Moreover it is also a part of MBBS / Medical course curriculum for Students around the Globe both in Basic science and Clinical Sciences.

On all X-rays check the following:

1. Patient details-  Name , age and Complaints in Brief ( If available)
2. Orientation, position and side description- Left, right, erect, AP -anterioposterior , PA- poserioanterior, supine, prone
3. Additional information- inspiratory, expiratory film
4. Rotation-  Rotated or not , Measure the distance from the medial end of each clavicle to the spinous process of  the vertebra at the same level, which should be equal in Good Xray.
5. Adequacy of inspiration- Nine pairs of ribs should be seen posteriorly in order to consider a chest x-ray adequate in terms of inspiration
6. Penetration- Good/Inadequate- one should barely see the thoracic vertebrae behind the heart
7. Exposure- Adequate /Inadequate- One needs to be able to identify both costophrenic angles and lung apices.

Read the X ray in Order Either Outside to Inside or Vice-versa. Most Prefer Out to in.

8. Soft tissue

• Look  for subcutaneous air, foreign bodies and surgical clips
• Caution with nipple shadows, which may mimic intrapulmonary nodules
• Compare side to side, if on both sides the “nodules” in question are in the same
• position, then they are likely to be due to nipple shadows

 9. Bony Cage and structures

• Check for fractures, dislocation, subluxation, osteoblastic or osteolytic lesions in clavicles, ribs, thoracic spine and humerus.

10. Trachea and Bronchi-

• Ensure trachea is visible and in midline
•  Trachea gets deviated away from abnormality- eg pleural effusion or tension pneumothorax
•  Trachea gets deviated towards abnormality- eg atelectasis
•  Trachea normally narrows at the vocal cords
•  View the carina, angle should be between 60 –100 degrees
•  Check for tubes, pacemaker, wires, lines foreign bodies
•  If an endotracheal tube is in place, check the positioning, the distal tip of the tube should be 3-4cm above the carina

11.Diaphragm and Angles

• See Costophrenic angles and Cardiophrenic angles- Normally should be sharp. Bluting denotes effussions.
• Right hemidiaphragm- Should be higher than the left. If much higher, think of effusion, lobar collapse, diaphragmatic paralysis. If you cannot see parts of the diaphragm, consider infiltrate or effusion
• If film is taken in erect or upright position you may see free air under the diaphragm if intraabdominal perforation is present

12.Lung Fields-

• Normal or Hyperinflated- Count Ribs- Anterior Ribs if 7 or more visible -Hyperinflated, Posterior ribs more than 9 than hyperinflated.
• Check for infiltrates-Identify the location of infiltrates by use of known radiological phenomena, eg loss of heart borders or of the contour of the diaphragm,Remember that right middle lobe abuts the heart, but the right lower lobe does not
• Identify the pattern of infiltration-
• o Interstitial pattern (reticular) versus alveolar (patchy or nodular) pattern
• o Lobar collapse
• o Look for air bronchograms, tram tracking, nodules, Kerley B lines
• o Pay attention to the apices
• Check for granulomas, tumour and pneumothorax

13.Cardia sillouhete and Mediastinum-

• Heart size and heart borders-Appropriate or blunted, Thin rim of air around the heart, think of pneumomediastinum, Cardiomegaly – Calculate Cardiothoracic Ratio
• Aorta- Widening, tortuosity, calcification
• Heart valves- Calcification, valve replacements
• SVC, IVC, azygos vein- Widening, tortuosity
• Check for a widened mediastinum-  Mass lesions (eg tumour, lymph nodes), Inflammation (eg mediastinitis, granulomatous inflammation), Trauma and dissection (eg haematoma, aneurysm of the major mediastinal vessels)

1. Powerpoint-

Developed by Microsoft Corp, is the most powerful and user-friendly application. It is also the most widely used software to prepare case presentation in Medical field.

It provides an easy interface, no need of special code or language knowledge and provides you a facility to add Media and charts to the presentation. You can always get lot of templates and sample slideshows out there in the internet.

2. Flash

Stunning presentations can be made using Flash a software from ADOBE. It is by far the best presentation technology on the market. You’ll require a high degree of  proficiency to work with flash.But the results are you can put up amazing animation effects and animations to impress your spectators. You will need a Flash course for this.

3 Apple Keynote

Even if you’ve never used Keynote before, you’ll find creating a presentation surprisingly simple. It all starts with an enhanced Theme Chooser that lets you preview an impressive collection of 44 Apple-designed themes. Drag across a theme to skim through its slide designs. Once you’ve chosen the perfect canvas for your presentation, simply substitute placeholder text and graphics with your own words and images. Thanks to the Slide Navigator, the progress of your presentation and its organization are always in view.

4. Open Office Impress

Open Office Impress is the free open source presentation technology. It contains a number of features not available in PowerPoint.IMPRESS is a truly outstanding tool for creating effective multimedia presentations. Your presentations will stand out with 2D and 3D clip art, special effects, animation, and high-impact drawing tools.

5. PowerConverter:

Anyone who creates PowerPoint® presentations can easily become a Flash author, just by using PowerCONVERTER! It lets you convert any PowerPoint presentation to Flash. A solution for those who don’t know Flash but want to use it for presentation.

Objective 1:

• To list the important causative agents of meningitis.

TYPES OF MENINGITIS

• Acute Pyogenic Meningitis
• Aseptic Meningitis
• Chronic Meningitis
  • Tuberculous
  • Fungal
  • Syphillitic
  • Protozoal
  • Helminthe

Causative agents of acute pyogenic meningitis

• Neonates
– Escherichia coli
– Group B streptococci
– Listeria monocytogenes
– Streptococcus pneumoniae

• Children
– Neisseria meningitidis
– Streptococcus pneumoniae,
– Haemophilus influenzae

• Adults
– Streptococcus pneumoniae,
– Neisseria meningitidis

• Elderly
– Listeria species

Causative Agents of Aseptic meningitis

• Common:
- Enteroviruses
- Herpes simplex virus 2 (HSV 2)
- Arthropod borne viruses (Tickborne, West Nile, Murray Valley, Japanese B)
- HIV (Human Immunodeficiency Virus)

• Less common
- Varicella zoster virus (VZV)
- Epstein Barr virus (EBV)

Causative Agents of Chronic Meningitis

Tuberculous meningitis

• Mycobacterium tuberculosis

Syphillitic meningits

• Treponema pallidum

Fungal meningitis

• Cryptococcus neoformans (most common in HIV patients)
• Candida albicans
• Mucor species
• Aspergillus fumigatus
• Coccidioides immitis
• Histoplasma capsulatum
• Blastomyces dermatitidis

Protozoal

• Toxoplasma gondii
• Trypanosoma
• Acanthamoeba

Helminthes

• Taenia solium

Objective 2:

• To outline laboratory diagnosis of bacterial meningitis.

Specimens

• CSF
• Blood
• Sample
• Nasal swab
• Peticheal lesions
• Autopsy

A. Examination of CSF

Macroscopy
• CSF is cloudy under increased pressure and blood may be seen.

CSF is centrifuged and following methods are used:

• Microscopy
• Culture

Microscopy

Unstained preparations: wet mounts

Stained smears:

• Common stains: Gram stain, Ziehl-Neelsen stain
• Fluorescent dyes: Acridine orange, Auramine rhodamine

Gram stain (left) and ZN stain (right)

Culture

Culture Media

• Enriched solid media- blood agar, chocolate agar
• Selective solid medium- MacConkey agar
• Robertson Cooked meat broth (for anaerobes)

Steps:

• CSF inoculated in culture media
• incubation at 35-36°C under 5-10% CO2
• Colonies appear after 18-24 hours, identified by morphology and biochemical reactions.

B. Blood culture

• incubated for 4-7 days, with daily subcultures

C. Nasopharyngeal Swab

• Useful for detection of carriers
• Done without contamination with saliva

D. Petechial lesions

Menigococci may be demonstrated by microscopy and culture

E. Autopsy

• Specimen from meninges, lateral ventricles, or surface of brain and spinal cord
• Within 12 hours of death of patient
• Smear or culture

Biochemical tests

• Catalase test
• Oxidase test
• Indole test
• Urease test
• Coagulase test
• Citrate Utilization test
• Triple sugar iron agar

Agglutination test:

• Direct slide agglutination test with specific antisera
• Latex agglutination test
• Immunoflourescence test
• Other rapid identification methods
• Molecular diagnosis – PCR test

Various changes in Acute Pyogenic Meningitis:

References:

• Textbook of Microbiology
• Diagnostic Microbiology

Prepared and Presented for Correlation Seminar in Kist Medical College by:

Studying Online

Pathology is an interesting subject but it is as difficult as any other subjects in medical science like anatomy, physiology, pharmacology, etc. We all are made differently and we all have different way of learning or studying. The method that I use to study may or may not be suitable to you. Lectures, books, pictures and slides are the common sources of learning. Using online resources to learn may be very helpful to many of us.

It is a vast subject and its knowledge is always expanding. So, it is more important that the pathology learnt in the undergraduate curriculum (like MBBS Basic Science) is basic and relevant, emphasizing the understanding of mechanisms and principles rather than detailed facts. As students continue their medical education into PG trainee years, more detailed systemic pathology will become more relevant and more appropriately learnt at that time.

Site home: http://medicalschoolpathology.com

Medical School Pathology is a resourceful medical website designed to assist self learner medical students for learning pathology. It provides online access to lecture notes and videos of all 29 chapters based on Robbin’s Pathology. Besides, it also provides medics with online laboratory for learning histopathology. This site probably won’t be useful to lay person because the description are mostly medical and includes medical jargons.

Chapters

GENERAL PATHOLOGY

1. Cellular Adaptations, Cell Injury, and Cell Death
2. Acute and Chronic Inflammation
3. Tissue Repair: Cellular Growth, Fibrosis, and Wound Healing
4. Hemodynamic Disorders, Thrombosis, and Shock

Textbook for pathology

5. Genetic Disorders
6. Diseases of Immunity
7. Neoplasia
8. Infectious Diseases
9. Environmental and Nutritional Pathology
10. Diseases of Infancy and Childhood

DISEASES OF ORGAN SYSTEMS

11. Blood Vessels
12. The Heart
13. Red Cells and Bleeding Disorders
14. White Cells, Lymph Nodes, Spleen, and Thymus
15. The Lung
16. Head and Neck
17. The Gastrointestinal Tract
18. The Liver and Biliary Tract
19. The Pancreas
20. The Kidney
21. The Lower Urinary Tract and the Male Genital Tract
22. The Female Genital Tract
23. The Breast
24. The Endocrine System
25. The Skin
26. Bones, Joints, and Soft Tissue Tumors
27. Peripheral Nerve and Skeletal Muscle
28. The Central Nervous System
29. The Eye

Online Resources For Self-Learning

Download Lecture notes in Powerpoint
Watch and Download Lecture videos of General Pathology
Watch and Download Lecture videos of Systemic Pathology
Watch and Download Histopathology Videos
Online Access to Rock Lab for Independent Study
Shotgun Histology