Three is a crowd

But is it really?

For the past 5 years I’ve spent learning about different diseases (including the signs and symptoms of a certain disease), injuries, illnesses, etc. I have realized that some, if not most of the cases in a hospital or clinic present with a *TRIAD of signs and/or symptoms which may be used to accurately diagnose a patient.

*Triad (n.) – a group or set of three connected people or things.

So without further ado, I present my top 5 favorite triads. (Top 5 mainly because I know 6 so far. LOL)

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5. Virchow’s Triad/Triad of Deep Vein Thrombosis (DVT)

  • I first learned about Virchow’s Triad in one episode of Grey’s Anatomy wherein the interns were reviewing for their internship exam. Meredith asked Cristina what Virchow’s Triad is, and little did I know that during a lecture in one of the classes I would eventually be taking, a doctor would ask me what Virchow’s Triad is. I obviously wasn’t able to answer as I only had encountered it once, but ever since then, it’s been engraved in my head. I could never forget it even if I tried.
  • Virchow’s Triad is composed of:
    • 1. Venous Stasis
      • It’s a risk factor for an increase in forming of clots in the deep veins of the legs. It’s mostly caused by long periods of immobilization.
    • 2. Hypercoagulability
      • It basically means that there is an abnormal tendency toward blood clotting
    • 3. Injury to Tunica Intima
      • The Tunica Intima is the inner most lining of the arteries and veins in the body. The TI comes in contact with the blood that passes through the veins and arteries.

**Bonus: How to diagnose (DVT) with a special test:

  • Homan’s Sign: Dorsiflex the foot with the leg extended, if the patient complains of pain over the calf, then he or she may have DVT

 

4. Triad of Post-Traumatic Hydrocephalus (PTHCP)

  • I first heard about the Triad of PTHCP when a doctor gave a lecture on Traumatic Brain Injury (TBI). He said that TBIs are normally accompanied by PTHCPs. This is also engraved in my brain mainly because its abbreviation is DAI, which also means Diffuse Axonal Injury, which, coincidentally happens when one suffers from a TBI.
  • The Triad of PTHCP consists of:
    • 1. Dementia
      • Dementia is characterized by a sudden change in personality, changes in memory, and may be accompanied by impaired reasoning.
    • 2. Ataxia
      • Ataxia means loss of control of body movements. For patients with PTHCP, this is usually seen through the patient’s gait. He/she shows the ataxic gait which is described as “an unsteady, or staggering gait which looks very uncoordinated.”
    • 3. Incontinence
      • Urinary Incontinence is the last character in the Triad of PTHCP. It basically means loss of control of the bladder. It ranges from a minor leakage, to total loss of bladder contents.

 

3. Triad of Anaesthesia

  • This Triad I learned only a few days ago. See, I had a cyst in my hand removed, and the surgeon on call asked me if I wanted to go under general or have the cyst removed under local anaesthesia. I chose to go for local as I wanted to see it getting excised. Anyway, during the operation, I asked the surgeon what his favorite triad was and he answered, “Siyempre. ‘Yung triad of anaesthesia!” (“The Triad of Anaesthesia, of course!”). I honestly did not know that there exists a Triad of Anaesthesia, so I definitely had to ask what it is!
  • The Triad of Anaesthesia consists of:
    • 1. Hypnosis:
      • No, it’s not what the magicians do. It’s a state of altered consciousness. Usually, when a patient is placed under general anaesthesia, he falls asleep when the anaesthetic agent is administered. Here, the patient falls into a hypnotic state.
    • 2. Analgesia
      • The definition of analgesia is pretty straightforward, I think. Analgesia means one is unable to feel pain. (I kinda wish I had this all the time. Loljk!)
    • 3. Muscle Relaxation
      • Do I really need to explain what muscle relaxation is? Good.

 

2. The Triad of O’ Donoghue/The Unhappy Triad

  • I dunno if this should have placed this as my top one since I almost experienced this, or… Yeah, I think the triad I chose for 1 is the best (for me)
  • The Triad of O’Donoghue is probably the worst nightmare (hence the name “Unhappy Triad”) of an athlete. The mechanism of injury of this triad is: Landing on a planted foot, knee slightly flexed and leg externally rotated.
  • The Unhappy Triad consists of:
    • Tears to:
      • 1. The Anterior Cruciate Ligament
        • It functions to prevent anterior displacement of the Tibia on a fixed Femur
        • It is one of the most injured knee ligaments
      • 2. The Medial Collateral Ligament
        • It functions to prevent valgus stress on the knees.
        • It is more common that the Lateral Collateral Ligament Tear
      • 3. The Medial Meniscus
        • The menisci are semi-lunar in shape and function to transmit load and distribution
        • It also functions to increase surface area on the articulating surfaces of the Femur and the Tibia

**Bonus: How to diagnose an ACL tear with a special test:

  • Anterior Drawer Test:
    • Place affected knee in 25 degrees of flexion, with the foot planted on the mat. Ask patient to lie down.
    • Sit on the dorsum of the patient’s foot.
    • Place hands on the anterior aspect of the Tibia just below the Tibial Tubercle. Grasp around the calf.
    • Pull the Tibia towards you and compare with the normal leg.
    • If there is a significant difference with amount of pull in the legs, then it is possible that there is an ACL tear.
    • Confirm diagnosis with an MRI.

**Bonus: How to diagnose an MCL tear with a special test:

  • Valgus Stress Test:
    • Have the patient lie down on the plinth or a mat.
    • Cradle the affected leg with the arm closest to the plinth. Hold the ankle between your arm and your body.
    • Use the palm of your other hand to push the lateral side of the knee joint inwards.
    • Compare with the unaffected leg.
    • Again, if there is any significant difference, then there may be a possible MCL tear.
    • Confirm the diagnosis with an MRI.

**Bonus: How to diagnose a Medial meniscus tear with a special test:

  • Apley’s Test:
    • Have the patient lie prone with his knee flexed to 90 deg. Grasp his foot.
    • While applying a downward pressure, rotate the tibia internally and externally.
    • If there is pain during IR of the Tibia, the Lateral Meniscus could have a tear. If there is pain during ER of the Tibia, then it is the Medial Meniscus with a possible tear.

 

DRUM ROLL PLEASE!

and finally, we’ve reached my most favorite Triad!

Although I believe that the Triad of O’ Donoghue is one unhappy triad, I like to believe that this triad is the unhappiest of them all. Mainly because… well… You’d die.

 

1. The Trauma Triad of Death

  • Again, I first came across this triad while I was watching an episode of Grey’s Anatomy. I forgot what episode specifically but it’s the triad that piqued my interest the most.
  • The Trauma Triad of Death consists of:
    • 1. Hypothermia:
      • It’s a condition wherein the body temperature goes well below the normal limits. It usually occurs when the body loses heat faster than it can produce heat.
    • 2. Acidosis:
      • It is when the organs in the body become acidotic, an excessively acidic condition.
    • 3. Coagulopathy
      • It is the condition where the body can no longer perform it’s clotting duties.
  • This triad normally happens when a patient is on the table. Once coagulopathy occurs, it will be very difficult to control the bleeding, and usually, once the trauma triad of death happens, it’ll be close to impossible to bring this patient back.

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So there we have it! My top 5 favorite triads. What do you say? would you have ranked it differently? Would you have replaced a few with your own favorites or do you completely agree with my list? Leave me a comment with your favorite Triads! Or you could also leave me a comment with your own list!

 

– Burnt Blue Scrubs

A day in the life of an aspiring MD

Hello everyone! This is officially my first blog (and blog post!)

I’m Fern, a 22-year old Physical Therapy student in the Philippines. I graduate in March of 2017 with high hopes of continuing my education and becoming an excellent trauma surgeon.

I’ll be posting everything medically related in this blog. From links to free downloads of ebooks, to pictures of my second cadaver dissection (I already dissected one during my third year in my bachelor’s degree, hence the “second”), to tips on how to survive medical school!

I’ll also be answering some questions you guys might have! I just have to learn how to work this site out first. As I’ve said, I’m new to this, and I kind of have no idea how to work it. I only know the basics, so maybe you guys could help me out, too!

Although I technically start medical school in June of 2017, I’ve decided to start this blog as a premonition of things to come. (a.k.a. I hope my positivity helps me get in a good medical school LOL) Also, since I’m not yet a medical student, I’ll probably be posting about Physical Therapy. I’m starting my internship this May!

So, I guess that’s that. Hope to hear from any of you guys soon!

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– Burnt Blue Scrubs