Saturday, February 25, 2017
Acute cardiac tamponade is an emergency condition in which fluid accumulates within the pericardial sac resulting in inability of heart to pump blood. The Beck's triad of medical signs a/w this condition - (mnemonic: DIM )
D- Decreased arterial and pulse pressure
I- Increased venous pressure (JVD)
M- Muffled heart sounds
- Jaskunwar Singh
Friday, February 24, 2017
Internal jugular vein of right side is preferred for right heart hemodynamics. This is because-
Hello all, let me slip in a quick mnemonic on Neomycin and Amikacin
1.Highest nephrotoxic drug-
2.Highest auditory toxicity is with-
N for N and A for A. Easy one to remember for the MCQs!
Indications for oestrogen hormonal therapy mnemonic: 8Ds
D- Deficiency states of oestrogen
D- Development of secondary sexual characters
D- Diagnosis of pregnancy ( along with progestogen )
D- Depression ( post- partum and perimenopausal )
D- Diastolic dysfunction ( in postmenopausal women )
D- associated Diseases (dermatologic, neurologic, autoimmune)
D- Decubitus ulcer
- Jaskunwar Singh
Thursday, February 23, 2017
Delirium- "It is a transient, usually reversible cause of mental dysfunction that results in a wide range of neuropsychiatric abnormalities, mostly presented by elderly as
- waxing and waning type of acute- confusional state
- fall in attention- span
- decreased awareness of surroundings
- low cognition levels."
Causes of Delirium- (mnemonic: DELIRIUM)
D- Drugs (anti- cholinergics, antipsychotics etc)
E- Encephalopathy (Wernicke's)
L- LSD intoxication
R- Respiratory failure
U- (v) visual sphere hallucinations
M- Metabolic disorders
Dementia- "A group of neuropsychiatric disorders characterised by chronic and gradual decrease in the ability of person to think, create memories, express emotions and other mental symptoms that affect the general well being."
Causes of Dementia (mnemonic: DEMENTIA)-
D- Degeneration (Primary cerebral)
E- Endocrinal dysfunction
M- Multiple sclerosis
E- Embolisation (vascular pathology)
N- Normal tension hydrocephalus
A- Alcohol intoxication
- Jaskunwar Singh
Also, the increased concentration of iron in brain is accompanied by iron deficiency in rest of the body.
This is possibly attained by decreasing absorption of iron from food and increasing permeability of blood- brain barrier.
- Jaskunwar Singh
Hey guys this post will be on Long QT syndrome as evident from the title :P.
In a brief introduction, it can be said that LQTS is simply because of abnormal myocardial repolarization most often due to a mutation in ion channel-associated gene. It can lead to fatal ventricular arrhythmias such as torsades de pointes.
So there is increased risk of Sudden Cardiac Death.
It has 3 common variants:
1. LQT1: Loss of function mutation in KCNQ1 gene. And in ECG you see early-onset broad-based T wave.
2. LQT2: Mutation in KCNH2 gene. In ECG T waves are of low amplitude, broad based and maybe bifid.
3. LQT3: Mutation in SCN5A gene. In ECG, there is prolonged ST segment with late-appearing T wave.
We use the ECG to diagnose LQTS and we estimate the probability by using Schwartz score.
Some of the important criteria are :-
1. QTc more than 480msec
2. T wave alternans (Varying amplitudes)
3. Torsades de pointes
4. Notched T waves in atleast 3 leads
5. Syncopal attacks with and without stress
6. Congenital deafness
7. Significant family history
Wednesday, February 22, 2017
There are certain physical stigmata of hypercholesterolemia that help the clinician to suspect FH in a patient with a premature cardiovascular disease:
- Xanthelasma (cholesterol deposits on both eyelids)
- Arcus corneae (bilateral; detected by fifth decade of life)
- Tendinous xanthomas (in hand and feet)
- Jaskunwar Singh
Tuesday, February 21, 2017
Aerobes and facultative anaerobes
Diameter: 1 micrometer
Gram profile: Gram positive Cocci
Arrangement: Grape like clusters
Sporeing or not: Non-sporing
Capsule: Usually capsulated. Non-capsulated strains have small amount of capsular material on the surface
Ordinary media: They grow readily with temperature range of 10-42°C ( Best at 37°C) and pH around 7.4 - 7.6
You can remember how colony looks by the name STAPHYLOCOCCUS it self.
S - Smooth
O - Opaque
C - Circular
C - Convex
It produces golden yellow pigment. Pigment production occurs best at 22℃ and only in aerobic culture. Growth represents "Oil-paint appearance".
Ludlam's medium - Lithium chloride and tellurite.
Mannitol salt agar or salt milk agar- 1%Mannitol, 7.5%NaCl, Phenol red indicator.
Columbia colistin nalidixic acid agar.
Liquid media: Turbidity.
Oxidase : Negative
MR andVP: Positive
Phosphatase : Positive (Useful for screening as S epidermidis is negative or slightly positive )
Urease : Positive
Produces thermonuclease enzymes.
Virulence factors :
Extracellular enzymes :
Coagulase (Most virulent)
Alpha: Most important hemolysin.
Beta: It is sphingomyelinase. Exhibits hot and cold phenomenon.
Leucocidin and gamma lysin is grouped under synergohymenotropic toxins.
9 types of enterotoxins: Responsible for staphylococcal food poisoning. Causes nausea, vomiting and diarrhoea within 2-6 hours.
A, B, C1, C2, C3, D, E, H and I.
(What are superantigens and how do they work?)
Remember " SOFT PENIS"
S - Skin infections
O - Osteomyelitis and arthritis
F - Food poisoning
T - Toxic shock syndrome
P - Pharyngitis and Pneumonia (Rarely)
E - Endocarditis
N - Necrotizing fascitis
I - Impetigo
S - Sepsis
Sputum - Respiratory Infections
Blood - Septicaemia
Urine - UTI
Faeces - Food poisoning
Sterile containers should be used
Sterile swabs for specimen from nose/perineum.
Gram stained smears is useful in case of pus, cocci in clusters may be seen.
Sensitive to penicillin: Penicillin G is DOC (Drug of choice)
Penicillin allergy: Cefazolin is DOC
Methicillin resistant S.aureus: Vancomycin
Vancomycin resistant: S.aureus: Streptogramins, Linezolid, Telavancin.
Stay awesome :)
Mnemonic is glucocorticoids itself!
Sunday, February 19, 2017
Saturday, February 18, 2017
Pierre Robin Sequence is one of the most common causes of isolated cleft palate in the newborns. Here's the mnemonic for the triad of symptoms- PRS
P- Cleft Palate only
R- Retrognathia (abnormal posterior position of jaw and maxilla)
S- Support to the lingual muscles is lost (Glossoptosis)
The sequence is known to be caused by genetic anomalies at chromosome 2, 11 or 17.
- Jaskunwar Singh
Hey guys, let's ponder upon the following case.
Before reading this case, just know that this is a case of cerebellar tumor. Now try to localize the tumor in the cerebellum by taking help of the symptoms of this kid. This will help you in the differential diagnosis given later.
A 4 year old complains of headache, drowsiness and occasional diplopia; he is unsteady on his feet with frequent falls. Examination demonstrates truncal ataxia, sometimes accompanied by incoordination of the limbs; variable ophthalmoparesis and papilledema on fundoscopic examination.
Any guesses on what this could be?
Ok so here goes the case discussion:
Medulloblastoma typically presents with a midline cerebellar syndrome, with hydrocephalus and resultant increased intracranial pressure.
Clinically, it can be distinguished from ependymoma involving the fourth ventricle by the early appearance of nausea and vomiting in the latter, due to involvement of area postrema. Cranial nerve palsies may appear with either tumor, and increasing intracranial pressure is typical of both.
The predominance of signs suggesting primary involvement of vermis distinguishes medulloblastoma from cystic or solid astrocytoma of the cerebellum which typically involves a cerebellar hemisphere rather than the vermis. Although rarely there are midline midline astrocytomas.
You are awesome if you were able to get this one right. :)
As you know the U wave in the ecg is seldom seen especially in leads V2 and V3 physiologically especially during bradycardia.
And it is seen pathologically in Hypokalemia.
So how is it generated?
If you are thinking due to repolarization of papillary muscles, let me tell you that this hypothesis is now obsolete.
There are three trending theories at present trying to explain it:
1. Delayed repolarization of the subendocardial Purkinje fibres.
2. Prolonged repolarization of the midmyocardium ( M cells)
3. After-potentials resulting from mechanical forces in the ventricular wall.
Friday, February 17, 2017
This post is all about treatment of Multiple Sclerosis.
Thursday, February 16, 2017
Hello awesomites let's know about PEG .
PEG stands for Percutaneous Endoscopic Gastrostomy .We normally use PEG tube .
also known as Feeding tube,Esophagogastroduodenoscopy tube.=P
In simple language PEG is method of placing a tube into the stomach percutaneously followed by endoscopy .
Tube is passed into a patient's stomach through abdominal wall .
It is preferred route of nutritional support in patients having dysphagia or in unconscious patients.
It offers superior exposure to GI systems.
Most of the PEG tube has mushroom shaped device at the end that holds it in the stomach and prevent it from falling .If it falls do not wait till next day the hole may heal and this may create complications.
Whereas PEG is also contraindicated in:-
-Distal enteral obstruction.
Wednesday, February 15, 2017
Hello awesomites !It's been long time that I haven't written anything due to exam pressure =). Let's start with today's simple topic.
What is scoliosis?
-It's a disorder in which spine has sideways curve like "C" or "S" .It may increases or remain same.Patient usually suffers from breathing problems ,constipation due to tightened organs.
-Factors causing scoliosis are mainly genetic though environmental factors may cause scoliosis.
-Diagnosis is mainly by Plain X-ray.
-Current methods requires surgery to adjust growth rods every 6 months .This may require 8 to 10 procedures in total.
What is MAGEC rods ?
-MAGnetic Expansion Control rods are used as non-invasive adjustments.
Surgeons can lengthen the rods using a Handle-held external magnet.It takes 15 minutes and is performed every 3-6 months .It is also cost effective.Once a surgeon implants the device it's easy to use by remote.
MAGEC is used in children's (normally under 10 age) with severe spine deformity .
Hi everyone. This is just a mnemonic post on RA deformities.
So there are 2 important deformities that are definitely seen clinically but are hard to remember.
The Boutonniere and the Swan neck deformities both occur as some defect at 3 joints :
The Proximal Interphalangeal Joint (PIP) and the Distal Interphalangeal Joint (DIP) and Metacarpophalangeal Joint (MCP).
So Remembering one of them is sufficient as the other one would be the exact inverse.
So Out one Ex .
Which means there's extension at DIP (the outer joint). Now after extension , alternate the next joint with flexion ( so Flexion at PIP ) followed by extension again ( so extension at MCP )
So , Boutonniere is -
DIP - Extension (out one is ex)
PIP - Flexion
MCP - Extension.
And Swan neck would be the opposite :
DIP - Flexion
PIP - Extension
MCP - Flexion
Hope this helped !
Tuesday, February 14, 2017
Since its Valentine's day, here is a love fact you need to know:
Emotional instability and stress associated with constant anxiety (in case you are suffering from I-love-you-penia or broken-heart syndrome) may actually lead to acute emotional trauma to the heart and result in rupture of heart strings, the "chordae tendineae".
The chronic negative effects on heart are associated with Takotsubo cardiomyopathy, aka broken heart syndrome which involves weakening of myocardial muscles and rupture of chordae tendineae leading to right sided heart failure, ventricular arrhythmias and rupture.
So ease your suffering by talking to the love of your life on this special day and confess about your feelings today. <3
Ps- Medicine loves you and cares for you <3
- Jaskunwar Singh
I always find X rays quite confusing especially when they appear same.
It's a short post about differentiating bone tumors.
Soap bubble appearance on X ray is expansile, eccentric vaguely trabeculated space having thin sharp defined sclerotic margins.
Mostly seen in bone tumors and other bone lesions.
On X ray they all appear same, only way to differentiate them is to know their location and other associated factors.
Commonly seen in
1) Aneurysmal bone cysts-
Location of ABC is Metaphysis.
It occurs in younger age group i.e less
than 20 years. So the X ray of such
patient will have non fused and
Preferred sites are long bones of upper and lower limb, especially femur.
2) Giant cell tumor(osteoclastoma) -
Location of GCT is epiphysis
Here the prevalent age group is 20-40, which means an adult sketetal structure.
While the preferred sites are same like ABC.
So if one see epiphyseal lesion with soap bubble appearance in mature bone, it has to be Giant cell tumor.
GCT presents with other classical signs of Egg shell crackling on palpitations.
Giant cells on histology.
Which are NOT the tumor cells. So its one of the example of misnomers. They are meant to misguide you.
Thats it :)
Monday, February 13, 2017
Sunday, February 12, 2017
Yes, you can subconsciously take on the attributes of your favourite fictional characters when reading a story- not just the thoughts and beliefs of the character, but the whole state of being itself.
Well, it is more often seen in those who are depressed or who don't have much life experiences of their own.
Also, if the reader is able to relate experiences in the life of character of the story, he might take it to his own life and adopt the mindset and perspective of the character. This may lead to temporary or permanent changes in his real life.
Excessive openness to experiences may lead to schizotypal, narcissistic or paranoid personality disorders among others.
Happy reading :D
- Jaskunwar Singh
Saturday, February 11, 2017
Well, if you know something about neurologic development in-utero, you must know that at eight weeks signals are not transmitted from the brain yet. Instead the signals travel from the spinal cord.
The left side of the cord matures faster than the right cord. This means the genes that control growth and development are activated faster on the left cord than the right one. In the hindbrain, it is the other way around.
- Jaskunwar Singh
Friday, February 10, 2017
If you can, give yourself a pat on the back and don't read further.
If you can't, give yourself a pat on the back, because you are going to learn how to remember it! :D
Jugular vein is on a high and stretching out on the RAPs of "the CREST" .. wohhooo.. :D
R- Right ventricular failure
A- Atrial septal defect (with mitral valve disease)
P- Pericardial compression/ tamponade
C- Circulatory overload
R- Renal failure
E- Excess fluid administration
S- Superior vena cava obstruction
T- Tricuspid stenosis
Hope you enjoy the crest too ;p
- Jaskunwar Singh
Lemme tell you the difference between Caput Succedaneum and Cephalhematoma today! :)
This is a topic that most medical students discuss at some point of time. I have found myself in the midst of similar conversations over my years at medical school.
After much study, I happened to reach an understanding that clarified the purpose of the test and provided a way to understand the results as well.
It would help if you think of the cerebellum as a processor (such as a C.P.U. in a computer).
There are 3 main inputs:
Romberg's test (3 steps):
1. Ask patient to stand with feet together.
2. Ask patient to close both eyes.
3. Maintain the posture for 60 seconds.
The Romberg's test is positive if the patient cannot stand for 60 seconds with feet together and eyes closed.
It is essential to understand that without the processor, the inputs do not matter (as there will be no output and no result).
Thus in Cerebellar ataxia, the patient will be unable to perform any of the above 3 steps and thus the Romberg's test cannot be performed on this patient.
In a situation where the cerebellar function is intact and Romberg's test is performed:
The first input (Vision) is lost when the eyes are closed.
It is now unto the 2 other pathways (Proprioceptive and Vestibular pathways) to provide input to the cerebellum.
Thus the Romberg's test will be positive in cases of:
1. Proprioceptive dysfunction e.g. Sensory peripheral neuropathy & Dorsal column dysfunction
2. Vestibular dysfunction e.g. Vestibular neuritis
This was my attempt to provide a brief summary about this topic and it has been compiled to the best of my understanding. Please feel free to discuss it further, in the comments section below.
Have a great day!
- Vikramjeet Kakade
Hello. This is about the things that your thing contains if you're a guy :p
So the spermatic cord is an important content of the inguinal canal in men.
And it contains a host of things.
Plenty of Dick Contributes To Good Sex Life
Plenty of = Pampiniform plexus
Dick = Ductus Deferens
Contributes = Cremasteric artery
To = Testicular Artery
Good = Genitofemoral Nerve (Genital br)
Sex = Sympathetic plexus
Life = Lymphatics.
So it's 3 Arteries + 2 nerves + 3 other things.
Hope you like this !
Hi everyone. This is a short post where I tell you about the thigh fascia.
So fascia of the thigh is super important during surgery , and we are expected to know its layers.
So it's got 2 layers : Camper's and Scarpa's.
Now which is outer and which is inner ?
OC IS good.
So OC = Outer Camper
IS = Inner Scarpa
Hope you liked this!
Thursday, February 9, 2017
Wednesday, February 8, 2017
This is the last post in the series: Alcohol and Drug Interactions. The previous posts in this series were Disulfiram-like Reaction, 2nd Part, and 3rd Part.
1. Binge drinking- Leads to inhibition of warfarin metabolism by CYP450 enzyme system. So it can precipitate warfarin toxicity with increased bleeding tendency in the body.
2. Chronic Alcohol consumption- Leads to induction of CYP450 enzyme system, so increases metabolism of Warfarin in the liver. So higher than usual dose of warfarin is needed to exert appropriate anticoagulant action in the patient.
Alcohol increases the sedative effects and also increases the risk of respiratory depression. It also attenuates cough reflex and gag reflex, so the patients have a higher risk of getting food stuck in their respiratory tract, remember Cafe Coronary.
1. NSAIDs have been implicated in an increased risk of ulcers and gastrointestinal bleeding in elderly
people. Alcohol may exacerbate that risk by enhancing the ability of these medications to damage the
2. Alcohol also potentiates the antiplatelet actions of Aspirin, hence increase the risk of bleeding in the patients.
3. Intake of alcohol with acetaminophen can increase the risk of acetaminophen-related toxic effects
on the liver. Acetaminophen breakdown by CYP2E1 (and possibly CYP3A) results in the formation of a toxic product(NABQI) that can cause potentially life-threatening liver damage. As mentioned earlier, heavy alcohol use enhances CYP2E1 activity. In turn, enhanced CYP2E1 activity increases
the formation of the toxic acetaminophen product. In people who drink heavily or who are fasting
(which also increases CYP2E1 activity), liver injury may occur at doses as low as 2 to 4 grams per day.
That concludes this series. I hope it will help you to guide your patients towards drinking alcohol more judiciously. :p
This is the third post in the series, Alcohol and drug interactions. The other posts are Disulfiram-like Reaction, 2nd Part and 4th Part.
Alcohol increases the risk of sedation, drowsiness and falls, especially in the elderly population and with the 1st gen antihistaminics.
With Barbiturates and Benzodiazepines
Alcohol acts synergistically with them to increase their sedative effects and memory-impairing effects( This memory-impairing effect is misused in Date Rape drug, Flunitrazepam(Rohypnol)). Besides it also inhibits their metabolism in the liver, hence, increasing the drug's levels in the blood.
With H2-Receptor Antagonists
These agents(eg., Cimetidine, Ranitidine) inhibit the action of Alcohol dehydrogenase(ADH) present in gastric mucosa. Cimetidine may also increase the rate of gastric emptying hence increasing the absorption of alcohol. So both of these effects contribute to increasing the Blood Alcohol levels.
With Muscle Relaxants
Several muscle relaxants (e.g., carisoprodol, cyclobenzaprine, and baclofen), when taken with alcohol, may produce a certain narcotic-like reaction that includes extreme weakness,
dizziness, agitation, euphoria, and confusion. For example, carisoprodol is a commonly abused and readily available prescription medication that is sold as a street drug. Its metabolism in the liver generates an anxiety-reducing agent that was previously marketed as a controlled substance (meprobamate). The mixture of carisoprodol with beer is popular among street abusers for creating a quick state of euphoria.
This is a continuation of the previous post on Disulfiram-like Reaction.
Let us start with a basic info. Pharmacokinetic drug interactions with alcohol are only seen in heavy drinkers whereas Pharmacodynamic drug interactions can be seen in moderate drinkers and even after a single episode of drinking.
As already mentioned, the Disulfiram-like reaction can occur with Isoniazid, Cefotetan, Cefamandole, Cefoperazone, Chloramphenicol, Sulfamethoxazole, Sulfisoxazole.
Besides patients on Isoniazid should abstain from drinking alcohol since isoniazid is hepatotoxic and the liver damage can be exacerbated by concurrent alcohol consumption
1. With TCAs: Alcohol increases the sedative action of TCAs, especially Amitriptyline, Doxepin etc.
Alcohol also impairs the first-pass metabolism of Amitriptyline in the liver causing increased bioavailability of the drug. Excessive increase in levels of TCAs in the blood can precipitate convulsions and cardiac arrhythmias.
2. Among SSRIs, all are relatively safer with alcohol; the safest being Fluoxetine.
3. With MAOIs(eg., Phenelzine, Tranylcypromine): There can be severe high BP(cheese reaction) if taken together with red wine which contains Tyramine.
That's all! :)
Do go through the subsequent posts in this series, 3rd Part and 4th Part.
So day before yesterday, there was my Forensic Medicine viva and the examiner asked me the causes of impotency. And I immediately started blabbing about Stress, Phimosis, Hypospadias, Peyronie's disease, I even mentioned Parkinson's disease. The examiner interjected me and asked the most common cause. I guessed heart disease and the related medications and he denied. Then he said it is excess consumption of alcohol and asked me not to underestimate alcohol and it's various interactions and correlations ever.
So here I am, trying to summarize the interactions of alcohol with the major classes of drugs.
I am not going to go into the details of the mechanism. Just, in brief, Disulfiram-like reactions entails flushing(due to dilatation of blood vessels), nausea, vomiting, sweating, hypotension, so reflex tachycardia which can be deleterious to a patient of coronary artery disease(CAD).
Now let us try to use CAD as a mnemonic here while learning certain other things as well.
1. It starts with C, a lot of drugs starting with C have this reaction, like Cefamandole, Cefoperazone, Cefotetan, Chloramphenicol.
2. Patients with CAD have Pain, so let us now manage that some analgesics starting with P(for Pain), Phenylbutazone, Phenacetin.
3. Patients with CAD can have attacks of Angina, for which we give Nitrates, so let us take that. Drugs with Nitro group: Nitroglycerin, Isosorbide dinitrate, Nitrofurantoin, Metronidazole. Why leave Sulpha group behind?
Drugs with Sulpha group: Sulphamethoxazole, Sulfisoxazole.
4. CAD often co-exists with Diabetes Mellitus(DM). So let us manage that with some Sulfonylureas; Tolbutamide, Tolazamide, Chlorpropamide and even the 2nd gen drug Glyburide.
5. Patients with DM are immunosuppressed. Hence, they are predisposed to Mycoses and TB. Manage them with Griseofulvin and Isoniazid respectively.
That's all! :)
Do go through the other posts in this series, 2nd Part, 3rd Part, and 4th Part
Tuesday, February 7, 2017
Sunday, February 5, 2017
Thursday, February 2, 2017
Here's a simple updated mnemonic on pharmacotherapy of congestive heart failure: UNLOAD FAST
U- Upright position/ Ultrafiltration
L- Lisinopril (ACE inhibitors)
O- Oxygen therapy
A- Aquapheresis/ ARBs/ Aldosterone inhibitors
D- Digoxin/ Diuretics
F- Furosemide/ Fluid restriction
A- Arterial dilators (to decrease Afterload)
S- Sodium restriction
T- Theophylline/ Thiamine/ Taurine
Latest updates suggest new classes of drugs for the treatment of CHF, approved by the USFDA -
- Angiotensin receptor-neprilysin inhibitors (a combination tablet of valsartan and sacubitril)
- Sino-atrial node modulator (ivabradine)
- Jaskunwar Singh
It's due to hyperinsulinemia!
Wednesday, February 1, 2017
Heart sounds are quite interesting and musical topic, something that makes more sense by practicing rather than just reading theoretically. This post is completely dedicated to second heart sound.
It is produced during closure of pulmonary and aortic valve.
It is a high pitched sound.
Diagnosis? Treatment till surgery is performed?
C for Carbamazepine
P for Phenytoin
Flumazenil acts on the GABA-A receptor and baclofen acts on the GABA-B receptor.
How do you remember this?