Sunday, June 18, 2017
Step 2 CK: Management of thromboembolic stroke
Drugs used to lower BP acutely in severe preeclampsia mnemonic
Drugs used to lower blood pressure acutely in severe preeclampsia (Maternal hypertensive crisis) mnemonic
"Lower Hypertension Now"
Labetalol iv preferred (Avoid in bradycardia)
Hydralazine iv
Nifedipine oral
That's all!
-IkaN
Micturition and Neurological diseases
Here, presenting you a detailed description of Pathologies of Bladder in Neurology. I believe this is the best resource on this topic available online for free. :)
Diaphragmatic hernia : Mnemonic and Review
Here's a short post on the key points about Congenital Diaphragmatic Hernia.
So there's deficiency in the diaphragm during development causing abdominal contents to budge into the Thorax.
There are 2 main types -->
1. Bochdalek.
2. Morgagni.
Now out of these 2, Bochdalek is commoner.
(It's hard to remember the word Bochdalek. I struggle with it every day. )
You can memorize it by realising that it rhymes with ' Scotch da Lake '
(Which means a lake of scotch in Punjabi)
Key points about Bochdalek -
BBBB
- Back - Located posteriorly
- Big - Bigger than the Morgagni form
- Bad - Poor prognosis
- Bag and Mask Contra indicated.
Also realise - Bochdalek
So it's got an L in it. L = Left. So it's more common on the left side. These hernia classically cause a scaphoid abdomen and Mediastinal shift to the opposite side.
Morgagni can be remembered by the opposite of the BBB
So it's
- Not on the back - Anteriorly
- Not Big - Small sized.
- Not as Bad - Prognosis is alright.
Also realise - Morgagni
It's got an R in it = Right. So it's more common on the right side. And it contains the Transverse colon generally.
So that's all !
Happy studying!
Stay awesome !
~ A.P.Burkholderia
Croup : Review of key points
Here's a short Mnemonic/Review of Important facts about Croup - Acute Tracheobronchitis !
Remember :
CROUPS
C - Common respiratory disease
R - Respiratory viruses like Parainfluenza
O - Oxygen Treatment (Humidified)
U - Ugly Cough - Barking / Seal like cough
P - Prodrome of illness followed by Inspiratory Stridor
S - Steeple sign on X Ray
It's helpful to remember Acute EPIGLOTTITIS as the complete opposite of CROUPS using similar ideas.
- Not as common.
- Caused by Bacteria generally (Strep , Hib)
- Oxygen Therapy + AntiBiotics
- Ugly - Sniffing dog like position + Drooling
- Prodrome not particularly, but Stormy acute onset.
- Shows Thumb print appearance on X Ray.
Hope this helped !
Happy Studying !
Stay awesome.
~ A.P.Burkholderia
CMS neurology form 2: Question on numbness, tingling and decreased grip strength
Differentiating C8 radiculopathy from ulnar neuropathy
Hello. This is a very short post (because I am super busy studying)
It's on differentiating C8 radiculopathy from Ulnar neuropathy based on a question I solved the other day. How would you differentiate the two in clinical practice?
C8 radiculopathy:
- Thumb abduction weakness: abductor pollicis brevis (C8, T1)
- Triceps affected (C6, C7, C8)
- Radiculopathies are often painful.
Ulnar neuropathy:
- Hand intrinsics (C8, T1) affected:
Palmar and dorsal interossei
Lumbricals III & IV
Abductor/opponens/flexor digiti minimi
- Basically, all hand intrinsics except for the median-supplied "LOAF" muscles (lumbricals I & II, opponens/ abductor/flexor pollicis brevis)
- Triceps not affected.
- Focal neuropathies aren't painful.
Conclusion: The ulnar nerve innervates all intrinsic hand muscles, except the abductor and flexor pollicis brevis, opponens pollicis, and lateral two lumbricals, which are innervated by C8 and T1 via the median nerve which helps differentiating the ulnar neuropathy from C8 radiculopathy.
That's all!
-IkaN
Saturday, June 17, 2017
Pills of knowledge in Ophthalm- Anterior ciliary artery
The point where the anterior ciliary artery pierces the sclera is often marked by a pigment. This is of particular importance while cauterization as in a bid to make everything look neat and shiny, the pigmented part shouldn't be cauterized as it will cause necrosis of the structures supplied by the artery.
Effects of Angiotensin-II on GFR
So this is a highly confusing topic. No matter how many times you read it, some amount of doubt is always there in your mind. So an advice to the readers, bookmark this post because you will be needing to read it more than once to get the drift.
First of all, let us review the effects of Angiotensin II on Glomerulus.
It constricts both the afferent and efferent arterioles but preferentially increases efferent resistance. Why? 3 reasons:
1. Efferent arterioles have a smaller diameter in their basal state.
2. Ang II stimulates the release of vasodilator NO from the afferent arteriole.
3. Ang II minimizes vasoconstriction at the afferent arteriole via the stimulation of Ang II type 2 (AT-2) receptors, which result in vasodilatation through a CYP450 dependent pathway.
The net effect of preferential rise in efferent arteriolar resistance is that the glomerular pressure is increased or stabilized(in hypoperfusion states), which helps to maintain or increase GFR. But in the long run, lots of fluid have been filtered out leaving behind the proteins which raise the colloid osmotic pressure, eventually enough to overrule the hydrostatic pressure and hence it leads to decrease in GFR.
Ang II also reduces GFR by causing constriction of the mesangial cells which reduces the effective surface area for filtration.
-VM
Pills of knowledge in Ophthalmology- Squint and refractive errors
1.A refractive error should be thoroughly assessed prior to surgical squint correction or the squint may recur.
2. Divergent squint occurs in myopes as the divergent system of muscles is more active during far vision. So, the far vision in myopes being hampered, the eyes try to diverge more.
3. Same goes for hypermetropes. They end up with a convergent squint if left uncorrected.
-That's all!
Sushrut Dongargaonkar
Differentiating peroneal neuropathy, sciatic nerve injury and L5 radiculopathy
Peroneal nerve supplies the dorsiflexors and evertors of the foot. There will be no weakness in plantar flexion and inversion in peroneal nerve injury.
- Acute foot drop (difficulty dorsiflexing the foot against resistance or gravity).
- Patients describe the foot as limp; there is a tendency to trip over it unless they compensate by flexing the hip higher when walking, producing what is called a "steppage" gait.
- Patients may also complain of paresthesias and/or sensory loss over the dorsum of the foot and lateral shin.
- Examination typically reveals weakness in foot dorsiflexion and foot eversion (deep and superficial peroneal nerve-innervated, respectively), with normal inversion and plantar flexion (posterior tibial nerve).
- Sensory disturbance is confined to the dorsum of the foot, including the web space between digits 1 and 2 and the lateral shin.
- Reflexes are normal.
- Weakness affecting most of the lower leg musculature, including the hamstrings.
- Hip flexion, extension, abduction and adduction, and knee extension are normal.
- Sensory loss involves the entire peroneal, tibial, and sural territories.
- In the lower leg, however, the medial calf and arch of the foot may be spared secondary to innervation by the preserved saphenous nerve (a branch of the femoral nerve). Sensation is also spared above the knee both anteriorly and posteriorly.
- The knee jerk is normal, but the ankle jerk is unobtainable.
- Back pain that radiates down the lateral aspect of the leg into the foot.
- On examination, strength can be reduced in foot dorsiflexion, toe extension, foot inversion, and foot eversion.
- Mild weakness in leg abduction may also be evident in severe cases due to involvement of gluteus minimus and medius. Atrophy may be subtle; it is most readily observed in extensor digitorum brevis.
- Sensory loss is confined to the lateral shin and dorsum of the foot.
- Reflexes are generally normal.
-IkaN
Friday, June 16, 2017
Alvarado Score Parameters Mnemonic ; For Appendicitis
Anorexia or ketones in urine - 1
Leukocytosis >10,000 -2
Vomiting/Nausea -1
migrAtory pain to right iliac fossa -1
Rebound tenderness -1
temperAture above 37.3 celsius -1
tenDerness in right iliac fossa -2
neutrOphilia >70% -1
Of these the second parameter from above and second parameter from below have 2 points credited for each. Every other parameter is credited with 1 point each.
The overall aggregate comes out of 10, which the highest possible score for Alvarado score.
If, the aggregate is,
<3 - Low risk for appendicitis
4-6 - Mid risk for appedicitis
>=7 - High risk for appendicitis
In some hospitals where a differential count is difficult to find, use a modified score with 9.
That's all guys, if you find any mistake let me know.
With love,
Jay~
P.S. - yayyy.....missed me much awesomites? I was away from the blog for the last 6 months from posting, because I had very disastrous scores for surgery in my university and I didn't feel worthy enough to write for you guys. (So my activity was largely concentrated in the Whatsapp Medicowesome groups, and the Author's page.) Anyways, I had to take a remedial exam for Surgery 2 weeks ago. And BAAM!!!!.....the results were released today, and yayyyyy.....I passed surgery! :)
I must thank all my Medicowesome admin/author collegues for tolerating my rants and, help me to push through the hellish scary time together. Thanks everyone. Finally I'm through it, and I'm back to writing for you all guys. So thought to start the first post after returning, with a General Surgery Diagnosing score with the help of Schwartz Textbook of Surgery.
See ya soon peepz! :)
Thursday, June 15, 2017
Pills of knowledge in Ophthalm- Posterior staphyloma
A posterior staphyloma is common because the durability of the layers of the eye where the optic nerve enters the eye is lesser in comparison.
-That's all!
Sushrut Dongargaonkar
Pills of knowledge in Ophthalm- Moxifloxacin
Moxifloxacin is the preferred antibiotic in Ophthalmic surgeries and pathologies because it gets concentrated into the anterior chamber and the aqueous.
That's all!
-Sushrut Dongargaonkar
EMG and NCS - Review
Hello there!
Today we'll see some important points on Electromyography (EMG) and Nerve conduction studies (NCS).
EMG evaluates abnormal electrical activity in muscles, and NCS investigates how electricity flows through a nerve.
They help to locate and determine the causes of diseases that affect muscles and peripheral nerves.
Procedure:
In EMG, a small needle is inserted into a muscle, to measure its electrical activity. In NCS, electrodes are placed on the skin overlying a nerve, and other recording electrodes are attached at a different point over the same nerve and a small shock is applied, and the electrical impulse is recorded.
Understanding the terminologies and results of these tests-
Amplitude: The electrical signal is represented as a wave, and the amplitude is its height.
ConductionVelocity (CV): The conduction velocity describes the speed at which the electrical impulse travels along the nerve.D
Duration This describes the width of an electrical wave.
ConductionBlock: The diminution of signal across an anatomical region such as the wrist. This suggests nerve entrapment.
So when a nerve stimulates a muscle to contract, there is a brief burst of electrical activity called a motor unit action potential (MUP).
Some of the abnormal responses seen are:
1)Fibrillations & positive sharp waves on the monitor seen in diseases of peripheral nerves.
Muscles sometimes start having spontaneous activity on their own.
2)Fasciculations: Sometimes the abnormality causes visible muscle twitches.
3)Abnormally large MUPS : These are seen If a nerve has been injured and then regrows.
On regeneration the nerve tends to branch out to include a wider area of the muscle and hence we get large motor unit potentials on the screen.
4) Abnormally small MUPS: When they're abnormally small or brief it suggests the presence of a disease of a muscle (a myopathy) where the muscle is unable to contract to and fails to provide the normal amplitude of the wave.
5)"Recruitment pattern": As a muscle is contracted, nerve fibers signal more and more bits of muscle (called motor units) to join in and help.
In a neuropathic disorder, the amplitude of different motor units is strong, but there are fewer of them because the nerve is unable to connect to as many units.
In myopathies, the number of motor units is normal, but the amplitude is smaller
You may never come across an actual EMG for an interpretation,but it is always good to know the investigation.
The interpretation of EMG and NCSs is not always straightforward and may not always lead to just one possible diagnosis — but the tests can reduce the number of diagnostic possibilities.
Hope this was helpful!
Let's Learn Together!
-Medha.
New TB Risk Factor
People with low levels of vitamin A who live with individuals who were sick with tuberculosis were 10 times more likely to develop the disease than people with high levels of the nutrient, according to research led by investigators at Harvard Medical School.
Vit A rich foods: Liver, fish, hard-boiled egg(not omelette), cheese, butter, cheddar etc
And now some vegetables: Sweet potato, Carrot, Squash, Spinach, Lettuce
Some fruits: Mango, Papaya, Guava, Watermelon, Apricot, Passion fruit
Another reason to love Mango!
-VM
Research update: Statins may increase risk of Parkinsons' disease
A new research by neuroscientists has updated our knowledge about the association between high cholesterol levels in people and prevalence of neurodegenerative diseases such as the Parkinson's.
Mind - wandering : How your body reacts to it?
First lets have a word about mind - wandering.. "Mind- wandering (or task-unrelated thoughts) is an experience of thoughts which are totally unrelated to the task you are doing right now, especially when it demands attention. It involves activities such as reading, driving, attending lectures, etc."
Wednesday, June 14, 2017
Dibucaine Number.
Hello !
Let's see what this Dibucaine number is.
So Dibucaine is a local anesthetic.
Dibucaine inhibits 80% of the normal Pseudocholinesterase enzyme and 20% of the Atypical enzyme.
The number is determined by measuring the percentage of Pseudocholinesterase enzyme that remains unchanged in the blood of individuals administered a standard dose of Dibucaine intravenously.
Normal Dibucaine number is 70-80% i.e 70-80%of normal enzyme is inhibited by Dibucaine.
If there is a point mutation in the enzyme making it a Atypical Pseudocholinesterase then Dibucaine will not be able to inhibit it and the number will decrease.
This number is used to measure the activity of Atypical Pseudocholinesterase,and to assess the likely hood of prolonged apnea after succinylcholine administration.
Sodium Fluoride can also be used in place of Dibucaine.
If you know more on it Add to this information.
Let's learn Together!
-Medha.
Monday, June 12, 2017
Contraindications for Noninvasive Ventilation Mnemonic
Hey guys
This is one of my rare mnemonic posts. I don't post much on this coz most of my mnemonics are kinda personal if not socially inappropriate :p
So Noninvasive ventilation, imagine having a mask on ur face, all air tight, almost strangulating and as if this isn't enough, with multiple tiny outlets giving jets of air which are titillating your highly itchable nasal area.
Unpleasant, right?
Talking of unpleasant, you do remember Hitler, right?
He GAAASED the Jews, since that's not a possibility for us since we all love Zuckerberg let's think about something on a similar note.
"GAAAS the HOEs"
G- GI bleeding
A- Aspiration
A- Angina( including MI)
A- Arrest( Cardiac and Respiratory)
S- Surgery on ur face
H- Haemodynamic instability
O- Obstruction ( in upper airway)
E- Encephalopathy ( Severe)
S- _____
I've left the last one blank for the reader to fill up. Hint: It has something to do with obstruction of the lower airways.
Hope this is helpful!
-VM
Sunday, June 11, 2017
Study Group Discussion: Salisbury Phenomenon
Whats Salisbury effect?
It's a very interesting phenomenon.
It states that when coronary collaterals develop in the face of myocardial ischemia, they improve the blood supply. However they physically restrict left ventricular dilation and thereby raise LVEDP(LV end diastolic pressure) and reduce LV compliance.
This is because they act like tendrils/scaffold which prevent ventricular dilation.
Nice one!
-VM