Thursday, August 30, 2018

Timeline in Psychiatry

Hello Medicowesomites! While studying psychiatry, you must have realised diagnosis of any condition requires two parameters:

1. Clinical presentation
2. Time

This post enlists how to make a psychiatric diagnosis in time.

Author's note: This blogpost is intended for an audience having a foundation knowledge of the subject.
It does not explain any concept or review any literature, instead serves as a quick cheat sheet for timeline required to make a psychiatric diagnosis.

[Kindly click on the image to view the table clearly]

Happy studying!

-- Ashish Singh

Wednesday, August 29, 2018

Hering's law of equal innervation

Now to study this law, we need to know clinical function diagram of eye muscles.

So according to this diagram,
Right SR is responsible for elevating right eye to right side.
Similarly, Left IO is responsible for elevating left eye to right side.

Since both the muscles are performing same action on two different eyes using two different muscles they are called yoke muscles of each other.
This is Hering's law of equal innervation.

Now, here is a trick to solve problem without looking into the diagram:

Right gets converted to Left.
S (Superior) gets converted to I (Inferior)
O (Oblique) gets converted to R (Rectus)
So the mnemonic for remembering muscle change is
ROSI (You can remember it as ROSS from friends!)
R gets converted to O.
S gets converted to I.
-Demotional bloke

Movements of eye muscles.

This post is actually the primary post for squint studies. Just basic post so we can explore squint in easy and simplified manner.
So there are seprate diagrams for anatomical and clinical functions. In this post we will go for former part.
Anatomical functions diagram.

Note: Don't use this diagram when you are studying squint. This diagram is used only for movements of eye muscles.
So every muscle has 3 actions except medial and lateral rectus.
Actions are divided into three types Primary, secondary and tertiary.
We know the basic or primary action of superior and inferior rectus is to elevate and depress the eyeball respectively.
According to the diagram given you also know that superior rectus can intort and adduct. Similarly, inferior rectus can extort and adduct the muscles.

How to remember this?
1) Through diagram.
2) Trick: Recti muscles are adductors

Now comes to SO(Superior oblique) and IO(Inferior oblique). Now this is also basic which we fail to notice often. These muscles are coming to tarsus part of eye obliquely. So, primary action is intortion and extortion respectively. Now go to diagram and you will notice that IO actually corresponds to SR hence it performs elevation and SO corresponds to IR so it performs depression.
Also, both the muscles are "Abductors"

How to remember this?
1) Diagram off course!
2) Trick: Superior muscles are Intorters and inferior muscles are extorters.
To keep the things in apple pie order I have made this chart. Hope it helps.
-Demotional bloke

Tuesday, August 7, 2018

Friday, August 3, 2018

Stop Antibiotic Abuse!

Hello Everyone,

It's been really long since the last post! Well it's been hectic all the way to and through residency.

I was recently researching on the topic of antibiotics while I stumbled upon this excellent piece of information cum approach by Dr.Strong on starting Anbiotics.

Well everyone should ask themselves these 12 questions before starting any antibiotic for one's patient and trust me you'll end up choosing the most appropriate one.
This is how we don't contribute to the Antibuse- "Antibiotic Abuse"( my personal neologism)

So now coming back to the questions, ask yourself these questions before you start any antibiotics,

1) What condition is being treated?
2) What are the commonly known bacterial species causing that condition?
3) Which antibiotic group is typically active against those?
4) What are the local resistance patterns for the chose antibiotic?
5)Will there be adequate organ penetration?
6) What is the preferred route of administration?
7)Any specific contraindication of the antibiotic to look out for?
8) Any required dose adjustment for coexisting renal or hepatic diseases?
9) Any specific drug interactions to be considered?
10) When on therapy anything that needs periodic monitoring?
11) How can the therapy be narrowed once bacterial sensitivities are available?
12) What will be the anticipated duration of the therapy?

Let's take a step towards stopping the rampant Antibuse.

That's all for now.

Let's learn Together!
-Medha Vyas.

Thursday, August 2, 2018

Ring-enhancing lesion in an immunocompromised host

Hello everyone,

If it is a ring-enhancing lesion in an immunocompromised host, the most commonly seen etiologies are Cerebral toxoplasmosis (50%) and Primary central nervous system (CNS) lymphoma (30%).

But let's talk about the uncommon etiologies -

ECG quiz: ST elevation in aVR and ST depression in other leads

Quiz question: ST elevation in aVR and ST depression in other leads is suggestive of?