Dwarfism vs Cretinism

Hello Everyone,
   How do we differentiate between dwarfism and cretinism?
Just remember GIRL

G- Growth- Reduced in both
I- IQ- Normal in pituitary dwarfism and decreased in cretenism
R-Reproduction-Absent or delayed puberty in both
L-Limbs- Proportionate in Dwarfs and Disproportionate in cretins.
                (C follows D)(cretins have disproportionate limbs)

What are features seen in a cretin?
Remember 5P's

1. Pot-bellied
2. Pale
3. Puffy-faced child
4. Protruding umbilicus
5. Protuberant tongue

That's all,
Thank you,
Chaitanya Inge

Authors' diary: Cerebellar tumor location and associated symptoms

Hello!

In 2013, I wrote this anatomy mnemonic on parts of the cerebellum and their functions.

I was tested this fact in a question today and I got it right. Yaay! :D

The question asked about a tumor, expected to know the most common location of the tumor and then expected you to know the symptoms caused due to it's location. Ooooh!

Anyway, lemme summarize what you should know:

Medulloblastomas usually occur in the vermis and spare the cerebellar hemispheres - They are more likely to cause truncal ataxia.

Pilocytic astrocytomas occur in the cerebellar hemispheres - They are more likely to cause intention tremors.

Added by VM:
An ependymoma can also cause truncal ataxia just like medulloblastoma. Ependymoma can be differentiated by it's location, again. Being more common on the floor of fourth ventricle, it will irritate area postrema and cause vomiting. It can also cause CN 7, CN 10 and CN 12 palsies. 

It's funny how in your preclinical years, all you ask is, "WHY DO I HAVE TO LEARN THIS?" 
And in your clinical years, you are always like - I wish I took my first and second year seriously! :P

-IkaN

Treatment of restless leg syndrome mnemonic + notes

Hello!

This is a loooooong post on the treatment of restless leg syndrome. (Bear with me!)

Those who are just here for the mnemonic 

Mechanism of action of gabapentin and pregabalin

Gabapentin binds to which of the following receptors?
1. GABAA receptors
2. GABAB receptors
3. alpa2delta subunit of voltage-sensitive Ca2+ channels
4. NMDA receptors

Akathisia vs Restless legs syndrome

Hey guys, Ikan posted a clinical vignette based on this differentiation. So I did a little digging.

Both Akathisia and RLS can be caused due to antipsychotics, Akathisia goes more with typical ones and RLS with atypical ones.

Besides RLS has some other characteristic features:

1. Associated with dysesthesia originating in legs whereas in case of akathisia patient feels like it's originating in the central core of the body.

2. RLS has evening-predominance, it disturbs sleep of the patient as the patient jerks his legs during sleep which might be noted by his gf or wife.

3. There is positive family history in RLS.

4. RLS can be induced by other centrally acting drugs like Diphenhydramine, Citalopram, Clonazepam etc if there is a positive family history.

Treatment:

First intervention should always be reduction of dose of antipsychotics.

While RLS responds well to dopamine agonists like Pramipexol and Ropinirole, Akathisia responds well to Mirtazapine, a tetracyclic antidepressant. Although withdrawing the causative drug works the best.
According to latest clinical trial reports, The first line treatment of akathisia is propranolol, second line is Benztropine​ and if these doesn't work we resort to benzodiazepines.

That's all! You never stop learning.

-VM

Abdominal Aorta Mnemonic

Hello Everyone,
Lets discuss abdominal aorta.
Its a game of odd numbers. Following branches are present:

• 3 Anterior
• 3 Lateral visceral
• 3 Terminal
• 5 Lateral Abdominal

3 Anterior branches single include:

• Coeliac Trunk (T12)
• Superior Mesenteric Artery (L1)
• Inferior Mesenteric Artery (L3)

3 paired lateral Visceral:

•  Middle Suprarenal(L1)
• Renal (between L1 and L2)
• Gonadal (L2)

5 paired lateral abdominal

• 4 Lumbar arteries (respectively at L1 L2 L3 L4)
• Inferior phrenic (T12)

3 Terminal

• 2 Common Illiac (L4)
• Median Sacral (L4)

How to remember it? @_@
Counter Strike Is MR GLIC's Mastery. ^_^

Fun Facts:

• There are 3 suprarenal arteries ( again a odd number). The superior branch is derived from the inferior phrenic artery, the middle branch originates directly from the aorta, and the inferior branch comes off the renal artery.

• The fifth lumbar arteries on either side arise from the median sacral artery. 

     Click Here to see a beautiful flowchart submitted to us.

That's all,

Thank you 

Chaitanya Inge

Fact of the day : Testosterone administration impairs 'cognitive reflection' in men

Hey Awesomites

You must have tried solving brain teasers at some point of time.. right? Ok so how many of you tried to solve it right at that instant ( sensing your gut reaction ), but guessed it wrong? If so, you might be having loads of testosterone in your veins!

X-Linked Dominant Disorders.

Hello everybody!

Let's learn a quick way to remember a few important X-linked Dominant Disorders.

The mnemonic goes like:

All Hypo Pigmented Rats Have Resistant Rickets.

All - Alport Syndrome.
Hypo - Familial Hypophosphatemia.
Pigmented - Incontinentia Pigmenti.
Rats - Rett Syndrome.
Resistant​ Rickets - Vit.D Resistant Rickets.

X linked dominant disorders are rare pattern of inheritance.

All affected males will transmit it to all their daughters and all affected females will transmit the disease to 50% of her sons/daughters.

If you have another mnemonic on the same do share.

Let's learn Together!
-Medha.

Marfan syndrome - High Yield Information.

Hello everybody,
lets today briefly revise all the high yield points on Marfan syndrome.

Marfan syndrome is an example of structural protein disorder and with autosomal dominant inheritance, lets see what exactly goes wrong in this condition.

Etiopathogenesis:

There is a missense mutation seen in the fibrillin-1 gene located on the chromosome no.15.
So to understand the condition better, lets understand a bit about fibrillin.

Fibrillin forms the glycoprotein component of cellular microfibrils and also provides a scaffold for the elastin deposition.
Abundant fibrillin is found in the connective tissues of the aorta,ligaments and the eye, these are the structures predominantly affected in the disorder too.

The defective fibrillin leads to defective microfibril assembly intracellularly and reduced elasticity in connective tissues.
 Defective fibrillin also leads to decreased TGF-beta(Transforming growth factor ) sequestration, and excess of TGF-B hampers normal vascular smooth muscle development and matrix production.

Morphological Features:

1) Skeletal changes:
    Tall stature with long extremities.
     Long tapering fingers and toes.(Arachnodactyly)
     Hyperextensibility.
     Dolicocephaly.
     Kyphosis ans scoliosis.
     Pectus excavatum or Pigeon breast deformity.

2) Cardiovascular changes:
     Aortic regurgitation: Due to aortic cystic medial degeneration leading to valvular ring dilatation & valvular incompetence. Most threatening valvular lesion.
     Mitral valve prolapse : Most common valvular lesion.
     Aortic Dissections are the most common cause of death in these patients.

3) Occular changes:
    Ectopia Lentis: bilateral superotemporal dislocation of lenses.
    Retinal Detachment : due to increased axial length of the globe.

Diagnosis:

Currently Revised Ghent Criteria is used for the diagnosis of Marfan syndrome.
It considers:
Family history,
Cardinal Clinical Signs in absence of family history,
Presence or absence of Fibrillin Mutation.

so that's all on marfans syndrome.

Fun Fact:
We all have been hearing about some famous personalities with Marfan syndrome like Abraham Lincon and Michael Phelps, but Tutankhamen the 11th pharoh of 18th Egyptian Dynasty was diagnosed to be suffering from Marfan's Syndrome by a series of CT scans and DNA tests carried out on his MUMMY!

Do post any other interesting facts you know about Marfan's Syndrome.

Let's Learn Together!
-Medha!

Fact of the day: Psychiatric effects of steroids

Did you know corticosteroid therapy can cause depression, mania, psychosis, and delirium?

Why?

The mechanism by which the corticosteroid induces symptoms such as mania, depression, and psychosis is not clear.

The administration of prednisone is associated with decreased levels of corticotrophin, norepinephrine, and beta-endorphin in the cerebrospinal fluid. Furthermore, corticosteroids induce an increased release of glutamate that induces neuronal toxicity due to accumulation effect.

-IkaN

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