Facebook: Acid and Alkali ingestion question.

Q1) In a child with accidental alkali ingestion, which of the following is recommended as acute treatment:-

A) Administer mild acid

B) Administer milk

C) Administer rice

D) Gag the child to induce emesis

So answer to the above question is Milk, Option B.

For acute administration of caustic ingestion, dilution with milk or water is recommended.

Contraindications in case of caustic ingestion:-

1) Neutralization

2) Induce emesis

3) Gastric lavage

Some key points:-

Acid ingestion produces coagulative necrosis and a somewhat protective thick eschar.

Alkali ingestion produces:-

1) Liquefactive necrosis

2) Saponification of fat

3) Exothermic reaction

PS: Do follow our Facebook Medicowesome page for more such questions.

 

Coronary artery anatomy mnemonic and video for visualization

Let's learn about the coronary artery anatomy today (and never forget it!)

Watch the video. Text and images below.

Funnel Plot

-also called as Begg’s plot
-type of scatter plot
-used to examine biases in meta-analyses

An ideal funnel plot is symmetric.
If no biases, 95% of studies lie within the triangle.

Rickettsia mnemonic

Hi!

Do you want to learn about Rickettsia today?

Rickettsia mnemonic (Rickettsia typhi, flea vector)

Mnemonic for head posture in A-V pattern squints

Chin up in what? Chin down in what? The vexing never ends. Well, as it turns out, the word 'vex' itself is here to save the day.

Chin up- V exotropia (VEx). Remember that squint is very 'vexing'. So you stare in the sky to remember at least a fraction of what you stuffed in your brain the day before. 

Other will be A esotropia. By exclusion, it's easy to remember. 

Chin down- V esotropia or A exotropia. Again, by exclusion, these get placed naturally under this heading.

So, just remember 'VEX' and you won't be vexed anymore! 

-Sushrut 

Mnemonic for Drug induced Cardiomyopathy

Hello everyone ....

Aunty is cycling 🚴‍♀️ on paved trails to protect her heart 💓 

Aunty = Anthracycline = Doxorubicin, Daunorubicin , Mitoxantrone 

Cycling = Cyclophosphamide 

paVEd = VEGF Inhibitors = Bevacizumab 

Trails = Trastuzumab

Mnemonic for GOLD classification for COPD severity

Hello,

In this video, Drashtant talks about the GOLD classification for COPD.

NEET - THE EXAM. THE MYSTERY. THE CLOWN

Mnemonic for ocular axes and angles

This one is for the PGs. The 4 axes and 3 angles are pretty confusing to remember plainly. Here's how I do it.

Fact of the day: AHN in old age

Hi!

Fact: New neurons proliferate as we age, in both physiologically and pathologically aging brains, even in the ninth decade of life.

Bell's phenomenon

It is the motion of the eyeball during lid closure and is a reflex between the occulomotor and the facial nerves.  There are 4 types-

1. Normal- Upward and outward movement of
                           the eyeball.

2. Inverse- Upward but inward movement.*

3. Reverse- Downward movement.*

4. Perverse- Lateral movement.

*Some authors opine that inverse is downward and outward while reverse is upward and inward.

The Bell's phenomenon is of importance in ptosis and lag ophthalmos surgeries .

-Sushrut

T cells in traumatic optic neuropathy- summoning the devil😈

Traumatic optic neuropathy is a tough nut to crack. High dose steroids and surgical decompression were the empirical modes of management. There is an ongoing search to save the optic nerve in trauma.

The innate adaptive T cell response has been deemed to be protective in traumatic optic neuropathy. It supposedly acts against the self directed antigens in traumatic optic neuropathy. The response can be augmented or induced depending upon an individual.

Other modalities are monisialogangliosides, neurotropic growth factors, and gene transfer of anti inflammatory cytokines.

A new group of steroids, the 'lazaroids' (great name that!) or 21 amino steroids provide free radical binding capability inherent to the group sans the glucorticoid activity.

-Sushrut

Photophobia vs blepharospasm

Both have the same presentation of tight lid closure.

In dark, blepharospasm won't be completely abolished while photophobia would.

Anaesthetisation(topical) reduces greatly the blepharospasm but not photophobia.

-Sushrut

Fuch's s in Ophthalmology

Following this are ascribed to Fuch

1. Fuch's heterochromic iridocyclitis
2. Fuch's corneal endothelial dystrophy
3. Gyrate atrophy of the choroid
4. Ciliary body adenoma

-Sushrut

No Vitamin A in Stargardt's disease

In lipofuscinoses like Stargardt's, fundus flavimaculatus, and Best's disease spectrum, Vitamin A and related compounds are avoided as the metabolites of those is what causes the disease in the first place. Usually, Vitamin A is prescribed empirically by general ophthalmologists for degenerative diseases of the retina.

-Sushrut

Age related macular degeneration- some facts

1. Dry AMD is the most common form, but wet AMD is responsible for 90% of the cases of visual loss.

2. Type 1 choroidal neovascular membrane is 'occult' and type 2 is 'classic'. This might be counter intuitive to remember.

3. In the genome, except for chromosome nos 7,11,13,21, and the Y chromosomes, all the other harbour genetic loci for AMD!

4. Hypermetropic eyes are at a greater risk of AMD. This, again is counterintuitive as myopic eyes are usually more prone to degenerative conditions.

5.Another, (sort of) counter intuitive fact is that 'hard' drusens do not lead to macular degeneration while 'soft' drusens precede macular degeneration.

6.Beta carotene, a treatment modality for AMD increases the risk of carcinoma of the lung in smokers as well as non smokers. Zinc causes genitourinary complications- UTIs, prostatic hyperplasia, and in women,stress incontinence. Also, zinc is ineffective in the prevention of advanced AMD. These results are from the two RCTs- AREDS 1 and 2 .

-Sushrut

Interesting retinal peculiarities

1. The respiratory rate of the retina is twice that of the brain.

2. The retina does not require insulin for glucose to enter the cells!

3. In the retina, glycolysis occurs despite having sufficient oxygen supply.

4. The retina is not just a sensory organ. Much of the image processing occurs at the retinal level itself.

-Sushrut

Fas- fas ligand interactions and uveitis

-Fas ligand/ FasL/ CD95 ligand is a type 2 membrane protein belonging to the TNF superfamily and is found on lymphocytes.

-In the eye, it is expressed on Iris and corneal endothelial cells.

-In the rest of the body, it is expressed on the thymus, testes, and the brain.

-Liver and intestines express this only in periods of severe inflammatory process.

- Apoptosis of the T lymphocytes can be triggered by FasL. Loss of this mechanism is touted to be one of the causes of uveitis.

Mechanism by which it acts is believed to be the selective apoptosis of cells producing TNF or by IL2 activation of lymphocytes.

-Sushrut

Effector blockade in the eye.

This is a mechanism by which the eye wards off the secondary effector phase of the immune response arc.
Thus, the cell mediated immunity appears to function less effectively in the uvea compared to the rest of the body.
Possible mechanisms include-

1. Immunomodulatory cytokines produced by the ocular tissues.

2. Immunomodulatory neuropeptides produced by ocular nerves

3. Functionally unique APCs.

4. Compliment inhibitors

..and some other factors.

-Sushrut

Anterior chamber associated immune deviation

Some specific antigens when placed in the anterior chamber of the eye result in a suppression of cell mediated immunity, with a normal humoral component.

There is something known as the ' oculo splenic axis' , whereby the antigens travel via the trabecular meshwork and reach the spleen. In the spleen, they secrete MIP 2 which attracts the NK cells. The NK cells in turn secrete IL10 and TGF beta. The T cells in this environment become regulatory cells and suppress the cell mediated immunity. Production of IL2 is suppressed.

The eye is an immuno privileged organ, as it needs to be structurally maintained pristine to preserve it's light carrying capability. ACAID is a mechanism by which Nature attempts to limit unwanted inflammatory responses in the anterior chamber.

It has implications in intraocular tumors, autoimmune, and infectious immune responses.

-Sushrut

PS- The failure of ACAID in the mechanism of lens induced uveitis still remains unexplained!