Monday, November 12, 2018

True or False #3

1. A high potassium diet, decreases risk of kidney stone. T or F

2. Increase Sodium intake  for reducing kidney stones. T or F

ANSWERS

1. True

A high potassium diet decreases urinary calcium excretion.

Foods rich in potassium enhance urinary Citrate excretion, likely from urinary alkalization, forming soluble calcium Citrate and thereby preventing stone formation

2. False

Decrease the sodium intake

So that when sodium is reabsorbed by the nephron, calcium is also passively reabsorbed and hence decreased calcium in urine.

You are your own Kingdom, pick up the Crown.

Bhopalwala. H

True or False #2

1. Herpangina involves the anterior oropharynx with grey vesicles and ulcers. T or F

2. Pleurodynia is also known as Bornholm disease. T or F

ANSWERS

1. False

Herpangina is caused by Coxsackievirus and involves the posterior oropharynx

Herpetic gingivostomatitis caused by HSV involves the anterior oropharynx and grey vesicles and ulcers

2. True

Pleurodynia — Pleurodynia is an acute enteroviral illness characterized by fever and paroxysmal spasms of the chest and abdominal muscles . Most cases occur during localized summer outbreaks among adolescents and adults. Regional and nationwide outbreaks involving a large number of older children and young adults have been reported at infrequent intervals, often separated by decades. The role of the group B coxsackieviruses, the most important cause of epidemic pleurodynia, was established in 1949 . Other agents rarely implicated in pleurodynia include echovirus serotypes 1, 6, 9, 16, and 19 and group A coxsackievirus serotypes 4, 6, 9, and 10 .

Pleurodynia can mimic more serious diseases, including bacterial pneumonia, pulmonary embolus, myocardial infarction, acute surgical abdomen, and herpes zoster infection. Most patients are ill for four to six days. Children have milder disease than adults, who are often confined to bed.

True or False #1

1. Vareniciline increases the risk of suicide and depression. T or F
2. Vareniciline increases the risk of CVS events. T or F

Saturday, November 10, 2018

Facebook: ANM registration

#Medicowesome
#PSM

In a subcenter population, Crude birth rate is 20. What is minimum expected number of pregnencies registered with ANM?

1) 110
2) 120
3)  55
4) 100

Answer within 24 hours.

Answer is Option 3)

Let's get to this tricky question.

Total subcentre population is 5000.
Total CBR =20 per 1000 mid year  population.
Hence, 20/1000* 5000
=100 births.

Now here comes the tricky part.

Abortion and still birth accounts for 10% wasted pregnencies.
So 100+10 (10% of total births)
=110.
As per rule, ANM should have 50% registration, therefore 110/2=55
Approximately C) 60

That's all.

-Demotional bloke.

Thursday, November 8, 2018

Authors' diary: CHADSVasc High

*talking about atrial fibrillation*

Management of Diabetic Ketoacidosis

Hi guys! Let’s look at how we manage one of the the most dreaded medical emergencies; a complication of Diabetes Mellitus type 2.

[Please click on the image to enhance it]

- Patients with DKA have a triad of hyperglycaemia, ketosis and metabolic acidosis and they are severely dehydrated due to osmotic diuresis.
- Those with altered sensorium or pH < 7.0 require intensive care. A comprehensive flow sheet of changes in vital signs, fluid intake/output and lab values must be maintained.
- Despite a bicarbonate deficit, most DKA patients often do not require bicarbonate replacement but may be given if arterial pH < 7.0
- Serum phosphate, magnesium and calcium may rarely need supplementation.
- Patient education is of utmost importance to prevent future recurrences.

Happy studying!
- Ashish Singh.

Wednesday, November 7, 2018

Assessment and plan: New onset atrial fibrillation with rapid ventricular response

Hello!

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

Hey everyone!

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

Ventricular arrhythmia notes

Hello! 

Anti-Ro/SSA antibodies and neonatal lupus

Hello everyone!

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

Hey guys, this whiteboard provides a general overview of how to manage patients with OrganoPhosphorous Compounds (OPC) poisoning.

      [Please click on the image to enhance it]

*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

Hello Awesomites!

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)

Hello Awesomites!

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

Hello Awesomites !

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

Studying for the USMLE can be a daunting task, especially when you're an International Medical Student/Graduate. Coming from a different background - culturally and educationally - the questions asked in these examinations reflect the health system and health needs of the US's population. Apart from the questions, the financial aspects of attaining residency in the United States may also be a setback for some. Overall, this journey is a test of patience and dedication to the profession and one's career goals.

Euvolemic hyponatremia algorithm

Just happened to create this image so I thought of sharing with you guys :)

-IkaN

Saturday, October 20, 2018

Tuesday, October 16, 2018

Why is the level of Vitamin B12 increased in CML?

Why is the level of Vitamin B12 increased in Chronic Myeloid Leukemia (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.

HELLO PEOPLEEEE!

Well this is not a medical joke or something that I made up. This syndrome is legit and very irritatting for the people who suffer from it. As said by Pryse Phillips the acronym is slightly forced but remains the best of the decade.

The acronym ACHOO is for Autosomal Dominant Compelling Helio-Opthalmic Outburst reflex which is basically sneezing in response to looking at a bright light, there can be a burst of 2-10 sneezes at a time.

Photic sneeze reflexes don't seem to make any sense at first. The purpose of sneezing is to clear unwanted irritants or germs from the nose. Bright light produces neither.
The phenomenon was first described in the 1950s, after a French doctor discovered several patients sneezing in response to the light of his ophthalmoscope, (the device doctors use to examine the retina). Further investigation revealed that it wasn't just any light that brought on the sneezing, but sudden flashes. These patients would reliably sneeze when quickly exposed sunlight, flash photography, and, in a few cases, even ultraviolet light.
There is no clear understanding on how photic sneez reflex works and hence a variety of theories have been proposed. 
For us its important to understand the basics of a normal sneez reflex arc.
The opthalmic division of the trigeminal nerve innervates the the nasal mucosa over the nasal septum and the anterior nasal passages. The afferent limb of the reflex arc is carried over the opthalmic nerve and the efferent limb is by the cranial nerves 5 and 7,9,10 and the motor nerves of the cervical and thoracic spinal cord.
The reflex centre is situated in the brainstem and upper spinal cord.
Any stimulation of the afferent limb of this reflex arc by dust or any foreign material sets the reflex arc in action which ultimately makes us sneez!
The primary clinical use of this sneez (sternutatory) reflex is a cross check on the corneal reflex.
Are there any other weird stimuli that cause people to involuntarily sneeze?
  • 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.
Well I hope this information was helpful. So the next time you hear some sneezing (ACHOO!) do remember this phenomenon.

Let's Learn Together.
-Medha Vyas.
x



Sunday, October 7, 2018

Question: Caloric test

#Medicowesome
#Ent

Q) Caloric test was done on right side with cold water and eyes were moved to opposite side. Which of the following correspond to interpretation of nystagmus in this test?
1) Eyes moves slowly to right
2) Eyes moves slowly to left
3) ‎Eyes moves rapidly to left
4) ‎Eyes moves rapidly to right
Answer in 24 hours with explanation of Caloric test.