GANGLION (Last minute revision)

Hello Awesomites !

These are point on parasympathetic ganglion.

-Upasana Y.

Spherocytosis

Hello Awesomites !

The future blogs will be on confusers.

Q. On peripheral blood smears there is presence of spherocytes. What are the differentials and the test to identify the same?

Most of you have prompted it as hereditary spherocytosis.
 Let see.

Ans. DIFFERENTIALS :- 

• HEREDITARY SPHEROCYTOSIS
• AUTO-IMMUNE HEMOLYTIC ANEMIA

 Best next step is to do DIRECT COOMBS TEST to rule out autoimmune hemolytic anemia.
For hereditary spherocytosis go for osmotic fragility test.  


 So spherocytosis doesn't means Hereditary, it could be acquired, usually preceded by an infection.

HAPPY STUDYING :) 
-Upasana Y.

Integrating Trendelenburg

This blog will compel all the signs /symptoms Or test related to 'Trendelenburg'. Let us know if you know more of the 'Trendelenburg' in the comment section so we can integrate it here. 

Trendelenburg's gait: 

A child with unilateral dislocation of hip lurches on the affected side while bearing weight on it. Seen in DDH, poliomyelitis, Superior Gluteal nerve palsy.
Trendelenburg's gait is also known as Abductor gait or lurching gait.

Trendelenburg's test:

Trendelenburg's surgery/procedure:
It is done in GSV and SFJ incompetence. Here flush ligation of SFJ is done. Flush ligation means vein is ligated as close as possible.
Six tributaries also need to be ligated to reduce recurrence rate.
Laterally: Superior circumflex iliac.
                  Superior epigastric vein.
Medially: Superior external pudendal
                   Deep external pudendal
Distally: Accessory anterior saphenous vein
                Posterior medical thigh vein

Stripping is an additional surgery. Should be done till knee, not below knee to avoid Saphaneous nerve.

Brodie Trendelenburg's test: 

It is done to determine the incompetency of the sapheno-femoral valve and incompetency of the communicating vein.
In both the tests, patient is first placed in the recumbent position and his legs are raised to empty the veins. The sapheno-femoral junction is now compressed with the thumb or a torniquet can be used.
1) To check sapheno-femoral valve incompetency, patient is asked to stand up quickly and pressure is released. If varices fill quickly by a column of a blood from above, it indicates incompetency of the sapheno-femoral valve. This is called Trendelenburg test.
2) To test communicating system, pressure is not released but maintain for 1 min. Gradual filling of the veins indicates incompetency of communicating veins.

That's it

-Demotional bloke. 

AVPU Scale

Hello Awesomites !

LONG TIME .

AVPU scale is like glasgow coma scale to determine the level of responsiveness.

A=ALERT AND AWARE

• Eyes open 
• Knows name,date,time,place

V=RESPONDS TO VERBAL STIMULUS 

• Not oriented to time and place
• Responds in a meaningful way
  

P=RESPONDS TO PAINFUL STIMULUS 

• Eyes do not open

• Responds when trapezium muscle is pinched

U=UNRESPONSIVE

• Eyes do not open
• Does not respond to pinching of muscles 

Best (A) to Worst (U)

Happy Studying :)
 -Upasana Y.  

Types of glare and mnemonic

There are 4 different types of glare-

1. Direct glare- When the source of light is placed in the same or nearly the same direction as the object of fixation.

2. Discomfort glare- Glare which produces discomfort without interfering with vision. One experiences it when the overall illumination of the surroundings is too bright. 

3.Indirect glare- When an intense light source is placed in a direction other than the object of fixation.

4. Disability glare- Glare which reduces visual performance without necessarily causing discomfort. It refers to the reduced visibility of a target due to the presence of light elsewhere in the visual field. Contrast is reduced, and thus the visibility of the target. 

Now. How to remember all four? 

You are familiar with direct and indirect ophthalmoscopes. 

Suppose an ophthalmologist begins with direct ophthalmoscopy, which causes discomfort, both, to the patient as well as himself, because it involves going too close to the face. The ophthalmologist then starts using an indirect ophthalmoscope with the patient in a supine position, but after a while ends up having cervical spondylosis. Thus, getting a disability.

That's all!

-Sushrut 

Mnemonic for GOLD classification for COPD severity

Hello,

In this video, Drashtant talks about the GOLD classification for COPD.

Draw the human heart with me

Hi everyone!

I just created a spontaneous draw with me video.

NEET - THE EXAM. THE MYSTERY. THE CLOWN

Mnemonic for ocular axes and angles

This one is for the PGs. The 4 axes and 3 angles are pretty confusing to remember plainly. Here's how I do it.

Authors' diary: Mercy

Today, when I walked into a patients room to talk to him, he said, "Mercy."

I wasn't sure if this 90 year old male with dementia said what he said.

I asked him, "Did you just say mercy?"

He said yes and nodded. It broke my heart. 

It's sad that aggressive treatments have come to this. When families want "Everything done" they don't see what we actually do.

There comes a point in life when it is okay to refuse treatments, not because you're negligient and ignorant about your health, but because it is the right thing to do.

With all our technological advancements in medicine, we can keep a body alive. We can have a ventilator with tracheostomy breathe for the patient, we can feed through a PEG tube, we can replace the kidney with dialysis, we can keep the blood pressure up with pressors. Sometimes, we can even bypass the heart and lungs through extra corporeal membrane oxygenation (ECMO). But just because we can do it, doesn't mean we should do it. What about quality of life? 

Medicine can only do so much. There comes a point in the natural course of human life when the body can't heal anymore. That's when it's okay to say, "No more." It's time for comfort care and hospice. 

Fortunately, for my patient, the physician explained about end of life to the decision makers and the family understood the goals of care. The patient was discharged to hospice. 

Contents page for Medicowesome secret project on Depression: Let's talk

Secret projects on Let's talk about depression - WHO day theme

What is the "Let's talk" project? How can I talk about mental illnesses?

Whatsapp group for medical professionals struggling with mental health issues

Hello, medicowesomites!

The Medicowesome admins had a recent discussion on depression and anxiety among health care professionals. We decided to create something like a support group on Whatsapp for those interested.

Pressure half time in aortic regurgitation notes

Hello! This post may be relevant to IM residents and cardiology fellows.

Olanzapine dose in CINV

Hi!

Olanzapine, an anti-psychotic, has been used in the patients of cancer for its beneficial effects on chemotherapy-induced nausea and vomiting (CINV) at a dose of 10 mg due to its anti-emetic action (neurotransmitter blockade at serotonin and dopamine receptors).

But due to its major adverse impact of daytime sedation, recent studies and randomized controlled trials have concluded its revised dose to be 5 mg for CINV.

To be noted here that the anti-emetic use of olanzapine is still off label, an unlicensed drug used for this purpose.

That's all

- Jaskunwar Singh

Mnemonic for Cherry 🍒 Red spots in Eye

Hello everyone….

" Story of Cherry 🍒 from farm to crowd "

From Farmer ( Mr.Tay Sachs ) 

Quintal of GM Cherry 🍒 storage (GM = Genetically modified ) 

Picked up 

By Dapper Gentleman (Mr.Sandhoff ) 

for selling to 

Crowd 

In Berlin 

(Like Cherry blossoms in Berlin... Google it.. ) 

Mnemonic for Antibodies in SLE & it's Clinical Importance

Hi everyone!

Here is a hack.

ANA = All Negative Absent = All Positive identified = Highest Sensitivity ( So best Screening Test ) 

Anti dsDNA = Disease Severity 

Anti Sm = Specific Most

Anti RNP = Raynaud & Polymyositis ( MCTD )

Mnemonic for Dawn & Somogyi phenomenon

Hello everyone....

A diabetic patient who is taking NPH insulin regularly at early evening time presents with early morning headache. He also feels very stressed & tiredness. 

I have checked that he is hyperglycemic.

Suddenly I think about Dawn & Somogyi phenomenon. But I have a confusion between that 2 terms.

So I make a mnemonic…

Here it is ..

Dawn & Somogyi phenomenon

In both Early Morning High Glucose 

= Due to ⬆️ GH & Cortisol Surge 

What is the difference ??

Sonographic diagnostic features of monochorionic monoamniotic twin pregnancy

1. Absence of dividing amniotic membrane

2. Presence of single placenta

3. Same gender fetus

4. Adequate amniotic fluid around each fetus

5. Both fetus moving freely 

Indications of long‐term oxygen therapy

Hi!

I was discussing the indications of long‐term oxygen therapy with a friend today...

Long‐term continuous oxygen therapy, ideally for ≥18 h/day is indicated when:

1. Daytime partial arterial oxygen concentration (PaO2) is ≤ 55 mm Hg at rest or a pulse oxygen saturation (SpO2) less than or equal to 88 percent.

2. Daytime PaO2 is 56–59 mm Hg and there is evidence for hypoxic organ damage (right heart failure, pulmonary hypertension or polycythaemia)

Fact of the day: AHN in old age

Hi!

Fact: New neurons proliferate as we age, in both physiologically and pathologically aging brains, even in the ninth decade of life.

Authors' diary: Battling jealousy

Hi!

I read comment on YouTube recently, "There are people who don't even share their notes and there are people like you who help others with their work..."

I know that feeling. It stems from a number of negative emotions. One of them is jealousy or envy - The intolerance in seeing someone else succeed more than you.