Mental distractions

Hey Awesomites!

Let me ask you a question.. how much focused you are during your study time? Well, as a medical student you try your best to focus on what is written in the book and in making your own notes. You are not aware of your surroundings anymore. Someone comes nearby and calls you or sits just beside you but still your eyes are on those words and difficult medical terms of the diseases and syndromes and the drugs used to treat them. This is called Change blindness, a perceptual phenomenon that occurs when you don't notice a major change in the environment because you are too focused on one particular thing.

Let me give you another example. A young guy is standing in a long queue at a place while some people arrive from the opposite side. He starts staring on a cute little child who was looking at him too. They share smiles, and eye contact for several minutes while the mother carrying the child moves on. The guy just stands still there and is not aware of the surroundings when other people behind shout at him because he is not moving forward or letting them go. All of a sudden he realizes where he is and so walks ahead. This transient moment is the change blindness. :D
Note: Even maintaining an eye- contact with someone, even a child in this case may prove strenuous for the brain especially during reasoning and verbal processing and so is itself a distraction (distracting the young guy from the queue and instead focusing on that child). That is why we periodically avert our eyes during conversations.

During this particular moment this guy activated his visual association area (visual cortex) while looking at that child which meant he was just paying attention to the perceptual details (the depth of eyes of that child, cuteness, innocence, love).

On the other hand, the older adults may notice changes and patterns happening around while doing a particular task as well. Reduced focus (mental distractions) in the aging brain is responsible for the abstract thinking in them that is needed for problem solving and creative work.

In other words, the healthy aging people show thinking patterns that allow them to make connections among pieces of information that are right in front of them as well as information they have have encountered in the past. For example, an older adult involved in a conversation might pick up information on current road conditions from a television nearby, whereas a younger adult might be paying a closer attention to the conversation itself. Later on, the older adult might make use of the information from the TV broadcast while planning a route home. 

The study suggests that older adults tend to have more focused attention in the morning and more of the abstract thinking later in the day. College students on the other hand tend to have their peak attention in the afternoon or evening and are less focused in mornings.

Inability to remember details of major events or just the location of objects begins in early midlife (the 40s) which does not mean the brain function is deteriorating, instead it may be the result of the changing focus of brain on the particular information during the process of memory formation and its retrieval. The experiments on this study have concluded that the middle- aged and older adults don't really show the same level of visual cortex activation as the young do when they recall the information. Instead, their medial prefrontal cortex is activated, a part of the brain that is involved in learning associations between events and the corresponding adaptive responses. The mPFC likely relies on the hippocampus to support rapid learning and memory consolidation.


Thats all
- Jaskunwar Singh

Classification of closed globe injuries

Closed globe injury classification:-

- Based on the mechanism of injury (type) :
A. Contusion (blunt trauma)
B. Lamellar laceration (due to a sharp object or blunt trauma)
C. Superficial foreign body (organic matter or metals)
D. Mixed (combined injuries)

- Based on the visual acuity (grade) :
A. >20/40 (0.5)
B. 20/50 - 20/100 (0.4 - 0.2)
C. 19/100 - 5/200 (0.2 - 0.025)
D. 4/200 - Light Perception (0.02 - L+ P+ )
E. No Light perception

- Based on the pupillary defect :
A. Relative afferent pupillary defect (RAPD) positive
B. Relative afferent pupillary defect (RAPD) negative

- Based on the Zones of violations :
Zone I- External (superficial injuries of bulbar conjunctiva, cornea and sclera)
Zone II- violation of the Anterior segment (structures in anterior chamber and the pars plicata)
Zone III- violation of the Posterior segment (structures posterior to the posterior lens capsule- retina, vitreous and optic nerve)


Thats all
- Jaskunwar Singh

Blood Indices

Hello readers,today I am gonna tell you about some blood indices -there meaning, normal values, and units ! . Hopefully they will be useful . I always use to mess up them during my very first year :(

1)Mean corpuscular volume (MCV):It denotes the  volume in a single RBC .It correspond to size of RBCs ,so when MCV is in normal range it denotes normocyte .When MCV increases , RBCs are known as macrocytic  eg : megaloblastic anemia  and when it decreases ,cell are microcytic eg: iron deficiency anemia.
MCV can be calculated by automated hematology analyzer or by using hematocrit value
MCV:-Hematocrit (%) ×10/RBC count
                                        (million /cubic mm).

Unit of MCV is femtolitre(fL)
Normal value is 80-95 fL

2)Mean corpuscular hemoglobin(MCH):-
It's the quantity or amount of hemoglobin present in one RBC. It's normally expressed in picogram or microgram .
Normal range is 27-31 pg
Formula -
MCH :-Hb (gm per 100mL)/Total RBCs in blood(million per cubic mm) .                                  I think no need to tell MCH decreases in anemia :D

3)Mean corpuscular hemoglobin concentration: It is concentration of hemoglobin in one RBC.It is actually the amount of hemoglobin expressed in relation to volume of RBC.(It's actually
Combination of above two terms )
So we express it in gram /dL
Normal value is 33-36 gm/dL
Formula :
MCHC:
Hb(g/100mL)×100/Hematocrit(%).

When RBC size decrease , RBC is known as hypochromic
In pernicious anemia RBCs are macrocytic and normochromic While in iron deficiency RBCs are microcytic and hypochromic.

We don't have hyperchromic RBC because content of RBC is limited !

~Ojas

   

Mnemonic for personality disorders

Hello!

Soo here's a nice memory aid I came across...
A: Mad
B: Bad
C: Sad

If you write two A's (AA) It does look like an M!
B for cluster B, B for Bad!
C and Sea sounds similar for Sad xD

Mnemonic for personality disorders

"SPAS BAN His ACD"

Rickettsia mnemonic

We transferred this post here because we lost the diagram: https://www.medicowesome.com/2020/03/rickettsia-mnemonic.html

Here are a few things you should know about rickettsia!

Rickettsia, are small, gram-negative, nonmotile, rod-shaped bacterium.

Nervous regulation of blood pressure

Hello awesomites ! Some days back I revised my concepts on regulation of blood pressure  so would like to share with you ,so lets start it .This is short -term regulation of blood pressure.

Changes in blood pressure is normally detected by 9th cranial nerve from carotid sinus and by 10th cranial nerve from aortic arch both of them carries signal to NTS (nucleus of tractus solitarius) present in medulla oblongata which in turn co-ordinate 3 centres  present in medulla oblongata.
- Cardio inhibitory centre .
- Cardio stimulatory centre.
- Vasomotor centre.

Now suppose there is increase in blood pressure ,let's see microscopically what changes we are gonna seen in nerve endings of 9th and 10th nerve.
An increase in blood pressure will stretch carotid sinus and aortic arch ,which in turn will cause stretching or spreading of nerve endings ,which will increase influx of the sodium ions . Ultimately increase in depolarisation wave will cause stimulation of NTS (Even decrease in depolarisation wave  will stimulate NTS ,which happens during decrease in blood pressure).Now as we know there is increase in blood pressure , NTS-our main character in this process  will control these 3 centres to control blood pressure. Let's see what it do to these  three  centres  present in medulla oblongata.
1)Cardio-inhibitory centre : This centre will be   stimulated  which in turn send fibers to SA node and AV node via right and left vagus nerve respectively.Leading to decrease in heart rate ,obviously cardiac output will decrease so will be blood pressure!.
2)Cardio-stimulatory centre: This centre will be inhibited which causes decrease in heart rate and cardiac output via it's fibers (post-ganglionic) which passes to lateral horn of spinal cord and then post-ganglionic fibers goes to sympathetic ganglion from where post-ganglionic sympathetic fibers  acts on heart causing decrease in heart rate and cardiac output.
3)Vasomotor centre:This centre do's more work compared to above two mentioned centres .It acts on three areas ,
Arteries
Veins
Adrenal medulla
Let's see how it reacts when there is increase in blood pressure.
a) On arteries :It causes vasodilation leading to decrease in Total peripheral resistance which is directly proportional to diastolic pressure hence causes decrease in diastolic blood pressure.
b )On veins :It causes vasodilation leading to decrease in venous return which is directly proportional to EDV and which in turn causes decrease in Cardiac output and hence decrease in systolic blood pressure.
c )On adrenal medulla: Decreases release of epinephrine and nor-epinephrine which is responsible for decrease in HR,so decrease in blood pressure.

Woahh! Was such a long blog!
I think it's not necessary to mention occlusion of carotid artery causes false phenomenon of decrease in blood pressure so opposite effects will be seen:)

~Ojas.

Levels Of Prevention & Mode Of Intervention

Hi everyone,
this is notes on community medicine topic. levels of prevention and mode of intervention.
Hope it helps.
That's all
Shubham Patidar jmc 013

Metoclopramide

Hello awesomites ! Today I am gonna talk about a drug named as "Metoclopramide".
Basically it's a anti-emetic drug.First let us know what is emesis !.In simple words emesis means vomiting.Chemoreceptor trigger zone (CTZ) is  located in area postrema and the nucleus tractus solitarius (NTS) of medulla oblongata.They both act as a important relay areas for afferent impulses arising in g.i.t.,throat and other viscera.
Metoclopramide is a Pro kinetic drug
It acts on GIT causing increase in peristaltic movement with relaxation of  pylorus .

Mechanism of action includes :

a)D2 antagonism:It Decreases dopamine concentration  and obviously acetylcholine concentration increases  !.Which causes activation of ACh receptors leading to increase in LES tone and gastric pressure .

b)5-HT4 agonism:Activates 5-HT4 receptors on primary afferent neurons (PAN) of the ENS,via excitatory interneurons.

Gastric hurrying and LES tonic effects are mainly due to this action which is synergised by bethanechol and attenuated by atropine .

c)5-HT3 antagonism: At high concentrations  it can block 5-HT3 receptors present on inhibitory myenteric interneurons and in NTS/CTZ .Increase in ACh concentration is also seen in minor condition

Long term use can cause parkinsonism-since decrease in dopamine , galactorrhea and gynecomastia .

It hastens use of many drugs like aspirin and diazepam by its action

~Jaskunwar Singh & Ojas 

Triad of Charcot

Hello

Charcot's triad in acute cholangitis: FOR
- Fever
- Obstructive jaundice
- Right upper quadrant pain

Chracot's triad in multiple sclerosis: SIN
- Scanning speech
- Intention tremors
- Nystagmus


Thats all
- Jaskunwar Singh

Multiple sclerosis mnemonic

Hey awesomites!

Presenting to you the first post of 2017 :)

Multiple sclerosis clinical features mnemonic:

DONALD TRUMP

D- Demyelinating disease

O- Optic neuritis

N- Neuromyelitis optica

A- Autoimmune aetiology

L- Leg pain

D- Depression

T- Triad of Charcot

R- Relapsing and remitting type (most common)

U- Uhthoff's phenomenon

M- McDonald's criteria (diagnostic)

P- P100 latency of nerves (delayed)

Thats all

- Jaskunwar Singh

2016: the flashback

Hey all!

In this post, I just want to share a flashback to the year 2016 and what I have learnt through the journey of these 365 days.

2016, you will be missed

Remember I promised 2016 was going to be awesome?

It was, it was. It was a beautiful year, personally.

Here's my year in review:

Create the change

Hello everyone

So it's the last day of 2016. And everyone is now talking about new year resolutions and stuff. But what do we want to resolve as medical students?

Remember the first day you joined the medical college? That day you promised yourself something. To be a good doctor one day and serve humanity. To study and work hard all day and night seven days a week and gain knowledge in every subject you study. You had taken your life- changing resolution on that first day itself.

I believe in change. I have always tried to explore myself and learn new things each day of my life. That's what we all should do. And not just in the initial days or weeks of the new year. Because you are known by your actions and not what you think.

So stop making resolutions and start taking your real life decisions. Change is the law of nature. Create the change in yourself each passing day for the better. That will make you feel good. And because your ultimate goal in life is not just to be a doctor but also be a good human being. Then one day you will be what you ever wanted to be.


That's all
- Jaskunwar Singh

Ectopia lentis mnemonic

Ectopia lentis (or lens dislocation) associated conditions mnemonic.

- MarFAN syndrome (FAN is up)- Superior dislocation of the lens
- HomocystinURIA (URINE goes down)- Inferior dislocation
- WeilMARCHesani syndrome (We will march forwards)- Anterior dislocation of the lens


Thats all
- Jaskunwar Singh

Top 10 series: Amiodarone

And here's a video on amiodarone!

Top 10 series: Methotrexate

Hello!
Here are top 10 facts about methotrexate!

LAP score

Leukocyte Alkaline Phosphatase score is used to differentiate a reactive process from chronic myelogenous leukemia. Here I  just mention the conditions with high and low LAP score (not a mnemonic this time :p )

High lap score:
- Neutrophilia ( as in bacterial infections)
- Polycythemia vera (neoplasm of bone marrow)
- Blast phase of XML
- Hodgkin's disease
- Leukemoid reactions
- in newborns, children and pregnancy.

Low lap score:
- Chronic Myelogenous leukaemia (chronic phase)
- Paroxysmal nocturnal hemoglobinuria
- Hereditary hypophosphatasia


That's all
Happy Medicowesome :)

- Jaskunwar Singh

Normal pressure hydrocephalus

Hey awesomites

Normal pressure hydrocephalus is a type of brain malfunction characterised by:
- Dilatation of ventricles
- Distortion of fibres in corona radiata
- Normal pressure on lumbar puncture
- And a triad of symptoms:-
                    - Cognitive loss (dementia)
                    - Apraxia of gait
                    - Pee problems  (urinary incontinence)
I have made a mnemonic for this triad. Since cephalus in hydrocephalus means head so here's a cap to cover it. Mnemonic- CAP

The main aim of treatment in this condition is to drain the excess of CSF. Surgical installation of ventriculoperitoneal shunt is the usual method which aims to drain csf into the peritoneal lining of abdomen from where it is easily absorbed.


Thats all
- Jaskunwar Singh

Seasonal affective disorder

Hey awesomites

Seasonal affective disorder  (SAD) is common in winters months when days are short and nights are long. It is caused by abnormal melatonin metabolism and the patient presents with acute depressive and atypical symptoms.

Here's a mnemonic for atypical symptoms of Seasonal affective disorder.
SAD
S- Sleepiness
A- Appetite increase
D- Decreased energy

Note: Treatment of this disorder includes exposure to bright light therapy. Melatonin tablets should not be prescribed in such cases.


That's all
- Jaskunwar Singh

Vogt's triad in tuberous sclerosis mnemonic

Vogt's triad in tuberous sclerosis mnemonic:
EpiLoiAs
Epi- Epilepsy
Loi- Low IQ
As- Adenoma sebacum

- Jaskunwar Singh

Vogt's triad in congestive glaucoma mnemonic

Vogt's triad in acute congestive glaucoma:
GAP
G - Glaucomflecken
A - Atrophy of iris stroma
P - Pupil dilatation

Also, check out the Vogt's triad in tuberous sclerosis mnemonic here

- Jaskunwar Singh