Step 2 CK: Overflow incontinence mnemonic

Greeting everyone!

In this post, I'll be sharing a mnemonic on overflow incontinence!

McCune Albright syndrome mnemonic

Hello everyone!

McCune–Albright syndrome is suspected when two of the three following features are present:

Endocrine hyperfunction such as precocious puberty
Polyostotic fibrous dysplasia
Unilateral Café-au-lait spots

Here's a mnemonic :)

Precocious puberty mnemonics

Hi! :)

Precocious puberty in females is secondary sexual characteristics, accelerated growth in females greater than 8 years of age.

Normal pubertal landmarks mnemonic:

Biophysical profile mnemonic and step 2 CK notes

Hello!

Here's a mnemonic for biophysical profile: BAT HAM
Breathing
Amniotic fluid volume
Tone
Heart rate Acceleration
Movements

Here's an overview of interpretations from the BPP score.

BPP 10/10
BPP 8/10 (Normal AFV)
No fetal indication for intervention.
Repeat weekly.

BPP 6/10 (Normal AFV)
Equivocal. Repeat test within 24 hours.

BPP 4/10 (Normal AFV)
Fetal lungs mature (>37 weeks), deliver.
Fetal lungs immature, betamethasone, repeat test within 24 hours.

General rule: If oligohydramnios, consider delivery.

BPP 8/10 (Decreased AFV)
BPP 6/10 (Decreased AFV)
Assess clinical scenario, consider delivery depending on gestational age, risk of fetal, maternal death, etc.

BPP 4/10 (Decreased AFV)
If >32 weeks, deliver.
If <32 weeks, observe.

BPP 2/10
BPP 0/10
Deliver regardless of gestational age.

That's all!
I wrote this down from a number of resources, including uptodate
-IkaN

Study group discussion: Rh incompatibility and ABO incompatibility

Here is some food for thought.

Think about which of the following scenario is worse:
1- Mom is O- and baby is O+ first pregnancy
2- Mom is O- and baby is O+ second pregnancy
3- Mom is O+ and baby is O+ second pregnancy
4- Mom is O+ and baby is A+ second pregnancy
5- Mom is O- and baby is A+ second pregnancy
6- Mom is O+ and baby is O- first pregnancy

Answer is 2
Rh incompatibility in second pregnancy. In presence of ABO incompatibility, Rh incompatibility, has lesser effect.

Detailed explanation:

The most common group O has anti A IgM, anti B IgM and anti AB IgG.
Group A has anti B IgM.
Group B has anti A IgM.
Group AB has no antibodies.

So if I was dumb enough to transfuse GroupyA blood to a group B guy there would be hemolysis. But what would be the mechanism for this?

The patient with group B would have anti A IgM. IgM is a very potent complement activator. IgM is very trigger itchy, it first shoots the cell and then asks questions. So this hemolysis is very fast.

Now coming to the Rh question, imagine there was a mom with O- group and baby with O+ group.

In first pregnancy, the mom is not exposed to the Rh antigen until delivery, so the 1st baby is safe. But there would be a mixture of baby and mom's blood.

Now imagine a weird person (Rh+ cell) walking through an airport, he would taken by the TSA (macrophage) for an "interrogation". So the macrophages do this interrogation (phagocytosis) in the dark corners of spleen and pick up info (antigens) about these weirdos. This info is passed to T cells and they issue warrants to B cells (IgG) for identifications of these guys and they are killed on site (IgG mediated destruction)

You can see that this will, obviously, take time time. When she gets pregnant with Rh incompatibile kid again, the IgG have been synthesized and they cross placenta and attack the baby RBC's. Voila - Hydrops fetalis.

Now imagine a mom who is O- and has a baby with A+ group. This time, at delivery, there is mixing of blood again!
But the mom has anti A IgM which is so fast like a ninja, kills of the majority of the cells before they go for their interrogation with macrophages in spleen... So ABO incompatibility actually protects against the Rh sensitization.

What's the clinical significance of Rh incompatibility?

Whenever you take care of a pregnant lady, you will confirm her blood group and if you suspect Rh incompatibility you would give her "Rh IgG" (standard dose) at 28 weeks, even though the fetal blood is not exposed to mom's immune system, this is done just in case - there might be a fall, injury etc and baby's blood may get into mom's circulation.

Why do you give Rh IgG when you want prevent the disease which is itself caused by IgG?

Rh IgG are heat treated and they cannot cross the placental barrier unlike normal IgG.

And finally, you give another dose of Rh IgG after delivery. But this time, you actually estimate the amount of fetal blood which is mixed with mom's blood by doing "Kleihauer betke test" and you give an appropriate dose.

Explained by DJ AweSpear.

Related posts:
Rh incompatibility
Hydrops fetalis
Blood group doubts
Removal of antigens from RBC's
Barts hemoglobin mnemonic

Differentials of nodular lymphangitis

To make this post fun, I created hypothetical scenarios. This will help making a differential diagnosis =)

Scenario 1: Patient is a rose gardener.

Scenario 2: Patient is an aquarium cleaner.

Scenario 3: Patient is a vegetable labourer in a farm. Honey colored drainage is seen at the site of ulceration. It is followed by subcutaneous nodules draining the primary lesion.

Scenario 4: There was a painful chancre at the primary lesion. After 5 days, tender lymphadenitis developed.

Answers:

Scenario 1: Sporothrix schenckii

Scenario 2: Mycobacterium marinum

Scenario 3: Lymphocutaneous disease by nocardia brasiliensis.

Scenario 4: Tularemia

Reading material:
Sporotrichosis, often occurring in gardeners, remains the most recognized cause of nodular lymphangitis.
Injuries sustained in marine environments suggest Mycobacterium marinum infection.
An incubation time of 1 to 5 days, a painful chancre at the initial lesion site, and prominent tender lymphadenitis strongly implicate tularemia.
Frankly purulent discharge from the primary lesion is associated with some infections due to Francisella and Nocardia species.

That's all!

-IkaN

Karyotype seen in different disorders

Karyotype in:
Turners syndrome
Kallmanns syndrome
Klinefelters syndrome

Answers:
45 XO
46 XX or 46 XY
47 XXY

Nocardia treatment mnemonic

Hello, peace keepers of the earth! =)

In today's post, I want to emphasise that the drug of choice for treatment of nocardia is TMP SMX. That's it!

Hantavirus mnemonic

Remember H for Hantavirus infections.

Hantavirus infections are associated with high Hematocrit, pulmonary edema (Heart failure like lungs), Hemorrhagic fever and Hypotension.

They're transmitted through deer mice feces.

That's all!

-IkaN

Antibiotics for Listeria monocytogenes infection

Mini Q&A for the day!

What is the drug of choice for Listeria monocytogenes meningitis?

Ampicillin.

What is the drug of choice for penicillin allergic patients?

TMP SMX for penicillin allergic patients.

What drugs do you use empirically for treatment of meningitis? When do you use ampicillin?

Ceftriaxone
Vancomycin
Add ampicillin for Listeria monocytogenes (Especially in elderly, neonate, immunocompromised.)

Ceftriaxone and cefotaxime

Why is cefotaxime preferred over ceftriaxone in neonates and patient with liver disease?

Ceftriaxone-induced biliary sludge is a solubility problem that occurs in patients receiving high-dose treatment (greater than or equal to 2 g).

The risk of developing ceftriaxone-associated biliary "pseudolithiasis" increases with increasing ceftriaxone dose and in patients with impaired gallbladder emptying.

Cefotaxime has renal excretion and therefore preferred over ceftriaxone.

Study group discussion: ACEI and bilateral renal artery stenosis

Angiotensin converting enzyme inhibitors (ACEI) are contraindicated in bilateral renal artery stenosis. Why?

In renal artery stenosis, renal perfusion is less and hence GFR is low. In such a case, nephrons adapt the filtration by causing efferent arteriolar constriction to maintain the pressure needed for filtration.
If ACEI is given, there is dilation of efferent arteriole and renal perfusion will again decrease further and GFR will become more low. Hence, contraindicated.

In bilateral renal stenosis, the effective renal blood flow is not significantly reduced but maintained at the cost of increasing the efferent artery tone. ACEI causes inhibition of angiotensin 2, leading to efferent artery vasodilation in glomerulus. This decreases intra glomerular pressure and filtration, resulting in renal  function detoriation.

Most commons of bacterial endocarditis

Q&A for the day!

Most common cause of bacterial endocarditis:

After tooth extraction -
Injection drug use -
Health care / catheter associated -
Originates from GI tract -
After genitourinary manipulation -

Answers:

After tooth extraction - Streptococcus viridans

Injection drug use - Staphylococcus aureus (Less common - Pseudomonas aeruginosa, Candida species)

Health care / catheter associated - S. aureus (Also Coagulase negative staphylococci CoNS)

Originates from GI tract - S. gallolyticus (Formerly known as Streptococcus bovis)

After genitourinary manipulation - Enterococci

That's all!
-IkaN

Glasgow coma scale mnemonic

Hello!

This post is on the Glasgow Coma Scale (GCS)

An important MCQ they like asking is that if the patient doesn't respond to pain, doesn't open his eyes and doesn't talk - What is the GCS? You'll be tempted to mark zero. Remember, the lower limit of GCS is 3, not 0.

Corticosteroid Side Effects Notes and Mnemonics

What a great day to study today!

In this post, I uploaded my notes on corticosteroids side effects mnemonics. 

Hope you find it helpful. 

That's all! 

-  शुभम् पाटीदार mbbs 013 बेच।

Intrinsic muscles of the hand mnemonic

Hello!
A short post on intrinsic muscles of the hand :)

Authors diary: Teachers day

Thank you for all the teachers day wishes. They truly made me smile (=

I'm glad I could be of help to all of you.

Inheritance: Funny illustration

From the authors diary:

I created this image for Jason Compton. Last year, they did a play on Beta Blockers at RhinoFest and used one of my illustrations for it. Even though I couldn't attend it, I'm always glad to be a part of being a fun way of information spreading!

This year, they're doing a family (multi-generational) theme and educating about genetics, inherited traits, etc.

I created this fun image for them.

Parents "hand me down" their clothes (jeans) and genes! The blue and yellow DNA mix to form different shades of green in the children.

I hope you like this illustration and all the very best for your play! =)

-IkaN

Viva questions: CHF and checking edema

So I thought of writing a few posts on questions that were asked to me in my vivas. You may not be asked the same questions, but these are just for you to get an idea on how it goes (:

What is the difference between orthopnea and paroxysmal nocturnal dyspnoea?
Orthopnea is dyspnea in the recumbent position.
PND is acute shortness of breath and cough, usually occurring after 1-3 hours of sleep.
Orthopnea is relieved by sitting upright, PND persists even after assuming the upright position.

Where will you check for edema in a bed ridden patient?
In the sacral area or in the scrotum.
(In ambulatory patients, check in the ankles and pretibial region.)

That's all!
I'll keep updating as and when I remember =)
-IkaN

Step 2 CK: Diagnosis of aortic dissection

I'll keep this post short and point wise.

Best initial: Chest x-ray (CXR).
Shows widened mediastinum.

Localization of stroke based on clinical findings

Hello!

This post focuses on the localization of the lesion in stroke, re-written from Harrison.

I divide this post into "Important to know" and "Extra notes" which are optional to learn about.

What's a stroke?

A stroke, or cerebrovascular accident, is defined by this abrupt onset of a neurologic deficit that is attributable to a focal vascular cause. Causes of ischemic stroke here.

Stroke syndromes are divided into:

(1) large-vessel stroke within the anterior circulation,

(2) large vessel stroke within the posterior circulation

(3) small-vessel disease of either vascular bed.

During vivas, you'll mostly be asked to localize the lesion into anterior circulation (ACA vs MCA). They don't expect much, but you should at least know the divisions (anterior circulation vs posterior circulation), occlusion of which artery involves speech, monoparesis of a leg is seen in stroke involving which artery, etc. Just the basics.

How to remember ACA stroke findings

Hello!

This is how I remember that stroke in the anterior cerebral artery predominantly involves hemiparesis of contralateral leg and foot.

The A is between the legs!

Study group discussion: Red cell Distribution Width (RDW)

Let's discuss Red cell Distribution Width (RDW) today!

RDW represents variation in RBC size.

If the RDW is large, it says that the cells are different in sizes.

Analogy: If RDW is large, we know the RBCs are all unity in diversity. Like India :P

What's the clinical significance?

Study group discussion: Different sized spherocytes

The difference in size of spherocytes has significance. It is assessed manually, on peripheral smear examination.

What's the importance of assessing size difference of spherocytes?

Wilsons disease mnemonic

So this bed time story was told to me by my granma in 2000 (who can see the future and knows who the POTUS will be in 2016 :P)
Its a story about a guy who uses a "WILSON's" racquet to play tennis. And you all probably know this legend right?

CT appearance of subdural and epidural hematoma mnemonic

Hello!

Subdural is crescent or semilunar shaped.

Epidural is biconvex lens shaped.

Phimosis and paraphimosis mnemonic

What is phimosis and paraphimosis?

Phimosis is constriction of the preputial orifice. In phimosis, the foreskin can not be retracted.

In paraphimosis, the foreskin can not be reduced back on the glans. It may cause a painful glans swelling going on to proceed to a gangrene. 

I always mix up the two, so mnemonic!

Another mnemonic - Call Paramedics if paraphimosis because it's a surgical emergency. 

This one was submitted by SG on our study group, "PAra is PAinful." 

That's all!
-IkaN

Step 2 CK: Management of liver laceration

Hello!

Say you have a hemodynamically unstable patient with a gunshot wound or blunt trauma to the RUQ.
Why shouldn't you simply suture and close deep liver lacerations?

Because of the risk of hemobilia and abscess formation.

Here's what a surgeon must do:

Polyarteritis nodosa mnemonic

Heyy!

Polyarteritis nodosa is a necrotizing vaculitis of small and medium sized muscular arteries.

Immune cells and brain development

Hello!

Do you know about microglia? OK think and tell..

Neurogenic claudication

Hey!

Did you know there is something called as neurogenic claudication?

Behcet's syndrome mnemonic

Hey guys! 

So I wanted to write something about Behcets and created a lame mnemonic for it.

Let's start :D

Anakinra mnemonic

Hello!

Anakinra is an IL-1 receptor antagonist used for the treatment of rheumatoid arthritis.

Types of arthritis

Causes of polyarticular symmetric arthritis

Rheumatoid arthritis
Systemic lupus erythematosus
Viral arthritis (Hepatitis, parvovirus EBV)

Causes of monoarticular arthritis

Antiphospholipid Syndrome mnemonic

Hello!

Lemme tell you about APLA today :)

It is an autoantibody-mediated acquired thrombophilia characterized by recurrent arterial or venous

thrombosis and/or pregnancy morbidity.

Study group discussion: Ferritin

Hello everyone!


Why do ferritin levels increase in Rheumatoid arthritis?
It is an acute phase protein.
The levels increase in serum as well as in synovial fluid. The rise is more in synovial fluid because of local production of ferritin in the inflamed joint.
Ferritin levels show a positive correlation with ESR, CRP, platelet count, and DAS score.
And a negative correlation with hematocrit levels.

Is there a difference of levels in inactive and active disease?
Yes, the levels are lower in inactive RA patients because of iron deficiency.
Synovial ferritin production in active RA leads to increase of ferritin in active disease.

Gold standards for diagnosis of iron deficiency in RA?
1. Bone marrow iron stain
2. Serum transferrin receptor analysis

What leads to high ferritin levels in SLE?
Ferritin synthesis is induced by interleukins IL-1, IL-6 and Tumor Necrosis Factor (TNF) alpha in hepatocytes.  In SLE, there is defect in IL-1 production while IL-6 and TNF-alpha levels are increased. So, the high levels of ferritin are due to IL-6 and TNF-alpha. (IL-1 does not play a major role in the synthesis of ferritin)
The ferritin levels are correlated with ANA titre, anti-dsDNA titre, and SLEDAI score.
(No significant correlation with acute phase parameters and negative correlation with complement levels)

Zika virus infection and the Alzheimers'

Hello everyone!


The mosquito-borne zika virus has spread to most of the parts of Latin America, Pacific islands and the US. It has been recently linked to Alzheimers' disease and depression!

Sjogren's syndrome mnemonic

Here's a short post about Sjogrens syndrome.

Hodgkins lymphoma and minimal change disease mnemonic

Which nephrotic syndrome is associated with Hodgkins lymphoma?

Lymphoma usually causes membranous nephropathy.

But Hodgkins is a weirdo which minimal change disease.

Mnemonic: Kids get MCD usually, so "Hodgkid"

Mnemonic by DJ AweSpear sent to us in our study group. Thanks!

Membranous glomerulonephritis mnemonic

Most common cause of nephrotic syndrome in adults.

Associated with clots - DVT, renal vein thrombosis and PE are common.

Nephrotic syndrome associated with malignancy.

It's membranous glomerulonephritis! :D

Study group discussion: Fall of fever by crisis and fall of fever by lysis

Difference between fall of fever by crisis and fall of fever by lysis ?

In fall of fever by crisis, there's sudden decrease in temperature (Mostly due to treatment).

In fall of fever by lysis, reduction in temperature occurs gradually.

Typhoid fever falls by lysis.
(Step ladder pattern!)

Dengue fever falls by crisis.

Systemic sclerosis autoantibodies mnemonic

Today, I forgot which antibodies scleroderma is associated with T_T

Apparently, Qbanks don't write Scl-70 in their options. They like writing "Autoantibodies against topoisomearase I" and make my life difficult.

Anyway, here's my attempt to remember this next time. I don't know if it'll work. But hey, no harm trying?

Mauskopf facies

Hello!
Here's a fact I read today.

"Mauskopf" means "Mouse head" in German.

IkaN be a Khaleesi

Hello!
This post is from the authors diary.

Game of thrones fan, continue reading.

Someone sent me this which is pretty hilarious. I sent it to two of my friends, one added more to it and the other suggested I put it on the blog xD

Different types of skin lesions (as in rashes)

                          Hey guys, we started Internal Medicine Last week, so we were studying about different types of skin lesion as in rashes in Harrison’ Internal Medicine 19e. So I made little chart myself to memorize it. So I thought to share it with you all.

Polymyalgia rheumatica and giant cell arteritis mnemonic

Here's a mini post for the day!

What are the symptoms of Polymyalgia rheumatica? What is it associated with?

#AnswerTime: A patient with delusion

Here's the answer to a question we posted earlier: http://www.medicowesome.com/2016/08/quiztime-patient-with-delusion.html

Answer:

#QuizTime: A patient with delusion

#QuizTime
A 32 year old male patient came to the Psychiatry  OPD complaining  that his wife wanted to kill him. He was asked why he didn't report to the police , to which he said they were not ready to believe him.
He was suspected of having a delusion of persecution.

De Quervain syndrome notes

Intro:
Here's a short post on De Quervain syndrome :D

Correction of hyponatremia and hypernatremia mnemonic

Hello!

Never correct sodium too quickly.

If you correct hypernatremia too fast, it'll result in cerebral edema. Why?
When hypernatremia is corrected too rapidly, cerebral edema results because the relatively more hypertonic ICF accumulates water.

If you correct hyponatremia too fast, it'll result in central pontine myelinolysis (CPM) aka osmotic demyelination syndrome. Why?

Chronic hyponatremia is associated with the loss of osmotically active organic osmolytes (such as myoinositol, glutamate, and glutamine) from astrocytes, which provide protection against brain cell swelling.
However, organic osmolytes cannot be as quickly replaced when the brain volume begins to shrink in response to correction of the hyponatremia. As a result, brain volume can fall from a value that is initially somewhat above normal to one below normal with rapid correction of hyponatremia.
The mechanism by which a rapid fall in brain volume results in demyelination has not been established.

How do I remember this?

Central pontine myelinolysis* mnemonic

Here's another mnemonic:
From low to high, your pons will die (CPM)
From high to low, your brain will blow (Cerebral edema, herniation)

That's all!

-IkaN