Tuesday, February 6, 2018
Monday, February 5, 2018
USMLE Step 3 - My two cents by Dr. B
My name is Dr. B and I have recently finished my Step 3 - results aren’t out yet, but I hope I can stay as just the author of this article and not have to read it once more. Fingers crossed!!
Pearls on polyps
Sunday, February 4, 2018
Headaches : Fun Facts
Here's just a list of fun facts about headaches :p
You might find some of them lame but hey, I can write whatever interests me - this is My-Graine you see ! (Sorry about that, had to crack that graine up since it's mine ;;) )
1. Coffee is actually an Anti Migraine substance ! It helps in vasodilation of cerebral vessels since it contains Caffeine and Theobromine (Compare : Theophylline) which are PDE Inhibitors.
There are drugs that combine Caffeine with Aspirin for this purpose ! Who would've thought ! Surprisingly, through mysterious mechanisms , Caffeine may Trigger migraine in few people.
(Go figure.)
2. Telcagepant is a novel drug being tried for treatment of Migraines. It's a CGRP Antagonist - Calcitonin Gene Related Peptide - Which is said to be a molecular mediator for Migraine headaches.
3. Constipation was said to cause headache. There's no evidence to prove this but old timers might still prescribe laxatives to treat headache.
4. Oxygen therapy helps treat Cluster headache !
5. Migraines may sometimes occur without headache ! Yeah , who would've thought.
So the patient would experience all other symptoms : Aura , Photo-phonophobia with vomiting and nausea , a mild headache And the post headache weakness !
It may actually become a stroke mimic at times as the weakness is pretty severe.
It's called "Acephalgic migraine"
6. Bickerstaff Migraine is a type of migraine where brainstem features are prominent. Also called Basilar migraine.
7. Tension type headache is the most common type of Primary headache ! But it may not have anything to do with being stressed at all.
8. People with cluster headaches may get so worked up and agitated they may actually want to bang their head and beg you to kill them , it's so severe ! (Talk about banging your head against a wall?)
9. There is a type of headache called 'Analgesic Overuse Headache'. The person with a known headache disorder begins to abuse NSAIDs to such an extent that taking the NSAID causes the headache ! So the solution is simple right ? STOP the NSAID?! BUT NO. IT'S NOT AS SIMPLE.
There is a sort of Physical dependence on it. And the withdrawal period is also characterized by headaches for a couple of of days/ weeks till the headaches finally stop. (What a pain!)
10. A subarachnoid Hemorrhage may be preceded by a series of minor headaches called 'Sentinel Headaches'. They can be warning signs in a known hypertensive and must be taken seriously.
That's all!
Hope this helps.
Happy Studying!
Stay awesome!
~ A.P.Burkholderia
Headache : Clinical Overview of Primary Headache Disorders
Preceded by an Aura - in the form of halos / fortification Spectra / floaters etc.
2 . Tension type headache
NO nausea vomiting ; may have photo and phonophobia. Not as rapidly progressive as migraine headaches.
Ipsilateral miosis , conjunctival injection , chemosis , rhinorrhea , sweating over forehead.
Patient may become agitated and restless.
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Happy Treating !
Stay awesome !
Headache : An Overview of Secondary Headaches
Headache
Headaches are possibly the most common symptoms patients might present with to Neurologists , and even to a General Practitioner!
Here's a more practical and clinical approach to identifying the cause of a headache.
Headache disorders can be secondary to a systemic or neurological condition such as Meningitis or Dengue ; or can be due to a primary headache disorder such as Migraine or Tension headache.
In this post I'd like to summarize causes of secondary headaches.
Important Causes of Secondary Headache
- Refractive Errors : if an Adolescent or person in his 20's comes with headache , it's important to look into the possibility of a Myopia causing headache.
- Hypertension : especially occipital headache in a 40-50 year old obese male.
- Sinusitis : Maxillary and Frontal sinusitis can commonly cause headache and may confuse for a primary headache disorder.
Associated with Post nasal drip , upper respiratory tract infection , sinus pain on bending over and tender sinuses.
- Systemic Infections :
Dengue - Especially a bifrontal headache
Malaria
Typhoid fever
- Meningitis , Encephalitis, Brain Abscess
Meningitis is typically fever , headache and altered sensorium with neck stiffness.
If these features are present with Diffuse Neurological depression it can be Encephalitis and if Focal features it could be an Abscess.
Tuberculous Meningitis is an important entity to be considered for Chronic headache in India.
- Venous Sinus thrombosis : Suspect in Females on OC Pills / Hormone Replacement or Men on chemotherapy.
Presents with chronic headache and may be accompanied by focal features occassionally.
- Trauma
- Sub Arachnoid Hemorrhage : the typical Thunder clap headache followed by complete collapse of the person is typically for SAH.
Typically in 30-40 year old men , with history of senitnel headaches and generally hypertensive.
- Brain Tumors
- Temporal Arteritis : 60 years and above - Large vessel Vasculitis causing sharp superficial headache especially in temporal region , raised ESR and responsive to steroids to a good extent.
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The next post will be a summary of clinical profiles of primary headache disorders.
Hope this helped !
Happy Studying!
Stay awesome !
~ A.P. Burkholderia.
Crepts : An Overview
Hi everyone ! Just a short summary post on Crepts. Would like to thank Upasana for suggesting this topic !
Crepts
1 . Synonyms = Rales , Crepitations , Crackles
2 . Character = Rustling/ Bubbling type of sounds
Short , sharp, interrupted sounds.
(Wet Sounds)
3 . Types =
Fine and Coarse crepts -
Differentiation is clinical - fine crepts have a shorter amplitude while Coarse crepts have a higher amplitude and are usually louder with a lower frequency.
So , if you hear crepts of mellow tone (lighter quality) , with a very small gap between two crepts they are fine.
If they are very harsh and widely spaced they're likely to be Coarse crepts.
As a thumb rule , fine crepts are generally Cardiac and Coarse are of Respiratory origin (with exceptions).
4 . Special types of Crepts :
Velcro crepts = Fine crepts of Interstitial Lung Disease
Coarse leathery crepts = Harsh Coarse crepts of Bronchiectasis
5 . Mechanism of Crepts :
- unclear but certain reasons are hypothesized.
- When an Alveolus is in a collapsed state and then bursts open it produces a crept.
So for example - in a pneumonia due to the exudates accumulated in the alveolus there is very little air in it and the alveolus is in a collapsed state at the end of expiration. Due to this, when a person inspires the collapsed alveolus and airway suddenly open with a snap and produce a sharp sound due to sudden pressure equalisation.
When many such alveoli open in a serial fashion from top to bottom we hear the typical bubbling sound of 'Crepts'.
- Older reasons - Air bubbling through exudative alveolus. But rejected as other forms of airway Obstruction like Bronchiectasis and Fibrosis causing collapsed airways also causes crepts.
6 . Causes of Crepts :
- Pneumonia / Consolidation
- Interstitial Lung Disease and Pulmonary Fibrosis
- Bronchiectasis
- Bronchitis
- Lung Abscess
- At times in COPD patients - Expiratory crepts may be heard.
Cardiac causes :
- Pulmonary edema due to Left Ventricular Failure.
7 . Cardiac vs Respiratory crepts :
Cardiac crepts are typically Basal and Bilateral , are fine crepts , associated with features of Heart Failure and may disappear on adminstering diuretics.
The opposite is true for Respiratory crepts.
Hope this was concise enough and helped !
Happy Studying!
Stay Awesome!
~ A.P.Burkholderia
Transamination
I’m pretty sure you know the difference :))
If non-essential amino acids are not delivered to the body through diet then how are they made in the body?
Answer is simple it is by the process of transamination
I hope my notes will help you! If you have any doubts, don’t hesitate to comment or send a message on WhatsApp group :)
Maxillary Artery notes
Saturday, January 27, 2018
Autonomic neuropathy in diabetes mnemonic
Autonomic neuropathy in diabetes mnemonic
Hi everyone! This is one of the longest mnemonic in my sleeve.
I made this one up because it comprises a group of bizzare symptoms which we seldom relate to diabetes and take less notice of. These symptoms are indications of poor glycemic control.
The mnemonic is, 'AUTONOMIC NEUROPATHY' itself:
A - Abdominal fullness
U - Urinary incontinence
T - Tachycardia (Resting)
O - Oesophageal atony (Dysphagia)
N - Nocturnal sweats
O - Oedema (dependent)
M - Micturition delayed
I - Infection
C - Constipation
N - Nocturnal diarrhoea
E - Erectile dysfunction
U - Uncontrolled glycaemia
R - Retrograde ejaculation
O -
P - Pupillary signs (pupil size decreases, delayed or absent reflexes)
A - anhidrosis
T - Temperature (cold feet)
HY - Hypotension (postural)
This mnemonic was written by our Medical Student Guest Author, Nikhil
Mnemonic for the Ascending tracts & Descending tracts in Spinal Cord
Vestibulospinal tract
Tectospinal tract
Olivospinal tract
**Since it’s a descending pathway, so all the fibers will travel to spinal cord from their origins. Therefore, just add “spinal” after each word (e.g. …spinal tract)
**Don’t forget that there’s lateral and anterior for Corticospinal tract. Honda CRV from Los Angeles maybe? Hahahah :3
SC – SpinoCerebellar tract (Posterior & Anterior)
FC – Fasciculus Cuneatus
FG – Fasciculus Gracilus
**Los Angeles for STudent ; PA for SCream
**In addition, if you follow the order of FC and FG, it actually matches with the position of them from left to right in the spinal cord and mirror reflect them. (FC àFG à FG à FC)
Friday, January 26, 2018
The basics: Osteomyelitis
Osteomyelitis is an infectious disease that attacks the bones, specifically the bone marrow. It can have several etiologies: infection from an open fracture, postoperative infection, spread of a blood-borne infection such as pharyngitis, otitis etc. The causative organisms are most often staphylococcus aureus and group A streptococcus.
It is manifested by episodes of fever, often excruciating pain and functional impotence in the affected limb.
It is prevalent among the poor, especially children. In Haiti, it represents a real cause of morbidity and mortality.
It can eventually cause various complications such as: chronic osteomyelitis, pathological fracture by weakening of the bone, length difference in limbs etc.
This mnemonic was written by our Medical Student Guest Author, Rebecca St Louis
She originally wrote this for us in French:
*Ostéomyélite aigüe*
L'ostéomyélite est une maladie infectieuse attaquant les os plus précisément la moëlle osseuse. Elle peut avoir plusieurs étiologies: infection à partir d'une fracture ouverte, infection post-opératoire, propagation d'une infection hématogène comme une pahryngite, une otite etc. Les germes en cause sont le plus souvent le staphylocoque auréus et le streptocoque du groupe A.
Elle se manifeste par des poussées de fièvre, par une douleur souvent atroce et une impotence fonctionnelle au niveau du membre atteint.
Elle est prévalente chez les pauvres surtout les enfants. En Haïti, elle représente une véritable cause de morbidité et de mortalité.
Elle peut occasionner àla longue diverses complications telles que: ostéomyélite chronique, fracture pathologique par fragilisation de l'os, différence de longueur au niveau des membres etc.
De ce fait, contribuer à l'abaissement de l'incidence de cette pathologie est d'une importance capitale. Voilà pourquoi nous encourageons les parents:
- à promouvoir l'application des règles d'hygiène par les enfants dès les premières années.
-à penser rapidement à faire sougner leurs enfants en cas d'infections hématogènes.