Painkillers may kill you!!

Painkiller (analgesic) is any medicine intended to relieve pain. Over-the-counter analgesics-that is, painkillers available without a prescription-include aspirin, acetaminophen, ibuprofen, naproxen sodium, and others. These drugs present no danger for most people when taken in the recommended dosage. But some conditions make taking even these common painkillers dangerous for the kidneys. Also, taking one of these drugs regularly over a long period of time may increase the risk for kidney problems. Most drugs that can cause kidney damage are excreted only through the kidneys. That is, they are not broken down by the liver, as alcohol is, or passed out of the body through the digestive tract.

 

Analgesic use has been associated with two different forms of kidney damage: acute renal failure and a type of chronic kidney disease called analgesic nephropathy.

Acute Kidney Failure

Some patient case reports have attributed incidents of sudden-onset acute kidney failure to the use of over-the-counter painkillers, including aspirin, ibuprofen, and naproxen sodium. Some of these patients experienced acute illnesses involving fluid loss or decreased fluid intake. Other patients in these reports had risk factors such as systemic lupus erythematosus, advanced age, chronic kidney disease, or recent heavy alcohol consumption. These cases involved a single dose in some instances and generally short-term analgesic use of not more than 10 days.
Acute kidney failure requires emergency dialysis to clean the blood. Kidney damage is frequently reversible, with normal kidney function returning after the emergency is over and the analgesic use is stopped.

Analgesic Nephropathy

A second form of kidney damage, called analgesic nephropathy, can result from taking painkillers every day for several years. Analgesic nephropathy is a chronic kidney disease that over years gradually leads to irreversible kidney failure and the permanent need for dialysis or a kidney transplant to restore kidney function. Researchers estimate that four out of 100,000 people will develop analgesic nephropathy. It is most common in women over 30.
The painkiller phenacetin has been taken off the market because of its association with analgesic nephropathy. Recent studies have suggested that longstanding daily use of analgesics such as acetaminophen or ibuprofen may also increase the risk of chronic kidney damage, but this evidence is not as clear.
In view of these findings, people with conditions that put them at risk for acute kidney failure should check with their health care provider before taking any analgesic medicine. People who take over-the-counter painkillers regularly should check with their primary care physician to make sure the drugs are not hurting their kidneys. The physician may be able to recommend a safer alternative and can order regular tests to monitor their kidney function.

Treatment

If you have been taking analgesics regularly to control chronic pain, you may be advised to find new ways to treat your pain, such as behavior modification or relaxation techniques. Depending on how much your kidney function has declined, you may be advised to change your diet, limit the fluids you drink, or take medications to avoid anemia and bone problems caused by kidney disease. Your doctor will monitor your kidney function with regular urine and blood tests.

Why do we cry when we laugh too hard?

  We cry when we're sad but why do we cry when we're overjoyed by something? Being sad and happy are two complete different thing. But we're also very emotional when we're very happy and very sad. Crying is a intense emotional response. When feelings overwhelm us, they show as tears.

We cry because when we laugh we put pressure on our tear ducts, so it forces the tears to come out.  Or in more biological way  tears also accompany the body's return to homeostasis after extreme excitation. So after a big laughing jag, tears are a sign that the body is returning to normal.

Acne Treatment

Acne is a skin condition that causes pimples or "zits." This includes whiteheads, blackheads, and red, inflammed patches of skin (such as cysts).

Causes, incidence, and risk factors

Acne occurs when tiny holes on the surface of the skin become clogged. These holes are called pores.

• Each pore opens to a follicle. A follicle contains a hair and an oil gland. The oil released by the gland helps remove old skin cells and keeps your skin soft.
• When glands produce too much oil, the pores can become blocked. Dirt, bacteria, and cells build up. The blockage is called a plug or comedone.
• If the top of the plug is white, it is called a whitehead.
• If the top of the plug is dark, it is called a blackhead.
• If the plug breaks open, swelling and red bumps occur.
• Acne that is deep in your skin can cause hard, painful cysts. This is called cystic acne.

Acne is most common in teenagers, but anyone can get acne, even babies. Three out of four teenagers have some acne. Hormonal changes may cause the skin to be more oily.
Acne tends to run in families. It may be triggered by:

• Hormonal changes related to puberty, menstrual periods, pregnancy, birth control pills, or stress
• Greasy or oily cosmetic and hair products
• Certain drugs (such as steroids, testosterone, estrogen, and phenytoin)
• High levels of humidity and sweating

Research does not show that chocolate, nuts, and greasy foods cause acne. However, diets high in refined sugars may be related to acne.

Symptoms

Acne commonly appears on the face and shoulders, but it may also occur on the trunk, arms, legs, and buttocks.

• Blackheads
• Crusting of skin bumps
• Cysts
• Papules (small red bumps)
• Pustules
• Redness around the skin eruptions
• Scarring of the skin
• Whiteheads

Signs and tests

Your doctor can diagnose acne by looking at your skin. Testing is usually not needed.

Treatment

SELF-CARE
Steps you can take to help your acne:

• Clean your skin gently with a mild, nondrying soap (such as Dove, Neutrogena, Cetaphil, CeraVe, or Basics). Remove all dirt or make-up. Wash once or twice a day, including after exercising. However, avoid scrubbing or repeated skin washing.
• Shampoo your hair daily, especially if it is oily. Comb or pull your hair back to keep the hair out of your face.

What NOT to do:

• Try not to squeeze, scratch, pick, or rub the pimples. Although it might be tempting to do this, it can lead to skin infections and scarring.
• Avoid wearing tight headbands, baseball caps, and other hats
• Avoid touching your face with your hands or fingers.
• Avoid greasy cosmetics or creams. Take off make-up at night. Look for water-based or "noncomedogenic" formulas. Noncomedogenic products have been tested and proven not to clog pores and cause acne.

If these steps do not clear up the blemishes, try over-the-counter acne medications. You apply these products directly to your skin.

• They may contain benzoyl peroxide, sulfur, resorcinol, or salicylic acid.
• They work by killing bacteria, drying up skin oils, or causing the top layer of your skin to peel.
• They may cause redness or peeling of the skin.

A small amount of sun exposure may improve acne a little, but mostly it just hides the acne. However, too much exposure to sunlight or ultraviolet rays is not recommended because it increases the risk for skin cancer.

PRESCRIPTION MEDICINES
If pimples are still a problem, a health care provider can prescribe stronger medications and discuss other options with you.
Antibiotics may help some people with acne:

• Oral antibiotics (taken by mouth) such as tetracycline, doxycycline, minocycline, erythromycin, trimethoprim, and amoxicillin
• Topical antibiotics (applied to the skin) such as clindamycin, erythromycin, or dapsone

Creams or gels applied to the skin may be prescribed:

• Retinoic acid cream or gel (tretinoin, Retin-A)
• Prescription formulas of benzoyl peroxide, sulfur, resorcinol, or salicylic acid
• Topical azelaic acid

For women whose acne is caused or made worse by hormones:

• A pill called spironolactone may help
• Birth control pills may help in some cases, though they may make acne worse

Minor procedures or treatments may also be helpful:

• A laser procedure called photodynamic therapy
• Your doctor may also suggest chemical skin peeling, removal of scars by dermabrasion, or removal, drainage, or injection of cysts with cortisone

People who have cystic acne and scarring may try a medicine called isotretinoin (Accutane). You will be watched closely when taking this medicine because of its side effects.
Pregnant women should NOT take Accutane, because it causes severe birth defects. Women taking Accutane must use two forms of birth control before starting the drug and enroll in the iPledge program. Your doctor will follow you on this drug and you will have regular blood tests.

Expectation

Acne usually goes away after the teenage years, but it may last into middle age. The condition often responds well to treatment after 6 - 8 weeks, but it may flare up from time to time.
Scarring may occur if severe acne is not treated. Some people, especially teenagers, can become very depressed if acne is not treated.

References

Acne, rosacea, and related disorders. In: Habif TP, ed. Clinical Dermatology. 5th ed. Philadelphia, Pa: Saunders Elsevier; 2009:chap 7.

Sinusitis

Sinusitis is inflammation of the sinuses that occurs with an infection from a virus, bacteria, or fungus.

  Causes, incidence, and risk factors

The sinuses are air-filled spaces in the skull (behind the forehead, nasal bones, cheeks, and eyes). Healthy sinuses contain no bacteria or other germs. Usually, mucus is able to drain out and air is able to circulate.
When the sinus openings become blocked or too much mucus builds up, bacteria and other germs can grow more easily.
Sinusitis can occur from one of these conditions:

• Small hairs (cilia) in the sinuses, which help move mucus out, do not work properly due to some medical conditions.
• Colds and allergies may cause too much mucus to be made or block the opening of the sinuses.
• A deviated nasal septum, nasal bone spur, or nasal polyps may block the opening of the sinuses.

Sinusitis can be called:

• Acute, when symptoms are present for 4 weeks or less. It is caused by bacteria growing in the sinuses.
• Chronic, when swelling and inflammation of the sinuses are present for longer than 3 months. It may be caused by bacteria or a fungus.

The following may increase your risk or your child's risk of developing sinusitis:

• Allergic rhinitis or hay fever
• Cystic fibrosis
• Day care
• Diseases that prevent the cilia from working properly
• Changes in altitude (flying or scuba diving)
• Large adenoids
• Smoking
• Weakened immune system from HIV or chemotherapy

Symptoms

The symptoms of acute sinusitis in adults usually follow a cold that does not improve, or one that gets worse after 5 - 7 days of symptoms. Symptoms include:

• Bad breath or loss of smell
• Cough, often worse at night
• Fatigue and generally not feeling well
• Fever
• Headache -- pressure-like pain, pain behind the eyes, toothache, or tenderness of the face
• Nasal stuffiness and discharge
• Sore throat and postnasal drip

Symptoms of chronic sinusitis are the same as those of acute sinusitis, but tend to be milder and last longer than 12 weeks.
Symptoms of sinusitis in children include:

• Cold or respiratory illness that has been improving and then begins to get worse
• High fever, along with a darkened nasal discharge, for at least 3 days
• Nasal discharge, with or without a cough, that has been present for more than 10 days and is not improving

Signs and tests

The doctor will examine you or your child for sinusitis by:

• Looking in the nose for signs of polyps
• Shining a light against the sinus (transillumination) for signs of inflammation
• Tapping over a sinus area to find infection

Regular x-rays of the sinuses are not very accurate for diagnosing sinusitis.

Viewing the sinuses through a fiberoptic scope (called nasal endoscopy or rhinoscopy) may help diagnose sinusitis. This is usually done by doctors who specialize in ear, nose, and throat problems (ENTs).
Imaging tests that may be used to decide on treatment are:

• A CT scan of the sinuses to help diagnose sinusitis or view the bones and tissues of the sinuses more closely
• An MRI of the sinuses if there might be a tumor or fungal infection

If you or your child has sinusitis that does not go away or keeps returning, other tests may include:

• Allergy testing
• Blood tests for HIV or other tests for poor immune function
• Ciliary function tests
• Nasal cultures
• Nasal cytology
• Sweat chloride tests for cystic fibrosis

Treatment

SELF CARE
Try the following measures to help reduce congestion in your sinuses:

• Apply a warm, moist washcloth to your face several times a day.
• Drink plenty of fluids to thin the mucus.
• Inhale steam 2 - 4 times per day (for example, while sitting in the bathroom with the shower running).
• Spray with nasal saline several times per day.
• Use a humidifier.
• Use a Neti pot to flush the sinuses.

Be careful with over-the-counter spray nasal decongestants. They may help at first, but using them for more than 3 - 5 days can make nasal stuffiness worse.
Also, for sinus pain or pressure:

• Avoid flying when you are congested.
• Avoid temperature extremes, sudden changes in temperature, and bending forward with your head down.
• Try acetaminophen or ibuprofen.

MEDICATIONS AND OTHER TREATMENTS
Antibiotics are usually not needed for acute sinusitis. Most of these infections go away on their own. Even when antibiotics do help, they may only slightly reduce the time you or your child is sick. Antibiotics may be prescribed sooner for:

• Children with nasal discharge, possibly with a cough, that is not getting better after 2 - 3 weeks
• Fever higher than 102.2° Fahrenheit (39° Celsius)
• Headache or pain in the face
• Severe swelling around the eyes

Acute sinusitis should be treated for 10 - 14 days. Chronic sinusitis should be treated for 3 - 4 weeks. Some people with chronic sinusitis may need special medicines to treat fungal infections.
At some point, your doctor will consider:

• Other prescription medications
• More testing
• Referral to an ear, nose, and throat (ENT) or allergy specialist

Other treatments for sinusitis include:

• Allergy shots (immunotherapy) to help prevent the disease from returning
• Avoiding allergy triggers
• Nasal corticosteroid sprays and antihistamines to decrease swelling, especially if there are nasal polyps or allergies

Surgery to enlarge the sinus opening and drain the sinuses may also be needed, especially in patients whose symptoms do not go away after 3 months of treatment, or in patients who have more than two or three episodes of acute sinusitis each year. An ENT specialist (also known as an otolaryngologist) can perform this surgery.
Most fungal sinus infections need surgery. Surgery to repair a deviated septum or nasal polyps may prevent the condition from returning.

Expectations (prognosis)

Sinus infections can usually be cured with self-care measures and medical treatment. If you are having repeated attacks, you should be checked for causes such as nasal polyps or other problems, such as allergies.

Complications

Although very rare, complications may include:

• Abscess
• Bone infection (osteomyelitis)
• Meningitis
• Skin infection around the eye (orbital cellulitis)

Calling your health care provider

Call your doctor if:

• Your symptoms last longer than 10 - 14 days or you have a cold that gets worse after 7 days
• You have a severe headache that is not relieved by over-the-counter pain medicine
• You have a fever
• You still have symptoms after taking all of your antibiotics properly
• You have any changes in your vision during a sinus infection

A green or yellow discharge does not mean that you definitely have a sinus infection or need antibiotics.

Prevention

The best way to prevent sinusitis is to avoid or quickly treat flus and colds:

• Eat plenty of fruits and vegetables, which are rich in antioxidants and other chemicals that could boost your immune system and help your body resist infection.
• Get an influenza vaccine each year.
• Reduce stress.
• Wash your hands often, particularly after shaking hands with others.

Other tips for preventing sinusitis:

• Avoid smoke and pollutants.
• Drink plenty of fluids to increase moisture in your body.
• Take decongestants during an upper respiratory infection.
• Treat allergies quickly and appropriately.
• Use a humidifier to increase moisture in your nose and sinuses.

Spinal Stenosis

Spinal stenosis is narrowing of the spinal column that causes pressure on the spinal cord, or narrowing of the openings (called neural foramina) where spinal nerves leave the spinal column.

 

 

Causes, incidence, and risk factors

Spinal stenosis usually occurs as a person ages and the disks become drier and start to bulge. At the same time, the bones and ligaments of the spine thickens or grow larger due to arthritis or long-term swelling (inflammation).
Spinal stenosis may also be caused by:

• Arthritis of the spine, usually in middle-aged or elderly people
• Bone diseases, such as Paget's disease of bone and achondroplasia
• Defect or growth in the spine that was present from birth (congenital defect)
• Herniated or slipped disk, which often happened in the past
• Injury that causes pressure on the nerve roots or the spinal cord
• Tumors in the spine.
  
  
  
  
  
  

  Cervical Stenosis

  It may cause pain as well as tingling or numbness that radiates from the neck, down the shoulders and into the arms and hands. Pressure on the spinal cord, as it runs through the cervical spine, can cause weakness and spasticity in the arms and legs, called cervical spondylotic myelopathy. Spasticity means you lose control over your muscles and have difficulty walking, placing your feet, or dropping objects. You may have trouble with balance and coordination such as shuffling or tripping while walking. 
  
  

  Thoracic Stenosis

  Thoracic spinal stenosis occurs when the spinal canal in the middle part of your back becomes narrowed. This creates pressure on your spine and can cause pain in your back and legs, loss of bladder or bowel function, and problems with balance. It is a rare condition. 
  
  

  Lumbar Spinal Stenosis

   Lumbar spinal stenosis occurs when the spinal canal in your lower back becomes narrowed. This creates pressure on your spine and can cause pain, weakness, or numbness in your lower back, buttocks, legs, and feet. It is a common condition as people age, and it is most often caused by arthritis in the spine.

 

Symptoms

Often, symptoms will get worse slowly over time. Most often, symptoms will be on one side of the body or the other, but may involve both legs.
Symptoms include:

• Numbness, cramping, or pain in the back, buttocks, thighs, or calves, or in the neck, shoulders, or arms
• Weakness of part of a leg or arm

Symptoms are more likely to be present or get worse when you stand or walk. They will often lessen or disappear when you sit down or lean forward. Most people with spinal stenosis cannot walk for a long period of time.
Patients with spinal stenosis may be able to ride a bicycle with little pain.
More serious symptoms include:

• Difficulty or poor balance when walking
• Problems controlling urine or bowel movements

Signs and tests

During the physical exam, your doctor will try to find the location of the pain and figure out how it affects your movement. You will be asked to:

• Sit, stand, and walk. While you walk, your doctor may ask you to try walking on your toes and then your heels.
• Bend forward, backward, and sideways
• Lift your legs straight up while lying down. If the pain is worse when you do this, you may have sciatica, especially if you also feel numbness or tingling in one of your legs.

Your doctor will also move your legs in different positions, including bending and straightening your knees. All the while, the doctor is checking your strength and your ability to move.
To test nerve function, the doctor will use a rubber hammer to check your reflexes. Touching your legs in many places with a pin, cotton swab, or feather tests how well you feel. Your doctor will tell you to speak up if there are areas where you have less feeling from the pin, cotton, or feather.
A brain and nervous system (neurological) examination can confirm leg weakness and decreased sensation in the legs. The following tests may be done:

• EMG
• Spinal MRI or spinal CT scan
• X-ray of the spine

Treatment

When your back pain does not go away, or it gets more painful at times, learning to take care of your back at home and prevent repeat episodes of your back pain can help you avoid surgery.
Your doctor and other health professionals will help you manage your pain and keep you as active as possible.

• Your doctor may refer you for physical therapy. The physical therapist will help you try to reduce your pain, using stretches. The therapist will show you how to do exercises that make your neck muscles stronger.
• You may also see a massage therapist, and someone who performs acupuncture. Sometimes a few visits will help your back or neck pain.
• Cold packs and heat therapy may help your pain during flare-ups.
• A number of different medications can help with your back pain. See also: Medicines for chronic pain

A type of talk therapy called cognitive behavioral therapymay be helpful if the pain is having a serious impact on your life. This technique helps you better understand your pain and teaches you how to manage back pain.
SURGERY
If the pain does not respond to these treatments, or you lose movement or feeling, you may need surgery. Surgery is done to relieve pressure on the nerves or spinal cord.
You and your doctor can decide when you need to have surgery for these symptoms. Spinal stenosis symptoms often become worse over time, but this may happen very slowly.

• People who had long-term back pain before their surgery are likely to still have some pain afterwards. Spinal fusion probably will not take away all the pain and other symptoms.
• Even when using MRI scans or other tests, it is hard for your surgeon to always predict whether you will improve and how much relief surgery will provide.

For more information about how surgery is done and who is most likely to benefit, see also:

• Foraminotomy
• Laminectomy
• Spinal fusion

Expectations (prognosis)

Many people with spinal stenosis are able to be active for many years with the condition, although they may need to make some changes in their activities or work.

Spine surgery will often partly or fully relieve symptoms. However, people who had long-term back pain before their surgery are still likely to have some pain afterward. Spinal fusion probably will not take away all of the pain and other symptoms.
Spine problems are possible after spine surgery. The area of the spinal column above and below a spinal fusion are more likely to be stressed when the spine moves. Also, if you needed more than one kind of back surgery (such as laminectomy and spinal fusion), you may be more likely to have future problems.

Complications

A lack of feeling can make you more likely to injure your legs or feet. Infections may get worse because you may not feel the pain. Changes caused by pressure on the nerves may be permanent, even if the pressure is relieved.

World Heart Day: 5 Steps To A Healthy Heart

Cardiovascular diseases are the World's largest killers, claiming 17.3 million lives a year. Risk factors for heart disease and stroke include raised blood pressure, cholesterol and glucose levels, smoking, inadequate intake of fruit and vegetables, overweight, obesity and physical inactivity.

Follow the tips given below to avoid heart problems and related diseases :-

Spend less time in front of TV: A study published in the Journal of the American College of Cardiology found that people who spent more than two hours day on screen-based entertainment, had a 125 per cent increase in risk of heart attacks.

Avoid high fructose foods: HFCs or High-fructose corn syrup, also known as corn sugar, is the most common added sweetener in processed foods and beverages. Although it is chemically similar to table sugar or sucrose, some studies have linked it to increased triglyceride levels, which can boost your heart attack risk.

Quit smoking: Smoking damages the lining of your arteries, and makes it narrower. The carbon monoxide in tobacco smoke reduces the amount of oxygen in your blood making the heart pump harder to supply the oxygen.

Get enough sleep: According to the Journal of the American Medical Association, too little sleep can promote calcium buildup in the heart arteries, leading to the plaques that can then break apart and cause heart attacks and strokes.

Get some exercise: The American Journal of Medicine and the British Heart Foundation second that exercising just for half an hour every day, cuts down your chances of dying of a heart attack by 60 per cent.

Cranial Nerves Mnemonic

 I-Olfactory

II-Optic

III-Oculomotor

IV-Trochlear 

V-Trigeminal 

VI-Abducens 

VII-Facial 

VIII-Acoustic (Vestibulocochlear) 

IX-Glossophrayngeal 

X-Vagus

XI-Spinal Accessory 

XII-Hypoglossal

"OOOTTAFAGVSH"

[On Old Olympus Towering Tops, A Finn And German Viewed Some Hops]

or

[Oh, oh, oh, to touch and feel very good velvet...ah, heaven]

You have I nose. You have II eyes. (I - Olfactory; II -- Optic) 

 

Cranial nerve 1 - Olfactory

The olfactory nerve is responsible for the sense of smell.
How is it tested? Place a smelly object (a lemon or a dirty sock) under the nose with the eyes closed.  The patient should be able to recognize that a smell is present.  The patient's ability to determine the source of the smell (a dirty sock) is less important.

Cranial nerve 2 - Optic

The optic nerve is responsible for the sense of sight.  Lesions of this nerve can cause full or partial blindness.
How is it tested? Using a wall eye chart, determine the visual acuity (how sharp images appear far away).  Also, having the patient look directly forward, check the ability to see things at an angle (peripheral vision). With an opthalmoscope (the doctor's eye-looking device), look within the eye at the optic disk.  Does the disk have sharp borders or are they raised and blurry (from papilloedema).

Cranial nerve 3 - Oculomotor

The oculomotor nerve is responsible for movement of the eyelids, dilation of the pupil, and coordinated movement of the eyes.
How is it tested? Is one of the eyelids drooping?  Do the eyeballs move in all four directions (up, down, left, and right) together?  Are the pupils the same size?  Do both pupils shrink when light is shined at the eye?

Cranial nerve 4 - Trochlear

The trochlear nerve is responsible for rotation of the eyeballs.
How is it tested? Do the eyeballs move in all four directions (up, down, left, and right) together?

Cranial nerve 5 - Trigeminal

The trigeminal nerve is responsible for sensation of the face and movement of the chewing muscles.
How is it tested? With the eyes closed, can the patient feel light touch on both sides of the face?   Does the patient have difficulty chewing?

Cranial nerve 6 - Abducens

The abducens nerve is responsible for movement of the eyes to the side.
How is it tested? Do the eyeballs move in all four directions (up, down, left, and right) together?

Cranial nerve 7 - Facial

The facial nerve is responsible for the muscles of the fac.
How is it tested?  Does the face appear symmetric when the patient smiles or frowns? Can the patient whistle or "pucker" the lips?
 

Cranial nerve 8 - Vestibulocochlear

The vestibulocochlear nerve is responsible for the sense of hearing and balance.
How is it tested? Can the patient hear with both ears?  Does the patient have normal balance? Can the patient stand on one foot?

Cranial nerve 9 - Glossopharyngeal

The glossopharyngeal nerve is responsible for the sense of taste and movement of the tongue.
How is it tested? Can the patient taste the difference between sour, sweet, and bitter?  When the patient opens her mouth and says "Ahhhh..." does the roof of the mouth move up symmetrically?  Does the tongue lean to one side?  Is there difficulty swallowing or eating?

Cranial nerve 10 - Vagus

The vagus nerve is responsible for movement of the laryngx and affects voice.
How is it tested? Is there unexplained hoarseness of the voice?  Is there difficulty swallowing or eating?

Cranial nerve 11 - Accessory

The accessory nerve is responsible for movement of the shoulder and some neck muscles.
How is it tested? Can the patient "shrug" the shoulders?  Do both shoulders rise equally?

Cranial nerve 12 - Hypoglossal

The hypoglossal nerve is responsible for movement of the tongue.
How is it tested? Does the tongue deviate to one side?  Is there difficulty swallowing or eating?

Foramina of the Skull and Structures Passing

Foramen Ovale:

Mnemonic: MALE
1. Mandibular Nerve (CN V3)
2. Accessory meningeal nerve
3. Lesser petrosal nerve
4. Emissary vein (Cavernous sinus to
pterygoid plexus)
5. Occasionally anterior trunk of middle
meningeal artery

Foramen Spinosum:

Mnemonic: MEN
1. Middle meningeal artery and vein
(posterior trunk)
2. Emissay vein
3. Nervus spinosus (Meningeal branch of
mandibular nerve)

Foramen Lacerum:

Mnemonic: MEIG
Structures passing whole length:
1. Meningeal branch of Ascending
pharyngeal artery
2. Emissary vein
Other structures partially traversing:
3. Internal carotid artery
4. Greater petrosal nerve

Carotid Canal:

Internal carotid artery (ICA) and venous and
sympathetic plexus around it

Foramen Rotundum:
Maxillary nerve (CN V2)

Stylomastoid Foramen:

1. Facial nerve (CN VII)
2. Posterior Auricular artery (Stylomastoid
branch)

Internal Acoustic Meatus:

1. Facial nerve (CN VII)
2. Vestibulo-cochlear nerve (CN VIII)
3. Nerves intermedius or pars intermedia of
wrisberg
4. Labyrinthe vessels

Hypoglossal canal:

1. Hypoglossal nerve
2. Meningeal branch of Hypoglossal nerve
3. Meningeal branch of Ascending
Pharyngeal artery
4. Emissary vein (Sigmoid sinus to internal
jugular vein)

Jugular Foramen:

1. Anterior part: Inferior Petrosal Sinus
2. Middle part: 9,10,11 MAP
a. CN IX (Glossopharyngeal nerve)
b. CN X (Vagus nerve)
c. CN XI (Accesory nerve)
d. Meningeal branch of Ascending
Pharyngeal Artery
3. Posterior part:
a. Internal Jugular vein (IJV) – Sigmoid sinus
junction
b. Emissary vein (Sigmoid sinus to occipital
vein)
c. Occipital artery
Mastoid canaliculus (entry) and
Tympanomastoid fissure (exit):
Auricular branch of vagus nerve
Tympanic Canaliculus
Tympanic branch of CN IX (Glossopharyngeal
nerve)

Incisive Foramen:

1. Greater palatine vessels
2. Nasopalatine nerves

Greater Palatine Foramen:

Mnemonic: GAP (Greater and Anterior Palatine Vessels)
1. Greater Palatine vessels
2. Anterior Palatine vessels

Lesser Palatine Foramen:

Middle and Posterior Palatine nerve

Superior Orbital Fissure:

1. Lacrimal nerve
2. Frontal nerve
3. Trochlear nerve
4. Occulomotor nerve
5. Nasociliary nerve
6. Abducent nerve
7. Superior ophthalmic vein

Foramen magnum:

Mnemonic: MAVer
1. Medulla oblongata
2. Ascending parts of spinal accessory
nerves
3. Vertebral arteries

DISEASE DIAGNOSIS BY TONGUE

Tongue acts as an easily accessible organ for the assessment of health of an individual and shows the state of hydration of the body. It is said that tongue is the mirror of the gastrointestinal system and any abnormal functioning of the stomach and intestines will be reflected on the tongue. 

Some characteristic changes occur in the tongue in some particular diseases.That is why the examination of the tongue is very essential and will give some clues for diagnosis. All doctors examine the tongue and they consider the changes in size,shape,colour,moisture,coating,nature of papillae and movements ect. 

Appearance of tongue in some abnormal conditions:- 

1) Movements of the tongue:-

a) In one sided paralysis of the body(hemiplegia)tongue moves towards the parylised side when protruded. 

b) Tremulus movement of the tongue is seen in diseases like thyrotoxicosis,delirium tremens and parkinsonisum.Tremor is also seen in nervous patients. 

c) In progressive bulbar palsy there will be wasting and paralysis of the tongue with fibrillation. Eventually the tongue gets shrivelled and lies functionless in the floor of the mouth. This condition is associated with dribbling of saliva and loss of speech. 

d) In chorea(involuntary rhythmic movements) the patient may not be able to keep the protruded tongue in rest,it will be moving involuntarily.

2) Moistness of the tongue:-

The moistness of the tongue gives some indication about the state of hydration of the body.Water volume depletion leads to peripheral circulatory failure characterised by weakness,thirst,restlessness,anorexia,nausea,vomiting, dry and parched tongue.

Dryness of the tongue is seen in following conditions.

a) Diarrhoea
b) Later stages of severe illness
c) Advanced uraemia
d) Hypovolumic shock
e) Heat exhaustion
f) Hyponatraemia
g) Acute intestinal obstruction
h) Starvation
i) Prlonged fasting.

3) Change in colour of tongue:-

a) Central cyanosis:-

Cyanosis is the bluish discolouration of the mucus membrane due to decrease in the amount of oxygen in the blood.This is seen in heart failure,respiratory failure and in anoxia.In cyanosis tongue,lips ect becomes pale bluish.

b) Jaundice:-

This is the yellowish discolouration of all mucus surfaces of the body (including tongue)due to increase of bilirubin in the blood.Jaundice is seen in hepatitis,bile duct obstruction,increased destruction of RBCs and ect...

c) Advanced uremia:-

This is the increase of urea and other nitrogenous waste products in the blood due to kidney failure.Here the tongue become brown in colour. 

d) Keto acidosis:-

This is the acidosis with accumulation of ketone bodies seen mainly in diabetes mellitus.Here the tongue become brown with a typical ketone smell from the mouth. 

e) Riboflavin deficiency:-

Deficiency of this vitamin (vitamin B2) produces megenta colour of the tongue with soreness and fissures of lips. 

f) Niacin deficiency:-

Deficiency of niacin (vitamin B3)and some other B complex vitamins results in bright scarlet or beefy red tongue. 

g) Anaemia:-

It is the decrease in haemoglobin percentage of the blood.In severe anaemia tongue becomes pale. 

4) Coating on the tongue:-

a) Bad breath:-

The main cause for bad breath is formation of a pasty coating(bio film) on the tongue which lodges thousands of anaerobic bacteria resulting in the production of offenssive gases.Those who complain about bad breath may have thick coating on the posterior part of the tongue. 

b) Typhoid fever:-

In typhoid fever tongue becomes white coared like a fur. 

c) Candidiasis;-

It is a fungal infection which affects the mucus surfaces of the body.On the tongue there will be sloughing white lesions.

d) In diabetes and hypoadrenalism there will be sloughing white lesions.

e) Secondary syphilis:-

Syphilis is a sexually transmitted diseased caused by trepenoma pallidum infection.In secondary stage of this disease we can see mucous patches which are painless,smooth white glystening opalescent plaques which can not be scraped off easily. 

f) Leokoplakia:-

Here white keratotic patches are seen on the tongue and oral cavity.This is a precancerous condition.

g) AIDS:-

In these patients hairy leukoplakia is seen. 

h) Peritonitis:-

It is the inflammation of the peritonium(inner covering of abdominal cavity which also covers the intestines and keep them in position) in this condition there is white furring of the tongue. 

i) Acute illness:-

Furring is also seen in some acute diseases. 

5) Papillae:-

These are small projections on the rongue associated with taste.There are different type of papillae on the healthy tongue.In some diseases there are some abnormal changes which are following. 

a) Hairy tongue:-

This condition is due to elongation of filiform papillae seen in poor oral hygeine ,general debility and indigestion. 

b) Geographic tongue:-

Here irregular red and white patches appear on the tongue.These lesions looks like a geographic map.The excact cause is not known. 

c) Median rhomboid glossitis:-

In this condition there is smooth nodular red area in the posterior mid line of the tongue.This is a congenital condition. 

d) Nutritional deficiency:-

In nutrional deficiency there is glossitis(inflammation of tongue) leading to papillary hypertrophy followed by atrophy. 

e) Benign migratory glossitis:-

It is an inflamatory condition of the tongue where multiple annular areas of desquamation of papillae appear on the tongue which shift from area to area in few days.

f) Thiamine and riboflavin deficiency:-

Deficiency of these vitamins cause hypertrophied filiform and fungiform papillae.

g) Niacin and iron deficiency:-

In this condition there is atrophy of papillae.Smooth tongue is encountered in iron deficiency. 

h) Vitamin A deficiency:-

This causes furrowed tongue. 

i) In nutritional megaloblastic anaemia tongue becomes smooth. 

j) Folic acid deficiency:-

Here macrocytic megaloblastic anaemia with glossitis is seen. 

k) Cyano coblamine deficiency:-

Here glossitis with macrocytic megaloblastic anaemia and peripheral neuropathy is encountered. 

l) Scarlet fever;-

In this streptococcal infection there is bright red papillae standing out of a thick white fur ,later the white coat disappear leaving enlarged papillae on the bright red surface and is called strawberry tongue. 

6) Ulcers on the tongue:-- 

a) Apthous ulcer:-

These are round painful ulcers appear in stressed individuals frequently. May be associated with food allergy.Usual sites are tongue,lips,oral mucosa and ect. 

b) Herpes simplex:-

It is an acute vesicular eruptions produced by herpes simplex virus.When these vesicles rupture it forms ulcers. 

c) Ulcer in cancer:-

Cancerous ulcers are having everted edges with hard base.Bleeding is also seen.Cancer of the tongue is common in tobacco chewers. 

d) Syphilitic ulcers:-

Syphilitic fissures are longitudinal in direction.In primary syphilis extra genital chancre is seen on the tongue.In secondary syphilis multiple shallow ulcers are seen on the under surface and sides of the tongue.In tertiary syphilis gumma may be seen on the midline of the dorsum of the tongue.

e) Dental ulcers:-

These ulcers are produced by sharp edges of carious teeth.

Osessive Compulsive Disorder (OCD)

Obsessive-compulsive disorder (OCD) is an anxiety disorder characterized by uncontrollable, unwanted thoughts and repetitive, ritualized behaviors you feel compelled to perform. If you have OCD, you probably recognize that your obsessive thoughts and compulsive behaviors are irrational – but even so, you feel unable to resist them and break free.

Like a needle getting stuck on an old record, obsessive-compulsive disorder (OCD) causes the brain to get stuck on a particular thought or urge. For example, you may check the stove twenty times to make sure it’s really turned off, wash your hands until they’re scrubbed raw, or drive around for hours to make sure that the bump you heard while driving wasn’t a person you ran over.
 

Understanding OCD obsessions and compulsions

Obsessions are involuntary, seemingly uncontrollable thoughts, images, or impulses that occur over and over again in your mind. You don’t want to have these ideas but you can’t stop them. Unfortunately, these obsessive thoughts are often disturbing and distracting.
Compulsions are behaviors or rituals that you feel driven to act out again and again. Usually, compulsions are performed in an attempt to make obsessions go away. For example, if you’re afraid of contamination, you might develop elaborate cleaning rituals. However, the relief never lasts. In fact, the obsessive thoughts usually come back stronger. And the compulsive behaviors often end up causing anxiety themselves as they become more demanding and time-consuming.
Most people with obsessive-compulsive disorder (OCD) fall into one of the following categories:

• Washers are afraid of contamination. They usually have cleaning or hand-washing compulsions.

• Checkers repeatedly check things (oven turned off, door locked, etc.) that they associate with harm or danger.
• Doubters and sinners are afraid that if everything isn’t perfect or done just right something terrible will happen or they will be punished.
• Counters and arrangers are obsessed with order and symmetry. They may have superstitions about certain numbers, colors, or arrangements.
• Hoarders fear that something bad will happen if they throw anything away. They compulsively hoard things that they don’t need or use.

Just because you have obsessive thoughts or perform compulsive behaviors does NOT mean that you have obsessive-compulsive disorder. With OCD, these thoughts and behaviors cause tremendous distress, take up a lot of time, and interfere with your daily life and relationships.

Signs and symptoms of obsessive-compulsive disorder (OCD)

Most people with obsessive-compulsive disorder (OCD) have both obsessions and compulsions, but some people experience just one or the other.

OCD signs and symptoms: Obsessive thoughts

Common obsessive thoughts in obsessive-compulsive disorder (OCD) include:

• Fear of being contaminated by germs or dirt or contaminating others.
• Fear of causing harm to yourself or others.
• Intrusive sexually explicit or violent thoughts and images.
• Excessive focus on religious or moral ideas.
• Fear of losing or not having things you might need.
• Order and symmetry: the idea that everything must line up “just right.”
• Superstitions; excessive attention to something considered lucky or unlucky.

OCD signs and symptoms: Compulsive behaviors

Common compulsive behaviors in obsessive-compulsive disorder (OCD) include:

• Excessive double-checking of things, such as locks, appliances, and switches.
• Repeatedly checking in on loved ones to make sure they’re safe.
• Counting, tapping, repeating certain words, or doing other senseless things to reduce anxiety.
• Spending a lot of time washing or cleaning.
• Ordering or arranging things “just so.”
• Praying excessively or engaging in rituals triggered by religious fear.
• Accumulating “junk” such as old newspapers or empty food containers.

Obsessive-compulsive disorder (OCD) symptoms in children

While the onset of obsessive-compulsive disorder usually occurs during adolescence or young adulthood, younger children sometimes have symptoms that look like OCD. However, the symptoms of other disorders, such as ADD, autism, and Tourette’s syndrome, can also look like obsessive-compulsive disorder, so a thorough medical and psychological exam is essential before any diagnosis is made.

Therapy as treatment for obsessive-compulsive disorder (OCD)

The most effective treatment for obsessive-compulsive disorder is often cognitive-behavioral therapy. Antidepressants are sometimes used in conjunction with therapy, although medication alone is rarely effective in relieving the symptoms of OCD.

Cognitive-behavioral therapy for obsessive-compulsive disorder (OCD)

Cognitive-behavioral therapy for obsessive-compulsive disorder (OCD) involves two components:

1. Exposure and response prevention involves repeated exposure to the source of your obsession. Then you are asked to refrain from the compulsive behavior you’d usually perform to reduce your anxiety. For example, if you are a compulsive hand washer, you might be asked to touch the door handle in a public restroom and then be prevented from washing. As you sit with the anxiety, the urge to wash your hands will gradually begin to go away on its own. In this way, you learn that you don’t need the ritual to get rid of your anxiety—that you have some control over your obsessive thoughts and compulsive behaviors.
2. Cognitive therapy focuses on the catastrophic thoughts and exaggerated sense of responsibility you feel. A big part of cognitive therapy for OCD is teaching you healthy and effective ways of responding to obsessive thoughts, without resorting to compulsive behavior.

Four Steps for Conquering Symptoms of Obsessive-Compulsive Disorder (OCD)

Psychiatrist Jeffrey Schwartz, author of Brain Lock: Free Yourself from Obsessive-Compulsive Behavior, offers the following four steps for dealing with OCD:

• RELABEL – Recognize that the intrusive obsessive thoughts and urges are the result of OCD. For example, train yourself to say, "I don't think or feel that my hands are dirty. I'm having an obsession that my hands are dirty." Or, "I don't feel that I have the need to wash my hands. I'm having a compulsive urge to perform the compulsion of washing my hands."
• REATTRIBUTE – Realize that the intensity and intrusiveness of the thought or urge is caused by OCD; it is probably related to a biochemical imbalance in the brain. Tell yourself, "It's not me—it’s my OCD," to remind you that OCD thoughts and urges are not meaningful, but are false messages from the brain.
• REFOCUS – Work around the OCD thoughts by focusing your attention on something else, at least for a few minutes. Do another behavior. Say to yourself, "I'm experiencing a symptom of OCD. I need to do another behavior."
• REVALUE – Do not take the OCD thought at face value. It is not significant in itself. Tell yourself, "That's just my stupid obsession. It has no meaning. That's just my brain. There's no need to pay attention to it." Remember: You can't make the thought go away, but neither do you need to pay attention to it. You can learn to go on to the next behavior.

Source: Westwood Institute for Anxiety Disorders

Family therapy for OCD treatment

Because OCD often causes problems in family life and social adjustment, family therapy can often be beneficial.

• Family therapy promotes understanding of the disorder and can help reduce family conflicts.
• It can motivate family members and teach them how to help their loved one.

Group therapy for OCD treatment

Through interaction with fellow OCD sufferers, group therapy provides support and encouragement and decreases feelings of isolation.

Self-help for OCD tip 1: Challenge obsessive thoughts and compulsive behaviors

If you have obsessive-compulsive disorder (OCD), there are many ways you can help yourself in addition to seeking therapy.

Refocus your attention

Learn to recognize and reduce stress

When you’re experiencing OCD thoughts and urges, try shifting your attention to something else.

• You could exercise, jog, walk, listen to music, read, surf the web, play a video game, make a phone call, or knit. The important thing is to do something you enjoy for at least 15 minutes, in order to delay your response to the obsessive thought or compulsion.
• At the end of the delaying period, reassess the urge. In many cases, the urge will no longer be quite as intense. Try delaying for a longer period. The longer you can delay the urge, the more it will likely change.

Write down your obsessive thoughts or worries

Keep a pad and pencil on you, or type on a laptop, smartphone, or tablet. When you begin to obsess, write down all your thoughts or compulsions.

• Keep writing as the OCD urges continue, aiming to record exactly what you're thinking, even if you’re repeating the same phrases or the same urges over and over.
• Writing it all down will help you see just how repetitive your obsessions are.
• Writing down the same phrase or urge hundreds of times will help it lose its power.
• Writing thoughts down is much harder work than simply thinking them, so your obsessive thoughts are likely to disappear sooner.

Anticipate OCD urges

By anticipating your compulsive urges before they arise, you can help to ease them. For example, if your compulsive behavior involves checking that doors are locked, windows closed, or appliances turned off, try to lock the door or turn off the appliance with extra attention the first time.

• Create a solid mental picture and then make a mental note. Tell yourself, “The window is now closed,” or “I can see that the oven is turned off.”
• When the urge to check arises later, you will find it easier to relabel it as “just an obsessive thought.”

Create an OCD worry period

Rather than trying to suppress obsessions or compulsions, develop the habit of rescheduling them.

• Choose one or two 10 minute “worry periods” each day, time you can devote to obsessing. Choose a set time and place (e.g. in the living room from 8:00 to 8:10 a.m. and 5:00 to 5:10 p.m.) that’s early enough it won’t make you anxious before bedtime.
• During your worry period, focus only on negative thoughts or urges. Don’t try to correct them. At the end of the worry period, take a few calming breaths, let the obsessive thoughts or urges go, and return to your normal activities. The rest of the day, however, is to be designated free of obsessions and compulsions.
• When thoughts or urges come into your head during the day, write them down and “postpone” them to your worry period. Save it for later and continue to go about your day.
• Go over your “worry list” during the worry period. Reflect on the thoughts or urges you wrote down during the day. If the thoughts are still bothering you, allow yourself to obsess about them, but only for the amount of time you’ve allotted for your worry period. 

Create a tape of your OCD obsessions

Focus on one specific worry or obsession and record it to a tape recorder, laptop, or smartphone.

• Recount the obsessive phrase, sentence, or story exactly as it comes into your mind.
• Play the tape back to yourself, over and over for a 45-minute period each day, until listening to the obsession no longer causes you to feel highly distressed.
• By continuously confronting your worry or obsession you will gradually become less anxious. You can then repeat the exercise for a different obsession.

Self-help for OCD tip 2: Take care of yourself

A healthy, balanced lifestyle plays a big role in keeping OCD behavior, fears, and worry at bay.

Practice relaxation techniques

While stress doesn’t cause OCD, a stressful event can trigger the onset of obsessive and compulsive behavior, and stress can often make obsessive-compulsive behavior worse.

• Mindful meditation, yoga, deep breathing, and other stress-relief techniques may help reduce the symptoms of anxiety brought on by OCD.
• Try to practice a relaxation technique for at least 30 minutes a day.

Adopt healthy eating habits

Start the day right with breakfast, and continue with frequent small meals throughout the day. Going too long without eating leads to low blood sugar, which can make you feel more anxious.

• Eat plenty of complex carbohydrates such as whole grains, fruits, and vegetables. Not only do complex carbs stabilize blood sugar, they also boost serotonin, a neurotransmitter with calming effects.

Exercise regularly

Exercise is a natural and effective anti-anxiety treatment that helps to control OCD symptoms by refocusing your mind when obsessive thoughts and compulsions arise.

• For maximum benefit, try to get 30 minutes or more of aerobic activity on most days. Aerobic exercise relieves tension and stress, boosts physical and mental energy, and enhances well-being through the release of endorphins, the brain’s feel-good chemicals.

Avoid alcohol and nicotine

Alcohol temporarily reduces anxiety and worry, but it actually causes anxiety symptoms as it wears off. Similarly, while it may seem that cigarettes are calming, nicotine is actually a powerful stimulant. Smoking leads to higher, not lower, levels of anxiety and OCD symptoms.

Get enough sleep

Not only can anxiety and worry cause insomnia, but a lack of sleep can also exacerbate anxious thoughts and feelings. When you’re well rested, it’s much easier to keep your emotional balance, a key factor in coping with anxiety disorders such as OCD.

Self-help for OCD tip 3: Reach out for support

Obsessive-compulsive behavior (OCD) can get worse when you feel powerless and alone, so it’s important to build a strong support system. The more connected you are to other people, the less vulnerable you’ll feel. Just talking about your worries and urges can make them seem less threatening.

Stay connected to family and friends

Obsessions and compulsions can consume your life to the point of social isolation. In turn, social isolation can aggravate your OCD symptoms. It’s important to have a network of family and friends you can turn to for help and support. Involving others in your treatment can help guard against setbacks and keep you motivated.

Join an OCD support group

You’re not alone in your struggle with OCD, and participating in a support group can be an effective reminder of that. OCD support groups enable you to both share your own experiences and learn from others who are facing the same problems. For a searchable database of OCD support groups, see the Resources and References section below.

Helping a loved one with obsessive-compulsive disorder (OCD)

If a friend or family member has OCD, your most important job is to educate yourself about the disorder. Share what you’ve learned with your loved one and let them know that there is help available. Simply knowing that OCD is treatable can sometimes provide enough motivation for your loved one to seek help.

Tips for helping a friend or family member with OCD

The way you react to a loved one’s OCD symptoms can have a big impact.

• Negative comments or criticism can make OCD worse, while a calm, supportive environment can help improve the outcome of treatment. Focus on the sufferer’s positive qualities and avoid making personal criticisms.
• Don’t scold someone with OCD or tell the person to stop performing rituals. They can’t comply, and the pressure to stop will only make the behaviors worse. Remember, your loved one’s OCD behaviors are symptoms, not character flaws.
• Be as kind and patient as possible. Each sufferer needs to overcome problems at their own pace. Praise any successful attempt to resist OCD, and focus attention on positive elements in the person’s life.
• Do not play along with your loved one’s OCD rituals. Helping the sufferer with rituals will only reinforce the behavior. Support the person, not their rituals.
• Create a pact to not allow OCD to take over family life. Sit down as a family and decide how you will work together to tackle your loved one’s OCD symptoms. Try to keep family life as normal as possible and the home a low-stress environment.
• Communicate positively, directly and clearly. Communication is important so you can find a balance between standing up to the OCD and not further distressing your loved one.
• Find the humor. Seeing the humor and absurdity in some OCD symptoms can help the sufferer become more detached from the disorder. Of course, a situation is only humorous if the sufferer finds it funny, too.

Best Of Luck...