Langerhans cell histiocytosis notes and mnemonic

Hey!

I'm clearly doing a lot of notes + mnemonic posts. Here's another one on Langerhans cell histiocytosis!

Langerhans lingers
L - Lytic lesion of bones
I - Diabetes Insipidus
N - Nil
G - Eosinophilic Granulomas
E - Exophthalmos
R - Rrrrr.... :P
S - Skin rash

From study group:

Any mnemonic for Hand Schuller Christian disease?

Mnemonic by IkaN: Hands LIE
Lytic bone lesions
Insipidus (Diabetes Insipidus)
Exophthalmos

Mnemonic by Dev: CDE
Calavarial skull defect
Diabetes insipidus
Exophthalmos

Disclaimer: It's a morbid mnemonic. If you are sensitive and religious, don't read it.
Mnemonic by Vinayak: Jesus CHRIST was killed by hammering nails into his HAND, he DIed, his hands' bone got LYSED and we celebrate EXmas:
For calvarial skull defects, you know, wood was also hammered into his head. DI is diabetes insipidus. EX is exophthalmos.

That's all!
-IkaN

Study group discussion: Skeletal resistance to PTH in CRF

Hi guys! So the question that was asked in the study group is- Why is there skeletal resistance to PTH in Chronic Kidney Disease?

Answer-

Skeletal Resistance to PTH has a multifaceted pathogenesis; the most imp factor being uraemia which screws with the PTH receptor's intracellular G-protein signaling mechanism in the Osteoblasts.

Dialysis in these patients increase the levels of Osteoprotegerin, which is a decoy molecule antagonizing the action of RANKL in promoting osteoclastogenesis; further intereference with the action of PTH.

Hyperphosphatemia and Hypocalcemia in CKD patients cause excessive release of PTH which leads to downregulation of its receptors on osteoblasts. 

Decreased levels of calcitriol screws in a special way, it makes the parathyroid gland think that the normal calcium level range is above the actual normal value, making the gland work overtime. For this we use calcimimetics like cinacalcet to decrease the set point back to the real normal value. And also without Calcitriol to assist, PTH's job becomes a lot more difficult. 

Earlier the most common CKD-related osteodystrophy was osteitis fibrosa cystica which was due to very high PTH levels causing pathologically increased bone turnover.

But now since we have developed drugs to tackle increased PTH levels, Adynamic Bone Disease has become the most common osteodystrophy because in the body of a CKD patient, it is already very difficult for PTH to carry out its function and if we are pharmacologically decreasing its values, we are ensuring that it works negligibly. 

That's enough Nephrology for one day! :)

  

-VM

ECG basics

So basically, ECG is  an electrical representation of heart activity on ECG paper. 

Here are some important postulates of ECG paper:

The needle of galvanometer travels 300 big squares in 1 minute or 60 seconds. 

That makes 0.2 seconds for each big square. 

In turn each big square is divided into 5 small boxes /squares.

So we get each small box counting about
0.04 seconds. 

So let's review all calculations:

1 Big square = 0.2 seconds.
1 small square = 0.04 seconds. 

Each P wave travels about 2 and 1/2 small  squares making upto 0.1 second.

The segment PQ (Sometimes we use PR) again takes 2 and 1/2 small squares making upto 0.1 second.

QRS complex used another 2 and 1/2  small squares making another 0.1 second. 

While S-T segments uses 10 small squares forming using 0.4 seconds.

Note: We normally consider 2 and 1/2 small squares but there can be 2 or 3 small squares. 

~Ojas

Pentavalent vaccines

Hey Awesomites!

Let's discuss something about the pentavalent vaccines and what advantage they have in the immunization of newborns..

Friedreichs Ataxia notes and mnemonic

Here's another notes + mnemonic post on Friedreichs Ataxia

Genetic stuff:
- Due to mutated frataxin gene
- GAA trinucleotide repeats
- Autosomal recessive
- Mitochondrial iron accumulation due to loss of iron transporter coded by frataxin gene results in oxidized intramitochondrial iron accumulation.

Clinical stuff:
- Cardiomyopathy is the most common cause of death in FA. Cardiomegaly, conduction defects, murmurs, fibrosis are seen.
- Musculoskeletal abnormalities like foot deformities (Hammer toe, pes cavus, pes equinovarus) and scoliosis is seen.
- Diabetes mellitus is seen in 20% of patients

Neurologic stuff:
- Nystagmus
- Titubation
- Dysarthria
- Dysmetria
- Ataxia of trunk and limb movements.
- Loss of proprioception and vibratory sense.
- Extensor plantar response, absence of deep tendon reflexes and weakness is found.

That's all!
Stuff.
-IkaN

Mnemonic: Friedreichs FRIEDS! 

Duodenal atresia notes and mnemonic

Duodenal atresia

Hey!

In this post, I wanted to emphasize duodenal atresia is associated with double bubble sign.

It's common in Downs syndrome and polyhydramnios maybe seen in utero.

Bilious vomiting is seen because the obstruction is after the ampulla of Vater.

Because the child is vomiting, abdominal distension is not seen.

That's all!
I need sleep right now.
-IkaN

The Sustainable Development Goals: Mnemonics and explanation

Hi everyone! I'm back with a note. This time on the Sustainable Development Goals (SDG's).

This is a crisp summary of what we need to know about them as Doctors or Health Care Practitioners (in any part of the world). They're so important that a major chunk of the Coldplay concert in Mumbai was based on them. (And every other person spoke about them. How Magic-al).

And they're Also very important for the Community Medicine students from India. So here goes :

SDG's were adopted by nations of the world on 25th September, 2015 to be achieved till 2030. 

They want to do 3 P's. 

End Poverty,
Bring Prosperity to all and
Protect the planet. 

A. The important Health related Goals : 

(Mnemonic by our IkaN)

pH HE EWE

(HE EWE as in Adam and Eve)

1 Poverty 

2 Hunger 

3 Health care 

4 Education 

5 Equality 

6 Water 

7 Energy 

B. Goal 3: Ensure Healthy lives and Promote Well Being. 

Targets 

Remember: BAMS VIP
Baby Adult Mother Sex. 
(OR : Adult and Mother have Sex to get Baby)
Vaccine. Infections. Pollution. 

Baby:
- Neonatal Mort - has 12 letters , so to be reduced to less than 12 by 2030. 

- Under 5 Mortality Rate  - 5*5 = 25. So less than 25 by 2030 

Adult:
- Decrease the burden of NCDs to one third of present.
- Mental health burden to be reduced. Tobacco control. 
- Drug abuse to be tackled. 

Mother:
- Maternal Mortality to less than 70 per 1 lakh world wide. 

Sex: 
- Sexual health and reproductive health strengthening. 

Vaccines:
- Promote and develop.

Infections:
- Tackle TB HIV Malaria Other tropical diseases Diarrheal diseases. 

Pollution:
- Air, Water, Soil, Noise pollution to be tackled. 

Kudos to IkaN who helped me out of this tough spot. This was a life saver and you're the best :* :)

Hope this helps everyone.
Until next time.

~A.P.Burkholderia

Transient synovitis vs septic arthritis

Hello!

In this post, I'll talk on how to to differentiate transient synovitis from septic arthritis.

Transient arthritis is non specific inflammation of the synovium, related to infection or trauma.

Septic arthritis is bacterial infection of the synovium of the joint.

Modified Kochers criteria can help distinguish the two.

Fever > 38.5
ESR > 40 mm/hr
WBC > 12,000 cells/mL
CRP > 20 mg/dL
Inability to bear weight on the affected limb

More the criteria, more likely the child has septic arthritis.

Here's a mnemonic for modified Kochers criteria: FEW Can Bear Kocher!

Fever, ESR, WBC, CRP, weight bearing.

Acute transient synovitis is the most common cause of painful hip in a child younger than 10 years. It is a diagnosis of exclusion and can mimic Osteoarthritis, Legg Calve Perthes disease, SCFE.

Treatment: Rest, anti inflammatory agents.

That's all!
-IkaN

Myotonic dystrophy notes and mnemonic

Hello!

Here are my notes + a mnemonic

Congenital myotonic dystrophy
- Autosomal Dominant
- CTG trinucleotide repeat
- Genetic anticipation seen

- Hypotonia "floppy infant"
- Hollowing of temporal bones
- Tenting of upper lip
- Respiratory muscle weakness
- Arthrogryposis
- Posterior subcapsular cataracts (Subcapsular spokes in stellate conformation) 

Juvenile myotonic dystrophy

- Facial and upper body weakness (Hatchet face due to temporalis, masseter, facial muscle atrophy; frontal baldness)
- Inability to relax muscle (Sustained grip)

- Cardiomyopathy
- Heart block
- Congestive heart failure

- Intellectual impairment
- Gonadal atrophy
- Posterior subcapsular cataracts

- Thenar, hypothenar muscle atrophy (Myotonia evident on percussion)
- Tongue depression
- Dementia

That's all!
Be kind.
-IkaN

Henoch Scholein purpura notes and mnemonic

Hello! Here are my notes + mnemonic on HSP.

IgA-mediated vasculitis of small vessels (IgA and C3 in skin, renal glomeruli, and gastrointestinal tract).

Most common cause of nonthrombocytopenic purpura in children.

Usually follows an upper respiratory infection.

Clinical features are:
Maculopapular rash below waist (Progresses to petechiae to palpable purpura).
Abdominal pain.
Arthritis.
Glomerulonephritis.

That's all!
-IkaN

Rheumatoid arthritis mnemonic

Hello!

Here's an old mnemonic on some of the clinical features of Rheumatoid arthritis.
Well, the name itself tells it.. RHEUMATOID ;p

R- Respiratory distress (Interstitial lung disease, bronchiolitis, pleural effusion)
H- Haematological manifestations (anemias, thrombocytosis, neutropenia)
E- Extra- articular RA (ExRA)
U- Urinary tract infections (mainly drug- induced)
M- Median nerve compression/ Morning stiffness
A- Amyloidosis
T- Tenosynovitis and bursitis
O- Ocular manifestations (Keratoconjunctivitis sicca, scleritis, episcleritis)
I- Immunologic manifestations (Sjogren's, Felty's and Caplan's syndrome)
D- Deformities (boutonniere, swan- neck, button- hole)

Thats all :)

- Jaskunwar Singh

A case on Medical ethics

Hello Awesomites!

Today I am gonna discuss with you a simple case based on medical ethics. A Forensic Medicine professor asked me in final viva last year. So here it goes...

3 month old with hypotonia

3 month old baby with history of honey intake (Given by grandpa) presents with constipation, feeding difficulty, hypotonia. What is the cause of the baby's symptoms?

1. Ingestion of preformed toxin
2. Ingestion of pesticide
3. Ingestion of bacterial spore
4. Bacterial infection of the meninges
5. Urinary tract infection

Answer given below:
.
.
.
.
.
.
.
.
.

If you picked 1, you're wrong.

Infant botulism is caused by botulinium spores in honey, corn syrup that germinate and multiply in the intestinal tract and produce toxin.

Adult botulism is caused by ingestion of preformed toxin.

I just wanted to make that point clear. And emphasize how tricky any exam can get with word play.

Don't stress.

That's all! =)

Oh and the answer is 3.

-IkaN