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Issue 13 - Join our STUDENT TEAM, what's new & Horner's syndrome demystified...

Evening team! Welcome to the 13th instalment of our weekly dose! In this week's newsletter, I'm going
Issue 13 - Join our STUDENT TEAM, what's new & Horner's syndrome demystified...
By Pulsenotes • Issue #13 • View online
Evening team!
Welcome to the 13th instalment of our weekly dose!
In this week’s newsletter, I’m going to be discussing our brand-new STUDENT TEAM, Sam will let you know what’s new @pulsenotes this week and, of course, some more medical knowledge from captain medicine, Benjamin Norton.
Enjoy our ‘weekly dose’? - Remember to tell your friends about us!

Now recruiting...
Super-keen medical / PA / healthcare students. Join our STUDENT TEAM!
Super-keen medical / PA / healthcare students. Join our STUDENT TEAM!
Super-keen medical / PA / healthcare student? Interested in shaping the future of pulsenotes and making what we do even better?..
Our student team is a new concept. Many students will be familiar with the ‘reps’ model, some of you may be 'reps’ already for other services or societies. We wanted to go beyond this concept, well beyond.
Yes, we’re looking for a student or two from each medical / PA / nursing university to help promote the work we’re doing at Pulsenotes. But, we also want to get YOU much more involved - from providing ideas and feedback on our latest features and content, to writing articles for our 'weekly dose’ newsletter or featuring your stories on our social media.
Pulsenotes is more than just a group of super-keen doctors. It is a community whose sole purpose is to make beautiful learning resources for students across the globe!
Interested? drop us an email hello@pulsenotes.com with why you’d like to join and a copy of your CV. We can’t wait to have you onboard!
What's new this week?
LIVE webinars - what we’ve got coming up…
Our summer series of FREE LIVE WEBINARS continues with a mix of medicine and surgery!
This week, Norton will be beginning his infectious diseases series, whilst I will be taking you through the basics of bowel obstruction.
  1. Thursday 30th July 14:00 am BST - Pulsenotes LIVE: Infectious diseases: Malaria. Don’t miss the first in Norton’s infectious diseases lectures! Learn how to recognise and manage this potentially fatal and global condition.
  2. Sunday 2nd August 11:00 am BST - Pulsenotes LIVE: Bowel obstruction. Join me on Sunday to discuss this common complaint seen on the general surgical take. Learn the key principles in its diagnosis, investigation and management.
Remember - recordings of all these LIVE events will be available for members that aren’t able to make it!
More new stuff…
We’ve just uploaded recordings of the following LIVE events for you to watch at your leisure! As ever, they are split into chapters, with speed controls to speed up or slow down as you wish!
  • Myasthenia gravis
  • Plastics emergencies (infective flexor tenosynovitis & finger replantation)
We’ve been growing our library and this week we’ve added these topics:
Norton's Corner
Oculosympathetic pathway with first, second and third order nerves
Oculosympathetic pathway with first, second and third order nerves
Horner’s syndrome
Horner’s is classical syndrome, which comes up time and time again at undergraduate level. It is characterised by unilateral ptosis, miosis and anhidrosis (lack of sweating) and apparent enophthalmos (appears like the eye is displaced posteriorly).
Horner’s syndrome occurs due to disruption of the normal sympathetic innervation of the eye. Often termed the oculosympathetic pathway.
From the brain to the eye, three nerves form this pathway:
  1. First-order (central): hypothalamus to spinal cord (C8-T1)
  2. Second-order (pre-ganglionic): spinal cord, via sympathetic chain, to superior cervical ganglion
  3. Third-order (post-ganglionic): superior cervical ganglion to eye in close proximity of the carotid artery
We can use the oculosympathtic pathway and the three nerves to form a differential diagnosis for a patient presenting with Horner’s syndrome.
First-order (central)
Clinical features
  • Miosis
  • Ptosis
  • Anhidrosis (ipsilateral body)
Differential
  • Stroke (lateral medullary syndrome)
  • Space-occupying lesion
  • Multiple sclerosis
  • Syringomyelia (fluid-filled cyst spinal cord)
Second-order (pre-ganglionic)
Clinical features
  • Miosis
  • Ptosis
  • Anhidrosis (ipsilateral face)
Differential
  • Trauma (brachial plexus injury)
  • Pancoast tumour (apical pulmonary tumour lung)
  • Thoracic aneurysm
Third-order (post-ganglionic)
Clinical features
  • Miosis
  • Ptosis
  • Anhidrosis (absent)
Differential
  • Carotid artery dissection
  • Migraine
Remember, when forming a differential, think about how you might structure your answer rather than giving a shopping list!
Benjamin Norton (@medicalreg)
Final words
Remember to get in contact with any questions, suggestions, or topics that you wish to be covered!
Thanks for reading, remember to tell your friends, and see you next week!
Instant access to over 180 topics, 1250 questions & 55 hrs of video lectures!
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