Slipped Capital Femoral Epiphysis mnemonic:
Tuesday, May 9, 2017
Step 2 CK: Treatment of DVT notes
Here are my notes for Step 2 CK exam!
DVT treatment: Anticoagulation.
Duration: Minimum 3 months.
DVT with high risk of bleeding: IVC filter.
DVT in pregnancy, malignancy: LMW heparin.
Massive DVT: Thrombolysis / clot removal with anticoagulation.
DVT due to HIT: Stop heparin containing products. Start non heparin anticoagulation.
When should you hospitalize: Patients with massive DVT (eg, iliofemoral DVT, phlegmasia cerulea dolens), concurrent pulmonary embolism, a high risk of bleeding on anticoagulant therapy, comorbid conditions, or other factors that warrant in-hospital care.
Notes from UpToDate:
Anticoagulation is the mainstay of therapy for patients with acute lower extremity deep vein thrombosis (DVT).
In patients with asymptomatic proximal DVT, we suggest anticoagulation identical to that for patients with symptomatic DVT.
Options include subcutaneous low molecular weight (LMW) heparin, subcutaneous fondaparinux, the oral factor Xa inhibitors rivaroxaban or apixaban, or unfractionated heparin (UFH).
Although there is agreement on the minimum length of time a patient with a first episode of DVT should be treated (ie, three months), the optimal length of time is not known.
Outpatient anticoagulation rather than inpatient therapy can be considered when patients are hemodynamically stable, have a low risk of bleeding, do not have renal insufficiency, and have a practical system in place at home for the administration and surveillance of anticoagulant therapy. It is not appropriate in patients with massive DVT (eg, iliofemoral DVT, phlegmasia cerulea dolens), concurrent pulmonary embolism, a high risk of bleeding on anticoagulant therapy, comorbid conditions, or other factors that warrant in-hospital care.
For patients in whom anticoagulation is contraindicated or in whom the risk of bleeding is estimated to outweigh the risk of recurrent thromboembolism, we suggest the insertion of an IVC filter rather than no therapy.
For patients with active malignancy and pregnant women, we suggest that LMW heparin be selected as the initial and long-term anticoagulant of choice rather than other agents.
For patients with massive iliofemoral DVT or phlegmasia cerulea dolens with symptoms for <14 days and good functional status, we suggest systemic or catheter-directed thrombolytic therapy, and/or clot removal (eg, catheter extraction, catheter fragmentation, surgical thrombectomy) rather than anticoagulation alone.
For patients with a DVT and a diagnosis of heparin-induced thrombocytopenia (HIT), all forms of heparin should be discontinued and immediate anticoagulation with a non-heparin anticoagulant started.
Extra: For select patients with isolated distal DVT (eg, those at high risk of bleeding, negative D-dimer level, asymptomatic or minor symptoms, without risk factors for extension, and/or minor thrombosis of the muscular veins), we suggest surveillance with serial ultrasound over a two-week period rather than anticoagulation. Those who exhibit signs of thrombus extension should be anticoagulated.
That's all!
-IkaN
Trypanosma mnemonic
This one will help you in having a fair idea about the linking of Trypanosoma species with the diseases caused and the vectors associated.
1. T. cruzi- American Chaga's disease.
Americans have big fat freeways on which they love to cruise in their cars. Also,if you are into automobiles, you can remember the car 'Cruze'
from Chevrolet, the American carmaker.
The vector is reduviid(kissing) bug. Do I need to say more?!
2. T.brucei- This one is full of the phonetic 'sa' in it- T. brucei causes sleeping sickness with the vector being the tsetse fly!
That's all!
-Sushrut Dongargaonkar
Congenital adrenal hyperplasia mnemonic
Second digit for sex hormones
First digit - BP
Second digit - sex steroids
An easier alternative submitted by Dev:
Just remember AT
A - Aldosterone
-IkaN
Monday, May 8, 2017
The basics: Lesions of Spinal Cord
Felix and Dreyer's tube mnemonic
The tubes used for serological diagnosis of typhoid are frequently asked and it takes many bungling to get the answer right. Here's a mnemonic which may come handy-
1. Felix tube- Short round bottomed which detects the 'O' antigen.
Remember the round bottom and round shape of the letter 'O'.
2. Dreyer's tube- Narrow, conical bottomed one which detects the 'H' antigen
Deserts are 'dry' and pyramids, which resemble cones are in the deserts of Egypt. Hence, conical bottomed Dreyer's tube. The letter 'H' is not round, so, it is this antigen which this tube detects.
Revise this mnemonic more than once so you get it clearly what's what.
-Sushrut Dongargaonkar
Episiotomy indications : Mnemonic
Hi everyone.
Posted in Ob-Gyn now. Let's just say it's not a lot of fun looking at diseased hoo-hoo's.
Just kidding.
Here's a Mnemonic for the absolute indications of Episiotomy.
Remember : PPPP
1. Perineum is rigid
2. Perineum has been operated on. (For Prolapse, stress urinary incontinence , etc)
3. Procedures are to be used. (Like Ventouse or Forceps)
4. Position / Presentation are abnormal. (Like Breech , face to pubis, shoulder dystocia , macrosomia)
The other indications which are non-absolute include :
- Maternal exhaustion
- Preterm/ post mature baby
- Trial of labour.
So I hope this didn't tear you up. (Pun intended).
Happy studying !
Stay awesome.
~ A.P.Burkholderia
Saturday, May 6, 2017
Fact of the day: Shoulder dislocation
An anterior shoulder dislocation is usually caused by a blow to the abducted, externally rotated, and extended arm (eg, blocking a basketball shot).
Violent muscle contractions following a seizure or electrocution represent the most common causes of posterior shoulder dislocation.
Acute Kidney Injury due to Anticancer drugs
Hey guys, there are multiple causes of acute kidney injury in a cancer patient, namely sepsis, metastasis, tumor lysis syndrome, etc. But there is another reason which we often overlook, which is drug-induced.
1. Thrombotic microangiopathy: Associated with agents targeting vascular endothelial growth factor(VEGF), eg., Ranibizumab, Bevacizumab. These drugs also block the angiogenesis in the glomerular vasculature, such that the injured endothelium isn't replaced, leading to multiple foci of platelet aggregations just like in TTP and HUS.
2. Focal segmental glomerulosclerosis: Associated with tyrosine kinase inhibitors are the most common and are frequently associated with acute kidney injury.
3. Acute Interstitial Nephritis:
The checkpoint inhibitors ipilimumab, nivolumab, and pembrolizumab activate host T cells to enhance tumor killing by preventing tumor ligand binding to cytotoxic T-lymphocyte antigen 4 and programmed death 1 receptors, which deactivate T cells. However, this effect causes loss of self-tolerance (and perhaps tolerance to other drugs), leading to various forms of autoimmune injury, including acute interstitial nephritis, which is associated with moderate-to-advanced-stage acute kidney injury.
That's all!
-VM
Gross motor milestones mnemonic
In this video, I talk about gross motor milestones from the age one to five years of age.
Source: Nelsons textbook of pediatrics.
Friday, May 5, 2017
Mumps complications mnemonic
That's all!
-IkaN
Maternal factors for IUGR mnemonic
The maternal factors that increase the risk of Intrauterine Growth Restriction ( IUGR ) in unborn babies ( small - for - dates ) include : MATERNAL RISK
M - Malnutrition / Multiparity
A - Anaemia ( severe )
T - Toxaemias of pregnancy
E - Excess physical activity
R - Raised blood pressure
N - Narrow birth spacing
A - Alcohol intake ( excess ) / Age ( young )
L - Low socio - economic scale
R - Recreational drug use
I - Infections
S - Smoking / Short stature
K
Thats all
- Jaskunwar Singh
Kangaroo mother care mnemonic
Components of Kangaroo mother care mnemonic : Baby Kangaroo HOPS in its mother's pouch ;p
H - Healthy diet provision ( breast - feeding )
O - Outpatient care ( due to early discharge )
P - Positioning of baby close to mother's chest
S - Support to mother and family
Thats all
- Jaskunwar Singh
Uric acid and struvite stones mnemonic
Well, urine is largely water which *can* be considered as transparent. That's why, uric acid stones don't show up on X-rays.
Struvite or triple phosphate stones have Proteus has the causative factor. Remember p for p
That's all!
-Sushrut Dongargaonkar
Drugs causing gingival hyperplasia mnemonic
It's important to know drugs causing hypertrophy of the gums for exam purposes.
Auditory Transduction simplified
Pigment producing mycobacteria mnemonic
There are these two mycobacteria which produce pigments- M. gordonae and M. szulgai in the dark. How to remember them?
1. A garden contains flowers which
are colourful. So you can remember M. gordonae that way.
2. Szulgai matches 'Nilgai' which is an Indian local word for the Indian
bluebuck/Indian blue bull. So the involvement of a color in the name can be correlated with pigment production.
That's all!
-Sushrut Dongargaonkar
Thursday, May 4, 2017
Beta blocker intoxication
Hello!
This is a short blog on beta blocker
intoxication.
Beta blockers acting on beta receptors have wide range of actions and uses.
Most common complication of beta blocker overuse is Cardiovascular depression like hypotension and bradycardia, impaired atrioventricular functions.
Can we give adrenergic drugs to reverse this action?
No, we can't .
Prolong use of beta blockers leads to upregulation of the beta receptors. Beta Agonists will further aggravate the adrenergic actions.
Which may cause tachycardia even arrhythmias.
Even Atropine is inconsistent in reversing the side effects
So the alternative used is Glucagon -
It stimulates cAMP synthesis independently of beta adrenergic receptors.
It has positive ionotropic and chronotropic action, thus it reverses the cardiovascular depression without causing tachycardia or other adrenergic effects.
It can also be used in calcium channels blocker overuse.
Glucagon therapy still dont have enough evidence to prove its efficiency.
Hence Judicious use of drugs is must.
Stay awesome!
~Khush
Effects of cholinergics and anticholinergics on the bladder mnemonic
Cholinergics, bethanechol, diabetes mellitus, denervation and overflow incontinence.
Anticholinergics, oxybutynin, urge incontinence.
And mnemonics. Enjoy!
Risperidone mechanism of action mnemonic
Risperidone is a second-generation antipsychotic that has affinity for D2, 5-HT2A, alpha 1, alpha 2 and H1 receptors.
The mechanism of action of risperidone is not fully understood, current theories focus mainly on its ability to block D2 and 5-HT2A receptors.
Hard time remembering this? I've got a solution!
Wednesday, May 3, 2017
Initiation factors in eukaryotic translation mnemonic
Chaitanya Inge
Rubeola vs Rubella mnemonic
RubeOla - Ordinary measles ( kOplik spots on buccal mucosa are pathognomic )
RuBella ( German measles ) - Well, I remember Bella B. Felsenheimer, a German musician and drummer ( Foschheimer spots on the soft palate are characteristic ).
Thats all
- Jaskunwar Singh
Torres bodies mnemonic
Okay, to be honest this one is not quite a very good mnemonic but I like to remember Torres bodies in yellow fever by the footballer Fernando Torres wearing his club jersey in yellow color, even if he doesn't. Well, yeah, that's about it! :-p
-Sushrut Dongargaonkar
Tuesday, May 2, 2017
Diagnostic Enzymes in Myocardial Infarction
I am very thankful to IkaN for helping me with Troponin and CK-MB. :)
Thats all,
Drugs that prolong QT interval mnemonic
Here are drugs that can prolong QT interval and cause Torsades de Pointes! The mnemonic is TOOOOORSADES!
Cerebral ring enhancing lesions Mnemonic
Cerebral Ring enhancing lesions are a common finding in MRI based questions asked in the boards. ;)
The mnemonic to help you remember it is: Suppose there is a Dr Grams who is missing his wedding ring and is searching for it fervently. So if you're doing an MRI and you see a ring what should you do?
CAL DR GRAMS
C- Contusion
A- Abscess
L- Lymphoma
D- Demyelinating disease
R- Radiation necrosis
G- Glioblastoma
R- Resolving Haematoma
A- Abscess
M- Metastatic lesion
S- Subacute infarct
Here's a mnemonic submitted by Jaskunwar Singh. It includes Tuberculosis and toxoplasmosis!
CAL DR SMART
C - Contusions
A - Abscess
L - Lymphoma
D - Demyelinating diseases
R - Radiation necrosis
S - Subacute infarct
M - Malignancy / Metastatic lesions
A - AIDS
R - Resolving haematoma
T - Toxoplasmosis / TB
I assume that everybody knows about toxoplasmosis and tuberculosis so I didn't include them in my mnemonic. Use the mnemonic that suits you =)
That's all :)
-VM
Study group discussion: A mnemonic for yawning? (pandiculation)
Monday, May 1, 2017
Vitamin B3 and pellagra mnemonics
Hello!
This post is all about niacin aka vitamin B3 and it's deficiency with loads of mnemonics. Who is excited?
1. How to remember Niacin is vitamin B3:
- You can remember the three vowels in nIAcIn, so it's vitamin B three.
- N has 3 strokes, so Niacin is B3
- NIA - B3
2. Vitamin B3 deficiency, Pellagra, is clinically manifested by photosensitive dermatitis, diarrhea, dementia.
Pellagra mnemonic:
"B3 causes D3"
Diarrhea, Dermatitis, Dementia.
3. Pellagra tends to occur in areas where people eat maize (or corn, the only grain low in digestible niacin) as a staple food.
Mnemonic: Corny people can't be nice. (Corn can't have niacin)
People - Pellagra. PP!
Corny people can't be nice and amazing! Get it? A-maize-ing! Hahahahha! I'm so pun-ny and funny!
4. The amino acid tryptophan is needed to make niacin, serotonin and melatonin.
Mnemonic: Have a nice trip to serotonin land (Serotonin rhymes with Melatonin).
Why is this fact clinically significant?
Carcinoid syndrome leads to excess production of serotonin, which depletes tryptophan. There's not enough tryptophan to produce niacin, resulting in pellagra.
5. Isoniazid (INH) use can cause vitamin B3.
Mnemonic: INH has 3 letters. B3 deficiency!
Also, isoNIAzid. For NIAcin deficiency.
6. Lastly, you should know about Hartnups disease which is due to defective neutral amino acid transporter on renal and intestinal epithelial cells
Here's a mnemonic by usmle1mikmonics:
HARTNUP Disease
Hartnup
Aminoaciduria
Renal (also intestinal) / Recessive
Transporter defect / Tryptophan deficiency
Neutral amino acids / Niacin deficiency / Nicotinamide supplements (Treatment)
Urine (Tryptophan lost in urine)
Pellagra / high Protein diet (Treatment)
D’s - Dermatitis, Dementia, Diarrhea
That's all!
-IkaN
Anterior Abdominal Wall : Mnemonics
Hi everyone. So I've just started Surgery and it makes me go back to Anatomy. A lot.
Here are some helpful Mnemonics on the Anterior abdominal wall
The External Oblique muscle is the SIR of all muscles.
It's the SIR of all muscles.
Hence , This SIR forms the Superficial Inguinal Ring.
Because it's the SIR , it forms the Sir of all ligaments too - the Inguinal Ligament.
The Fascia Transversalis is a scary thing. Whenever I see it , I get DAR. ( Dar is the Hindi word for Fear)
So I get DIR when I look at it. :P
And hence the Deep Inguinal Ring is in the Fascia Transversalis.
Since this is such a scary muscle , the important artery Inferior Epigastric Pierces this muscle. Making it more DIR-avna.
Finally,
How should one remember the direction of the External and Internal oblique muscles ?
Hands in your pocket is External Oblique.
So medially and downwards.
Hands on the Tits is Internal Oblique.
So medially and upwards.
Hope these help you !
Happy Studying !
Stay aweosme.
~ A.P.Burkholderia
How is Visual Contrast achieved?
Let us discuss Visual contrast today. This question has haunted me for a long time.
Let's start with the basics, the cells in various layers of retina and their function.
Here's a quick review of things you have already read:
1. What is photoreceptor?
It is a rod or cone. It detects light.
2. What is horizontal cell?
It is present between rods and cones. It is inhibitory in function. (It is involved in lateral inhibition which we will discuss later!)
3. What is bipolar cell?
It transmits information from photoreceptor to ganglion cells.
Now, lets come to the details.
4. What are metabotropic receptors?
First of all what you must understand is Metabotropic receptors and Inotropic receptors are receptors present on bipolar cells.
They recieve stimulas from photoreceptors (mostly decreased glutamate is the stimulas).
Metabotropic receptors cause depolarisation that is excitation of centre of receptive field of bipolar cells
They cause inhibition of centre of receptive field i.e. hyperpolarization. (remember, I for Inhibition)
6. Receptive field - What is it?
It is a region of retina where if the light falls it is going to alter the firing of neurons. (By firing I don’t mean guns :P) It means the action potentials generated and transmitted by the photoreceptors. So each cell has a characteristic receptive field. It can be as small as a dot or as large as this page itself. But don't limit this concept to a photoreceptor only. Almost all sensory cells example in somatosensory system or in auditory system possess a receptive field.
Receptive field of a bipolar cell is arranged into a central disk,
the “center” and a concentric ring, the “surround”, each region responding oppositely to light.
Coming to the crux of the topic i.e. Visual Contrast.
How do the things we have discussed so far help us achieve that?
Visual Contrast is achieved by two mechanisms:
1. Lateral Inhibition
2. Excitation of Some Bipolar Cells and Inhibition of Others — The Depolarizing and Hyperpolarizing Bipolar Cells.
1. How does lateral inhibition help?
First: It does not allow the signal to spread through the dendritic and axonic trees. Hence point to point transmission occurs.
Second: The direct and indirect pathways accentuate each other. This can be easily understood. Photoreceptor sends excitatory signals to bipolar cell. But the adjacent photoreceptor sends a inhibitory signal through the horizontal cell. Mostly these two neutralize each other so no net stimulus is transmitted to bipolar cell.
But If the adjacent cell is unstimulated by light, It will not inhibit the excitatory signals transmitted by the photoreceptor which is stimulated by light. Hence it will allow excitation of bipolar cell.
This allows extra excitation of bipolar cell. We get a better contrast. The area which is dark remains dark. But the area which is bright becomes even brighter. This is what visual contrast is all about.
The fun part of all this is, a lot of visual illusion make use of this principle. Do google "Simultaneous Contrast" :) .
2. How do different Bipolar cells help?
Because depolarizing and hyperpolarizing bipolar cells lie immediately against each other, this provides a mechanism for separating contrast borders in the visual image, even when the border lies exactly between two adjacent photoreceptors.
We will take a simple example. Suppose light is striking at periphery of two receptive fields. Remember it is shaped like a disk, with a centre and periphery both opposite in nature.Suppose One is On centre bipolar cell and other is Off centre bipolar cell(On centre: Activated when light hits centre but periphery is inactivated and vice versa for Off centre). So only the Off centre bipolar cell will detect it. Hence mixing up of signals is avoided. Again what I get is a sharper border. That is what contrast is all about.
That is how it is all done.
Interesting fact: The cells in the retina don't follow the "all or none" law. Transmission is by Electrotonic conduction. From ganglionic cell onwards cells follow all or none law.
Thats all,
Thank you,
Chaitanya Inge
Lewy body dementia mnemonic
Hey there.
Dementia with Lewy Bodies (DLB) is characterized clinically by deficits in attention and visuospatial function; fluctuating cognition; recurrent visual hallucinations; and spontaneous motor features of parkinsonism. Other associated symptoms include repeated falls, syncope, autonomic dysfunction, neuroleptic sensitivity, delusions, hallucinations in other modalities, sleep disorders, and depression.
Here are mnemonics and how I remember these points!
Lewy has halLEWYcinations.
Visual hallucinations are common.
Lewy is slowy.
Slow movements for Parkinson's disease .
Lewy is sleepy.
REM sleep abnormalities like drowsiness.
Lewy is slippy.
DLB is associated with frequent falls.
Lewy is slow-y, sleepy, slippy and sees things (halLEWYcinations)
lEwy also has an E for eosinophilic intracytoplasmic alpha synuclein aggregates.
That's all!
-IkaN
Authors' diary: Jas a year
Our admin and author, Jaskunwar Singh, completed 1 year of writing with Medicowesome today :D