Friday, January 31, 2020

Advice to young doctors

It is okay to disagree with another physician and acknowledge differences in the style of practicing medicine. Medicine is not black and white. Develop your own preferences based on evidence and experience.

A truly experienced physician understands the intricacies of medicine and will not criticize another physician for a decision they made under a different clinical circumstance with the information they had available.

A physician who second guesses themselves and critically analyzes their decisions retrospectively and prospectively are better than those who are over-confident about their diagnosis and management. Think about the decisions you make.

If you ever come across a bad patient outcome, yourself or your colleagues, do not jump to conclusions. There may be other factors, that you do not have knowledge of, which may have played a role.

When feedback is given, don't take it personally. Learn from the experience objectively and detach yourself from it. This way, you will learn more instead of getting offended and defensive about it.

To not get emotionally involved takes time. Give yourself time. Change the voice of the conversation in your head.

I am still learning.

A young doctor.

Wednesday, January 29, 2020

Facebook: Wolffian duct

Q1) Ejaculatory duct in males develops from 
A) Ureteric bud
B) Mesonephric duct
C) Wolffian duct
D) Paramesonephric duct


Answer to this question is Option C) Wolffian duct.
But isn't Wolffian duct also called as Mesonephric duct ? So can you pick option B instead of option C?
Well, unless your exam allows multiple answers to be correct, do not pick 'Mesonephric duct'. Here is why?

The mesonephros gives mesonephric duct which opens in the Urogenital Sinus and forms trigone of the bladder. Mesonephric duct also gives ureteric bud to the Metanephros to form Renal system.
Now after this has happened, the Mesonephric duct will be called as Wolffian Duct which forms the internal genital organs and in females, disappears.

That's it!
Demotional bloke

Sunday, January 26, 2020

Mnemonic for head posture in A-V pattern squints

Chin up in what? Chin down in what? The vexing never ends. Well, as it turns out, the word 'vex' itself is here to save the day.

Chin up- V exotropia (VEx). Remember that squint is very 'vexing'. So you stare in the sky to remember at least a fraction of what you stuffed in your brain the day before. 

Other will be A esotropia. By exclusion, it's easy to remember. 

Chin down- V esotropia or A exotropia. Again, by exclusion, these get placed naturally under this heading.

So, just remember 'VEX' and you won't be vexed anymore! 


Friday, January 24, 2020

Mnemonic for Drug induced Cardiomyopathy

Hello everyone ....

Aunty is cycling 🚴‍♀️ on paved trails to protect her heart 💓 

Aunty = Anthracycline = Doxorubicin, Daunorubicin , Mitoxantrone 

Cycling = Cyclophosphamide 

paVEd = VEGF Inhibitors = Bevacizumab 

Trails = Trastuzumab

Friday, January 17, 2020

Facebook: PFT-1

Q1) Which of the following is/are not a contraindications of performing PFT(Pulmonary function test)? 

A) MI within one year

B) Unstable angina

C) Recent thoraco-abdominal surgery

D) Recent ophthalmic surgery

E) Past history of pneumothorax

So correct options are - A and E

Following are contraindications to perform pulmonary function test. 

Mnemonic: UR IRcTC

U- Unstable angina

R- Recent thoracoabdominal surgery

I- Myocardial infarction within the last month

R- Recent ophthalmic surgery

T- Thoracic or abdominal surgery 

C- Current pneumothorax

That's it! 

-Demotional bloke. 

Parasitic infections and Asthma

In parasitic infection, polyclonal IgE produced by body occupies the receptor produced by mast cells. This leads to decrease action of specific IgE required for asthma. 
This mechanism is probably the cause of decrease prevalence of asthma in tropical population. 

That's it 
-Demotional bloke

Thursday, January 16, 2020

Choristomas Vs Hamartomas

I get super confused with both the following terms, so I made a lame technique to remember both of them. 


It sounds more like a Christmas. So Christmas tree is usually not grown in India but we do keep it as a sign of Christmas. 
So Christmas tree is normal, but the site (India or any other habitat) is not the usual site of tree, so let's say abnormal. 
So Choristomas is normal tissue at abnormal anatomical sites.

Example - Normal pancreatic cells under the small bowel mucosa.
They are not considered as neoplasm.


'Hamara' in Hindi means 'mine'. 
Remember: this place is mine. So here, place is normal and tissue is abnormal!
That is, abnormal tissue at normal anatomical sites.

Example - Lung hamartomas exhibit cartilage, bronchi, and blood vessels. 
They are considered as neoplasm.

That's it! 
-Demotional bloke

Wednesday, January 15, 2020

Areas devoid of pain fibres

Areas devoid of pain fibers 
Mnemonic: BED PACK
B- Brain parenchyma
E- Ependyma
D- Duramater (Neither covering blood vessel or forming dural venous sinus) 
P- Pia mater
A- Arachnoid mater
C-Choroid plexus

That's it 
-Demotional bloke

Areas devoid of BBB

Area devoid of BBB 

Mnemonic: MAP SNOW
M- Median eminence
A- Area postrema
P- Pineal gland
S- Subfornical organ
N- Neurohypophysis
O- OVLT- Organum vasculosum laminer terminalis 

That's it 

- Demotional bloke

Tuesday, January 14, 2020

Egg shell calcification

Following are the cases in which we get eggshell calcification of lympho nodes on radiography. 

SSRI Love Hitting BAT
(Lame? I know!

R- After Radiotherapy
I L- Post irradiation lymphoma
H- Histoplasmosis
A- Amyloidosis
T- Tuberculosis

That's it ! 
- Demotional bloke

Ocular Alzheimer's disease

A paper published in 2003 has dubbed glaucoma as 'ocular Alzheimer's disease' because some of the pathophysiological elements are similar.

Sunday, January 12, 2020

Saturday, January 11, 2020

Psychiatry MCQ-1

So here are two multiple choice questions, whose answer changes with options

Q1)Most common psychiatric disorder is :-
A) Anxiety
B) Depression
C) Phobia
D) Schizophrenia

Here answer is A) Anxiety

Most common psychiatric disorder is 
A) General Anxiety disorder
B) Panic anxiety disorder 
C) Phobia anxiety disorder 
D) Depression

Here answer is D) Depression

Reason for such variation is that Anxiety is not just a single disease like depression.
Infact it is group of disorders. 

So Depression is the single most common psychiatric disease whereas Anxiety is the most common psychiatric disease. 

Friday, January 10, 2020

GANGLION (Last minute revision)

Hello Awesomites !

These are point on parasympathetic ganglion.

-Upasana Y.


Hello Awesomites !

The future blogs will be on confusers.

Q. On peripheral blood smears there is presence of spherocytes. What are the differentials and the test to identify the same?

Most of you have prompted it as hereditary spherocytosis.
 Let see.

 Best next step is to do DIRECT COOMBS TEST to rule out autoimmune hemolytic anemia.
For hereditary spherocytosis go for osmotic fragility test.  

 So spherocytosis doesn't means Hereditary, it could be acquired, usually preceded by an infection.

-Upasana Y.

Thursday, January 9, 2020

Integrating Trendelenburg

This blog will compel all the signs /symptoms Or test related to 'Trendelenburg'. Let us know if you know more of the 'Trendelenburg' in the comment section so we can integrate it here. 

Trendelenburg's gait

A child with unilateral dislocation of hip lurches on the affected side while bearing weight on it. Seen in DDH, poliomyelitis, Superior Gluteal nerve palsy.
Trendelenburg's gait is also known as Abductor gait or lurching gait.

Trendelenburg's test:

Trendelenburg's surgery/procedure:
It is done in GSV and SFJ incompetence. Here flush ligation of SFJ is done. Flush ligation means vein is ligated as close as possible.
Six tributaries also need to be ligated to reduce recurrence rate.
Laterally: Superior circumflex iliac.
                  Superior epigastric vein.
Medially: Superior external pudendal
                   Deep external pudendal
Distally: Accessory anterior saphenous vein
                Posterior medical thigh vein

Stripping is an additional surgery. Should be done till knee, not below knee to avoid Saphaneous nerve.

Brodie Trendelenburg's test

It is done to determine the incompetency of the sapheno-femoral valve and incompetency of the communicating vein.
In both the tests, patient is first placed in the recumbent position and his legs are raised to empty the veins. The sapheno-femoral junction is now compressed with the thumb or a torniquet can be used.
1) To check sapheno-femoral valve incompetency, patient is asked to stand up quickly and pressure is released. If varices fill quickly by a column of a blood from above, it indicates incompetency of the sapheno-femoral valve. This is called Trendelenburg test.
2) To test communicating system, pressure is not released but maintain for 1 min. Gradual filling of the veins indicates incompetency of communicating veins.

That's it

-Demotional bloke. 

AVPU Scale

Hello Awesomites !


AVPU scale is like glasgow coma scale to determine the level of responsiveness.

  • Eyes open 
  • Knows name,date,time,place
  • Not oriented to time and place
  • Responds in a meaningful way
  • Eyes do not open
  • Responds when trapezium muscle is pinched
  • Eyes do not open
  • Does not respond to pinching of muscles 
Best (A) to Worst (U)

Happy Studying :)
 -Upasana Y.  

Tuesday, January 7, 2020

Types of glare and mnemonic

There are 4 different types of glare-

1. Direct glare- When the source of light is placed in the same or nearly the same direction as the object of fixation.

2. Discomfort glare- Glare which produces discomfort without interfering with vision. One experiences it when the overall illumination of the surroundings is too bright. 

3.Indirect glare- When an intense light source is placed in a direction other than the object of fixation.

4. Disability glare- Glare which reduces visual performance without necessarily causing discomfort. It refers to the reduced visibility of a target due to the presence of light elsewhere in the visual field. Contrast is reduced, and thus the visibility of the target. 

Now. How to remember all four? 
You are familiar with direct and indirect ophthalmoscopes. 

Suppose an ophthalmologist begins with direct ophthalmoscopy, which causes discomfort, both, to the patient as well as himself, because it involves going too close to the face. The ophthalmologist then starts using an indirect ophthalmoscope with the patient in a supine position, but after a while ends up having cervical spondylosis. Thus, getting a disability.

That's all!


Saturday, January 4, 2020

Authors' diary: Mercy

Today, when I walked into a patients room to talk to him, he said, "Mercy."

I wasn't sure if this 90 year old male with dementia said what he said.

I asked him, "Did you just say mercy?"

He said yes and nodded. It broke my heart. 

It's sad that aggressive treatments have come to this. When families want "Everything done" they don't see what we actually do.

There comes a point in life when it is okay to refuse treatments, not because you're negligient and ignorant about your health, but because it is the right thing to do.

With all our technological advancements in medicine, we can keep a body alive. We can have a ventilator with tracheostomy breathe for the patient, we can feed through a PEG tube, we can replace the kidney with dialysis, we can keep the blood pressure up with pressors. Sometimes, we can even bypass the heart and lungs through extra corporeal membrane oxygenation (ECMO). But just because we can do it, doesn't mean we should do it. What about quality of life? 

Medicine can only do so much. There comes a point in the natural course of human life when the body can't heal anymore. That's when it's okay to say, "No more." It's time for comfort care and hospice. 

Fortunately, for my patient, the physician explained about end of life to the decision makers and the family understood the goals of care. The patient was discharged to hospice. 

Friday, January 3, 2020

Contents page for Medicowesome secret project on Depression: Let's talk

Whatsapp group for medical professionals struggling with mental health issues

Hello, medicowesomites!

The Medicowesome admins had a recent discussion on depression and anxiety among health care professionals. We decided to create something like a support group on Whatsapp for those interested.

Pressure half time in aortic regurgitation notes

Hello! This post may be relevant to IM residents and cardiology fellows.

Olanzapine dose in CINV


Olanzapine, an anti-psychotic, has been used in the patients of cancer for its beneficial effects on chemotherapy-induced nausea and vomiting (CINV) at a dose of 10 mg due to its anti-emetic action (neurotransmitter blockade at serotonin and dopamine receptors).

But due to its major adverse impact of daytime sedation, recent studies and randomized controlled trials have concluded its revised dose to be 5 mg for CINV.

To be noted here that the anti-emetic use of olanzapine is still off label, an unlicensed drug used for this purpose.

That's all
- Jaskunwar Singh