Saturday, December 31, 2016
So it's the last day of 2016. And everyone is now talking about new year resolutions and stuff. But what do we want to resolve as medical students?
Remember the first day you joined the medical college? That day you promised yourself something. To be a good doctor one day and serve humanity. To study and work hard all day and night seven days a week and gain knowledge in every subject you study. You had taken your life- changing resolution on that first day itself.
I believe in change. I have always tried to explore myself and learn new things each day of my life. That's what we all should do. And not just in the initial days or weeks of the new year. Because you are known by your actions and not what you think.
So stop making resolutions and start taking your real life decisions. Change is the law of nature. Create the change in yourself each passing day for the better. That will make you feel good. And because your ultimate goal in life is not just to be a doctor but also be a good human being. Then one day you will be what you ever wanted to be.
- Jaskunwar Singh
- MarFAN syndrome (FAN is up)- Superior dislocation of the lens
- HomocystinURIA (URINE goes down)- Inferior dislocation
- WeilMARCHesani syndrome (We will march forwards)- Anterior dislocation of the lens
- Jaskunwar Singh
Friday, December 30, 2016
Thursday, December 29, 2016
High lap score:
- Neutrophilia ( as in bacterial infections)
- Polycythemia vera (neoplasm of bone marrow)
- Blast phase of XML
- Hodgkin's disease
- Leukemoid reactions
- in newborns, children and pregnancy.
Low lap score:
- Chronic Myelogenous leukaemia (chronic phase)
- Paroxysmal nocturnal hemoglobinuria
- Hereditary hypophosphatasia
Happy Medicowesome :)
- Jaskunwar Singh
Normal pressure hydrocephalus is a type of brain malfunction characterised by:
- Dilatation of ventricles
- Distortion of fibres in corona radiata
- Normal pressure on lumbar puncture
- And a triad of symptoms:-
- Cognitive loss (dementia)
- Apraxia of gait
- Pee problems (urinary incontinence)
I have made a mnemonic for this triad. Since cephalus in hydrocephalus means head so here's a cap to cover it. Mnemonic- CAP
The main aim of treatment in this condition is to drain the excess of CSF. Surgical installation of ventriculoperitoneal shunt is the usual method which aims to drain csf into the peritoneal lining of abdomen from where it is easily absorbed.
- Jaskunwar Singh
Seasonal affective disorder (SAD) is common in winters months when days are short and nights are long. It is caused by abnormal melatonin metabolism and the patient presents with acute depressive and atypical symptoms.
Here's a mnemonic for atypical symptoms of Seasonal affective disorder.
A- Appetite increase
D- Decreased energy
Note: Treatment of this disorder includes exposure to bright light therapy. Melatonin tablets should not be prescribed in such cases.
- Jaskunwar Singh
Virchow triad is about the 3 reasons for Deep Venous Thrombosis.
So I remember it as,
H - Hypercoaguability
E - Endothelial damage
S - Stasis
Many people may have many mnemonics. But this is mine. Hope you find it helpful. :)
- Complicated appendicitis has a perforated or gangrenous appendix.
- Non complicated appendicitis has a non-perforated appendix.
The treatment plans are different too!
- Non complicated appendicitis needs an immediate appendectomy
- Complicated appendicitis need to go through an antibiotic course before going to an appendectomy.
S- Serotonin: helps initiate sleep cycle and promotes wakefulness.
A- Acetylcholine: levels are higher during REM sleep.
N- Norepinephrine: levels are lower during REM sleep.
D- Dopamine: high levels responsible for arousal and wakefulness.
- The regulation of levels of Acetylcholine and Norepinephrine is an important biochemical trigger for REM sleep. Higher levels of Ach and lower levels of NE means there is increase in the time period of Rapid eye movement phase of sleep cycle.
- Serotoninergic neurons are present in Distal Raphe nuclei which enhances wakefulness. Thats why the 5-HT activity decreases during NREM sleep and becomes silent during REM phase.
- Dopamine agonists, such as bromocriptine, pramipexole and others are used to treat parkinson's disease which work by acting on dopamine receptors and compensate for the lack of dopamine which the brain cells no longer produce. They are used together with levodopa. By increasing dopamine levels they restore the balance of Acetylcholine and dopamine thus increasing wakefulness.
- Antipsychotic drugs are dopamine antagonists. So they decrease wakefulness and increase sleep time of a person.
- Higher levels of Ach during REM sleep is associated with erections in men.
- Jaskunwar Singh
ok fine! How to remember it?
Think of the additional T that comes in syntheTase is from ATP! ;)
Got a way to memorize it?
Ok, back to our business! Ligases, what to they do? Obvio, they LIGATE! Or simply connect! But connect what?
Think of these guys as a Plumber who connects those pipes! ;)
- Synthetase - Formation of new bond between substrates using the energy from an ATP
- Synthase - Link two molecules without using the energy from ATP (Confusing with Synthetase? They use ATP. Check here for a memory aid.)
- Carboxylase - Formation of a new bond between a substrate and a CO2 using the energy from an ATP
- Racemase - Conversion of D isomer to L isomer or vice versa(Read about them here more in IkaN's article)
- Mutase - Conversion of one constitutional isomer into another. They shift one functional group from one place to another place within the same molecule.
ok the major subclasses?
- Dehydratase - Removal of H2O from a substrate (Confusing with Dehydrogenase?Read Part1)
- Decarboxylase - Removal of CO2 from a substrate
- Deaminase - Removal of NH3 from a substrate
- HYDRATASE - ADDING of H2O to a substrate
- Aldolase - Produces Aldehydes via elimination reactions
Wednesday, December 28, 2016
There are 5 major classes of Hydrolases. They always Hydrolyse means breaking it down with the help of H2O.
- Lipase - Hydrolysis of ESTER linkages of lipids
- Protease - Hydrolysis of AMIDE linkages of proteins
- Nuclease - Hydrolysis of SUGAR PHOSPHATE ESTER linkages of Nucleic Acids. Phosphodiesterases also do the same
- Carbohydrase - Hydrolysis of GLYCOSIDIC bonds of Carbohydrates
- Phosphatase - Hydrolysis of PHOSPHATE ESTER bonds.
Transferases, do Transfer! But transfer what? There are two major types of Transferases!
- Transaminase --> Transfer of an Amino group between substrates
- Kinases --> Transfer of a Phosphate group between substrates often from ATP
- Methyltranferase --> Tranfers single-carbon units between substrates
- Phosphorylase -->Transfers inorganic phosphate to a substrate
What does Kinase even mean? It comes from the greek work Kinein means "To move". It originally had nothing to do with Phosphates. But now we almost exclusively use this for Phosphate transfers. :)
There are 5 main types of Enzymes in this category. As the name suggests, two of them are Oxidases and Reductases. The other ones are Dehydrogenases, Oxygenases and Peroxidases.
- Oxidases --> Oxidizes a substrate
- Reductases --> Reduces a substrate
- Dehydrogenases --> A double bond is introduced to the substrate, by removal of two H atoms. The H are accepted by a Coenzyme.
- Oxygenase --> Directly incorporates Oxygen into the substrate
- Peroxidase --> Uses Hydrogen Peroxide H2O2 as an electrone acceptor
Question? Yes! Removal of Hydrogen and adding of Oxygen are also considered a type of Oxidation because it increases the oxidation number of the substrate! Pre-Med Organic Chemistry anyone? ;)
See you soon with the other categories guys!
P.S. - Don't confuse Dehydrogenase with Dehydratase!!! We go through that here:)
People who have night terrors are often misdiagnosed, nightmares being the most common. Post traumatic stress disorder is another common misdiagnosis (in adults).
Recent research suggests that getting an extra sleep for 30- 40 minutes a night reduces both nightmares and night terrors to a great extent.
Scheduled awakening therapy-
Another treatment strategy (for night terror) is "Scheduled awakening therapy". It involves waking the person from sleep 15- 30 minutes before the episodes typically occur so that the cycle is interrupted and prevent the onset of the night terror. But the child is not to be fully awaken in the middle of the night.
Thats where the idea of sleep guardian came from. The sleep guardian plans smartly and finds a right time to partially wake up the child and vibrate each night (for less than 3 minutes). This prevents the episode of night terrors and sleep is not actually totally disturbed.
This method of prevention of night terrors has shown 90% positive results within first week with 80% fewer night terrors after four weeks of use.
- Jaskunwar Singh
Hello awesome people !
Today's topic is - ADAMANTINOMA ! (and no it's not what would only happen to Wolverine! Haha see what I did there ?! )
1)Also known as Ameloblastoma (Ameloblasts are enamel forming cells), Eve's disease (looks like ADAM & EVE had a tiff over who'd name it, and clearly it was a draw! :p)
2) Its a benign tumor, but behaves like a malignant one, it metastasizes to lungs. (so wanna be)
3) Sites : #Mandible (most common site) (anyone else going weak in the knees seeing Hugh Jackman's jawline?, cool now you'll remember it better!)
Talking of knees, #Tibia is the 2nd most common site !
#Pituitary because the stalk of pituitary and enamel arise from oral epithelium
3) Slow growing tumor, with multiple cystic spaces...patients often complain of falling teeth or fracture mandible :(
4) X ray shows a "Honeycomb" appearence
5) Treatment? Well since this tumor is very "Adamant" simple curettage will cause recurrence, hence we do a wide excision (1cm margin)...Sometimes a Hemimandibulectomy may have to be done! (Sounds like what Wolverine would do to his enemies!)
All the Wolverine fans put your hands up and read this again !! :p
That's about it !!
Nerve root :C7-T1.
Key points :
On the back of medial epicondyle of humerus ulnar nerve can be palatable it produces tingling sensations Hence humerus is called as "Funny bone".
Ulnar nerve is not a content of Cubital fossa .
Remember:Ulnar nerve supplies total 15 muscles in hand!
4 hypothenar eminence ,medial 2 lumbricals ,4 dorsal and 4 Palmer interossei and ADDuctor pollicis
Forearm(Read carefully don't get confused)
Medial half of flexor digitorum profundus(Thinking about lateral half ??!!! Well ,it is supplied by Median nerve )
Flexor carpi ulnaris (Thinking about extensor carpi ulnaris ?! Read carefully ,Supplied by radial nerve)
2)Ulnar nerve lesion at the wrist :Ulnar claw hand which shows
a)Hyperextension at metacarpophalangeal joints and flexion at the interphalangeal joints ,involving ring and little fingers (Little finger is held in extension by extensor muscles )
b)Sensory loss is confined to the medial one third of the palm and medial one and a half fingers including nail bed .Medial half of dorsum of hands also shows Sensor loss
c)Vasomotor changes :Skin is warmer due to arteriolar dilation ,it is also drier due to absence of sweating because of loss of sympathetic supply.
d)Trophic changes:Long standing cases of paralysis lead to dry and scaly skin .The nails crack easily
It should be noted that median nerve lesions are more disabling.In contrast ,Ulnar nerve lesions leave a relatively efficient hand
Here's the mini contents page for ENT instruments, this post is linked to the main contents page :)
Tuesday, December 27, 2016
Pulmonary complications- HE CAL BOB
C- Cor pulmonale
A- Aspergilloma/ Atypical MTB
L- Lung calcification
O- Obstructive pulmonary disease
B- Bronchopleural fistula
Extra- pulmonary complications- PALE
P- Poncet's polyarthritis
A- Anorectal fistula/ Amyloidosis
E- Empyema necessitans/ Enteritis
- Jaskunwar Singh
Monday, December 26, 2016
This viral infection is associated with a previous childhood exposure to varicella zoster (chickenpox) which remains hidden within and becomes active later in life when immune functions of the body weaken.
P.S. - Special thanks to Krupal Patel in Medicowesome Whatsapp group who brought picture to our attention! :)
Urge to move legs
Symptoms begin with rest
Relief on movement
Disordered dopamine function in association with abnormal iron metabolism
Iron for IDA
Membranous conjunctivitis: severe form
Beta- hemolytic streptococci
Stevens- Johnson syndrome
- Lid swelling
- mucopurulent bloody discharge
- white membrane
- easily peel off without bleeding
- Lids are hardened
- semisolid exudates: result in necrosis of conjunctiva and cornea
- difficult to peel off
- associated with bleeding from the undersurface
Important points to be noted:-
- The membrane forms more commonly over palpebral conjunctiva beginning from the edge of lid.
- There is enlarged preauricular lymph nodes with suppurative discharge.
- Marginal corneal ulcer due to secondary infection (especially streptococci).
- high risk of symblephron (adhesion between palpebral and bulbar conjunctiva)
- Penicillin (10,000 units/ ml) is the doc for acute diphtherial infection. Systemic administration and a quick injection of anti- diphtheritic serum (4,000- 10,000 units BD)
- Removal of the membranes is not advised because of the risk of adhesion (symblephron).
- Local and systemic administration of bacitracin and penicillin is recommended in case of streptococcal infection.
Vitamin A toxicity
Signs and symptoms:
Sixth nerve palsy
Visual field defects
To rule out space occupying lesions - CT / MRI normal
Most accurate - Lumbar puncture with opening CSF pressure measurement
Why does increased ICP cause 6th nerve (Abducens) palsy?
Increased ICP can result in downward displacement of the brainstem, causing stretching of the sixth nerve secondary to its location within Dorello's canal.
Sunday, December 25, 2016
I was reading treatment for MS today.
Do you want to remember the disease modifying therapies for relapsing forms of multiple sclerosis?
Here's a mnemonic! "Ms is Nat (not) glad. All terrified by mighty ox with fuming fungus."
Multiple sclerosis (Ms)
Glatiramer acetate (Glad)
Alemtuzumab (All terrified)
INF beta (By)
Mitoxanthrane (Mighty ox)
Dimethyl fumarate (Fuming)
Remember, for acute attacks, use Glucocorticoids.
So I needed another mnemonic for neurofibromatosis because my first mnemonic wasn't good enough xD
This time, the mnemonic is NODES!
Merry Christmas everyone!
Neurofibromatosis type 1 old mnemonic: http://www.medicowesome.com/2014/10/neurofibromatosis-1-mnemonic.html
Mnemonic :: *Great Girls Wont Buy Red Yellow Bags*
*Kit 1 - Grey*
*Kit 2 - Green*
*Kit 3 - White*
*Kit 4 - Blue*
*Kit 5 - Red*
*Kit 6 - Yellow*
*Kit 7 - Black*
*Kit 1 is GreaT*
*Kit 2 is Green*
_*BV CA Green TV*_
Coz no self respectingan would buy a green TV...he'll buy it out of love for wife😜😜😜
*Kit-3 is ABC*
For Chancre and chancroid
Also notice C is 3rd letter and 3 letters ABC in the mnemonic for Kit 3
*Kit - 4 Remember that if you forget this then its BAD*
Azithral coz allergy to penicillin
*Kit - 5 is Red as in Mnemonic*
Remember that Red is for love and love is *Her* eyes and smile
*Kit - 6 is Yellow as in Mnemonic*
Yel *low* for *low*er abd pain
*Kit - 7 is Black* coz last colour is the colour palate also BLAC
Since I have written posts regarding the association of vitamin D deficiency with certain neurological disorders previously, I am here again with one more addition into the box (on sincere request of our main author IkaN.. :p ).
Saturday, December 24, 2016
Thursday, December 22, 2016
M- Mood swings
E- Excess sweating
A- Adrenal fatigue
B- Blood pressure changes
L- Lips tingling
I- Increased appetite/ hunger
S- Shakiness (tremors)
M- Muscle pain
- Jaskunwar Singh
10 years ago,only a few would have thought that a device in our pockets would be good enough to access all the information of the world, would do social networking, calls, would calculate, act as a torch and what not.
We today are on a similar brink ofrevolution in genetic engineering, where the effects would be so magnificent that they would need to be measured on a Richter scale!
Enter CRISPR, which is an acronym for 'clustered regularly interspaced shortpalindromic repeats', a crispy new technology which promises to shrink the costs involved in genetic engineering by 90%, makes the procedure easier andshorter.
*What is it?
We have managed to hack an antibacteriophage mechanism in bacteria to our advantage.
Only a few bacteria survive bacteriophage invasion. To protect themselves from a further invasion, they store a part of the phage DNA into their archives.
When another attack does occur, an RNA copy of the archived phage DNA is presented to what is known as a CAS 9 protein.
CAS 9 compares the two copies, one from the foreign DNA and the other from the archives, and is very precise at that.
If it finds a 100% match, it cuts off thenew phage's DNA, thus rendering the attack a big embarrassment for the bacteriophage. :-p
*What can we do with it?
Oh, a lot of awesome things!
-Pissing off viruses
In 2015, scientists armed with CRISPR achieved a significant reduction of HIV load from patiens.
This year, in mice, they slashed off 51% HIV DNA from mice, just by a couple of shots in their tails!
*Making cancer re evaluate its careerchoice-
Malignant cell detection by the immune system can be enhanced.
A lot of desirable traits- super awesome eyesight, superman esque strength and so on, can be selected from a wide palette during embryogenesis.
*Bidding adieu to genetic diseases
*Making ourselves look hot at 120-
CRISPR holds the potential to slow and even reverse ageing! We can take a leaf off the books of certain aquatic species who already are doing that.
.. and a lot more.
*The last word
A few controversies sorround though.
- We don't know if any adverse
reactions may triggered, as our
knowledge is still just the tip of the
- Some powers like say dictators
might use it to gain precedence.
- The fear of genetic pollution.
Anyway, these are just hurdles which we need to plan and overcome for a glorious future for humanity!
Wednesday, December 21, 2016
these two are the most commonly asked questions within bullous diseases.
the major difference you need to know is
pemphigus vulgaris- bullae are suprabasal. hence these are not tense and rupture easily..not very common in a clinical case for you to find a bulla
bullous pemphigoid- bullae are subepidermal..and hence tense.
a mnemonic..like a bull..bullae in Bullous pemphigoid are tough and stronger
There are outer 5 layers. So the outer ones start with 'O' in the first letter. And the inner 5 layers initiate with 'I' in the first letter.
- Jaskunwar Singh
Hope you are enjoying Medipicsowesome!
Adams–Oliver syndrome (AOS) is a rare congenital disorder characterized by defects of the scalp and cranium (cutis aplasia congenita), transverse defects of the limbs, and mottling of the skin.
The baby has a defect in the frontal and parietal bone and terminal limb defects in the legs.
This is Shubham Patidar . Today I am posting my notes on Serological and Viral Markers of Hepatitis B Infection in concise and simple way. This is very important short note ask in pharmacology, pathology, community medicine, medicine , microbiology, in undergraduate theory exam . and mcq comes in post graduate medical examinations.
Enjoy Learning !
That's all !
Tuesday, December 20, 2016
Hi everyone !
So this is another short post about 'Past pointing'. I hope you don't consider it pointless to discuss this. (I know, play along.)
There are a few tests called 'Finger-Nose-Finger' test and 'Finger-Nose' test. These detect how controlled and precise your movements are.
Say, for example , I ask a patient to touch my finger (which I place directly in front of him), then touch his own nose and touch my finger once again.
A normal person should be able to do this correctly and accurately.
However, in lesions of at least 2 structures of our body , the patient's finger overshoots the examiner's or can't seem to reach it correctly.
This is called 'Past Pointing' , as the patient shoots past the destination point.
2 important lesions where you get this are :
So, in a Cerebellar lesion things are very straight forward.
You'd get pastpointing only on the side of the lesion as only that side has become stripped from the cerebellar control. The other side has intact Cerebellar control.
Cerebellum = Same side Past Pointing.
Cerebellum is Single and Lonely
The Vestibular System defects are slightly more complex and also very controversial. So irrespective of which side you try, you'd get Bilateral past pointing in a Vestibular lesion.
Such a pastpointing is generally more prominent on the side of the Slow Component of the nystagmus produced (Whatt?). Yeah. Also, the Slow side of nystagmus and the side of past pointing are also the same as the side to which you'd lose your balance in a Vestibular disorder !
So Remember :
My SLOW Vestibular friend FALLS to pointy end but can Swing BOTH ways .
So Slow Component of nystagmus , and Falling during gait testing would be present and Pointing would be towards the same side too.
But Past Pointing can Bilateral (Swings both ways).
Hope this helps. Let me know how I can improve it!
Happy studying ! :)
Cough is a common symptom that may be associated with an infection of upper respiratory tract, which if not given attention to can progress to a life- threatening chronic disease! Normally, its just a common reflex that helps clear mucus off from the throat and the upper airways. But there are certain variations in the presence and progression of cough. So what is your cough trying to tell you about your health? Let's know about this...
Hi everyone. This is just a short post to help you remember the functions of the Vestibular System. Memorising this always gives me a vertigo. ;)
The Vestibular System has 2 components :
1. Semicircular canals
2. Utricle and Saccule.
So the Vestibular System detects the following :
Angular Acceleration/Rotational movements.
Position of Head in space.
So the Semi circular canals are concerned with Angular Acceleration. You can remember that as :
Circle = Rotates ; So SCC detect Rotational movements or Angular Acceleration
The rest are functions of Utricle and Saccule.
Remember : GPL - Girls Premiere League.
For : Gravity, Position of Head and Linear acceleration.
Now remember :
Saccule - NOT Sleeping line. So Vertical movements.
Utricle - Horizontal (since sleeping line was not Saccule it will be Utricle)
Another way would be "UHH' Utricle for Horizontal.
Hope this helped you.
Happy studying ! :)
Step 3 is elaborated in detail here:
First post of Medipicsowesome. Yaay!
Thanatophoric dysplasia (TD) is a lethal skeletal dysplasia. It is the 2nd most common lethal skeletal dysplasia after osteogenesis imperfecta type II.
It is characterized by extremely short limbs and folds of extra (redundant) skin on the arms and legs.
Other features of this condition include a narrow chest, short ribs, underdeveloped lungs, and an enlarged head with a large forehead and prominent, wide-spaced eyes.
Type I thanatophoric dysplasia is distinguished by the presence of curved thigh bones and flattened bones of the spine (platyspondyly).
Type II thanatophoric dysplasia is characterized by straight thigh bones and a moderate to severe skull abnormality called a cloverleaf skull.
This baby seems to have type II thanatophoric dysplasia.
The condition is uniformly fatal within a few hours of birth either from respiratory failure or from brainstem compression from a narrow foramen magnum.
This baby died a few hours after birth.
Cool fact: The term thanatophoric derives from the Greek words "thanatos" meaning "death" and "foros" meaning "bearing/carrying/bringing".
The Medicowesome family has decided to create a library of medical pictures. Excited? =)
We are going to label all these posts as Medipicsowesome.
It'll contain pictures of specimens, diseases, instruments, etc.
Since we wish to avoid copyright issues, we will be taking permission for most pictures / giving credits from which they're taken. If a picture belongs to you and you do not wish to see it uploaded on the site, email us at firstname.lastname@example.org and we will take it down immediately.
I have taken permission from the patients for pictures clicked in my wards, explaining they'll be uploaded on the blog for medical students to learn. Only after their permission, I have uploaded the pictures. To maintain confidentiality, I will blur eyes / faces too.
If you want to share cases you've seen on Medipicsowesome, we'll be happy to upload it. Just email us the picture with a description and make sure you have the permission of the patient!
Subject: Medipicsowesome submission
The idea was come up by all authors, especially, Sakkan. Thanks for the encouragement everyone else! < 3
Monday, December 19, 2016
Root value :C5-T1
1)Median nerve is most medial content of Cubital fossa
In Cubital fossa it gives 3
Branches to flexor muscles
Remember this mnemonics
Feel Climate (in) Rajasthan,Days (in) Singapore (in) PLs
Flexor carpi radialis .(FELL CLIMATE -Rajasthan)
Flexor digitorum superficials(Days
Palmaris Longus (PLs) .
In forearm it gives Anterior interosseous branch which supplies:-
1)Lateral half of flexor digitorum profundus (Well,medial half is supplies by ulnar nerve)
2)Pronator quadratus(my Fav!)
3)Flexor policies Longus(Extensor policies Longus and brevis both supplied by radial nerve)
In arm ,median nerve supplies 5 muscles !
3 thenar muscles ,(Abductor pollicis brevis ,flexor pollicies brevis ,opponens pollicis )
Lateral 2 lumbricals!
1)Known as labourers nerve /eye of hand
2)Pointing index finger occurs due to paralysis of long flexors of digit .
3)Ape or monkey thumb deformity if thenar muscles are paralysed
4)Must know carpal tunnel syndrome(Happens when median nerve is trapped )REMEMBER Skin over the thenar eminence is not affected as the branch of median nerve supplying it arises from forearm
5)FROMENT's.sign/Book holding test &paper holding test is done to test median nerve .
6) Complete claw hand when Ulnar and median nerves are paralysed.
Sunday, December 18, 2016
Hyperplasia means increase in the cell number.
It tends to occur only in organs where the cells retain the ability to divide. It can be physiologic or pathologic.
The morphology of the organ on gross or the cells on microscopy does not differ in physiologic or pathologic hyperplasia. What differentiates the two is the inciting stimulus.
for eg- Breast/ Endometrial hyperplasia is a feature of pregnancy as well as in certain hormone producing tumors of the ovary. The tissue microscopically, only shows increased number of mature cells. However, the hyperplasia that occurs due to pregnancy (physiologic) process is labelled as "Physiologic" while that which occurs due to ANY pathologic process is labelled as
Hey! Here's a case kinda thingy that I made up.
An HIV positive male presents with loss of recent memory and left sided paralysis. A CT scan is done. What are the differentials based on the CT findings given below?
1. Multiple ring enhancing lesions
2. Single, periventricular ring enhancing lesion
3. Cerebral atrophy with secondary ventricular involvement
4. Multiple non enhancing white matter lesions
Answers given below
1. Multiple ring enhancing lesions - Toxoplasmosis. TMP SMX for prevention!
2. Single, periventricular ring enhancing lesion - CNS lymphoma. Usually, positive for EBV.
3. Cerebral atrophy with secondary ventricular involvement - AIDS dementia complex. Though paralysis would not be a feature. Only defects in short term memory and executive function is seen.
4. Multiple non enhancing white matter lesions - Demyelination of subcortical white matter suggestive of progressive multifocal leukoencephalopathy is caused by JC virus.
Saturday, December 17, 2016
Riluzole is a glutamate inhibitor which is used in Amyotrophic laterla sclerosis.
How to remember this?
Unnecessary mnemonic #521
Rilu glues all.
Rilu - Riluzole
Glues - Glutamate inhibitor
Al - ALS
I'm sorry, that was a terrible mnemonic. Forget ice bucket, I'd win the pathetic mnemonic bucket challenge :P
Thursday, December 15, 2016
This new technique in radiotherapy is revolutionising the world of treatment in oncology. The technique is largely unheard and my intention of writing the post is to share it with a maximum number of people.
Invented by John R Adler, Peter and Russell Schönberg in 1990, 'CK' is about targetting radiation with a high accuracy to neoplastic tissues.
A linear accelerator of 6MV delivers X ray radiation of 6-800cGy while a robotic arm maneuvers the 'linac' around the body of the patient so that most of the neoplastic cells are irradiated. An accuracy of 0.5 mm is maintained during the process.
For ensuring such level of accuracy, tissue tracking is needed. There are different methods of tracking for bones, lungs and viscera. For soft tissues like pancreas, gold fiducials(hair like implants) are inserted so that the movement of the tissues as the patient breathes can be identified accurately.
About 1-5 sessions are needed depending upon the pathology. There's no anaesthesia and long treatment hours involved, unlike surgery. Plus, the procedure is significantly cheaper than say, Whipple's pancreaticoduodenectomy!
I have an exam soon and I was struggling with this, so, I made this up!
To remember causes of Acute Pancreatitis, you need to think of none other than your nursery school days! :P
So, here we go- ABCDEFGHI, (oh wait did I just say "HI" :P)
Now going a little off track, but, when I was small I used to do a lot of gardening, so I remember rest of the causes as Me POT.
Alcohol ingestion (acute or chronic)
Connective tissue diseases- SLE, TTP, PAN
Drugs- diuretics- frusemide, thiazide. (Others are anti retroviral drugs, sulphomamides, tetracycline, tamoxifen, etc)
Hereditary Pancreatitis/ Hyperparathyroidism/ hypercalcemia/ Hypertrigylceridemia
Metabolic conditions - renal failure,
Penetrating Peptic Ulcer
Trauma to abdomen
Phew, a long list. Isn't it?
Hope it helps!!
Recently during surfing on net ,i came across very interesting topic of surgery -Head transplant ,would like to share with you all people
World's 1st attempt to transplant a human head was launched in year 2015 at a surgical conference in united states.
Procedure was 1st put forward by Sergio canavero -an Italian neurosurgeon.
The actual procedure will be as followed :
Two teams will work in concert making deep incisions on patient's neck exposing vital arteries, veins and nerves ,next step is the most crucial step of cutting spinal cord using $200,000 diamond nanoblade !.
Head is than moved on to donors body and spinal cord can be fused together using polyethylene glycol to encourage the fat in cell membrane to mesh out once the neck is transplanted
and then patient would then be placed into a coma for about a month to prevent movement and to allow healing procedure
while implanted electrodes provide regular electrical stimulation to spinal cord finally when patients wakes up from coma he will be able to see his face and speak !!!! But will need a physiotherapy for 1 year to begin walking .
Dr sergio canavero said that surgery would be ready in 2017 probably .
A computer scientist Spiridonov with Werdnig-Hoffman disease has volunteered to offer his head to study as he is suffering from incurable spinal muscular atrophy and has decided to give one final shot to have a new body !
This instrument is used to lower down the tongue and hold it while the Davis mouth gag serves to hold the mouth open during tonsillectomy and other oral procedures. it comes in various sizes and used depending upon the age of patient.
The mouth gag is held in position by using the Draffin bipod stand which consists of two rods.
- Jaskunwar Singh
Used in tonsillectomy to grasp the tonsils and pull medially. (dissection method)
The shaft is bent at an angle towards the handle. Ends of this instrument are cup- shaped with holes.
- Jaskunwar Singh
Used in Submucous resection (SMR) and septoplasty procedures.
It helps keep mucoperichondrial flaps away to make space for proper access and vision to the interior of nose and perform surgery efficiently.
IMPORTANT: In septoplasty, the flap is raised only on one side while in SMR, both sides flaps are raised. So due to cosmetic reasons and high risk of septal complications, septoplasty is preferred over the submucous resection.
- Jaskunwar Singh
A 7 year old boy is brought to you. He is intellectually disabled. On examination, you notice hyperextensible joints. Large hands, large feet, protruding ears, elongated face are also seen. The patients testes are large in size compared to his age. Diagnosis?
Ehler Danlos syndrome
Fragile X syndrome
It's Fragile X syndrome. Why isn't it's Marfans? Because Marfans has normal IQ.
Here are my notes + mnemonic for Fragile X syndrome.
Did you know?
Fragile X is the most common cause of inherited mental retardation.
It was the first trinucleotide repeat disorder to be recognized.
Uses: to correct lateral deviation of fractured nose and disimpaction
Most students get confused between Walsham's forceps and Asch's forceps. The difference is in the structure of the instruments itself.
Walsham's forceps: paired instrument used for reduction of nasal bone fractures. One nasal blade is placed externally while the other blade goes into the nose and supports the nasal bone.
Also, the blades are not elevated in walsham's forceps as in the case of asch's.
Asch's forceps: unpaired instrument used for reduction of nasal septum and vomer fractures. It is used along with Walsham's forceps for the reduction procedures. The blades are elevated. (ASCh = Ascending)
- Jaskunwar Singh
Used to widen the tracheal incision to aid in the insertion of
Remember: It is curved at its ends so that it doesn't block the field of vision of the surgeon while making the incision and insertion of the tube.
- Jaskunwar Singh
Uses: Examination of external ear and tympanic membrane
In operative procedures like myringoplasty, myringotomy.
Removal of wax, foreign body, otomycosis, ear discharge.
Different sizes for patients according to age.
- Jaskunwar Singh
Straight forceps (Birkitt's tonsil artery forceps) used to catch the bleeding point. (in tonsillar fossa) following tonsillectomy.
|Birkitt's first tonsillar artery forceps|
|Wilson's second artery forceps|
- Jaskunwar Singh
The septum is grasped with the blades of this instrument and straightened to make proper alignment.
The blades are elevated. Remember ASCh- Ascending.
The instrument is often confused with Walsham's fracture. Both are used in reduction procedures of fractures of nasal septum.
To know about differentiating features, click here.
- Jaskunwar Singh
Used to examine external nose.
There's a specific technique to hold this instrument during examination of the patient. Its really simple but if you don't practice to hold it, you will forget it for sure.
Keep your ring finger beneath one arm of the speculum and index finger in between the two arms. Press the other arm with middle finger such that the two lower ends meet.
Here's the picture of the right way to hold it.-
Wednesday, December 14, 2016
Today its a short post ( a mnemonic actually ;p ) on the principles of primary health care. (I was asked in SPM viva a few days back. ;p )
As a rule, always find a mnemonic in the name itself, I took care of it and made it in the easiest way possible. So here it is ..
C- Community participation
A- Approach (multi- sectorial)
R- Right technology (appropriate)
E- Equitable distribution of health services.
Happy Medicowesome :)
- Jaskunwar Singh
Tuesday, December 13, 2016
I'm clearly doing a lot of notes + mnemonic posts. Here's another one on Langerhans cell histiocytosis!
L - Lytic lesion of bones
I - Diabetes Insipidus
N - Nil
G - Eosinophilic Granulomas
E - Exophthalmos
R - Rrrrr.... :P
S - Skin rash
From study group:
Any mnemonic for Hand Schuller Christian disease?
Mnemonic by IkaN: Hands LIE
Lytic bone lesions
Insipidus (Diabetes Insipidus)
Mnemonic by Dev: CDE
Calavarial skull defect
Disclaimer: It's a morbid mnemonic. If you are sensitive and religious, don't read it.
Mnemonic by Vinayak: Jesus CHRIST was killed by hammering nails into his HAND, he DIed, his hands' bone got LYSED and we celebrate EXmas:
For calvarial skull defects, you know, wood was also hammered into his head. DI is diabetes insipidus. EX is exophthalmos.
Monday, December 12, 2016
So basically, ECG is an electrical representation of heart activity on ECG paper.
Here are some important postulates of ECG paper:
The needle of galvanometer travels 300 big squares in 1 minute or 60 seconds.
That makes 0.2 seconds for each big square.
In turn each big square is divided into 5 small boxes /squares.
So we get each small box counting about
So let's review all calculations:
1 Big square = 0.2 seconds.
1 small square = 0.04 seconds.
Each P wave travels about 2 and 1/2 small squares making upto 0.1 second.
The segment PQ (Sometimes we use PR) again takes 2 and 1/2 small squares making upto 0.1 second.
QRS complex used another 2 and 1/2 small squares making another 0.1 second.
While S-T segments uses 10 small squares forming using 0.4 seconds.
Note: We normally consider 2 and 1/2 small squares but there can be 2 or 3 small squares.
Sunday, December 11, 2016
Here's another notes + mnemonic post on Friedreichs Ataxia
- Due to mutated frataxin gene
- GAA trinucleotide repeats
- Autosomal recessive
- Mitochondrial iron accumulation due to loss of iron transporter coded by frataxin gene results in oxidized intramitochondrial iron accumulation.
- Cardiomyopathy is the most common cause of death in FA. Cardiomegaly, conduction defects, murmurs, fibrosis are seen.
- Musculoskeletal abnormalities like foot deformities (Hammer toe, pes cavus, pes equinovarus) and scoliosis is seen.
- Diabetes mellitus is seen in 20% of patients
- Ataxia of trunk and limb movements.
- Loss of proprioception and vibratory sense.
- Extensor plantar response, absence of deep tendon reflexes and weakness is found.
Mnemonic: Friedreichs FRIEDS!
In this post, I wanted to emphasize duodenal atresia is associated with double bubble sign.
It's common in Downs syndrome and polyhydramnios maybe seen in utero.
Bilious vomiting is seen because the obstruction is after the ampulla of Vater.
Because the child is vomiting, abdominal distension is not seen.
I need sleep right now.
Hi everyone! I'm back with a note. This time on the Sustainable Development Goals (SDG's).
This is a crisp summary of what we need to know about them as Doctors or Health Care Practitioners (in any part of the world). They're so important that a major chunk of the Coldplay concert in Mumbai was based on them. (And every other person spoke about them. How Magic-al).
And they're Also very important for the Community Medicine students from India. So here goes :
SDG's were adopted by nations of the world on 25th September, 2015 to be achieved till 2030.
They want to do 3 P's.
Bring Prosperity to all and
Protect the planet.
A. The important Health related Goals :
(Mnemonic by our IkaN)
pH HE EWE
(HE EWE as in Adam and Eve)
3 Health care
B. Goal 3: Ensure Healthy lives and Promote Well Being.
Remember: BAMS VIP
Baby Adult Mother Sex.
(OR : Adult and Mother have Sex to get Baby)
Vaccine. Infections. Pollution.
- Neonatal Mort - has 12 letters , so to be reduced to less than 12 by 2030.
- Under 5 Mortality Rate - 5*5 = 25. So less than 25 by 2030
- Decrease the burden of NCDs to one third of present.
- Mental health burden to be reduced. Tobacco control.
- Drug abuse to be tackled.
- Maternal Mortality to less than 70 per 1 lakh world wide.
- Sexual health and reproductive health strengthening.
- Promote and develop.
- Tackle TB HIV Malaria Other tropical diseases Diarrheal diseases.
- Air, Water, Soil, Noise pollution to be tackled.
Kudos to IkaN who helped me out of this tough spot. This was a life saver and you're the best :* :)
Hope this helps everyone.
Until next time.
In this post, I'll talk on how to to differentiate transient synovitis from septic arthritis.
Transient arthritis is non specific inflammation of the synovium, related to infection or trauma.
Septic arthritis is bacterial infection of the synovium of the joint.
Modified Kochers criteria can help distinguish the two.
Fever > 38.5
ESR > 40 mm/hr
WBC > 12,000 cells/mL
CRP > 20 mg/dL
Inability to bear weight on the affected limb
More the criteria, more likely the child has septic arthritis.
Here's a mnemonic for modified Kochers criteria: FEW Can Bear Kocher!
Fever, ESR, WBC, CRP, weight bearing.
Acute transient synovitis is the most common cause of painful hip in a child younger than 10 years. It is a diagnosis of exclusion and can mimic Osteoarthritis, Legg Calve Perthes disease, SCFE.
Treatment: Rest, anti inflammatory agents.
Saturday, December 10, 2016
Here are my notes + a mnemonic
Congenital myotonic dystrophy
- Autosomal Dominant
- CTG trinucleotide repeat
- Genetic anticipation seen
- Hypotonia "floppy infant"
- Hollowing of temporal bones
- Tenting of upper lip
- Respiratory muscle weakness
- Posterior subcapsular cataracts (Subcapsular spokes in stellate conformation)
Juvenile myotonic dystrophy
- Facial and upper body weakness (Hatchet face due to temporalis, masseter, facial muscle atrophy; frontal baldness)
- Inability to relax muscle (Sustained grip)
- Heart block
- Congestive heart failure
- Intellectual impairment
- Gonadal atrophy
- Posterior subcapsular cataracts
- Thenar, hypothenar muscle atrophy (Myotonia evident on percussion)
- Tongue depression
Hello! Here are my notes + mnemonic on HSP.
IgA-mediated vasculitis of small vessels (IgA and C3 in skin, renal glomeruli, and gastrointestinal tract).
Most common cause of nonthrombocytopenic purpura in children.
Usually follows an upper respiratory infection.
Clinical features are:
Maculopapular rash below waist (Progresses to petechiae to palpable purpura).
Friday, December 9, 2016
Here's an old mnemonic on some of the clinical features of Rheumatoid arthritis.
Well, the name itself tells it.. RHEUMATOID ;p
R- Respiratory distress (Interstitial lung disease, bronchiolitis, pleural effusion)
H- Haematological manifestations (anemias, thrombocytosis, neutropenia)
E- Extra- articular RA (ExRA)
U- Urinary tract infections (mainly drug- induced)
M- Median nerve compression/ Morning stiffness
T- Tenosynovitis and bursitis
O- Ocular manifestations (Keratoconjunctivitis sicca, scleritis, episcleritis)
I- Immunologic manifestations (Sjogren's, Felty's and Caplan's syndrome)
D- Deformities (boutonniere, swan- neck, button- hole)
Thats all :)
- Jaskunwar Singh
3 month old baby with history of honey intake (Given by grandpa) presents with constipation, feeding difficulty, hypotonia. What is the cause of the baby's symptoms?
1. Ingestion of preformed toxin
2. Ingestion of pesticide
3. Ingestion of bacterial spore
4. Bacterial infection of the meninges
5. Urinary tract infection
Answer given below:
If you picked 1, you're wrong.
Infant botulism is caused by botulinium spores in honey, corn syrup that germinate and multiply in the intestinal tract and produce toxin.
Adult botulism is caused by ingestion of preformed toxin.
I just wanted to make that point clear. And emphasize how tricky any exam can get with word play.
That's all! =)
Oh and the answer is 3.
Thursday, December 8, 2016
Many medicowesomites have asked about how to apply for their USMLE exams. Finally, here is the procedure. Sorry this took so long
I have answered all the queries in the end.
If you have any more questions, comment in the commments section below and I'll try to reply :)
Wednesday, December 7, 2016
Here is another stigmata apart from those mentioned previously by IkaN in a post here,
Stigmata of infective endocarditis:-
(Remember- It's all in the hands)
- Janeway's lesions: non- tender, erythematous macules on the palms and soles.
- Osler's nodes: ephemeral spots of painful nodular erythema on hands and feet.
- Splinter haemorrhages: seen on the thumb of the patient.
- Jaskunwar Singh
There is damage to the optic nerve, etiology of glaucoma is yet to be known.
Here's a short post on important points in diagnosis of Buerger's disease (don't confuse the name with Berger's disease which is IgA nephropathy) also known as Thromboangiitis obliterans.
- Recurrent inflammation and thrombosis of small and medium sized vessels
- Hands and feet are affected the most
- Vasculitis and ischemia (causing blackish discoloration of skin)
- Chronic smoking (a definite predisposing/ risk factor)
Clinical features and diagnostic criteria:
- male patient 30-40 years of age
- history of chronic tobacco use
- Angiography: - cock- screw appearance of arteries of wrists and ankles
- tree root/ spider leg appearance due to collateral circulation
- Exclusion of other vascular diseases ( Raynaud's phenomenon, atherosclerosis, diabetes, hypertension, endocarditis, hypercoagulable states, auto-immune disorders) is important.
- Skin biopsy (rare)
Note: A possible Rickettsial infection (mostly Rickettsia rickettsiae) could be there which adds on to the pathology of the disease! (usually in cases of amputation of the affected area)
- Jaskunwar Singh
Supracondylar fracture of the humerus
- Transverse fracture of the distal part of the humerus.
- Bruises of anterior elbow (Proximal fragments buttons through the brachialis muscle)
- Posterior fat pad sign is seen in non displaced fracture of the humerus.
IMPORTANT: Assess radial and ulnar pulses because brachial artery can be compromised.
Tuesday, December 6, 2016
"Selena Gomez and Ke$ha both are young and have big hearts."
Selenium deficiency causes Keshan disease which is cardiomyopathy in young children. Also, singers like to dye their hair (Loss of hair pigment is seen in Selenium deficiency aka Keshan disease).
Submitted by Krutika.
Interesting fact: Keshans disease is thought to be caused by Selenium deficiency and coxsackie virus. It's common in places where selenium content in soil is low (China).
Thanks Krutika for the mnemonic =)
Monday, December 5, 2016
Brain abscess notes
Here's what I studied =)
- Direct spread (Paranasal sinusitis, otitis media, mastoiditis, dental infection)
- Head trauma or surgical procedure
- Hematogenous spread (Pneumonia, endocarditis)
- MRSA (Head trauma, neurosurgical procedure)
- Headache > 75% patients
- Fever only in 50% patients (Important: Absence of fever should not exclude the diagnosis)
- Focal neurologic deficits > 60% patients
- Other symptoms - Papilledema, nausea, vomiting, drowsiness, confusion
Hemiparesis - Frontal lobe abscess
Dysphasia - Temporal lobe abscess
Nystagmus, ataxia - Cerebellar abscess
- MRI is better than CT.
- Ring enhancing lesion with surrounding edema on neuro imaging studies is seen.
- Most accurate: Brain biopsy
High yield: Biopsy is essential to distinguish brain abscess from cancer and also to determine the precise organism.
Don'ts: Do NOT do a LP. CSF analysis doesn't contribute to diagnosis or therapy. Increases the risk of herniation.
Extra: Abscesses due to Listeria have blood culture positive > 85% of the time.
- Brain tumors (Cancer can give fever)
- Empirical antibiotics should be modified after results of gram stain and culture.
- Surgical drainage.
- Prophylactic anticonvulsant therapy (High risk [>35%] of seizures)
- Glucocorticoids are reserved for substantial periabscess edema and mass effect due to increased ICP.
- Serial MRI or CT scan monthly to document resolution of abscess.
All of you know that cholesterol is synthesized locally in brain as well as peripherally in liver, both separated by a line of blood-brain barrier. But what about the case of hypercholesterolemia and how it eventually leads to increased amyloid depositions. what is the ultimate link between high serum levels of cholesterol and the Alzheimer's disease?
Recently, while studying pharmacology, I came to know about the third system of ANS - Enteric nervous system, apart from sympathetic and parasympathetic systems .
Here is some information of ENS:
It consists of highly organized neurons situated in the wall of GI tract.
It mainly includes Auerbach's plexus and Meissner's plexus.
The most interesting point about ENS is this network receives preganglionic fibers from the parasympathetic system and from postganglionic sympathetic neurons.
ENS controls GI motility, secretions, mucosal blood flow.
ENS causes relaxation or stimulation of smooth muscles.
Non-cholinergic excitatory transmitters such as substance - P plays a modulatory role in controlling ENS!