Treatment of post traumatic stress disorder (PTSD) mnemonic

Hello!

Here's a short post on the treatment of PTSD. It comes with a mnemonic!

Schizophrenia subtypes mnemonic

Schizophrenia types mnemonic: CURDP

Diagnosis vs. Prognosis! Which is which?

When I was in 1^st year I used to mistake these two parts of patient care very much. Let’s try to understand these concepts.

Diagnosis (Dx) – The identified disease/condition that the person has. We get to a diagnosis, after considering all the symptoms, and signs.

Prognosis – What’s going to happen in future for the patient regarding this disease.

Step 2 CK: ADHD treatment

Hello! This post is on the treatment of Attention Deficit Hyperactive Disorder (ADHD)!

Cognitive behavioural therapy is the first line of treatment for ADHD.

As for pharmacotherapy, FDA has approved two types of medications — stimulants and non-stimulants.

Bupropion mnemonic

Hello!

Watch the video to check the mnemonic out :D

Study group discussion: Dopamine, prolactin, Parkinson's disease and Schizophrenia

A schizophrenic presents with galactorrhea. The patient’s medication regimen includes haloperidol. Blockade of which  neurotransmitters is responsible for this patient's clinical presentation?

Dopamine. Since it is a Prolactin Inhibitor - Inhibition of Dopamine causes hyperprolatctinemia.

Doubt: Level of dopamine also decreases in Parkinson's disease. So can hyperprolactinemia also be seen in Parkinson's disease?

In Parkinson's, there is loss of dopamine only in the substantia niagra.

There are 4 main dopaminergic pathways in the CNS:
1. Nigrostrial pathway which is involved in Parkinson's disease.
2. Mesolimbic pathway involved in Schizophrenia.
3. Paraventricular pathway involved in satiety.
4. Tuberoinfundibular pathway involved in prolactin secretion.

Drugs can affect all pathways, that's why, the side effects. But Parkinson's only hits the nigrostrial pathway.

Study group discussion: Dead space

What is dead space?

Physiologic or total dead space is the sum of anatomic dead space and alveolar dead space. Anatomic dead space is the volume of gas within the conducting zone (as opposed to the transitional and respiratory zones) and includes the trachea, bronchus, bronchioles, and terminal bronchioles; it is approximately 2 mL/kg in the upright position. Alveolar dead space is the volume of gas within unperfused alveoli (and thus not participating in gas exchange either); it is usually negligible in the healthy, awake patient.

Flexion of the head decreases dead space. Why?

Flexion of head decreases anatomical dead space. Therefore, physiological dead space will also be decreased.

Neck extension and jaw protrusion can increase the dead space twofold.

Supine position decreases dead space and the dead space increases in upright position. Why?

In upright position, there is decreased perfusion to the uppermost alveoli.

Intubation decreases dead space by 70 ml approx. Why?

The size of the ET tube is smaller than the trachea. Therefore, reduction in the dead space.

Administration of bronchodilator increases dead space. Why?

The conduction zone, from the nose to the respiratory bronchioles, is dead space. Bronchodilators dilate the brochus and bronchioles and not the alveoli, increasing dead space.

Certain anaesthetics, like halothane and sevoflurane, cause bronchodilation. Hence, an important concept and MCQ.

The cause of increased dead space in general anesthesia is multifactorial, including loss of skeletal muscle tone and loss of bronchoconstrictor tone.

That's all!

Pray that my goals are completed on a timely basis. I need your prayers.

-IkaN

Apoptosis - Quick review

Apoptosis is ' Programmed Cell death'

It is a physiologic and a Pathologic phenomenon.

There are 2 pathways of apoptosis-
A. Extrinsic pathway- a/ w activation of caspase 8
B. Intrinsic pathway- a/w activation of caspase 9

Most striking feature- Absence of inflammation.
Earliest feature- Cell shrinkage
Most characteristic feature- Nuclear pyknosis

Diabetes Mellitus - Oral Treatment

Diabetes Mellitus (DM) is a heterogeneous group of disorders, characterised by hyperglycaemia and it's complications.

Hyperglycaemia according to American Diabetes Association is when
1. Fasting Blood Sugar level is more than or equal to 126mg/dL
2. Post prandial Blood sugar is more than or equal to 200mg/dL

The interesting part is here
DM Type 2 is either because of
i) increased glucose production by the liver ( when a person is sleeping) or
ii) impaired insulin secretion ( usually noticed after meals as insulin reserves are not sufficient or there is insulin resistance)

Let's talk of 2 scenarios,
In case i) Fasting blood glucose is high and
In case ii) Post Prandial blood glucose is high.

Now,
For case i), Metformin which is said to decrease the glucose production from liver is a better treatment option.
(Remember, Metformin also works against Insulin Resistance, so it also works in case ii !)

For case ii), since the problem is with insulin secretion or its resistance, Insulin Secretagogs work the best! Sulfonylurea increase the insulin secretion from ß cells in the pancreas, thereby tackling the problem.
Remember, Sulfonylureas are commonly used after Metformin!

If you want a super drug :P to tackle both these scenarios then Metformin and Thiazolidinediones are your best options. However, the side effect profile of the latter one is worrisome so used less often.

Here's one of my favourite quotes, Hardwork beats talent when talent doesn't work hard !
That's all!

- Rippie

Lights, Pokemon, Seizures!

Did you know light can induce seizures?

Photic-induced seizures — Photosensitivity has received considerable attention as a seizure trigger. The light stimulation may come from a natural or artificial source, in particular television shows and video games.

Deviation of the tongue, jaw, uvula and lips in cranial nerve palsy mnemonic

Hello! Long time no see (From my side :D )

So in this post, I'll be taking about what deviates where with a mnemonic! Yaay!
What? Jaw, tongue, lips and uvula.

Let's start with LMN lesions of the respective cranial nerves.

Two interesting facts.

Hey awesomites! Happened to read two interesting things today-

1. The Y sperm is relatively lighter due to the acrocentric chromosome, amounting to the relatively skewed sex ratio towards males across the globe.

2. Homeobox gene 8 controls the expression of forelimbs, messing with it causes alters the position of the forelimbs.

That's all!

Concepts vs mnemonics

"There are two ways to learn something - One is through pure logic  ie, from first principles (building up a concept). The other is mnemonics (To help retrieve info quickly... To avoid all the time and thinking taken to derive it).

The best thing is to learn both ways. If you forget the mnemonic, you can derive it from the concept. If you forget the concept, you'd at least have the mnemonic." - SG

Many people question whether mnemonics really help. This is what I have to say in explanation. Learn both like SG said. They'll help if you manage to remember, if you forget, you can use your knowledge and understanding to come to the same conclusion.

That's all!

SG is a good friend and is very philosophical on learning. These are some random thoughts that she sent and I thought of sharing them because I strongly agree!

-IkaN

Transmission of toxoplasmosis

Toxoplasmosis is transmitted through:
Cat bite
Droplets
Orofecal route
Cat scratch

This is a tricky question if you haven't revised parasitology. You'll vaguely remember the association with cats, so you'll be tempted to pick one which mentions the word cat.

Remember, toxoplasmosis is transmitted through cat feces, so orofecal route is the correct answer.

That's all!
-IkaN

Treatment of Babesiosis

Short post for the day!

Barbecue city - BBQ City
Babesia, Quinine, Clindamycin

Step 2 CK: GBS prophylaxis mnemonic

Hi!

Drugs used for GBS prophylaxis mnemonic: PACE CV
Penicillin
Ampicillin
Cefazolin
Erythromycin
Clindamycin
Vancomycin

Indications of GBS prophylaxis:
- Previous infant with invasive GBS disease.
- GBS bacteriuria / positive culture during current pregnancy.
- Unknown GBS status with:
- Delivery at < 37 weeks
- Amnionic membrane rupture > 18 hours
- Intrapartum temperature > 100.4 (38.0)

That's all!
-IkaN

Most common sites of bone tumors mnemonic

I made these mnemonics on request by an awesomite, Yashwanth.

Here's the most common sites list he sent, mnemonics follow.

SAAG mnemonic

Hello!

SAAG is serum albumin ascites gradient.

SAAG is >1.1 in portal HTN, CHF, HVT and constrictive pericarditis.

The mnemonic for this is SAAG is High in conditions with an H.

portal Hypertension
congestive Heart failure
Hepatic vein thrombosis
Heart constriction (Constrictive pericarditis)

For completion, SAAG < 1.1 is seen in nephrotic syndrome, cancer and infections (except SBP)

That's all!
Have an amazing day!
-IkaN

Lofgrens syndrome mnemonic

What is Lofgrens syndrome?

The triad of Arthritis, Erythema Nodosum & Hilar adenopathy seen in sarcoidosis.

Why smoking is protective for endometrial cancer?

Smoking is a risk factor for quite a number of cancers. But it can be protective for certain diseases as well..like ulcerative colitis.

It is also protective for endometrial carcinoma and how?
1. It reduces estrogen level
2. Decreases weight
3. Associated with early menopause.

Remember that endometrial cancer is due to excess estrogen..and even being obese or having diabetes mellitus is a well known risk factor

Irrespective smoking is bad for health. Each cigarette reduces your life span by 11 minutes or so they say.

Live happy stay healthy

-sakkan

Types of abortion mnemonic

Hello!

I'll start off the post with a mnemonic and then go on explaining what these terms mean...

Prostaglandins mnemonic for obstetrics

Hey!
Thought this will help.

Dinosaurs are Extinct. Ex-two-inct.
Dinoprostone is PGE2.

Carboprost. Carbofrost.
Carboprost is PGF2 alpha.

MIsoprostol - M flipped is E and I looks like 1.
Misoprostol is PGE1.

That's all!
-IkaN

Step 2 CK: Overflow incontinence mnemonic

Greeting everyone!

In this post, I'll be sharing a mnemonic on overflow incontinence!

McCune Albright syndrome mnemonic

Hello everyone!

McCune–Albright syndrome is suspected when two of the three following features are present:

Endocrine hyperfunction such as precocious puberty
Polyostotic fibrous dysplasia
Unilateral Café-au-lait spots

Here's a mnemonic :)

Precocious puberty mnemonics

Hi! :)

Precocious puberty in females is secondary sexual characteristics, accelerated growth in females greater than 8 years of age.

Normal pubertal landmarks mnemonic:

Biophysical profile mnemonic and step 2 CK notes

Hello!

Here's a mnemonic for biophysical profile: BAT HAM
Breathing
Amniotic fluid volume
Tone
Heart rate Acceleration
Movements

Here's an overview of interpretations from the BPP score.

BPP 10/10
BPP 8/10 (Normal AFV)
No fetal indication for intervention.
Repeat weekly.

BPP 6/10 (Normal AFV)
Equivocal. Repeat test within 24 hours.

BPP 4/10 (Normal AFV)
Fetal lungs mature (>37 weeks), deliver.
Fetal lungs immature, betamethasone, repeat test within 24 hours.

General rule: If oligohydramnios, consider delivery.

BPP 8/10 (Decreased AFV)
BPP 6/10 (Decreased AFV)
Assess clinical scenario, consider delivery depending on gestational age, risk of fetal, maternal death, etc.

BPP 4/10 (Decreased AFV)
If >32 weeks, deliver.
If <32 weeks, observe.

BPP 2/10
BPP 0/10
Deliver regardless of gestational age.

That's all!
I wrote this down from a number of resources, including uptodate
-IkaN

Study group discussion: Rh incompatibility and ABO incompatibility

Here is some food for thought.

Think about which of the following scenario is worse:
1- Mom is O- and baby is O+ first pregnancy
2- Mom is O- and baby is O+ second pregnancy
3- Mom is O+ and baby is O+ second pregnancy
4- Mom is O+ and baby is A+ second pregnancy
5- Mom is O- and baby is A+ second pregnancy
6- Mom is O+ and baby is O- first pregnancy

Answer is 2
Rh incompatibility in second pregnancy. In presence of ABO incompatibility, Rh incompatibility, has lesser effect.

Detailed explanation:

The most common group O has anti A IgM, anti B IgM and anti AB IgG.
Group A has anti B IgM.
Group B has anti A IgM.
Group AB has no antibodies.

So if I was dumb enough to transfuse GroupyA blood to a group B guy there would be hemolysis. But what would be the mechanism for this?

The patient with group B would have anti A IgM. IgM is a very potent complement activator. IgM is very trigger itchy, it first shoots the cell and then asks questions. So this hemolysis is very fast.

Now coming to the Rh question, imagine there was a mom with O- group and baby with O+ group.

In first pregnancy, the mom is not exposed to the Rh antigen until delivery, so the 1st baby is safe. But there would be a mixture of baby and mom's blood.

Now imagine a weird person (Rh+ cell) walking through an airport, he would taken by the TSA (macrophage) for an "interrogation". So the macrophages do this interrogation (phagocytosis) in the dark corners of spleen and pick up info (antigens) about these weirdos. This info is passed to T cells and they issue warrants to B cells (IgG) for identifications of these guys and they are killed on site (IgG mediated destruction)

You can see that this will, obviously, take time time. When she gets pregnant with Rh incompatibile kid again, the IgG have been synthesized and they cross placenta and attack the baby RBC's. Voila - Hydrops fetalis.

Now imagine a mom who is O- and has a baby with A+ group. This time, at delivery, there is mixing of blood again!
But the mom has anti A IgM which is so fast like a ninja, kills of the majority of the cells before they go for their interrogation with macrophages in spleen... So ABO incompatibility actually protects against the Rh sensitization.

What's the clinical significance of Rh incompatibility?

Whenever you take care of a pregnant lady, you will confirm her blood group and if you suspect Rh incompatibility you would give her "Rh IgG" (standard dose) at 28 weeks, even though the fetal blood is not exposed to mom's immune system, this is done just in case - there might be a fall, injury etc and baby's blood may get into mom's circulation.

Why do you give Rh IgG when you want prevent the disease which is itself caused by IgG?

Rh IgG are heat treated and they cannot cross the placental barrier unlike normal IgG.

And finally, you give another dose of Rh IgG after delivery. But this time, you actually estimate the amount of fetal blood which is mixed with mom's blood by doing "Kleihauer betke test" and you give an appropriate dose.

Explained by DJ AweSpear.

Related posts:
Rh incompatibility
Hydrops fetalis
Blood group doubts
Removal of antigens from RBC's
Barts hemoglobin mnemonic

Differentials of nodular lymphangitis

To make this post fun, I created hypothetical scenarios. This will help making a differential diagnosis =)

Scenario 1: Patient is a rose gardener.

Scenario 2: Patient is an aquarium cleaner.

Scenario 3: Patient is a vegetable labourer in a farm. Honey colored drainage is seen at the site of ulceration. It is followed by subcutaneous nodules draining the primary lesion.

Scenario 4: There was a painful chancre at the primary lesion. After 5 days, tender lymphadenitis developed.

Answers:

Scenario 1: Sporothrix schenckii

Scenario 2: Mycobacterium marinum

Scenario 3: Lymphocutaneous disease by nocardia brasiliensis.

Scenario 4: Tularemia

Reading material:
Sporotrichosis, often occurring in gardeners, remains the most recognized cause of nodular lymphangitis.
Injuries sustained in marine environments suggest Mycobacterium marinum infection.
An incubation time of 1 to 5 days, a painful chancre at the initial lesion site, and prominent tender lymphadenitis strongly implicate tularemia.
Frankly purulent discharge from the primary lesion is associated with some infections due to Francisella and Nocardia species.

That's all!

-IkaN

Karyotype seen in different disorders

Karyotype in:
Turners syndrome
Kallmanns syndrome
Klinefelters syndrome

Answers:
45 XO
46 XX or 46 XY
47 XXY

Nocardia treatment mnemonic

Hello, peace keepers of the earth! =)

In today's post, I want to emphasise that the drug of choice for treatment of nocardia is TMP SMX. That's it!