Topics to read before PG entrance exams!

Hello Awesomites!

The aim is to help the students who want to give upcoming NEET PG Exam and are clueless about how to plan and prepare ?
I know my friend struggling day in and out for life in Covid wards. Exams doesn't matter now.
When they will have time in hand I want to help them out with plan beforehand. They are already brilliant enough to have been through all the challenges. :)

I know you can't predict what is important for this or next exams. Atleast with time in hand you can glance through some topics that contribute 70% of any exam. I am sharing the list 1st year subject I made during my preparation.

1.ANATOMY

• Embryology 

1. Pharyngeal arches
2. Neural crest derivatives
3. Oogenesis and spermatogenesis
4. Notochord and remnants 
5. Extraembryonic mesoderm
6. Diaphragm 
7. Cardiovascular system ( Abnormal subclavian artery)
8. Urogenital system 

• Histology 

1. Cerebellum
2. Osteoblasts
3. Urinary bladder epithelium
4. Cell junctions
5. Collagen types
6. cartilage
7. Tonsil,Lymph nodes, spleen,thymus
8. Stomach glands
9. Skin with sebaceous glands
10. Connective tissue types
11. Retina 
12. Salivary gland

• NEUROLOGY

1. Fornix 
2. Corpus callosum
3. Cranial nerves and its lesion
4. Brainstem syndromes (lateral medullary )
5. Foramen of skull
6. Facial nerve and trigeminal nerve
7. blood brain barrier
8. Functional area and functional columns
9. Parasympathetic ganglion 
10. Phrenic nerve and vagus

• GROSS

1.  Compartments of lower limb with nerve and blood supply
2. Blood supply of thyroid,oesophagus,ureter,Anal canal 
3. Waldeyer ring
4. External carotid artery
5. Circle of willis
6. Muscle of eye
7. Brachial plexus (Sensory and motor supply of upper limb)
8. Perineum
9. Cruciate ligaments
10. Vocal cords
11. Mediastinum
12. IVC tributaries
13. Cavernous sinus and superior orbital fissure 
14. Splanchanic plexus

2. BIOCHEMISTRY

• Inborn error of metabolism (Types,Enzyme deficient,hallmark feature,Investigation of choice and treatment)
• Rate limiting step 
• Carbohydrate metabolism (Glycolysis,Glycogen storage disease,Glucogenesis,glycogenolysis,PFK-1)
• Lipid metabolism ( Hyperlipoproteinemia and hypolipoproteinemia)
• Vitamin (Coenzyme)
• Electron transport chain inhibitor
• Heme metabolism and Porphyria
• Ketone body formation 
• Urea cycle disorder
• Competitive, non competitive and allosteric inhibitors
• Mitochondrial disorders 
• Amino acid disorder
• Lead poisoning
• Translation process 

3.PHYSIOLOGY

• Receptors
• Neurotransmitter and functions
• Second messenger
• Reflexes
• Baroreceptors and chemorecptors
• JVP 
• ECG And EEG
• Spirometry
• RAAS 
• Counter current exchanger and multiplier
• Factors affecting compliance of lung 
• Action potential
• Smooth muscle and cardiac muscle
• Channels and types 
• GIT hormones 
• Tracts and lesions(brown sequerd syndrome)
• LH,FSH,GH and insulin glucagon

 Following are the list of 2nd year topics.

1.FORENSIC MEDICINE

• Ballistics (Bullet ranges)
• Identification (female male, blood sample)
• Recent amendments in acts (POCSO act, MTP Act)
• Application of IPC,CrPC sections
• Postmortem changes
• Dentition And Xray of wrist elbow and pelvis to determine age
• Injuries -fracture of skull, RTA, Bruise
• Toxicology- Plant based image, Preservation of viscera, Snakes,Arsenic, OP poisoning,Mercury,cadmium,Cardiac poison
• Consent
• Grievous hurt and murder vs culpable homicide
• Seminal stains
• Dowry death and Rape
• Battered baby syndrome
• Plant Toxicology (castor,abrus,strychnine,Dhatura,Aconite,Oleander,Calotropis,Opium,Cannabis)

2. PATHOLOGY-

• Breast cancer, Lung cancer and Ovarian and testicular cancer
• CD markers
• Hemolytic anemia
• Vasculitis
• Endocarditis And MI
• Types of hypersensitivity reaction
• Platelet and coagulation disorder(ITP,TTP,hemophilias,vWD)
• Stains And vacutainers
• Transfusion reaction 
• Graft rejction
• Crohns vs Ulcerative colitis
• Necrosis, apoptosis and its variant
• Mode of inheritance
• Leukemia and lymphoma prognostic markers
• Renal histology and gross
• Liver histology and gross
• CNS tumors 

3.PHARMACOLOGY

• Antimicrobial Drug of choice and mechanism of action 
• Classification - aminoglycoside , MRSA And drugs for cystic fibrosis
• Hypolipidemic Agents 
• Asthma ( New drugs and guidelines)
• Arthritis (RA and gout)
• General pharmacology ( Pharmacokinetics,clinical trial,Pharmacodynamics)
• Concentration dependent kinetics and time dependent kinetics and post antibiotic effect
• Anti TB drugs
• Anti viral and anti HIV (anti hep B and C)
• Anti fungal
• CVS- MI ,HF, angina managment
• Endocrine- DM,Osteoporosis,SERM,SERD,Gnrh agonist
• GIT-Constipation (opioid induced,IBS related) ,Diarrhea,peptic ulcer
• CNS-Anti epileptic, Sedative,lithium toxicity,neurodegenerative disorder, side effect 
• ANS- Emergency medicines,anaphylaxis, receptors ,poisoning 
• Chemotherapy-Anticancer,monoclonal antibody,small molecules,kinase inhibitors
• Prostaglandins 
• Insulin 

4.MICROBIOLOGY-

• Sterilisation and disinfection (Indicator)
• Immunology (Antibody,complement deficiency,Primary immunodeficiency)
• Latest outbreaks (Zika,Congohemorrhagic fever,Ebola,Corona)
• Sexually transmitted infections
• Vectors
• Parasitology -Eggs
• Congenital infections-Toxoplasmosis,congenital syphillis,rubella,herpes,varicella
• HPV infection,HHV-8
• Bioterrorism
• Larva migrans,larva currens (cutaneous and visceral)
• CD4 counts and Opportunistic infection
•  HIV and TB
• Food poisoning
• Atypical bacteria treatment and infection 
• Dimorphic fungi
• Actinomycosis,Botryomycosis and eumycetoma
• Meningitis
• Exanthematous disease
• Neisseria,diphtheria,Listeria,bacillus anthrax,legionella,campylobacter jejuni
• Bacterial virulence factors,growth factors
• Rickettsial disease, spirochetes(weils ds) 
• Drug resistance mechanism

Following is the list of 3rd year topics.

1.COMMUNITY MEDICINE-

• Surveillance programs
• Sensitivity, specificity,PPV and NPV (Screening of disease)
• Types of studies 
• Odds ratio and relative risk ratio
• Bias
• Sampling 
• Biostatistics- central tendency  (Box and whisker plot )
•  Level of prevention 
• Vaccine and types (Toxoid and live attenuated)
• Demography and family planning
• Biomedical waste
• Health programmes ( RNTCP, HIV)
• Communication
• Nutrition and related programmes
• Disaster
• Null hypothesis,P value and alpha value
• Confidence limit 

2.OPHTHALMOLOGY-

•  Refractive errors (Astigmatism)
• Surgery and post op complication(Glaucoma,cataract,squint)
• Conjuctivitis
• Corneal ulcer (Bacterial,fungal and herpetic) (Stains)
• ROP and systemic retinopathy (Hypertensive and diabetic retinopathy)
• Retinitis pigmentosa and syndromes
• Retinal detachment and cause
• Retinoblastoma
•  Strabismus
• Optic neuritis
• Visual field defect 
• Blow out fracture and trauma to eye
• Glaucoma and drugs(Contraindication and indication)
• Managment of ptosis
• Light reflex and accomodation reflex and pupil
• 3,4,6 Cranial nerve
•  OCT ,Fluorescein angiograhy,tonometers,charts,
• Sudden loss of vision and gradual loss of vision differentials

3. ENT-

• Appearance of tympanic membrane in various disease
• Surgery (Tonsillectomy,Adenoidectomy,Mastoidectomy)
• Paranasal sinus
• CSF rhinorrhea
• Laryngeal disease (Papilloma,vocal cord paralysis, laryngeal muscles action, laryngeal cancers)
• Tracheostomy
• Abscess 
• Nasopharyngeal carcinoma
• Juvenile angiofibroma
• Test of hearing and vertigo
• Otosclerosis
• Cochlear implants
• Oral cavity cancers 
• cervical Lymph node  and neck dissections

 Following is the list of Final year topics.

 1.OBSTETRIC AND GYNECOLOGY-

• Pre-eclampsia (Definitions)
• HELLP
• PPH (prophylaxis and treatment)
• Perineal tear (Types and managment)
• Diabetes and anomalies scan 
• Shoulder dystocia maneuvers
• Molar pregnancy (High risk and low risk for GTN)
• Ectopic (Diagnosis, Investigation and managment)
• Abortions 
• Recurrent pregnancy loss (Investigations and causes)
• Cervical incompetence
• MTP
• Diagnosis and physiological changes of pregnancy 
•  Abruptio vs placenta previa vs Vasa previa
• Heart disease
• MgSO4 and drug
• Fetal monitoring -NST,BPP,doppler
• Twins and complications
• Labor-stages,partogram
• Placenta types and associated pathology
• Rh incompatibility
• Amenorrhea (primary and secondary)
• Mullerian anomalies (Class)
• Asherman, AIS,Gonadectomy indication
• Puberty and precocious puberty
• Menopause (Hormone replacement therapy guidelines) 
• Postmenopausal bleeding and premature ovarian failure (Levels of FSH)
• Semen analysis (Evaluation and IUI and TESE)
• PCOS -Diagnosis,drugs
• Endometriosis
• Cervical,vulval,ovarian,endometrial cancer,Fibroid
• Krukenberg
• PID
• Prolapse 
• Emergency contaceptives
• IUD
• Absolute contraindications in whole subject
• Female sterilisation  

2.PEDIATRICS-

• Developmental milestones
• Neonatal reflexes
• Neonatal resuscitation
• Jaudice,sepsis,Hyaline membrane disease
• Congenital infections-TORCH
• Vaccines(IAP and NIS)
• Diarrhea,pneumonia,dehydration managment
• Pediatric epilepsy
• Febrile seizure (Risk factors,recurrent risk,prohylaxis)
• Severe acute malnutrition
• Rickets
• meningitis
• Neuro-Cerebral palsy and neurocutaneous syndrome
• Pediatric vasculitis-HSP and Kawasaki Disease
•  Nephrotic syndrome
• Congenital heart disease( VSD,TOF,TGA and ductus dependent CHD)
• Trisomies
• Hypoxic Ischemic encephalopathy VS Periventricular leukomalacia
• Fluid managment including shock managment in children
• Childhood pneumonia, Epiglottitis, Acute laryngotracheobronchitis
• Microcephaly and macrocephaly 
• Hydrocephalus and Neural tube defect  
• Fetal alcohol syndrome,warfarin syndrome

3. ANESTHESIA-

• IV anesthetic agents (Propofol)
• Day care surgery (Drug of choice)
• Venous air embolism
• Local anesthetic (Remember concentration also)
• Vaporisers color 
• Inhalational agents 
• Monitoring (Capnography)
• Color coding of cylinder
• Circuits
• Mallampati and ASA grading
• Premedication duration of stoppage and continuation
• Muscle relaxant
• Airway devices
• Endotracheal tube (formula)
• Epidural vs spinal anesthesia (Level of blocks)
• Modes of ventilation

 4.DERMATOLOGY-

•  Pigmentation Diseases 

1. Hyperpigmentation
2. Nevus (Nevus of ota/mongolian spot/CMN/AMN)
3. Melasma
4. Acanthosis nigricans
5. Becker nevus
6. Hypopigmentation -PKDL/Pityriasis versicolor/alba/Hansens
7. Depigmentation-Vitiligo/Contact leukoderma

• Signs (Auspitz,nikolsky,bulla spread sign)
• Histopathology of psoriasis and lichen planus
• Mast cell disorder-Urticaria pigmentosa image
• Papulosquamous disease - Psoriasis ,lichen planus
• Treatment of Psoriasis
• STD (Syphillis,chancroid,donovanosis,Herpes genitalis,syndromic approach)
• Microbiology of STD organism( Dark ground,school of fish,Tzanck smear,Donovan body,Gonococcus)
• Drug Reaction -Fixed drug eruption, erythema multiforme,SJS/TEN
•  Blistering disease 

1. Pemphigus(clinical treatment)
2. Bullos pemphigoid
3. dermatitis herpetiformis
4. Histopathology of blister level and Direct immunofluorescence image

• Infections

1. Fungal (Tinea /pityriasis versicolor)
2. Hansens 
3. TB
4. Viral (HPV/HHV/Molluscum contagiosum)

• Hair disease-Alopecia images,DLE,trichotillomania
• Acne,Rosacea
• cutaneous markers of internal malignancy

5.RADIOLOGY-

• Emergency radiology-RTA,splenic injury,FAST,Perforation
• Radiological anatomy especially applied aspect
• CNS tumor
• Bone tumor
• BIRADS
• TIRADS
• Radiation physics and acute radiation syndrome
• Radiotherapy basics
• Contrast in various studies
• USG and doppler
• Doppler waveforms

6.ORTHOPEDICS-

• Knee joint (Everything)
• Shoulder dislocation
• Bone (Oncology+radiological picture)
• Pediatric Hip(Rdaiology +managment)
• Infections(TB,Osteomyelitis)
• CTEV
• AVN
• Tennis elbow and dequeverian
• Eponyms and test
• Blood supply of femur
• Pseudoarthrosis
• Genu varum/valgus,cubitus varus/valgus
• malunion 
• Instruments

7.SURGERY-

• Glasgow coma scale (Changes)
• Burn
• Cannula color coding 
• Triage
• Trauma
• Incisions,suture,foleys,NG tube,Knots,Scores
• Latest updates in breast cancer,thyroid and hepatobiliary cancers,Pancreatic cancer,stomach,colorectal cancer
• Bed sores staging 
•  Renal stones managment
• Gall stone managment and surgical complication
• Bariatric surgery
• Acute pancreatitis managment 
• Upper GI and lower GI bleed management and causes
• Aortic aneurysm
• Meckel diverticulum
• Wound classification
• Cancer-(Breast,rectum,stomach,oesophagus,HCC,prostate,thyroid)
• Cancer follow up duration 
• Carcinoid and GIST and gastrinoma

 8.MEDICINE-

•  ECG visuals
• Cardiac emergencies-Arrest,Unstable angina,MI,Arrhythmia,Dissection
• Respiratory emergency-Pulmonary embolism,pneumothorax,Asthma 
• Stroke
• Meningitis (Bacterial,viral,aseptic)
• Approach to patient in Coma
• Seizure
• Electrolyte imbalance
• ABG
• Hypertension and its emergency and management
• Murmurs and valvular lesions
• Pericardial d/o
• hepatitis(Viral,autoimmune)
• Non alcoholic and alcoholic liver disease
• Glomerular disease
• UTI
• CKD
• DM (management of different complications)
• Neurodegenerative d/o ,neuropathy,myopathy
• Septic shock guidelines
• GBS
• Poisoning 
• New asthma guidelines
• RTA and Inherited channelopathies
• MEN syndrome
• SIADH, DI,Pheochromocytoma
• AIDS defining illness
• Connective tissue disorder
• Infective endocarditis and rheumatic heart disease
• Prakinson and alzheimers
• IBS,UC ,Crohns
• Cardiomyopathy
• Jones and dukes criteria
• dyslipidemia management 

10.PSYCHIATRY-

• General psychiatry (terms and its meaning )
• MMSE
• Psychotic disorders

1. Schizophrenia
2. Delusional d/o- Named syndromes (Capgras,Fregoli,Othello,Ekbom)

• Mood disorder (Treatment is very important)

1. Mania
2. Depression
3. Bipolar

• Neurotic disorder 

1. Anxiety disorder
2. OCD related disorder
3. Dissociative disorder
4. Trauma and stress related disorder
5. Somatoform disorder

• Substance abuse and deaddiction
• Organic mental disorder(dementia)
• Sleep disorder
• Eating disorder
• Sexual disorder
• Personality types and disorder
• Drugs (SSRI and its sideeffect)
• Psychotherapy types and choice
• Defence mechanism  

You can edit this according to you. 

Hope it will help.

-Upasana Y.

Treating Alcohol withdrawal - scheduled vs PRN benzodiazepines

Hello,

Sometimes it's frustrating to see different physicians use different approaches to management of the same condition or disease. How do you practice in that case?

You look at the evidence, the guidelines and make your own decision based on it.

Then even though if your attending practices something opposite of what the guidelines say, you know what is right and what you will practice in the future :)

Anyway, now that I am done venting - what do guidelines say about scheduled vs as needed benzodiazepines for alcohol withdrawal?

Atropine poisoning

Atropine poisoning is also called as Anti-muscarinic poisoning.

It is caused due to ingestion of :-
1) Datura plant
2) ‎Atropa belladona
3) Hyoscyamus
4) ‎Anti-histamine drugs
5) Anti-psychotic drugs
6) ‎Anti-depressants like TCA
7) ‎Anti-Parkinsonism

Clinical features:

Let's go from head to toe!

1) Brain:
Atropine causes following symptoms
-Hallucinations
-‎Confusion
-‎Delirium

Also called as Mad as hatters!

Remember: Atropine drives you crazy!

2) Eyes:
AcH causes constriction of pupils. No or less AcH causes Mydriasis

Fun fact 1: In ancient times, women used to apply Atropa belladona in eye for attracting men by dilating pupil.

Fun fact 2: Most of the dinner dates are candle night dinner, why? To dilate pupils and look attractive.
Also described as "Blind as a bat"

Remember: Atropine makes you look seductive!

3) Eyes and Mouth:-
AcH is responsible for secretion of saliva and tears.
Lack of AcH action causes - Dry mouth and Dry eyes.

Also described as "Dry as a bone"
Most common feature in Adults.

Remember: Atropine Dries you!

4) Face:
AcH causes constriction of blood vessels. Atropine blocks this action and hence causes dilation of the blood vessel. Hence this causes flushing of face.

Also described as - Red as a beet.

Remember: Atropine makes you blush!

5) Body temperature:
AcH is responsible for secretion of the glands. Lack of secretion causes decrease or no cooling effect. Hence it causes-Hyperthermia.

Also described as - Hot as a hare
Most common feature in children.

Remember: Atropine makes you hot!

Most common cause of death is Respiratory paralysis.
Next common is Shock.

I remember all this feature with the help of story:

I went on a candle night dinner with hot girl. Ofcourse, she was blushing because I'm crazy to have dry resins after dinner! (Okay that's lame and I know!)

Key points:-

Candle night dinner - Mydriasis
Hot-Hyperthermia
Blushing-Flushing of face
Crazy-Deliruim, Hallucination and confusion
Dry resins-Dry secretion

Treatment:
1) Supportive treatment:

Gastric lavage using Tannic acid : To remove unabsorbed poison. Avoid potassium permagnate.

Forced acidic diuresis: Because Atropine is an alkaline drug

Seizures are treated by Diazepam

Patient is kept in dark quiet room-To avoid hallucination.

Ice bags given to treat maintain temperature.

2) Antidote: Physostigmine since it crosses BBB.

That's it
-Demotional bloke.

Calcium monitoring in ethylene glycol poisoning

Seizures often occurs in ethylene glycol poisoning.  It has multifaceted pathophysiology but one of the major cause is hypocalcemia.

Hypocalcemia occurs in ethylene glycol poisoning because ethylene glycol is metabolized to oxalate, which forms calcium oxalate depleting calcium from ECF.

Also, correcting associated metabolic acidosis by bicarbonate supplementation can further cause hypocalcemia due to increased binding of calcium to albumin.

This is why, calcium levels should always be monitored meticulously in such patients.

- Kirtan Patolia ( BJ medical college)

Algorithmic Management of Organophosphate Poisoning

Hey guys, this whiteboard provides a general overview of how to manage patients with OrganoPhosphorous Compounds (OPC) poisoning.

      [Please click on the image to enhance it]

*Use of benzodiazepines has been associated with decreased mortality and morbidity, even in the absence of convulsions.

Signs of atropinization refer to the target end-points for atropine therapy and includes:
- Clear chest on auscultation, no wheeze
- Heart rate >80 beats/min
- Systolic Blood Pressure >90 mmHg
- Dry axillae
- Pupils no longer pin-point (miotic)

Early treatment with oximes is necessary before phosphorylated cholinesterase enzymes undergo “aging” and become resistant to reactivation (due to loss of their alkyl group).

That would be all.
Happy studying!

- Ashish Singh.

MCQ Mnemonics Series: Age for organ donation

Minimum age required for consent to donate organs as per transplantation of human organ act:

16
18✔
21
no limit

Don *ate* *et* *eighteen* *etin*

Shubham Pathidar

Euthanasia

Hello Awesomites!
Here's a quick review on the topic Euthanasia, a collection of asked MCQs on euthanasia.

EUTHANASIA

Mercy killing or Assisted suicide
Physician assisted suicide is legal in some States of the US
Painless killing of a person who is suffering from incurable disease, senility, permanent damage to the brain which cannot be repaired or cured
Legally permitted in: USA, Uruguay, Poland, Australia, Switzerland, Nether lands
Not legalized in India

Types-

Active (Positive)euthanasia-
Act of commission
Death induced by direct/indirect action
legal in Netherlands and Belgium
E.g. giving large dose of a drug that hastens death

Passive (Negative)euthanasia-
Act of omission
No specific medicine or life supporting measures given
Death induced by discontinuation of life sustaining measures
legal in India
E.g. stopping heart lung machines in a severely defective new born, disconnecting ventilator in a brain dead patient

Voluntary euthanasia-
Euthanasia induced at the will of an individual by his request
A patient suffering from an incurable disease requesting the doctor to terminate his life

In/Non voluntary euthanasia-
Induced in patients who are unable to express their wishes
E.g. a person with irreversible coma or a severely defective infant
Paternalism - abuse of medical knowledge so as to distort the doctor-patient relationship in such a way that the patient is deprived of his ability to take rational choice.

Thank you!
MD Mobarak Hussain (Maahii)

Arsenic Poisoning

Hello awesomites!
Here's a Mnemonic on Arsenic Poisoning
The mnemonic is AR4SENIC

A-Aldrich Mees line (Nail)
R-Raindrop pigmentation
Reinsch Test (Gutzeit test used nowadays)
Rashes(fading measles rashes)
Red velvety mucosa(Postmortem finding)
S-Subendocardial hemorrhage(Postmortem finding)
E-Excess pigmentation and keratosis (Palms and soles)
N-Neuritis
I-Iron oxide n BAL(antidote)
C-Cholera like symptoms

I hope that it's helpful.
That's all!
Thank you.

Image based question on toxicology

Hello awesomites!

Yesterday, we posted an Image based MCQ - And as promised, here is the answer!

#FMT
#Pharmacology 

Q. A child accidentally consumed a fruit shown in the picture. Which of the following drugs is used for management?

A. Neostigmine
B. Pyridostigmine
C. Physostigmine
D. Atropine

The correct answer is C. Physostigmine.

The plant shown in the picture is Datura Stramonium. It contains Atropine which is Anticholinergic. The drug of choice for Anticholinergic toxicity is Physostigmine.

MD Mobarak Hussain (Maahii)

Baclofen for treatment of alcohol dependence

Hello!

Recent evidence suggest that the gamma-aminobutyric acid-B receptor agonist baclofen is a promising agent for the treatment of alcoholism.

Yep!

Baclofen produces an effortless decrease or suppression of alcohol craving. It decreases alcohol consumption including in those with poor motivation. The drug causes few side effects and does not add to the intoxication effect of alcohol.

It benefits patients with alcohol dependence (even those who are still in precontemplation stage of motivation!)

Research has shown that baclofen reduces withdrawal symptoms of alcohol and is safe in those with liver impairment.

Although further studies that compare long-term alcohol-related outcome of baclofen with established drugs such as naltrexone and disulfiram are needed.

Interesting, isn't it?

-IkaN

NBME 7 question on intoxication

Disclaimer: This is an NBME form 7 question for step 2 CK. If you are planning to take USMLE step 2 CK in the future, I would recommend that you DO NOT read this post because it will bias your assessments.

Fact of the day: Marchiafava-Bignami disease

Marchiafava-Bignami disease is a rare disorder of demyelination or necrosis of the corpus callosum and adjacent subcortical white matter that occurs predominantly in malnourished alcoholics. Dementia, spasticity, dysarthria, and inability to walk may present as an acute, subacute or chronic condition.

Lesions appear as hypodense areas in portions of the corpus callosum on CT and as discrete or confluent areas of decreased T1 signal and increased T2 signal on MRI. Alcohol abusers without liver disease, amnesia, or cognitive dysfunction show thinning of the corpus callosum at autopsy and on MRI, suggesting that alcohol or malnutrition damages the corpus callosum commonly in the absence of the necrotic lesions of Marchiafava-Bignami disease.

Interesting, isn't it?
-IkaN

No cyanosis in cyanide poisoning. Why?

I was reading about cyanide poisoning today and saw "Cherry red skin" in the clinical manifestations. I know that carbon monoxide poisoning causes a cherry red color to blood. But why cyanide?

The curiosity lead to this post.

In normal cellular metabolism, most adenosine triphosphate (ATP) is generated from oxidative phosphorylation. .

Cyanide avidly binds to the ferric ion (Fe3+) of cytochrome oxidase a3, inhibiting this final enzyme in the mitochondrial cytochrome complex. When this enzyme's activity is blocked, oxidative phosphorylation ceases. The cell must then switch to anaerobic metabolism of glucose to generate ATP.

Anaerobic metabolism leads to the formation of lactic acid and the development of metabolic acidosis. Hydrogen ions produced by ATP hydrolysis are no longer consumed in aerobic ATP production, exacerbating this acidosis. Serum bicarbonate decreases as it buffers excess acid, leading to an increased anion gap.

Despite an ample oxygen supply, cells cannot utilize oxygen because of their poisoned electron transport chain. This functional (or "histotoxic”) hypoxia is particularly deleterious to the cardiovascular and central nervous systems (especially the basal ganglia).

Because of the decreased utilization of oxygen by tissues, the venous oxyhemoglobin concentration will be high, making venous blood appear bright red.

Therefore, despite hypotension, apnea, and/or bradycardia, the patient does not usually appear cyanotic in the setting of cyanide poisoning.

Clinical features:
Central nervous system toxicity is the most prominent in cyanide toxicity – Headache, anxiety, confusion, vertigo, coma, seizures.

Which should you suspect cyanide poisoning?
Victims of fires
Reported ingestions
Treatment with sodium nitroprusside

Antidote:
Hydroxocobalamin
Sodium thiosulfate
Nitrites (to induce methemoglobinemia)

That's all!
-IkaN

Theophylline toxicity mnemonic

Theophylline's effects arise from antagonism of adenosine receptors and indirect adrenergic activity.

It is used as a bronchodilator for patients with asthma or chronic obstructive pulmonary disease.

IPC 176 177 178 179 mnemonic

Shilika strikes back with a video! :D

Phencyclidine intoxication mnemonic

A combative, agitated, psychotic patient with multi directional nystagmus, tachycardia and hypertension. 

Yup. You guessed it right. It's PCP intoxication. 

Here's a mnemonic 

Fact of the day: Burning the heart to ashes

An interesting fact about heart I read today:

The heart is resilient, literally. When a body is burnt, the heart is the last organ to oxidize. While the rest of the body can catch flame like a polyester sheet on campfire, it takes hours to burn the heart to ash because it's deep inside!

That's all!

Did you know? According to Hindu mythology, when Arjuna cremated the body of Lord Krishna, his whole body turned into ashes, except his heart which was still burning. Arjuna washed the ashes and burning heart into the river.

- Jaskunwar Singh

A case on Medical ethics

Hello Awesomites!

Today I am gonna discuss with you a simple case based on medical ethics. A Forensic Medicine professor asked me in final viva last year. So here it goes...

IPC and CrPC mnemonics

Hello!
This post is for Indian medical students only.

IPC 319, 320, 323, 324, 325, 326, 334, 335 mnemonic

Hey!