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Cranial Nerve 1- Olfaction This patient has difficulty identifying the smells presented. Loss of smell is anosmia. The most common cause is a cold (as in this patient) or nasal allergies. Other causes include trauma or a meningioma affecting the olfactory tracts. Anosmia is also seen in Kallman syndrome because of agenesis of the olfactory bulbs. Cranial Nerve 2- Visual acuity This patientâs visual acuity is being tested with a Rosenbaum chart. First the left eye is tested, then the right eye. He is tested with his glasses on so this represents corrected visual acuity. He has 20/70 vision in the left eye and 20/40 in the right. His decreased visual acuity is from optic nerve damage. Cranial Nerve II- Visual field The patient's visual fields are being tested with gross confrontation. A right sided visual field deficit for both eyes is shown. This is a right hemianopia from a lesion behind the optic chiasm involving the left optic tract, radiation or striate cortex. Cranial Nerve II- Fundoscopy The first photograph is of a fundus showing papilledema. The findings of papilledema include 1. Loss of venous pulsation 2. Swelling of the optic nerve head so there is loss of the disc margin 3. Venous engorgement 4. Disc hyperemi 5. Loss of the physiologic cup an 6. Flame shaped hemorrhages. This photograph shows all the signs except the hemorrhages and loss of venous pulsations. The second photograph shows optic atrophy, which is pallor of the optic disc resulting form damage to the optic nerve from pressure, ischemia, or demyelination. Images Courtesy Dr. Kathleen Digre, University of Uta Cranial Nerves 2 & 3- Pupillary Light Refle The swinging flashlight test is used to show a relative afferent pupillary defect or a Marcus Gunn pupil of the left eye. The left eye has perceived less light stimulus (a defect in the sensory or afferent pathway) then the opposite eye so the pupil dilates with the same light stimulus that caused constriction when the normal eye was stimulated. Video Courtesy of Dr.Daniel Jacobson, Marshfield Clini and Dr. Kathleen Digre, University of Uta Cranial Nerves 3, 4 & 6- Inspection & Ocular Alignmen This patient with ocular myasthenia gravis has bilateral ptosis, left greater than right. There is also ocular misalignment because of weakness of the eye muscles especially of the left eye. Note the reflection of the light source doesn't fall on the same location of each eyeball. Video Courtesy of Dr.Daniel Jacobson, Marshfield Clini and Dr. Kathleen Digre, University of Uta Cranial Nerves 3, 4 & 6- Versions • The first patient shown has incomplete abduction of her left eye from a 6th nerve palsy. • The second patient has a left 3rd nerve palsy resulting in ptosis, dilated pupil, limited adduction, elevation, and depression of the left eye. Second Video Courtesy of Dr.Daniel Jacobson, Marshfield Clini and Dr. Kathleen Digre, University of Uta Cranial Nerves 3, 4 & 6- Duction Each eye is examined with the other covered (this is called ductions). The patient is unable to adduct either the left or the right eye. If you watch closely you can see nystagmus upon abduction of each eye. When both eyes are tested together (testing versions) you can see the bilateral adduction defect with nystagmus of the abducting eye. This is bilateral internuclear ophthalmoplegia often caused by a demyelinating lesion effecting the MLF bilaterally. The adduction defect occurs because there is disruption of the MLF (internuclear) connections between the abducens nucleus and the lower motor neurons in the oculomotor nucleus that innervate the medial rectus muscle. Saccades Smooth Pursui The patient shown has progressive supranuclear palsy. As part of this disease there is disruption of fixation by square wave jerks and impairment of smooth pursuit movements. Saccadic eye movements are also impaired. Although not shown in this video, vertical saccadic eye movements are usually the initial deficit in this disorder. Video Courtesy of Dr.Daniel Jacobson, Marshfield Clini and Dr. Kathleen Digre, University of Utah Optokinetic Nystagmu This patient has poor optokinetic nystagmus when the tape is moved to the right or left. The patient lacks the input from the parietal-occipital gaze centers to initiate smooth pursuit movements therefore her visual tracking of the objects on the tape is inconsistent and erratic. Patients who have a lesion of the parietal-occipital gaze center will have absent optokinetic nystagmus when the tape is moved toward the side of the lesion. Vestibulo-ocular refle The vestibulo-ocular reflex should be present in a comatose patient with intact brainstem function. This is called intact "Doll’s eyes" because in the old fashion dolls the eyes were weighted with lead so when the head was turned one way the eyes turned in the opposite direction. Absent "Doll’s eyes" or vestibulo-ocular reflex indicates brainstem dysfunction at the midbrain-pontine level. Vergenc Light-near dissociation occurs when the pupils don't react to light but constrict with convergence as part of the near reflex. This is what happens in the Argyll-Robertson pupil (usually seen with neurosyphilis) where there is a pretectal lesion affecting the retinomesencephalic afferents controlling the light reflex but sparing the occipitomesencephalic pathways for the near reflex. Video Courtesy of Dr.Daniel Jacobson, Marshfield Clini and Dr. Kathleen Digre, University of Uta Cranial Nerve 5- Sensor There is a sensory deficit for both light touch and pain on the left side of the face for all divisions of the 5th nerve. Note that the deficit is first recognized just to the left of the midline and not exactly at the midline. Patients with psychogenic sensory loss often identify the sensory change as beginning right at the midline. Cranial Nerves 5 & 7 - Corneal refle A patient with an absent corneal reflex either has a CN 5 sensory deficit or a CN 7 motor deficit. The corneal reflex is particularly helpful in assessing brainstem function in the unconscious patient. An absent corneal reflex in this setting would indicate brainstem dysfunction. Cranial Nerve 5- Motor • The first patient shown has weakness of the pterygoids and the jaw deviates towards the side of the weakness. • The second patient shown has a positive jaw jerk which indicates an upper motor lesion affecting the 5th cranial nerve. First Video Courtesy of Alejandro Stern, Stern Foundation Cranial Nerve 7- Motor • The first patient has weakness of all the muscles of facial expression on the right side of the face indicating a lesion of the facial nucleus or the peripheral 7th nerve. • The second patient has weakness of the lower half of his left face including the orbicularis oculi muscle but sparing the forehead. This is consistent with a central 7th or upper motor neuron lesion. Video Courtesy of Alejandro Stern, Stern Foundatio Cranial Nerve 7- Sensory, Tast The patient has difficulty correctly identifying taste on the right side of the tongue indicating a lesion of the sensory limb of the 7th nerve. Cranial Nerve 8- Auditory Acuity, Weber & Rinne Test This patient has decreased hearing acuity of the right ear. The Weber test lateralizes to the right ear and bone conduction is greater than air conduction on the right. He has a conductive hearing loss. Cranial Nerve 8- Vestibula Patients with vestibular disease typically complain of vertigo – the illusion of a spinning movement. Nystagmus is the principle finding in vestibular disease. It is horizontal and torsional with the slow phase of the nystagmus toward the abnormal side in peripheral vestibular nerve disease. Visual fixation can suppress the nystagmus. In central causes of vertigo (located in the brainstem) the nystagmus can be horizontal, upbeat, downbeat, or torsional and is not suppressed by visual fixation. Cranial Nerve 9 & 10- Moto When the patient says "ah" there is excessive nasal air escape. The palate elevates more on the left side and the uvula deviates toward the left side because the right side is weak. This patient has a deficit of the right 9th & 10th cranial nerves. Video Courtesy of Alejandro Stern, Stern Foundatio Cranial Nerve 9 & 10- Sensory and Motor: Gag Refle Using a tongue blade, the left side of the patient's palate is touched which results in a gag reflex with the left side of the palate elevating more then the right and the uvula deviating to the left consistent with a right CN 9 & 10 deficit. Video Courtesy of Alejandro Stern, Stern Foundation Cranial Nerve 11- Moto When the patient contracts the muscles of the neck the left sternocleidomastoid muscle is easily seen but the right is absent. Looking at the back of the patient, the left trapezius muscle is outlined and present but the right is atrophic and hard to identify. These findings indicate a lesion of the right 11th cranial nerve. Video Courtesy of Alejandro Stern, Stern Foundation Cranial Nerve 12- Moto Notice the atrophy and fasciculation of the right side of this patient's tongue. The tongue deviates to the right as well because of weakness of the right intrinsic tongue muscles. These findings are present because of a lesion of the right 12th cranial nerve.  

An interactive learning resource that explores the life cycle of the Schistosoma mansoni parasite and how it exploits the human immune system in order to survive. All links are back up and running. Please let me know if you experience any diffuclties. Thank you!  

This animation shows a simplified version of the macrophage's role in the initiation of atherosclerosis. In an atherosclerotic-prone blood vessel, macrophages invade the subendothelial space. Oxidised Low-Density Lipoproteins (oxLDL) present within the vessel wall will bind to scavenger receptors on the macrophage's surface, such as CD36. This will activate the macrophage, and it will phagocytose the oxLDL. As this process continues, the macrophage increases in size and forms a Foam Cell, which is too large to pass between the endothelial cells back into the lumen. Therefore, the foam cells remain in the subendothelial space and are the main cells present within an atherosclerotic plaque. *** Done for Student Selected Component (SSC), University of Aberdeen. Year 2. 2011. Made in Adobe Photoshop CS2 and Adobe Imageready.  

This animation shows a simplified version of the macrophage's role in the initiation of atherosclerosis. In an atherosclerotic-prone blood vessel, macrophages invade the subendothelial space. Oxidised Low-Density Lipoproteins (oxLDL) present within the vessel wall will bind to scavenger receptors on the macrophage's surface, such as CD36. This will activate the macrophage, and it will phagocytose the oxLDL. As this process continues, the macrophage increases in size and forms a Foam Cell, which is too large to pass between the endothelial cells back into the lumen. Therefore, the foam cells remain in the subendothelial space and are the main cells present within an atherosclerotic plaque. *** Done for Student Selected Component (SSC), University of Aberdeen. Year 2. 2011. Made in Adobe Photoshop CS2 and Adobe Imageready.  

Tommy attempts to perform an examination of the spine.  

Very simple guide to the different types of shock, and rough management. Taking it back to basics!  

Never turn your back when you're trying to make a video promo for your medical education YouTube. You never know who is going to interfere.... Share if you like, remember to subscribe and keep smiling :) -Harriet  

A very Merry Christmas from all of us here at HippocraTV. We'll be back in the new year with lots of new videos. Deck the Halls courtesy of Kevin Macleod (Incompetech.com) #ThatsSoAlan  

Sample from 'Ace the OSCE' a Prize Winning OSCE Video Library. 100% Pass rate by subscribers last year and 100%Money Back Guarantee you pass your OSCEs! Real Patients with Real Signs (& standardised patients too). Includes a Handbook with detailed notes on each video. Winner of 1st Prize at the British Medical Association 2009 Book Awards: Electronic Media category. Subscribe Now at www.AceMedicine.com  

This video excerpt describes how amblyopia develops in children. Basically, if one eye doesn't see well from an early age, the wiring never forms correctly back to the occipital cortex.  

Watch a woman get a 3D-printed skull For more latest tech news and product reviews SUBSCRIBE to http://www.youtube.com/user/TechyGUYS When a Dutch woman with a rare condition needed a new skull, surgeons 3D-printed one for her and put it on her brain like a cap. An entire human cranium can now be added to the growing list of 3D-printed body parts that includes a fingertip, a hand, prosthetic eyes, arms, a jaw, and even a new foot for a duck. The plastic skull was made by an Australian firm and placed on the brain of a Dutch woman at Utrecht University's University Medical Center in the Netherlands. The operation, which lasted 23 hours, took place about three months ago, and Dutch News just reported that the patient has returned to work -- plastic noggin and all. "The patient has her sight back entirely, is symptom-free, is back to work, and it is almost impossible to see that she's ever had surgery," lead neurologist Ben Verweij said in a statement. Prior to the procedure, the woman's skull was more than three times thicker than a normal skull due to a rare condition. The increased thickness caused the woman's skull to press on her brain, leading to severe headaches and vision loss. Although the report doesn't name the condition, Camurati-Engelmann disease is among the ailments that can cause skull bones to thicken. "Implants used to be made by hand in the operating theater using a sort of cement which was far from ideal," Verweij said of the procedure, according to Dutch News. "Using 3D printing we can make one to the exact size. This not only has great cosmetic advantages, but patients' brain function often recovers better than using the old method." Verweiji says that although portions of skulls have been swapped out in the past, this is the first time an entire cranium has been replaced in a patient. And I bet this is the first time you've ever seen a plastic skull get attached to a real live brain. Let me know what you think in the comments below. TAGS play station 4, play station, play station 2 emulator, play station emulator, play station 3, free play station emulator, play station network, sony play station, play station 2, xbox one, xbox, xbox 360, xbox live, xbox 360 iso, xbox emulator, xbox 360 game, gta 5 cheat xbox, xbox iso, gta 5 cheat xbox 360, xbox 360 deal, microsoft, microsoft office, microsoft window, microsoft security essentials, microsoft office 2000, 2003 edition microsoft office professional, 2003 microsoft office student, microsoft word, 2007 microsoft office system, microsoft window xp, download microsoft word, microsoft window media center, microsoft internet explorer, 2007 download microsoft word, microsoft excel, microsoft account, microsoft outlook, microsoft corporation, microsoft window 7, microsoft surface, microsoft office word, microsoft download, microsoft online, microsoft office 2010, explorer internet microsoft update, microsoft power point, microsoft update, download microsoft office, microsoft xbox 360, microsoft computer training, apple, apple store, apple itunes music store, apple itunes, apple ipad, apple iphone, apple ipod, apple laptop, apple vacation, apple ipad mini, apple fix, apple logo, apple tv, apple support community, apple software download, apple iphone 5c, apple iphone 5s, apple iphone 4, apple iphone 5, samsung galaxy, samsung, samsung galaxy s4, samsung galaxy s3, viber for samsung, samsung flight, samsung galaxy note, samsung phone, att samsung galaxy, samsung galaxy note 3, samsung kies, samsung galaxy s iii, sprint samsung galaxy, samsung galaxy s2, samsung galaxy tab 3, samsung galaxy s 4, samsung tablet, samsung galaxy tab, samsung galaxy s, att samsung, samsung galaxy note 2, samsung galaxy s5, samsung galaxy tab 2, samsung galaxy mega, samsung galaxy s3 mini, samsung galaxy s4 mini, samsung galaxy s ii, how to screen shot on samsung galaxy s4, mobile samsung, sony, sony video game, sony tv, sony vaio, sony xperia, sony play station, sony ericsson, sony xperia z, sony laptop, sony entertainment network, sony camera, sony xperia z1, sony tv live, sony psp wall, sony vegas, sony vaio laptop, sony computer, sony style, sony mobile,  

The rotator cuff (rotor cuff) is a term given to the group of muscles and their tendons that act to stabilize the shoulder. The Rotator Cuff muscles are connected individually to a group of flat tendons, which fuse together and surround the front, the back, and the top of the shoulder joint. The Rotator Cuff ligaments attach bone to bone and provide stability to the shoulder joint bones.  

 

Medical Protection Society Website  

Medical Protection Society Website  

This is bleeding into the subarachnoid space. The classical sign is a sudden onset intense headache (“feel like I’ve been hit on the back of the head Doc”).   The bleeding occurs as the result of rupture of aneurysm (80%) and AV malformations (15%). In the remainder of cases, no cause can be identified. Trauma is also a major cause, but is not considered true SAH.    

Fifth Disease - so called as it was the fifth of the six common childhood skin rashes when it was first classified back in the 18th and 19th centuries. Formally known as Erythema Infectiosum and also colloquially called slapped cheek syndrome. Aietiology and Epidemiology  Caused by infection with Parvovirus B19 (aka erythrovirus)    

Our qualitative assessment of the impact to date of medical revalidation on the behaviour of doctors and the culture of organisations within seven case study sites across England. Medical revalidation of doctors became a statutory obligation for all employing organisations in 2012, but its origins stretch back to 2000. In that period, the NHS has undergone many changes and been scrutinised by several reviews. It was against this shifting context that The King's Fund carried out a qualitative assessment of the impact to date of medical revalidation on the behaviour of doctors and the culture of organisations within seven case study sites across England.