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 

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 

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

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) 

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.

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) 

EKG quiz #1

What does this EKG show? 

Answer will be posted soon.

-IkaN

Normal cardiac pressures mnemonic (Normal Swan-Ganz pressures)

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?

Types of pulmonary hypertension mnemonic

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

Cardiac valves anatomy and mnemonics

Check out the YouTube video here!

-IkaN 

ECG axis mnemonic (short version)

Video here:

 

Notes below:

Brainstem & Cortical Strokes | Mnemonic & Tricks

 https://www.youtube.com/watch?v=5SOe6PzbKgQ

Abdominal aortic aneurysm notes

Here are my notes for the ABIM. Old post https://www.medicowesome.com/2016/11/step-2-ck-abdominal-aortic-aneurysm.html

-IkaN 

Babeosis mnemonic

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

You know you love me, xoxo, gossip girl!

-IkaN 

Red blood cell transfusion thresholds mnemonic

 Hello everyone! Just look here.. 

What does it mean ? SHOAN …? 

the name Shoan is of Hebrew origin and means "Gift of Salvation". 

That’s all!

Thank you! 🩺🫀

Basal Ganglia Circuit

Hello everyone!  Confusing loop has now simplified look! 👀 

First of all, Basal ganglia receives cortical input, provides negative feedback to cortex to modulate movement.

3 things must be remembered. 

• SNc (Substantia nigra) input to the striatum via the nigrostriatal dopaminergic pathway releases GABA.
• Dopamine binds to D1 , stimulating the excitatory pathway, and to D2 , inhibiting the inhibitory pathway. 
• Pathways from Thalamus to Motor cortex & from Motor cortex to Basal ganglia - “Stimulatory” 

That’s why this circuit is important in voluntary movements and adjusting posture. 

Here is my attempt to simplify this circuit through a drawing. By understanding that you’ll never forget it! 

• I-N-hibitory pathway goes through Gp-I & N-ucleus(Subthalamic)!
• If BG output = +, then increased motor activity
• If BG output = -, then decreased motor activity 

In PARKINSON’S DISEASE, SNc degenerates = lose dopaminergic input to BG

Less stimulation of direct pathway (⬇️gas) and less Inhibition of Indirect pathway (⬆️ brake) = overall indirect wins =less motor activity. This explains bradykinesia and rigidity of PD but not tremor. 

STN and GPi are targets of Deep Brain Stimulation in PD. 

Deep brain Stimulation INHIBITS activity in these structures—inhibiting either would lead to decreased inhibitory output of BG = increased motor activity-> improve PD symptoms. 

Lesion of STN -HEMIBALLISMUS= uncontrolled erratic large amplitude movements on one side.  Why INCREASED movement with STN lesion? 

By decreasing STN excitation of GPi we essentially ‘remove’ indirect pathway from equation, and direct pathway becomes unchecked -> ⬆️ movement      

Thank you! 🩺

Ehler-Danlos Syndrome (EDS) - High yield only

Hi! So let's learn EDS together. I've tabled a list of high-yield points of all the types of EDS. It requires little bit of revision but once you get a pictorial familiarity you should be able to recall them all. 

Have fun!

So, how to remember?

Step 1. Divide the table into 2 halves. Sl no. 1,2,3 have in common a lot of features:

• They are all Autosomal Dominant. 
• They have common Clinical features - skin HYPERelasticity, joint HYPERmobility and HYPER (easy) bruising. 
• Go serially, Classical has the first 2, Type I and II and HYPERmobile is III and lastly Vascular is type IV 
• Vascular type has additionally - arterial & uterine rupture.

Step 2. Now the second section Sl no. 4,5,6

• EDS types with enzyme defects are Autosomal Recessive. So, 4 and 6 are AR. 
• Kyphoscoliotic EDS is Type VI (K rearranged is a V and I)
• For the last 2, mnemonic is ABCD😛 Arthrochalasia VII a, b and VII c is Dermatosparaxis.
• KyphoSCOLIOTIC EDS - defective lysyl hydroxylase (=> abnormal cross linking of collagen or KOLLAGEN => think of bones 🦴 => congenital SCOLIOSIS)
• ARTHROchalasia is COL IA (1st letter is A) and hence presents with severe JOINT hyper mobility.
• DERMATospARaxis is AR and a defective Procollagen-N-peptidase and presents with CUTIS laxa. (Cuties are Pros ;)

Step 2. For the Gene types, come down in descending order: 5 4 3 2 1 0 

Step 3. Remember Type V - DOEST NOT EXIST. 

Step 4. Revise again 😉

That's it! Stay safe 🌸

- Anagha :)

Crescent-shaped gametocytes in P. falciparum malaria

The most definitive finding of P. falciparum that can be seen in a blood smear when viewed under a microscope is the shape of the gametocytes.

Here is my mnemonic for it.

Causes of Hypoglycemia | Mnemonic