AFASS criteria

Hello Awesomites ! :D

AFASS CRIETRIA is used to decide whether a HIV positive mother can breast feed or not provided that she has not started top feed yet.
(Why? Once the mother started to top feed the child, this criteria is not used. HIV positive mother in such case should continue top feed. Because mixed kind of feed is more dangerous than top feed alone)

Acceptable: The mother perceives no problem in replacement feeding. Potential problems may be cultural, social, or due to fear of stigma and discrimination.

Feasible: The mother (or family) has adequate time, knowledge, skills, resources and support to correctly mix formula or milk and feed the infant up to 12 times in 24 hours.

Affordable: The mother and family, with community or health system support if necessary, can pay the cost of replacement feeding without harming the health or nutrition status of the family.

Sustainable: Availability of a continuous supply of all ingredients needed for safe replacement feeding for up to one year of age or longer.

Safe: Replacement foods are correctly and hygienically prepared and stored, and fed preferably by cup.

Source: http://motherchildnutrition.org/info/afass-principles.html (Click to know what all questions are asked)

-Upasana Y.:)

Inguinal lymph nodes

Hello Awesomites! :)

Long time. Happy to be back. :D

Today we will study Inguinal Lymph nodes along with its clinical significance.

You know fascia lata is present in our lower limbs.

The Lymph nodes lying above it is called as superficial inguinal Lymph nodes.

The Lymph nodes lying beneath it is called as deep inguinal Lymph nodes.

The superficial Lymph nodes are further divided into horizontal and vertical groups.

The deep lymph nodes are deep to fascia lata and 1-2 nodes can be found in femoral canal. This nodes in the femoral canal are called as deep inguinal Lymph node of Rosenmuller or of Cloquet. This drains glans penis and clitoris.

Through the umbilicus is taken a watershed line of Lymphatic drainage of anterior abdominal wall.

The anterior abdominal wall below the umbilicus drains in the superficial inguinal lymph nodes.

Entire perineum except glans penis and glans clitoris are drained by superficial lymph nodes.
Most of the lower limb is drained by superficial inguinal lymph nodes except the territory of short saphenous vein (This part of lower limb is drained by popliteal group of lymph nodes).

Some part of Uterus and uterine tubes are also drained by superficial inguinal lymph nodes.

Anal canal below pectinate line also drains in superficial inguinal lymph nodes.

Superficial Inguinal lymph node drain lymph from the

1.     gluteal region,

2.      inferior anterior abdominal wall,

3.      perineum

4.     superficial lower limbs

5.     Anal canal below pectinate line

Deep Inguinal Lymph node drains

1.     deep lymphatics of the distal lower extremity

2.      perineum (e.g. glans penis / clitoris),

CLINICAL SIGNIFICANCE:

In sexually transmitted diseases, you will find enlargement of this lymph nodes.
Inguinal lymph nodes are the frequent sites of metastasis for malignant lymphoma, squamous cell carcinoma of anal canal, vulva and penis, malignant melanoma and squamous cell carcinoma of skin over lower extremities or trunk. 

-Upasana Y. :)

Allergic Broncho-Pulmonary Aspergillosis (ABPA) treatment mnemonic

To remember that Allergic Broncho-Pulmonary Aspergillosis is treated by corticosteroids mainly and not anti-fungals although Aspergillus is a fungus, just write:

Allergic Broncho- Pulmonary Aspergillosis ==> as => Allergic BronC-Orticosteroids Pulmonary Aspergillosis

and that's it :)

-Murad

Query on Step 2 CS deadline & match timeline

I read this link and I'm confused, it says:

To participate in the National Resident Matching Program® (NRMP®) Main Residency Match®, international medical students/graduates must have passed all exams required for ECFMG Certification. If you plan to participate in the 2019 Match (in March 2019) and still need to pass Step 2 Clinical Skills (CS), you should register now to take the examination.

To help ensure that your result will be available in time to participate in the 2019 Match, you must take Step 2 CS by December 31, 2018. If you do not register now and schedule soon, it is possible that you will not be able to obtain a test date in 2018. At the time of this writing, the earliest available test date at any test center is in August 2018.

Link: April 2018 https://www.ecfmg.org/news/2018/04/09/imgs-participating-in-2019-match-should-apply-for-step-2-cs-now/

I plan to apply for matching in 2019, do I need to take the exam in December 2018?

- Sent through email

Hello,

Let me clear terminologies before I start explaining.

Match 2018 means: Application in September 2017, results in March 2018, Residency starts in July 2018.

You said apply for matching in 2019, which means apply in September 2019 for the March 2020 match, yes?

Let's talk about the 2019 match mentioned in the link you sent. It says currently, there will be no availability of testing centres for this year's match (September 2018 application, March 2019 Match, Residency starts in July 2019). The ECFMG website is able to predict the number of applications that they are going to receive. This year, they predict there will be no testing centers available, which is why I am guessing they are asking you to register in April (register now).

Your confusion arises because of two reasons:
You don't know the match terminologies with respect to the year.
You don't know the timeline for the match.

When they mean apply right now and give the exam before December, they are talking as a general mandatory requirement. IT IS A ABSOLUTE MUST HAVE.

To be a competitive candidate, IMGs tend to give the exam in such a way that the results are out before September so that we have all the exam results before the application cycle of the match. IT IS OPTIONAL BUT PREFERRED.

So really, the virtual deadline to give the exam for us is July. We also prefer to graduate before September to get ECFMG certified, however, it's not mandatory.

It is quite vigilant of you to keep an eye out for these notices on the ECFMG website.

Since the dates are not easily available, when you plan to go for an elective, try to register in advance.

If you go to the ECFMG website, there is a site called a step 2 CS scheduling and you can view the dates available at various centres. So register as soon as possible if you want to get your desired dates. Here's the link https://csess2.ecfmg.org/calendar.aspx

PS: The step 2 CS permit is available for one year and it does not expire quickly (compared to other exam permits that expire in 3 months) which is a huge advantage.

So to summarize, July is the ideal deadline for Step 2 CS to get results before September (Application submission). December is the mandatory deadline to get result before February (ROL submission, to be eligible for the match).

Google the step 2 CS reporting schedule to help plan for your match.
https://www.ecfmg.org/news/2018/04/18/results-reporting-schedule-for-step-2-cs/

Hope that helps!

-IkaN

Enamel Rods

• An enamel rod is the basic unit of tooth enamel. 
• Measuring 4 μm wide to 8 μm high, 
• An enamel rod is a tightly packed, highly organized mass of hydroxyapatite crystals
• It provides rigidity to the rods and strengthens the enamel.
• Enamel rods normally have a clear crystalline structure
• Light can pass through rods
• Many rods have a fish scale appearance
• Shape: Hexagonal
• Pattern: Keyhole or paddle-shaped prism pattern

Number: 

• 5 million= mandibular lower incisor to
• 12 million= maxillary first molar

The direction of rods:

• Rods are rarely straight, they follow a wavy course from dentin to the enamel surface
• Generally, they are oriented at the right angles to Dentin surface 
• Horizontal direction in the cervical and central part of the Crown
• Oblique to vertical direction in the incisal regions

Striations: 

• Rods are built up of segments separated by Dark Line in a rhythmic manner
• Visible by the action of mild acids
• Striations are uniform of 4 centimetre

- Written by Anisha Valli

Hertwig's Epithelial Root Sheath- HERS

Hertwig's epithelial root sheath

• It originates from the cervical portion of the enamel organ.
• It plays an important role in determining shape length size and number of roots.
• It is a double layer of cells which consists of outer enamel epithelium and inner enamel epithelium.
• Root sheath extends around dental papilla and separates it from surrounding dental follicle all through except the Basil portion.
• Inner enamel epithelial layer of root sheath influences the formation of odontoblast from the outer portion of the radicular dental papilla. 
• These odontoblasts lead to the formation of the first layer of radicular dentin.

As the first layer of radicular dentin is laid down:

• HERS loses its continuity 
• The cells of the dental follicle or dental sac invade double layer of HERS 
• Root sheath degenerates to form epithelial Islands

Therefore, it allows connective tissue of dental follicle to come in contact with newly formed radicular dentin. 

This causes differentiation of cementoblast from dental follicle which deposits cementum on newly formed radicular dentin.

Transitory Sutures

Transitory Sutures are found in cap stage of tooth development

Enamel Knot: Enamel organ cells form a knob-like extension which extends to the underlying dental papilla.

Enamel cord: it is a vertical extension of enamel knot

Enamel septum: when enamel cord extends to meet outer enamel epithelium it divides stellate reticulum into two parts

Enamel navel: Depression present at the junction of enamel septum and Outer enamel epithelium is known as enamel navel and it resembles umbilicus

Enamel Knot signals determine the shape of the tooth
Enamel Knot and Enamel cord act as a reservoir of dividing cells 

- Written By Anisha Valli

Human Papilloma Virus mnemonics

To remember that HPV vaccination starts at 11 years old and that HPV is the most common STD in the US, use the following mnemonics:

=> Write Human Papilloma Virus with 11 instead of the 2 Ls so it becomes as follows:
Human Papi11oma Virus

the 11 in papilloma will remind you of number 11 :)

=> remember HPV as the Highest Prevalent Virus :P
so this will remind you that it is the commonest STD

and that's it

-Murad

MDMA mnemonic

Hello! 

This post is about MDMA.

MDMA? Yep. It's short for 3,4-methylenedioxymethamphetamine.

Commonly called “Molly” or “ecstasy”.

MDMA can elicit feelings of euphoria, wakefulness, intimacy, and disinhibition.

Intoxication causes dangerous side effects such as:

Hypertension
Hyperthermia
Delirium
Psychomotor agitation
Hyponatremia
Intracranial hemorrhage
Myocardial infarction
Aortic dissection
Disseminated intravascular coagulation
Rhabdomyolysis
Seizures
Serotonin syndrome

Here's a mnemonic!

That's all!

-IkaN

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

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.

Medicowesome secret project: Long Distance Metastasis

What is the secret project? How can I participate?

USMLEowesome: Basics about the Step 2 CS exam

Hello!

In this video I will cove the basics about the Step 2 CS exam:

Medicowesome secret project: Trouble in St. Bowel High School

What is the secret project? How can I participate?

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.

Medicowesome secret project: Calcified hearts

What is the secret project? How can I participate?

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

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.

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

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