Testicular swellings and transillumination mnemonic

Hello!

In today's post, I'll be shedding light on your testes! :P

For those who don't know what transillumination is, it is shining of light through a swelling and seeing if the light is transmitted through it or not.

In this post, I'll be talking about swelling of testes.

Aromatase inhibitors and ER positive breast cancer

Happy Monday everyone!

Why are aromatase inhibitors effective in post menopausal women who have breast cancer and why not in women who are premenopausal?

I was asked this question during rounds.

Step 2 CS: What to ask a patient with positive pregnancy test

What to ask if a patient comes in with a positive pregnancy test:

FIGO staging of carcinoma cervix

Hello!

I made this video like a year back but never got around posting it on the blog. So, here it is! :D

Fallopian tube facts and mnemonics

Hello! I read some facts about the fallopian tube so I'll be sharing it with you today!

What part of the fallopian tube does fertilization occur?
Ampulla of the fallopian tube is the most common site for fertilization.

Sometimes, the embryo isn't transported to the uterus by the cilia, causing ectopic pregnancy. This is why, ampulla of the fallopian tube is the most common site of ectopic pregnancy.

How do I remember this? Mnemonic!

FAME
Fertilization
AMpulla
Ectopic

Another random fact to remember is, isthmus is most common site of rupture of ectopic pregnancies because it is inflexible and has a thick muscularis.

Mnemonic: ISTHMUS
Inflexible
Stiff
THick
MUScularis

That's all!
-IkaN

Remembering Apgar scoring.

Hello awesomites, finding it difficult to remember the components of Apgar score? Well, I think grouping them makes it easy-

1. The heart and lungs lie close hence,  you can group 'heart rate' and 'respiratory effort' together.

2. Reflexes are carried out none other than muscles, hence 'muscle tone' and 'reflex irritability' or 'reflex response' go into the second group.

3. Color, now it is easy to remember.

That's all!

Hormonal changes during menopause mnemonic

Short post for the day! :)

"EPIc FALL"
- Estrogen
- Progesterone
- Inhibin
levels Fall during menopause.

Study group discussion: Non contraceptive uses of condom

Non contraceptive uses of condom? I was asked this question in today's viva!

To prevent STIs.

Reduces incidence of HPV infection. 

Reduces chances of cervical cancer.

Condom pack to stop bleeding.

Condom to stop PPH.

Condoms can also be used as gloves for per vaginal examination where there is unavailability of gloves mostly in rural
areas. Strange but interesting fact!

Condoms are also used to cover the USG probe in transvaginal scan.

And there exists a thing called condom catheter.. Used for weaning people off from a regular foleys! Due to prolong use of foleys patient loses urge to micturate. Sometimes.. So we use condom catheter. Which is basically a condom plus a urinary catheter attatched to it.

For vaginoplasty used to make moulds.

In treatment of infertility, used for 2-3 months.

Study group discussion: Newer vaccines

Can anyone explain what newer vaccines mean? And which vaccines are included in this?

I think HPV is a newer vaccine.
The flu, hepatitis, rotavirus, pneumococcal & meningococcal are newer vaccines too... But this is in general stuff.
If you're looking for a definition, I don't know about that :/

Oh wait - I found a good link to newer vaccines.

These are 4 new vaccines added to the universal immunization programme (UIP) in India.
They are - Rotavirus, JE, injectable polio and rubella.

And here's more to it - If you're studying PSM in India :P

Vaccines against rotavirus, rubella and polio (injectable) will help the country meet its Millennium Development Goals 4 targets that include reducing child mortality by two-thirds by 2015, besides meeting meet global polio eradication targets. An adult vaccine against Japanese encephalitis will also be introduced in districts with high levels of the disease.

Okey. I was not sure if they were newly added or newly developed, that's why asked.

I think newly added - they had been developed long before, I suppose.

Yap same in our settings..They added rubella. And HPV for young females (Tanzania)

(India) What is the program called in your country, like is it UIP there too?

(Tanzania) Yap we use EPI.. Extended programme for immunization.

(India) We have that here too.. There's national, extended and universal.

(India) EPI was for six vaccine preventable diseases... Then it was updated to UIP with vaccination of mother with TT and vaccine spectrum for child was also extended. The one we use now is infact the UIP.

Nice. I didn't know the difference.

P.S. Thanks IkaN!

They give tetanus toxoid to preg mothers!?

Yep.

At first visit and I think two months later.

It's actually a viva question - When does immunization of the baby begin? The answer is in utero because tetanus given to the mum helps the baby before it's born.

Study group discussion: Embryology and gestational trophoblastic disease

I have a few questions on embryology!

At which stage does the embryo implant?

Isn't confabulations when you lie and believe it to be the truth

Blastocyst? 18-20 cell stage?

Yes!

When does the urine pregnancy test become positive? And why?

14 days?

Why 14 days?

HCG is secreted.. I don't know. The placenta starts forming?

The trophoblast invades the sinuses at day 12 so that's when beta HCG from the syncitiotrophoblast gets into the mother's blood in high amounts.

Okay! I didn't know this :D

*We had a confusion about when it gets in the blood vs when it comes in urine, so we Googled*

A urine home pregnancy test HPT usually becomes positive within a week or so after implantation, or around the time of your expected menstrual period. It becomes positive about 12-14 days days after ovulation and fertilization.

Implantation occurs at which day?

6 day!

So 6+7=13

That's when you'll get urine test positive!

Speaking of placenta, which Placental hormone is the cause of gestational diabetes?

HPL. Human placental lactogen.

Yes, HPL it is!

Which placental hormone correlates best with growth of placenta?

Human placental somatomammotropin.

If a patient is pregnant through IVF. Till when do you give progesterone and why?

8 weeks.

Cause it takes 8-12 wks for the placenta to completely take over the function of hormone production from ovaries.

Yes, placenta takes over progesterone production around 10 weeks!

Also serum HCG doubles up every 48 hours!

Yes, hCG doubles every 2 days

Clinical significance?

In Ectopic pregnancy, it fails to double.

Downs syndrome!

What if it's more?

In GTD, it increases.

Yep.

Snow storm apperance! It's seen in gestational trophoblastic disease on USG.

Yes, snow storm is in hydatidiform mole.

In my viva, I was asked how will you suspect GTD in a normal pregnancy, clinically?

Thyroid symptoms.
Excess vomiting.

Patient has no symptoms. She came in for a normal check up. Clinically, no tests.

Increased hCG.

You won't do hCG for everyone who comes in, right?

You will see grape like vesicles per vaginum. Excess vaginal bleeding.

No grapes visible. She is at 7 month gestation. Completely normal.

Think more basic, guys!

You are asking just signs, right?

I was asked how will you suspect hydatidiform mole CLINICALLY in a asymptomatic patient.

The uterus height does increase.
That's symphysio fundal height (SFH)

Correct!

And if you are lucky enough.. There is this boggy feeling to the uterus.

No palpable finding.. No fetal parts.
Yes!

Then you won't be able to asculate for a heart sound. That's what my examiner wanted to hear!

Study group discussion: Reason behind names of oral contraceptive pills and retroalimentation

I remember in my obstetrics practical.. I was asked why the name mala was used for mala-D or mala-N. These are oral combined contraceptive distributes free in India.
Anyone from India knows why?
I tried searching online.. Didn't find the reason why!

Mala means garland in Hindi. I have no idea why they would call a contraceptive a chain of flowers or beads though!

I am not sure but i think something like mala pearl and it's importance?
Mala N and D have other names like moti, pearl.

This Mala n and mala d is a garland like with beads equal to number of days in a month.

The mala D thing you asked... The backside of the packet shows the pattern in which they're supposed to be taken... That looks like beads in string... So may be that's why the name...

Makes sense.

Yes, but they can inhibit the synthesis of sexual hormones. If used for prolonged time, it makes harder for a woman to get pregnant after stopping them. They're very effective though.

Hmm.. I never read anything like that.

Read about retroalimentation of sexual hormones.

What's that?

If they are taken orally, the body stops producing them normally. They have a negative retroalimentation, meaning that if theres estrogens in the body, other glands will notice and they wont produce it naturally. Hormones have a whole organ-brain system of production.

So that's bad?

No, not bad.
Doesnt mean they'll be sterile.
Just means itll take time for the body to produce them naturally again.

I've read that if woman take hormonal therapy they have more propensity to get endometrial cancer.

Yeah, that's why progesterone is added.

Study group discussion: Clomiphene citrate

Please can you explain me the mechanism of Clomiphene citrate?
Clomiphene citrate is a Selective Estrogen Receptor Modulator!

Clomiphene citrate's primary action is to block the oestrogen receptors on the pituitary.

Hence, because of the lack of negative feedback..more of FSH is produced.. Hence more follicles.

This primarily used in ovulation induction in woman.. Main example polycystic ovarian syndrome.

Also, in males it is used if the cause of impotency is less gonaodotrophins.

Important viva question is.. Dose in females is 50mg OD but in males its 25 mg.

Ooh. Why is the dose lesser in males?

Oh that.. I never searched for it. But best guess would be in males the breakdown would be slower. Hence less drug.

Also, remember after the follicles are well stimulated injection hcg is given (cause it mimics LH) and brings out ovulation.

Extra: Side effect of clomiphene citrate is ovarian hyperstimulation syndrome in females

But never ever give hcg to a woman with PCOD.. It's contraindicated cause already LH is high. Else you will cause ovarian hyperstimulation syndrome.

Oh it's HCG, I thought it's clomiphene which was the culprit.

From what I read clomiphene does cause OHS by its own... But the gonadotrophins given externally are the major culprits.

One fact HCG is obtained from urine of pregnant woman. Even FSH and LH..urine of menopausal woman. I guess better recombinant counterparts are available though.

The conversation lead to urine and fecal transplants, will be published in the next post!

Fothergills repair or Manchester operation mnemonic

Hello everyone!
We'll be learning about one of the operations used in the treatment of vaginal prolapse.

It's Fothergills operation and I'll be sharing a mnemonic I use to remember the points about the operation.

Fothergills repair is also known as Manchester operation.

So the mnemonic for Fothergills repair is, "MANCHESTer"

Hirsutism mnemonic

The mnemonic for causes of hirsutism is, "Hair On Chin"

Dermoid cyst mnemonic

The mnemonic to remember points to be written on dermoid cyst is, "DERMOID CYST"

Vaginal candidiasis (Candida infection) mnemonic

Vaginal candidiasis is asked in gynaecology exams.

What is the difference between menstrual regulation and vacuum evacuation?

What is the difference between menstrual regulation and vacuum evacuation?

I was reading gynaecology when I realized that the principles of surgical instrumentation for menstrual regulation are identical to those for first-trimester abortion done by using vacuum aspiration.

Both the procedures involve aspiration of contents of the uterine cavity by means of a plastic cannula called Karman's cannula.

So what's the difference?
Confirmation of pregnancy.

Menstrual Regulation (MR) is the treatment of the delayed menstrual period, to assure a non-pregnant state and a normal menstrual cycle the next time. It is early vacuum evacuation.

Vacuum aspiration is medical termination of pregnancy or abortion. Pregnancy is confirmed when this procedure is performed.

Why give it different names?

MR has an advantage in the countries where abortion is legally banned because it can be conducted without a confirmatory pregnancy test.

Additional info: MR is also used for some other clinical purposes, such as, for uterine biopsy, to treat incomplete abortions, to regularise the menses.

That's all!

This doubt was clarified by a friend's professor. Thanks!

-IkaN

Tests for ovulation mnemonic

Some random memory aids I made while studying infertility.

Fern test mnemonic:
Remember FErN.
Fern test
Estrogen
NaCl
Ferning appears due to presence of sodium chloride in the mucus secreted under Estrogen effect.

Spin on: Spinnbarkeit phenomenon is seen in Ovulatory mucus.

Secretack: Secretory mucus fractures under tension; this property is known as tack.

Basal body temperature mnemonic:

I remember progesterone is pyrogenic because they both start with P.

This helps me remember the drop in body temperature during ovulation, the rise in temperature during the Secretory phase. 

It also helps me know that during menstruation the progesterone levels and body temperature drop and if the temperature does not fall, it may be suggestive of conception.

That's all!
-IkaN 

Semen report notes + mnemonic

In physical examination of semen you must look whether the sperm "QVALiPhiFied" (Qualified)
Quantity: 3-5 ml
Viscosity: < 3
Appearance: Greyish white color
Liquefication time: 30 minutes
pH: >7.2
Fragrance | Odour: Characteristic seminal odour

That's all!
-IkaN

DeLancey supports of genital tract mnemonic

Mnemonic time! 

"You (U) sorta care for one"
Level 1: Uterosacral and cardinal ligaments

"Park two arcs"
Level 2: Pelvic fascia and paracolpos connects the vagina to the lateral pelvic wall through the arcus tendineus

"ThriLL"
Level three: Levator ani muscle supports lower one third of the vagina. 

Random tip time! 

When you write about the supports, make sure you mention the mechanical support (the axis), the muscular supports, the fibromuscular support and the peritoneal support as well. Extra points for those! 

Diagram time!