Sunday, June 18, 2017
Step 2 CK: Management of thromboembolic stroke
Drugs used to lower BP acutely in severe preeclampsia mnemonic
Drugs used to lower blood pressure acutely in severe preeclampsia (Maternal hypertensive crisis) mnemonic
"Lower Hypertension Now"
Labetalol iv preferred (Avoid in bradycardia)
Hydralazine iv
Nifedipine oral
That's all!
-IkaN
Micturition and Neurological diseases
Here, presenting you a detailed description of Pathologies of Bladder in Neurology. I believe this is the best resource on this topic available online for free. :)
Diaphragmatic hernia : Mnemonic and Review
Here's a short post on the key points about Congenital Diaphragmatic Hernia.
So there's deficiency in the diaphragm during development causing abdominal contents to budge into the Thorax.
There are 2 main types -->
1. Bochdalek.
2. Morgagni.
Now out of these 2, Bochdalek is commoner.
(It's hard to remember the word Bochdalek. I struggle with it every day. )
You can memorize it by realising that it rhymes with ' Scotch da Lake '
(Which means a lake of scotch in Punjabi)
Key points about Bochdalek -
BBBB
- Back - Located posteriorly
- Big - Bigger than the Morgagni form
- Bad - Poor prognosis
- Bag and Mask Contra indicated.
Also realise - Bochdalek
So it's got an L in it. L = Left. So it's more common on the left side. These hernia classically cause a scaphoid abdomen and Mediastinal shift to the opposite side.
Morgagni can be remembered by the opposite of the BBB
So it's
- Not on the back - Anteriorly
- Not Big - Small sized.
- Not as Bad - Prognosis is alright.
Also realise - Morgagni
It's got an R in it = Right. So it's more common on the right side. And it contains the Transverse colon generally.
So that's all !
Happy studying!
Stay awesome !
~ A.P.Burkholderia
Croup : Review of key points
Here's a short Mnemonic/Review of Important facts about Croup - Acute Tracheobronchitis !
Remember :
CROUPS
C - Common respiratory disease
R - Respiratory viruses like Parainfluenza
O - Oxygen Treatment (Humidified)
U - Ugly Cough - Barking / Seal like cough
P - Prodrome of illness followed by Inspiratory Stridor
S - Steeple sign on X Ray
It's helpful to remember Acute EPIGLOTTITIS as the complete opposite of CROUPS using similar ideas.
- Not as common.
- Caused by Bacteria generally (Strep , Hib)
- Oxygen Therapy + AntiBiotics
- Ugly - Sniffing dog like position + Drooling
- Prodrome not particularly, but Stormy acute onset.
- Shows Thumb print appearance on X Ray.
Hope this helped !
Happy Studying !
Stay awesome.
~ A.P.Burkholderia
CMS neurology form 2: Question on numbness, tingling and decreased grip strength
Differentiating C8 radiculopathy from ulnar neuropathy
Hello. This is a very short post (because I am super busy studying)
It's on differentiating C8 radiculopathy from Ulnar neuropathy based on a question I solved the other day. How would you differentiate the two in clinical practice?
C8 radiculopathy:
- Thumb abduction weakness: abductor pollicis brevis (C8, T1)
- Triceps affected (C6, C7, C8)
- Radiculopathies are often painful.
Ulnar neuropathy:
- Hand intrinsics (C8, T1) affected:
Palmar and dorsal interossei
Lumbricals III & IV
Abductor/opponens/flexor digiti minimi
- Basically, all hand intrinsics except for the median-supplied "LOAF" muscles (lumbricals I & II, opponens/ abductor/flexor pollicis brevis)
- Triceps not affected.
- Focal neuropathies aren't painful.
Conclusion: The ulnar nerve innervates all intrinsic hand muscles, except the abductor and flexor pollicis brevis, opponens pollicis, and lateral two lumbricals, which are innervated by C8 and T1 via the median nerve which helps differentiating the ulnar neuropathy from C8 radiculopathy.
That's all!
-IkaN
Saturday, June 17, 2017
Pills of knowledge in Ophthalm- Anterior ciliary artery
The point where the anterior ciliary artery pierces the sclera is often marked by a pigment. This is of particular importance while cauterization as in a bid to make everything look neat and shiny, the pigmented part shouldn't be cauterized as it will cause necrosis of the structures supplied by the artery.
Effects of Angiotensin-II on GFR
So this is a highly confusing topic. No matter how many times you read it, some amount of doubt is always there in your mind. So an advice to the readers, bookmark this post because you will be needing to read it more than once to get the drift.
First of all, let us review the effects of Angiotensin II on Glomerulus.
It constricts both the afferent and efferent arterioles but preferentially increases efferent resistance. Why? 3 reasons:
1. Efferent arterioles have a smaller diameter in their basal state.
2. Ang II stimulates the release of vasodilator NO from the afferent arteriole.
3. Ang II minimizes vasoconstriction at the afferent arteriole via the stimulation of Ang II type 2 (AT-2) receptors, which result in vasodilatation through a CYP450 dependent pathway.
The net effect of preferential rise in efferent arteriolar resistance is that the glomerular pressure is increased or stabilized(in hypoperfusion states), which helps to maintain or increase GFR. But in the long run, lots of fluid have been filtered out leaving behind the proteins which raise the colloid osmotic pressure, eventually enough to overrule the hydrostatic pressure and hence it leads to decrease in GFR.
Ang II also reduces GFR by causing constriction of the mesangial cells which reduces the effective surface area for filtration.
-VM
Pills of knowledge in Ophthalmology- Squint and refractive errors
1.A refractive error should be thoroughly assessed prior to surgical squint correction or the squint may recur.
2. Divergent squint occurs in myopes as the divergent system of muscles is more active during far vision. So, the far vision in myopes being hampered, the eyes try to diverge more.
3. Same goes for hypermetropes. They end up with a convergent squint if left uncorrected.
-That's all!
Sushrut Dongargaonkar
Differentiating peroneal neuropathy, sciatic nerve injury and L5 radiculopathy
Peroneal nerve supplies the dorsiflexors and evertors of the foot. There will be no weakness in plantar flexion and inversion in peroneal nerve injury.
- Acute foot drop (difficulty dorsiflexing the foot against resistance or gravity).
- Patients describe the foot as limp; there is a tendency to trip over it unless they compensate by flexing the hip higher when walking, producing what is called a "steppage" gait.
- Patients may also complain of paresthesias and/or sensory loss over the dorsum of the foot and lateral shin.
- Examination typically reveals weakness in foot dorsiflexion and foot eversion (deep and superficial peroneal nerve-innervated, respectively), with normal inversion and plantar flexion (posterior tibial nerve).
- Sensory disturbance is confined to the dorsum of the foot, including the web space between digits 1 and 2 and the lateral shin.
- Reflexes are normal.
- Weakness affecting most of the lower leg musculature, including the hamstrings.
- Hip flexion, extension, abduction and adduction, and knee extension are normal.
- Sensory loss involves the entire peroneal, tibial, and sural territories.
- In the lower leg, however, the medial calf and arch of the foot may be spared secondary to innervation by the preserved saphenous nerve (a branch of the femoral nerve). Sensation is also spared above the knee both anteriorly and posteriorly.
- The knee jerk is normal, but the ankle jerk is unobtainable.
- Back pain that radiates down the lateral aspect of the leg into the foot.
- On examination, strength can be reduced in foot dorsiflexion, toe extension, foot inversion, and foot eversion.
- Mild weakness in leg abduction may also be evident in severe cases due to involvement of gluteus minimus and medius. Atrophy may be subtle; it is most readily observed in extensor digitorum brevis.
- Sensory loss is confined to the lateral shin and dorsum of the foot.
- Reflexes are generally normal.
-IkaN
Friday, June 16, 2017
Alvarado Score Parameters Mnemonic ; For Appendicitis
Anorexia or ketones in urine - 1
Leukocytosis >10,000 -2
Vomiting/Nausea -1
migrAtory pain to right iliac fossa -1
Rebound tenderness -1
temperAture above 37.3 celsius -1
tenDerness in right iliac fossa -2
neutrOphilia >70% -1
Of these the second parameter from above and second parameter from below have 2 points credited for each. Every other parameter is credited with 1 point each.
The overall aggregate comes out of 10, which the highest possible score for Alvarado score.
If, the aggregate is,
<3 - Low risk for appendicitis
4-6 - Mid risk for appedicitis
>=7 - High risk for appendicitis
In some hospitals where a differential count is difficult to find, use a modified score with 9.
That's all guys, if you find any mistake let me know.
With love,
Jay~
P.S. - yayyy.....missed me much awesomites? I was away from the blog for the last 6 months from posting, because I had very disastrous scores for surgery in my university and I didn't feel worthy enough to write for you guys. (So my activity was largely concentrated in the Whatsapp Medicowesome groups, and the Author's page.) Anyways, I had to take a remedial exam for Surgery 2 weeks ago. And BAAM!!!!.....the results were released today, and yayyyyy.....I passed surgery! :)
I must thank all my Medicowesome admin/author collegues for tolerating my rants and, help me to push through the hellish scary time together. Thanks everyone. Finally I'm through it, and I'm back to writing for you all guys. So thought to start the first post after returning, with a General Surgery Diagnosing score with the help of Schwartz Textbook of Surgery.
See ya soon peepz! :)
Thursday, June 15, 2017
Pills of knowledge in Ophthalm- Posterior staphyloma
A posterior staphyloma is common because the durability of the layers of the eye where the optic nerve enters the eye is lesser in comparison.
-That's all!
Sushrut Dongargaonkar