Opportunistic infections in AIDS

AIDS is a retroviral disease caused by HIV. It is characterized by the triad of immunosuppression associated with:
1) Opportunistic infections.
2) ‎Secondary neoplasms.
3) ‎Neurological manifestation.

Opportunistic infections seen are:

1) Bacterial infections:

MANS.

M-M.tuberculosis
A-Atypical mycobacterial infections
N-Nocardiosis
S-Salmonella

M.tuberculosis is the most common infection with HIV in India.

2) Viral infection:

H.C. verma of John Cunningham.

H-Herpes simplex virus
C-Cytomegalovirus
V-Varicella zoster virus
John Cunningham -JC virus causing     progressive multifocal leukoencephalopahty.

3) Fungal infections:

H P computers creates crossword

H-Histoplasmosis
P-Pneumocystis jiroveci
computers-Cryptococcosis
creates-Coccidiomycosis
crosswords-Candidiasis

Candidiasis is the most common fungal infection of AIDS in India

Pneumocystis jiroveci is the most common fungal infection of AIDS in world.

4) Protozoal infection:
CITy

C-Cryptosporidium
I-Isosporidium
T-Toxoplasmosis

-Demotional bloke.

Metabolism of HDL notes

Hello, 

Here is a short post on the metabolism of HDL.

USMLE Step 3 - My two cents by Dr. B

USMLE step 3 - My two cents!

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

Hey everyone, this is my first blog! So I realised recently that Ear, Nose, Throat (or ENT for short) has a lot of theory so here's a short post on nasal polyps, for remembering this short, important but a little tedious topic. 

Antrochoanal and ethmoidal polyps are the commonly found types of polypoid growths found in the nasal cavity. They can be fleshy growth of tissue due to various causes, and usually leads to complaints of nasal obstruction and breathing difficulties. Here's a guide to remember the points of difference between the antrochoanal and ethmoidal polyps. For the following:

A - age 

A - aetiology

N - number

L - laterality

O - origin

G - growth

S - size and shape

R - recurrence

T - treatment 

The mnemonic is: "An Apple Never Lives On Green Shrubs (and) Red Trees" 

Interesting imagery, ain't it? 

So what are the differences between the two types of polyps based on these points? 

Age - antrochoanal polyps are found in children, whereas ethmoidal are found in adults. 

Aetiology - usually antrochoanal are having an infectious aetiology, whereas ethmoidal have allergic or other factors as cause for their origin. 

Number- only one antrochoanal polyp usually is present, whereas ethmoidal is usually multiple in number. 

Laterality - antrochoanal are unilateral, the other kind is bilateral mostly. 

Origin - Antrochoanal begins from the ostium of maxillary sinus but ethmoidal, as the name suggests, originates from the ethmoidal sinuses, uncinate process, middle turbinate and middle meatus. 

Growth - As the name suggests, this polyp grows behind towards the choana and hangs down behind the soft palate. The ethmoidal polyp, grows forward and may present at the nares. 

Size and shape - interestingly, antrochoanal polyps are trilobed with the three parts being antral, choanal and nasal. Ethmoidal are grape- like round masses. 

Recurrence - antrochoanal has lesser chance of recurrence as compared to ethmoidal polyps. 

Treatment - antrochoanal polyps are removed by polypectomy, endoscopic removal or Caldwell-Luc operation. Ethmoidal polyps are treated by ethmoidectomy, polypectomy or endoscopic surgery. 

I hope this has been helpful to you! Best of luck for your studies! 

Also, Fact Fatigue: Polyps growing in the ear, middle ear cavity ones, are never avulsed, because it's dangerous and could lead to damage to the branches of facial nerve passing through the walls of the middle ear.

This mnemonic was written by our Medical Student Guest Author, Devanshi Shah

Read more about MSGAI: http://www.medicowesome.com/2018/01/medical-student-guest-author-internship.html

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

Primary headache disorders are poorly understood and the treatment isn't satisfactory. Hence it's super important to rule out Secondary causes before labelling a patient to have primary headache.

Here's a summary of clinical profiles of patients with Primary Headache disease.

Patient profiles for primary headache disorders

1. Migraine headache

Age : 30-40 years

Sex : Females >>> Males

Frequency : May be random, usually following a trigger.

Trigger : Subjective ; Lack / excess sleep , Menses , Starving , Chocolate for some people , Excess sunlight , oily food , etc.

Character : Throbbing / Pulsatile headache

Distribution : generally hemicranial to begin with but may Generalise over 1-2 hours.

Associated features : 
Preceded by an Aura - in the form of halos / fortification Spectra / floaters etc.

The attack is associated with Nausea, vomiting , photophobia and phonophobia.

Post Headache state : weakness after the headache subsides. Generally 4-48 h is the duration.

> 72 h = Status Migranosus.

_______________________________________
2 . Tension type headache

Age : 30-40 years

Sex : Females = Males

Frequency : May be random. Can occur daily.

Trigger :  unclear ; Stress or Tension may or may not be an established risk factor.

Character : constriction/ band like sensation around the head - Like a helmet.

Distribution : band like around the head. Fronto occipital region affected more than others.

Associated features : 
NO nausea vomiting ; may have photo and phonophobia. Not as rapidly progressive as migraine headaches.

Post Headache state : weakness not as severe as in migraine headache.

_______________________________________

3. Cluster headache

Age : 20-30 years

Sex : Females <<< Males

Frequency : Can occur daily - classically at the same time every day or at similar intervals during the day.

Trigger :  unclear ; alcohol , smoking , hot weather may precipitate

Character : Throbbing / can be sharp pain. May be sudden in onset. Very severe.

Distribution : always unilateral and involves Peri and retrorbital area.

Associated features : 
Ipsilateral miosis , conjunctival injection , chemosis , rhinorrhea , sweating over forehead.
Patient may become agitated and restless.

Post Headache state : weakness not as severe as in migraine headache.
_______________________________________

Hope this post actually helped and wasn't merely a headache ;)
Happy Treating !
Stay awesome !

~ A.P. Burkholderia

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.

_____________________________

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

Have you ever wondered about the difference between non-essential and essential amino acids? 

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

Hello Friends! This is Anisha :))

Maxillary artery is divided into three branches. Again, each branch is subdivided. 

We also have to learn their course which is very confusing and we forget it during our exam :( 

So, I came up with an easy way to learn it. I decided that I will show the course of the artery in form of a diagram ( you will get more marks! ) and write down what it supplies. 

I hope my notes will help you :)) All the best

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

Hiiiii everyone, it’s mnemonic time again! From the title, I guess you all know what it is about… I had a hard time memorizing these tracts so I created this mnemonic to help you guys out!

he drove a honda CRV TO disneyland.

Corticospinal tract (Lateral & Anterior)

Rubrospinal tract
Vestibulospinal tract
Tectospinal tract
Olivospinal tract

**Disneyland = Descending. Hence, this mnemonic is for the descending 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

That Los Angeles STudent went up to stage and SCream using the PA system because he got a Freaking Cool First Grade result.

ST – SpinoThalamic tract (Lateral & Anterior)
SC – SpinoCerebellar tract (Posterior & Anterior)
FC – Fasciculus Cuneatus
FG – Fasciculus Gracilus

**Went up = Ascending. Hence, this mnemonic is for the ascending tract
**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)

Please comment if you have a better mnemonic! Let’s share our mnemonics ^.^

-Calvin Ong K. Y.

Complications of Myocardial Infarction Mnemonic

 Hello everyone!

Here's another whiteboard mnemonic of a commonly tested topic. The scary MI and the scary DARTH VADER from Star Wars.
































Let me know if anything requires clarification.

Hope it helps. Happy studying!
-- Ashish Singh