Sunday, January 31, 2021

Risk factors of Acute otitis media in child


Why Foot imaging is essential for Diabetic foot ulcer ?

Because osteomyelitis can arise without evidence of soft tissue infection due to neuropathy (diminished pain) and poor peripheral blood flow (diminished erythema, warmth, and purulence).  Therefore, foot imaging (eg, x-ray, MRI) is generally recommended for all diabetic foot ulcers that are:

How to identify Necrotizing surgical site infection ?

Saturday, January 30, 2021

Occupational English Test

OET Experience

Occupational English Test

Hello! Let's look at Occupational English Test and why healthcare people must give it a thought before considering IELTS as your English test. For people who never heard of OET, Occupational English test is designed for healthcare professionals who wish to work in an English speaking country. Simply put, It is kind of IELTS for medical people but very different from IELTS. You'll see why.

OET Speaking

Speaking : (15-20 mins)

Speaking test is conducted on the same day for paper-based test while for the computer-based test it's one day before or after. How is it conducted? Speaking test has two role-plays.

OET Writing

Writing : (45 mins)

Unlike IELTS, in OET, writing test includes letter writing for 45mins. The letter can be a referral, a transfer or a discharge according to the given case notes. But mostly for doctors ,it's a referral letter. Out of the 45 mins first 5 mins are to read the case notes and only after that we are allowed to write the letter.

OET Reading

Reading: (60mins)

Reading test has 3 parts where Part-A is for 15 mins and 45 mins is for Part-B,Part-C combined. All articles are related to healthcare scenarios.

OET Listening

OET Experience

Listening : (45 mins)

Listening test will be for around 45mins and has three parts,each part more difficult than the one before.The extracts are either monologues or conversations and are related to healthcare workplaces.

Algorithm 3 : Community acquired pneumonia management

Friday, January 29, 2021

Auto-brewery Syndrome

 I heard about auto-brewery syndrome today!

It is a condition in which ethanol is produced through endogenous fermentation by fungi or bacteria in the gastrointestinal (GI) tract.

Algorithm 2 : CSF report | Step 2 CK

Wednesday, January 27, 2021

Topiramate mnemonic

How I remember that the anti-epileptic drug (AED) topiramate is associated with kidney stones:
To-pee-ra-mate can cause you "to pee rocks, mate." Rocks = stones, pee = urine.

How I remember that the AED topiramate is associated with mild cognitive impairment:
toPIRAmATE can make you a "pirate" and make you forget "Tom"! (This one is a stretch but can work lol)


Monday, January 25, 2021

Mnemonic for Thanatophoric dysplasia (thanatophoric dwarfism)


A lethal skeletal dysplasia. It is the most common lethal skeletal dysplasia followed by osteogenesis imperfecta type II. 

Mutation of fibroblast growth receptor 3 (FGFR3) gene 

Type 1 : telephone handle like femurs

Type 2 : presence of a cloverleaf skull. Limb shortening milder and bowing is not there. 

Mnemonic : PCR

P = Platyspondyly (flattened vertebral bodies) 

C = Cloverleaf skull

R = Rhizomelic dwarfism , Rib cage is small 

Rhizomelic dwarfism Proximal (i.e. femoral, humeral) limb shortening.

Present as Nonviable fetus do spontaneous vaginal delivery!

Thank you!

Saturday, January 23, 2021

The moderator band of the right ventricle

The moderator band is an intra-cavitary structure in the right ventricle (RV) spanning from the lower limit of the inflow tract of the RV anterior septum to the base of the anterior papillary muscle of the RV free wall.

It carries a fascicle of the right bundle that allows for rapid activation of the RV free wall.

That's all!

Friday, January 22, 2021

Why von Willebrand disease has normal aPTT sometimes ?

VWF acts as a carrier protein for factor VIII.  Factor VIII is more rapidly degraded when unbound, and VWF deficiency can therefore lead to impairment of the intrinsic coagulation pathway leading to a prolonged activated PTT.  

Etiology of Fetal hydrops Mnemonic

Thursday, January 21, 2021

Mnemonic for pregnancy complications with short inter pregnancy interval

Definition : <6-18 months from delivery to next pregnancy

During pregnancy, maternal folate and iron are depleted for fetal development, and the resulting maternal anemia is exacerbated by normal blood loss during delivery (eg, up to 10%-20% of blood volume).  In breastfeeding women, continued nutritional demands from the newborn prevent repletion of normal folate and iron stores, resulting in prolonged anemia!

Wednesday, January 20, 2021

Anti-epileptics in pregnancy mnemonic

 The choice of antiepileptic drugs for women with epilepsy of childbearing age who are planning a pregnancy are

Wednesday, January 13, 2021

Medications that can cause depression

Did you know that the medications we prescribe can be associated with depression?

Beta-blockers and reserpine should also be considered as the cause of depression in those newly started on the medication.

Other such medications include:

Friday, January 8, 2021

Tripod position mnemonic

Hi everyone!

Short mnemonic is here..

“Tripod TONE is forwarding air into the Lungs” 

Sunday, January 3, 2021

Mnemonic for LAB evaluations for SSRI overdose


Short mnemonic!

Isolated SSRI overdose = Asx / mild CNS Depression 

If symptomatic SSRI overdose with altered mental status & abnormal physical findings. 

Then Check for “ECG” 

Mnemonic = ECG! 

 = ECG ( As Citalopram & Escitalopram can cause QT prolongation ) 


C = Coingestants (Ethanol , Benzodiazepines, Acetaminophen )& biCarbonate Levels ( assess for Metabolic acidosis ) 

G = Glucose levels ( rule out hypoglycemia as a cause of altered mental status) 

Mnemonic for Caustic Esophageal injury

Hi everyone! 

Here is a short mnemonic! 

ACidic Substance = Coagulation Necrosis ( Protein denaturation) - 

results in Eschar - prevents further acid penetration & thereby severe injury.

ALakaline Substance = Liquefactive Necrosis (Cell membrane dissolution) - deeper penetration results in more severe injuries. 

1st step = Serial CXR & abdominal x-ray to identify perforation

If no perforation or respiratory distress then Upper GI endoscopy within 24 hours to assess severity for esophageal damage. 

Thank you! 

Saturday, January 2, 2021

The Moderna Vaccine: End of Pandemic?


The Moderna (mRNA-1273) SARS-CoV-2 vaccine is the second vaccine to receive emergency use authorisation (EUA) by the FDA. Like the Pfizer vaccine, it is also a lipid nanoparticle encapsulated mRNA vaccine, and therefore has the same mechanism of action. Please read about the brief mechanism from the Pfizer vaccine article: I will try to avoid big numbers and statistics in this article. 

Both Moderna and Pfizer vaccines start protecting their recipients 10 days after the first dose, with maximum protection two weeks after the second dose. They both have efficacy ranging from 94-95% in protecting against symptomatic Covid-19. However, studies haven't yet evaluated their role in preventing asymptomatic Covid-19, a substantial missing link. 

Can Covid-19 vaccines mitigate the pandemic? 

People picture vaccines as a way back to normalcy, as before the pandemic; unless these mRNA vaccines' role in controlling asymptomatic SARS-CoV-2 infection is studied, normalcy is out of our reach. The other issues concerning the above question are -

1. Since the phase 3 studies of these vaccines are relatively 'young', we don't have sufficient knowledge about the nature and duration of immunological protection. Animal studies have shown that neutralizing antibodies confer protection and CD4 and CD8 T cells also amplify the immunological response. We don't know how long will the neutralizing antibodies last in our plasma after receiving the vaccine. 

2. With both these vaccines, there is an inevitable study flaw. Vaccine recipients faced more systemic adverse events, such as fever, fatigue, headache, myalgia than the placebo group. These symptoms can also occur with Covid-19. Therefore, it is not unlikely that vaccine recipients could have designated their symptoms to the 'shot', and hesitated to refer themselves to be tested for Covid-19.

3. The third issue is quite popular in the daily news. What if the virus mutates and renders itself 'immune' to the vaccine? Some new strains have come up worldwide, and expectedly, the diaspora has started panicking. People need answers quickly while science takes time. So we cannot rule out the possibility that the virus devises a way to escape from the vaccine-induced immunological response. 

4. Vaccine-associated enhanced disease (VAED). Earlier preclinical studies with SARS and MERS have demonstrated that low-level neutralizing antibodies in the plasma can trigger a severe form of the disease. Both the Moderna and Pfizer vaccines are 100% effective in protecting against severe Covid-19, notwithstanding this fact, the regulatory authorities should monitor these and other vaccine candidates for this adverse event. 

5. Anti-Vaxxers! The anti-vaccine sentiment is appalling, and there have been 'anti-vaccine' protests in many parts of the world, including the US, Germany, Poland, and others. There are numerous fake news and misinformation in social media platforms that misguide people and tarnish their perspective about the vaccines. And this phenomenon has even affected the medical professionals. The healthcare authorities have an onerous task to incite confidence in the general public and safeguard them from misinformation. 


The adverse effect profile of both the vaccines is similar, with the most common being local injection-site reactions. Systemic side effects are more common in the vaccine group and comprise mainly of fatigue and headache. Bell's palsy occurred in three (out of 15,210) vaccine recipients within 28 days of administration. This anecdotal risk would be studied in the planned two-year follow-up. 

Being a physician in the Indian subcontinent, there are various reasons to mistrust this vaccine. Both the mRNA vaccines have been studied primarily in the US population (mainly whites), and we don't have any data on its long-term effects. Recently, I have come across various tweets and posts in my social media feed with the headline - " Doctors and nurses are declining the vaccine." I am unaware of these posts' credibility; however, this isn't false in my experience. Well for what it's worth, we haven't seen a whole lot of polio, diphtheria or smallpox recently. 

Thanks for reading!