Tuesday, June 1, 2021

How to write a Personal Statement for Residency

 

How to write a Personal Statement for residency


How to begin

  1. Daily start writing down ideas in Evernote/any app which lets you take notes
  2. Think of a strong patient interaction/personal story where you helped the patient and which also shows your medicine-related skills/knowledge/work ethic. Make it about yourself, what you did, and how it helped you. Do not write the entire history of the patient.
  3. Either with the same story as above or explain the reason/reasons why you are interested in that particular field.
  4. Make a list of your hobbies/ non-medical experiences and find a common connection between that skill set, which can actually help you during residency.
  5. Read loads of sample personal statements from google!!!
  6. Do not copy them (plagiarism is HARMFUL). 
  7. Once you are done, send your draft to mentors/English professors/seniors etc.
  8. Make sure there are absolutely no grammatical errors. (English being a 2nd language is not an excuse for poor grammar).

 

Don’t’s

        This is not the time to show off your creative writing skills. We are applying for a residency, not a literature graduate position. Keep it simple and easy to read.

        Do not use super-long sentences. IMGs have a tendency of using a lot of ‘and’ and writing 3-4 line long sentences. Keep it short.

        Target content that fits into one page. 600-700 words approx. Don’t go over 800, don’t stay under 500.

        Do not use negative incidents/ bad mouth your home school or resources.

        Don’t lie. You will get caught. If you say you have worked on multiple research projects and if you are unable to answer basic questions regarding your research, you WON’T be selected.

        You never know how much importance programs give to the PS, so always make sure it is a well-written PS.

        Don’t quote your CV.

        Don’t use clichés or common quotes.

        Don’t start every sentence with “I.”

        Come across as arrogant. This is the place to showcase your strengths, but in a humble way.

 

 

How to divide paragraphs: 1st paragraph

        The first and last paragraphs are the most commonly read parts. Make them interesting and strong. It should be personalized.

        Begin strong: Story/Hobby/What got you into medical school or you can skip that and talk about what got you interested in your specialty.

        It should be a story about yourself and how it relates to your specialty, not just a history of the patient you saw.

 

DON’T’s

·        “Every patient has a story to tell.”

·        Some major illness in the family/ death motivated me to become a physician.

·        “I love to travel. Each journey takes us down a different path. Each journey inspired a new thought. I feel medicine is similar to traveling. Every patient has his own journey and I want to be there to make it fruitful for them.” (This is not the right analogy. Travel and medicine have nothing in common)

·        “I will never forget ___”

·        “I grew up with dermatology in my blood”

 

DO’s

·        “Growing up in rural ____, I experienced ____. Here I realized _____. The strict value system of perseverance and dedication led me to ____.”

·        Start with your hobby.
E.g. Football….team sport….captain of the football team….motivated my team, resolved conflicts. At the same time I realized, that whenever someone got hurt, I would assist my coach with first aid. I realized that my inclination for helping my injured team mates extended beyond the football field. Bridge it into medical school and how you continued doing the same. Got you interested in EM/ortho etc.

·        “Medicine is a field in which my love for pathophysiology and my commitment to serving others can continue to grow. I have a strong desire to use my problem-solving abilities while helping people through their most difficult times.” And then give an example justifying these 2 statements.

 

 

How to divide paragraphs: 2nd, 3rd and 4th paragraphs

        Talk about your strengths in a very SUBTLE way, citing examples.

        Talk about your achievements and extra curriculars, your motivation and end it with what skill-set you derived from it.

        Include hobbies. Connect them with medicine and how it will make you a better resident.

        Relate how your actions and experiences during medical school will make you a strong physician.

        What will you bring to their program?

        Don’t quote your CV.

        Show who you are as a person, not just as an ideal medical student.

 DO’s

        Talk about your strengths in a very SUBTLE way, citing examples.

        Talk about your achievements and extra curriculars, your motivation and end it with what skill-set you derived from it.

        Include hobbies. Connect them with medicine and how it will make you a better resident.

        Relate how your actions and experiences during medical school will make you a strong physician.

        What will you bring to their program?

        Don’t quote your CV.

        Show who you are as a person, not just as an ideal medical student.

 DON’T’s

·        I love IM as it is such a broad field with a vast number of diseases.
(Same goes for FM and Peds and all other branches. Avoid such blanket statements.)

·        I want to be trained to manage patients on my own and do right by them to be one of the best in my field.
(Umm…isn’t this what residency is about. Everyone wants that. What is it that you are specifically looking for?)

·        Also, avoid “I love” “I want to”

·        “IM combines the wide spectrum of exotic and the mundane illness, providing a scope of touching maximum lives.”
Do you mean to say FM/EM/ortho/surgery etc. do not provide this?

·        “My mentor taught me more about medicine and how to approach a patient better than I had learned in all of my classes.”
Do not put your other classes in a negative light.

 

 

How to divide paragraphs: last paragraph

        Summerise.

        Tie in all your major attributes.

        Talk about: What you are looking for in a program

        Talk about: Where do you see yourself in a few years?

 DO’s

        I will bring to residency energy, enthusiasm, integrity, and ability. I expect a challenging, rich environment in which to learn and practice good medicine.

        I know I have set high goals for myself: clinician, educator, and health advocate. The majority of the time I find working with underserved populations extremely rewarding; however, it can also be emotionally demanding.

        The combination of working at an individual level to address health needs and at a more macroscopic level to affect health policy is synergistic for me.

        I eagerly await the unique privilege of participating in such a rewarding and exciting field of patient care.

 DON’T’s

        Don’t be too specific regarding fellowship goals unless you are absolutely sure.

        If you are sure regarding your fellowship, your CV should have enough experience to back it up.

        “Medicine encompasses numerous areas that I have always found intriguing. Becoming a physician is a lifelong dream that will fulfill both my personal and career goals.”
What are the goals? State them. What are the intriguing areas? It is a vague sentence. Avoid fluff.

        “My career goal is to enter a university-based anesthesiology program.”
Then community programs (forming a major chunk of interviews for IMGs, will not call you for an interview. Be diplomatic.


Time Frame

         June 1st half: Begin jotting down ideas and writing sentences. Focus on ideas. Don’t worry about sounding smart/grammar right now.

        June 2nd half: Start compiling the ideas and sentences into paragraphs. Check the flow. Keep reading samples to understand how to write it.

        July 1st half: Make your 1st draft. Send it to seniors/attendings/mentors.

        July 2nd half: Incorporate the changes suggested by them and make another draft.

        Aug 1st half: Send it out for suggestions again.

        Aug 2nd half: Make a final draft. Here your ideas, stories, hobbies, major points should be finalized and free-flowing. Now run a final grammar check. Send it to someone with professional level English for edits and grammar.

        Sept 1st week: Final draft ready

 

Take away

        Personal Statements might not fetch you interviews unless it is extra-ordinary. You will get interviews based on your scores and other aspects of the application.

        You may lose out on an interview due to a bad PS. (Incorrect grammar, poorly written)

        Interviewers love to talk about the hobbies mentioned in the personal statement, so make sure they are real!!

        They are looking to know you as a person, so make sure your PS does not describe 1000s of other medical students as well.

        Once you land an interview, the PS might play a role in getting you ranked high. The program wants a candidate that would ‘Match’ their expectations!

 

Cluster Headache

 Is the cluster headache giving you a headache?

Here's an easy way to remember it.

C-Conjunctival congestion

L-Lacrimation

U-Unilateral

S-same time, periodicity

T-Tearing of conjunctiva

E-Excess autonomic activity

R-Rhinorrhoea

These clinical features help us to differentiate cluster headache from other types of unilateral headaches.

Treatment includes

1. 100% Oxygen at 10-12L/min for 15-20 mins

2.Sumitriptan 6mg S/c

3. Sumitriptan 20mg and Zolmitriptan 5mg nasal spray

Remember ORAL SUMITRIPTAN DOES NOT WORK!!

That's it folks!

Happy studying!

Dr. ShilPill

Saturday, May 29, 2021

The Happy face

 Hi everyone!

Lets talk about a 2 year old girl with a h/o seizure disorder who presents to your clinic for the first time for routine care. Past medical records shows that the patient is on anti-seizure medication since the last year. There is no family history of seizures. Parents report poor feeding and sleep disturbances. The girl appears to be very happy, laughing all the time for no reason. On examination, her head circumference is in the 10th percentile and is noted to have hand flapping behavior. She has not met the expected milestones for her age. What is the diagnosis?

???

ANGELMAN SYNDROME 























Fun fact: Angelman Syndrome was previously known as "Happy Puppet Syndrome"😄


- Padma Sri Katikaneni

Psychogenic non epileptic seizure (PNES)

 PNES  characteristics : 

  • No loss of consciousness or postictal period

Comorbidities  
  • Psychiatric conditions (depression, anxiety)
  • Physical/sexual abuse
  • Epilepsy

Mnemonic = “WALT” - means Unsteady! 


Thank you! 🩺🫀


Friday, May 28, 2021

Red blood cell transfusion thresholds mnemonic

 Hello everyone! Just look here.. 

What does it mean ? SHOAN …? 
the name Shoan is of Hebrew origin and means "Gift of Salvation". 
That’s all!
Thank you! 🩺🫀


Subarachnoid haemorrhage

Clinically important steps required for SAH management ( from its onset ) 


  • Most commonly due to ruptured saccular (berry) aneurysm
  • Severe & sudden onset of headache different from previous headache pattern or described as "worst headache of my life"
  • Nausea, vomiting, brief loss of consciousness, focal neurologic deficits, or meningismus
  • Noncontrast head CT >90% sensitive within 2-6 hr of SAH onset
  • Lumbar puncture required to exclude SAH definitively in patients with negative CT scan of the head
  • Xanthochromia confirms diagnosis (usually >6 hr from SAH onset)
  • Cerebral angiography to identify bleeding source

Happy studying! 
Thanks folks! 🩺

A cardiologist and infectious disease specialist discuss their favorite statin

Cardiologist: What's your favorite statin? Atorvastatin? Rosuvastatin? 
Infectious disease specialist: Cilastatin! 

I onced misspelled it as cilastin and this joke was inspired. Idea credits to Randy Bornmann! 

Biophysical Profile Mnemonic

 

Biophysical Profile 
Just add an extra “V” 
See the management here .. 

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

Thank you! 🩺

Thursday, May 27, 2021

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

Tuesday, May 25, 2021

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! 🩺

Sunday, May 23, 2021

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 I
  • 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


Step 3. Remember Type V - DOEST NOT EXIST. 

Step 4. Revise again 😉

That's it! Stay safe 🌸
- Anagha :)

Thursday, May 20, 2021

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.

Wednesday, May 19, 2021

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                                                                                                                       



                  


Tuesday, May 18, 2021

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

Monday, May 17, 2021

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




Sunday, May 16, 2021

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 Oropharyn   

(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

Thursday, May 13, 2021

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. 

Wednesday, May 12, 2021

Kartagener syndrome mnemonic

 Hi!

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

Tuesday, May 11, 2021

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 

Sunday, May 9, 2021

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

Saturday, May 8, 2021

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

Friday, May 7, 2021

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