Step 2 CK: CLL notes and staging mnemonic

Hey!

Chronic lymphocytic leukemia is proliferation of normal B lymphocytes that function abnormally.

The WBC count in CLL is > 20,000/flL with 80-98% lymphocytes.

Smudge cells are seen in CLL.

Staging of CLL mnemonic

High  LSAT score :D

Stage 0: High WBC
Stage 1: Lymphadenopathy
Stage 2: Splenomegaly + Hepatomegaly
Stage 3: Anemia
Stage 4: Thrombocytopenia

For stage 0 and stage 1, no treatment is required.

Therapy is indicated for patients with advanced stage disease, high tumor burden, severe disease-related "B" symptoms, or repeated infections.

Hepatosplenomegaly, anemia and thrombocytopenia are preferably treated with fludarabine and rituximab (FR).

For refractory cases, cyclophosphamide can be used (FCR regimen)

Older individuals (> 65 years of age) can be treated with ibrutinib, a bruton’s tyrosine kinase (BTK) inhibitor (preferred) or chlorambucil plus anti-CD20 monoclonal antibodies.

Autoimmune hemolysis or thrombocytopenia is treated with prednisone (Autoimmune warm IgG antibodies)

CLL has a good prognosis compared to other leukemias. Most common cause of death is due to infection.

That's all!
-IkaN

Bulbar and pseudobulbar palsy mnemonic

Hello! This is a mini post on bulbar and pseudobulbar palsy.

Bulbar palsy is the paralysis of the muscles supplied by the cranial nerves coming out from the bulb also known as the medulla (Cranial nerves 9, 10, 12) and it is lower motor neuron palsy.

Pseudobulbar palsy is paralysis of the same cranial nerves but the upper motor neuron type. Mostly due to lesions in the brain.

Mnemonic: pseUdo has a U for UMN lesion.

That's all!
-IkaN

Cataplesy and cataplexy mnemonic

Awesomite: Hi! Urgent mnemonic help. So can you tell me how I can remember this -

A case with dyspnea and blurring of vision

A 63-year-old male presented with increasing fatigability and dyspnoea for 2 months, and headache and blurring of vision for past 15 days. Physical examination was significant for pallor, mild hepatomegaly and a palpable spleen (2 cm).
Labs showed:
Hemoglobin concentration of 4.0 g/dL
Total white cell count of 25000/cmm
Platelet count of 60000/cmm
Monoclonal gammopathy (M spike) was seen in gamma globulin region, which turned out to be IgM on immunofixation.
Fundus examination revealed venous dilatation, tortuosity and superficial retinal hemorrhages.

Diagnosis? Treatment?

Tetanus are Anaerobic! Can Oxygen infusion into the wound, heal tetanus?

Think about it for a moment! Then look for the answer.

Non-Hodgkins lymphoma treatment (CHOP regimen) mnemonic

Hey!

If you can't remember the drugs used in the CHOP regimen of Non-hodgkin's lymhoma, I have a mnemonic for you.

Hodgkins lymphoma treatment (ABVD regimen) mnemonic

Hey!

If you can't remember the drugs used in the ABVD regimen of Hodgkin's lymhoma, I have a mnemonic for you.

Study group discussion: ADP fibrinogen test

What is ADP (Adenosine diphosphate) fibrinogen test?

ADP, formed by Ib receptor, acts on IIb IIIa receptor through fibrinogen and causes aggregation.

In vWD and Bernard Soulier disease (Ib defect), if you add ADP, aggregation would take place and test will be normal as it acts on IIb IIIa receptor.

In glanzmann thrombasthenia, the IIb IIIa receptor is deficient. ADP can not act on the receptor, if added. That's why, the test becomes abnormal.

Therefore, the test is normal in vWD, Bernard soulier disease and abnormal in glanzmann thrombasthenia.

Explained by Abhishek Shukla

Homocysteine metabolism notes for USMLE

Hey!

Let's do a quick and dirty Q&A post :D

Homocysteine metabolism

PATCHED: When the tonsils shows a membrane

Hello everyone.

I'm back with a simple mnemonic to deal with a questionably common but very important issue: The Patch On The Tonsil.

Difference between neuroleptic malignant syndrome and serotonin syndrome

Neuroleptic malignant syndrome:
Evolves over one to three days.
Sluggish neuromuscular responses (Rigidity, bradyreflexia)
Typical course: Mental status changes appear first, followed by rigidity, then hyperthermia, and autonomic dysfunction (Tachycardia, high BP, tachypnea)

Step 2 CK: AML (Acute myelogenous leukemia) notes

Hello! So these are my notes on AML :)

Treatment of AML mnemonic

Hi.

The mnemonic for treatment of AML is ABCD!

Fever : What questions to ask your patient and why

Fever
So we're familiar with the definition and measurement of fever. But while taking a case or interacting with a patient with this simple and most basic symptom , what all should we ask for to make sure we don't miss out on anything ?

Here's a list of things your Historytaking should elicit :

Ask for :

1. Onset and Duration.
When did the fever begin - and for how long has it lasted. (This would give a clue whether the person suffers from an Acute Febrile Illness - which can generally be attributed to Infectious Disease , or a rather Chronic form of fever which could be due to Granulomatous diseases or even Neoplastic and Autoimmune conditions )

2. Progression.
(Has it worsened or Become better since its onset. This gives a clue about the present status of the patient. )

3. Chills , Rigors , Sweat .
(It's essential to include the presence or absence  of chills+Rigors + Sweat immediately in the fever description. Presence of Chills and Rigors indicate any infectious process in the body and can be found in Malaria and UTI's among other conditions. Sweating after feeling hot and then cold  is characteristically associated with Malaria)
(Important : Presence of the B Symptoms - which are Night Sweats ; Fever ; Weight loss. Seen with Lymphomas and TB)

4. Periodicity .
(It's of extreme value to understand the pattern of the fever.
If the fever is present throughout the day with a variation of not more than 1°C it is of the Continuous Type : As seen in Enteric Fever and even UTI's .
If the fever is present throughout the day but the variation is more than 1°C it is of the 'Remittent' variety. It may not be possible to distinguish between these 2 on history alone.
Intermittent is when the fever stays only for some duration during the day and the patient is afebrile during the remaining part )

5. Diurnal variation ?
(Night rise of fever could be suggestive of Tuberculosis)

6. Associated with Rash or any Spots ?
(Viral exanthems like Dengue , Chikungunya , Zika or even Rickettsial diseases commonly present with some form of rashes)
(Another possibility could be a primary Skin condition induced fever )

7. Arthralgia , Myalgia ?   
(Arboviruses like Dengue and Chikungunya are infamous for these. Arthralgia is especially debilitating in Chikungunya fever. Body ache is also common in both. Retro-orbital pain and Bifrontal headache are common with Dengue.)

8.  Icterus , High colored urine.
(Presence of these  - especially during the post monsoon season should raise suspicion of Leptospirosis or Acute Viral hepatitis. Enteric fever may be considered)

9. Cough , weight loss?
(Presence of these should raise query of TB or Pneumonia )

10. Dysuria, urgency , frequency?
( UTI is a common cause of AFI especially in Diabetics )

11. Altered sensorium, photophobia , vomiting ?
( Characteristic of Meningitis /Encephalitis)

12. Eating outside , GI disturbances ? (Enteric fever or Gastroenteritis should be suspected )

I hope this gave a crisp summary of how a fever case can be approached . Goodbye ! Happy-Treating !
A.P.Burkholderia

Study group discussion: Why are agglutinates not seen in warm type autoimmune hemolytic anemia?

Why are agglutinates not seen in warm type autoimmune hemolytic anemia?

Because the antibody is IgG. IgG is called incomplete antibody.

RBCs have a strong negative charge on their surface called zeta potential. So the shortest distance attainable between two RBCs is 18nm. IgM molecule has a large pemtameric structure, so it has a distance of 30 nm between two binding sites. Hence, it is able to agglutinate RBCs.

But the small IgG molecule has only 12 nm gap between two binding sites. So it can't bind to multiple RBCs and hence fails to agglutinate them.

So it just coats the RBCs, which is taken to spleen to be killed.

That's all!

Thank you, Divya, for explaining this to us =)

-IkaN

Marijuana and cannabinoids intoxication mnemonic

Hey!

So in this post, imma gonna talk about what happens when you smoke weed yo.

The symptoms of marijuana intoxication are:

Munchies (Polyphagia)
Autonomic hyperactivity (Mild hypertension, dry mouth)
Racing heart (Tachycardia)
Injection (Scleral, conjunctival injection)
Judgement impaired
Uphoria (Euphoria)
Anxiety
Nystagmus
Ataxia

Treatment? Intoxication is self-limited to several hours. Interestingly, the treatment for marijuana intoxication and withdrawal are exactly the same: supportive care only.

That's all!

Don't do pot, you dope, you :P

-IkaN

Step 2 CK: Treatment of narcolepsy and cataplexy

Treatment of Narcolepsy:
Patients with sleepiness severe enough to require medication can be treated with stimulant medications.

IPC and CrPC mnemonics

Hello!
This post is for Indian medical students only.

IPC 319, 320, 323, 324, 325, 326, 334, 335 mnemonic

Hey!

Narcolepsy mnemonic

Hello!

This post is on narcolepsy.

For those who don't know, narcolepsy is characterized by:

Crown rump length and gestational sac diameter

The crown rump length in mm is calculated by subtracting 42 from the gestational age in number of days.

The gestational sac diameter in mm is calculated by subtracting 30 from the gestational age in number of days.