Sunday, December 2, 2018
Peculiar pattern of pulmonary edema
Obesity in Prader-Willi syndrome and WAGR syndrome
Saturday, December 1, 2018
Paroxysmal nocturnal hemoglobinuria
2)Complement detects self vs nonself cells by these complement inhibitors. Function of these complement inhibitors is to:
3)In the absence of these inhibitors, complement proteins bind cell membranes of our own cells and through the alternative complement pathway can lyse self-cells.
4)CD55/DAF decrease → More C3 convertase→Increase C3b→Increase opsonization→Extra Vascular Hemolysis.
CD59/MIRL decrease→More MAC→Intra Vascular Hemolysis.
5)Why nocturnal hemoglobinuria- hemolysis occurs throughout day but its more at night because: (a)Increased hemolysis in night due to respiratory acidosis(Shallow breathing).
(b)Overnight concentration of urine is more and hemoglobinuria is clearly evident.
6)Diagnosis:(a)Flow cytometry- decrease CD55 and CD59 levels.
(b)HAM test-confirmatory.
(c)Direct coombs test-Negative (Helps to differentiate PNH and AIHA- its positive in AIHA)
7)Treatment:
-Srikar Sama
SOURCE: UpToDate, Uworld.
Thursday, November 29, 2018
Psammoma Body
Psammoma body :
1)Psammoma bodies are round microscopic calcific collections.2)A single necrotic cell act as a nidus and calcium deposits around it in laminated and concentric fashion.Psammoma body is an example for dystrophic calcification (Ca2+ deposition in abnormal tissues secondary to injury/necrosis in context of Normal calcium levels).
3)It is used in histopathology for diagnosis of certain tumours like:
Mnemonic : Remember it as SPAMmoma
S- Serous cystadenocarcinoma of ovary
Somatostatinoma
PA-Papillary thyroid carcinoma
Papillary renal cell carcinoma
Atrial myxomas
Dietary Risk Factors For Calcium Stones
A lower fluid intake will lead to lower urine output, thereby promoting stone formation by increasing the concentration of calcium and oxalate.
Warfarin Induced Skin Necrosis
Mechanism:
1)Mechanism of action of Warfarin is it inhibits VitK epoxide reductase,so there is decrease in synthesis of VitK dependent factors - (factors II, VII, IX, and X) and natural anticoagulants (protein S and protein C).
2)Now no new clotting factors are produced but the old circulating clotting factors are still present (warfarin has no effect on already circulating clotting factors).
3)Among the factors II, VII, IX, X, ProteinC that are already present,ProteinC has the shortest half life,So ProteinC is depleted more rapidly than the others.
4)Now there is no anticoagulant in the body to oppose the action of already present clotting factors,so there will be initial coagulation till factors II, VII, IX, X gets depleted i.e till their half lives are completed.
5)This initial coagulation occurs in dermal vasculature which causes Skin Necrosis.
Prevention:
Overlapping of warfarin with heparin during the first several days of warfarin administration(if Heparin is given along with warfarin, this prevents functioning of circulating factors since heparin inhibits the activity of circulating thrombin and factorXa) and then warfarin is continued for long term therapy.
Source: UpToDate, First Aid.
-Srikar Sama
New application process for ECFMG registration
This post is regarding new application process for ecfmg registration.
STEP1 : The process for obtaining USMLE ID is still the same which has been described very clearly here http://www.medicowesome.com/2016/12/how-to-apply-for-usmle-exams.html#more
STEP2 - ECFMG CERTIFICATION USING IWA:
1)when you go to IWA and login to your account you will only have one option : apply for certification (no application for examination any more ) so you will just click on that.
2)simply follow the steps and confirm you information and you will end up getting a payment page of 125$.
STEP3 - FORM 186 :
1)After payment they will send you form 186 (unlike before you dont need to go to your medical school and have it signed by your deen)
2)You will simply go to the website :- https://www.notarycam.com/ecfmg/
STEP4 - INTERVIEW WITH ONLINE NOTARY :
1)Fill an application and upload form (186) and high quality image of your passport or photo ID preferably but not necessarily in english.
2)You will receive an email from one of the online notaries and schedule an appointment of an online meeting with him/her.
3)If you are ready at the moment you can schedule an appointment immediately(which is what i did) or you can schedule for an appointment later.
4)During your meeting with the notary please prepare your passport as you will be asked to show it, to confirm your identity.
5)Afterwards the notary will ask you to position your self to the mid of screen and ask your permission for taking a screenshot.(If your webcam is of low quality they will ask you to mail them a passport picture of yours,so be ready with that too)
6)Then you will have to electronically sign your form-no need to actually sign it,they will display your name in few fonts and you have select one.
7)Now you have done your part.The notary will seal the document and send it to the ecfmg.
8)You will get an 2 emails after this process-one from notary that they have sent your form186 to ECFMG and second email is from ECFMG which you will be getting after few days that they have accepted your form 186.
-Srikar Sama
Monday, November 26, 2018
A rare type of fistula-Arterioenteric fistula
Sunday, November 25, 2018
A few USPSTF guidelines
USPSTF guidelines are important to remember for step 2 CK, step 3 and residency!
Here are a few high yield ones!
Ingenious Immune System
Pemphigus vulgaris vs Paraneoplastic Pemphigus vulgaris (PNP)
- Kirtan Patolia
Friday, November 23, 2018
Talazoparib: Zenith of novelty
Thursday, November 22, 2018
Stones in Crohn's disease
True or False #9
1.Atopic dermatitis presents on flexor surfaces in infants. T or F
ANSWER
F
Extensor surfaces
Flexor in older children and adults
How to remember this?
Infants slEEEEEEEp a lot right.
Hence EEEEEEEExtensor surface involved in infants in atopic dermatitis
That will help you remember the opposite ( flexor surfaces) involved in older children and adults
That's all.
Tuesday, November 20, 2018
Calcium monitoring in ethylene glycol poisoning
Seizures often occurs in ethylene glycol poisoning. It has multifaceted pathophysiology but one of the major cause is hypocalcemia.
Hypocalcemia occurs in ethylene glycol poisoning because ethylene glycol is metabolized to oxalate, which forms calcium oxalate depleting calcium from ECF.
Also, correcting associated metabolic acidosis by bicarbonate supplementation can further cause hypocalcemia due to increased binding of calcium to albumin.
This is why, calcium levels should always be monitored meticulously in such patients.
- Kirtan Patolia ( BJ medical college)
Cryptic conundrum in ET: Thrombosis or bleeding?
In essential thrombocytosis, contrary to what might be surmised, bleeding is more of threat than thrombosis.
This is because high platelet count especially above 1 million/mm3 cause acquired von willebrand disease, much like type 2b von willebrand disease, where excessive affinity of vWF for platelet Gpib result in excessive removal of platelet-vWF complex by spleen results in thrombocytopenia and loss of high molecular weight vWF multimers.
However, incidence of erythromelalgia , transient ischemic attack and other microvascular events are also high in patients with essential thrombocytosis.
Pretty complex and contradictory, right?
- Kirtan Patolia ( BJ medical college).
Sunday, November 18, 2018
Diabetic amyotrophy
Hello everyone!
Today, I will be talking about diabetic amyotrophy.
Diabetic amyotrophy has a lot of names!
It is also known as Bruns-Garland syndrome, diabetic myelopathy, proximal diabetic neuropathy, diabetic polyradiculopathy, diabetic motor neuropathy, diabetic radiculoplexopathy, diabetic lumbosacral plexopathy, and diabetic LRPN.
Diabetic amyotrophy typically occurs in patients with type 2 diabetes mellitus. The traditional features include the acute, asymmetric, focal onset of pain followed by weakness involving the proximal leg, with associated autonomic failure and weight loss. Progression occurs over months and is followed by partial recovery in most patients.
The diagnosis of diabetic amyotrophy is mainly based upon the presence of suggestive clinical features in a patient with known or newly diagnosed diabetes mellitus. Appropriate laboratory investigations, particularly electrodiagnostic studies, and neuroimaging in select patients, are useful to exclude other peripheral and central nervous system etiologies as a cause of the neurologic symptoms and signs.
No treatments are proven to be effective for diabetic amyotrophy or for idiopathic LRPN.
PS: Distal symmetric sensorimotor polyneuropathy is the most common type of diabetic neuropathy - it is characterized by a progressive loss of distal sensation correlating with loss of sensory axons, followed, in severe cases, by motor weakness and motor axonal loss. Classic "stocking-glove" sensory loss is typical in this disorder.
Source: UpToDate
That's all!
-IkaN
Saturday, November 17, 2018
Zebra series: Lemierre's syndrome
Hello everyone!
Let's talk about Lemierre's syndrome today.
Lemierre's syndrome is characterized by disseminated abscesses and thrombophlebitis of the internal jugular vein after infection of the oropharynx. The predominant pathogen is a gram-negative anaerobic bacillus, Fusobacterium necrophorum.
That's the Zebra for the day!
IkaN