Bartonella henselae and Pasteurella multocida infection mnemonic

Hello!

Sometimes I confuse the clinical manifestations of these two cat related diseases - Cat scratch disease caused by Bartonella henselae and Pasteurella multocida infection caused by cat bites. 

I probably wouldn't have confused these two in my step 1 days, but the older you get, the more confusing rare diseases become,

Sooo... Mnemonic!

Preparing for NEET: Part 1

Hello folks,

This is a common post requested as to how to prepare for NEET PG exams.
And as to whether joining classes is really required to get a decent rank.

So today I will share with you a study schedule told to me by my professor. Which takes around 7 month hardcore prep.

Now for a general approach to it
1. Classes are not essential. Classes add only 20% to the entire PG prep of yours.. That's with like max optimum attention and taking down notes vigorously.

2. Don't read standard books. The competition is so high, that the publishers end up increasing the number of pages. Just to make the book more appealing. Reading those books is a waste of your time cause they repeat the explanations over and over again with unnecessary details which will make you take a month atleast to finish a subject like obstetrics.
The only decent book I found was modit khanna for medicine, like the initial pages of high yield notes and the questions and not the explanations. Don't read the explanations unless the answer is not known to you through the high yeild section.

3. Try getting your hands on class notes. Be it DAMS, Bhatia or IAMS. They are all amazing and to the point. And that's what is needed.

4. Get the NEET PG question booklet, by Arvind Arora. A minimum of last five years questions of NEET is a must to solve.

5. Never sit with a pen and a paper or a marker during your first read for any subject. You will end up marking the whole book and write unnecessary notes  and wasting a lot of precious time. Save it for your second and third read or when you are confident enough that you know the flow of the subject and now just need to focus on details.

6. While reading if you have any doubts make a point to jot it down and find answers before sleeping or at the end of the week. But do solve them. Cause at the end just before exams these are the doubts that trouble you the most.

7. You need to score only a 75% aggregate to score a decent rank. Like to be in the top 3000. That is very much possible with a 7 month smart prep. For the the fight in between the top 3000 see the next para

8. Imagine yourself after a 24hr emergency duty, back to back and just next day you have to write theory paper of your uni exam.That's a near about situation of how mind stressed you are before neet.
Like it's 20 subjects..and you need to shift your focus from ophthalmology to psm in a matter of seconds. If you can't do that and if you waste your time even like an extra 5 mins on one question then you will be compromising the tail questions and that's when the stress gets to you. You keep looking at the timer and boom you black out.

A solution to this is you need to train your brain to deal with this situation. I have an aggregate of tips from medicowesome authors to deal with this.

- Solve the grand test. Just don't stick to one subject solving be as varied as possible. Like your best shot is solving 100 random questions every day doesn't matter if you know only 5subjects out of the 20, you only need to train your brain to deal with it.

- Solve the questions after an on call or after a very stressful day, give yourself the taste of it. So that your brain will be able to switch attentions during exams.

I feel the battle between the top 3000 rankers all comes down to who switched their attention between questions the fastest. The knowledge is the same it all matters that whether you were able to use it to your best or not.

9. Follow medicowesome :D
A bit cheeky but seriously it helps. Every now and then try reading the various posts. It will help you to condition your brain to all the subjects piece by piece.

10. A lot of questions are photo based. Try making your own picture library like jot down the things of pics you want to search for and look for it at the end of the day or the week end.

11. We don't promote apps and stuff but I would seriously advice downloading the pg prep app from Google play. It has stats to show your progress, daily exams, a 55 thousand question bank, photo questions, subject wise and grand test questions. It is amazing. Go ahead download it if you haven't and stick to it.

12. Have a way to destress yourself during the prep. Like be it running , movie, at a cafe or a novel.
Pg prep is a monotonous dumb thing to do , let's not lie to our selves -_-
You need to keep your engine at a steady pace so that you are able to fast track during the last month before your exam.
Like I personally read manga :D
Weekly updates were my solace and paradise. That's the way I treated myself after I had completed my schedule for the week.

I will upload a seven month prep schedule in part 2.

- Sakkan

Myopic Shift : Explanation

Hi everyone ! So this is a short post on the Second Sight or the Myopic Shift seen in Cataract.

So in people who  have a hypermetropic / presbyopic power , tend to experience a reduction in their refractive errors when Cataract starts to develop. This is called Myopic Shift or Second sight.
This​ occurs most commonly in nuclear cataracts. Now why this occurs is , the lens in early stages of Cataract undergoes sclerosis. That increases the Power of the lens ( this increases the refractive index).
Thus it makes the lens slightly more Powerful , or Convex. Due to this it acts as a correction for Hyperopia/ Presbyopia (Where the error was due to a weaker lens. )
This transient Myopic nature of the eye is called the Myopic Shift.
It does go away when the Cataract progresses as the sclerosis begins to reduce refractive surface in the lens.

Hope this helped! Stay awesome  !
Happy Studying :)

~ A.P.Burkholderia

Infants of Diabetic Mothers (IDM) : A clinical overview

Hello

With the prevalence of insulin - dependent diabetes mellitus and maternal hyperglycemia, serious consequences to the ingrowing foetus may occur during its organogenesis. Lets have a quick review of the clinical problems in the infants of diabetic mothers ( IDM ) with some lame mnemonics :p -

GENERAL BUILT :
- Macrosomia ( birth weight >4,000 gm ) resulting in difficult labor and complications such as traumatic asphyxia, shoulder dystocia, BP injury, etc.
- Large for gestational age

CONGENITAL ANOMALIES :-

1. CARDIOVASCULAR - mnemonic : CASTeD
- Cyanotic heart disease
- Asymmetric septal hypertrophy ( resulating in small LV )
- Septal defects ( VSD, ASD )
- Transposition of blood vessels
- Decreased cardiac output ( due to perinatal asphyxia and metabolic acidosis )

2. SKELETAL AND CNS -
- Caudal regression syndrome
- Mental retardation

3. NEURAL TUBE DEFECTS - mnemonic : HAM

- Holoprosencephaly

- Anencephaly

- Meningomyelocoele

4. RENAL and GENITOURINARY - mnemonic : HURT

- Hydronephrosis

- Urethral dysplasia

- Renal agenesis

- Thrombosis of renal vein

( patient presents with flank mass, intermittent hematuria, and thrombocytopenia )

5. GASTROINTESTINAL - mnemonic : GAS

- Gastrointestinal obstruction ( due to duodenal atresia )

- Anorectal malformations

- Small left colon syndrome

6. RESPIRATORY -
- Hyaline membrane disease ( Infantile RDS )
- Persistent Pulmonary Hypertension

7. METABOLIC changes -

- Hyperbilirubinemia ( due to polycythemia )

- Hypoglycemia occurs 30 - 90 mins post delivery which may take several days to resolve. Rebound hypoglycemia may occur in response to rapid, large boluses of glucose ( 10-15 mg/kg/min ).

- Hypocalcemia ( levels <7 mg/dL ) occurs within hours to days after birth due to a delay in PTH synthesis after birth, often accompanied with Hypomagnesemia.


Thats all
Hope this helps :)

- Jaskunwar Singh

Mnemonico diagnostico : Risk approach to Antenatal cases

Hello

'High - risk' antenatal cases contribute to 70 - 80% of perinatal morbidity and mortality rates. The screening and diagnostic tests to evaluate and identify such cases is a must so as to provide special care to the mother - child duo. Risk approach for antenatal cases according to WHO includes : ( mnemonic - RISK APPROACH )

Prader-Willi syndrome and Angelman syndrome mnemonic

Hello! Let me start with the mnemonic and then I'll explain these syndromes in detail.

Hypersensitivity types mnemonics

Hypersensitivity types are:

Type 1 RTA pathophysiology, notes and mnemonic

Hello! This post is on type 1 renal tubular acidosis.

What causes Type 1 RTA?
Defective H+ ion secretion in the distal tubule.
Impairment in H+ ions secretion result in an inability to acidify the pH beyond 5.5 (Used in the diagnosis of type 1 RTA)


The plasma bicarbonate is significantly reduced and may fall below 10 meq/L.
These patients tend to have urinary K+ wasting and hypokalemia (thought to be due to increased potassium secretion by distal tubular cells in the setting of diminished H+ ion secretion.)

What type of RTA is associated with an enhanced chance if nephrolithiasis?
Distal or type 1 RTA can cause nephrocalcinosis / calcium oxalate kidney stones.
Mnemonic: ONE predisposes to stONEs

Pathophysiology: Hypercalciuria, hyperphosphatemia, nephrolithiasis (calcium phosphate stones) and nephrocalcinosis are frequently associated with untreated type 1 RTA. The hypercalciuria is thought to be due to:
1) increased calcium phosphate release from bone as a result of bone buffering of excess acid and
2) reduction in tubular calcium reabsorption secondary to chronic acidosis.
The hypercalciuria, alkaline urine, and reduced excretion of citrate in the urine (which normally prevents calcium crystallization) promote the precipitation of calcium phosphate and stone formation.

Which conditions are associated with type 1 RTA?
diStal RTA is associated with the 3 S's:
Sjogren's
SLE

Sickle cell anemia

Treatment: Bicarbonate administration

That's all!
-IkaN

Mnemonico diagnostico : Vitamin D deficient Rickets

Hey Awesomites

The clinical features specific for Rickets due to vitamin D deficiency are : Vit D BHP RICKETS

V - Visceroptosis ( due to ligament laxity )
D - DEXA scan / low bone Density
B - Bossing of skull
H - Harrison's groove
P - Ping pong ball sensation
R - Rachitic rosary
I - Iron deficiency and other anemias
C - Coxa vara
K - Kyphosis
E - Eruption of teeth ( delayed )
T - Thoracolumbar ( Lordosis )
S - Sternum and ribs protrusion ( Pigeon chest )


Thats all
- Jaskunwar Singh

Difference between Duodenal and Gastric Ulcer

Hello everyone, let’s talk about the ever confusing difference between Duodenal and Gastric Ulcer. Both the ulcers are a type of Peptic Ulcer which occurs due the action of acid resulting in the damage of alimentary mucosa. The main cause for both of them could be infection with H. pylori or intake of NSAIDs.

Mnemonico diagnostico : Klinefelter's syndrome

Hey Awesomites

Criteria for diagnosis of Klinefelter's syndrome in males mnemonic : KLINEFELTER

K - (K) Cryptorchidism
L - Leydig cells hypertrophy
I - Increased gonadotrophins
N - Negative/ Positive chromatism (aberrations)
E - Elongated legs
F - Failure of secondary sexual characters
E - Eunuchoidism
L - Late pubic hair
T - Testicular failure
E - Erectile dysfunction / Elbow deformities
R - Retardation (mental)


Thats all
- Jaskunwar Singh

Non Contraceptive uses of the Condom

Hi everyone. So we know what we use a condom for generally :p
But there are a few non Contraceptive uses for this magical device that prevents babies :').

So here goes -

1. Prevention of STD's.
2. Can be used in Balloon Tamponade to control PPH.
3. Used to cover the USG probe inserted into the female tract.
4. Can be used as a mould for the vagina during Vulvoplasty.
5. Women with Anti Sperm antibodies during the initial phase. (Controversial).

So that's about it.
We know no 5 more reasons to use condoms !
Go get em ; )
Happy studying.
Stay awesome.

~ A.P.Burkholderia

How to remember Hepatitis B is associated with membranous glomerulonephritis

Writing this post because I confused it with focal segmental glomerulonephritis yesterday.

Hepatitis B is associated with membranous glomerulonephritis.

Mnemonic: Happy memory - Heppy membory - Hepatitis B Membranous nephropathy :D

That's all!
-IkaN

Bromocriptine : Utility Review

Hi everyone ! Here's a brief review on the drug Bromocriptine which happens to be one of my favorite drugs. So here goes.

- Bromocriptine is a Dopaminergic agonist , specifically acting on the D2 Receptors.

- It is a very widely used drug , with various and multi systemic uses.

Uses :

1. Parkinson's disease.
- Bromocriptine and other D2 agonists like Rotigotine , Ropinirole and Pramipexole can be used to treat Parkinsonism.
- They act by providing a sort of  replacement for the depleted dopamine in the circuits of the basal ganglia.
- They are quite effective , especially in case of L Dopa resistance , or deterioration of symptoms when on L dopa.

2. Neuroleptic Malignant Syndrome.
- NMS is perhaps caused by D2 blockade due to drugs like Haloperidol and Fluphenazine.
- Thus it makes sense if you give this D2 agonist to treat this disorder.

3. Hyperprolactinemia.
- Dopamine acts as a Prolactin Inhibitory Factor (PIF) at the Hypthalamo-Pituitary level.
- In cases of Hyperprolactinemia where there is gynecomastia and galactorrhea,  giving D2 agonists counteracts the elevated prolactin levels.
- Thus it's useful in Anti psychotic/ Metoclopramide induced Hyperprolactinemia.
- Can be used in Ovulation induction due to elevated prolactin by a Pituitary adenoma.

4. Diabetes Mellitus.
- Bromocriptine modulates the Dopaminergic discharge at the Hypothalamus level.
- This modulates the circadian rhythm and resets the abnormal metabolic drive of the Hypothalamus and reduces the insulin resistance.
- The specific Quick Release formulation is used for this indication.
- It may be used in conjunction with Insulin and does not cause hypoglycemia.
- It cannot however be used for DKA

5. Acromegaly.
- Inhibits the excess Growth Hormone secretion by acting at the Hypothalamus level.

Hope this helped !
Happy studying and stay awesome!
~ A.P.Burkholderia

Neuroleptic Malignant Syndrome : A Crisp Overview

Hi everyone ! So I recently saw a patient who possibly had Neuroleptic malignant syndrome. So I though I would do a post on it !

1. The Syndrome -

NMS is an idiosyncratic reaction to Anti psychotic drugs. It causes a host of symptoms like Rigidity , Hyperpyrexia and altered consciousness.

2. The Etiology -

- All Antipsychotic drugs can cause NMS. But most commonly implicated are Haloperidol, Fluphenazine and Chlorpromazine.
- Especially at risk are those taking Depot preparations.
- Even lithium in high doses can precipitate this.
- Atypical Antipsychotic drugs have a lower propensity to cause this.

3. The Pathophysiology -
- Although largely speculative , the cause is said to be the dopaminergic blockade by the anti psychotic drugs.
- Blockade of D2 in Hypothalamus is responsible for the Behavioral and Temperature changes.
- Blockade of D2 in the basal ganglia ( nigro striatal pathway) causes the Rigidity.
- increased muscular activity can cause muscle break down.

4. The Clinical Features - 

- generally within 4-10 days after starting the Antipsychotic drug. But can even occur years later.
- Hyperthermia ( Hypothalamus is conked off )
- Lead pipe Rigidity ( Basal ganglia are screwed)
- Altered mental state - delirious.
- Sweating/ Diaphoresis  ( compensation for high temp)
- Tachycardia
- Dyspnea
- Urinary incontinence
- Dysphagia
- Pallor.

Symptoms develop over a period of 24-72 hours.

5. Tests -
- Creatine Phosphokinase (CPK MM) is raised
- Leukocytosis
- Low Iron
- Deranged LFT and LDH

( Can be used to differentiate from serotonin syndrome)

- Diagnosis requires Hyperthermia + Rigidity +   2  other features ( including riased leukocytes and CK MM)

6. Management -
- ABCD
- Ventilatory support if needed
- stop Antipsychotic drugs.
- Anti pyrectics . Ice packs. Cooling blankets.
- BDZ
- Specific -->
Dantrolene - Muscle relaxant and Hyperthermia management. 400 mg/D.

- Bromocriptine - D2 agonist.

- ECT may be needed.

Hope this was helpful ! Happy studying and Stay awesome.

~ A.P.Burkholderia

Reversible Causes of Dementia : Mnemonic

Hi everyone ! This is a short post on causes of dementia that can be corrected. This is very important as most causes other than these have no available treatment ! (One Reversible cause of dementia is the Demeantor's kiss ;;) Treat using  Expectro Patronum)

So the medically treatable causes include the following.

Remember : ABCD2E

- Alcoholism
- Vitamin B deficiency - Thiamine / Niacin /B12
- CNS infections - HIV , Chronic Meningoencephalitis , Whipple Disease, Neurosyphilis.
- Depression
- Drug induced
- Endocrine - Thyroid disturbances

Let's look at how these can be corrected medically.
- A = Alcohol abuse. May be a result of Alcoholic delirium/ Wernicke-Korsakoff syndrome. So the management would include giving Thiamine to the patient , and alcohol withdrawal using Disulfiram ans other anti craving drugs like Ondansetron, Acamprosate, Topiramate and Naltrexone.

- Vitamin B Deficiency = Thiamine deficiency we've seen above.
Niacin Deficiency causes 3 D's - Diarrhea , Dermatitis and Dementia. So treat that using Niacin.
B12 Deficiency and possibly folic acid can also cause Dementia.

- CNS Infections = They cause transient cognitive changes that are reversible on treating the disease.

- Depression = may cause depressive pseudodementia or even true dementia. (pseudo dementia = no confabulation or impaired recent memory)

- Drug induced = Chronic use of drugs like BDZ , Opiates and TCA's.

- Endocrine = Hypothyroidism is notorious to cause Dementia.

~~~~~~~~~~~~~~~~~~~~~~~

The surgically correctable causes are below.
Remember = T2 H2

- Tumors  (esp frontal lobe tumors )
- Trauma (Subdural Hematoma)
- Normal Pressure Hydrocephalus (NPH)
- Hydrocephalus

- Tumors are resected surgically.
-  For the hydrocephalus group , ventriculo peritoneal shunting is performed.
- NPH = Triad of symptoms showing Gait disturbances , Urinary incontinence and Dementia. (GUD)

Hope this post helped you and didn't leave you too demented. !  If it did, have some chocolate like Lupin would offer ;;)
Happy studying.
Stay awesome.

~ A.P.Burkholderia

Fact of the day: Nightmares are a warning for serious mental problems

Hello

Not one or two, but frequent nightmares are major caveats for underlying serious mental problems. Rapid Eye Movement sleep disorder is a rare disorder that causes the person to act violently during dreamy state. This may be a warning sign for major neurologic disorders like Parkinson's and neurodegenerative diseases like Alzheimer's !!

Night owls are more likely to have frequent sleep and mood disturbances than the early sleepers. Evidences suggest people suffering from nightmares and related sleep disorders are more likely to have suicidal tendencies than those not, in addition to other contributing factors.


- Jaskunwar Singh

Drugs causing hyperkalemia mnemonic

Hello!

I modified the K BANK mnemonic and added more to it to cover a few more drugs.

The mnemonic for drugs causing hyperkalemia is: K BANK Digs, cycles, sucks, self help (Sulf hep!)

K - Potassium sparing diuretics (Obviously!)

B - Non selective beta blockers

A - ACEI, ARBs

N - NSAIDs

K - Potassium supplements

Digs - Digoxin

Cycles - Cyclosporine

Sucks - Succinylcholine

Sulf - Sulfonamides, Trimethoprim

Hep - Heparin

That's all!

-IkaN

Direct acting cholinomimetic agonist mnemonic

Hi everyone, 

Here's the mnemonic for direct acting cholinomimetic drugs: ABC VPN

Nerve fibres : A clinico-physiological approach.

Hello everyone. So I've not been active at all lately , cause Final Year ! Pretty depressing 🙄. Anyway. Here's a post about the nerves and what we need to know for clinical application!

Nerves

So Erlanger and Gasser classified the nerves into A, B and C based on Myelination and size.

So you have :
A
(Which has Alpha , Beta , Gamma , Delta fibres )
B
C

Out of these , the first 3 : 
A - Alpha , Beta , Gamma = Large fibres which are largely Myelinated.

And next 3 :
A - Delta , B , C = Small fibres which are not Myelinated as much.

How I remember these fibres is as per evolutionary significance.
The least Myelinated fibres , which are the smallest are the ones all living creatures need. As we progress from C to B to A , we continue to gather more and more well developed and specialised fibres.

C -
The smallest fibres.
Least Myelinated.
Most basic fibres and most primitive from an evolutionary stand point !
Control sensations of Dull Pain and Temperature (Heat)

B -
Small fibres.
Low Myelination.
Next most Basic Instinct - Urination.
Controls your Autonomic nervous system.
Remember- B = Bladder

A Delta -
Moderately Small fibres.
Lower Myelination than other A fibres.
Responsible for sensation of Sharp pain and Temperature ( Cold )

Thus to summarize the small fibres -

We have C , B and A Delta.
Out of these
C and A Delta control Pain and Temperature
( where C controls Dull pain and Heat ; A Delta controls Sharp pain and Cold )
And B controls Bladder /ANS.

(How to remember A Delta vs C.
C is more primitive. Hence controls Dull pain. Sharp pain is a little more specialized and hence is controlled by the relatively more modern fibre - the A Delta)

Coming to the large fibres.

We progress from A gamma to A beta to A alpha.

A Gamma :
Large but smaller then Alpha and beta.
Myelinated but not as much as alpha and beta.
Responsible for muscle tone.
Remember : A Gamma = Gamma motor neuron which is responsible for tone.

A Beta :
Very large.
Well Myelinated.
Responsible for modern sensations like Fine touch, Pressure and Vibration.

A Alpha :
Largest.
Most Myelinated.
Responsible for Muscle Contraction and Most modern sense - Proprioception.
It's the Bomb of the fibres hence responsible for muscle contraction.

Thus , demyelinating diseases like Guillian Barre syndrome and CIDP would affect the fibres that are used to being Myelinated.
So your presentation in these diseases would generally involve loss of:
A Alpha - Motor + Proprioception
A Beta -  Modern sensations of fine touch and vibration.
A Gamma - Tone

And Axonal Polyneuropathic Diseases like Metabolic or Post infectious ones would involve loss and abnormalities of -
A Delta - Sharp Pain and Cold
B - ANS
C - Dull pain and Heat.

Hope this was helpful !
Happy studying !
Stay awesome.

~ A.P. Burkholderia

Case control study vs Cohort study mnemonic

Super short post :)

Case control study - Start with an outcome and go back in time to study the risk factor.
Simplified: Case (Diseased) vs Control (No disease)

Cohort study - Start with risk factor and see who developed the disease and who did not.
Mnemonic: cOhOrt has two O's.
One O has an R (cohORt), which means one group has the risk factor.
Other O does not have an R (cOhort), which means the other group does not have the risk factor.
Compare the two to see who gets the disease.

How to remember that case control studies measure odds ratio and cohort studies measure relative risk:

You take surgical "cases" to the "OR" (Operating room)
Case control study - Odds Ratio

cohoRRRRRRt measures Relative Risk.

kthxbye!

-IkaN