Gift ideas for medical students

1. A card with a witty medical joke.

Natural killer

Difference between heterocyclic aminoacids and aromatic aminoacids

"Are not heterocyclic aminoacids coming under aromatic amino acids? Then why aren't they coming under aromatic amino acids? Why a separate category?"

This question was asked by Anonymous on my "Amino acids with electrically charged side chains mnemonic" blog.

Difference between smooth ER and Rough ER mnemonic

Hello! Hope you're having a good day =)

In today's post, I'll be sharing how to remember the difference between rough endoplasmic reticulum and smooth endoplasmic reticulum.

von Willebrand disease mnemonic

Greetings everyone!

As you all probably already know, I've been studying loads of hematology this week. Here's another compilation of facts + mnemonic on  von Willebrand disease!

How to remember gene for differentiation of gonads

Hello!

How to remember gene for differentiation of gonads

Mnemonic: Why (Y) are you Sorry (SRY)?

Y chromosome contains SRY gene which differentiates gonads to testes.

Daxone (DAX1) went for (WNT-4) double X (XX) .

Genetic factor DAX1 and signaling molecule WNT-4 are necessary for development of ovary.

That's all!

-IkaN

Normal values of Calcium, Phosphate, PTH and Alkaline phosphate mnemonic

Hey!

Here are a few mnemonics on how to remember the normal range of calcium, phosphate, PTH and Alkaline phosphate.

You may need to memorise these values for time restricted exams where wasting time looking up tables for normal values may cost you a few points.

Studying Biochemistry

"Just came across your blog. I must say you are very inspirational. I am first year medical student but I find it hard to study biochemistry. I would like to know if there is a good way to learn it. Any tips?" -Asked by email

How to speed read

I have modified a lot of general principles of speed reading for us, medical students, because we need to understand what we read.

Causes of macrocytic anemia mnemonic

Hello.

We all know that vitamin B9 and B12 causes macrocytic anemia but do you know the OTHER causes of macrocytic anemia?

They are:
Orotic aciduria
Thiamine deficiency
Hypothyroidism
DysErythropoietic anemia

Mnemonic: OTHEr

That's all!

-IkaN

Growth hormone deficiency mnemonic

Hello!

Today I'll be sharing a mnemonic on Growth hormone deficiency!

Barts hemoglobin mnemonic

So I just came across a question asking me why Barts hydrops fetalis is lethal. The answer is because Barts hemoglobin can't release oxygen to the tissues.

And I thought, "Barts can't fart oxygen." as a funny way to remember this xD

What is Barts hemoglobin anyway?

Tetramers of gamma globin chains formed when there is deletion of all four alpha globin genes.

How do you remember Barts hemoglobin has gamma chains?
I made a sentence with a lot of B's and G's. I'm not even sure if you can call it a mnemonic.
"BiG bart bargains for bar games."
I don't know if it works.

That's all!

-IkaN

Graves ophthalmoplegia case

Hello everyone!

I saw an interesting case in the ward today. And I'll be asking loads of questions for you to answer as you read along!

There was a 75 year old man with proptosis, inability to move his right eye inferiorly or adduct his eye. Any guesses on what it could be?

Antianginal drug classes mnemonic

Hello!

So today, on our study group, Vaidehi posted a mnemonic for anti anginal drugs.

The mnemonic is, "Black Nights Can Please Others"

1) Beta blockers:
Propranolol, Metoprolol

2) Nitrates (Since nights are sorry and long so do we have - )
Short acting Nitrates: GTN
Long acting Nitrates: Isosorbide

3) Calcium channel blockers: Verapamil, Nifedipine

4) Potassium channel openers (Can also be remembered as - A pleasing person is open to others)
Nicorandil

5) Others:
Dipyridamole, Ivabradine

Thanks a lot for the mnemonic Vaidehi!

-IkaN

Related post: Anti arrhythmic drug classes mnemonic

Repeating PG entrance exam

"I'm a PG aspirant... This is my third year of PG preparation. I lost all interest in medicine. I've lost all hope too. I'm just tired of trying. I don't know who to talk to. I don't know how you get so much passion to write your blogs. I don't how to study also."

I understand that giving an exam for the third time must be really frustrating and tiring.

So my advice to you is - Make sure you prepare so well this time that it's your last attempt and that you get whichever post graduation seat you desire. Study real hard, no excuses.

It's natural that you tend to lose interest in learning repetitive facts. Maybe you should try hunting for new ideas, new perspectives and gain a different understanding of old concepts?

Google about facts you've learnt earlier. This time, instead of memorizing, think of why.

Question everything - Why does this muscle cause that movement? Why does sickle cell anemia cause leukocytosis? Why does phenytoin produce vitamin B9 deficiency?

Trust me, questions and curiosity will awaken an unexplored passion in you - The one you lost in studying the same things over and over again.

Causes of sideroblastic anemia mnemonic

Mini post for the day!

Do you know the causes of Sideroblastic anemia? No? You guys are such liars!

Mnemonic: LIARS

Hemoglobin and erythropoiesis mnemonics

Hi everyone! Long time no see? :D

Today, I'll be sharing a few facts and mnemonics on hemoglobin and erythropoiesis. Let's get started!

Do you know the order in which hemoglobin appear from early embryo to infancy?
It's embryonic hemoglobin first (Gower 1, Gower 2, Portland) then fetal and after that, adult.

Mnemonic: Gower goes, fetal follows, adult afterwards. 

(Also, notice the reverse alphabetical order -  G, F, e, d, c, B, A)

The alphabets also pair the chains with their respective hemoglobin!
GF - Gamma Fetal
BA - Beta Adult

Study group discussion: Contraindications of ACE inhibitors

Why ACE inhibitors are contraindicated -
During pregnancy
In CCF due to severe aortic stenosis
Bilateral renal artery stenosis

Please explain.

Study group discussion: Polygonal cells

What are polygonal cells ?

I know I'm stating the obvious, but can I guess cells which are polygonal in shape? :P

According to Google, Polygonal cells have many sides. (Four to five mostly)

The skin has a layer of polygonal cells called the stratum spinosum.

Criteria for LVH in ECG

Hey everyone!

Someone requested me to do a criteria for LVH in ECG. Here are a few!

Cornell criteria: Add the R wave in aVL and the S wave in V3. If the sum is > 28 mm in males or > 20 mm in females, then LVH is present.

Mnemonic: 20 carnivals tree

caRniVALS (Corn evil? Cornell?) tree

R in aVL (caRniVaL).

S in V three (tree).

3 looks like a Mirrored 8.

So 28 in Males, 20 in females.

Study group discussion: Decerebrate and Decorticate rigidity

Can anyone please explain how do we get decerebrate & decorticate posturing?

ORS and baby - My ORS week poster

It's ORS week again! And this time, I made the poster in Marathi, one of my favorite languages!

ORS week poster in Marathi

For all those who don't know Marathi, here's a translation. (The dialogue might not sound as cute in English, but here it goes!)

ORS week poster: 5 reasons why ORS is a superhero

So here it is - the superhero poster I made for ORS week :D

ORS superhero poster

Vitamin D resistant rickets mnemonic

Vitamin D resistant rickets mnemonic

"WASP"
Wa: Waddling gait
S: Short stature
P: Phosphate low

Difference between secondary and superinfection

Should antibiotics be prescribed for an adult with the usual fever, headache and sore throat symptoms?

Not unless he develops secondary bacterial infection.

Metachromatic Leukodystrophy mnemonic

Inspired by the case I saw in the OPD yesterday, I thought I'd share a mnemonic I use to remember the same.

"Aryl has many Colorful look a like, Cerebral brothers. They are Clumsy and Crazy."

Internship diaries: Metachromatic leukodystrophy

Hey everyone! I'm posting the study group discussion we had because it's so much less to type :D

I saw a case of metachromatic leukodystrophy in the OPD yesterday.

Can anyone tell me what is metachromatic dystrophy?

For those who don't know, it's a lysosomal storage disease. Deficiency of the enzyme aryl sulfatase A causes accumulation of cerbroside sulfate.

Study group discussion: Hot vs Cold fomentation

Can anyone tell me when should we give hot fomentation and when should we give cold fomentation?

Immediately after an injury -  Cold fomentation.
Later on - Hot fomentation.

Cold is for acute injuries like sprains, joint injuries, sports injuries.

Hot is more for chronic conditions like back aches, muscle spasms.

The point is after an acute injury, you need to reduce the swelling and inflammation. So you cool the area to decrease blood flow.

After a day of injury, you would want to increase blood flow to heal the area.

Amazing!

Study group discussion: Fluids in inferior wall myocardial infarction

Why are fluids indicated in inferior wall MI?

Inferior wall MI is associated with severe hypotension. So first, correct the hypotension, then, thrombolyse.

Yes, but any reason for the hypotension?

Because inferior wall has vagal plexus. Patients with inferior wall MI are parasympathetic i.e. high vagal tone.

Study group discussion: Referred pain

Can someone please give me regions of referred pain areas?
Eg. Pain in the shoulder could infer problem with diaphragm.

Right shoulder pain - problem with gall bladder (eg. Cholecystitis)
Left shoulder and ulnar border of left arm and hand - myocardial infarction.

Knee pain can refer to hip.

Renal colic pain is referred to the back.

Splenic rupture can refer pain to left shoulder - Kehr's sign

What is Kehr's sign please?

Splenic rupture or hemorrhage irritates the diaphragm on left side and that refer s the pain to the left shoulder. Same like cholecystitis on right side.

Study group discussion: ECCE

Why ECCE is not done when zonules are not intact?

What is ECCE?

Extra capsular cataract extraction.
Because the IOL will be implanted in the remaining posterior capsule - And if the zonule is not intact, it may cause lens subluxation.

Awesome.

Study group discussion: Cystogastrotomy for pseudopancreatic cyst

One interesting question:
In cystogastrotomy, as surgical treatment for pseudo pancreatic cyst...Why do food particles don't enter from stomach to pseudocyst through the communication?
This question asked by surgical professor in OT today.

Because cyst will be always in positive pressure and clinical studies show that the cyst rapidly decompresses. Approximating the mucosa with cyst wall, which has no epithelial lining, leads to rapid shrinkage of stoma. Within few days, neither the stoma nor the cyst is evident on radiology or endoscopy.

Wow. This is great stuff!

Study group discussion: Serum ascites albumin gradient

Can anyone explain the serum ascites albumin gradient in a super simplified way?

High SAAG: Imbalance between hydrostatic and portal pressures.

Low SAAG: Ascites due to protein leakage.

SAAG = Serum albumin - Albumin in ascitic fluid. And is directly proportional to portal pressure.

Internship diaries: Calcium channel blockers and peripheral edema mnemonic

As you all know, I am doing internship or housejob and it's really tiring but a good learning experience. Lemme share what I learnt / revised today!

In my medicine OPD, we start most newly diagnosed hypertensive patients on amlodipine, a calcium channel blocker. Many of the patients, after a few weeks of therapy, come back complaining of lower extremity edema. You check their electrolytes, LFT's and RFT's and they are all normal.

Conn's syndrome mnemonic

Hi. I keep forgetting that Conn's syndrome is hyperaldosteronism. Can you help me out with this?

Sure! :D

The N's are for sodium - Hypernatremia!

The C makes a K for potassium, which is less than the number of N's, therefore, hypokalemia!

Also, Na+ is sodium. A could remind you of Aldosterone.
AL could remind you of ALkalosis.

That's all!

-IkaN

Which books do I study from while in second year MBBS?

Hello!

One of my readers asked to write a books recommendation posts for second year and here it is!
This post is mainly for Indian medical students because I'll be talking about some local authors which might not be available or preferred in your country. But of course, foreign medical students can read it too as they might find the general points helpful! ^__^

Something I learnt from my first year - You should never be hasty in buying books. Medical textbooks are pretty damn expensive and you don't wanna be stuck with a book you don't like for the rest of the year.

So here's what I recommend - Be "bookless" for the intial few weeks. Don't buy any books. Pretend you're broke and rely only on the library.

Ask - Friends, seniors, book sellers, internet about books they think you should buy. Immediate seniors will be the best resource - Ask them why you should go for one book and not the other, know their reasons. You should be able to cut the long list of 10-12 books and bring it down to 2-3 books.

In the bookless period, go to your library (Or use ebooks), read a few topics (Not just one!) from the two to three books you think you should buy. You'll like one and that's the book you should read for the rest of the year!

Don't judge a book by it's initial few pages. You have to read topics of substance, big topics not the small ones. Example, don't read about Louis Pasteur and see which book wrote it better. Read about Staphylococcus or ELISA.

Before I begin, I'll be very clear and tell you that all I can do is recommend. You do the deciding =)

Pharmacology
K. D. Tripathi or KDT: It's a good book. It'll stick with you throughout the year!
How to study: Read classifications first because you wanna know the drug names before you start reading into the tiny details. If you write a good classification table in the beginning of your answer, you impress the reader. Know special side effects of drugs, it gives you an upper edge while writing theory papers (No examiner wants to read nausea and vomitting over and over again!)

Katzung: Now this book is HUGE. It's fun to read!
How to study: Get it from a library or use a PDF. Read the topics you like. I read diuretics from this book and boy I enjoyed it. It's too much to read so when exams near, you'll lose the book and run back to Tripathy. So keep in mind that this is not THE book and you won't be able to finish it or come back to it later. Take points and put it in your Tripathi in the first read itself.

Lippincott: It is simple and preferred by a lot of international readers.
How to study: I haven't read it, so I don't know how good it is T_T

Pathology
Pappa Robbins or the big Robbins: It's awesome.
How to study: It's a huge book, so do the "Important" topics from here first. Important? Yeah, the stuff that's been asked a lot of times in the previous papers. Try to do general pathology, CVS, RS and renal from this book.

Baby Robbins or the small Robbins: It's useless.
How to study: Don't.

Harshmohan: It has lots of diagrams and point wise notes. You know who likes diagrams and point wise answers? Teachers.
How to study: Stuff you couldn't read from Robbins due to lack of time, read it from here. (Don't forget the diagrams!)

Microbiology
Ananthanarayan: It's just the right amount of information. If you study this one well, you won't require any other book.
How to study: You wanna know how an organism looks like and what diseases it causes. Do cultural characteristics too. General microbiology - Read the important stuff. If you don't enjoy immunology while reading it, you're doing it wrong. It's my favorite subject! Imagine, read comics.

Parasitology
Any book will do: I studied from Arora.
How to study: Diagrams are key. If you can draw the life cycle, half your work is done. Diagnosis and treatment is simple.

Forensic and Medical Toxicology
I never studied this subject from multiple books to pick a personal favorite, sorry! :|

Internet
I use a lot of internet for studying. It keeps things interesting. There's always a new perspective you can gain via the internet. Videos, images, jokes, mnemonics. It keeps things fresh. And books can get boring sometimes, so use the internet, read blogs, have fun! :)

PS: If you are thinking of preparing for USMLE but are not too sure (Because second year is too early to decide your future xD), finish off the Kaplan videos, notes and Goljan audio.

That's all!

Ask me whatever you like in the comments section below!

-IkaN

Related posts:
How to make concise medical notes
How to make medical mnemonics

Hemochromatosis mnemonic

Hey everyone!

Today I had a vignette on hemochromatosis and I could not put the clues together :(
It's interesting how various clinical complaints like erectile dysfunction, hepatomegaly, diabetes, joint pain can be hints to a condition related to iron metabolism!

Pharmacology emoticon game answers

Here's the game.. And below are the answers!

Microbiology emoticon game - Part two answers

The link to the game for you, if you haven't attempted the game yet :D

And here are the answers *drum roll*

Microbiology emoticon game - Part one answers

Here's the link to the game if you haven't solved it yet!

And here are the answers!

The mystery drug

This post is on the Pharmacology emoticon game I posted ages ago. Here's the link to the game so you know what I'm talking about =D

Antibiotic associated diarrhea mnemonic

Clostridium difficile is the most common cause of antibiotic associated diarrhea.

How do I remember this?

"Difficile grows when the normal flora are deficient."

Antibiotic associated diarrhea is treated with metronidazole.

How do I remember this?

"Definitely treat difficile with metrodiffizole."

That's all!

-IkaN

Study group discussion: Suprapubic cystostomy experience

So last night, in the emergency department, comes a 65 yr old male complaining of difficulty in passing urine.
On examination: His lower abdomen is distended. A pyriform shaped swelling reaching the umbilicus.

He was having acute retention of urine. Tried introducing a 16 fr catheter. But failed. Next step?

You try intorducing a 10 fr paediatric catheter.

But we didn't have one to our dispense. So we did supra pubic.

What is the procedure?
Palpate and percuss first. Then insert the catheter directly at 90 degree.

The moment I did.. The patient heaved a sigh of relief. On further work up, it was a case of BPH.

How do you make sure you don't injure inferior epigastric vessels?

Midline 4 cm above pubic symphysis. Inferior epigastric vessels are more lateral.

Does dopamine cause vasoconstriction or vasodilation?

Is dopamine a vasoconstrictor or a vasodilator?

Both! It depends on the rate of infusion.

At low rates of infusion (0.5 to 2 mcg/kg/min), dopamine causes vasodilation that is presumed to be due to a specific agonist action on dopamine receptors in the renal, mesenteric, coronary and intracerebral vascular beds.

At higher rates of infusion (10-20 mcg/kg/min), there is some effect on alpha- adrenoceptors, with consequent vasoconstrictor effects and a rise in blood pressure. The vasoconstrictor effects are first seen in the skeletal muscle vascular beds, but with increasing doses, they are also evident in the renal and mesenteric vessels.

Immunology emoticon game answers

Here are the answers!

Immunology emoticon game

And it's back again! Except, it is more tougher conceptually.

We figured guessing words out of emoticons is too lame and easy for you medicos and thought we'd add questions to make it more fun!

Immunology emoticon game

Study group experience #17

Pathophysiology of liquefactive and coagulative necrosis in hypoxia

Leucine, tryptophan and niacin
CPS 1 and CPS 2

T4 level
Tonsils and pharynx review questions

Food, pain and ulcers
Refsums disease
Kimmelstiel-Wilson in medicine
Pheochromocytoma and eleven  

Kochs contact
Questions on tuberculosis  

Differentials of wasting of small muscles of the hand

We did a massive change in all 4 groups, we clubbed Asians in two groups and Non Asians in two groups. Now the groups are segregated time zone wise, leading to better fruitful discussions! Though we do a bit of a mix and match here and there.

Also, we recently made group 5. It's a lot of discussions to take it for people who are in all 5 groups!

Study group discussion: T4 level

Studying the anatomy of the thorax.. Does anyone know the events occurring at T4 level?

At t4 level:
- Arch of aorta starts and ends at this level
- Azygous vein ends here to join SVC
- Trachea divides into primary bronchi

Study group discussion: Food, pain and ulcers

How does food relieve pain in duodenal ulcer and aggravate pain in stomach ulcer?

Food reaching stomach causes acid secretion. Therefore, pain increases.

In case of duodenal ulcer, eating causes pyloric spincter contraction, acid is prevented from reaching the duodenum
Therefore, pain is relieved.

Beckwith-wiedemann syndrome mnemonic

"Becky is big."
Beckwith-wiedemann syndrome mnemonic

"Big body"
Macrosomia

"Big tongue"
Macroglossia

"Big abdomen"
Omphalocele

"Big pancreas"
Hyperinsulinemia -> Hypoglycemia

"Big organs"
Visceromegaly

"Likes to get bigger"
Associated with Wilms tumor, gonadoblastoma and neuroblastoma


That's all!

-IkaN

Study group discussion: Pheochromocytoma and eleven

What is rule of 11 for pheochromocytoma?

11% are extra-adrenal
11% are bilateral
11% are malignant
11% are found in children
11% are familial
11% are not associated with hypertension
11% contain calcification