Study group discussion: ACEI and bilateral renal artery stenosis

Angiotensin converting enzyme inhibitors (ACEI) are contraindicated in bilateral renal artery stenosis. Why?

In renal artery stenosis, renal perfusion is less and hence GFR is low. In such a case, nephrons adapt the filtration by causing efferent arteriolar constriction to maintain the pressure needed for filtration.
If ACEI is given, there is dilation of efferent arteriole and renal perfusion will again decrease further and GFR will become more low. Hence, contraindicated.

In bilateral renal stenosis, the effective renal blood flow is not significantly reduced but maintained at the cost of increasing the efferent artery tone. ACEI causes inhibition of angiotensin 2, leading to efferent artery vasodilation in glomerulus. This decreases intra glomerular pressure and filtration, resulting in renal  function detoriation.

Most commons of bacterial endocarditis

Q&A for the day!

Most common cause of bacterial endocarditis:

After tooth extraction -
Injection drug use -
Health care / catheter associated -
Originates from GI tract -
After genitourinary manipulation -

Answers:

After tooth extraction - Streptococcus viridans

Injection drug use - Staphylococcus aureus (Less common - Pseudomonas aeruginosa, Candida species)

Health care / catheter associated - S. aureus (Also Coagulase negative staphylococci CoNS)

Originates from GI tract - S. gallolyticus (Formerly known as Streptococcus bovis)

After genitourinary manipulation - Enterococci

That's all!
-IkaN

Glasgow coma scale mnemonic

Hello!

This post is on the Glasgow Coma Scale (GCS)

An important MCQ they like asking is that if the patient doesn't respond to pain, doesn't open his eyes and doesn't talk - What is the GCS? You'll be tempted to mark zero. Remember, the lower limit of GCS is 3, not 0.

Corticosteroid Side Effects Notes and Mnemonics

What a great day to study today!

In this post, I uploaded my notes on corticosteroids side effects mnemonics. 

Hope you find it helpful. 

That's all! 

-  शुभम् पाटीदार mbbs 013 बेच।

Intrinsic muscles of the hand mnemonic

Hello!
A short post on intrinsic muscles of the hand :)

Authors diary: Teachers day

Thank you for all the teachers day wishes. They truly made me smile (=

I'm glad I could be of help to all of you.

Inheritance: Funny illustration

From the authors diary:

I created this image for Jason Compton. Last year, they did a play on Beta Blockers at RhinoFest and used one of my illustrations for it. Even though I couldn't attend it, I'm always glad to be a part of being a fun way of information spreading!

This year, they're doing a family (multi-generational) theme and educating about genetics, inherited traits, etc.

I created this fun image for them.

Parents "hand me down" their clothes (jeans) and genes! The blue and yellow DNA mix to form different shades of green in the children.

I hope you like this illustration and all the very best for your play! =)

-IkaN

Viva questions: CHF and checking edema

So I thought of writing a few posts on questions that were asked to me in my vivas. You may not be asked the same questions, but these are just for you to get an idea on how it goes (:

What is the difference between orthopnea and paroxysmal nocturnal dyspnoea?
Orthopnea is dyspnea in the recumbent position.
PND is acute shortness of breath and cough, usually occurring after 1-3 hours of sleep.
Orthopnea is relieved by sitting upright, PND persists even after assuming the upright position.

Where will you check for edema in a bed ridden patient?
In the sacral area or in the scrotum.
(In ambulatory patients, check in the ankles and pretibial region.)

That's all!
I'll keep updating as and when I remember =)
-IkaN

Step 2 CK: Diagnosis of aortic dissection

I'll keep this post short and point wise.

Best initial: Chest x-ray (CXR).
Shows widened mediastinum.

Localization of stroke based on clinical findings

Hello!

This post focuses on the localization of the lesion in stroke, re-written from Harrison.

I divide this post into "Important to know" and "Extra notes" which are optional to learn about.

What's a stroke?

A stroke, or cerebrovascular accident, is defined by this abrupt onset of a neurologic deficit that is attributable to a focal vascular cause. Causes of ischemic stroke here.

Stroke syndromes are divided into:

(1) large-vessel stroke within the anterior circulation,

(2) large vessel stroke within the posterior circulation

(3) small-vessel disease of either vascular bed.

During vivas, you'll mostly be asked to localize the lesion into anterior circulation (ACA vs MCA). They don't expect much, but you should at least know the divisions (anterior circulation vs posterior circulation), occlusion of which artery involves speech, monoparesis of a leg is seen in stroke involving which artery, etc. Just the basics.

How to remember ACA stroke findings

Hello!

This is how I remember that stroke in the anterior cerebral artery predominantly involves hemiparesis of contralateral leg and foot.

The A is between the legs!

Study group discussion: Red cell Distribution Width (RDW)

Let's discuss Red cell Distribution Width (RDW) today!

RDW represents variation in RBC size.

If the RDW is large, it says that the cells are different in sizes.

Analogy: If RDW is large, we know the RBCs are all unity in diversity. Like India :P

What's the clinical significance?

Study group discussion: Different sized spherocytes

The difference in size of spherocytes has significance. It is assessed manually, on peripheral smear examination.

What's the importance of assessing size difference of spherocytes?

Wilsons disease mnemonic

So this bed time story was told to me by my granma in 2000 (who can see the future and knows who the POTUS will be in 2016 :P)
Its a story about a guy who uses a "WILSON's" racquet to play tennis. And you all probably know this legend right?

CT appearance of subdural and epidural hematoma mnemonic

Hello!

Subdural is crescent or semilunar shaped.

Epidural is biconvex lens shaped.

Phimosis and paraphimosis mnemonic

What is phimosis and paraphimosis?

Phimosis is constriction of the preputial orifice. In phimosis, the foreskin can not be retracted.

In paraphimosis, the foreskin can not be reduced back on the glans. It may cause a painful glans swelling going on to proceed to a gangrene. 

I always mix up the two, so mnemonic!

Another mnemonic - Call Paramedics if paraphimosis because it's a surgical emergency. 

This one was submitted by SG on our study group, "PAra is PAinful." 

That's all!
-IkaN

Step 2 CK: Management of liver laceration

Hello!

Say you have a hemodynamically unstable patient with a gunshot wound or blunt trauma to the RUQ.
Why shouldn't you simply suture and close deep liver lacerations?

Because of the risk of hemobilia and abscess formation.

Here's what a surgeon must do:

Polyarteritis nodosa mnemonic

Heyy!

Polyarteritis nodosa is a necrotizing vaculitis of small and medium sized muscular arteries.

Immune cells and brain development

Hello!

Do you know about microglia? OK think and tell..

Neurogenic claudication

Hey!

Did you know there is something called as neurogenic claudication?

Behcet's syndrome mnemonic

Hey guys! 

So I wanted to write something about Behcets and created a lame mnemonic for it.

Let's start :D