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!