I am starting a Zebra Series on Medicowesome.
Tuesday, November 13, 2018
Monday, November 12, 2018
True or False #7
True or False #6
1. Nightmare is a REM sleep behavior disorder. T or F
2. Night Terror is a REM sleep behavior disorder. T or F
ANSWERS
1. True
Things you should REMember for Nightmare disorder are :
REM
Second half of the night
Responsive to comfort
REMembers the dream
2. False
Night terrors: Abrupt arousals from sleep (panicked scream, terror, autonomic arousal, unresponsive to comfort)
- Little or no dream recall
- Amnesia for episodes
Sleep is a gift, always be grateful for it.
True or False #5
1. Narcolepsy exhibits a reduced REM latency. T or F
ANSWER
1. True
Narcolepsy: depletion of hypocretin secreting neurons in lateral hypothalamus that are involved in maintaining wakefulness
Diagnostic: recurrent lapses into sleep or napping several times in the same day, >3 times a week for >3mo. and at least 1 of the following
-Cataplexy: Conscious of bilateral loss of muscle tone precipitated by emotions or abnormal facial movement (without emotional triggers)
-Hypocretin - 1 (orexin A) deficiency in CSF
- REM sleep latency <15 minutes
Tetrad:
-Sleep attacks
-Cataplexy
-Hypnagogic or hypnopompic hallucinations
-Sleep paralysis
Dx: Shortened REM sleep latency on polysomnografy
Low levels of hypocretin 1 in CSF
You may feel weak, you may fall down, say no to Cataplexy, say yes to CATA GETUP!!
True or False #4
1. Imaging is contraindicated in pregnancy for diagnosing latent TB. T or F
2. Check for latent TB before prescribing Infliximab. T or F
ANSWERS
1. False
Diagnostic evaluation after positive test — Patients with a positive TST or IGRA must undergo clinical evaluation to rule out active tuberculosis. This includes evaluation for symptoms (eg, fever, cough, weight loss) and radiographic examination of the chest (with appropriate shielding), regardless of gestational age.
Patients with a positive TST or IGRA with no evidence of active TB may be presumed to have latent TB.
2. True
Toxicity of Infliximab includes :
Respiratory infection (possible reactivation of latent TB)
Fever
Hypotension
Last man standing wins. Keep grinding.
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
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
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.