So, this post is the answer to our previous question asked on medicowesome facebook page. Question was
#Medicowesome #Microbiology
A vitreous aspirate from a case of metastatic endopthalmitis on culture yields Gram-positive round to oval cells, 12-14 mm in size. The aspirate on Gram staining show the presence of pseudohyphae. Which of the following is the most likely aetiological agent?
1) Aspergillus.
2) Rhizopus.
3) Candida.
4) Fusarium.
Answer: Option 3) Candida.
Let's analyse the question and extract the information one by one.
So, we get two things from the question.
a) The causative organism has pseudohyphae and
b) It is stained by gram stains.
Among the given options, only Candida can form pseudohyphae. All other options are filamentous fungi forming true mycelia and Candia is the only fungi that are usually gram positive on smears.
Some awesome points that must be known on Candida infections.
1) Candida is unicellular organism belonging to yeast like fungus categories. All Candida species are commensals of humans. So, their mode of transmission is endogenous while most of the fungus have mode of transmission as inhalation.
2) They form pseudohyphae.
3) Candida albicans is different from other candida because :-
a) It forms true hyphae or germ tubes when grown in serum.
b) It forms thick walled large spores called chlamydospores.
c) It is dimorphic. It means it grows as yeast at 37°C and as molds at 25°C.
4) Test to differentiate between C. Albicans and other Candida is called germ tube test or Reynolds Braude phenomenon.
-C. Albicans when placed at 37°C in human serum forms germ cell tubes within 2 hours.
5)Candida albicans is the most common cause of mucosal candidiasis.
6) Candidiasis is the most common systemic mycosis. It is also the most common fungal infection in neutropenic and immunocompetent patients.
7) It causes oral thrush, oesophageal candidasis, cerebral candidasis and pulmonary candidiasis.
Extra information:
Their is one test which I learned online and some people consider it as diagnosis of candida infections.
The Spittle Test:
When you get up in the morning, and before you brush your teeth, eat or drink anything, fill a glass with bottled water at room temperature.
Spit some saliva gently into the glass.
Come back every 20 minutes for the next hour and check for some of these signs.
1) Strings coming down through the water from the saliva at the top.
2) Cloudy saliva sitting at the bottom of the glass.
3) Opaque specks of saliva.
Also, in above question we deducted that the given pathogenic organism is gram stain so we get to learn about stains as well.
Normally, fungi are stained by PAS and methenamine silver but some fungi are stained by special stains like :-
Candida is stained by gram stain.
Cryptococcus is stained by mucicarmine, India ink.
Histoplasma is stained by Giemsa stain.
Thanks for reading!
Ojas Gite.
.
Schizophrenia: Types and Prognosis mnemonic.
So to begin with, Schizophrenia is a psychiatric disorder classified under psychosis.
Psychosis is a mental state involving loss of contact with reality, causing deterioration of normal social functioning.
Features of psychosis are:
Loss of insight.
Marked disturbance in personality and behaviour.
Loss of contact with reality.
Impairment in judgement.
Presence of delusions and hallucinations.
A quick recap : Psychosis is classified as -
• Organic e.g. Substance related psychosis, head trauma
• Major e.g. Schizophrenia, mood disorders
• Third psychosis e.g. delusional disorder, acute and transient psychotic disorders.
There are 7 types of schizophrenia and the mnemonic goes like
PHC (primary health centre) U R SO far
1. Paranoid: The commonest type and good prognosis. The onset is later in life 3-4th decade. Major symptoms are delusion of persecution and grandeur.
2. Hebephrenic: 2nd most common and the worst prognosis. Disorganisation of thought, speech, affect and personality is more prominent than other types. Also there is marked emotional impairment.
3. Catatonic: The best prognosis (especially reactive catatonia). Characterised by marked disturbance in motor activity. Further divided into 3 forms i.e. Excited, Stuporous, and one alternating between the two.
4. Undifferentiated: Where symptoms do not fit in any subtypes.
5. Residual: Chronic type where the positive symptoms vanish and patient is left with 'residual' negative symptoms
6. Simple: only negative symptoms from onset (no positive symptoms at all)
7. Others (f):
Schizophrenia + mental retardation = Pfropf syndrome
Schizophrenia + self-mutilation = Van-Gogh syndrome
Now let us see what exactly we mean by positive and negative symptoms.
Positive symptoms are those psychotic symptoms not seen in normal individuals (of course, haa!) but are “actively expressed” in the patients (something is added extra and so called positive).
Negative symptoms are normally expected behaviours like emotions like feelings thoughts and drives that a normal person experiences are absent in the patient (Normal things are being taken away and so called negative).
That’s all for now,
Stay awesome!
Keep calm and keep studying!
-Ashish G. Gokhale
Scientific name
|
Trade name
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Cephalexin
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Keflex
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Ceftriaxone
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Rocephin
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Cefdinir
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Omnicef
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Cefadroxil
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Duracef
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Azithromycin
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Zithromax
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Ampicillin - Sulbactam
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Unasyn
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Piperacillin - Tazobactam
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Zosyn ( also called Piptazo)
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Levofloxacin
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levaquin
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Linezolid
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Zyvox
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Nitrofurantion
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Macrobid
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Dalfopristin - Quinupristin
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Synercid
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Hello Awesomites!
Here's a quick review on the topic Euthanasia, a collection of asked MCQs on euthanasia.
EUTHANASIA
Mercy killing or Assisted suicide
Physician assisted suicide is legal in some States of the US
Painless killing of a person who is suffering from incurable disease, senility, permanent damage to the brain which cannot be repaired or cured
Legally permitted in: USA, Uruguay, Poland, Australia, Switzerland, Nether lands
Not legalized in India
Types-
Active (Positive)euthanasia-
Act of commission
Death induced by direct/indirect action
legal in Netherlands and Belgium
E.g. giving large dose of a drug that hastens death
Passive (Negative)euthanasia-
Act of omission
No specific medicine or life supporting measures given
Death induced by discontinuation of life sustaining measures
legal in India
E.g. stopping heart lung machines in a severely defective new born, disconnecting ventilator in a brain dead patient
Voluntary euthanasia-
Euthanasia induced at the will of an individual by his request
A patient suffering from an incurable disease requesting the doctor to terminate his life
In/Non voluntary euthanasia-
Induced in patients who are unable to express their wishes
E.g. a person with irreversible coma or a severely defective infant
Paternalism - abuse of medical knowledge so as to distort the doctor-patient relationship in such a way that the patient is deprived of his ability to take rational choice.
Thank you!
MD Mobarak Hussain (Maahii)
Hi everyone !
Here's a short mnemonic post !
Neural Crest Cells are very special cells that form at around 2-3 weeks of gestation.
They're right next to the Neural folds of the Neural tube to begin with and then eventually come to lie lateral to the tube, after which they migrate to various parts of the body giving rise to a bunch of things.
It's kind of SUPER IMPORTANT to memories what structures arise out of the Crest cells.
One of the reasons for it is that neural crest cell tumors will express certain neuroendocrine markers and that will make it easier to detect them on histopathology.
The other reason is that it's literally the most favorite embryology question - whether it's NEET PG or Step1!
So here goes :
Mnemonic - LAMAS BABy
L - Lepto meninges (Pia + Arachnoid)
A - Adrenal Medulla
M - Melanocytes
A - ANS Ganglia
S - Schwann Cells
B - Branchial Arches
A - Aortopulmonary windows + Endocardial Cushions
B - Bronchogenic cells - Pneumocytes
Y - Yo
This will also help you understand why Melanomas , Bronchogenic Carcinoma , Schwannoma, Pheochromocytoma and even Neuroblastoma are all positive for similar markers and have similar appearances at times along with similar histopathological fetaures.
Hope this list covers them all!
Happy Studying!
Stay Awesome!
~ A.P. Burkholderia
Hey there. How's it going? So I had this idea of compartmentalizing mentorship for different phases of USMLE.
Normally, what happens is a person asks questions which aren't very specific to a particular phase, and ends up annoying the opposite person.
So what if we divide usmle into 3 steps as they already are, also about paper work, electives, observerships, lodging boarding in different parts of USA, and make a list of people specific to each step who want to help and provide mentorship. This way many people who are looking to give back to this process, have a chance of passing on the kindness.
So if you are done with any of the steps or want to provide mentorship for any of the things listed above, or have a thing that should be added to the list, send us your name and which part of the process you would like to help with. This way there can be more focused distribution of knowledge and mentorship.
People willing to help, send us your details. If we have enough people willing to volunteer, we can grow this thing into something really helpful. Depending on the number of responses of volunteers, we will take this thing forward.
Leave your ideas and suggestions, if you have any. Thanks for reading.
If you are willing to help - email me at medicowesome@gmail.com with "USMLE Mentor" in the subject.
If you have IkaNs number on Whatsapp, contact her.
Varicose Vein
Hello Awesomites!
Through this post I'm trying to share the high yielding points on Varicose Veins.
VARICOSE VEINS
Primary:
Congenital absence or incompetence of valves
Inheritance with FOXC2 gene
Klippel-Trenuanay syndrome
Congenital AV fistula
Cutaneous hemangiomas
Hypertrophy of involved limb
Absence of deep venous system
Secondary:
Recurrent thrombophlebitis
Occupational – prolonged standing
Obstruction to venous return –abdominal tumors, retroperitoneal mass, Pregnancy.
Iliac vein thrombosis
Clinical features
Lipodermatosclerosis (brawny induration), pigmentation, thickening, chronic inflammation and induration of skin in calf muscle and around ankle.
Brodie-Trendelenburg test
To assess the competence of SFJ
Patient lies flat, elevate the leg and gently empty the veins, palpate the SFJ and ask the patient to stand whilst maintaining pressure. If the veins do not refill- SFJ is incompetent. If the veins do refill SFJ may or may not be incompetent, presence of distal incompetent perforators.
Cough impulse (Morrisey's test)
Locate the saphenofemoral junction(2-4 cm inferolateral to pubic tubercle) and ask the patient to cough. Impulse or fluid thrill felt indicates saphenofemoral incompetence.
Modified Perthes Test:Ask the patient to stand and tourniquet is applied at SF junction and ask to walk. Superficial veins become prominent – indicate deep vein thrombosis.
Three tourniquet test - To find the site of incompetent perforator
Tourniquets at SFJ, above knee level, below knee level.
Fegan's test:Detect the perforators
Investigations:
Duplex Ultrasound imaging – gold standard
Doppler examination – only when duplex is not available
Phlebography – not needed in primary venous insufficiency. Only performed as preoperative adjuncts when deep venous reconstruction is being planned
Ascending phlebography – differentiates primary from secondary insufficiency
Descending phlebography - identifies specific valvular incompetence suspected on B mode scanning.
Medical treatment:
Calcium dobesilate
Diosmin
Hesperidin
Toxerutin
Surgical management:
Trendelenburg's operation (juxta femoral flush ligation + stripping the varicose vein) for SFJ incompetency
Subfacial ligation of Cockett and Dodd :perforator incompetence with SF competency
VNUS closure(ablation catheter introduced into the SF junction and slowly withdrawn)
TRIVEX – veins identified by subcutaneous illumination; injection of fluid & superficial veins are sucked
Endo venous laser ablation (EVLA)
Sclerotherapy
That's all. Thank you.
-MD Mobarak Hussain (Maahii)
Here's a summary of the important Hutchinson's in medicine!
1. Hutchinson Teeth
Seen in - Congenital Syphilis
Feature - Peg shaped Incisors , Widely spaced and smaller teeth.
Associations - Mulberry Molars : Multi-cusped Molars.
2. Hutchinson Sign of the Nail
Seen in - Subungual Melanoma
Feature - Melano-nychia ( Black colored nail) , feature of a melanoma below the nail plate.
3. Pseudo Hutchinson Sign of the Nail
Seen in - Melanocytic be of nail bed
Feature - Melano-nychia like appearance.
4. Hutchinson sign
Seen in - Varicella Zoster infection
Feature - Vesicle at the tip of the nose - indicative of Zoster infection. May precede Herpes Zoster Ophthalmicus.
5. Hutchinson Triad
Seen in - Congenital Syphilis
Feature - Hutchinson teeth + Interstitial keratitis + Sensorineural Hearing loss.
6. Hutchinson Patch
Seen in - Syphilitic Keratitis
Feature - Salmon patch on the cornea
7. Hutchinson Mask
Seen in - Tabes Dorsalis, Neurosyphilis
Feature - Mask like sensation over the face due to involvement of trigeminal.
8. Hutchinson Pupil
Seen in - Raised Intracranial tension especially due to a mass.
Feature - Pupil dilated and unreactive to light due to 3rd cranial nerve compression.
Those are all the Hutchinson I can think of !
Let me know if you got any more.
Happy Studying!
Stay Awesome !
Hi everyone. My skin Lecturer just taught me this so I thought let's post this =)
So growth rates !
We need to know 3 of them - Hair , Finger nails and Toe Nails.
Hair is the fastest growing.
So remember just one number for it - 0.37 mm/day.
Now , next fastest is finger nails.
For this divide by 3.
0.12 so 0.1 mm / day is finger nails.
Now divide this by 3 to get the value for Toe nails.
So 0.03 mm/ day is for Toe nails !
That's all for this post !
Stay awesome !
Happy Studying !
~ A.P.Burkholderia
