#AnswerTime: A patient with delusion

Here's the answer to a question we posted earlier: http://www.medicowesome.com/2016/08/quiztime-patient-with-delusion.html

Answer:

#QuizTime: A patient with delusion

#QuizTime
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.

De Quervain syndrome notes

Intro:
Here's a short post on De Quervain syndrome :D

Correction of hyponatremia and hypernatremia mnemonic

Hello!

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

Here's another mnemonic:
From low to high, your pons will die (CPM)
From high to low, your brain will blow (Cerebral edema, herniation)

That's all!

-IkaN

Study group discussion: Widow makers artery

Does anyone know why left anterior descending artery is called widow's artery?

Approach to acid base disorders: Metabolic alkalosis notes

In suspected metabolic alkalosis, always check urinary chloride levels.

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.

Approach to acid base disorders: Metabolic acidosis notes

Hello!

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

What causes renal bruit?

Narrowing of the renal artery (Renal artery stenosis) causes renal bruit.

Hexagonal crystals in cystinuria mnemonic

Hexagonal crystals are seen in cystinuria.

Envelope shaped crystals in urine: Calcium oxalate mnemonic

Heyyyyyy!

X in oXalate looks like an envelop to me :D

Drugs causing crystal induced AKI mnemonic

Hello!

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.

Secondary focal segmental glomerulosclerosis mnemonic

How to remember diseases associated with focal segmental glomerulosclerosis - Remember the letter H!

Hodgkins lymphoma and minimal change disease

Fact for the day: Hodgkins lymphoma is associated with minimal change disease.

Complications of nephrotic syndrome

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.

Multiple Endocrine Neoplasia

MEN are autosomal dominant syndromes.

They are classified as-

1. MEN 1 ( Wermer syndrome)
Pituitary, pancreas & Parathyroid adenomas.

2. MEN 2
a) 2A (Sipple syndrome)
Hyperparathyroidism, medullary carcinoma of the thyroid and pheochromocytoma.
b) 2B
Medullary carcinoma of the thyroid, pheochromocytoma, and mucosal ganglioneuromatosis.

Related post: MEN syndrome mnemonic

Step 2 CK: Types of incontinence mnemonic

Here's a short post on types of incontinence. It is important to know for step 2 CK as well as step 2 CS!

Local anaesthetics - What's in a name?

Personally I am very bad at remembering weird names. I feel like I am being bullied, horribly tortured for the sins I have committed whenever I have to deal with learning names.

Anyways chuck remembering stupid names, we will be smart and figure out a way to remember them..without trying too hard. Like using Google maps to reach a place through shortcuts :D

So Aminoesters and aminoamides are the two types of local anaesthetic in use.

You just need to remember that the esters has only one letter "I" and the amides has two letter "I"

Also that the esters can be effectively neutralised by the cholinesterase in plasma, that's pretty nice cause these substances are known to cause allergic reactions.

Just for the sake of naming.
The highly unstable esters are..
Procaine
Chlorprocaine
Tetracaine
Benzocaine
Cocaine

And again just for the sake of completing this post-
Lidocaine
Mepivacaine
Prilocaine
Bupivacaine
Etidocaine
Ropivacaine

They are dreadful I agree..but "I" will save the day :D

Laughing gas aka Nitrous oxide

Some random facts about nitrous oxide

1. Discovered by preistly

2. Cylinder colour blue

3. Stored as a liquid ( critical temp 36.5 C )

4. Aka laughing gas

5. Not metabolised in the body

6. In anaesthesia it acts as a carrier to other agents..used in conc of 33%O2 + 66%N20 + 1% inhalational agent

7. For every one mole of nitrogen removed, 35 moles of N2O enters..that means compliant spaces in our body take in more gas with increased in pressure..therefore nitrous oxide is constraindicated in these situations.

  Pneumothorax
  Pneumoperitoneum
  Tympanaplasty
  Posterior fossa surgeries ( high risk of air embolism)
  Intestinal obstruction
  Microlaryngeal surgeries ( N2O diffuses through the tube cuff and double or triple the volume of the cuff leading to laryngospasm)

8. Side effects - it can lead
   Bone marrow aplasia
   Sub acute degeneration of spinal cord
  Megaloblastic anaemia
( It inactivates B12 if used for more than 6 hrs in a surgery )

- happy studying
Sakkan :)

 

Mnemonic for foramen of cranial nerves

Here are awesome notes drawn by Mini on foramina for passage of cranial nerves:

Mnemonic for foramen of cranial nerves

Edward syndrome notes and mnemonic

Hello!

So here's how Yeshwanth remembers the features of Edwards syndrome.. He thinks of Accelerate from Ben 10!

Here are his notes:

Gout and pseudogout mnemonic

Hello!

Remember N for Gout:
N for Na urate crystals
N for Negative refringent crystals on polarised microscopy
N for Needle shaped crystals