Causes of Charcot Arthropathy Mnemonic: 10 S 3 Theories of Charcot Arthropathy a. Neuro-traumatic: Damage to sensory feedback → Repeated microtrauma → Release of proinflammatory cytokines → Bone resorption b. Neuro-vascular: Change in vascularity caused by dysregulation of vasomotor and trophic nerve supply c. Neuro-inflammatory: Abnormal persistence of inflammatory response…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Rheumatoid Arthritis – ACR 2021 Guidelines: Summary
Among various methods of measuring disease activity in rheumatoid arthritis, we will be discussing Clinical Disease Activity Index (CDAI). CDAI = TJC(28) + SJC(28) + PGA(10) + EGA(10) Interpretation of CDAI: CDAI Score Range Disease Severity ≤ 2.8 Remission > 2.8 – 10.0 Low > 10.0 – 22.0 Moderate >…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Methotrexate : Mnemonic
Methotrexate is a dihydrofolate reductase (DHFRase) inhibitor which inhibits DNA repair, synthesis and cellular replication. Actively proliferating tissues such as malignant cells, bone marrow, fetal cells, buccal and intestinal mucosa, and cells of the urinary bladder are in general more sensitive to its effect. A convenient regimen for Low Dose…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Approach to Rheumatoid Factor Positive test
Rheumatoid factor (RF; also mistakenly called RA factor) is an auto-antibody (commonly IgM and rarely IgG or IgA) directed against the Fc portion of IgG. Increase in both IgM and IgA RFs is almost exclusively observed in patients with RA (Rheumatoid Arthritis). Clinical Significance of Rheumatoid Factor 1. A positive…
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Pain all over body, Sleep disturbance, Fatigue, Headaches – Fibromyalgia
What is Fibromyalgia? Fibromyalgia is a chronic illness characterized by many symptoms that occur all at once: 1. Widespread pain 2. Fatigue 3. Sleep problems 4. Cognitive disturbances (concentration, memory) 5. Altered mood (anxiety, depression) 6. Other symptoms: headache, digestive disorders, dizziness, muscle spasms, chills, low-grade fever, ringing in the…
Surgical Skills 
Bilateral V-Y (Kutler) flap for finger stump closure
Indications Classically, this flap is indicated in patients with transverse or volar oblique amputations. In actuality, the patient in whom this flap is useful generally will have an amputation where there is more tissue on the radial and ulnar margins of an amputation and exposed distal phalanx. Limitations Generally, the…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Ketamine : Mnemonic
K: Kids (Induction agent of choice in children) E: Emergence reaction (floating sensations, vivid dreams and hallucination; reduced using benzodiazepines), Enantiomers (S-Ketamine and R-Ketamine) T: Thalamo-cortical dissociation with limbic system causing dissociative anesthesia A: Analgesic, Amnesic, Antidepressant, All routes (IV, IM, PO, Intranasal, Epidural, Intrathecal) M: Meals – can be…
Clinical Skills and Approaches 
Subacromial Injection
Indications: Diagnostic and therapeutic purposes of – Syringe preparation: Position: Comfortably seated with the arm at the side and the hands resting on the lap. Posterior approach: Lateral approach: