Wednesday, December 29, 2021

Introducing Cardiowesome

Hi everyone, 

As you already know I have started my Cardiology Fellowship this year. I'm going to post a lot of blogs on cardiovascular diseases that might of not be palatable for medical students. Only some of these posts maybe helpful (pharmacology related, EKG ones, and basic pathophysiology of cardiovascular diseases). 

I understand that the majority of my posts will be limited to a specialized group of cardiologists, echocardiographers, emergency medicine physicians, critical care professionals, POCUS users, electrophysiologists, heart failure specialists, and interventional cardiologists.

This is why, I'm introducing a new label on the medicowesome blog called cardiowesome. These are advanced posts targeted for cardiology fellows and trainees.

I hope you enjoy reading them and learning with me. 

-IkaN (Nakeya Dewaswala Bhopalwala) 

S' Tissue Doppler Imaging - Derived Tricuspid Lateral Annular Systolic Velocity mnemonic


S’ Wave: Tissue doppler imaging-Derived Tricuspid Lateral Annular Systolic Velocity

S’ value less than 9.5 cm/sec indicating RV dysfunction. Mnemonic... If you stare at the number long enough you'll see 9.5 in it lol. 

The first peak above baseline that is timed with the QRS represents isovolumetric contraction and not the tricuspid annular velocity.

-IkaN (Nakeya Dewaswala Bhopalwala) 

Relative wall thickness 0.42 mnemonic

The RWT reports the relationship between the wall thickness and cavity size. It is an index of LV concentricity. 

The golden number to remember for RWT is 0.42 as it allows further classification of LV mass increase as either concentric hypertrophy (RWT >0.42) or eccentric hypertrophy (RWT ≤0.42). 

Since there are so many numbers to remember in echocardiography, I made a mnemonic for RWT. 

Relative = 0 (Relative zero)
Wall = 4 (4 letters in the word wall)
Thickness = 2 (2 strokes in the letter T) 

Hope this helps! 

-IkaN (Nakeya Dewaswala Bhopalwala) 

Tuesday, December 28, 2021

Monday, December 27, 2021

Relative wall thickness on echocardiography

Relative wall thickness (RWT) is calculated as two times posterior wall thickness (PWT) divided by the left ventricular internal diastolic diameter (LVIDd). 

RWT allows further classification of LV mass increase as either concentric hypertrophy (RWT >0.42) or eccentric hypertrophy (RWT ≤0.42).

-IkaN (Nakeya Dewaswala Bhopalwala) 

Infective endocarditis vegetations - which side do they develop?

Infective endocarditis vegetations tend to develop on the upstream side of the valve (flow side) which is typically tend to be the lower pressure side. These are the ventricular side of the aortic valve and the atrial side of the mitral or tricuspid valve. 


Image shows parasternal long axis view on echocardiography showing vegetations on the mitral and aortic valve (green vegetations because vegetables are green lol!)

-IkaN 

Sunday, December 26, 2021

COVID - OMICRON

Hello friends!

This post is about omicron variant of COVID.
Why do we have to know about any new variants?
✓ more infectious than previous one?
✓ if it's more virulent?
✓ any diagnostic difficulties?
✓ treatment failure?
✓ does previous vaccine work for it?

Basically this OMICRON has more than 30 different mutations on surface of S1 or S2 spike protein with lineage number B.1.1.529 variant of concern (voc).

Preliminary data shows that it is highly infectious but the data is limited. We need to wait for further studies.

Most of the vaccines are targeting 'S' spike protein so antibodies are produced against 'S' spike. Risk of vaccine failure due to 'S' spike mutation is still a point of concern but data is limited now.

Diagnostics- most of the other targets (including N and RdRp genes) remain unaffected. These RTPCR tests detect atleast 2 different SARS-CoV-2 targets, which serves as a backup in case mutation arises. Current PCR tests can detect this variant. 'S' gene target failure can occur if not detected.

Severity of disease - more in immunocompromised and extremes of age groups.

Effectiveness of vaccines - Antibodies decrease severity and death .

Reinfection is higher with omicron.

Treatment - steroids and IL-6 receptor blockers are still effective.

So, be cautious but don't panic! 

That's all!
Dr.Madhuri 




Tuesday, December 21, 2021

EVALUATION OF THYROID FUNCTION

1-Plasma TSH is the first investigation of choice  in a patient with suspected thyroid diease.
This may be mildly elevated in mild or subclinical hypothyroidism
TSH levels may be suppressed  in hyperthyroidism.
The anterior pituitary is very sensitive to minor changes in thyroid hormone levels which is why TSH is usually considered to be the most reliable investigation of thyroid function. 


2- Plasma free T4- confirms the diagnosis and assesses the severity of hyperthyroidism.  It is also used to diagnose secondary hypothyroidism. 



Both TSH and free T3 and T4 levels should be considered as it may be misleading in patients suffering from any pituitary disease. 

Eg: TSH may be normal or low in secondary hypothyroidism 
Raised T4 and T3 levels may be seen in initial stage of levothyroxine therapy. 

Other investigations may include measurement of antibodies against TSH receptors or other Thyroid antigens 
For instance: Antibodies to TPO, Thyroglobulin, TSH Receptor.

Some drugs may affect TFTs. For example: amiodarone may cause a decrease in free T4 and elevation of TSH. Amiodarone may also cause a decrease in TSH  causing hyperthyroidism in certain patients.



-Rudrani

Saturday, December 18, 2021

Mitral valve anatomy and types of mitral regurgitation mnemonic


Mnemonic:
Prolapse tip points towards LV
Flail tip flips away from LV
Secondary stay away from each other (dilation) 

Friday, December 17, 2021

Job's syndrome

Job's syndrome is also known as hyper- IgE syndrome.
It has autosomal dominant inheritance ( STAT3 gene).

Here is the mnemonic to remember its key features :
A - Abscesses of face and lungs by staphylococcus aureus ( pneumatocele)
B - Bone fragility
C - Coarse facies
D - Dermatological features like eczema.
E - Eosinophilia, increased Ig E.

Trick to remember important points: 
"Steve Jobs is a dominant person, interested in business STATs"

That's all!
Dr. Madhuri.


Tuesday, December 14, 2021

Metoprolol tartrate vs succinate dosing mnemonic

Metoprolol tartrate is short acting. 

Metoprolol succinate is long acting. 

Mnemonic succinate single dose, tartrate two doses.

-IkaN (Nakeya Dewaswala Bhopalwala) 

Wednesday, November 17, 2021

Wednesday, November 10, 2021

Treatment of myocardial infarction associated pericarditis


Hi everyone! There are two types of myocardial infarction associated with pericarditis. Let
s learn more about the management!

Early infarct-associated pericarditis: Occurs 1 to 3 days after transmural myocardial infarction (because of the interaction of the healing necrotic epicardium with the overlying pericardium). 
Late post-myocardial infarction pericarditis (Dressler’s syndrome): Occurs weeks to months after myocardial infarction. 

Initial therapy includes high-dose aspirin (650 to 1,000 mg every 6 to 8 hours).
Proton pump inhibitor (PPI)  - improves the gastric tolerability of the aspirin. 
Acetominophen can be added for pain management.

Dosing of aspirin:
Initial: 650 mg to 1 g every 8 hours until resolution of symptoms for at least 24 hours and normalization of inflammatory biomarkers (eg, C-reactive protein). A treatment period of one to two weeks before tapering is usually sufficient. 
Taper: Decrease each dose by 250 to 500 mg every 1 to 2 weeks. Ensure patient remains asymptomatic and inflammatory biomarkers are normal. 

There is no published experience on the use of colchicine in peri-infarction pericarditis. Colchicine may reduce the need for pericardiocentesis or other pericardial interventions and is usually given at a dose of 0.6 mg twice daily for a month, or longer if the patient has a recurrence of symptoms.

Why are NSAIDs such as ibuprofen avoided in the peri-infarct period?
Interferes with the antiplatelet aggregation effects of aspirin. 
Interferes with myocardial healing.
PS: Acetominophen does not affect the coagulation system and can be used.

References:

-IkaN (Nakeya Dewaswala)

Monday, November 1, 2021

Normal P wave ECG notes and mnemonic

Here is the video:

 

Mnemonic:

Notes:
Sinus P waves
Axis: 0 and +75 degrees
Upright: Leads I, II, V5, V6
Inverted: aVR
Duration: <120ms or 3 small squares
Amplitude:
Limb leads: < 2.5 mm (0.25mV)
Precordial leads: < 1.5 mm (0.15mV)

-IkaN

Determining pacemaker type from EKG (RV pacing vs biventricular pacing)

 Hello, cardiowesomites!

Today we are going to learn how to determine pacemaker type from EKG (RV pacing vs biventricular pacing)


Notes:

Thursday, October 21, 2021

LV aneurysm: Difference between true LV aneurysm and LV pseudoaneurysm

LV aneurysms are most commonly caused by myocardial infarction. What's the difference between true aneurysm and pseudoaneurysm?

Thursday, October 14, 2021

Types of pulmonary hypertension mnemonic

Here are my notes and a video on types of pulmonary hypertension - WHO classification! It comes with a mnemonic :)

Monday, September 27, 2021

HVPG = Hepatic Venous Pressure Gradient

 HVPG = WHVP - Free Hepatic venous pressures 

  • WHVP = Wedged hepatic venous pressure
  • gradient between pressures in the portal vein and the intra-abdominal portion of IVC 
  • When blood flow in a hepatic vein is stopped by a wedged catheter, the proximal static column of blood transmits the pressure from the preceding communicated vascular territory (hepatic sinusoids) to the catheter. Thus, WHVP reflects hepatic sinusoidal pressure.
  • In the normal liver, due to pressure equilibration through interconnected sinusoids, wedged pressure is slightly lower than portal pressure, though this difference is clinically insignificant.

➡️ While in Cirrhosis , Sinusoidal interconnection are lost. Therefore, WHVP gives an accurate estimation of portal pressure in cirrhosis !!!


Normal HVPG = 1-5 mm hg 

HVPG >5 = Portal HTN 

HVPG > 10 = Clinically Significant portal HTN 

HVPG > 12 = Threshold for Variceal Rupture = So use Beta Blocker to ⬇️ it.

Measurement of the Hepatic Venous Pressure Gradient (HVPG)


Thank you ! 🩺




Saturday, September 25, 2021

Cardiovascular drugs that can cause digoxin toxicity

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

Saturday, September 18, 2021

SYNTAX score mnemonic

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.

Tuesday, August 24, 2021

Glimpse into my plan for "Last 18 Days to NEET PG"

 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.


Thursday, July 22, 2021

Babeosis mnemonic


This is how I remember babeosis is associated with Maltese cross appearance.

You know you love me, xoxo, gossip girl!

-IkaN 

Friday, June 25, 2021

Lesch Nyhan syndrome - Mechanisms (Revised post)

 Hello friends! Let's refresh our biochemistry knowledge today.


Lesch-Nyhan syndrome is characterized by choreoathetosis, dystonia, hyperuricemia, gout, self mutilatory behavior especially self-biting of fingers, and intellectual disability due to HGPRTase mutations.

So how do HGPRTase mutations actually cause dystonia and other extrapyramidal signs and symptoms?

1.)  For the synthesis of dopamine, tetrahydrobiopterin as a cofactor for tyrosine hydroxylase is required.
Tetrahydrobiopterin itself is derived by a series of reactions in which GTP cyclohydrolase is a rate-limiting enzyme.
Now HGPRTase deficiency causes depletion of GTP thereby ultimately depleting tetrahydrobiopterin.

In fact, GTP cyclohydrolase mutations are known to cause dopa-responsive dystonia and phenotype similar to Lesch-Nyhan syndrome.

2.)  Secondly, dopamine receptors are linked to G-protein coupled receptors which alternate between GTP-GDP bound states, yet another link between GTP depletion and perturbation of dopamine signaling.

3.) Adenosine deficiency due to the reduction in salvage may adversely affect the role of adenosine as a neuroprotective agent.

Lastly, in Lesch Nyhan syndrome no characteristic imaging abnormalities are seen but reduced dendritic arborizations in the caudate nucleus, putamen, and nucleus accumbens are thought to underlie clinical manifestations.

So to summarise, Lesch Nyhan syndrome can be considered as one of the basal ganglia disorders with Wilson's disease and Huntington's disease being the other notable ones.

Have a great day!



-Kirtan Patolia

Celiac Disease (Spectrum of Manifestations)

 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


Friday, June 11, 2021

Hormone Basics - Part 1

 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

Osler's triad mnemonic

 


Thank you!

Wednesday, June 9, 2021

Reactive arthritis mnemonic

 

Thank you!

Dizziness & Vertigo | Harrison’s IM



IgG4-related systemic disease mnemonic

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. 

Sunday, June 6, 2021

Dengue classification

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 

  • SBP 80 mmHg  for those < 5 years of age 
  • SBP 90 mmHg  for those equal to or > 5 years of age.

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

  1. Sudden high-grade fever (≥38.5°C) Children have high fever but are generally less symptomatic than adults during the febrile phase. The febrile phase lasts for three to seven days, after which most patients recover without complications. 
  2. What is Biphasic fever ("saddleback") ?  - 1st febrile phase remits & recurs approx 1 to 2 days later & this 2nd febrile phase lasts 1 to 2 days.
  3. Serum aspartate transaminase (AST) levels are frequently elevated; the elevations are usually modest (2 to 5 times the upper limit of normal values), but marked elevations (5 to 15 times the upper limit of normal) occasionally occur.
  4. Between days 3 and 7 of the illness, you must watch for signs of vascular leakage. Corresponding clinical manifestations may include persistent vomiting, increasingly severe abdominal pain, tender hepatomegaly, development of pleural effusions and/or ascites, mucosal bleeding, and lethargy or restlessness; laboratory findings may include a high or increasing hematocrit level (≥20 percent from baseline) concurrent with a rapid decrease in the platelet count
  5. The vast majority of DENV infections that progress to a critical phase result from secondary infections more than 18 months after the first infection.The critical phase lasts for 24 to 48 hours.
Thank you! 🫀🩺


Wednesday, June 2, 2021

Study smarter not harder- Active recall, the foolproof method to ace any test

 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.

Complete Androgen Insensitivity- A perfect female

 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

Tuesday, June 1, 2021

How to write a Personal Statement for Residency

 

How to write a Personal Statement for residency


How to begin

  1. Daily start writing down ideas in Evernote/any app which lets you take notes
  2. Think of a strong patient interaction/personal story where you helped the patient and which also shows your medicine-related skills/knowledge/work ethic. Make it about yourself, what you did, and how it helped you. Do not write the entire history of the patient.
  3. Either with the same story as above or explain the reason/reasons why you are interested in that particular field.
  4. Make a list of your hobbies/ non-medical experiences and find a common connection between that skill set, which can actually help you during residency.
  5. Read loads of sample personal statements from google!!!
  6. Do not copy them (plagiarism is HARMFUL). 
  7. Once you are done, send your draft to mentors/English professors/seniors etc.
  8. Make sure there are absolutely no grammatical errors. (English being a 2nd language is not an excuse for poor grammar).

 

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.

 DO’s

        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.

 DON’T’s

·        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?

 DO’s

        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’s

        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 1st half: Begin jotting down ideas and writing sentences. Focus on ideas. Don’t worry about sounding smart/grammar right now.

        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!