Diagnostic Enzymes in Myocardial Infarction

   

Hello Everyone,

Here’s a quick mnemonic on Sequence of elevated enzymes in myocardial infarction. I got it from https://imgusmlestep1.blogspot.in. Originally it was  like this Time to CALL 911. I have modified it. It goes like this

                             Time to CALL 12 24 30 48.

The numbers represent time of peak elevation of the enzymes.

Sequence of elevated enzymes are:

        Troponin: Cardiac Troponin I and Cardiac Troponin C (12 hours)

        Creatine Phosphokinase (MB) (24 hrs)

        Aspartate Transaminase (30 hrs)

        Lactate Dehydrogenase 1 (48 hrs) 

Important Facts:

Cardiac troponin I (cTnI) is highly sensitive and specific for damage to cardiac tissue. cTnI appears in plasma within 4–6 hours after an MI, peaks in 8–28 hours, and remains elevated for 3–10 days.Elevated cTns, in combination with the clinical presentation and characteristic changes in the electrocardiogram, are currently considered the “gold standard” in the diagnosis of a MI.

Creatine Phosphokinase (MB):Appearance of this hybrid isoenzyme in plasma is virtually specific for infarction of the myocardium .Following an acute MI, CK2 appears approximately 4–8 hours following onset of chest pain, reaches a peak of activity at approximately 24 hours, and returns to baseline after 48–72 hours.

A quick comparison between Cardiac troponin and Creatine Phosphokinase:

Troponin is more sensitive than CK-MB because more troponin is found in the heart per gram of myocardium and that a greater percentage depleted from the heart by cardiac injury arrives in the blood 

With regard to specificity, troponin elevations are almost always specific for cardiac injury, except for the infrequent analytical false positives caused by fibrin interference and/or cross-reacting antibodies. CK-MB is not specific for cardiac injury, as a small amount is found in skeletal muscle.

I am very thankful to IkaN for helping me with Troponin and CK-MB.  :)

Thats all,

Thank you

Chaitanya Inge  

Drugs that prolong QT interval mnemonic

Hello!

Here are drugs that can prolong QT interval and cause Torsades de Pointes! The mnemonic is TOOOOORSADES!

Cerebral ring enhancing lesions Mnemonic

Cerebral Ring enhancing lesions are a common finding in MRI based questions asked in the boards. ;)

The mnemonic to help you remember it is: Suppose there is a Dr Grams who is missing his wedding ring and is searching for it fervently. So if you're doing an MRI and you see a ring what should you do?

CAL DR GRAMS

C- Contusion
A- Abscess
L- Lymphoma

D- Demyelinating disease
R- Radiation necrosis

G- Glioblastoma
R- Resolving Haematoma
A- Abscess
M- Metastatic lesion
S- Subacute infarct

Here's a mnemonic submitted by Jaskunwar Singh. It includes Tuberculosis and toxoplasmosis!

CAL DR SMART

C - Contusions
A - Abscess
L - Lymphoma

D - Demyelinating diseases
R - Radiation necrosis

S - Subacute infarct
M - Malignancy / Metastatic lesions
A - AIDS
R - Resolving haematoma
T - Toxoplasmosis / TB

I assume that everybody knows about toxoplasmosis and tuberculosis so I didn't include them in my mnemonic. Use the mnemonic that suits you =)

That's all :)

-VM

Study group discussion: A mnemonic for yawning? (pandiculation)

Hello!

Pandiculation definition: A stretching and stiffening of the trunk and extremities, as when fatigued and drowsy or on waking, often accompanied by yawning. 

Here's a study group discussion xD

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Vitamin B3 and pellagra mnemonics

Hello!

This post is all about niacin aka vitamin B3 and it's deficiency with loads of mnemonics. Who is excited?

1. How to remember Niacin is vitamin B3:

- You can remember the three vowels in nIAcIn, so it's vitamin B three.
- N has 3 strokes, so Niacin is B3
- NIA - B3

2. Vitamin B3 deficiency, Pellagra, is clinically manifested by photosensitive dermatitis, diarrhea, dementia.

Pellagra mnemonic:
"B3 causes D3"
Diarrhea, Dermatitis, Dementia.

3. Pellagra tends to occur in areas where people eat maize (or corn, the only grain low in digestible niacin) as a staple food.

Mnemonic: Corny people can't be nice. (Corn can't have niacin)

People - Pellagra. PP!

Corny people can't be nice and amazing! Get it? A-maize-ing! Hahahahha! I'm so pun-ny and funny!

4. The amino acid tryptophan is needed to make niacin, serotonin and melatonin.
Mnemonic: Have a nice trip to serotonin land (Serotonin rhymes with Melatonin).

Why is this fact clinically significant?
Carcinoid syndrome leads to excess production of serotonin, which depletes  tryptophan. There's not enough tryptophan to produce niacin, resulting in pellagra.

5. Isoniazid (INH) use can cause vitamin B3.

Mnemonic: INH has 3 letters. B3 deficiency!
Also, isoNIAzid. For NIAcin deficiency.

6. Lastly, you should know about Hartnups disease which is due to defective neutral amino acid transporter on renal and intestinal epithelial cells 

Here's a mnemonic by usmle1mikmonics:
HARTNUP Disease
Hartnup
Aminoaciduria
Renal (also intestinal) / Recessive
Transporter defect / Tryptophan deficiency
Neutral amino acids / Niacin deficiency / Nicotinamide supplements (Treatment)
Urine (Tryptophan lost in urine)
Pellagra / high Protein diet (Treatment)
D’s - Dermatitis, Dementia, Diarrhea

That's all!
-IkaN

Anterior Abdominal Wall : Mnemonics

Hi everyone. So I've just started Surgery and it makes me go back to Anatomy. A lot.
Here are some helpful Mnemonics on the Anterior abdominal wall

The External Oblique muscle is the SIR of  all muscles.
It's the SIR of all muscles.
Hence , This SIR forms the Superficial Inguinal Ring.
Because it's the SIR , it forms the Sir of all ligaments too - the Inguinal Ligament.

The Fascia Transversalis is a scary thing. Whenever I see it , I get DAR. ( Dar is the Hindi word for Fear)
So I get DIR when I look at it. :P
And hence the Deep Inguinal Ring is in the Fascia Transversalis.
Since this is such a scary muscle , the important artery Inferior Epigastric Pierces this muscle. Making it more DIR-avna.

Finally,
How should one remember the direction of the External and Internal oblique muscles ?
Hands in your pocket is External Oblique.
So medially and downwards.

Hands on the Tits is Internal Oblique.
So medially and upwards.

Hope these help you !
Happy Studying !
Stay aweosme.

~ A.P.Burkholderia

How is Visual Contrast achieved?

Hello everyone,
Let us discuss Visual contrast today. This question has haunted me for a long time.

Let's start with the basics, the cells in various layers of retina and their function.

Here's a quick review of things you have already read:

1. What is photoreceptor?
It is a rod or cone. It detects light.

2. What is horizontal cell?
It is present between rods and cones. It is inhibitory in function. (It is involved in lateral inhibition which we will discuss later!)

3. What is bipolar cell?
It transmits information from photoreceptor to ganglion cells.



Now, lets come to the details.

4. What are metabotropic receptors?

First of all what you must understand is Metabotropic receptors and Inotropic receptors are receptors present on bipolar cells.

They recieve stimulas from photoreceptors (mostly decreased glutamate is the stimulas).

Metabotropic receptors cause depolarisation that is excitation of centre of receptive field of bipolar cells

5.What are inotropic receptors?
They cause inhibition of centre of receptive field i.e. hyperpolarization. (remember, I for Inhibition)

6. Receptive field - What is it?
It is a region of retina where if the light falls it is going to alter the firing of neurons. (By firing I don’t mean guns :P) It means the action potentials generated and transmitted by the photoreceptors. So each cell has a characteristic receptive field. It can be as small as a dot or as large as this page itself. But don't limit this concept to a photoreceptor only. Almost all sensory cells example in somatosensory system or in auditory system possess a receptive field.

Receptive field of a bipolar cell is arranged into a central disk,
the “center” and a concentric ring, the “surround”, each region responding oppositely to light.

Coming to the crux of the topic i.e. Visual Contrast.

How do the things we have discussed so far help us achieve that?

Visual Contrast is achieved by two mechanisms:
1. Lateral Inhibition
2. Excitation of Some Bipolar Cells and Inhibition of Others — The Depolarizing and Hyperpolarizing Bipolar Cells.

1. How does lateral inhibition help?
First: It does not allow the signal to spread through the dendritic and axonic trees. Hence point to point transmission occurs.
Second: The direct and indirect pathways accentuate each other. This can be easily understood. Photoreceptor sends excitatory signals to bipolar cell. But the adjacent photoreceptor sends a inhibitory signal through the horizontal cell. Mostly these two neutralize each other so no net stimulus is transmitted to bipolar cell.
      But If the adjacent cell is  unstimulated by light, It will not inhibit the excitatory signals transmitted by the photoreceptor which is stimulated by light. Hence it will allow excitation of bipolar cell.
This allows extra excitation of bipolar cell. We get a better contrast. The area which is dark remains dark. But the area which is bright becomes even brighter. This is what visual contrast is all about.
The fun part of all this is, a lot of visual illusion make use of this principle. Do google "Simultaneous Contrast"  :) .

2. How do different Bipolar cells help?
Because depolarizing and hyperpolarizing bipolar cells lie immediately against each other, this provides a mechanism for separating contrast borders in the visual image, even when the border lies exactly between two adjacent photoreceptors.
We will take a simple example. Suppose light is striking at periphery of two receptive fields. Remember it is shaped like a disk, with a centre and periphery both opposite in nature.Suppose One is On centre bipolar cell and other is Off centre bipolar cell(On centre: Activated when light hits centre but periphery is inactivated and vice versa for Off centre). So only the Off centre bipolar cell will detect it. Hence mixing up of signals is avoided. Again what I get is a sharper border. That is what contrast is all about.

That is how it is all done.

Interesting fact: The cells in the retina don't follow the "all or none" law. Transmission is by Electrotonic conduction. From ganglionic cell onwards cells  follow all or none law.

Thats all,
Thank you,
Chaitanya Inge

Lewy body dementia mnemonic

Hey there.

Dementia with Lewy Bodies (DLB) is characterized clinically by deficits in attention and visuospatial function; fluctuating cognition; recurrent visual hallucinations; and spontaneous motor features of parkinsonism. Other associated symptoms include repeated falls, syncope, autonomic dysfunction, neuroleptic sensitivity, delusions, hallucinations in other modalities, sleep disorders, and depression.

Here are mnemonics and how I remember these points!

Lewy has halLEWYcinations.
Visual hallucinations are common.

Lewy is slowy.
Slow movements for Parkinson's disease .

Lewy is sleepy.
REM sleep abnormalities like drowsiness.

Lewy is slippy.
DLB is associated with frequent falls.

Lewy is slow-y, sleepy, slippy and sees things (halLEWYcinations)

lEwy also has an E for eosinophilic intracytoplasmic alpha synuclein aggregates.

That's all!
-IkaN

Authors' diary: Jas a year

Hello!

Our admin and author, Jaskunwar Singh, completed 1 year of writing with Medicowesome today :D

Causes of coma : mnemonic

Hello

Coma ( unresponsive and unarousable state ) causes mnemonic

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Collier's Sign

Hey guys!

Collier’s sign (“posterior fossa stare,” “tucked lid” sign) is elevation and retraction of the upper eyelids, baring the sclera above the cornea, with the eyes in the primary position or looking upward.

This may be seen with upper dorsal midbrain supranuclear lesions (e.g., Parinaud’s syndrome). There may be accompanying paralysis of vertical gaze (especially upgaze) and light-near pupil-
lary dissociation.

The sign is thought to reflect damage to the posterior commissure levator palpebrae superioris inhibitory fibers; causing overactivity of this muscle.

-VM

Hydatid cyst mnemonic

Here's a mini mnemonic on hydatid cyst. Caused by E. Granulosus.

H - Hepatic cysts common
Y -
D - Dogs are definitive host
A - Albendazole treatment (Remember, anaphylaxis risk if aspirated)
T -
I -
D -

C - Calcification (eggshell calcification)
Y -
S -
T -

That's all!
-IkaN

Phencyclidine intoxication mnemonic

A combative, agitated, psychotic patient with multi directional nystagmus, tachycardia and hypertension. 

Yup. You guessed it right. It's PCP intoxication. 

Here's a mnemonic 

Melanoma marker mnemonic

The immunohistological marker for melanoma is HMB 45.

You can remember it by remembering the gorilla named 'Harambe' (HaraMBe) of Cincinnati zoo who was in the news as he unfortunately had to be put down because a child entered his enclosure.

You can correlate melanoma's black pigment with that of Harambe's black fur.

That's​ all!

- Sushrut Dongargaonkar

Chronic granulomatous disease mnemonic

Chronic granulomatous disease mnemonic

CGD - GRANULES!
G - chronic Granulomatous disease
R - Rhodamine (Dihydrorhodamine abnormal flow cytometry)
R - ROS, Respiratory burst decreased
A - Abscess / Granulomas
N - Nitroblue tetrazolium dye test
N - NADPH oxidase defective

Catalase positive organisms mnemonic: CATALASE!
Candida
Aspergillus
Tuberculosis
Listeria
Staphylococcus aureus
Serratia
pSeudomonas
E coli

That's all!

-IkaN

Deglutition

Hello Everyone!

 Today lets discuss deglutition. Human's love this process :) .

1.What is Deglutition?

Process by which food  moves from mouth into stomach.

2.What are the different stages?

Oral

Pharyngeal

Oesophageal

3.Is it voluntary?

No, Only the Oral stage is voluntary.

4.What is the oral stage?

Bolus is pushed by the tongue into the Oropharynx.

What is the pharyngeal stage?

It is a involuntary stage. Here bolus moves from pharynx to oesophagus. Bolus has got 4 paths in pharynx

Back in mouth: This is prevented by position of tongue against soft palate.
Upward into nasopharynx: Prevented by elevation of soft palate.
Forward into larynx: Prevented as follows(Only if you don’t talk while swallowing food :P

• Approximation of vocal cords
• Forward and upward movement of vocal cords
• Backward movements of epiglottis to seal opening of larynx
• This causes Deglutition Apnea

Enters the Oesophagus:

• Pharyngoesophageal sphincter relaxes.
• Also upward movement of larynx stretches opening of oesophagus.

What is Oesophageal Stage?

Food from oesophagus enters the stomach.Peristaltic waves aid in this process.Two types of Waves are seen:
Primary peristaltic contractions
Secondary peristaltic contractions

What is the role of lower oesophageal sphincter(LES)?

It undergoes Receptive Relaxation. i.e. it relaxes only upon entry of bolus. Otherwise it is constricted.We have 2 clinical conditions associated with it:

1.Achlasia cardia : Failure of sphincter to relax during swallowing. Causes accumulation of food in oesophagus.

2.Gastroesophageal Reflex disease(GERD): Due to incompetence of LES. Acidic content from stomach regurgitates back into pharynx.

That's all,
Thank you,
Chaitanya Inge

Condyloma acuminata vs condyloma lata mnemonic

Hello!

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Mnemonic for Sulci And Gyri of the cerebrum

Hello everyone,
  Memorising sulci and gyri of the cerebrum consists of two parts:

1. Memorising the names of the sulci and gyri
2. Memorising the locations

Today I will help you with the first part. Please bear with me, it will be a lengthy one.
Lets start with Superolateral surface
We have 4 regions on superolateral surface. They are

1. Frontal 
2. Parietal
3. Temporal
4. Occipital

Trick for superolateral surface revolves around 3 letters, they are: PSI

Frontal

Sulci- PSI      Gyri- PSIM
Sulci:

1. Precentral 
2. Superior frontal
3. Inferior frontal

Gyri

1. Precentral
2. Superior Frontal
3. Inferior frontal
4. Middle frontal 

Temporal
Sulci:SI  Gyri: SMI
  Names of Sulci are:

1. Superior Temporal
2. Inferior Temoral

Gyri

1. Superior Temporal
2. Middle Temporal
3. Inferior Temporal

Parietal
Sulci: PI Gyri: PSI

Sulci

1. Postcentral
2. Intraparietal

Gyri

1. Post central 
2. Superior Parietal
3. Inferior Parietal

For occipital. Remember a simple mnemonic : Sulci- SaLLTy C    Gyri- Gisa.

Sulci
SaLLTy C

1. Superior and Inferior Polar
2. Lunate
3. Lateral Occipital
4. Transverse Occipital
5. Calcarine

And the gyri

GISA

1. Gyrus descendens
2. Inferior Occipital
3. Superior Occipital
4. Arcus parieto-occipitalis.

So that completes the superolateral surface.

Now moving on to Medial Surface

  Here's the mnemonic CAPS. Men wear CAPs.  

Now  it goes like this Sulci- CCCAPPS. Gyri- Men wear CCaPPPPs

Sulci 

1. Calcarine
2. Callosal 
3. Cingulate
4. Anterior parolfactory
5. Posterior Parolfactory
6. Parieto-Occipital
7. Suprasplenial or subparietal

Gyri

1. Median frontal
2. Cuneus
3. Cingulate
4. Paraterminal
5. Paraolfactory
6. Paracentral
7. Precuneus

Finally moving to the Inferior Surface

 Here's the mnemonic

     when Cars HOORns  PeoPle LAugh LoudLy on boys playing GaMMes on streets!

Sulci (red coloured in mnemonic)

1. Collateral
2. H shaped orbital sulci
3. Olfactory
4. Occipitotemporal
5. Rhinal

Gyri(purpled coloured in mnemonic

1. Parahippocampal
2. Posterior Orbital
3. Lateral orbital
4. Anterior Orbital
5. Lingual
6. Lateral Occipitotemporal
7. Gyrus rectus
8. Median Occipitotemporal
9. Medial Orbital

Lets hope it will make memorising these things a bit easier.

That's all,
Thankyou,
Chaitanya Inge