Study group discussion: Ethacrynic acid and sensorineural deafness

Can someone explain how ethacrynic  acid causes deafness?

Na+K+Cl+ transporter is also present in the ear. This transporter is the main site of action for ethacrynic acid. So when it acts the transporter Is inhibited leading to ionic imbalance. This results in hearing loss.

It is the diuretic which is most dangerous when it comes to causing sensorineural deafness.
Even then it's use indicated in one special condition. Guess which condition?

If a patient has reaction to sulpha drugs.. The DOC becomes ethacrynic acid.

Recent studies revealed that the ototoxic effect of EA is actually involved in selectively blocking the lateral spiral artery in the cochlea and suppressing the blood flow supply to the cochlear lateral wall. The epithelial ischemia and anoxia in stria vascularis resulted in a significant depression of endolymphatic potential which was equivalent to cutting off the power supply of the cochlea . During the ischemic damage to the epithelium and capillaries on the cochlear lateral wall, the vascular permeability and membranous permeability in stria vascularis were also affected so that the ototoxic drug can penetrate through the broken blood-cochlea barrier to enter the cochlea.the ototoxic drug can reach the cochlear hair cells either through the cuticular plate facing the endolymph or through the under parts of the hair cells in the cortilymph.

In short bro, hair cell damage directly by EA.

Oooh. So it first causes ischemia and then enters the hair cells. But at the end the outer hair cells are getting damaged. Nice!

I am finding first year MBBS extremely difficult and tough

"Sis.. I just joined medical college. Finding it extremely tough to study. None of the subjects seem familiar. I'm losing all my positivism and feeling helpless."

Firstly, take a moment to congratulate yourself. You've made it to medical school! New subjects is going to be so much fun!

"I feel left behind. I'm not able to answer. What is taught in lecture is very minimalistic compared to text book."

Drugs causing hemolysis in G6PD deficiency mnemonic

Mnemonic for drugs causing hemolysis in G6PD deficiency is, "PAINS"

(Cause hemolysis in g6pd deficiency PAINS ;) )

Tips on how to find vein or phlebotomy

Study: Know your anatomy, so if you can't see or feel the veins, you still know where to go.

Just the anatomy of where the veins are. Sometimes you can't see them (old people, people with dark skin) and you can't really feel them. I've done some blind insertions before successfully.

Dont panic: Initially, you will find it hard, but do not get embarrassed if you miss.

Tourniquet: Tying a torniquet often helps by making the vein more swollen and prominent.

In our hospital, the patient's relative is asked to hold with the fingers tightly around the arm instead of using torniquets.

Study group discussion: Carcinoid syndrome

What's carcinoid syndrome?

It's caused by serotonin. There's a GI tumor called carcinoid tumor which secretes it. So basically, the syndrome is caused by serotonin (Flushing, wheezing, etc)

What's the treatment for carcinoid?

Somatostatin analog, octreotide.

Which vitamin deficiency is associated with carcinoid syndrome?

Study group discussion: What causes Carharts notch?

In otosclerosis, why carharts notch at 2000 Hz in PTA?

Carhart attributed this phenomenon to "mechanical factors associated with stapedial fixation."

But why the greatest dip at 2 kHz?

The ossicular chain has two basic modes of vibration. The first mode, with a peak around 1200 Hz, is the primary mode for AC stimulation. This mode is associated with a "hinging" motion of the ossicles caused by AC stimulation of the tympanic membrane at the umbo. The second mode, with a peak around 1700 Hz, is described as a "pivoting" motion of the malleus/incus, with an axis of rotation somewhat orthogonal to the axis of rotation associated with the "hinging" motion. The second mode is less robust than the primary mode for AC stimulation, but it is the dominant mode when excited by BC stimulation. A decreased mobility of the ossicular chain at 1700 Hz due to otosclerosis also affects the surrounding frequencies, but is seen most prominently as a BC loss at 2000 Hz in audiometric testing.

Causes of carpal tunnel syndrome mnemonic

Short post for the day!

Mnemonic: CARPAL Tunnel Syndrome

Atypical carcinoid syndrome mnemonic

Happy Friday everyone!

Carcinoid tumors are neuroendocrine tumors of the GI tract. They can make high levels of neuropeptides and amines, like serotonin, which can cause brief episodes of flushing, diarrhea, cough, wheezing, shortness of breath, heart disease, and in rare cases, pellagra. (Typical carcinoid syndrome)

Atypical carcinoids have a normal plasma serotonin level. They are characterized by extended episodes of deep purple flushing, headache, shortness of breath, and in rare cases, lacrimation (tears).

Following Medicowesome

"I really want to read all your posts from time to time. How can I follow you?"

I feel that email is the best option.
You can follow by any RSS feed here.

As for social media, I regularly update Facebook and Twitter.
Twitter: https://twitter.com/medicowesome
Facebook: https://www.facebook.com/medicowesome

For those of you who use Whatsapp, the Broadcast list is a wonderful idea.
I add contacts to my broadcast list and send links to blog posts (new and old) on a daily basis.
Broadcast list: http://medicowesome.blogspot.in/2015/09/medicowesome-broadcast-list.html

Submissions: Anti-diarrhoeal and drugs used for constipation notes

These awesome notes were written by Kiki!

Triad of pheochromocytoma mnemonic

To remember the classic triad of pheochromocytoma, remember 3 P's.

Study group discussion: Pharmacology of drugs used in Parkinsons disease

Why does bradykinesia and rigidity occur in Parkinson's disease?

Bradykinesia is due to deficiency of dopamine.
Rigidity is due to uncompensated increase in acetylcholine.

Why levodopa is always given in combination with carbidopa and entacapone? 

Carbidopa is given to protect levodopa against dopa decarboxylase enzyme which causes its peripheral breakdown. Peripheral conversion of dopamine is harmful.. Can cause cardiac arrhythmias and postural hypotension.

Entacapone is given to block COMT.

Difference between entcapone and talcapone?

Study group discussion: Why are platelets low in hepatic disease?

Why are platelets low in hepatic disease?

You need cytokines to tell the marrow to synthesis platelets. They are synthesized chiefly by liver.

It is also been associated with the concept of hypersplenism leading to sequestration of thrombocytes in the enlarged spleen.

Submissions: Anti-diabetic drugs and insulin

Written by kiki <3 p="">

Anti-diabetic drugs classification

Upper segment to lower segment ratio (US:LS ratio) mnemonic

Hey!

I was asked to measure the US:LS in a child. My professor was suspecting Rickets. So let's learn the normal ratios is various age groups!

Submissions: Respiratory drugs classification notes

These notes were written by kiki :)

ACE inhibitors that are not prodrugs mnemonic and dysgeusia

Before I tell you about the mnemonic, lemme tell you about Titanic.

The captain of Titanic was not a pro in sailing because he sank the ship xD

Or because he listened to Bruce, "The press knows the size of Titanic, now I want them to marvel at her speed, too. We must give them something new to print. This maiden voyage of Titanic must make headlines!" 

Haste is waste, Bruce. Lol.

So now you know what I am talking about, here's the mnemonic:

"Captain who Listens and acts hastily is not a pro."

Scaphoid fracture mnemonic

This was sent to me by a friend, Akshay Dhaiya! I modified it a little bit :D

He likes to call the scaphoid fracture as the Spiderman fracture. Why?

Because it's caused by supination and dorsiflexion of wrist.
(Just like how spidey throws his web!)

Spiderman - Supinating and dorsiflexing the wrist xD

How to remember the function of anconeus muscle (Screwing movement at elbow joint)

Short anatomy post for the day!

I remember about Scrat the squirrel form Ice Age, always screwing around for an acorn.

Why is gout more common in men?

Hey everyone!

I was trying to find out is hyperuricemia in Von Gierkes disease gender specific.. I didn't get the answer to my question (If you do, please let me know!), but I did found out that hyperuricemia, in general, is more common in men.

Why?

Pterygium is more common on the nasal side: Why?

Why do pterygia occur more commonly in nasal side?

Environmental factors, such as a warm climate, dust and UV light, are the main causes of pterygia.

Major And Minor Blood Cross Matching Compatibility Tests

Hello awesomites! Jay ™ here today, once again with a new blog post. Yayy! ^_^

Today we will discuss about Major and minor blood cross match compatibility test. This is usually performed before the transfusion of blood from a donor to a recipient in a hospital setting.

Before we get to this we need to get known to a table which we will use in the following tests.

Blood Type	Agglutinogen (Antigen)	Agglutinin (Antibody)
A	A	Anti b
B	B	Anti a
AB	A + B	None
O	None	Anti A + Anti B

In major compatibility test we mix Donor Cells (Dc) with Recipient Serum(Rs).

In minor compatibility test, we mix Recipient Cells (Rc) with Donor Serum (Ds)

For the Cells we check the Column of Agglutinogen and for Serum we check the Column of Agglutinin for obvious reasons of the place of presence of each.

So for an Example – 

Granular contents of neutrophils mnemonic

This post was requested by someone.. So I made a mnemonic.

Medicowesome broadcast list

I have created a broadcast list on Whatsapp for those who want to recieve links to recent blog posts.

It's not a group, you'll just receive updates about new blogs from me regularly through a personal message.

If you would like me to send you links instead of you checking the blog or Twitter.. Just email me your number with proper country code at medicowesome@gmail.com with "Broadcast list" in the subject. I'll message you in a week.

Study group experience #18

Here's what we discussed so far:

Decerebrate and Decorticate rigidity

Drunken crab syndrome

Polygonal cells

Contraindications of ACE inhibitors

Acromegaly

Antianginal drug classes mnemonic

Why more phenytoin is prescribed at night

HSV encephalitis and musical hallucinations

Monroe Kenri's Law

ECCE

Fluids in inferior wall myocardial infarction

Serum ascites albumin gradient

Suprapubic cystostomy experience

Referred pain

Hot vs Cold fomentation

Cystogastrotomy for pseudopancreatic cyst

Wow. 6 groups. I don't know what to say so I'm going to tell you what others said:

"The group has been good. I've learnt a lot through here. Especially spot diagnoses."

"I mean people asking questions, even though repeat, sometimes helps just to consolidate."

"Hey.. Just wanted you to know that my grades have gone up since the group :)"

These were so nice to read!

-IkaN

Volume of ascitic fluid, abdominal assessment in ascites and my viva incident

Hey everyone!

A colleague asked this question on the study group  - What volume of ascitic fluid are the following tests positive: Puddle sign, Shifting dullness, Fluid thrill?

What I found out - Minimum amount of fluid required for detection of ascites by various methods are:

Diagnostic tap 10 - 20 ml

Ultrasonography 100 ml

CT scan 100 ml

Puddle sign  120 ml

Shifting dullness 500 ml
Fluid thrill 1000 - 1500 ml

I would also like to add an incident that happened in my viva:

I had a patient with liver cirrhosis in my exam. The examiner asked me that which physical examination signs I knew for the detection of suspected ascites and what my findings were.

Why does thiazide, a diuretic, cause a paradoxical anti-diuretic effect in Diabetes insipidus?

Hey everyone!

I have explained this before (In one of my earlier posts on free water clearance) but someone found my language too complicated to understand. So I decided to write this post.. An explanation which is "free" of complicated terms like free water clearance. Yaay! :D

ADH absorbs water. In nephrogenic diabetes insipidus, the kidney is unresponsive to ADH.

What do you then?

You use a drug called thiazide.

Thiazide diuretics inhibit the NaCl co-transporter  in the renal distal convoluted tubule (DCT).
The DCT is water impermeable.. So the DCT action is NOT how thiazides preserve water.

Then what is preserving water?

Submissions: Mature defense mechanisms mnemonic

Mature defense mechanisms mnemonic

SMASH
Suppression
Mature defenses
Altruism
Sublimation
Humor

This mnemonic was submitted by mist amidst

Ethosuximide mnemonic

Greetings everyone!

This little pharmacology pearl was written by Keto :)

eThosuximide is the T drug.

It blocks the T-type Ca2+ channels:
T stands for Transient which can be found in the Thalamus.

Remember, that thalamus is a relay nucleus with a lot of subnuclei. Everything travels through, EXCEPT smell. So a patient with "Transient" absence (peTiT mal) seizure, you can let them smell something to bring them back. And... eThosuximide is the drug they need.

Study group discussion: Monroe Kenri's Law

Here's a cool fact:

Monroe Kenri's law states that cerebral perfusion pressure = Mean blood pressure (MBP) - Intracranial pressure (ICP)

Hence, in cases of increased ICT or intrcranial heamorrhage, BP rises.
This is physiological so that blood supply to the brain can be maintained.

Hence, in cases of stroke, never try to reduce BP unless it is above 200. If you reduce BP, the blood supply to brain is compromised.

Cushing's triad in cases of increased ICT:
1. Increased BP
2. Bradycardia
3. Irregular respiration.
(Because increased ICP compresses the brain stem)

Related post: Cushing's triad (How to make medical notes)

Bleomycin metabolism

This is a short post on pharmacology!

Bleomycin is inactivated by a cytosolic cysteine proteinase enzyme, Bleomycin hydrolase.

This enzyme is widely distributed in normal tissues with the exception of the skin and lungs, both targets of Bleomycin toxicity.

This is why, Bleomycin causes pulmonary fibrosis.

It's also why bleomycin is used in skin cancers like squamous cell cancer.

That's all!

-IkaN

Hyperphosphatemia in chronic kidney disease

This is a really short post :D

What's the mechanism behind hyperphospatemia in kidney disease?

Kidney activates vitamin D.

Tarsal Bones Mnemonic

Hey guys, Jay here once again. Today I was studying my anatomy, and our lower limb region is going on. Since our regional exam is next week, I wanted to study the foot and especially the tarsal bones. Me, the one who is so fond of mneumonics, tried finding some mnemonic to remember the tarsal bones. I found one on internet I made one myself. So let me first list the tarsal bones.
1. Calcaneous
2. Talus
3. Navicular
4. Medial cuneiform
5. Intermediate cuneiform
6. Lateral cuneiform
7. Cuboid

The one on Internet:

The Circus Needs More Interesting Little Clowns

But in this Calcaneous and Talus have exchanged places. So when I saw this, I edited it a bit. :) So it kinda goes with the first syllable as well. ^_^

CaT Navy Meets Interesting Little Cubs

CaT has Calcaneous and Talus both.

Hope it helped Awesomites. :) Until we meet again then, Ciao!! Au revoir!!! :D

《Jay》

Heart murmurs mnemonic

Hello people with a pumping heart in their chests, obviously! <3

In this post, I'll be taking about the few mnemonics I use in relationship to murmurs.

"PASS" is a good mnemonic for remembering that pulmonic and aortic stenosis give a systolic murmur.

The opposite of PASS, ie, other two valves and the other defect gives a systolic murmur too. (Mitral and tricuspid regurgitation gives a systolic murmur!)

VSD has a S so that's systolic.

Now, the other ones - pulmonic and aortic regurgitation, mitral and tricuspid stenosis will cause diastolic murmurs :)

Here's another mnemonic submitted by one of the readers:

Primary, secondary and tertiary hyperparathyroidism mnemonic

This idea was submitted by Keto. It helps go through Calcium and Phosphorous levels very quickly.

The values are somewhat logical and can be thought through.. But if you're on ward or on a board exam this can be handy.

Hyperparathroidism mnemonic

Why is there an increased white cell count in sickle cell anemia?

Hello sweet people!

I spent today's free time searching for what is the cause of leukocytosis in sickle cell anemia =P

Sickle cell disease typography

Making Referrals - Bio Medical Ethics

Hey awesomites, I'm Jay, and I'm your new Medicowesome contributor! yayy!! :) And today we are going to talk about Referrals. This is another important ethical responsibility of a physician.

A physician’s Central responsibility is WELFARE OF THE PATIENT, and that means, Physician should work for the best interest of the patient not him/herself.

Referral simply means that, when we reach the boundaries of our competence, we should hand our patient to a more competent physician. Keeping a patient with ourselves to hide our incompetency or to earn more money is a huge NO-NO!!!

We shouldn’t be ashamed to ask for help from our colleagues, and we shouldn’t be continuing to treat a patient, if we cannot give him/her a fruitful therapy as our boundary of competency has reached. That’s when we should write a LETTER OF REFFERAL to a Consultant(BritE)/Attending(AmE) Physician or to another colleague with a broader knowledge or idea of the subject.

Submissions: Bio medical ethics

Bio Medical Ethics - by Jay ™

Today’s blog post is about Bio Medical ethics or Ethics of Medical care that a health care practitioner has to adhere to.

Medical ethics started off as Hippocratic Oath made in 460~ BC in the Book called Corpuz Hippocratum.

“Do No Harm” is the Primary Ethical concern of Medical Ethics. 

Constitutional pancytopenia mnemonic

Constitutional pancytopenia mnemonic

Rich in name, poor in cells.

"I fancy this carat (gold), diamond and silver man. He is a mega rich noob down here!"

Fancy: Fanconi syndrome
Dis (Dys) Carat: Dyskeratosis congenita
Diamond silver man: Shwachman Diamond syndrome.
A mega: Amegakaryocytic thrombocytopenia
Noob: Noonan syndrome
Down: Downs syndrome

That's all!

The mnemonic is just as hard xP

-IkaN

Study group discussion: Drunken crab syndrome

Which parasite causes the drunken crab syndrome?

Paragonimus westermani.

Drunken crabs, because man gets infected with it by eating raw crabs. In Taiwan, these crabs are marinated in wine. Hence, the name!

Also called kejang.

Wow I didn't know this.

Nice to know, I was formulating all sort of weird possibilities for symptoms based on that.

I thought of a motion abnormality.. Since crabs can walk sidewise.

When I first came across this... Even I thought that the person would have a drunken gait or something!

Wonder how a crab would walk in cerebellar ataxia.. Considering they have a cerebellum.. Or not!

Lets talk about crabs!

Crabs is also slang for STD.
It's not slang, my bad. It's lice in pubic hair. Also known as crab lice.

CRAB is used for Multiple Myloma symptoms too.
CRAB:
C = Calcium (elevated),
R = Renal failure,
A = Anemia,
B = Bone lesions

And then there's Krabbe's disease, some sort of leucodystrophy.

Lame mnemonic for drunken crab.. Our teacher said -- Mr. Krabs gets drunk in Taiwan .. Because he found out.. His daughter "P"earl  (paragonimus) is a man (westermanii)

Nice mnemonic!

Typhoid: Leukopenia, chronic carrier state and cancer (Why does typhoid fever cause leukopenia?)

I see a lot of patients with typhoid in the casualty and usually, they all have leucopenia. So I wondered - Why does the WBC count decrease in typhoid or enteric fever? Why does the WBC count become low unlike other infections?

After loads and loads of Googling, I found the answer to my question.

Study group discussion: Acromegaly

What is the most common cause of death in patient with acromegaly?

Cardiomyopathy leading to heart failure.

Why is diabetes more common in acromegaly?

GH has anti insulin effect.

Cool fact: GH increases insulin production. But at the same time causes insulin resistance.

How can you find out by giving glucose that patient has acromegaly or not?

Normally, growth hormone should be suppressed by giving glucose. Suppression of GH by giving glucose excludes acromegaly.

What is the treatment for acromegaly?

Pegvisomant - GH receptor antagonist.
Transsphenoidal removal of pituitary tumor.

Study group discussion: HSV encephalitis and musical hallucinations

Fun fact: HSV encephalitis is associated with musical hallucinations.

It's due to disruption of connections between the sensory cortex and reticular formation.

Is that specific for HSV only? Like the way auditory hallucinations is characteristic of schizophrenia?

No, it occurs in epilepsy, intoxication and other focal brain lesions as well.

I've heard that musical hallucinations occurs in people who listen to music for long periods of time. Not sure if it's true.

JVP in pericardial tamponade

Greetings everyone!

Today, I was reading about JVP in pericardial tamponade. I started explaining a few concepts to myself and then I thought maybe everyone would like to know about this! So I wrote them down for you guys to read.

Why is y descent absent in JVP in pericardial tamponade? 
Y wave is due to ventricular relaxation. The ventricles can't relax when the pericardium is full of fluid, leading to the absence of y descent.

JVP in pericardial tamponade

Why is there a prominent x descent in JVP of pericardial tamponade?

Pharmacological agents that relax lower esophageal sphincter mnemonic

Pharmacological agents that relax lower esophageal sphincter mnemonic

ABCDEF MINTS

Alcohol
Anticholinergics like Atropine
Barbiturates
Benzodiazepines like Diazepam
Caffeine or coffee
Chocolate (My favorite!)
Dopamine
E (Prostaglandin E1 & E2)
Fat
Meperidine
Nitrates
Theophylline
Smoking
Peppermint (mints)

That's all!
-IkaN

Cirrhosis of liver: Concepts, mechanism and pathophysiology

Hello everyone! 

In this really long post, I'll be discussing the pathophysiology of some of the signs, symptoms and conditions seen in chronic liver failure / alcoholic liver disease. We are going to focus on the WHY.

Let's get started ^__^

Why is gynecomastia, testicular atrophy and female pubic hair distribution seen in males with chronic liver failure?
Physiology:
- Liver metabolizes estrogens.
Pathology:
- In cirrosis, estrogen degradation is decreased, so estrogen concentration are elevated causing testicular atrophy, gynecomastia & changes in pubic hair.
- Estrogen also induces SHBG production and this further reduces the free testosterone levels.

Stigmata of diseases

What does stigmata mean?

Stigmata means some lesion, mostly skin, which is visible, showing the patient is suffering from that particular disease.
In some diseases, like leprosy and tuberculosis, the patient may not want to reveal the condition because of the stigmata associated with the disease in society. But due to certain signs, the disease gets revealed. (These diseases were considered a disgrace in earlier days.)

Examples - 

Submissions: Branches of the abdominal aorta flow chart

Hello!
This lovely anatomy flowchart was submitted to us by Benedict Kusi Ampofo.

Thyroid carcinoma mnemonic

Hello! 
I made a real easy way of remembering thyroid tumors :)

Papillary carcinoma mnemonic:
Popular (Most common thyroid cancer)
Palpable lymph nodes (Lymphatic metastasis is common)
Positive I (131) uptake
Post radiation in head and neck (One of the causes)
Pops out of the capsule (Usually encapsulated but invades capsule)
Pops everywhere in the gland (Multifocal)
Positive, pleasing, perfect, parexcellence, peerless prognosis
(Excellent prognosis because it's slow growing)
[Another mnemonic is PG - Papillary, Good prognosis =D ]
Histology:
Popping eyes (Clear nuclei, Orphan Annie Eyes)
Papillary pattern
Psammoma bodies
Pseudoinclusions (Intranuclear cytoplasmatic inclusions)

Study group discussion: Why more phenytoin is prescribed at night

Why do we give phenytoin in 1-0-2 dose after discharge? Why two tablets at night?

Phenytoin causes marked drowsiness that can confound the mental status (read GCS) exam in medicated patients, most critically those who have had neurosurgery and are given phenytoin for postoperative seizure control. In an outpatient being prescribed phenytoin one would plausibly order more to be taken when the patient is likely to be asleep instead of when they're awake.

Thank you for sharing this with us.

One article says, previously, we used to give 300 mg once daily. After chronic use, patients started developing adverse reactions of drug. It was then decided to start using phenytoin in divided doses. (100 mg TID).

Also remember that gingival hyperplasia is a very important and distinctive secondary effect of phenytoin, my teachers say that it stays even if you stop the medicine, but I'm not sure of that since I have not read that anywhere else.