Sunday, January 3, 2016

Preparing for MCQ exams in Medical School

Well, hi again! Jay here. Today I’m gonna discuss about how to prepare for MCQ points in your exams.
If your college is like mine, where MCQ is the main format of asking questions in Med school, my friend, you are not alone in feeling helpless or lost in sometimes. For some of us, explaining stuff makes more sense but the truth is in MCQs you really cannot explain. You have to be on point.
So without further time wasting, here I am with my points which works for me. But I really understand it could be different from person to person. If you have some more points, why not comment down below? ;)

What causes thrombocytopenia in malaria?

Hello everyone!

I see a lot of patients in the casualty with fever, chills & thrombocytopenia but to my surprise, they've been diagnosed with malaria (Instead of dengue). I was wondering what the mechanism is.

The speculated mechanisms leading to thrombocytopenia are: coagulation disturbances, splenomegaly, bone marrow alterations, antibody-mediated platelet destruction, oxidative stress and the role of platelets as cofactors in triggering severe malaria.

In uncomplicated cases of malaria, thrombocytopenia is the result of splenic pooling of platelets aggravated by a moderate decrease in platelet life span.

That's all!

-IkaN

Friday, January 1, 2016

2016 is going to be awesome, I promise.

Happy new year everyone!

I hope you have a great year ahead.
May you succeed in all good you do and may all your dreams come true.

This post comes under "Author's diary" label so, disclaimer, I am not writing any academic information in this blog. I am going to be an open book and tell you about my year and what I learnt from it :)

So... Here's IkaN's 2015 year in review.


We made our first study group on Whatsapp in Jan 2015.
What I learnt through the study groups: The world is HUGE and each and everyone out there is awesome in their own way! I connected with hundreds of international medical students and got to know their stories - How political instability and war hampered studies for some, how difficult recovery from being suicidal can be, how society can make someone who is gay want to leave their country. Everyone is fighting. Every one of you is a survivor. You inspire me with something new everyday. Thank you for everything.

I started my internship year in Feb 2015.
What I learnt through Internship (Or house job): Some days it's going to be a piece of cake, some days you will want to cry. It's okay. You are growing and becoming something better than you were yesterday. Let it shape you. Let the 48+ hour shifts kill you. It's okay to feel bad about a patients death contrary to what others expect you to do - To not feel bad about it, to be a robot. Sometimes, you are going to diagnose severe bronchitis and make life saving calls. Other times, you are just going get a report from the lab. Remind yourself that no job is small. Be patient with yourself when you are unable to find a vein. You'll learn, slowly. Don't carry a lazy, grumpy or arrogant attitude to work. Be polite, be humble, be hard working. Be brilliant at whatever you do.

Mid year, I had a bitter realization that I might not be able to go to the US for further studies.
What I learnt: When things don't seem to work out, we need to begin again. I was really upset about it but I didn't let it define me. I got over it and started preparing for post graduation in my home country (PG CET in India). Realize that some things may not work out the way you planned them. If there are things and circumstances that you can not control, you know there's no way out and that you have done everything you could - Let go and find a new dream. It's not the end of the world.

By the end of the year, unexpected doors opened. (Yes, I am dreaming of residency in the states again! :D )
What I learnt: Miracles happen. Silent prayers get answered. Dreams come true. That's what faith can do. Faith? Faith in yourself - That you can survive no matter what your circumstances. That you are a warrior. Faith in the higher power, if you believe in one. Maybe I just got lucky. But regardless of luck, I was willing to give my best at life. I was ready to bloom wherever planted. I think that's what counts the most.

Other things from 2015:
I co-authored a book. It's called Immunowesome and will be out in 2016.
4 new authors at Medicowesome :D
Created a broadcast list and a Facebook  group.
Many, many guest authors and contributions! You guys are amazing.
Set up a Tee shirts, mugs and accessories store on Society6.

Travel diaries:
- Visited Rajasthan, Gujarat and Madhya Pradesh - Met a Medicowesome reader during the trip (It was awesome meeting you and I would love to meet all of you someday!)
- Traveled to Dubai to meet my parents and spent New Years here. The fireworks were grand. I saw a lady sleeping in her hospital scrubs in the metro. Medical students are the same everywhere. (Sleepless and cute xD ) 
- Practiced in a rural area near Mumbai. The village people live nice, simple and healthy lives.
- Visited Iraq. People of Iraq are beautiful, contrary to what the media portrays. Saw a child with Epidermolysis bullosa. Language wasn't a barrier while communicating with the people. 

So.. That's enough of me living in the past.

Things to do next year:
Make better study timetables.
Be grateful. 
Live in the moment today. Tomorrow is not promised.
Exercise regularly. It gives you endorphins.
Read the instructions carefully.
Be less anxious about the uncertain future.
Pray. 
Share more knowledge. Write more blogs.
Watch through glittering eyes. See the best in every creation.
Have more faith in people.
Don't let anyone make love small or light to you.
Be patient. Nothing good gets away.
Believe in yourself.
Transform into a wonderful person.

Maybe it's just a change in date. Maybe not.

Thursday, December 31, 2015

Hoover's sign mnemonic

What is Hoover's sign?
The paradoxical inspiratory indrawing of the lateral rib margin is known as Hoovers sign. In simple words, it is the inspiratory retraction of the lower intercostal spaces.

What causes Hoover's sign?
It is due to direct traction on the lateral rib margins by the flattened diaphragm.

Lancefield group for classification of Streptococci mnemonic

Mini bacteriology post! Yaay!

In which Lancefield group does Streptococcus pyogenes and Streptococcus agalactiae belong? How do you remember them?

Streptococcus Pyogenes belongs to Lancefield Group A mnemonic:
I remember GAP jeans (Because of the gap company manufactures amazing clothes) - Group A Pyogenes.

Streptococcus Agalactiae belongs to Lancefield Group B mnemonic:
Remember B for Baby. Streptococcus Agalactiae causes meningitis in babies and belongs to Lancefield Group B. Babies also love Galaxy chocolates and stars.

That's all!

-IkaN

Wednesday, December 30, 2015

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?

Monday, December 28, 2015

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

Friday, December 25, 2015

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

Wednesday, December 16, 2015

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!

Thursday, December 10, 2015

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!

Wednesday, December 9, 2015

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

Tuesday, December 8, 2015

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