Monday, April 30, 2018

Conjunctival xerosis mnemonics

Conjunctival Xerosis

Hello everyone today let's discuss the causes and treatment of conjunctival xerosis.

So basically there are two types of conjunctival xerosis.
a. Epithelial xerosis
b. Parenchymatous xerosis

Epithelial xerosis.
The most common example is Xerophthalmia i.e. Vitamin A deficiency.

Let us discuss Xerophthalmia.

The cause of vitamin A deficiency is mostly its dietary deficiency or defective absorption.

The new WHO classification of Xerophthalmia

XN:   Night Blindness
X1A: conjunctival xerosis
X1B: bitots spots
X2:   corneal xerosis
X3A: keratomalacia <1/3rd of cornea
X3B: keratomalacia >1/3rd of cornea   
XS: corneal scar
XF: fundal changes – known as Uyemura spots, these are defects in the Retinal
Pigment Epithelium.

Treatment:
It consists of local ocular therapy with artificial tears along with vitamin A therapy.
Schedule for vitamin A is as follows :

>1 year of age – 1lakh IU i.m. given on 0 1 14 days
                                OR
 2lakh IU orally given on 0 1 14 days

<1 year of age – half the dose.

This has to be carried along with treatment of underlying causes like malnutrition or other disorders like diarrhoea dehydration.

Other causes of night blindness:
1. High myopia
2. Late stage of angle closure glaucoma
3. Oguchi syndrome
4. Gyrate atrophy of choroid
5. Retinitis pigmentosa

Parenchymatous Xerosis
It mainly involves the adenoid layer of the conjunctiva.
It can take place due two main reasons     holla! We have a mnemonic here
1. Due to cicatrizing disorders  (cicatrizing disorders turn conjunctiva reasonably shrivelled)
2. Due to over exposure to atmosphere ( marked exposure causes parenchymatous xerosis)

Cicatrizing disorders
1. Cicatricial phemphigoid
2. Diptheric membranous conjunctivitis
3. Trachoma
4. Chemical burns
5. Radiotherapy
6. Stevens-johnson syndrome


Overexposure to atmosphere
1. Marked proptosis
2. Ectropion
3. Coma (lack of blinking)
4. Palsy of cranial nerve 7 (facial palsy)

That’s all for now,
Stay Awesome!
Keep calm and keep studying!

- Ashish G. Gokhale

Wednesday, April 25, 2018

Step 2 CK: Blunt abdominal trauma

Hello!

When you are presented with a case of blunt abdominal trauma (BAT) in your exam, first determine whether the patient is stable or unstable.

Saturday, April 21, 2018

Medicowesome secret project: Trouble in St. Bowel High School

Coronary circulation: Fun fact about blood flow to the myocardium

Hello everyone, here is a post busting a myth about coronary circulation.

Many of us have always thought that the heart itself receives blood during diastole which is only partially true. Here is the complete story.

Getting back to basics, let us revise a bit about the cardiac anatomy.

Tuesday, April 17, 2018

USMLEowesome: United States Clincal Experience (USCE), electives and obs...

United States Clinical Experience - An overview

Intended audience: Those who want to know more about USCE


What this video will cover:
Why do you need USCE?
Types of USCE
Deciding where to apply, which electives?
Paperwork required for electives (brief overview)
Strong letter (applicable for USCE and the match)
CV (brief overview)
Visa interview: Important! Do not mess it up!
If you are not accepted: Have back ups!
If you are accepted: Video for another time :)

Links from the video:

Types of USCE:
http://www.medicowesome.com/2016/03/a-short-post-on-how-to-apply-for.html
http://www.medicowesome.com/2016/04/dr-thinker-united-states-clinical.html
http://www.medicowesome.com/2017/06/my-elective-experience.html
http://electives.us/typesofusce.html

Paperwork:
http://www.medicowesome.com/2016/03/a-short-post-on-how-to-apply-for.html
http://electives.us/electiveapplication.html 

Read this before your visa interview: http://electives.us/usvisaandelectives.html

Link to the powerpoint:
https://drive.google.com/open?id=1aRH5u4Vk7RfHIKrBsDl0TjTMtuVmlVnW

That's all!

-IkaN

Sunday, April 15, 2018

USMLEowesome: Studying for the USMLE Step 1 exam

Hello!

The intended audience for this video is those who have decided to give the exam and are starting to study for it.

Friday, April 13, 2018

Facebook: Microbiology Candida.

So, this post is the answer to our previous question asked on medicowesome facebook page. Question was

#Medicowesome #Microbiology

A vitreous aspirate from a case of metastatic endopthalmitis on culture yields Gram-positive round to oval cells, 12-14 mm in size. The aspirate on Gram staining show the presence of pseudohyphae. Which of the following is the most likely aetiological agent?

1)  Aspergillus.
2)  Rhizopus.
3)  Candida.
4)  Fusarium.

Answer: Option 3) Candida.

Let's analyse the question and extract the information one by one.
So, we get two things from the question.
a) The causative organism has pseudohyphae and
b) It is stained by gram stains.

Among the given options, only Candida can form pseudohyphae. All other options are filamentous fungi forming true mycelia and Candia is the only fungi that are usually gram positive on smears.

Some awesome points that must be known on Candida infections.

1) Candida is unicellular organism belonging to yeast like fungus categories. All Candida species are commensals of humans. So, their mode of transmission is endogenous while most of the fungus have mode of transmission as inhalation.
2) They form pseudohyphae.
3) Candida albicans is different from other candida because :-
   a) It forms true hyphae or germ tubes when grown in serum.
   b) It forms thick walled large spores called chlamydospores.
   c) It is dimorphic. It means it grows as yeast at 37°C and as molds at 25°C.

4) Test to differentiate between C. Albicans and other Candida is called germ tube test or Reynolds Braude phenomenon.
-C. Albicans when placed at 37°C in human serum forms germ cell tubes within 2 hours.
5)Candida albicans is the most common cause of mucosal candidiasis.
6) Candidiasis is the most common systemic mycosis. It is also the most common fungal infection in neutropenic and immunocompetent patients.
7) It causes oral thrush, oesophageal candidasis, cerebral candidasis and pulmonary candidiasis.

Extra information:

Their is one test which I learned online and some people consider it as diagnosis of candida infections.

The Spittle Test:
When you get up in the morning, and before you brush your teeth, eat or drink anything, fill a glass with bottled water at room temperature.
Spit some saliva gently into the glass.
Come back every 20 minutes for the next hour and check for some of these signs.

1) Strings coming down through the water from the saliva at the top.
2) Cloudy saliva sitting at the bottom of the glass.
3) Opaque specks of saliva.

Also, in above question we deducted that the given pathogenic organism is gram stain so we get to learn about stains as well.
Normally, fungi are stained by PAS and methenamine silver but some fungi are stained by special stains like :-

Candida is stained by gram stain.
Cryptococcus is stained by mucicarmine, India ink.
Histoplasma is stained by Giemsa stain.

Thanks for reading!
Ojas Gite.

.

Schizophrenia: Types and Prognosis mnemonic

Schizophrenia: Types and Prognosis mnemonic.

So to begin with, Schizophrenia is a psychiatric disorder classified under psychosis.
Psychosis is a mental state involving loss of contact with reality, causing deterioration of normal social functioning. 

Features of psychosis are:
Loss of insight.
Marked disturbance in personality and behaviour.
Loss of contact with reality.
Impairment in judgement.
Presence of delusions and hallucinations.

A quick recap : Psychosis is classified as   -

• Organic e.g. Substance related psychosis, head trauma
• Major e.g. Schizophrenia, mood disorders
• Third psychosis e.g. delusional disorder, acute and transient psychotic disorders.

There are 7 types of schizophrenia and the mnemonic goes like
PHC (primary health centre) U R SO far

1. Paranoid: The commonest type and good prognosis. The onset is later in life 3-4th decade. Major symptoms are delusion of persecution and grandeur.

2. Hebephrenic: 2nd most common and the worst prognosis. Disorganisation of thought, speech, affect and personality is more prominent than other types. Also there is marked emotional impairment.

3. Catatonic: The best prognosis (especially reactive catatonia). Characterised by marked disturbance in motor activity. Further divided into 3 forms i.e. Excited, Stuporous, and one alternating between the two.

4. Undifferentiated: Where symptoms do not fit in any subtypes.

5. Residual: Chronic type where the positive symptoms vanish and patient is left with 'residual' negative symptoms

6. Simple: only negative symptoms from onset (no positive symptoms at all)

7. Others (f): 
Schizophrenia + mental retardation = Pfropf syndrome
Schizophrenia + self-mutilation = Van-Gogh syndrome

Now let us see what exactly we mean by positive and negative symptoms.
Positive symptoms are those psychotic symptoms not seen in normal individuals (of course, haa!) but are “actively expressed” in the patients (something is added extra and so called positive).

Negative symptoms are normally expected behaviours like emotions like feelings thoughts and drives that a normal person experiences are absent in the patient (Normal things are being taken away and so called negative).

That’s all for now,
Stay awesome!
Keep calm and keep studying!
-Ashish G. Gokhale

Thursday, April 12, 2018

USMLEowesome: Basics about the Step 1 exam

This video is for those who have no idea about the Step 1 exam.



Things I forgot to cover in this video:
You can not retake the exam, if you pass or fail, you score stays forever!
How the score is reported and what is a good score.

It'll be covered in the next video.

Download the slides from here:
https://drive.google.com/open?id=1cETyEFg4kJS8uXYTF8twPg22CLqPCfiE

That's all!
-IkaN

Being street-smart during interviews: Flights!

During the hectic interview season and when you wanna travel from the east coast to the west coast, you will need flights for sure :D

Below are some tips about tickets and flights:

1- buying tickets:

> It is almost always cheaper to buy tickets online, check: Expedia, Kayak, Google flights and Cheapoair websites and compare the prices.

> Check Southwest (recommended) website too, its flights won’t show in the websites mentioned above.
What is special about Southwest is that it allows you to have 2 checked bags (up to 23 kgs each) for free! Also, you can change your flight one-time without paying anything or pay the difference between the 2nd ticket but without losing the original one.
Southwest has some nice offers too and tickets sometimes go as low as 49$ :O

> There is an app called “Hopper” on smartphones, it gives you the prices of different flights and notify you if the prices go up or drop. It also shows you which days are more expensive and which are cheap.
It sometimes shows you a bit more expensive price than the websites mentioned above so you can use it to have a general idea about cheaper days then buy the ticket from the internet.

2- When to buy the ticket?

> In general, the earlier you buy the ticket, the cheaper it will be. Be careful, sometimes this doesn’t happen and you suddenly find that the price of a certain flight has dropped so keep looking.

> Some airlines may have some offers on Black Friday and Cyber Monday so stick to your laptop these 2 days and save some money :D

> Avoid buying tickets during the Christmas season. Prices become crazy skyhigh!

3- Which airlines to choose?

I will talk about the ones I tried only:
American Airlines and United: pretty much the same (at least in my experience), the price of any checked bag is not included in the ticket so you need to pay for it (25$ or 35$). They also charge you 100$ if you have an overweight bag ( >23 kgs / 50 pounds ).

They have a rule that you have to check your “checked bag” 30 and sometimes 45 minutes before your flight, so even if you arrive 30 minutes before your flight and you have a bag to check, you will miss the flight and automatically rescheduled to the next one.

Spirit: Although some people had bad experiences with it, it still has one of the cheapest ticket prices, but put in mind that you ll pay for everything in your flight including the water you drink. (Interestingly, my experience with them was so smooth though)

Other airlines include but are not limited to: Delta and Frontier.

Some important tips:

> If you travelling to a small city, don't fly there directly. Instead, book your flights to the city with a bigger airport (mostly the capital of each state) then take a bus from their to your desired destination. This can also be done to states that are near each other (Fly to a state near to your final destination then take a bus from that state). This may help in saving a lot of money but will need more time.

> Don't forget to check the weather forecast, snow storms result in many cancellations.

> For international travelers to US, if your airport doesn't allow you to board the plane except if you have a return ticket, you can simply buy a return ticket within 24 hrs of your departure flight and cancel it after your check in. This is better than buying a round-trip ticket or paying a fee to change the date of the return flight especially if you are not sure of this date.

===
Update: 6/2/2018...Thanks to Hyndavi:
copied:

I used Delta airlines for most of the part.
1. They allow you a free carry-on bag which is good for carrying interview stuff. Compare prices with other airlines adding the baggage cost and make a purchase.

2. In December and January, there might be a lot of delays and flight cancellations. Make sure you call them after your trip and ask for compensation. They usually credit in miles which you can use at later stage. There are incidences where I claimed even after a month. Email or lodge a complaint.They are pretty responsive. American airlines is good too.

3. Whenever there is a delay or cancellation request them for an immediate rescheduling. For interviews during December and January, try to take the earliest flights possible to avoid missing an interview.

4.Try to carry a snack whenever possible as food in the airports repeatedly can cause unwanted expenditure.

5. Never check-in a carryon bag because a luggage missing or any delay can affect your interview. Sometimes, they just collect if before boarding and give it back after landing, which is ok.

6. Regarding Southwest, if you cancel a ticket, you get a credit into your Southwest account which you can use at a later stage. .
========
Comment below for any other tips you feel may be helpful :D Happy flying everyone :)

-Murad