Saturday, July 22, 2017
Rash involving hands and feet mnemonic
Hypervitaminosis A mnemonic
Hello!
Here's a mnemonic to remember the features of Hypervitaminosis A.
The mnemonic is, "H.A.R.D. Puzzle."
H - Hepatosplenomegaly, Hair sparse, Hyperostosis
A - Anemia, Anorexia
R - Really painful bones
D - Dry skin
Puzzle - Pseudotumor cerebri
Thank you.
MD Mobarak Hussain (Maahii)
Necrotizing Enterocolitis - Important points
Here are some high yield points about Necrotizing Enterocolitis.
1. It is the most common life threatening emergency of gastrointestinal tract in neonates.
2. Triad of - Intestinal ischemia, enteral nutrition and bacterial translocation.
3. Distal part of Ileum and proximal segment of colon are most frequently involved.
4. Coagulation necrosis is the characteristic histological finding in the intestinal specimens in Necrotizing Enterocolitis.
5. Pneumatosis intestinalis (air in the bowel) is diagnostic on X-ray.
6. Portal venous gas shadow is a sign of severe Necrotizing Enterocolitis on X-ray.
7. Most important risk factor is Prematurity.
8. Pneumoperitoneum is a sign of advanced NEC with perforation.
These points should help you in quick revision.
Thank you!
MD Mobarak Hussain (Maahii)
Friday, July 21, 2017
Lung Cancer Subtypes
Subtypes of lung cancer:-
1. Squamous cell cancer-
Most common variant in India.
Smoking is a risk factor.
Central in location.
Local growth is surgically resectable.
Cavity formation is seen.
2. Adenocarcinoma-
Most common variant of lung cancer overall.
Most common lung cancer among non smokers.
Peripheral in location.
Transbronchial spread i.e. it arises at one lobe and spreads to the another lobe.
3. Small cell carcinoma/Oat cell carcinoma-
Most aggressive variant.
Smoking is a risk factor.
Central in location.
It exhibits micrometastasis.
It has worst prognosis.
4. Large cell carcinoma-
Observed in Non smokers.
Peripheral in location.
This is associated with Estrogen production which manifests as Gynecomastia.
I hope this will help you to distinguish between the various subtypes.
Thank you
-Md Mobarak Hussain (Maahii)
Thursday, July 20, 2017
Oxalate stones in Crohn's Disease
Tachyarrhythmias
Here are some high yielding MCQ points on arrhythmia
Most common arrhythmia mechanism is re-entry.
Most common sustained arrhythmia is atrial fibrillation.
Most common benign rhythm identified is atrial premature contraction.
Most common arrhythmia in COPD patient is multifocal atrial tachycardia.
Post operative atrial fibrillation is managed with landiolol hydrochloride.
Atrial fibrillation getting converted to ventricular fibrillation is seen with accessory pathway conducting antegradely like Bundle of Kent in WPW syndrome.
VT storm or electrical storm is 3 or more separate episodes of VT within 24 hours.
Most commonly identified arrhythmia in cardiac arrest patient is ventricular fibrillation.
Most common cause of Sudden death in HCM is polymorphic VT/Ventricular fibrillation VF.
Thank you
-Md Mobarak Hussain (Maahii)
ERAS token, AAMC account, Letter of Recommendation
Viral Exanthems - Mnemonic
Mnemonic to remember the Viral Exanthems of childhood
ME gave ROSE to my BELLA after eating CHICKEN at 5 PM.
ME =MEasles
ROSE= ROSEola
BELLA = ruBELLA
CHICKEN = CHICKEN Pox
5 P= 5th disease (Parvovirus)
Thank you!
-Md Mobarak Hussain (Maahii)
Megaloblastic Anemia
1. Why do we get " Megaloblasts" in Megaloblastic anaemia?
2. Why we get anaemia in Megaloblastic anaemia?
Megaloblastic anaemia is called so due to presence of " Megaloblasts" in bone marrow.
What are " Megaloblasts" They're gigantic, abnormally BIG RBC-precursors seen in bone marrow. WHY do we see them ?
It needs some conceptual understanding.
Normally, RBC-precursors are big cells which divide rapidly as they mature & become progressively smaller as they divide while maturing towards mature-form of RBCs. Now, the problem begins in Megaloblastic anaemia that this cell-division is impaired due to lack of nutrients ( Folate & Vitamin B12). Vit B12 & Folate are critical for normal DNA synthesis & cell maturation. It's also described by a complex -term called " Nuclear-Cytoplasmic Asynchrony".
As DNA-synthesis is impaired, nuclear maturation of RBC-precursors get slowed up & could not match with the pace of cytoplasmic maturity/development. This DEFECTIVE NUCLEAR MATURATION halts cell-division & those big "MEGA" RBC-precursors remain as Big, MEGA, gigantic " Megaloblasts" in bone marrow giving the name as " Megaloblastic anaemia". Moreover, these " Megaloblasts" do NOT mature enough to get released into the peripheral blood & most RBC-precursors undergo " apoptosis " or apoptotic-death in bone marrow ..this causes anaemia in Megaloblastic anaemia.
Hope this helps some of you to understand the basic concepts.
-Md Mobarak Hussain (Maahii)
Wednesday, July 19, 2017
Monday, July 17, 2017
Brain to gut: Lets talk
The brain and gut chat and share neurohumoral and immunologic messages with each other most of the times. That is why our emotions affect our stomach and intestines and vice versa. This healthy communication is disturbed when we are stressed out, anxious, or depressed.
Stress (more of psychological type) influences the type of bacteria inhabiting the gut, making a loss of our bowel flora diversification and increasing the concentration of harmful pathogens in the gut, thus leading to certain inflammatory and infectious processes.
Chronic flare - ups of inflammatory bowel disease result in deviation of the mood towards negative side by upto 60 percent by a process of rewiring the neuronal circuitary, called neuroplasticity. This inturn worsens the condition of gut on long-term basis.
Recent studies suggest that talk therapy - particularly cognitive behavioral therapy, and anti- depressants may be supportive in such cases to reduce the flaring up of inflammatory bowel syndrome.
In case of irritable bowel syndrome, that is a functional disorder ( without any actual organic cause ), the CBT and use of anti- depressants improve the symptoms in upto 60 percent patients. But which patients are likely to benefit still needs further research. Till then, we know that a referral for talk therapy in the patients of IBS is a must.
Thats all
- Jaskunwar Singh
Sunday, July 16, 2017
Favorites of brain cells: The game of genetics
Many cells in the brain express two copies of a gene - maternal and paternal. But some express only one. If the single copy that is expressed carries a genetic mutation, it may result in cellular dysfunction and thus there are consequences.
Research on newborn mouse suggests that in about 85 percent of genes in the dorsal raphe nucleus, known for secreting serotonin, differentially activate their maternal and paternal gene copies. Ten days later in the juvenile brain, both copies are activated equally for all but 10 percent of genes.
The disparity also occurs in humans and in other systems like liver and muscles.
Like for example, in humans, a gene called DEAF1 that is implicated in autism and intellectual disability, shows a preferential expression of one copy of genes in multiple areas of brain. This is true for genes in other mental and neurologic disorders like Huntington's disease, schizophrenia, ADHD, and bipolar disorder.
( Source )
Thats all
- Jaskunwar Singh
Novel Monoclonal Antibodies: Emicizumab and Caplacizumab
Emicizumab:
Patients with Haemophilia A need regular infusions of Factor VIII, and a majority of patients develop antibodies against this exogenous factor VIII rendering the therapy less effective.
Emicizumab is here to solve this problem. It mimics the physiological function of factor VIII, that is to enhance the interaction between activated factor IX and factor X to facilitate the activation of factor X. Emicizumab binds both factor IXa and factor X and increases the interaction between them.
Caplacizumab:
Patients with Thrombotic Thrombocytopenic Purpura(TTP) has antibodies against ADAMTS13. Reduction of ADAMTS13 levels leads to formation of vWF multimers that enhance platelet aggregation and consequent thrombus formation in all major systemic blood vessels. The current therapy protocol consists of Plasma exchange and Immunosuppressants.
Caplacizumab binds to vWF and prevents its interaction with GP1b receptor on platelets, thereby inhibiting platelet aggregation.
-VM
Fact of the day: Liquid biopsy for cancer detection
We have known since long that surgical biopsies done routinely in cancer patients to diagnose and detect progression of the disease may increase the risk of carcinogenic changes in the cells in future, due to the changes that had prompted the biopsies.
A non - invasive and painless diagnostic tool that replaces the cutting is "liquid biopsy" that finds the hidden cancer cells anywhere in the body. The liquid biopsy is taken from a simple blood test to look for microscopic pieces of DNA circulating in the blood that contains genetic mutations causing tumors to spread, among billions of other DNA that were in the blood.
A year ago, a circulating tumor DNA test was approved by FDA that spots these mutations.
Thats all
- Jaskunwar Singh
Saturday, July 15, 2017
Poikilocytosis
Also known as erythrocytes, is the most common type of blood cell and the principal means of oxygen transport in the body.
The normal biconcave shape is the essential feature of its biological function.
Through various stages of development and maturation, RBC loses its nucleus and most organelles in order to accommodate maximum space for haemoglobin.
This feature of RBC is critically affected by genetic and acquired pathological conditions.
Poikilocytosis is the term used to denote the variation in the shape of red blood cells.
Let's look at the major abnormalities in the shape of RBCs and the conditions in which they are seen:
1. Spherocyte - hereditary spherocytosis, autoimmune haemolytic anaemia, ABO haemolytic disease of the new born
2. Schistocyte - thalassemia, hereditary elliptocytosis, megaloblastic anaemia, iron deficiency anaemia and severe burns
3. Irregular contracted red cells - drug and chemical induced haemolytic anaemia, unstable haemoglobinopathies
4. Target cell (a type of leptocytosis)- iron deficiency anaemia, thalassemia, chronic liver disease and after splenectomy
5. Sickle cell (drepanocyte)- sickle cell anaemia
6. Tear drop cell - myelofibrosis, underlying marrow infiltrate
7. Crenated red cell - in blood films due to alkaline pH, presence of traces of fatty sustances on the slides or film allowed to stand over night
8. Acanthocyte - post splenectomy, chronic liver disease, Abetalipoproteinemia, McLeod blood group phenotype
9. Burr cell - uremia, liver disease, artifact
10. Stomatocyte - hereditary stomatocytosis, chronic alcoholism
11. Ovalocyte - hereditary ovalocytosis, hereditary elliptocytosis, severe iron deficiency anaemia
The diagram given represents the corresponding cells
Credits to: Shivani Mangalgi.
Myopathies series- Part 2
Diagnostic role of enzyme in myopathies.
- ELEVATED CK: - In Glycogen storage disease associated myopathies.
(In some GSD there will be mild elevated CK) - MILD ELEVATED CK:- In Fatty acid oxidation disorder.
- NORMAL CK: - In Mitochondrial myopathies.Also in some fatty acid oxidation disorder.
Metabolic myopathies types:-
1. Second wind phenomenon: - suggestive of GSD V / McArdle’s
LDH, PGM or PGK enzyme deficiency
CPTII Deficiency
4. Proximal weakness: - GSD II / Pompe.
Fact of the day: Gonorrhea and vulvovaginitis
Friday, July 14, 2017
Evaluation of Pseudophakia
Clinical evaluation of a case of Pseudophakia.
Pseudophakia is a term used to describe the condition wherein an artificial intraocular lens is implanted after surgery for cataract.
On history - History of cataract surgery present.
On examination -
1) Deep Anterior Chamber (the posterior support for the iris is lost as the IOLs are thinner that the natural lens)
2) Conjunctival flap and subconjunctival hemorrhage ( seen only in recent cases)
3) Scleral/ Corneal incision and scar.
4) Iridodonesis (tremulous iris)
5) Jet black pupil
6) Shimmering light reflex from the IOL.
Oculocardiac Reflex
Oculocardiac Reflex/Aschner phenomenon.
This is one of the trigeminovagal reflexes produced on digital massage of eye. Digital massaging of the eyeball is done to lower intraocular pressure after producing a retrobulbar or a peribulbar block. But rarely....this event is followed by cardiac depression, asystole and even death. The afferent is by the ophthalmic division of trigeminal nerve which relays in the visceral motor nucleus of the vagus nerve. The efferent is carried by the parasympathetic vagus nerve to the heart. It is most commonly seen in pediatric cases during squint surgery.
It is not seen very commonly in adults and in other surgeries as the procedure would involve just one eye and massaging of this eye is not sufficient to produce bradycardia normally.
Treatment: atropine or glycopyrrolate . Cardiopulmonary resuscitation might be needed in severe cases.
Thursday, July 13, 2017
Bulbar and Psuedobulbar palsy : Overview
Here's a short overview of Bulbar and Pseudobulbar palsy !
If there is a lesion is at the level of Medulla - affecting the motor neurons : The nuclei of the cranial nerves - you get LMN Palsy features - Flaccid paralysis of 9 10 11 12 Cranial nerves. This is called a 'Bulbar palsy' as the bulb (Medulla) is involved in isolation.
Now , essentially when the fibres supplying the motor neurons of the bulb (your Medulla) are affected themselves - that is any neurons above the nucleus of the nerve - it's a UMN lesion. So you get 9 10 11 12 UMN palsy - Spastic paralysis.
This would be Pseudo-bulbar as same CN involved but lesion is above the Medulla
So Pseudobulbar you'd have a hyper active gag reflex while it'll be absent in Bulbar.(Mediated by 9th cranial nerve).
You'd have a Hot potato like speech in Pseudobulbar as your vocal muscles of larynx and tongue are spastic. - (10th and Cranial 11th. )
While you'd see a nasal twang in Bulbar (also called Donald duck speech)
As your soft palate doesn't abut against the nasal cavity (due to LMN flaccid paralysis). Also causing nasal Regurgitation of food in Bulbar.
So they both essentially present with 9 10 features and some of the 11 12. Hence one is Pseudo and the other is true Bulbar.
Psuedobulbar would also have emotional problems. Called Pseudobulbar affect (as the higher fibres are involved - lesions are generally multiple infarcts in the cortex).
A few important causes :
Psuedobulbar palsy :
- Vascular = B/L Frontal lobe lesion , B/L Pontine stroke , Vascular dementia = Multi infarct dementia.
- Central Pontine Myelinolysis
- Degenerative = Multiple sclerosis , Motor neuron disease
- Cerebral Palsy
_________________________________
Bulbar palsy :
- Guillian Barre Syndrome
- Polio
- Motor neuron Disease
- B/L Medullary infarction
Hoping this helped !
Happy studying guys !
And stay awesome !!
~ A.P.Burkholderia.