Painful and painless genital ulcers mnemonic

Hey!

Today's post is about sexually transmitted pathogens that cause (painful and painless) genital ulcers.

Causes of painful genital ulcers:

Haemophilus ducreyi (the causative agent of chancroid)
Herpes simplex virus types I and II (HSV-1 and HSV-2)

Causes of painless genital ulcers:

Treponema pallidum (the causative agent of syphilis)
Klebsiella granulomatis (the causative agent of granuloma inguinale; also known as "Donovanosis")

Chlamydia trachomatis serovars L1-3 (the causative agents of lymphogranuloma venereum; LGV)

And now, mnemonics for everybody! Wohhooo!

Fact of the day : Blood pressure should be measured in both arms

Hello

Measuring the blood pressure offers an important glimpse into the patient's health. In general practice, the readings are taken from left arm in right - handed patients and vice - versa.

But some healthy people can have slightly different numbers between arms - a huge difference signals a blockade or an abnormality !! The difference in systolic pressure between arms should not be greater than 5 points. ( Not one, but at least three recordings must be taken at three minute intervals and the one with lowest numbers is taken as the final reading. )

If the recordings in one arm are higher than the other, then that arm should be used for future measurements.

In young, it could sign a narrowing of the main artery ( coarctation of aorta ) or other congenital heart defects. In the elderly, it could be a sign of underlying atherosclerotic condition, or may be aortic dissection !! Note that in a woman with breast cancer who has had mastectomy and lymph nodes resection, the measurements are not to be taken in the arm on the side of mastectomy.

When to take the readings in both arms?
Well, not everytime obviously. But every once in a while should be okay.. may be once the patient is in his teens and then in his 40s or 50s.
( Source )

Thats all
- Jaskunwar Singh

Pathophysiology of hepatojugular reflux

Hello. Let's talk about the HJR today!

What is the hepatojugular reflux?

Distention of the neck veins when pressure is applied over the liver.

Fact of the day: Paradoxical agitation with benzodiazepines

Benzodiazepines frequently are administered to patients to induce sedation.

Paradoxical reactions to benzodiazepines, characterized by increased talkativeness, emotional release, excitement, and excessive movement, are relatively uncommon and occur in less than 1% of patients.

The exact mechanism of paradoxical reactions remains unclear. 

It is important to be aware of this side effect because increasing the dose of benzodiazepine would worsen the condition.

Acalculous cholecystitis notes

Hello!

Let's learn about Acalculous cholecystitis today. These are my step 2 CK notes, made from UpToDate.

What is acalculous cholecystitis?

Acalculous cholecystitis is an acute necroinflammatory disease of the gallbladder with a multifactorial pathogenesis. It is typically seen in patients who are hospitalized and critically ill.

Clinical features:
In critically ill patients, the appearance of unexplained fever, leukocytosis, or vague abdominal discomfort may be the only sign of acalculous cholecystitis. Patients may also have jaundice or a right upper quadrant mass. Laboratory test abnormalities may include a leukocytosis or abnormal liver tests, but they are nonspecific.

Diagnosis: USG.

Why?
Advantages of ultrasonography are that it is noninvasive, can be done at the bedside, and has good sensitivity and specificity for diagnosing acalculous cholecystitis. In addition, ultrasonography may reveal alternative diagnoses (such as calculous cholecystitis). Thickening of the gallbladder wall is the most reliable feature seen in patients with acalculous cholecystitis.

Ultrasonographic features:
●Absence of gallstones or sludge
●Thickening of the gallbladder wall (>3 mm)
●Pericholecystic fluid
●Striated gallbladder
●A positive Murphy's sign induced by the ultrasound probe (may be absent in patients who are obtunded or sedated)
●Mucosal sloughing
●Gallbladder distension (>5 cm).

Treatment:
In patients with acalculous cholecystitis, we recommend the initiation of broad spectrum antibiotics as soon as blood cultures have been drawn.

Infection with enteric pathogens, including E. coli, E. faecalis, Klebsiella, Pseudomonas, Proteus species, and Bacteroides is common.

Preferred surgery: Cholecystostomy rather than cholecystectomy.

Why?

Cholecystostomy is effective and is less invasive than cholecystectomy. (especially in critically ill patients.)

However, cholecystectomy should be performed if there are findings suggesting gallbladder necrosis, emphysematous cholecystitis, or perforation. Cholecystectomy is also a reasonable alternative in patients who are good surgical candidates.

That's all!
-IkaN

Medulla (Fun Mnemonic Diagrams)

Hello Everyone,
Today lets discuss sections of medulla. I remember them as three sisters!

Breast feeding and maternal cancer

Breast feeding decreases the risk of all of the following cancers in the mother EXCEPT:

Breast cancer
Ovarian cancer
Endometrial cancer

Fact of the day : Worrywarts have high verbal intelligence

Hey intelligent people
Here is another fact of the day post for you all ;p

Recent innumerous studies and research by scientists have confirmed the link between the 'worry mode' and high verbal IQ. People who are worrywarts may be better at addressing, analyzing and solving problems in situations by using language - based reasoning.

Obsessive worrying, rumination, and overthinking about situations and events is associated with more sharpening of your critical thinking skills and mental preparation for future scenarios.


Thats all
- Jaskunwar Singh

Fact of the day : Biopsy for atypical hyperplasia and risk of breast cancer

Hello

Women who have had breast biopsies in the recent past, that showed atypical hyperplasia, are at increased risk of breast cancer in the future. This is because of the changes in the breast that prompted the biopsies and not the biopsy itself, according to the Gail model of breast cancer risk assessment.

Moreover, high breast density (due to high fat diet and obesity) - individualised and as a modifiable risk factor itself, in combination with proliferative benign breast disease, increase the risk of cancer, but is relatively uncommon.

Source: http://jnci.oxfordjournals.org/content/105/14/1043.full.pdf

Thats all
- Jaskunwar Singh

Fact of the day: Lymphocytosis in pertussis

Why does pertussis cause lymphocytosis even though it is a bacteria?

Pertussis toxin (PT), from Bordetella pertussis, causes lymphocytosis.

Lymphocytosis is because of impaired entry of lymphocytes into lymph nodes. 

Slipped Capital Femoral Epiphysis mnemonic

Hello!

Slipped Capital Femoral Epiphysis mnemonic:

Step 2 CK: Treatment of DVT notes

Here are my notes for Step 2 CK exam!

DVT treatment: Anticoagulation.

Duration: Minimum 3 months.

DVT with high risk of bleeding: IVC filter.

DVT in pregnancy, malignancy: LMW heparin.

Massive DVT: Thrombolysis / clot removal with anticoagulation.

DVT due to HIT: Stop heparin containing products. Start non heparin anticoagulation.

When should you hospitalize: Patients with massive DVT (eg, iliofemoral DVT, phlegmasia cerulea dolens), concurrent pulmonary embolism, a high risk of bleeding on anticoagulant therapy, comorbid conditions, or other factors that warrant in-hospital care. 

Notes from UpToDate:

Anticoagulation is the mainstay of therapy for patients with acute lower extremity deep vein thrombosis (DVT).

In patients with asymptomatic proximal DVT, we suggest anticoagulation identical to that for patients with symptomatic DVT.

Options include subcutaneous low molecular weight (LMW) heparin, subcutaneous fondaparinux, the oral factor Xa inhibitors rivaroxaban or apixaban, or unfractionated heparin (UFH).

Although there is agreement on the minimum length of time a patient with a first episode of DVT should be treated (ie, three months), the optimal length of time is not known.

Outpatient anticoagulation rather than inpatient therapy can be considered when patients are hemodynamically stable, have a low risk of bleeding, do not have renal insufficiency, and have a practical system in place at home for the administration and surveillance of anticoagulant therapy. It is not appropriate in patients with massive DVT (eg, iliofemoral DVT, phlegmasia cerulea dolens), concurrent pulmonary embolism, a high risk of bleeding on anticoagulant therapy, comorbid conditions, or other factors that warrant in-hospital care. 

For patients in whom anticoagulation is contraindicated or in whom the risk of bleeding is estimated to outweigh the risk of recurrent thromboembolism, we suggest the insertion of an IVC filter rather than no therapy.

For patients with active malignancy and pregnant women, we suggest that LMW heparin be selected as the initial and long-term anticoagulant of choice rather than other agents.

For patients with massive iliofemoral DVT or phlegmasia cerulea dolens with symptoms for <14 days and good functional status, we suggest systemic or catheter-directed thrombolytic therapy, and/or clot removal (eg, catheter extraction, catheter fragmentation, surgical thrombectomy) rather than anticoagulation alone.

For patients with a DVT and a diagnosis of heparin-induced thrombocytopenia (HIT), all forms of heparin should be discontinued and immediate anticoagulation with a non-heparin anticoagulant started.

Extra: For select patients with isolated distal DVT (eg, those at high risk of bleeding, negative D-dimer level, asymptomatic or minor symptoms, without risk factors for extension, and/or minor thrombosis of the muscular veins), we suggest surveillance with serial ultrasound over a two-week period rather than anticoagulation. Those who exhibit signs of thrombus extension should be anticoagulated. 

That's all!
-IkaN

Trypanosma mnemonic

This one will help you in having a fair idea about the linking of Trypanosoma species with the diseases caused and the vectors associated.

1. T. cruzi- American Chaga's disease.

Americans have big fat freeways on which they love to cruise in their cars. Also,if you are into automobiles, you can remember the car 'Cruze'
from Chevrolet, the American carmaker.

The vector is reduviid(kissing) bug. Do I need to say more?!

2. T.brucei-  This one is full of the phonetic 'sa' in it- T. brucei causes sleeping sickness with the vector being the tsetse fly!

That's all!

-Sushrut Dongargaonkar

Congenital adrenal hyperplasia mnemonic

Hey, do you know a way to remember the Congenital Adrenal Hyperplasia and it's enzyme deficiencies?

It's the same mnemonic that everyone uses:

The 1 looks like an up arrow for increase

First digit for blood pressure
Second digit for sex hormones

11 hydroxylase deficiency:

1 - BP - High (Hypertension) 

1 - Sex steroids - High (Virilization in females) 

21 hydroxylase deficiency:

2 - BP - Low (Hypotension)

1 - Sex steroids - High (Virilization in females)

17 hydroxylase deficiency:

1 - BP - High (Hypertension) 

7 - Sex steroids - No increase

There was a point in my life where I forgot which digit stood for what. I have a mnemonic for that as well... It's a vulgar mnemonic.

I think of erection, first the blood goes into the corpora cavernosa and then the penis is erect. I remember the sequence of digits by - "First comes the blood, then comes the boner."
First digit - BP
Second digit - sex steroids

An easier alternative submitted by Dev:
Just remember AT
A - Aldosterone

T - Testosterone

I modified it to cat.

Meow. 

-IkaN 

The basics: Lesions of Spinal Cord

Here is a basics video on Spinal cord with mnemonics for first year med students by Chaitanya Inge. Enjoy :)

Felix and Dreyer's tube mnemonic

The tubes used for serological diagnosis of typhoid are frequently asked and it takes many bungling to get the answer right. Here's a mnemonic which may come handy-

1. Felix tube- Short round bottomed which detects the 'O' antigen.
Remember the round bottom and round shape of the letter 'O'.

2. Dreyer's tube- Narrow, conical bottomed one which detects the 'H' antigen
Deserts are 'dry' and pyramids, which resemble cones are in the deserts of Egypt. Hence, conical bottomed Dreyer's tube. The letter 'H' is not round, so, it is this antigen which this tube detects.

Revise this mnemonic more than once so you get it clearly what's what.

-Sushrut Dongargaonkar

Episiotomy indications : Mnemonic

Hi everyone.
Posted in Ob-Gyn now. Let's just say it's not a lot of fun looking at diseased hoo-hoo's.
Just kidding.

Here's a Mnemonic for the absolute indications of Episiotomy.

Remember : PPPP

1. Perineum is rigid
2. Perineum has been operated on. (For Prolapse, stress urinary incontinence , etc)
3. Procedures are to be used. (Like Ventouse or Forceps)
4. Position / Presentation are abnormal. (Like Breech , face to pubis, shoulder dystocia , macrosomia)

The other indications which are non-absolute include :
- Maternal exhaustion
- Preterm/ post mature baby
- Trial of labour.

So I hope this didn't tear you up. (Pun intended).
Happy studying !
Stay awesome.
~ A.P.Burkholderia

Fact of the day: Shoulder dislocation

An anterior shoulder dislocation is usually caused by a blow to the abducted, externally rotated, and extended arm (eg, blocking a basketball shot).

Violent muscle contractions following a seizure or electrocution represent the most common causes of posterior shoulder dislocation.

Acute Kidney Injury due to Anticancer drugs

Hey guys, there are multiple causes of acute kidney injury in a cancer patient, namely sepsis, metastasis, tumor lysis syndrome, etc. But there is another reason which we often overlook, which is drug-induced.

1. Thrombotic microangiopathy: Associated with agents targeting vascular endothelial growth factor(VEGF), eg., Ranibizumab, Bevacizumab. These drugs also block the angiogenesis in the glomerular vasculature, such that the injured endothelium isn't replaced, leading to multiple foci of platelet aggregations just like in TTP and HUS.

2. Focal segmental glomerulosclerosis: Associated with tyrosine kinase inhibitors are the most common and are frequently associated with acute kidney injury.

3. Acute Interstitial Nephritis:
The checkpoint inhibitors ipilimumab, nivolumab, and pembrolizumab activate host T cells to enhance tumor killing by preventing tumor ligand binding to cytotoxic T-lymphocyte antigen 4 and programmed death 1 receptors, which deactivate T cells. However, this effect causes loss of self-tolerance (and perhaps tolerance to other drugs), leading to various forms of autoimmune injury, including acute interstitial nephritis, which is associated with moderate-to-advanced-stage acute kidney injury.

That's all!

-VM

Submissions: Syndromes associated with pheochromocytoma

Submitted by Vivek on the study group =)

Gross motor milestones mnemonic

Hello!

In this video, I talk about gross motor milestones from the age one to five years of age.

Source: Nelsons textbook of pediatrics.