Biomedical waste: Waste Categories, treatment options and color coding mnemonic

PLEASE NOTE: This post was written in 2015, the categories have been updated since then :(
I have not deleted this post because some still find it helpful :)
We will edit it soon!

Greetings, people.

This waste disposal system is used in India. Since it's all complex and plain memorization, why not make a mnemonic? :D

For those who don't know the categories and stuff in detail, I'll copy paste them at the end of the post for reference. I'll be sharing the mnemonic first.

Let's begin! ^__^

How to remember Waste Categories:

1-3: HAM (Human, Animal, Microbiology)
4-7: Sharp medico, bloody solid (Sharps, Medicines, Blood stained or Soiled, Solid)
8-10: LAC (Liquid, Ash, Chemicals)

Facebook group

Here's another experiment, for study purposes, of course: https://www.facebook.com/groups/409305369268170

Pharmacology notes by Kiki

On excessive worrying about exams

(I received an email yesterday and based on that email, I am writing this post.)

This is the most important advice I would like to give medical students world wide. Or anyone for that matter - Don't take exams seriously.

Once exams start, you can not be stressing yourself.

It's a fragile period, you are testing yourself, there is competition and expectations that you have to meet. It's easy for anyone who isn't psychologically prepared or doesn't have the right mental attitude to break down.

I have heard of people become suicidal right before the exam or simply decide to quit.

Don't let stress kill you. It's just a piece of paper. The score is just a number. You have amazing, amazing things and adventures ahead of you, I promise. Just survive this. One day at a time.

Don't quit before trying. Just attempt and see what happens. Go ahead. Keep going, keep moving forward. You are more prepared than you think you are. It's just the stress fogging your thoughts.

I pretend it's video game. The test is just a level I need to cross by collecting points. I need to keep running like the dude in Temple Run and keep collecting coins. Going level after level just like in Candy Crush. I have given so many exams and crossed so many levels till date. Here's another one, no big deal. I don't need a high score to finish the game, I just need to play the game.

Practice reckless optimism. After reading one page, I do a flying kick and say I am gonna do so good in tomorrow's test. Laugh about how anxious you are and how the score won't even matter after 10 years. Sing a song. Eat chocolate. Be happy and keep studying. Fake it till you make it.

Organising notes and information while studying

"Hello IkaN!
I hope you're okay and happy :)
Can you teach me how to be organized? How can I save my notes?
I don't know why I'm so untidy. I want to be just like you, helping others & having good grades! <3
Please help me out here!"

- Email by an awesomite

Hello! I'm okay and at peace (:

Your organization depends on where you study from.

I study from books and ebooks so my study life seems very complicated to others.

I can read while I'm in the bus or in the train on my phone, so I always have ebooks or audio lectures with me. I can't write while traveling so everything I learn is saved on my phone. When I study with my books at home, I like having the traditional pen & paper to write, doddle and draw. Or a white board.

Here's how I save the information I have studied:

1. Make subject wise notebooks and write notes in it:
This is effective when you're studying from multiple text books and you need to merge all information into one for fast review during exams. I recommend making notes after you've read from all the textbooks if you're using this technique. You don't need to be tidy!
PS: This is time consuming.

2. If you're using ebooks, highlight and bookmark:
I read Harrison (Which is a HUGE internal medicine book) this way. The bookmarks would show me the topics I've read and while revising, I'd go through the highlighted lines only.
(App I use: Adobe Reader)

3. Type your notes and make sure they're synchronised:
If I have too much information on the digital platform and too little time to write on paper, copy paste on a notes app. Make sure you sync and back em up.
(Apps I use: Google Keep, ColorNote)

4. Blog:
The internet a wonderful place to save everything! (Many a times, I look for my own notes on Google =P)
If you don't have time for a fancy blog, just a simple tumblr with your study material is a good way to keep things in one place.
(Apps I use: Blogger, Tumblr)

Extra tips:
- Make a separate book for points you write during lectures. They're not always important but you will want you refer that book for the one thing your teacher said that you can't recollect while studying.
- If you think it's important, always write / save it somewhere. In my experience, you regret the things you didn't save =P
- Don't always focus on making the notes. Understand the information first, then organize it so that you revise and remember it.

The fact that you find me someone you wish to be like makes me happy. I hope I live up to the image you have of me =)

Until next time!

Study group discussion: Mannitol in cerebral edema and pulmonary edema

Why isn't mannitol used in pulmonary edema? And why is it used in cerebral edema?

Mannitol would expand the intravascular volume, increasing cardiac output and causing pulmonary edema (more fluid going to the lungs than it can drain.)

(Assuming the pulmonary edema is due to CHF:) The increased hydrostatic pressure proximal to the left atrium causes transudation in the lungs. Although mannitol can act as a diuretic, it initially increases plasma volume due to its effects on elevating plasma oncotic pressure.

Increased plasma volume --> increased left atrial preload in the face of decompensation that already occurred even at a lower preload --> increased LAP (PCWP) with further decompensation --> exacerbation of pulmonary venular transudation.

So basically, it causes edema by volume overload.

It's blood brain barrier (BBB) that allow us to use mannitol for brain edema. Since no such barrier is there in lungs, mannitol can cross capillaries into alveoli and worsen it. Even in cerebral edema, we give mannitol only when the BBB is intact. Otherwise, mannitol can create havoc there too.

Infusion of hypertonic solutions of any effective small molecular weight solute (eg hypertonic saline, mannitol or urea) will dehydrate the brain. In the peripheral capillaries, these solutes are not effective at exerting an osmotic force because they can easily cross these capillary membranes.

Neuropathic joint disease

Hey everyone!

Today, I felt like sharing random things that I learnt today. It's about neuropathic joint disease - Destructive joint disease due to loss of pain and proprioception.

Neuropathic joint resembles osteoarthritis (Osteophytes, loose bodies, loss of articular cartilage, etc.)

I couldn't think of neuropathic joint disease as  a differential today because I was so caught up in osteoarthritis!

The distribution of joint involvement depends on the underlying neurologic disorder.
Tabes dorsalis: Hip, knee, ankle.
Syringomyelia: Glenohumeral joint, elbow, wrist.
Diabetes: Tarsal and tarsometatarsal joint.

This is a major clue. The joint distribution.

Diabetes mellitus is the most common cause of Charcot's joint.

Other causes of Charcot's joint include yaws, leprosy, Charcot Mary Tooth disease and meningomyelocele.

That's all!

I cannot feel, what is real..

- IkaN

How to remember HOCM is an Autosomal Dominant disease

Hey!

HOCM is hypertrophic obstructive cardiomyopathy.

HOCM is the most common cause of sudden cardiac death in ADolescents.

HOCM is Autosomal Dominant.

Fun fact: Most common cause of sudden cardiac death in children in Aortic Stenosis.

-IkaN

Next best step in management in ST depression and ST elevation in acute coronary syndromes

This is a discussion I had with a lot of people. My questions are put in inverted commas.

"I don't understand the next best step in the management in acute coronary syndromes. If there's ST elevation MI, you do angioplasty. But when there was a ST depression, they preferred heparin after aspirin even when angioplasty was in the options. Why is that? Why does the management change depending on elevation or depression?"

ST elevation means transmural ischemia so maybe angioplasty is the only way to restore flow. ST depression means subendocardial ischemia so occlusion isn't complete. Heparin and blood thinners might work.

"But then if you can do angioplasty (Catherization lab available), why give heparin?"

They do send for angioplasty later. Heparin can be given immediately to prevent the situation from getting worse.

"But then again, why wouldn't you do that with ST elevation too?"

ST elevation means the occlusion is complete. Heparin wouldnt be effective. In NSTEMI and unstable angina, there's still some lumen viable.

"Patients with MI with ST-segment depression should not be treated with fibrinolysis. Why isn't fibrinolysis done in ST depression angina?

We say that the occlusion isn't complete because there is subendocardial ischemia in ST depression and we give heparin to prevent further occlusion. But why not give streptokinase? Why not eradicate what is already formed instead of trying to prevent progression of clot?"

Because fibrinolysis treatment has it's own side effects and it's not effective in all the cases. It's contraindicated because studies have shown it does more harm than good in only ST depression.

Like, for example, there is reperfusion injury which would might make the only subendocardial infarct into a transmural one. 3 in ten patients end up with cerebral haemorrhage. There are so many other clauses.

Hence it's only indication is a transmural infarction.. The damage is already great. Irrespective of using t-PA the patient condition is critical.

That's all!

Thank you everyone who helped me out on this one.

-IkaN

Study group discussion: Pathogenesis of diarrhea in medullary carcinoma of thyroid

By which mechanism, does medullary thyroid cancer cause secretory diarrhea?

Medullary thyroid carcinoma is usually associated with men syndrome in which we get VIPoma, which is associated with diarrhoea.

Upto date: "Systemic symptoms may occur due to hormonal secretion by the tumor. Tumor secretion of calcitonin, calcitonin-gene related peptide, or other substances can cause diarrhea or facial flushing in patients with advanced disease. In addition, occasional tumors secrete corticotropin (ACTH), causing ectopic Cushing's syndrome."

Colonic function was markedly impaired in three ways: (a) water absorption was decreased by half; (b) as the main excreted solutes were organic acids, a large electrolyte gap was recorded in faecal water, and (c) colonic transit time of the meal marker was very short, and was in agreement with the rapid transit of ingested radioopaque markers. These data strongly suggest that decreased absorption in the colon secondary to a motor disturbance is the main mechanism of diarrhoea in this case of medullary thyroid carcinoma, while calcitonin induced small intestinal fluid secretion suggested earlier is either non-existent, or only of minor importance.
Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1433550/

My dd for tumors and secretory diarrhea (someone wants to add):
- carcinoid tumor
- VIPoma
- Gastinoma
- Medullary thyroid cancer

Macrocytic anemia mnemonic

Mnemonic for Macrocytosis (Non B12 causes):

ALPHA NERD

Alcohol
Liver disease
Pregnancy
Hemolysis (especially chronic)
Agglutination

Neoplasia (Including myelodysplasia)
Endocrine (Hypothyroidism)
Reticulocytosis
Drugs (Especially myelosuppressives like chemotherapy, anti-HIV meds)

This awesome mnemonic was written by Adnan Arif.

-IkaN

Submissions: Indications of removing nasogastric tube post op mnemonic

What are the indications for removing NG tube post operation:

They're 4 P's!

1. Peristalsis achieved
2. Passage of flatus

Study group discussion: Drugs with oral bioavailability of 100%

List of drugs with 100% bioavailability from oral route: