Treatment of MDR tuberculosis mnemonic

Hi everyone! 

This is a complicated mnemonic. Too many drugs but hopefully it will help you write a SAQ on it :)

Before I get to the mnemonic, here are some general principles. 

4 drugs to which the mycobacteria are susceptible should be used. 

6 months intensive phase is followed by a continuation phase for 18-24 months.
An injectable drug like kanamycin or streptomycin is dropped in the continuation phase.

1st group:
High-dose isoniazid, pyrazinamide, and ethambutol are thought of as an adjunct for the treatment of MDR and XDR tuberculosis.

2nd group: Fluoroquinolones, of which the first choice is high-dose levofloxacin.

3rd group are the injectable drugs:
Capreomycin, amikacin, kanamycin.
Mnemonic: CAKe

4th group:
Cycloserine, aminosalicylic acid (PAS), thioamides (Ethionamide).
Mnemonic: CAT

If susceptibility to drugs is not available:
Give KEEPQ for 6 months and then PEEQ for 18 months (Drop the injectable, remember?)
Kanamycin
Ethionamide
Ethambutol
Pyrazinamide
Quinolone

If resistant to Rifampin and Isoniazid:
Give PEQS for 6 months and then PEEQ for 18 months.
Pyrazinamide
Ethambutol
Quinolone
Streptomycin
And then replace injectable Streptomycin with Ethionamide

If resistant to all first line drugs:
Quinolone + any one from CAKe + any two from CAT

That's all! 

-IkaN

Updated on 16th February, 2015:

Mnemonic for drug resistance in MDR TB:

HeR multi drug resistance. 

Resistance to H (Isoniazid) and R (Rifampin) is defined as MDR TB. 

Mnemonic for XDR TB:

Her extra fluorescent cake. 

Resistance to H (Isoniazid), R (Rifampin), any fluoroquinolone and one of the three second line injectable drugs (Capreomycin, Amikacin & Kanamycin) is defined as XDR or extensive drug resistance. 

Related post:

Antitubercular drugs mnemonic

Choledochal cyst types mnemonic

This was asked in my prelims.

Here's the text. Mnemonic in the picture.

Type-I cysts have been subclassified into 3 types.

Type IA shows marked cystic dilation of the entire extrahepatic biliary tree, with sparing of the intrahepatic ducts.

Type IB is defined by focal, segmental dilation of the extrahepatic bile duct.

Type-IC cysts are smooth fusiform dilations of the entire extrahepatic bile duct, usually extending from the pancreaticobiliary junction to the intrahepatic biliary tree.

Type-II cysts are discrete diverticuli of the extrahepatic duct with a narrow stalk connection to the CBD

Type-III cysts are also called choledochocele. They consist of dilation of the distal CBD that is confined to the wall of the duodenum, and often bulge into the duodenal lumen.

Type-IV cysts are multiple in nature and are further subdivided based on intrahepatic duct development.

Type-IVA cysts are multiple intrahepatic and extrahepatic dilations.

Type-IVB cysts refer to multiple dilations of the extrahepatic biliary tree only.

Type-V CCs refer to Caroli disease, also known as communicating cavernous ectasia, which is multiple saccular or cystic dilations of the intrahepatic bile ducts.

Classification of choledochal cysts mnemonic 

Foot drop (Notes)

Hi everyone!
These notes are messier than usual because I wasn't planning to upload them at first.
Lemme know in the comments if you don't understand something, I'll type it out for ya!
Related post: Peroneal nerve branches anatomy mnemonic

Peripheral neuropathy definition and causes (MBBS notes)

Sundays are so good :)

Definition of mononeuropathy, polyneuropathy and mononeuritis multiplex

Various causes of peripheral neuropathy (I wrote the ones I found easy to remember ^_^ ) 

Updated on 19th October, 2014

Errata: Spelling of separate is wrong. 

And according to a reader, Azaz Patel, the definition isn't exactly appropriate because discrete anatomical delineation doesn't occur in neuropathy, especially the piamater part.

Haven't found any other definition on Google so I don't know :/

Lemme know if you guys have a good definition ^_^

That's all! 

-IkaN 

What is the cause of reversal of sleep wake pattern in patients with cirrhosis?

This was asked in a viva.
So I did my usual Googling and found this as a satisfactory answer :)

Several mechanisms may be involved in the development of circadian abnormalities in cirrhosis, including the effect of gut-derived toxins on the brain and decreased sensorial inputs that entrain the circadian clock such as insufficient light exposure, social isolation, or low levels of activity and retinohypothalamic and endocrine (e.g., melatonin) abnormalities.

The sleep-wake cycle is one of the functions regulated by the circadian clock, the suprachiasmatic nucleus of the anterior hypothalamus, which has efferent connections that influence a large array of biological functions including the secretion of melatonin from the pineal gland.

For people who sleep “normal hours”, natural melatonin production peaks between 2 am and 4 am, with the peaks becoming smaller with advancing age. Normally melatonin is a natural sleep-inducing agent. Because daylight reduces melatonin production and blood levels of melatonin are usually high at night and low during the day.

In patients with cirrhosis, the diurnal plasma melatonin profile shows a significant delay in the onset of plasma melatonin increase and a delay in its peak nocturnal level. This displacement of the melatonin profile could be a reflection of a shift in the phase of the circadian clock.

Injuries that can occur due to fall on outstretched hand mnemonic

Hey everyone!
This question is frequently asked in orthopedics section of surgery.

For Rolling Stones fans, this mnemonic is lovely <3
For others, imagine trying to crush a rolling stone with your outstretched hand :P

"Been Crushing on Rolling Stones."
Bennetts fracture
Colles fracture
Collar bone fracture (rare)
Reverse Bennetts fracture
Rolando fracture
Smiths fracture
Scaphoid fracture

For the sake of completion, I would like to add other injuries associated with FOOSH:
Green stick fracture of distal radius
Epiphyseal fracture of distal radius
Ulnar collateral ligament injury

That's all!
-IkaN

What is the difference between menstrual regulation and vacuum evacuation?

What is the difference between menstrual regulation and vacuum evacuation?

I was reading gynaecology when I realized that the principles of surgical instrumentation for menstrual regulation are identical to those for first-trimester abortion done by using vacuum aspiration.

Both the procedures involve aspiration of contents of the uterine cavity by means of a plastic cannula called Karman's cannula.

So what's the difference?
Confirmation of pregnancy.

Menstrual Regulation (MR) is the treatment of the delayed menstrual period, to assure a non-pregnant state and a normal menstrual cycle the next time. It is early vacuum evacuation.

Vacuum aspiration is medical termination of pregnancy or abortion. Pregnancy is confirmed when this procedure is performed.

Why give it different names?

MR has an advantage in the countries where abortion is legally banned because it can be conducted without a confirmatory pregnancy test.

Additional info: MR is also used for some other clinical purposes, such as, for uterine biopsy, to treat incomplete abortions, to regularise the menses.

That's all!

This doubt was clarified by a friend's professor. Thanks!

-IkaN

Investigations in renovascular hypertension

Captopril enhanced radionucleotide renal scan.
Duplex doppler flow study.
MR angiography with gadolinium enhancements.
Spiral CT scan with IV contrast agents.

Renal angiogram is important in determining whether the renovascular hypertension is due to atherosclerosis or due to fibromuscular dysplasia.

Renal vein renin determination is important to assess the outcome of surgery.

That's all!
Just a short summary :)
-IkaN

Antiarrhythmic drug classes mnemonic

Greetings people! 

Antiarrhythmic drugs are super tough to memorize.
Good thing is, we can imagine weird things and manage!  :D
This post is about weird drawings and memory aids that will hopefully help you lovely medicos. Here it goes!

Class I A antiarrhythmics mnemonic:
The Queen proclaims dis (this)  pyramid.
For 1 A: Quinidine, Procainamide, Disopyramide.
Queens are royalty, first class people. This helps me remember class 1 A as well.

I also think A for active and active people have potential for more duration, associating the fact that class I A drugs prolong action potential duration.

Antitubercular drugs mnemonic

Happy Saturday people!

Memorizing AKT is very important for MBBS, since tuberculosis has a high prevalence in developing countries and in patients with AIDS.

Here's how I remember them!

RIPE for the drug names.

For doses:
INH has 3 alphabets, so 300mg OD.

RiFampin has a F. F for four, F for five. 450mg OD.

Ethambutol starts with E. E for Eight. 800mg OD.

Pyrazinamide has the biggest name, so 1500mg OD or 750mg BD.

That's all! :)
Become the best you possibly can!
-IkaN

Related post:

Treatment of MDR tuberculosis mnemonic http://medicowesome.blogspot.in/2014/10/treatment-of-mdr-tuberculosis-mnemonic.html

Tests for ovulation mnemonic

Some random memory aids I made while studying infertility.

Fern test mnemonic:
Remember FErN.
Fern test
Estrogen
NaCl
Ferning appears due to presence of sodium chloride in the mucus secreted under Estrogen effect.

Spin on: Spinnbarkeit phenomenon is seen in Ovulatory mucus.

Secretack: Secretory mucus fractures under tension; this property is known as tack.

Basal body temperature mnemonic:

I remember progesterone is pyrogenic because they both start with P.

This helps me remember the drop in body temperature during ovulation, the rise in temperature during the Secretory phase. 

It also helps me know that during menstruation the progesterone levels and body temperature drop and if the temperature does not fall, it may be suggestive of conception.

That's all!
-IkaN 

Tumors of colon and various polyposis syndrome mnemonic

Peutz Jegher's Syndrome mnemonic:
Remember the initial letters of the disease - PJS.
P: Pigmented oral mucosa
J: Jejunal polyps
S: STK 11 defect

Intermittent claudication notes

A mixie of points from various books. Hope it helps!