Documentation and prescription for home oxygen

This post is only relevant to practicing physicians/ residents.

Facebook: Schizophrenia treatment

Q2) A schizophrenic patient was on chlorpromazine and olanzapine for the past 6 months, with each drug being prescribed for atleast 6 weeks. The patient is still symptomatic. What is next line of management?
A) Haloperidol depot
B) Aripiprazole
C) Risperidone depot
D) Clozapine

#Medicowesome
#Psychiatry
#Pharmacology

Answer to the above question is D) Clozapine.
Explanation: If two drugs are used for schizophrenia and yet no improvement is seen, then Clozapine is used. Clozapine is DOC for resistant schizophrenia.

Some key points of Clozapine:-
1) It is most effective Antipsychotic
2) Clozapine is most toxic Antipsychotic.
3) It causes following special side effects:-
    a) Agranulocytosis :
-Therapeutic Drug monitoring (TDM) cannot be done because plasma concentration is not proportional with agranulocytosis
- Hence it is C/I with Carbamazepine.
   b) De novo seizure.
   c) Myocarditis.
   d) Sedation - Most common side effect.
   e) Sialorrhea- Wet pillow syndrome.
4) It shows Antisuicidal effect.

That's all!

- Demotional bloke!

Facebook: Acid and Alkali ingestion question.

Q1) In a child with accidental alkali ingestion, which of the following is recommended as acute treatment:-

A) Administer mild acid

B) Administer milk

C) Administer rice

D) Gag the child to induce emesis

So answer to the above question is Milk, Option B.

For acute administration of caustic ingestion, dilution with milk or water is recommended.

Contraindications in case of caustic ingestion:-

1) Neutralization

2) Induce emesis

3) Gastric lavage

Some key points:-

Acid ingestion produces coagulative necrosis and a somewhat protective thick eschar.

Alkali ingestion produces:-

1) Liquefactive necrosis

2) Saponification of fat

3) Exothermic reaction

PS: Do follow our Facebook Medicowesome page for more such questions.

 

Simplifying Carotid Sheath For AIIMS Aspirants

Carotid Sheath

C - Cervical Fascia Modification
A - Ant'r relation = Ansa Cervicalis
R - ❌
O - ❌
T - Tenth nerve/ vagus is a content
I - Internal Jugular Vein  & Internal Carotid are contents
D - DOES NOT contain External Carotid

Happy Preparing :)

Post BCG injection site reaction

Hello Awesomites!


Today,the mother came with one week 5 day old newborn. She noticed a papule in left upper arm of newborn. She was afraid and thus visited the OPD.On history, the child was vaccinated on day 0 . So we counselled her as it was Post-BCG Vaccination injection site reaction characterized by a papule, which may be red, tender and indurated. The papule commences two or more weeks after vaccination and then may progress to become ulcerated healing after 2-5 months leaving a superficial scar.


I forgot to take picture due to rush. You can google the pictures.

-Upasana Y. 

Rett syndrome notes

Hello friends!

Today we are going to learn about Rett syndrome. 

*Frequency : 1 in 15,000.

*90% of the cases are SPORADIC

*5-10% are X-Linked Dominant, so more common in females. 

(Remember males get only one X chromosome from mother whereas females get X chromosome each from mother and father).

*Mutation in gene : MeCP2.

*Virtually always seen in girls because males usually die in utero or shortly after birth.

*Important finding : Decreased pontine NE and Nigro-striatal Dopamine levels.

Clinical features : 

*At birth : Normal growth and normal head circumference.

*Normal attainment of milestones till 5-6 months of age, later there will be progressive regression of language (both receptive and expressive) and motor milestones.

*It causes Acquired Microcephaly.

*Hallmark : Repetitive hand writing movements with loss of purposeful movements.

*It can cause 5 As:

Apnea (intermittent)

Ataxia

Autistic behaviour

Arrhythmias

Acquired Microcephaly

*In addition to all of these, cyanosis, GTCS can also be seen.

*Staging :

Stage 1 : Onset stage (6-18 months)

Stage 2 : Rapid destructive (1-4 years) - 

Stage 3 : Plateau phase (2-10 years)

Stage 4 : Late motor phase (decreased motor movts) - Scoliosis can occur.

*Imaging : No pathognomonic finding. However, significant reduction on brain weight upto 60-80% is often seen.

*HPE : Decreased synapses, dendritic length and branching.

*Treatment : Supportive.

Hope it will help :)

Madhuri.

Pediatric Residency Series: Conferences

The Table below has the name of some Pediatric conferences and the respective subspecialty                          

Pediatric Conferences 

Subspecialty	Conference	Dates	Link
Everything / all subspecialties	Pediatric Academic Societies (PAS)	April/May	https://2020.pas-meeting.org/
	Southern Society of Pediatric Research (SSPR)  (Mainly for Southern states)	February	https://www.southernspr.org/l/default.asp
Pediatric Cardiology	American Heart Association conference(AHA)	November	https://professional.heart.org/professional/EducationMeetings/MeetingsLiveCME/ScientificSessions/UCM_316900_Scientific-Sessions.jsp
	American College of Cardiology conference(ACC)	March	https://accscientificsession.acc.org/
	CHOP: Annual Update on Pediatric and Congenital Cardiovascular Disease	February	https://chop.cloud-cme.com/default.aspx?P=5&EID=928
Pediatric Allergy/Immunology	American Academy of Allergy, Asthma, and Immunology (AAAAI)	March	http://aaaai2020.org/
	American College of Allergy, Asthma, and Immunology (ACAAI)	November	https://annualmeeting.acaai.org/
	Texas Allergy, Asthma, and Immunology Society (TAAIS) -no poster presentations	April	https://taais.org/intro-view/2020-taais-annual-meeting/
Pediatric Neurology	Child Neurology Society (Getting a poster in may be difficult)	October	https://www.childneurologysociety.org/meetings/future-cns-annual-meetings.
	American Academy of Neurology	April/May	https://www.aan.com/conferences-community/upcoming-conference-dates/
Child Abuse	Ray E. Helfer Society.	April	https://www.helfersociety.org/
Pediatric Genetics	American Society of Human Genetics (ASHG) annual meeting	October	https://www.ashg.org/2019meeting/
	Annual Clinical Genetics Meeting (ACGM)	March	https://www.acmgmeeting.net/acmg2020/Public/mainhall.aspx
	Society For Inherited Metabolic disorders (SIMD)	March/April	https://www.simd.org/meetings/
Pediatric Hematology/Oncology	American Society of Pediatric Hemato-Oncology (ASPHO)	May	http://aspho.org/meetings/conference/overview
	American Society of Clinical Oncology (ASCO)	Variable	https://www.asco.org/meetings
	American Society of Hematology	February	https://icaho.binayfoundation.org/ash-review-2020/?gclid=Cj0KCQiAxfzvBRCZARIsAGA7YMygEl2NN94_002yg6RkPits6AjbbfMLdhbPSAHzHvMaE1xyc7rOtc4aAs5fEALw_wcB
Pediatric Hospitalist Medicine	Pediatric Hospitalist Medicine Conference	July	https://www.hospitalmedicine.org/event/pediatric-hospital-medicine/

 

Will be updated as soon as more info become available :)

Do not forget to leave comments about names of conferences you know for different subspecilaties so they can be added to the table. 

-Murad