NYHA Classification for heart failure mnemonic and practicals tip

Greetings everyone!

I was reading about Congestive Heart Failure today and thought of sharing a practicals pearl with you guys.. NYHA class should always be mentioned when you are presenting a case of CHF.

Case presentation tip: While presenting your case, instead of just saying "Patient belongs to NYHA Class III" you could say, "Patient is categorized into NYHA Class III, which means the patient is comfortable at rest, but is limited on exertion."
This shows you know what you are talking about and the examiner won't stop and ask about all the classes :)
You should do the same when it comes to other diseases.

Your professor may ask - How did you come to know that the patient belongs to Class III?

Atrial fibrillation

I was reading Atrial fibrillation today and thought I'd write a small quick review blog on it.

A patient with atrial fibrillation will usually present with palpitations or fatigue.

On physical examination, irregularly irregular pulse is characteristic.

ECG is diagnostic.

Extra tip: Your patient may have his rhythm well controlled when you see him in the wards and you might not have the characteristic physical finding of an irregular pulse or have an ECG in hand. In that case and especially during vivas, do mention that you would like to rule out other causes of fatigue by ordering CBC, SE & LFT.
CBC: Complete blood count
SE: Serum electrolytes
LFT: Liver function tests

In an acute setting, you must provide symptom relief through rate control. Beta blockers, calcium channel blockers are preferred. Digoxin is considered if blood pressure is low.

Fun fact: Why isn't Digoxin an awesome drug for rate control in exercise and anxiety?
Because the increased rate in exercise and anxiety is primarily due to adrenergic stimulation and Digoxin works through Vagal stimulation.

You need to rule out reversible causes of atrial fibrillation like electrolyte imbalance, thyrotoxicosis, fever, alcohol and drugs. Always order TSH levels.
Extra tip: Also ask for a history of snoring since sleep apnea is a treatable cause of atrial fibrillation.

Rate control is usually done first since it mitigates symptoms. Rhythm control is preceded by measures to reduce stroke, which includes either 3 weeks of anticoagulation by dabigatran / warfarin or clot exclusion by TEE.

CHADS2 score is used to decide whether anticoagulation is required. It is based on risk stratification.

Dabigatran is preferred over warfarin because INR monitoring isn't required. However, it is expensive, contraindicated in renal failure and there is no reversal in major bleeding.

Electric cardioversion or chemical cardioversion may be done depending on patient symptoms.

Drugs used for chemical cardioversion are: Flecainide, Ibutelide, Procainamide, Amiodarone.

Curative catheter ablation may be tried in patients who have recurrent atrial fibrillation and in whom antiarrhythmic drug trial has failed.

Cool fact: Propafenone is "pill in pocket" drug used by patients when they feel onset of palpitations. It is used in conjunction with beta blockers to prevent fast dysrhythmias.

Here are a few mnemonics I got online:

Precipitants / causes of Atrial fibrillation: PIRATES
PE, Ischemia, Respiratory diseases like COPD, Atrial enlargement or myxoma, Thyroid, Ethanol, Sepsis or Sleep Apnea

Mnemonic for determining major risk of bleeding: HAS BLED
HTN, abnormal LFT / RFT, Stroke, Bleeding history, Liable INR, Elderly, Drugs that predispose to bleeding.
If score >3, higher risk of major bleeding.

That's all!

-IkaN

Related post: Antiarrhythmic drug classes mnemonic

Christmas tree rash

Greetings everyone!

Here's a mini fact: Christmas tree rash is seen in Pityriasis rosea.

That's all!
Merry Christmas everyone!
-IkaN

Related post: Christmas disease mnemonic

FIGO staging of carcinoma cervix

Hello!

I made this video like a year back but never got around posting it on the blog. So, here it is! :D

Study group discussion: Pathogenesis of pruritus in obstructive jaundice

What is the reason for pruritus and itching in obstructive jaundice?

Patients have differing sensitivities to elevated bile salt concentrations,
which act on peripheral pain afferent nerves to produce the sensation of itching. This stimulation involves
opiate-mediated pathways, and opiate antagonists can block cholestasis-associated itching.

Itching does not appear to be associated with histamine release, and antihistamine therapy is generally ineffective.

Ultraviolet B phototherapy has been successfully used to treat pruritus.

Thanks for explaining the mechanism to us, Benedict!

Breast Cancer TNM Staging mnemonic

Hello. This was requested by someone and I thought I'll post a few tips that help me remember the staging of breast cancer.

We're using the TNM classification in this post and I'll be talking about T & N only.

Let's get started!

Battle's sign mnemonic

Hello.

Battles sign is ecchymosis over the mastoid process and is mostly indicative of a fracture of the skull.

Mnemonic:
Battle Sign
Bruises Seen
Basilar Skull fracture

I love this mnemonic posted online too: BattlE - Behind Ear.

That's all!
You're a warrior.
-IkaN

The University of wisconsin solution

the university of wisconsin solution or UW solution is considered as the gold standard solution for transport of of liver in cold storage for transplant. it can also be used for the transport of kidney, pancreas and heart.

thanks.
sakkan

Biomedical waste: Waste Categories, treatment options and color coding mnemonic

PLEASE NOTE: This post was written in 2015, the categories have been updated since then :(
I have not deleted this post because some still find it helpful :)
We will edit it soon!

Greetings, people.

This waste disposal system is used in India. Since it's all complex and plain memorization, why not make a mnemonic? :D

For those who don't know the categories and stuff in detail, I'll copy paste them at the end of the post for reference. I'll be sharing the mnemonic first.

Let's begin! ^__^

How to remember Waste Categories:

1-3: HAM (Human, Animal, Microbiology)
4-7: Sharp medico, bloody solid (Sharps, Medicines, Blood stained or Soiled, Solid)
8-10: LAC (Liquid, Ash, Chemicals)

Facebook group

Here's another experiment, for study purposes, of course: https://www.facebook.com/groups/409305369268170

Pharmacology notes by Kiki

On excessive worrying about exams

(I received an email yesterday and based on that email, I am writing this post.)

This is the most important advice I would like to give medical students world wide. Or anyone for that matter - Don't take exams seriously.

Once exams start, you can not be stressing yourself.

It's a fragile period, you are testing yourself, there is competition and expectations that you have to meet. It's easy for anyone who isn't psychologically prepared or doesn't have the right mental attitude to break down.

I have heard of people become suicidal right before the exam or simply decide to quit.

Don't let stress kill you. It's just a piece of paper. The score is just a number. You have amazing, amazing things and adventures ahead of you, I promise. Just survive this. One day at a time.

Don't quit before trying. Just attempt and see what happens. Go ahead. Keep going, keep moving forward. You are more prepared than you think you are. It's just the stress fogging your thoughts.

I pretend it's video game. The test is just a level I need to cross by collecting points. I need to keep running like the dude in Temple Run and keep collecting coins. Going level after level just like in Candy Crush. I have given so many exams and crossed so many levels till date. Here's another one, no big deal. I don't need a high score to finish the game, I just need to play the game.

Practice reckless optimism. After reading one page, I do a flying kick and say I am gonna do so good in tomorrow's test. Laugh about how anxious you are and how the score won't even matter after 10 years. Sing a song. Eat chocolate. Be happy and keep studying. Fake it till you make it.

Organising notes and information while studying

"Hello IkaN!
I hope you're okay and happy :)
Can you teach me how to be organized? How can I save my notes?
I don't know why I'm so untidy. I want to be just like you, helping others & having good grades! <3
Please help me out here!"

- Email by an awesomite

Hello! I'm okay and at peace (:

Your organization depends on where you study from.

I study from books and ebooks so my study life seems very complicated to others.

I can read while I'm in the bus or in the train on my phone, so I always have ebooks or audio lectures with me. I can't write while traveling so everything I learn is saved on my phone. When I study with my books at home, I like having the traditional pen & paper to write, doddle and draw. Or a white board.

Here's how I save the information I have studied:

1. Make subject wise notebooks and write notes in it:
This is effective when you're studying from multiple text books and you need to merge all information into one for fast review during exams. I recommend making notes after you've read from all the textbooks if you're using this technique. You don't need to be tidy!
PS: This is time consuming.

2. If you're using ebooks, highlight and bookmark:
I read Harrison (Which is a HUGE internal medicine book) this way. The bookmarks would show me the topics I've read and while revising, I'd go through the highlighted lines only.
(App I use: Adobe Reader)

3. Type your notes and make sure they're synchronised:
If I have too much information on the digital platform and too little time to write on paper, copy paste on a notes app. Make sure you sync and back em up.
(Apps I use: Google Keep, ColorNote)

4. Blog:
The internet a wonderful place to save everything! (Many a times, I look for my own notes on Google =P)
If you don't have time for a fancy blog, just a simple tumblr with your study material is a good way to keep things in one place.
(Apps I use: Blogger, Tumblr)

Extra tips:
- Make a separate book for points you write during lectures. They're not always important but you will want you refer that book for the one thing your teacher said that you can't recollect while studying.
- If you think it's important, always write / save it somewhere. In my experience, you regret the things you didn't save =P
- Don't always focus on making the notes. Understand the information first, then organize it so that you revise and remember it.

The fact that you find me someone you wish to be like makes me happy. I hope I live up to the image you have of me =)

Until next time!