Owl’s eye appearance

 

Lambda sign and T sign

 

Low voltage criteria on ECG mnemonic

Entire amplitude of the QRS (R + S wave) must be < 5mm in all limb leads or < 10mm in all precordial leads. How do I remember this? Mnemonic!​

- IkaN (Nakeya Dewaswala)

Twin pregnancy

: increased age and parity

Family history of twins

Treatment for infertility 

2 varieties:dizygotic and monozygotic

MZ twins are of the following variety depending on the time of twinning

1-within 72hrs of fertilization =dichorionic, diamniotic

2-between 4th and 8th day= monochorionic, diamniotic

3-between 8th and 12th day=monochorionic, monoamniotic

4-after 12days=siamese or conjoint twins

Signs for chorionicity on USG:

Dichorionicity:twin peak/lambda sign

Monochorionicity: T sign/inverted T sign

Maternal complications:

Anemia

Hyperemesis

Pre-eclampsia 

Preterm labor

PPH

Twin complications:

Conjoined twinning

Twin to twin transfusion syndrome

Acardiac twin

Discordant growth

-Rudrani. 

Different routes of administration of pencillin

-Shreya HA 

Triad of hypocalcemia mnemonic and illustration

Shreya HA

MEN syndrome: trick to remember chromosomes

Shreya HA

Hepatitic LFT enzymes and Cholestatic LFT enzymes illustration

ALT_ Alanine aminotransferase

AST_ Aspartate aminotransferase 

ALP_ Alkaline phosphatase 

GGT_ Gamma glutamyl transferase

 

Shreya HA

Atropine dose for bradycardia (ACLS) mnemonic

It's 1 mg. 

-IkaN (Nakeya Dewaswala) 

Therapuetic modalities of prolactinoma and acromegaly difference

Reference : Davidson textbook of medicine

Shreya HA

GLUT-4 mnemonic and illustration

GLUT-4 functions for the insulin-dependent translocation of glucose.

Shreya HA

Puedomonas mnemonic and illustration

Here's an illustration on pseudomonas for the desi students studying microbiology! 

STORY OF PSUEDOMONAS :

Here is you're friend , Psuedomonas

I am pink in colour __ gram negative

I have a long red hair __ flagella

I don't have an additional jacket __ non capsulated

I live on oxygen mask __ obligate aerobe

I play Holi everyday with red , green brown and blue _ pyorubicin , pyoverdin , pyomelanin, pyocyanin.Pigments produced by psuedomonas

My Diet chart __ biochemical reactions and culture media

Biochemical diet _

• Oxidase ka Bartha __ oxidase test positive

• Hugh leifson soup __ hugh leifson media __ glucose oxidation

• Cata cola __ catalase reaction positive

Culture diet _

• Nutrient shake _ In nutrient broth forms surface pellicle ( obligate aerobe)

• Nutrient cake __ nutrient agar _with green / blue colonies , sweet odor

• Red currant cake __ blood agar __ beta hemolysis

• Yellow McConkey sauce __ McConkey agar __ yellow colonies ( doesn't belong to enterobactericea )

• Cetrimide karela fry __ selective medium for psuedomonas __ cetrimide agar 

-Shreya HA

USMLE STEP1 just changed! You need to too!

 

On 26 Jan 2022, the USMLE Step 1 changed its score reporting format to Pass/Fail only. This means, that those who give their exam after this date cannot see their 3 digit score, and neither can anybody else (yes, not even PDs)

WEST Syndrome:

When does a medical student considers herself lucky? 

When she gets to see a patient with a disease so rare, that it's a once in a lifetime case. 

I was the lucky one.

Patient History-

We have a boy around 2 years of age, coming from lower socio economic class. He was a full term baby with normal birth weight. However, there is a history of HIE i.e Hypoxic ischemic encephalopathy during the time of birth.

Since then, patient has complaints of seizures; sometimes so severe that hospitalization was necessary. He has been hospitalised on and off every 1 month. 

Patient turned 2 years and still isn't able to crawl/sit/stand/walk and only speaks monosyllable words. This is called developmental delay.

EEG was found to be hypsarrythmic. 

Thus, Diagnosis of West syndrome was made.

What is West Syndrome?

It is a seizure syndrome and it has characteristic triad of:-

1. Infantile spasms- salaam spells

2. Developmental delay

3. Hypsarrythmia- high amplitude spikes in a         chaotic background.

Patient presentation?

Patients presents with history of salaam spells that is sudden dropping of head and flexion of arms occurring mostly during time of waking. Mother complaints of baby unable to sit or crawl.

Causes;

1. Hypoxic ischemic encephalopathy 

2. Neurocutaneous syndrome like tuberous sclerosis

3. Perinatal infections

4. Hemorrhage 

5. Idiopathic

EEG findings- high amplitude spikes in a chaotic background. 

Credits- epilepsydiagnosis.com

Treatment- no definitive treatment. Only symptomatic management.

Vigabatrin is the drug of choice; especially in Tuberous sclerosis.

ACTC and prednisone for 2-12 weeks, according to response.

Prognosis - poor if developmental retardation is found.

Thank you.

- Thirak Vaishnav

Severe mitral stenosis mnemonic

Mitral valve area < 1.5 cm² or diastolic pressure half time > 150 ms

-IkaN (Nakeya Dewaswala Bhopalwala) 

Quantification of severe mitral regurgitation (MR) mnemonic

Quantification of severe chronic mitral regurgitation mnemonic. 

Courtesy Dr. Mikel Smith

-IkaN (Nakeya Dewaswala Bhopalwala) 

Mitral stenosis gradient and heart rate

Why is the pressure gradient in mitral stenosis heart rate dependent? Why is the pressure gradient in aortic stenosis heart rate dependent?

Parkinson's disease medication taper sequence mnemonic

 In Parkinson's disease, how do you taper off medications to reduce psychotic symptoms? This is a step 3 question.

Density of blood mnemonic

-IkaN (Nakeya Dewaswala Bhopalwala) 

Nadolol mnemonic

-IkaN (Nakeya Dewaswala Bhopalwala) 

-tropy words in cardiology mnemonic (chronotropy, inotropy, dromotropy, lusitropy, and bathmotropy)

Atenolol in pregnancy and breastfeeding

Atenolol is contraindicated in pregnancy.

Where does this data come from?

Apex beat in Aortic stenosis vs regurgitation

 Hello

Clinical pearl: Retroperitoneal hematoma

 Hello

Vascular access during cardiac catheterization (in cases of myocardial infarction, for example) obtained through femoral artery above the level of inguinal ligament may lead to retroperitoneal hematoma due to arterial puncture.

DRESS syndrome and Dressler's syndrome - what's in a name?

 Hello

DRESS syndrome and Dressler's syndrome - what's in the name?

MCQ: Carbamazepine

Q1) Which of the following statements is true about carbamazepine:-

A) It is indicated in complex partial seizures.

B) It is an enzyme inhibitors

C) It can cause megaloblastic anaemia

D) It is the drug of choice for status epilepticus.

#recentNEET

#NEETPG 

#Medicowesome

#pharmacology 

So, the answer to the above question is an option 

A) It is indicated in complex partial seizures.

Let's get started with Carbamazepine:-

It is an antiepileptic drug that acts by lengthening the inactivated state of the Na+ channel. 

Uses:-

1) DOC for Partial seizure/trigeminal neuralgia.

2) Bipolar disorder.

3) Acute mania

4) GTCS.

Let's rule out other options:-

Option B) It's an enzyme inducer. It is a substrate as well as inducer for CYP3A4 and CYP2C9. Oxcarbazepine is a less powerful CYP enzyme inducer.

Option C) Carbamazepine causes agranulocytosis or aplastic anaemia and not megaloblastic anaemia.

Other side effects include:

1) Hyponatremia: Delayed and more common in the elderly. Risk is higher in Oxcarbazepine.

2) Hypersensitivity

4) Hepatoxicity 

3) Steven Johnson syndrome (Associated with HLA-B 1502 gene)

4) Ataxia 

4) Blurred vision/ Diplopia 

For the last two side effects, we need TDM for adjusting the dose. Remember, Ataxia and Blurred vision is not a Idiosyncratic reactions.

Let's do questions related to Carbamazepine!

Q1) What adverse effect is risked to ongoing valproate therapy?

-Hepatotoxicity.

Q2) A cancer patient is on anticancer drugs (vincristine etc) and develops multiple episodes of seizures, refractory to diazepam and lidocaine. Blood tests show elevated ADH and euvolemic hyponatremia. Which drug can be used to treat this patient?

- You can't use Carbamazepine because it causes increase sensitivity of renal tubules to ADH levels. 

In this case, we use Phenytoin which causes a decrease in ADH secretion and corrects hyponatremia.

~Ojas

Acute rheumatic fever and RHD - diagnostic criteria

Hello

Diagnosis of ARF and RHD based on modified Jones' criteria - let's review:

Introducing Cardiowesome

Hi everyone, 

As you already know I have started my Cardiology Fellowship this year. I'm going to post a lot of blogs on cardiovascular diseases that might of not be palatable for medical students. Only some of these posts maybe helpful (pharmacology related, EKG ones, and basic pathophysiology of cardiovascular diseases). 

I understand that the majority of my posts will be limited to a specialized group of cardiologists, echocardiographers, emergency medicine physicians, critical care professionals, POCUS users, electrophysiologists, heart failure specialists, and interventional cardiologists.

This is why, I'm introducing a new label on the medicowesome blog called cardiowesome. These are advanced posts targeted for cardiology fellows and trainees.

I hope you enjoy reading them and learning with me. 

-IkaN (Nakeya Dewaswala Bhopalwala) 

S' Tissue Doppler Imaging - Derived Tricuspid Lateral Annular Systolic Velocity mnemonic

S’ Wave: Tissue doppler imaging-Derived Tricuspid Lateral Annular Systolic Velocity

S’ value less than 9.5 cm/sec indicating RV dysfunction. Mnemonic... If you stare at the number long enough you'll see 9.5 in it lol. 

The first peak above baseline that is timed with the QRS represents isovolumetric contraction and not the tricuspid annular velocity.

-IkaN (Nakeya Dewaswala Bhopalwala) 

Relative wall thickness 0.42 mnemonic

The RWT reports the relationship between the wall thickness and cavity size. It is an index of LV concentricity. 

The golden number to remember for RWT is 0.42 as it allows further classification of LV mass increase as either concentric hypertrophy (RWT >0.42) or eccentric hypertrophy (RWT ≤0.42). 

Since there are so many numbers to remember in echocardiography, I made a mnemonic for RWT. 

Relative = 0 (Relative zero)

Wall = 4 (4 letters in the word wall)

Thickness = 2 (2 strokes in the letter T) 

Hope this helps! 

-IkaN (Nakeya Dewaswala Bhopalwala)