Saturday, January 30, 2016

Mnemonic for the layers of the skin (Epidermis)

Hey guys! 

Here's an easy mnemonic to remember the layers of the epidermis and some other fun facts.

The Epidermis consists of 5 layers (From base to top)

- Stratum basale
- Stratum spinosum
- Stratum granulosum
- Stratum lucidum
- Stratum corneum


Top to Bottom:
Come Lets Get Sun Burnt                                            
Bottom to Top:
Britney Spears Glows Like Candy (If  you like her!)
Britney Spears Grows Like Cancer (If you don't like her :P )

Stratum Basale (as it is the basal layer) :
Columnar epithelial cells. 
These cells multiply and produce the keratinocytes which move up the layers. 
Melanocytes are present in this layer which produce melanosome (melanin packed in granules) and ship them to the keratinocytes in other layers  through their dendrites. 

Stratum Spinosum / prickle cell layer (contains desmosomal bridges which look like spines.) :
Polygonal cells.
Connected to each other by the aforementioned desmosomal bridges.

Stratum Granulosum (contain keratohyaline granules) :
Diamond shaped cells. 
Granules contain protein filaggrin (filament aggregation) which is responsible for the aggregation of keratin filaments. 

Stratum Lucidum:
Flat cells. 
Present only in palms and soles.
Epidermis in rest of the body has only 4 layers.

Stratum Corneum (horny layer) :
Most superficial layer. 
Cells are fully keratinised and end up as anucleate dead cells which later desquamate. 

Basale, spinosum and granulosum together are called as the living layer. 
Corneum is called as the dead layer. 

Dermis consists of the superficial papillary dermis and the deep reticular dermis.

Fun facts:
Skin is the largest organ in the body.
Keratin is synthesised in the Spinosum layers but accumulates in the granulosum layer.
The migration of cells from basal layer to desquamation is known as the Turn over Time which is normally 4-5 weeks.
Merkel cells(sensory end organ) present in the basal layer are responsible for the touch sensation.

P.S. The image has been taken from another site.


Signs seen in Aortic regurgitation mnemonic

Hello! In this post, I talk about the signs seen in Aortic regurgitation and share a few mnemonics with you. I also inserted some gif images to make it fun.

I recommend using mnemonics for the signs you can't remember after learning them thoroughly than trying to memorize the mnemonics first :)

Let's get started :D

de Musset's sign: Rhythmic nodding or bobbing of the head in synchrony with the beating of the heart.
Mnemonic: Imagine a musketeer, raising his hat and then bowing his head stylishly.

Quincke's sign: Regurgitant blood flow into a dilated left ventricle during diastole leads to a decrease in diastolic pressure and a consequent increase in stroke volume, resulting in blanching and flushing, respectively, of the nail bed.
PS: They are pulsations which are SEEN, they are NOT FELT.
Quincke's pulse is the capillary pulsations and any thing that demonstrates these pulsations may be known as Quincke's sign. (I don't know for sure though.)

Other ways to see Quincke's pulse:
- While drawing the thumb nail sharply across the forehead, one can cause a red mark, which can be seen paling and flushing with each beat of the heart.
- When pressing a glass slide on the inner part of the lower lip, the same capillary pulsation will be seen. 
So these two can also be called Quincke's signs! :)

Mnemonic: I honestly don't have a mnemonic for this one. Uhh.. How about.. "Quickly keep Quiet with Quincke's finger on your lips?" The Q's to remind you of Quincke. Finger for nail bed. Lips for the glass slide thingy.

Friday, January 29, 2016

Causes of inverted T waves

Causes of inverted T waves :

1. Normal in lead V1 , V2 and V3 ( V3 only in blacks )  , normal in avR too

2. Ventricular hypertrophy

3 . ischemia / infarction

4. Digoxin toxicity

5. Bundle branch block

Written by Huzaifa Bhopalwala (Previously known as mist amidst)

ST elevation other than MI

Causes of ST elevation other than MI:

1. Prinzmetal angina
2. Hyperkalemia
3. Acute pericarditis and myocarditis
4. Brugada syndrome
5. Arrhythmogenic RV cardiomyopathy
6. PE (Pulmonary embolism )
8. And Normal variants ( high Take off and early repolarization )

Written by Huzaifa Bhopalwala (Previously known as mist amidst)

Thursday, January 28, 2016

Zika-The next Ebola?

Zika virus is a member of the flavivirus group currently spreading wildly across the Americas, especially the Latin America.

Okay, it's just another virus.Who cares?
Zika virus spreads by a mosquito bite,Aedes aegypti. 80% of the affected population are asymptomatic. Its manifests itself as a fever, headache,  joint pains and rarely conjunctivitis just like any other flu. Basically you don't know you have it.

A headache and joint pain epidemic? Stop kidding me. 

Wednesday, January 27, 2016

Is diarrhoea really that bad?


Since I haven't found a solid topic to post on I'll be doing this bit.
Remember that dreaded diarrhea which struck when you were traveling off on a trip far from home and you thought you could trade your life for a toilet? That might be a saviour though.

Whaaa? Stop that Shit? No really. Read on.
Serotonin is primarily produced by enterochromaffin cells in the crypts of Leiburkuhn. These are

Mnemonic for the laryngeal muscles and their actions

Hey people,

We've all tried to remember the laryngeal muscles time and again but it just doesn't stick right?
I devised an easy way which helped me.

Tuesday, January 26, 2016

Mnemonic: Organisms penetrating an intact Cornea

The organisms affecting the cornea(like pneumococcus) usually do so if there is a preexisting injury especially a breach in the basement membrane of the epithelium.
But some do so despite it being intact, by creating a CHNL.

Hypoxia and radiotherapy

What effect do you think hypoxia would have on radiotherapy?

Okay I know this. Hypoxia kills cells so it should help right?
I'm afraid you couldn't be more wrong.

Thursday, January 21, 2016

Mnemonic for Vit B complex

Hey guys, Jay here! These days we are having Nutrition subject and we were studying Vitamin B complex recently. Since it's confusing to me I made a mnemonic using the names of my class mates :P

With all due respect to my classmates who are future physicians, here is my mnemonic! :)

What is the difference between Vegetarianism and Veganism?

Hey guys Jay here once again. Today I thought to talk about a subject matter discussed in our Nutrition class. That is about Vegetarianism and Veganism.

Many think these both terms are interchangeable, but in fact it is NOT!!!

So let us compare Vegetarianism and Veganism...

Saturday, January 16, 2016

Dextrorotary or levorotatory and D or L forms

Greetings readers!

Dextrorotary or levorotatory and D or L forms - We hear these terms, especially, in biochemistry of chiral carbon atoms.

Now, I always thought in D-glucose, the D is for dextrorotary. But I was wrong.

Time management and avoiding silly mistakes in exams

"Hello there! Do you have any tips to stay focus and manage my time while doing a paper? I tend to rush and didn't read the questions properly which caused me to make stupid mistakes!" - Asked on Tumbr

Divide number of questions by number of minutes. Have some spare time at the end.

How to keep up with medical school

"I was wondering if you have any tips on how to study daily and not fall behind in med school?" - Asked on Tumblr

“He who fails to plan, plans to fail.”

Friday, January 15, 2016

How to Behave like a Good Doctor? (Part 1)

                     Anybody with a hard earned MD/DO or MBBS(MBChB/BM/MBBChir etc all fall here) can be a doctor. But not every doctor is a good doctor. Not every good doctor can present themselves well and behave as a doctor.
Hello awesomites, I’m Jay here, once again with some insights on How behave as a Doctor in a Clinical setting. Today we had a discussion in our Medical History Lecture about this, I’m basing the article on that. This part 1.
  1. Attitude
You should have a proper attitude as a doctor. In front of your patient, you should look confident. You should not be

Monday, January 11, 2016


Hey guys!

As you all know, I'm preparing for USMLE and I wish to do an Internal Medicine residency in the USA. A part of the process for international medical students requires electives, which is, clinical experience in the US.

I am in Cleveland, Ohio in the months of January - April 2016 for my electives.
I will also be coming to Houston, Texas for my USMLE Step 2 CS exam.

If you're around at that time, I would love to meet you. Please come say hi.

For those of you who have been to the US for electives, please let me know do's and dont's. Anything you wish someone had told you prior to the experience.

I will also be blogging about every tiny detail - From preparation to what I experienced - So that it helps someone like me in the future :)

That's all!

Wish me luck and pray for me.


PS: I will not be disclosing the name of the hospital and specialty on the blog. Reason being patient confidentiality and privacy purposes.

Tuesday, January 5, 2016

What causes Uthoff's phenomenon in Multiple Sclerosis?

Why do patients with multiple sclerosis experience worsening of neurological symptoms after heat exposure, that is, after taking a hot bath or after exercise?

It's known as Uhthoff's phenomenon.

Uhthoff's phenomena is due to ion channel modifications, in conjunction with thermoregulatory derangements that occur in MS, transiently altering the conduction properties of demyelinated axons.

This is from uptodate:
Heat sensitivity — Heat sensitivity (Uhthoff phenomenon) is a well-known occurrence in MS; small increases in the body temperature can temporarily worsen current or preexisting signs and symptoms.
This phenomenon is presumably the result of conduction block developing in central pathways as the body temperature increases. Normally, the nerve conduction safety factor decreases with increasing temperature until a point is reached at which conduction block occurs; this point of conduction block is reached at a much lower temperature in demyelinated nerves.

(This was discussed on our study group.)

Monday, January 4, 2016

Pathogenesis of tendon rupture by Fluoroquinolones

Study group discussion: Why does ciprofloxacin cause tendinitis or tendon rupture?

The exact pathophysiology of FQ-induced tendinopathy remains elusive; however, some concepts have been suggested:
FQ: Fluoroquinolones

1. FQs are synthetic antibiotics that act by inhibiting bacterial DNA gyrase (topoisomerase II). DNA gyrase is directly involved in DNA replication and cell should not exert a negative effect on human cell lines because the affected bacterial enzymes have little homology with mammalian DNA gyrase. However, it is possible that FQs have a direct cytotoxic effect on enzymes found in mammalian musculoskeletal tissue.

2. FQs have chelating properties against several metal ions (e.g., calcium, magnesium, aluminum), and have been known to cause direct toxicity to type 1 collagen synthesis and promote collagen degradation.

3. Animal studies have shown that FQs cause cartilage damage by inducing necrosis of chondrocytes (36 hours after treatment), disruption of the extracellular matrix, and formation of vesicles and fissures at the articular surface.

Review questions and mnemonic on drug induced pancreatitis

(This was discussed in our study group)

Some review questions on drug induced pancreatitis!

Which diuretics can lead to pancreatitis?

Thiazides and furosemide

Which Antiretroviral drugs can lead to pancreatitis?

Didanosine and stavudine

Which antibiotics can lead to pancreatitis?

Metronidazole and tetracyclines

Seizure med leading to pancreatitis?


Immunosuppressive drugs leading to pancreatitis?

L asparaginase

Ok the last one.. Drugs for treatment of IBD leading to pancreatitis?


(Mnemonic, if you need one)
Furosemide, Azathioprine, Valproate
Didanosine, Asparginase, Metronidazole
ASA, Tetracycline, Thiazides, Stavudine, Sulfasalazine.

Sunday, January 3, 2016

Preparing for MCQ exams in Medical School

Well, hi again! Jay here. Today I’m gonna discuss about how to prepare for MCQ points in your exams.
If your college is like mine, where MCQ is the main format of asking questions in Med school, my friend, you are not alone in feeling helpless or lost in sometimes. For some of us, explaining stuff makes more sense but the truth is in MCQs you really cannot explain. You have to be on point.
So without further time wasting, here I am with my points which works for me. But I really understand it could be different from person to person. If you have some more points, why not comment down below? ;)

What causes thrombocytopenia in malaria?

Hello everyone!

I see a lot of patients in the casualty with fever, chills & thrombocytopenia but to my surprise, they've been diagnosed with malaria (Instead of dengue). I was wondering what the mechanism is.

The speculated mechanisms leading to thrombocytopenia are: coagulation disturbances, splenomegaly, bone marrow alterations, antibody-mediated platelet destruction, oxidative stress and the role of platelets as cofactors in triggering severe malaria.

In uncomplicated cases of malaria, thrombocytopenia is the result of splenic pooling of platelets aggravated by a moderate decrease in platelet life span.

That's all!


Friday, January 1, 2016

2016 is going to be awesome, I promise.

Happy new year everyone!

I hope you have a great year ahead.
May you succeed in all good you do and may all your dreams come true.

This post comes under "Author's diary" label so, disclaimer, I am not writing any academic information in this blog. I am going to be an open book and tell you about my year and what I learnt from it :)

So... Here's IkaN's 2015 year in review.

We made our first study group on Whatsapp in Jan 2015.
What I learnt through the study groups: The world is HUGE and each and everyone out there is awesome in their own way! I connected with hundreds of international medical students and got to know their stories - How political instability and war hampered studies for some, how difficult recovery from being suicidal can be, how society can make someone who is gay want to leave their country. Everyone is fighting. Every one of you is a survivor. You inspire me with something new everyday. Thank you for everything.

I started my internship year in Feb 2015.
What I learnt through Internship (Or house job): Some days it's going to be a piece of cake, some days you will want to cry. It's okay. You are growing and becoming something better than you were yesterday. Let it shape you. Let the 48+ hour shifts kill you. It's okay to feel bad about a patients death contrary to what others expect you to do - To not feel bad about it, to be a robot. Sometimes, you are going to diagnose severe bronchitis and make life saving calls. Other times, you are just going get a report from the lab. Remind yourself that no job is small. Be patient with yourself when you are unable to find a vein. You'll learn, slowly. Don't carry a lazy, grumpy or arrogant attitude to work. Be polite, be humble, be hard working. Be brilliant at whatever you do.

Mid year, I had a bitter realization that I might not be able to go to the US for further studies.
What I learnt: When things don't seem to work out, we need to begin again. I was really upset about it but I didn't let it define me. I got over it and started preparing for post graduation in my home country (PG CET in India). Realize that some things may not work out the way you planned them. If there are things and circumstances that you can not control, you know there's no way out and that you have done everything you could - Let go and find a new dream. It's not the end of the world.

By the end of the year, unexpected doors opened. (Yes, I am dreaming of residency in the states again! :D )
What I learnt: Miracles happen. Silent prayers get answered. Dreams come true. That's what faith can do. Faith? Faith in yourself - That you can survive no matter what your circumstances. That you are a warrior. Faith in the higher power, if you believe in one. Maybe I just got lucky. But regardless of luck, I was willing to give my best at life. I was ready to bloom wherever planted. I think that's what counts the most.

Other things from 2015:
I co-authored a book. It's called Immunowesome and will be out in 2016.
4 new authors at Medicowesome :D
Created a broadcast list and a Facebook  group.
Many, many guest authors and contributions! You guys are amazing.
Set up a Tee shirts, mugs and accessories store on Society6.

Travel diaries:
- Visited Rajasthan, Gujarat and Madhya Pradesh - Met a Medicowesome reader during the trip (It was awesome meeting you and I would love to meet all of you someday!)
- Traveled to Dubai to meet my parents and spent New Years here. The fireworks were grand. I saw a lady sleeping in her hospital scrubs in the metro. Medical students are the same everywhere. (Sleepless and cute xD ) 
- Practiced in a rural area near Mumbai. The village people live nice, simple and healthy lives.
- Visited Iraq. People of Iraq are beautiful, contrary to what the media portrays. Saw a child with Epidermolysis bullosa. Language wasn't a barrier while communicating with the people. 

So.. That's enough of me living in the past.

Things to do next year:
Make better study timetables.
Be grateful. 
Live in the moment today. Tomorrow is not promised.
Exercise regularly. It gives you endorphins.
Read the instructions carefully.
Be less anxious about the uncertain future.
Share more knowledge. Write more blogs.
Watch through glittering eyes. See the best in every creation.
Have more faith in people.
Don't let anyone make love small or light to you.
Be patient. Nothing good gets away.
Believe in yourself.
Transform into a wonderful person.

Maybe it's just a change in date. Maybe not.