Study group discussion: Ferritin

Hello everyone!


Why do ferritin levels increase in Rheumatoid arthritis?
It is an acute phase protein.
The levels increase in serum as well as in synovial fluid. The rise is more in synovial fluid because of local production of ferritin in the inflamed joint.
Ferritin levels show a positive correlation with ESR, CRP, platelet count, and DAS score.
And a negative correlation with hematocrit levels.

Is there a difference of levels in inactive and active disease?
Yes, the levels are lower in inactive RA patients because of iron deficiency.
Synovial ferritin production in active RA leads to increase of ferritin in active disease.

Gold standards for diagnosis of iron deficiency in RA?
1. Bone marrow iron stain
2. Serum transferrin receptor analysis

What leads to high ferritin levels in SLE?
Ferritin synthesis is induced by interleukins IL-1, IL-6 and Tumor Necrosis Factor (TNF) alpha in hepatocytes.  In SLE, there is defect in IL-1 production while IL-6 and TNF-alpha levels are increased. So, the high levels of ferritin are due to IL-6 and TNF-alpha. (IL-1 does not play a major role in the synthesis of ferritin)
The ferritin levels are correlated with ANA titre, anti-dsDNA titre, and SLEDAI score.
(No significant correlation with acute phase parameters and negative correlation with complement levels)

Zika virus infection and the Alzheimers'

Hello everyone!


The mosquito-borne zika virus has spread to most of the parts of Latin America, Pacific islands and the US. It has been recently linked to Alzheimers' disease and depression!

Sjogren's syndrome mnemonic

Here's a short post about Sjogrens syndrome.

Hodgkins lymphoma and minimal change disease mnemonic

Which nephrotic syndrome is associated with Hodgkins lymphoma?

Lymphoma usually causes membranous nephropathy.

But Hodgkins is a weirdo which minimal change disease.

Mnemonic: Kids get MCD usually, so "Hodgkid"

Mnemonic by DJ AweSpear sent to us in our study group. Thanks!

Membranous glomerulonephritis mnemonic

Most common cause of nephrotic syndrome in adults.

Associated with clots - DVT, renal vein thrombosis and PE are common.

Nephrotic syndrome associated with malignancy.

It's membranous glomerulonephritis! :D

Study group discussion: Fall of fever by crisis and fall of fever by lysis

Difference between fall of fever by crisis and fall of fever by lysis ?

In fall of fever by crisis, there's sudden decrease in temperature (Mostly due to treatment).

In fall of fever by lysis, reduction in temperature occurs gradually.

Typhoid fever falls by lysis.
(Step ladder pattern!)

Dengue fever falls by crisis.

Systemic sclerosis autoantibodies mnemonic

Today, I forgot which antibodies scleroderma is associated with T_T

Apparently, Qbanks don't write Scl-70 in their options. They like writing "Autoantibodies against topoisomearase I" and make my life difficult.

Anyway, here's my attempt to remember this next time. I don't know if it'll work. But hey, no harm trying?

Mauskopf facies

Hello!
Here's a fact I read today.

"Mauskopf" means "Mouse head" in German.

IkaN be a Khaleesi

Hello!
This post is from the authors diary.

Game of thrones fan, continue reading.

Someone sent me this which is pretty hilarious. I sent it to two of my friends, one added more to it and the other suggested I put it on the blog xD

Different types of skin lesions (as in rashes)

                          Hey guys, we started Internal Medicine Last week, so we were studying about different types of skin lesion as in rashes in Harrison’ Internal Medicine 19e. So I made little chart myself to memorize it. So I thought to share it with you all.

Polymyalgia rheumatica and giant cell arteritis mnemonic

Here's a mini post for the day!

What are the symptoms of Polymyalgia rheumatica? What is it associated with?

#AnswerTime: A patient with delusion

Here's the answer to a question we posted earlier: http://www.medicowesome.com/2016/08/quiztime-patient-with-delusion.html

Answer:

#QuizTime: A patient with delusion

#QuizTime
A 32 year old male patient came to the Psychiatry  OPD complaining  that his wife wanted to kill him. He was asked why he didn't report to the police , to which he said they were not ready to believe him.
He was suspected of having a delusion of persecution.

De Quervain syndrome notes

Intro:
Here's a short post on De Quervain syndrome :D

Correction of hyponatremia and hypernatremia mnemonic

Hello!

Never correct sodium too quickly.

If you correct hypernatremia too fast, it'll result in cerebral edema. Why?
When hypernatremia is corrected too rapidly, cerebral edema results because the relatively more hypertonic ICF accumulates water.

If you correct hyponatremia too fast, it'll result in central pontine myelinolysis (CPM) aka osmotic demyelination syndrome. Why?

Chronic hyponatremia is associated with the loss of osmotically active organic osmolytes (such as myoinositol, glutamate, and glutamine) from astrocytes, which provide protection against brain cell swelling.
However, organic osmolytes cannot be as quickly replaced when the brain volume begins to shrink in response to correction of the hyponatremia. As a result, brain volume can fall from a value that is initially somewhat above normal to one below normal with rapid correction of hyponatremia.
The mechanism by which a rapid fall in brain volume results in demyelination has not been established.

How do I remember this?

Central pontine myelinolysis* mnemonic

Here's another mnemonic:
From low to high, your pons will die (CPM)
From high to low, your brain will blow (Cerebral edema, herniation)

That's all!

-IkaN

Study group discussion: Widow makers artery

Does anyone know why left anterior descending artery is called widow's artery?

Approach to acid base disorders: Metabolic alkalosis notes

In suspected metabolic alkalosis, always check urinary chloride levels.

Metabolic alkalosis associated with a reduction in the ECV (Vomiting, diuretics):
There will be a stimulus for Na and Cl reabsorption to replenish extracellular volume.
Urinary Cl is very low ( < 25 meq/L).
Administration of NaCl and water leads to correction of the metabolic alkalosis.
Such causes of metabolic alkalosis are said to be saline responsive.

Approach to acid base disorders: Metabolic acidosis notes

Hello!

I made these notes while studying acid base disturbances. Now they might not make sense to someone who has never studied this topic before.. But for those who have read about it, this should be excellent for revision.

Calculation of anion gap:
ALWAYS calculate the anion gap first.
Anion gap = [Na+]  − ([Cl-] + [HCO3−])
Normal anion gap = 8 - 16 mEq / L

What causes renal bruit?

Narrowing of the renal artery (Renal artery stenosis) causes renal bruit.

Hexagonal crystals in cystinuria mnemonic

Hexagonal crystals are seen in cystinuria.

Envelope shaped crystals in urine: Calcium oxalate mnemonic

Heyyyyyy!

X in oXalate looks like an envelop to me :D