ECG axis mnemonic (short version)

Video here:

 

Notes below:

Brainstem & Cortical Strokes | Mnemonic & Tricks

 https://www.youtube.com/watch?v=5SOe6PzbKgQ

HVPG = Hepatic Venous Pressure Gradient

 HVPG = WHVP - Free Hepatic venous pressures 

• WHVP = Wedged hepatic venous pressure
• gradient between pressures in the portal vein and the intra-abdominal portion of IVC 
• When blood flow in a hepatic vein is stopped by a wedged catheter, the proximal static column of blood transmits the pressure from the preceding communicated vascular territory (hepatic sinusoids) to the catheter. Thus, WHVP reflects hepatic sinusoidal pressure.
• In the normal liver, due to pressure equilibration through interconnected sinusoids, wedged pressure is slightly lower than portal pressure, though this difference is clinically insignificant.

➡️ While in Cirrhosis , Sinusoidal interconnection are lost. Therefore, WHVP gives an accurate estimation of portal pressure in cirrhosis !!!

Normal HVPG = 1-5 mm hg 

HVPG >5 = Portal HTN 

HVPG > 10 = Clinically Significant portal HTN 

HVPG > 12 = Threshold for Variceal Rupture = So use Beta Blocker to ⬇️ it.

Measurement of the Hepatic Venous Pressure Gradient (HVPG)

https://www.youtube.com/watch?v=9cEOpr-MRL4

Thank you ! 🩺

Cardiovascular drugs that can cause digoxin toxicity

A number of cardiovascular drugs predispose patients to digoxin toxicity, including verapamil, quinidine, and amiodarone. The dosage of digoxin must be reduced if given concomitantly with these drugs. The presumed mechanism underlying this interaction involves the ability of these drugs to inhibit the P-glycoprotein transporter.

Mnemonic: These drugs cause you to go whack! VAQ - Verapamil, Amiodarone, Quinidine

Other drugs to keep in mind are Diltiazem, Spironolactone, Flecainide.

Mnemonic by Huzefa Bhopalwala

References:

Waldorff S, Hansen PB, Egeblad H, Berning J, Buch J, Kjaergård H, Steiness E. Interactions between digoxin and potassium-sparing diuretics. Clin Pharmacol Ther. 1983 Apr;33(4):418-23. doi: 10.1038/clpt.1983.56. PMID: 6831820.

Andrejak M, Hary L, Andrejak MT, Lesbre JP. Diltiazem increases steady state digoxin serum levels in patients with cardiac disease. J Clin Pharmacol. 1987 Dec;27(12):967-70. doi: 10.1002/j.1552-4604.1987.tb05598.x. PMID: 3437068.

Lewis GP, Holtzman JL. Interaction of flecainide with digoxin and propranolol. Am J Cardiol. 1984 Feb 27;53(5):52B-57B. doi: 10.1016/0002-9149(84)90502-2. PMID: 6695818.

Koren, G., MacLeod, S. CHARACTERISTICS OF DIGOXIN INTERACTION WITH QUINIDINE, VERAPAMIL AND AMIODARONE: IN VIVO AND IN VITRO STUDIES. Pediatr Res 18, 154 (1984). https://doi.org/10.1203/00006450-198404001-00367

SYNTAX score mnemonic

In the SYNTAX (Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) trial, patients with 3-vessel and left main coronary artery disease (LMCAD) treated with coronary artery bypass graft surgery (CABG) compared with percutaneous coronary intervention (PCI) with first-generation drug-eluting stents (DES) had lower 5-year rates of death, myocardial infarction (MI), stroke, or unplanned revascularization.

Abdominal aortic aneurysm notes

Here are my notes for the ABIM. Old post https://www.medicowesome.com/2016/11/step-2-ck-abdominal-aortic-aneurysm.html

-IkaN 

Glimpse into my plan for "Last 18 Days to NEET PG"

 Hello believers at other end,

If You have a plan and it is working well for you then no need to read it further.
All the best and Happy studying.


18 days= 14 days(2 weeks) + 4 days( I would never count in last days )
 

 I) 1st week = divide each day in three major slot and 2 minor slots

By the end of 1st week I want to complete major and minor notes 6 minor + 4 major subject + PYQ +MCQ  of important topics + review images and volatile stuff.

Seems daunting and impossible !?
Say it to yourself "not daunting for me" Just 7 days and see the progress in the end.

morning hours = 

1 hour [ half hour pharma ( General,ANS,CVS,GIT ,RS+HORMONES,NEURO,Antimicrobial) 7 days)

+ 

other half an hour ( Carb,lipid ,proteins,molecular,vitamins) *5days + last 2days when bio is completed I added PSM formulas for half an hour)

9am-12pm  =

PYQ in form of GT on desktop like an exam ( And do it within 1 and half hour superficially) Review wrong ones .( Aim is to go through papers in stipulated time and when you do the same for consecutive 7 days you can analyze a pattern of your mistakes and type of questions being repeated)

12 pm lunch 

Afternoon 12:30- 4pm ( further divide into 2 slots ) 

2 hour fast reading. I complete minor subjects (Ortho,FMT,anesthesia,dermatology,ophthalmology,Ent,psychiatry)

Next 2 hours I divide for major subject (Surgery+med+obsgynae) 2days and 2 hours each. +pedia 1 day only

4-5 I take nap of 15 min and then do volatile stuff
5-6 I go for walk with earphones and revised imp scores criterias  oR TEACH A FRIEND ON PHONE

6-8 I practice MCQ as much as possible.(I do mcq of selective topics sometime mixed bags )

8-9 [half an hour micro ( gram positive,gram negative,viro rna,viro dna,mycobacterium+immuno,parasito,lifecycles) +half an hour Patho ( systemwise with images) ]

9-10 long break with dinner + telegram or updating yourself with any new thing or some series (depend on mood)

10-11 Images +graphs+formulas

11- 12 Previous day video at 2X until I fall asleep



By the end of 1 week = (SURG+MED+PEDIA+OBS) +(Ortho,FMT,anesthesia,dermatology,ophthalmology,Ent,psychiatry) +IMAGES +PYQ +WEAK TOPIC MCQ+PHARMA +MICRO+PATHO+BIOCHEM= 15 SUBJECTS with images.

II) 2nd week =Remaining 4 subjects

Morning hours and after 6pm slot is same .

9-12 pm I give mock after 2 days and aim is time management only . Assess wrong only if not much time is left . (I would advise you to give mock rather than GT )

afternoon = 2 hours ( physio,PSM) + 2 hours (Anat) (Radio I followed what Zainab mam has told us to do )

+COVID notes
+Revision revision and revision

III) 4 days(NO GT) = Revise volatile stuff + pyq incorrect ones+images+ mcq (I plan it accordingly whatever I feel right and confident with )

In free time or breaks I take printout of admit card and keep the necessary documents ready 2 day before.

Plan 2 days before what topics you feel can come and you are not confident with and want to go through it once. write it down .It is your gut feeling :D

NOTE- You need not to follow it like what I have said .I respect your journey as much as I respect mine. So do what makes you confident.

In the end, it is just an exam. You will get another chance. Just stay calm.

All the best.

Colonoscopy screening intervals and management of polyps for ABIM boards

Here is the video

-IkaN

Colonoscopy screening intervals and management of polyps notes

Causes of Membranous nephropathy - Mnemonic

 

Babeosis mnemonic

This is how I remember babeosis is associated with Maltese cross appearance.

You know you love me, xoxo, gossip girl!

-IkaN 

Lesch Nyhan syndrome - Mechanisms (Revised post)

 Hello friends! Let's refresh our biochemistry knowledge today.

Lesch-Nyhan syndrome is characterized by choreoathetosis, dystonia, hyperuricemia, gout, self mutilatory behavior especially self-biting of fingers, and intellectual disability due to HGPRTase mutations.

So how do HGPRTase mutations actually cause dystonia and other extrapyramidal signs and symptoms?

1.)  For the synthesis of dopamine, tetrahydrobiopterin as a cofactor for tyrosine hydroxylase is required.
Tetrahydrobiopterin itself is derived by a series of reactions in which GTP cyclohydrolase is a rate-limiting enzyme.
Now HGPRTase deficiency causes depletion of GTP thereby ultimately depleting tetrahydrobiopterin.

In fact, GTP cyclohydrolase mutations are known to cause dopa-responsive dystonia and phenotype similar to Lesch-Nyhan syndrome.

2.)  Secondly, dopamine receptors are linked to G-protein coupled receptors which alternate between GTP-GDP bound states, yet another link between GTP depletion and perturbation of dopamine signaling.

3.) Adenosine deficiency due to the reduction in salvage may adversely affect the role of adenosine as a neuroprotective agent.

Lastly, in Lesch Nyhan syndrome no characteristic imaging abnormalities are seen but reduced dendritic arborizations in the caudate nucleus, putamen, and nucleus accumbens are thought to underlie clinical manifestations.

So to summarise, Lesch Nyhan syndrome can be considered as one of the basal ganglia disorders with Wilson's disease and Huntington's disease being the other notable ones.

Have a great day!

-Kirtan Patolia

Celiac Disease (Spectrum of Manifestations)

 Hello friends! I hope all of you are doing well. Today I wanted to share with you the many faces of Celiac Disease. Although considered as the disease which chiefly causes gastrointestinal symptoms, the entire spectrum of possible manifestations it can cause is quite broad.

Some significant associations are as follows:

1.) GI- Enteropathy associated T-cell lymphoma (EATL), Microscopic colitis

2.) Liver- NASH

3.) Spleen- Functional Asplenia (SLE & Amyloidosis being other notable causes)

4.) CNS- Seizures with posterior cerebral calcification, Neuro-psychiatric symptoms, Ataxia

5.) Hematology- Evans syndrome

6.) Pulmonary- Diffuse alveolar hemorrhage

Here is the full spectrum. Hope you like it.

-Kirtan Patolia

Overview of methods of haemostasis in surgery

Contrast induced nephropathy

 

Hormone Basics - Part 1

 Hormones are divided into 2 groups

Group 1 hormones- Act via nuclear receptors

    Type 1- Have cytoplasmic receptors with effector elements in the nucleus e.g Steroid hormones (cortisol), Gonadal hormones (Androgens, estrogens, progesterones)

Mnenonic- There is only 1 General Secretary

  Type 2 -Directly act at the nucleus e,g, vit D,vit A, Thyroxine

Mnemonic-Directly AcT at the nucleus

Group 2 hormones-  Act via the cell membrane surface receptors

1. GPCR- Very extensive, will require a second post

2.Tyrosine Kinase- All Growth factors(Except TGF alpha and beta) and Insulin (Tip to remember: TKI or tyrosine kinase inhibitors are used in a lot of malignancies, there's abnormal growth in malignancies and hence TKIs stop that growth, also I in TKI will remind you of insulin, Insulin causes fat to grow!!)

3. JAK-STAT(cytokine receptor) Mr. JAcK is a Drunkard!! all he needs is PEG 

Prolactin, 

Erythropoietin, 

Growth hormone.

(Pro tip: GH and PRL are called as twin hormones, JAK STAT mutations are involved in Myeloproliferative disorders say Polycyathemia and erythropietin is needed there)

4.Serine threonine Pathway: This pathway is a perfect BAIT for the hormones.

Bone morphogenic protein  

Activin

Inhibin

Trasformation growth factor alpha and beta

That's all for today!

Have fun and stay safe!

How did you find the post?

Let me know in the comments section below!

Dr. ShilPill

Osler's triad mnemonic

 

Thank you!

Reactive arthritis mnemonic

 

Thank you!

Dizziness & Vertigo | Harrison’s IM

IgG4-related systemic disease mnemonic

It is chronic disease characterized by fibrosis and sclerosis of various tissues due to infiltration with lymphocytes that secrete IgG4. Manifestations include sclerosing sialadenitis, retroperitoneal fibrosis, autoimmune pancreatitis, Riedel thyroiditis, tubulointerstitial nephritis, and other fibrosclerotic conditions.

That's all!

Thank you.