Diamond blackfan anemia notes and mnemonic

Diamond blackfan anemia

It is congenital pure red cell aplasia.

A 7 year old with hyperextensible joints

A 7 year old boy is brought to you. He is intellectually disabled. On examination, you notice hyperextensible joints. Large hands, large feet, protruding ears, elongated face are also seen. The patients testes are large in size compared to his age. Diagnosis?

Marfans syndrome
Ehler Danlos syndrome
Fragile X syndrome
Friedreichs Ataxia
Homocystinuria

Answer below
.
.
.
.
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It's Fragile X syndrome. Why isn't it's Marfans? Because Marfans has normal IQ.

Here are my notes + mnemonic for Fragile X syndrome.

Did you know?
Fragile X is the most common cause of inherited mental retardation.
It was the first trinucleotide repeat disorder to be recognized.

That's all!
-IkaN

Walsham's forceps

Walsham's forceps

Uses: to correct lateral deviation of fractured nose and disimpaction

and repositioning of bony fragments.

Most students get confused between Walsham's forceps and Asch's forceps. The difference is in the structure of the instruments itself.

Walsham's forceps: paired instrument used for reduction of nasal bone fractures. One nasal blade is placed externally while the other blade goes into the nose and supports the nasal bone.
Also, the blades are not elevated in walsham's forceps as in the case of asch's.

Asch's forceps: unpaired instrument used for reduction of nasal septum and vomer fractures. It is used along with Walsham's forceps for the reduction procedures. The blades are elevated. (ASCh = Ascending)


Thats all
- Jaskunwar Singh

Trousseau's tracheal dilator

Trousseau's tracheal dilator

Used to widen the tracheal incision to aid in the insertion of

 tracheostomy tube.

Remember: It is curved at its ends so that it doesn't block the field of vision of the surgeon while making the incision and insertion of the tube.

Thats all
- Jaskunwar Singh

Toynbee's ear speculum

Toynbee's ear speculum

Uses: Examination of external ear and tympanic membrane

In operative procedures like myringoplasty, myringotomy.
Removal of wax, foreign body, otomycosis, ear discharge.

Different sizes for patients according to age.

Thats all
- Jaskunwar Singh

Tonsil artery forceps

This instrument is of two types: straight and curved.

Straight forceps (Birkitt's tonsil artery forceps) used to catch the bleeding point. (in tonsillar fossa) following tonsillectomy.

Birkitt's first tonsillar artery forceps

Wilson's second artery forceps

Curved forceps used as replacement forceps before tying a ligature to the bleeding points following tonsillectomy. (also called Second tonsillar artery forceps)


Thats all
- Jaskunwar Singh

Asch's forceps

Asch's septum forceps

Used for reducing procedures in cases of nasal septum fractures. (Reduction Rhinoplasty) 

The septum is grasped with the blades of this instrument and straightened to make proper alignment.

The blades are elevated. Remember ASCh- Ascending.

The instrument is often confused with Walsham's fracture. Both are used in reduction procedures of fractures of nasal septum.
To know about differentiating features, click here.

Thats all
- Jaskunwar Singh

Thudicum's nasal speculum

Used to examine external nose.

Light is focused at different sites to examine antero- inferior part of nasal septum, roof, floor, and lateral wall by tilting patient's head in various directions.

There's a specific technique to hold this instrument during examination of the patient. Its really simple but if you don't practice to hold it, you will forget it for sure.
 Keep your ring finger beneath one arm of the speculum and index finger in between the two arms. Press the other arm with middle finger such that the two lower ends meet. 

Here's the picture of the right way to hold it.-

Luc's forceps

Lets start with instruments used in surgical procedures of Otorhinolaryngology..

Firstly, lets talk about Luc's forceps.

This instrument has a fenestrated tip with sharp blades to hold

and grasp a tissue and cut it. So basically it is used for cutting.

Uses:

1. As the name suggests, it is used in Caldwell- Luc's operation (Anterior antrostomy) for removing antral mucosa. 

2. Submucosal Resection of nasal septum. (to remove bone or cartilage from the septum required for a graft)

3. Polypectomy  

4. Turbinectomy

Thats all

- Jaskunwar Singh

A tip for confusing things

many of us have this tendency and inner hunger to know everything, but not all of us are prodigies now are we?

hence a typical example.

types of thyroplasty

type1- medialization of cord

type2- lateralization

type3- shortening

type4- lengthening

no many how many times i have read it, i am bound to get confused. i will remember that type 1 and type 2 had to do with changing the position of the cord from midline, but i am totally going to forget whether medialization was first or not. 

The examiners exploit this very weakness. some sadist i tell you! 

anyways not always will you be able to get your hands on mnemonics that will save your neck..and yes sometimes it is even really tough to remember the mnemonics themselves during exams -_-

my tip is 

just remember

type1- medialization

type3- shortening

hell with everything else..this attitude will save your neck more than you can imagine. use this with eveything confusing. 

just dont give your brain the chance to be confused..read and have a visual image of only the very core of the answer. and trust yourself that when push comes to shove you will be able to answer the question correctly 

-sakkan

Primary Health Care

Hey Awesomites

Today its a short post ( a mnemonic actually ;p )  on the principles and elements of primary health care. (I was asked in SPM viva a few days back. ;p )
As a rule, always find a mnemonic in the name itself, I took care of it and made it in the easiest way possible. So here it is ..

C- Community participation
A- Approach (multi- sectorial)
R- Right technology (appropriate)
E- Equitable distribution of health services.

Elements of primary health care: MI NEEDS
- MCH and family planning
- Immunization
- Nutrition
- Education
- Endemic and common diseases
- Drugs provision
- Sanitation.

Thats all
Happy Medicowesome :)

- Jaskunwar Singh

Caput v/s Cephalhematoma - Ways to remember.

Though simple, takes time in the exam if confused.

So here's a way to save the time meanwhile being sure of the answer for the topic.

Langerhans cell histiocytosis notes and mnemonic

Hey!

I'm clearly doing a lot of notes + mnemonic posts. Here's another one on Langerhans cell histiocytosis!

Langerhans lingers
L - Lytic lesion of bones
I - Diabetes Insipidus
N - Nil
G - Eosinophilic Granulomas
E - Exophthalmos
R - Rrrrr.... :P
S - Skin rash

From study group:

Any mnemonic for Hand Schuller Christian disease?

Mnemonic by IkaN: Hands LIE
Lytic bone lesions
Insipidus (Diabetes Insipidus)
Exophthalmos

Mnemonic by Dev: CDE
Calavarial skull defect
Diabetes insipidus
Exophthalmos

Disclaimer: It's a morbid mnemonic. If you are sensitive and religious, don't read it.
Mnemonic by Vinayak: Jesus CHRIST was killed by hammering nails into his HAND, he DIed, his hands' bone got LYSED and we celebrate EXmas:
For calvarial skull defects, you know, wood was also hammered into his head. DI is diabetes insipidus. EX is exophthalmos.

That's all!
-IkaN

Study group discussion: Skeletal resistance to PTH in CRF

Hi guys! So the question that was asked in the study group is- Why is there skeletal resistance to PTH in Chronic Kidney Disease?

Answer-

Skeletal Resistance to PTH has a multifaceted pathogenesis; the most imp factor being uraemia which screws with the PTH receptor's intracellular G-protein signaling mechanism in the Osteoblasts.

Dialysis in these patients increase the levels of Osteoprotegerin, which is a decoy molecule antagonizing the action of RANKL in promoting osteoclastogenesis; further intereference with the action of PTH.

Hyperphosphatemia and Hypocalcemia in CKD patients cause excessive release of PTH which leads to downregulation of its receptors on osteoblasts. 

Decreased levels of calcitriol screws in a special way, it makes the parathyroid gland think that the normal calcium level range is above the actual normal value, making the gland work overtime. For this we use calcimimetics like cinacalcet to decrease the set point back to the real normal value. And also without Calcitriol to assist, PTH's job becomes a lot more difficult. 

Earlier the most common CKD-related osteodystrophy was osteitis fibrosa cystica which was due to very high PTH levels causing pathologically increased bone turnover.

But now since we have developed drugs to tackle increased PTH levels, Adynamic Bone Disease has become the most common osteodystrophy because in the body of a CKD patient, it is already very difficult for PTH to carry out its function and if we are pharmacologically decreasing its values, we are ensuring that it works negligibly. 

That's enough Nephrology for one day! :)

  

-VM

ECG basics

So basically, ECG is  an electrical representation of heart activity on ECG paper. 

Here are some important postulates of ECG paper:

The needle of galvanometer travels 300 big squares in 1 minute or 60 seconds. 

That makes 0.2 seconds for each big square. 

In turn each big square is divided into 5 small boxes /squares.

So we get each small box counting about
0.04 seconds. 

So let's review all calculations:

1 Big square = 0.2 seconds.
1 small square = 0.04 seconds. 

Each P wave travels about 2 and 1/2 small  squares making upto 0.1 second.

The segment PQ (Sometimes we use PR) again takes 2 and 1/2 small squares making upto 0.1 second.

QRS complex used another 2 and 1/2  small squares making another 0.1 second. 

While S-T segments uses 10 small squares forming using 0.4 seconds.

Note: We normally consider 2 and 1/2 small squares but there can be 2 or 3 small squares. 

~Ojas

Pentavalent vaccines

Hey Awesomites!

Let's discuss something about the pentavalent vaccines and what advantage they have in the immunization of newborns..

Friedreichs Ataxia notes and mnemonic

Here's another notes + mnemonic post on Friedreichs Ataxia

Genetic stuff:
- Due to mutated frataxin gene
- GAA trinucleotide repeats
- Autosomal recessive
- Mitochondrial iron accumulation due to loss of iron transporter coded by frataxin gene results in oxidized intramitochondrial iron accumulation.

Clinical stuff:
- Cardiomyopathy is the most common cause of death in FA. Cardiomegaly, conduction defects, murmurs, fibrosis are seen.
- Musculoskeletal abnormalities like foot deformities (Hammer toe, pes cavus, pes equinovarus) and scoliosis is seen.
- Diabetes mellitus is seen in 20% of patients

Neurologic stuff:
- Nystagmus
- Titubation
- Dysarthria
- Dysmetria
- Ataxia of trunk and limb movements.
- Loss of proprioception and vibratory sense.
- Extensor plantar response, absence of deep tendon reflexes and weakness is found.

That's all!
Stuff.
-IkaN

Mnemonic: Friedreichs FRIEDS! 

Duodenal atresia notes and mnemonic

Duodenal atresia

Hey!

In this post, I wanted to emphasize duodenal atresia is associated with double bubble sign.

It's common in Downs syndrome and polyhydramnios maybe seen in utero.

Bilious vomiting is seen because the obstruction is after the ampulla of Vater.

Because the child is vomiting, abdominal distension is not seen.

That's all!
I need sleep right now.
-IkaN

The Sustainable Development Goals: Mnemonics and explanation

Hi everyone! I'm back with a note. This time on the Sustainable Development Goals (SDG's).

This is a crisp summary of what we need to know about them as Doctors or Health Care Practitioners (in any part of the world). They're so important that a major chunk of the Coldplay concert in Mumbai was based on them. (And every other person spoke about them. How Magic-al).

And they're Also very important for the Community Medicine students from India. So here goes :

SDG's were adopted by nations of the world on 25th September, 2015 to be achieved till 2030. 

They want to do 3 P's. 

End Poverty,
Bring Prosperity to all and
Protect the planet. 

A. The important Health related Goals : 

(Mnemonic by our IkaN)

pH HE EWE

(HE EWE as in Adam and Eve)

1 Poverty 

2 Hunger 

3 Health care 

4 Education 

5 Equality 

6 Water 

7 Energy 

B. Goal 3: Ensure Healthy lives and Promote Well Being. 

Targets 

Remember: BAMS VIP
Baby Adult Mother Sex. 
(OR : Adult and Mother have Sex to get Baby)
Vaccine. Infections. Pollution. 

Baby:
- Neonatal Mort - has 12 letters , so to be reduced to less than 12 by 2030. 

- Under 5 Mortality Rate  - 5*5 = 25. So less than 25 by 2030 

Adult:
- Decrease the burden of NCDs to one third of present.
- Mental health burden to be reduced. Tobacco control. 
- Drug abuse to be tackled. 

Mother:
- Maternal Mortality to less than 70 per 1 lakh world wide. 

Sex: 
- Sexual health and reproductive health strengthening. 

Vaccines:
- Promote and develop.

Infections:
- Tackle TB HIV Malaria Other tropical diseases Diarrheal diseases. 

Pollution:
- Air, Water, Soil, Noise pollution to be tackled. 

Kudos to IkaN who helped me out of this tough spot. This was a life saver and you're the best :* :)

Hope this helps everyone.
Until next time.

~A.P.Burkholderia

Transient synovitis vs septic arthritis

Hello!

In this post, I'll talk on how to to differentiate transient synovitis from septic arthritis.

Transient arthritis is non specific inflammation of the synovium, related to infection or trauma.

Septic arthritis is bacterial infection of the synovium of the joint.

Modified Kochers criteria can help distinguish the two.

Fever > 38.5
ESR > 40 mm/hr
WBC > 12,000 cells/mL
CRP > 20 mg/dL
Inability to bear weight on the affected limb

More the criteria, more likely the child has septic arthritis.

Here's a mnemonic for modified Kochers criteria: FEW Can Bear Kocher!

Fever, ESR, WBC, CRP, weight bearing.

Acute transient synovitis is the most common cause of painful hip in a child younger than 10 years. It is a diagnosis of exclusion and can mimic Osteoarthritis, Legg Calve Perthes disease, SCFE.

Treatment: Rest, anti inflammatory agents.

That's all!
-IkaN

Myotonic dystrophy notes and mnemonic

Hello!

Here are my notes + a mnemonic

Congenital myotonic dystrophy
- Autosomal Dominant
- CTG trinucleotide repeat
- Genetic anticipation seen

- Hypotonia "floppy infant"
- Hollowing of temporal bones
- Tenting of upper lip
- Respiratory muscle weakness
- Arthrogryposis
- Posterior subcapsular cataracts (Subcapsular spokes in stellate conformation) 

Juvenile myotonic dystrophy

- Facial and upper body weakness (Hatchet face due to temporalis, masseter, facial muscle atrophy; frontal baldness)
- Inability to relax muscle (Sustained grip)

- Cardiomyopathy
- Heart block
- Congestive heart failure

- Intellectual impairment
- Gonadal atrophy
- Posterior subcapsular cataracts

- Thenar, hypothenar muscle atrophy (Myotonia evident on percussion)
- Tongue depression
- Dementia

That's all!
Be kind.
-IkaN

Henoch Scholein purpura notes and mnemonic

Hello! Here are my notes + mnemonic on HSP.

IgA-mediated vasculitis of small vessels (IgA and C3 in skin, renal glomeruli, and gastrointestinal tract).

Most common cause of nonthrombocytopenic purpura in children.

Usually follows an upper respiratory infection.

Clinical features are:
Maculopapular rash below waist (Progresses to petechiae to palpable purpura).
Abdominal pain.
Arthritis.
Glomerulonephritis.

That's all!
-IkaN

Rheumatoid arthritis mnemonic

Hello!

Here's an old mnemonic on some of the clinical features of Rheumatoid arthritis.
Well, the name itself tells it.. RHEUMATOID ;p

R- Respiratory distress (Interstitial lung disease, bronchiolitis, pleural effusion)
H- Haematological manifestations (anemias, thrombocytosis, neutropenia)
E- Extra- articular RA (ExRA)
U- Urinary tract infections (mainly drug- induced)
M- Median nerve compression/ Morning stiffness
A- Amyloidosis
T- Tenosynovitis and bursitis
O- Ocular manifestations (Keratoconjunctivitis sicca, scleritis, episcleritis)
I- Immunologic manifestations (Sjogren's, Felty's and Caplan's syndrome)
D- Deformities (boutonniere, swan- neck, button- hole)

Thats all :)

- Jaskunwar Singh

A case on Medical ethics

Hello Awesomites!

Today I am gonna discuss with you a simple case based on medical ethics. A Forensic Medicine professor asked me in final viva last year. So here it goes...

3 month old with hypotonia

3 month old baby with history of honey intake (Given by grandpa) presents with constipation, feeding difficulty, hypotonia. What is the cause of the baby's symptoms?

1. Ingestion of preformed toxin
2. Ingestion of pesticide
3. Ingestion of bacterial spore
4. Bacterial infection of the meninges
5. Urinary tract infection

Answer given below:
.
.
.
.
.
.
.
.
.

If you picked 1, you're wrong.

Infant botulism is caused by botulinium spores in honey, corn syrup that germinate and multiply in the intestinal tract and produce toxin.

Adult botulism is caused by ingestion of preformed toxin.

I just wanted to make that point clear. And emphasize how tricky any exam can get with word play.

Don't stress.

That's all! =)

Oh and the answer is 3.

-IkaN

How to apply for USMLE exams

Hello!

Many medicowesomites have asked about how to apply for their USMLE exams. Finally, here is the procedure. Sorry this took so long

I have answered all the queries in the end.

If you have any more questions, comment in the commments section below and I'll try to reply :)

Descriptive Epidemiology

Hello everyone !
Here's a video telling you a little bit of the Descriptive Epidemiology.
Let me know how you like it and I can continue to make some more to finish it up and tell you more about Epidemics!

Stigmata of infective endocarditis

Hey Awesome people!

Here is another stigmata apart from those mentioned previously by IkaN in a post here,

Stigmata of infective endocarditis:-
(Remember- It's all in the hands)

- Janeway's lesions: non- tender, erythematous macules on the palms and soles.
- Osler's nodes: ephemeral spots of painful nodular erythema on hands and feet.
- Splinter haemorrhages: seen on the nails.

Thats all!

- Jaskunwar Singh

Glaucoma

For all those who don't know what is glaucoma here is the quick review :-

There is damage to the optic nerve, etiology of glaucoma is yet to be known.

Generally, there is increase in intraocular tension , intraocular pressure above 25-30mm Hg which can cause loss of vision. In acute inflammation, WBCs and tissue debris can block exit of intraocular fluid through channel of Schlemm and in chronic conditions, especially in older individuals, fibrous occlusion of the trabecular spaces appears to be culprit!

Buerger's disease

Hey awesomites!

Here's a short post on important points in diagnosis of Buerger's disease (don't confuse the name with Berger's disease which is IgA nephropathy) also known as Thromboangiitis obliterans.

- Recurrent inflammation and thrombosis of small and medium sized vessels
- Hands and feet are affected the most
- Vasculitis and ischemia (causing blackish discoloration of skin)
- Chronic smoking (a definite predisposing/ risk factor)

Clinical features and diagnostic criteria:
            - male patient 30-40 years of age
            - history of chronic tobacco use
            - Angiography: - cock- screw appearance of arteries of wrists and ankles
                                      - tree root/ spider leg appearance due to collateral circulation
            - Exclusion of other vascular diseases ( Raynaud's phenomenon, atherosclerosis, diabetes, hypertension, endocarditis, hypercoagulable states, auto-immune disorders) is important.
            - Skin biopsy (rare)

Note: A possible Rickettsial infection (mostly Rickettsia rickettsiae) could be there which adds on to the pathology of the disease!  (usually in cases of  amputation of the affected area)

Thats all!

- Jaskunwar Singh

Supracondylar fracture of the humerus

Supracondylar fracture of the humerus

- Transverse fracture of the distal part of the humerus.
- Bruises of anterior elbow (Proximal fragments buttons through the brachialis muscle)
- Posterior fat pad sign is seen in non displaced fracture of the humerus.

IMPORTANT: Assess radial and ulnar pulses because brachial artery can be compromised.

That's all!
-IkaN

Submissions: Selenium deficiency mnemonic

"Selena Gomez and Ke$ha both are young and have big hearts."

Selenium deficiency causes Keshan disease which is cardiomyopathy in young children. Also, singers like to dye their hair (Loss of hair pigment is seen in Selenium deficiency aka Keshan disease).

Submitted by Krutika.

Interesting fact: Keshans disease is thought to be caused by Selenium deficiency and coxsackie virus. It's common in places where selenium content in soil is low (China).

That's all!
Thanks Krutika for the mnemonic =)
-IkaN

How to browse through knowledge on Medicowesome

So we have written over 1000 posts. It's absolutely crazy! :D

About me

Hey Awesomites!

Well, I am not a new author here. I am honored to write so many posts for the blog . Let me introduce myself so that all of you can know about me...

Treatment of cholesterol-induced Alzheimer's

Hey awesomites!

Pathology done! Now lets know about its pharmacology here :)

Cranial Nerve Exits Mnemonic (2 2 4 4 )

Hey guys, Jay here!

This is a very simple self explanatory image which I made.

Brain abscess notes

Brain abscess notes

Here's what I studied =)

Causes
- Direct spread (Paranasal sinusitis, otitis media, mastoiditis, dental infection)
- Head trauma or surgical procedure
- Hematogenous spread (Pneumonia, endocarditis)

Organisms:
- Streptococci
- Bacteroides
- Pseudomonas
- Hemophilus
- Enterobacteriaceae
- MRSA (Head trauma, neurosurgical procedure)

Symptoms:
- Headache > 75% patients
- Fever only in 50% patients (Important: Absence of fever should not exclude the diagnosis)
- Focal neurologic deficits > 60% patients
- Other symptoms - Papilledema, nausea, vomiting, drowsiness, confusion
Hemiparesis - Frontal lobe abscess
Dysphasia - Temporal lobe abscess
Nystagmus, ataxia - Cerebellar abscess

Neuroimaging:
- MRI is better than CT.
- Ring enhancing lesion with surrounding edema on neuro imaging studies is seen.
- Most accurate: Brain biopsy
High yield: Biopsy is essential to distinguish brain abscess from cancer and also to determine the precise organism.

Don'ts: Do NOT do a LP. CSF analysis doesn't contribute to diagnosis or therapy. Increases the risk of herniation.

Extra: Abscesses due to Listeria have blood culture positive > 85% of the time.

Differentials:
- Meningitis
- Meningoencephalitis
- Brain tumors (Cancer can give fever)

Treatment:
- Empirical antibiotics should be modified after results of gram stain and culture.
- Surgical drainage.
- Prophylactic anticonvulsant therapy (High risk [>35%] of seizures)
- Glucocorticoids are reserved for substantial periabscess edema and mass effect due to increased ICP.
- Serial MRI or CT scan monthly to document resolution of abscess.

That's all!
-IkaN

Hypercholesterolemia and the Alzheimer's disease

Hey awesomites!

All of you know that cholesterol is synthesized locally in brain as well as peripherally in liver, both separated by a line of blood-brain barrier. But what about the case of hypercholesterolemia and how it eventually leads to increased amyloid depositions. what is the ultimate link between high serum levels of cholesterol and the Alzheimer's disease?

Enteric nervous system (ENS)

Recently, while studying pharmacology, I came to know about the third system of ANS - Enteric nervous system, apart from sympathetic and parasympathetic systems .

Here is some information of ENS:

It consists of highly organized neurons situated in the wall of GI tract.

It mainly includes Auerbach's plexus and Meissner's plexus.

The most interesting point about ENS is this network receives preganglionic fibers from the parasympathetic system and from postganglionic sympathetic neurons.

ENS controls GI motility, secretions, mucosal blood flow.

ENS causes relaxation or stimulation of smooth muscles.

Non-cholinergic excitatory transmitters such as substance - P plays a modulatory role in controlling ENS!

~Ojas