fairly quickly, but as the summer months went on it was clear that this illness wasn’t going to disappear overnight. I spent my summer going through a copious amount of medications in hope that I’d feel better for term starting. I visited my GP several times and had bloods taken regularly. After 2 months, I finally got given a diagnosis; I had a helicobacter pylori infection. I started eradication therapy for a week and although it made my symptoms worse, I was positive would make me better and I’d be well again within the week. The week passed with no improvements in my condition. Frustrated, I went back to my GP who referred me for an endoscopy. Term started back the next week and despite feeling miserable I managed to drag myself out to every lecture, tutorial and lab. Within a few weeks I began to fall behind in my work, doing the bare minimum required to get through. Getting up each morning was a struggle and forcing myself to sit in lectures despite the severe nausea I was experiencing was becoming a bigger challenge each day. In October I went for my endoscopy which, for those of you that don't know, is a horribly uncomfortable procedure. My family and friends assured me that this would be the final stage and I’d be better very very soon. The results came back and my GP gave me a different PPI in hope that it would fix everything. I waited a few weeks and struggled through uni constantly hoping that everything would magically get better. I gave up almost all my extra-circular activities which for me, the extrovert I am, was possibly the hardest part of it all. I wanted to stay in bed all the time and I become more miserable every day. I was stressing about falling behind in uni and tensions began to build up in my personal life. It got to the point where I couldn’t eat a meal without it coming back up causing me to lose a substantial amount of weight. I got so stressed that I had to leave an exam to throw up. I was truly miserable. I seen a consultant just before Christmas who scheduled me in for some scans, but it wasn’t until January. I was frustrated at how long this was going on for and I thought it was about time I told the medical school about my situation. They were very understanding and I was slightly surprised at just how supportive they were. I contacted my head of year who arranged a visit with me for January. During the Christmas break I had a chance to relax and forget about everything that was stressing me. I got put on a stronger anti-sickness medication which, surprisingly, seemed to work. The tensions in my life that had built up in the last few months seemed to resolve themselves and I began to feel a lot more positive! I met with my head of year just last week who was encouraged by my newly found positive behaviour. We’ve agreed to see how things progress over the next few months, but things are looking a lot brighter than before. I’ve taken on a new attitude and I’m determined to work my hardest to get through this year. I’m currently undertaking an SSC so I have lots of free time to catch up on work I missed during the last term. My head of year has assured me that situations like the one I’m in happen all the time and I’m definitely not alone. I feel better knowing that the medical school are behind me and are willing to help and support me through this time. The most important thing I have taken from this experience is the fact that you’ll never know the full extent of what a patient is going through. Illness effects different people in different ways and it may not just be a persons health thats affected, it can affect all aspects of their life. This experience has definitely opened my eyes up and hopefully I’ll be able to understand patients’ situations a little better.  
Nicole Mooney
over 5 years ago
Foo20151013 2023 e7fpn8?1444774293
3
339

The Importance Of Clinical Skills

In the USA the issue of indiscriminate use of expensive, sophisticated, and time consuming test in lieu of, rather than in addition to, the clinical exam is being much discussed. The cause of this problem is of course multifactorial. One of the factors is the decline of the teaching of clinical skills to our medical students and trainees. Such problems seem to have taken hold in developing countries as well. Two personal anecdotes will illustrate this. In the early nineties I worked for two years as a faculty member in the department of ob & gyn at the Aga Khan University Medical School in Karachi, Pakistan. One day, I received a call from the resident in the emergency room about a woman who had come in because of some abdominal pain and vaginal bleeding. While the resident told me these two symptoms her next sentence was: “… and the pelvic ultrasound showed…” I stopped her right in her tracks before she could tell me the result of the ultrasound scan. I told her: “First tell me more about this patient. Does she look ill? Is she bleeding heavily? Is she in a lot of pain and where is the pain? What are her blood pressure and pulse rate? How long has she been having these symptoms? When was her last menstrual period? What are your findings when you examined her ? What is the result of the pregnancy test?”. The resident could not answer most of these basic clinical questions and findings. She had proceeded straight to a test which might or might not have been necessary or even indicated and she was not using her clinical skills or judgment. In another example, the resident, also in Karachi, called me to the emergency room about a patient with a ruptured ectopic pregnancy. He told me that the patient was pale, and obviously bleeding inside her abdomen and on the verge of going into shock. The resident had accurately made the diagnosis, based on the patient’s history, examination, and a few basic laboratory tests. But when I ran down to see the patient, he was wheeling the patient into the radiology department for an ultrasound. "Why an ultrasound?" I asked. “You already have made the correct diagnosis and she needs an urgent operation not another diagnostic procedure that will take up precious time before we can stop the internal bleeding.” Instead of having the needless ultrasound, the patient was wheeled into the operating room. What I am trying to emphasize is that advances in technology are great but they need to be used judiciously and young medical students and trainees need to be taught to use their clinical skills first and then apply new technologies, if needed, to help them to come to the right diagnosis and treatment. And of course we, practicing physicians need to set the example. Or am I old fashioned and not with it? Medico legal and other issues may come to play here and I am fully aware of these. However the basic issue of clinical exam is still important. Those wanting to read more similar stories can download a free e book from Smashwords. The title is: "CROSSCULTURAL DOCTORING. ON AND OFF THE BEATEN PATH." You can access the e book here.  
DR William LeMaire
over 5 years ago
5
3
195

Going to work in a different country? Different culture? Different language? Avoid getting tripped up as I did!

I grew up in Belgium and went to medical school in Louvain, Belgium. I came to the USA for my internship and selected a small hospital in upstate New York. What an initial culture shock that was! The first problem was the language. I knew enough "school" English to get by, or so I thought. Talking on the phone was the hardest. Initially, the nurses in the hospital thought that I was the most conscientious intern they had ever worked with. When I was on duty and the nurses called me on the phone at night, I would always go to the ward, look over the chart, see the patient and then write a note and orders, rather than just handle things over the phone like all the other interns did when called for rather minor matters. Little did the nurses realize that the reason I would get up in the middle of the night and physically go to the ward was due to the fact that I had no idea what they were talking about. I did not understand a word of what the nurses were telling or asking me on the telephone, especially not when they were using even common American abbreviations, like PRN, QID, LMP etc. [PRN (Latin) means as needed; QID (Latin) means four times a day and LMP means last menstrual period]. That problem rapidly resolved as I began to understand more and more of the English medical terms. However, there is a major difference between understanding day-to-day common English and grasping all the idioms and sayings. A rather amusing anecdote will illustrate that. About two months into my internship, I was on call at night when one of the nurses telephoned me in the early evening. A patient (Mrs X) was having a bad headache and wanted something for it. I was proud that I had understood the problem over the phone and was even more proud that I managed to order something for her headache without having to walk over to the ward. An hour or so later, the same nurse called me for the same patient because she had been constipated and wanted something for it. Again I understood and again I was able to prescribe a laxative over the phone without having to go to see the patient. A while later the same nurse called to let me know that Mrs X was agitated and wanted something for sleep. I understood again and prescribed a sleeping pill. Close to the 11pm shift change the same nurse called me once more: "Dr. LeMaire, I am so sorry to keep bothering you about Mrs X, but she is really a pain in the neck…" Immediately some horrible thought occurred to me. Here is a patient who has a bad headache, is constipated and agitated and now has a pain in her neck. These could all be symptoms of meningitis and here I have been ordering medications over the phone for a potentially serious condition. I broke out in a cold sweat and I told the nurse "I am coming." I ran over to the ward where that patient was hospitalized, went to her room and after introducing myself said "Mrs. X, the nurse tells me that you have a pain in your neck." The rest is history. The patient lodged a complaint about the nurse and me, but we both got off with a minor reprimand and in fact somewhat of a chuckle by the administrator handling the complaint. Such tripping up by the idioms and sayings can of course happen in any language. Be aware! Dr. William LeMaire  
DR William LeMaire
over 4 years ago
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Wrist Replacement

If you have wrist arthritis with no relief from pain, you may need an artificial joint. Learn what to expect from this wrist surgery.  
youtube.com
over 3 years ago
0
2
58

Lecture: New directions in the psychology of chronic pain management - Dr Lance McCracken

<span style="font-style: italic;">Listen again</span>:<br />Download <a href="http://www.archive.org/download/NewDirectionsInThePsychologyOfChronicPainManagement-DrLanceMccracken/Wspg-dec-2007-lanceMccracken_64kb.mp3">mp3 of lecture</a> 34.4Mb Duration: 1:11:35<br />Listen to <a href="http://www.archive.org/download/NewDirectionsInThePsychologyOfChronicPainManagement-DrLanceMccracken/NewDirectionsInThePsychologyOfChronicPainManagement-DrLanceMccracken_64kb.m3u"> lo-fi stream</a><br /><br /><span style="font-style: italic;">Further reading:<br /></span>DAHL, J., &amp; LUNDGREN, T. (2006). <i>Living beyond your pain using acceptance and commitment therapy to ease chronic pain. </i>Oakland, CA, New Harbinger Publications.<br /><a href="http://www.worldcat.org/oclc/63472470&amp;tab=details">http://www.worldcat.org/oclc/63472470</a><br /><br />HAYES, S. C., STROSAHL, K., &amp; WILSON, K. G. (1999). <i>Acceptance and commitment therapy an experiential approach to behavior change. </i>New York, Guilford Press.<br /><a href="http://www.worldcat.org/oclc/41712470&amp;tab=details">http://www.worldcat.org/oclc/41712470</a><br /><br />MCCRACKEN, L. M. (2005). <i>Contextual cognitive-behavioral therapy for chronic pain. </i>Progress in pain research and management, v. 33. Seattle, IASP Press.<br /><a href="http://www.worldcat.org/oclc/57564664&amp;tab=details">http://www.worldcat.org/oclc/57564664</a><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/13562045-6816145727901784888?l=wspain.blogspot.com' alt='' /></div>  
West of Scotland Pain Group lectures
about 9 years ago
11
2
76

Chronic Abdominal Pain

<p>This podcast addresses chronic abdominal pain in children. It gives medical students an approach to the history and physical examination in chronic abdominal pain and discusses the role of investigations. 'Red Flag' findings on history and physical exam are stressed. We specifically discuss Irritable Bowel Syndrome, Inflammatory Bowel Disease, Peptic Ulcer Disease, Constipation, Lactose Intolerance and Functional Abdominal Pain.&nbsp;<span style="font-size: 11px; color: #333333;">This episode was written by Peter MacPherson and Dr. Melanie Lewis. Peter is a medical student at the University of Alberta. Dr. Lewis is a general pediatrician and an Associate Professor of Pediatrics at the University of Alberta and Stollery Children's Hospital. She is also the Clerkship Director.&nbsp;</span></p>  
Pedscases.Com
about 9 years ago
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2
36

Picture quiz - chronic knee pain in an adolescent

This was a picture quiz I created for a teaching session I delivered to fellow students in a small-group tutorial.  
Alistair Mayne
over 7 years ago
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24

CNS Sample

Sensory pathways ! Spinothalamic pathway - Pain, temperature, touch & pressure - 1ary neurone can ascend or descend in tract of Lissauer - Before entering dors…  
Nicole Chalmers
over 5 years ago
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172

Rheumatoid Arthritis

RA is a type of inflammatory arthritis. Other examples include seronegative spondyarthritides, reactive arthritis, lyme arthritis, crystal arthritis and postviral arthritis.   Features of inflammatory arthritis Pain and stiffness worse in the morning and after rest Early morning pain and stiffness may last several hours (in OA, duration is much shorter)  
almostadoctor.com - free medical student revision notes
over 5 years ago
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Summary of Headaches

  Headache  
almostadoctor.com - free medical student revision notes
over 5 years ago
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49

Peripheral Neuropathy

All peripheral nerves are myelinated, except C fibres – which carry information about pain. These C fibres are sometimes called ‘slow fibres’ because the signal travels slowly due to the lack of myelination.   Specific causes of peripheral neuropathy The mnemonic DAVID can be used as a method to remember specific causes of peripheral neuropathies  
almostadoctor.com - free medical student revision notes
over 5 years ago
Www.bmj
2
56

A man with a mass in the thigh

A 54 year old man presented to his general practitioner because of a fullness in his left lateral thigh that he first noticed while playing golf, although it was not related to an identifiable injury. He had a history of hypertension and fibromyalgia and was taking atenolol, ramipril, pregabalin, and tramadol but was otherwise well. The GP thought that the swelling was caused by a muscular injury, but the patient re-presented four months later because the mass had grown from a small bump to a swelling of 8 cm in diameter. It was also beginning to cause some knee stiffness but no pain. On examination he had a large firm swelling in his lateral thigh. On this occasion his GP referred him on a two week wait to the regional plastic surgery department. An ultrasound scan showed a 6 × 8 cm intramuscular mass with cystic changes and patchy neovascularity, but no inguinal or pelvic lymphadenopathy. Ultrasonography was followed by magnetic resonance imaging, with and without gadolinium contrast (fig 1⇓).  
bmj.com
over 5 years ago
5
2
23

Back Pain

Ultra-short presentation on abdominal pain. The presentation is only a overview rather than a comprehensive presentation of all the causes of back pain.  
Debkumar Chowdhury
over 4 years ago