This one is for the PGs. The 4 axes and 3 angles are pretty confusing to remember plainly. Here's how I do it.
Sunday, January 5, 2020
Saturday, January 4, 2020
Authors' diary: Mercy
Today, when I walked into a patients room to talk to him, he said, "Mercy."
I wasn't sure if this 90 year old male with dementia said what he said.
I asked him, "Did you just say mercy?"
He said yes and nodded. It broke my heart.
It's sad that aggressive treatments have come to this. When families want "Everything done" they don't see what we actually do.
There comes a point in life when it is okay to refuse treatments, not because you're negligient and ignorant about your health, but because it is the right thing to do.
With all our technological advancements in medicine, we can keep a body alive. We can have a ventilator with tracheostomy breathe for the patient, we can feed through a PEG tube, we can replace the kidney with dialysis, we can keep the blood pressure up with pressors. Sometimes, we can even bypass the heart and lungs through extra corporeal membrane oxygenation (ECMO). But just because we can do it, doesn't mean we should do it. What about quality of life?
Medicine can only do so much. There comes a point in the natural course of human life when the body can't heal anymore. That's when it's okay to say, "No more." It's time for comfort care and hospice.
Fortunately, for my patient, the physician explained about end of life to the decision makers and the family understood the goals of care. The patient was discharged to hospice.
Friday, January 3, 2020
Whatsapp group for medical professionals struggling with mental health issues
Hello, medicowesomites!
The Medicowesome admins had a recent discussion on depression and anxiety among health care professionals. We decided to create something like a support group on Whatsapp for those interested.
The Medicowesome admins had a recent discussion on depression and anxiety among health care professionals. We decided to create something like a support group on Whatsapp for those interested.
Pressure half time in aortic regurgitation notes
Hello! This post may be relevant to IM residents and cardiology fellows.
Olanzapine dose in CINV
Hi!
Olanzapine, an anti-psychotic, has been used in the patients of cancer for its beneficial effects on chemotherapy-induced nausea and vomiting (CINV) at a dose of 10 mg due to its anti-emetic action (neurotransmitter blockade at serotonin and dopamine receptors).
But due to its major adverse impact of daytime sedation, recent studies and randomized controlled trials have concluded its revised dose to be 5 mg for CINV.
To be noted here that the anti-emetic use of olanzapine is still off label, an unlicensed drug used for this purpose.
That's all
- Jaskunwar Singh
Tuesday, December 31, 2019
Mnemonic for Cherry 🍒 Red spots in Eye
Hello everyone….
" Story of Cherry 🍒 from farm to crowd "
From Farmer ( Mr.Tay Sachs )
Quintal of GM Cherry 🍒 storage (GM = Genetically modified )
Picked up
By Dapper Gentleman (Mr.Sandhoff )
for selling to
Crowd
In Berlin
(Like Cherry blossoms in Berlin... Google it.. )
Sunday, December 29, 2019
Mnemonic for Antibodies in SLE & it's Clinical Importance
Hi everyone!
Here is a hack.
ANA = All Negative Absent = All Positive identified = Highest Sensitivity ( So best Screening Test )
Here is a hack.
ANA = All Negative Absent = All Positive identified = Highest Sensitivity ( So best Screening Test )
Anti dsDNA = Disease Severity
Anti Sm = Specific Most
Anti RNP = Raynaud & Polymyositis ( MCTD )
Saturday, December 28, 2019
Mnemonic for Dawn & Somogyi phenomenon
Hello everyone....
A diabetic patient who is taking NPH insulin regularly at early evening time presents with early morning headache. He also feels very stressed & tiredness.
I have checked that he is hyperglycemic.
Suddenly I think about Dawn & Somogyi phenomenon. But I have a confusion between that 2 terms.
So I make a mnemonic…
Here it is ..
Dawn & Somogyi phenomenon
In both Early Morning High Glucose
= Due to ⬆️ GH & Cortisol Surge
What is the difference ??
Sonographic diagnostic features of monochorionic monoamniotic twin pregnancy
1. Absence of dividing amniotic membrane
2. Presence of single placenta
3. Same gender fetus
4. Adequate amniotic fluid around each fetus
5. Both fetus moving freely
Friday, December 27, 2019
Indications of long‐term oxygen therapy
Hi!
I was discussing the indications of long‐term oxygen therapy with a friend today...
Long‐term continuous oxygen therapy, ideally for ≥18 h/day is indicated when:
1. Daytime partial arterial oxygen concentration (PaO2) is ≤ 55 mm Hg at rest or a pulse oxygen saturation (SpO2) less than or equal to 88 percent.
2. Daytime PaO2 is 56–59 mm Hg and there is evidence for hypoxic organ damage (right heart failure, pulmonary hypertension or polycythaemia)
I was discussing the indications of long‐term oxygen therapy with a friend today...
Long‐term continuous oxygen therapy, ideally for ≥18 h/day is indicated when:
1. Daytime partial arterial oxygen concentration (PaO2) is ≤ 55 mm Hg at rest or a pulse oxygen saturation (SpO2) less than or equal to 88 percent.
2. Daytime PaO2 is 56–59 mm Hg and there is evidence for hypoxic organ damage (right heart failure, pulmonary hypertension or polycythaemia)
Fact of the day: AHN in old age
Hi!
Fact: New neurons proliferate as we age, in both physiologically and pathologically aging brains, even in the ninth decade of life.
Tuesday, December 24, 2019
Authors' diary: Battling jealousy
Hi!
I read comment on YouTube recently, "There are people who don't even share their notes and there are people like you who help others with their work..."
I know that feeling. It stems from a number of negative emotions. One of them is jealousy or envy - The intolerance in seeing someone else succeed more than you.
I read comment on YouTube recently, "There are people who don't even share their notes and there are people like you who help others with their work..."
I know that feeling. It stems from a number of negative emotions. One of them is jealousy or envy - The intolerance in seeing someone else succeed more than you.
Treatment resistant depression notes
Hi! Quick notes for a friend :)
Treatment resistant depression: Major depressive episodes that do not respond satisfactorily to at least two trials of antidepressant monotherapy.
Things to consider:
Assess adherence
Identify comorbidities
Reassess diagnosis
Treatment strategies:
Augmentation (adding a treatment)
Switching treatment
Treatment resistant depression: Major depressive episodes that do not respond satisfactorily to at least two trials of antidepressant monotherapy.
Things to consider:
Assess adherence
Identify comorbidities
Reassess diagnosis
Treatment strategies:
Augmentation (adding a treatment)
Switching treatment
Monday, December 23, 2019
Important Mnemonics for Oral hypoglycaemic drugs in Diabetes
Hello
everyone ..
I
make mnemonics for some important side effects of oral hypoglycemic
drugs.
You
must know that because you may prescribe it for 1 out of 11 adults in whole
population the of world….!!
Side effects of Oral hypoglycaemic drugs along with
it's class & mechanism of action
#Mnemonic 1
Big Men ForminG Poor Diabetic neuropathy ( D/Dx B12 Deficiency ➡️ confirmed by
doing B12 LAB test.)
Biguanide = Metformin
Inhibit
mGPD
It
causes Vitamin B12 Deficiency & Lactic
Acidosis (LA)
#Mnemonic 2
1st Key to SUccess
is Lord "Ram"
1st Gen SUlfonylureas
Closes K+ Channel
Ram = Disulfiram
like reaction….
#Mnemonic 3
Paragliding makes your heart failed or maybe a fracture or bladder injury
Para = PPAR Y
Gliding = Glitazone
activates it...
#Mnemonic 4
"Rosy red Blood don't reach to
heart (MI) but goes into Pee = Red Pi ( Pee = Urine in Bladder Cancer )
MI
(rosiglitazone)
Bladder
cancer (pioglitazone)
#Mnemonic 5
“Change
your Daily Personal Passivity (DPP) otherwise
your heart fails”
DPP = DPP-4 inhibitors
#Mnemonic 6
“Candid Status is Very Good in Love Test”
SGLT-2 inhibitors can cause Vulvovaginal Candidiasis
Drugs category & their Suffix
Pramlintide = Amylin
Analogue
1st
gen Sulfonylureas = “Amide”
2nd
gen Sulfonylureas = “Ride” & “Zide”
Meglitinides
= “Nide”
DPP-4
Inhibitors = “Gliptin”
Glitazones / thiazolidinediones
= “Zone”
SGLT
-2 Inhibitors = “Flozin”
#Mnemonic 7
Alpha glucosidase
inhibitors = "Please Side your Car & Pay Toll"
Acarbose & Miglitol
#Clinical Pearls
Weight neutral = DPP 4 & Alpha Glucosidase
inhibitors
SGLT2 inhibitors & GLP-1 = Used in CVD
( Cardiovascular diseases) patients
In case of Renal failure you can only give 2 type of
drugs orally = DPP 4 inhibitors & Glitazones
Injectables can be given in renal failure.
3 times / day dosing = Pramlintide , Alpha
Glucosidase inhibitors & Glinide
Regular Insulin ( Short acting ) is preferred
for
DKA ( IV)
Hyperklaemia (Add Glucose)
Stress Hyperglycemia
Thank you :)
- Dr. Drashtant Prajapati
Sunday, December 22, 2019
Therapeutics in Sickle Cell Anemia
Apart from Hydroxyurea, Analgesics and vasodilators like phosphodiesterase inhibitors, certain tantalizing novel drugs have been approved for Sickle cell anemia.... Let's take a closer look at them.
(1) Voxelotor (HbS polymerization inhibitor) binds covalently to N-terminal valine of alpha chain of HbS (around 30% of HbS in individual cell) stabilizing it's oxygenated form and causing left ward shift of dissociation curve without impairing oxygen delivery to tissues.
Consistently reduces hemolysis and viscosity with in 2 weeks of administration... FIRST EVER therapy targeting core defect.
(1) Voxelotor (HbS polymerization inhibitor) binds covalently to N-terminal valine of alpha chain of HbS (around 30% of HbS in individual cell) stabilizing it's oxygenated form and causing left ward shift of dissociation curve without impairing oxygen delivery to tissues.
Consistently reduces hemolysis and viscosity with in 2 weeks of administration... FIRST EVER therapy targeting core defect.
Saturday, December 21, 2019
Benign vs Malignant pulmonary calcifications mnemonic
A nice mnemonic to differentiate benign and malignant pulmonary calcifications is:
Malignant calcifications are ***SuPER bad*** :P
S: Spiculated
P: Punctate
E: Eccentric
R: Reticular
I use those 3 starts (***) to remind me of punctate.(vs the other P of Popcorn in the benign lesions)
Bening ones are the rest:
Popcorn, laminated, concentric and diffuse homogeneous
-Murad
NB: these calcification types suggest benign vs malignant lesions and are not diagnostic per se.
Check the other amazing mnemonic by Drashtant in the comments section below :)
Malignant calcifications are ***SuPER bad*** :P
S: Spiculated
P: Punctate
E: Eccentric
R: Reticular
I use those 3 starts (***) to remind me of punctate.(vs the other P of Popcorn in the benign lesions)
Bening ones are the rest:
Popcorn, laminated, concentric and diffuse homogeneous
-Murad
Check the other amazing mnemonic by Drashtant in the comments section below :)
Thursday, December 19, 2019
Inferior wall MI treatment mnemonic
Inferior wall MI is different than other MIs . It is associated with sinus bradycardias and AV block.
Wednesday, December 18, 2019
Lower back pain notes
Hello!
Here are my quick and dirty notes on Low back pain (LBP) mostly seen in ambulatory medicine! I will not be going into evidence-based medicine (EBM) physical examination (PE) findings but I have put a quick note for conditions you can test on PE so you can look them up.
Here are my quick and dirty notes on Low back pain (LBP) mostly seen in ambulatory medicine! I will not be going into evidence-based medicine (EBM) physical examination (PE) findings but I have put a quick note for conditions you can test on PE so you can look them up.
Hepatorenal Syndrome: An Overview
Hello good folks! Let's discuss HepatoRenal Syndrome (HRS) in brief.
Cirrhosis + Ascites + Renal Failure = HRS, after excluding other causes of kidney damage.
How common is HRS?
1 in 10 patients of advanced cirrhosis or acute liver failure develop HRS.
How does HRS happen?
Abnormal haemodynamics, that's how. Pathogen, faulty immune system and mesenteric angiogenesis result in splanchnic and systemic vasodilation but renal vasoconstriction. Other factors maybe contributory.
Types and management
Type 1: Rapidly progressive, median survival about 2 weeks. Haemodialysis may be required.
Type 2: Slowly progressive, median survival about 6 months. Transjugular Intrahepatic Portosystemic Shunt (TIPS) maybe required.
Liver and/or kidney transplant maybe considered for both types.
Thanks for reading.
- Ashish Singh.
Cirrhosis + Ascites + Renal Failure = HRS, after excluding other causes of kidney damage.
How common is HRS?
1 in 10 patients of advanced cirrhosis or acute liver failure develop HRS.
How does HRS happen?
Abnormal haemodynamics, that's how. Pathogen, faulty immune system and mesenteric angiogenesis result in splanchnic and systemic vasodilation but renal vasoconstriction. Other factors maybe contributory.
Types and management
Type 1: Rapidly progressive, median survival about 2 weeks. Haemodialysis may be required.
Type 2: Slowly progressive, median survival about 6 months. Transjugular Intrahepatic Portosystemic Shunt (TIPS) maybe required.
Liver and/or kidney transplant maybe considered for both types.
Thanks for reading.
- Ashish Singh.
Dihydropyridine vs non-Dihydropyridine CCBs mnemonic
Dihydropyridine vs non-Dihydropyridine CCBs were always a struggle to me because they are both CCBs but at the same time they have some differences.
I hope that the following mnemonic will help in reminding you which one is Dihydro and which one is not :D :
The mnemonic (remember DIE HARD movie and Bruce Willis)
I am a DIe Hard FAN
DIHydropyridine CCBs:
FAN
F- felodipine
A- amlodipine
N- nicardipine
So non-Dihydropyridine CCBs are Verapamil and Dilitazem.
I hope that the following mnemonic will help in reminding you which one is Dihydro and which one is not :D :
The mnemonic (remember DIE HARD movie and Bruce Willis)
I am a DIe Hard FAN
DIHydropyridine CCBs:
FAN
F- felodipine
A- amlodipine
N- nicardipine
So non-Dihydropyridine CCBs are Verapamil and Dilitazem.
The original FAN mnemonic was posted here:
http://woanchyi818.blogspot.com/2015/03/calcium-channel-blockers-ccbs.html
http://woanchyi818.blogspot.com/2015/03/calcium-channel-blockers-ccbs.html
good luck :)
Murad
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