Hello
Diagnosis of ARF and RHD based on modified Jones' criteria - let's review:
Hello
Diagnosis of ARF and RHD based on modified Jones' criteria - let's review:
Hello
Variations in clinical presentation of rheumatic/ sydenham's chorea -
Hello, cardiowesomites!
Today we are going to learn how to determine pacemaker type from EKG (RV pacing vs biventricular pacing)
LV aneurysms are most commonly caused by myocardial infarction. What's the difference between true aneurysm and pseudoaneurysm?
HVPG = WHVP - Free Hepatic venous pressures
A number of cardiovascular drugs predispose patients to digoxin toxicity, including verapamil, quinidine, and amiodarone. The dosage of digoxin must be reduced if given concomitantly with these drugs. The presumed mechanism underlying this interaction involves the ability of these drugs to inhibit the P-glycoprotein transporter.
Mnemonic: These drugs cause you to go whack! VAQ - Verapamil, Amiodarone, Quinidine
Other drugs to keep in mind are Diltiazem, Spironolactone, Flecainide.
Mnemonic by Huzefa Bhopalwala
References:
Waldorff S, Hansen PB, Egeblad H, Berning J, Buch J, Kjaergård H, Steiness E. Interactions between digoxin and potassium-sparing diuretics. Clin Pharmacol Ther. 1983 Apr;33(4):418-23. doi: 10.1038/clpt.1983.56. PMID: 6831820.
Andrejak M, Hary L, Andrejak MT, Lesbre JP. Diltiazem increases steady state digoxin serum levels in patients with cardiac disease. J Clin Pharmacol. 1987 Dec;27(12):967-70. doi: 10.1002/j.1552-4604.1987.tb05598.x. PMID: 3437068.
Lewis GP, Holtzman JL. Interaction of flecainide with digoxin and propranolol. Am J Cardiol. 1984 Feb 27;53(5):52B-57B. doi: 10.1016/0002-9149(84)90502-2. PMID: 6695818.
Koren, G., MacLeod, S. CHARACTERISTICS OF DIGOXIN INTERACTION WITH QUINIDINE, VERAPAMIL AND AMIODARONE: IN VIVO AND IN VITRO STUDIES. Pediatr Res 18, 154 (1984). https://doi.org/10.1203/00006450-198404001-00367
In the SYNTAX (Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) trial, patients with 3-vessel and left main coronary artery disease (LMCAD) treated with coronary artery bypass graft surgery (CABG) compared with percutaneous coronary intervention (PCI) with first-generation drug-eluting stents (DES) had lower 5-year rates of death, myocardial infarction (MI), stroke, or unplanned revascularization.
Hello believers at other end,
If You have a plan and it is working well for you then no need to read it further.
All the best and Happy studying.
18 days= 14 days(2 weeks) + 4 days( I would never count in last days )
I) 1st week = divide each day in three major slot and 2 minor slots
By the end of 1st week I want to complete major and minor notes 6 minor + 4 major subject + PYQ +MCQ of important topics + review images and volatile stuff.
Seems daunting and impossible !?
Say it to yourself "not daunting for me" Just 7 days and see the progress in the end.
morning hours =
1 hour [ half hour pharma ( General,ANS,CVS,GIT ,RS+HORMONES,NEURO,Antimicrobial) 7 days)
+
other half an hour ( Carb,lipid ,proteins,molecular,vitamins) *5days + last 2days when bio is completed I added PSM formulas for half an hour)
9am-12pm =
PYQ in form of GT on desktop like an exam ( And do it within 1 and half hour superficially) Review wrong ones .( Aim is to go through papers in stipulated time and when you do the same for consecutive 7 days you can analyze a pattern of your mistakes and type of questions being repeated)
12 pm lunch
Afternoon 12:30- 4pm ( further divide into 2 slots )
2 hour fast reading. I complete minor subjects (Ortho,FMT,anesthesia,dermatology,ophthalmology,Ent,psychiatry)
Next 2 hours I divide for major subject (Surgery+med+obsgynae) 2days and 2 hours each. +pedia 1 day only
4-5 I take nap of 15 min and then do volatile stuff
5-6 I go for walk with earphones and revised imp scores criterias oR TEACH A FRIEND ON PHONE
6-8 I practice MCQ as much as possible.(I do mcq of selective topics sometime mixed bags )
8-9 [half an hour micro ( gram positive,gram negative,viro rna,viro dna,mycobacterium+immuno,parasito,lifecycles) +half an hour Patho ( systemwise with images) ]
9-10 long break with dinner + telegram or updating yourself with any new thing or some series (depend on mood)
10-11 Images +graphs+formulas
11- 12 Previous day video at 2X until I fall asleep
By the end of 1 week = (SURG+MED+PEDIA+OBS) +(Ortho,FMT,anesthesia,dermatology,ophthalmology,Ent,psychiatry) +IMAGES +PYQ +WEAK TOPIC MCQ+PHARMA +MICRO+PATHO+BIOCHEM= 15 SUBJECTS with images.
II) 2nd week =Remaining 4 subjects
Morning hours and after 6pm slot is same .
9-12 pm I give mock after 2 days and aim is time management only . Assess wrong only if not much time is left . (I would advise you to give mock rather than GT )
afternoon = 2 hours ( physio,PSM) + 2 hours (Anat) (Radio I followed what Zainab mam has told us to do )
+COVID notes
+Revision revision and revision
III) 4 days(NO GT) = Revise volatile stuff + pyq incorrect ones+images+ mcq (I plan it accordingly whatever I feel right and confident with )
In free time or breaks I take printout of admit card and keep the necessary documents ready 2 day before.
Plan 2 days before what topics you feel can come and you are not confident with and want to go through it once. write it down .It is your gut feeling :D
NOTE- You need not to follow it like what I have said .I respect your journey as much as I respect mine. So do what makes you confident.
In the end, it is just an exam. You will get another chance. Just stay calm.
All the best.
Hello friends! Let's refresh our biochemistry knowledge today.
Hello friends! I hope all of you are doing well. Today I wanted to share with you the many faces of Celiac Disease. Although considered as the disease which chiefly causes gastrointestinal symptoms, the entire spectrum of possible manifestations it can cause is quite broad.
Some significant associations are as follows:
1.) GI- Enteropathy associated T-cell lymphoma (EATL), Microscopic colitis
2.) Liver- NASH
3.) Spleen- Functional Asplenia (SLE & Amyloidosis being other notable causes)
4.) CNS- Seizures with posterior cerebral calcification, Neuro-psychiatric symptoms, Ataxia
5.) Hematology- Evans syndrome
6.) Pulmonary- Diffuse alveolar hemorrhage
Here is the full spectrum. Hope you like it.
-Kirtan Patolia
Hormones are divided into 2 groups
Group 1 hormones- Act via nuclear receptors
Type 1- Have cytoplasmic receptors with effector elements in the nucleus e.g Steroid hormones (cortisol), Gonadal hormones (Androgens, estrogens, progesterones)
Mnenonic- There is only 1 General Secretary
Type 2 -Directly act at the nucleus e,g, vit D,vit A, Thyroxine
Mnemonic-Directly AcT at the nucleus
Group 2 hormones- Act via the cell membrane surface receptors
1. GPCR- Very extensive, will require a second post
2.Tyrosine Kinase- All Growth factors(Except TGF alpha and beta) and Insulin (Tip to remember: TKI or tyrosine kinase inhibitors are used in a lot of malignancies, there's abnormal growth in malignancies and hence TKIs stop that growth, also I in TKI will remind you of insulin, Insulin causes fat to grow!!)
3. JAK-STAT(cytokine receptor) Mr. JAcK is a Drunkard!! all he needs is PEG
Prolactin,
Erythropoietin,
Growth hormone.
(Pro tip: GH and PRL are called as twin hormones, JAK STAT mutations are involved in Myeloproliferative disorders say Polycyathemia and erythropietin is needed there)
4.Serine threonine Pathway: This pathway is a perfect BAIT for the hormones.
Bone morphogenic protein
Activin
Inhibin
Trasformation growth factor alpha and beta
That's all for today!
Have fun and stay safe!
How did you find the post?
Let me know in the comments section below!
Dr. ShilPill
It is chronic disease characterized by fibrosis and sclerosis of various tissues due to infiltration with lymphocytes that secrete IgG4. Manifestations include sclerosing sialadenitis, retroperitoneal fibrosis, autoimmune pancreatitis, Riedel thyroiditis, tubulointerstitial nephritis, and other fibrosclerotic conditions.
That's all!
Thank you.
WHO 1997 classification :
Dengue fever — >2 of the following
●Headache
●Retro-orbital or ocular pain
●Myalgia and/or bone pain
●Arthralgia
●Rash
●Hemorrhagic manifestations (eg, positive tourniquet test, petechiae, purpura/ecchymosis, epistaxis, gum bleeding, blood in emesis, urine, or stool, or vaginal bleeding)
●Leukopenia
Dengue hemorrhagic fever — The cardinal feature of DHF is plasma leakage due to increased vascular permeability as evidenced by hemoconcentration (≥20 percent rise in hematocrit above baseline). In the setting of DHF, the presence of intense abdominal pain, persistent vomiting, and marked restlessness or lethargy, especially coinciding with defervescence, should alert the clinician to possible impending DSS.
According to the guidelines, a DHF diagnosis requires all of the following be present:
●Fever or history of acute fever lasting 2 to 7 days, occasionally biphasic
●Hemorrhagic tendencies evidenced by at least one of the following:
•A positive tourniquet test – The tourniquet test is performed by inflating a blood pressure cuff on the upper arm to a point midway between the systolic and diastolic pressures for 5 minutes. A test is considered positive when 10 or more petechiae per 2.5 cm (1 inch) square are observed. The test may be negative or mildly positive during the phase of profound shock. It usually becomes positive, sometimes strongly positive, if the test is conducted after recovery from shock.
•Petechiae, ecchymoses, or purpura.
•Bleeding from the mucosa, gastrointestinal tract, injection sites, or other locations.
•Hematemesis or melena.
●Thrombocytopenia (100,000 cells per mm3 or less) – In healthy individuals, 4 to 10 platelets per oil-immersion field (100x; the average of the readings from 10 oil-immersion fields is recommended) indicates an adequate platelet count. An average of 3 platelets per oil-immersion field is considered low (ie, 100,000 per mm3).
●Evidence of plasma leakage due to increased vascular permeability manifested by at least one of the following:
•A rise in the hematocrit equal to or greater than 20 percent above average for age, sex, and population.
•A drop in the hematocrit following volume-replacement treatment equal to or greater than 20 percent of baseline.
•Signs of plasma leakage such as pleural effusion, ascites, and hypoproteinemia.
Dengue shock syndrome — DSS consists of DHF with marked plasma leakage that leads to circulatory collapse (shock) as evidenced by narrowing pulse pressure or hypotension.
●Rapid and weak pulse.
●Narrow pulse pressure ( ≤20 mmHg) or manifested by: observed early in the course of shock.
•Hypotension for age – observed later or in patients who experience severe bleeding.
Hypotension is defined to be a
•Cold, clammy skin and restlessness.
WHO 2009 classification —
Dengue without warning signs —>2 of the following
●Nausea/vomiting
●Rash
●Headache, eye pain, muscle ache, or joint pain
●Leukopenia
●Positive tourniquet test
Dengue with warning signs — any of the following
●Abdominal pain or tenderness
●Persistent vomiting
●Clinical fluid accumulation (ascites, pleural effusion)
●Mucosal bleeding
●Lethargy or restlessness
●Hepatomegaly >2 cm
●Increase in hematocrit concurrent with rapid decrease in platelet count
Severe dengue —at least one of the following :
●Severe plasma leakage leading to:
•Shock
•Fluid accumulation with respiratory distress
●Severe bleeding
●Severe organ involvement:
•Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) ≥1000 units/L
•Impaired consciousness
•Organ failure
If I ask an average student about their preferred study strategy the answer most likely would be Highlighting, summarising, and re-reading. Making aesthetically pleasing notes in a myriad of colours may be appealing to many but is passively re-reading already familiar content an effective study strategy?
Two of the most effective study strategies I have come across are active recall and spaced repetition. In this post, I will be talking about the science behind this method. I’ll cover spaced repetition in another post.
Hello everyone!
In today's post I'll try to explain you what Complete Androgen Insensitivity Syndrome (CAIS) is.
Androgens are primarily male hormones required for a normal male development. But also, these androgens are secreted in females by their adrenal glands and have some role in female body development too, e.g Growth of pubic and axillary hair.
Now imagine, a very very beautiful adolescent girl, say around 16 years of age, comes to your clinic with a history of primary amenorrhoea. She has absolutely flawless skin (No acne like other 16yr olds), breast development normally, no pubic and axillary hair and on further examination, some inguinal mass, maybe a hernia.
You ask the radiologist for an USG abdomen and pelvis. Don't be surprised to find testes as the hernia content and no uterus!!
This is a classic case of CAIS.
Karyotype analysis- 46XY
Inheritance- XL recessive, mutation in the AR (Androgen Receptor) gene
Genitalia- Female with blind vaginal pouch
Wolffian duct- Often present
Mullerian Duct- Absent
Gonads- Testes
Hormone Profile- Increased LH and Testosterone (But the receptors have resistance to it's action)
Increased Estradiol, FSH slightly raised.
For more pictographic representation, Watch HOUSE MD S02E13 "Skin deep"
That's it!
Happy Studying
Stay awesome!
Dr. ShilPill
How to write a Personal Statement for
residency
How to begin
Don’t’s
•
This is not the time to show off your creative
writing skills. We are applying for a residency, not a literature graduate
position. Keep it simple and easy to read.
•
Do not use super-long sentences. IMGs have a
tendency of using a lot of ‘and’ and writing 3-4 line long sentences. Keep it
short.
•
Target content that fits into one page. 600-700
words approx. Don’t go over 800, don’t stay under 500.
•
Do not use negative incidents/ bad mouth your
home school or resources.
•
Don’t lie. You will get caught. If you say you
have worked on multiple research projects and if you are unable to answer basic
questions regarding your research, you WON’T be selected.
•
You never know how much importance programs give
to the PS, so always make sure it is a well-written PS.
•
Don’t quote your CV.
•
Don’t use clichés or common quotes.
•
Don’t start every sentence with “I.”
•
Come across as arrogant. This is the place to
showcase your strengths, but in a humble way.
How to
divide paragraphs: 1st paragraph
•
The first and last paragraphs are the most
commonly read parts. Make them interesting and strong. It should be
personalized.
•
Begin strong: Story/Hobby/What got you into
medical school or you can skip that and talk about what got you interested in
your specialty.
•
It should be a story about yourself and how it relates to your specialty, not just a history
of the patient you saw.
DON’T’s
·
“Every patient has a story to tell.”
·
Some major illness in the family/ death
motivated me to become a physician.
·
“I love to travel. Each journey takes us down a
different path. Each journey inspired a new thought. I feel medicine is similar
to traveling. Every patient has his own journey and I want to be there to make
it fruitful for them.” (This is not the right analogy. Travel and medicine have
nothing in common)
·
“I will never forget ___”
·
“I grew up with dermatology in my blood”
DO’s
·
“Growing up in rural ____, I experienced ____.
Here I realized _____. The strict value system of perseverance and dedication
led me to ____.”
·
Start with your hobby.
E.g. Football….team sport….captain of the football team….motivated my team,
resolved conflicts. At the same time I realized, that whenever someone got
hurt, I would assist my coach with first aid. I realized that my inclination
for helping my injured team mates extended beyond the football field. Bridge it
into medical school and how you continued doing the same. Got you interested in
EM/ortho etc.
·
“Medicine is a field in which my love for
pathophysiology and my commitment to serving others can continue to grow. I
have a strong desire to use my problem-solving abilities while helping people
through their most difficult times.” And then give an example justifying these 2
statements.
How to
divide paragraphs: 2nd, 3rd and 4th paragraphs
•
Talk about your strengths in a very SUBTLE way,
citing examples.
•
Talk about your achievements and extra
curriculars, your motivation and end it with what skill-set you derived from
it.
•
Include hobbies. Connect them with medicine and
how it will make you a better resident.
•
Relate how your actions and experiences during
medical school will make you a strong physician.
•
What will you bring to their program?
•
Don’t quote your CV.
•
Show who you are as a person, not just as an
ideal medical student.
•
Talk about your strengths in a very SUBTLE way,
citing examples.
•
Talk about your achievements and extra
curriculars, your motivation and end it with what skill-set you derived from
it.
•
Include hobbies. Connect them with medicine and
how it will make you a better resident.
•
Relate how your actions and experiences during
medical school will make you a strong physician.
•
What will you bring to their program?
•
Don’t quote your CV.
•
Show who you are as a person, not just as an
ideal medical student.
·
I love IM as it is such a broad field with a vast number of diseases.
(Same goes for FM and Peds and all other branches. Avoid such blanket
statements.)
·
I want to be trained to manage patients on my own and do right by them to be one of the best in my field.
(Umm…isn’t this what residency is about. Everyone wants that. What is it that
you are specifically looking for?)
·
Also, avoid “I love” “I want to”
·
“IM combines the wide spectrum of exotic and
the mundane illness, providing a scope of touching maximum lives.”
Do you mean to say FM/EM/ortho/surgery etc. do not provide this?
·
“My mentor taught me more about medicine and how
to approach a patient better than I had learned in all of my classes.”
Do not put your other classes in a negative light.
How to
divide paragraphs: last paragraph
•
Summerise.
•
Tie in all your major attributes.
•
Talk about: What you are looking for in a
program
•
Talk about: Where do you see yourself in a few
years?
•
I will bring to residency energy, enthusiasm,
integrity, and ability. I expect a challenging, rich environment in which to
learn and practice good medicine.
•
I know I have set high goals for myself:
clinician, educator, and health advocate. The majority of the time I find
working with underserved populations extremely rewarding; however, it can also
be emotionally demanding.
•
The combination of working at an individual
level to address health needs and at a more macroscopic level to affect health
policy is synergistic for me.
•
I eagerly await the unique privilege of
participating in such a rewarding and exciting field of patient care.
•
Don’t be too specific regarding fellowship goals
unless you are absolutely sure.
•
If you are sure regarding your fellowship, your
CV should have enough experience to back it up.
•
“Medicine encompasses numerous areas that I have
always found intriguing. Becoming a physician is a lifelong dream that will
fulfill both my personal and career goals.”
What are the goals? State them. What are the intriguing areas? It is a vague
sentence. Avoid fluff.
•
“My career goal is to enter a university-based
anesthesiology program.”
Then community programs (forming a major chunk of interviews for IMGs, will not
call you for an interview. Be diplomatic.
Time
Frame
•
June 2nd half: Start compiling the
ideas and sentences into paragraphs. Check the flow. Keep reading samples to
understand how to write it.
•
July 1st half: Make your 1st
draft. Send it to seniors/attendings/mentors.
•
July 2nd half: Incorporate the
changes suggested by them and make another draft.
•
Aug 1st half: Send it out for
suggestions again.
•
Aug 2nd half: Make a final draft.
Here your ideas, stories, hobbies, major points should be finalized and free-flowing. Now run a final grammar check. Send it to someone with professional
level English for edits and grammar.
•
Sept 1st week: Final draft ready
Take
away
•
Personal Statements might not fetch you
interviews unless it is extra-ordinary. You will get interviews based on your
scores and other aspects of the application.
•
You may lose out on an interview due to a bad PS.
(Incorrect grammar, poorly written)
•
Interviewers love to talk about the hobbies
mentioned in the personal statement, so make sure they are real!!
•
They are looking to know you as a person, so
make sure your PS does not describe 1000s of other medical students as well.
•
Once you land an interview, the PS might play a
role in getting you ranked high. The program wants a candidate that would
‘Match’ their expectations!