Hey guys,
Here's a short and sharp mnemonic post.
Hope it helps.
Sunday, November 3, 2019
Saturday, November 2, 2019
Pulmonary hypertension notes
Hi!
Pulmonary hypertension (PH) is defined as a resting mean pulmonary artery pressure of 25 mm Hg or greater measured during right heart catheterization.
(How I remember the number 25 - PH: 2 letters, Hyper: 5 letters).
Classification of Pulmonary Hypertension mnemonic
"A heart lung chronic thrombotic unclarity"
1: pulmonary Arterial hypertension
2: PH due to left-sided heart disease
3: PH due to lung diseases and/or hypoxia
4: Chronic thromboembolic pulmonary hypertension and other pulmonary artery obstructions
5: PH with unclear or multifactorial causes
The transpulmonary pressure gradient (TPG): The difference between mean pulmonary arterial pressure (mPAP) and left atrial pressure (LAP, commonly estimated by pulmonary capillary wedge pressure PCWP).
A TPG of >12 mmHg would result in a diagnosis of “out of proportion” pulmonary hypertension - suggesting intrinsic pulmonary vascular disease in patients with left-heart conditions associated with increased pulmonary venous pressure.
Will update post as I learn more...
Pulmonary hypertension (PH) is defined as a resting mean pulmonary artery pressure of 25 mm Hg or greater measured during right heart catheterization.
(How I remember the number 25 - PH: 2 letters, Hyper: 5 letters).
Classification of Pulmonary Hypertension mnemonic
"A heart lung chronic thrombotic unclarity"
1: pulmonary Arterial hypertension
2: PH due to left-sided heart disease
3: PH due to lung diseases and/or hypoxia
4: Chronic thromboembolic pulmonary hypertension and other pulmonary artery obstructions
5: PH with unclear or multifactorial causes
The transpulmonary pressure gradient (TPG): The difference between mean pulmonary arterial pressure (mPAP) and left atrial pressure (LAP, commonly estimated by pulmonary capillary wedge pressure PCWP).
A TPG of >12 mmHg would result in a diagnosis of “out of proportion” pulmonary hypertension - suggesting intrinsic pulmonary vascular disease in patients with left-heart conditions associated with increased pulmonary venous pressure.
Will update post as I learn more...
-IkaN
Platypnea-Orthodeoxia Syndrome in interatrial right-to-left shunt
Hi everyone! This is a short post :)
Platypnea (flat breathing): Dyspnea induced by upright posture and relieved by recumbency.
Orthodeoxia: Arterial oxygen desaturation accentuated by upright posture and improved by recumbency.
Platypnea (flat breathing): Dyspnea induced by upright posture and relieved by recumbency.
Orthodeoxia: Arterial oxygen desaturation accentuated by upright posture and improved by recumbency.
What's Wrong With My Gallbladder, Doc?
A quick mini-post to help you make a quick diagnosis.
[Please click on the image to enhance it]
Please remember to practise caution as the presentations may overlap.
Thank you for reading.
- Ashish Singh
Wednesday, October 30, 2019
Post-LP Headache
Hey guys!
Here's all you need to you know about that nasty headache some patients get, after a lumbar puncture (LP).
How common?
Up to one-thirds of all cases.
What are the risk factors?
None. Despite years of anecdotal advice to the contrary, none of the following has ever been scientifically shown to be a risk factor: position during or after the procedure; hydration status before, during or after; amount of CSF removed; immediate activity or rest post-LP.
When does it happen?
Within 24 hours of LP.
How does it present?
Let's SOCRATES the pain here.
Site: Frontal > Occipital
Onset: Acute
Character: Dull aching
Radiation: None
Association: Mild neck stiffness, nausea
Time Course: Lasts for 2 days to 2 weeks
Exacerbating factor: Sitting upright or standing, and so the relieving factor is lying down
Severity: Varies
What is the pathology?
Thought to be continued leakage of CSF from the puncture site and intracranial hypotension. Other neuro-vascular mechanisms may be involved.
How do I prevent it?
Using the smallest practical needle and keeping the bevel facing up. Before withdrawing the needle, reinserting the stilette.
How do I treat it?
It's self limiting. Can use analgesia, as per WHO Pain Ladder. In extreme cases, can also involve an anaesthetist for an epidural 'blood patch'.
Know something you'd like to add? Let me know.
Thank you for reading. Have a nice rest of the day, you.
- Ashish Singh
Here's all you need to you know about that nasty headache some patients get, after a lumbar puncture (LP).
How common?
Up to one-thirds of all cases.
What are the risk factors?
None. Despite years of anecdotal advice to the contrary, none of the following has ever been scientifically shown to be a risk factor: position during or after the procedure; hydration status before, during or after; amount of CSF removed; immediate activity or rest post-LP.
When does it happen?
Within 24 hours of LP.
How does it present?
Let's SOCRATES the pain here.
Site: Frontal > Occipital
Onset: Acute
Character: Dull aching
Radiation: None
Association: Mild neck stiffness, nausea
Time Course: Lasts for 2 days to 2 weeks
Exacerbating factor: Sitting upright or standing, and so the relieving factor is lying down
Severity: Varies
What is the pathology?
Thought to be continued leakage of CSF from the puncture site and intracranial hypotension. Other neuro-vascular mechanisms may be involved.
How do I prevent it?
Using the smallest practical needle and keeping the bevel facing up. Before withdrawing the needle, reinserting the stilette.
How do I treat it?
It's self limiting. Can use analgesia, as per WHO Pain Ladder. In extreme cases, can also involve an anaesthetist for an epidural 'blood patch'.
Know something you'd like to add? Let me know.
Thank you for reading. Have a nice rest of the day, you.
- Ashish Singh
Monday, October 28, 2019
Ashman beat
Hello!
What's an Ashman beat?
An aberrant PVC, usually of RBBB morphology, which follows a short RR interval and is preceded by a relatively prolonged RR interval.
The mechanism is pretty cool!
What's an Ashman beat?
An aberrant PVC, usually of RBBB morphology, which follows a short RR interval and is preceded by a relatively prolonged RR interval.
The mechanism is pretty cool!
Retinoic Acid and Malignancy
Hello Awesomites !
This is going to be short post.
Relevant for exams.
All trans retinoic acid is used in APML (ACUTE PROMYELOCYTIC LEUKEMIA)
Cis retinoic acid and derivatives like 13-cis-retinoic acid (13-cRA) reduces second aerodigestive tract tumors in patients with resected head and neck cancers.
13-cis RA is used in Neuroblastoma.
Happy studying.
-Upasana Y.
This is going to be short post.
Relevant for exams.
All trans retinoic acid is used in APML (ACUTE PROMYELOCYTIC LEUKEMIA)
Cis retinoic acid and derivatives like 13-cis-retinoic acid (13-cRA) reduces second aerodigestive tract tumors in patients with resected head and neck cancers.
13-cis RA is used in Neuroblastoma.
Happy studying.
-Upasana Y.
Differentiation syndrome
Hello Awesomites !
AML (M3) also known as acute promyelocytic leukemia.
The drug is ATRA+As2o3 ( All trans retinoic acid +arsenic trioxide).
After few days from therapy :-
unexplained fever,
acute respiratory distress with interstitial pulmonary infiltrates,
and/or a vascular capillary leak syndrome
leading to acute renal failure.
Suspect :-
Differentiation syndrome (DS), formerly known as retinoic acid syndrome, is the main life-threatening complication of therapy with differentiating agents (all-trans retinoic acid [ATRA] or arsenic trioxide [ATO]) in patients with acute promyelocytic leukemia (APL).
The differentiation of leukemic blasts and promyelocytes induced by ATRA and/or ATO may lead to cellular migration, endothelial activation, and release of interleukins and vascular factors responsible of tissue damage.
Roughly one quarter of patients with APL undergoing induction therapy will develop the DS.
Treatment -
Early therapy with intravenous corticosteroids. The use of invasive diagnostic techniques, such as bronchoscopy and bronchoalveolar lavage or lung biopsy, is not usually required in patients with suspected DS and respiratory distress with lung infiltrates.
Be careful with invasive procedure as these patients have concomitant coagulopathy (DIC like state)
The early administration of high-dose dexamethasone at the onset of the first signs or symptoms of DS is crucial, since it appears to dramatically reduce mortality of this complication.
HAPPY STUDYING :)
-Upasana Y.
AML (M3) also known as acute promyelocytic leukemia.
The drug is ATRA+As2o3 ( All trans retinoic acid +arsenic trioxide).
After few days from therapy :-
unexplained fever,
acute respiratory distress with interstitial pulmonary infiltrates,
and/or a vascular capillary leak syndrome
leading to acute renal failure.
Suspect :-
Differentiation syndrome (DS), formerly known as retinoic acid syndrome, is the main life-threatening complication of therapy with differentiating agents (all-trans retinoic acid [ATRA] or arsenic trioxide [ATO]) in patients with acute promyelocytic leukemia (APL).
The differentiation of leukemic blasts and promyelocytes induced by ATRA and/or ATO may lead to cellular migration, endothelial activation, and release of interleukins and vascular factors responsible of tissue damage.
Roughly one quarter of patients with APL undergoing induction therapy will develop the DS.
Treatment -
Early therapy with intravenous corticosteroids. The use of invasive diagnostic techniques, such as bronchoscopy and bronchoalveolar lavage or lung biopsy, is not usually required in patients with suspected DS and respiratory distress with lung infiltrates.
Be careful with invasive procedure as these patients have concomitant coagulopathy (DIC like state)
The early administration of high-dose dexamethasone at the onset of the first signs or symptoms of DS is crucial, since it appears to dramatically reduce mortality of this complication.
HAPPY STUDYING :)
-Upasana Y.
Friday, October 25, 2019
Route of bisphosphonate administration mnemonic
Mini post!
IVZ: Intravenous zoledronic acid (once a year)
oRAl: Oral bisphosphonates are Risedronate and Alendronate
- IkaN
IVZ: Intravenous zoledronic acid (once a year)
oRAl: Oral bisphosphonates are Risedronate and Alendronate
- IkaN
Denosumab
Hi! Long time no see :)
This post is on Denosumab!
MOA:
- Monoclonal antibody against the receptor activator of nuclear factor κB ligand (RANKL)
- Reduces bone resorption by inhibiting the development of osteoclasts
Route: SC
Dosing: Administered twice yearly
This post is on Denosumab!
MOA:
- Monoclonal antibody against the receptor activator of nuclear factor κB ligand (RANKL)
- Reduces bone resorption by inhibiting the development of osteoclasts
Route: SC
Dosing: Administered twice yearly
Saturday, September 28, 2019
Quinsy Complication
This post is written by Sweta Senthil.
I don't know why she targeted me to make this mnemonic but it makes sense to remember the complication of Quinsy.
So mnemonic is "OJAS Pee"
Edema of larynx
Jugular Vein Thrombosis
Abscess of Lung/Pneumonitis
Septicemia, Spontaneous hemorrhage
Parapharyngeal Abscess
That's it!
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