Thursday, June 25, 2015

Study group discussion: Fluids in inferior wall myocardial infarction

Why are fluids indicated in inferior wall MI?

Inferior wall MI is associated with severe hypotension. So first, correct the hypotension, then, thrombolyse.

Yes, but any reason for the hypotension?

Because inferior wall has vagal plexus. Patients with inferior wall MI are parasympathetic i.e. high vagal tone.

Monday, June 22, 2015

Study group discussion: Referred pain

Can someone please give me regions of referred pain areas?
Eg. Pain in the shoulder could infer problem with diaphragm.

Right shoulder pain - problem with gall bladder (eg. Cholecystitis)
Left shoulder and ulnar border of left arm and hand - myocardial infarction.

Knee pain can refer to hip.

Renal colic pain is referred to the back.

Splenic rupture can refer pain to left shoulder - Kehr's sign

What is Kehr's sign please?

Splenic rupture or hemorrhage irritates the diaphragm on left side and that refer s the pain to the left shoulder. Same like cholecystitis on right side.

Thursday, June 18, 2015

Study group discussion: ECCE

Why ECCE is not done when zonules are not intact?

What is ECCE?

Extra capsular cataract extraction.
Because the IOL will be implanted in the remaining posterior capsule - And if the zonule is not intact, it may cause lens subluxation.


Study group discussion: Cystogastrotomy for pseudopancreatic cyst

One interesting question:
In cystogastrotomy, as surgical treatment for pseudo pancreatic cyst...Why do food particles don't enter from stomach to pseudocyst through the communication?
This question asked by surgical professor in OT today.

Because cyst will be always in positive pressure and clinical studies show that the cyst rapidly decompresses. Approximating the mucosa with cyst wall, which has no epithelial lining, leads to rapid shrinkage of stoma. Within few days, neither the stoma nor the cyst is evident on radiology or endoscopy.

Wow. This is great stuff!

Friday, June 12, 2015

Study group discussion: Serum ascites albumin gradient

Can anyone explain the serum ascites albumin gradient in a super simplified way?

High SAAG: Imbalance between hydrostatic and portal pressures.

Low SAAG: Ascites due to protein leakage.

SAAG = Serum albumin - Albumin in ascitic fluid. And is directly proportional to portal pressure.

Thursday, June 11, 2015

Internship diaries: Calcium channel blockers and peripheral edema mnemonic

As you all know, I am doing internship or housejob and it's really tiring but a good learning experience. Lemme share what I learnt / revised today!

In my medicine OPD, we start most newly diagnosed hypertensive patients on amlodipine, a calcium channel blocker. Many of the patients, after a few weeks of therapy, come back complaining of lower extremity edema. You check their electrolytes, LFT's and RFT's and they are all normal.

Conn's syndrome mnemonic

Hi. I keep forgetting that Conn's syndrome is hyperaldosteronism. Can you help me out with this?

Sure! :D

The N's are for sodium - Hypernatremia!

The C makes a K for potassium, which is less than the number of N's, therefore, hypokalemia!

Also, Na+ is sodium. A could remind you of Aldosterone.
AL could remind you of ALkalosis.

That's all!


Which books do I study from while in second year MBBS?


One of my readers asked to write a books recommendation posts for second year and here it is!
This post is mainly for Indian medical students because I'll be talking about some local authors which might not be available or preferred in your country. But of course, foreign medical students can read it too as they might find the general points helpful! ^__^

Something I learnt from my first year - You should never be hasty in buying books. Medical textbooks are pretty damn expensive and you don't wanna be stuck with a book you don't like for the rest of the year.

So here's what I recommend - Be "bookless" for the intial few weeks. Don't buy any books. Pretend you're broke and rely only on the library.

Ask - Friends, seniors, book sellers, internet about books they think you should buy. Immediate seniors will be the best resource - Ask them why you should go for one book and not the other, know their reasons. You should be able to cut the long list of 10-12 books and bring it down to 2-3 books.

In the bookless period, go to your library (Or use ebooks), read a few topics (Not just one!) from the two to three books you think you should buy. You'll like one and that's the book you should read for the rest of the year!

Don't judge a book by it's initial few pages. You have to read topics of substance, big topics not the small ones. Example, don't read about Louis Pasteur and see which book wrote it better. Read about Staphylococcus or ELISA.

Before I begin, I'll be very clear and tell you that all I can do is recommend. You do the deciding =)

K. D. Tripathi or KDT: It's a good book. It'll stick with you throughout the year!
How to study: Read classifications first because you wanna know the drug names before you start reading into the tiny details. If you write a good classification table in the beginning of your answer, you impress the reader. Know special side effects of drugs, it gives you an upper edge while writing theory papers (No examiner wants to read nausea and vomitting over and over again!)

Katzung: Now this book is HUGE. It's fun to read!
How to study: Get it from a library or use a PDF. Read the topics you like. I read diuretics from this book and boy I enjoyed it. It's too much to read so when exams near, you'll lose the book and run back to Tripathy. So keep in mind that this is not THE book and you won't be able to finish it or come back to it later. Take points and put it in your Tripathi in the first read itself.

Lippincott: It is simple and preferred by a lot of international readers.
How to study: I haven't read it, so I don't know how good it is T_T

Pappa Robbins or the big Robbins: It's awesome.
How to study: It's a huge book, so do the "Important" topics from here first. Important? Yeah, the stuff that's been asked a lot of times in the previous papers. Try to do general pathology, CVS, RS and renal from this book.

Baby Robbins or the small Robbins: It's useless.
How to study: Don't.

Harshmohan: It has lots of diagrams and point wise notes. You know who likes diagrams and point wise answers? Teachers.
How to study: Stuff you couldn't read from Robbins due to lack of time, read it from here. (Don't forget the diagrams!)

Ananthanarayan: It's just the right amount of information. If you study this one well, you won't require any other book.
How to study: You wanna know how an organism looks like and what diseases it causes. Do cultural characteristics too. General microbiology - Read the important stuff. If you don't enjoy immunology while reading it, you're doing it wrong. It's my favorite subject! Imagine, read comics.

Any book will do: I studied from Arora.
How to study: Diagrams are key. If you can draw the life cycle, half your work is done. Diagnosis and treatment is simple.

Forensic and Medical Toxicology
I never studied this subject from multiple books to pick a personal favorite, sorry! :|

I use a lot of internet for studying. It keeps things interesting. There's always a new perspective you can gain via the internet. Videos, images, jokes, mnemonics. It keeps things fresh. And books can get boring sometimes, so use the internet, read blogs, have fun! :)

PS: If you are thinking of preparing for USMLE but are not too sure (Because second year is too early to decide your future xD), finish off the Kaplan videos, notes and Goljan audio.

That's all!

Ask me whatever you like in the comments section below!


Related posts:
How to make concise medical notes
How to make medical mnemonics

Wednesday, June 10, 2015

Tuesday, June 9, 2015

Antibiotic associated diarrhea mnemonic

Clostridium difficile is the most common cause of antibiotic associated diarrhea.

How do I remember this?

"Difficile grows when the normal flora are deficient."

Antibiotic associated diarrhea is treated with metronidazole.

How do I remember this?

"Definitely treat difficile with metrodiffizole."

That's all!


Study group discussion: Suprapubic cystostomy experience

So last night, in the emergency department, comes a 65 yr old male complaining of difficulty in passing urine.
On examination: His lower abdomen is distended. A pyriform shaped swelling reaching the umbilicus.

He was having acute retention of urine. Tried introducing a 16 fr catheter. But failed. Next step?

You try intorducing a 10 fr paediatric catheter.

But we didn't have one to our dispense. So we did supra pubic.

What is the procedure?
Palpate and percuss first. Then insert the catheter directly at 90 degree.

The moment I did.. The patient heaved a sigh of relief. On further work up, it was a case of BPH.

How do you make sure you don't injure inferior epigastric vessels?

Midline 4 cm above pubic symphysis. Inferior epigastric vessels are more lateral.

Does dopamine cause vasoconstriction or vasodilation?

Is dopamine a vasoconstrictor or a vasodilator?

Both! It depends on the rate of infusion.

At low rates of infusion (0.5 to 2 mcg/kg/min), dopamine causes vasodilation that is presumed to be due to a specific agonist action on dopamine receptors in the renal, mesenteric, coronary and intracerebral vascular beds.

At higher rates of infusion (10-20 mcg/kg/min), there is some effect on alpha- adrenoceptors, with consequent vasoconstrictor effects and a rise in blood pressure. The vasoconstrictor effects are first seen in the skeletal muscle vascular beds, but with increasing doses, they are also evident in the renal and mesenteric vessels.

Immunology emoticon game answers

Here are the answers!

Monday, June 8, 2015

Immunology emoticon game

And it's back again! Except, it is more tougher conceptually.

We figured guessing words out of emoticons is too lame and easy for you medicos and thought we'd add questions to make it more fun!

Immunology emoticon game

Friday, June 5, 2015

Study group experience #17

We did a massive change in all 4 groups, we clubbed Asians in two groups and Non Asians in two groups. Now the groups are segregated time zone wise, leading to better fruitful discussions! Though we do a bit of a mix and match here and there.

Also, we recently made group 5. It's a lot of discussions to take it for people who are in all 5 groups!

Study group discussion: T4 level

Studying the anatomy of the thorax.. Does anyone know the events occurring at T4 level?

At t4 level:
- Arch of aorta starts and ends at this level
- Azygous vein ends here to join SVC
- Trachea divides into primary bronchi

Study group discussion: Food, pain and ulcers

How does food relieve pain in duodenal ulcer and aggravate pain in stomach ulcer?

Food reaching stomach causes acid secretion. Therefore, pain increases.

In case of duodenal ulcer, eating causes pyloric spincter contraction, acid is prevented from reaching the duodenum
Therefore, pain is relieved.

Thursday, June 4, 2015

Beckwith-wiedemann syndrome mnemonic

"Becky is big."
Beckwith-wiedemann syndrome mnemonic

"Big body"

"Big tongue"

"Big abdomen"

"Big pancreas"
Hyperinsulinemia -> Hypoglycemia

"Big organs"

"Likes to get bigger"
Associated with Wilms tumor, gonadoblastoma and neuroblastoma

That's all!


Monday, June 1, 2015

Study group discussion: Pheochromocytoma and eleven

What is rule of 11 for pheochromocytoma?

11% are extra-adrenal
11% are bilateral
11% are malignant
11% are found in children
11% are familial
11% are not associated with hypertension
11% contain calcification