Showing posts with label USMLE. Show all posts
Showing posts with label USMLE. Show all posts

Sunday, January 2, 2022

MCQ: Carbamazepine

Q1) Which of the following statements is true about carbamazepine:-
A) It is indicated in complex partial seizures.
B) It is an enzyme inhibitors
C) It can cause megaloblastic anaemia
D) It is the drug of choice for status epilepticus.

#recentNEET
#NEETPG 
#Medicowesome
#pharmacology 

So, the answer to the above question is an option 
A) It is indicated in complex partial seizures.

Let's get started with Carbamazepine:-
It is an antiepileptic drug that acts by lengthening the inactivated state of the Na+ channel. 
Uses:-
1) DOC for Partial seizure/trigeminal neuralgia.
2) Bipolar disorder.
3) Acute mania
4) GTCS.

Let's rule out other options:-
Option B) It's an enzyme inducer. It is a substrate as well as inducer for CYP3A4 and CYP2C9. Oxcarbazepine is a less powerful CYP enzyme inducer.

Option C) Carbamazepine causes agranulocytosis or aplastic anaemia and not megaloblastic anaemia.

Other side effects include:
1) Hyponatremia: Delayed and more common in the elderly. Risk is higher in Oxcarbazepine.
2) Hypersensitivity
4) Hepatoxicity 
3) Steven Johnson syndrome (Associated with HLA-B 1502 gene)
4) Ataxia 
4) Blurred vision/ Diplopia 
For the last two side effects, we need TDM for adjusting the dose. Remember, Ataxia and Blurred vision is not a Idiosyncratic reactions.

Let's do questions related to Carbamazepine!

Q1) What adverse effect is risked to ongoing valproate therapy?

-Hepatotoxicity.

Q2) A cancer patient is on anticancer drugs (vincristine etc) and develops multiple episodes of seizures, refractory to diazepam and lidocaine. Blood tests show elevated ADH and euvolemic hyponatremia. Which drug can be used to treat this patient?

- You can't use Carbamazepine because it causes increase sensitivity of renal tubules to ADH levels. 
In this case, we use Phenytoin which causes a decrease in ADH secretion and corrects hyponatremia.

~Ojas

Monday, December 27, 2021

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 

Sunday, December 26, 2021

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 




Saturday, December 18, 2021

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) 

Friday, December 17, 2021

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.


Tuesday, December 14, 2021

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) 

Wednesday, November 17, 2021

Thursday, October 21, 2021

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?

Thursday, October 14, 2021

Types of pulmonary hypertension mnemonic

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

Thursday, July 22, 2021

Babeosis mnemonic


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

You know you love me, xoxo, gossip girl!

-IkaN 

Tuesday, June 1, 2021

How to write a Personal Statement for Residency

 

How to write a Personal Statement for residency


How to begin

  1. Daily start writing down ideas in Evernote/any app which lets you take notes
  2. Think of a strong patient interaction/personal story where you helped the patient and which also shows your medicine-related skills/knowledge/work ethic. Make it about yourself, what you did, and how it helped you. Do not write the entire history of the patient.
  3. Either with the same story as above or explain the reason/reasons why you are interested in that particular field.
  4. Make a list of your hobbies/ non-medical experiences and find a common connection between that skill set, which can actually help you during residency.
  5. Read loads of sample personal statements from google!!!
  6. Do not copy them (plagiarism is HARMFUL). 
  7. Once you are done, send your draft to mentors/English professors/seniors etc.
  8. Make sure there are absolutely no grammatical errors. (English being a 2nd language is not an excuse for poor grammar).

 

Don’t’s

        This is not the time to show off your creative writing skills. We are applying for a residency, not a literature graduate position. Keep it simple and easy to read.

        Do not use super-long sentences. IMGs have a tendency of using a lot of ‘and’ and writing 3-4 line long sentences. Keep it short.

        Target content that fits into one page. 600-700 words approx. Don’t go over 800, don’t stay under 500.

        Do not use negative incidents/ bad mouth your home school or resources.

        Don’t lie. You will get caught. If you say you have worked on multiple research projects and if you are unable to answer basic questions regarding your research, you WON’T be selected.

        You never know how much importance programs give to the PS, so always make sure it is a well-written PS.

        Don’t quote your CV.

        Don’t use clichés or common quotes.

        Don’t start every sentence with “I.”

        Come across as arrogant. This is the place to showcase your strengths, but in a humble way.

 

 

How to divide paragraphs: 1st paragraph

        The first and last paragraphs are the most commonly read parts. Make them interesting and strong. It should be personalized.

        Begin strong: Story/Hobby/What got you into medical school or you can skip that and talk about what got you interested in your specialty.

        It should be a story about yourself and how it relates to your specialty, not just a history of the patient you saw.

 

DON’T’s

·        “Every patient has a story to tell.”

·        Some major illness in the family/ death motivated me to become a physician.

·        “I love to travel. Each journey takes us down a different path. Each journey inspired a new thought. I feel medicine is similar to traveling. Every patient has his own journey and I want to be there to make it fruitful for them.” (This is not the right analogy. Travel and medicine have nothing in common)

·        “I will never forget ___”

·        “I grew up with dermatology in my blood”

 

DO’s

·        “Growing up in rural ____, I experienced ____. Here I realized _____. The strict value system of perseverance and dedication led me to ____.”

·        Start with your hobby.
E.g. Football….team sport….captain of the football team….motivated my team, resolved conflicts. At the same time I realized, that whenever someone got hurt, I would assist my coach with first aid. I realized that my inclination for helping my injured team mates extended beyond the football field. Bridge it into medical school and how you continued doing the same. Got you interested in EM/ortho etc.

·        “Medicine is a field in which my love for pathophysiology and my commitment to serving others can continue to grow. I have a strong desire to use my problem-solving abilities while helping people through their most difficult times.” And then give an example justifying these 2 statements.

 

 

How to divide paragraphs: 2nd, 3rd and 4th paragraphs

        Talk about your strengths in a very SUBTLE way, citing examples.

        Talk about your achievements and extra curriculars, your motivation and end it with what skill-set you derived from it.

        Include hobbies. Connect them with medicine and how it will make you a better resident.

        Relate how your actions and experiences during medical school will make you a strong physician.

        What will you bring to their program?

        Don’t quote your CV.

        Show who you are as a person, not just as an ideal medical student.

 DO’s

        Talk about your strengths in a very SUBTLE way, citing examples.

        Talk about your achievements and extra curriculars, your motivation and end it with what skill-set you derived from it.

        Include hobbies. Connect them with medicine and how it will make you a better resident.

        Relate how your actions and experiences during medical school will make you a strong physician.

        What will you bring to their program?

        Don’t quote your CV.

        Show who you are as a person, not just as an ideal medical student.

 DON’T’s

·        I love IM as it is such a broad field with a vast number of diseases.
(Same goes for FM and Peds and all other branches. Avoid such blanket statements.)

·        I want to be trained to manage patients on my own and do right by them to be one of the best in my field.
(Umm…isn’t this what residency is about. Everyone wants that. What is it that you are specifically looking for?)

·        Also, avoid “I love” “I want to”

·        “IM combines the wide spectrum of exotic and the mundane illness, providing a scope of touching maximum lives.”
Do you mean to say FM/EM/ortho/surgery etc. do not provide this?

·        “My mentor taught me more about medicine and how to approach a patient better than I had learned in all of my classes.”
Do not put your other classes in a negative light.

 

 

How to divide paragraphs: last paragraph

        Summerise.

        Tie in all your major attributes.

        Talk about: What you are looking for in a program

        Talk about: Where do you see yourself in a few years?

 DO’s

        I will bring to residency energy, enthusiasm, integrity, and ability. I expect a challenging, rich environment in which to learn and practice good medicine.

        I know I have set high goals for myself: clinician, educator, and health advocate. The majority of the time I find working with underserved populations extremely rewarding; however, it can also be emotionally demanding.

        The combination of working at an individual level to address health needs and at a more macroscopic level to affect health policy is synergistic for me.

        I eagerly await the unique privilege of participating in such a rewarding and exciting field of patient care.

 DON’T’s

        Don’t be too specific regarding fellowship goals unless you are absolutely sure.

        If you are sure regarding your fellowship, your CV should have enough experience to back it up.

        “Medicine encompasses numerous areas that I have always found intriguing. Becoming a physician is a lifelong dream that will fulfill both my personal and career goals.”
What are the goals? State them. What are the intriguing areas? It is a vague sentence. Avoid fluff.

        “My career goal is to enter a university-based anesthesiology program.”
Then community programs (forming a major chunk of interviews for IMGs, will not call you for an interview. Be diplomatic.


Time Frame

         June 1st half: Begin jotting down ideas and writing sentences. Focus on ideas. Don’t worry about sounding smart/grammar right now.

        June 2nd half: Start compiling the ideas and sentences into paragraphs. Check the flow. Keep reading samples to understand how to write it.

        July 1st half: Make your 1st draft. Send it to seniors/attendings/mentors.

        July 2nd half: Incorporate the changes suggested by them and make another draft.

        Aug 1st half: Send it out for suggestions again.

        Aug 2nd half: Make a final draft. Here your ideas, stories, hobbies, major points should be finalized and free-flowing. Now run a final grammar check. Send it to someone with professional level English for edits and grammar.

        Sept 1st week: Final draft ready

 

Take away

        Personal Statements might not fetch you interviews unless it is extra-ordinary. You will get interviews based on your scores and other aspects of the application.

        You may lose out on an interview due to a bad PS. (Incorrect grammar, poorly written)

        Interviewers love to talk about the hobbies mentioned in the personal statement, so make sure they are real!!

        They are looking to know you as a person, so make sure your PS does not describe 1000s of other medical students as well.

        Once you land an interview, the PS might play a role in getting you ranked high. The program wants a candidate that would ‘Match’ their expectations!

 

Saturday, May 29, 2021

The Happy face

 Hi everyone!

Lets talk about a 2 year old girl with a h/o seizure disorder who presents to your clinic for the first time for routine care. Past medical records shows that the patient is on anti-seizure medication since the last year. There is no family history of seizures. Parents report poor feeding and sleep disturbances. The girl appears to be very happy, laughing all the time for no reason. On examination, her head circumference is in the 10th percentile and is noted to have hand flapping behavior. She has not met the expected milestones for her age. What is the diagnosis?

???

ANGELMAN SYNDROME 























Fun fact: Angelman Syndrome was previously known as "Happy Puppet Syndrome"😄


- Padma Sri Katikaneni

Tuesday, May 25, 2021

Salter-Harris classification of fractures


Salter Harris classification is used for fractures involving the physis ( growth plates) of long bones. These fractures are common in children as their skeletal growth is not fully complete.

Depending on the extent and the structures involved, there are 5 types as follows: 


Here is a mnemonic to remember the different types, which actually goes by the name of the classification itself!

S - Separation through growth plate or physis
A - Above the physis
L - Lower to physis
T - Through the physis, metaphysis, epiphysis
ER-ERasure of physis ( as it is a compression fracture of growth plate)

Hope this helps!
-Padma Sri Katikaneni







 

Wednesday, May 19, 2021

Cancer Screening - US Preventive Services Task Force (USPSTF) guidelines

     As the saying goes - "Awareness is Power in a world where information is everywhere", lets quickly learn the USPSTF recommended guidelines for Cancer screening

CANCER                                                          

SCREENING MODALITY

AGE GROUP   

Breast Cancer

  • Biennial Mammography                                                                                            

Women aged 50 to 74 yrs 

Cervical Cancer    

  • Cervical cytology every 3yrs  


  • Cervical cytology every 3 yrs 

or

  • High risk HPV(hrHPV) testing every 5 yrs

or

  • hrHPV testing in combination with cytology every 5yrs (cotesting) 

                                                                                                               

Women aged 21 to 29 yrs 


Women aged 30 to 65 yrs   

Lung Cancer  

  • Annual Low dose CT chest (who have a 20 pack-year smoking history and currently smoke/quit within past 15 yrs)



Adults aged 50 to 80 yrs

Colorectal Cancer 

  • Colonoscopy screening every 10 yrs

  • Flexible sigmoidoscopy every 5 yrs

  • Computed tomography colonography every 5 yrs

  • High-sensitivity guaiac fecal occult blood test (HSgFOBT) or fecal immunochemical test (FIT) every yr

  • Stool DNA-FIT every 1 to 3 yrs


Adults aged 45 to 75 yrs


P.S. - USPSTF now recommends screening for Colorectal cancer in adults aged 45 to 75 years


- Padma Sri Katikaneni