Drugs responsible :
SAME Piiiiii (Peeeeee)
Sulfonamides
Acyclovir
Methotrexate
Ethylene glycol
Protease inhibitors
Drugs responsible :
SAME Piiiiii (Peeeeee)
Sulfonamides
Acyclovir
Methotrexate
Ethylene glycol
Protease inhibitors
So, this post is regarding answer of our recent pharmacology question posted on facebook medicowesome group. If you still are not following it, please follow for latest updates and interesting questions.
Q) What is the probable diagnosis in a patient with a dilated pupil not responsive in 1% pilocarpine? (AIIMS 2011 Nov)
1) Diabetic 3rd nerve palsy.
2) Adie's tonic pupil.
3) Uncal herniation.
4) Pharmacological block.
Answer is option 4- Pharmacological block.
Let's start with the basics of the ANS to understand the question.
First, imagine an eye with simplest of the structures.
A central area called as pupil. Surrounded by group of muscles called as "constrictor pupillae muscles" which obviously helps in constriction (miosis) of the pupil as their name suggests. They are further surrounded by "radial muscles" which causes dilation (and mydriasis) of the eye.
Now, each of these muscles will have receptors on them. Receptors need to be stimulated for their respective actions, right? - Yes!
Now, remember - M3 receptors are present on constrictor muscles and Alpha-1 receptors are present on radial muscles.
Now, you must be thinking why I am goofing around with such simple basic concepts?!
Hold on, question may contain confusing options but you already know the answer. Atleast now you do know!
(Read question again and come back!)
Pilocarpine is selective M3 agonist. Stimulation of M3 receptors will lead to miosis.
In pharmacological block, drugs like atropine block the muscarinic receptors present on the pupil. As, the receptors cannot work, pilocarpine cannot produce miosis.
( You really don't need to know all the things to answer MCQs. Sometimes basics are enough!)
Now, let us know more about other options.
1) Diabetic 3rd nerve palsy: Occulomotor motor nerve supplies constrictor puplillae So, palsy of 3rd nerve will cause mydriasis but does it cause any damage to receptors? - No.
So, pilocarpine will respond and thus miosis will occur!
2) Adie's tonic pupil: It manifests as denervation supersenstiviy. Normal pupil responds to 1% pilocarpine but not to dilated solution like 0.05-0.1%. However, in Adie's pupil due to supersenstiviy of receptors, even this diluted solution may results in constriction.
3) Uncal herniation: Pressure on 3rd nerve causes pupil dilation but again it will respond to pilocarpine as receptors are intact.
Some important MCQ points related to above information.
1) Echothiophate is also M3 agonists. It is an anti-glaucomic drug which acts by promoting drainage of fluid via schlemm's canal.
Adverse effect: Causes cataract.
2) Adrenergic drugs causes mydriasis (Stimulation of Alpha-1 receptors) and Anticholinergic drugs (Inhibiting M3 receptors) causes mydriasis and cycloplegia.
Hii everyone!
Massive blood transfusion is defined as
Complications from massive transfusion include :
1) Hypothermia
2) Hypocalcemia - because citrate present in transfused blood is a calcium chelator, it decreases the available calcium.
3) Acidosis - as citrate is acidic in nature.
4) Hyperkalemia - as Hydrogen ions are present in excess due to acidosis, it is compensated by H+ loss in urine and K+ is regained back into blood. So this causes hyperkalemia.
5) Hypokalemia - in stored blood, the Na+-K+ pump is less functioning, so there is decrease in intracellular K+ in stored blood. But after blood transfusion, the Na+ K+ pump again starts functioning and increases intracellular K+, this leads to decrease in the available K+ outside the cell causing hypokalemia.
6) Dilutional coagulopathy - massive blood transfusion leads to dilution of clotting factors . It later manifests as DIC-like leading to multiorgan failure and death.
Thanks for reading.
Madhuri.
Hii everyone!
This post is about the complications from a single blood transfusion.
1) The most common complication is febrile nonhemolytic tranfusion reaction(FNHTR). -- this occurs due to anti-HLA antibodies in the recipient which kills WBCs leading to release of interleukins and cytokines which are pyrogens. So the treatment is antipyretics.
2) Urticaria - it is due to IgE antibodies in plasma. So we give antihistamines to control it.
3) Hemolytic transfusion reaction - due to antibodies against RBCs. This is rare. It may occasionally occur due to clinical errors in pretranfusion tests.
4) Infections - bacterial infection due to faulty storage, hepatitis, HIV, malaria.
5) Air embolism
6) Thrombophlebitis
7) Transfusion- related acute lung injury - usually occurs within 6 hrs after transfusion.
Hope this helps.
Madhuri
I read this link and I'm confused, it says:
To participate in the National Resident Matching Program® (NRMP®) Main Residency Match®, international medical students/graduates must have passed all exams required for ECFMG Certification. If you plan to participate in the 2019 Match (in March 2019) and still need to pass Step 2 Clinical Skills (CS), you should register now to take the examination.
To help ensure that your result will be available in time to participate in the 2019 Match, you must take Step 2 CS by December 31, 2018. If you do not register now and schedule soon, it is possible that you will not be able to obtain a test date in 2018. At the time of this writing, the earliest available test date at any test center is in August 2018.
Link: April 2018 https://www.ecfmg.org/news/2018/04/09/imgs-participating-in-2019-match-should-apply-for-step-2-cs-now/
I plan to apply for matching in 2019, do I need to take the exam in December 2018?
- Sent through email
Hello,
Let me clear terminologies before I start explaining.
Match 2018 means: Application in September 2017, results in March 2018, Residency starts in July 2018.
You said apply for matching in 2019, which means apply in September 2019 for the March 2020 match, yes?
Let's talk about the 2019 match mentioned in the link you sent. It says currently, there will be no availability of testing centres for this year's match (September 2018 application, March 2019 Match, Residency starts in July 2019). The ECFMG website is able to predict the number of applications that they are going to receive. This year, they predict there will be no testing centers available, which is why I am guessing they are asking you to register in April (register now).
Your confusion arises because of two reasons:
You don't know the match terminologies with respect to the year.
You don't know the timeline for the match.
When they mean apply right now and give the exam before December, they are talking as a general mandatory requirement. IT IS A ABSOLUTE MUST HAVE.
To be a competitive candidate, IMGs tend to give the exam in such a way that the results are out before September so that we have all the exam results before the application cycle of the match. IT IS OPTIONAL BUT PREFERRED.
So really, the virtual deadline to give the exam for us is July. We also prefer to graduate before September to get ECFMG certified, however, it's not mandatory.
It is quite vigilant of you to keep an eye out for these notices on the ECFMG website.
Since the dates are not easily available, when you plan to go for an elective, try to register in advance.
If you go to the ECFMG website, there is a site called a step 2 CS scheduling and you can view the dates available at various centres. So register as soon as possible if you want to get your desired dates. Here's the link https://csess2.ecfmg.org/calendar.aspx
PS: The step 2 CS permit is available for one year and it does not expire quickly (compared to other exam permits that expire in 3 months) which is a huge advantage.
So to summarize, July is the ideal deadline for Step 2 CS to get results before September (Application submission). December is the mandatory deadline to get result before February (ROL submission, to be eligible for the match).
Google the step 2 CS reporting schedule to help plan for your match.
https://www.ecfmg.org/news/2018/04/18/results-reporting-schedule-for-step-2-cs/
Hope that helps!
-IkaN