ZANYA

  During surgery when the skin and superficial fascia are incised, and the surgeon gets to the external oblique layer which is where the superficial inguinal ring is, and a hernia is seen emerging from the superficial ring, that confirms the diagnosis that there’s an inguinal hernia but it still does not tell which type of inguinal hernia.So the question now is how that hernia sac got to the superficial inguinal ring? This question can be answered by pushing that hernia sac back with your finger following it into the abdominal cavity.When you push it back, it will go back through the same route it used for coming out.If your finger happens to get to the deep inguinal ring because the hernia went back through the inguinal canal to the deep inguinal ring, you will know it is the deep inguinal ring when you feel the pulse of the inferior epigastric artery and that artery is medial to your finger(which means your finger is lateral to the artery).This means this is an INDIRECT HERNIA. R...

  To distinguish between a direct and an indirect inguinal hernia on physical examination, connecting   the ANTERIOR SUPERIOR ILIAC SPINE and the PUBIC TUBERCLE is the INGUINAL LIGAMENT ,not inguinal canal.You can palpate the ANTERIOR SUPERIOR ILIAC SPINE(ASIS) and the PUBIC TUBERCLE.In thin and muscular people, you may be able to palpate the inguinal ligament, but in most people you cannot palpate that ligament.So as long as you can palpate the two bony attachment (ANTERIOR SUPERIOR ILIAC SPINE and the PUBIC TUBERCLE), you just draw an imaginary   line to connect them and that tells you that is where the inguinal ligament is. Once you know where the inguinal ligament is,then know that the INGUINAL CANAL is about an half an inch above the medial half of the inguinal ligament,with the superficial inguinal ring just above the pubic tubercle and the deep inguinal ring just above the midpoint of the inguinal ligament. You can place your examining finger on the superficial ing...

  The reason a female is a female is because she does not have a Y chromosome. In other words, a female is not a female because she has 2X (XX) chromosomes. She is a female because she does not have a Y chromosome. This means, an embryo is pre-destined or programmed to become female and will become female unless something is done to force that embryo to become male, and what forces it to become male has something to do with the Y chromosome. If there isn’t a Y chromosome, then the   embryo will become a female as the embryo was pre-programmed to be. This leads to the question; what is it about the Y chromosome that accomplishes this? There is a region on the Y chromosome called the SRY segment. SRY means Sex determining Region of the Y chromosome. The SRY segment codes for the Testis Determining Factor (TDF). And so the Y chromosome has TDF. The TDF will cause the gonad to become a Testis. In the abscense of TDF, in other words if there’s no Y chromosome, then that gonad wil...

  Learning objectives; By the end of this lesson, you will be able to; -Describe the development of the gonads in terms of meiosis, spermatogenesis and oogenesis. There are 2 long ridges of mesoderm (one on the left and the other on the right) at the back of the abdomen and these ridges of mesoderm are called the UROGENITAL RIDGES. Each urogenital ridge has 2 parts: 1)     1)    A layer/portion much longer and lateral called the NEPHROGENIC PORTION of the urogenital ridge.Nephrogenic means that it is going to be related to the formation of the kidney structures. 2)       2)  A smaller and more medial portion called the GONADAL PORTION of the urogenital ridge. This gonadal portion is the mesoderm that will cause the formation of the gonads (on the right   side and also on the left side). Even though it is at the gonadal portion that the gonads are going to form, the primordial germ   cells  (cells that are going to...

  QUESTION : A 3yr old boy is brought to the clinic because of a 3 day history of a rash. His mother reports that he has had fever and malaise for 5 days. He attends daycare with several other children who have a similar rash. Now at the clinic, his temperature is 38.5C. Physical examination shows a diffuse rash more on the face and trunk. There is a wide range of lesions 5-10mm in diameter on an erythematous base. Some are maculopapular, some are vesicular and a few are crusted. There are no oral or mucosal lesions. 1)      1)   Give 4 differential diagnoses 2)       2)  Tell the most likely diagnosis.     SOLUTION: 1)       DIFFERENTIAL DIAGNOSES: A)      Chickenpox (Varicella/Varicella zoster) B)      Impetigo C)      Folliculitis D)      Insect bite   2)       MOST LIKELY DIAGNOSIS = Chicken...

  QUESTION: A 26yr old comes to the emergency with sudden onset of lower abdominal pain starting 3hrs ago increasing in intensity. Vaginal spotting started 2hrs ago. Last menstrual period was 6weeks ago. She has been sexually active since age 17 with multiple partners. She is on foam contraception. She had an appendectomy some few years ago. She is afebrile and stable. Abdomen is flat with lower quadrant tenderness and rebound tenderness,right>left. Speculum exam- dark vaginal blood wihtout cervical purulence. Cevix is closed, thick but moderately tender to motion. Uterus is slightly enlarged. A)      What are your differential diagnoses? B)      What is the most likely diagnosis? C)      What will be your investigations?   SOLUTION: a)DIFFERENTIAL DIAGNOSES: 1)Right ectopic pregnancy 2)Pelvic inflammatory diseases( PID) 3)Ruptured ovarian cyst 4)Endometriosis 5)Abortion    ...