Wednesday, May 29, 2019
Indications of skin grafting mnemonic + notes
Indications of skin grafting :
☆ Mnemonic - BITS
Monday, May 27, 2019
Sites of Bronchiectasis
Bronchiectasis site in lung depends upon the etiological factors
Upper lobe bronchiectasis:
Mnemonic: Upper - PCT
Upper- Upper lobe
P- Post radiation
C- Cystic fibrosis
T- Tuberculosis
Middle lobe bronchiectasis:
Mnemonic: MMC (Like BMC!)
M- Middle lobe
M- Mycobacterium avium
C- Ciliary dyskinesia
Lower lobe bronchiectasis:
Mnemonic: Left-ICA (Internal carotid artery)
Left- Lower lobe
I- Interstitial lung disease
CA- Chronic aspiration
That's all.
Thank you :)
-Demotional bloke
Saturday, May 18, 2019
History, physiology and medical aspects of fasting
My senior resident at JFK Medical Center did a presentation on fasting. I thought of sharing it with you (especially since it is Ramazan/Ramadan).
Thursday, May 16, 2019
Hook effect of prolactin in large pituitary adenomas
Hello everyone,
Here's something I learnt today when a case of large pituitary adenoma causing visual field loss was presented today.
But let's talk about my favorite subject first - Immunology!
The intensity of an antigen-antibody interaction depends primarily on the relative proportion of the antigen and the antibody. A relative excess of either will impair adequate immune complex formation. This is called the “high-dose hook effect” or the “prozone phenomenon.”
This is important consideration whe measuring prolactin. Extremely high levels of prolactin can interfere with the assay and produce falsely low readings.
This high-dose hook effect occurs because there is not enough antibody to bind to both ends of all antigenic peptides, in this case, prolactin.
Most prolactin is complexed to a single antibody. Only few remaining prolactin peptides are “sandwiched” and therefore detectable.
This results in a falsely low prolactin value.
Hence, as the antigen concentrations increase, there is a proportional increase in assay titers up to a certain level. Antigen concentrations above this threshold level would “hook” down the assay values resulting in very low measurements.
In order to avoid the high-dose hook effect, the serum prolactin should be estimated in appropriate dilution in all patients with large pituitary tumors.
-IkaN (tired Internal Medicine Resident)
Source:
The 'hook effect' on serum prolactin estimation in a patient with macroprolactinoma. https://www.ncbi.nlm.nih.gov/m/pubmed/11303248/
Monday, May 13, 2019
Protein gap
Albumin accounts for the majority of total serum protein.
Viral infections, plasma cell malignancies, or autoimmune conditions there is an excess of immunoglobulins, raising the total amount of serum protein independent of albumin.
The gamma gap is typically considered to be elevated if it is above 4 g/dL.
In the right clinical context, gamma gap should be worked up with SPEP, UPEP, and a serum free light chain assay.
Random exercise: Calculate the protein gap.
Total protein 8.9 g/dL (normal 6.4-8.3 g/dL)
Albumin is 3.6 g/dL (normal 3.4-4.8 g/dL)
That's all!
-IkaN
Work up of thyroid nodule
Here is the shorter version of this post: Investigating thyroid nodule for Step 2 CK (link: https://www.medicowesome.com/2016/06/step-2-ck-investigating-thyroid-nodule.html)
So - if you find a thyroid nodule on physical examination - what do you do next?
Caudal anaesthesia
The indications for single shot CA are abdominal,urologic or orthopedic surgical procedures located in the sub-umbilical abdominal, pelvic and genital areas, or the lower limbs, where postoperative pain does not require prolonged strong analgesia. Examples include inguinal or umbilical herniorrhaphy, orchidopexy, hypospadias and club foot surgery.
Anatomical landmarks (Figure)
The sacrum is roughly the shape of an equilateral triangle,with its base identified by feeling the two
posterosuperior iliac processes and a caudal summit corresponding to the sacral hiatus.The sacral hiatus is located at the caudal end of the median crest and is created by failure of the S5 laminae
to fuse (Figure). The hiatus is surrounded by the sacral cornu.
Preparation
Obtain consent for the procedure either from the patient or, if appropriate, from the parents. After induction of general anaesthesia and airway control, the patient is positioned laterally (or ventrally),
with their hips flexed to 90°. Skin disinfection should be performed carefully, because of the proximity to the anus.
After defining the bony landmarks of the sacral triangle, the two sacral cornuae are identified by moving your fingertips from side to side.The gluteal cleft is not a reliable mark of the midline. The puncture is performed between the two sacral cornuae. The needle is oriented 60° in relation to back plane, 90° to skin surface. The needle bevel is oriented ventrally, or parallel to the fibers of the sacro-coccygeal ligament.
After verifying absence of spontaneous reflux of blood or cerebrospinal fluid (more sensitive than an aspiration test), injection of LA should be possible be without resistance. Inject slowly (over about one minute).
-Upasana Y. :)
Sunday, May 12, 2019
HbA1c and Estimated Average Glucose
Hello Awesomites!
Sounds new. Wait till the end!
Do You know what is HBA1c?
HbA1c is produced by the condensation of Glucose with N-terminal valine of each beta chain of HbA.
Diagnostic importance
The rate of synthesis of HBA1c is proportional to exposure of RBC to glucose. Concentration of HBA1c is indication of blood glucose concentration.
It reflect mean blood Glucose level over 2-3 months prior to its measurement.If HbA1c is <7% then diabetes is in good control. To get an accurate result the concentration should be monitored for several months.
Estimated average glucose (eAG) :- It is new term in diabetic management.It helps to interpret HbA1c levels into average glucose concentration.
eAG(mg/dl) =(28.7×HbA1c) - 46.7
Drawback
The A1c doesn’t replace self blood-glucose monitoring. Because the A1c is an average of all your blood sugars, it does not tell you your blood sugar patterns. If someone has certain type of hemoglobin mutations (variation in the hemoglobin structure) (HbA1c is falsely low) , is severely anemic (low red blood cell count), iron deficient( HbA1c is falsely high) or is being treated blood transfusions or medications to increase the production of new red blood cells, the A1c test may not be accurate.
Thank you.
Upasana Y. :)
Monday, May 6, 2019
Diabetic Retinopathy
I edited the slides so you can see better :)
Slides are available for download here:
PARTNER 3 trial journal club
A few months ago, I did a journal club on the PARTNER 3 trial.
I have been meaning to create an audio file and upload the whole journal club as a video on YouTube but unfortunately, I don't seem to have the time.
This is why, I decided to go ahead and release my slides instead so it helps anyone who is doing a journal club on the same :)
Sunday, May 5, 2019
Oblique muscle mnemonic
It can be hard to remember which oblique does what. Remember this. 'Extortion' as we all know is forcing money out of someone. People from the 'inferior' strata of the society extort money. See where am I going?!
So! Inferior oblique causes extorsion( 'extortion' is a bit different- c'mon, be a grammar Nazi!)
What remains? Superior oblique. So..it then is responsible for intorsion.
Similar is the case for superior and inferior recti.
Hope I saved you from ophthalm extorting your precious time.
-Sushrut
Monday, April 29, 2019
Cardiovascular changes in pregnancy
At term
- Blood volume increases by 50%
- increased uterine blood flow 500-800ml/min
- uterus recieves 10-15% cardiac output
Sunday, April 28, 2019
Internship dairies: Finding a vein
So here's a quick post in support of Internship Diaries. I would like to give you advice on how to do blood draws and insert IV lines.
First of all, learn properly before you try it on another human being. Watch YouTube videos, learn by observing.
Second, the tourniquet is your friend. If you don't have a tourniquet, use a glove instead. It will make the veins more plump.
Third. Feel the vein before you attempt to insert the needle or cannula. FEEL IT.
Be patient and take your time. It's better to spend 30 seconds extra than to poke somebody and spend five minutes more trying to find a vein.
I know that this is phlebotomy and nursing advice and it may not be needed in hospitals where the ancillary staff does it.
But hey, hope this helps! :)
PS: I just realized I've written a longer post before here: https://www.medicowesome.com/2015/10/tips-on-how-to-find-vein-or-phlebotomy.html
-IkaN
Strabismus/Squint
Strabismus has been confusing me for long, so I decided to come up with a chart:
You can download the chart at https://drive.google.com/file/d/1leP_Ir3FZU0J-0isZcYHkgd5x_ujQFX8/view?usp=sharing
Thanks!
Chaitanya Inge
Upasana Yadav
Saturday, April 27, 2019
Propofol infusion syndrome
Hello friends!
It is the triad of metabolic acidosis, skeletal myopathy and acute cardiomyopathy.
It is seen in children on prolonged infusion.
It occurs due to failure of metabolism of free fatty acids.
Madhuri.
Propofol
Hi friends!
Propofol is a non-barbiturate intravenous anesthetic agent.
Colour : milky white liquid.
Chemical name : 2,6-diisopropylphenol.
Composition: soyabean oil, glycerol and lecithin.
Metabolism:70% in liver, 30% in lungs and kidneys.
Propofol is associated with quick recovery. So it is the drug of choice for day care surgeries.
Systemic effects:
CVS : It decreases systemic vascular resistance leading to fall in blood pressure causing tachycardia. But it actually causes bradycardia. The reason being blunting of carotid body receptor response (which we have studied in our physiology)
RS : It causes maximum depression of upper airway reflexes. So it is the drug of choice for insertion of laryngeal mask airway.
CNS : It causes cerebral vasoconstriction leading to fall in intracranial pressure. It is an antiemetic, antipruritic and antioxidant.
It is an anticonvulsant but may cause involuntary movements.
Thanks for reading!
Madhuri.
Massive blood transfusion strategy
In patients with massive haemorhage with a loss of more than 40% of blood volume - rapid transfusions are given with colloids, crystalloids and packed RBCs.
This causes coagulopathy by diluting the a clotting factors.
Hence, prophylactic infusion of platelets and fresh frozen plasma is done.
Initially, it was given in a ratio of 1:1:4
One part platelet & ffp transfusion to every 4 bags of blood.
It has been renewed now to 1:1:1 ratio
It has caused significant reduction in mortality 40% versus 60%
Thank you!
40% blood loss translates to grade 4 hemorrhagic shock or grade 1 degree of urgency per the urgency grid for obstetric hemorrhage. I removed the grading in the initial part of the post to avoid confusion as different grades mean different severity of shock based on the scale used.
- sakkan
EPISODE 01 INTERNSHIP DIARIES - (The best way to FINISH is to START first!)
“Hello Dr. Kesh” She looks back at you.
“Omg!” You think. “This is it! People are calling me doctor now! Yoohoo!” you smile widely.
****
Dr. Wen is a helpful young doctor in his late thirties who happens to be the Chief Resident of Internal Medicine. His orientation on the hospital rules were quite lengthy but was important. His ending was quite remarkable.
You check the slip in your hand.
“Ward 3” it says. You slowly walk toward your post.
“Dr. Kesh” You hear your nurse is shouting your name
DEFINITION OF TERMS
- Consent - The consent or receiving the willingness of the patient to undergo a medical procedure is a must before you would perform any medical procedure. It could be ranging from a simple needle prick test or to an imaging or an operation.
- IVF - Intra Venous Fluid. These are the liquid substances directly delivered into a vein.
.
Thursday, April 25, 2019
Tuesday, April 23, 2019
Think before you order a test: High resolution CT scan (HRCT)
Let's talk about HRCT today!
HRCT is the use of thin-section CT images (0.625-mm to 1.5-mm slice thickness) with a high spatial frequency reconstruction algorithm, to detect and characterize diseases that affect the pulmonary parenchyma and small airways.
HRCT cuts THIN slices.
Awesome, isn't it? Why not use an HD camera for every photograph?
Because it comes with a price!