Showing posts with label Physiology. Show all posts
Showing posts with label Physiology. Show all posts

Wednesday, June 15, 2022

Hepatitic LFT enzymes and Cholestatic LFT enzymes illustration

ALT_ Alanine aminotransferase
AST_ Aspartate aminotransferase 
ALP_ Alkaline phosphatase 
GGT_ Gamma glutamyl transferase
 
Shreya HA

Monday, May 30, 2022

Tuesday, May 18, 2021

Fact of the day - Athlete's heart

Hi!


Athlete's heart - physiologic eccenteric hypertrophy (cardiac remodeling) - changes include resting bradycardia, higher cardiac output with exercise, dilatation of LV cavity size with hypertrophy of myocytes compared to normal heart.

vs pathologic hypertrophy in case of systolic heart failure, aortic/mitral regurgitation, dilated cardiomyopathy(DCM) (volume overload conditions).


LV systolic ejection fraction is normal - low-normal in athletes.

(vs HCM- high, DCM- low)

HCM is a common cause of death in athletes, especially those with family history.


That's all

- Jaskunwar Singh


Wednesday, June 17, 2020

Topics to read before PG entrance exams!

Hello Awesomites!

The aim is to help the students who want to give upcoming NEET PG Exam and are clueless about how to plan and prepare ?
I know my friend struggling day in and out for life in Covid wards. Exams doesn't matter now.
When they will have time in hand I want to help them out with plan beforehand. They are already brilliant enough to have been through all the challenges. :)

I know you can't predict what is important for this or next exams. Atleast with time in hand you can glance through some topics that contribute 70% of any exam. I am sharing the list 1st year subject I made during my preparation.

1.ANATOMY
  • Embryology 
  1. Pharyngeal arches
  2. Neural crest derivatives
  3. Oogenesis and spermatogenesis
  4. Notochord and remnants 
  5. Extraembryonic mesoderm
  6. Diaphragm 
  7. Cardiovascular system ( Abnormal subclavian artery)
  8. Urogenital system 
  • Histology 
  1. Cerebellum
  2. Osteoblasts
  3. Urinary bladder epithelium
  4. Cell junctions
  5. Collagen types
  6. cartilage
  7. Tonsil,Lymph nodes, spleen,thymus
  8. Stomach glands
  9. Skin with sebaceous glands
  10. Connective tissue types
  11. Retina 
  12. Salivary gland
  • NEUROLOGY
  1. Fornix 
  2. Corpus callosum
  3. Cranial nerves and its lesion
  4. Brainstem syndromes (lateral medullary )
  5. Foramen of skull
  6. Facial nerve and trigeminal nerve
  7. blood brain barrier
  8. Functional area and functional columns
  9. Parasympathetic ganglion 
  10. Phrenic nerve and vagus
  • GROSS
  1.  Compartments of lower limb with nerve and blood supply
  2. Blood supply of thyroid,oesophagus,ureter,Anal canal 
  3. Waldeyer ring
  4. External carotid artery
  5. Circle of willis
  6. Muscle of eye
  7. Brachial plexus (Sensory and motor supply of upper limb)
  8. Perineum
  9. Cruciate ligaments
  10. Vocal cords
  11. Mediastinum
  12. IVC tributaries
  13. Cavernous sinus and superior orbital fissure 
  14. Splanchanic plexus
2. BIOCHEMISTRY
  • Inborn error of metabolism (Types,Enzyme deficient,hallmark feature,Investigation of choice and treatment)
  • Rate limiting step 
  • Carbohydrate metabolism (Glycolysis,Glycogen storage disease,Glucogenesis,glycogenolysis,PFK-1)
  • Lipid metabolism ( Hyperlipoproteinemia and hypolipoproteinemia)
  • Vitamin (Coenzyme)
  • Electron transport chain inhibitor
  • Heme metabolism and Porphyria
  • Ketone body formation 
  • Urea cycle disorder
  • Competitive, non competitive and allosteric inhibitors
  • Mitochondrial disorders 
  • Amino acid disorder
  • Lead poisoning
  • Translation process 
3.PHYSIOLOGY
  • Receptors
  • Neurotransmitter and functions
  • Second messenger
  • Reflexes
  • Baroreceptors and chemorecptors
  • JVP 
  • ECG And EEG
  • Spirometry
  • RAAS 
  • Counter current exchanger and multiplier
  • Factors affecting compliance of lung 
  • Action potential
  • Smooth muscle and cardiac muscle
  • Channels and types 
  • GIT hormones 
  • Tracts and lesions(brown sequerd syndrome)
  • LH,FSH,GH and insulin glucagon
 Following are the list of 2nd year topics.

1.FORENSIC MEDICINE
  • Ballistics (Bullet ranges)
  • Identification (female male, blood sample)
  • Recent amendments in acts (POCSO act, MTP Act)
  • Application of IPC,CrPC sections
  • Postmortem changes
  • Dentition And Xray of wrist elbow and pelvis to determine age
  • Injuries -fracture of skull, RTA, Bruise
  • Toxicology- Plant based image, Preservation of viscera, Snakes,Arsenic, OP poisoning,Mercury,cadmium,Cardiac poison
  • Consent
  • Grievous hurt and murder vs culpable homicide
  • Seminal stains
  • Dowry death and Rape
  • Battered baby syndrome
  • Plant Toxicology (castor,abrus,strychnine,Dhatura,Aconite,Oleander,Calotropis,Opium,Cannabis)
2. PATHOLOGY-
  • Breast cancer, Lung cancer and Ovarian and testicular cancer
  • CD markers
  • Hemolytic anemia
  • Vasculitis
  • Endocarditis And MI
  • Types of hypersensitivity reaction
  • Platelet and coagulation disorder(ITP,TTP,hemophilias,vWD)
  • Stains And vacutainers
  • Transfusion reaction 
  • Graft rejction
  • Crohns vs Ulcerative colitis
  • Necrosis, apoptosis and its variant
  • Mode of inheritance
  • Leukemia and lymphoma prognostic markers
  • Renal histology and gross
  • Liver histology and gross
  • CNS tumors 
3.PHARMACOLOGY
  • Antimicrobial Drug of choice and mechanism of action 
  • Classification - aminoglycoside , MRSA And drugs for cystic fibrosis
  • Hypolipidemic Agents 
  • Asthma ( New drugs and guidelines)
  • Arthritis (RA and gout)
  • General pharmacology ( Pharmacokinetics,clinical trial,Pharmacodynamics)
  • Concentration dependent kinetics and time dependent kinetics and post antibiotic effect
  • Anti TB drugs
  • Anti viral and anti HIV (anti hep B and C)
  • Anti fungal
  • CVS- MI ,HF, angina managment
  • Endocrine- DM,Osteoporosis,SERM,SERD,Gnrh agonist
  • GIT-Constipation (opioid induced,IBS related) ,Diarrhea,peptic ulcer
  • CNS-Anti epileptic, Sedative,lithium toxicity,neurodegenerative disorder, side effect 
  • ANS- Emergency medicines,anaphylaxis, receptors ,poisoning 
  • Chemotherapy-Anticancer,monoclonal antibody,small molecules,kinase inhibitors
  • Prostaglandins 
  • Insulin 
4.MICROBIOLOGY-
  • Sterilisation and disinfection (Indicator)
  • Immunology (Antibody,complement deficiency,Primary immunodeficiency)
  • Latest outbreaks (Zika,Congohemorrhagic fever,Ebola,Corona)
  • Sexually transmitted infections
  • Vectors
  • Parasitology -Eggs
  • Congenital infections-Toxoplasmosis,congenital syphillis,rubella,herpes,varicella
  • HPV infection,HHV-8
  • Bioterrorism
  • Larva migrans,larva currens (cutaneous and visceral)
  • CD4 counts and Opportunistic infection
  •  HIV and TB
  • Food poisoning
  • Atypical bacteria treatment and infection 
  • Dimorphic fungi
  • Actinomycosis,Botryomycosis and eumycetoma
  • Meningitis
  • Exanthematous disease
  • Neisseria,diphtheria,Listeria,bacillus anthrax,legionella,campylobacter jejuni
  • Bacterial virulence factors,growth factors
  • Rickettsial disease, spirochetes(weils ds) 
  • Drug resistance mechanism

Following is the list of 3rd year topics.

1.COMMUNITY MEDICINE-
  • Surveillance programs
  • Sensitivity, specificity,PPV and NPV (Screening of disease)
  • Types of studies 
  • Odds ratio and relative risk ratio
  • Bias
  • Sampling 
  • Biostatistics- central tendency  (Box and whisker plot )
  •  Level of prevention 
  • Vaccine and types (Toxoid and live attenuated)
  • Demography and family planning
  • Biomedical waste
  • Health programmes ( RNTCP, HIV)
  • Communication
  • Nutrition and related programmes
  • Disaster
  • Null hypothesis,P value and alpha value
  • Confidence limit 
2.OPHTHALMOLOGY-
  •  Refractive errors (Astigmatism)
  • Surgery and post op complication(Glaucoma,cataract,squint)
  • Conjuctivitis
  • Corneal ulcer (Bacterial,fungal and herpetic) (Stains)
  • ROP and systemic retinopathy (Hypertensive and diabetic retinopathy)
  • Retinitis pigmentosa and syndromes
  • Retinal detachment and cause
  • Retinoblastoma
  •  Strabismus
  • Optic neuritis
  • Visual field defect 
  • Blow out fracture and trauma to eye
  • Glaucoma and drugs(Contraindication and indication)
  • Managment of ptosis
  • Light reflex and accomodation reflex and pupil
  • 3,4,6 Cranial nerve
  •  OCT ,Fluorescein angiograhy,tonometers,charts,
  • Sudden loss of vision and gradual loss of vision differentials
3. ENT-
  • Appearance of tympanic membrane in various disease
  • Surgery (Tonsillectomy,Adenoidectomy,Mastoidectomy)
  • Paranasal sinus
  • CSF rhinorrhea
  • Laryngeal disease (Papilloma,vocal cord paralysis, laryngeal muscles action, laryngeal cancers)
  • Tracheostomy
  • Abscess 
  • Nasopharyngeal carcinoma
  • Juvenile angiofibroma
  • Test of hearing and vertigo
  • Otosclerosis
  • Cochlear implants
  • Oral cavity cancers 
  • cervical Lymph node  and neck dissections
 Following is the list of Final year topics.

 1.OBSTETRIC AND GYNECOLOGY-

  • Pre-eclampsia (Definitions)
  • HELLP
  • PPH (prophylaxis and treatment)
  • Perineal tear (Types and managment)
  • Diabetes and anomalies scan 
  • Shoulder dystocia maneuvers
  • Molar pregnancy (High risk and low risk for GTN)
  • Ectopic (Diagnosis, Investigation and managment)
  • Abortions 
  • Recurrent pregnancy loss (Investigations and causes)
  • Cervical incompetence
  • MTP
  • Diagnosis and physiological changes of pregnancy 
  •  Abruptio vs placenta previa vs Vasa previa
  • Heart disease
  • MgSO4 and drug
  • Fetal monitoring -NST,BPP,doppler
  • Twins and complications
  • Labor-stages,partogram
  • Placenta types and associated pathology
  • Rh incompatibility
  • Amenorrhea (primary and secondary)
  • Mullerian anomalies (Class)
  • Asherman, AIS,Gonadectomy indication
  • Puberty and precocious puberty
  • Menopause (Hormone replacement therapy guidelines) 
  • Postmenopausal bleeding and premature ovarian failure (Levels of FSH)
  • Semen analysis (Evaluation and IUI and TESE)
  • PCOS -Diagnosis,drugs
  • Endometriosis
  • Cervical,vulval,ovarian,endometrial cancer,Fibroid
  • Krukenberg
  • PID
  • Prolapse 
  • Emergency contaceptives
  • IUD
  • Absolute contraindications in whole subject
  • Female sterilisation  
2.PEDIATRICS-
  • Developmental milestones
  • Neonatal reflexes
  • Neonatal resuscitation
  • Jaudice,sepsis,Hyaline membrane disease
  • Congenital infections-TORCH
  • Vaccines(IAP and NIS)
  • Diarrhea,pneumonia,dehydration managment
  • Pediatric epilepsy
  • Febrile seizure (Risk factors,recurrent risk,prohylaxis)
  • Severe acute malnutrition
  • Rickets
  • meningitis
  • Neuro-Cerebral palsy and neurocutaneous syndrome
  • Pediatric vasculitis-HSP and Kawasaki Disease
  •  Nephrotic syndrome
  • Congenital heart disease( VSD,TOF,TGA and ductus dependent CHD)
  • Trisomies
  • Hypoxic Ischemic encephalopathy VS Periventricular leukomalacia
  • Fluid managment including shock managment in children
  • Childhood pneumonia, Epiglottitis, Acute laryngotracheobronchitis
  • Microcephaly and macrocephaly 
  • Hydrocephalus and Neural tube defect  
  • Fetal alcohol syndrome,warfarin syndrome
3. ANESTHESIA-
  • IV anesthetic agents (Propofol)
  • Day care surgery (Drug of choice)
  • Venous air embolism
  • Local anesthetic (Remember concentration also)
  • Vaporisers color 
  • Inhalational agents 
  • Monitoring (Capnography)
  • Color coding of cylinder
  • Circuits
  • Mallampati and ASA grading
  • Premedication duration of stoppage and continuation
  • Muscle relaxant
  • Airway devices
  • Endotracheal tube (formula)
  • Epidural vs spinal anesthesia (Level of blocks)
  • Modes of ventilation
 4.DERMATOLOGY-
  •  Pigmentation Diseases 
  1. Hyperpigmentation
  2. Nevus (Nevus of ota/mongolian spot/CMN/AMN)
  3. Melasma
  4. Acanthosis nigricans
  5. Becker nevus
  6. Hypopigmentation -PKDL/Pityriasis versicolor/alba/Hansens
  7. Depigmentation-Vitiligo/Contact leukoderma
  • Signs (Auspitz,nikolsky,bulla spread sign)
  • Histopathology of psoriasis and lichen planus
  • Mast cell disorder-Urticaria pigmentosa image
  • Papulosquamous disease - Psoriasis ,lichen planus
  • Treatment of Psoriasis
  • STD (Syphillis,chancroid,donovanosis,Herpes genitalis,syndromic approach)
  • Microbiology of STD organism( Dark ground,school of fish,Tzanck smear,Donovan body,Gonococcus)
  • Drug Reaction -Fixed drug eruption, erythema multiforme,SJS/TEN
  •  Blistering disease 
  1. Pemphigus(clinical treatment)
  2. Bullos pemphigoid
  3. dermatitis herpetiformis
  4. Histopathology of blister level and Direct immunofluorescence image
  • Infections
  1. Fungal (Tinea /pityriasis versicolor)
  2. Hansens 
  3. TB
  4. Viral (HPV/HHV/Molluscum contagiosum)
  • Hair disease-Alopecia images,DLE,trichotillomania
  • Acne,Rosacea
  • cutaneous markers of internal malignancy
5.RADIOLOGY-
  • Emergency radiology-RTA,splenic injury,FAST,Perforation
  • Radiological anatomy especially applied aspect
  • CNS tumor
  • Bone tumor
  • BIRADS
  • TIRADS
  • Radiation physics and acute radiation syndrome
  • Radiotherapy basics
  • Contrast in various studies
  • USG and doppler
  • Doppler waveforms
6.ORTHOPEDICS-
  • Knee joint (Everything)
  • Shoulder dislocation
  • Bone (Oncology+radiological picture)
  • Pediatric Hip(Rdaiology +managment)
  • Infections(TB,Osteomyelitis)
  • CTEV
  • AVN
  • Tennis elbow and dequeverian
  • Eponyms and test
  • Blood supply of femur
  • Pseudoarthrosis
  • Genu varum/valgus,cubitus varus/valgus
  • malunion 
  • Instruments
7.SURGERY-
  • Glasgow coma scale (Changes)
  • Burn
  • Cannula color coding 
  • Triage
  • Trauma
  • Incisions,suture,foleys,NG tube,Knots,Scores
  • Latest updates in breast cancer,thyroid and hepatobiliary cancers,Pancreatic cancer,stomach,colorectal cancer
  • Bed sores staging 
  •  Renal stones managment
  • Gall stone managment and surgical complication
  • Bariatric surgery
  • Acute pancreatitis managment 
  • Upper GI and lower GI bleed management and causes
  • Aortic aneurysm
  • Meckel diverticulum
  • Wound classification
  • Cancer-(Breast,rectum,stomach,oesophagus,HCC,prostate,thyroid)
  • Cancer follow up duration 
  • Carcinoid and GIST and gastrinoma
 8.MEDICINE-
  •  ECG visuals
  • Cardiac emergencies-Arrest,Unstable angina,MI,Arrhythmia,Dissection
  • Respiratory emergency-Pulmonary embolism,pneumothorax,Asthma 
  • Stroke
  • Meningitis (Bacterial,viral,aseptic)
  • Approach to patient in Coma
  • Seizure
  • Electrolyte imbalance
  • ABG
  • Hypertension and its emergency and management
  • Murmurs and valvular lesions
  • Pericardial d/o
  • hepatitis(Viral,autoimmune)
  • Non alcoholic and alcoholic liver disease
  • Glomerular disease
  • UTI
  • CKD
  • DM (management of different complications)
  • Neurodegenerative d/o ,neuropathy,myopathy
  • Septic shock guidelines
  • GBS
  • Poisoning 
  • New asthma guidelines
  • RTA and Inherited channelopathies
  • MEN syndrome
  • SIADH, DI,Pheochromocytoma
  • AIDS defining illness
  • Connective tissue disorder
  • Infective endocarditis and rheumatic heart disease
  • Prakinson and alzheimers
  • IBS,UC ,Crohns
  • Cardiomyopathy
  • Jones and dukes criteria
  • dyslipidemia management 
10.PSYCHIATRY-
  • General psychiatry (terms and its meaning )
  • MMSE
  • Psychotic disorders
  1. Schizophrenia
  2. Delusional d/o- Named syndromes (Capgras,Fregoli,Othello,Ekbom)
  • Mood disorder (Treatment is very important)
  1. Mania
  2. Depression
  3. Bipolar
  • Neurotic disorder 
  1. Anxiety disorder
  2. OCD related disorder
  3. Dissociative disorder
  4. Trauma and stress related disorder
  5. Somatoform disorder
  • Substance abuse and deaddiction
  • Organic mental disorder(dementia)
  • Sleep disorder
  • Eating disorder
  • Sexual disorder
  • Personality types and disorder
  • Drugs (SSRI and its sideeffect)
  • Psychotherapy types and choice
  • Defence mechanism  
You can edit this according to you. 
Hope it will help.
-Upasana Y.

Friday, January 17, 2020

Facebook: PFT-1


Q1) Which of the following is/are not a contraindications of performing PFT(Pulmonary function test)? 

A) MI within one year

B) Unstable angina

C) Recent thoraco-abdominal surgery

D) Recent ophthalmic surgery

E) Past history of pneumothorax

So correct options are - A and E


Following are contraindications to perform pulmonary function test. 

Mnemonic: UR IRcTC

U- Unstable angina

R- Recent thoracoabdominal surgery

I- Myocardial infarction within the last month

R- Recent ophthalmic surgery

T- Thoracic or abdominal surgery 

C- Current pneumothorax

That's it! 

-Demotional bloke. 

Wednesday, August 28, 2019

Bell's phenomenon

It is the motion of the eyeball during lid closure and is a reflex between the occulomotor and the facial nerves.  There are 4 types-

1. Normal- Upward and outward movement of
                           the eyeball.

2. Inverse- Upward but inward movement.*

3. Reverse- Downward movement.*

4. Perverse- Lateral movement.

*Some authors opine that inverse is downward and outward while reverse is upward and inward.

The Bell's phenomenon is of importance in ptosis and lag ophthalmos surgeries .

-Sushrut

Wednesday, July 31, 2019

Inferior wall MI and Bezold-Jarisch reflex

Hello everyone!

Acute myocardial infarction (AMI), especially of the inferior left ventricular wall, is often associated with transient hypotension and sinus bradycardia.

Ever wondered... Why?

Saturday, May 18, 2019

History, physiology and medical aspects of fasting

Hello everyone,

My senior resident at JFK Medical Center did a presentation on fasting. I thought of sharing it with you (especially since it is Ramazan/Ramadan).

Monday, May 13, 2019

Protein gap

The gamma gap aka paraprotein gap or protein gap is the difference between total serum proteins and albumin measured from a comprehensive metabolic panel.

Albumin accounts for the majority of total serum protein.

Viral infections, plasma cell malignancies, or autoimmune conditions there is an excess of immunoglobulins, raising the total amount of serum protein independent of albumin.

The gamma gap is typically considered to be elevated if it is above 4 g/dL.

In the right clinical context, gamma gap should be worked up with SPEP, UPEP, and a serum free light chain assay.

Random exercise: Calculate the protein gap.
Total protein 8.9 g/dL (normal 6.4-8.3 g/dL)
Albumin is 3.6 g/dL (normal 3.4-4.8 g/dL)

That's all!

-IkaN

Friday, April 12, 2019

What Is Going On In Migraine?

Despite the high prevalence of migraines, the underlying pathophysiology is poorly understood.

What was thought?
Cerebral and meningeal arteries dilatation. Now largely disproven.

What do we think?
- MRI says episodic cerebral edema with dilatation of intracereberal vessels and less water diffusion that doesn’t respect vascular territories.

- PET says it’s a subcortical disorder affecting modulation of sensory processing.

- Magneto-EncepaloGraphic (MEG) scan suggests failure of inhibitory circuitry in the visual cortex.

- Hormones play a role. Migraines occur just as commonly in males as in pre-pubertal and post-menopausal females but the ratio tilts towards women of reproductive age group by 3:1. About half of the women complain of migraine synchrony with menses.

- 5-HT overload as suggested by its metabolites in the urine. While the exact significance is controversial, the efficacy of Triptans (5-HT 1b/1d agonists) supports its role.

- Trigeminal nerve dysfunction suggested by blockade of trigeminal nerve impulses by Triptans. They also inhibit release of substance P and pro-inflammatory neuropeptides.

This is what we know so far. To thread this string is your responsibility, future Dr. Neurologist. Good luck!



- Ashish Singh

Tuesday, April 2, 2019

Pathophysiology: Diabetic Ketoacidosis

Hello guys, here’s a whiteboard summary of how DKA happens.


[Please click on the image to enhance it]

- DKA is a medical emergency. It’s a complication of type 1 diabetes.
- DKA has a triad of hyperglycemia, ketosis [metabolic acidosis] and dehydration.
- Main ketone bodies are beta-hydroxybutyrate and acetoacetate. Acetone is only a minor ketoacid.
- Lactic acidosis also contributes to metabolic acidosis.
- More glucose in blood leads to more glucose filtered into urine causing osmotic diuresis.


- Ashish Singh 

Wednesday, March 27, 2019

Pathophysiology: Multiple Sclerosis

Hey guys, let’s look at the fundamentals of multiple sclerosis.

Multiple sclerosis is an autoimmune disease of the CNS characterised by
- chronic inflammation
- demyelination
- reactive gliosis/ scarring
- neuronal loss
with a course that is relapsing-remitting or progressive
and lesions that are disseminated in time and space.

Here’s how it happens:

[Please click on the image to enhance it]


- Ashish Singh

Monday, March 11, 2019

Restrictive vs Liberal approach to transfusion in Sepsis

Hello everyone, 

Here are some studies on approach to blood transfusion during sepsis:

One multicenter randomized study of 998 patients with septic shock reported no difference in 28-day mortality between patients who were transfused when the hemoglobin was ≤7 g/dL (restrictive strategy) and patients who were transfused when the hemoglobin was ≤9 g/dL (liberal strategy) . The restrictive strategy resulted in 50 percent fewer red blood cell transfusions (1545 versus 3088 transfusions) and did not have any adverse effect on the rate of ischemic events (7 versus 8 percent).

One randomized trial initially reported a mortality benefit from a protocol that included transfusing patients to a goal hematocrit >30 (hemoglobin level 10 g/dL) . However, similarly designed studies published since then reported no benefit to this strategy. 

Bhopalwala. H

Source: UpToDate 

Norepinephrine in ICU

Norepinephrine (noradrenaline) Levophed

8 to 12 mcg/minute (0.1 to 0.15 mcg/kg/minute)

A lower initial dose of 5 mcg/minute may be used, eg, in older adults 2 to 4 mcg/minute (0.025 to 0.05 mcg/kg/minute) 35 to 100 mcg/minute (0.5 to 0.75 mcg/kg/minute; up to 3.3 mcg/kg/minute has been needed rarely)

Initial vasopressor of choice in septic, cardiogenic, and hypovolemic shock.
Wide range of doses utilized clinically.

Must be diluted; eg, a usual concentration is 4 mg in 250 mL of D5W or NS (16 micrograms/mL).

Bhopalwala. H

Milrinone in ICU

Inotrope (nonadrenergic, PDE3 inhibitor)

Milrinone Primacor

Optional loading dose: 50 mcg/kg over 10 minutes (usually not given) 0.125 to 0.75 mcg/kg/minute

Alternative for short-term cardiac output augmentation to maintain organ perfusion in cardiogenic shock refractory to other agents.

Increases cardiac contractility and modestly increases heart rate at high doses; may cause peripheral vasodilation, hypotension, and/or ventricular arrhythmia.

Renally cleared; dose adjustment in renal impairment needed.

Must be diluted; eg, a usual concentration is 40 mg in 200 mL D5W (200 micrograms/mL); use of a commercially available pre-diluted solution is preferred.

Bhopalwala. H

Thursday, May 24, 2018

Referred Pain

The pain sensation produced in some parts of the body is felt in other structures away from the place of development. This is called referred pain According to dermatome rule,
  • Pain is referred (transferred) to a structure.
  • This structure is developed from the same Dermatome from which pain producing structure is developed.
I know! It’s confusing *_*
Let me make it easy for you, There is a pain in your heart and this pain is transferred to your left arm.
How is this happening •_• This is because the heart and inner aspect of the left arm is developed from the same dermatome. Now, you must be thinking, what about other areas of the body!
  1. Pain in testis is referred to the abdomen.
  2. Pain in the ovary is referred to the umbilicus.
  3. Pain in the diaphragm is referred to the right shoulder.
  4. Renal pain is referred to loin.
Thought question: Do you know about any other areas? Comment me with your answers! 
I wonder, can acidity cause referred pain?

- Written by Anisha Valli

Tuesday, February 27, 2018

Oxytocin

OXYTOCIN

Hello Awesomites! Here's a collection of important facts about the love hormone oxytocin.

Oxytocin sensitivity is increased during delivery.

In lactating women genital stimulation enhances oxytocin release.

Oxytocin challenge test for assessing fetal well being is contraindicated in - Placenta previa
Previous two LSCS
Premature labour

Posterior pituitary secretes Oxytocin.

Oxytocin causes Milk ejection, Contraction of uterine muscle & Myoepithelial cell contraction.

Post partum hemorrhage, Uterine inertia & Breast engorgment due to inefficient milk ejection reflex are indication for oxytocin.

Side effect of oxytocin are Placental abruption, Fetal distress & Water intoxication.

Oxytocin is synthesized in Hypothalamus.

Oxytocin is a Polypeptide.

Oxytocin is Secreted in both sexes.

Oxytocin is an example of neurohormone.

Atosiban is an Oxytocin antagonist.

-MD Mobarak Hussain (Maahii)

Saturday, February 24, 2018

Tumor lysis syndrome and rhabdomyolysis: Why does calcium decrease?

Doubt in response to you post on tumor lysis syndrome: What is the mechanism behind hyperphosphatemia causing hypocalcemia in tumor lysis syndrome? Wouldn’t the tumor cells also release calcium, thus leading to hypercalcemia? Asked via email

Saturday, October 21, 2017

Electrocardiogram


File:Ecg.png - Wikimedia Commons

P wave

  • Positive wave
  • Shape is up rounded deflection
  • Cause: Depolarisation of atrial musculature.
  • Duration: 0.1 sec
  • Intensity: 0.1-0.12 mV
  • Represents functional activity of atria.


Clinical Aspects:
  1. Mitral stenosis: left atrium is hypertrophied and P wave is larger and prolonged.
  2. Tricuspid stenosis: Right atrium is hypertrophied and P wave is taller but there is no change (normal) duration.
  3. Atrial fibrillation: P wave disappears and is replaced by fine irregular oscillations.
  4. Ectopic Pacemaker: (reverse) The impulses are sent from AV node to SA node.

QRS COMPLEX

  • Q wave is often absent.
  • Cause: Ventricular Depolarisation.
  • Duration: 0.08 sec ( less than P wave)
  • Intensity: 0.1 mV to 0.2 mV ( amplitude is more)
  • R wave is 1 mV
  • S wave is 0.4 mV
  • Total Intensity is 1.5 mV to 1.6 mV

Clinical Aspects
  1. Deep Q wave: more than 0.2 mV. This is seen Myocardial Infarction.
  2. Tall R wave: more than 0.1 mV. This is seen in ventricular hypertrophy.
  3. Low Voltage QRS Complex:  This is related to hormones and pericardial fluid. Hypothyroidism and Pericardial fluid around the heart.
  4. QRS COMPLEX: Prolonged in bundle branch block.

T wave

  • Cause: Ventricular Repolarization.
  • It’s positive wave because the direction of Ventricular repolarization is opposite to depolarization.
  • Duration: 0.27
  • Intensity: 0.3 mV

Clinical Aspects

  1. Flattened T wave: old age.
  2. Height increases: during exercise.
  3. Inverted T wave: this is seen in myocardial infarction.
  4. Tall and peaked T wave:  Hyperkalaemia.

U wave
  • Positive round wave
  • Repolarization of papillary muscled
  • Duration: 0.08 sec
  • Intensity: 0.2 mV
  • Rarely seen
  • Prominent in hypokalaemia.

P R interval

  • Onset of P wave to onset of QRS complex (PQ interval)
  • Represents AV conduction time.
  • Duration: 0.12 to 0.21 sec

Clinical Aspects

  1. Prolonged PR interval: AV conduction block.

J Point

  • The meeting point of QRS complex with ST segment.
  • It represents the end of Depolarisation and beginning of repolarization.
  • At this point, no current flows around heart.


I hope this helped you :))  Have a good day!