Tuesday, April 25, 2017
Mnemonic : Deviated Nasal Septum clinical features
The clinical features ( s/s ) that are presented by a patient with DNS are : NOSE MASH
NO - Nasal Obstruction
S - Septal cartilage and bone deformity
E - Epistaxis
M - Middle Ear infection
A - Anosmia
S - Sinusitis
H - Headache
- Jaskunwar Singh
C Peptide levels : An Overview
Hello everyone!So I ended up uttering 'C peptide' recently in my Medicine Viva and my professor screwed me over it.
(Clearly I didn't C it through :'D )
So I thought of doing a brief summary on it.
Here goes.
1. What is C peptide ?
- When pro- insulin is cleaved , it gives insulin and C peptide.
- C peptide in general has a longer half life than insulin and is easier to detect.
- The pathway is something like this :
Pre proinsulin produced in Rough Endoplasmic Reticulum of Pancreas --> Transported to the Golgi apparatus and cleaved to form Proinsulin --> Packed into secretory granules --> In these granules proinsulin is converted to : Insulin and C peptide.
- Traditionally it is said to have no intrinsic activity but recent studies say it might have anti oxidant and anti inflammatory properties.
2. What does it indicate ?
- So , its presence indicates presence of Insulin in the body in a proportionate amount.
- Hence in a case of Hypoglycemia if C peptide levels are high, it's likely to be due to increased endogenous Insulin levels.
3. C peptide levels increased in -
- Insulinoma
- Sulfonylurea induced Hypoglycemia ( As they are Insulin Secretagogues)
- Type 2 Diabetes Mellitus ( Hyperinsulinism due to resistance)
- Insulin Resistance states like Obesity , PCOS , Cushing's.
4. C peptide levels reduced in -
- Type 1 Diabetes as Insulin secretion is reduced
- Latent Autoimmune Diabetes of Adult (LADA )
- Factitious hypoglycemia - Due to excess exogenous Insulin administration.
- Hypoglycemia due IGF secreting tumors.
So if you get a patient with Hypoglycemia with elevated insulin levels , C peptide levels help you decide if due to exogenous Insulin , or Endogenous Insulin ( Sulfonylurea induced or Insulinoma).
Hope this helped !
Stay awesome.
Happy studying!
~ A.P Burkholderia.
Monday, April 24, 2017
The Basics : Middle Ear
In this post, I will be talking about the middle ear structures and its relations with its neighbors ( just a summary ).
The Middle Ear is an air filled and bilaterally compressed/ concaved cavity lined by mucous membrane located in between the external and internal parts of ear. It is divided into:
- Epitympanum or the Attic ( 6mm ) - lies above pars tensa and medial to pars flaccida
- Mesotympanum ( 2mm ) - lies opposite to pars tensa
- Hypotympanum ( 4mm ) - lies below the level of pars tensa
BOUNDARIES of the middle ear ( homologous to structure of a cube ) :-
Roof : Tegmen tympani - a thin bony plate that is a part of petrous part of temporal bone, separates the middle ear cleft from middle cranial fossa.
- Infection in the middle ear may spread superiorly and lead to formation of abscess in the meninges ( especially Extradural abscess ), meningitis or if severe, it may even lead to abscess formation in the temporal lobe.
Floor : Jugular bulb - The middle ear cavity is separated from jugular bulb by a thin piece of bone that if deficient may lead to formation of a layer of fibrotic tissue and mucous membrane in between. The contents of jugular bulb are:
- Internal Jugular vein
- Glossopharyngeal nerve ( IX )
- Vagus ( X )
- Accessory nerve ( XI )
The tympanic branch of glossopharyngeal nerve enters the middle ear at the junction of the floor and medial wall to play an important role in formation of tympanic plexus.
Anterior wall : The upper part of the narrow anterior wall has two openings or tunnels for - ( mnemonic : TEA )
- Canal for Tensor tympani muscle
- Pharyngotympanic ( or Eustachian ) tube
The lower part of anterior wall is separated from the Internal Carotid Artery by a thin plate of bone. The ICA is surrounded by a plexus of sympathetic nerves that enter middle ear through openings in this bony plate to form tympanic plexus.
Posterior wall : Posteriorly, it is related to middle ear cleft ( Aditus, Antrum and mastoid air cells )
- Infection in this region may spread posteriorly into the sigmoid sinus ( in posterior cranial fossa ) and cause thrombophlebitis !!
Medial wall : Medially the middle ear cavity is related to the promontory, oval and round window
Lateral wall : Tympanic membrane separates the middle ear from the external ear.
A brief about the functions of middle ear:
On the incoming of sound waves, the tympanic membrane oscillates and these oscillations are sensed by the strongly attached and faithful middle ear ossicle, the Malleus. The sound energy is transmitted as such by the ossicles ( Malleus - Incus - Stapes ) to the internal ear for further processing.
The major function of these ossicles is amplification of sound waves - Tympanic membrane is 17 times larger than the oval window - So that means the sound energy is picked up by the larger area ( TM ) and impinged over a much smaller area ( oval window ) thus amplifying it 17 times.
In addition, the lever action of the ossicular chain is approx. 1.3 units. Thus the intensity ( force ) of sound waves/ vibrations changes ( increased by ~20 times ) and not the frequency !! If the sound waves are not amplified ( in case OC is removed ), the Air Conduction would be lost. So BC > AC and thus hearing would then be poor.
Thats all
Hope this helped :)
Stay Awesome!
- Jaskunwar Singh
Craniopharyngioma mnemonic
The C's of Craniopharyngioma
Children
Calcification
Cholesterol crystals
Cyst formation
Central diabetes insipidus
Compresses chiasm, can't C (see, because butemporal hemianopia)
CR: CRAniopharyngioma RAthkes pouch remnant
Yup. That's all!
-IkaN
Sunday, April 23, 2017
'A' wave in JVP : Mnemonic and explanation
Hi everyone. So JVP is one of the most theoretical clinical signs I've ever studied. And though parts of it are logical , I find it tedious to memorize all causes for a particular finding.
So I've prepared a Mnemonic for prominent a waves.
Here goes.
The A wave is a positive wave of the JVP.
It represents the Right Atrial pressure during systole.
Causes of a prominent a wave
Remember :
CRePT's
C - Cor Pulmonale
R - Right heart Failure
P - Pulmonary stenosis
T - Tricuspid stenosis
S - The S tells you it's Stenosis for P and T.
The a wave essentially represents the pressure in the Right atrium during systole.
So any condition that causes this pressure to increase would cause a prominent A wave.
Cor Pulmonale and RVF are basically congestion in RV causing elevation of pressure in the RV.
This means the atrium needs to pump with greater force into the Ventricle for the venous return to enter the Ventricle. This increases the RA pressure causing prominent a wave.
Pulmonary Stenosis leads to accumulation of blood in the RV and this follows a similar fate as the above mentioned causes.
Tricuspid stenosis causes obstruction to the flow of blood from RA to RV. Thus accentuating the pressure in the RA.
That's the Prominent a wave for you !
~~~~~~~~~~~
Now there's something called the Cannon a wave.
These represents contraction of the RA against a closed Tricuspid valve.
The causes of this include -
A- V dissociation.
Heart blocks.
Ventricular arrhythmias - V tach , Ventricular premature complexes and Ventricular pacing.
~~~~~~~~~~~
The a wave would be absent in Atrial fibrillation as the atrium is functionally not pumping at all , and just vibrating.
These are the a wave findings for you !
Hope this helped
Stay awesome.
~ A.P. Burkholderia
Number needed to treat and number needed to harm mnemonic
Hello!
Number needed to treat = 1 / Absolute risk reduction
Mnemonic: TARR - Treat Absolute Risk Reduction
Number needed to harm = 1 / Attributable risk
Mnemonic: HARM - Harm Attributable Risk M
That's all
-IkaN
The Basics : Lateral wall of Nasal cavity
Saturday, April 22, 2017
Clubbing : Why it occurs.
This is a short post on why clubbing happens.
So it's simple !
It's cause people like to go out and get drunk.
Just kidding. Here goes.
- It's the bulbous enlargement of the terminal digits and the nail bed.
- Symmetrical clubbing can occur due to a host of causes.
- To summarize :
A. Respiratory
: Lung cancer
: Suppurative lung conditions like
: Pulmonary Fibrosis
B. Cardiac
- Cyanotic heart disease
- Eisenmenger Syndrome
- Infective endocarditis
- Inflammatory bowel disease
- Cirrhosis - esp Biliary
D. Endocrine
- Thyroid Acropachy
- Acromegaly
But what makes sense to me , I want to share with you'll! And it was an absolute pain to find something convincing enough. So just stick with me here ;;)
The most widely accepted theory right now is the megakaryocyte theory.
IBD - especially Crohn disease seen to have thrombocytosis eventually which may aggravate the PDGF.
In cirrhosis of liver , especially biliary , pulmonary arteriovenous shunting is observed. This could result in the megakaryocyte entrapment as explained.
Another theory suggests inflammation triggers a vagal response causing Vasodilator effects. ( Neurogenic).
Other theories -
Hypoxia induced
Reduced ferritin related
Neurogenic
Humoral - various PG's and other humoral molecules.
The most widely accepted theory is the Megakaryocyte theory.
Hope this satisfied you !
Thank you.
Stay awesome.
~A.P.Burkholderia
Preparing for NEET - Part 2
Authors' diary: Homemade cheap DIY alternatives for a smartphone camera stand
In this video, I show how I keep my camera stable while shooting videos of my notes / whiteboard.
I use paper cups and books as my camera stand.
Friday, April 21, 2017
Paraneoplastic Dermatoses - Tripe Palm.
(The palmar ridges are accentuated and resemble to the stomach mucosa of a ruminant-tripe.)
-Medha.
Nail Changes in Medicine : A Summary
Hi everyone. Just a list of changes you can see in the nails in different systemic Diseases. So let's get nailed ;)
1. Clubbing -
Loss of angle between the nail and the nail fold - More soft and bulbous nail.
Typically indicates Cardio Pulmonary function disturbance :
--> Cardiac conditions like Cyanotic heart disease, Infective endocarditis and Atrial myxoma.
--> Respiratory conditions :
Neoplastic like CA lung ( Esp. Squamous cell CA) , Mesothelioma.
Infective like Bronchiectasis , Abscess , Empyema.
(Non cardiorespiratory causes = Inflammatory bowel disease, Biliary Cirrhois.
Thyroid Acropachy , Acromegaly. )
2. Koilonychia -
Spoon shaped nails.
Strongly indicative of Iron Deficiency anemia or Fungal nail infection.
3. Onycholysis -
Destruction of nail.
Seen in Psoriasis , Hyperthyroid and Fungal nail infection.
4. Chronic Paronychia -
Inflammation of nail fold. May have swollen nail and discharge with throbbing pain. May occur due to frequent nail biting.
5. Cyanosis -
Can be looked for in nail bed. We have a post on this already.
6. Beau line -
Transverse furrows from temporary arrest of nail growth due to increased stress.
Nails grow at 0.1 mm/d , so furrow distance from the cuticle can be used to time the attack. Can be seen in Malaria , Typhus , Rheumatic fever , Kawasaki.
7. Mees line -
White transverse bands in Arsenic poisoning / Renal failure.
8. Muerhcke's line -
White parallel lines without furrowing on the nail.
Seen in Hypoalbuminemia.
9. Terry's nails -
Proximal portion of nail is white / pink , tip is reddish brown.
Seen in cirrhosis , CRF
10. Splinter hemorrhage -
Longitudinal Hemorrhage streaks under the nail seen in Infective endocarditis.
What a fun way to get nailed down 😂 Happy studying !
Stay awesome.
~ A.P.Burkholderia.
Drug Induced Edema : Mnemonic
Hi everyone. Here's a short post highlighting drugs causing edema.
Remember : SWOLLEN
S - Steroids
W (V) - Vasodilator drugs
O - Oral Hypoglycemic drug - Glitazones
L - CycLosporine
L
E - Endocrine - Growth Hormone
N - NSAIDs
1. Steroids -
Due to the Mineralocorticoid action of reabsorbing the Sodium from the kidneys, they act as volume expanders.
2. Vasodilator drugs -
Especially CCB's like Amlodipine are known to cause this. Other Vasodilator drugs used for hypertension can also cause edema like Alpha Methyl dopa, Hydralazine, etc
3. Oral Hypoglycemic drug : Glitazones -
The Glitazones act on the PPAR gamma receptors. These receptors are also present in the kidneys and vascular system. They somehow modulate the kidneys to reabsorb Na+ and also act on the level of blood vessels via PPAR receptors.
This is one of the reasons why they are c/i in Heart failure and Liver cirrhosis ( as they cause fluid overload).
4. Cyclosporine -
Reduces the GFR , thus more fluid retention.
5. Growth hormone. I don't understand why. Do tell me if you find out !
6. NSAIDs -
NSAIDs inhibit PG synthesis in kidneys causing renal vasoconstriction and this reducing the GFR.
This causes excess fluid accumulation eventually causing edema.
That's all!
Happy studying. Stay awesome. :)
~ A.P.Burkholderia
Adult ADHD : A Clinical Overview
Attention - Deficit Hyperactivity Disorder ( ADHD ) is a mental health disorder that usually occurs in childhood and continues into adulthood. The symptoms in adults may not be as clear as in children. In India, there are more than 10 million cases of adult ADHD per year.
In adults, the symptoms of hyperactivity may decrease, but the characteristic features of decreased attention span, mood swings, impulsive behavior, difficulty in communication and language skills, restlessness may still continue to appear.
Now lets talk about the signs. The WHO has lately released a set of six questions to test the adults for signs of ADHD - Adult Self - Report Scale Screener (ASRS) is a self - screening questionnaire that you can use to determine if you might have ADHD. The answers to these questions predict the people suffering from this disorder and is a simple way of screening :
1. How often do you have difficulty in concentrating on what the other person is saying to you, directly as well as indirectly ?
2. How often do you leave your seat when you are in a group or meetings in which you are expected to remain seated?
3. How often do you have difficulty in unwinding and relaxing when you have time to yourself ?
4. When you are in a conversation, how often do you find yourself finishing sentences of the people you are talking to before they can finish them themselves?
5. How often do you put things off until the last minute?
6. How often do you depend on others to keep your life in order and attend to details?
- The answers to these set of questions can be 'never', 'rarely', 'sometimes', 'often', or 'very often'.
- If the answer to four of the six questions is 'sometimes', 'often' or 'very often' , the person may be considered to have ADHD!
Note that this is a simple way of screening the people for signs of ADHD, and not the diagnostic criteria.
Thats all
- Jaskunwar Singh
Thursday, April 20, 2017
Croup mnemonic
If croup crops up in the exam, here are some high yield points you should know:
Croup CROPS!
Corticosteroids
Racemic epinephrine
Oxygen
Parainfluenza virus
Seal barking cough
Stridor
Subglottic stenosis
Steeple sign
#TLDR
Parainfluenza virus type 1 is the most common cause of croup.
The onset of symptoms in laryngotracheitis is gradual, beginning with nasal irritation, congestion, and coryza. Fever, hoarseness, barking cough, and stridor usually develop during the next 12 to 48 hours.
In children with croup, a posterior-anterior chest radiograph demonstrates subglottic narrowing, commonly called the "steeple sign"
Children with croup are treated with dexamethasone, nebulized epinephrine and humidified oxygen depending on severity.
Remember, intubation is rarely required in croup, so think of other etiologies if the patient needs intubation.
That's all!
-IkaN