Drugs used to lower blood pressure acutely in severe preeclampsia (Maternal hypertensive crisis) mnemonic
"Lower Hypertension Now"
Labetalol iv preferred (Avoid in bradycardia)
Hydralazine iv
Nifedipine oral
That's all!
-IkaN
Drugs used to lower blood pressure acutely in severe preeclampsia (Maternal hypertensive crisis) mnemonic
"Lower Hypertension Now"
Labetalol iv preferred (Avoid in bradycardia)
Hydralazine iv
Nifedipine oral
That's all!
-IkaN
Here's a short post on the key points about Congenital Diaphragmatic Hernia.
So there's deficiency in the diaphragm during development causing abdominal contents to budge into the Thorax.
There are 2 main types -->
1. Bochdalek.
2. Morgagni.
Now out of these 2, Bochdalek is commoner.
(It's hard to remember the word Bochdalek. I struggle with it every day. )
You can memorize it by realising that it rhymes with ' Scotch da Lake '
(Which means a lake of scotch in Punjabi)
Key points about Bochdalek -
BBBB
- Back - Located posteriorly
- Big - Bigger than the Morgagni form
- Bad - Poor prognosis
- Bag and Mask Contra indicated.
Also realise - Bochdalek
So it's got an L in it. L = Left. So it's more common on the left side. These hernia classically cause a scaphoid abdomen and Mediastinal shift to the opposite side.
Morgagni can be remembered by the opposite of the BBB
So it's
- Not on the back - Anteriorly
- Not Big - Small sized.
- Not as Bad - Prognosis is alright.
Also realise - Morgagni
It's got an R in it = Right. So it's more common on the right side. And it contains the Transverse colon generally.
So that's all !
Happy studying!
Stay awesome !
~ A.P.Burkholderia
Here's a short Mnemonic/Review of Important facts about Croup - Acute Tracheobronchitis !
Remember :
CROUPS
C - Common respiratory disease
R - Respiratory viruses like Parainfluenza
O - Oxygen Treatment (Humidified)
U - Ugly Cough - Barking / Seal like cough
P - Prodrome of illness followed by Inspiratory Stridor
S - Steeple sign on X Ray
It's helpful to remember Acute EPIGLOTTITIS as the complete opposite of CROUPS using similar ideas.
- Not as common.
- Caused by Bacteria generally (Strep , Hib)
- Oxygen Therapy + AntiBiotics
- Ugly - Sniffing dog like position + Drooling
- Prodrome not particularly, but Stormy acute onset.
- Shows Thumb print appearance on X Ray.
Hope this helped !
Happy Studying !
Stay awesome.
~ A.P.Burkholderia
Hello. This is a very short post (because I am super busy studying)
It's on differentiating C8 radiculopathy from Ulnar neuropathy based on a question I solved the other day. How would you differentiate the two in clinical practice?
C8 radiculopathy:
- Thumb abduction weakness: abductor pollicis brevis (C8, T1)
- Triceps affected (C6, C7, C8)
- Radiculopathies are often painful.
Ulnar neuropathy:
- Hand intrinsics (C8, T1) affected:
Palmar and dorsal interossei
Lumbricals III & IV
Abductor/opponens/flexor digiti minimi
- Basically, all hand intrinsics except for the median-supplied "LOAF" muscles (lumbricals I & II, opponens/ abductor/flexor pollicis brevis)
- Triceps not affected.
- Focal neuropathies aren't painful.
Conclusion: The ulnar nerve innervates all intrinsic hand muscles, except the abductor and flexor pollicis brevis, opponens pollicis, and lateral two lumbricals, which are innervated by C8 and T1 via the median nerve which helps differentiating the ulnar neuropathy from C8 radiculopathy.
That's all!
-IkaN
The point where the anterior ciliary artery pierces the sclera is often marked by a pigment. This is of particular importance while cauterization as in a bid to make everything look neat and shiny, the pigmented part shouldn't be cauterized as it will cause necrosis of the structures supplied by the artery.
1.A refractive error should be thoroughly assessed prior to surgical squint correction or the squint may recur.
2. Divergent squint occurs in myopes as the divergent system of muscles is more active during far vision. So, the far vision in myopes being hampered, the eyes try to diverge more.
3. Same goes for hypermetropes. They end up with a convergent squint if left uncorrected.
-That's all!
Sushrut Dongargaonkar
A posterior staphyloma is common because the durability of the layers of the eye where the optic nerve enters the eye is lesser in comparison.
-That's all!
Sushrut Dongargaonkar
Moxifloxacin is the preferred antibiotic in Ophthalmic surgeries and pathologies because it gets concentrated into the anterior chamber and the aqueous.
That's all!
-Sushrut Dongargaonkar
Hello there!
Today we'll see some important points on Electromyography (EMG) and Nerve conduction studies (NCS).
EMG evaluates abnormal electrical activity in muscles, and NCS investigates how electricity flows through a nerve.
They help to locate and determine the causes of diseases that affect muscles and peripheral nerves.
Procedure:
In EMG, a small needle is inserted into a muscle, to measure its electrical activity. In NCS, electrodes are placed on the skin overlying a nerve, and other recording electrodes are attached at a different point over the same nerve and a small shock is applied, and the electrical impulse is recorded.
Understanding the terminologies and results of these tests-
Amplitude: The electrical signal is represented as a wave, and the amplitude is its height.
ConductionVelocity (CV): The conduction velocity describes the speed at which the electrical impulse travels along the nerve.D
Duration This describes the width of an electrical wave.
ConductionBlock: The diminution of signal across an anatomical region such as the wrist. This suggests nerve entrapment.
So when a nerve stimulates a muscle to contract, there is a brief burst of electrical activity called a motor unit action potential (MUP).
Some of the abnormal responses seen are:
1)Fibrillations & positive sharp waves on the monitor seen in diseases of peripheral nerves.
Muscles sometimes start having spontaneous activity on their own.
2)Fasciculations: Sometimes the abnormality causes visible muscle twitches.
3)Abnormally large MUPS : These are seen If a nerve has been injured and then regrows.
On regeneration the nerve tends to branch out to include a wider area of the muscle and hence we get large motor unit potentials on the screen.
4) Abnormally small MUPS: When they're abnormally small or brief it suggests the presence of a disease of a muscle (a myopathy) where the muscle is unable to contract to and fails to provide the normal amplitude of the wave.
5)"Recruitment pattern": As a muscle is contracted, nerve fibers signal more and more bits of muscle (called motor units) to join in and help.
In a neuropathic disorder, the amplitude of different motor units is strong, but there are fewer of them because the nerve is unable to connect to as many units.
In myopathies, the number of motor units is normal, but the amplitude is smaller
You may never come across an actual EMG for an interpretation,but it is always good to know the investigation.
The interpretation of EMG and NCSs is not always straightforward and may not always lead to just one possible diagnosis — but the tests can reduce the number of diagnostic possibilities.
Hope this was helpful!
Let's Learn Together!
-Medha.
People with low levels of vitamin A who live with individuals who were sick with tuberculosis were 10 times more likely to develop the disease than people with high levels of the nutrient, according to research led by investigators at Harvard Medical School.
Vit A rich foods: Liver, fish, hard-boiled egg(not omelette), cheese, butter, cheddar etc
And now some vegetables: Sweet potato, Carrot, Squash, Spinach, Lettuce
Some fruits: Mango, Papaya, Guava, Watermelon, Apricot, Passion fruit
Another reason to love Mango!
-VM
Hello !
Let's see what this Dibucaine number is.
So Dibucaine is a local anesthetic.
Dibucaine inhibits 80% of the normal Pseudocholinesterase enzyme and 20% of the Atypical enzyme.
The number is determined by measuring the percentage of Pseudocholinesterase enzyme that remains unchanged in the blood of individuals administered a standard dose of Dibucaine intravenously.
Normal Dibucaine number is 70-80% i.e 70-80%of normal enzyme is inhibited by Dibucaine.
If there is a point mutation in the enzyme making it a Atypical Pseudocholinesterase then Dibucaine will not be able to inhibit it and the number will decrease.
This number is used to measure the activity of Atypical Pseudocholinesterase,and to assess the likely hood of prolonged apnea after succinylcholine administration.
Sodium Fluoride can also be used in place of Dibucaine.
If you know more on it Add to this information.
Let's learn Together!
-Medha.
Hey guys
This is one of my rare mnemonic posts. I don't post much on this coz most of my mnemonics are kinda personal if not socially inappropriate :p
So Noninvasive ventilation, imagine having a mask on ur face, all air tight, almost strangulating and as if this isn't enough, with multiple tiny outlets giving jets of air which are titillating your highly itchable nasal area.
Unpleasant, right?
Talking of unpleasant, you do remember Hitler, right?
He GAAASED the Jews, since that's not a possibility for us since we all love Zuckerberg let's think about something on a similar note.
"GAAAS the HOEs"
G- GI bleeding
A- Aspiration
A- Angina( including MI)
A- Arrest( Cardiac and Respiratory)
S- Surgery on ur face
H- Haemodynamic instability
O- Obstruction ( in upper airway)
E- Encephalopathy ( Severe)
S- _____
I've left the last one blank for the reader to fill up. Hint: It has something to do with obstruction of the lower airways.
Hope this is helpful!
-VM
Whats Salisbury effect?
It's a very interesting phenomenon.
It states that when coronary collaterals develop in the face of myocardial ischemia, they improve the blood supply. However they physically restrict left ventricular dilation and thereby raise LVEDP(LV end diastolic pressure) and reduce LV compliance.
This is because they act like tendrils/scaffold which prevent ventricular dilation.
Nice one!
-VM
Hi everyone ! Just a short review on Ductus Arteriosus.
- Ductus Arteriosus is basically a communication between the Pulmonary trunk and the Systemic Aorta.
- This communication is between pulmonary trunk and the end of Arch of aorta. Just after the Brachiocephalic trunk , and Left Common carotid and Subclavian have branched off.
- In embryonic life this communication helps transport blood from RV- Pulmonary artery to the Systemic circulation.
So ,
Remember :
Prostaglandins Persist
-Prostaglandins, especially PGE1 , act on the Ductal muscle tissue and keep it Open.
-So the Ductus arteriosus stays open.
-This is important in certain Duct dependent lesions
- Duct dependent heart lesions are those which need the presence of an Open ductus to receive blood in systemic / Pulmonary circulation.
- For example -->
✓ Duct dependent lesions for Systemic Circulation are those that cause obstruction to the Left side heart to pump blood into the aorta. These include :
- Coarctation of Aorta ( especially pre Ductal ) : Here there is a constriction of the aorta just before the ductus Arteriosus. So , a persistent Ductus would transport blood from pulmonary circulation into the systemic.
If ductus gets closed , there would be minimal blood flow to the Lower limbs and abdomen.
- Critical Aortic stenosis.
- Left side Hypoplastic heart.
~~~~~~~~~~~~~~~~~~~~~~~~~
✓ Duct dependent lesions for pulmonary circulation
-These are lesions where pulmonary blood flow would be severely reduced due to some RV- Outflow tract Abnormality and the only source to the lungs would be through the ductus shunting some blood from aorta into the pulmonary vein.
- These include :
- Critical Pulmonary Stenosis
- Hypoplastic Right heart syndrome
- Tetrology of Fallot
- Tricuspid Atresia
- Ebstein Anomaly
Another important disease is Transposition of the great vessels where this sort of corrects the defect.
~~~~~~~~~~~~~~~~~~~~~~~~~
So. We've seen in what conditions we'd like to keep the Ductus Arteriosus open / persistent.
Normally this Ductus closes functionally within 24 hours of birth. And anatomically between 10 and 14 days post natally.
If this persists on its own for a long time it causes a Congenital Heart Disease called Patent Ductus Arteriosus.
This defect is characterised by shunting of blood into the pulmonary trunk constantly during systole and diastole causing a Continuous murmur.
To close this ductus , we could try using Indomethacin / Ibuprofen especially in preterm children.
These drugs inhibit Prostaglandin synthesis , thus causing Ductus Smooth muscle to constrict and eventually close.
So that's all about the ductus !
Happy studying !
And Stay Awesome !
~ A.P.Burkholderia