Study group discussion: Acromegaly

What is the most common cause of death in patient with acromegaly?

Cardiomyopathy leading to heart failure.

Why is diabetes more common in acromegaly?

GH has anti insulin effect.

Cool fact: GH increases insulin production. But at the same time causes insulin resistance.

How can you find out by giving glucose that patient has acromegaly or not?

Normally, growth hormone should be suppressed by giving glucose. Suppression of GH by giving glucose excludes acromegaly.

What is the treatment for acromegaly?

Pegvisomant - GH receptor antagonist.
Transsphenoidal removal of pituitary tumor.

Study group discussion: HSV encephalitis and musical hallucinations

Fun fact: HSV encephalitis is associated with musical hallucinations.

It's due to disruption of connections between the sensory cortex and reticular formation.

Is that specific for HSV only? Like the way auditory hallucinations is characteristic of schizophrenia?

No, it occurs in epilepsy, intoxication and other focal brain lesions as well.

I've heard that musical hallucinations occurs in people who listen to music for long periods of time. Not sure if it's true.

JVP in pericardial tamponade

Greetings everyone!

Today, I was reading about JVP in pericardial tamponade. I started explaining a few concepts to myself and then I thought maybe everyone would like to know about this! So I wrote them down for you guys to read.

Why is y descent absent in JVP in pericardial tamponade? 
Y wave is due to ventricular relaxation. The ventricles can't relax when the pericardium is full of fluid, leading to the absence of y descent.

JVP in pericardial tamponade

Why is there a prominent x descent in JVP of pericardial tamponade?

Pharmacological agents that relax lower esophageal sphincter mnemonic

Pharmacological agents that relax lower esophageal sphincter mnemonic

ABCDEF MINTS

Alcohol
Anticholinergics like Atropine
Barbiturates
Benzodiazepines like Diazepam
Caffeine or coffee
Chocolate (My favorite!)
Dopamine
E (Prostaglandin E1 & E2)
Fat
Meperidine
Nitrates
Theophylline
Smoking
Peppermint (mints)

That's all!
-IkaN

Cirrhosis of liver: Concepts, mechanism and pathophysiology

Hello everyone! 

In this really long post, I'll be discussing the pathophysiology of some of the signs, symptoms and conditions seen in chronic liver failure / alcoholic liver disease. We are going to focus on the WHY.

Let's get started ^__^

Why is gynecomastia, testicular atrophy and female pubic hair distribution seen in males with chronic liver failure?
Physiology:
- Liver metabolizes estrogens.
Pathology:
- In cirrosis, estrogen degradation is decreased, so estrogen concentration are elevated causing testicular atrophy, gynecomastia & changes in pubic hair.
- Estrogen also induces SHBG production and this further reduces the free testosterone levels.

Stigmata of diseases

What does stigmata mean?

Stigmata means some lesion, mostly skin, which is visible, showing the patient is suffering from that particular disease.
In some diseases, like leprosy and tuberculosis, the patient may not want to reveal the condition because of the stigmata associated with the disease in society. But due to certain signs, the disease gets revealed. (These diseases were considered a disgrace in earlier days.)

Examples - 

Submissions: Branches of the abdominal aorta flow chart

Hello!
This lovely anatomy flowchart was submitted to us by Benedict Kusi Ampofo.

Thyroid carcinoma mnemonic

Hello! 
I made a real easy way of remembering thyroid tumors :)

Papillary carcinoma mnemonic:
Popular (Most common thyroid cancer)
Palpable lymph nodes (Lymphatic metastasis is common)
Positive I (131) uptake
Post radiation in head and neck (One of the causes)
Pops out of the capsule (Usually encapsulated but invades capsule)
Pops everywhere in the gland (Multifocal)
Positive, pleasing, perfect, parexcellence, peerless prognosis
(Excellent prognosis because it's slow growing)
[Another mnemonic is PG - Papillary, Good prognosis =D ]
Histology:
Popping eyes (Clear nuclei, Orphan Annie Eyes)
Papillary pattern
Psammoma bodies
Pseudoinclusions (Intranuclear cytoplasmatic inclusions)

Study group discussion: Why more phenytoin is prescribed at night

Why do we give phenytoin in 1-0-2 dose after discharge? Why two tablets at night?

Phenytoin causes marked drowsiness that can confound the mental status (read GCS) exam in medicated patients, most critically those who have had neurosurgery and are given phenytoin for postoperative seizure control. In an outpatient being prescribed phenytoin one would plausibly order more to be taken when the patient is likely to be asleep instead of when they're awake.

Thank you for sharing this with us.

One article says, previously, we used to give 300 mg once daily. After chronic use, patients started developing adverse reactions of drug. It was then decided to start using phenytoin in divided doses. (100 mg TID).

Also remember that gingival hyperplasia is a very important and distinctive secondary effect of phenytoin, my teachers say that it stays even if you stop the medicine, but I'm not sure of that since I have not read that anywhere else.

Gift ideas for medical students

1. A card with a witty medical joke.

Natural killer

Difference between heterocyclic aminoacids and aromatic aminoacids

"Are not heterocyclic aminoacids coming under aromatic amino acids? Then why aren't they coming under aromatic amino acids? Why a separate category?"

This question was asked by Anonymous on my "Amino acids with electrically charged side chains mnemonic" blog.

Difference between smooth ER and Rough ER mnemonic

Hello! Hope you're having a good day =)

In today's post, I'll be sharing how to remember the difference between rough endoplasmic reticulum and smooth endoplasmic reticulum.

von Willebrand disease mnemonic

Greetings everyone!

As you all probably already know, I've been studying loads of hematology this week. Here's another compilation of facts + mnemonic on  von Willebrand disease!