Tuesday, November 26, 2019


In simple words, Attrition is the loss of tooth structure occlusally due to excessive forces by the occluding teeth, grinding of teeth, deep bite.

Monday, November 25, 2019

Aurora kinases

Hello friends, Let's talk about Aurora kinases today.... Aurora sounds so beautiful, right ?

Aurora kinases represent serine threonine kinases with instrumental role in cell division.

Specifically, Aurora kinase A is required for duplication and separation of centromere, and Aurora B is required for attachment of microtubules to centromere.

They are often over expressed in tumors resulting in defective cytokinesis during cell division, eventually causing aneuploidy and driving the carcinogenesis.

Now, it really gets interesting; usually when functioning of microtubules are perturbed say by paclitaxel, then spindle check point inhibitor is activated leading to cell demise by upregulation of P53, PUMA and other mediators.

But in case of Aurora kinase inhibition, cells keep on dividing especially in case of P53 mutated cells. Since centromeres will not segregate, it ultimately leads to tetraploid genome and four centromeres in a cell, causing catastrophic mitosis in subsequent cell cycle effectively tearing apart the genome.

They are significant because often when other tyrosine kinase inhibitors targeting EGFR, VEGFR, FGFR are used, tumors over express Aurora kinases, there by over riding the inhibition mediated by tyrosine kinase inhibitors.... So targeting them is key to maintain remission in patients already on kinase inhibitors.

Few examples of drugs in trials: Monastrol, Hesperidin.

It's called Aurora because of the similarity between the appearance of microtubule spindles during cell division and Aurora Borealis.

Pretty Majestic, right?

Submitted by Kirtan Patolia 

Risk factors for puerperal sepsis mnemonic


Risk factors for puerperal sepsis mnemonic:

Maternal complications of diabetes in pregnancy mnemonic


Maternal complications of Diabetes in pregnancy mnemonic:

Sunday, November 24, 2019

JVP documentation

Hi everyone!

Someone questioned on how to document JVP. Just saying JVP is 8 cm is not enough - Say what is your reference for better documentation :)

Friday, November 22, 2019


Hey! =)

What does cryoprecipitate contain? 
Cryoprecipitate preparations contain concentrated amounts of fibrinogen (factor I), factor VIII (antihaemophilic factor), von Willebrand factor, factor XIII (fibrin-stabilizing factor), and fibronectin.

Why is it called cryoprecipitate?

Sunday, November 17, 2019

Pharmacologic treatment of pulmonary hypertension (notes and mnemonics)


Vasodilator response: A favorable vasodilator response is defined as a fall in mPAP of 10 mm Hg or greater to less than 40 mm Hg with an unchanged or improved cardiac output, in response to an agent such as inhaled NO or IV epoprostenol.

Cardiovocal syndrome - Ortner syndrome

In 1897, Norbert Ortner described hoarseness caused by recurrent laryngeal nerve paralysis in patients with a large left atrium due to mitral valve stenosis.


Istradefylline (Selective Adenosine 2A receptor antagonist), inhibits the adenosine's inhibitory effect on GABAergic transmission in direct nigro-striatal pathway while simultaneously inhibiting adenosine's stimulatory effect on GABAergic transmission in indirect nigro-striato-pallidal pathway, ultimately leading to stimulation of thalamo-stimulatory direct pathway and inhibition of thalamo-inhibitory indirect pathway.


Selinexor (Selective inhibitor of nuclear export) inhibits XPO1 (exporter protein 1).

XPO1 is often overexpressed in tumors leading to transport of tumor suppressor proteins like p16, p14, p27 from nucleus to cytoplasm and there by evading the apoptosis.


Here is a submission by Kirtan on Luspatercept!

Luspatercept (recombinant fusion protein containing Activin receptor type IIB moeity) blocks excessive SMAD2/3 activity (Mothers against decapentaplegic homolog) lying downstream of TGF-beta signalling by binding endogenous TGF-beta family members, including Bone morphogenetic proteins (BMP), Activin, Inhibin, Lefty A/B, Artemin, Persephin, GDF, GDNF and MIS.

Acute type-II respiratory failure causes mnemonic


Causes of Acute type-II Respiratory failure mnemonic:

Wednesday, November 13, 2019

Fact of the day - BUC in UGI bleed


Blood urea levels are positively associated with upper GI bleed. But here's the fact:

Monday, November 11, 2019

Sunday, November 10, 2019

How to read CSF analysis report?

Video by Jay!

Multiple Myeloma notes and mnemonics


Multiple myeloma - everything P

- malignant Proliferation of Plasma cells derived from a single clone.
- Immunoglobulin produced is a "ParaProtein" (M- protein)
- POEMS syndrome

- Pancytopenia

- plasma cell leukemia ( greater than 2,000 per mm3 )

- punched-out lesions in radiographs of flat bones
- bone pain
- pathological fractures

- Bence -Jones proteinuria
- production of excess Amyloid protein
- hyPer- calci -emia and -uria

These three result in renal damage and renal failure.

- prone to infections, particularly in respiratory and urinary tract.

( mnemonic - HPRVSCST )
- Headache
- Postural hypotension
- Retinal venous congestion
- Vertigo
- Strain (blurred vision)
- Congestive cardiac failure
- subtype IgA
- nysTagmus

- purpura
- profuse bleeding ( epistaxis, gastrointestinal )

- peripheral neuropathy
- compressive myopathy
- carpal tunnel syndrome ( nerve entrapment)
- Amyloidosis.

- total serum protein raised
- low albumin
- high globulin ( decreased A:G ratio )
- high beta-2 microglobulin ( greater than 5.5 mg/dL means poor prognosis; stage III)

Plasmacytomas in Paraskeletal soft tissues - poor prognosis; treated by palliative radiotherapy.

That's all
Anything more to add, you're most welcome :)
- Jaskunwar Singh

Saturday, November 9, 2019

How to calculate SVR and PVR using Ohm's law


Ohms law: Current (I) equals the voltage difference (ΔV) divided by resistance (R)
Simplified, V=IR

In hemodynamics, what is voltage difference? The pressure difference or pressure gradient! (ΔP)

Friday, November 8, 2019

Saturday, November 2, 2019

Pulmonary hypertension notes


Pulmonary hypertension (PH) is defined as a resting mean pulmonary artery pressure of 25 mm Hg or greater measured during right heart catheterization.

(How I remember the number 25 - PH: 2 letters, Hyper: 5 letters).

Classification of Pulmonary Hypertension mnemonic

"A heart lung chronic thrombotic unclarity"
1: pulmonary Arterial hypertension
2: PH due to left-sided heart disease
3: PH due to lung diseases and/or hypoxia
4: Chronic thromboembolic pulmonary hypertension and other pulmonary artery obstructions
5: PH with unclear or multifactorial causes

The transpulmonary pressure gradient (TPG): The difference between mean pulmonary arterial pressure (mPAP) and left atrial pressure (LAP, commonly estimated by pulmonary capillary wedge pressure PCWP).

A TPG of >12 mmHg would result in a diagnosis of “out of proportion” pulmonary hypertension - suggesting intrinsic pulmonary vascular disease in patients with left-heart conditions associated with increased pulmonary venous pressure.

Will update post as I learn more... 


Step 3 NBME Form 4 answers explanations

Publishing incomplete post form drafts :)

Platypnea-Orthodeoxia Syndrome in interatrial right-to-left shunt

Hi everyone! This is a short post :)

Platypnea (flat breathing): Dyspnea induced by upright posture and relieved by recumbency.

Orthodeoxia: Arterial oxygen desaturation accentuated by upright posture and improved by recumbency.

Peripartum heart failure associated with prolonged tocolytic therapy

Did you know?

What's Wrong With My Gallbladder, Doc?

A quick mini-post to help you make a quick diagnosis.

[Please click on the image to enhance it]

Please remember to practise caution as the presentations may overlap.

Thank you for reading.

Ashish Singh