Neuropathic joint disease

Hey everyone!

Today, I felt like sharing random things that I learnt today. It's about neuropathic joint disease - Destructive joint disease due to loss of pain and proprioception.

Neuropathic joint resembles osteoarthritis (Osteophytes, loose bodies, loss of articular cartilage, etc.)

I couldn't think of neuropathic joint disease as  a differential today because I was so caught up in osteoarthritis!

The distribution of joint involvement depends on the underlying neurologic disorder.
Tabes dorsalis: Hip, knee, ankle.
Syringomyelia: Glenohumeral joint, elbow, wrist.
Diabetes: Tarsal and tarsometatarsal joint.

This is a major clue. The joint distribution.

Diabetes mellitus is the most common cause of Charcot's joint.

Other causes of Charcot's joint include yaws, leprosy, Charcot Mary Tooth disease and meningomyelocele.

That's all!

I cannot feel, what is real..

- IkaN

How to remember HOCM is an Autosomal Dominant disease

Hey!

HOCM is hypertrophic obstructive cardiomyopathy.

HOCM is the most common cause of sudden cardiac death in ADolescents.

HOCM is Autosomal Dominant.

Fun fact: Most common cause of sudden cardiac death in children in Aortic Stenosis.

-IkaN

Next best step in management in ST depression and ST elevation in acute coronary syndromes

This is a discussion I had with a lot of people. My questions are put in inverted commas.

"I don't understand the next best step in the management in acute coronary syndromes. If there's ST elevation MI, you do angioplasty. But when there was a ST depression, they preferred heparin after aspirin even when angioplasty was in the options. Why is that? Why does the management change depending on elevation or depression?"

ST elevation means transmural ischemia so maybe angioplasty is the only way to restore flow. ST depression means subendocardial ischemia so occlusion isn't complete. Heparin and blood thinners might work.

"But then if you can do angioplasty (Catherization lab available), why give heparin?"

They do send for angioplasty later. Heparin can be given immediately to prevent the situation from getting worse.

"But then again, why wouldn't you do that with ST elevation too?"

ST elevation means the occlusion is complete. Heparin wouldnt be effective. In NSTEMI and unstable angina, there's still some lumen viable.

"Patients with MI with ST-segment depression should not be treated with fibrinolysis. Why isn't fibrinolysis done in ST depression angina?

We say that the occlusion isn't complete because there is subendocardial ischemia in ST depression and we give heparin to prevent further occlusion. But why not give streptokinase? Why not eradicate what is already formed instead of trying to prevent progression of clot?"

Because fibrinolysis treatment has it's own side effects and it's not effective in all the cases. It's contraindicated because studies have shown it does more harm than good in only ST depression.

Like, for example, there is reperfusion injury which would might make the only subendocardial infarct into a transmural one. 3 in ten patients end up with cerebral haemorrhage. There are so many other clauses.

Hence it's only indication is a transmural infarction.. The damage is already great. Irrespective of using t-PA the patient condition is critical.

That's all!

Thank you everyone who helped me out on this one.

-IkaN

Study group discussion: Pathogenesis of diarrhea in medullary carcinoma of thyroid

By which mechanism, does medullary thyroid cancer cause secretory diarrhea?

Medullary thyroid carcinoma is usually associated with men syndrome in which we get VIPoma, which is associated with diarrhoea.

Upto date: "Systemic symptoms may occur due to hormonal secretion by the tumor. Tumor secretion of calcitonin, calcitonin-gene related peptide, or other substances can cause diarrhea or facial flushing in patients with advanced disease. In addition, occasional tumors secrete corticotropin (ACTH), causing ectopic Cushing's syndrome."

Colonic function was markedly impaired in three ways: (a) water absorption was decreased by half; (b) as the main excreted solutes were organic acids, a large electrolyte gap was recorded in faecal water, and (c) colonic transit time of the meal marker was very short, and was in agreement with the rapid transit of ingested radioopaque markers. These data strongly suggest that decreased absorption in the colon secondary to a motor disturbance is the main mechanism of diarrhoea in this case of medullary thyroid carcinoma, while calcitonin induced small intestinal fluid secretion suggested earlier is either non-existent, or only of minor importance.
Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1433550/

My dd for tumors and secretory diarrhea (someone wants to add):
- carcinoid tumor
- VIPoma
- Gastinoma
- Medullary thyroid cancer

Macrocytic anemia mnemonic

Mnemonic for Macrocytosis (Non B12 causes):

ALPHA NERD

Alcohol
Liver disease
Pregnancy
Hemolysis (especially chronic)
Agglutination

Neoplasia (Including myelodysplasia)
Endocrine (Hypothyroidism)
Reticulocytosis
Drugs (Especially myelosuppressives like chemotherapy, anti-HIV meds)

This awesome mnemonic was written by Adnan Arif.

-IkaN

Submissions: Indications of removing nasogastric tube post op mnemonic

What are the indications for removing NG tube post operation:

They're 4 P's!

1. Peristalsis achieved
2. Passage of flatus

Study group discussion: Drugs with oral bioavailability of 100%

List of drugs with 100% bioavailability from oral route:

Jay

Hello guys, I'm Jay, the newest author here ( edit : back in 2015...lol, by 2019, I'm the 4th oldest author here.) in the Medicowesome, and I'm really really...like REALLY....excited to be here! :D

The flow of CSF Mnemonic

Hello guys, It's Jay once again. Today I'm going to tell you a mnemonic on how to memorize the CSF flow. Interesting eh? 

OK Let's get to work!

First of all let us know the CSF flow as it flows!

Lateral Ventricle → foramen Monroe→Third ventricle → Sylvius Aqueduct→ fourth ventricle→ foramen Magendie → foramen Lushka→Subarachnoid space→Arachnoid Villi→Superior Sagittal Sinus

The mnemonic is

Lady Monroe's Three Siblings Fought, for Magical Lights Seeing Arrogant Seniors

Hope it would help you guys! Thanks! See you later !

Auscultating breath sounds mnemonic

While Auscultating the Chest of patient and analysing Type of breathing, whether it's Bronchial or Vesicular.

Remember GRIP

1. Bronchial breathing:
Gap is present between Inspiration & expiration.
Respiration shows Inspiration & expiration equal length
Intensity is loud.
Pitch is high.

2. Vesicular Breathing:
Gap is absent.
Respiration shows Expiration is short.
Intensity is low.
Pitch is low.

This post was written by Adnan Arif. Thanks Adnan! (:

-IkaN
Related post: Abnormal breath sounds mnemonic

Submissions: Ankylosing Spondylitis (Radiological signs notes)

These cool notes were written by Shireesha Mallik. Check em out!

Ankylosing Spondylitis (Radiological signs notes)

Antithyroid drugs mnemonic

1. Durgs that inhibit hormone synthesis (Antithyroid drugs):
Propylthiouracil, methimazole, carbimazole.

Mnemonic: Professor Met Carby

2. Drugs that inhibit thyroid trapping (Ionic inhibitors):
Nitrates (NO3), thiocyanates (SCN), perchlorate (ClO4) .

Mnemonic:  NTP

3. Inhibit hormone release:
Iodine, iodides of Na & K, organic iodides.

Mnemonic: I prevents release (Iodine, it's salts and organic form.)

4. Destroy thyroid tissue: Radioactive Iodine (I 131, I 123, I 125)

Mnemonic: Iodine normal is 128 (+3 &-3 are radioactive so is I 123)

That's all!

The mnemonics were submitted by Sareer. Thank you, Sareer, you're awesome.

-IkaN

Biochemical tests for Streptococcus pneumoniae mnemonic

Hey!

I had made a mnemonic to remember the biochemical tests given by Streptococcus pneumoniae.

Submissions: Murmur characteristics mnemonic

When you are listening to a murmur, look for "SECRET Pi"

Site
Effect of posture
Character (Tapping, heaving, thrill)
Radiation ( Axilla, neck, shoulder)
Effect of Respiration
Timing
Pitch

This mnemonic was submitted by Adnan Arif =)

Thanks Adnan!

-IkaN

Validity and reliability mnemonic

Hey everyone!

Someone requested me to make a mnemonic on reliability and validity. Let me tell you in short what these terms mean!

What is validity and reliability?

Let's take the example of measuring blood glucose levels.
Suppose, we have developed a test to measure glucose levels and we measure it in healthy man. Normal standard we have set is, let's say, 80.

Reliability means test will give the same value each time. Let's say, we measured three times it gave reading of 120, 120, 120 that is reliable. Reliability is consistency. Also called precision.

But validity means the test will give a value which is close to our standard value, that is, 80 in this case. The three readings we get this time are 82, 85, 79. So this test is reliable, but not valid. Validity is also called accuracy. Validity is not affected by sample size.

This interplay of words messes up with one of my readers brain, so I'm sharing the mnemonic I made on it. I thought it was silly at first, to use a mnemonic to remember words, but I'm glad you all are as weird as me.

VACuum = Validity + ACcuracy

PReCiSe = Precision + Reliability + Consistency + Sample size dependent

That's all!

Life is so good. I've never been so happy and calm. I'll tell you why soon, but for now, I just wanted you guys to know (:

-IkaN

Related post: Biostatistics mnemonic

Study group discussion: Ethacrynic acid and sensorineural deafness

Can someone explain how ethacrynic  acid causes deafness?

Na+K+Cl+ transporter is also present in the ear. This transporter is the main site of action for ethacrynic acid. So when it acts the transporter Is inhibited leading to ionic imbalance. This results in hearing loss.

It is the diuretic which is most dangerous when it comes to causing sensorineural deafness.
Even then it's use indicated in one special condition. Guess which condition?

If a patient has reaction to sulpha drugs.. The DOC becomes ethacrynic acid.

Recent studies revealed that the ototoxic effect of EA is actually involved in selectively blocking the lateral spiral artery in the cochlea and suppressing the blood flow supply to the cochlear lateral wall. The epithelial ischemia and anoxia in stria vascularis resulted in a significant depression of endolymphatic potential which was equivalent to cutting off the power supply of the cochlea . During the ischemic damage to the epithelium and capillaries on the cochlear lateral wall, the vascular permeability and membranous permeability in stria vascularis were also affected so that the ototoxic drug can penetrate through the broken blood-cochlea barrier to enter the cochlea.the ototoxic drug can reach the cochlear hair cells either through the cuticular plate facing the endolymph or through the under parts of the hair cells in the cortilymph.

In short bro, hair cell damage directly by EA.

Oooh. So it first causes ischemia and then enters the hair cells. But at the end the outer hair cells are getting damaged. Nice!

I am finding first year MBBS extremely difficult and tough

"Sis.. I just joined medical college. Finding it extremely tough to study. None of the subjects seem familiar. I'm losing all my positivism and feeling helpless."

Firstly, take a moment to congratulate yourself. You've made it to medical school! New subjects is going to be so much fun!

"I feel left behind. I'm not able to answer. What is taught in lecture is very minimalistic compared to text book."

Drugs causing hemolysis in G6PD deficiency mnemonic

Mnemonic for drugs causing hemolysis in G6PD deficiency is, "PAINS"

(Cause hemolysis in g6pd deficiency PAINS ;) )

Tips on how to find vein or phlebotomy

Study: Know your anatomy, so if you can't see or feel the veins, you still know where to go.

Just the anatomy of where the veins are. Sometimes you can't see them (old people, people with dark skin) and you can't really feel them. I've done some blind insertions before successfully.

Dont panic: Initially, you will find it hard, but do not get embarrassed if you miss.

Tourniquet: Tying a torniquet often helps by making the vein more swollen and prominent.

In our hospital, the patient's relative is asked to hold with the fingers tightly around the arm instead of using torniquets.

Study group discussion: Carcinoid syndrome

What's carcinoid syndrome?

It's caused by serotonin. There's a GI tumor called carcinoid tumor which secretes it. So basically, the syndrome is caused by serotonin (Flushing, wheezing, etc)

What's the treatment for carcinoid?

Somatostatin analog, octreotide.

Which vitamin deficiency is associated with carcinoid syndrome?

Study group discussion: What causes Carharts notch?

In otosclerosis, why carharts notch at 2000 Hz in PTA?

Carhart attributed this phenomenon to "mechanical factors associated with stapedial fixation."

But why the greatest dip at 2 kHz?

The ossicular chain has two basic modes of vibration. The first mode, with a peak around 1200 Hz, is the primary mode for AC stimulation. This mode is associated with a "hinging" motion of the ossicles caused by AC stimulation of the tympanic membrane at the umbo. The second mode, with a peak around 1700 Hz, is described as a "pivoting" motion of the malleus/incus, with an axis of rotation somewhat orthogonal to the axis of rotation associated with the "hinging" motion. The second mode is less robust than the primary mode for AC stimulation, but it is the dominant mode when excited by BC stimulation. A decreased mobility of the ossicular chain at 1700 Hz due to otosclerosis also affects the surrounding frequencies, but is seen most prominently as a BC loss at 2000 Hz in audiometric testing.