Thursday, January 25, 2018
Arterial Supply of the Head & Neck in a Nutshell!
Here’s some mnemonic I created myself for the branches of external carotid artery and the branches of facial artery. To memorize the name of the branches of external carotid artery, you just need to....
IV cannula color code and size mnemonic
IV cannula color code and size mnemonic
Here is an interesting way of remembering the colors of the IV cannulas that I found in the comments section of Quora. Hope it is helpful!
We start from gauge size number 14 upto gauge size number 24.
All we have to do is remember the layers of the earth from the core right upto the sun.
1) Core of the earth is the innermost layer which is orange - number 14
2) Layer of clay which is grey - number 16
3) Layer of grass which is green - number 18
4) Flowers which are pink - number 20
5) The blue sky - number 22
6) The sun which is yellow- number 24
7) Beyond the Earth is the galaxy which is purple / violet - number 26
This mnemonic was written by our Medical Student Guest Author, Daksh Mehta!
Moderate Ascites : An approach to management
Hi everyone ! This is just a general proforma on how to manage Moderate ascites occuring due to Liver Cirrhosis.
Hope you find this helpful.
Moderate Ascites
Ix :
- Complete hemogram
- LFT : complete ; look for Liver dysfunction. Important parameters for Alcoholic liver disease : AST / ALT ratio > 2 and GGT levels raised.
- Creatinine BUN : for Pre renal AKI / Hepatorenal Syndrome
- Electrolytes : Sodium , Potassium , Calcium.
- Urine Routine and Microscopy
Ascitic fluid analysis -
∆ Biochem : SAAG ( Serum Ascites Albumin Gradient) , Ascitic fluid Proteins , ADA.
∆ Path : Cell count. ( > 250 per micro litte suggests Spontaneous Bacterial Peritonitis).
∆ Micro : Microscopy and Culture.
USG
AFP (Alpha feto protein) for HCC screen.
Rx :
- Bed rest and admit the patient
- Salt reduced to < 2g/day
- Fluid restricted - less than 1 L per day
- Spironolactone 100 mg per day +/- Frusemide 40 mg. ( Gen Frusemide added on day 4)
- Monitor output , input , girth , weight
- Ideal Weight loss - 0.5 - 1 kg/day
- If not - amp up doses of diuretics by day 3/4
- Max doses = Spironolactone 400 mg
Lasix = 160 mg
- Therapeutic Paracentesis indicated if - Tense Ascites , Child B Cirrhosis , creatinine < 3.
5-10 L in an hour can be removed + IV albumin 6-8 gm/L
If failure to respond to Max dose of diuretics - that is 400 mg Spironolactone and 160 mg Frusemide , it is termed as Refractory Ascites and needs further evaluation and Paracentesis.
_________________________________________
Basis for using Spironolactone as preferred drug in Cirrhotic Ascites : Ascites occurs in these patients Largely due to lack of degradation of Steroids by liver, and activation of Renin Angiotensin Aldosterone system.
Basis for SAAG ratio :
Difference between Serum and Ascitic fluid Albumin.
i.e. SAAG = Serum protein - Ascitic fluid protein
If the difference is more than 1.1 it indicates the Ascitic fluid was not very proteinaceous and in fact had low protein compared to serum , i.e. , it's a Transudative Ascites. Most important of which is Liver Cirrhosis (Where the Serum proteins are low themselves as well, so is the total Ascitic fluid protein.)
If the difference is less than 1.1 it indicates the Ascitic fluid was highly protein rich and it's an Exudative Ascites.
Let me know if you'd like anything clarified.
Hope this helps !
Happy Studying!
Stay awesome :)
~ A.P. Burkholderia
'Named Murmurs' : Eponyms and Cardiac Auscultation
Hi everyone !
So I'm posting after ages now , since final exams just got done.
Hopefully I'll be a doctor soon (fingers crossed).
This post is about few important named auscultation findings in Cardiology. It'll provide a list of things at the same place, hopefully you find it helpful 😃
So here we go :
1. Graham Steele Murmur
What is it : Early to Mid Diastolic Murmur at Pulmonary area
Which condition(s) : Pulmonary Regurgitation
Key features : can be seen in Right sided overload states eg. Right ventricular failure , Mitral stenosis (MS).
( Remember Mnemonic : General Secretary or Public Relations : GS PR, trust me I've used this about Everytime I've been asked this Q)
2. Carvallo Sign
What is it : increase in intensity of a systolic murmur bear Apex on inspiration.
Which condition(s) : Tricuspid Regurgitation (TR)
Key features : So the murmur of TR is a systolic one. This is heard very close to the Apex and at times may be confused for the Systolic murmur of Mitral Regurgitation.
Since the murmur of TR is a right sided murmur it increases in intensity on inspiration (as venous return increases to the right side on inspring ) , while the murmur of MR may reduce / even disappear on inspiration.
3. Austin Flint Murmur
What is it : Mid Diastolic Murmur at Mitral area
Which condition(s) : Aortic Regurgitation (AR)
Key features : It is a functional murmur seen in AR. When the blood regurgitates from the aorta to the Left Ventricle , a jet may strike at the mitral valve leaflet - narrowing its lumen producing a functional mitral stenosis , presenting with a Mid Diastolic murmur.
4. Carey Coombs Murmur
What is it : Mid Diastolic Murmur at Mitral area
Which condition(s) : Mitral Valvulitis ( Rheumatic )
Key features : It's different from MS murmur : No Opening snap , no radiation , no Pre systolic accentuation.
5. Gallavardin phenomenon
What is it : Systolic Murmur heard at the Apex
Which condition(s) : Aortic Stenosis
Key features : functional murmur heard at Apex in AS - example of conduction of murmur.
( So I always would confuse Gallavardin and Carvallo.
Here's a Mnemonic : Gal's AS is on fire. )
6. Still's murmur
What is it : Systolic murmur ( without thrill)
Which condition(s) : Random : in Children
Key features : Musical murmur ( innocent ) seen in kids , absolutely harmless.
7. Hemic Murmur
What is it : Systolic Murmur ( Without thrill)
Which condition(s) : Severe Anemia
Key features : Functional murmur.
8. Gibson Murmur
What is it : Continuous murmur at upper left sternal border
Which condition(s) : Patent Ductus Arteriosus
Key features : said to have a 'Machinery' character.
Hope you find this helpful !
Happy studying !
Stay Awesome. :)
~ A.P.Burkholderia.
Hypolipidemic drugs classification mnemonic
Hypolipidemic drugs classification mnemonic
The mnemonic for classification of hypolipidemic drugs is, “DIBS On Oily Food”
D - Dietary cholesterol absorption inhibitors
Ezetemibe (E for Eat)
D and E are alphabets next to each other.
I - Inhibitor of TAG synthesis and lipolysis
Nicotinic acid (I looks like a cigarette, that reminds you of Nicotine hence, nicotinic acid)
B - Bile acid sequestrants
Cholestyramine
Colestipol
Colesevam
B and C are alphabets next to each other.
S - Statins
Mnemonic: PLAy with Skipping RoPeS
P - Pravastatin
L - Lovastatin
A - Atorvastatin
S=> Statin (All end with statin)
R - Rosuvastatin
P - Pitavastatin
S - Simvastatin
O - Omega 3 fatty acids
O - Others such as Gugulipid
F - Fibric acid derivatives
Mnemonic: Fabric Clothes, Gems and Benz are Fine
Fabric - Fibrates (most of them end with fibrate)
C - Clofibrate
G - Gemfibrozil
B - Benzafibrate
F - Fenofibrate
Hope this helps!
This mnemonic was written by our Medical Student Guest Author, Anagha Rao :)
Wednesday, January 24, 2018
Magnesium sulphate in management of pre-eclampsia (dosing)
Medicowesome Student Guest Author Internship (MSGAI) program
We are launching the Medical Student Guest Author Internship (MSGAI) program for Medicowesome this month!
If you have wanted to contribute or write about medicine but you haven't been able to - this is your chance! :)
For this project, I am not only asking people to write mnemonics and posts but also mentoring student authors who are interested in medical education. It's basically a small program on how to compile ideas and make them presentable. Writing and teaching has also made me a better student (and helped with my grades!) so I will be giving a little guidance on that as well.
But to participate in the Medical Student Guest Author Internship program you must have:
Neural crest (clinical aspect)
Neural crest forms neural and non-neural population.
1. Facial clefts, ear malformations, and other facial defects-
4. Pigmentary disorders
Tuesday, January 23, 2018
Hepatic encephalopathy
Step 3 CCS tips & Frequently Asked Questions
This post is all about how to study for CCS.
How to study for CCS?
Use the UW software. It is more than enough.
Should I do Archer videos?
They are just 5 videos and are not mandatory to do. It's just that most students do not know how to fast forward the clock, change location, etc. and Archer does a pretty good job at explaining it. (I might do a video later!)
Should I opt for softwares other than UW?
It is not necessary because UW has just enough. Other softwares might train you to do "extra" unnecessary orders which maybe sub-optimal in the real exam because there is not enough time to do everything.
MUST DO before the real exam: Practice the CCS cases on the usmle.org website. You have to be comfortable with the software and the different orders available.
Monday, January 22, 2018
Interesting physical exam finding in Henoch-Schonlein purpura
Here's a cool fact that someone I absolutely adore shared with me: The Pediatricians call Henoch-Schonlein purpura as, “Butt-itis” because the rash frequently coalesces on the pressure points and is gravity dependent, in other words, on the buttock!
Thursday, January 11, 2018
Henoch Schonlein purpura
HSP is also known as Anaphylactoid purpura.
• Most common vasculitis in children.
• Most common Leucocytoplastic vasculitis.
It predominantly affects small vessels (venules, capillaries, arterioles).
It is usually self limited but may progress to end stage renal disease.
Clinical features:
1) Skin: rash, palpable purpura (non-thrombocytopenic purpura).
2) Joints: arthritis, arthalgia.
3) Kidneys: glomerulonephritis (proteinuria, hematuria).
° Severe renal failure occurs in about 1-2%, characterized by crescenteric glomerulonephritis which is treated with intravenous methyl prednisolone.
4) GIT : colicky abdominal pain.
On investigation: total Ig A increases.
Renal biopsy: mesangial Ig A deposits.
Treatment: conservative treatment
Oral prednisolone may be given.
Thanks for reading.
Madhuri Reddy.