Sunday, December 15, 2019

Topical vs Oral antifungal mnemonic

Hey my friends, a common question in qbanks is when to use topical vs oral antifungals in Tinea infections.
Well, you can use the following mnemonic:

Tinea CAPitis => Imagine a CAP covering your head/scalp so you need a systemic treatment => Oral treatment (eg: Terbinafine) to reach it.
Scientifically, the systemic/oral treatment is needed to reach the hair shaft.

Tinea Corporis: Since Tinea Capitis is the oral one, Tinea Corporis is the topical one :)


Murad :)

Tuesday, December 10, 2019

Classification and causes of hyponatremia mnemonics + notes

Hi!

Classification and causes of hyponatremia mnemonics + notes:

1. Hyponatremia with low osmolality :
     (i) reduced effective blood volume
              (A) increased ECF volume -
                               - Edematous kidney (nephrotic syndrome)
                               - Cirrhosis of liver
                               - Failure of heart

              (B) REduced ECF volume -
                                - Renal loss of Na ( Diuretics, Ketonuria, Addison's disease)
                                - Extrarenal loss of Na ( sweating, diarrhea, vomiting, peritonitis, pancreatitis)

    (ii) Normal/ increased EBV
                - Inadequate ADH syndrome
                - Constant thirst
                - Renal failure (chronic)

2. Hyponatremia with raised osmolality :
( H & M)
- Hyperglycemia 
- Mannitol administration 

Note -
- Hyponatremia per se does not produce any significant clinical features. The low osmolality that it causes is responsible for various features.
- Slow correction of hypotonicity produces gradual rise in osmolality without any significant risk. But rapid correction of hyponatremia produces loss of brain water resulting in brain damage!
- The rate of correction should be around 0.6 mEq/L/hr. In severely symptomatic patients, total correction in a day should not exceed 8-10 mEq/L/hr.

That's all
Hope it helps
- Jaskunwar Singh

Wednesday, November 27, 2019

Attrition

In simple words, Attrition is the loss of tooth structure occlusally due to excessive forces by the occluding teeth, grinding of teeth, deep bite

Aetiology

  • Age 
  • Hard and Abrasive diet 
  • Chewing Habits 
  • Opposing porcelain crowns
  • Lack of posterior support- cause of anterior teeth attrition
  • Bruxism and Clenching
Clinical Manifestations
Occluding surface attrition causes small polished facet on a cusp tip or ridge or incisal edge
In severe cases, reverse cusp in place of cusp tips and inclined planes. This causes dentinal exposure and loss of vertical dimension of teeth.
Precipating Factors
  • Deficient masticatory capabilities of teeth
  • Cheek biting
  • Caries- because of the increased vulnerability of exposed dentinal surfaces 
  • TMJ Problems
  • Jutted out appearance of restoration and flattening of surrounding occlusal surface. %
Treatment : Pathologic
  • Advice the patient to wear splints 
  • To manage localised anterior teeth wear: use dahl technique
  • The more traditional way of dealing with a full arch or full mouth rehabilitation is to use conventional crowns eg, onlays of a full crown


Tuesday, November 26, 2019

Aurora kinases

Hello friends, Let's talk about Aurora kinases today.... Aurora sounds so beautiful, right ?

Aurora kinases represent serine threonine kinases with instrumental role in cell division.

Specifically, Aurora kinase A is required for duplication and separation of centromere, and Aurora B is required for attachment of microtubules to centromere.

They are often over expressed in tumors resulting in defective cytokinesis during cell division, eventually causing aneuploidy and driving the carcinogenesis.

Now, it really gets interesting; usually when functioning of microtubules are perturbed say by paclitaxel, then spindle check point inhibitor is activated leading to cell demise by upregulation of P53, PUMA and other mediators.

But in case of Aurora kinase inhibition, cells keep on dividing especially in case of P53 mutated cells. Since centromeres will not segregate, it ultimately leads to tetraploid genome and four centromeres in a cell, causing catastrophic mitosis in subsequent cell cycle effectively tearing apart the genome.

They are significant because often when other tyrosine kinase inhibitors targeting EGFR, VEGFR, FGFR are used, tumors over express Aurora kinases, there by over riding the inhibition mediated by tyrosine kinase inhibitors.... So targeting them is key to maintain remission in patients already on kinase inhibitors.

Few examples of drugs in trials: Monastrol, Hesperidin.

It's called Aurora because of the similarity between the appearance of microtubule spindles during cell division and Aurora Borealis.

Pretty Majestic, right?

Submitted by Kirtan Patolia 

Risk factors for puerperal sepsis mnemonic

Hi!

Risk factors for puerperal sepsis mnemonic:
PUERPERAL SEPSIS

Maternal complications of diabetes in pregnancy mnemonic

Hi!

Maternal complications of Diabetes in pregnancy mnemonic:
PREGNANCy

Monday, November 25, 2019

JVP documentation

Hi everyone!

Someone questioned on how to document JVP. Just saying JVP is 8 cm is not enough - Say what is your reference for better documentation :)

Saturday, November 23, 2019

Cryoprecipitate

Hey! =)

What does cryoprecipitate contain? 
Cryoprecipitate preparations contain concentrated amounts of fibrinogen (factor I), factor VIII (antihaemophilic factor), von Willebrand factor, factor XIII (fibrin-stabilizing factor), and fibronectin.

Why is it called cryoprecipitate?

Wednesday, November 20, 2019

Monday, November 18, 2019

Hyperkalemia and hypokalemia causes mnemonics

Hi!

Pharmacologic treatment of pulmonary hypertension (notes and mnemonics)

Hi!

Vasodilator response: A favorable vasodilator response is defined as a fall in mPAP of 10 mm Hg or greater to less than 40 mm Hg with an unchanged or improved cardiac output, in response to an agent such as inhaled NO or IV epoprostenol.

Cardiovocal syndrome - Ortner syndrome

In 1897, Norbert Ortner described hoarseness caused by recurrent laryngeal nerve paralysis in patients with a large left atrium due to mitral valve stenosis.

Istradefylline

Istradefylline (Selective Adenosine 2A receptor antagonist), inhibits the adenosine's inhibitory effect on GABAergic transmission in direct nigro-striatal pathway while simultaneously inhibiting adenosine's stimulatory effect on GABAergic transmission in indirect nigro-striato-pallidal pathway, ultimately leading to stimulation of thalamo-stimulatory direct pathway and inhibition of thalamo-inhibitory indirect pathway.

Selinexor

Selinexor (Selective inhibitor of nuclear export) inhibits XPO1 (exporter protein 1).

XPO1 is often overexpressed in tumors leading to transport of tumor suppressor proteins like p16, p14, p27 from nucleus to cytoplasm and there by evading the apoptosis.

Luspatercept

Here is a submission by Kirtan on Luspatercept!

Luspatercept (recombinant fusion protein containing Activin receptor type IIB moeity) blocks excessive SMAD2/3 activity (Mothers against decapentaplegic homolog) lying downstream of TGF-beta signalling by binding endogenous TGF-beta family members, including Bone morphogenetic proteins (BMP), Activin, Inhibin, Lefty A/B, Artemin, Persephin, GDF, GDNF and MIS.

Acute type-II respiratory failure causes mnemonic

Hi!

Causes of Acute type-II Respiratory failure mnemonic:
DEPRESSION

Saturday, November 16, 2019

Radiologic features seen in pulmonary emphysema mnemonic

Hi!

Radiologic features seen in a case of pulmonary emphysema (Chest X-ray PA view):
mnemonic: PSTR-ANTR

Clinical features of Pneumococcal Pneumonia mnemonic

Hi!

Clinical features of pneumococcal pneumonia mnemonic:
HI STREPTOCOCCUS