External cephalic version mnemonic

When should ECV be performed?

Light's criteria for exudative pleural effusion

Here's a mnemonic on Light's criteria for exudative pleural effusion.

Mnemonico diagnostico : Direct laryngoscopy in Laryngomalacia

Hey awesomites

Laryngomalacia is the most common congenital anomaly of the larynx characterised by excessive flaccidity of supraglottic larynx which results in inspiratory stridor and cyanosis.

Mnemonic for Direct laryngoscopy findings : FlOP

Fl - Floppy aryepiglottic folds
O - Omega- shaped epiglottis
P - Prominent arytenoids

- The short bands ( aryepiglottic folds ) cause the epiglottis to curl upon itself.
- Epiglottis is elongated and folded longitudinally to form an omega.
- Arytenoids are situated posteriorly and show prominence.

Also check out the mnemonic for differentiating laryngomalacia from tracheomalacia Here .


Thats all
- Jaskunwar Singh

Painful and painless genital ulcers mnemonic

Hey!

Today's post is about sexually transmitted pathogens that cause (painful and painless) genital ulcers.

Causes of painful genital ulcers:

Haemophilus ducreyi (the causative agent of chancroid)
Herpes simplex virus types I and II (HSV-1 and HSV-2)

Causes of painless genital ulcers:

Treponema pallidum (the causative agent of syphilis)
Klebsiella granulomatis (the causative agent of granuloma inguinale; also known as "Donovanosis")

Chlamydia trachomatis serovars L1-3 (the causative agents of lymphogranuloma venereum; LGV)

And now, mnemonics for everybody! Wohhooo!

Fact of the day : Blood pressure should be measured in both arms

Hello

Measuring the blood pressure offers an important glimpse into the patient's health. In general practice, the readings are taken from left arm in right - handed patients and vice - versa.

But some healthy people can have slightly different numbers between arms - a huge difference signals a blockade or an abnormality !! The difference in systolic pressure between arms should not be greater than 5 points. ( Not one, but at least three recordings must be taken at three minute intervals and the one with lowest numbers is taken as the final reading. )

If the recordings in one arm are higher than the other, then that arm should be used for future measurements.

In young, it could sign a narrowing of the main artery ( coarctation of aorta ) or other congenital heart defects. In the elderly, it could be a sign of underlying atherosclerotic condition, or may be aortic dissection !! Note that in a woman with breast cancer who has had mastectomy and lymph nodes resection, the measurements are not to be taken in the arm on the side of mastectomy.

When to take the readings in both arms?
Well, not everytime obviously. But every once in a while should be okay.. may be once the patient is in his teens and then in his 40s or 50s.
( Source )

Thats all
- Jaskunwar Singh

Pathophysiology of hepatojugular reflux

Hello. Let's talk about the HJR today!

What is the hepatojugular reflux?

Distention of the neck veins when pressure is applied over the liver.

Fact of the day: Paradoxical agitation with benzodiazepines

Benzodiazepines frequently are administered to patients to induce sedation.

Paradoxical reactions to benzodiazepines, characterized by increased talkativeness, emotional release, excitement, and excessive movement, are relatively uncommon and occur in less than 1% of patients.

The exact mechanism of paradoxical reactions remains unclear. 

It is important to be aware of this side effect because increasing the dose of benzodiazepine would worsen the condition.

Acalculous cholecystitis notes

Hello!

Let's learn about Acalculous cholecystitis today. These are my step 2 CK notes, made from UpToDate.

What is acalculous cholecystitis?

Acalculous cholecystitis is an acute necroinflammatory disease of the gallbladder with a multifactorial pathogenesis. It is typically seen in patients who are hospitalized and critically ill.

Clinical features:
In critically ill patients, the appearance of unexplained fever, leukocytosis, or vague abdominal discomfort may be the only sign of acalculous cholecystitis. Patients may also have jaundice or a right upper quadrant mass. Laboratory test abnormalities may include a leukocytosis or abnormal liver tests, but they are nonspecific.

Diagnosis: USG.

Why?
Advantages of ultrasonography are that it is noninvasive, can be done at the bedside, and has good sensitivity and specificity for diagnosing acalculous cholecystitis. In addition, ultrasonography may reveal alternative diagnoses (such as calculous cholecystitis). Thickening of the gallbladder wall is the most reliable feature seen in patients with acalculous cholecystitis.

Ultrasonographic features:
●Absence of gallstones or sludge
●Thickening of the gallbladder wall (>3 mm)
●Pericholecystic fluid
●Striated gallbladder
●A positive Murphy's sign induced by the ultrasound probe (may be absent in patients who are obtunded or sedated)
●Mucosal sloughing
●Gallbladder distension (>5 cm).

Treatment:
In patients with acalculous cholecystitis, we recommend the initiation of broad spectrum antibiotics as soon as blood cultures have been drawn.

Infection with enteric pathogens, including E. coli, E. faecalis, Klebsiella, Pseudomonas, Proteus species, and Bacteroides is common.

Preferred surgery: Cholecystostomy rather than cholecystectomy.

Why?

Cholecystostomy is effective and is less invasive than cholecystectomy. (especially in critically ill patients.)

However, cholecystectomy should be performed if there are findings suggesting gallbladder necrosis, emphysematous cholecystitis, or perforation. Cholecystectomy is also a reasonable alternative in patients who are good surgical candidates.

That's all!
-IkaN

Medulla (Fun Mnemonic Diagrams)

Hello Everyone,
Today lets discuss sections of medulla. I remember them as three sisters!

Breast feeding and maternal cancer

Breast feeding decreases the risk of all of the following cancers in the mother EXCEPT:

Breast cancer
Ovarian cancer
Endometrial cancer

Fact of the day : Worrywarts have high verbal intelligence

Hey intelligent people
Here is another fact of the day post for you all ;p

Recent innumerous studies and research by scientists have confirmed the link between the 'worry mode' and high verbal IQ. People who are worrywarts may be better at addressing, analyzing and solving problems in situations by using language - based reasoning.

Obsessive worrying, rumination, and overthinking about situations and events is associated with more sharpening of your critical thinking skills and mental preparation for future scenarios.


Thats all
- Jaskunwar Singh

Fact of the day : Biopsy for atypical hyperplasia and risk of breast cancer

Hello

Women who have had breast biopsies in the recent past, that showed atypical hyperplasia, are at increased risk of breast cancer in the future. This is because of the changes in the breast that prompted the biopsies and not the biopsy itself, according to the Gail model of breast cancer risk assessment.

Moreover, high breast density (due to high fat diet and obesity) - individualised and as a modifiable risk factor itself, in combination with proliferative benign breast disease, increase the risk of cancer, but is relatively uncommon.

Source: http://jnci.oxfordjournals.org/content/105/14/1043.full.pdf

Thats all
- Jaskunwar Singh

Fact of the day: Lymphocytosis in pertussis

Why does pertussis cause lymphocytosis even though it is a bacteria?

Pertussis toxin (PT), from Bordetella pertussis, causes lymphocytosis.

Lymphocytosis is because of impaired entry of lymphocytes into lymph nodes. 

Slipped Capital Femoral Epiphysis mnemonic

Hello!

Slipped Capital Femoral Epiphysis mnemonic:

Step 2 CK: Treatment of DVT notes

Here are my notes for Step 2 CK exam!

DVT treatment: Anticoagulation.

Duration: Minimum 3 months.

DVT with high risk of bleeding: IVC filter.

DVT in pregnancy, malignancy: LMW heparin.

Massive DVT: Thrombolysis / clot removal with anticoagulation.

DVT due to HIT: Stop heparin containing products. Start non heparin anticoagulation.

When should you hospitalize: Patients with massive DVT (eg, iliofemoral DVT, phlegmasia cerulea dolens), concurrent pulmonary embolism, a high risk of bleeding on anticoagulant therapy, comorbid conditions, or other factors that warrant in-hospital care. 

Notes from UpToDate:

Anticoagulation is the mainstay of therapy for patients with acute lower extremity deep vein thrombosis (DVT).

In patients with asymptomatic proximal DVT, we suggest anticoagulation identical to that for patients with symptomatic DVT.

Options include subcutaneous low molecular weight (LMW) heparin, subcutaneous fondaparinux, the oral factor Xa inhibitors rivaroxaban or apixaban, or unfractionated heparin (UFH).

Although there is agreement on the minimum length of time a patient with a first episode of DVT should be treated (ie, three months), the optimal length of time is not known.

Outpatient anticoagulation rather than inpatient therapy can be considered when patients are hemodynamically stable, have a low risk of bleeding, do not have renal insufficiency, and have a practical system in place at home for the administration and surveillance of anticoagulant therapy. It is not appropriate in patients with massive DVT (eg, iliofemoral DVT, phlegmasia cerulea dolens), concurrent pulmonary embolism, a high risk of bleeding on anticoagulant therapy, comorbid conditions, or other factors that warrant in-hospital care. 

For patients in whom anticoagulation is contraindicated or in whom the risk of bleeding is estimated to outweigh the risk of recurrent thromboembolism, we suggest the insertion of an IVC filter rather than no therapy.

For patients with active malignancy and pregnant women, we suggest that LMW heparin be selected as the initial and long-term anticoagulant of choice rather than other agents.

For patients with massive iliofemoral DVT or phlegmasia cerulea dolens with symptoms for <14 days and good functional status, we suggest systemic or catheter-directed thrombolytic therapy, and/or clot removal (eg, catheter extraction, catheter fragmentation, surgical thrombectomy) rather than anticoagulation alone.

For patients with a DVT and a diagnosis of heparin-induced thrombocytopenia (HIT), all forms of heparin should be discontinued and immediate anticoagulation with a non-heparin anticoagulant started.

Extra: For select patients with isolated distal DVT (eg, those at high risk of bleeding, negative D-dimer level, asymptomatic or minor symptoms, without risk factors for extension, and/or minor thrombosis of the muscular veins), we suggest surveillance with serial ultrasound over a two-week period rather than anticoagulation. Those who exhibit signs of thrombus extension should be anticoagulated. 

That's all!
-IkaN

Trypanosma mnemonic

This one will help you in having a fair idea about the linking of Trypanosoma species with the diseases caused and the vectors associated.

1. T. cruzi- American Chaga's disease.

Americans have big fat freeways on which they love to cruise in their cars. Also,if you are into automobiles, you can remember the car 'Cruze'
from Chevrolet, the American carmaker.

The vector is reduviid(kissing) bug. Do I need to say more?!

2. T.brucei-  This one is full of the phonetic 'sa' in it- T. brucei causes sleeping sickness with the vector being the tsetse fly!

That's all!

-Sushrut Dongargaonkar

Congenital adrenal hyperplasia mnemonic

Hey, do you know a way to remember the Congenital Adrenal Hyperplasia and it's enzyme deficiencies?

It's the same mnemonic that everyone uses:

The 1 looks like an up arrow for increase

First digit for blood pressure
Second digit for sex hormones

11 hydroxylase deficiency:

1 - BP - High (Hypertension) 

1 - Sex steroids - High (Virilization in females) 

21 hydroxylase deficiency:

2 - BP - Low (Hypotension)

1 - Sex steroids - High (Virilization in females)

17 hydroxylase deficiency:

1 - BP - High (Hypertension) 

7 - Sex steroids - No increase

There was a point in my life where I forgot which digit stood for what. I have a mnemonic for that as well... It's a vulgar mnemonic.

I think of erection, first the blood goes into the corpora cavernosa and then the penis is erect. I remember the sequence of digits by - "First comes the blood, then comes the boner."
First digit - BP
Second digit - sex steroids

An easier alternative submitted by Dev:
Just remember AT
A - Aldosterone

T - Testosterone

I modified it to cat.

Meow. 

-IkaN 

The basics: Lesions of Spinal Cord

Here is a basics video on Spinal cord with mnemonics for first year med students by Chaitanya Inge. Enjoy :)

Felix and Dreyer's tube mnemonic

The tubes used for serological diagnosis of typhoid are frequently asked and it takes many bungling to get the answer right. Here's a mnemonic which may come handy-

1. Felix tube- Short round bottomed which detects the 'O' antigen.
Remember the round bottom and round shape of the letter 'O'.

2. Dreyer's tube- Narrow, conical bottomed one which detects the 'H' antigen
Deserts are 'dry' and pyramids, which resemble cones are in the deserts of Egypt. Hence, conical bottomed Dreyer's tube. The letter 'H' is not round, so, it is this antigen which this tube detects.

Revise this mnemonic more than once so you get it clearly what's what.

-Sushrut Dongargaonkar

Episiotomy indications : Mnemonic

Hi everyone.
Posted in Ob-Gyn now. Let's just say it's not a lot of fun looking at diseased hoo-hoo's.
Just kidding.

Here's a Mnemonic for the absolute indications of Episiotomy.

Remember : PPPP

1. Perineum is rigid
2. Perineum has been operated on. (For Prolapse, stress urinary incontinence , etc)
3. Procedures are to be used. (Like Ventouse or Forceps)
4. Position / Presentation are abnormal. (Like Breech , face to pubis, shoulder dystocia , macrosomia)

The other indications which are non-absolute include :
- Maternal exhaustion
- Preterm/ post mature baby
- Trial of labour.

So I hope this didn't tear you up. (Pun intended).
Happy studying !
Stay awesome.
~ A.P.Burkholderia

Fact of the day: Shoulder dislocation

An anterior shoulder dislocation is usually caused by a blow to the abducted, externally rotated, and extended arm (eg, blocking a basketball shot).

Violent muscle contractions following a seizure or electrocution represent the most common causes of posterior shoulder dislocation.

Acute Kidney Injury due to Anticancer drugs

Hey guys, there are multiple causes of acute kidney injury in a cancer patient, namely sepsis, metastasis, tumor lysis syndrome, etc. But there is another reason which we often overlook, which is drug-induced.

1. Thrombotic microangiopathy: Associated with agents targeting vascular endothelial growth factor(VEGF), eg., Ranibizumab, Bevacizumab. These drugs also block the angiogenesis in the glomerular vasculature, such that the injured endothelium isn't replaced, leading to multiple foci of platelet aggregations just like in TTP and HUS.

2. Focal segmental glomerulosclerosis: Associated with tyrosine kinase inhibitors are the most common and are frequently associated with acute kidney injury.

3. Acute Interstitial Nephritis:
The checkpoint inhibitors ipilimumab, nivolumab, and pembrolizumab activate host T cells to enhance tumor killing by preventing tumor ligand binding to cytotoxic T-lymphocyte antigen 4 and programmed death 1 receptors, which deactivate T cells. However, this effect causes loss of self-tolerance (and perhaps tolerance to other drugs), leading to various forms of autoimmune injury, including acute interstitial nephritis, which is associated with moderate-to-advanced-stage acute kidney injury.

That's all!

-VM

Submissions: Syndromes associated with pheochromocytoma

Submitted by Vivek on the study group =)

Gross motor milestones mnemonic

Hello!

In this video, I talk about gross motor milestones from the age one to five years of age.

Source: Nelsons textbook of pediatrics.

Mumps complications mnemonic

Here's a short post on complications of Mumps!

Here's Jaskunwar Singh's mnemonic on comps of mumps. It's more extensive, mine just covers the important stuff. 

M - Meningitis

U - Urogenital infection (Orchitis, Oophoritis)

M - Male infertility

P - Pancreatitis

S - Salivary glands affected 

Also more M's:

M - Miscarriage in pregnant women (12 - 16 weeks)

M - Myocarditis

That's all!
-IkaN 

Maternal factors for IUGR mnemonic

Hello

The maternal factors that increase the risk of Intrauterine Growth Restriction ( IUGR ) in unborn babies ( small - for - dates ) include : MATERNAL RISK

M - Malnutrition / Multiparity
A - Anaemia ( severe )
T - Toxaemias of pregnancy
E - Excess physical activity
R - Raised blood pressure
N - Narrow birth spacing
A - Alcohol intake ( excess ) / Age ( young )
L - Low socio - economic scale

R - Recreational drug use
I - Infections
S - Smoking / Short stature
K


Thats all
- Jaskunwar Singh

Kangaroo mother care mnemonic

Hello

Components of Kangaroo mother care mnemonic : Baby Kangaroo HOPS in its mother's pouch ;p

H - Healthy diet provision ( breast - feeding )
O - Outpatient care ( due to early discharge )
P - Positioning of baby close to mother's chest
S - Support to mother and family


Thats all
- Jaskunwar Singh

Uric acid and struvite stones mnemonic

Well, urine is largely water which *can* be considered as transparent. That's why, uric acid stones don't show up on X-rays.

Struvite or triple phosphate stones have Proteus has the causative factor. Remember p for p

That's all!

-Sushrut Dongargaonkar

Drugs causing gingival hyperplasia mnemonic

Hello!

It's important to know drugs causing hypertrophy of the gums for exam purposes.

Auditory Transduction simplified

Basics of auditory transduction simplified by Chaitanya Inge in his first awesome video! Check it out! :D

Pigment producing mycobacteria mnemonic

There are these two mycobacteria which produce pigments- M. gordonae and M. szulgai in the dark. How to remember them?

1. A garden contains flowers which
are colourful. So you can remember M. gordonae that way.

2. Szulgai matches 'Nilgai' which is an Indian local word for the Indian
bluebuck/Indian blue bull. So the  involvement of a color in the name can be correlated with pigment production.

That's all!

-Sushrut Dongargaonkar
   

Addisons disease mnemonic

Hey!
Do you have a mnemonic for adrenal insufficiency?

Cryptococcus neoformans notes and mnemonics

Hello!

This post is on cryptococcus neoformans.

Easy way to memorise Organ of Corti

Hello Everyone!

               Here is a easy way to memorise the Organ of Corti structure.

We've also upload a video explaining the same. Check it out =) 

Thank you,

Chaitanya Inge

Beta blocker intoxication

Hello!
This is a short blog on beta blocker
intoxication.

Beta blockers acting on beta receptors have wide range of actions and uses.

Most common complication of beta blocker overuse is Cardiovascular depression like hypotension and bradycardia, impaired atrioventricular functions.
Can we give adrenergic drugs to reverse this action?
No, we can't .
Prolong use of beta blockers leads to upregulation of the beta receptors. Beta Agonists will further aggravate the adrenergic actions.
Which may cause tachycardia even arrhythmias.
Even Atropine is inconsistent in reversing the side effects

So the alternative used is Glucagon -
It stimulates cAMP synthesis independently of beta adrenergic receptors.
It has positive ionotropic and chronotropic action, thus it reverses the cardiovascular depression without causing tachycardia or other adrenergic effects.

It can also be used in calcium channels blocker overuse.
Glucagon therapy still dont have enough evidence to prove its efficiency.

Hence Judicious use of drugs is must.
Stay awesome!

~Khush

Effects of cholinergics and anticholinergics on the bladder mnemonic

In this video I talk about:

Cholinergics, bethanechol, diabetes mellitus, denervation and overflow incontinence.

Anticholinergics, oxybutynin, urge incontinence.

And mnemonics. Enjoy!

Risperidone mechanism of action mnemonic

Hello! This post is about the atypical antipsychotic - Risperidone!

Risperidone is a second-generation antipsychotic that has affinity for D2, 5-HT2A, alpha 1, alpha 2 and H1 receptors.

The mechanism of action of risperidone is not fully understood, current theories focus mainly on its ability to block D2 and 5-HT2A receptors.

Hard time remembering this? I've got a solution!

IPC 176 177 178 179 mnemonic

Shilika strikes back with a video! :D

Initiation factors in eukaryotic translation mnemonic

Hello Everyone,

Lets discuss Initiation factors today. Here's the the mnemonic:

1. elF-1: 1 looks like i . So it causes Dissociation of 80 S

2. eLF-2: Two- Formation of Ternary complex. Also GTP needed

3. eLF-3: 3 looks like B. hence it causes Breakdown(dissociation of 80 S)

4. elF-4:   

cap binding protein complex elF-4F=  elF-4E + elF-4G+ elF-4A . Binds to 5’End of mRNA through elF-4E  

elF-4A and elF-4B: A has helicAse activity.Makes use of ATP 

                                B makes things Better. :)

                                Both help  reduce complex secondary structure of 5’end of m-RNA.                                                                                                           (A+B=reduce Complexity)

5. eLF-5: 5 looks like S. So it causes: 

      1. releaSe of initiation factors

      2. aSSociation of 40S and 80S Subunits

Here are some diagrams that will help you:

That’s all,

Thank you,
Chaitanya Inge

Rubeola vs Rubella mnemonic

Hello!

RubeOla - Ordinary measles ( kOplik spots on buccal mucosa are pathognomic )

RuBella ( German measles ) - Well, I remember Bella B. Felsenheimer, a German musician and drummer ( Foschheimer spots on the soft palate are characteristic ).


Thats all
- Jaskunwar Singh

Torres bodies mnemonic

Okay, to be honest this one is not quite a very good mnemonic but I like to remember Torres bodies in yellow fever by the footballer Fernando Torres wearing his club jersey in yellow color, even if he doesn't. Well, yeah, that's about it! :-p

-Sushrut Dongargaonkar

Diagnostic Enzymes in Myocardial Infarction

   

Hello Everyone,

Here’s a quick mnemonic on Sequence of elevated enzymes in myocardial infarction. I got it from https://imgusmlestep1.blogspot.in. Originally it was  like this Time to CALL 911. I have modified it. It goes like this

                             Time to CALL 12 24 30 48.

The numbers represent time of peak elevation of the enzymes.

Sequence of elevated enzymes are:

        Troponin: Cardiac Troponin I and Cardiac Troponin C (12 hours)

        Creatine Phosphokinase (MB) (24 hrs)

        Aspartate Transaminase (30 hrs)

        Lactate Dehydrogenase 1 (48 hrs) 

Important Facts:

Cardiac troponin I (cTnI) is highly sensitive and specific for damage to cardiac tissue. cTnI appears in plasma within 4–6 hours after an MI, peaks in 8–28 hours, and remains elevated for 3–10 days.Elevated cTns, in combination with the clinical presentation and characteristic changes in the electrocardiogram, are currently considered the “gold standard” in the diagnosis of a MI.

Creatine Phosphokinase (MB):Appearance of this hybrid isoenzyme in plasma is virtually specific for infarction of the myocardium .Following an acute MI, CK2 appears approximately 4–8 hours following onset of chest pain, reaches a peak of activity at approximately 24 hours, and returns to baseline after 48–72 hours.

A quick comparison between Cardiac troponin and Creatine Phosphokinase:

Troponin is more sensitive than CK-MB because more troponin is found in the heart per gram of myocardium and that a greater percentage depleted from the heart by cardiac injury arrives in the blood 

With regard to specificity, troponin elevations are almost always specific for cardiac injury, except for the infrequent analytical false positives caused by fibrin interference and/or cross-reacting antibodies. CK-MB is not specific for cardiac injury, as a small amount is found in skeletal muscle.

I am very thankful to IkaN for helping me with Troponin and CK-MB.  :)

Thats all,

Thank you

Chaitanya Inge  

Drugs that prolong QT interval mnemonic

Hello!

Here are drugs that can prolong QT interval and cause Torsades de Pointes! The mnemonic is TOOOOORSADES!

Cerebral ring enhancing lesions Mnemonic

Cerebral Ring enhancing lesions are a common finding in MRI based questions asked in the boards. ;)

The mnemonic to help you remember it is: Suppose there is a Dr Grams who is missing his wedding ring and is searching for it fervently. So if you're doing an MRI and you see a ring what should you do?

CAL DR GRAMS

C- Contusion
A- Abscess
L- Lymphoma

D- Demyelinating disease
R- Radiation necrosis

G- Glioblastoma
R- Resolving Haematoma
A- Abscess
M- Metastatic lesion
S- Subacute infarct

Here's a mnemonic submitted by Jaskunwar Singh. It includes Tuberculosis and toxoplasmosis!

CAL DR SMART

C - Contusions
A - Abscess
L - Lymphoma

D - Demyelinating diseases
R - Radiation necrosis

S - Subacute infarct
M - Malignancy / Metastatic lesions
A - AIDS
R - Resolving haematoma
T - Toxoplasmosis / TB

I assume that everybody knows about toxoplasmosis and tuberculosis so I didn't include them in my mnemonic. Use the mnemonic that suits you =)

That's all :)

-VM

Study group discussion: A mnemonic for yawning? (pandiculation)

Hello!

Pandiculation definition: A stretching and stiffening of the trunk and extremities, as when fatigued and drowsy or on waking, often accompanied by yawning. 

Here's a study group discussion xD

Medicowesome secret project: Segregation of waste and recycling

What is the Earth day secret project about?

Vitamin B3 and pellagra mnemonics

Hello!

This post is all about niacin aka vitamin B3 and it's deficiency with loads of mnemonics. Who is excited?

1. How to remember Niacin is vitamin B3:

- You can remember the three vowels in nIAcIn, so it's vitamin B three.
- N has 3 strokes, so Niacin is B3
- NIA - B3

2. Vitamin B3 deficiency, Pellagra, is clinically manifested by photosensitive dermatitis, diarrhea, dementia.

Pellagra mnemonic:
"B3 causes D3"
Diarrhea, Dermatitis, Dementia.

3. Pellagra tends to occur in areas where people eat maize (or corn, the only grain low in digestible niacin) as a staple food.

Mnemonic: Corny people can't be nice. (Corn can't have niacin)

People - Pellagra. PP!

Corny people can't be nice and amazing! Get it? A-maize-ing! Hahahahha! I'm so pun-ny and funny!

4. The amino acid tryptophan is needed to make niacin, serotonin and melatonin.
Mnemonic: Have a nice trip to serotonin land (Serotonin rhymes with Melatonin).

Why is this fact clinically significant?
Carcinoid syndrome leads to excess production of serotonin, which depletes  tryptophan. There's not enough tryptophan to produce niacin, resulting in pellagra.

5. Isoniazid (INH) use can cause vitamin B3.

Mnemonic: INH has 3 letters. B3 deficiency!
Also, isoNIAzid. For NIAcin deficiency.

6. Lastly, you should know about Hartnups disease which is due to defective neutral amino acid transporter on renal and intestinal epithelial cells 

Here's a mnemonic by usmle1mikmonics:
HARTNUP Disease
Hartnup
Aminoaciduria
Renal (also intestinal) / Recessive
Transporter defect / Tryptophan deficiency
Neutral amino acids / Niacin deficiency / Nicotinamide supplements (Treatment)
Urine (Tryptophan lost in urine)
Pellagra / high Protein diet (Treatment)
D’s - Dermatitis, Dementia, Diarrhea

That's all!
-IkaN

Anterior Abdominal Wall : Mnemonics

Hi everyone. So I've just started Surgery and it makes me go back to Anatomy. A lot.
Here are some helpful Mnemonics on the Anterior abdominal wall

The External Oblique muscle is the SIR of  all muscles.
It's the SIR of all muscles.
Hence , This SIR forms the Superficial Inguinal Ring.
Because it's the SIR , it forms the Sir of all ligaments too - the Inguinal Ligament.

The Fascia Transversalis is a scary thing. Whenever I see it , I get DAR. ( Dar is the Hindi word for Fear)
So I get DIR when I look at it. :P
And hence the Deep Inguinal Ring is in the Fascia Transversalis.
Since this is such a scary muscle , the important artery Inferior Epigastric Pierces this muscle. Making it more DIR-avna.

Finally,
How should one remember the direction of the External and Internal oblique muscles ?
Hands in your pocket is External Oblique.
So medially and downwards.

Hands on the Tits is Internal Oblique.
So medially and upwards.

Hope these help you !
Happy Studying !
Stay aweosme.

~ A.P.Burkholderia

How is Visual Contrast achieved?

Hello everyone,
Let us discuss Visual contrast today. This question has haunted me for a long time.

Let's start with the basics, the cells in various layers of retina and their function.

Here's a quick review of things you have already read:

1. What is photoreceptor?
It is a rod or cone. It detects light.

2. What is horizontal cell?
It is present between rods and cones. It is inhibitory in function. (It is involved in lateral inhibition which we will discuss later!)

3. What is bipolar cell?
It transmits information from photoreceptor to ganglion cells.



Now, lets come to the details.

4. What are metabotropic receptors?

First of all what you must understand is Metabotropic receptors and Inotropic receptors are receptors present on bipolar cells.

They recieve stimulas from photoreceptors (mostly decreased glutamate is the stimulas).

Metabotropic receptors cause depolarisation that is excitation of centre of receptive field of bipolar cells

5.What are inotropic receptors?
They cause inhibition of centre of receptive field i.e. hyperpolarization. (remember, I for Inhibition)

6. Receptive field - What is it?
It is a region of retina where if the light falls it is going to alter the firing of neurons. (By firing I don’t mean guns :P) It means the action potentials generated and transmitted by the photoreceptors. So each cell has a characteristic receptive field. It can be as small as a dot or as large as this page itself. But don't limit this concept to a photoreceptor only. Almost all sensory cells example in somatosensory system or in auditory system possess a receptive field.

Receptive field of a bipolar cell is arranged into a central disk,
the “center” and a concentric ring, the “surround”, each region responding oppositely to light.

Coming to the crux of the topic i.e. Visual Contrast.

How do the things we have discussed so far help us achieve that?

Visual Contrast is achieved by two mechanisms:
1. Lateral Inhibition
2. Excitation of Some Bipolar Cells and Inhibition of Others — The Depolarizing and Hyperpolarizing Bipolar Cells.

1. How does lateral inhibition help?
First: It does not allow the signal to spread through the dendritic and axonic trees. Hence point to point transmission occurs.
Second: The direct and indirect pathways accentuate each other. This can be easily understood. Photoreceptor sends excitatory signals to bipolar cell. But the adjacent photoreceptor sends a inhibitory signal through the horizontal cell. Mostly these two neutralize each other so no net stimulus is transmitted to bipolar cell.
      But If the adjacent cell is  unstimulated by light, It will not inhibit the excitatory signals transmitted by the photoreceptor which is stimulated by light. Hence it will allow excitation of bipolar cell.
This allows extra excitation of bipolar cell. We get a better contrast. The area which is dark remains dark. But the area which is bright becomes even brighter. This is what visual contrast is all about.
The fun part of all this is, a lot of visual illusion make use of this principle. Do google "Simultaneous Contrast"  :) .

2. How do different Bipolar cells help?
Because depolarizing and hyperpolarizing bipolar cells lie immediately against each other, this provides a mechanism for separating contrast borders in the visual image, even when the border lies exactly between two adjacent photoreceptors.
We will take a simple example. Suppose light is striking at periphery of two receptive fields. Remember it is shaped like a disk, with a centre and periphery both opposite in nature.Suppose One is On centre bipolar cell and other is Off centre bipolar cell(On centre: Activated when light hits centre but periphery is inactivated and vice versa for Off centre). So only the Off centre bipolar cell will detect it. Hence mixing up of signals is avoided. Again what I get is a sharper border. That is what contrast is all about.

That is how it is all done.

Interesting fact: The cells in the retina don't follow the "all or none" law. Transmission is by Electrotonic conduction. From ganglionic cell onwards cells  follow all or none law.

Thats all,
Thank you,
Chaitanya Inge

Lewy body dementia mnemonic

Hey there.

Dementia with Lewy Bodies (DLB) is characterized clinically by deficits in attention and visuospatial function; fluctuating cognition; recurrent visual hallucinations; and spontaneous motor features of parkinsonism. Other associated symptoms include repeated falls, syncope, autonomic dysfunction, neuroleptic sensitivity, delusions, hallucinations in other modalities, sleep disorders, and depression.

Here are mnemonics and how I remember these points!

Lewy has halLEWYcinations.
Visual hallucinations are common.

Lewy is slowy.
Slow movements for Parkinson's disease .

Lewy is sleepy.
REM sleep abnormalities like drowsiness.

Lewy is slippy.
DLB is associated with frequent falls.

Lewy is slow-y, sleepy, slippy and sees things (halLEWYcinations)

lEwy also has an E for eosinophilic intracytoplasmic alpha synuclein aggregates.

That's all!
-IkaN