Tuesday, May 3, 2022

USMLE STEP1 just changed! You need to too!

 

On 26 Jan 2022, the USMLE Step 1 changed its score reporting format to Pass/Fail only. This means, that those who give their exam after this date cannot see their 3 digit score, and neither can anybody else (yes, not even PDs)

Sunday, March 20, 2022

WEST Syndrome:

When does a medical student considers herself lucky? 

When she gets to see a patient with a disease so rare, that it's a once in a lifetime case. 

I was the lucky one.


Patient History-

We have a boy around 2 years of age, coming from lower socio economic class. He was a full term baby with normal birth weight. However, there is a history of HIE i.e Hypoxic ischemic encephalopathy during the time of birth.

Since then, patient has complaints of seizures; sometimes so severe that hospitalization was necessary. He has been hospitalised on and off every 1 month. 

Patient turned 2 years and still isn't able to crawl/sit/stand/walk and only speaks monosyllable words. This is called developmental delay.

EEG was found to be hypsarrythmic. 

Thus, Diagnosis of West syndrome was made.


What is West Syndrome?

It is a seizure syndrome and it has characteristic triad of:-

1. Infantile spasms- salaam spells

2. Developmental delay

3. Hypsarrythmia- high amplitude spikes in a         chaotic background.


Patient presentation?

Patients presents with history of salaam spells that is sudden dropping of head and flexion of arms occurring mostly during time of waking. Mother complaints of baby unable to sit or crawl.


Causes;

1. Hypoxic ischemic encephalopathy 

2. Neurocutaneous syndrome like tuberous sclerosis

3. Perinatal infections

4. Hemorrhage 

5. Idiopathic


EEG findings- high amplitude spikes in a chaotic background. 


Credits- epilepsydiagnosis.com

Treatment- no definitive treatment. Only symptomatic management.

Vigabatrin is the drug of choice; especially in Tuberous sclerosis.

ACTC and prednisone for 2-12 weeks, according to response.


Prognosis - poor if developmental retardation is found.



Thank you.


- Thirak Vaishnav

Friday, February 11, 2022

Severe mitral stenosis mnemonic


Mitral valve area < 1.5 cm² or diastolic pressure half time > 150 ms

-IkaN (Nakeya Dewaswala Bhopalwala) 

Wednesday, January 26, 2022

Mitral stenosis gradient and heart rate

Why is the pressure gradient in mitral stenosis heart rate dependent? Why is the pressure gradient in aortic stenosis heart rate dependent?

Sunday, January 16, 2022

Parkinson's disease medication taper sequence mnemonic

 In Parkinson's disease, how do you taper off medications to reduce psychotic symptoms? This is a step 3 question.

Monday, January 3, 2022

Apex beat in Aortic stenosis vs regurgitation

 Hello

Clinical pearl: Retroperitoneal hematoma

 Hello

Vascular access during cardiac catheterization (in cases of myocardial infarction, for example) obtained through femoral artery above the level of inguinal ligament may lead to retroperitoneal hematoma due to arterial puncture.