External cephalic version mnemonic

When should ECV be performed?

Light's criteria for exudative pleural effusion

Here's a mnemonic on Light's criteria for exudative pleural effusion.

Mnemonico diagnostico : Direct laryngoscopy in Laryngomalacia

Hey awesomites

Laryngomalacia is the most common congenital anomaly of the larynx characterised by excessive flaccidity of supraglottic larynx which results in inspiratory stridor and cyanosis.

Mnemonic for Direct laryngoscopy findings : FlOP

Fl - Floppy aryepiglottic folds
O - Omega- shaped epiglottis
P - Prominent arytenoids

- The short bands ( aryepiglottic folds ) cause the epiglottis to curl upon itself.
- Epiglottis is elongated and folded longitudinally to form an omega.
- Arytenoids are situated posteriorly and show prominence.

Also check out the mnemonic for differentiating laryngomalacia from tracheomalacia Here .


Thats all
- Jaskunwar Singh

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.