Diuretics and antidiuretics notes

Diuretics and anti-diurectics notes by Shubham. Isn't he plain awesome for sending his notes to us?

Treatment of acne mnemonic

Hello!

Here's a short post on acne.

Antimicrobials for treatment of acne mnemonic: ABCDE
Azelaic acid
Benzoyl peroxide
Clindamycin
Dapsone
Erythromycin

GnRH agonists, GnRH antagonists, uses and mnemonic

Hey guys!

Here are a few more notes by the one and only, Shubham Patidar! This time on dopamine, prolactin and GnRH :D

Potter Sequence

A sequence is where a single initial aberration leads to a series of anomalies in the body. The best example of a sequence is 'Potter Sequence'.

Conditions like renal agenesis, maternal hypertension lead to oligohydramnios. The amniotic fluid plays a role in the lung development in the second half of pregnancy & so, there is a higher incidence of pulmonary hypoplasia in such foetuses which is the main cause of their death.

Oligohydramnios leads to direct pressure of the uterine wall on the developing foetus leading to flattened nose, recessed chin & low set ears. This is Potter sequence- sequence here because the initial aberration- oligohydramnios leads to & explains all the changes occurring later.

Happy Sunday!

Metronidazole notes and mnemonic

These amazing notes on Metronidazole were written by Shubham Patidar!

Biotin deficiency mnemonic

Hello!

Here's an interesting case of vitamin deficiency you should read.

Biotin deficiency is rare. Nice to know for exams though. Soooo.. I made a mnemonic. Biotin reminds me of the comic character, Tin Tin!

Biotin mnemonic

Study group discussion: A case of vitamin deficiency

Here's a vignette that I found on USMLE forums:

A 20-year-old male patient is admitted to the hospital 6 months ago following a motorcycle accident resulting in a severe closed head injury. The man has experienced recurrent fungal skin infections resistant to treatment for 1 month and severe vomiting over the last 2 days. Review of the patient's records shows he was well before the injury. He now suffers severe permanent cognitive impairment and requires continuous high-dose phenytoin therapy to manage chronic debilitating tonic-clonic seizures. The patient is resting comfortably in no apparent distress. He is unable to converse coherently. Vital signs are normal. Physical exam is striking for nearly total alopecia. A periorofacial erythematous macular rash is present along with severe seborrheic dermatitis and several truncal ringlike lesions consistent with tinea corpus infection.

Select the most likely vitamin deficiency.

Answer Choices:

A. Vitamin A deficiency

B. Vitamin B12 deficiency

C. Vitamin C deficiency

D. Vitamin D deficiency

E. Vitamin E deficiency

F. Thiamine deficiency

G. Pyridoxine deficiency

H. Folate deficiency

I. Biotin deficiency

Order of decision making

Ideally, a doctor discusses the available options of treatment with the patient, the patient makes a decision and informed consent is obtained.

However, this may not be possible on every occasion and it is the physician's responsibility to ensure that a decision is made that would be what the patient would have wanted (if the patient does not have the capacity to make the decision himself/herself).

Apoptosis genes mnemonic

Hello all :)

So we basically have bcl 2 , bcl XL, mcl-1, Bax, bak, bcl -xs genes which influence apoptosis.

Now let's imagine a cell committing suicide which is apoptosis.

Dysphagia

Hi everyone!

So, here's what I found interesting today!

Dysphagia is awareness of something sticking in the throat or retrosternally during swallowing.

Whereas, odynophagia is pain as food or drink descends the esophagus. It almost always implies an infection of esophagus e.g.candida esophagus in HIV patients.

Remember, dysphagia often has a significant cause which can be malignant and almost always needs investigation!

Can there be different patterns of dysphagia?
Yes.
It can be more for solids than liquids.
When it is rapidly progressive, look out for a malignant cause! When it's fairly less rapid in progression, suspect a benign stricture (rarely an esophageal pouch)!

Or, it can be more for liquids than solids.
This usually is the case in neurogenic dysphagia and can be sometimes associated with aspiration or coughing.

That's all!
- Rippie

Cronkhite Canada syndrome

Cronkhite Canada syndrome

Cyanosis

So, I found a few interesting things about cyanosis.

Cyanosis is bluish discolouration of skin and mucous membranes.

Reason?
It occurs when amount of reduced Hemoglobin is more than 4g/dl. (Harrison's, 19E)
Even small amounts of methemoglobin (1.5g/dl) and sulphmethemoglobin (0.5g/dl) can evoke cyanosis!
(Just remember, bigger the name lesser the amount required :P)

Types?
Central and Peripheral cyanosis

What happens in both of them?
Central cyanosis has either i) low arterial oxygen saturation or ii) abnormal Hemoglobin derivatives so skin as well as mucous membranes are involved!

Peripheral cyanosis is due to either i)increased oxygen extraction or ii)reduced amount of blood reaching periphery (simply, vasoconstriction [so you may find cold skin] or reduced cardiac output =D) so only skin is involved.

Where to check for cyanosis?
Lips, nail beds, ears and malar eminences.

Fun facts:

1. Cyanosis in heart failure can be mixed i.e. Central plus peripheral

2. "Differential cyanosis" is when lower limbs are cyanosed and NOT the upper limbs! It happened when there's a Patent Ductus Arteriosus (PDA) with Reversal of shunt!

3. So can cyanosis of only upper limbs happen? Yeah, if there's a PDA with Reversal of shunt with Transposition of great vessels!

Most interesting one:
4. In PDA with reversal of shunt with Pre-ductal coarctation of aorta all limbs except for Right Upper Limb can be cyanosed! If you're wondering why, then the answer is that if the coarctation is before the origin of left Subclavian Artery you may find its blood supply being hampered and so the cyanosis of left upper limb. Both the lower limbs get its blood supply from arteries after the level of coarctation, so it's invariably going to be cyanosed!

Quite a lot, right?
That's all!

-Rippie

Evolution, transposons, retrotransposons.

We all like to think mutation as a random occurrence, an occurrence only due to chance which is mostly harmful and may be evolutionary significant once in a blue moon.
There are actually, contrary evidences to all that. Evidences which will force us to rethink all our notions and accept Jean Baptiste Lamarck as our hero(yeah the Giraffe-neck guy).

How,do you ask? Well, we'll have to begin by learning what 'junk' DNA is. Junk DNA (better call it noncoding DNA) is a vast amount of nucleic acid lying unused in the nucleus. Actually, only 3% of the 'normal' DNA codes at a given time. Rest of it lies unused.

With me still here? Great. Now, we come to 'jumping genes' or 'transposons'. What initially was considered as a rigid blueprint, the DNA is so not like it. In fact, its a dynamic entity. Genes moving here and there, cutting,copying, and  pasting themselves within the strands.
These frisky genes are the transposons. In experiments conducted by Barbara MC Clintock, it was discovered that when corn plants were subjected to environmental stresses, the genes arranged themselves so as to confer them with a survival benefit. Yes, a sort of intentional mutation was done by the plant itself!
Later, in experiments conducted by Harvard researcher John Cairns on certain lactophobic strains of E coli, where the bacteria were deprived of all the nutrition except for lactose, it was observed that those bugs lost their milk fear rather readily, quicker than mere chance would have allowed to mess with their genetics.
Lamarck doesn't sound too stupid now, does he?!

And now, coming to the most interesting part, does all this magic occur in us, as well? Hell yeah. And wait till I mention the name of the partner in crime - Retroviruses.Yep.You read that right.
These are the viruses which can penetrate the Weissman barrier - a barrier which prevents traits acquired by the parent's somatic cells to pass to the germ cells.The idea is to prevent harmful acquired traits like radiation induced DNA damage from passing to the offspring.

Coming to viruses again,we all know how they work their charm. Using the host machinery and then in the process, sometimes ending up as a part of our own DNA- the junk DNA about which I wrote earlier.Today,it is a known fact that at least 8% of our DNA can be traced back to retroviruses. With this vast noncoding (junk) DNA, the space to play for the jumping genes opens up many folds, and hence a higher number of permutations and combinations become available for an acceptable mutation to occur.

Now what the hell are 'retrotransposons' in the title? Well, a subtype of jumping genes. Normal transposons work by cutting and pasting within the genome, while these retrotransposons are copy pasters.
But more interestingly, their work resembles very, very close to retroviruses. A retrotransposon initially copies itself on an RNA strand, travels,and uses reverse transcriptase to paste itself into a new location on the DNA strand. Does this mean retrotransposons are descended from retroviruses?! You bet!

This has led many to theorize that viruses have actually accelerated human evolution by endowing us with acres of junk DNA and retrotransposons, while we continued to provide them a warm, cozy environ. 
Some thought innit?

LDL Cholesterol- The 'bad' turns good

Hello!

Since long back, the low-density lipoproteins have been linked to high rates of cardiovascular disease and mortality! But is it really so?

USMLE STEP 1: Psychiatry: Malingering and Factitious disorders.

Hey there..! Hello..

 So whenever you come across a clinical vignette in which the patient comes with UNEXPLAINED symptoms or complaints and doesn't seem to have an actual illness, but is either faking it or creating it, the patient is either MALINGERING or has a FACTITIOUS DISORDER.

Alzheimer's due to infections?

Hey awesomites!!!
Could Alzheimers' stem from infections?

Stress and epilepsy

For epilepsy patients Stress and anxiety exacerbate the condition by increasing the frequency and severity of attacks!!

MAC prophylaxis mnemonic

Bonjour!

Mycobacterium avium complex infections need to be prevented in patients with AIDS if their CD4 cell counts are less than 50/microL.

Clinical and radiological features of rickets mnemonic

Hello!

So I had created this video long back but just realized I never uploaded it on the blog. Here it is! :)

Study group discussion: White jaundice

Can anyone explain about what is white jaundice?

I think it refers to cholestasis syndrome (obstruction of bile outflow)

Jaundice (Increased conjugated bilirubin)
Acholia (Pale stools, thus "white jaundice")
Choluria (Dark urine)
May have generalized pruritus (Due to cholesterol)

Here's what someone else wrote:

White Jaundice is not a separate disease, it is a very old term for jaundice.

Jaundice is a condition in which bilirubin, which is a yellow coloured pigment, accumulates in the body and causes the skin to turn bright yellow. In severe cases, the skin can appear brown.

To confirm that someone is jaundiced, and not just dark-skinned, the whites of the eyes are examined, yellow colouration here is a clear sign of jaundice, hence the old expression "white jaundice".

Migraines linked to Vitamin D deficiency

Hey awesomites!

A new study suggests that migraine attacks are linked to vitamin deficiencies.

The question is - 'Could supplements be the key to fight such attacks?'

Vitamin D in Type - 2 Diabetes Mellitus

Hey awesomites!

Vitamin  D has an important role in overcoming insulin resistance in type 2 diabetes. Here's how...

Why does acute promyelocytic leukemia (M3) cause DIC?

Disseminated intravascular coagulopathy (DIC) is caused by an inappropriate activation of the coagulation cascade

Indications of hypertonic saline

Hey :D

The only indications of hypertonic saline is when there is hyponatremia in the body severe enough to cause symptoms like mental status changes.

Oral hypoglycemic drugs used for diabetes mellitus mnemonic

Hello!

So whenever there is a LOT of things to remember, like a lot of drug classes or a lot of microorganisms, I personify them. I make them real life characters and give them creep personality traits.

Here's a mnemonic kinda thingy on drugs used in diabetes mellitus aka oral hypoglycemics!

Atelectasis

Atelectasis simply means collapse of the lung parenchyma. This includes failure of expansion of the lung parenchyma( Congenital) and a normally inflated lung parenchyma getting collapsed(Acquired).

There are 3 types of Acquired Atelectasis-

1. Resorption Atelectasis

Basically an obstruction in the airway causes collapse of the airway distally. The mediastinum shifts towards the side of the collapsed lung.

2. Compression Atelectasis

The lung collapses due to the compressing force which may be due to hydro thorax/hemothorax etc. The mediastinum shifts to the opposite side of the collapsed lung.

3. Contraction Atelectasis

Due to chronic interstitial fibrosis which makes the lung smaller. The only type of Atelectasis which is irreversible.

Ionotrophy, chronotrophy, dromotrophy, lusirophy and bathmotrophy

The heart is amazing.. Just like we have 5 senses, theheart has 5 properties < 3

They are rhythmicity, conductivity, excitiability, contractility and relaxation. These properties have been given fancy names too!

Hyperthyroidism and hyperdynamic circulation

Hello!

Hyperthyroidism results in a hyperdynamic circulation. This post was created because I attempted to know why :D

The cardiac effects of hyperthyroidism commonly cause increased preload with low systemic vascular resistance, a high heart rate, high cardiac output and increased cardiac muscle oxygen consumption. So that's why, hyperdynamic circulation!

Step 2 CK: Investigating thyroid nodule

Hello! 

If you find a thyroid nodule on clinical examination, the next best step is to get a TSH level.

Why? Because it helps you decide which investigation to order next!

If TSH is low, you need to do a radionucleotide scan first.

Why? Because it helps you decide whether or not you need a fine needle aspiration cytology (FNAC)

If the nodule is functioning, do not do a FNA. It just means hyperthyroidism. Observe or treat depending of FT4, T3 levels.

If the nodule is non functional, however, you must do a FNAC for a possible malignancy.

If TSH is normal or elevated, it means there could be something suspicious in the glad, do FNAC of the nodule.

Why not do a scan? Because the nodule will likely be non functional and will tell you nothing else to change your management,

UpToDate mentions sonographic criteria for biopsy before jumping to a FNA, but Master The Boards says that USG can never exclude malignancy and you must always do a FNAC.

 Investigating thyroid nodule

That's all!

-IkaN

Pendred syndrome mnemonic

Hello!

What is pendrin?
An iodine transporter, pendrin, is located on the apical surface of thyroid cells which mediates iodine efflux into the lumen.

What is pendred syndrome?
Mutation of the pendrin gene causes Pendred syndrome, a disorder characterized by defective organification of iodine, goiter, and sensorineural deafness.

How do I remember this?

Diabetes insipidus and SIADH mnemonics

"Do you have any mnemonics on vasopressin related disorders? I always mix up diabetes insipidus and syndrome of inappropriate anti-diuretic hormone!"

Sorry for replying so late. You are probably in your second year med school because once you get old, you can never mix up the two. Anyway, I made these mini mnemonics for ya, hope they help! :)

Normal sodium, potassium and serum osmolality values mnemonic

Hello!

In my last post, I helped you guys remember normal arterial blood gas values. Now, we are going to remember a few electrolytes. Yaay! :D

Step 2 CK: Conjunctivitis in newborn

Hello! 

These are some points that I felt are high yield while studying conjunctivitis in newborn =)

Cystic fibrosis and prolonged neonatal jaundice

Why does cystic fibrosis cause prolonged neonatal jaundice? 

Friedreich's ataxia mnemonic

Mini post for the day :)

Step 2 CK: Treatment of Pneumocystis carinii pneumonia (PCP) mnemonic

Hello my old friend!

Today's post is on  Pneumocystis carinii pneumonia (PCP)!

Here are my notes and mnemonics :D

Fetal Hydantoin syndrome mnemonic

This is a short post on fetal hydantoin syndrome.

Step 2 CK: Anterior and posterior urethral injuries and mnemonic

Hello!

I was studying about urethral injuries today for my Step 2 CK exam and these are my notes :)
I put them in a question and answer format. Hope it helps! 

What are the pats of the male urethra?
The male urethra is anatomically subdivided into anterior and posterior segments at the level of the urogenital diaphragm.

Posterior urethra:
Prostatic urethra
Membranous urethra

Anterior urethra:
Bulbous urethra
Penile urethra

Mnemonic: PM BP

Parts of male urethra mnemonic

Step 2 CK: Blunt pancreatic trauma

Happy Monday everyone!

Today, I am going to be talking about a uncommon condition, blunt pancreatic trauma.

Blunt pancreatic trauma occurs when high energy force is applied to the upper abdomen, which crushes the retroperitoneal structures against the vertebral bodies.

Superficial and deep veins in upper and lower extremity mnemonic

Hello!

It's important to know the superficial and deep veins of the extremities.

Why?

Because management of thrombosis of a deep vein differs from thrombosis of a superficial vein.

Myasthenia gravis and muscles involved

Today, in the study group, someone asked about nerves not involved in MG.

Myasthenia gravis can present as a pupil-sparing third nerve palsy with ptosis.

Why is the pupil spared?

Step 2 CK score 251 experience by Saminathan Anbalagan

So in this post, Saminathan Anbalagan, IMG from India talks about how he scored a 251 on Step 2 CK and his journey.

Saminathan:
There are a lot of experience posts which are excellent guides.. I actually went through many of them and took the one which suited me.. So I’ll first write about few areas where I felt difficult.. And then give the whole experience..

I didn't have proper guidance for the assessments.. CMS, NBME and UWSA.. I didn't know how to go about.. I guess many people are feeling the same.. So lemme give an overview..

Step 1 score 256 experience by Satish Advani

So in this post, Satish Advani, CMC Pakistan talks about how he scored a 256 on Step 1 and his journey.

Satish:

I’ll try to make this guide as helpful as possible. Whatever I write here is based on my own experience and the experiences of top scorers I observed during my preparation. 

Resources:

This is the most important part of your preparation and probably most variable also because it depends on your previous knowledge and your way of studying so you have to find out what works for you.

Kaplan, highyield, roadmap, BRS, etc etc the list goes on and on. Important thing is to stick with one book for one subject. If you have difficulty understanding anything google it. It will take sometime but it is going to be worth it.

Here is the list of stuff I used, whether or not I found them helpful and what was my previous knowledge in these subjects (on a scale of 0 to 10)

Physiology: 4/10

I never read Guyton or Ganong in my medical school. Just glanced at a review book to but still I never found this subject too hard.

Kaplan notes - Read the notes and watched the videos . I didn’t like this book. Dragged myself upto the renal system then decided to skip. And then started BRS.

BRS physiology - Hands down the best book for physiology. Probably somewhat difficult to understand at first because its written in a concise way but it’s GOLD my friends. It's questions are important also specially the CVS and respiratory part. Owe my star to this book for these systems.

Testicular swellings and transillumination mnemonic

Hello!

In today's post, I'll be shedding light on your testes! :P

For those who don't know what transillumination is, it is shining of light through a swelling and seeing if the light is transmitted through it or not.

In this post, I'll be talking about swelling of testes.

Electives: How much does it cost and how to be cost effective

Hello!

This post is on how to reduce your expenditure when you travel for studies.

When I went to US for electives, I was on a really low budget and had to save every cent. I couldn't afford spending lavishly and no blog briefs you about the finances clearly. So I thought of writing a blog on how to be cost efficient during electives so that it would help someone who was chasing dreams with loans like I am :)

Pulmonary contusion vs ARDS for Step 2 CK

Hey everyone!

Because the radiographic findings in pulmonary contusion and ARDS are so similar, I thought of writing a small post on it :)

Both have patchy irregular alveolar interstitial opacities on x-ray. Also, both these conditions present with tachypnea and hypoxemia.

So how do we differentiate the two?

Nail changes in psoriasis mnemonic

Hello! Here's a mnemonic on nail changes in Psoriasis!

Proximal - BLOP
Beaus line
Leuconychia
Onycholysis
Pitting

Special and differentiating investigations in Anemia

Here, we would try to summarize all the investigations useful to differentiate various types of anemias--

1. Microcytic hypochromic anemias
-S. Ferritin, Total Iron Binding capacity, Transferrin saturation help in distinguishing IDA, AOCD, Beta thal trait.
HbA2 levels between 3.5-8% are diagnostic of beta thal trait.

2. Macrocytic anemias
S. VitB12 and S.Folic acid assays to differentiate megaloblastic from non megaloblastic macrocytic anemias.
PBS f/s/o megaloblastic anemia - macovalocytes, hypersegmented neutrophils, pancytopenia +/-

3. Warm Antibody against P antigen and cold antibodies (I antigen) to detect AIHA and also to differentiate AIHA from HS.

4. G6PD Assays- suspected G6PD deficiency anemias

Redistribution of drug

I knew what is is Distribution of drug but I think somewhere along my medical school I might have missed reading about REdistribution of drug. Here's what it is:

Biochemistry – How to study?

We see many requests coming to our study groups, asking for few tips to study Biochemistry. Today I thought we should talk about it for the sake of our 1^st year Medicowesomites!! Yay!

Ok, Biochemistry, as the name itself implies is about Chemistry in Biological systems. So what do we most encounter in Biochemistry and how to tackle them?