Thursday, July 22, 2021

Babeosis mnemonic

This is how I remember babeosis is associated with Maltese cross appearance.

You know you love me, xoxo, gossip girl!


Friday, June 25, 2021

Lesch Nyhan syndrome - Mechanisms (Revised post)

 Hello friends! Let's refresh our biochemistry knowledge today.

Lesch-Nyhan syndrome is characterized by choreoathetosis, dystonia, hyperuricemia, gout, self mutilatory behavior especially self-biting of fingers, and intellectual disability due to HGPRTase mutations.

So how do HGPRTase mutations actually cause dystonia and other extrapyramidal signs and symptoms?

1.)  For the synthesis of dopamine, tetrahydrobiopterin as a cofactor for tyrosine hydroxylase is required.
Tetrahydrobiopterin itself is derived by a series of reactions in which GTP cyclohydrolase is a rate-limiting enzyme.
Now HGPRTase deficiency causes depletion of GTP thereby ultimately depleting tetrahydrobiopterin.

In fact, GTP cyclohydrolase mutations are known to cause dopa-responsive dystonia and phenotype similar to Lesch-Nyhan syndrome.

2.)  Secondly, dopamine receptors are linked to G-protein coupled receptors which alternate between GTP-GDP bound states, yet another link between GTP depletion and perturbation of dopamine signaling.

3.) Adenosine deficiency due to the reduction in salvage may adversely affect the role of adenosine as a neuroprotective agent.

Lastly, in Lesch Nyhan syndrome no characteristic imaging abnormalities are seen but reduced dendritic arborizations in the caudate nucleus, putamen, and nucleus accumbens are thought to underlie clinical manifestations.

So to summarise, Lesch Nyhan syndrome can be considered as one of the basal ganglia disorders with Wilson's disease and Huntington's disease being the other notable ones.

Have a great day!

-Kirtan Patolia

Celiac Disease (Spectrum of Manifestations)

 Hello friends! I hope all of you are doing well. Today I wanted to share with you the many faces of Celiac Disease. Although considered as the disease which chiefly causes gastrointestinal symptoms, the entire spectrum of possible manifestations it can cause is quite broad.

Some significant associations are as follows:

1.) GI- Enteropathy associated T-cell lymphoma (EATL), Microscopic colitis

2.) Liver- NASH

3.) Spleen- Functional Asplenia (SLE & Amyloidosis being other notable cause)

4.) CNS- Seizures with posterior cerebral calcification, Neuro-psychiatric symptoms, Ataxia

5.) Hematology- Evans syndrome

6.) Pulmonary- Diffuse alveolar hemorrhage

Here is the full spectrum. Hope you like it.

-Kirtan Patolia

Friday, June 11, 2021

Hormone Basics - Part 1

 Hormones are divided into 2 groups

Group 1 hormones- Act via nuclear receptors

    Type 1- Have cytoplasmic receptors with effector elements in the nucleus e.g Steroid hormones (cortisol), Gonadal hormones (Androgens, estrogens, progesterones)

Mnenonic- There is only 1 General Secretary

  Type 2 -Directly act at the nucleus e,g, vit D,vit A, Thyroxine

Mnemonic-Directly AcT at the nucleus

Group 2 hormones-  Act via the cell membrane surface receptors

1. GPCR- Very extensive, will require a second post

2.Tyrosine Kinase- All Growth factors(Except TGF alpha and beta) and Insulin (Tip to remember: TKI or tyrosine kinase inhibitors are used in a lot of malignancies, there's abnormal growth in malignancies and hence TKIs stop that growth, also I in TKI will remind you of insulin, Insulin causes fat to grow!!)

3. JAK-STAT(cytokine receptor) Mr. JAcK is a Drunkard!! all he needs is PEG 



Growth hormone.

(Pro tip: GH and PRL are called as twin hormones, JAK STAT mutations are involved in Myeloproliferative disorders say Polycyathemia and erythropietin is needed there)

4.Serine threonine Pathway: This pathway is a perfect BAIT for the hormones.

Bone morphogenic protein  



Trasformation growth factor alpha and beta

That's all for today!

Have fun and stay safe!

How did you find the post?

Let me know in the comments section below!

Dr. ShilPill

Osler's triad mnemonic


Thank you!

Wednesday, June 9, 2021

Reactive arthritis mnemonic


Thank you!

Dizziness & Vertigo | Harrison’s IM

IgG4-related systemic disease mnemonic

It is chronic disease characterized by fibrosis and sclerosis of various tissues due to infiltration with lymphocytes that secrete IgG4. Manifestations include sclerosing sialadenitis, retroperitoneal fibrosis, autoimmune pancreatitis, Riedel thyroiditis, tubulointerstitial nephritis, and other fibrosclerotic conditions.

That's all!

Thank you. 

Sunday, June 6, 2021

Dengue classification

WHO 1997 classification :

Dengue fever —  >2 of the following 


Retro-orbital or ocular pain

Myalgia and/or bone pain



Hemorrhagic manifestations (eg, positive tourniquet test, petechiae, purpura/ecchymosis, epistaxis, gum bleeding, blood in emesis, urine, or stool, or vaginal bleeding)


Dengue hemorrhagic fever — The cardinal feature of DHF is plasma leakage due to increased vascular permeability as evidenced by hemoconcentration (≥20 percent rise in hematocrit above baseline). In the setting of DHF, the presence of intense abdominal pain, persistent vomiting, and marked restlessness or lethargy, especially coinciding with defervescence, should alert the clinician to possible impending DSS.

According to the guidelines, a DHF diagnosis requires all of the following be present:

Fever or history of acute fever lasting 2 to 7 days, occasionally biphasic 

Hemorrhagic tendencies evidenced by at least one of the following:

A positive tourniquet test – The tourniquet test is performed by inflating a blood pressure cuff on the upper arm to a point midway between the systolic and diastolic pressures for 5 minutes. A test is considered positive when 10 or more petechiae per 2.5 cm (1 inch) square are observed. The test may be negative or mildly positive during the phase of profound shock. It usually becomes positive, sometimes strongly positive, if the test is conducted after recovery from shock.

Petechiae, ecchymoses, or purpura.

Bleeding from the mucosa, gastrointestinal tract, injection sites, or other locations.

Hematemesis or melena.

Thrombocytopenia (100,000 cells per mm3 or less) –  In healthy individuals, 4 to 10 platelets per oil-immersion field (100x; the average of the readings from 10 oil-immersion fields is recommended) indicates an adequate platelet count. An average of 3 platelets per oil-immersion field is considered low (ie, 100,000 per mm3).

Evidence of plasma leakage due to increased vascular permeability manifested by at least one of the following:

A rise in the hematocrit equal to or greater than 20 percent above average for age, sex, and population.

A drop in the hematocrit following volume-replacement treatment equal to or greater than 20 percent of baseline.

Signs of plasma leakage such as pleural effusion, ascites, and hypoproteinemia.

Dengue shock syndrome — DSS consists of DHF with marked plasma leakage that leads to circulatory collapse (shock) as evidenced by narrowing pulse pressure or hypotension.

Rapid and weak pulse.

Narrow pulse pressure ( ≤20 mmHg) or manifested by: observed early in the course of shock.

Hypotension for age – observed later or in patients who experience severe bleeding.

Hypotension is defined to be a 

  • SBP 80 mmHg  for those < 5 years of age 
  • SBP 90 mmHg  for those equal to or > 5 years of age.

Cold, clammy skin and restlessness.

WHO 2009 classification — 

Dengue without warning signs —>2 of the following 



Headache, eye pain, muscle ache, or joint pain


Positive tourniquet test

Dengue with warning signs —  any of the following 

Abdominal pain or tenderness

Persistent vomiting

Clinical fluid accumulation (ascites, pleural effusion)

Mucosal bleeding

Lethargy or restlessness

Hepatomegaly >2 cm

Increase in hematocrit concurrent with rapid decrease in platelet count

Severe dengue —at least one of the following :

Severe plasma leakage leading to:


Fluid accumulation with respiratory distress

Severe bleeding

Severe organ involvement:

Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) ≥1000 units/L

Impaired consciousness

Organ failure

  1. Sudden high-grade fever (≥38.5°C) Children have high fever but are generally less symptomatic than adults during the febrile phase. The febrile phase lasts for three to seven days, after which most patients recover without complications. 
  2. What is Biphasic fever ("saddleback") ?  - 1st febrile phase remits & recurs approx 1 to 2 days later & this 2nd febrile phase lasts 1 to 2 days.
  3. Serum aspartate transaminase (AST) levels are frequently elevated; the elevations are usually modest (2 to 5 times the upper limit of normal values), but marked elevations (5 to 15 times the upper limit of normal) occasionally occur.
  4. Between days 3 and 7 of the illness, you must watch for signs of vascular leakage. Corresponding clinical manifestations may include persistent vomiting, increasingly severe abdominal pain, tender hepatomegaly, development of pleural effusions and/or ascites, mucosal bleeding, and lethargy or restlessness; laboratory findings may include a high or increasing hematocrit level (≥20 percent from baseline) concurrent with a rapid decrease in the platelet count
  5. The vast majority of DENV infections that progress to a critical phase result from secondary infections more than 18 months after the first infection.The critical phase lasts for 24 to 48 hours.
Thank you! 🫀🩺

Wednesday, June 2, 2021

Study smarter not harder- Active recall, the foolproof method to ace any test

 If I ask an average student about their preferred study strategy the answer most likely would be Highlighting, summarising, and re-reading. Making aesthetically pleasing notes in a myriad of colours may be appealing to many but is passively re-reading already familiar content an effective study strategy?

Two of the most effective study strategies I have come across are active recall and spaced repetition. In this post, I will be talking about the science behind this method. I’ll cover spaced repetition in another post.