Volume of ascitic fluid, abdominal assessment in ascites and my viva incident

Hey everyone!

A colleague asked this question on the study group  - What volume of ascitic fluid are the following tests positive: Puddle sign, Shifting dullness, Fluid thrill?

What I found out - Minimum amount of fluid required for detection of ascites by various methods are:

Diagnostic tap 10 - 20 ml

Ultrasonography 100 ml

CT scan 100 ml

Puddle sign  120 ml

Shifting dullness 500 ml
Fluid thrill 1000 - 1500 ml

I would also like to add an incident that happened in my viva:

I had a patient with liver cirrhosis in my exam. The examiner asked me that which physical examination signs I knew for the detection of suspected ascites and what my findings were.

Why does thiazide, a diuretic, cause a paradoxical anti-diuretic effect in Diabetes insipidus?

Hey everyone!

I have explained this before (In one of my earlier posts on free water clearance) but someone found my language too complicated to understand. So I decided to write this post.. An explanation which is "free" of complicated terms like free water clearance. Yaay! :D

ADH absorbs water. In nephrogenic diabetes insipidus, the kidney is unresponsive to ADH.

What do you then?

You use a drug called thiazide.

Thiazide diuretics inhibit the NaCl co-transporter  in the renal distal convoluted tubule (DCT).
The DCT is water impermeable.. So the DCT action is NOT how thiazides preserve water.

Then what is preserving water?

Submissions: Mature defense mechanisms mnemonic

Mature defense mechanisms mnemonic

SMASH
Suppression
Mature defenses
Altruism
Sublimation
Humor

This mnemonic was submitted by mist amidst

Ethosuximide mnemonic

Greetings everyone!

This little pharmacology pearl was written by Keto :)

eThosuximide is the T drug.

It blocks the T-type Ca2+ channels:
T stands for Transient which can be found in the Thalamus.

Remember, that thalamus is a relay nucleus with a lot of subnuclei. Everything travels through, EXCEPT smell. So a patient with "Transient" absence (peTiT mal) seizure, you can let them smell something to bring them back. And... eThosuximide is the drug they need.

Study group discussion: Monroe Kenri's Law

Here's a cool fact:

Monroe Kenri's law states that cerebral perfusion pressure = Mean blood pressure (MBP) - Intracranial pressure (ICP)

Hence, in cases of increased ICT or intrcranial heamorrhage, BP rises.
This is physiological so that blood supply to the brain can be maintained.

Hence, in cases of stroke, never try to reduce BP unless it is above 200. If you reduce BP, the blood supply to brain is compromised.

Cushing's triad in cases of increased ICT:
1. Increased BP
2. Bradycardia
3. Irregular respiration.
(Because increased ICP compresses the brain stem)

Related post: Cushing's triad (How to make medical notes)

Bleomycin metabolism

This is a short post on pharmacology!

Bleomycin is inactivated by a cytosolic cysteine proteinase enzyme, Bleomycin hydrolase.

This enzyme is widely distributed in normal tissues with the exception of the skin and lungs, both targets of Bleomycin toxicity.

This is why, Bleomycin causes pulmonary fibrosis.

It's also why bleomycin is used in skin cancers like squamous cell cancer.

That's all!

-IkaN

Hyperphosphatemia in chronic kidney disease

This is a really short post :D

What's the mechanism behind hyperphospatemia in kidney disease?

Kidney activates vitamin D.

Tarsal Bones Mnemonic

Hey guys, Jay here once again. Today I was studying my anatomy, and our lower limb region is going on. Since our regional exam is next week, I wanted to study the foot and especially the tarsal bones. Me, the one who is so fond of mneumonics, tried finding some mnemonic to remember the tarsal bones. I found one on internet I made one myself. So let me first list the tarsal bones.
1. Calcaneous
2. Talus
3. Navicular
4. Medial cuneiform
5. Intermediate cuneiform
6. Lateral cuneiform
7. Cuboid

The one on Internet:

The Circus Needs More Interesting Little Clowns

But in this Calcaneous and Talus have exchanged places. So when I saw this, I edited it a bit. :) So it kinda goes with the first syllable as well. ^_^

CaT Navy Meets Interesting Little Cubs

CaT has Calcaneous and Talus both.

Hope it helped Awesomites. :) Until we meet again then, Ciao!! Au revoir!!! :D

《Jay》

Heart murmurs mnemonic

Hello people with a pumping heart in their chests, obviously! <3

In this post, I'll be taking about the few mnemonics I use in relationship to murmurs.

"PASS" is a good mnemonic for remembering that pulmonic and aortic stenosis give a systolic murmur.

The opposite of PASS, ie, other two valves and the other defect gives a systolic murmur too. (Mitral and tricuspid regurgitation gives a systolic murmur!)

VSD has a S so that's systolic.

Now, the other ones - pulmonic and aortic regurgitation, mitral and tricuspid stenosis will cause diastolic murmurs :)

Here's another mnemonic submitted by one of the readers:

Primary, secondary and tertiary hyperparathyroidism mnemonic

This idea was submitted by Keto. It helps go through Calcium and Phosphorous levels very quickly.

The values are somewhat logical and can be thought through.. But if you're on ward or on a board exam this can be handy.

Hyperparathroidism mnemonic

Why is there an increased white cell count in sickle cell anemia?

Hello sweet people!

I spent today's free time searching for what is the cause of leukocytosis in sickle cell anemia =P

Sickle cell disease typography

Making Referrals - Bio Medical Ethics

Hey awesomites, I'm Jay, and I'm your new Medicowesome contributor! yayy!! :) And today we are going to talk about Referrals. This is another important ethical responsibility of a physician.

A physician’s Central responsibility is WELFARE OF THE PATIENT, and that means, Physician should work for the best interest of the patient not him/herself.

Referral simply means that, when we reach the boundaries of our competence, we should hand our patient to a more competent physician. Keeping a patient with ourselves to hide our incompetency or to earn more money is a huge NO-NO!!!

We shouldn’t be ashamed to ask for help from our colleagues, and we shouldn’t be continuing to treat a patient, if we cannot give him/her a fruitful therapy as our boundary of competency has reached. That’s when we should write a LETTER OF REFFERAL to a Consultant(BritE)/Attending(AmE) Physician or to another colleague with a broader knowledge or idea of the subject.

Submissions: Bio medical ethics

Bio Medical Ethics - by Jay ™

Today’s blog post is about Bio Medical ethics or Ethics of Medical care that a health care practitioner has to adhere to.

Medical ethics started off as Hippocratic Oath made in 460~ BC in the Book called Corpuz Hippocratum.

“Do No Harm” is the Primary Ethical concern of Medical Ethics.