Thursday, December 31, 2015

Hoover's sign mnemonic

What is Hoover's sign?
The paradoxical inspiratory indrawing of the lateral rib margin is known as Hoovers sign. In simple words, it is the inspiratory retraction of the lower intercostal spaces.

What causes Hoover's sign?
It is due to direct traction on the lateral rib margins by the flattened diaphragm.

Lancefield group for classification of Streptococci mnemonic

Mini bacteriology post! Yaay!

In which Lancefield group does Streptococcus pyogenes and Streptococcus agalactiae belong? How do you remember them?

Streptococcus Pyogenes belongs to Lancefield Group A mnemonic:
I remember GAP jeans (Because of the gap company manufactures amazing clothes) - Group A Pyogenes.

Streptococcus Agalactiae belongs to Lancefield Group B mnemonic:
Remember B for Baby. Streptococcus Agalactiae causes meningitis in babies and belongs to Lancefield Group B. Babies also love Galaxy chocolates and stars.

That's all!


Wednesday, December 30, 2015

NYHA Classification for heart failure mnemonic and practicals tip

Greetings everyone!

I was reading about Congestive Heart Failure today and thought of sharing a practicals pearl with you guys.. NYHA class should always be mentioned when you are presenting a case of CHF.

Case presentation tip: While presenting your case, instead of just saying "Patient belongs to NYHA Class III" you could say, "Patient is categorized into NYHA Class III, which means the patient is comfortable at rest, but is limited on exertion."
This shows you know what you are talking about and the examiner won't stop and ask about all the classes :)
You should do the same when it comes to other diseases.

Your professor may ask - How did you come to know that the patient belongs to Class III?

Monday, December 28, 2015

Atrial fibrillation

I was reading Atrial fibrillation today and thought I'd write a small quick review blog on it.

A patient with atrial fibrillation will usually present with palpitations or fatigue.

On physical examination, irregularly irregular pulse is characteristic.

ECG is diagnostic.

Extra tip: Your patient may have his rhythm well controlled when you see him in the wards and you might not have the characteristic physical finding of an irregular pulse or have an ECG in hand. In that case and especially during vivas, do mention that you would like to rule out other causes of fatigue by ordering CBC, SE & LFT.
CBC: Complete blood count
SE: Serum electrolytes
LFT: Liver function tests

In an acute setting, you must provide symptom relief through rate control. Beta blockers, calcium channel blockers are preferred. Digoxin is considered if blood pressure is low.

Fun fact: Why isn't Digoxin an awesome drug for rate control in exercise and anxiety?
Because the increased rate in exercise and anxiety is primarily due to adrenergic stimulation and Digoxin works through Vagal stimulation.

You need to rule out reversible causes of atrial fibrillation like electrolyte imbalance, thyrotoxicosis, fever, alcohol and drugs. Always order TSH levels.
Extra tip: Also ask for a history of snoring since sleep apnea is a treatable cause of atrial fibrillation.

Rate control is usually done first since it mitigates symptoms. Rhythm control is preceded by measures to reduce stroke, which includes either 3 weeks of anticoagulation by dabigatran / warfarin or clot exclusion by TEE.

CHADS2 score is used to decide whether anticoagulation is required. It is based on risk stratification.

Dabigatran is preferred over warfarin because INR monitoring isn't required. However, it is expensive, contraindicated in renal failure and there is no reversal in major bleeding.

Electric cardioversion or chemical cardioversion may be done depending on patient symptoms.

Drugs used for chemical cardioversion are: Flecainide, Ibutelide, Procainamide, Amiodarone.

Curative catheter ablation may be tried in patients who have recurrent atrial fibrillation and in whom antiarrhythmic drug trial has failed.

Cool fact: Propafenone is "pill in pocket" drug used by patients when they feel onset of palpitations. It is used in conjunction with beta blockers to prevent fast dysrhythmias.

Here are a few mnemonics I got online:

Precipitants / causes of Atrial fibrillation: PIRATES
PE, Ischemia, Respiratory diseases like COPD, Atrial enlargement or myxoma, Thyroid, Ethanol, Sepsis or Sleep Apnea

Mnemonic for determining major risk of bleeding: HAS BLED
HTN, abnormal LFT / RFT, Stroke, Bleeding history, Liable INR, Elderly, Drugs that predispose to bleeding.
If score >3, higher risk of major bleeding.

That's all!


Related post: Antiarrhythmic drug classes mnemonic

Friday, December 25, 2015

Christmas tree rash

Greetings everyone!

Here's a mini fact: Christmas tree rash is seen in Pityriasis rosea.

That's all!
Merry Christmas everyone!

Related post: Christmas disease mnemonic

Wednesday, December 16, 2015

FIGO staging of carcinoma cervix


I made this video like a year back but never got around posting it on the blog. So, here it is! :D

Study group discussion: Pathogenesis of pruritus in obstructive jaundice

What is the reason for pruritus and itching in obstructive jaundice?

Patients have differing sensitivities to elevated bile salt concentrations,
which act on peripheral pain afferent nerves to produce the sensation of itching. This stimulation involves
opiate-mediated pathways, and opiate antagonists can block cholestasis-associated itching.

Itching does not appear to be associated with histamine release, and antihistamine therapy is generally ineffective.

Ultraviolet B phototherapy has been successfully used to treat pruritus.

Thanks for explaining the mechanism to us, Benedict!

Thursday, December 10, 2015

Breast Cancer TNM Staging mnemonic

Hello. This was requested by someone and I thought I'll post a few tips that help me remember the staging of breast cancer.
We're using the TNM classification in this post and I'll be talking about T & N only.
Let's get started!

Wednesday, December 9, 2015

Battle's sign mnemonic


Battles sign is ecchymosis over the mastoid process and is mostly indicative of a fracture of the skull.

Battle Sign
Bruises Seen
Basilar Skull fracture

I love this mnemonic posted online too: BattlE - Behind Ear.

That's all!
You're a warrior.

Tuesday, December 8, 2015

The University of wisconsin solution

the university of wisconsin solution or UW solution is considered as the gold standard solution for transport of of liver in cold storage for transplant. it can also be used for the transport of kidney, pancreas and heart.