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Lesson Posted on 19/08/2020 Tuition/MBBS & Medical Tuition

EPISTAXIS ENT

Harvinder Kumar

I am a young doctor , pursuing post graduation . Always read to help out my juniors and learn from my...

Epistaxis Epistaxis is split into anterior and posterior bleeds, whereby the former often have a visible source of bleeding and usually occurs due to an insult to the network of capillaries that form Kiesselbach’s Plexus. Posterior haemorrhages, on the other hand, tend to be more profuse and... read more

Epistaxis

Epistaxis is split into anterior and posterior bleeds, whereby the former often have a visible source of bleeding and usually occurs due to an insult to the network of capillaries that form Kiesselbach’s Plexus.

 Posterior haemorrhages, on the other hand, tend to be more profuse and originate from deeper structures. 

They occur more frequently in older patients and confer a higher risk of aspiration and airway compromise.

CAUSES

While most cases of epistaxis tend to be benign and self-limiting,

 they may be an indicator of serious pathology.

The most common cause is trauma to the nose- this can range from the insertion of foreign bodies, nose picking and nose blowing.

Bleeding can also indicate platelet function disorders such as thrombocytopenia, splenomegaly, leukaemia, Waldenstrom’s macroglobulinaemia and ITP. As these tend to be congenital, they often present earlier in life.

In adolescent males, juvenile angiofibroma is a beginning tumour that may bleed as it is highly vascularised. 

If the nasal septum looks abraded or atrophied, inquire about drug use. This is because inhaled cocaine is a potent vasoconstrictor, and repeated use may result in obliteration of the septum. 

In the elderly, 1. hereditary haemorrhagic telangiectasia may cause prolonged nasal bleeding. 

2.(Wegener’s) and pyogenic granuloma may also present with nosebleeds.

Management Positioning

1. If the patient is haemodynamically stable, bleeding can be controlled with first aid measures. This involves:

Asking the patient to sit with their torso forward and their mouth open- avoid lying down unless they feel faint. This decreases blood flow to the nasopharynx and allows the patient to spit out any blood in their mouth. It also reduces the risk of aspirating blood.

Pinch the cartilaginous (soft) area of the nose firmly and consistently for at least 20 minutes and ask the patient to breathe through their mouth.

 

If first aid measures are successful, 

2. Consider using a topical antiseptic such as Naseptin (chlorhexidine and neomycin) to reduce crusting and the risk of vestibulitis. Cautions to this include patients that have peanut, soy or neomycin allergies, and Mupirocin is a viable alternative.

Criteria for admission:

Admission and follow up care may be considered in patients under if a comorbidity (e.g. coronary artery disease, or severe hypertension) is present, an underlying cause is suspected or if they are aged under two years (as underlying causes such as haemophilia or leukaemia are more likely in this age group).

If bleeding does not stop after 10-15 minutes of continuous pressure on the nose, consider cautery or packing. 

REMEMBER !!!!!!

Cautery should be used if the source of the bleed is visible and cautery is tolerated- it is not so well-tolerated in younger children! Packing may be used if cautery is not viable or the bleeding point cannot be visualised. If the nose is packed in primary care, the patient should be admitted to the hospital for review.

Cautery:

Ask the patient to blow their nose to remove any clots. Be wary that bleeding may resume.

Use a topical local anaesthetic spray (e.g. Co-phenylalanine) and wait 3-4 minutes for it to take effect.

Identify the bleeding point and apply the silver nitrate stick for 3-10 seconds until it becomes grey-white. Avoid touching areas which do not require treatment, and only cauterise one side of the septum as there is a risk of perforation.

Dab the area clean with a cotton bud and apply Naseptin or Muciprocin.

 

Anterior nasal packing                           posterior nasal packing

Packing:

Anaesthetise with topical local anaesthetic spray (e.g. Co-phenylalanine) and wait for 3-4 minutes

Pack the patient’s nose while they are sitting with their head forward, following the manufacturer’s instructions

Pressure on the cartilage around the nostril can cause cosmetic changes, and this should be reviewed after inserting the pack.

Examine the patient’s mouth and throat for any continuing bleeding, and consider packing the other nostril as this increases pressure on the septum and offending vessel.

Patients should be admitted to hospital for observation and review, and ENT if available.

Patients that are haemodynamically unstable or compromised should be admitted to the emergency department- control bleeding with first aid measures in the interim. Patients with a bleed from an unknown or posterior source (i.e. the bleeding site cannot be located on speculum, bleeding from both nostrils or profuse) should be admitted to hospital.

Self-care advice involves reducing the risk of re-bleeding. Patients should be informed that blowing or picking the nose, heavy lifting, exercise, lying flat, drinking alcohol, or hot drinks should be avoided. The same applies to patients who have just been cauterised, as any strain on the nostril may induce a re-bleed.

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Answered on 02/06/2020 Tuition/MBBS & Medical Tuition/Microbiology CBSE/Class 11/Science/Biology

Sahil Trikha

Neurobiologist with 5 years experience in college & high school

Cellulose is a polysaccharide (a Form of carbohydrate) made of many β linked D(dextrorotary)-glucose. Found primarily in plant cell walls and many algae cell walls. Non-cellulosic cell walls are not made of cellulose, e.g., Peptidoglycan cell walls in Bacteria which are made of proteins/amino acids... read more

Cellulose is a polysaccharide (a Form of carbohydrate) made of many β linked D(dextrorotary)-glucose. Found primarily in plant cell walls and many algae cell walls. Non-cellulosic cell walls are not made of cellulose, e.g., Peptidoglycan cell walls in Bacteria which are made of proteins/amino acids (pep-) & carbohydrates/sugars (-glycan). 

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Answered on 11/04/2020 Tuition/MBBS & Medical Tuition

Dr Dhairyasheel Salunkhe

Unmatched performance , Invest and Win.

The benefit of an MBA as such is subjective. It's how much formal education you apply along with self-education of daily business issues. For international business operations, it's better to have a degree, its an add on plus. My friend secured an MBA degree in the UK, but it's of no use here and even... read more

The benefit of an MBA as such is subjective. It's how much formal education you apply along with self-education of daily business issues. For international business operations, it's better to have a degree, its an add on plus. My friend secured an MBA degree in the UK, but it's of no use here and even there, as he was rejected for his selling skills.
I hope it helps.

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Lesson Posted on 08/02/2020 Tuition/MBBS & Medical Tuition/Pathology

Nephrotic syndrome

Dr H.

I am presently working as a junior resident doctor in St.John's hospital Bangalore. I am giving online...

Definition:Massive proteinuria >3.5g/day First protein to be excreted is albumin-->transferrin-->vitamin D binding protein-->thyroglobulin-->protein c and s-->globulin 1.Minimal change disease: Sudden onset selective proteinuria Age:5-15yrs Prognosis :excellent Kidney biopy:... read more

Definition:Massive proteinuria >3.5g/day

First protein to be excreted is albumin-->transferrin-->vitamin D binding protein-->thyroglobulin-->protein c and s-->globulin

1.Minimal change disease:

Sudden onset selective proteinuria 

Age:5-15yrs

Prognosis :excellent

Kidney  biopy: light microscopy-no findings

Fluorescent microscopy-no findings 

Electron microscopy-podocytopathy(loss of foot processes of podocytes)

2.Membranous glomerulonephritis

Etiology:primary-Antiphopholipid A2antibody 

Secondary-infections like Hep B,HIV,Hep C,leprosy

Autoimmune diseases

drugs

Malignancies 

Kidney biopsy:light microscopy-GBM thickening

Fluorescent microscopy-subepithelial granular deposits

Electron microscopy-subepithelial deposits with podocytopathy

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Lesson Posted on 19/07/2019 Tuition/MBBS & Medical Tuition/Microbiology Tuition/BSc Tuition/Medical Microbiology Tuition/BA Tuition/Basic Microbiology

Causative organisms of various diseases

Manika G.

Teaching is my hobby and I like when I can do something for others.

ORGANISMS DISEASE Streptococcus viridian group Alpha hemolytic a). Streptococcus sanguis • predominantly organisms of plaque in healthy mouth • subacute bacterial endocarditis • another group cause caries after S. Mutans b) S. Salivarious •... read more
ORGANISMS DISEASE

Streptococcus viridian group

Alpha hemolytic

a). Streptococcus sanguis

• predominantly organisms of plaque in healthy mouth

• subacute bacterial endocarditis 

• another group cause caries after S. Mutans

b) 

S. Salivarious

• Form longest chain

• First organism to invade cavity

c) S. Mutans 

Smooth surface caries

Synthetise glucan by its action on dietary carbohydrate

Streptococcus pyogens (beta haemolytic)

pharyngitis, cellulitis, scarlet fever, quinsy, Ludwig's angina

Rheumatic fever

Dental infections most common organism

Streptococcus agalactiae

Neonatal meningitis

Septicemia

Pneumococci or streptococcus pneumonae

Bacterial pneumonae

Meningitis, septicemia

Staphylococci

Skin infections 

Furuncle, style, impetigo, carbuncle

Burns and wounds

Osteomyletis and silaadenitis

Toxic shock syndrome

Staphylococcus aureus /pyrogens

 

 

cystic fibrosis

Toxic shock syndrome 

ACUTE endocarditis

Food poisoning 

Sialadenitis

 

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Lesson Posted on 20/05/2019 Tuition/MBBS & Medical Tuition/Medicine

Understanding Calcium hemostasis when Hypocalcemia is Present

Sharook Mubarak

I am pursuing USMLE exams for my postgraduation,so i am very well versed with my concepts of internal...

Hello, my colleagues, I will be discussing calcium regulation today along with PTH Normal Calcium level : 10mg/dL or 5mEq/L or 2.5mmol/L Calcium is regulated by Parathyroid hormone(PTH) which is secreted by the parathyroid gland. A decrease in Calcium level in blood --> Activates PTH hormone... read more

Hello, my colleagues,

I will be discussing calcium regulation today along with PTH

Normal Calcium level  : 10mg/dL or 5mEq/L or 2.5mmol/L

Calcium is regulated by Parathyroid hormone(PTH) which is secreted by the parathyroid gland.

A decrease in Calcium level in blood --> Activates PTH hormone --->> PTH hormone goes to

1) BONES - Activates osteoclasts and lyse the bone and release Ca+ and PO4- into blood

Ca which was released through lysing of the bone is bound along with P04 so it cannot be used as a free Ca, PTH does this unpairing of Ca and P04 with the help of Kidneys

2) KIDNEYS - Ca and Po4 gets filtered in the kidney, and usually PO4 gets reabsorbed in PCT of the kidney which is inhibited by PTH. Hence P04 gets excreted in the urine, whereas Ca2+ is reabsorbed in DCT, PTH increases this absorption,

So the net result is more calcium and less phosphate in the blood. It is free Ca2+(ionised Ca2+)

3) Finally, PTH also activates Vitamin D in the kidney, this Vitamin D goes into the gut and increases the further absorption of calcium and phosphate into the blood

Thus Calcium hemostasis is maintained through PTH when calcium levels go low

I will try to input more topics if you guys find it useful.

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Answered on 05/10/2019 Tuition/MBBS & Medical Tuition Tuition/MBBS & Medical Tuition/Microbiology Exam Coaching/Medical Entrance Coaching +1 Tuition/MBBS & Medical Tuition/Biochemistry less

Rajesh Jayanandan

Community Medicine Tutor for exams

1. Post MBBS you can prepare for NEET (or upcoming NEXT) Postgraduate entrance exam and do a PG in the subject of your choice to practice as a consultant in Hospitals or clinics.2. With the MBBS degree, you can join through your State Medical Service exam in Government Medical Service as a Medical Officer... read more

1. Post MBBS you can prepare for NEET (or upcoming NEXT) Postgraduate entrance exam and do a PG in the subject of your choice to practice as a consultant in Hospitals or clinics.
2. With the MBBS degree, you can join through your State Medical Service exam in Government Medical Service as a Medical Officer in Primary Health Centers/ Community Health Centers / District Hospitals.
3. Post MBBS you can apply for Combined Medical Service Exam (CMS) of UPSC and join in central government medical services like CGHS or Railway Hospitals as a Medical Officer.
4. You can write the Insurance Medical Officer (IMO) exam of ESI Hospitals and join as Medical Officers in ESIC.
5. You can attend the walk-in Interview of ESI/JIPMER/AIIMS/ Private medical colleges to join as a Junior resident/ Tutor in the department available. (regular or contract basis)
6. You can participate as a duty doctor and work in ER/ ICU/ wards of Private nursing homes or hospitals
7. You can start your clinic and practice as a general practitioner. You can also do online courses or distance education or fellowship courses like Family medicine or Diabetology or geriatric medicine to strengthen your practice.
6. You can do AFIH course (3 months) in Industrial Health and join as Factory Medical Officer in Industries.
7. Yoy can join the Army through SSC as an Army Medical Officer.
8. Can do Aviation medicine and join Airforce Hospitals or Sports medicine and join as Doctor in sports teams.
9. can join ICMR/NIE like research organizations and continue as Research Scientist.
10. can join NGOs and participate in their outreach activities like health camps.
11. Can join WHO or UNICEF as a Consultant and serve as Surveillance Medical Officer (SMO) or Project Managers. Doing a Master in Public Health (MPH) after MBBS would be an added advantage.
12. can prepare for foreign medical licensing exams like USMLE (US) /PLAB (UK) /MCCQ (Canada) /Prometric exam (for gulf) etc. to practice in other countries.
13. you can also join as duty doctors in hospitals of Maldives, Seychelles etc. without entrance exams.
14. you can practice from home as an online Doctor through telemedicine apps like click2clinik/ letsdoc etc.
15. You can join as drug safety physicians in clinical trial research of Pharmaceutical industries.

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Answered on 16/07/2019 Tuition/MBBS & Medical Tuition Tuition/MBBS & Medical Tuition/Microbiology Exam Coaching/Medical Entrance Coaching +1 Tuition/MBBS & Medical Tuition/Biochemistry less

Manika G.

Yes, you can crack without having tuitions in biology, as biology is an interesting subject and students can read and learn on their own. Keep your mind focused on your goal.
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Answered on 14/08/2018 Tuition/MBBS & Medical Tuition Tuition/MBBS & Medical Tuition/Microbiology Exam Coaching/Medical Entrance Coaching +1 Tuition/MBBS & Medical Tuition/Biochemistry less

Dr. Rahul Bevara

Medical Tutor

Hey Namrata, I don't think there are any colleges in India that pay students while they are studying. You will only get paid during your internship when you are working in the hospital. The stipend amount will vary between colleges..
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Answered on 04/08/2018 Tuition/MBBS & Medical Tuition Tuition/MBBS & Medical Tuition/Microbiology Exam Coaching/Medical Entrance Coaching +1 Tuition/MBBS & Medical Tuition/Biochemistry less

Dr. Rahul Bevara

Medical Tutor

Hey Pavan, Medical colleges charge tution fee only for 4 and half years. Once you start internship, you don't need to pay any tuition fee. You will get a monthly stipend from the college during your internship. The amount that is given as stipend will vary depending on the college and state. On an average... read more

Hey Pavan, 

Medical colleges charge tution fee only for 4 and half years. Once you start internship, you don't need to pay any tuition fee. You will get a monthly stipend from the college during your internship. The amount that is given as stipend will vary depending on the college and state. On an average Govt colleges pay about 6k - 12k. Private colleges may pay more or less. 

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