Sunday, May 31, 2015

Fallopian tube facts and mnemonics

Hello! I read some facts about the fallopian tube so I'll be sharing it with you today!

What part of the fallopian tube does fertilization occur?
Ampulla of the fallopian tube is the most common site for fertilization.

Sometimes, the embryo isn't transported to the uterus by the cilia, causing ectopic pregnancy. This is why, ampulla of the fallopian tube is the most common site of ectopic pregnancy.

How do I remember this? Mnemonic!
FAME
Fertilization
AMpulla
Ectopic

Another random fact to remember is, isthmus is most common site of rupture of ectopic pregnancies because it is inflexible and has a thick muscularis.

Mnemonic: ISTHMUS
Inflexible
Stiff
THick
MUScularis

That's all!
-IkaN

Tuesday, May 26, 2015

Meckel Gruber syndrome mnemonic

Hello everyone!

We are going to learn about Meckel Gruber syndrome today!

It's an autosomal recessive syndrome characterized by GRUBEP!

G: ambiguous Genitalia
R: Renal dysplasia
U: Ureteric hypoplasia
B: Bladder hypoplasia
E: Encephalocele
P: Polydactyly
Pancreatic dysplasia

That's all!

There is nothing free except the grace of God.

-IkaN

Remembering Apgar scoring.

Hello awesomites, finding it difficult to remember the components of Apgar score? Well, I think grouping them makes it easy-

1. The heart and lungs lie close hence,  you can group 'heart rate' and 'respiratory effort' together.

2. Reflexes are carried out none other than muscles, hence 'muscle tone' and 'reflex irritability' or 'reflex response' go into the second group.

3. Color, now it is easy to remember.

That's all!

Sunday, May 24, 2015

Study group discussion: CPS 1 and CPS 2

Today's discussion is about Carbamoyl Phosphate Synthetase!

What are differences between CPS 1 and CPS 2?

CPS 1 works in the urea cycle.
CPS 2 in pyramidine synthesis.

CPS 1 is mitochondrial.
CPS 2 is cytosolic.

(Medicowesome mnemonic: Two is cys-two-lic)

The source of nitrogen for CPS 1 is ammonia.
For CPS 2, it is the amide group of glutamine.

N acetyl glutamate is activator for CPS 1.
ATP is activator for CPS 2.

Woah that's a lot of points I didn't know about!

Study group discussion: Leucine, tryptophan and niacin

Which essential amino acid interferes with the conversion of which another essential amino acid into niacin?

Leucine.

In shorghum or jowar, high leucine content inhibits conversion of tryptophan into niacin active form.

Any one knows the mechanism?

Because it inhibits quinolinate phopshoribosyl transferase.

Friday, May 22, 2015

Hormonal changes during menopause mnemonic

Short post for the day! :)

"EPIc FALL"
- Estrogen
- Progesterone
- Inhibin
levels Fall during menopause.

Monday, May 18, 2015

Estrogen and osteoporosis

Lack of estrogen causes a decrease in osteoprotegerin.

Osteoprotegerin (OPG), also known as osteoclastogenesis inhibitory factor (OCIF), is a cytokine and a member of the tumor necrosis factor (TNF) receptor superfamily.

Osteoprotegerin inhibits the differentiation of macrophages into osteoclasts and also regulates the resorption of osteoclasts.
Mnemonic: Osteoprotegerin protects bone (By preventing macrophage differentiation into osteoclasts.)

Osteoprotegerin, a RANK homolog, works by binding to the RANK-ligand on Osteoblast/Stromal cells, thus blocking the RANK-RANK lingand interaction between Osteoblast/Stromal cells and Osteoclast precursors. This has the effect of inhibiting the differentiation of the Osteoclast Precursor into a mature Osteoclast.
Mnemonic: Osteoprotegerin ranks high in protecting bones.

So, estrogen kinda inhibits the osteoclasts which causes osteoporosis is the moral of the story?

Yep.

Extra: Recombinant human osteoprotegerin specifically acts on bone, increasing bone mineral density and bone volume. Osteoprotegerin has been used experimentally to decrease bone resorption in women with postmenopausal osteoporosis and in patients with lytic bone metastases.

That's all!

-IkaN

Friday, May 15, 2015

Submissions: Chagas disease notes

Here are some beautifully presented points on Chagas disease written by Jolhf Mathai Koshy.

I didn't know about Romanas sign and Chagomas.

The MEGA mnemonic for cardiomegaly, splenomegaly, megaeosophagus and megacolon is brilliant.

Now, my brain is swollen up with sweet information! Thanks a lot, Jolhf!

-IkaN

Related post: Study group discussion on Chagas disease

Tuesday, May 12, 2015

Whipples disease mnemonic

Mini post of the day!

Whipples disease responds to antibiotics like ceftriaxone and TMP-SMX.
"Whip Whipples with antibiotics."

W: Caused by T. Whippleii
Hip: Reminds me of arthralgias
P: For PAS positive macrophages
L: Lymphadenopathy
E: Eye findings

Friday, May 8, 2015

Celiac disease mnemonic

Hello. Something about celiac disease today!

"In celiac disease, the gut is cealed (sealed) with GLUe."

Tuesday, May 5, 2015

Study group discussion: Kimmelstiel-Wilson in medicine

Review - How do KW lesions, disease and syndrome differ from each other?

KW lesions refer to nodular glomerulosclerosis - the KW nodules

KW syndrome is nephrotic syndrome developing due to the lesions.

KW disease refers to any other manifestations occurring due to the lesions.

Any other manifestations like?

Manifestations of glomerulonephropathy. I guess hematuria, anasarca, uremia and others.

Study group discussion: Questions on tuberculosis

20 year old girl with a TB contact history comes to OPD with complaint of hemoptysis. Her TST is 20mm and her smear & culture is positive for mycobacterium TB.

Now some questions related to pulmonary TB!

What is brocks syndrome?

When the enlarging hilar lymph node causes collapse of bronchi, leading to bronchiectasis is called Brocks syndrome. Specially right middle lobe.

What do you exactly mean by post primary tuberculosis?

Post primary refers to TB that occurs few weeks after primary TB when the immunity has developed.

Chemoprophylaxis with which drug should be prescribed if a patient is gonna undergo some immunity wrecking thing like eg, gonna take long term steroids and their CXR shows evidence of previous TB?

Isoniazid.

Breech mnemonic

Hello!

So today, I forgot the types of breech.

And that's why, I made a illustration with eh mnemonic.

There are two types of full breech:
- Complete breech
- Frank breech

There are many types of incomplete breech:
- Footling
- Kneeling

That's all!

-IkaN

Friday, May 1, 2015

Study group discussion: Kochs contact

Question: Definition of Koch's contact!

Answers, comments posted on the group -

1. Should have:
Sputum positive pulmonary tuberculosis or sputum negative culture positive pulmonary TB

2. Person who is open case of Koch, person who just started AKT and person who completed AKT within 2 years.

Extras:

It was my pediatrics viva question. I didn't know the answer back then! Thanks!

The contact should be a member of the household or be frequenting regularly.

The first identified case in a household is called as index case.

Saturday, April 25, 2015

Nitroglycerin

Here are some facts about nitrates!

The prototype drug is nitroglycerin. Other nitrates are isosorbide mononitrate and isosorbide dinitrate.

Nitroglycerin taken sublingually bypasses the first pass metabolism of liver and acts quickly. That is why, it is preferred in termination of an acute attack of angina where a rapid action is needed.

Nitroglycerin in low doses, causes venodilation, decreasing preload. In higher doses, it causes arterial and venous dilation, causing a decrease in preload and afterload.

Repeated and frequent exposure causes tissue tolerance to nitrates. That is why, nitrate free interval is recommended daily, especially with the use of transdermal patches or ointment.

Side effects of nitroglycerin are headache, postural hypotension and reflex tachycardia.


Supraventricular tachycardia mnemonic

To remember about SVT, all you need to remember is the cause and you know the symptoms and treatment!

Thursday, April 23, 2015

Internship diaries: Gamjee roll

Attending, burns ward: Bring the *list of things* and a Gamjee along and come for dressing x patient.

Me: What?! Gamjeee?

*inner me*: Samwise Gamgee :D

Study group discussion: Differentials of wasting of small muscles of the hand

What are causes of wasting of small hand muscles?

The approach is to start with the spinal cord and move towards the muscles.

Spinal cord

Syringomyelia
Cervical spondylitis with compression of c8 root segment
Tumour
Trauma

Anterior horn

Motor neuron disease
Polio
Spinal muscular atrophy

Root lesion

C8 compression

Lower trunk brachial plexus

Thoracic outlet syndrome
Trauma, radiation, infiltration, inflammation

Peripheral nerve

Median and ulnar nerve lesion
Peripheral motor neuropathy

Myopathy

Distal myopathy
Dystrophia myotonica

Trophic disorder

Arthripathies
Ischaemia including vasculitis
Shoulder hand syndrome

That's a long list!

You're right. The most important thing is to remember the categories and some of the more common things listed.

Yup I love the way you listed it out.

Entropy, Enthalpy and Gibbs free energy – The monsters of bioenergetics.

The first law of thermodynamics is very famous. It says, "Energy can neither be created nor be destroyed but is converted from one form to another."

So simple.

But can you explain the second law of thermodynamics? A bit puzzled, aren't you?

It's the very reason I call it the monsters of bioenergetics. Let's convert these monsters into cute little pixies :)

The second law of thermodynamics says, "The entropy of the universe goes on increasing over time."

What is entropy?
Entropy is the degree of randomness.

A solid has closely placed molecules. Hence, the randomness in molecules is less. On the on the other hand, in liquids, the distance between the molecules is more. Hence, they have more randomness and more entropy value.

Melting of ice is a good example which illustrates the second law of thermodynamics. When the ice melts, solid gets converted into it's liquid form. The distance between the molecules increases from solid to liquid and thus, the entropy increases!

Here's an interesting fact: The human body consumes carbohydrates, breaks it down and stores its energy as ATP, which is a high energy molecule. One would argue that storage of such high energy molecule is against the second law, as entropy of the body is not increasing in this reaction. The entropy increases, but in this case, the entropy of the universe increases because we release carbon dioxide into the surrounding!

Since we are on this topic, let's address two more terms - Gibbs free energy and enthalpy!

Gibbs free energy

It is the Gibbs free energy which determines whether the reaction will proceed spontaneously to equilibrium without any input from surrounding.

In a reaction, if reactants are unstable (Having more energy) and the products are stable (Having less energy), then the reaction tends to move forward spontaneously without any input from surrounding.

On the other hand, if reactant is more stable than products then for this reaction to happen there has to some input of energy from surrounding.

Hence, if products have less Gibbs free energy than the reactants (i.e. change in Gibbs free energy is negative) then the reaction is spontaneous/exergonic irrespective of whether it is exothermic or endothermic.

Exergonic reaction - Thermodynamics
If products have more Gibbs free energy than the reactants (i.e. change in Gibbs free energy is positive) then the reaction is non-spontaneous/endergonic.

Endergonic reaction - Thermodynamics
Enthalpy

Enthalpy (H) is a sum of useful energy and non-useful energy. The non-useful part is the Entropy (S) and the useful part is the Gibbs free energy (G).

ΔH = ΔG + TΔS

To summarize all the three terms: 
Entropy: Degree of randomness (Non-useful energy)
Gibbs free energy: Energy available to do work (Useful energy)
Enthalpy: Sum of Entropy and Gibbs free energy!

Written by Komal M. Kadam
Illustrated by Immense Immunology Insight
Related post: How to remember the sign and direction of Gibbs free energy change

Sunday, April 19, 2015

How to remember the direction of torsion of testis

Torsion of the right testis occurs in the clockwise direction and left testis occurs in the anticlockwise direction.