Monday, February 27, 2017

Dealing with psm

Hello.
This was a question from one of our readers..as to how to deal with psm.

Personally I too have dealt with a lot of trauma related to it. So I will share you my own tips and tricks.

Just keep this basic funda in your head while dealing psm. YOU DONT HAVE TO READ EVERYTHING.

Never start reading psm chapters from the very first page. You will be lost in a whirlpool so huge and exhaust yourself to the limits in a matter of hours..and you are bound to never touch the book again.

Now how to approach it..if say your professor is teaching a chapter on contraceptives. Just go through ONLY last three year worth questions..and mark out all the questions just for contraceptives. Never do the whole ten years or five years  questions together. Cause you will end up marking the whole book..and that depresses you. So first start last three years.

Once you have done the marking. Psm has one lovely plus point..that apart from the humongous text..it also has charts and diagrams. READ the diagrams first..the flow charts those should be the ones you should learn first. And for answers who don't have flow charts..and have things like components and sub headings of this and that and shit..I suggest just mugg up the names of the sub topics. Just the names only. Make mnemonics, make weird stories..do whatever but you need to learn them.
This trick is important cause think of your examiner. He is tired of reading the same old answers over and over again. So if you go ahead and make beautiful flow charts..or if you just emphasise on the various components and sub headings itself..your job is half done.

And regarding the actual reading of the text. Do it later when you feel more confident..and that time also just stick to the specific answers from previous yr papers.

psm is crazy huge..I have learnt that during exams it was more easy to make up matter to write for psm..but what I didn't remember was that one word of the sub headings or details of the flow chart.
And that's where you go wrong.

Let me know if it helped you and also if any other doubts.

-sakkan

Fish oil for treatment of asthma

Hello

Asthma is a chronic, exaggerated and allergic inflammatory response in the respiratory airways to certain allergens that vary according to seasons.

Omega- 3 fatty acids in high- quality fish oils and other products reduce the inflammation by regulating B- cell function. IgE production is reduced, which otherwise acts to cause asthma symptoms and allergic reactions in patients with mild form of asthma.

The fatty acids are used up by the cells in the lining of respiratory passages to produce hormones that tend to "turn- off" certain factors responsible for attracting white blood cells to the site of inflammation such as leukotrienes, interleukins, and other cytokines.

However, these oils are less effective in severe forms of the disease and in the majority of patients taking corticosteroids.

According to a study, prenatal exposure to fish oils (mainly in third trimester) reduces the risk of wheeze and asthma in children.


Thats all
- Jaskunwar Singh

Sunday, February 26, 2017

Ischaemic Preconditioning


Hey, guys!!

This post is on a very interesting condition. To put it in simple terms, Ischaemic preconditioning is a defensive technique adopted by those cardiac myocytes which have faced ischaemia in the past against future ischaemic episodes. There is another defensive procedure called Collaterals but that occurs in chronic ischaemia while Preconditioning occurs in acute conditions.

It was first observed while monitoring the ECG of a patient undegoing coronary balloon angioplasty. When the coronary artery was occluded by inflated balloon transiently, the ECG showed QRS distortions indicative of ischaemia but when it was occluded once again, ECG showed almost normal QRS waveforms.

Mechanism of Ischaemic preconditioning has something to do with Katp channels, the one blocked by Sulfonylureas like Glibenclamide, and also Adenosine receptors. But how exactly these components are involved, isn't clear yet.

That's all!

-VM

Basics of Coagulase test

Hello awesomites let's today see today about enzyme "Coagulase".

Coagulase is an enzyme produced by several micro-organisms to protect them from host's immune system . Coagulase  is especially produced by S.aureus hence we use coagulase test to differentiate between S.aureus and other species of Staphylococcus.

How does Coagulase enzyme act in S.aureus  ?
Basically it enables conversion of fibrinogen to fibrin.In case of S.aureus Coagulase reacts with prothrombin and forms Staphylothrombin
complex which helps enzyme protease to convert fibrinogen to fibrin which results in clotting of blood.Coagulase in S.aureus is tightly bound to surface and hence fibrin thus formed coats ,the bacteria and hence bacteria is protected from  host's immune system .

Two forms of coagulase exist:
1) Clumping factor (Bound to cell).
2) Free Coagulase or Coagulase.

What is Clumping factor?
It acts directly on the fibrinogen in plasma and helps in adherence of the organism to fibrinogen resulting in clumping .
Detected by slide coagulase test.

What is free coagulase ?
It is excreted from the cell as a free enzyme.It first acts on prothrombin ,the product so formed acts on fibrinogen and forms a fibrin clot.
It needs coagulase reacting factor (CRF).
8 types of coagulase have been identified .Most human strain forms coagulase A
It is detected by tube coagulase test.

Trick to remember test ?
Slide coagulase test -Clumping factor


And you can simply put other test for free coagulase.! =P
Stay cool and awesome:)
~Ojas

Saturday, February 25, 2017

Beck's triad mnemonic

Hello

Acute cardiac tamponade is an emergency condition in which fluid accumulates within the pericardial sac resulting in inability of heart to pump blood. The Beck's triad of medical signs a/w this condition - (mnemonic: DIM )

D- Decreased arterial and pulse pressure
I- Increased venous pressure (JVD)
M- Muffled heart sounds


- Jaskunwar Singh

Friday, February 24, 2017

Right IJV for assessment of right heart hemodynamics

Hello

Internal jugular vein of right side is preferred for right heart hemodynamics. This is because-

Aminoglycoside mnemonic

Hello all, let me slip in a quick mnemonic on Neomycin and Amikacin

1.Highest nephrotoxic drug-
   Neomycin

2.Highest auditory toxicity is with-
    Amikacin

N for N and A for A. Easy one to remember for the MCQs!

That's all!

-Sushrut


Osteogenesis imperfecta mnemonic

I just wanted to enlist a few points on Osteogenesis imperfecta so....

Fact of the day: Milk and acidity

Milk is commonly recommended as therapy for patients with peptic ulcer.

Indications for oestrogen therapy mnemonic

Hello
Indications for oestrogen hormonal therapy mnemonic: 8Ds


D- Deficiency states of oestrogen
D- Development of secondary sexual characters
D- Diagnosis of pregnancy ( along with progestogen )
D- Dysmenorrhea
D- Depression ( post- partum and perimenopausal )
D- Diastolic dysfunction ( in postmenopausal women )
D- associated Diseases (dermatologic, neurologic, autoimmune)
D- Decubitus ulcer


That's all
- Jaskunwar Singh

Thursday, February 23, 2017

Differentiating gram positive cocci

Hello awesomites!

Today, let's see how can we differentiate between Staphylococci and Streptococci!

Delirium and Dementia mnemonics

Hello

Delirium- "It is a transient, usually reversible cause of mental dysfunction that results in a wide range of neuropsychiatric abnormalities, mostly presented by elderly as
- waxing and waning type of acute- confusional state
- fall in attention- span
- decreased awareness of surroundings
- low cognition levels."

Causes of Delirium- (mnemonic: DELIRIUM)
D- Drugs (anti- cholinergics, antipsychotics etc)
E- Encephalopathy (Wernicke's)
L-  LSD intoxication
I- Infections
R- Respiratory failure
I- Insomnia
U- (v) visual sphere hallucinations
M- Metabolic disorders


Dementia- "A group of neuropsychiatric disorders characterised by chronic and gradual decrease in the ability of person to think, create memories, express emotions and other mental symptoms that affect the general well being."

Causes of Dementia (mnemonic: DEMENTIA)-
D- Degeneration (Primary cerebral)
E- Endocrinal dysfunction
M- Multiple sclerosis
E- Embolisation (vascular pathology)
N- Normal tension hydrocephalus
T- Tumors
I- Infections
A- Alcohol intoxication


That's all
- Jaskunwar Singh

Skin cancer mnemonics

Here are some memory aids that I use :)

Fact of the day: Cocaine addiction and iron concentration in brain

Do you know? Cocaine addiction leads to increased concentration of iron in globus pallidus. The more one takes this drug, more amounts of iron get accumulated in this region of brain, which normally acts as a 'brake' for inhibiting behaviour.

Also, the increased concentration of iron in brain is accompanied by iron deficiency in rest of the body.

This is possibly attained by decreasing absorption of iron from food and increasing permeability of blood- brain barrier.


- Jaskunwar Singh

Long QT Syndrome

Hey guys this post will be on Long QT syndrome as evident from the title :P.

In a brief introduction, it can be said that LQTS is simply because of abnormal myocardial repolarization most often due to a mutation in ion channel-associated gene. It can lead to fatal ventricular arrhythmias such as torsades de pointes.
So there is increased risk of Sudden Cardiac Death.

It has 3 common variants:

1. LQT1: Loss of function mutation in KCNQ1 gene. And in ECG you see early-onset broad-based T wave.

2. LQT2: Mutation in KCNH2 gene. In ECG T waves are of low amplitude, broad based and maybe bifid.

3. LQT3: Mutation in SCN5A gene. In ECG, there is prolonged ST segment with late-appearing T wave.

We use the ECG to diagnose LQTS and we estimate the probability by using Schwartz score.
Some of the important criteria are :-

1. QTc more than 480msec
2. T wave alternans (Varying amplitudes)
3. Torsades de pointes
4. Notched T waves in atleast 3 leads
5. Syncopal attacks with and without stress
6. Congenital deafness
7. Significant family history

That's all!

- VM

Wednesday, February 22, 2017

Fact of the day: Muscle relaxant of choice during anaesthesia in renal and hepatic failure

Did you know? Atracurium, cisatracurium, and mivacurium have theoretical advantages for patients with hepatic or renal failure because these drugs undergo extensive plasma degradation. 

Stigmata of Hypercholesterolemia

Hello

There are certain physical stigmata of hypercholesterolemia that help the clinician to suspect FH in a patient with a premature cardiovascular disease:

- Xanthelasma (cholesterol deposits on both eyelids)
- Arcus corneae (bilateral; detected by fifth decade of life)
- Tendinous xanthomas (in hand and feet)


That's all
- Jaskunwar Singh

Tuesday, February 21, 2017

Top 10 series: Magnesium sulfate

Here is the video!

By A. P. Burkholderia



Fact of the day: GH hormone

The growth of the brain and eyes is not controlled by GH hormone :)

Fact of the day: Talking to yourself is a sign of smartness

"Look at that guy, roaming around here and there in the marketplace, muttering words and talking to himself. He seems totally insane. Doesn't he?"

Micro-organism series: Staphylococcus aureus

Hello awesomites here is our first bacteria of micro-organism series - Staphylococcus aureus

Morphology:
Aerobes and facultative anaerobes
Diameter: 1 micrometer
Gram profile: Gram positive Cocci
Arrangement: Grape like clusters
Motility: Non-motile
Sporeing or not: Non-sporing
Capsule: Usually capsulated. Non-capsulated strains have small amount of capsular material on the surface

Cultural characteristics:

Ordinary media: They grow readily with temperature range of 10-42°C ( Best at 37°C) and pH around 7.4 - 7.6

Nutrient agar:
You can remember how colony looks by the name STAPHYLOCOCCUS it self.
S - Smooth
O - Opaque
C - Circular
C - Convex
Easily emulsifiable.
It produces golden yellow pigment. Pigment production occurs best at 22℃ and only in aerobic culture. Growth represents "Oil-paint appearance".

Blood agar: Shows beta type of hemolysis when incubated under 20-25% carbon dioxide.

MacConkey agar: Pink colour small colonies (Because it ferments lactose!)

Selective media:
Ludlam's medium - Lithium chloride and tellurite.
Mannitol salt agar or salt milk agar- 1%Mannitol, 7.5%NaCl, Phenol red indicator.
Columbia colistin nalidixic acid agar.

Liquid media: Turbidity.

Biochemical Reactions:
Catalase : Positive
Oxidase : Negative
Mannitol: Positive
Indole: Negative
MR andVP: Positive
Phosphatase : Positive (Useful for screening as S epidermidis is negative or slightly positive )
Urease : Positive

Produces thermonuclease enzymes.

Virulence factors :
Extracellular enzymes :
Coagulase (Most virulent)
Lipase
Hyaluronidase
Staphylokinase

Toxins:
5 types of Cytolytic toxins: Alpha, Beta, Gamma, Delta and Leucocidins
Alpha: Most important hemolysin.
Beta: It is sphingomyelinase. Exhibits hot and cold phenomenon.
Leucocidin and gamma lysin is grouped under synergohymenotropic toxins.

9 types of enterotoxins: Responsible for staphylococcal food poisoning. Causes nausea, vomiting and diarrhoea within 2-6 hours.
A, B, C1, C2, C3, D, E, H and I.

Super antigens:
Toxic shock syndrome toxin (TSST)
Exfoliative
Enterotoxins
(What are superantigens and how do they work?)

Disease caused:
Remember " SOFT PENIS"
S - Skin infections
O - Osteomyelitis and arthritis
F - Food poisoning
T - Toxic shock syndrome
P - Pharyngitis and Pneumonia (Rarely)
E - Endocarditis
N - Necrotizing fascitis
I - Impetigo
S - Sepsis

Laboratory diagnosis:
Specimen and lesions
Pus - Suppurative lesions
Sputum - Respiratory Infections
Blood - Septicaemia
Urine - UTI
CSF- Meningitis
Faeces - Food poisoning
Collection and transport :
Sterile containers should be used
Sterile swabs for specimen from nose/perineum.
Direct microscopy :
Gram stained smears is useful in case of pus, cocci in clusters may be seen.

Treatment:
Sensitive to penicillin: Penicillin G is DOC (Drug of choice)
Penicillin allergy: Cefazolin is DOC
Methicillin resistant S.aureus: Vancomycin
Vancomycin resistant: S.aureus: Streptogramins, Linezolid, Telavancin.

That's all!
Finally done!
Stay awesome :)
~Khushboo shaikh,IkaN,and ojas
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