Monday, April 24, 2017
Sunday, April 23, 2017
'A' wave in JVP : Mnemonic and explanation
Hi everyone. So JVP is one of the most theoretical clinical signs I've ever studied. And though parts of it are logical , I find it tedious to memorize all causes for a particular finding.
So I've prepared a Mnemonic for prominent a waves.
Here goes.
The A wave is a positive wave of the JVP.
It represents the Right Atrial pressure during systole.
Causes of a prominent a wave
Remember :
CRePT's
C - Cor Pulmonale
R - Right heart Failure
P - Pulmonary stenosis
T - Tricuspid stenosis
S - The S tells you it's Stenosis for P and T.
The a wave essentially represents the pressure in the Right atrium during systole.
So any condition that causes this pressure to increase would cause a prominent A wave.
Cor Pulmonale and RVF are basically congestion in RV causing elevation of pressure in the RV.
This means the atrium needs to pump with greater force into the Ventricle for the venous return to enter the Ventricle. This increases the RA pressure causing prominent a wave.
Pulmonary Stenosis leads to accumulation of blood in the RV and this follows a similar fate as the above mentioned causes.
Tricuspid stenosis causes obstruction to the flow of blood from RA to RV. Thus accentuating the pressure in the RA.
That's the Prominent a wave for you !
~~~~~~~~~~~
Now there's something called the Cannon a wave.
These represents contraction of the RA against a closed Tricuspid valve.
The causes of this include -
A- V dissociation.
Heart blocks.
Ventricular arrhythmias - V tach , Ventricular premature complexes and Ventricular pacing.
~~~~~~~~~~~
The a wave would be absent in Atrial fibrillation as the atrium is functionally not pumping at all , and just vibrating.
These are the a wave findings for you !
Hope this helped
Stay awesome.
~ A.P. Burkholderia
Number needed to treat and number needed to harm mnemonic
Hello!
Number needed to treat = 1 / Absolute risk reduction
Mnemonic: TARR - Treat Absolute Risk Reduction
Number needed to harm = 1 / Attributable risk
Mnemonic: HARM - Harm Attributable Risk M
That's all
-IkaN
The Basics : Lateral wall of Nasal cavity
Saturday, April 22, 2017
Clubbing : Why it occurs.
This is a short post on why clubbing happens.
So it's simple !
It's cause people like to go out and get drunk.
Just kidding. Here goes.
- It's the bulbous enlargement of the terminal digits and the nail bed.
- Symmetrical clubbing can occur due to a host of causes.
- To summarize :
A. Respiratory
: Lung cancer
: Suppurative lung conditions like
: Pulmonary Fibrosis
B. Cardiac
- Cyanotic heart disease
- Eisenmenger Syndrome
- Infective endocarditis
- Inflammatory bowel disease
- Cirrhosis - esp Biliary
D. Endocrine
- Thyroid Acropachy
- Acromegaly
But what makes sense to me , I want to share with you'll! And it was an absolute pain to find something convincing enough. So just stick with me here ;;)
The most widely accepted theory right now is the megakaryocyte theory.
IBD - especially Crohn disease seen to have thrombocytosis eventually which may aggravate the PDGF.
In cirrhosis of liver , especially biliary , pulmonary arteriovenous shunting is observed. This could result in the megakaryocyte entrapment as explained.
Another theory suggests inflammation triggers a vagal response causing Vasodilator effects. ( Neurogenic).
Other theories -
Hypoxia induced
Reduced ferritin related
Neurogenic
Humoral - various PG's and other humoral molecules.
The most widely accepted theory is the Megakaryocyte theory.
Hope this satisfied you !
Thank you.
Stay awesome.
~A.P.Burkholderia
Preparing for NEET - Part 2
Authors' diary: Homemade cheap DIY alternatives for a smartphone camera stand
In this video, I show how I keep my camera stable while shooting videos of my notes / whiteboard.
I use paper cups and books as my camera stand.
Friday, April 21, 2017
Paraneoplastic Dermatoses - Tripe Palm.
(The palmar ridges are accentuated and resemble to the stomach mucosa of a ruminant-tripe.)
-Medha.
Nail Changes in Medicine : A Summary
Hi everyone. Just a list of changes you can see in the nails in different systemic Diseases. So let's get nailed ;)
1. Clubbing -
Loss of angle between the nail and the nail fold - More soft and bulbous nail.
Typically indicates Cardio Pulmonary function disturbance :
--> Cardiac conditions like Cyanotic heart disease, Infective endocarditis and Atrial myxoma.
--> Respiratory conditions :
Neoplastic like CA lung ( Esp. Squamous cell CA) , Mesothelioma.
Infective like Bronchiectasis , Abscess , Empyema.
(Non cardiorespiratory causes = Inflammatory bowel disease, Biliary Cirrhois.
Thyroid Acropachy , Acromegaly. )
2. Koilonychia -
Spoon shaped nails.
Strongly indicative of Iron Deficiency anemia or Fungal nail infection.
3. Onycholysis -
Destruction of nail.
Seen in Psoriasis , Hyperthyroid and Fungal nail infection.
4. Chronic Paronychia -
Inflammation of nail fold. May have swollen nail and discharge with throbbing pain. May occur due to frequent nail biting.
5. Cyanosis -
Can be looked for in nail bed. We have a post on this already.
6. Beau line -
Transverse furrows from temporary arrest of nail growth due to increased stress.
Nails grow at 0.1 mm/d , so furrow distance from the cuticle can be used to time the attack. Can be seen in Malaria , Typhus , Rheumatic fever , Kawasaki.
7. Mees line -
White transverse bands in Arsenic poisoning / Renal failure.
8. Muerhcke's line -
White parallel lines without furrowing on the nail.
Seen in Hypoalbuminemia.
9. Terry's nails -
Proximal portion of nail is white / pink , tip is reddish brown.
Seen in cirrhosis , CRF
10. Splinter hemorrhage -
Longitudinal Hemorrhage streaks under the nail seen in Infective endocarditis.
What a fun way to get nailed down 😂 Happy studying !
Stay awesome.
~ A.P.Burkholderia.