Hello!
These are frequently tested on the USMLEs, so be aware of them :)
These are frequently tested on the USMLEs, so be aware of them :)
Wednesday, October 11, 2017
Tuesday, October 10, 2017
Quick Facts - Fried Egg Appearance!
Hello everybody!
So the next time you make your own fried egg add some medicine to it!
Here is a list of certain characteristic fried egg appearances that you may Come across:
Mycoplasma Pneumoniae colonies show fried egg colonies on Eaton agar.
Oligodendroglioma cells show a fried egg appearance.
Hairy cell leukemia cells on bone marrow biopsy.
Seminoma and Dysgerminoma cells on light microscopy.
Parietal cells of the stomach due to acidophilic cytoplasm & large central nuclei also resemble fried egg appearance.
Plasma cells in MULTIPLE MYELOMA
Malassezia furfur
They also show fried egg appearance on sabourauds dextrose agar with olive oli overlay.
They also show fried egg appearance on sabourauds dextrose agar with olive oli overlay.
Let's learn Together!
Medha.
Medha.
Quick Facts - Human Herpes Virus 6!
Hello everyone!
Here are some quick important facts for the Human herpes Virus 6 (HHV-6)
HHV-6 affects T cells binds to CD46.
It has two variants 6A and 6B
The 6B variant causes 6th disease (easy to remember HHV-6 causes 6th disease)
also called as Roseola infantum or exanthema subitum in children.
Roseola infantum -The disease is characterized by high grade fever wherein Febrile seizures can be seen.
After the defervescence the Rash classically appears.
One important finding is Nagayama spots which are small reddish papular lesion seen on the soft palate.
In Older age grp causes Infectious Mononucleosis like disease.
If you have more facts on it, Do share!
-Let's Learn Together!
Medha
USMLE Step 3: CCS Inflammatory bowel disease checklist
These are just my notes / checklist from the UW case 3. This post will not make sense to you if you are not preparing for CCS.
How to remember Sulfasalazine is associated with low sperm count
Hello!
I keep forgetting that sulfasalzine is the IBD drug associated with oligospermia... Sooo mnemonic.
I keep forgetting that sulfasalzine is the IBD drug associated with oligospermia... Sooo mnemonic.
Sunday, October 8, 2017
High tHcy associated with mortality from acute stroke!
Hey Awesomites
Various prospective studies in the past years have concluded that high levels of total Homocysteine ( tHcy ) are an independent risk factor for increased mortality from ischemic stroke, after adjustment of confounding factors!
This association is only significant in the large vessel atherosclerosis stroke subtype, and is relatively not significant in small vessel occlusion subtype.
The question that now arises is - Do elevated plasma tHcy levels cause more serious strokes or is it that more serious strokes result in higher tHcy levels?
Studies have found that elevated tHcy levels induce oxidative injury to vascular endothelial cells and impair the production of NO, thus increasing the arterial pressure and risk of stroke.
Also, tHcy enhances platelet adhesion to endothelial cells, promotes the growth of vascular smooth muscles, and is associated with higher levels of prothrombotic factors such as Beta- thromboglobulin, tissue plasminogen activator, and factor VII C.
Whether the more serious strokes increase levels of tHcy and the changes in the levels before and after the acute episode needs further studies for clarification.
Note : High tHcy is not a cause of stroke and is not associated with stroke severity. Patients in the highest tHcy quartile ( >18.6 umol/L ) with Acute ischemic stroke in large vessels of brain are in increased risk of Long - term mortality.
Therapy to control and lower tHcy levels with vitamin B supplements has been shown to reduce the risk of stroke and other acute cardiovascular events.
Metabolic B12 deficiency is present in 30% of vascular patients over the age of 70 years, while higher doses of B12 are required in elderly people than younger ones.
However, renal function tests should be done before starting the supplementation because high doses of cyanocobalamine increase cyanide levels in patients with renal impairment ( GFR <50 ml/min ).
( Source )
That's all
- Jaskunwar Singh
Various prospective studies in the past years have concluded that high levels of total Homocysteine ( tHcy ) are an independent risk factor for increased mortality from ischemic stroke, after adjustment of confounding factors!
This association is only significant in the large vessel atherosclerosis stroke subtype, and is relatively not significant in small vessel occlusion subtype.
The question that now arises is - Do elevated plasma tHcy levels cause more serious strokes or is it that more serious strokes result in higher tHcy levels?
Studies have found that elevated tHcy levels induce oxidative injury to vascular endothelial cells and impair the production of NO, thus increasing the arterial pressure and risk of stroke.
Also, tHcy enhances platelet adhesion to endothelial cells, promotes the growth of vascular smooth muscles, and is associated with higher levels of prothrombotic factors such as Beta- thromboglobulin, tissue plasminogen activator, and factor VII C.
Whether the more serious strokes increase levels of tHcy and the changes in the levels before and after the acute episode needs further studies for clarification.
Note : High tHcy is not a cause of stroke and is not associated with stroke severity. Patients in the highest tHcy quartile ( >18.6 umol/L ) with Acute ischemic stroke in large vessels of brain are in increased risk of Long - term mortality.
Therapy to control and lower tHcy levels with vitamin B supplements has been shown to reduce the risk of stroke and other acute cardiovascular events.
Metabolic B12 deficiency is present in 30% of vascular patients over the age of 70 years, while higher doses of B12 are required in elderly people than younger ones.
However, renal function tests should be done before starting the supplementation because high doses of cyanocobalamine increase cyanide levels in patients with renal impairment ( GFR <50 ml/min ).
( Source )
That's all
- Jaskunwar Singh
Saturday, October 7, 2017
Heme Synthesis Mnemonic
Hello Everyone!
Lets discuss heme synthesis today. Here's the Pathway:
That's all,
Thankyou
-Chai
Lets discuss heme synthesis today. Here's the Pathway:
That's all,
Thankyou
-Chai
Post - intubation Cardiac Arrest : possible mechanisms
Hey Awesomites
Early post - intubation Cardiac Arrest ( within 10 minutes ) is a serious major complication of emergency intratracheal intubation associated with high in - hospital mortality, and occurs with approximately 2% frequency in the ED.
Various retrospective and case- control studies have been well designed to establish the connection and factors associated in the causation. One of the studies by Heffner et al. found that a higher pre - intubation shock index ( PISI ), that is defined as heart rate divided by systolic BP, and a higher weight of the patient are independently associated with post - intubation CA.
Systolic hypotension ( BP less than 90 mmHg ) is independently associated with post - intubation CA.
Emergency intubation can cause hypotension potentially as a consequence of actual intubation acting as a sympatholytic stimulus, mechanical ventilation ( positive pressure ventilation with subsequent fall in venous return ), and/ or the induction agents used.
Also important to note is that the association between pre - intubation hypotension and post - intubation progressive decline in BP and subsequently pulseless electrical activity arrest raises the question of whether treatment of hypotension before intubating by fluid resuscitation and vasopressors can decrease the rate of post - intubation CA.
That's all
- Jaskunwar Singh
Early post - intubation Cardiac Arrest ( within 10 minutes ) is a serious major complication of emergency intratracheal intubation associated with high in - hospital mortality, and occurs with approximately 2% frequency in the ED.
Various retrospective and case- control studies have been well designed to establish the connection and factors associated in the causation. One of the studies by Heffner et al. found that a higher pre - intubation shock index ( PISI ), that is defined as heart rate divided by systolic BP, and a higher weight of the patient are independently associated with post - intubation CA.
Systolic hypotension ( BP less than 90 mmHg ) is independently associated with post - intubation CA.
Emergency intubation can cause hypotension potentially as a consequence of actual intubation acting as a sympatholytic stimulus, mechanical ventilation ( positive pressure ventilation with subsequent fall in venous return ), and/ or the induction agents used.
Also important to note is that the association between pre - intubation hypotension and post - intubation progressive decline in BP and subsequently pulseless electrical activity arrest raises the question of whether treatment of hypotension before intubating by fluid resuscitation and vasopressors can decrease the rate of post - intubation CA.
That's all
- Jaskunwar Singh
Tuesday, October 3, 2017
Fact of the day : Easier approach shot to the pouch of Douglas
Hey Awesomites
The posterior fornix of the vagina is separated from the peritoneal cavity by a single layer of peritoneum and the posterior vaginal wall. Therefore, vaginal approach from its posterior aspect for evacuation of pus in the pouch of Douglas can be done without much difficulty.
On the other hand, approach to uterovesical pouch ( anterior relation ) is much more difficult from the vaginal route and consists of a series of steps :
- Incise the vagina
- separate bladder from cervix
- Traverse the vesicocervical space ( till the uterovesical fold of peritoneum is reached )
This difference is due to the normal physiological position of the uterus that is anteverted and anteflexed; the direction of external os being downwards and backwards.
That's all
- Jaskunwar Singh
The posterior fornix of the vagina is separated from the peritoneal cavity by a single layer of peritoneum and the posterior vaginal wall. Therefore, vaginal approach from its posterior aspect for evacuation of pus in the pouch of Douglas can be done without much difficulty.
On the other hand, approach to uterovesical pouch ( anterior relation ) is much more difficult from the vaginal route and consists of a series of steps :
- Incise the vagina
- separate bladder from cervix
- Traverse the vesicocervical space ( till the uterovesical fold of peritoneum is reached )
This difference is due to the normal physiological position of the uterus that is anteverted and anteflexed; the direction of external os being downwards and backwards.
That's all
- Jaskunwar Singh
Basic modalities of Transitional Zone
Hey Awesomites
Squamocolumnar junction ( the transitional zone ) is a junction formed by merging of squamous epithelium of the vagina with the columnar epithelium of endocervix.
Squamous non keratinized epithelium lining the vaginal mucosa has three distinct layers -
- Basal layer of cuboidal cells
- Middle layer of prickle cells
- Superficial layer of cornified cells
Embryologically, the junction consists of columnar epithelium that spreads over the external os and only the basal and middle layer of squamous epithelium lining the vaginal mucosa.
After attaining puberty, hormonal effects of oestrogen and progesterone induce metaplastic changes in columnar epithelium. Therefore, the squamous epithelium comes in close vicinity to the external os.
During reproductive age, growth of uterus, hypertrophy of cervical cells and associated hormonal changes and in females exposed to DES in utero, the transitional zone extrudes well out of the external os.
Due to high cellular activity and sensitivity to certain irritants and mutagens, there is high risk of dysplastic changes in the squamocolumnar epithelium and eventually carcinoma cervix. So, scrapings for PAP smear are done without difficulty from this exposed area to screen the patients.
In menopausal women, the atrophy of cervix leads to in drawing of SCJ into the canal. Hence the junction is not easily accessible and this ill exposure is the reason for high rates of false negative findings in PAP smear in older women! Hormonal therapy in such patients improves the positivity of results.
That's all
Jaskunwar Singh
Squamocolumnar junction ( the transitional zone ) is a junction formed by merging of squamous epithelium of the vagina with the columnar epithelium of endocervix.
Squamous non keratinized epithelium lining the vaginal mucosa has three distinct layers -
- Basal layer of cuboidal cells
- Middle layer of prickle cells
- Superficial layer of cornified cells
Embryologically, the junction consists of columnar epithelium that spreads over the external os and only the basal and middle layer of squamous epithelium lining the vaginal mucosa.
After attaining puberty, hormonal effects of oestrogen and progesterone induce metaplastic changes in columnar epithelium. Therefore, the squamous epithelium comes in close vicinity to the external os.
During reproductive age, growth of uterus, hypertrophy of cervical cells and associated hormonal changes and in females exposed to DES in utero, the transitional zone extrudes well out of the external os.
Due to high cellular activity and sensitivity to certain irritants and mutagens, there is high risk of dysplastic changes in the squamocolumnar epithelium and eventually carcinoma cervix. So, scrapings for PAP smear are done without difficulty from this exposed area to screen the patients.
In menopausal women, the atrophy of cervix leads to in drawing of SCJ into the canal. Hence the junction is not easily accessible and this ill exposure is the reason for high rates of false negative findings in PAP smear in older women! Hormonal therapy in such patients improves the positivity of results.
That's all
Jaskunwar Singh
Types of tympanic membrane perforation
Hello Awesomites ! :D
There are different types of perforation of tympanic membrane. We name it on the basis of :-
1. Size of perforation
2. Site of perforation
So, let us begin.
ACCORDING TO SIZE OF PERFORATION,
1. Pinhole :- 1-2 mm in size.
2. Small :- Area involving one quadrant or <10% of pars tensa.
3. Medium :- Area involving 2-3 quadrant or 10-40% of pars tensa.
4. Subtotal :- Area involving the pars tensa >75% and does not involve the annulus.
5. Total :- A total perforation is present in tympanic membrane. Tympanic membrane is essentially absent and involve annulus also.
ACCORDING TO SITE OF PERFORATION,
1. Anterior
2.Posterior
3.Inferior
4.Central
OR,
1.Central :- A simple perforation in pars tensa with intact annulus.
Perforation is surrounded all around by pars tensa.
2. Marginal :- Perforation in the pars tensa surrounded partly by pars tensa and partly by bone.
3. Attic :- Perforation in pars flaccida.
I found this topic very confusing in my exams.
I hope it helped. :D
Have a great day ahead.
-Upasana Y. :)
Monday, October 2, 2017
Corpus Callosum - Let's connect
Hey Awesomites
Jas here
I am back :)
Let's talk about the largest connective pathway in the brain, the Corpus Callosum that is made up of more than 200 million nerve fibres, connecting our left brain to the right.
Jas here
I am back :)
Let's talk about the largest connective pathway in the brain, the Corpus Callosum that is made up of more than 200 million nerve fibres, connecting our left brain to the right.
Friday, September 29, 2017
Rotator Cuff muscles and their actions (mnemonic)
To remember the actions of Rotator Cuff muscles ( Supraspinatus, Infraspinatus, Teres Minor and Subscapularis), just remember the following:
1- The mnemonic for the muscles is: SITS
2- We will start with ABDuction and finish with ADDuction
3- The vowels in English can be remembered by AEEIou ( shout to remember better :P )
4- Now just match letters from the 2 mnemonics in the same order they are written in
as you can see in the table:
So S goes with A...I goes with E...T goes with E and the last S goes with I.
Never forget the action of Rotator Cuff muscles again :)
-Murad
1- The mnemonic for the muscles is: SITS
2- We will start with ABDuction and finish with ADDuction
3- The vowels in English can be remembered by AEEIou ( shout to remember better :P )
4- Now just match letters from the 2 mnemonics in the same order they are written in
as you can see in the table:
So S goes with A...I goes with E...T goes with E and the last S goes with I.
Never forget the action of Rotator Cuff muscles again :)
-Murad
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