Showing posts with label Pearls. Show all posts
Showing posts with label Pearls. Show all posts

Thursday, 8 October 2015

Pathology/Hematology Pearls

Pathology/Hematology Pearls:
1) Thrombocytopenia**, REGARDLESS of severity, is NOT a contraindication of Bone Marrow Biopsy.

2) ABSOLUTE contraindications to performing a Bone Marrow Biopsy:
Hemophilia
Severe DIC, or other related severe bleeding disorders (Other than Thrombocytopenia).

3) Sternum:
Bone Marrow Aspiration
OK (if carefully done)
#but 
Bone Marrow BIOPSY
Contraindicated.

4) Most favorite (common) site for BM exam aspirate/biopsy:
Posterior superior iliac crest and spine Adults, Children & most Infants.
Anterior Tibia
premature infants and some full-term infants (Age must be BELOW 18 moths)

**However depending on the circumstances, platelet transfusion to insure a platelet count >20,000/mL may be warranted PRIOR to the procedure.

Tuesday, 6 October 2015

Heat Loss - Pearl of Wisdom

:: Pearl of Wisdom for MOST Confusing Topic ::

If patient naked heat loss  RADIATION

If patient naked and lying (contact with table)  CONDUCTION

If patient naked and temperature mention RADIATION

if humidity mention  CONVECTION
Convection requires medium (medium is humidity)

If Tracheostomy ETT  EVAPORATION.

(Shared by Dr Syeda Najma Ibrar - Thanks to her)

Tuesday, 29 September 2015

BEST DIAGNOSTIC TESTS FOR ANEMIAS


BEST DIAGNOSTIC TESTS FOR ANEMIAS:

*Iron deficiency anemia =====> Dec ferritin (not "increased TIBC")

*Thalesemia =====> Hb Electrophoresis

* Lead Poisoning =====> Lead level Blood+Urine

* B12 Def =====> Increase methylmalonic acid

* Folate def =====> RBCs Folate levels (not "blood folate levels")

* Pernicious Anemia =====> Antibodies against intrinsic factor

* PNH =====> flow ctyometry

* Sickle Cell =====> Hb electrophoresis

* G6PD def =====> RBC enzyme essay

* pyruvate kinase disease =====> Rbc enzyme assay

* Aplastic anemia =====> Bone marrow examination

* Hemolytic anemia =====> Decreased haptoglobin (not "increased reticulocytosis")

NOTE: This post covers many controversial MCQs


Shared by Dr Muhammad Fawad 

Sunday, 20 September 2015

52 HIGHEST Yield Pearls

52 HIGHEST Yield Pearls:

1) Hepatitis "D" Virus has HIGHEST mortality in ALL people EXCEPT#Pregnancy.
In Pregnant women: MOST LETHAL is Hepatitis E virus.

2) "While calculating Serum Osmolality the serum Na is multiplied by 2 to account for the accompanying ANIONS (mostly Cl- & HCO3-)."

3) Most Common cause of Metastasis to LIVER is primary cancers of Lung.
LLLLLungs send metastasis to LLLLLiver.

4) Ketamine is the ONLY induction agent that causes Bronchodilation.
Again:
Ketamine is the ONLY induction agent that causes Bronchodilation.

5) AANNencephaly: failure of AANNterior neuropore to close.(at day 25)
SSSpinda bifida: failure of poSSSterior neuropore to close.(at day 27)

6) Muscle Spindles: Innervated by 1a fibers - cause skeletal muscle to CONTRACT.
GTOs: innervated by 1b - cause contracting muscle to RELAX

7) In SSSpontaneous pneumothorax: trachea shifts to ipSSSilateral side.
In TTTension pneumothorax: trachea deviates to conTTTralateral side.

8) Antibiotics SAFE in pregnancy:
All Penicillins.
All Cephalosporins.
All Carbapenems.
Aztreonam.
Azithromycin.
Nitrofurantoin (Avoid in last trimester because can cause hemolysis in G6PD deficient fetus).
Metronidazole (SAFE in ALL trimesters).

9) MICROcytic anemia + NORMAL iron studies* = Thalassemia.
*Iron studies = Serum Ferritin, TIBC etc

10) Know the difference:
#Atopic Dermatitis: Type-1 HS (Hyper Sensitivity)
#Contact Dermatitis: Type 4 HS.

11) In CHRONIC Hepatitis:
Check serum #ALT to monitor THERAPY response (Follow-up)
Check #PT to look (rule out) Acute Liver FAILURE.

12) IN Nephron:
Maximum reabsorption of H2O take place in Proximal Convoluted Tubules, REGARDLESS to ADH status (present or absent).

13) Generally:
Mass in ANTERIOR Mediastinum =THYMOMA.
Mass in POSTERIOR Mediastinum = NEUROGENIC TUMOR.

14) Most Common Congenital heart "#Lesion" = Bicuspid aortic valve.
Most Common Congenital heart "#Defect" = VSD.

15) Increased neural activity #before a SKILLED Voluntary movement is first seen in the "CORTICAL ASSOCIATION AREAS".

16) Ampullary region of Uterine tube:
WIDEST part of the Fallopian.
MOST COMMON SITE of Ectopic Pregnancy &
MOST COMMON SITE of Fertilization.

17) The ONLY gynecological cancer that is staged clinically, NOT surgically is cervical cancer.

18) The ONLY hematologic disease that cause hyperchromic microcytosis is Hereditary Spherocytosis.

19) The ONLY hematologic disease that cause iron deficiency anemia DESPITE increase RBCs is Polycythemia Vera.

20) The MOST COMMON thyroid CA is Papillary (P-opular).
It also has P-sammoma bodies on histology.
It causes P-alpable lymph nodes (lymphatic spread)

21) ALL Quinolones lack anaerobic coverage EXCEPT Moxifloxacin.

22) COLD sensations are transmitted by myelinated "A-delta" fibers.
WARM sensations are transmitted by unmyelinated "C" fibers.

23) Sigmoid Colon:
I) MOST COMMON (MC) site of Colorectal Carcinoma.
II) MC site of Volvulus in Elderly adults (in young -> Cecum).
II) MC site of Diverticulosis.

24) Homocysteine level is ELEVATED in BOTH (Vit B 12 & Folate deficiencies) While Methylmalonic Acid level is NORMAL in Folate & ELEVATED in B12.

25) ALL ß-blockers are safe during gestation EXCEPT atenolol.
Once more:
ALL ß-blockers are safe during gestation EXCEPT atenolol.

26) Ectopic Pregnancy:
Most Common site: Ampulla.
Most common site for Rupture: Isthmus.

27) In SIADH = Serum Osmolarity DECreased
In Water Deprivation : Serum Osmolarity HIGH or Normal (#NEVERDecreased)

28) Oral Cavity:
Premalignant CONDITIONS = Submucous Fibrosis & Lichen planus.
Premalignant LESIONS = Erythroplakia & Leukoplakia.

29) All the EXTENSION movements (Elbow, Wrist, Fingers) of Upper Limb is innervated by Radial Nerve.

30) Treatment of Hyperthyroidism in Pregnancy: 
Propylthiouracil in FIRST trimester. 
Methimazole AFTER the first trimester.
[If they didn't mention Trimester in question then SELECT PropylThioUracil (PTU)]

31) Urine extravasation in:
Rupture of 
Penile urethra -> SCROTUM
Bulbar -> SUPERFICIAL perenial pouch
Prostatatic urethra -> DEEP perenial pouch

32) All RNA viruses replicate in the cytoplasm of the host cell EXCEPT Influenza & HIV.
All RNA viruses are single stranded EXCEPT Reovirus.
All DNA viruses replicate in the nucleus of the host cell EXCEPT Poxvirus.
All DNA viruses are double stranded EXCEPT Parvovirus.

33) #Tamoxifen is an estrogen receptor #AGONIST in the uterus.
#Raloxifene is an estrogen receptor #ANTAGONIST in the uterus.
Tamoxifen for #PREmenopausal women with high risk for breast cancer.
Raloxifene for #POSTmenopausal women with high risk for breast cancer.

34) Isolated #6th cranial nerve palsy causes #HORIZONTAL diplopia. 
Isolated #4th cranial nerve palsy causes #VERTICAL diplopia.

35) Diagnostic Test for Streptococcal #INFECTION: blood CULTURE.
Diagnostic Test for Strep infection #COMPLICATIONS (Rh. Fever/PS-GN) : ASO titre.

36) E. Coli is the:
MOST COMMON cause of Pyogenic Peritonitis (visceral perforation).
&
MOST COMMON cause of Spontaneous Bacterial Peritonitis.

37) Most Common #aspiration site is #Right #LOWER lobe (doesn't matter pt is standing, sitting, supine or dancing)
EXCEPTION: ONLY in ONE condition it can aspirate to Middle or even Upper lobe => in right sided position.

38) Pt CAN'T stand on his/her toes : Rupture of #ACHILLES tendon.
Pt can STAND on his/her toes but feel PAIN : Rupture of #PLANTARIStendon.

39) The main cause of Edema in Nephrotic Syndrome is Sodium Retention, #NOT Hypoalbuminemia.
(The Hypoalbuminemia is LESS important contributor)

40) Know the Difference:
Antibodies form #IN: Spleen.
Antibodies form #BY: Plasma Cells.

41) Q fever:
The ONLY rickettsial disease WITHOUT a #rash.
The ONLY rickettsial disease NOT needing vector for transmission.

42) Nasal deformity + granuloma + Acid Fast Bacilli = Leprosy.
Nasal deformity + granuloma + hematuria & positive c-ANCA = Wegner’s Disease.

43) Polycystic Kidney Disease:
The most common cause of Death is
ESRD - Renal failure.
[Ruptured Berry Aneurysm (SAH) is NOT correct]

44) Chronic hepatitis B is the most common cause of HCC worldwide with
chronic hepatitis C being the most common cause in Europe.

45) Location of Melanocytes in the skin: Stratum basalis (the deepest layer of the five EPIdermis layers.)

46) Fossa navicularis is the only part of male urethra that is NOT lined by transitional epithelium. It is lined by non-keratinized squamous epithelium.

47) Down syndrome and Leukemia :
- Younger than 5 year old --> AML (M7 subtype)
- Older than 5 year old --> ALL

48) Respiratory Bronchioles:
- FUNCTIONALLY separate the Upper & Lower respiratory tract.
- Lymphatic channels begin at this level & flow upward.

49) 
History of Asbestos exposure: Mesothelioma. 
History of Smoking: Bronchogenic carcinoma. 
History of BOTH (Smoking + Asbestos exposure) : Bronchogenic carcinoma.
50) The Key feature of SHOCK is TISSUE HYPOPERFUSION, not a specific level of systemic arterial Blood Pressure.

51) The most ACCURATE noninvasive index of core temperature is Esophageal temperature.
(Esophageal > Rectal > Oral)

52) Syndromes & Congenital Heart Defect:
Down AVSDs.
Turner
Coarctation of Aorta.
Marfan
Aortic Aneurysm.
Williams
Aortic stenosis.
Noonan
Pulmonary stenosis.

Sunday, 8 March 2015

Random Pearls


ALL steroid hormones are protein bound EXCEPT DHEA.

ALL protein hormones are not bound to plasma proteins EXCEPT IGF-1.

ALL hormones are secreted in pulsatile fashion EXCEPT Thyroxin.


Regarding TB:
‪#‎Ghon‬ Complex - ONLY in ‪#‎PRIMARY‬ T.B.
‪#‎Cavitation‬ - ONLY in ‪#‎SECONDARY‬ T.B.
Calcification, Positive PPD, Caseating granuloma - in BOTH.

The MOST COMMON thyroid Carcinoma is Papillary (P-opular).
It also has P-sammoma bodies on histology.
It causes P-alpable lymph nodes (lymphatic spread)

n. MeninGitidis ferments Maltose & Glucose.
n. Gonorrhoeae ferments ONLY Glucose.

Thursday, 2 October 2014

LYMPHATIC DRAINAGE OF MAJOR ORGANS


LYMPHATIC DRAINAGE OF MAJOR ORGANS

GIT: all lymph of GIT is drained into CYSTERNA CHYLI, THORACIC DUCT & then finally drains into LEFT SUBCLAVIAN VEIN

CERVICAL ESOPHAGUS drains into Deep cervical nodes

THORACIC ESOPHAGUS drains into posterior mediastinal nodes

ABDOMINAL ESOPHAGUS drains into Preaortic & celiac nodes

STOMACH is drained to Aortic nodes

SMALL INTESTINE drains into Superior Mesentric nodes

LARGE INTESTINE drains into Central nodes through Epicolic, Paracolic & Intermediate nodes

RECTUM: Upper half drains into Inferior mesentric nodes
Lower half drains into internal iliaac nodes

ANAL CANAL: Upper half into internal iliac nodes
Lower half into Superficial inguinal nodes

MALE GENITAL TRACT
SCROTUM drains into Superficial inguinal nodes
TESTIS drains into Paraaortic nodes
PROSTATE drains into Internal & external Iliac nodes
PENIS.. Skin.. Superficial Inguinal nodes
Deep structure.. Internal Iliac nodes

FEMALE GENITAL TRACT
OVARY, FALLOPIAN TUBES, UPPER UTERINE CORPUS drains into Aortic & paraaortic nodes.
UPPER VAGINA, CERVIX drains into External & Internal Iliac nodes.
LOWER VAGINA & VULVA drains into Inguinal nodes.

[Shared by Dr Zara Bashir]

Tuesday, 16 September 2014

Tamoxifen vs Raloxifene



Tamoxifen is an estrogen receptor AGONIST in the uterus.
Raloxifene is an estrogen receptor ANTAGONIST in the uterus.


Tamoxifen for PREmenopausal women with high risk for breast cancer.
Raloxifene for POSTmenopausal women with high risk for breast cancer.


Tuesday, 2 September 2014

3 Pearls of Wisdom

:: 3 Pearls of Wisdom ::

1)
Oral Cavity: 
Premalignant CONDITIONS = Submucous Fibrosis & Lichen planus.
Premalignant LESIONS = Erythroplakia & Leukoplakia.

2)
Isolated 6th cranial nerve palsy causes HORIZONTAL diplopia. 
Isolated 4th cranial nerve palsy causes VERTICAL diplopia.

3) 
Fluent aphasia: Cerebral lesion is POSTERIOR to the central sulcus. 
Nonfluent aphasia: Cerebral lesion is ANTERIOR to the central sulcus.

Tuesday, 5 August 2014

Hematology Key Concept Pearls


:: Hematology Key Concept Pearls ::

1) Microcytic Anemia with Low Ferritin & High TIBC = Iron deficiency Anemia.



2) Microcytic Anemia with High Ferritin & Low TIBC = Anemia of Chronic Disease.



3) Microcytic Anemia with High Serum Iron = Sideroblastic Anemia.



4) Microcytic Anemia with NORMAL Iron studies = Thalassemia.
________
TIBC = Total Iron Binding Capacity
Ferritin = Stored Iron