ECG basics

So basically, ECG is  an electrical representation of heart activity on ECG paper. 

Here are some important postulates of ECG paper:

The needle of galvanometer travels 300 big squares in 1 minute or 60 seconds. 

That makes 0.2 seconds for each big square. 

In turn each big square is divided into 5 small boxes /squares.

So we get each small box counting about
0.04 seconds. 

So let's review all calculations:

1 Big square = 0.2 seconds.
1 small square = 0.04 seconds. 

Each P wave travels about 2 and 1/2 small  squares making upto 0.1 second.

The segment PQ (Sometimes we use PR) again takes 2 and 1/2 small squares making upto 0.1 second.

QRS complex used another 2 and 1/2  small squares making another 0.1 second. 

While S-T segments uses 10 small squares forming using 0.4 seconds.

Note: We normally consider 2 and 1/2 small squares but there can be 2 or 3 small squares. 

~Ojas

Pentavalent vaccines

Hey Awesomites!

Let's discuss something about the pentavalent vaccines and what advantage they have in the immunization of newborns..

Friedreichs Ataxia notes and mnemonic

Here's another notes + mnemonic post on Friedreichs Ataxia

Genetic stuff:
- Due to mutated frataxin gene
- GAA trinucleotide repeats
- Autosomal recessive
- Mitochondrial iron accumulation due to loss of iron transporter coded by frataxin gene results in oxidized intramitochondrial iron accumulation.

Clinical stuff:
- Cardiomyopathy is the most common cause of death in FA. Cardiomegaly, conduction defects, murmurs, fibrosis are seen.
- Musculoskeletal abnormalities like foot deformities (Hammer toe, pes cavus, pes equinovarus) and scoliosis is seen.
- Diabetes mellitus is seen in 20% of patients

Neurologic stuff:
- Nystagmus
- Titubation
- Dysarthria
- Dysmetria
- Ataxia of trunk and limb movements.
- Loss of proprioception and vibratory sense.
- Extensor plantar response, absence of deep tendon reflexes and weakness is found.

That's all!
Stuff.
-IkaN

Mnemonic: Friedreichs FRIEDS! 

Duodenal atresia notes and mnemonic

Duodenal atresia

Hey!

In this post, I wanted to emphasize duodenal atresia is associated with double bubble sign.

It's common in Downs syndrome and polyhydramnios maybe seen in utero.

Bilious vomiting is seen because the obstruction is after the ampulla of Vater.

Because the child is vomiting, abdominal distension is not seen.

That's all!
I need sleep right now.
-IkaN

The Sustainable Development Goals: Mnemonics and explanation

Hi everyone! I'm back with a note. This time on the Sustainable Development Goals (SDG's).

This is a crisp summary of what we need to know about them as Doctors or Health Care Practitioners (in any part of the world). They're so important that a major chunk of the Coldplay concert in Mumbai was based on them. (And every other person spoke about them. How Magic-al).

And they're Also very important for the Community Medicine students from India. So here goes :

SDG's were adopted by nations of the world on 25th September, 2015 to be achieved till 2030. 

They want to do 3 P's. 

End Poverty,
Bring Prosperity to all and
Protect the planet. 

A. The important Health related Goals : 

(Mnemonic by our IkaN)

pH HE EWE

(HE EWE as in Adam and Eve)

1 Poverty 

2 Hunger 

3 Health care 

4 Education 

5 Equality 

6 Water 

7 Energy 

B. Goal 3: Ensure Healthy lives and Promote Well Being. 

Targets 

Remember: BAMS VIP
Baby Adult Mother Sex. 
(OR : Adult and Mother have Sex to get Baby)
Vaccine. Infections. Pollution. 

Baby:
- Neonatal Mort - has 12 letters , so to be reduced to less than 12 by 2030. 

- Under 5 Mortality Rate  - 5*5 = 25. So less than 25 by 2030 

Adult:
- Decrease the burden of NCDs to one third of present.
- Mental health burden to be reduced. Tobacco control. 
- Drug abuse to be tackled. 

Mother:
- Maternal Mortality to less than 70 per 1 lakh world wide. 

Sex: 
- Sexual health and reproductive health strengthening. 

Vaccines:
- Promote and develop.

Infections:
- Tackle TB HIV Malaria Other tropical diseases Diarrheal diseases. 

Pollution:
- Air, Water, Soil, Noise pollution to be tackled. 

Kudos to IkaN who helped me out of this tough spot. This was a life saver and you're the best :* :)

Hope this helps everyone.
Until next time.

~A.P.Burkholderia

Transient synovitis vs septic arthritis

Hello!

In this post, I'll talk on how to to differentiate transient synovitis from septic arthritis.

Transient arthritis is non specific inflammation of the synovium, related to infection or trauma.

Septic arthritis is bacterial infection of the synovium of the joint.

Modified Kochers criteria can help distinguish the two.

Fever > 38.5
ESR > 40 mm/hr
WBC > 12,000 cells/mL
CRP > 20 mg/dL
Inability to bear weight on the affected limb

More the criteria, more likely the child has septic arthritis.

Here's a mnemonic for modified Kochers criteria: FEW Can Bear Kocher!

Fever, ESR, WBC, CRP, weight bearing.

Acute transient synovitis is the most common cause of painful hip in a child younger than 10 years. It is a diagnosis of exclusion and can mimic Osteoarthritis, Legg Calve Perthes disease, SCFE.

Treatment: Rest, anti inflammatory agents.

That's all!
-IkaN

Myotonic dystrophy notes and mnemonic

Hello!

Here are my notes + a mnemonic

Congenital myotonic dystrophy
- Autosomal Dominant
- CTG trinucleotide repeat
- Genetic anticipation seen

- Hypotonia "floppy infant"
- Hollowing of temporal bones
- Tenting of upper lip
- Respiratory muscle weakness
- Arthrogryposis
- Posterior subcapsular cataracts (Subcapsular spokes in stellate conformation) 

Juvenile myotonic dystrophy

- Facial and upper body weakness (Hatchet face due to temporalis, masseter, facial muscle atrophy; frontal baldness)
- Inability to relax muscle (Sustained grip)

- Cardiomyopathy
- Heart block
- Congestive heart failure

- Intellectual impairment
- Gonadal atrophy
- Posterior subcapsular cataracts

- Thenar, hypothenar muscle atrophy (Myotonia evident on percussion)
- Tongue depression
- Dementia

That's all!
Be kind.
-IkaN

Henoch Scholein purpura notes and mnemonic

Hello! Here are my notes + mnemonic on HSP.

IgA-mediated vasculitis of small vessels (IgA and C3 in skin, renal glomeruli, and gastrointestinal tract).

Most common cause of nonthrombocytopenic purpura in children.

Usually follows an upper respiratory infection.

Clinical features are:
Maculopapular rash below waist (Progresses to petechiae to palpable purpura).
Abdominal pain.
Arthritis.
Glomerulonephritis.

That's all!
-IkaN

Rheumatoid arthritis mnemonic

Hello!

Here's an old mnemonic on some of the clinical features of Rheumatoid arthritis.
Well, the name itself tells it.. RHEUMATOID ;p

R- Respiratory distress (Interstitial lung disease, bronchiolitis, pleural effusion)
H- Haematological manifestations (anemias, thrombocytosis, neutropenia)
E- Extra- articular RA (ExRA)
U- Urinary tract infections (mainly drug- induced)
M- Median nerve compression/ Morning stiffness
A- Amyloidosis
T- Tenosynovitis and bursitis
O- Ocular manifestations (Keratoconjunctivitis sicca, scleritis, episcleritis)
I- Immunologic manifestations (Sjogren's, Felty's and Caplan's syndrome)
D- Deformities (boutonniere, swan- neck, button- hole)

Thats all :)

- Jaskunwar Singh

A case on Medical ethics

Hello Awesomites!

Today I am gonna discuss with you a simple case based on medical ethics. A Forensic Medicine professor asked me in final viva last year. So here it goes...

3 month old with hypotonia

3 month old baby with history of honey intake (Given by grandpa) presents with constipation, feeding difficulty, hypotonia. What is the cause of the baby's symptoms?

1. Ingestion of preformed toxin
2. Ingestion of pesticide
3. Ingestion of bacterial spore
4. Bacterial infection of the meninges
5. Urinary tract infection

Answer given below:
.
.
.
.
.
.
.
.
.

If you picked 1, you're wrong.

Infant botulism is caused by botulinium spores in honey, corn syrup that germinate and multiply in the intestinal tract and produce toxin.

Adult botulism is caused by ingestion of preformed toxin.

I just wanted to make that point clear. And emphasize how tricky any exam can get with word play.

Don't stress.

That's all! =)

Oh and the answer is 3.

-IkaN

How to apply for USMLE exams

Hello!

Many medicowesomites have asked about how to apply for their USMLE exams. Finally, here is the procedure. Sorry this took so long

I have answered all the queries in the end.

If you have any more questions, comment in the commments section below and I'll try to reply :)

Descriptive Epidemiology

Hello everyone !
Here's a video telling you a little bit of the Descriptive Epidemiology.
Let me know how you like it and I can continue to make some more to finish it up and tell you more about Epidemics!

Stigmata of infective endocarditis

Hey Awesome people!

Here is another stigmata apart from those mentioned previously by IkaN in a post here,

Stigmata of infective endocarditis:-
(Remember- It's all in the hands)

- Janeway's lesions: non- tender, erythematous macules on the palms and soles.
- Osler's nodes: ephemeral spots of painful nodular erythema on hands and feet.
- Splinter haemorrhages: seen on the nails.

Thats all!

- Jaskunwar Singh

Glaucoma

For all those who don't know what is glaucoma here is the quick review :-

There is damage to the optic nerve, etiology of glaucoma is yet to be known.

Generally, there is increase in intraocular tension , intraocular pressure above 25-30mm Hg which can cause loss of vision. In acute inflammation, WBCs and tissue debris can block exit of intraocular fluid through channel of Schlemm and in chronic conditions, especially in older individuals, fibrous occlusion of the trabecular spaces appears to be culprit!

Buerger's disease

Hey awesomites!

Here's a short post on important points in diagnosis of Buerger's disease (don't confuse the name with Berger's disease which is IgA nephropathy) also known as Thromboangiitis obliterans.

- Recurrent inflammation and thrombosis of small and medium sized vessels
- Hands and feet are affected the most
- Vasculitis and ischemia (causing blackish discoloration of skin)
- Chronic smoking (a definite predisposing/ risk factor)

Clinical features and diagnostic criteria:
            - male patient 30-40 years of age
            - history of chronic tobacco use
            - Angiography: - cock- screw appearance of arteries of wrists and ankles
                                      - tree root/ spider leg appearance due to collateral circulation
            - Exclusion of other vascular diseases ( Raynaud's phenomenon, atherosclerosis, diabetes, hypertension, endocarditis, hypercoagulable states, auto-immune disorders) is important.
            - Skin biopsy (rare)

Note: A possible Rickettsial infection (mostly Rickettsia rickettsiae) could be there which adds on to the pathology of the disease!  (usually in cases of  amputation of the affected area)

Thats all!

- Jaskunwar Singh

Supracondylar fracture of the humerus

Supracondylar fracture of the humerus

- Transverse fracture of the distal part of the humerus.
- Bruises of anterior elbow (Proximal fragments buttons through the brachialis muscle)
- Posterior fat pad sign is seen in non displaced fracture of the humerus.

IMPORTANT: Assess radial and ulnar pulses because brachial artery can be compromised.

That's all!
-IkaN

Submissions: Selenium deficiency mnemonic

"Selena Gomez and Ke$ha both are young and have big hearts."

Selenium deficiency causes Keshan disease which is cardiomyopathy in young children. Also, singers like to dye their hair (Loss of hair pigment is seen in Selenium deficiency aka Keshan disease).

Submitted by Krutika.

Interesting fact: Keshans disease is thought to be caused by Selenium deficiency and coxsackie virus. It's common in places where selenium content in soil is low (China).

That's all!
Thanks Krutika for the mnemonic =)
-IkaN

How to browse through knowledge on Medicowesome

So we have written over 1000 posts. It's absolutely crazy! :D

About me

Hey Awesomites!

Well, I am not a new author here. I am honored to write so many posts for the blog . Let me introduce myself so that all of you can know about me...

Treatment of cholesterol-induced Alzheimer's

Hey awesomites!

Pathology done! Now lets know about its pharmacology here :)