Hello, cardiowesomites!
Today we are going to learn how to determine pacemaker type from EKG (RV pacing vs biventricular pacing)
LV aneurysms are most commonly caused by myocardial infarction. What's the difference between true aneurysm and pseudoaneurysm?
HVPG = WHVP - Free Hepatic venous pressures
A number of cardiovascular drugs predispose patients to digoxin toxicity, including verapamil, quinidine, and amiodarone. The dosage of digoxin must be reduced if given concomitantly with these drugs. The presumed mechanism underlying this interaction involves the ability of these drugs to inhibit the P-glycoprotein transporter.
Mnemonic: These drugs cause you to go whack! VAQ - Verapamil, Amiodarone, Quinidine
Other drugs to keep in mind are Diltiazem, Spironolactone, Flecainide.
Mnemonic by Huzefa Bhopalwala
References:
Waldorff S, Hansen PB, Egeblad H, Berning J, Buch J, Kjaergård H, Steiness E. Interactions between digoxin and potassium-sparing diuretics. Clin Pharmacol Ther. 1983 Apr;33(4):418-23. doi: 10.1038/clpt.1983.56. PMID: 6831820.
Andrejak M, Hary L, Andrejak MT, Lesbre JP. Diltiazem increases steady state digoxin serum levels in patients with cardiac disease. J Clin Pharmacol. 1987 Dec;27(12):967-70. doi: 10.1002/j.1552-4604.1987.tb05598.x. PMID: 3437068.
Lewis GP, Holtzman JL. Interaction of flecainide with digoxin and propranolol. Am J Cardiol. 1984 Feb 27;53(5):52B-57B. doi: 10.1016/0002-9149(84)90502-2. PMID: 6695818.
Koren, G., MacLeod, S. CHARACTERISTICS OF DIGOXIN INTERACTION WITH QUINIDINE, VERAPAMIL AND AMIODARONE: IN VIVO AND IN VITRO STUDIES. Pediatr Res 18, 154 (1984). https://doi.org/10.1203/00006450-198404001-00367
In the SYNTAX (Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) trial, patients with 3-vessel and left main coronary artery disease (LMCAD) treated with coronary artery bypass graft surgery (CABG) compared with percutaneous coronary intervention (PCI) with first-generation drug-eluting stents (DES) had lower 5-year rates of death, myocardial infarction (MI), stroke, or unplanned revascularization.
Hello believers at other end,
If You have a plan and it is working well for you then no need to read it further.
All the best and Happy studying.
18 days= 14 days(2 weeks) + 4 days( I would never count in last days )
I) 1st week = divide each day in three major slot and 2 minor slots
By the end of 1st week I want to complete major and minor notes 6 minor + 4 major subject + PYQ +MCQ of important topics + review images and volatile stuff.
Seems daunting and impossible !?
Say it to yourself "not daunting for me" Just 7 days and see the progress in the end.
morning hours =
1 hour [ half hour pharma ( General,ANS,CVS,GIT ,RS+HORMONES,NEURO,Antimicrobial) 7 days)
+
other half an hour ( Carb,lipid ,proteins,molecular,vitamins) *5days + last 2days when bio is completed I added PSM formulas for half an hour)
9am-12pm =
PYQ in form of GT on desktop like an exam ( And do it within 1 and half hour superficially) Review wrong ones .( Aim is to go through papers in stipulated time and when you do the same for consecutive 7 days you can analyze a pattern of your mistakes and type of questions being repeated)
12 pm lunch
Afternoon 12:30- 4pm ( further divide into 2 slots )
2 hour fast reading. I complete minor subjects (Ortho,FMT,anesthesia,dermatology,ophthalmology,Ent,psychiatry)
Next 2 hours I divide for major subject (Surgery+med+obsgynae) 2days and 2 hours each. +pedia 1 day only
4-5 I take nap of 15 min and then do volatile stuff
5-6 I go for walk with earphones and revised imp scores criterias oR TEACH A FRIEND ON PHONE
6-8 I practice MCQ as much as possible.(I do mcq of selective topics sometime mixed bags )
8-9 [half an hour micro ( gram positive,gram negative,viro rna,viro dna,mycobacterium+immuno,parasito,lifecycles) +half an hour Patho ( systemwise with images) ]
9-10 long break with dinner + telegram or updating yourself with any new thing or some series (depend on mood)
10-11 Images +graphs+formulas
11- 12 Previous day video at 2X until I fall asleep
By the end of 1 week = (SURG+MED+PEDIA+OBS) +(Ortho,FMT,anesthesia,dermatology,ophthalmology,Ent,psychiatry) +IMAGES +PYQ +WEAK TOPIC MCQ+PHARMA +MICRO+PATHO+BIOCHEM= 15 SUBJECTS with images.
II) 2nd week =Remaining 4 subjects
Morning hours and after 6pm slot is same .
9-12 pm I give mock after 2 days and aim is time management only . Assess wrong only if not much time is left . (I would advise you to give mock rather than GT )
afternoon = 2 hours ( physio,PSM) + 2 hours (Anat) (Radio I followed what Zainab mam has told us to do )
+COVID notes
+Revision revision and revision
III) 4 days(NO GT) = Revise volatile stuff + pyq incorrect ones+images+ mcq (I plan it accordingly whatever I feel right and confident with )
In free time or breaks I take printout of admit card and keep the necessary documents ready 2 day before.
Plan 2 days before what topics you feel can come and you are not confident with and want to go through it once. write it down .It is your gut feeling :D
NOTE- You need not to follow it like what I have said .I respect your journey as much as I respect mine. So do what makes you confident.
In the end, it is just an exam. You will get another chance. Just stay calm.
All the best.
Hello friends! Let's refresh our biochemistry knowledge today.
Hello friends! I hope all of you are doing well. Today I wanted to share with you the many faces of Celiac Disease. Although considered as the disease which chiefly causes gastrointestinal symptoms, the entire spectrum of possible manifestations it can cause is quite broad.
Some significant associations are as follows:
1.) GI- Enteropathy associated T-cell lymphoma (EATL), Microscopic colitis
2.) Liver- NASH
3.) Spleen- Functional Asplenia (SLE & Amyloidosis being other notable causes)
4.) CNS- Seizures with posterior cerebral calcification, Neuro-psychiatric symptoms, Ataxia
5.) Hematology- Evans syndrome
6.) Pulmonary- Diffuse alveolar hemorrhage
Here is the full spectrum. Hope you like it.
-Kirtan Patolia
Hormones are divided into 2 groups
Group 1 hormones- Act via nuclear receptors
Type 1- Have cytoplasmic receptors with effector elements in the nucleus e.g Steroid hormones (cortisol), Gonadal hormones (Androgens, estrogens, progesterones)
Mnenonic- There is only 1 General Secretary
Type 2 -Directly act at the nucleus e,g, vit D,vit A, Thyroxine
Mnemonic-Directly AcT at the nucleus
Group 2 hormones- Act via the cell membrane surface receptors
1. GPCR- Very extensive, will require a second post
2.Tyrosine Kinase- All Growth factors(Except TGF alpha and beta) and Insulin (Tip to remember: TKI or tyrosine kinase inhibitors are used in a lot of malignancies, there's abnormal growth in malignancies and hence TKIs stop that growth, also I in TKI will remind you of insulin, Insulin causes fat to grow!!)
3. JAK-STAT(cytokine receptor) Mr. JAcK is a Drunkard!! all he needs is PEG
Prolactin,
Erythropoietin,
Growth hormone.
(Pro tip: GH and PRL are called as twin hormones, JAK STAT mutations are involved in Myeloproliferative disorders say Polycyathemia and erythropietin is needed there)
4.Serine threonine Pathway: This pathway is a perfect BAIT for the hormones.
Bone morphogenic protein
Activin
Inhibin
Trasformation growth factor alpha and beta
That's all for today!
Have fun and stay safe!
How did you find the post?
Let me know in the comments section below!
Dr. ShilPill
It is chronic disease characterized by fibrosis and sclerosis of various tissues due to infiltration with lymphocytes that secrete IgG4. Manifestations include sclerosing sialadenitis, retroperitoneal fibrosis, autoimmune pancreatitis, Riedel thyroiditis, tubulointerstitial nephritis, and other fibrosclerotic conditions.
That's all!
Thank you.
WHO 1997 classification :
Dengue fever — >2 of the following
●Headache
●Retro-orbital or ocular pain
●Myalgia and/or bone pain
●Arthralgia
●Rash
●Hemorrhagic manifestations (eg, positive tourniquet test, petechiae, purpura/ecchymosis, epistaxis, gum bleeding, blood in emesis, urine, or stool, or vaginal bleeding)
●Leukopenia
Dengue hemorrhagic fever — The cardinal feature of DHF is plasma leakage due to increased vascular permeability as evidenced by hemoconcentration (≥20 percent rise in hematocrit above baseline). In the setting of DHF, the presence of intense abdominal pain, persistent vomiting, and marked restlessness or lethargy, especially coinciding with defervescence, should alert the clinician to possible impending DSS.
According to the guidelines, a DHF diagnosis requires all of the following be present:
●Fever or history of acute fever lasting 2 to 7 days, occasionally biphasic
●Hemorrhagic tendencies evidenced by at least one of the following:
•A positive tourniquet test – The tourniquet test is performed by inflating a blood pressure cuff on the upper arm to a point midway between the systolic and diastolic pressures for 5 minutes. A test is considered positive when 10 or more petechiae per 2.5 cm (1 inch) square are observed. The test may be negative or mildly positive during the phase of profound shock. It usually becomes positive, sometimes strongly positive, if the test is conducted after recovery from shock.
•Petechiae, ecchymoses, or purpura.
•Bleeding from the mucosa, gastrointestinal tract, injection sites, or other locations.
•Hematemesis or melena.
●Thrombocytopenia (100,000 cells per mm3 or less) – In healthy individuals, 4 to 10 platelets per oil-immersion field (100x; the average of the readings from 10 oil-immersion fields is recommended) indicates an adequate platelet count. An average of 3 platelets per oil-immersion field is considered low (ie, 100,000 per mm3).
●Evidence of plasma leakage due to increased vascular permeability manifested by at least one of the following:
•A rise in the hematocrit equal to or greater than 20 percent above average for age, sex, and population.
•A drop in the hematocrit following volume-replacement treatment equal to or greater than 20 percent of baseline.
•Signs of plasma leakage such as pleural effusion, ascites, and hypoproteinemia.
Dengue shock syndrome — DSS consists of DHF with marked plasma leakage that leads to circulatory collapse (shock) as evidenced by narrowing pulse pressure or hypotension.
●Rapid and weak pulse.
●Narrow pulse pressure ( ≤20 mmHg) or manifested by: observed early in the course of shock.
•Hypotension for age – observed later or in patients who experience severe bleeding.
Hypotension is defined to be a
•Cold, clammy skin and restlessness.
WHO 2009 classification —
Dengue without warning signs —>2 of the following
●Nausea/vomiting
●Rash
●Headache, eye pain, muscle ache, or joint pain
●Leukopenia
●Positive tourniquet test
Dengue with warning signs — any of the following
●Abdominal pain or tenderness
●Persistent vomiting
●Clinical fluid accumulation (ascites, pleural effusion)
●Mucosal bleeding
●Lethargy or restlessness
●Hepatomegaly >2 cm
●Increase in hematocrit concurrent with rapid decrease in platelet count
Severe dengue —at least one of the following :
●Severe plasma leakage leading to:
•Shock
•Fluid accumulation with respiratory distress
●Severe bleeding
●Severe organ involvement:
•Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) ≥1000 units/L
•Impaired consciousness
•Organ failure
If I ask an average student about their preferred study strategy the answer most likely would be Highlighting, summarising, and re-reading. Making aesthetically pleasing notes in a myriad of colours may be appealing to many but is passively re-reading already familiar content an effective study strategy?
Two of the most effective study strategies I have come across are active recall and spaced repetition. In this post, I will be talking about the science behind this method. I’ll cover spaced repetition in another post.
Hello everyone!
In today's post I'll try to explain you what Complete Androgen Insensitivity Syndrome (CAIS) is.
Androgens are primarily male hormones required for a normal male development. But also, these androgens are secreted in females by their adrenal glands and have some role in female body development too, e.g Growth of pubic and axillary hair.
Now imagine, a very very beautiful adolescent girl, say around 16 years of age, comes to your clinic with a history of primary amenorrhoea. She has absolutely flawless skin (No acne like other 16yr olds), breast development normally, no pubic and axillary hair and on further examination, some inguinal mass, maybe a hernia.
You ask the radiologist for an USG abdomen and pelvis. Don't be surprised to find testes as the hernia content and no uterus!!
This is a classic case of CAIS.
Karyotype analysis- 46XY
Inheritance- XL recessive, mutation in the AR (Androgen Receptor) gene
Genitalia- Female with blind vaginal pouch
Wolffian duct- Often present
Mullerian Duct- Absent
Gonads- Testes
Hormone Profile- Increased LH and Testosterone (But the receptors have resistance to it's action)
Increased Estradiol, FSH slightly raised.
For more pictographic representation, Watch HOUSE MD S02E13 "Skin deep"
That's it!
Happy Studying
Stay awesome!
Dr. ShilPill
