Ultrasound renal stone differential diagnosis .

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renal sinus ultrasound stone location in calyx (not in medulla,not in cortex) echogenic foci acoustic shadowing twinkle artifact on colour Doppler color comet tail artifact Staghorn calculi Ultrasound beam-stone angle Difference between kidney gravel & stone RENAL ECHOCONCRETION Vascular Reflectors (Normal or calcified renal vessels are the most notable and common causes of intrarenal bright echo reflectors) Segmental Arteries Arcuate Arteries Sinus Vessels renal vein thrombosis calcification Calcifications of the branches of the renal artery Nonvascular Reflectors: Prominent Papillae Reflectors Within the Renal Parenchyma Milk of Calcium Cysts Renal Cortical Calcification Junctional Parenchymal Line Angiomyolipomas Foreign Bodies Bright echoes within the Renal Parenchyma medullary nephrocalcinosis focal pyelonephritis. Echogenic tips of the renal pyramids apex Transient pyramidal echogenicity echogenic neonate renal pyramids (Tamm-Horsfall protein) fungal balls blood clots Renal calcification in infants with Furosemid therapy

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Ultrasound renal stone differential diagnosis .

Breast mammogram ultrasound lipoma, oil cyst, galactocele intramammary lymph node in UOQ hamartoma Simple cyst (typical) calcification Surgical scar Breast implants, scirrhous carcinoma lobular carcinoma Skin calcifications vascular calcifications Sutural Dystrophic popcorn Large Rodlike rim Round/punctuate Fat necrosis Milk of calcium Fibrocystic FCC fibroadenomas Fat necrosis with oil cyst mastitis with Abscess Haematoma atypical ductal hyperplasia Intracystic papilloma ductal carcinoma in situ, invasive ductal carcinoma BIRAD

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Duplex peripheral veins cephalic vein basilic vein subclavian vein axillary vein brachial vein inferior vena cava external iliac vein common femoral vein superficial femoral vein profunda femoral vein popliteal vein anterior tibial vein posterior tibial vein peroneal vein medial and lateral circumflex vein gastrocnemius vein soleal vein great saphenous vein anterior accessory great saphenous posterior accessory great saphenous lateral subdermal venous plexus superficial external pudendal deep external pudendal superficial and deep epigastric superficial circumflex iliac thigh extension (te) of the ssv Giacomini vein perforating veins Boyd's perforators dodd's perforators Hunterian perforators recanalization hypoplastic lsv duplex us primary varicose tortuous dilated varicose veins varicosities of the vein of Giacomini recurrent varicose vein superficial phlebitis deep venous thrombosis acute deep venous thrombosis subacute deep venous thrombosis acute occlusive deep venous thrombosis partial thrombosis acute deep venous thrombosis leg calf veins thrombosis superficial venous system thrombosis thrombophlebitis compression ultrasound venous thrombosis segmental iliac vein thrombus venous stasis popliteal cysts haematoma superficial thrombophlebitis arteriovenous fistula lymphoedema hyperperfusion syndrome muscle tears

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Duplex Ultrasound Doppler waveform changes.peripheral arterial triplex ultrasound Aorta innominate subclavian vein axillary artery brachial artery radial/ulnar veins palmar arch Common iliac artery External iliac artery Common femoral artery Profunda femoris artery Superficial femoral artery Popliteal artery Tibio-peroneal trunk Posterior tibial artery Anterior tibial artery Peroneal artery Dorsalis pedis artery Angle Color Gain Doppler gain PRF BOX(size,direction) steering Sample volume Gate size,Site of sample Base line Velocity scale Depth Wall filter Settings appropriate for specific examinations assigned by set-up/application keys Focus triphasic waveform Systolic Acceleration time spectral window laminar flow Color Doppler peripheral arterial disease Causes of leg pain ARTERIAL OCCLUSIVE DISEASE CAUSES Classification of vasculitis Biphasic waveform flow monophasic waveform flow bidirectional flow Loss of third and then second phase of the wave¬form Increased acceleration time (rapid rise of systolic deflection) Widening of the ystolic complex (5-Spectral broadening) Damping of the waveform Spectral broadening fill in spectral windowe Loss of sharpness of spectrum(irregular) Turbulance aliasing Rounding of PSV tip Absent flow in occlusion rising of PSV reverse flow opposite systole rapid fall of systolic deflection rising of end diastolic velocity Active Hyperemia postoperative vasospasm limb ischemia peripheral arterial triplex ultrasound waveform change peripheral arterial triplex ultrasound arterial stenosis ,occlusion peripheral arterial triplex ultrasound vasculitis inflamed arteries (arteritis) macaroni sign Takayasu’s arteritis Giant cell arteritis Temporal artery Giant cell arteritis polyarteritis nodosa Kawasaki progressive systemic sclerosis Buerger disease Thromboangiitis obliterans (Buerger’s disease) Ormond's Disease peripheral arterial triplex ultrasound hand,foot Triplex Raynaud Phenomenon secondary raynaud's phenomenon BAKER CYST Blind ended channels bypass graft surveillance lerich arterial steal syndrome Complex Regional Pain Syndrome dialysis arteriovenous fistula Cystic Adventitial Disease

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Duplex carotid vertebral jagular extracranial vessel Ultrasound assessment of the extracranial cerebral circulation Intima media complex IMC Superior thyroid branch Dicrotic notch internal carotid artery External carotid artery Common Carotid artery Atherosclerotic disease (stenosis) Non-Atherosclerotic disease fibromuscular dysplasia dissection vasospasm aneurysm pseudoaneurysm AVF arteritis carotid body tumour idiopathic carotidynia carotid stenosis signs Plaque surface Smooth Irregular ulcerated Intraplaque haemorrhage.Surface ulcerations Intraluminal thrombus formation vertebral artery Subclavian steal syndrome stenosis occlusion Dissection Kinking Short neck decrease size or contour of the neck Internalization of flow externalization of flow Color “Bleed” Disturbed Flow ALIASING INTERNAL JUGULAR VEINS Assymetry with ectatic diltation Jugular vein thrombosis Abnormal waveform Internal Jugular Vein Impingement Cardiac disease manifestation

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Endometrioma,Benign cystic teratoma – dermoid,Simple cyst or cystadenoma,Functional cyst haemorrhagic cyst,Malignant tumour with ascites,Most follicular cyst,hemorrhagic corpus luteal cyst,benign serous tumor,Endometrioma,cystic teratoma,Most serous cystadenocarcinoma endometrioid adenocarcinoma,clear cell carcinoma,serous borderline malignancies,cystadenofibroma Most mucinous cystadenoma Endometrioma theca lutein cyst mature cystic teratoma tubo-ovarian abscess polycystic ovarian syndrome ovarian hyperstimulation syndrome mucinous borderline malignancies Most mucinous cystadenocarcinoma mucinous borderline malignancies cystadenofibroma, struma ovarii granulosa cell tumor Most sex cord-stromal tumor such as fibroma fibrothecoma,granulosa cell tumor sclerosing stromal tumor surface epithelial tumor such as Brenner tumor serous papillary carcinoma Malignant germ cell tumor such as dysgerminoma endodermal sinus tumor Lymphoma metastatic tumor

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Ultrasound Normal liver Ultrasound Liver parenchymal patterns Ultrasound Liver fibrosis Ultrasound Liver cirrhosis Ultrasound liver cirrhotic nodules Ultrasound Viral hepatitis ultrasound scoring criteria for liver fibrosis /cirrhosis Ultrasound duplex Portal hypertension contrast enhanced CEU-LIRDS Liver elastography Fibroscan Ultrasound radiologic Mimics of Cirrhosis Ultrasound Congestive hepatopathy Ultrasound Primary biliary cirrhosis Ultrasound Primary Sclerosing cholangitis Ultrasound Wilson disease ultrasound Ultrasound autoimmune hepatitis (AIH) Ultrasound liver sarciodosis Ultrasound liver cystic fibrosis Ultrasound liver haemochromatosis Ultrasound Fulminant hepatic failure Ultrasound Gilbert’s syndrome ultrasound liver sarciodosis Ultrasound liver differential diagnosis . Ultrasound diffuse liver disease all things fibrosis,cirrhosis,us scoring,ce lrad,fibroscan,hepatitis,psc,aih,pbc

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plain x-ray abdomen gas normal air fluid level in-the-abdomen gasless abdomen small bowel obstruction large intestinal obstruction ileus gastric dilatation extraluminal abdomen gas (pneumonpperitoneum) extraluminal abdomen gas(retropneumonpperitoneum gas in specific organs (hepatobiliary ,genitourinary) gasless abdomen ‘step-ladder apperance stretch/slit sign string of pearls sign coiled spring sign small-bowel feces sign disproportionate dilatation of sb gallstone ileus intussusception caecal volvulus sigmoid volvulus colonic pseudo obstruction ogilvie syndrome acute colitis toxic megacolon ischemic colitis sentinel loops intestinal pseudo-obstruction syndromes gastric volvulus organoaxial gastric volvulus mesenterico-axial right upper quadrant gas crescent sign: air beneath the diaphragm peri hepatic sub hepatic morrison’s pouch fissure for ligament teres doges cap sign rigler’s (double wall sign) ( both the serosal and the related mucosal walls of the bowel are delineated it means free air is at that serosal surface ) ligament visualization falciform ligament sign: air delineating the falciform ligament umbilical inverted ‘v’ sign triangular air cupola sign football sign or air dome (a large air collection beneath that does not confirm to any bowel loop) continous diaphragm sign scrotal air in children decubitus abdomen sign double bubble sign lesser sac sign peritonitis postoperative pelvic and spinal fractures

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Chest ultrasound Anterior lung : sliding sign B-line pneumothorax Lung bases effusion consolidation pulmonary edema Diaphraamatic paralysis Pneumothorax Effusion Pneumonia ARDS Fibrosis COPD asthma Pneumothorax Absent sliding sign (unilateral) + Lung point barcode or stratosphere sign sign on M-mode =pneumothorax Cardiac ultrasound : normal (not in tension pneumo) B-line B3 interstitial edema B7 alveolar edema Pleural effusion Anechioc fluid in pleura quad sign sinusoid sign spine sign consolidation (Pneumonia) Tissue pattern /hepatization shred sign Air bronchograms Fluid bronchograms Dynamic air and fluid bronchogram .Diaphragmatic paralysis Diaphragmatic movement (excursion) reduced movement Paradoxical movement Thickness of diaphragm M-mode study IVC normal (dilated in tension pneumo) cardiac Acute coronary syndrome Global function(CHF) Valvular heart disease Right ventricle Strain Tamponade pulmonary embolism aneurysm ascending aorta Global cardaic dysfunction sliding B-lines (anterior &bilateral) pleural effusion poor cardaic function systolic dysfunction diastolic dysfunction Tamponed Severe pericardial effusion diastolic collapse of right ventricle water bed sign Tampoline sign Pulmonary embolism (PE) RV mid free wall hypokinesis with apical sparing (a.k.a. McConnell’s sign) free-floating right-heart thrombus ,PA Dilated right ventricle D shape RV .Abnormal interventricular septal motion (Septal bowing) TR ,raised PASP PA dilatation Lack of inspiratory collapse of IVC , Dilated uncollapsed IVC Underfilled left ventricle with normal function lung sliding : Normal bilaterally Right ventricle Strain Right ventricle dysfunction PE ,PH Focal wall injury (infraction) Dilatation (RV dilation IVC dilatation and loss of respiratory variations respiratory increase of inter-ventricular dependence Inferior vena cava IVC : respiratory Collapse dilatation Deep venous thrombosis No Compression By ultrasound Absent or abnormal flow on spectral or color Doppler venous distention Intraluminal material free floating thrombus Abdominal liver cirrhosis renal failure

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Lymphoma Glioma Meningioma en plaque Metastases .Intracrainal infections Ventriculitis Encephalitis Septic meningitis toxoplasmosis Cytomegalovirus ACUTE DEMELINATING ENCEPHALOMYELITIS Para sagittal subdural empyema Cerebritis brain Abscess Tuberculous meningitis Cysticercosis periventricular calcifications .Intracranial hemorrhage Calverial bones epidural Subdural Subarachnoid Intra-cerebral Intra-ventricular Infarction Hemorrhagic infarction Lacunar infarction Sub cortical arteriosclerotic encephalopathy Hydrocephalus Aquiductal stenosis Brain stem glioma .Pineal body germinoma Atresia of the outlet foramina Obstructive communicating hydrocephalus Basal meningitis Subarachroid hemorrhage Meningeal carcinomatosis Dural sinus thrombosis Holoprosencephaly Semi lobar Holoprosencephaly Dandy-Walker malformation Hydrancephaly Mega cisterna magna Agenesis of corpus callosum Corpus Callosum anomalies Agenesis of corpus callosum Intraventricular lesions Choriod plexus papilloma Intraventricular Meningioma Subependymal Giant Cell Astrocytoma Vascular malformation Bilateral internal carotid aneurysms Arteriovenous malformation Cavernous hemangiomas Venous angioma Sturge webber syndrome Ependymoma Medulloblastoma Primitive Neuroepithelial tumors [PNET] Medulloblastoma Acoustic neuroma Epidermiod cyst Cerebellar Hemorrhage Cerebellar Infarction Pontine infarction Pilocytic Astrocytoma Hemangioblastoma Multiple sclerosis Brain stem hematoma Brain stem glioma Osmotic demyelination syndrome Central pontine myelinolysis Colloid cyst Intra-ventricular dermoid cyst Anaplastic astrocytoma Falcine meningioma with cystic component Tuberous sclerosis with Subependymal Giant Cell Astrocytoma ARACHNOID CYSTcorpus callosum lipoma corpus callosum marchiafava CORPUS CALLOSUM MS CNS Herniations descending trasnstentorial herniation cholesterol granuloma endolymphatic sac tumor glomus tympanicum .malignent otitis externa, osteomyelitis base skull chordoma germinoma neuroenteric cyst schizencephaly septic cavernous sinus thrombosis superficial siderosis epidermoid pineal diffusion LEFORT fracture tripod fracture adrenoleukodystrophy leigh disease AIDS PML progressive multifocal leukoencephalopathy karappe disease , dysmyelinition , thalamic involvement leukodystrophy alexander metachromatic leuckodystrophy melas meerf ...leukodystrophy zellweger subacute sclerosing pan encephalitis jugular schwannoma .Neuroblastoma metastasis TRIGEMINAL SCHWANNOMA Neurofibroma Tuberous Sclerosis Von Hippel-Lindau Disease cerberallar haemangioblastoma basal ganglia calcifications .karappe disease LYSOSOMAL STORAGE DISEASES metachromatic leukodystrophy krabbe mucopolysaccharidosis PEROXISOMAL DISORDERS .adrenoleukodystrophy zellweger syndrome MITOCHONDRIAL DYSFUNCTION MELAS syndrome Leigh's disease Ke

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Convexity Meningioma Lymphoma Glioma Meningioma en plaque Metastases Intracrainal infections Ventriculitis Encephalitis Septic meningitis toxoplasmosis Cytomegalovirus ACUTE DEMELINATING ENCEPHALOMYELITIS Para sagittal subdural empyema Cerebritis brain Abscess Tuberculous meningitis Cysticercosis periventricular calcifications Intracranial hemorrhage Calverial bones epidural Subdural Subarachnoid Intra-cerebral Intra-ventricular Infarction Hemorrhagic infarction Lacunar infarction Sub cortical arteriosclerotic encephalopathy Hydrocephalus Aquiductal stenosis Brain stem glioma Pineal body germinoma Atresia of the outlet foramina Obstructive communicating hydrocephalus Basal meningitis thrombosis Holoprosencephaly Semi lobar Holoprosencephaly Dandy-Walker malformation Hydrancephaly Mega cisterna magna Agenesis of corpus callosum Corpus Callosum anomalies Agenesis of corpus callosum Intraventricular lesions Choriod plexus papilloma Intraventricular Meningioma Subependymal Giant Cell Astrocytoma Vascular malformation Bilateral internal carotid aneurysms Arteriovenous malformation Cavernous hemangiomas Venous angioma Sturge webber syndrome Ependymoma Medulloblastoma Primitive Neuroepithelial tumors [PNET] Medulloblastoma Acoustic neuroma Epidermiod cyst Cerebellar Hemorrhage Cerebellar Infarction Pontine infarction Pilocytic Astrocytoma Hemangioblastoma Multiple sclerosis Brain stem hematoma Brain stem glioma Osmotic demyelination syndrome Central pontine myelinolysis Colloid cyst Intra-ventricular dermoid cyst Anaplastic astrocytoma Falcine meningioma with cystic component Tuberous sclerosis with Subependymal Giant Cell Astrocytoma ARACHNOID CYSTcorpus callosum lipoma corpus callosum marchiafava CORPUS CALLOSUM MS CNS Herniations descending trasnstentorial herniation cholesterol granuloma endolymphatic sac tumor glomus tympanicum malignent otitis externa, osteomyelitis base skull chordoma germinoma neuroenteric cyst schizencephaly septic cavernous sinus thrombosis superficial siderosis epidermoid pineal diffusion LEFORT fracture tripod fracture adrenoleukodystrophy leigh disease AIDS PML progressive multifocal leukoencephalopathy karappe disease , dysmyelinition , thalamic involvement leukodystrophy alexander metachromatic leuckodystrophy melas meerf ..zellweger subacute sclerosing pan encephalitis jugular schwannoma Neuroblastoma metastasis TRIGEMINAL SCHWANNOMA Neurofibroma Tuberous Sclerosis Von Hippel-Lindau Disease cerberallar haemangioblastoma basal ganglia calcifications karappe disease LYSOSOMAL STORAGE DISEASES metachromatic leukodystrophy krabbe mucopolysaccharidosis PEROXISOMAL DISORDERS adrenoleukodystrophy zellweger syndrome MITOCHONDRIAL DYSFUNCTION MELAS syndrome Leigh's disease Kearn-sayre syndrome CANAVAN DISEASE UNKNOWN CAUSES Pelizaeus-

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Physiology of Chemical Sensation of smell.pdf

MedicoseAcademics

Title: Sense of Smell Presenter: Dr. Faiza, Assistant Professor of Physiology Qualifications: MBBS (Best Graduate, AIMC Lahore) FCPS Physiology ICMT, CHPE, DHPE (STMU) MPH (GC University, Faisalabad) MBA (Virtual University of Pakistan) Learning Objectives: Describe the primary categories of smells and the concept of odor blindness. Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction. Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain. Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential. Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes. Key Topics: Olfactory Genes: 3% of the human genome accounts for olfactory genes. 400 genes for odorant receptors. Olfactory Membrane: Located in the superior part of the nasal cavity. Medially: Folds downward along the superior septum. Laterally: Folds over the superior turbinate and upper surface of the middle turbinate. Total surface area: 5-10 square centimeters. Olfactory Mucosa: Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell. Sustentacular Cells: Produce mucus and maintain ionic and molecular environment. Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months. Bowman’s Gland: Secretes mucus. Stimulation of Olfactory Cells: Odorant dissolves in mucus and attaches to receptors on olfactory cilia. Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve. Quality of a Good Odorant: Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble. Facilitated by odorant-binding proteins in mucus. Membrane Potential and Action Potential: Resting membrane potential: -55mV. Action potential frequency in the olfactory nerve increases with odorant strength. Adaptation Towards the Sense of Smell: Rapid adaptation within the first second, with further slow adaptation. Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system. Primary Sensations of Smell: Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid. Odor Detection Threshold: Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm). Some toxic substances are odorless at lethal concentrations. Characteristics of Smell: Odor blindness for single substances due to lack of appropriate receptor protein. Behavioral and emotional influences of smell. Transmission of Olfactory Signals: From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition. Primitive, less old, and new olfactory systems with different path

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