Medicowesome

A century of awesomeness.
WOOTS PARTY AND LOTS OF MESSAGES HAHHAA.
Proud to be a part.
Proud to be a silent contributer to the 100. Been reading all your messages like a creep this entire time. Congrats!
I think I don't have enough knowledge to answer most questions here, but I do like reading yours!
Yup me too a silent one! But I really love this group. Boosts me to learn more.
Cheers to all 100 <3

To all the new coming awesomites, since the first group is full, I'll make your group in a week irrespective of the number.

How to sign up for the group: Medicowesome study group on Whatsapp - The Official invitation

Uses of tricyclic antidepressants mnemonic

Amitryptyline for neuropathic pain.

When you say “Aah” in pain, remember Amitryptyline!

Clomipramine for obsessive compulsive disorder.

Clomi when you feel Compulsion ;)

Imipramine for nocturnal enuresis.

Eemi Eee.. will not let you pee in bed ^__^

Lame but helps :D

Saturday, February 7, 2015

Hematology and chemical pathology mnemonics

An awesomite requested for Pathology hematology bottles mnemonics. I asked him (or her) to send notes and attempted to make lame mnemonics on the same.

Uploading the notes + mnemonics for reference:

THE PURPLE ONE (aka “Lavender”)
These bottles are generally used for haematology tests where whole blood is required for analysis.

ADDITIVE: EDTA (ethylenediaminetetraacetic acid)

COMMON TESTS:
Full blood count (FBC)
Erythrocyte sedimentation rate (ESR)
Blood film for abnormal cells or malaria parasites
Reticulocyte
Red cell folate
Monospot test for EBV
HbA1C for diabetic control
Parathyroid hormone (PTH)*
less commonly used for: ciclosporin/tacrolimus levels, some viral PCR tests, G6PD, ACTH level*, porphyria screen*, plasma metanephrines*, fasting gut hormone screen*

Mnemonic: PurplE
P: Parasite, PTH, PCR, Porphyria
E: EDTA

Study group discussion: Safflower, Butter and Cholesterol.

Out of butter and safflower oil.. Which of it contains cholesterol? And which doesn't, and why?

This has to be tricky.

It wouldn't be fun if it wasnt! :D

Well, defying logic, butter doesn't and safflower does?

Haha. Wrong!

Oh man. I hate vivas.

What's the reason?

Butter does because it comes from animals. Plant products never contain cholesterol, only animal products do.

Correct!

Study group discussion: Weight loss in malignancy

What's the cause of weight loss in malignancy?

Malignancy is cachexia.. Due to increased TNF and IL - 1.

Malignancy: Due to decreased appetite.

The TNF and IL - 1 decrease appetite as well as increase protein catabolism.

Study group discussion: Sweet syndrome

Has anyone out here heard of sweet syndrome?

And I checked it's not related to diabetes. -__-

Acute febrile neutrophilic dermatitis.

It is caused due to?

Acute febrile neutrophilic dermatosis (Sweet syndrome) is a reactive process (a hypersensitivity reaction) that occurs in response to systemic factors, such as hematologic disease, infection, inflammation, vaccination, or drug exposure.

Named after Rober Sweet.

Study group discussion: Necrobiosis lipoidica

What is necrobiosis lipoidica?

Which condition causes it?

Papule on Lowerlimb seen in DM.

What's DM?

Diabetes mellitus.

It's not simply a papule. It's necrosis of the skin.

Study group discussion: Cushing's syndrome

What is Cushing Reflex?

It's related to cushing syndrome or disease?

Nah. It consist of signs of Raised I.C.T: Hypertension, bradycardia, dilatation of pupil and pyramidal tract sign.

It is caused due to raised ICT?

There is more entity..Cushing's ulcer and curling ulcer. One of them is caused due to raised ICT I think. The other being a stress ulcer. Both in the stomach.

Curling ulcer is due to burns.

They both are confusing terms.

Cushing ulcer is caused when there's brain injury. With ICT as mention above

Agree.

Does anyone know the mechanism?

Cushing ulcer and Curling ulcer are peptic ulcers caused by CNS injury and burns respectively.
One possible explanation for the development of Cushing ulcers is the stimulation of vagal nuclei due to the increased intracranial pressure which leads to increased secretion of gastric acid.
Curling ulcers may be explained by a reduced plasma volume, which leads to sloughing of the gastric mucosa or secretion of burn toxins (necrotic and carbonaceous materials released from burned cells) by the stomach.

There is the cushing sign too

Must you know the difference between Cushing's disease and Cushing syndrome then?

Cushing disease is the disease caused due to a tumor of the pituitary..With increased secretion of ACTH.
The other is the syndrome caused due to excess cortisol in the blood.. Exogenous commonly. I am not sure whether adrenal tumors are also included in Cushing syndrome or not.

Cushing sign occurs as a result of Cushing reflex.

Here are study links on Cushing's!
Cushing's ulcer mnemonic: http://medicowesome.blogspot.ae/2014/03/ulcers-of-stomach-mnemonic.html

Cushing syndrome notes: http://medicowesome.blogspot.ae/2014/12/how-to-make-concise-medical-notes.html (View image)

Study group discussion: Smallest, largest and longest muscle

Which is the smallest muscle in the body?

Stapedeus.

Nope, stapedius ain't the answer.

Then?

Erector pili muscle. The one responsible for goose bumps.

Oh yes! I forget it's a muscle cause it is so small and seems insignificant.

Haha me too!

Awesome.

Largest muscle?

Gluteus maximus!

The longest muscle?

Sartorius. Originates from ASIS to Pes anserinus.

Updated on 22nd February, 2015:

I read the previous posts, errector pili -smallest smooth musle, smallest skeletal muscle -stapedius!

Smooth muscle not in our control , innervated by sympathetic system,triggering agents - cold, fear.

Which is the strongest muscle in the body?

Ahh makes sense.

Strongest would be the one in the thigh?

Gluteus maximus!

Nope.

Masseter.

True! Well done!

Shouldn't it be the quadriceps? I don't see the masseter kicking foot balls and running with the weight of the body :P

Yes, based on its weight, with all muscles working together it can close the teeth with a force of 25 kgs on the incisors.

Ooh.

Or 90 kgs on molars!

I got a good link on that!

There are lots of ways to measure strength. One is brute force, in which case biggest is best. All skeletal muscles are bundles of many individual fibers that contain small force generating structures called sarcomeres. “Generally speaking, more muscle tissue means a larger total number of sarcomeres, which means greater maximum force generation,” Tasko says. That means the largest muscles—the quadriceps on the front of your thighs and the gluteus maximus on your rear—produce the most force.

I thought the strongest was the tongue!

I was told that it was the muscle that can do the most amount of damage - the tongue (Obviously, not physical damage, you know what I mean, right?)

Oh oh most hard working muscle in the body?

Heart <3

Why not diaphragm?

Umm I donno.. Because you can have a paralyzed diaphragm and live but you can't have a paralyzed heart?

I personally think that heart is made popular for no reason :P

Study group discussion: Babinski sign

What is pyramidal tract sign?

Did you mean Babinski sign ?
There are a specific set of clinical signs for pyramidal tract disease..I haventy heard of just one particular one.. But yes, out of the many..Babinski is the most specific for pyramidal tract disease.

A few days after UMN syndrome, motor signs appear
These include spasticity, hyperactive reflexes, extensor plantar responses.

That's because the CSF will press on the cortical neurons.. And cause a upper motor neuron type of lesion.

UMN lesion is due to lesion in corticospinal tract between cerebral cortex and SC.

Well, not all pyramidal signs are called Babinski. Babinski is the extensor response to plantar reflex when the lateral surface of the feet is striken/scratched.

Achcha what are the components of the positive babinski reflex? - review question.

Extension of great toe, fanning of other toes, contraction of tensor fascia lata.

Plus, dorsiflexion of ankle and knee joint.

Yeah, that.

Other ways to elicit a babinski ?
Plus the equivalent of babinski in the upper limbs?

It's plantar reflex. It can be elicited different ways, one's babinski, others are Oppenheim and Chaddock.

Schaeffer too.

Yep.

And do you elicit Babinski with sharp end or blunt end of the hammer? (Viva question)

In Babinski, you have to produce pain and pressure both at same time so I guess blunt end if the hammer is used.

To support my answer - I have also seen many doctors using their keys (blunt end) for eliciting Babinski.

The tip of a pen can also be used to elicit Babinski.

Yeah, they taught us that we could use keys if we didn't have a hammer handy.

Always red, it looks better on a patient's foot.

In paediatrics.. We used our own nails to elicit Babinski!

I was doubtful that it would work.. But it did.. Especially, children aged below 3-5 years.

Study group discussion: Monospot test for EBV infection

Anyone explain Monospot test please!

Heterophile antibodies in the blood?

I was just reading this. The test works with the agglutination of horse's RBC when in contact with heterophile antibodies.

Yes.. Used in detection of these antibodies in infectious mononucleosis.

When you have infectious mononucleosis you produce antibodies anti-epstein barr virus and other unspecific antibodies which are called heterophile antibodies.

Aren't anti sheep antibodies produced in monospot test ?
I mean Heterophile anti sheep red cell antibodies?

That would be Paul Bunnel test.

But infected B cells secrete anti sheep red cell antibodies that are diagnosed for mononucleosis. .

I think the only difference between monospot and paul bunnel test is the origin of the RBC. In monospot they come from horses and on Paul Bunnell, from sheeps.

Study group discussion: Sarcoidosis and calcium regulation

I have a review question for sarcoidosis.

What is the characteristic appearance of sarcoidosis radiological imaging?

Lambda sign?
Panda sign?

No. Hint..That's also what tuberculosis shows positive.

BL hilar lymphadenopathy.

Tree in the bud sign.
You then differentiate it from TB ..Based on whether the lymph nodes are showing necrosis or not.

Can you elaborate on the tree in bud sign?

It's an appearance on chest CT. I read it is specific for TB and sarcoidosis.

Oh so if there is necrosis, it's Tb? If not, it's sarcoidosis?

Yup. That too can be differentiated on CT.. By looking at the lymph nodes.

I have a review question. Which cells will you see in sputum examination of a patient with sarcoidosis?

Elevated CD4/CD8 ratio.

Why is that?

I don't know exactly but CD 4 + inflammation is specific to sarcoidosis. Helps differentiate it from other non granulomatous interstitial lung diseases.

*A parallel discussion on calcium was going on, since they both are related to each other, I'm posting the calcium discussion here as well*

Percentage of dietary calcium absorbed is inversely related to intake. How is this possible?

If you take more calcium, it absorbs less? I don't know how that is possible.

The body has to maintain a homeostasis for calcium.. If reduced intake..There will be paradoxical increased receptors via Vitamin D. To maintain a constant absorption.
If increased intake..The body reduces the absorption. The mechanism..PTH is stimulated via low serum calcium.. And PTH is the one responsible to make the final active form of vitamin D.
So if calcium in the blood stabilizes, there will be reduced impulses by PTH..conversely less vitD and less absorption.

It means that if your body's need/absorption of calcium equals x.
If your intake equals x, you'd be absorbing 100% of it.
If your intake equals 2x , you'd be absorbing 50% of it.
If it equals 4x you'd be absorbing 25% of it, and so on.
At a normal steady state of absorption, the more the intake is, the less the absorption percentage of it.

Excellente.

Can anyone associate calcium and sarcoidosis?

Hypercalemia.

Why?

Because of increase in Vitamin D by granulomas.

PTH decreases then.

Which enzyme?
And which cell is involved?

It's the interstitial alveolar macrophages that secrete alpha hydroxylase that activates vitamin D.

Is sarcoidosis a cause for dystrophic calcification then?

No, metastatic.

Bravo!

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Sunday, February 8, 2015

Study group discussion: Wolff-Parkinson-White (WPW) and increased QRS interval

Study group experience #6