Karim Omar

#FOAMed #POCUS

[Karim Omar @karimomar7425]

@DrNmarianaSVas Apoptotic bodies in hepatocytes in viral hepatitis and Yellow fever

[Karim Omar @karimomar7425]

@abouhussain98 شوفت بقى

[Karim Omar @karimomar7425]

@DrNmarianaSVas Tetralogy of Fallot

[Karim Omar @karimomar7425]

@DrNmarianaSVas Asbestosis

[The American Society of Neuroradiology @TheASNR]

Great job everyone!

[Karim Omar @karimomar7425]

@DrNmarianaSVas - Burkitt lymphoma t(8:14).
- Liver ultrasound finding in Acute hepatitis.

[Karim Omar @karimomar7425]

@DrNmarianaSVas Goodpasture Syndrome(Anti-GBM disease)

[N. Mariana S. Vasquez MD @DrNmarianaSVas]

✨ Warm vs Cold Autoimmune Hemolytic Anemia

The easiest way to separate them on USMLE/NBME questions:

Warm AIHA
IgG → reacts at body temperature
Extravascular hemolysis in the spleen
Spherocytes
Positive direct Coombs test for IgG

Classic associations: SLE, CLL, methyldopa

↓

Cold agglutinin disease
IgM → reacts in cold temperatures
→ Complement activation → hemolysis
RBC agglutination
Positive direct Coombs test for C3

Classic associations: Mycoplasma pneumoniae, EBV, lymphoproliferative disorders

USMLE / NBME shortcut

Warm → IgG → Spleen → Spherocytes

Cold → IgM → Complement → Agglutination

Clinical clue:

Patient with pneumonia develops acrocyanosis/Raynaud-like symptoms + hemolysis
Think cold agglutinin disease✨

[Karim Omar @karimomar7425]

@DrNmarianaSVas Reynold's pentad (Ascending Cholangitis)

[N. Mariana S. Vasquez MD @DrNmarianaSVas]

✨ JAK2 Mutation: The High Yield Map

Think myeloproliferative neoplasms when you see JAK2.

JAK2 V617F → constitutive JAK STAT signaling → increased myeloid proliferation

Polycythemia vera
JAK2 mutation → ↑ RBC production
↑ Hemoglobin/Hct
Low EPO
Pruritus after hot shower + erythromelalgia

Essential thrombocythemia
JAK2 mutation → ↑ megakaryocytes
Marked thrombocytosis
Thrombosis or bleeding

Primary myelofibrosis
JAK2 mutation → abnormal megakaryocytes
Cytokine release → bone marrow fibrosis
Massive splenomegaly + teardrop RBCs
Extramedullary hematopoiesis

Important USMLE distinction

JAK2 is also seen in some MPNs without V617F, particularly JAK2 exon 12 mutations in polycythemia vera.

The classic MPN mutation pattern

PV → JAK2

ET → JAK2 / CALR / MPL

Primary myelofibrosis → JAK2 / CALR / MPL

Clinical shortcut

RBCs ↑ + EPO ↓ → think PV → test JAK2

Platelets ↑ → think ET → JAK2, CALR, or MPL

Massive spleen + teardrop cells → think primary myelofibrosis✨

[Karim Omar @karimomar7425]

@DrNmarianaSVas Miller-Fisher syndrome a variant of Guillain Barre syndrome

[Lea Alhilali, MD @teachplaygrub]

Anyone can see the bright spot of diffusion imaging!

What sets you apart is your ability to tell them where it is—what vascular territory

Here are the vascular territories you need to know:

* Posterior Inferior Cerebellar Artery (PICA)
Soft under surface of the cerebellum

* Superior Cerebellar Artery (SCA)
The SCA territory is the top of the cerebellum (SCA is the SCAlp of the cerebellum)

* Basilar perforators
Make a line in the pons like a penetrating injury. So perforator infarcts look like perforating injuries

* Anterior Choroidal artery
This supplies the posterior limb of the internal capsule & corticospinal tract. Remember COR-roidal is COR-ticospinal

* Lenticulostriate arteries
Infarct territory looks like a tadpole

* Heubner's artery: infarct is the caudate head.
Remember "who called" which sounds like "heu caud" so heubner takes out the caudate

* Anterior cerebral artery (ACA)
Medial, anterior surface of the cerebral hemispheres

* Middle cerebral artery (MCA)
Lateral surface of the cerebral hemispheres

* Posterior cerebral artery (PCA)
Medial, posterior surface of the cerebral hemispheres

Hopefully now when it comes to the vascular territories, you will always be right when it's bright!!

[N. Mariana S. Vasquez MD @DrNmarianaSVas]

✨ Postpartum Blues vs Depression vs Psychosis

All can occur after delivery, but timing and severity separate them.

Postpartum blues
Onset: first few days
→ Tearfulness, irritability, mood swings
→ Still able to care for the baby
→ Resolves within 2 weeks
→ Reassurance + support

Postpartum depression
Usually begins within the first few weeks to months
→ Persistent depressed mood or anhedonia
→ Sleep/appetite changes, guilt, poor concentration
→ May have suicidal thoughts or difficulty caring for the baby
→ Symptoms >2 weeks
→ Psychotherapy ± antidepressants

Postpartum psychosis
Usually develops within days to weeks
→ Delusions, hallucinations, disorganized behavior, severe confusion
→ May have thoughts of harming herself or the baby
→ Psychiatric emergency → hospitalization

USMLE shortcut

Blues → <2 weeks → reassurance

Depression → >2 weeks → treat

Psychosis → hallucinations/delusions → emergency

Extra key:
Postpartum psychosis is strongly associated with bipolar disorder and carries a high risk of suicide and infanticide.✨

[N. Mariana S. Vasquez MD @DrNmarianaSVas]

✨ Neonatal Cyanosis: Choanal Atresia vs TOF
Choanal atresia
Feeding → BLUE
Crying → PINK
Why? Crying opens the mouth → mouth breathing bypasses the nasal obstruction.
TOF
Crying → BLUE
Knee chest → PINK
Why? Crying ↑ RV outflow obstruction → ↑ right to left shunt.
USMLE clue:
Blue with feeding, pink with crying → Choanal atresia ✨

[Tony Breu @tony_breu]

1/15
🤔Does end-stage renal disease (ESRD) make diabetes disappear?

No, but in some patients with ESRD, insulin needs fall. A1c drops. Diabetes medications can be stopped.

This has been called “burnt-out diabetes.”

Let's examine why.

[Dr Kamlesh Darji @DrKamleshDarji1]

Most Repeated One Liners: Part 2 #NEETPG

1. Commonest secondary cause of nephrotic syndrome in adults: Diabetic nephropathy

2. Commonest cause of nephritic syndrome in children: Post-infectious glomerulonephritis

3. Commonest renal malignancy in adults: Clear cell renal cell carcinoma

4. Commonest renal malignancy in children: Wilms tumor (nephroblastoma)

5. Commonest renal stone: Calcium oxalate

6. Stone associated with urea-splitting organisms: Struvite (triple phosphate), classically staghorn

7. Commonest cause of chronic kidney disease worldwide: Diabetic nephropathy

8. Commonest bladder malignancy: Urothelial (transitional cell) carcinoma

9. Commonest site of urothelial carcinoma: Urinary bladder

10. Commonest cause of hypothyroidism in iodine-sufficient regions: Hashimoto thyroiditis

11. Commonest cause of hyperthyroidism: Graves disease

12. Commonest cause of primary hyperparathyroidism: Parathyroid adenoma

13. Commonest cause of Cushing syndrome overall: Exogenous corticosteroids

14. Commonest cause of endogenous Cushing syndrome: Pituitary corticotroph adenoma (Cushing disease)

15. Commonest functioning pituitary adenoma: Prolactinoma

16. Commonest adrenal medullary tumor in adults: Pheochromocytoma

17. Commonest extracranial solid tumor of childhood: Neuroblastoma

18. Commonest site of peptic ulceration: First part of the duodenum

19. Commonest cause of chronic gastritis: Helicobacter pylori

20. Commonest Lauren subtype of gastric adenocarcinoma: Intestinal type

21. Commonest mesenchymal tumor of the GI tract: Gastrointestinal stromal tumor

22. Commonest site of GIST: Stomach

23. Commonest cause of acute appendicitis in children: Lymphoid hyperplasia

24. Commonest tumor of the appendix: Carcinoid (well-differentiated neuroendocrine tumor)

25. Commonest cause of acute pancreatitis worldwide: Gallstones

26. Commonest site of pancreatic carcinoma: Head of pancreas

27. Leading global infectious cause of cirrhosis: Chronic hepatitis B

28. Commonest benign tumor of the uterus: Leiomyoma

29. Commonest gynecological malignancy in developed countries: Endometrial carcinoma

30. Commonest histological type of cervical carcinoma: Squamous cell carcinoma

31. Commonest benign breast tumor in young women: Fibroadenoma

32. Commonest breast malignancy: Invasive ductal carcinoma, no special type

33. Breast carcinoma classically associated with multifocality, multicentricity and bilaterality: Invasive lobular carcinoma

34. Commonest cause of bloody nipple discharge: Intraductal papilloma

35. Commonest lung carcinoma in non-smokers and in women: Adenocarcinoma

36. Lung carcinoma most strongly associated with cigarette smoking: Small cell carcinoma

37. Commonest cause of a solitary pulmonary nodule that is benign: Granuloma

38. Commonest primary malignancy of the pleura: Malignant mesothelioma

39. Commonest skin malignancy: Basal cell carcinoma

40. Commonest site of basal cell carcinoma: Sun-exposed head and neck skin

41. Commonest precursor lesion of squamous cell carcinoma of skin: Actinic keratosis

42. Commonest melanoma subtype in India: Acral lentiginous melanoma

43. Most important prognostic factor in localized primary cutaneous melanoma: Breslow thickness

44. Commonest benign bone tumor: Osteochondroma

45. Commonest benign tumor of the hand: Enchondroma

46. Commonest site of giant cell tumor of bone: Epiphysis of distal femur and proximal tibia

47. Commonest soft tissue sarcoma in adults: Liposarcoma

Thank you for reading. All the best.

[Doc Navarrow @DocNavarrow]

🏍️An adolescent presents after a motor vehicle collision with a brief loss of consciousness. GCS is 15, and there is no history of seizures or other neurological symptoms.

🧑‍⚕️What abnormality do you identify?

[Dr Kamlesh Darji @DrKamleshDarji1]

Important Histopathology Buzzwords #NEETPG

GROSS APPEARANCE

1. Nutmeg liver : chronic venous congestion (right heart failure).

2. Anitschkow cells / Aschoff bodies: rheumatic carditis.

3. Bread-and-butter pericarditis : fibrinous pericarditis.

4. Cottage cheese necrosis : caseation (TB).

5. Soap bubble appearance : giant cell tumor of bone.

6. Sunburst / Codman triangle : osteosarcoma.

7. Onion-skin periosteal reaction : Ewing sarcoma.

8. Bag of worms (scrotum): varicocele.

9. Chicken fat clot : postmortem clot.

MICROSCOPY

10. Starry sky : Burkitt lymphoma.

11. Owl-eye cells :Reed-Sternberg (Hodgkin) and CMV inclusion.

12. Fried-egg appearance : oligodendroglioma. (Also plasmacytoma perinuclear hof - softer trap.)

13. Chicken-wire capillaries : oligodendroglioma (pairs with fried-egg).

14. Onion-skin arteriolar thickening: malignant hypertension. (Also periarteriolar fibrosis in spleen - SLE.)

15. Flea-bitten kidney : malignant hypertension / microscopic petechiae.

16. Spike-and-dome (silver stain): membranous nephropathy.

17. Tram-track double contour : MPGN.

18. Wire-loop capillaries : lupus nephritis (Class IV).

19. Kimmelstiel-Wilson nodules: diabetic nephropathy.

20. Crescents: RPGN.

CELL / NUCLEAR DESCRIPTORS

21. Orphan Annie eye nuclei : papillary thyroid carcinoma.

22. Salt-and-pepper chromatin : neuroendocrine tumor.

23. Signet ring cells : gastric (diffuse) carcinoma; also Krukenberg.

24. Clear cells with delicate vasculature : renal cell carcinoma (clear cell).

25. Hobnail cells : clear cell carcinoma (Müllerian).

26. Lollipop / staghorn vessels : Castleman (hyaline vascular); staghorn also in solitary fibrous tumor.

27. Popcorn cell (LP cell) : nodular lymphocyte-predominant Hodgkin.

28. Flame cells : myeloma plasma cells.

29. Smudge cells: CLL.

30. Faggot cells (bundles of Auer rods) : APML.

ARCHITECTURE

31. Rosenthal fibres : pilocytic astrocytoma.

32. Homer-Wright rosettes: neuroblastoma, medulloblastoma.

33. Flexner-Wintersteiner rosettes: retinoblastoma.

34. Perivascular pseudorosettes: ependymoma.

35. Palisading necrosis + microvascular proliferation: glioblastoma.

36. Whorls + psammoma bodies: meningioma.

37. Antoni A / Antoni B + Verocay: schwannoma.

38. Cartwheel / clock-face nucleus: plasma cell.

Thank you for reading. Follow for more posts. I also wrote notes on 100 important pathology topics.

[sikandar adwani @SikandarAdwani]

Valproate tremor is more interesting than the usual description of just a fine hand tremor.

The typical tremor is:

• Bilateral
• Mainly postural and kinetic
• Most obvious in the hands
• Seen while writing, eating, holding a cup or keeping the arms outstretched

But look a little more carefully.

Valproate tremor can also involve the head, voice and legs.

Some patients can even have a resting component.

The tremor may appear after starting valproate or after increasing the dose, and higher doses increase the risk.

A therapeutic serum valproate level does not exclude it.

Another useful point: subtle tremor is much more common than the tremor patients actually complain about.

Around 14% is the pooled incidence reported in randomized trials, while careful examination detects tremor much more frequently.

So when a patient on valproate says that the hands have started shaking, don't stop at asking whether tremor is present.

Ask them to stretch the hands, write, draw a spiral, pour water, hold a cup and bring a spoon to the mouth.

Valproate tremor is best understood by watching the patient use the hands.

#NeuroX #MedX #Valproate

[Dr Kamlesh Darji @DrKamleshDarji1]

High-yield information #NEETPG

⚡ Oncogenes

1. RAS (KRAS/NRAS/HRAS) : GTPase in signal transduction; point mutation → constitutively "on." Most commonly mutated oncogene in human tumors → pancreas, colon, lung

2. MYC : transcription factor.
C-MYC → Burkitt lymphoma t(8;14);
N-MYC amplification → neuroblastoma;
L-MYC → small cell lung ca

3. HER2/NEU (ERBB2) : receptor tyrosine kinase; amplification → breast & gastric ca

4. ABL : BCR-ABL fusion from t(9;22) Philadelphia chromosome → CML

5. RET : receptor tyrosine kinase → MEN 2A/2B, medullary & papillary thyroid ca

6. KIT (CD117) : receptor tyrosine kinase → GIST, mastocytosis

7. CYCLIN D1 (CCND1) : drives G1→S; t(11;14) → mantle cell lymphoma

8. BRAF : serine/threonine kinase; V600E → melanoma, hairy cell leukemia, papillary thyroid ca

⚡ Tumor Suppressors

1. RB : governor of G1/S, binds E2F → retinoblastoma, osteosarcoma

2. TP53 (p53) : "guardian of the genome"; arrests cycle + triggers apoptosis. Most commonly mutated gene in human cancer → Li-Fraumeni

3. APC : degrades β-catenin (WNT pathway) → FAP, colorectal ca

4. BRCA1/BRCA2 : DNA double-strand break repair → breast & ovarian ca

5. VHL : degrades HIF → clear cell RCC, hemangioblastoma, pheochromocytoma

6. NF1 : neurofibromin (RAS-GAP) → neurofibromatosis type 1

7. WT1 : transcription factor → Wilms tumor

8. PTEN : inhibits PI3K/AKT → Cowden syndrome, endometrial & breast ca