Biophysical Profile Mnemonic

 

Biophysical Profile 

Just add an extra “V” 

See the management here .. 

https://www.medicowesome.com/2016/09/biophysical-profile-mnemonic-and-step-2.html

See the video here https://www.medicowesome.com/2018/03/nonstress-test-and-biophysical-profile_6.html 

“ The value of experience is not in seeing much, but in seeing wisely”.  - William Osler  

Thank you! 🩺

Immunofluorescence patterns in glomerular diseases notes and mnemonics

Immunopathologic patterns of immunoglobulins (Igs) and/or complement components deposited in glomerular diseases notes and mnemonics

Linear deposition:

Anti-GBM disease (mainly IgG)

unspecifically IgG in diabetes mellitus

Granular deposition: 

membranoproliferative GN

post-infectious GN

membranous GN

IgA, IgM, C1q, C3

Pauci immune deposition:

Granulomatosis with polyangiitis (Wegener) PR3-ANCA/c-ANCA

Eosinophilic granulomatosis with polyangiitis (Churg-Strauss)

Microscopic polyangiitis MPO-ANCA/p-ANCA

Love,

IkaN 

Treatment options for latent tuberculosis mnemonic

Treatment options for latent tuberculosis 

6 or 9 months of isoniazid 

3 months of isoniazid plus rifapentine, given once weekly

4 months of rifampin, given daily

3 months of isoniazid plus rifampin, given daily

That's all!

IkaN 

Fact of the day - hypercalcemia in sarcoidosis

 Hi!

Hypercalcemia and hypervitaminosis-D is seen in patients with sarcoidosis and other granulomatous inflammatory conditions. This is because the granulomatous macrophages have high 1-alpha hydroxylase activity --> high levels of 1,25-OH2 vitamin D (calcitriol), produced in addition to this enzyme's normal activity in the kidneys.

That's all

- Jaskunwar Singh

Salter-Harris classification of fractures

Salter Harris classification is used for fractures involving the physis ( growth plates) of long bones. These fractures are common in children as their skeletal growth is not fully complete.

Depending on the extent and the structures involved, there are 5 types as follows: 

Here is a mnemonic to remember the different types, which actually goes by the name of the classification itself!

S - Separation through growth plate or physis

A - Above the physis

L - Lower to physis

T - Through the physis, metaphysis, epiphysis

ER-ERasure of physis ( as it is a compression fracture of growth plate)

Hope this helps!

-Padma Sri Katikaneni

 

Basal Ganglia Circuit

Hello everyone!  Confusing loop has now simplified look! 👀 

First of all, Basal ganglia receives cortical input, provides negative feedback to cortex to modulate movement.

3 things must be remembered. 

• SNc (Substantia nigra) input to the striatum via the nigrostriatal dopaminergic pathway releases GABA.
• Dopamine binds to D1 , stimulating the excitatory pathway, and to D2 , inhibiting the inhibitory pathway. 
• Pathways from Thalamus to Motor cortex & from Motor cortex to Basal ganglia - “Stimulatory” 

That’s why this circuit is important in voluntary movements and adjusting posture. 

Here is my attempt to simplify this circuit through a drawing. By understanding that you’ll never forget it! 

• I-N-hibitory pathway goes through Gp-I & N-ucleus(Subthalamic)!
• If BG output = +, then increased motor activity
• If BG output = -, then decreased motor activity 

In PARKINSON’S DISEASE, SNc degenerates = lose dopaminergic input to BG

Less stimulation of direct pathway (⬇️gas) and less Inhibition of Indirect pathway (⬆️ brake) = overall indirect wins =less motor activity. This explains bradykinesia and rigidity of PD but not tremor. 

STN and GPi are targets of Deep Brain Stimulation in PD. 

Deep brain Stimulation INHIBITS activity in these structures—inhibiting either would lead to decreased inhibitory output of BG = increased motor activity-> improve PD symptoms. 

Lesion of STN -HEMIBALLISMUS= uncontrolled erratic large amplitude movements on one side.  Why INCREASED movement with STN lesion? 

By decreasing STN excitation of GPi we essentially ‘remove’ indirect pathway from equation, and direct pathway becomes unchecked -> ⬆️ movement      

Thank you! 🩺

Ehler-Danlos Syndrome (EDS) - High yield only

Hi! So let's learn EDS together. I've tabled a list of high-yield points of all the types of EDS. It requires little bit of revision but once you get a pictorial familiarity you should be able to recall them all. 

Have fun!

So, how to remember?

Step 1. Divide the table into 2 halves. Sl no. 1,2,3 have in common a lot of features:

• They are all Autosomal Dominant. 
• They have common Clinical features - skin HYPERelasticity, joint HYPERmobility and HYPER (easy) bruising. 
• Go serially, Classical has the first 2, Type I and II and HYPERmobile is III and lastly Vascular is type IV 
• Vascular type has additionally - arterial & uterine rupture.

Step 2. Now the second section Sl no. 4,5,6

• EDS types with enzyme defects are Autosomal Recessive. So, 4 and 6 are AR. 
• Kyphoscoliotic EDS is Type VI (K rearranged is a V and I)
• For the last 2, mnemonic is ABCD😛 Arthrochalasia VII a, b and VII c is Dermatosparaxis.
• KyphoSCOLIOTIC EDS - defective lysyl hydroxylase (=> abnormal cross linking of collagen or KOLLAGEN => think of bones 🦴 => congenital SCOLIOSIS)
• ARTHROchalasia is COL IA (1st letter is A) and hence presents with severe JOINT hyper mobility.
• DERMATospARaxis is AR and a defective Procollagen-N-peptidase and presents with CUTIS laxa. (Cuties are Pros ;)

Step 2. For the Gene types, come down in descending order: 5 4 3 2 1 0 

Step 3. Remember Type V - DOEST NOT EXIST. 

Step 4. Revise again 😉

That's it! Stay safe 🌸

- Anagha :)

Types of COVID-19 antibody tests

Hi everyone! 

In this post, I will go over in very short the different types of  COVID-19 antibody tests.

Cancer Screening - US Preventive Services Task Force (USPSTF) guidelines

     As the saying goes - "Awareness is Power in a world where information is everywhere", lets quickly learn the USPSTF recommended guidelines for Cancer screening

CANCER	SCREENING MODALITY	AGE GROUP
Breast Cancer	Biennial Mammography	Women aged 50 to 74 yrs
Cervical Cancer	Cervical cytology every 3yrs   Cervical cytology every 3 yrs  or High risk HPV(hrHPV) testing every 5 yrs or hrHPV testing in combination with cytology every 5yrs (cotesting)	Women aged 21 to 29 yrs  Women aged 30 to 65 yrs
Lung Cancer	Annual Low dose CT chest (who have a 20 pack-year smoking history and currently smoke/quit within past 15 yrs)	Adults aged 50 to 80 yrs
Colorectal Cancer	Colonoscopy screening every 10 yrs Flexible sigmoidoscopy every 5 yrs Computed tomography colonography every 5 yrs High-sensitivity guaiac fecal occult blood test (HSgFOBT) or fecal immunochemical test (FIT) every yr Stool DNA-FIT every 1 to 3 yrs	Adults aged 45 to 75 yrs

P.S. - USPSTF now recommends screening for Colorectal cancer in adults aged 45 to 75 years

- Padma Sri Katikaneni                                                                                                                       

                  

Human herpes viruses (HHV) types mnemonic

Human herpes viruses mnemonic... In case you get them mixed up...

Fact of the day - Athlete's heart

Hi!

Athlete's heart - physiologic eccenteric hypertrophy (cardiac remodeling) - changes include resting bradycardia, higher cardiac output with exercise, dilatation of LV cavity size with hypertrophy of myocytes compared to normal heart.

vs pathologic hypertrophy in case of systolic heart failure, aortic/mitral regurgitation, dilated cardiomyopathy(DCM) (volume overload conditions).

LV systolic ejection fraction is normal - low-normal in athletes.

(vs HCM- high, DCM- low)

HCM is a common cause of death in athletes, especially those with family history.

That's all

- Jaskunwar Singh

METABOLIC SYNDROME - MNEMONIC

BE AWARE of THE HIGH SUGARS

(3 or more of the following : diagnosis of Metabolic syndrome)

Blood Pressure >/=130/85mmHg

Abdominal obesity ( waist circumference) > 40 inches in males; >35 inches in females

Triglycerides >/=150 mg/dl

HDL cholesterol < 40mg/dl in males; < 50mg/dl in females

Fasting blood Sugars >/=100mg/dl

Hope this helps:)

- Padma Sri Katikaneni

Megalencephaly mnemonic

Hello friends! 

Here's is the simple mnemonic to remember the important causes of Megalencephaly.

CATS

Canavan's disease

Alexander disease

Tay- Sachs disease

Sandoff disease.

That's all!

Dr.Madhuri Reddy

COMMON METASTASES - MNEMONICS

SITE OF METASTASIS                              PRIMARY TUMOUR 

BRAIN                                                                    Lots of Bad Stuff Kill microGlia

                                                                                 Lung, Breast, Skin (melanoma), Kidney, GI(colon)

LIVER                                                                     Cancer Sometimes Penetrates Big Liver   

                                                                                 Colon, Stomach, Pancreas, Breast, Lung 

BONE                                                                      Permanently Relocated Tumours Like Bones

                                                                                 Prostate, Renal, Thyroid, Lungs, Breast

     

P.S. - FOUR CARCINOMAS ROUTE HEMATOGENOUSLY! 

        (Follicular carcinoma thyroid, Choriocarcinoma, Renal cell carcinoma, Hepatocellular Carcinoma)

Hope these mnemonics help!

Feel free to add any more fun mnemonics :)

- Padma Sri Katikaneni

Internal Medicine residency program Excel sheet (2020)

Hi guys,

I am sharing an excel sheet containing 200+ Internal Medicine residency programs. Feel free to download it and edit the information and programs according to your profile and needs. There may be a few IMG friendly programs that are missing, so do your homework and don't apply blindly. Use this as a template sheet to work on!

Kindly note, the comments are subjective, and none of the authors endorse them as proven facts. Some information may be incorrect as a lot of manual labor went into making this sheet.

Hope this helps in making the ERAS application process easier!

https://docs.google.com/spreadsheets/d/1l2Vra6wDcZX5_FMLOFcetZua64wwNsdXKDKB0saGykg/edit?usp=sharing

HERPANGINA vs HERPETIC GINGIVOSTOMATITIS

	HERPANGINA (Hand-Foot-Mouth Disease)	HERPETIC GINGIVOSTOMATITIS
CAUSATIVE VIRUS	Coxsackie A virus	Herpes Simplex type 1 virus (HSV-1)
AGE	3-10 years	6 months-5 years
CLINICAL                             PRESENTATION	Grayish Vesicles on                Posterior Oropharynx      (soft palate, tonsils, tonsillar pillars, Uvula)	Clusters of vesicles on       Anterior Oropharynx (Lips, buccal mucosa, tongue, gingiva, hard palate)
TREATMENT	Supportive management with oral hydration and analgesics	Oral Acyclovir

Fact of the day - halothane hepatotoxicity

 Hi!

A patient with biliary stones who's undergone laparoscopic cholecystectomy may develop signs of hepatotoxicity between 2 days - three weeks post-op. due to halothane. The mechanism is this anesthetic's biotransformation to reactive metabolites through P450.

At risk category of patients are females more than 40 years of age.
Labs show elevated AST and ALT.
Hepatitis is relatively rare.

Other effects:

- Cardiac arrhythmias

- malignant hyperthermia

- hypertension


That's all

- Jaskunwar Singh

Levetiracetam - pregnancy considerations

 Hi!

Levetiracetam, used primarily for seizures control, is also used off-label for SAH, status epilepticus, seizure prophylaxis in craniotomy and traumatic brain injury.

Dosing is increased in pregnancy and closely monitored regularly due to various physiologic effects, especially in third trimester. (levitate dose of levetiracetam) :-

- increased volume of distribution, Vd (increase in plasma volume, CO)

- increased renal excretion (increase in GFR; levitate the rate)

- rapid and almost complete absorption via GIT  (unlike other drugs with decreased absorption in pregnancy)

- low risk of adverse effects and fetal malformations when used in monotherapy. (low with mono, high with poly)

- Levetiracetam is NOT metabolized by liver; Cyt P450 independent. Bioavailability 100%. (unlike other antiepileptics - hepatic metabolism increases in pregnancy)

Levetiracetam crosses placenta and can be detected in the newborn. (leve leaves mother)

The newborns are at greater risk of SGA and low APGAR score.

Protein-binding of the drug is low (<10%). So, decrease in albumin concentration during pregnancy does not significantly affect the drug concentration. (low pro)

That's all

- Jaskunwar Singh

Glomerulonephritis associated with infectious diseases mnemonic

Hepatitis B: Membranous glomerulonephritis

Hepatitis C: Membranoproliferative glomerulonephritis

HIV: Focal segmental glomerulosclerosis

By IkaN

Embryology of eye mnemonic

Hello friends!

Here's is the simplest way to remember embryology of eye.

*Out of all layers (ecto,meso, endo), the endoderm doesn't contribute to the embryology of eye.

* Mesoderm forms - extraocular muscles

* Rest of the structures are derived from ectoderm.

* Surface ectoderm forms the structures which are visible to us from outside like Corneal epithelium

Conjunctival epithelium

 Lacrimal gland

 Lens ( important)

*Neuroectoderm forms neural structures like

Retina

Ciliary body ( not muscles)

Iris - both sphincter and dilator pupillae

Optic nerve

* Neural crest derivatives are 

Meninges of optic nerve

Schwann cells

Ciliary ganglion

Ciliary muscles 

For the remaining derivatives, watch the following picture.

Thank you.

Dr. Madhuri Reddy. 

Kartagener syndrome mnemonic

 Hi!

Kartagener syndrome (primary ciliary dysfunction, aka immotile cilia syndrome) mnemonic :-

Toxoplasmosis classic triad mnemonic

 Hi!

Toxoplasmosis classic triad in neonates mnemonic: CATS 

- CAlcifications (intracranial)

- Tension hydrocephalus

- See (Chorioretinitis)

Also, check out this video mnemonic by IkaN

- Jaskunwar Singh

ARDS management mnemonic

 Maintenance “DOSE”

Dry Lungs - “Dry lungs -Happy lungs”

• Maintain negative fluid balance to reduce pulmonary edema

Open but not Over-distended 

Management of asymptomatic carotid atherosclerotic disease and carotid artery stenosis mnemonic

Super short post!

A) Asymptomatic

≥80% stenosis: Carotid endarterectomy

≤79% stenosis: Medical management

Mnemonic AGES: Asymptomatic Greater than Eighty Surgery

B) Symptomatic

≥70% stenosis: Carotid endarterectomy

Mnemonic SSS: Symptomatic Seventy Surgery

50%-69% stenosis

Male: Carotid endarterectomy

Female: Medical management

Mnemonic MMM: Males Manage More than fifty with surgery

<50% stenosis: Medical management

That's all!

-IkaN

Creatinine clearance in elderly - basic notes

 Hi!

Elderly people have a decrease in creatinine clearance (CrCl), which means an increase in serum Cr. It is observed that annual rate of this decrease in CrCl is approximately 1 ml/min. after the age of 50 years.

Therefore, it is important to calculate the dose and dosing intervals of nephrotoxic drugs (eg., aminoglycosides) in these patients in order to prevent the precipitation of ARF.

In general,

CrCl <100 ml/min is abnormal.

However, CrCl <10 ml/min signifies the onset and worsening of acute renal failure.

Note -

• GFR is directly proportional to CrCl.

• GFR decreases by age, but not always accompanied by rise in Cr.

• Cockcroft-Gault formula is commonly referred to for calculating CrCl.

CrCl = (Ucr × V)/Pcr (~GFR)

• Double the Cr = Half the GFR.

Note that those patients with signs of worsening diabetes and resulting glomerulopathies, an increase in both GFR and CrCl is seen, which thus causes hyper filtration injury. 

That's all

- Jaskunwar Singh

Rigler's triad mnemonic

 Hi!

Rigler's triad in gall stone ileus mnemonic:

GALL in GIT

Belimumab mnemonic

What is belimumab?

Belimumab is a  monoclonal antibody directed against soluble B lymphocyte stimulator (BLyS).

Belimumab is used in the treatment of? 

Systemic Lupus Erythematosus (SLE)

Mnemonic: Belly Selly SLE (rhymes! sing it enough times and you will never forget)

At present, belimumab is indicated as add-on therapy in adults with active, antinuclear antibody or anti-dsDNA-positive SLE with a high degree of disease activity in the skin and/or musculoskeletal systems that remain moderately to severely active despite optimized standard immunosuppression. 

Patients with severe lupus nephritis or active CNS lupus are not the candidates for belimumab.

That's all!

-IkaN

Direct oral anticoagulants (DOACs) dosing for stroke prevention in atrial fibrillation mnemonic

Hi everyone!

Here are some DOAC dosing mnemonics for atrial fibrillation! 

RivarOxaban: Once daily

Apixaban: Twice daily 

Dabigatran: Twice daily

EdOxaban: Once daily

Mnemonic: Drugs with O have Once-daily dosing. 

Rivaroxaban: 20 mg once daily with the evening meal (creatinine clearance [CrCl] >50 mL/minute); or 15 mg once daily with the evening meal (CrCl ≤50 mL/minute).

Mnemonic: R without the straight line | looks like 2 to me for 20 mg!

Apixaban: 5 mg twice daily (CrCl >50 mL/minute); or 2.5 mg twice daily for those with any two of the following: age ≥80 years, body weight ≤60 kg, or serum creatinine ≥1.5 mg/dL.

Mnemonic: Apixa has 5 letters for 5 mg!

Dabigatran: 110 mg BID or 150 mg BID (CrCl >30 mL/minute).

European labeling suggests dose reduction in patients older than 75 years (eg, 150 mg orally once per day or 110 mg orally twice per day).

Edoxaban: 30 mg (weight ≤60 kg) or 60 mg (weight >60 kg) orally once daily.

That's all!

Remember that the dosing varies for VTE treatment and prophylaxis so do not apply these mnemonics for VTE.

-IkaN

Formulation, absorption and associated side effect of dabigatran

Did you know that the absorption of dabigatran etexilate is dependent on an acid environment in the stomach?

This is why it is formulated together with tartaric acid pellets. These pellets provide an acidic environment, which increases drug dissolution and absorption, regardless of variations in gastric pH. This is also why the absorption is not affected by the coadministration of a proton pump inhibitor.

A lower pH is associated with dyspepsia, esophagitis, and plays a part in the increased risk of gastrointestinal bleeding.

-IkaN

Simvastatin combination with fibrates in clinical practice

 Hi!

High-yield in clinical practice:

DO NOT combine simvastatin with gemfibrozil (class-X interaction; high risk of acute liver damage and rhabdomyolysis). Inhibition of CYP450 enzyme by gemfibrozil plays the role in increasing levels of simvastatin 2-3x.

Combination of simvastatin with fenofibrate is relatively safer, although close observation and regular monitoring is required (class-C interaction). Serum levels of simvastatin remain unchanged.

- Jaskunwar Singh