Thursday, November 8, 2018
Management of Diabetic Ketoacidosis
Wednesday, November 7, 2018
Assessment and plan: New onset atrial fibrillation with rapid ventricular response
Here is case one for the A&P series!
Assessment and plan: 99 yo M with PMH of ... admitted for ... is being evaluated for new onset atrial fibrillation with rapid ventricular response.
Authors' diary: Assessment and plan
As a medical student rotating in the US, I would have a tough time "typing" the assessment and plan. I would have it straight in my head but putting it all into words was difficult. I guess because I came from a different medical system where we don't write assessment and plan in our notes.
Monday, November 5, 2018
Anti-Ro/SSA antibodies and neonatal lupus
Did you know? Anti-Ro/SSA antibodies are associated with neonatal lupus (congenital heart block (CHB), neonatal transient skin rash, hematological and hepatic abnormalities).
How do I remember this?
Thursday, November 1, 2018
Algorithmic Management of Organophosphate Poisoning
*Use of benzodiazepines has been associated with decreased mortality and morbidity, even in the absence of convulsions.
Signs of atropinization refer to the target end-points for atropine therapy and includes:
- Clear chest on auscultation, no wheeze
- Heart rate >80 beats/min
- Systolic Blood Pressure >90 mmHg
- Dry axillae
- Pupils no longer pin-point (miotic)
Early treatment with oximes is necessary before phosphorylated cholinesterase enzymes undergo “aging” and become resistant to reactivation (due to loss of their alkyl group).
That would be all.
Happy studying!
- Ashish Singh.
Monday, October 29, 2018
Role of BNP in acute exacerbation of COPD
Heart failure and COPD are common and they commonly co-exist in the same patient. Diagnosis may be difficult during acute exacerbation.
BNP/nT-pro-BNP is good Negative predictive value to rule out the presence of heart failure.
Spirometry is useful when the patient’s volume status is optimized. During acute HF exacerbation, diagnostic accuracy may be limited.
ECHO may be helpful to rule out systolic or diastolic dysfunction.
Why is it important to know?
Some therapies in COPD may be associated with worsening cardiac events in HF patients.
1) Oral steroids: - increased sodium and fluid retention.
2) Beta2 agonist: - increased HR and increased oxygen demand.
3) Aminophylline: - increased risk of arrhythmia.
You can further read about this in Link between COPD and HF
HAPPY STUDYING !
-Upasana Y. :)
Sunday, October 28, 2018
IRIS (Immune reconstitution inflammatory syndrome)
In terms of understanding immunity, HIV and leprosy never fails to fascinate me.There is whole spectrum of change in response of immune system.
So let us begin with the immune system which begins to recover. (Fall down 7 times get up 8!)
Immune reconstitution inflammatory response abbreviated as IRIS is a condition seen in some cases of AIDS or immunosuppression, in which the immune system begins to recover, but then responds to a previously acquired opportunistic infection with an overwhelming inflammatory response that paradoxically makes the symptoms of infection worse.
There are 2 presentations:-
1. Paradoxical IRIS: worsening of symptoms of a known disease during ART
2. Unmasking IRIS: present of an occult opportunistic infection, in which disease that was not clinically apparent prior to ART, manifests during ART
Proper history:
-Time course of symptoms
-History of Opportunistic infection,
-Recently diagnosed Opportunistic infections
-Treatment of Opportunistic infection: date of initiation, adherence, duration and clinical response
-ART initiation date,
- Specific antiretroviral regimen,
-medication adherence,
-Previous history of ART
-CD4 cell count and HIV viral load before ART initiation
-Current CD4 cell count and HIV viral load,
The risks of corticosteroid therapy should be weighed against the severity of the IRIS manifestations and the potential benefits.Risks of corticosteroid therapy include the following:
-Hyperglycemia.
-Hypertension.
-Mental status changes.
-Avascular necrosis.
-Worsening of an existing infection.
-Predisposition to a new infection.
It teaches me something about "Balance".
-Upasana Y. :)
Facebook:ENT X-rays part - 1
#Medicowesome
#Ent
Which is the last sinus to appear radiologically on X-ray?
1) Maxillary sinus
2) Ethmoid sinus
3) Sphenoid sinus
4) Frontal sinus
Answer with detail explanation through blog in 12 hours.
So, this post is regarding our Facebook page question on ENT X-rays.
Correct answer is Option 4- Frontal sinus.
Let's get into some details and all of them are potential one liner questions.
Order of development of Paranasal sinus is
Maxillary > Ethmoid > Sphenoid > Frontal
I remember this order with mnemonic - "MESs Food"
Maxillary sinus and (Anterior) Ethmoid sinus are present at birth.
Maxillary sinus appears at 4-5 months of age radiologically.
(Anterior) Ethmoid appears at 1 year of age radiologically.
Sphenoid sinus: Development start at 2nd or 3rd year after birth and continues till adulthood. Making it last sinus to complete development.
It appears radiologically after 4 year of birth.
Frontal sinus: Development starts after 4 year of birth and completed at 13-14 years of age.
It appears radiologically after 6 years of birth.
Happy learning :)
-That's all
-Demotional bloke.
CHA2DS2-VASc Risk Score
You all must be familiar with the complications of atrial fibrillation (AF). The management of atrial fibrillation is centered on these complications.
Thromboembolism is caused by AF. CHA2DS2VASc score is to estimate stroke risk in AF patients and to start OACs (oral anticoagulants).
Previously, we have CHADS2 Score.
HEART FAILURE OR LVEF LESS THAN OR EQUAL TO 40%
|
1
|
HYPERTENSION
|
1
|
AGE MORE THAN OR EQUAL TO 75
|
2
|
DIABETES MELLITUS
|
1
|
STROKE,TIA or THROMBOEMBOLISM
|
2
|
VASCULAR DISEASE (PREVIOUS MI,PERIPHERAL ARTERY DISEASE, OR AORTIC
PLAQUE)
|
1
|
AGE 65-74 YEARS
|
1
|
FEMALE SEX (BUT NOT A RISK FACTOR IF FEMALE SEX IS THE ONLY FACTOR)
|
1
|
MAXIMUM SCORE
|
9
|
SCORE 0
|
RECOMMEND NO THROMBOTIC THERAPY
|
SCORE 1
|
CONSIDER RISK/BENEFIT AND HAS-BLED SCORE TO AID DECISION OF ANTI-THROMBOTIC OR ANTI PLATELET THERAPY
|
SCORE 2
|
RECOMMEND OACs
|
HAS-BLED is a scoring system developed to assess 1-year risk of major bleeding in patients taking anticoagulants with atrial fibrillation.
-Upasana Y. :)
Saturday, October 27, 2018
Studying for Step One
Euvolemic hyponatremia algorithm
Saturday, October 20, 2018
Lab values Fishbone skeleton / Ishikawa Diagram in text
Tuesday, October 16, 2018
Why is the level of Vitamin B12 increased in CML?
Pathophysiology: The transport of vitamin B12 in the blood as well as hepatic uptake require the presence of transcobalamins (TCBs).
TCB types I (TCB I) and III (TCB III) ensure the binding of ∼80% of circulating vitamin B12.
Monday, October 8, 2018
ACHOO SYNDROME.
- Sneezing induced by feeling full. (One case study of a relatively normal 32-year-old man found that "fullness of the stomach immediately after meals invariably results in three or four uncontrollable sneezes."
- And the weirdest: For some, eating chocolate can induce some unwanted sneezes how barbaric.
Let's Learn Together.
-Medha Vyas.
x
Sunday, October 7, 2018
Question: Caloric test
#Ent
2) Eyes moves slowly to left
3) Eyes moves rapidly to left
4) Eyes moves rapidly to right
Wednesday, September 26, 2018
Inverse glaucoma
In normal eye aqueous humour flow from ciliary body to anterior chamber. In Malignant glaucoma or Aqueous misdirection syndrome, aqueous humour escapes into posterior chamber. Now posterior chamber has two fluids - aqueous and vitreous. This mixture now push our lens forward. This leads to formation of shallow AC.
Now in this case if I give Pilocarpine then ciliary zonules will be slacked which will ultimately causes lens to move more anteriorly, leading to shallow AC.
Remember: Pilocarpine is DOC for acute congestive glaucoma and it is C/I in inverse glaucoma.
So I will need to give drugs which will cause tightening of ciliary zonules. This can happen when I will relax ciliary muscle. Now relaxation of ciliary muscles is done by cycloplegic drugs. Example - Atropine/ Homatropine.
Did you see the contrast?
Atropine is C/I in Acute ACG but it is DOC for inverse glaucoma!
Hope it helps!
That's all
-Demotional bloke
Saturday, September 22, 2018
Congenital syphilis picmonic
With reference to this post: http://www.medicowesome.com/2017/03/buzz-words-for-congenital-syphilis.html
Friday, September 21, 2018
Significance of ictal head turning in frontal and temporal lobe seizure
Wednesday, September 19, 2018
Question: Rhinoscleroma
#Ent
2) Caused by fungus
3) Treatment by antifungal drug
4) Caused by bacteria
5) Causative organism may be cultured from biopsy material
Question: Rhinosporidiosis.
#Ent
2) Grayish mass
3) Surgery is the treatment
4) Radiotherapy is treatment
-One chitinous wall
-Clear cytoplasm
-Nucleus along with nucleolus
-Outer Chitinous
-Inner Cellulose layer
Water contaminated by diseased animals.
Can extent upto soft palate.
Bleeds easily on touching. So, we can also see blood tinged discharge.
Complete excision with diathermy knife and cauterization of its base.