Friday, April 21, 2017

Drug Induced Edema : Mnemonic

Hi everyone. Here's a short post highlighting drugs causing edema.

Remember : SWOLLEN

S - Steroids
W (V) - Vasodilator drugs
O - Oral Hypoglycemic drug - Glitazones
L - CycLosporine
L
E - Endocrine - Growth Hormone
N - NSAIDs

1. Steroids -
Due to the Mineralocorticoid action of reabsorbing the Sodium from the kidneys, they act as volume expanders.

2. Vasodilator drugs -
Especially CCB's like Amlodipine  are known to cause this. Other Vasodilator drugs used for hypertension can also cause edema like Alpha Methyl dopa, Hydralazine, etc

3. Oral Hypoglycemic drug : Glitazones -
The Glitazones act on the PPAR gamma receptors. These receptors are also present in the kidneys and vascular system. They somehow modulate the kidneys to reabsorb Na+ and also act on the level of blood vessels via PPAR receptors.
This is one of the reasons why they are c/i in Heart failure and Liver cirrhosis ( as they cause fluid overload).

4. Cyclosporine -
Reduces the GFR , thus more fluid retention.

5. Growth hormone. I don't understand why. Do tell me if you find out !

6. NSAIDs -
NSAIDs inhibit PG synthesis in kidneys causing renal vasoconstriction and this reducing the GFR.
This causes excess fluid accumulation eventually causing edema.

That's all!
Happy studying. Stay awesome. :)

~ A.P.Burkholderia

Adult ADHD : A Clinical Overview

Hey Awesomites

Attention - Deficit Hyperactivity Disorder ( ADHD ) is a mental health disorder that usually occurs in childhood and continues into adulthood. The symptoms in adults may not be as clear as in children. In India, there are more than 10 million cases of adult ADHD per year.

In adults, the symptoms of hyperactivity may decrease, but the characteristic features of decreased attention span, mood swings, impulsive behavior, difficulty in communication and language skills, restlessness may still continue to appear.

Now lets talk about the signs. The WHO has lately released a set of six questions to test the adults for signs of ADHD - Adult Self - Report Scale Screener (ASRS) is a self - screening questionnaire that you can use to determine if you might have ADHD. The answers to these questions predict the people suffering from this disorder and is a simple way of screening :

1. How often do you have difficulty in concentrating on what the other person is saying to you, directly as well as indirectly ?

2. How often do you leave your seat when you are in a group or meetings in which you are expected to remain seated?

3. How often do you have difficulty in unwinding and relaxing when you have time to yourself ?

4. When you are in a conversation, how often do you find yourself finishing sentences of the people you are talking to before they can finish them themselves?

5. How often do you put things off until the last minute?

6. How often do you depend on others to keep your life in order and attend to details?

- The answers to these set of questions can be 'never', 'rarely', 'sometimes', 'often', or 'very often'.
- If the answer to four of the six questions is 'sometimes', 'often' or 'very often' , the person may be considered to have ADHD!

Note that this is a simple way of screening the people for signs of ADHD, and not the diagnostic criteria.


Thats all
- Jaskunwar Singh

Thursday, April 20, 2017

Croup mnemonic

If croup crops up in the exam, here are some high yield points you should know:

Croup CROPS!

Corticosteroids
Racemic epinephrine
Oxygen

Parainfluenza virus

Seal barking cough
Stridor
Subglottic stenosis
Steeple sign

#TLDR
Parainfluenza virus type 1 is the most common cause of croup.

The onset of symptoms in laryngotracheitis is gradual, beginning with nasal irritation, congestion, and coryza. Fever, hoarseness, barking cough, and stridor usually develop during the next 12 to 48 hours. 

In children with croup, a posterior-anterior chest radiograph demonstrates subglottic narrowing, commonly called the "steeple sign" 

Children with croup are treated with dexamethasone, nebulized epinephrine and humidified oxygen depending on severity.

Remember, intubation is rarely required in croup, so think of other etiologies if the patient needs intubation.

That's all!
-IkaN

Edge of an ulcer : An overview

Hello

An overview on how edge of an ulcer appears with characteristic identification features depending on the underlying causes: (SPURE)

Sloping edge - Venous ulcer, also seen in traumatic cases. It is red - purplish in color and consists of new healing epithelium. ( spreading type )

Punched out edge - Arterial and Neuropathic ulcer. Edges are punched out at right angles. ( non spreading type )

Undermined edge - Decubitus and Tuberculous ulcer. It spreads rapidly to destroy the surrounding tissue !!

Rolling back - Basal cell Ca. It is characterised by raised, pearly white beaded edge with central necrotic tissue.

Everted edge - Squamous cell Ca. It is a rapidly growing invasive ulcer with heaped up and everted edges.




Thats all
Hope this helps :)

- Jaskunwar Singh

Submission: Internal Illiac artery branches mnemonic


submitted by Mayank Kesharwani

Submission: Direction of growing end of bone, opposite to direction of nutrient artery


submitted by: Mayank Kesharwani

Upper limb joints types mnemonic

Hey Awesomites

From proximal to distal, the joints and its types are:

Shoulder joint - Ball and socket type
Elbow joint - Hinge joint
Radio carpal ( wrist ) joint - Ellipsoidal and biaxial type
Carpo metacarpal joint - Saddle joint
Metacarpo phalyngeal joint - Ellipsoidal ( condylar ) joint
Interphalyngeal joint - Hinge joint

Mnemonic to remember the types, from proximal to distal : BaSu ( Ball and Socket ) writes Hindi ( hinge ) in elliptics ( Ellipsoidal ) but is sadly (Saddle ) condemned ( Condylar ) without hinges .


Thats all
- Jaskunwar Singh

Submission ( notes and mnemonic ) by Mayank Kesharwani - ( PS: This is a Hindi Urdu mnemonic )
Bhaiya Hum ESE Hain

Bhaiya - Ball and Socket joint
Hum - Hinge joint
E - Ellipsoidal
S - Saddle
E - Ellipsoidal
Hain - Hinge


Thanks Mayank for sharing :)

Submissions : Tonsillar Bed mnemonic

Hello

Tonsillar bed mnemonic ( from within outwards ) :

P(b) S S B(p)

Pharyngo Basilar fascia
Superior constrictor
Styloglossus
Bucco pharngeal fascia



- Submitted by Mayank Kesharwani

Submissions : Important vertebral levels

Hello

Important vertebral levels for bifurcations:
- Common carotid artery bifurcation - C4 vertebra
- Tracheal bifurcation - T4 ( may ascend or descend upto two vertebrae higher or lower with breathing )
- Abdominal Aorta bifurcation - L4

Important vertebral levels for formations:
- Cricoid cartilage-  C5- C6
- Thoracic duct crosses right to left - T5 ( and enters left IJV )
- Inferior Vena Cava formation - L5 ( from two common iliac veins )

Submitted by Mayank Kesharwani

Submissions: Rolando fracture mnemonic

Hello



TATA truck ROLLS on wheels

The shape of this fracrure is T- shaped or Y ( bent- T ) shaped, which resembles the sign of the Tata motors truck, and Roll is for "Rolando fracture"

Mnemonic submitted by Mayank Kesharwani
Diagram by Jaskunwar Singh 

Medicowesome secret project: Let's talk about unpleasant changes

Medicowesome secret project: Let's talk about providing psychological support

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

Wednesday, April 19, 2017

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 )

Tuesday, April 18, 2017

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

Monday, April 17, 2017

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