Study group discussion: Widow makers artery

Does anyone know why left anterior descending artery is called widow's artery?

Approach to acid base disorders: Metabolic alkalosis notes

In suspected metabolic alkalosis, always check urinary chloride levels.

Metabolic alkalosis associated with a reduction in the ECV (Vomiting, diuretics):
There will be a stimulus for Na and Cl reabsorption to replenish extracellular volume.
Urinary Cl is very low ( < 25 meq/L).
Administration of NaCl and water leads to correction of the metabolic alkalosis.
Such causes of metabolic alkalosis are said to be saline responsive.

Approach to acid base disorders: Metabolic acidosis notes

Hello!

I made these notes while studying acid base disturbances. Now they might not make sense to someone who has never studied this topic before.. But for those who have read about it, this should be excellent for revision.

Calculation of anion gap:
ALWAYS calculate the anion gap first.
Anion gap = [Na+]  − ([Cl-] + [HCO3−])
Normal anion gap = 8 - 16 mEq / L

What causes renal bruit?

Narrowing of the renal artery (Renal artery stenosis) causes renal bruit.

Hexagonal crystals in cystinuria mnemonic

Hexagonal crystals are seen in cystinuria.

Envelope shaped crystals in urine: Calcium oxalate mnemonic

Heyyyyyy!

X in oXalate looks like an envelop to me :D

Drugs causing crystal induced AKI mnemonic

Hello!

So today I was reading about acyclovir and crystal induced acute kidney injury.

Acyclovir is rapidly excreted in the urine (being both filtered and secreted) and has a relatively low solubility. Intravenous (IV) therapy may lead to the deposition of acyclovir crystals in the tubules if the patient is volume depleted. This results in intratubular obstruction and foci of interstitial inflammation.

Secondary focal segmental glomerulosclerosis mnemonic

How to remember diseases associated with focal segmental glomerulosclerosis - Remember the letter H!

Hodgkins lymphoma and minimal change disease

Fact for the day: Hodgkins lymphoma is associated with minimal change disease.

Complications of nephrotic syndrome

Complications of nephrotic syndrome:

Infection with encapsulated bacteria, varicella (Vaccinate before or during treatment with high dose steroids)

Thromboembolism due to decreased antithrombin III (Prophylactic anticoagulation is not recommended unless patient has had a thromboembolic event, albumin < 2 g/dL, fibrinogen > 6 g/L, antithrombin < 70%)

Hypovolemia, anascara, renal insufficiency.

Increased risk of early atherosclerosis due to hyperlipidemia.

Multiple Endocrine Neoplasia

MEN are autosomal dominant syndromes.

They are classified as-

1. MEN 1 ( Wermer syndrome)
Pituitary, pancreas & Parathyroid adenomas.

2. MEN 2
a) 2A (Sipple syndrome)
Hyperparathyroidism, medullary carcinoma of the thyroid and pheochromocytoma.
b) 2B
Medullary carcinoma of the thyroid, pheochromocytoma, and mucosal ganglioneuromatosis.

Related post: MEN syndrome mnemonic

Step 2 CK: Types of incontinence mnemonic

Here's a short post on types of incontinence. It is important to know for step 2 CK as well as step 2 CS!

Local anaesthetics - What's in a name?

Personally I am very bad at remembering weird names. I feel like I am being bullied, horribly tortured for the sins I have committed whenever I have to deal with learning names.

Anyways chuck remembering stupid names, we will be smart and figure out a way to remember them..without trying too hard. Like using Google maps to reach a place through shortcuts :D

So Aminoesters and aminoamides are the two types of local anaesthetic in use.

You just need to remember that the esters has only one letter "I" and the amides has two letter "I"

Also that the esters can be effectively neutralised by the cholinesterase in plasma, that's pretty nice cause these substances are known to cause allergic reactions.

Just for the sake of naming.
The highly unstable esters are..
Procaine
Chlorprocaine
Tetracaine
Benzocaine
Cocaine

And again just for the sake of completing this post-
Lidocaine
Mepivacaine
Prilocaine
Bupivacaine
Etidocaine
Ropivacaine

They are dreadful I agree..but "I" will save the day :D

Laughing gas aka Nitrous oxide

Some random facts about nitrous oxide

1. Discovered by preistly

2. Cylinder colour blue

3. Stored as a liquid ( critical temp 36.5 C )

4. Aka laughing gas

5. Not metabolised in the body

6. In anaesthesia it acts as a carrier to other agents..used in conc of 33%O2 + 66%N20 + 1% inhalational agent

7. For every one mole of nitrogen removed, 35 moles of N2O enters..that means compliant spaces in our body take in more gas with increased in pressure..therefore nitrous oxide is constraindicated in these situations.

  Pneumothorax
  Pneumoperitoneum
  Tympanaplasty
  Posterior fossa surgeries ( high risk of air embolism)
  Intestinal obstruction
  Microlaryngeal surgeries ( N2O diffuses through the tube cuff and double or triple the volume of the cuff leading to laryngospasm)

8. Side effects - it can lead
   Bone marrow aplasia
   Sub acute degeneration of spinal cord
  Megaloblastic anaemia
( It inactivates B12 if used for more than 6 hrs in a surgery )

- happy studying
Sakkan :)

 

Mnemonic for foramen of cranial nerves

Here are awesome notes drawn by Mini on foramina for passage of cranial nerves:

Mnemonic for foramen of cranial nerves

Edward syndrome notes and mnemonic

Hello!

So here's how Yeshwanth remembers the features of Edwards syndrome.. He thinks of Accelerate from Ben 10!

Here are his notes:

Gout and pseudogout mnemonic

Hello!

Remember N for Gout:
N for Na urate crystals
N for Negative refringent crystals on polarised microscopy
N for Needle shaped crystals

Patau syndrome notes

These were submitted by Yeswanth Gopisetti

Montegia and galezzia fractures mnemonic

Hello everyone! 

In today's post, I'll be sharing a mnemonic on Monteggia and Galezzia fractures! 

U for ulna in Monteggia  

R for radius in Galezzia 

Also, U in Monteggia is at the Upper end of ulna. 

R in Galezzia is at the lower end of radius. 

Another mnemonic is M for Monteggia, M for the medial bone, which is ulna! 

Submitted by DoctorWizard 

Ketamine- A new antidepressant!

Hello!

Remember those conventional classes of drugs used for treating major depressive disorders?? Well, now I have a better one. Ketamine!
Haha yea trust me... this commonly used anaesthetic, analgesic, hallucinogenic drug has got its place in another class of drugs- The anti-depressants. :D

#AnswerTime: Female with weakness of lower limbs

Okay so answer tim! 

I posted a quiz time question here: http://www.medicowesome.com/2016/07/quiztime.html?m=0

Here's the solution to it. 

Sorry this got so late, I've had exams -.-

The IMNCI problem - Solved. (Mnemonic)

Hi everyone !
So I was just studying Pediatrics and sometimes they expect us to remember how to fill the IMNCI form 😭 #SoCruel.
So here's a mnemonic I made for the headers :

For a child below 2 months -->
Bl*w Job TDM

So
Bl*w= Bacterial infection
Job= Jaundice
T=Temperature (hypothermia)
D= Diarrhea
M= Malnutrition

__________________________________
For a child above 2 months -->
3 Di*ks in FEMAles Is Fun

So 3 D*cks are  :
Danger signs
Diarrhea
Dypnea /difficult breathing /cough.

FEMAles  :
  F = Fever
  E = Ear problem
  M = Malnutrition
  A = Anemia

Is = Immunization

Fun = Feeding .

Hope you find this one helpful.
Will continue with the GI hormone series once exams are done.  :p
Bye.

Solitarius and ambiguus

Vagal nuclei was a hated subject to me..so bad that I would turn the page if I ever came across it.

This thing helps keep my facts straight when it comes to these horrid nuclei.. hopefully it will help you too.

Ambiguous in a literal meaning is to outshine everyone else. There are many ways to do that. The most everlasting impression you leave is how you interact to people..what to say and when to say.

That's what nucleus ambiguous helps you to achieve..these are the neurons controlling the palate, pharynx and larynx. Hence, the controller of speech :)

its the vagus, the glossopharyngeal and spinal accessory that share this nucleus

Nucleus Solitarius is for taste sensation and for the supply of carotid and aortic body chemoreceptos
Hence, it's the facial, glossopharyngeal and vagus nerve that share this particular nucleus

Psst- let me know of your way to remember this. Our ideas may be solitary..but let's make it ambiguous together :D

Sticks like a gum

I am generally against the idea of using mnemonics.. but this particular one is a life saver for me.. though stupid :D

Think of a chewing GUM, think of the times when it was stuck to your fingers..and you struggled to get rid of it.

That's how valgum..when things stick to each other.

No more worries as to what is genu valgum and genu varus.

Additional mnemonic by Subbiah: After K is L, by alphabetical order. Hence Knock knees is vaLgum.

Antibodies to stop Heart disease!

Hello everyone!

Cardiovascular disease is one of the most leading causes of death in the world today, with major risk factors not merely high cholesterol and high blood pressure but also the actual lesions being directly responsible for the disease- Atherosclerotic plaques.
Antibodies that help the immune system remove dead and dying cells have been shown to reduce atherosclerosis. 
Read further to know the "how" of that.. :D

Why use glycine in TURP?

TURP is the current standard surgical procedure for BPH. The various irrigation fluids are

NaCl- since there is use of cautery in TURP.. NaCl can be hazardous to the surgeon as well as the patient

Distilled water- while resection of prostate tissue, there is exposure of the underlying vessels..which leads to rapid absorption of the irrigating fluid. Distilled water is highly hypotonic.. which can cause widespread hemolysis.

Glycine- currently the most preferred agent. The commonly used conc is 1.5% glycine with an osmolality of 230mosmoles(plasma 285-290mosmole) At this conc the hypotonicity is balanced with the toxicity of glycine. Though it can still cause volume overload with dilutional hyponatremia..it is not as severe as with distilled water.

Dilution hyponatremia Is a dreaded complication of TURP. The management includes I.V NaCl solution (0.9% & 3%), fluid restriction and furosemide.

Other less known solutions are- Glucose , mannitol and urea
A costly but comparatively safer option is cytal( sorbitol+mannitol)..but due to cost restriction..it's not that common.

#QuizTime: Female with weakness of lower limbs

#Quiz time

A 25 year old female who is a marathoner presented to the OPD with weakness of her lower limbs. She said she isn't able to practice as her legs feel very tired. This started with her foot , about a week back, And now her entire leg feels weak.
History is otherwise insignificant , but there is a history of mild fever with a very light maculopapular rash about 4 weeks back, within a span of 3 weeks after she returned from a Running Contest in Brazil.

GI Hormones: Cholecystokinin Pancreozymin

Hi everyone ! So this is the 3rd post in  the series of the hormones of the GIT.
Last post we discussed about the Zollinger Ellison syndrome as a result of  Gastrin.  This post we look at the 2nd member of the gastrin family. Cholecystokinin PZ
Hope you like it. ::)

⛔Cholecystokinin Pancreo-Zymin ⛔

◾Produced by : I cells in mucosa of Upper SI.

◾Physiology of secretion :
○ Acts vis CCK A receptor. (Gastrin acts via CCK-B if you recollect)
○Pre-Pro-CCK fragmented into many parts.
○Multiple AA in each for, but same 5 AA at Carboxy terminal
○Also found in distal ileum and colon + Cerebral Cortex.

◾Functions : lots.

○Gall bladder motility (contraction - kinesis)
○Stimulates pancreatic enzyme secretion ; augments secretin's actions
○Trophic action on pancreas
○Inhibits gastric emptying
○Causes contraction of pyloric sphincter -->preventing duodenal content aspiration.
○CNS --> role in regulation of satiety/food intake, Anxiety.

________________________________________

So if you notice, this does way more things than its brother Gastrin. Now it might get a little tedious to remember. So think of it this way :
Cholecysto-kinin Pancreo-Zymin. So first part of the name is cholecysto = Gall bladder. Kinin=motility. So 1. GB motility. Next is Pancreozymin. So acting on the zymogen granules in pancreas to bring about 2. enzyme secretion. Now along with causing enzyme stimulation it'll also tell the pancreas to grow up , hence exerting a 3. trophic action. So far so good?
Now for all of this gall and pancreatic fluid to reach the intestines , the barrier of the Oddi sphincter needs to be passed. So it'll 4.relax this sphincter causing the secretions to flow freely into the gut.
This causes a lot of fluid to be present in the duodenum. Since this is in proximity to the pylorus, the pyloric sphincter will  have to be shut to prevent aspiration of alkaline duodenal stuff into the stomach, hence 5.pyloric sphincter constricts.
Finally, since it's modulating so much of the digestion , it's got receptors in the CNS that 6.stimulate/depress hunger based on the CCK levels (like more CCK indicates more food being gulped down)
I have no idea about the anxiety part. So we're gonna have to go with it. Lol.

◾Regulation :

○Factors that increase -->
□Luminal  : fatty acids (>10Carbon atoms) -as lipase from pancreas acts on lipids and gall fluid contains fat digestive bile acids + AA.
□Other : CCK-Releasing peptide (intestinal mucosa) + Monitor factor (pancreatic)
+ feedback b/w degradation and secretioPZ

◾Applications
○ CCK in the injectable form can be used as a diagnostic aid to check Gall bladder motility

○ CCK Antagonists -->
□Proglumide =Non Selective. Ulceroprotective effect. (Gut action). May increase analgesic property of Opioids and help reduce Tolerance to them (CNS Action).
□Lorglumide =Selective fir CCK A type. Gut action.
□Studies are on going to harness their potential as anti-anxiety or anorectics. (CNS actions)

:)
Next post - The secretin family.
Hope you'll are finding this helpful. Let me know if you have any doubts or suggestions. Bye until then=)

-:Drug Doses:-

Hi everyone !
here is collection of drug doses according to their classification,Hope it helps you:)

Pericarditis, pericardial tamponade, X descent and Y descent

Hello everyone!

Here's another awesome mnemonic submitted by Aditi!

"cPAY TAX"

In constrictive pericarditis, prominent Y descent is seen (X descent is also prominent.

In pericardial tamponade, prominent X descent is seen (Y descent is absent).

Thank you so much for sending your mnemonics to us, girl! (=

Causes of triple deformity of the knee mnemonic

To remember the causes of TRIPLE DEFORMITY of knee, remember word "TRIPLE"

T - TB
R - Rheumatoid arthritis
I - Illiotibial band
P - Polio
E - Excessive bleeding

Submitted by Aditi Bhosale

Bone in bone appearance mnemonic

Remember mnemonic, "TOPDOG" for bone in bone appearance:

T - Thalassemia
O - Osteoporosis
P - Pyles disease
D - Diaphragmatic achalasia
O - Osteodysplasty
G - Gauchers disease

Submitted by Aditi Bhosale

Good prognostic factors in nerve injury mnemonic

Good prognostic factors in nerve injury.

Remember that, "NERVE is Good"

N-Neuropraxia
E-Early repair
R-Radial that is pure motor or poor sensory has best prognosis
V-Vascularity intact
E-End to end anastomosis
G- growing age

Submitted by Aditi Bhosale

Tuberculosis mnemonics

Hello!

Today's post is all about TB! :D

So many names to remember :/

Enterobius vermicularis notes & mnemonics

Enterobius vermicularis notes

Here are my notes for Enterobius vermicularis. Uploading so you guys can refer to them (:

GI Hormones: Zollinger Ellison Syndrome

Hi everyone ! So this is the 2nd post in  the series of the hormones of the GIT. 

Last post we discussed about the functions of the hormone Gastric.  This post we look at its applied aspects. And that's majorly looking into the Zollinger Ellison Syndrome. 

Hope you like it. ::)

⛔ZOLLINGER ELLISON SYNDROME⛔

■Etiology: sporadic or Associated with MEN1 SYNDROME (Multiple Endocrine Neoplasia syndrome)

■TRIAD : Tumor + Hypergastrinemia + Peptic ulcerations. 

↪Tumor. = Gastrinoma. 50% gastrinomas are malignant.                                                       ○MC Site is the duodenum
○(☆MC site for PUD in general is also duodenum. So it only makes sense that for the mucosa to ulcerate there must be a local gastrin supply available ).

○2nd MC site for gastrinoma = Pancreas. Originally the tumor was defined as a non Beta cell Pancreatic tumor. 😨. Now its been realised the duodenum was the culprit all along.
○PUD and Hypergastrinemia. = due to increased gastrin secretion by the tumor, gastrin exerts an increase in the acid secretion + its trophic action on gastric mucosa. This causes erosions of gastric mucosa as well as causes hypertrophy of it (paradox). Thus we get a Hypertrophic Gastropathy + PUD.

↪S/S:
○Abdominal pain is the MC symptom . Can mimic PUD.
○2nd MC symptom is Diarrhea.
May be associated with mucosal damage due to acid leading to villous atrophy (excessive acid of stomach. Pancreatic/intestinal alkalinity may be unable to counteract. Pancreatic secretions may be compromised due to tumor)
○Heartburn
○GI bleed -- hematemesis, melena. Due to ulcer-hemorrhage. 

↪Inv:
○S.gastrin levels - >100. IOC for screening
○May follow up a positive result with gastric acid function tests
○Somatostatin receptor scintigraphy.
○Evaluate for Liver /LN mmets
○S.Calcium -- associated with MEN1.

↪Rx :
○PPI. Symptomatic treatment achieved with OMEPRAZOLE and friends.
○Can use Octreotide - Somatostatin analogue. It's a generalised inhibitor of pretty much all hormones.
○Surgical Rx of tumor advised to avoid mets

☆☆☆☆☆MEN1 --> Hyper parathyroidism , pituitary tumors ,Pancreatic tumors.
(Mnemonic : All MEN like 3 things - Pus*y, Pus*y, Pus*y. = parathyroid, pituitary, pancreas) ; 

Autosomal Dominant. cause men are dominant, lol. ¤¤ 

The next post is going to be about the only  other member in the Gastrin family -CCK PZ. 

So don't fail it to check it out. ;;) 

Bye till then. :* :D

GI Hormones: Gastrin

Hi everyone, so this is my first post in the series of GI hormones!

There are 2 families of GI hormones -

1. Gastrin family (Gastrin , CCK)

2. Secretin family (Secretin, glucagon, VIP, GIP)

Others - Motilin, Peptide YY, Substance P, Ghrelin, Guanylin

In this post, I'll be talking about one of the members of the gastrin family, gastrin itself! :D


⛔⛔GASTRIN⛔⛔

I. Produced by: 

■ G cells - enteroendocrine cells located in antral gastric mucosa.

II. Physiology of secretion:     

■ Acts via CCK-B receptor

■ Progastrin is cleaved to form 3 different residues :G 14, 17,34.

■ Sulfated and carboxylated forms also exist.

■ Amidated form is more stable.

■ G17 is principal form w.r.t. GI actions.

■ G34 has longer t1/2 than others.

■ Inactivated in SI, kidneys

III. Functions: 

■ Stimulates Gastric acid and Pepsin secretion

■ Trophic action - stimulates growth of mucosa of Gut.

IV. Regulation:

A. Factors that increase secretion of gastrin: 

■ Luminal:

- Amino Acids (Aromatic) in stomach 

- Distension

Because the job of this hormone is to bring about protein breakdown via pepsin and increase pH of the stomach, Hence it is released in response to protein and other contents entering the stomach. Tells the stomach it's time to do its job!

■ Neural:

- Vagal discharge as it secretes GRP at the postganglionic fibres.

Both sympathetic and parasympathetic fibres in gut are stimulatory (dual ANS stimulation).. What can we do about it?

■ Bloodborne:

- Epinephrine

- Ca2+

Calcium is a universal stimulant of motility and exocytosis from glands; epinephrine = dual ans stimultion.

Factors that decrease secretion of gastrin:

■ Luminal:

- Acid

- Somatostatin

Acid tells the G cell to shut up. There's enough acidity. No need for stomach to yap.

Somatostatin keeps all other hormones in check!

■ Bloodborne:

- Secretin family (Secretin, VIP, GIP, glucagon) (archnemesis)

Applied aspects of Gastrin:
■ Normal S. Gastrin levels = upto 100pg/ml
■ Hypergastrinemia:
- Pathological Increase (eg. Gastrin secreting tumor)
- Compensatory Increase (eg. Pernicious Anemia i.e. Type A Gastritis; due to destruction of    acid secreting cells compensation with increased  gastrin.)
■ Hypogastrinemia:
- Antral loss eg. Antrectomy, Achlorhydria.
- H pylori associated ulcers/gastritis may show hypogastrinemia, but association is not very clearly established. 

My next post will be on Zollinger Ellison Syndrome.  Excited? :D I know I am 😎

Hope you guys like it. 

~ A. P. Burkholderia

Strongyloides Stercaralis Notes And Mnemonics

Hey everyone!
These are microbiology  notes made by me =) Hope it helps you ☺

"Inception"- a real thing!

Hello!

Remember the movie, "Inception" starring Leonardo DiCaprio??? Loved it.. right? :D
OK. Let me recall it for you.. Leo's character interferes with other's dreams to implant new ideas in their minds. It was a trippy plot premise. But, not entirely a Sci-Fi!!!

So, now what if I say we could do 'inception' without the subject being aware of what is being learned... "Yes, it is possible in reality now", the scientists say.

Normal AST, ALT and ALP values mnemonic

Continuing the normal values mnemonic posts :D

Today's post is on liver enzymes!

Normal SGOT, SGPT and ALP values!

Immunization schedule notes and chart

Hello!
So in these notes, I write about type of vaccine, strain used for vaccine prepration, diluent, content, dose, route, site of vaccination,strength,  protective efficacy, protective duration, contraindications, complications, age limit and storage of vaccines and special points used in the Indian immunization schedule.

It's a nice summary for those studying pediatrics, preventive and social medicine, pharmacology, microbiology and medicine. 

Stay Awesome ☺

Step 2 CK: Interventions that lower mortality in STEMI and ACS

Hello!

For Step 2 CK, remembering things that lower mortality is essential. Here's a mnemonic for interventions that lower mortality in STEMI (ST elevation MI), NSTEMI (Non ST elevation MI) and UA (Unstable angina).

Gastrointestinal Stromal Tumors Mnemonic

Hi everyone !
So here is a post about a few important points on GIST I figured can be remembered in an easier way if you love the letter "C" ! G does look like a C :D

Uses of somatostatin and bromocriptine notes & mnemonics

Hey everyone!
These are pharmacology notes made by me =)

Olympics 2016 and the Zika

Hey Awesomites!!!

You all know the Olympics and Paralympics are on their way in August and September. Excited, aren't you? Woohhooooo! :D

Its taking place in Rio de Janeiro, Brazil this year. So if any of you or your known really plan to travel to Brazil for the Olympics and the Paralympics... You have to know about the current situation of Zika virus out there. Brazil, along with many surrounding countries of America, are experiencing an Outbreak of Zika Virus.

Forensic toxicology notes part - 3

These are my toxicology notes. Hope it helps you!

Forensic toxicology notes part - 2

These are my toxicology notes. Hope it helps you.☺

Instructions for new authors: How to post through blogger app

If you wanna be an independent author at Medicowesome, here's what you need to do:

Email me at medicowesome@gmail.com asking that you want to write for Medicowesome. I'll say yaay! Of course, yes! :D

Make a blogger account (blogger.com) using your Gmail account.

Send me your gmail address. I will send you an author invitation, you must accept it within 24 hours.

Forensic Toxicology notes part - 1

These are my toxicology notes. Hope  it helps you! 

Alkaptonuria notes and mnemonic

Today, Hari sent me his notes on Alkaptonuria.

Alkaptorr makes him think of helicopter! And he imagines a black ox sitting in it!

Alkaptonuria mnemonic