Varicocele grading.

 

Clinical and ultrasonography grading of varicocele

Varicocele grading is done to provide a standardization in the diagnosis, treatment and follow-up of the disease.

Varicocele staging (grade) is done in two main ways:

1.     Grading system made clinically, namely by examination.

2.     Grading with scrotal color Doppler ultrasonography.

Clinical Grading of varicocele

Grade	Description
Grade 0	Seen on ultrasound, but not physically detectable (also called “subclinical varicocele”)
Grade I	Palpable (felt on exam) when the patient is performing the valsalva maneuver (“bearing down”)
Grade II	Palpable even without valsalva
Grade III	Varicocele causing visible deformity of the scrotum.

Modified Canadian Cardiovascular Society grading of angina pectoris.

Modified Canadian Cardiovascular Society

grading of angina pectoris

Canadian Cardiovascular Society grading of angina pectoris contain only 4 grades and Class 0 is not an official part of the CCS functional classification of angina pectoris, however it has been mentioned in several sources, referring to myocardial ischemia without symptoms.

Grade 0	Asymptomatic Angina	Mild myocardial ischemia with no symptoms.
Grade I	Angina only with strenuous exertion	Angina with strenuous or rapid or prolonged exertion at work or recreation (Ordinary physical activity does not cause angina, such as walking and climbing stairs).
Grade II	Angina with moderate exertion	Slight limitation of ordinary activities when they are performed rapidly, after meals, in cold, in wind, under emotional stress, during the first few hours after waking up, but also walking uphill, climbing more than one flight of ordinary stairs at a normal pace and in normal conditions.
Grade III	Angina with mild exertion	Having difficulties walking one or two blocks or climbing one flight of stairs at normal pace and conditions.
Grade IV	Angina at rest	No exertion needed to trigger angina.

 Dr Ibrahim

Return to list of medical grades (click here)

- Sher's grading of abruptio placentae.

Sher's grading of abruptio placentae.
(according to severity)

1. Grade I (Retrospective) Not recognized clinically before delivery: small retroplacental Haematoma discovered on maternal surface of placenta after delivery, No APH.
2. Grade II mild vaginal bleeding,uterine tenderness and tetany, No fetal distress, no maternal shock.
3. Grade III Severe vaginal bleeding, uterine tenderness and tetany, fetal distress then death, maternal shock, according to DIC:

                          IIIa:Without DIC
                          IIIb:With DIC

Dr Ibrahim
Return to list of medical grades (click here) 

- Savary miller endoscopic grading of GORD.

 Savary miller endoscopic grading of GORD.

I-single erosive lesion.
II-multiple erosion lesion.
III-Circumferential erosion lesion.
IV-chronic lesions(ulcer,stricture,Short esophagus)
V-columnar epithelium (Barrett´s Epithelium).

Dr Ibrahim
Return to list of medical grades (click here) 

- Sperm Motility grading.

Sperm Motility grading.

(Human sperm stained for semen quality testing in the clinical laboratory.)

• Grade 1: sperm are immotile meaning that they fail to move at all.
• Grade 2: sperm are labeled as non-progressive motility because they do not move forward despite the fact that they move their tails.
• Grade 3: sperm (non-linear motility) also move forward but tend to travel in a curved or crooked motion.
• Grade 4: sperm are known to have progressive motility meaning they are the strongest and swim fast in a straight line.

Ideal sperm quality dictates that a man should have grade 3 or 4 sperm in order to fertilize an egg.

 Dr Ibrahim
Return to list of medical grades (click here) 

- Saint's triad.

Saint's triad.

It is a common association of:-

1. Gall stones.
2. Hiatal Hernia
3. Diverticulosis coli.

Dr Ibrahim

Return to other triads here.

unhappy triad - O'Donoghue's triad

unhappy triad

or O'Donoghue's triad

or terrible triad

Twisting force in a weight bearing knee joint causes injury to;-

1. Medial collateral ligament.
2. Anterior cruciate ligament.
3. Medial meniscus.

Dr Ibrahim

Return to other triads here.

- Anderson's triad.

Anderson's triad

The association of :-

1. Cystic fibrosis
2. Celiac disease 
3. Vitamin A deficiency

Dr Ibrahim

 

Return to other triads here.

- Whipple's triad.

Whipple's triad

or 

Whipple's criteria

Suggest a patient's symptoms result from hypoglycemia:-

1. Symptoms caused by hypoglycemia e.g. during fasting or exercise.
2. A low plasma glucose measured at the time of the symptoms.
3. Relief of symptoms with glucose administration.
    
   Dr Ibrahim
    
   Return to other triads here.

- Hutchinson’s Triad.

Hutchinson's triad

It is a common pattern of presentation for congenital syphilis.
It consists of :-

1. Interstitial keratitis
2. Hutchinson incisors
3. Eighth nerve deafness.

Dr Ibrahim

Return to other triads here.

- Compound fracture grading - Gustilo-Anderson grading.

Compound fracture grading 

Gustilo-Anderson grading.

- Grade I :- clean , less than 1cm wound , minimal soft tissue injury, simple or minimally comminuted fracture. 

- Exploding head syndrome.

Exploding head syndrome

 

Def:- is a condition that causes the sufferer occasionally to experience a tremendously loud noise as originating from within his or her own head, usually described as the sound of an explosion, roar, gunshot, loud voices or screams, a ringing noise, or the sound of electrical arcing (buzzing).
This noise usually occurs within an hour or two of falling asleep, but is not necessarily the result of a dream and can happen while awake as well.

Causes:- 
The cause of the exploding head syndrome (EHS) is not known, but :

• Some physicians have reported its correlation with stress, anxiety, and extreme fatigue.
• It may be the result of a sudden movement of a middle ear component or of the eustachian tube. 
• It may be the result of a form of minor seizure in the temporal lobe where the nerve cells for hearing are located.

- Renal trauma grading scale.

Basically we can divide renal trauma into five grades.

The grades I , II and III are classified as minor traumas, and the grades IV,V as major :-

• Grade I: contusion or subcapsular hematoma, without parenchymal laceration.
• Grade II: superficial cortical laceration less than 1 cm deep.
• Grade III: deep cortical laceration extending more than 1 cm.
• Grade IV:
1. corticomedullary laceration with collecting system injury and urinary extravasation. 
2.  vascular injury:- laceration or thrombosis of a segmental artery.

• Grade V:
1. Multiple deep lacerations.
2. Thrombosis of the main renal artery.
3. Avulsion of renal hilum which devascularizes kidney.

- Otitis Externa table.

Otitis Externa table.

This is a table for comparison between different types of Otitis Externa.

First what is Otitis Externa?

Simply it is It is Inflammation of the skin of the external auditory canal.

To download the table from MediaFire Click here size 20KB

In the table there is a comparison between

• Furunclosis( Localized otitis externa )
• Diffuse otitis externa
• Necrotizing otitis externa (Malignant otitis externa)
• Otomycosis
• Herpes zoster oticus (Ramsey- Hunt syndrome)

As regard:-

• Definition
• Aetilogy
• Predisposing Factors
• Clinical picture
• Treatment

You can print the table on large papers (A3 papers)

Good luck,

Dr Ibrahim

-Toxic Causes of respiratory Failure.

Toxic Causes of respiratory Failure

1-Central:-

• Alcohol
• Barbiturate
• Opiate

2-Peripheral:-

A-Airway obstruction:-

• Falling back of the tongue.
• Vomitus.
• Excessive Secretions e.g Organophosphurus,carbamate.
• Oedema of the air way e.g Irritant fumes,Chlorine gas.
• Laryngeal spasm (Cyanide).
• Pneumonia(Hydrocarbon aspiration).
• Bronchospasm(Organophosphurus).
• Pulmonray
• oedema(Organo-phosphurus).

b-Paralysis of respiratory muscles:-

• Botulinum toxins.
• Snake bite.
• post-convulsion muscle exhaust.
• Organophosphurus.

C-Neuromuscular blocker:-

Physostigmine,Neostigmine.

Dr Ibrahim

-Guillain Barré syndrome.

Guillain Barré syndrome

Aetiology(theories):-

• Postinfection:50% of cases have preceding respiratory or GIT viral infection.
• Post vaccination:following vaccination against swine flu virus.
• Lymphoma.
• Autoimmune theory.

Clinical Picture:-
1-Initial febrile illness.
2-Motor affection:-

• Bilateral symmetrical ascending affection of both lower limbs,trunk,upper limbs,Bulbar muscles,facial muscles then diphragm and respiratory muscles.
• The Affection is proximal more than distal in adult.
• The Affection is proximal more than distal in infant and childrens.
• Weakness is associated with hypotonia and areflexia.
  

-Lambert-Eaton syndrome.

Lambert-Eaton syndrome
or
Myasthenic-myopayhic syndrome.

*Pathophysiology:-

• a myasthenic syndrome due to autoimmune orocess targeting the mechanism of releasing A.CH from nerve terminals.
• It often associated with bronchogenic carcinoma or other malignancies.

*Clinical picture:-
Proximal weakness,wasting and fatigue but with less common ocular and bulbar affection than Myasthenia.

*Diagnosis:-

• EMG:- shows paradoxical increase  in successive muscle contractions.
• No significant response to prostigmine,but respond to guanidine HCL 20 mg/Kg/day or prednisolone+imuran.
• No acetylecholine receptor antibodies.
• CXR to determine if associated with bronchogenic carcinoma or not.

*Treatment:-

• Treatment of the underlying neoplasm.
• Plasmapheresis.
• Immunosuppression.

Dr Ibrahim

Return to list of medical syndromes here

-Vircow's triad.

Vircow's triad is the aetiology of thrombosis which is composed of :-

1-Damage of vascular endothelium(Vascular trauma):-
this damage expose the endothelial collagen which is rough surface to which platelets can stick firmly and release thromboxane A2 that help more platelet aggregation.

2-Slowing(Reduced)in the blood flow (stasis):-
these changes help thrombosis by allowing the platelets to deviate from the axial stream and cross the peripheral plasmatic zone to stick to the vascular endothelium.

3-Change in blood composition(Increased coagulability ):-
a-Increase number of blood elements.
-Increase platelets so become more sticky and agglutinate in small masses and adhere to vascular endothelium.
-Increase WBCs and RBCs increase viscosity of blood and stasis.
b-Biochemical changes that cause systemic activation of the cloting system.

"VIR chow"

Vascular trauma
Increased coagulability
Reduced blood flow (stasis)

Dr Ibrahim

Return to other triads here.

- Grades in medicine.

Grades in medicine 

In many branches of medicine we meet what is called "grades" this grades were put to classify certain conditions. Here I will put the grades what i had found as they meet me in books in simple way......... so you can share us.

• Grading of Murmurs (click here).
• Grading of Vesicoureteric Reflux (click here).
• Grades of Dyspnea (click here).
• Grades of respiratory distress. (click here).
• Grades of splenomegaly. (click here).
• Grading of hypertensive retinopathy (click here).
• Grades of binocular single vision. (click here).
• Grades for quantitative assessment of muscle power (click here).
• Deep tendon reflex grading (click here).
• Poisoning severity grading (click here).
• Grading of function in rheumataid disease(click here).
•  ASA Grading system (click here).
• Renal trauma grading scale (click here).
• Compound fracture grading- Gustilo-Anderson grading (click here).
• Sperm Motility grading.(click here).
• Wagner Grading System for Diabetic Foot Infections.(click here).
• Savary miller endoscopic grading of GORD.(click here).
• Sher's grading of abruptio placentae.(click here).
• Modified Canadian Cardiovascular Society grading of angina pectoris
• Varicocele grading (click here) 
  

Dr Ibrahim