Saturday, January 27, 2018

Autonomic neuropathy in diabetes mnemonic

Autonomic neuropathy in diabetes mnemonic

Hi everyone! This is one of the longest mnemonic in my sleeve.

I made this one up because it comprises a group of bizzare symptoms which we seldom relate to diabetes and take less notice of. These symptoms are indications of poor glycemic control.

The mnemonic is, 'AUTONOMIC NEUROPATHY' itself:

A - Abdominal fullness
U - Urinary incontinence
T - Tachycardia (Resting)
O - Oesophageal atony (Dysphagia)
N - Nocturnal sweats
O - Oedema (dependent)
M - Micturition delayed
I - Infection
C - Constipation

N - Nocturnal diarrhoea
E - Erectile dysfunction
U - Uncontrolled glycaemia
R - Retrograde ejaculation
O -
P - Pupillary signs (pupil size decreases, delayed or absent reflexes)
A - anhidrosis
T - Temperature (cold feet)
HY - Hypotension (postural)

This mnemonic was written by our Medical Student Guest Author, Nikhil

Mnemonic for the Ascending tracts & Descending tracts in Spinal Cord

Hiiiii everyone, it’s mnemonic time again! From the title, I guess you all know what it is about… I had a hard time memorizing these tracts so I created this mnemonic to help you guys out!

he drove a honda CRV TO disneyland.

Corticospinal tract (Lateral & Anterior)
Rubrospinal tract
Vestibulospinal tract
Tectospinal tract
Olivospinal tract

**Disneyland = Descending. Hence, this mnemonic is for the descending tract
**Since it’s a descending pathway, so all the fibers will travel to spinal cord from their origins. Therefore, just add “spinal” after each word (e.g. …spinal tract)
**Don’t forget that there’s lateral and anterior for Corticospinal tract. Honda CRV from Los Angeles maybe? Hahahah :3

That Los Angeles STudent went up to stage and SCream using the PA system because he got a Freaking Cool First Grade result.

STSpinoThalamic tract (Lateral & Anterior)
SCSpinoCerebellar tract (Posterior & Anterior)
FCFasciculus Cuneatus
FGFasciculus Gracilus

**Went up = Ascending. Hence, this mnemonic is for the ascending tract
**Los Angeles for STudent ; PA for SCream
**In addition, if you follow the order of FC and FG, it actually matches with the position of them from left to right in the spinal cord and mirror reflect them. (FC àFG à FG à FC)

Please comment if you have a better mnemonic! Let’s share our mnemonics ^.^
-Calvin Ong K. Y.

Complications of Myocardial Infarction Mnemonic

 Hello everyone!

Here's another whiteboard mnemonic of a commonly tested topic. The scary MI and the scary DARTH VADER from Star Wars.

Let me know if anything requires clarification.

Hope it helps. Happy studying!
-- Ashish Singh

Friday, January 26, 2018

The basics: Osteomyelitis

Osteomyelitis is an infectious disease that attacks the bones, specifically the bone marrow. It can have several etiologies: infection from an open fracture, postoperative infection, spread of a blood-borne infection such as pharyngitis, otitis etc. The causative organisms are most often staphylococcus aureus and group A streptococcus.

It is manifested by episodes of fever, often excruciating pain and functional impotence in the affected limb.

It is prevalent among the poor, especially children. In Haiti, it represents a real cause of morbidity and mortality.

It can eventually cause various complications such as: chronic osteomyelitis, pathological fracture by weakening of the bone, length difference in limbs etc.

This mnemonic was written by our Medical Student Guest Author, Rebecca St Louis

She originally wrote this for us in French:

*Ostéomyélite aigüe*

L'ostéomyélite est une maladie infectieuse attaquant les os plus précisément la moëlle osseuse. Elle peut avoir plusieurs étiologies: infection à partir d'une fracture ouverte, infection post-opératoire, propagation d'une infection hématogène comme une pahryngite, une otite etc. Les germes en cause sont le plus souvent le staphylocoque auréus et le streptocoque du groupe A.

Elle se manifeste par des poussées de fièvre, par une douleur souvent atroce et une impotence fonctionnelle au niveau du  membre atteint.

Elle est prévalente chez les pauvres surtout les enfants. En Haïti, elle représente une véritable cause de morbidité et de mortalité.

Elle peut occasionner àla longue diverses complications telles que: ostéomyélite chronique, fracture pathologique par fragilisation de l'os, différence de longueur au niveau des membres etc.

De ce fait, contribuer à l'abaissement de l'incidence de cette pathologie est d'une importance capitale. Voilà pourquoi nous encourageons les parents:
- à promouvoir l'application des règles d'hygiène par les enfants dès les premières années.
-à penser rapidement à faire sougner leurs enfants en cas d'infections hématogènes.

MIL: Cystic degeneration of pterygium

A case of cystic degeneration of pterygium

Causes of a Non Healing Ulcer : Summary

Hi everyone !

This is a short summary on what causes an ulcer to have delayed healing.
Most cases in the wards and the boards are Traumatic ulcers that have now failed to heal due to some or the other reason. Most commonly the reason is Diabetes , other common ones including Poor general health and Varicose veins.
This post summarises the causes.

Causes of Non healing ulcer

Local :
- Site of high pressure / mobility
- Repeated trauma to site
- Foreign body at the ulcer base
- Local infection at ulcer site

Focal :
- Varicose ulcer (Generally at the Medial malleolus)
Reason : Venous congestion eventually causes the trapped macrophages etc to release their mediators producing Inflammatory changes + Pigmentary changes occur due to microruptures of congested venules causing Hemosiderin formation and irritation of skin by the Pigment.
- Deep Vein Thrombosis (Same as above).
- Peripheral Arterial Disease ( Arterial blockade -- causes tissue Hypoxia and thus impaired healing ) 
- Neuropathy ( Impaired sensations cause repeated trauma at the site of the ulcer delaying its healing ).
- Lymphatic D's ( Lymphedema -- can cause skin hypertrophy and other odd changes due to mediators from the Lymph causing ulceration)

Systemic :
- Malnutrition
- Anemia
- Low proteins
- Vitamin deficiencies - esp Vit C , K
- Diabetes Mellitus
- Hypertension (Martorell Ulcer)


Why Diabetes causes non healing of any ulcer ?
3 important reasons :
- Microangiopathy : Due to deposition of various Glycated end products into the microcirculation causing Hypoxia and thus impaired healing
- Neuropathy : due to diabetic Neuropathy , the sensations to the area may be diminished and this will cause repeated trauma to the ulcer.
- Infections : High glucose levels serve as a pabulum or conducive manure for growth of various microbes.  Infection causes impaired healing of the ulcer.

Hope this was helpful!
Happy Studying!
Stay awesome !
~ A.P. Burkhodleria

Thursday, January 25, 2018

Alport syndrome mnemonic


This mnemonic is on Alport syndrome!
Well, the 'Port' in alPORT reminds me of 'Pirate ship' (port - a port in the sea - pirate ship).

1. The pirate flag has cross bones which kinda reminds me of X for X - linked disease. 

2. ‎Number 4 in the port side for type 4 collagen defect.

3. ‎'Bloody' pirates reminds me of haematuria and glomerular basement membrane damage. 

4. ‎Captain shouting, "AAARGH" for crew members who can't hear (Sensory neural hearing loss)
S for sensory, S for sailor, the deaf sailor kinda reminds me of it.

6. ‎Eye patch - for cataract.

That's all!
Stay awesome!

This mnemonic was written by our Medical Student Guest Author, Nikhil.

The image was illustrated by our Medicowesome author, Chaitanya Inge.

Lymphoma and Leukemia Translocations Mnemonic

Hello everyone!

Here's an intuitive way to remember the chromosomal translocations involved in various lymphomas and leukemias.

Hope this helps. Happy studying!

-- Ashish Singh

Arterial Supply of the Head & Neck in a Nutshell!

Helloooo everyone!!

Here’s some mnemonic I created myself for the branches of external carotid artery and the branches of facial artery. To memorize the name of the branches of external carotid artery, you just need to....

IV cannula color code and size mnemonic

IV cannula color code and size mnemonic

Here is  an interesting way of remembering the colors of the IV cannulas that I found in the comments section of Quora. Hope it  is helpful!

We start from gauge size number 14 upto gauge size number 24.

All we have to do is remember the layers of the earth from the core right upto the sun.

1) Core of the earth is the innermost layer which is orange - number 14
2) Layer of clay which is grey - number 16
3) Layer of grass which is green - number 18
4) Flowers which are pink - number 20
5) The blue sky - number 22
6) The sun which is yellow- number 24
7) Beyond the Earth is the galaxy which is purple / violet - number 26

This mnemonic was written by our Medical Student Guest Author, Daksh Mehta!

Moderate Ascites : An approach to management

Hi everyone ! This is just a general proforma on how to manage Moderate ascites occuring due to Liver Cirrhosis.
Hope you find this helpful.

Moderate Ascites

Ix :

- Complete hemogram
- LFT : complete ; look for Liver dysfunction. Important parameters for Alcoholic liver disease : AST / ALT ratio > 2 and GGT levels raised.
- Creatinine BUN : for Pre renal AKI / Hepatorenal Syndrome
- Electrolytes : Sodium , Potassium , Calcium.
- Urine Routine and Microscopy

Ascitic fluid analysis -
∆ Biochem : SAAG ( Serum Ascites Albumin Gradient) , Ascitic fluid Proteins , ADA.
∆ Path :  Cell count. ( > 250 per micro litte suggests Spontaneous Bacterial Peritonitis).
∆ Micro : Microscopy and Culture.

AFP (Alpha feto protein) for HCC screen.

- Bed rest and admit the patient
- Salt reduced to < 2g/day
- Fluid restricted - less than 1 L per day
- Spironolactone 100 mg per day +/- Frusemide 40 mg. ( Gen Frusemide added on day 4)
- Monitor output , input , girth , weight
- Ideal Weight loss - 0.5 - 1 kg/day
- If not - amp up doses of diuretics by day 3/4
- Max doses = Spironolactone 400 mg
Lasix = 160 mg
- Therapeutic Paracentesis indicated if - Tense Ascites , Child B Cirrhosis , creatinine < 3.
5-10 L in an hour can be removed  + IV albumin 6-8 gm/L

If failure to respond to Max dose of diuretics - that is 400 mg Spironolactone and 160 mg Frusemide , it is termed as Refractory Ascites and needs further evaluation and Paracentesis.

Basis for using Spironolactone as preferred drug in Cirrhotic Ascites : Ascites occurs in these patients  Largely due to lack of degradation of Steroids by liver, and activation of Renin Angiotensin Aldosterone system.

Basis for SAAG ratio :
Difference between Serum and Ascitic fluid Albumin.
i.e. SAAG = Serum protein - Ascitic fluid protein
If the difference is more than 1.1 it indicates the Ascitic fluid was not very proteinaceous and in fact had low protein compared to serum , i.e. , it's a Transudative Ascites. Most important of which is Liver Cirrhosis (Where the Serum proteins are low themselves as well, so is the total Ascitic fluid protein.)

If the difference is less than 1.1 it indicates the Ascitic fluid was highly protein rich and it's an Exudative Ascites.

Let me know if you'd like anything clarified.
Hope this helps !
Happy Studying!
Stay awesome :)

~ A.P. Burkholderia

'Named Murmurs' : Eponyms and Cardiac Auscultation

Hi everyone !
So I'm posting after ages now , since final exams just got done.
Hopefully I'll be a doctor soon (fingers crossed).

This post is about few important named auscultation findings in Cardiology. It'll provide a list of things at the same place, hopefully you find it helpful 😃

So here we go : 

1. Graham Steele Murmur

What is it : Early to Mid Diastolic Murmur at Pulmonary area 
Which condition(s) : Pulmonary Regurgitation
Key features : can be seen in Right sided overload states eg. Right ventricular failure , Mitral stenosis (MS).
( Remember Mnemonic : General Secretary or Public Relations : GS PR, trust me I've used this about Everytime I've been asked this Q)

2.  Carvallo Sign  

What is it : increase in intensity of a systolic murmur bear Apex on inspiration. 
Which condition(s) : Tricuspid Regurgitation (TR)
Key features : So the murmur of TR is a systolic one. This is heard very close to the Apex and at times may be confused for the Systolic murmur of Mitral Regurgitation.
Since the murmur of TR is a right sided murmur it increases in intensity on inspiration (as venous return increases to the right side on inspring ) , while the murmur of MR may reduce / even disappear on inspiration.

3. Austin Flint Murmur

What is it : Mid Diastolic Murmur at Mitral area 
Which condition(s) : Aortic Regurgitation (AR)
Key features : It is a functional murmur seen in AR. When the blood regurgitates from the aorta to the Left Ventricle , a jet may strike at the mitral valve leaflet - narrowing its lumen producing a functional mitral stenosis , presenting with a Mid Diastolic murmur.

4. Carey Coombs Murmur

What is it : Mid Diastolic Murmur at Mitral area 
Which condition(s) : Mitral Valvulitis ( Rheumatic )
Key features : It's different from MS murmur : No Opening snap , no radiation , no Pre systolic accentuation.

5. Gallavardin phenomenon

What is it : Systolic Murmur heard at the Apex
Which condition(s) : Aortic Stenosis
Key features : functional murmur heard at Apex in AS - example of conduction of murmur. 
( So I always would confuse Gallavardin and Carvallo.
Here's a Mnemonic : Gal's AS is on fire. )

6. Still's murmur
What is it : Systolic murmur ( without thrill)
Which condition(s) : Random : in Children
Key features : Musical murmur ( innocent ) seen in kids , absolutely harmless.

7. Hemic Murmur

What is it : Systolic Murmur ( Without thrill)
Which condition(s) : Severe Anemia
Key features : Functional murmur.

8. Gibson Murmur

What is it : Continuous murmur at upper left sternal border
Which condition(s) : Patent Ductus Arteriosus
Key features : said to have a 'Machinery' character.

Hope you find this helpful !
Happy studying !
Stay Awesome. :)

~ A.P.Burkholderia.

Hypolipidemic drugs classification mnemonic

Hypolipidemic drugs classification mnemonic

The mnemonic for classification of hypolipidemic drugs is, “DIBS On Oily Food”

D - Dietary cholesterol absorption inhibitors
Ezetemibe (E for Eat)
D and E are alphabets next to each other.

I - Inhibitor of TAG synthesis and lipolysis
Nicotinic acid (I looks like a cigarette, that reminds you of Nicotine hence, nicotinic acid)

B - Bile acid sequestrants
B and C are alphabets next to each other.

S - Statins
Mnemonic: PLAy with Skipping RoPeS
P - Pravastatin
L - Lovastatin
A - Atorvastatin
S=> Statin (All end with statin)
R - Rosuvastatin
P - Pitavastatin
S - Simvastatin

O - Omega 3 fatty acids

O - Others such as Gugulipid

F - Fibric acid derivatives
Mnemonic: Fabric Clothes, Gems and Benz are Fine
Fabric - Fibrates (most of them end with fibrate)
C - Clofibrate
G - Gemfibrozil
B - Benzafibrate
F - Fenofibrate

Hope this helps!

This mnemonic was written by our Medical Student Guest Author, Anagha Rao :)

Wednesday, January 24, 2018

Magnesium sulphate in management of pre-eclampsia (dosing)

Dosing of magnesium sulphate in management of pre-eclampsia

Using magnesium sulphate as a neuroprotective agent against seizures is a well known fact. We have been taught to follow Pritchard's regimen all through medical school, but actually dealing with it in the labour ward is a whole other scenario!

In the Indian setup (especially a government setup), magnesium sulphate is not always found in the concentration it is to be administered.

Medicowesome Student Guest Author Internship (MSGAI) program

Hey everyone!

We are launching the Medical Student Guest Author Internship (MSGAI) program for Medicowesome this month!

If you have wanted to contribute or write about medicine but you haven't been able to - this is your chance! :)

For this project, I am not only asking people to write mnemonics and posts but also mentoring student authors who are interested in medical education. It's basically a small program on how to compile ideas and make them presentable. Writing and teaching has also made me a better student (and helped with my grades!) so I will be giving a little guidance on that as well.

But to participate in the Medical Student Guest Author Internship program you must have:

Neural crest (clinical aspect)

Hello Awesomites! :D

Let us go back to the contribution of neural crest cells to many different systems (neural, skin, teeth, head, face, heart, adrenal glands, and gastrointestinal tract).

Neural crest forms neural and non-neural population.
-Cranial neural crest
-cardiac neural crest
-trunk neural crest
-Vagal neural crest

Malformations of NC origin
-Facial clefts, ear malformations, and other Facial defects 
-Branchial fistulae and anomalies of pharyngeal arch derivatives
-Cardiovascular malformations 
-Pigmentary disorders
-Abnormal enteric innervation 
-Hemangiomas and vascular malformations

1. Facial clefts, ear malformations, and other facial defects-
 The shaping of the face is therefore patterned under the influence of the NC.
The more common malformations of the region
-preauricular tags
-cleft lip, and cleft palate
-CHARGE association
-Treacher Collins, or Goldenhar syndrome.

2. Branchial fistulae and anomalies of pharyngeal arch derivatives 
-Malformations of the endocrine glands that are derived from the pharyngeal arches and pouches have the same origin. That is:-
The paired thymus which originate from the third pharyngeal pouch on each side,
The parathyroids, derived from the third (lower glands) and fourth pharyngeal pouches (upper glands) ,
C-cells of the thyroid (derived from the ultimobranchial body in the fifth pouch)
-Branchial cyst

3. (IMPORTANT) Cardiovascular malformations
TA, DORV, Tetralogy of Fallot (TOF), narrow outflow pulmonary tract (NOPT), transposition of the great vessels, perimembranous ventricular septal defect (VSD), and other heart defects are the result of defective NC influence on the region.

4. Pigmentary disorders 
-Neurocutaneous melanoses 
-neurofibromatosis of Von Recklinghausen 
-Tuberous sclerosis and all the gastrointestinal polyposes in which there are mucosal or cutaneous pigmentary spots (Peutz Jeghers, Cowden, Cronkhite- Canada etc.)
-neurofibromatosis albinism

5. Abnormal enteric innervation
-Hirschsprung disease
- Neuronal intestinal dysplasia

6. Tumors
Due to abnormal proliferation of NC cells
-Peripheral neuroectodermal tumor

7. Hemangiomas and vascular malformations 
The concept that hemangiomas and vascular malformations are derived from the NC is relatively new, but accepted. The flat vascular malformations that are located in the areas corresponding to the cutaneous innervation of the cranial nerves may have intracranial extension (Sturge-Weber syndrome) and are of this origin.

In next post, I will discuss NEUROCUTANEOUS SYNDROME as an extension of this post.
Feel connected: D

-Upasana Y. :)

Tuesday, January 23, 2018

Hepatic encephalopathy

Hello Awesomites! :D

Long time.

Today we will be discussing the Treatment of Hepatic Encephalopathy.
I like this topic because of its integration with biochemistry.

-After stable: Identify and treat trigger of Encephalopathy.

-Nasogastric aspiration (in case of bleeding) and protection of airway with a endotracheal tube. Always prefer to give prophylaxis for SBP with Amoxiclav / Cephalosporin if GI bleed is the trigger.

-Avoid constipation and favour bowel emptying by bowel wash, enema or by lactulose (15-30ml 3 to 4 times daily) or lactitol.  
-Bowel sterilisation by neomycin 1 gm qid or ampicillin. Neomycin helps in decreasing ammonia production or its absorption from the bowel. 
-Avoid drugs, especially sedatives and diuretics. 
-Protein is restricted and vegetable based protein may be given. 
-IV mannitol as a fast drip for reducing cerebral oedema.

-Newer/ Experimental modalities:
Flumezanil (BDZ antagonist)


-It creates an acidic intestinal environment to prevent NH3 absorption.
-Promote growth of glycolytic bacteria rather than proteolytic bacteria.
-Increase GI motility.

* L-ornithine-L-aspartate (LOLA)

-Provide a urea cycle alternative substrate.

* Rifaximin
-The recommended dose is one 550 mg tablet taken orally two times a day. Poorly absorbed Antibiotic to alter GI microbes.

*Correct Hyponatremia,Hypoglycemia and Hypovolemia.

*Branched chain Amino acids in diet. (Leucine and isoleucine)

-When no response to standard treatment, portosystemic shunting is considered.
Liver transplant allocation can be determined by using the MELD and sodium level (MELD-NA) score.
MELD score consist of:-
-Bilirubin (Means how well my liver take up byproduct from blood)
-INR (Means synthesis function of liver)
-Creatinine (Hepatorenal syndrome)

I hope it helped.
I want to thank Antariksh for edits in this post. :))

-Upasana Y. :)

Step 3 CCS tips & Frequently Asked Questions

This post is all about how to study for CCS.

How to study for CCS?
Use the UW software. It is more than enough.

Should I do Archer videos?
They are just 5 videos and are not mandatory to do. It's just that most students do not know how to fast forward the clock, change location, etc. and Archer does a pretty good job at explaining it. (I might do a video later!)

Should I opt for softwares other than UW?
It is not necessary because UW has just enough. Other softwares might train you to do "extra" unnecessary orders which maybe sub-optimal in the real exam because there is not enough time to do everything.

MUST DO before the real exam: Practice the CCS cases on the website. You have to be comfortable with the software and the different orders available.

Monday, January 22, 2018

Interesting physical exam finding in Henoch-Schonlein purpura

Hello everyone!

Here's a cool fact that someone I absolutely adore shared with me: The Pediatricians call Henoch-Schonlein purpura as, “Butt-itis” because the rash frequently coalesces on the pressure points and is gravity dependent, in other words, on the buttock!

Thursday, January 11, 2018

Henoch Schonlein purpura

HSP is also known as Anaphylactoid purpura.

• Most common vasculitis in children.
• Most common Leucocytoplastic vasculitis.
  It predominantly affects small vessels (venules, capillaries, arterioles).
  It is usually self limited but may progress to end stage renal disease.
Clinical features:
1) Skin: rash, palpable purpura (non-thrombocytopenic purpura).
2) Joints: arthritis, arthalgia.
3) Kidneys: glomerulonephritis (proteinuria, hematuria).
  ° Severe renal failure occurs in about 1-2%, characterized by crescenteric glomerulonephritis which is treated with intravenous methyl prednisolone.
4) GIT : colicky abdominal pain.

   On investigation: total Ig A increases.
Renal biopsy: mesangial Ig A deposits.

Treatment: conservative treatment
    Oral prednisolone may be given.

Thanks for reading.

Madhuri Reddy.