Wednesday, August 31, 2016

Study group discussion: Red cell Distribution Width (RDW)

Let's discuss Red cell Distribution Width (RDW) today!

RDW represents variation in RBC size.
If the RDW is large, it says that the cells are different in sizes.
Analogy: If RDW is large, we know the RBCs are all unity in diversity. Like India :P
What's the clinical significance?

Study group discussion: Different sized spherocytes

The difference in size of spherocytes has significance. It is assessed manually, on peripheral smear examination.

What's the importance of assessing size difference of spherocytes?

Wilsons disease mnemonic

So this bed time story was told to me by my granma in 2000 (who can see the future and knows who the POTUS will be in 2016 :P)
Its a story about a guy who uses a "WILSON's" racquet to play tennis. And you all probably know this legend right?

Monday, August 29, 2016

Sunday, August 28, 2016

Phimosis and paraphimosis mnemonic

What is phimosis and paraphimosis?

Phimosis is constriction of the preputial orifice. In phimosis, the foreskin can not be retracted.

In paraphimosis, the foreskin can not be reduced back on the glans. It may cause a painful glans swelling going on to proceed to a gangrene. 

I always mix up the two, so mnemonic!

Another mnemonic - Call Paramedics if paraphimosis because it's a surgical emergency. 

This one was submitted by SG on our study group, "PAra is PAinful." 

That's all!

Step 2 CK: Management of liver laceration


Say you have a hemodynamically unstable patient with a gunshot wound or blunt trauma to the RUQ.
Why shouldn't you simply suture and close deep liver lacerations?

Because of the risk of hemobilia and abscess formation.

Here's what a surgeon must do:

Saturday, August 27, 2016

Polyarteritis nodosa mnemonic


Polyarteritis nodosa is a necrotizing vaculitis of small and medium sized muscular arteries.

Thursday, August 25, 2016

Wednesday, August 24, 2016

Neurogenic claudication

Did you know there is something called as neurogenic claudication?

Behcet's syndrome mnemonic

Hey guys! 
So I wanted to write something about Behcets and created a lame mnemonic for it.
Let's start :D

Monday, August 22, 2016

Anakinra mnemonic


Anakinra is an IL-1 receptor antagonist used for the treatment of rheumatoid arthritis.

Types of arthritis

Causes of polyarticular symmetric arthritis

Rheumatoid arthritis
Systemic lupus erythematosus
Viral arthritis (Hepatitis, parvovirus EBV)

Causes of monoarticular arthritis

Antiphospholipid Syndrome mnemonic

Lemme tell you about APLA today :)

It is an autoantibody-mediated acquired thrombophilia characterized by recurrent arterial or venous
thrombosis and/or pregnancy morbidity.

Sunday, August 21, 2016

Study group discussion: Ferritin

Hello everyone!

Why do ferritin levels increase in Rheumatoid arthritis?
It is an acute phase protein.
The levels increase in serum as well as in synovial fluid. The rise is more in synovial fluid because of local production of ferritin in the inflamed joint.
Ferritin levels show a positive correlation with ESR, CRP, platelet count, and DAS score.
And a negative correlation with hematocrit levels.

Is there a difference of levels in inactive and active disease?
Yes, the levels are lower in inactive RA patients because of iron deficiency.
Synovial ferritin production in active RA leads to increase of ferritin in active disease.

Gold standards for diagnosis of iron deficiency in RA?
1. Bone marrow iron stain
2. Serum transferrin receptor analysis

What leads to high ferritin levels in SLE?
Ferritin synthesis is induced by interleukins IL-1, IL-6 and Tumor Necrosis Factor (TNF) alpha in hepatocytes.  In SLE, there is defect in IL-1 production while IL-6 and TNF-alpha levels are increased. So, the high levels of ferritin are due to IL-6 and TNF-alpha. (IL-1 does not play a major role in the synthesis of ferritin)
The ferritin levels are correlated with ANA titre, anti-dsDNA titre, and SLEDAI score.
(No significant correlation with acute phase parameters and negative correlation with complement levels)

Zika virus infection and the Alzheimers'

Hello everyone!

The mosquito-borne zika virus has spread to most of the parts of Latin America, Pacific islands and the US. It has been recently linked to Alzheimers' disease and depression!

Saturday, August 20, 2016

Sjogren's syndrome mnemonic

Here's a short post about Sjogrens syndrome.

Hodgkins lymphoma and minimal change disease mnemonic

Which nephrotic syndrome is associated with Hodgkins lymphoma?

Lymphoma usually causes membranous nephropathy.

But Hodgkins is a weirdo which minimal change disease.

Mnemonic: Kids get MCD usually, so "Hodgkid"

Mnemonic by DJ AweSpear sent to us in our study group. Thanks!

Membranous glomerulonephritis mnemonic

Most common cause of nephrotic syndrome in adults.

Associated with clots - DVT, renal vein thrombosis and PE are common.

Nephrotic syndrome associated with malignancy.

It's membranous glomerulonephritis! :D

Study group discussion: Fall of fever by crisis and fall of fever by lysis

Difference between fall of fever by crisis and fall of fever by lysis ?

In fall of fever by crisis, there's sudden decrease in temperature (Mostly due to treatment).

In fall of fever by lysis, reduction in temperature occurs gradually.

Typhoid fever falls by lysis.
(Step ladder pattern!)

Dengue fever falls by crisis.

Systemic sclerosis autoantibodies mnemonic

Today, I forgot which antibodies scleroderma is associated with T_T

Apparently, Qbanks don't write Scl-70 in their options. They like writing "Autoantibodies against topoisomearase I" and make my life difficult.

Anyway, here's my attempt to remember this next time. I don't know if it'll work. But hey, no harm trying?

Mauskopf facies

Here's a fact I read today.

"Mauskopf" means "Mouse head" in German.

Wednesday, August 17, 2016

IkaN be a Khaleesi

This post is from the authors diary.
Game of thrones fan, continue reading.

Someone sent me this which is pretty hilarious. I sent it to two of my friends, one added more to it and the other suggested I put it on the blog xD

Tuesday, August 16, 2016

Different types of skin lesions (as in rashes)

                          Hey guys, we started Internal Medicine Last week, so we were studying about different types of skin lesion as in rashes in Harrison’ Internal Medicine 19e. So I made little chart myself to memorize it. So I thought to share it with you all.

Sunday, August 14, 2016

Polymyalgia rheumatica and giant cell arteritis mnemonic

Here's a mini post for the day!

What are the symptoms of Polymyalgia rheumatica? What is it associated with?

Saturday, August 13, 2016

#AnswerTime: A patient with delusion

Here's the answer to a question we posted earlier:


#QuizTime: A patient with delusion

A 32 year old male patient came to the Psychiatry  OPD complaining  that his wife wanted to kill him. He was asked why he didn't report to the police , to which he said they were not ready to believe him.
He was suspected of having a delusion of persecution.

Saturday, August 6, 2016

De Quervain syndrome notes

Here's a short post on De Quervain syndrome :D

Correction of hyponatremia and hypernatremia mnemonic


Never correct sodium too quickly.

If you correct hypernatremia too fast, it'll result in cerebral edema. Why?
When hypernatremia is corrected too rapidly, cerebral edema results because the relatively more hypertonic ICF accumulates water.

If you correct hyponatremia too fast, it'll result in central pontine myelinolysis (CPM) aka osmotic demyelination syndrome. Why?

Chronic hyponatremia is associated with the loss of osmotically active organic osmolytes (such as myoinositol, glutamate, and glutamine) from astrocytes, which provide protection against brain cell swelling.
However, organic osmolytes cannot be as quickly replaced when the brain volume begins to shrink in response to correction of the hyponatremia. As a result, brain volume can fall from a value that is initially somewhat above normal to one below normal with rapid correction of hyponatremia.
The mechanism by which a rapid fall in brain volume results in demyelination has not been established.

How do I remember this?

Central pontine myelinolysis* mnemonic
Here's another mnemonic:
From low to high, your pons will die (CPM)
From high to low, your brain will blow (Cerebral edema, herniation)

That's all!


Study group discussion: Widow makers artery

Does anyone know why left anterior descending artery is called widow's artery?

Tuesday, August 2, 2016

Approach to acid base disorders: Metabolic alkalosis notes

In suspected metabolic alkalosis, always check urinary chloride levels.

Metabolic alkalosis associated with a reduction in the ECV (Vomiting, diuretics):
There will be a stimulus for Na and Cl reabsorption to replenish extracellular volume.
Urinary Cl is very low ( < 25 meq/L).
Administration of NaCl and water leads to correction of the metabolic alkalosis.
Such causes of metabolic alkalosis are said to be saline responsive.

Approach to acid base disorders: Metabolic acidosis notes


I made these notes while studying acid base disturbances. Now they might not make sense to someone who has never studied this topic before.. But for those who have read about it, this should be excellent for revision.

Calculation of anion gap:
ALWAYS calculate the anion gap first.
Anion gap = [Na+]  − ([Cl-] + [HCO3−])
Normal anion gap = 8 - 16 mEq / L

Monday, August 1, 2016

What causes renal bruit?

Narrowing of the renal artery (Renal artery stenosis) causes renal bruit.

Hexagonal crystals in cystinuria mnemonic

Hexagonal crystals are seen in cystinuria.

Envelope shaped crystals in urine: Calcium oxalate mnemonic


X in oXalate looks like an envelop to me :D

Drugs causing crystal induced AKI mnemonic


So today I was reading about acyclovir and crystal induced acute kidney injury.

Acyclovir is rapidly excreted in the urine (being both filtered and secreted) and has a relatively low solubility. Intravenous (IV) therapy may lead to the deposition of acyclovir crystals in the tubules if the patient is volume depleted. This results in intratubular obstruction and foci of interstitial inflammation.

Secondary focal segmental glomerulosclerosis mnemonic

How to remember diseases associated with focal segmental glomerulosclerosis - Remember the letter H!

Hodgkins lymphoma and minimal change disease

Fact for the day: Hodgkins lymphoma is associated with minimal change disease.

Complications of nephrotic syndrome

Complications of nephrotic syndrome:

Infection with encapsulated bacteria, varicella (Vaccinate before or during treatment with high dose steroids)

Thromboembolism due to decreased antithrombin III (Prophylactic anticoagulation is not recommended unless patient has had a thromboembolic event, albumin < 2 g/dL, fibrinogen > 6 g/L, antithrombin < 70%)

Hypovolemia, anascara, renal insufficiency.

Increased risk of early atherosclerosis due to hyperlipidemia.