Satyendra Dhar, MD SFHM
@DharSaty
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Assist Clin Professor, 🗣️ The more I read, the more I acquire, the more certain I am that I know Nothing🫀 Support:
Nucleus of RBC 💝
Joined May 2020
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Have an aim in life, continuously acquire knowledge, work hard, & have perseverance to realise the great life.
-A. P. J. A.K
Below 👇 is the link of my collection of medical infographics.
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DIURETICS
Legend is "Lasix" name was chosen because duration of action is ~ 6 hrs.
Potency:
40mg Furosemide = 20mg Torsemide = 1mg Bumex.
In pts with severe edema, due to inadequate GI absorption, switch to IV Lasix or oral Torsemide. Bioavailability of Torsemide is predictable
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STEROIDS:
👉Prednisone = Cortisone = Dexamethasone = Hydrocortisone Acetate.
👉5mg = 25mg = 0.75mg = 20mg.
👉Hydrocortisone.
* Synthetic version of cortisol.
* Short acting, active form of glucocorticoid.
👉Prednisolone/prednisone.
* Intermediate acting.
* Four times more
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Electrolyte imbalances have a very broad range of signs & symptoms, from being completely asymptomatic to having fatal arrhythmias.
👇👇are the common electrolyte disorder algorithms. Thank u
@grepmeded
&
@ManualOMedicine
#MedTwitter
#MedStudentTwitter
#MedEd
#MBBS
#usmle
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INSULIN CONVERSION
Total daily dose of insulin (TDD) =
N X Wt in Kg
(N= 0.5-1.0 for obese, resistant & most type 2 DM)
Administer:
½ as Basal (Long acting) HS & ½ in 3 divided doses a day before each meal
Target pre-meal BG < 140 & random BG < 180 in non-ICU pts
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DKA DIAGNOSTIC CRITERIA:
Serum glucose >250mg/dL
Arterial pH<7.3
Serum HCO3 <18mEq/L
At least moderate ketonuria or ketonemia
👉Continue insulin infusion until ketoacidosis is resolved, serum glucose <200 mg/dL & S/C insulin is begun
👉2.6-3.2% of DKA admissions are euglycemic
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Prednisone = Cortisone = Dexamethasone = Hydrocortisone Acetate
5 mg = 25 mg = 0.75 mg = 20 mg
Patients taking a physiological dose of 5 mg prednisone or 20 mg hydrocortisone/day or higher, for a period of 3 weeks or more should be considered at risk of HPA axis suppression.
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EQUIVALENT DOSES:
👉Bumetanide (1mg-oral/IV) = Furosemide 40mg (oral) = Furosemide 20mg (IV) = Torsemide 10-20mg = Ethacrynic acid (50 mg oral).
👉Chlorthalidone (12.5 mg) = Hydrochlorothiazide (25 mg) = Indapamide (1.25 mg).
👉Ramipril (2.5 mg daily) = Benazepril (10 mg
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D-dimer
Remember it is ⬆️ in:
Activation of hemostatic & thrombolytic system, pregnancy, inflammation, malignancy, trauma, postsurgical Rx, liver disease (⬇️ clearance), & ❤️ disease.
Lipemia, ⬆️TG, ⬆️ bilirubin, ⬆️RF, or hemolysis may falsely ⬆️the D-dimer level.
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Hematology Algorithms
Red cell distribution width (RDW)=(standard deviation of MCV/mean MCV)×100. Normal range11.5–14.5% has suspicion of thalassemia trait & high often indicates IDA
Mentzer index=(MCV/RBC count). < 13 may represent thalassemia trait & >13 often indicates IDA
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PT & aPTT
Factor XIII :PT & aPTT ↔️
Factor XII :PT↔️, aPTT⬆️
Factor XI :PT↔️, aPTT ⬆️
Factor X :PT & aPTT ⬆️
Factor IX :PT↔️, aPTT⬆️
Factor VIII :PT↔️, aPTT⬆️
Factor VII :PT⬆️; aPTT↔️
Factor V :PT & aPTT⬆️
Factor V & VIII :PT & aPTT⬆️
Factor II/Fibrinogen :PT & aPTT ⬆️
↔️=NORMAL
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RHABDOMYOLYSIS:
👉Characterized by skeletal muscle breakdown & necrosis.
👉Elevated Creatine kinase (CK) hallmark of rhabdomyolysis.
👉Defined based on CK values five times above the upper limit of normal.
👉Half-life of CK is 1.5 days; elevated<12hrs, peaks in 3 days, &
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FLUID ANALYSIS
Systematic approach to analysis of the fluid in conjunction with clinical presentation helps to understand etiology, narrow differential diagnoses, & design a management plan. Includes biochemistry, microscopic examinations & infectious disease tests.
See👇
#meded
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MIDDLE CEREBRAL ARTERY
Largest cerebral artery & most commonly affected by CVA. Deficit depend on extent of infarct & hemispheric dominance:
-C/L hemiparesis
-C/L hemisensory loss
-Hemianopia
-Aphasia (if the dominant hemisphere is involved)
-Neglect (non-dominant hemisphere)
👇
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Hyponatremia (<135 mEq/L):
👉Electrolyte abnormality caused by an excess of total body water in comparison to that of the total body sodium content.
👉Measuring the serum osmolality, urine sodium concentration and urine osmolality helps to differentiate among the possible
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CALCIUM METABOLISM
Name for the element was taken from the Latin word for lime- “CALX’. Silvery, rather soft, lightweight metal itself was first isolated (1808) by Sir Humphry Davy after distilling mercury from an amalgam formed by electrolyzing mixture of lime & mercuric oxide.
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STATINS
👉High-intensity
Atorvastatin 40-80 mg/d Rosuvastatin 20-40 mg/d
👉Moderate
Simvastatin 20-40 mg/d
Atorvastatin 10-20 mg/d
Rosuvastatin 5-10 mg/d
👉Monotherapy with non-statin (niacin, ezetimibe, bile acid sequestrants & fibrates) does not⬇️ CVS morbidity or mortality.
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THYROID EMERGENCIES
Emergencies related to thyroid gland diseases are infrequently observed in the clinical practice. They are caused by either overt dysfunction or marked enlargement of the gland that jeopardize the life of patients, & require admission to ICU in most cases.👇
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NAIL CHANGES
Clubbing, which is one example of a nail manifestation of systemic disease, was first described by Hippocrates in the 5th century B.C. Careful examination of the fingernails & toenails can provide clues to underlying systemic diseases. See 👇
@grepmeded
#MedEd
👇👇
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Electrolyte Repletion:
Significant Electrolyte depletion can result in serious complications & doses may need to be adjusted based on factors including creatine, cardiac status & responses to initial doses. Follow Ur Hospital Policy
@grepmeded
@Paul_Wischmeyer
#meded
#MedTwitter
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Hemoglobin A1c
-Abnormal in conditions that alter longevity of RBC
-Does not provide accurate assessment of frequency or severity of hypoglycemic events
- For every 1-point⬇️, risk of longterm diabetic complications⬇️by ~40%
-Good predictor of lipid profile, CV diseases & stroke.
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PULMONARY NODULE:
Evaluation is guided by size, assessment of probability of malignancy, available diagnostic testing, patient comorbidities, & patient preferences. Focal pulmonary lesions > 3 cm in diameter are called lung masses & considered malignant until proven otherwise.
👇
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STEROIDS
Prednisone = Cortisone = Dexamethasone = Hydrocortisone Acetate
5mg = 25mg = 0.75mg = 20mg
Patients taking physiological dose of 5mg prednisone or 20mg hydrocortisone/day or higher, for a period of ≥ 3 weeks should be considered at risk of HPA axis suppression.
👇👇
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ALBUMINURIA
👉Indicator of kidney damage and /or a biomarker of systemic diseases dates back to 1969, when elevated albumin levels were first demonstrated in the urine of patients with newly diagnosed diabetes.
👉Urine dipstick is a relatively insensitive marker for
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FLUID ANALYSIS
Determining etiology of the clinical entity requires fluid to be rapidly sampled, visualized, examined microscopically, analyzed for chemical, microbiological & cellular content. Systematic approach to analysis of the fluid is presented below.
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Mean Arterial Pressure (MAP):
Surrogate indicator of blood flow & better indicator of tissue perfusion.
MAP = [Cardiac Output (CO) x Systemic Vascular Resistance (SVR)] + Central Venous Pressure (CVP).
Because CVP is usually at or near 0 mmHg.
MAP ≈ CO × SVR
CO = HR X SV
#MAP
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Electrolyte Repletion:
Regimens vary widely & follow hospital policies. Always consider renal & hepatic clearance, & potential A/E. Attempt to identify & Rx underlying cause; correct concurrent electrolyte abnormalities & consider level of monitoring required during correction.
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Middle cerebral artery (MCA):
MCA territory is the most commonly affected territory in a cerebral infarction, due to the size of the territory & the direct flow from ICA into MCA, providing the easiest path for thromboembolism.
@grepmeded
#MedEd
#MedTwitter
#MedStudentTwitter
👇
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C-REACTIVE PROTEIN:
Discovered-Tillett & Francis in1930. First identified as a substance in serum with acute inflammation that reacted with "C" carbohydrate Ab of capsule of pneumococcus. NSAIDs, Statins, Mg can⬇️; Obesity, insomnia, depression, smoking & DM can⬆️CRP.
@grepmeded
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RHEUMATOID LUNG DISEASE:
👉
▪️RA-associated interstitial lung disease (RA-ILD).
▪️Pleural disease (pleural thickening/effusions).
▪️Airway disease (Both upper & lower airway).
▪️Rheumatoid nodules
▪️Drug-induced lung toxicity (i.e., Methotrexate-induced lung injury)
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IRON DEFICIENCY ANEMIA (IDA)
Microcytic anemia (MA) is defined as presence of small, often hypochromic, RBC in a PB smear & is characterized by a low MCV.
Remember mnemonics “TICS” for MA:
T – Thalassemia
I – Iron Deficiency
C – Chronic Disease
S – Sideroblastic anemia
IDA👇👇
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Oxygen delivery to periphery depends on the O2 content & tissue blood flow (equal to CO)
O2 Delivery
DO2 =CaO2 x CO
O2 Content
CO2 =(1.39 x Hb x O2Sat/100)+ (0.003 x PO2)
O2 Consumption Fick
VO2 =CO x (CaO2 – CvO2)
O2 Dissociation
Curve relates O2 sats at varying O2 tensions.
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CIRCLE OF WILLIS (CoW)
Named after Thomas Willis, who first described in his book "Cerebri anatome: cui accessit nervorum descriptio et usus”. Also numbered CN, still used to this day. Complete CoW (where no component is absent or hypoplastic) is seen in 20-25% of individuals👇👇
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Mean Arterial Pressure (MAP)
MAP = DP + 1/3(SP – DP) or
MAP = DP + 1/3(PP)
To perfuse vital organs requires the maintenance of a minimum MAP of 60 mmHg. MAP < 60 for an extended period, end-organ manifestations - ischemia & infarction can occur.
#MedEd
@grepmeded
#MedTwitter
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METABOLIC ACIDOSIS
Simple acid-base "Rules"
👉pCO2 = 1.5 x HCO3 + 8 ± 2
👉pCO2 = HCO3 + 15
👉pCO2 should approximate the decimal digits of arterial pH (e.g., if pH is 7.25, then pCO2 should be 25 mmHg)
👉Corrected AG = (Serum AG measured) + (2.5 x [4.5 - Observed serum albumin])
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Posterior cerebral artery strokes can be challenging to diagnose, have nonspecific & inconsistent symptoms on presentation. May present - headache & mild visual changes - vision loss, diplopia, inability to see 1/2 of the view, or difficulty reading perceiving colors etc.
See 👇
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Ankle brachial index:
< 0.9 abnormal
0.7–0.89 mild PAD
0.4–0.69 moderate PAD
< 0.4 severe PAD
> 1.3 calcified or noncompressible vessels (DM or CKD)
Toe Brachial Index:
Used when ABI is high
≥ 0.7 normal
< 0.7 abnormal
< 0.7 with claudication,
< 0.2 with pain at rest.
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Virchow's node
Left supraclavicular lymph node ("Troisier sign"- enlarged palpable hard node)
Thoracic duct end Lymph node.
Receives afferent drainage from left head, neck, chest, abdomen, pelvis & B/L LE, eventually drains into Jugulo-subclavian venous jxn via thoracic duct.
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OTTAWA ANKLE RULES:
A clinical decision-making strategy for determining which patients require radiographic imaging for ankle & midfoot injuries. Proper application has high (97.5%) sensitivity & reduces need for radiographs by ~35%.
#MedTwitter
#MedEd
#Twitterortho
#anklepain
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LACTIC ACIDOSIS (LA)
Causes of dynamic lactate despite
fluid resuscitation
* Metformin associated LA
* Liver failure
* Occult malignancy, Lymphoma
* Thiamine, phosphorus deficiency
* Drugs: Albuterol, epinephrine,
linezolid, propylene/ethylene glycol
@BrownJHM
@grepmeded
See 👇
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⚕️BACTERIAL MENINGITIS
👉Opening pressure > 300 mm H2O (39% of patients).
👉Cloudy, green, or purulent.
👉Glucose < 34 mg per dL,
👉Protein > 220 mg per dL,
👉WBCs > 2,000 per μL, or
Neutrophils > 1,180 per μL.
👉Gram stain testing: specificity of 97% and
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DUPUYTREN CONTRACTURE
Fibroproliferative disorder of palmar fascia→causes pathologic nodules & cords in palm→permanent & irreversible flexion contractures of ≥1digits.
Etiology-unknown
Affects 4 & 5 digits
Risks: M>F,hereditary,OH-use,DM,seizures, Scandinavian,HIV,↑with age.
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Bile Acids (BA) & Diabetes:
-BA metabolism altered in obesity & DM
-BA stimulate GLP1 production in the distal SB & colon, stimulating insulin secretion & are involved in carb & fat metabolism
-Through their insulin sensitizing effect play a part in insulin resistance & type 2 DM
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Diabetes-related foot infection (DFI)
Recommendation (IWGDF/IDSA Guidelines):
👉Perform MRI when osteomyelitis remains in doubt despite clinical, plain X-rays and laboratory findings.
👉When suspicion of osteomyelitis, bone (rather than soft tissue) samples should be obtained.
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Beta-Blocker Overdose/toxicity:
👉Bradycardia & hypotension (most common).
👉Myocardial depression & cardiogenic shock (severe overdoses).
👉Ventricular dysrhythmias (Common with propranolol & acebutolol).
👉Others (mental status change, seizure, hypoglycemia, & bronchospasm).
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PROCALCITONIN
👉Triggers for synthesis:
Bacterial toxins (endotoxin/cytokines→TNFα, IL-1β, IL-6)
👉⬆️6-12 hrs following initial bacterial infections.
👉⬆️steadily 2-4 hrs following onset of sepsis.
👉t 1/2: 20-24 hrs.
👉Antibiotic Rx⬇️this by 50% over 24 hrs.
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CREATINE KINASE
Elevated levels hallmark of rhabdomyolysis.
Half-life of1.5days; elevated<12hrs, peaks in 3days, normalizes in 5days.
Myoglobin half-life of 2-3hrs & rapidly excreted by kidneys.
Rapid & unpredictable metabolism makes myoglobin less useful marker of muscle injury.
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NEUTROPENIC FEVER
Single oral temp ≥ 101F; or ≥ 100.4F for at least an hour, with
ANC< 1500cells/microliter.
-Severe neutropenia, ANC < 500
-Profound neutropenia, ANC <100
ANC = multiply total WBC count by percentage of PMNs & band neutrophils.
Credit
@LuskinMarlise
#MedEd
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Warfarin Induced Skin Necrosis
Once suspected, warfarin should be stopped & patient should be given Vitamin K & FFP to reverse the effects.
C/O: Intense pain & paresthesia in affected areas
Begin as an area of erythema→ecchymoses→petechiae→hemorrhagic bullae with necrosis.
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ACUTE COMPARTMENT SYNDROME
The definitive surgical therapy is emergent fasciotomy, with subsequent fracture reduction or stabilization & vascular repair, if needed. The goal is restoration of muscle perfusion < 6 hours.
Intra compartmental pressure > 30 mmHg aids diagnosis.👇
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Albuminuria is important risk factor for CKD progression & a biomarker of glomerular dysfunction. HIPPOCRATES was the first who recognized proteinuria: "When bubbles settle on the surface of the urine, they indicate disease of the kidneys & that the complaint will be protracted”.
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Mentzer Index=MCV/RBC count
(Sen & Sp of 91 & 83% for IDA; 83 & 91% for βTT)
RDW=Measures variability of red cell volume/size.
RDW-CV (%)=1 SD of RBC volume/MCVx100%
Reticulocyte Index (RI)=Retic ct x Hct / Normal Hct
RPI=RI/Maturation correction
RPI=Retic ct x Hb/Normal Hb x 0.5
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TONGUE PATHOLOGY
Recognition & diagnosis of tongue abnormalities require examination of tongue morphology & thorough history - onset & duration, antecedent symptoms, tobacco & alcohol use. Complete head & neck examination, & assessment for lymphadenopathy, is essential. 👇👇
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Lower Extremity Ulcers:
General principles of management include wound debridement, infection control, application of dressings, off-loading of localized pressure, treatment of underlying conditions - DM & PAD; & lifestyle changes (smoking cessation & dietary modifications).
👇👇
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SGLT2 inhibitors
* Act on SGLT-2 proteins expressed in renal PCT to⬇️reabsorption of filtered glucose,⬇️renal threshold for glucose &⬆️urinary glucose excretion.
* ⬇️risk of CV adverse events in DM2 with underlying CV illness &⬇️risk of ESRD, CV mortality, hospitalization for HF.
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ABG vs VBG
pH
Average VBG is 0.03-0.04 < ABG
Relationship true even in shock & severe MA.
pC02
Venous pCO2 <45 mmHg➡️100% NPV for hypercarbia.
Correlation (confidence intervals 5.7- 8.6mmHg)
PaO2
No correlation
HCO3
Correlates similar to pH (difference of 0.52-1.5 mmol/L)
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Medications Known to Decrease Vitamin B12 Levels
- colchicine (affects the ileal receptors for vit b12 absorption)
- ethanol (affects intestinal absorption)
- histamine 2 receptor antagonists
- metformin,
- proton pump inhibitors (PPI)
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Thrombocytopenia
👇one of my very old and busy slide.
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QT/QTc- Interval:
👉Start of Q-wave to end of the T-wave (time of ventricular depolarization + repolarization).
👉Life threatening risk of prolonged QTc >500ms = Torsades de pointes (TdP); SCD.
👉Prolonged QT/QTc interval may be a clue to electrolyte disturbances (hypocalcemia
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LUDWIG’S ANGINA (LA):
The term “angina” is derived from Latin word for choke (angere) & the Greek word for strangle (ankhone).
In LA, refers to feeling of strangling & choking secondary to lingual airway obstruction, the most serious potential complication of this condition.
👇
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LACTIC ACID (or lactate)
Measured to assess for tissue hypoxia, shock, sepsis, and metabolic conditions.
Elevated levels indicate that cells are not getting enough oxygen, leading to anaerobic metabolism.
👉Ranges:
Normal Range:
•Typically, the normal range for blood
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LIVER ABSCESS
· Pyogenic abscess, accounts for 80% of abscess.
· Amebic abscess due to Entamoeba histolytica, accounts for 10%.
· Fungal abscess, accounts for < 10%.
· 50% of solitary liver abscesses occur in the right Liver lobe.
· Right hepatic lobe (~75%), less commonly left
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Furosemide
Legend is, "Lasix" was chosen ➡️duration of action is about 6 hrs. Because it lasts six hours. Loop diuretics, acts on the thick ascending limb of the loop of Henle.
#MedTwitter
#MedEd
#USMLE
#medschool
#MedStudentTwitter
#medstudent
#TwitterRx
@grepmeded
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HYPOMAGNESEMIA
FEMg = [(UMg x PCr)/(PMg x UCr x 0.7)] x 100
> 2%, etiology likely renal wasting (Drugs :diuretics, aminoglycosides or cisplatin)
Corrected Mg=Actual Mg + 0.08 (4-Alb)
MgSo4 vial=1 gm =96mg elemental Mg
Rechecking serum Mg too soon ➡️ a false sense of security.
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GRADING in clinical medicine
Grading system is often used in Clinical medicine to indicate the severity scale of a disease or a pathology.👇are some of the grading system used often in daily practice. Please comment & add if you know any other grading systems.
@grepmeded
#MedEd
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Drugs associated with worsening of Myasthenia Gravis (MG):
· D-penicillamine
· Botulinum toxin.
· Telithromycin
· Fluoroquinolones
· Quinine
· Magnesium
· Macrolide antibiotics
· Corticosteroids (may cause transient worsening within first 2 wks).
· Aminoglycoside antibiotics.
·
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LACTATE DEHYDROGENASE.
👉Cytoplasmic enzyme (tissues throughout the body).
👉Oxido-reductase (anaerobic metabolic pathway).
👉Highest concentration : ❤️ 💪🫘& RBC.
👉Drugs ⬆️LDH: alcohol, aspirin, narcotics, anesthetics, clofibrate, procainamide.
👉Cancer cells (Warburg effect)
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Myxedema coma & thyroid storm are associated with increased mortality. Prompt recognition of these states is necessary to initiate treatment. Management requires medical and supportive therapies & should be treated in an ICU setting.
@grepmeded
#meded
#MedTwitter
#MedStudents
👇
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Guillain–Barré syndrome (GBS)
*Progressive B/L weakness of arms & legs
*Absent or⬇️tendon reflexes in affected limbs
*Progressive phase lasts from days-4wks
*Mild sensory s/s
*CN involvement (B/L VII palsy)
*Autonomic dysfxn
*Muscular or radicular back or limb pain
*⬆️CSF protein
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Spontaneous bacterial peritonitis-
suspected, any of the following:
- Temp> 37.8°C
- Abdominal pain &/or tenderness
- Change in mental status
- Ascitic fluid PMN count ≥250 cells/mm3
Most cases due to→E. coli & Klebsiella (strept & staph can occur).
Duration of ABX Rx-5 days
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PANCREATIC PSEUDOCYSTS
Fluid collections in pancreatic tissue or adjacent pancreatic space.
Unlikely to resolve spontaneously if:
- Persists for > 6 weeks
- Chronic pancreatitis is evident
- There is a pancreatic duct anomaly or
- Pseudocyst is surrounded by a thick wall
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LACTULOSE
Metabolized to acetic & lactic acid→↓pH→↓survival of urease producing bacteria→conversion NH3 to NH4+(less readily absorbed)
Cathartic -↑fecal nitrogen waste
RIFAXIMIN
Antimicrobial, < 0.4% absorbed
↓colon deaminating bacteria (produce NH3 from urea)
@LiverFellow
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HYPOGLYCEMIA IN NON-DIABETICS:
👉Hormonal dysfunction
Addison's disease
Hypopituitarism
👉Non-B cell tumors.
👉Post-gastric bypass
👉Insulinomas.
👉Drugs:
NSAID’s, phenylbutazone, propoxyphene,
Quinine
Lithium, TCA,
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Parathyroid gland was first described by Richard Owen. Vassale & Generali Francesco observed tetany following parathyroidectomy. Schlagenhaufer suggested, 1915, in an attempt to cure bone disease, solitary parathyroid enlargement, if present, should be excised.
👇Hyperthyroidism
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D-dimer
This blood test has very high NPV. PPV of a positive D-dimer test is low as there are many conditions in which the thrombolytic system is activated. The specificity of the D-dimer test ⬇️with ⬆️age.
See 👇👇
#MedTwitter
#MedEd
#MedStudentTwitter
#medstudent
@grepmeded
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Procalcitonin, peptide precursor of calcitonin, was first identified by Leonard Deftos & Bernard Roos (1970s). In healthy people, circulating levels are <0.05 ng/mL but in severe bacterial infection & sepsis, levels can ⬆️ many fold within 4-6 hrs.
@grepmeded
#MedEd
#MedTwitter
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Sensitivity and Specificity ??
what is sensitivity?
what is specificity?
👇👇
Well, both are measures of a test’s 👉validity.
👉Remember:
🙋♂️SNOUT
SeNsitive test with a Negative result rules OUTthe disease
🙋♂️SPIN
Specific test with a Positive result rules INthe disease.
1/n
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Diabetic Ketoacidosis
ADA diagnostic criteria:
- Serum glucose level > 250 mg/dL
- Elevated serum ketone level
- pH < 7.3
- Serum bicarbonate level < 18 mEq/L
Insulin deficiency & infection are main precipitating factors
Remember:
SGLT-2 inhibitors may precipitate euglycemic DKA
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Transjugular Intrahepatic Portosystemic Shunt (TIPS):
👉Shunt between an intrahepatic branch of the portal vein and the hepatic vein, allowing blood to bypass the high-resistance vessels within the fibrotic liver.
👉Indications:
✔️Early/urgent (within 72 hrs; preferably within
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Cardiomyopathies
Is more than ischemic or non-ischemic. 👇
Takotsubo was first described in Japan. Name is derived from centuries-old style of octopus trap to catch octopuses where pot has a narrow neck & a wide base, allowing octopuses to enter but not leave.
#MedEd
@grepmeded
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Cerebral vascular accident-CVA
Hippocrates, “father of medicine” first recognized CVA > 2400 years ago & called it apoplexy, Greek term - "struck down by violence". Name described sudden changes occurring in stroke, but didn’t necessarily convey what’s actually happening in brain
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ABDOMINAL AORTIC ANEURYSM
SURGICAL repair - for men with
AAA ≥ 5.5cm or > 4.0cm that has rapidly increased in size (defined as increase in 1.0cm in diameter over a 1-year).
Annual RISK for rupture:
0% for AAAs 3.0-3.9cm
1% for 4.0-4.9 &
11% for 5.0-5.9cm
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#MedEd
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Sensitivity and Specificity:
The question is:👇
In a study, 200 of the 300 people with the disease had a positive test & 500 of the 700 people without the disease had a negative test
HOW TO DO CALCULATIONS: 👇
The first & important step is to prepare:
🙋♂️2 x 2 TABLE
1/n
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Current US FDA/Expert Consensus Guidance
👉SGLT2i contraindicated in patients with baseline eGFR< 20.
👉Sacubitril/valsartan contraindicated in patients with baseline eGFR< 30 and should be discontinued if eGFR falls below 30.
👉MRA contraindicated in patients with baseline
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Incidentaloma:
A radiological neologism, to denote a lesion found incidentally & of dubious clinical significance. The word 'incidentaloma' first appears in the literature in 1982 in a paper by Glenn W Geelhoed, a surgeon, & Edward M Druy, a radiologist.
See 👇👇
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ACA infarcts are rare➡️ collateral circulation➡️ by the Ant Comm Art. Presents as C/L hemiparesis + loss of sensibility in foot & LE. Sometimes urinary incontinence➡️ involvement of medial paracentral gyrus. Proximal lesion➡️ cognitive impairment➡️ lesions in prefrontal cortex.👇
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PCA strokes can restrict blood supply of multiple brain regions including occipital lobe, inferomedial temporal lobe, large portion of thalamus, upper brainstem & midbrain. Symptoms may be nonspecific & inconsistent upon initial presentation, therefore challenging to diagnose.
👇
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DIURETICS:
Hg was advocated in 1600, but discovery of sulfanilamide-induced NaHCo3 diuresis in 1940s provided the first step in the new age of effective diuretics. In 1950s
chlorothiazide was introduced, first orally effective agent to mobilize NaCI
#MedEd
@grepmeded
@JLimHospMD
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OBSTRUCTIVE SLEEP APNEA:
STOP-BANG questionnaire
Snoring loudly
Tired (Often feel tired, fatigued, or daytime sleepy)
Observed- stop breathing during sleep.
BP (Have or are being Rx for HTN)
BMI ≥35
Age >50yrs
Neck circumference >40cm
Gender- male
High risk ≥3
Low risk < 3
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Mg deficiency is commonly encountered in clinical practice. Key is to find primary cause. Asymptomatic managed with supplements prescribed as outpatients. Symptomatic need admission & IV Mg. 👇
#MedTwitter
#MedEd
#medschool
#MedStudentTwitter
#medstudent
#TwitterRx
@grepmeded
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Drug-induced thrombocytopenia:
👉Immune-mediated:
🩺Drugs trigger an immune response, leading to the production of antibodies that attack and destroy platelets.
🩺Examples: Certain antibiotics (penicillin and sulfonamides), anti-inflammatory drugs (non-steroidal
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Medications associated with an increased risk of falls or fractures:
-Levothyroxine (decreases bone density)
-Loop diuretics (impairs renal calcium absorption)
-PPI (reduce calcium absorption)
-SSRI/sedatives (increase risk of fall caused by sedation, postural hypotension)
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Higher concentrations of insulin are available to deliver larger doses of insulin with less volume & decrease the number of injections needed at one time when patients require high
Concentrated Insulin.
#MedEd
@grepmeded
#MedTwitter
#MedStudentTwitter
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C DIFFICILE INFECTION
Fidaxomicin vs Vancomycin
👉Fidaxomicin:
Macrocyclic antibiotic
Bactericidal (rapidly kills C. diff)
Prolonged post-antibiotic effect
45% RR in recurrences
Improved global cure
Inhibit sporulation
200mg BID X10days
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Peritonitis
Infectious peritonitis has many life-threatening complications➡️ mesenteric vein thrombosis, ARDS, progressive MOF, & death. Other include prolonged ileus, surgical wound infection, intra-abdominal abscess, enteric fistula, & inflammatory adhesions.
@grepmeded
#MedEd
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MUSCLE WEAKNESS:
UMN lesions: anywhere from cortex to descending tracts.
👉Hyperreflexia
👉Spasticity,
👉+ve Babinski reflex
LMN lesions: anywhere from anterior horn of spinal cord, peripheral nerve, neuromuscular jxn, or muscle.
👉Hyporeflexia
👉Flaccid paralysis
👉Atrophy
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DIGOXIN:
* Augments inotropy
*⬆️vagal tone &⬇️conduction through AV node
👉Indications:
* HFrEF
* A fib or A flutter
👉Digitalis effect:
* T wave flattening or inversion
* QT interval shortening.
* Scooped ST segments with ST depression (lateral leads).
*⬆️amplitude of U waves.
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MONKEYPOX:
WHO has activated its highest alert level for the growing monkeypox outbreak, declaring the virus a public health emergency of international concern.
HERE IS WHAT WE KNOW UNTIL NOW 👇👇👇👇👇👇👇
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