Mechanism of Steroid Induced Leukocytosis There are 3 major mechanisms responsible for corticosteroid induced granulocytosis: 1. Demargination of neutrophils from endothelial cells (60% of the rise): Recall the leukocyte adhesion cascade in the chapter of inflammation. L-selectins are present in leukocytes that mediates their rolling on the endothelial lining of…
Case Reports 
Extensive Small Cell Lung Cancer
Short Case Summary 74 years old smoker, male patient presented with significant weight loss, productive cough and abdominal discomfort of short duration. Patient was icteric with stable vitals. On examination of chest, there was decreased air entry over right lung field. On examination of abdomen, liver was palpable with hard,…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Drug Resistance TB Management Summary
Antitubercular drug symbols H = Isoniazid R = Rifampicin Z = Pyrazinamide E = Ethambutol S = Streptomycin Km = Kanamycin Cm = Capreomycin Lfx = Levofloxacin Ofx = Ofloxacin Mfx = Moxifloxacin Eto = Ethionamide PAS = Para-aminosalicylic acid Cs = Cycloserine Amx/Clv = Amoxicillin-Clavulanate Bdq = Bedaquiline Lzd…
Clinical Skills and Approaches 
Gower’s sign
Synonyms: Gower’s maneuver, Myopathic walking, Butt-first maneuver Identifying Gower’s sign To check for Gower’s sign, place the patient in the supine position and ask him to rise. A positive Gower’s sign – an inability to lift the trunk without using the hands and arms to brace and push – indicates…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Substance abuse vs Substance dependence
Both of these substance use disorders are maladpative patterns of substance use, leading to clinically significant impairment/distress but defined by separate criteria. Substance abuse ≥1 of the following occurring within a 12 month period: Mnemonic: 4 Rs Role failure: Recurrent use resulting in failure to fulfill role obligation Risky behavior:…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Depression Criteria Mnemonic
Mnemonic: DEPRESSION Major symptoms Depressed mood Energy loss or fatigue Pleasure loss or anhedonia Minor symptoms Retardation or agitation (psychomotor) Eating and weight change (at least 5% in the last month) Sleep changed – insomnia or hypersomnia Suicidial ideation or behavior I‘m a failure (Loss of confidence or self-esteem) Only…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Silhouette and Cervico-thoracic sign
Synonyms: Obscured margin sign, Loss of outline sign Silhouette refers to the shadow and derived it’s origin from shadow papercuts done by Etienne de Silhouette. Principle of Silhouette sign On a normal Chest X-ray the well-defined borders of the heart and the domes of the diaphragm are visualised because the adjacent…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Ball-on-Tee, Lobster Claw and Signet Ring Sign – Renal papillary necrosis
Synonym: Necrotizing papillitis In renal papillary necrosis, part or all of necrotic renal papilla sloughs and may fall into the pelvicalyceal system, which may remain there (and get calcified) or may be voided down the ureter (often causing obstruction). The renal medulla and papillae are vulnerable to ischemic necrosis because…