Radiology Resources

Radiology is an essential part of today's practice of medicine. The skill of studying and deciphering radiological images can be greatly enhanced by visiting these websites.

Another Good One

Great thinkers have always encountered opposition from mediocre minds.

Albert Einstein

Renal Physiology

Another FREE site developed by medical students which summarizes the important aspects of renal physiology. Covers:

· Renal Handling of Sodium and Potassium

· Urinary Concentration & Dilution

· Diuresis & Diuretics

· Acid-Base Balance

· Divalent Cations

Take the quiz at the end.

Skeleton and Skull Self-Test

For those of you still unsure of the names of all those cracks and holes, here is a self-test.

Whole Brain Atlas

Those of you struggling to conceptualise the brain in three dimensions and to distinguish between T1, T2 and CT scan images, would do well to peruse this web site. Great images and a good place to test your knowledge of normal brain structures as well as abnormal situations. Well worth a visit.

Medical Mnemonics

Generally speaking, I'm not very keen on mnemonics, as I find them rather difficult to remember (unless I think them up myself). This is very much the case with most of the ones on this website .There are a few good ones though and here are my favourites for Neuro and Head and Neck:

ObliqLiques cause lateral rotation of eyeball.

Action of the obliques is opposite to their names. Action of the rectii is rightly fitting to their names.
Both superiors cause intorsion and both inferiors cause extorsion.

Geniculate bodies: paired to respective colliculi SLIM:
Superior colliculi: Lateral geniculate body.
Inferior colliculi: Medial geniculate body.

Geniculate bodies: medial vs. lateral system MALE:
Medial=Auditory. Lateral=Eye.
Medial geniculate body is for auditory system, lateral geniculate body is for visual system.

Spinal tracts: Gracilus vs. Cuneatus: origin from upper vs. lower limbs Gracilus is the name of a muscle in the legs, so Fasciculus Gracilus is for the lower limbs.

Precentral vs. postcentral gyrus: motor vs. sensory Just an extension of the rule that anterior = ventral = efferent = motor.
The precentral gyrus is on the anterior side of the brain, so is therefore motor.

Olivary nuclei: ear vs. eye roles Superior Olivary nucleus: SOund localization.
· Inferior olivary nucleus is therefore the one for sight [tactile, proprioception also].

Pterygoid muscles: function of lateral vs. medial "Look at how your jaw ends up when saying first syllable of 'Lateral' or 'Medial' ":
"La": your jaw is now open, so Lateral opens mouth.
"Me": your jaw is still closed, so medial closes the mandible.

Bifurcation vertebral landmarks · A bifurcation occurs on 4th level of each vertebral column:
C4: bifurcation of common carotid artery
T4: bifurcation of trachea
L4: bifurcation of aorta

Deep tendon reflexes: root supply "1,2,3,4,5,6,7,8":
S1-2: ankle
L3-4: knee
C5-6: biceps, supinator
C7-8: triceps

Eye Simulator

This website is a great way to revise the movements of the eyes and test yourself on cranial nerve lesions. Rather clunky, but it works, provided you have Shockwave installed.

Learn the Blood Supply of the Brain

This website looks primitive but it's a great way to revise the blood supply of the brain and spinal cord. I particularly liked the quiz mode. Try it out and let me know what you think.

Brain MRIs

Some of you are having difficulty with interpretation of brain MRI sections. Take a look at this link for a quick tutorial.

So, Why Do You Want to be a Doctor?

I'm sure you have thought about this, long and hard. Read: http://student.bmj.com/issues/07/09/life/310.php
What are YOUR reasons? Have they changed since you started medical school?

Clinical Examination Videos

St. George's Hospital Medical School in London has produced a number of very good videos outlining basic clinical examination.
Cardiovascular System: http://www.youtube.com/watch?v=dp5m2tXHDmA&mode=related&search
Respiratory System: http://www.youtube.com/watch?v=hWGzi5h2UR8&mode=related&search
Abdominal Examination: http://www.youtube.com/watch?v=AktNxbiTO0I&mode=related&search
Thyroid Gland: http://www.youtube.com/watch?v=3EnLqNaRPZM&mode=related&search
Hope you find these useful.

Free Online Medical Ethics Course

A new free online course in medical ethics has been launched by the World Medical Association in cooperation with the Norwegian Medical Association. See http://lupin-nma.net/index.cfm?m=2&s=1&kursid=143&file=kurs/K143/intro.cfm for free access. A diploma is provided to all those completing the course.

Can You Tell Crackles From Wheezes?

The Ohio State University College of Medicine and Public Health's Department of Family Medicine has developed an interactive web-based learning center designed to teach medical students the fundamental principles of physical examination.

Practice taking blood pressure, listen to breath sounds, do a fundoscopic examination, or if you are still a freshman, review cardiac physiology.

Mc Gill Virtual Stethoscope

This site provides a virtual stethoscope interface for auscultating normal and abnormal cardiac and respiratory sounds as well as other material related to auscultation and cardiac and pulmonary physiology and pathophysiology.

Useful for medical students from year 1 onwards.

MJM Wardrounds

Useful set of podcasts on everything from important topics like pulmonary embolism to the arcane (vipers and ACE inhibitors), and lots more in between. Spoken in Queen's English, which makes a nice change from all that twangy American you find all over U tube!

ECG Self Assessment for Students and Clinicians

Proficiency in electrocardiogram (ECG) interpretation is an essential skill for medical students, housestaff, and clinicians. However, current textbook and classroom instructional materials do not adequately integrate ECG interpretation into specific contexts where waveform findings must be correlated with other clinical data.

Harvard Medical School has produced this unique web-based tutorial. Makes a change from the traditional lecture format!

Advice to Smokers

When I am asked, the advice I give to smokers is this: "As a physician I can tell you that if you smoke you will probably die of heart disease or cancer. If you don't smoke you will probably die of heart disease or cancer, but usually some years later. During the extra time non-smoking gives you, you may develop the infirmities, disabilities, illnesses, and aches and pains which go along with old age, and then die. My overall recommendation is not to smoke, however, because it really does increase the risk of dying from emphysema which is a very unpleasant way to die. As a taxpayer, however, I applaud your decision to smoke since you will probably be much less of a financial burden to taxpayers because you will die sooner. You might even be a financial asset to them if you time it right." Robert A Da Prato, physician

Personal Comment

As a student, and even more often as a junior doctor, I was repeatedly told that the first step to learning is to accept ignorance.

Secret Worlds: The Universe Within

View the Milky Way at 10 million light years from the Earth. Then move through space towards the Earth in successive orders of magnitude until you reach a tall oak tree just outside the buildings of the National High Magnetic Field Laboratory in Tallahassee, Florida. I lived right here for almost 12 years.

After that, begin to move from the actual size of a leaf into a microscopic world that reveals leaf cell walls, the cell nucleus, chromatin, DNA and finally, into the subatomic universe of electrons and protons. Amazing...

The Patient's Perspective

This site shows you a wide variety of personal experiences of health and illness. You can watch, listen to or read their interviews, find reliable information on treatment choices and where to find support. The site covers cancers, heart disease, mental health, neurological conditions, screening programmes, pregnancy, teenage health, chronic illnesses and many others.

DIPEx was voted by the Times as one of the top 3 patient health sites (2006), was in the Guardian's top 10 health websites (2004) and was singled out in a recent study (Times article March 2007) as a favourite, trusted site for patients.

Enough Said

After all is said and done, more is said than done. I hope to be the exception to this....

For Those of You Who are Unsure About What You are Doing Here

If it were not for the great variability among individuals, medicine might as well be a science and not an art. William Osler, 1892

E-Anatomy

This is a FREE anatomy e-learning web site. More than 1500 slices from normal CT and MR exams were selected in order to cover the entire sectional anatomy of the human body. A user-friendly interface allows you to glide through multi-slice image series combined with interactive textual information, 3D models and anatomy drawings. Year 2 students look at Face CT and Brain MR. Year 1 students look at Lung and Mediastinum. It's worth registering to get full screen access. Remember: this is the anatomy you will be "seeing" in your clinical years, so get used to it!

Spine Trauma

Another FREE site. Learn how to:

- Determine whether there is spinal cord involvement in a trauma patient;
- Recognize the different injury patterns on imaging studies.

The site contains interactive material including:
· ANATOMY
· EPIDEMIOLOGY
· SPINE RADIOGRAPH INTERPRETATION QUIZ
· CASE SCENARIOS
· SPINE RADIOGRAPH INTERPRETATION
· PRACTICE GUIDELINES
· DETERMINING SPINE STABILITY
· IMMOBILIZATION & TRACTION DEVICES

Skull Osteology Quiz

Attention Year 2 students!

You should be able to answer all these questions by now.

Anonymous

Great minds discuss ideas.
Average minds discuss events.
Small minds discuss people.

High Power Microscopy is Low Power Histology

In the histology lab, a common mistake is to "zoom" right into every tissue. Make sure you spend time with your low-power objectives ... this strategy will really pay off during the exams. Check out the histoweb site for a good overview of why histology matters. Another good site is found here.

Embryology Resources

A day by day and week by week review of embryological terms with graphical representations from the University of Pennsylvania.

Another one from the University of Cincinnati College of Medicine. In order to play the animations, you need to save them to your computer.

Letter to God

Dear God,

As You undoubtedly know, there is a little argument down here about intelligent design and evolution. If You really did create us in a day, and if You ever find humans worth another try, there are a few anatomical modifications that we hope You might consider the next time around.

As it happens, Lord, some of the organs You included in the mix have not turned out so well. Tonsils and appendixes don't seem to be especially useful apart from keeping surgeons occupied, or as clues to infection with "mad cow disease." And sinuses. Even if they do lighten the head, all they ever do is get infected. Couldn't we just have stronger neck muscles?

Our perversity in wanting to walk upright, when it is clear that this was not Your intention, has led to some real problems with our spines and leg joints. Would it be possible for You either to fix the pelvis at a right angle to prevent us from this error, or strengthen our weight bearing joints? We also hope You will anticipate our penchant for portable email devices by designing tiny little fingertips to operate the keys.

And the aesthetically splendid symmetry—could You extend it even further? It would certainly cut down our problem with trauma and strokes to have each side of our brain perform exactly the same functions. The rest of the head is outstanding, as are the limbs, but when we get into the thorax and abdomen, we have a few requests. You probably did not intend us to discard our diet of berries and nuts for fatty meats and pastries, but that's what happened, with disastrous consequences to our cardiovascular systems. Two hearts and a lipid-resistant lining to blood vessels would be just the thing (or give us an enzyme that transforms our preferred cuisine to harmless molecules).

We found out about alcohol, Lord, so it would be nice to have a liver (and maybe a pancreas) in reserve. Or You might remove the enzymatic chain that metabolises alcohol and make us too sick to consume it. Ditto for all the other drugs we seem so prone to abuse.

Thanks to Your gracious allotment of intelligence, we are on the verge of creating plenipotentiary cell banks, but there is a serious unresolved problem of individual compatibility. Somewhere—perhaps in redesigned sinuses, if for some reason You prefer that we keep them—there might be a little storehouse of such cells that could be tapped into when the need arises.

Despite the beautiful symmetry and economy of design with which we are blessed, it has occurred to us that the placement of our genital and excretory organs in such close proximity was either done to remind us of Original Sin, or because there did not seem to be a satisfactory anatomical alternative. Could You think about this? No obvious repositioning arrangement comes to mind, but some kind of retractable underarm mechanism might be practical.

In fact, this whole survival of the species thing deserves some rethinking. The delicate balance between the pleasures of sex and the pain of reproduction has been an issue for our womenfolk, who have borne the brunt of the pain. Maybe if they were given only two or three eggs together with a comfortable course of pregnancy and childbirth, the need for an endless succession of menstrual periods and the hot flushes of menopause could be eliminated without endangering our continued existence here on earth.

We hope, Lord, that You do not take offence at these suggestions, which are offered in all humility from creatures who surely do not fully understand the reasons that went into Your marvel of design, from its coating of skin to its molecular engineering, and we are truly grateful for Your efforts on our behalf.

PS: We know You have a sense of humour, Lord, but could you please do something about adolescence?

---

Paul Brown, BMJ, June 2006

A Court Case

No, don't worry, I have not been taken to jail. Take a look here though and you will find a tongue in cheek argument between the sympathetic and parasympathetic systems. Rather fun way to learn. Enjoy!

Punctuation

A professor wrote the following on the blackboard: "A woman without her man is nothing." The students were asked to punctuate the phrase.
Some students wrote: "A woman, without her man, is nothing."
Others wrote: "A woman: without her, man is nothing."
How would you punctuate it?

Heart Sounds Tutorial

Another free site with wonderful examples of various normal and abnormal heart sounds with matching physiological explanations. The animations are basic but clear. There is also a testing mode to make sure that you got it. Good revision for Year 3 to 5 students too.

Year 2 CTS

You will find here the instructions pertaining to preparing for CTS this academic year. Further details will be provided in class this week.

Mastering Anatomy

I usually give this talk to incoming students but was unable to do so last Tuesday due to industrial action. You can contact me via this blog if you have any other questions.

Welcome Freshmen

The powerpoint show of the lecture on Bones and Joints is found here. This lecture has embedded sound so that you can listen to it again. Please note that the link will be removed on Friday October 10.