Thursday, December 31, 2015

Hoover's sign mnemonic

What is Hoover's sign?
The paradoxical inspiratory indrawing of the lateral rib margin is known as Hoovers sign. In simple words, it is the inspiratory retraction of the lower intercostal spaces.

What causes Hoover's sign?
It is due to direct traction on the lateral rib margins by the flattened diaphragm.

Lancefield group for classification of Streptococci mnemonic

Mini bacteriology post! Yaay!

In which Lancefield group does Streptococcus pyogenes and Streptococcus agalactiae belong? How do you remember them?

Streptococcus Pyogenes belongs to Lancefield Group A mnemonic:
I remember GAP jeans (Because of the gap company manufactures amazing clothes) - Group A Pyogenes.

Streptococcus Agalactiae belongs to Lancefield Group B mnemonic:
Remember B for Baby. Streptococcus Agalactiae causes meningitis in babies and belongs to Lancefield Group B. Babies also love Galaxy chocolates and stars.

That's all!

-IkaN

Wednesday, December 30, 2015

NYHA Classification for heart failure mnemonic and practicals tip

Greetings everyone!

I was reading about Congestive Heart Failure today and thought of sharing a practicals pearl with you guys.. NYHA class should always be mentioned when you are presenting a case of CHF.

Case presentation tip: While presenting your case, instead of just saying "Patient belongs to NYHA Class III" you could say, "Patient is categorized into NYHA Class III, which means the patient is comfortable at rest, but is limited on exertion."
This shows you know what you are talking about and the examiner won't stop and ask about all the classes :)
You should do the same when it comes to other diseases.

Your professor may ask - How did you come to know that the patient belongs to Class III?

Monday, December 28, 2015

Atrial fibrillation

I was reading Atrial fibrillation today and thought I'd write a small quick review blog on it.

A patient with atrial fibrillation will usually present with palpitations or fatigue.

On physical examination, irregularly irregular pulse is characteristic.

ECG is diagnostic.

Extra tip: Your patient may have his rhythm well controlled when you see him in the wards and you might not have the characteristic physical finding of an irregular pulse or have an ECG in hand. In that case and especially during vivas, do mention that you would like to rule out other causes of fatigue by ordering CBC, SE & LFT.
CBC: Complete blood count
SE: Serum electrolytes
LFT: Liver function tests

In an acute setting, you must provide symptom relief through rate control. Beta blockers, calcium channel blockers are preferred. Digoxin is considered if blood pressure is low.

Fun fact: Why isn't Digoxin an awesome drug for rate control in exercise and anxiety?
Because the increased rate in exercise and anxiety is primarily due to adrenergic stimulation and Digoxin works through Vagal stimulation.

You need to rule out reversible causes of atrial fibrillation like electrolyte imbalance, thyrotoxicosis, fever, alcohol and drugs. Always order TSH levels.
Extra tip: Also ask for a history of snoring since sleep apnea is a treatable cause of atrial fibrillation.

Rate control is usually done first since it mitigates symptoms. Rhythm control is preceded by measures to reduce stroke, which includes either 3 weeks of anticoagulation by dabigatran / warfarin or clot exclusion by TEE.

CHADS2 score is used to decide whether anticoagulation is required. It is based on risk stratification.

Dabigatran is preferred over warfarin because INR monitoring isn't required. However, it is expensive, contraindicated in renal failure and there is no reversal in major bleeding.

Electric cardioversion or chemical cardioversion may be done depending on patient symptoms.

Drugs used for chemical cardioversion are: Flecainide, Ibutelide, Procainamide, Amiodarone.

Curative catheter ablation may be tried in patients who have recurrent atrial fibrillation and in whom antiarrhythmic drug trial has failed.

Cool fact: Propafenone is "pill in pocket" drug used by patients when they feel onset of palpitations. It is used in conjunction with beta blockers to prevent fast dysrhythmias.

Here are a few mnemonics I got online:

Precipitants / causes of Atrial fibrillation: PIRATES
PE, Ischemia, Respiratory diseases like COPD, Atrial enlargement or myxoma, Thyroid, Ethanol, Sepsis or Sleep Apnea

Mnemonic for determining major risk of bleeding: HAS BLED
HTN, abnormal LFT / RFT, Stroke, Bleeding history, Liable INR, Elderly, Drugs that predispose to bleeding.
If score >3, higher risk of major bleeding.

That's all!

-IkaN

Related post: Antiarrhythmic drug classes mnemonic

Friday, December 25, 2015

Christmas tree rash

Greetings everyone!

Here's a mini fact: Christmas tree rash is seen in Pityriasis rosea.

That's all!
Merry Christmas everyone!
-IkaN

Related post: Christmas disease mnemonic

Wednesday, December 16, 2015

FIGO staging of carcinoma cervix

Hello!

I made this video like a year back but never got around posting it on the blog. So, here it is! :D

Study group discussion: Pathogenesis of pruritus in obstructive jaundice

What is the reason for pruritus and itching in obstructive jaundice?

Patients have differing sensitivities to elevated bile salt concentrations,
which act on peripheral pain afferent nerves to produce the sensation of itching. This stimulation involves
opiate-mediated pathways, and opiate antagonists can block cholestasis-associated itching.

Itching does not appear to be associated with histamine release, and antihistamine therapy is generally ineffective.

Ultraviolet B phototherapy has been successfully used to treat pruritus.

Thanks for explaining the mechanism to us, Benedict!

Friday, December 11, 2015

Breast Cancer TNM Staging mnemonic

Hello. This was requested by someone and I thought I'll post a few tips that help me remember the staging of breast cancer.
We're using the TNM classification in this post and I'll be talking about T & N only.
Let's get started!

Wednesday, December 9, 2015

Battle's sign mnemonic

Hello.

Battles sign is ecchymosis over the mastoid process and is mostly indicative of a fracture of the skull.

Mnemonic:
Battle Sign
Bruises Seen
Basilar Skull fracture

I love this mnemonic posted online too: BattlE - Behind Ear.

That's all!
You're a warrior.
-IkaN

Tuesday, December 8, 2015

The University of wisconsin solution

the university of wisconsin solution or UW solution is considered as the gold standard solution for transport of of liver in cold storage for transplant. it can also be used for the transport of kidney, pancreas and heart.

thanks.
sakkan

Thursday, November 26, 2015

Biomedical waste: Waste Categories, treatment options and color coding mnemonic

PLEASE NOTE: This post was written in 2015, the categories have been updated since then :(
I have not deleted this post because some still find it helpful :)
We will edit it soon!

Greetings, people.

This waste disposal system is used in India. Since it's all complex and plain memorization, why not make a mnemonic? :D

For those who don't know the categories and stuff in detail, I'll copy paste them at the end of the post for reference. I'll be sharing the mnemonic first.

Let's begin! ^__^

How to remember Waste Categories:

1-3: HAM (Human, Animal, Microbiology)
4-7: Sharp medico, bloody solid (Sharps, Medicines, Blood stained or Soiled, Solid)
8-10: LAC (Liquid, Ash, Chemicals)

Facebook group

Here's another experiment, for study purposes, of course: https://www.facebook.com/groups/409305369268170

Pharmacology notes by Kiki


On excessive worrying about exams

(I received an email yesterday and based on that email, I am writing this post.)

This is the most important advice I would like to give medical students world wide. Or anyone for that matter - Don't take exams seriously.

Once exams start, you can not be stressing yourself.
It's a fragile period, you are testing yourself, there is competition and expectations that you have to meet. It's easy for anyone who isn't psychologically prepared or doesn't have the right mental attitude to break down.

I have heard of people become suicidal right before the exam or simply decide to quit.

Don't let stress kill you. It's just a piece of paper. The score is just a number. You have amazing, amazing things and adventures ahead of you, I promise. Just survive this. One day at a time.

Don't quit before trying. Just attempt and see what happens. Go ahead. Keep going, keep moving forward. You are more prepared than you think you are. It's just the stress fogging your thoughts.

I pretend it's video game. The test is just a level I need to cross by collecting points. I need to keep running like the dude in Temple Run and keep collecting coins. Going level after level just like in Candy Crush. I have given so many exams and crossed so many levels till date. Here's another one, no big deal. I don't need a high score to finish the game, I just need to play the game.

Practice reckless optimism. After reading one page, I do a flying kick and say I am gonna do so good in tomorrow's test. Laugh about how anxious you are and how the score won't even matter after 10 years. Sing a song. Eat chocolate. Be happy and keep studying. Fake it till you make it.

Saturday, November 21, 2015

Organising notes and information while studying

"Hello IkaN!
I hope you're okay and happy :)
Can you teach me how to be organized? How can I save my notes?
I don't know why I'm so untidy. I want to be just like you, helping others & having good grades! <3
Please help me out here!"

- Email by an awesomite

Hello! I'm okay and at peace (:

Your organization depends on where you study from.

I study from books and ebooks so my study life seems very complicated to others.

I can read while I'm in the bus or in the train on my phone, so I always have ebooks or audio lectures with me. I can't write while traveling so everything I learn is saved on my phone. When I study with my books at home, I like having the traditional pen & paper to write, doddle and draw. Or a white board.

Here's how I save the information I have studied:

1. Make subject wise notebooks and write notes in it:
This is effective when you're studying from multiple text books and you need to merge all information into one for fast review during exams. I recommend making notes after you've read from all the textbooks if you're using this technique. You don't need to be tidy!
PS: This is time consuming.

2. If you're using ebooks, highlight and bookmark:
I read Harrison (Which is a HUGE internal medicine book) this way. The bookmarks would show me the topics I've read and while revising, I'd go through the highlighted lines only.
(App I use: Adobe Reader)

3. Type your notes and make sure they're synchronised:
If I have too much information on the digital platform and too little time to write on paper, copy paste on a notes app. Make sure you sync and back em up.
(Apps I use: Google Keep, ColorNote)

4. Blog:
The internet a wonderful place to save everything! (Many a times, I look for my own notes on Google =P)
If you don't have time for a fancy blog, just a simple tumblr with your study material is a good way to keep things in one place.
(Apps I use: Blogger, Tumblr)

Extra tips:
- Make a separate book for points you write during lectures. They're not always important but you will want you refer that book for the one thing your teacher said that you can't recollect while studying.
- If you think it's important, always write / save it somewhere. In my experience, you regret the things you didn't save =P
- Don't always focus on making the notes. Understand the information first, then organize it so that you revise and remember it.

The fact that you find me someone you wish to be like makes me happy. I hope I live up to the image you have of me =)

Until next time!

Study group discussion: Mannitol in cerebral edema and pulmonary edema

Why isn't mannitol used in pulmonary edema? And why is it used in cerebral edema?

Mannitol would expand the intravascular volume, increasing cardiac output and causing pulmonary edema (more fluid going to the lungs than it can drain.)

(Assuming the pulmonary edema is due to CHF:) The increased hydrostatic pressure proximal to the left atrium causes transudation in the lungs. Although mannitol can act as a diuretic, it initially increases plasma volume due to its effects on elevating plasma oncotic pressure.

Increased plasma volume --> increased left atrial preload in the face of decompensation that already occurred even at a lower preload --> increased LAP (PCWP) with further decompensation --> exacerbation of pulmonary venular transudation.

So basically, it causes edema by volume overload.

It's blood brain barrier (BBB) that allow us to use mannitol for brain edema. Since no such barrier is there in lungs, mannitol can cross capillaries into alveoli and worsen it. Even in cerebral edema, we give mannitol only when the BBB is intact. Otherwise, mannitol can create havoc there too.

Infusion of hypertonic solutions of any effective small molecular weight solute (eg hypertonic saline, mannitol or urea) will dehydrate the brain. In the peripheral capillaries, these solutes are not effective at exerting an osmotic force because they can easily cross these capillary membranes.

Neuropathic joint disease

Hey everyone!

Today, I felt like sharing random things that I learnt today. It's about neuropathic joint disease - Destructive joint disease due to loss of pain and proprioception.

Neuropathic joint resembles osteoarthritis (Osteophytes, loose bodies, loss of articular cartilage, etc.)

I couldn't think of neuropathic joint disease as  a differential today because I was so caught up in osteoarthritis!

The distribution of joint involvement depends on the underlying neurologic disorder.
Tabes dorsalis: Hip, knee, ankle.
Syringomyelia: Glenohumeral joint, elbow, wrist.
Diabetes: Tarsal and tarsometatarsal joint.

This is a major clue. The joint distribution.

Diabetes mellitus is the most common cause of Charcot's joint.

Other causes of Charcot's joint include yaws, leprosy, Charcot Mary Tooth disease and meningomyelocele.

That's all!

I cannot feel, what is real..

- IkaN

Friday, November 13, 2015

How to remember HOCM is an Autosomal Dominant disease

Hey!

HOCM is hypertrophic obstructive cardiomyopathy.

HOCM is the most common cause of sudden cardiac death in ADolescents.

HOCM is Autosomal Dominant.

Fun fact: Most common cause of sudden cardiac death in children in Aortic Stenosis.

-IkaN

Thursday, November 12, 2015

Next best step in management in ST depression and ST elevation in acute coronary syndromes

This is a discussion I had with a lot of people. My questions are put in inverted commas.

"I don't understand the next best step in the management in acute coronary syndromes. If there's ST elevation MI, you do angioplasty. But when there was a ST depression, they preferred heparin after aspirin even when angioplasty was in the options. Why is that? Why does the management change depending on elevation or depression?"

ST elevation means transmural ischemia so maybe angioplasty is the only way to restore flow. ST depression means subendocardial ischemia so occlusion isn't complete. Heparin and blood thinners might work.

"But then if you can do angioplasty (Catherization lab available), why give heparin?"

They do send for angioplasty later. Heparin can be given immediately to prevent the situation from getting worse.

"But then again, why wouldn't you do that with ST elevation too?"

ST elevation means the occlusion is complete. Heparin wouldnt be effective. In NSTEMI and unstable angina, there's still some lumen viable.

"Patients with MI with ST-segment depression should not be treated with fibrinolysis. Why isn't fibrinolysis done in ST depression angina?

We say that the occlusion isn't complete because there is subendocardial ischemia in ST depression and we give heparin to prevent further occlusion. But why not give streptokinase? Why not eradicate what is already formed instead of trying to prevent progression of clot?"

Because fibrinolysis treatment has it's own side effects and it's not effective in all the cases. It's contraindicated because studies have shown it does more harm than good in only ST depression.

Like, for example, there is reperfusion injury which would might make the only subendocardial infarct into a transmural one. 3 in ten patients end up with cerebral haemorrhage. There are so many other clauses.

Hence it's only indication is a transmural infarction.. The damage is already great. Irrespective of using t-PA the patient condition is critical.

That's all!

Thank you everyone who helped me out on this one.

-IkaN

Sunday, November 8, 2015

Study group discussion: Pathogenesis of diarrhea in medullary carcinoma of thyroid

By which mechanism, does medullary thyroid cancer cause secretory diarrhea?

Medullary thyroid carcinoma is usually associated with men syndrome in which we get VIPoma, which is associated with diarrhoea.

Upto date: "Systemic symptoms may occur due to hormonal secretion by the tumor. Tumor secretion of calcitonin, calcitonin-gene related peptide, or other substances can cause diarrhea or facial flushing in patients with advanced disease. In addition, occasional tumors secrete corticotropin (ACTH), causing ectopic Cushing's syndrome."

Colonic function was markedly impaired in three ways: (a) water absorption was decreased by half; (b) as the main excreted solutes were organic acids, a large electrolyte gap was recorded in faecal water, and (c) colonic transit time of the meal marker was very short, and was in agreement with the rapid transit of ingested radioopaque markers. These data strongly suggest that decreased absorption in the colon secondary to a motor disturbance is the main mechanism of diarrhoea in this case of medullary thyroid carcinoma, while calcitonin induced small intestinal fluid secretion suggested earlier is either non-existent, or only of minor importance.
Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1433550/

My dd for tumors and secretory diarrhea (someone wants to add):
- carcinoid tumor
- VIPoma
- Gastinoma
- Medullary thyroid cancer

Macrocytic anemia mnemonic

Mnemonic for Macrocytosis (Non B12 causes):

ALPHA NERD

Alcohol
Liver disease
Pregnancy
Hemolysis (especially chronic)
Agglutination

Neoplasia (Including myelodysplasia)
Endocrine (Hypothyroidism)
Reticulocytosis
Drugs (Especially myelosuppressives like chemotherapy, anti-HIV meds)

This awesome mnemonic was written by Adnan Arif.

-IkaN

Wednesday, November 4, 2015

Jay

Hello guys, I'm Jay, the newest author here in the Medicowesome, and I'm really really...like REALLY....excited to be here! :D

The flow of CSF Mnemonic

Hello guys, It's Jay once again. Today I'm going to tell you a mnemonic on how to memorize the CSF flow. Interesting eh? 

OK Let's get to work!

First of all let us know the CSF flow as it flows!

Lateral Ventricle → foramen Monroe→Third ventricle → Sylvius Aqueduct→ fourth ventricle→ foramen Magendie → foramen Lushka→Subarachnoid space→Arachnoid Villi→Superior Sagittal Sinus


The mnemonic is

Lady Monroe's Three Siblings Fought, for Magical Lights Seeing Arrogant Seniors

Hope it would help you guys! Thanks! See you later !


Monday, November 2, 2015

Auscultating breath sounds mnemonic

While Auscultating the Chest of patient and analysing Type of breathing, whether it's Bronchial or Vesicular.

Remember GRIP

1. Bronchial breathing:
Gap is present between Inspiration & expiration.
Respiration shows Inspiration & expiration equal length
Intensity is loud.
Pitch is high.

2. Vesicular Breathing:
Gap is absent.
Respiration shows Expiration is short.
Intensity is low.
Pitch is low.

This post was written by Adnan Arif. Thanks Adnan! (:

-IkaN
Related post: Abnormal breath sounds mnemonic

Submissions: Ankylosing Spondylitis (Radiological signs notes)

These cool notes were written by Shireesha Mallik. Check em out!
Ankylosing Spondylitis (Radiological signs notes)

Sunday, November 1, 2015

Antithyroid drugs mnemonic

1. Durgs that inhibit hormone synthesis (Antithyroid drugs):
Propylthiouracil, methimazole, carbimazole.

Mnemonic: Professor Met Carby

2. Drugs that inhibit thyroid trapping (Ionic inhibitors):
Nitrates (NO3), thiocyanates (SCN), perchlorate (ClO4) .

Mnemonic:  NTP

3. Inhibit hormone release:
Iodine, iodides of Na & K, organic iodides.

Mnemonic: I prevents release (Iodine, it's salts and organic form.)

4. Destroy thyroid tissue: Radioactive Iodine (I 131, I 123, I 125)

Mnemonic: Iodine normal is 128 (+3 &-3 are radioactive so is I 123)

That's all!

The mnemonics were submitted by Sareer. Thank you, Sareer, you're awesome.

-IkaN

Saturday, October 31, 2015

Biochemical tests for Streptococcus pneumoniae mnemonic

Hey!
I had made a mnemonic to remember the biochemical tests given by Streptococcus pneumoniae.

Submissions: Murmur characteristics mnemonic

When you are listening to a murmur, look for "SECRET Pi"

Site
Effect of posture
Character (Tapping, heaving, thrill)
Radiation ( Axilla, neck, shoulder)
Effect of Respiration
Timing
Pitch

This mnemonic was submitted by Adnan Arif =)

Thanks Adnan!

-IkaN

Thursday, October 29, 2015

Validity and reliability mnemonic

Hey everyone!

Someone requested me to make a mnemonic on reliability and validity. Let me tell you in short what these terms mean!

What is validity and reliability?

Let's take the example of measuring blood glucose levels.
Suppose, we have developed a test to measure glucose levels and we measure it in healthy man. Normal standard we have set is, let's say, 80.

Reliability means test will give the same value each time. Let's say, we measured three times it gave reading of 120, 120, 120 that is reliable. Reliability is consistency. Also called precision.

But validity means the test will give a value which is close to our standard value, that is, 80 in this case. The three readings we get this time are 82, 85, 79. So this test is reliable, but not valid. Validity is also called accuracy. Validity is not affected by sample size.

This interplay of words messes up with one of my readers brain, so I'm sharing the mnemonic I made on it. I thought it was silly at first, to use a mnemonic to remember words, but I'm glad you all are as weird as me.

VACuum = Validity + ACcuracy

PReCiSe = Precision + Reliability + Consistency + Sample size dependent

That's all!

Life is so good. I've never been so happy and calm. I'll tell you why soon, but for now, I just wanted you guys to know (:

-IkaN

Related post: Biostatistics mnemonic

Study group discussion: Ethacrynic acid and sensorineural deafness

Can someone explain how ethacrynic  acid causes deafness?

Na+K+Cl+ transporter is also present in the ear. This transporter is the main site of action for ethacrynic acid. So when it acts the transporter Is inhibited leading to ionic imbalance. This results in hearing loss.

It is the diuretic which is most dangerous when it comes to causing sensorineural deafness.
Even then it's use indicated in one special condition. Guess which condition?

If a patient has reaction to sulpha drugs.. The DOC becomes ethacrynic acid.

Recent studies revealed that the ototoxic effect of EA is actually involved in selectively blocking the lateral spiral artery in the cochlea and suppressing the blood flow supply to the cochlear lateral wall. The epithelial ischemia and anoxia in stria vascularis resulted in a significant depression of endolymphatic potential which was equivalent to cutting off the power supply of the cochlea . During the ischemic damage to the epithelium and capillaries on the cochlear lateral wall, the vascular permeability and membranous permeability in stria vascularis were also affected so that the ototoxic drug can penetrate through the broken blood-cochlea barrier to enter the cochlea.the ototoxic drug can reach the cochlear hair cells either through the cuticular plate facing the endolymph or through the under parts of the hair cells in the cortilymph.

In short bro, hair cell damage directly by EA.

Oooh. So it first causes ischemia and then enters the hair cells. But at the end the outer hair cells are getting damaged. Nice!

Monday, October 26, 2015

I am finding first year MBBS extremely difficult and tough

"Sis.. I just joined medical college. Finding it extremely tough to study. None of the subjects seem familiar. I'm losing all my positivism and feeling helpless."

Firstly, take a moment to congratulate yourself. You've made it to medical school! New subjects is going to be so much fun!

"I feel left behind. I'm not able to answer. What is taught in lecture is very minimalistic compared to text book."

Sunday, October 25, 2015

Drugs causing hemolysis in G6PD deficiency mnemonic

Mnemonic for drugs causing hemolysis in G6PD deficiency is, "PAINS"
(Cause hemolysis in g6pd deficiency PAINS ;) )

Tips on how to find vein or phlebotomy

Study: Know your anatomy, so if you can't see or feel the veins, you still know where to go.
Just the anatomy of where the veins are. Sometimes you can't see them (old people, people with dark skin) and you can't really feel them. I've done some blind insertions before successfully.

Dont panic: Initially, you will find it hard, but do not get embarrassed if you miss.

Tourniquet: Tying a torniquet often helps by making the vein more swollen and prominent.
In our hospital, the patient's relative is asked to hold with the fingers tightly around the arm instead of using torniquets.

Tuesday, October 20, 2015

Study group discussion: Carcinoid syndrome

What's carcinoid syndrome?

It's caused by serotonin. There's a GI tumor called carcinoid tumor which secretes it. So basically, the syndrome is caused by serotonin (Flushing, wheezing, etc)

What's the treatment for carcinoid?

Somatostatin analog, octreotide.

Which vitamin deficiency is associated with carcinoid syndrome?

Monday, October 19, 2015

Study group discussion: What causes Carharts notch?

In otosclerosis, why carharts notch at 2000 Hz in PTA?

Carhart attributed this phenomenon to "mechanical factors associated with stapedial fixation."

But why the greatest dip at 2 kHz?

The ossicular chain has two basic modes of vibration. The first mode, with a peak around 1200 Hz, is the primary mode for AC stimulation. This mode is associated with a "hinging" motion of the ossicles caused by AC stimulation of the tympanic membrane at the umbo. The second mode, with a peak around 1700 Hz, is described as a "pivoting" motion of the malleus/incus, with an axis of rotation somewhat orthogonal to the axis of rotation associated with the "hinging" motion. The second mode is less robust than the primary mode for AC stimulation, but it is the dominant mode when excited by BC stimulation. A decreased mobility of the ossicular chain at 1700 Hz due to otosclerosis also affects the surrounding frequencies, but is seen most prominently as a BC loss at 2000 Hz in audiometric testing.

Friday, October 16, 2015

Causes of carpal tunnel syndrome mnemonic

Short post for the day!

Mnemonic: CARPAL Tunnel Syndrome

Atypical carcinoid syndrome mnemonic

Happy Friday everyone!

Carcinoid tumors are neuroendocrine tumors of the GI tract. They can make high levels of neuropeptides and amines, like serotonin, which can cause brief episodes of flushing, diarrhea, cough, wheezing, shortness of breath, heart disease, and in rare cases, pellagra. (Typical carcinoid syndrome)

Atypical carcinoids have a normal plasma serotonin level. They are characterized by extended episodes of deep purple flushing, headache, shortness of breath, and in rare cases, lacrimation (tears).

Wednesday, October 14, 2015

Following Medicowesome

"I really want to read all your posts from time to time. How can I follow you?"

I feel that email is the best option.
You can follow by any RSS feed here.

As for social media, I regularly update Facebook and Twitter.
Twitter: https://twitter.com/medicowesome
Facebook: https://www.facebook.com/medicowesome

For those of you who use Whatsapp, the Broadcast list is a wonderful idea.
I add contacts to my broadcast list and send links to blog posts (new and old) on a daily basis.
Broadcast list: http://medicowesome.blogspot.in/2015/09/medicowesome-broadcast-list.html

Submissions: Anti-diarrhoeal and drugs used for constipation notes

These awesome notes were written by Kiki!

Triad of pheochromocytoma mnemonic

To remember the classic triad of pheochromocytoma, remember 3 P's.



Tuesday, October 13, 2015

Study group discussion: Pharmacology of drugs used in Parkinsons disease

Why does bradykinesia and rigidity occur in Parkinson's disease?

Bradykinesia is due to deficiency of dopamine.
Rigidity is due to uncompensated increase in acetylcholine.

Why levodopa is always given in combination with carbidopa and entacapone? 

Carbidopa is given to protect levodopa against dopa decarboxylase enzyme which causes its peripheral breakdown. Peripheral conversion of dopamine is harmful.. Can cause cardiac arrhythmias and postural hypotension.

Entacapone is given to block COMT.

Difference between entcapone and talcapone?


Study group discussion: Why are platelets low in hepatic disease?

Why are platelets low in hepatic disease?

You need cytokines to tell the marrow to synthesis platelets. They are synthesized chiefly by liver.

It is also been associated with the concept of hypersplenism leading to sequestration of thrombocytes in the enlarged spleen.

Submissions: Anti-diabetic drugs and insulin

Written by kiki <3 p="">
Anti-diabetic drugs classification

Upper segment to lower segment ratio (US:LS ratio) mnemonic

Hey!

I was asked to measure the US:LS in a child. My professor was suspecting Rickets. So let's learn the normal ratios is various age groups!

Saturday, October 10, 2015

ACE inhibitors that are not prodrugs mnemonic and dysgeusia

Before I tell you about the mnemonic, lemme tell you about Titanic.

The captain of Titanic was not a pro in sailing because he sank the ship xD

Or because he listened to Bruce, "The press knows the size of Titanic, now I want them to marvel at her speed, too. We must give them something new to print. This maiden voyage of Titanic must make headlines!" 

Haste is waste, Bruce. Lol.

So now you know what I am talking about, here's the mnemonic:

"Captain who Listens and acts hastily is not a pro."

Scaphoid fracture mnemonic

This was sent to me by a friend, Akshay Dhaiya! I modified it a little bit :D

He likes to call the scaphoid fracture as the Spiderman fracture. Why?

Because it's caused by supination and dorsiflexion of wrist.
(Just like how spidey throws his web!)

Spiderman - Supinating and dorsiflexing the wrist xD

How to remember the function of anconeus muscle (Screwing movement at elbow joint)

Short anatomy post for the day!

I remember about Scrat the squirrel form Ice Age, always screwing around for an acorn.

Tuesday, October 6, 2015

Why is gout more common in men?

Hey everyone!

I was trying to find out is hyperuricemia in Von Gierkes disease gender specific.. I didn't get the answer to my question (If you do, please let me know!), but I did found out that hyperuricemia, in general, is more common in men.

Why?

Sunday, October 4, 2015

Pterygium is more common on the nasal side: Why?

Why do pterygia occur more commonly in nasal side?

Environmental factors, such as a warm climate, dust and UV light, are the main causes of pterygia.

Major And Minor Blood Cross Matching Compatibility Tests

Hello awesomites! Jay ™ here today, once again with a new blog post. Yayy! ^_^

Today we will discuss about Major and minor blood cross match compatibility test. This is usually performed before the transfusion of blood from a donor to a recipient in a hospital setting.
Before we get to this we need to get known to a table which we will use in the following tests.

Blood Type
Agglutinogen (Antigen)
Agglutinin (Antibody)
A
A
Anti b
B
B
Anti a
AB
A + B
None
O
None
Anti A + Anti B

In major compatibility test we mix Donor Cells (Dc) with Recipient Serum(Rs).
In minor compatibility test, we mix Recipient Cells (Rc) with Donor Serum (Ds)
For the Cells we check the Column of Agglutinogen and for Serum we check the Column of Agglutinin for obvious reasons of the place of presence of each.

So for an Example – 

Wednesday, September 30, 2015

Medicowesome broadcast list

I have created a broadcast list on Whatsapp for those who want to recieve links to recent blog posts.

It's not a group, you'll just receive updates about new blogs from me regularly through a personal message.

If you would like me to send you links instead of you checking the blog or Twitter.. Just email me your number with proper country code at medicowesome@gmail.com with "Broadcast list" in the subject. I'll message you in a week.

Study group experience #18

Here's what we discussed so far:

Decerebrate and Decorticate rigidity
Cystogastrotomy for pseudopancreatic cyst

Wow. 6 groups. I don't know what to say so I'm going to tell you what others said:

"The group has been good. I've learnt a lot through here. Especially spot diagnoses."

"I mean people asking questions, even though repeat, sometimes helps just to consolidate."
"Hey.. Just wanted you to know that my grades have gone up since the group :)"
These were so nice to read!

-IkaN

Volume of ascitic fluid, abdominal assessment in ascites and my viva incident

Hey everyone!

A colleague asked this question on the study group  - What volume of ascitic fluid are the following tests positive: Puddle sign, Shifting dullness, Fluid thrill?

What I found out - Minimum amount of fluid required for detection of ascites by various methods are:
Diagnostic tap 10 - 20 ml
Ultrasonography 100 ml
CT scan 100 ml
Puddle sign  120 ml
Shifting dullness 500 ml
Fluid thrill 1000 - 1500 ml
I would also like to add an incident that happened in my viva:

I had a patient with liver cirrhosis in my exam. The examiner asked me that which physical examination signs I knew for the detection of suspected ascites and what my findings were.

Why does thiazide, a diuretic, cause a paradoxical anti-diuretic effect in Diabetes insipidus?

Hey everyone!

I have explained this before (In one of my earlier posts on free water clearance) but someone found my language too complicated to understand. So I decided to write this post.. An explanation which is "free" of complicated terms like free water clearance. Yaay! :D

ADH absorbs water. In nephrogenic diabetes insipidus, the kidney is unresponsive to ADH.

What do you then?

You use a drug called thiazide.

Thiazide diuretics inhibit the NaCl co-transporter  in the renal distal convoluted tubule (DCT).
The DCT is water impermeable.. So the DCT action is NOT how thiazides preserve water.

Then what is preserving water?

Monday, September 28, 2015

Submissions: Mature defense mechanisms mnemonic

Mature defense mechanisms mnemonic

SMASH
Suppression
Mature defenses
Altruism
Sublimation
Humor

This mnemonic was submitted by mist amidst

Ethosuximide mnemonic

Greetings everyone!

This little pharmacology pearl was written by Keto :)

eThosuximide is the T drug.
It blocks the T-type Ca2+ channels:
T stands for Transient which can be found in the Thalamus.

Remember, that thalamus is a relay nucleus with a lot of subnuclei. Everything travels through, EXCEPT smell. So a patient with "Transient" absence (peTiT mal) seizure, you can let them smell something to bring them back. And... eThosuximide is the drug they need.

Study group discussion: Monroe Kenri's Law

Here's a cool fact:

Monroe Kenri's law states that cerebral perfusion pressure = Mean blood pressure (MBP) - Intracranial pressure (ICP)

Hence, in cases of increased ICT or intrcranial heamorrhage, BP rises.
This is physiological so that blood supply to the brain can be maintained.

Hence, in cases of stroke, never try to reduce BP unless it is above 200. If you reduce BP, the blood supply to brain is compromised.

Cushing's triad in cases of increased ICT:
1. Increased BP
2. Bradycardia
3. Irregular respiration.
(Because increased ICP compresses the brain stem)

Related post: Cushing's triad (How to make medical notes)

Sunday, September 27, 2015

Bleomycin metabolism

This is a short post on pharmacology!

Bleomycin is inactivated by a cytosolic cysteine proteinase enzyme, Bleomycin hydrolase.

This enzyme is widely distributed in normal tissues with the exception of the skin and lungs, both targets of Bleomycin toxicity.

This is why, Bleomycin causes pulmonary fibrosis.

It's also why bleomycin is used in skin cancers like squamous cell cancer.

That's all!

-IkaN

Saturday, September 26, 2015

Hyperphosphatemia in chronic kidney disease

This is a really short post :D

What's the mechanism behind hyperphospatemia in kidney disease?

Kidney activates vitamin D.

Tarsal Bones Mnemonic

Hey guys, Jay here once again. Today I was studying my anatomy, and our lower limb region is going on. Since our regional exam is next week, I wanted to study the foot and especially the tarsal bones. Me, the one who is so fond of mneumonics, tried finding some mnemonic to remember the tarsal bones. I found one on internet I made one myself. So let me first list the tarsal bones.
1. Calcaneous
2. Talus
3. Navicular
4. Medial cuneiform
5. Intermediate cuneiform
6. Lateral cuneiform
7. Cuboid

The one on Internet:

The Circus Needs More Interesting Little Clowns

But in this Calcaneous and Talus have exchanged places. So when I saw this, I edited it a bit. :) So it kinda goes with the first syllable as well. ^_^

CaT Navy Meets Interesting Little Cubs

CaT has Calcaneous and Talus both.
Hope it helped Awesomites. :) Until we meet again then, Ciao!! Au revoir!!! :D

《Jay》

Wednesday, September 23, 2015

Heart murmurs mnemonic

Hello people with a pumping heart in their chests, obviously! <3

In this post, I'll be taking about the few mnemonics I use in relationship to murmurs.
"PASS" is a good mnemonic for remembering that pulmonic and aortic stenosis give a systolic murmur.

The opposite of PASS, ie, other two valves and the other defect gives a systolic murmur too. (Mitral and tricuspid regurgitation gives a systolic murmur!)

VSD has a S so that's systolic.

Now, the other ones - pulmonic and aortic regurgitation, mitral and tricuspid stenosis will cause diastolic murmurs :)

Here's another mnemonic submitted by one of the readers:

Primary, secondary and tertiary hyperparathyroidism mnemonic

This idea was submitted by Keto. It helps go through Calcium and Phosphorous levels very quickly.

The values are somewhat logical and can be thought through.. But if you're on ward or on a board exam this can be handy.

Hyperparathroidism mnemonic

Sunday, September 20, 2015

Why is there an increased white cell count in sickle cell anemia?

Hello sweet people!
I spent today's free time searching for what is the cause of leukocytosis in sickle cell anemia =P

Sickle cell disease typography

Making Referrals - Bio Medical Ethics

Hey awesomites, I'm Jay, and I'm your new Medicowesome contributor! yayy!! :) And today we are going to talk about Referrals. This is another important ethical responsibility of a physician.

A physician’s Central responsibility is WELFARE OF THE PATIENT, and that means, Physician should work for the best interest of the patient not him/herself.

Referral simply means that, when we reach the boundaries of our competence, we should hand our patient to a more competent physician. Keeping a patient with ourselves to hide our incompetency or to earn more money is a huge NO-NO!!!

We shouldn’t be ashamed to ask for help from our colleagues, and we shouldn’t be continuing to treat a patient, if we cannot give him/her a fruitful therapy as our boundary of competency has reached. That’s when we should write a LETTER OF REFFERAL to a Consultant(BritE)/Attending(AmE) Physician or to another colleague with a broader knowledge or idea of the subject.

Saturday, September 19, 2015

Submissions: Bio medical ethics

Bio Medical Ethics - by Jay ™

Today’s blog post is about Bio Medical ethics or Ethics of Medical care that a health care practitioner has to adhere to.

Medical ethics started off as Hippocratic Oath made in 460~ BC in the Book called Corpuz Hippocratum.

“Do No Harm” is the Primary Ethical concern of Medical Ethics. 

Constitutional pancytopenia mnemonic

Constitutional pancytopenia mnemonic

Rich in name, poor in cells.

"I fancy this carat (gold), diamond and silver man. He is a mega rich noob down here!"

Fancy: Fanconi syndrome
Dis (Dys) Carat: Dyskeratosis congenita
Diamond silver man: Shwachman Diamond syndrome.
A mega: Amegakaryocytic thrombocytopenia
Noob: Noonan syndrome
Down: Downs syndrome

That's all!

The mnemonic is just as hard xP

-IkaN

Friday, September 18, 2015

Study group discussion: Drunken crab syndrome

Which parasite causes the drunken crab syndrome?

Paragonimus westermani.

Drunken crabs, because man gets infected with it by eating raw crabs. In Taiwan, these crabs are marinated in wine. Hence, the name!

Also called kejang.

Wow I didn't know this.

Nice to know, I was formulating all sort of weird possibilities for symptoms based on that.

I thought of a motion abnormality.. Since crabs can walk sidewise.

When I first came across this... Even I thought that the person would have a drunken gait or something!

Wonder how a crab would walk in cerebellar ataxia.. Considering they have a cerebellum.. Or not!

Lets talk about crabs!

Crabs is also slang for STD.
It's not slang, my bad. It's lice in pubic hair. Also known as crab lice.

CRAB is used for Multiple Myloma symptoms too.
CRAB:
C = Calcium (elevated),
R = Renal failure,
A = Anemia,
B = Bone lesions

And then there's Krabbe's disease, some sort of leucodystrophy.

Lame mnemonic for drunken crab.. Our teacher said -- Mr. Krabs gets drunk in Taiwan .. Because he found out.. His daughter "P"earl  (paragonimus) is a man (westermanii)

Nice mnemonic!

Typhoid: Leukopenia, chronic carrier state and cancer (Why does typhoid fever cause leukopenia?)

I see a lot of patients with typhoid in the casualty and usually, they all have leucopenia. So I wondered - Why does the WBC count decrease in typhoid or enteric fever? Why does the WBC count become low unlike other infections?

After loads and loads of Googling, I found the answer to my question.

Study group discussion: Acromegaly

What is the most common cause of death in patient with acromegaly?

Cardiomyopathy leading to heart failure.

Why is diabetes more common in acromegaly?

GH has anti insulin effect.

Cool fact: GH increases insulin production. But at the same time causes insulin resistance.

How can you find out by giving glucose that patient has acromegaly or not?

Normally, growth hormone should be suppressed by giving glucose. Suppression of GH by giving glucose excludes acromegaly.

What is the treatment for acromegaly?

Pegvisomant - GH receptor antagonist.
Transsphenoidal removal of pituitary tumor.

Study group discussion: HSV encephalitis and musical hallucinations

Fun fact: HSV encephalitis is associated with musical hallucinations.

It's due to disruption of connections between the sensory cortex and reticular formation.

Is that specific for HSV only? Like the way auditory hallucinations is characteristic of schizophrenia?

No, it occurs in epilepsy, intoxication and other focal brain lesions as well.

I've heard that musical hallucinations occurs in people who listen to music for long periods of time. Not sure if it's true.

Thursday, September 17, 2015

JVP in pericardial tamponade

Greetings everyone!

Today, I was reading about JVP in pericardial tamponade. I started explaining a few concepts to myself and then I thought maybe everyone would like to know about this! So I wrote them down for you guys to read.

Why is y descent absent in JVP in pericardial tamponade? 
Y wave is due to ventricular relaxation. The ventricles can't relax when the pericardium is full of fluid, leading to the absence of y descent.

JVP in pericardial tamponade
Why is there a prominent x descent in JVP of pericardial tamponade?

Pharmacological agents that relax lower esophageal sphincter mnemonic

Pharmacological agents that relax lower esophageal sphincter mnemonic

ABCDEF MINTS

Alcohol
Anticholinergics like Atropine
Barbiturates
Benzodiazepines like Diazepam
Caffeine or coffee
Chocolate (My favorite!)
Dopamine
E (Prostaglandin E1 & E2)
Fat
Meperidine
Nitrates
Theophylline
Smoking
Peppermint (mints)

That's all!
-IkaN

Wednesday, September 16, 2015

Cirrhosis of liver: Concepts, mechanism and pathophysiology

Hello everyone! 

In this really long post, I'll be discussing the pathophysiology of some of the signs, symptoms and conditions seen in chronic liver failure / alcoholic liver disease. We are going to focus on the WHY.

Let's get started ^__^

Why is gynecomastia, testicular atrophy and female pubic hair distribution seen in males with chronic liver failure?
Physiology:
- Liver metabolizes estrogens.
Pathology:
- In cirrosis, estrogen degradation is decreased, so estrogen concentration are elevated causing testicular atrophy, gynecomastia & changes in pubic hair.
- Estrogen also induces SHBG production and this further reduces the free testosterone levels.

Stigmata of diseases

What does stigmata mean?

Stigmata means some lesion, mostly skin, which is visible, showing the patient is suffering from that particular disease.
In some diseases, like leprosy and tuberculosis, the patient may not want to reveal the condition because of the stigmata associated with the disease in society. But due to certain signs, the disease gets revealed. (These diseases were considered a disgrace in earlier days.)

Examples - 

Tuesday, September 15, 2015

Sunday, September 13, 2015

Thyroid carcinoma mnemonic

Hello! 
I made a real easy way of remembering thyroid tumors :)

Papillary carcinoma mnemonic:
Popular (Most common thyroid cancer)
Palpable lymph nodes (Lymphatic metastasis is common)
Positive I (131) uptake
Post radiation in head and neck (One of the causes)
Pops out of the capsule (Usually encapsulated but invades capsule)
Pops everywhere in the gland (Multifocal)
Positive, pleasing, perfect, parexcellence, peerless prognosis
(Excellent prognosis because it's slow growing)
[Another mnemonic is PG - Papillary, Good prognosis =D ]
Histology:
Popping eyes (Clear nuclei, Orphan Annie Eyes)
Papillary pattern
Psammoma bodies
Pseudoinclusions (Intranuclear cytoplasmatic inclusions)

Saturday, September 12, 2015

Study group discussion: Why more phenytoin is prescribed at night

Why do we give phenytoin in 1-0-2 dose after discharge? Why two tablets at night?

Phenytoin causes marked drowsiness that can confound the mental status (read GCS) exam in medicated patients, most critically those who have had neurosurgery and are given phenytoin for postoperative seizure control. In an outpatient being prescribed phenytoin one would plausibly order more to be taken when the patient is likely to be asleep instead of when they're awake.

Thank you for sharing this with us.

One article says, previously, we used to give 300 mg once daily. After chronic use, patients started developing adverse reactions of drug. It was then decided to start using phenytoin in divided doses. (100 mg TID).

Also remember that gingival hyperplasia is a very important and distinctive secondary effect of phenytoin, my teachers say that it stays even if you stop the medicine, but I'm not sure of that since I have not read that anywhere else.

Thursday, September 10, 2015

Tuesday, September 8, 2015

Difference between smooth ER and Rough ER mnemonic

Hello! Hope you're having a good day =)

In today's post, I'll be sharing how to remember the difference between rough endoplasmic reticulum and smooth endoplasmic reticulum.

Monday, September 7, 2015

von Willebrand disease mnemonic

Greetings everyone!

As you all probably already know, I've been studying loads of hematology this week. Here's another compilation of facts + mnemonic on  von Willebrand disease!

Saturday, September 5, 2015

How to remember gene for differentiation of gonads

Hello!

How to remember gene for differentiation of gonads

Mnemonic: Why (Y) are you Sorry (SRY)?

Y chromosome contains SRY gene which differentiates gonads to testes.

Daxone (DAX1) went for (WNT-4) double X (XX) .

Genetic factor DAX1 and signaling molecule WNT-4 are necessary for development of ovary.

That's all!

-IkaN

Wednesday, September 2, 2015

Normal values of Calcium, Phosphate, PTH and Alkaline phosphate mnemonic

Hey!

Here are a few mnemonics on how to remember the normal range of calcium, phosphate, PTH and Alkaline phosphate.

You may need to memorise these values for time restricted exams where wasting time looking up tables for normal values may cost you a few points.

Tuesday, September 1, 2015

Studying Biochemistry

"Just came across your blog. I must say you are very inspirational. I am first year medical student but I find it hard to study biochemistry. I would like to know if there is a good way to learn it. Any tips?" -Asked by email

How to speed read

I have modified a lot of general principles of speed reading for us, medical students, because we need to understand what we read.

Causes of macrocytic anemia mnemonic

Hello.

We all know that vitamin B9 and B12 causes macrocytic anemia but do you know the OTHER causes of macrocytic anemia?

They are:
Orotic aciduria
Thiamine deficiency
Hypothyroidism
DysErythropoietic anemia

Mnemonic: OTHEr

That's all!

-IkaN

Monday, August 31, 2015

Sunday, August 30, 2015

Barts hemoglobin mnemonic

So I just came across a question asking me why Barts hydrops fetalis is lethal. The answer is because Barts hemoglobin can't release oxygen to the tissues.

And I thought, "Barts can't fart oxygen." as a funny way to remember this xD

What is Barts hemoglobin anyway?

Tetramers of gamma globin chains formed when there is deletion of all four alpha globin genes.

How do you remember Barts hemoglobin has gamma chains?
I made a sentence with a lot of B's and G's. I'm not even sure if you can call it a mnemonic.
"BiG bart bargains for bar games."
I don't know if it works.

That's all!

-IkaN

Graves ophthalmoplegia case

Hello everyone!

I saw an interesting case in the ward today. And I'll be asking loads of questions for you to answer as you read along!

There was a 75 year old man with proptosis, inability to move his right eye inferiorly or adduct his eye. Any guesses on what it could be?

Saturday, August 29, 2015

Antianginal drug classes mnemonic

Hello!

So today, on our study group, Vaidehi posted a mnemonic for anti anginal drugs.

The mnemonic is, "Black Nights Can Please Others"

1) Beta blockers:
Propranolol, Metoprolol

2) Nitrates (Since nights are sorry and long so do we have - )
Short acting Nitrates: GTN
Long acting Nitrates: Isosorbide

3) Calcium channel blockers: Verapamil, Nifedipine

4) Potassium channel openers (Can also be remembered as - A pleasing person is open to others)
Nicorandil

5) Others:
Dipyridamole, Ivabradine

Thanks a lot for the mnemonic Vaidehi!

-IkaN

Related post: Anti arrhythmic drug classes mnemonic

Friday, August 28, 2015

Repeating PG entrance exam

"I'm a PG aspirant... This is my third year of PG preparation. I lost all interest in medicine. I've lost all hope too. I'm just tired of trying. I don't know who to talk to. I don't know how you get so much passion to write your blogs. I don't how to study also."

I understand that giving an exam for the third time must be really frustrating and tiring.

So my advice to you is - Make sure you prepare so well this time that it's your last attempt and that you get whichever post graduation seat you desire. Study real hard, no excuses.

It's natural that you tend to lose interest in learning repetitive facts. Maybe you should try hunting for new ideas, new perspectives and gain a different understanding of old concepts?
Google about facts you've learnt earlier. This time, instead of memorizing, think of why.
Question everything - Why does this muscle cause that movement? Why does sickle cell anemia cause leukocytosis? Why does phenytoin produce vitamin B9 deficiency?
Trust me, questions and curiosity will awaken an unexplored passion in you - The one you lost in studying the same things over and over again.

Thursday, August 27, 2015

Causes of sideroblastic anemia mnemonic

Mini post for the day!

Do you know the causes of Sideroblastic anemia? No? You guys are such liars!

Mnemonic: LIARS

Hemoglobin and erythropoiesis mnemonics

Hi everyone! Long time no see? :D

Today, I'll be sharing a few facts and mnemonics on hemoglobin and erythropoiesis. Let's get started!

Do you know the order in which hemoglobin appear from early embryo to infancy?
It's embryonic hemoglobin first (Gower 1, Gower 2, Portland) then fetal and after that, adult.
Mnemonic: Gower goes, fetal follows, adult afterwards. 
(Also, notice the reverse alphabetical order -  G, F, e, d, c, B, A)

The alphabets also pair the chains with their respective hemoglobin!
GF - Gamma Fetal
BA - Beta Adult

Sunday, August 23, 2015

Study group discussion: Contraindications of ACE inhibitors

Why ACE inhibitors are contraindicated -
During pregnancy
In CCF due to severe aortic stenosis
Bilateral renal artery stenosis

Please explain.

Study group discussion: Polygonal cells

What are polygonal cells ?

I know I'm stating the obvious, but can I guess cells which are polygonal in shape? :P

According to Google, Polygonal cells have many sides. (Four to five mostly)

The skin has a layer of polygonal cells called the stratum spinosum.

Wednesday, August 12, 2015

Criteria for LVH in ECG

Hey everyone!

Someone requested me to do a criteria for LVH in ECG. Here are a few!

Cornell criteria: Add the R wave in aVL and the S wave in V3. If the sum is > 28 mm in males or > 20 mm in females, then LVH is present.

Mnemonic: 20 carnivals tree
caRniVALS (Corn evil? Cornell?) tree
R in aVL (caRniVaL).
S in V three (tree).
3 looks like a Mirrored 8.
So 28 in Males, 20 in females.

Friday, August 7, 2015

ORS and baby - My ORS week poster

It's ORS week again! And this time, I made the poster in Marathi, one of my favorite languages!

ORS week poster in Marathi
For all those who don't know Marathi, here's a translation. (The dialogue might not sound as cute in English, but here it goes!)

Wednesday, August 5, 2015

Monday, July 27, 2015

Difference between secondary and superinfection

Should antibiotics be prescribed for an adult with the usual fever, headache and sore throat symptoms?

Not unless he develops secondary bacterial infection.

Friday, July 24, 2015

Metachromatic Leukodystrophy mnemonic

Inspired by the case I saw in the OPD yesterday, I thought I'd share a mnemonic I use to remember the same.

"Aryl has many Colorful look a like, Cerebral brothers. They are Clumsy and Crazy."

Internship diaries: Metachromatic leukodystrophy

Hey everyone! I'm posting the study group discussion we had because it's so much less to type :D

I saw a case of metachromatic leukodystrophy in the OPD yesterday.

Can anyone tell me what is metachromatic dystrophy?

For those who don't know, it's a lysosomal storage disease. Deficiency of the enzyme aryl sulfatase A causes accumulation of cerbroside sulfate.

Saturday, July 4, 2015

Study group discussion: Hot vs Cold fomentation

Can anyone tell me when should we give hot fomentation and when should we give cold fomentation?

Immediately after an injury -  Cold fomentation.
Later on - Hot fomentation.

Cold is for acute injuries like sprains, joint injuries, sports injuries.

Hot is more for chronic conditions like back aches, muscle spasms.

The point is after an acute injury, you need to reduce the swelling and inflammation. So you cool the area to decrease blood flow.

After a day of injury, you would want to increase blood flow to heal the area.

Amazing!

Thursday, June 25, 2015

Study group discussion: Fluids in inferior wall myocardial infarction

Why are fluids indicated in inferior wall MI?

Inferior wall MI is associated with severe hypotension. So first, correct the hypotension, then, thrombolyse.

Yes, but any reason for the hypotension?

Because inferior wall has vagal plexus. Patients with inferior wall MI are parasympathetic i.e. high vagal tone.

Monday, June 22, 2015

Study group discussion: Referred pain

Can someone please give me regions of referred pain areas?
Eg. Pain in the shoulder could infer problem with diaphragm.

Right shoulder pain - problem with gall bladder (eg. Cholecystitis)
Left shoulder and ulnar border of left arm and hand - myocardial infarction.

Knee pain can refer to hip.

Renal colic pain is referred to the back.

Splenic rupture can refer pain to left shoulder - Kehr's sign

What is Kehr's sign please?

Splenic rupture or hemorrhage irritates the diaphragm on left side and that refer s the pain to the left shoulder. Same like cholecystitis on right side.

Thursday, June 18, 2015

Study group discussion: ECCE

Why ECCE is not done when zonules are not intact?

What is ECCE?

Extra capsular cataract extraction.
Because the IOL will be implanted in the remaining posterior capsule - And if the zonule is not intact, it may cause lens subluxation.

Awesome.

Study group discussion: Cystogastrotomy for pseudopancreatic cyst

One interesting question:
In cystogastrotomy, as surgical treatment for pseudo pancreatic cyst...Why do food particles don't enter from stomach to pseudocyst through the communication?
This question asked by surgical professor in OT today.

Because cyst will be always in positive pressure and clinical studies show that the cyst rapidly decompresses. Approximating the mucosa with cyst wall, which has no epithelial lining, leads to rapid shrinkage of stoma. Within few days, neither the stoma nor the cyst is evident on radiology or endoscopy.

Wow. This is great stuff!

Friday, June 12, 2015

Study group discussion: Serum ascites albumin gradient

Can anyone explain the serum ascites albumin gradient in a super simplified way?

High SAAG: Imbalance between hydrostatic and portal pressures.

Low SAAG: Ascites due to protein leakage.

SAAG = Serum albumin - Albumin in ascitic fluid. And is directly proportional to portal pressure.

Thursday, June 11, 2015

Internship diaries: Calcium channel blockers and peripheral edema mnemonic

As you all know, I am doing internship or housejob and it's really tiring but a good learning experience. Lemme share what I learnt / revised today!

In my medicine OPD, we start most newly diagnosed hypertensive patients on amlodipine, a calcium channel blocker. Many of the patients, after a few weeks of therapy, come back complaining of lower extremity edema. You check their electrolytes, LFT's and RFT's and they are all normal.

Conn's syndrome mnemonic

Hi. I keep forgetting that Conn's syndrome is hyperaldosteronism. Can you help me out with this?

Sure! :D

The N's are for sodium - Hypernatremia!

The C makes a K for potassium, which is less than the number of N's, therefore, hypokalemia!

Also, Na+ is sodium. A could remind you of Aldosterone.
AL could remind you of ALkalosis.

That's all!

-IkaN

Which books do I study from while in second year MBBS?

Hello!

One of my readers asked to write a books recommendation posts for second year and here it is!
This post is mainly for Indian medical students because I'll be talking about some local authors which might not be available or preferred in your country. But of course, foreign medical students can read it too as they might find the general points helpful! ^__^

Something I learnt from my first year - You should never be hasty in buying books. Medical textbooks are pretty damn expensive and you don't wanna be stuck with a book you don't like for the rest of the year.

So here's what I recommend - Be "bookless" for the intial few weeks. Don't buy any books. Pretend you're broke and rely only on the library.

Ask - Friends, seniors, book sellers, internet about books they think you should buy. Immediate seniors will be the best resource - Ask them why you should go for one book and not the other, know their reasons. You should be able to cut the long list of 10-12 books and bring it down to 2-3 books.

In the bookless period, go to your library (Or use ebooks), read a few topics (Not just one!) from the two to three books you think you should buy. You'll like one and that's the book you should read for the rest of the year!

Don't judge a book by it's initial few pages. You have to read topics of substance, big topics not the small ones. Example, don't read about Louis Pasteur and see which book wrote it better. Read about Staphylococcus or ELISA.

Before I begin, I'll be very clear and tell you that all I can do is recommend. You do the deciding =)

Pharmacology
K. D. Tripathi or KDT: It's a good book. It'll stick with you throughout the year!
How to study: Read classifications first because you wanna know the drug names before you start reading into the tiny details. If you write a good classification table in the beginning of your answer, you impress the reader. Know special side effects of drugs, it gives you an upper edge while writing theory papers (No examiner wants to read nausea and vomitting over and over again!)

Katzung: Now this book is HUGE. It's fun to read!
How to study: Get it from a library or use a PDF. Read the topics you like. I read diuretics from this book and boy I enjoyed it. It's too much to read so when exams near, you'll lose the book and run back to Tripathy. So keep in mind that this is not THE book and you won't be able to finish it or come back to it later. Take points and put it in your Tripathi in the first read itself.

Lippincott: It is simple and preferred by a lot of international readers.
How to study: I haven't read it, so I don't know how good it is T_T

Pathology
Pappa Robbins or the big Robbins: It's awesome.
How to study: It's a huge book, so do the "Important" topics from here first. Important? Yeah, the stuff that's been asked a lot of times in the previous papers. Try to do general pathology, CVS, RS and renal from this book.

Baby Robbins or the small Robbins: It's useless.
How to study: Don't.

Harshmohan: It has lots of diagrams and point wise notes. You know who likes diagrams and point wise answers? Teachers.
How to study: Stuff you couldn't read from Robbins due to lack of time, read it from here. (Don't forget the diagrams!)

Microbiology
Ananthanarayan: It's just the right amount of information. If you study this one well, you won't require any other book.
How to study: You wanna know how an organism looks like and what diseases it causes. Do cultural characteristics too. General microbiology - Read the important stuff. If you don't enjoy immunology while reading it, you're doing it wrong. It's my favorite subject! Imagine, read comics.

Parasitology
Any book will do: I studied from Arora.
How to study: Diagrams are key. If you can draw the life cycle, half your work is done. Diagnosis and treatment is simple.

Forensic and Medical Toxicology
I never studied this subject from multiple books to pick a personal favorite, sorry! :|

Internet
I use a lot of internet for studying. It keeps things interesting. There's always a new perspective you can gain via the internet. Videos, images, jokes, mnemonics. It keeps things fresh. And books can get boring sometimes, so use the internet, read blogs, have fun! :)

PS: If you are thinking of preparing for USMLE but are not too sure (Because second year is too early to decide your future xD), finish off the Kaplan videos, notes and Goljan audio.

That's all!

Ask me whatever you like in the comments section below!

-IkaN

Related posts:
How to make concise medical notes
How to make medical mnemonics

Wednesday, June 10, 2015

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