Wednesday, August 31, 2016
Its a story about a guy who uses a "WILSON's" racquet to play tennis. And you all probably know this legend right?
Monday, August 29, 2016
Sunday, August 28, 2016
What is phimosis and paraphimosis?
Phimosis is constriction of the preputial orifice. In phimosis, the foreskin can not be retracted.
In paraphimosis, the foreskin can not be reduced back on the glans. It may cause a painful glans swelling going on to proceed to a gangrene.
I always mix up the two, so mnemonic!
Another mnemonic - Call Paramedics if paraphimosis because it's a surgical emergency.
This one was submitted by SG on our study group, "PAra is PAinful."
Say you have a hemodynamically unstable patient with a gunshot wound or blunt trauma to the RUQ.
Why shouldn't you simply suture and close deep liver lacerations?
Because of the risk of hemobilia and abscess formation.
Here's what a surgeon must do:
Saturday, August 27, 2016
Thursday, August 25, 2016
Wednesday, August 24, 2016
Monday, August 22, 2016
Sunday, August 21, 2016
Why do ferritin levels increase in Rheumatoid arthritis?
It is an acute phase protein.
The levels increase in serum as well as in synovial fluid. The rise is more in synovial fluid because of local production of ferritin in the inflamed joint.
Ferritin levels show a positive correlation with ESR, CRP, platelet count, and DAS score.
And a negative correlation with hematocrit levels.
Is there a difference of levels in inactive and active disease?
Yes, the levels are lower in inactive RA patients because of iron deficiency.
Synovial ferritin production in active RA leads to increase of ferritin in active disease.
Gold standards for diagnosis of iron deficiency in RA?
1. Bone marrow iron stain
2. Serum transferrin receptor analysis
What leads to high ferritin levels in SLE?
Ferritin synthesis is induced by interleukins IL-1, IL-6 and Tumor Necrosis Factor (TNF) alpha in hepatocytes. In SLE, there is defect in IL-1 production while IL-6 and TNF-alpha levels are increased. So, the high levels of ferritin are due to IL-6 and TNF-alpha. (IL-1 does not play a major role in the synthesis of ferritin)
The ferritin levels are correlated with ANA titre, anti-dsDNA titre, and SLEDAI score.
(No significant correlation with acute phase parameters and negative correlation with complement levels)
Saturday, August 20, 2016
Which nephrotic syndrome is associated with Hodgkins lymphoma?
Lymphoma usually causes membranous nephropathy.
But Hodgkins is a weirdo which minimal change disease.
Mnemonic: Kids get MCD usually, so "Hodgkid"
Mnemonic by DJ AweSpear sent to us in our study group. Thanks!
Difference between fall of fever by crisis and fall of fever by lysis ?
In fall of fever by crisis, there's sudden decrease in temperature (Mostly due to treatment).
In fall of fever by lysis, reduction in temperature occurs gradually.
Typhoid fever falls by lysis.
(Step ladder pattern!)
Dengue fever falls by crisis.
Thursday, August 18, 2016
This post is from the authors diary.
Tuesday, August 16, 2016
Sunday, August 14, 2016
Saturday, August 13, 2016
A 32 year old male patient came to the Psychiatry OPD complaining that his wife wanted to kill him. He was asked why he didn't report to the police , to which he said they were not ready to believe him.
He was suspected of having a delusion of persecution.
Saturday, August 6, 2016
Never correct sodium too quickly.
If you correct hypernatremia too fast, it'll result in cerebral edema. Why?
When hypernatremia is corrected too rapidly, cerebral edema results because the relatively more hypertonic ICF accumulates water.
If you correct hyponatremia too fast, it'll result in central pontine myelinolysis (CPM) aka osmotic demyelination syndrome. Why?
Chronic hyponatremia is associated with the loss of osmotically active organic osmolytes (such as myoinositol, glutamate, and glutamine) from astrocytes, which provide protection against brain cell swelling.
However, organic osmolytes cannot be as quickly replaced when the brain volume begins to shrink in response to correction of the hyponatremia. As a result, brain volume can fall from a value that is initially somewhat above normal to one below normal with rapid correction of hyponatremia.
The mechanism by which a rapid fall in brain volume results in demyelination has not been established.
How do I remember this?
|Central pontine myelinolysis* mnemonic|
From low to high, your pons will die (CPM)
From high to low, your brain will blow (Cerebral edema, herniation)
Wednesday, August 3, 2016
Metabolic alkalosis associated with a reduction in the ECV (Vomiting, diuretics):
There will be a stimulus for Na and Cl reabsorption to replenish extracellular volume.
Urinary Cl is very low ( < 25 meq/L).
Administration of NaCl and water leads to correction of the metabolic alkalosis.
Such causes of metabolic alkalosis are said to be saline responsive.
I made these notes while studying acid base disturbances. Now they might not make sense to someone who has never studied this topic before.. But for those who have read about it, this should be excellent for revision.
Calculation of anion gap:
ALWAYS calculate the anion gap first.
Anion gap = [Na+] − ([Cl-] + [HCO3−])
Normal anion gap = 8 - 16 mEq / L
Monday, August 1, 2016
X in oXalate looks like an envelop to me :D
So today I was reading about acyclovir and crystal induced acute kidney injury.
Acyclovir is rapidly excreted in the urine (being both filtered and secreted) and has a relatively low solubility. Intravenous (IV) therapy may lead to the deposition of acyclovir crystals in the tubules if the patient is volume depleted. This results in intratubular obstruction and foci of interstitial inflammation.
Complications of nephrotic syndrome:
Infection with encapsulated bacteria, varicella (Vaccinate before or during treatment with high dose steroids)
Thromboembolism due to decreased antithrombin III (Prophylactic anticoagulation is not recommended unless patient has had a thromboembolic event, albumin < 2 g/dL, fibrinogen > 6 g/L, antithrombin < 70%)
Hypovolemia, anascara, renal insufficiency.
Increased risk of early atherosclerosis due to hyperlipidemia.