Sunday, February 23, 2020

Mnemonic for Clinical Signs of Aortic Regurgitation video

Schroeder's Vs Bandl's ring

Schroeder's  Vs Bandl's ring

Bandl's ring:- 

1) It is seen in obstructed labour
2) It is a pathological ring
3) It is a retraction ring
4) It moves up with uterine contractions
5) It can be palpable per-abdominally but not pervaginally
(Remember- Bandl has A after B which stands for per-abdominally)
6) Management: Like obstructed labour, C-section and antibiotics.

Schroeder's ring:-

1) Seen when oxytocin is used judiciously.
2) It is a physiological ring.
3) It is a constriction ring.
4) It is fixed ring, does not move with uterine contractions
5) It can be palpable pervaginally but not per-abdominally.
6) Management: It dissolves on it's own.
If not, then management in first stage of labour includes C-section.
Management in second stage includes forceps or c section.

That's it!
Demotional bloke

Friday, February 21, 2020

Post Partum Hemorrhage - Updates


Following bleeding scenarios amount to PPH under the latest WHO document
  1. Blood loss >500 mL in c/o Vaginal delivery
  2. Blood loss > 1 L in c/o C Section + in c/o twins
  3. Blood loss > 1.5 L in c/o Hysterectomy
  4. Blood loss on any case more than what is expected over a period of 24 hours

Following bleeding scenarios amount to PPH as per the latest ACOG recommendations

  1. Blood loss equal to or more than 1 L irrespective of mode of delivery
  2. Bleeding with signs and symptoms of hypovolemia


Updates in Management of PPH

  1. Uterine massage is added along with uterotonics
  2. PGE1 if given Per Rectally (not recommended), 1000 micrograms is advised
  3. Inj Tranexamic Acid is recommended in all bleeding diasthesis - 1 gram slow IV (over 20 minutes) 
  4. Mechanical Devices allowed
    1. Sengstaken Blakemore Catheter
    2. Bakri Balloon Catheter

Monday, February 17, 2020

HMG CoA synthase,reductase and lyase

Hello Awesomites!

LONG TIME. 
As I promised, the future blogs will be on confusers.
Here I go.


Study hard!
-Upasana Y :)

Saturday, February 15, 2020

Mnemonic for Catalytically perfect enzymes !!

Hii...
Certain rare enzymes , 
They are so efficient that almost every time enzyme meets its substrate, the reaction occurs. 
E + S ➡️ ES Complex ➡️ Instantaneously Product formed 
For such enzymes this becomes the rate limiting step & is only determined by 
Rate of Diffusion of molecules in solution.
Means , Catalytically perfect reactions are only limited by substrate diffusion rate.( Substrate diffusion into active site ) 

This enzymes are called Diffusion limited/ Catalytically perfect enzymes.

Catalytic efficiency reaches the diffusion limit.

Examples =
Furiously trying to CAtCh ( think Ball) diffusion limit in Superover.

Fumarase 
Triose phosphate isomerase 
Catalase 
Cytochrome C peroxidase
CAH ( Carbonic anhydrase )
AchE ( Ach esterase ) 
Ball = Beta lactamase 
Superover = SOD = Superoxide Dismutase 


Thank you...
By Drashtant

Thursday, February 13, 2020

Voila! Its a baby bone.

Bone formation is critical to skeletal development as well as maintenance. Bone is a hollow matrix of calcium phosphate a and apatites wherein calcium is under a state of constant turnover balanced by degradation of calcium apatite and absorption of new calcium from the gut as well as breakdown by PTH and Vitamin D. 

Here's how you can remember what your body produces when are forming new bone. Remember that as 

Old FAP



Formation of Bone


  • Bone Specific ALP
  • Procollagen type I
  • Osteocalcein
  • Osteonectin

Sunday, February 9, 2020

Mnemonic for Galactosemia & Hereditary fructose intolerance

Hi everyone , this is a short video explaining mnemonic for Galactosemia & hereditary fructose intolerance.


Thank you :)
By Drashtant 

Monday, February 3, 2020

A compilation of similarities between corneal dystrophies

Many dystrophies have commonalities. Following are enumerated as under-

1. Associated with TGF Beta1 mutations-
       - Epithelial basement membrane dystrophy
       - Reis- Bückler's 
       - Thiel- Behnke 
       - Lattice and granular(type1) dystrophies

2. Associated with mutations on 5q31 locus-
         - Reis- Bückler's
         - Lattice and granular(types 1 and  2)

3. Autosomal recessive -
          - Gelatinous drop like
          -.macular
          - Congenital hereditary endothelial( type 2)

4. X linked- 
           - Lisch ( X linked dominant) 

-All others are autosomal dominant. 

5. Chromosome 12- Meesman's, congenital 
                                     hereditary stromal.

6. Chromosome 20- Posterior polymorphous, 
                                    congenital hereditary 
                                     endothelial.

7. Chromosome 1- Gelatinous drop like,
                                   posterior polymorphous.


8. Amyloid deposition is seen in- 
                   - Gelatinous drop like
                   - Lattice
                   - Granular (type2) 
                   - Congenital hereditary endothelial.

9. Bowman's membrane is lost in- 
                   -Gelatinous drop like
                   - Reis-Bückler's (replaced by irregular
                       material
                   - Thiel-Behnke's ( replaced by a
                       fibrocellular layer)


10. Recurrence after keratoplasty-
                    -  Reis-Bückler's
                    -. Lattice, granular, and macular
                    - Schynder 
                     -  Congenital hereditary stromal.


11. Association with glaucoma and keratoconus-
                    - Posterior polymorphous
                    - Fuch's endothelial. 

Now don't blame me for the list being too exhaustive 🙄

Source- Postgraduate ophthalmology by Zia Chaudhari and M Vanathi 

-Sushrut 

Sunday, February 2, 2020

Corona virus

Corona virus:
A) Virology:
1) Coronaviruses are classified as a family within the Nidovirales order, viruses that replicate using a nested set of mRNAs. The coronavirus subfamily is further classified into four genera: alpha, beta, gamma, and delta coronaviruses. 
2) Positive mRNA strand virus. It is largest known RNA strand.

B) Routes of transmission — Respiratory coronaviruses probably spread in a fashion similar to that of rhinoviruses, via direct contact with infected secretions or large aerosol droplets. Immunity develops soon after infection but wanes gradually over time.

C) Clinical Manifestation:
Characterized by
1) Upper respiratory tract infections
2) Acute otitis media
3) Pneumonia
4) Temporarily linked to asthma attacks in both adults and children
5) The idea that coronaviruses produce diarrhea in humans is intriguing because of their clear intestinal pathogenicity in animals
6) Gastrointestinal manifestations -diarrhea, vomiting, nausea, and abdominal pain.
7) There is one reported case of encephalitis due to corona virus
8)Also seen in association with Kawasaki disease.

D) Diagnosis:
Until recently, no sensitive, rapid method existed to detect all of the known human coronavirus strains. Rapid techniques that can be used to detect coronaviruses from nasopharyngeal samples include reverse-transcriptase polymerase chain reaction (RT-PCR) and immunofluorescence antigen detection assays.

E) Treatment:
1) There is currently no treatment recommended for coronavirus infections except for supportive care as needed
2) Chloroquine has shown some activity against cultured cells.

F)Prevention:
1) Preventive measures are the same as for rhinovirus infections, which consist of handwashing and the careful disposal of materials infected with nasal secretions. Several antiseptic/disinfectant solutions used commonly in hospitals and households, including chloroxylenol, benzalkonium chloride, and cetrimide/chlorhexidine, have been shown to be ineffective against coronaviruses

That's it!

Source: Up-to-date.



Correct order of Stage of Death

Proposed by Kubler Ross 

" Mnemonic = DA BudDhA "

D Denial = Refuse to believe Dx 
A Anger = Frustrated , Ask "Why Me ? "

B Bargaining = in return for a cure , they promise to fulfill one or many pledges ( Charity ) 

D Depression 
A Acceptance = Realize that death is inevitable

Thank you 
By Drashtant 

Saturday, February 1, 2020

Advice to young doctors

It is okay to disagree with another physician and acknowledge differences in the style of practicing medicine. Medicine is not black and white. Develop your own preferences based on evidence and experience.

A truly experienced physician understands the intricacies of medicine and will not criticize another physician for a decision they made under a different clinical circumstance with the information they had available.

A physician who second guesses themselves and critically analyzes their decisions retrospectively and prospectively are better than those who are over-confident about their diagnosis and management. Think about the decisions you make.

If you ever come across a bad patient outcome, yourself or your colleagues, do not jump to conclusions. There may be other factors, that you do not have knowledge of, which may have played a role.

When feedback is given, don't take it personally. Learn from the experience objectively and detach yourself from it. This way, you will learn more instead of getting offended and defensive about it.

To not get emotionally involved takes time. Give yourself time. Change the voice of the conversation in your head.

I am still learning.

Sincerely,
A young doctor.

Wednesday, January 29, 2020

Facebook: Wolffian duct

Q1) Ejaculatory duct in males develops from 
A) Ureteric bud
B) Mesonephric duct
C) Wolffian duct
D) Paramesonephric duct

#Medicowesome
#Gynaecology

Answer to this question is Option C) Wolffian duct.
But isn't Wolffian duct also called as Mesonephric duct ? So can you pick option B instead of option C?
Well, unless your exam allows multiple answers to be correct, do not pick 'Mesonephric duct'. Here is why?

The mesonephros gives mesonephric duct which opens in the Urogenital Sinus and forms trigone of the bladder. Mesonephric duct also gives ureteric bud to the Metanephros to form Renal system.
Now after this has happened, the Mesonephric duct will be called as Wolffian Duct which forms the internal genital organs and in females, disappears.

That's it!
Demotional bloke