Sunday, February 1, 2015

Study group discussion: Physiology books

Which is the best physiology book? I find Guyton to be really dull and Rhoades lacks details.

Ganong is okay, I guess.

Ganong has always been my first love.

I usually go for Ganong, but Costanza and Berne-Levy are also pretty good.

Costanza is not as detailed though, it's good for refreshing your memory the week before exams.

Yep. BRS is good for last minute revision!

Which are the simpler books for physiology? I know of Ganong.

Which was the other one?

Guyton?

Guyton is too extensive.
I read Guyton only in 1st year.
Good for clearing basics.

Yes, I find Guyton better than other physiology books.

Try BRS physiology.. It's little and has everything you need to know. Like it's smaller than Ganong.

Smaller the better!

I think it's 100 -  200 pages.

Study group discussion: Respiratory physiology

Does anyone have a mnemonic for respiratory centers?

DIVE!
The Dorsal nucleus is for Inspiration (tidal).
The Ventral nucleus for Expiration.

The ventral nucleus is especially important for forced respiration because expiration in general is passive. In tidal respiration, during the inspiration phase, the diaphragm and external intercostal muscles work. But the tidal expiration is completely passive because of elastic recoil.

Review question: Which all values of lung volumes you cant measure by spirometry? And why?

Reserve volume.
Functional residual capacity.
Vital capacity.

It's because spirometry measures through expiration. And the stuff that stays inside the lungs can't be measured!

What is the importance of residual volume? Why is it crucial for your body to retain air even after forceful expiration?

So that the lungs don't collapse on themselves. That's the most important one. There are two other uses!

Gas exchange is a continuous process, just because you expire, doesn't mean the gas exchange stops.

Third, the residual volume doesn't allow sudden changes in the outside concentration of air to affect your internal homeostasis. It takes 16 to 20 breaths for the outside air to affect your residual volume. This gives ample of time for your chemoreceptors to detect the slight changes in pH and respond.

Oh wow.. I didn't know this. Cool stuff. The breaths part though. Our body is waaay ahead of us than we think.

Totally!

Another review question! Mechanism of chemoreceptors? What passes through the BBB?

CO2 is not polar and is small, the BBB allows hydrophobic substances to pass through, so CO2 would pass the BBB.
The chemoreceptors monitor the H+ concentration of cerebrospinal fluid (CSF), including the brain interstitial fluid.
CO2 readily penetrates membranes, including the bloodbrain barrier, whereas H+ and HCO3– penetrate slowly. The CO2 that enters the brain and CSF is promptly hydrated. The H2CO3 dissociates, so that the local H+ concentration rises. The H+ concentration in brain interstitial fluid parallels the arterial PCO2.

Mechanism of peripheral receptors?

Oxygen potassium sensitizer channel. Lack of oxygen closes this channel, leading to increase in potassium in the ICF, depolarising it.

Do you know about the conditions in which you do not give 100% oxygen to the patient?

In cases where the CO2 levels are increased. Example, emphysema.. Cause the problem here is the respiratory drive is completely dependent on the blood CO2 level. So if you give 100% O2 the patient will go in apnea.

Yep. There's one more besides the CO2 indication. The neonate. Why?

Causes retinopathy of prematurity due to oxidative stress!

Study group discussion: Cause of decreased glucose levels in CSF in bacterial meningitis

I have a question, my professor told us that the cause of decreased glucose in CSF relates to permeability changes caused by the exudates. Which I find a good reason for the protein levels but glucose is not the same. In books and other references, I found the reason being bacterial and brain tissue consumption of glucose and non replenishment of it being the cause.

Can someone tell me for sure the cause for glucose depletion in csf in meningitis?

I think it's the glucose consumption. Permeability changes play a minor role.

Yes I'd also go with consumption.

Because permeability changes occur in viral meningitis as well.

That's what I also thought because permeability changes occur in all of the forms even the non infective ones.

Study group discussion: How to do percussion

I can't seem to get the hang of percussion and I have OSCE exams coming up :(
Any tips?

What exactly are you having trouble with?

I was always told to just hit once and not repeatedly like a drum, just once or twice and listen.

Ok well I know the technique it just doesn't sound as loud as the docs that are training us.

Ahh i know that you mean, happens to me too, but I don't know how to make it louder, I just try really hard to focus and block all external sounds... Plus, I lean as close as I can to the patient without it being obvious.

I think in part it just comes with practice and gaining experience.

Yeah I'll keep practicing.

When I was first learning it the sound was very dull and I had to try a few times to hit the correct spot.
But now it's just two quick taps.

Make sure that you're not resting your palm on the patient since that can dull the sound.

Ok, I see.

And when tapping make it fast and strong, as if your fingers were hot and you just wanted to get it over with.

Some people tap and let the finger rest, which can also full the sound.

Someone told me to press the pleximeter firmly, it gives better results than trying to strike harder with the plexiform during percussion.

Our supervisor usually sits a far from the patients and asks one to tap until she can hear from a far.

But yeah..Quick double strikes and fast finger withdrawal.

Yes, you can tap as hard as you like but if you aren't pressing your finger down firmly you're not gonna get much.

Note that firmly does not mean hard.

You should not get tired from pressing down your finger.

Plus concentrate on the feel of the vibration against your fingers.

My taps are never really loud enough, but then I practised by percussing myself to know the feel. That's good enough.

Study group discussion: Schizophrenia and Schizotypal disorder

What's difference between schizophrenia and schizotypal?

Schizotypal have odd behaviour and magical thinking.

Why schizophrenia is not placed in personality disorder?

Schizophrenia is a much more serious mental disorder, while schizotypal personality disorder is a (relatively) mild condition where the patient has social anxiety, extreme need to be alone and usually believes in odd things.

For example, have you seen or read Harry Potter? Luna Lovegood could be an example for a schizotypal personality disorder.

Schizophrenia on the other hand, could be... Hmm... Couldn't think of a HP reference.
Anyway, a person who is delusional, has hallucinations, hears voices, again believes odd things but on a much more serious level and is willing to do a lot of things to support those beliefs or because of them.

"Personality" is like, the things that make you YOU... That makes you different from other people.

Our teachers says prophets were schizotypial.. No offense, Living alone in deserts and hearing voices!

Personality disorders are classified as the differences from the norm, they are not always extremely dangerous/harmful mental disorders like schizophrenia. "personality disorders" are just a certain behavioral pattern.

Hahah well that could be said actually, if a person came to my hospital claiming he was a prophet we would give him medication probably!

Can you help me differentiate thought content vs thought form and thought process?

I can try to help.
Thought content is what you are thinking about. Say, you are sitting in your house looking out the window, there are 2 people walking and they have a dog. Looking at them your thought content would be those 2 people, the dog, and that they are walking.

This is in the beginning..

Then you start to form more complex thoughts, the way those develop are your thought process.

"Those people are walking. They are walking in front of my house. They have a dog. Why do they have a dog? Why are they in front of my house? Are they watching me? Who sent them here?"

This is an example of a thought process, the way ideas are forming and developing in the person's head.

This was an example of a paranoid way of thinking by the way, which is common in schizophrenia.

Hey buddy thanks it was very helpful!

You are welcome :)

Renal tubular acidosis types mnemonic

Hi everyone!

We were discussing RTA on our study group when we decided we needed a mnemonic for it!

Study group discussion: Malignant hypertension

What the difference between essential & malignant hypertension?

Essential is of unknown cause. Also known as the primary hypertension.
Malignant hypertension is also known as hypertensive emergency.

Malignant hypertension is an acute form that effects one or more organ systems.
Cardiovascular system, central nervous system and renal systems are irreversibly damaged.

Also papilledema! Remember reading it in ophthalmology.

In malignant hypertension, BP shd be lowered asap with antihypertensive agents. Mostly, iv injection of sodium nitroprusside is given for immediate effect so that BP is lowered.

There was also something about nitroglycerin and nitroprusside.. Which should be used when in malignant hypertension.
Don't remember what it was.. Like if cerebral edema is more use this stuff and if some other symptom is more you'll use the other one of the two.

Just read it up.. They say you choose based on the end organ damage.
Nitroprusside is widely used, especially if the person has neurological symptoms, cerebral edema.
Nitroglycerine will be the drug of choice if the heart is involved (Ischemia, acute coronary syndrome)

I'll have to correct myself, nitroglycerin isn't used anymore in hypertensive emergencies because of the side effect profile. If used, it's used as an adjunct.

Read a ncbi article on the same: Nitroglycerin is a potent venodilator, and only at high doses does it affect arterial tone. It causes hypotension and reflex tachycardia, which are exacerbated by the volume depletion characteristic of hypertensive emergencies. Nitroglycerin reduces blood pressure by reducing preload and cardiac output, which are undesirable effects in patients with compromised cerebral and renal perfusion. Low dose (60 mg/min) nitroglycerin may, however, be used as an adjunct to intravenous antihypertensive therapy in patients with hypertensive emergencies associated with acute coronary syndromes or acute pulmonary edema.

*After a lot of unsure discussions on hypertensive emergency, hypertensive urgency and malignant hypertension we concluded this*

Emergency: End organ damage.
Urgency: No end organ damage.

Malignant hypertension = Hypertensive emergency.

Hypertensive crisis: Severe elevation in blood pressure, with diastolic blood pressure (DBP) > 120-130 mmHg.

Nitroprusside is given in hypertensive emergency. However, watch out for cyanide toxicity when you choose to administer it.

Got a revision question! Which drug is used in cyanide toxicity?

Nitrites.
Sodium thiosulphate.
Cyanide toxicity - GTN.

Yes!

Study group discussion: Migraine, aura and floaters

What did Leonardo have in the movie Shutter Island?

Migraine, I think.

Migraine? When was that?

Migraine was what he started having as a symptom may be.

Oh yes, the headaches and flashes of light.

Auras?

Yes, those.

What are auras?

The lights some people see before they have a migraine headache.

Auras can present in any way of sensation.

Some patients also complain that something smells before the attack.. Smell of burning rubber or something. It's also a part of the aura.

You can have flashes of light, ringing in ears, sensation on hands and even sudden salivation. 

In migraine I guess the most common type of aura is of the visual type.. Seeing flashes of light.

In reality, it moves and vibrates. then expands and fades away.

I see bits and pieces of light too against a very bright room.. I read it's the pieces of proteins in the vitreous of your eye moving around.

Oh yes, I found those proteins very fascinating as a kid.

Would rub my eyes intentionally to see them and wondered if others could see them as well.

Seemed like little bubbles floating!

Floaters!

And when it is sudden and excessive.. It is a sign of retinal detachment!

Floaters.. I once argued with an opthalmologist, I kept telling him it was normal and he kept saying they're pathological.

Did he said why?
If the person has no other symptoms.. Just floaters once in a while.

Study group discussion: Dissociative identity disorder, Post-Traumatic Stress Disorder and Shutter Island

What about split personality disorders?

What I know it's that they're quite uncommon. But they present upon a trauma.

Psychological trauma.

There was a theoretical mcq in a question bank on split personality disorder. A female who said she recieved phone calls of strange men that she didn't remember meeting. It's easy to think it's a delusion if you don't keep split personality disorders in mind.

Was that shown in the movie
Karthik calling Karthik?

Haven't seen the movie.

Do no harm shows a neurosurgeon with a split personality. I am not sure if the series was purely fictional or based on a real life incident.

I guess it was fiction.

It was a very bad show.
Because it's super difficult to find a straight split personality.

Yes, it was based on DID.. Was a fiction.

It was a very bad show.
Because it's super difficult to find a straight split personality.

What's DID?
Dissociative identity disorder.

I don't know what the term is on the DSM V.

DSM V calls it dissociative identity disorder.

Multiple personality disorder is the same as split personality, right?

More than two personlities are called multiple personality disorder.

I have seen so many fictional works on it.. Makes you think it's common when it's not.

I know people who live with mental illness(es), and so I know what worked for them as well as what didn't.  And because so many people have approached me to talk to me about their mental health issues, I have very strong feelings about mental healthcare, so I do my own research, too.

Dissociative identity disorder is often treated by psychological therapy trying to merge the personalities into the core personality.  I don't know exactly how it's done.  I don't think there's medication for it.  It's pretty rare.  I don't know anyone with DID.

I wonder if perhaps dissociation as part of PTSD etc. instead of as part of DID would also be a good explanation for why someone might get phone calls from someone they don't remember meeting.

What's PTSD ?

Post-traumatic stress disorder.

It's a type of anxiety disorder that people sometimes develop after a traumatic experience.

Sometimes people with PTSD dissociate (they might 'lose' bits of time, for example).

Not remembering phone calls of strange men could be dissociation as part of a post traumatic stress disorder. But in that case, would the inciting trauma be of rape?

Potentially.  Not necessarily.  And rape isn't the only form of sexual assault.  [I'm not sure whether rape causes more *psychological* damage than other forms of sexual assault or not... if someone knows, I'd appreciate an answer.  I seem to recall someone saying that all forms of sexual violence are approximately equal in terms of suffering and trauma, because ultimately the important part is the existence of that violation, not the type of violation.]

Which are the other forms of sexual violence? Groping?

Yes.
Rubbing up against a person in a sexual way.
Taking photographs up someone's skirt would be a sexual crime, although I don't know how that would fit within definitions of sexual assault and violence.  It's still a violation of someone's body, though.

If someone kills a person, will he forget that, in case, he has PTSD ?

Not everyone with PTSD forgets the incident.  A lot of people with PTSD actually remember the incident very, very vividly.

If the person remembers the incident, then will he be in a state of shock? Or will he act normally?

It depends on the person.  If it was a sudden crime of passion there's a good chance the person will be shocked once they realise what they've done.
But some people are entirely capable of killing people without real remorse or shock.
And those people act normally.

What did Leonardo have in the movie Shutter Island?

I read a post online which says that the character Teddy Daniels or Andrew Laeddis played by Leonardo DiCaprio in the movie Shutter Island had Delusional Disorder, Post-Traumatic Stress Disorder, Schizophrenia and Dissociative identity disorder.

I didn't think someone could have delusional disorder and schizophrenia at the same time.

There are a lot of inaccuracies in the movie.

Migraine, I think.

Migraine? When was that?

Migraine was what he started having as a symptom may be.

We started taking about migraines after that which will be continued in the next post!

The Bicarbonate buffer system

some real cool facts i learned today--

1.       Buffers don’t eliminate acid, they simply neutralize acid at the tissue level..and transport it to areas from where it can be eliminated.

2.       The body has a three level of defense system, the first line are the buffers which are available for immediate action.. and the second (lungs) and third line (kidneys) through which these acids are permanently eliminated

3.       Why is it necessary to maintain the pH at a narrow range of 7.35-7.45? The structure and function of enzymes and proteins are dependent on pH..cause the containing amino acids have a charge which is highly dependent on the pH value. The body just can’t afford for the blood pH to rise or fall without deleterious consequences.



4.       Bicarbonates are the most important buffers in extracellular fluid. Why? Cause it is present in very high amount. 

Plus to top it all the HCO3- base component is in excess by 20 times! over its counterpart acid H2CO3. A very huge ratio of 20 to 1, means that the HCO3- component will always be available plenty whenever there is excess of metabolic acids to be eliminated. This is called the alkali reserve.

 Also the acid H2CO3 when formed can be very easily eliminated from the body via the lungs through the release of CO2.

 So overall bicarbonate is the only buffer which is excessive, fast acting and can be easily replenished.

5.       How does this buffer system work? The base HCO3- combines with H+ to form H2CO3. This is a weak acid, meaning once it is formed..it won’t let the H+ roam around free in the blood that easily. There will be only a mediocre rise in pH in comparison to a tremendous rise if bicarbonate wouldn't have been there. This pH stimulates the respiratory centre, which causes hyperventilation and release of CO2. 

-M-



Study group discussion: Histrionic personality disorder, Munchausen syndrome and MSBP

What's histrionic personality disorder?

I looked it up and found this on wiki:
A mnemonic that can be used to remember the characteristics of histrionic personality disorder is shortened as "PRAISE ME":
Provocative (or seductive) behavior
Relationships are considered more intimate than they actually are
Attention-seeking
Influenced easily
Speech (style) wants to impress; lacks detail
Emotional lability; shallowness
Make-up; physical appearance is used to draw attention to self
Exaggerated emotions; theatrical

Attention seeking in general.

Oh so how does this relate to mothers bringing their children in often for medical attention. Same thing?

Umm isn't that Munchausen syndrome by proxy? Different things.

Munchausen is more of medical attention seeking and histrionic looks like attention seeking in general.

If you're seeking medical attention for yourself, it's Manchausen syndrome and if you're trying to get attention to yourself by showing others are sick (mostly a child) it's Munchausen syndrome by proxy.

Oh ok. Thanks!

MSBP cases tend to involve faking medical symptoms, though. So mothers bringing in their children frequently for medical attention for real symptoms are probably helicopter parents (overly anxious and involved) but not necessarily MSBP.   Although if they exaggerate real symptoms that could be MSBP as well.

As for histrionic, it's not impossible that it would manifest as a parent bringing their child in for medical attention far more than is necessary, but as with all personality disorders, it's much more pervasive and would affect all other areas of their life and how they interact with the world, not just how often they bring their child in for medical attention.

Ah ok. Is Munchausen only specific to using another as a portal to attention. Or can this be self afflicted in order for the same degree of attention?

Munchausen by proxy is using other people's medical issues for attention. Usually children or the elderly or other dependents. Sometimes pets.

I had a patient who went to repeated doctors complaining that her child has joint pain, stiffness. Diagnostic procedures were done and all of them came out to be normal. They were suspecting MSBP in that case.

Munchausen syndrome (not by proxy) is when the person uses their own medical symptoms (often fake).

Ah ok. Now I see. So how does one start treatment for something like this?

Histrionic is in my opinion the most self defeating of the personality disorders with the exception of self defeating personality disorder, which isn't actually a recognized personality disorder anymore. Because people with histrionic need attention so much that they'll take on whatever role will get them the most attention  instead of being true to themselves.

Treatment for munchausen by proxy or not: Psychological treatment.  Helping them figure out how to get attention in healthier ways.  Interpersonal skills training.  Self esteem help so they don't need attention so much. Not giving them as much attention or sympathy might help, but it's mean and you need to be absolutely certain their faking it.

There was an episode in House MD on a patient with Munchausen syndrome. She induced hypoglycemia, seizures and took colchicine to mess up her blood profile.
She however had a medical condition that needed attention which made me realize that you can not dismiss every symptom in a patient with Munchausen without diagnostic procedures. It could be something serious. Interesting episode.

That's a huge issue with dealing with people with mental illnesses.   Doctors so often dismiss them because the mental illnesses can distort how they see things, but dismissing them means that you could miss out on something real and serious.

Would be truly unfortunately for a misdiagnosis that could potentially lead to death because the patient took antibiotics or of that nature.

Thanks for the information. Came accross the disorder while strolling the hospital. Answered so well.

Which did you come across?  Histrionic or MSBP?

Histrionic. While I walking through mental health. A group of docs were discussing personality disorders from the sound of it. That was one of which I over heard.

Ah. Personality disorders are tricky.  People aren't very likely to seek treatment, and they're not particularly easy to treat even when people seek help.  And they're complicated to diagnose because people often have symptoms from more than one, so trying to figure out which fits best is complicated.

Yeah that makes sense. I work in a military hospital so we alot of patients that will come back with not only physical but mental damage as well. The last patient I over saw had cellilitus, 2nd degree burns of the feet and would only speak to the females of the ward.
Mutisim something?

Selective mutism?

Yes!

Study group experience #3

Here's what we discussed so far:

Eating disorders (A must read)
Ascites (USMLE oriented question) 
Diuretics (Very interesting stuff)
A lot of mini discussions happen here and there and I can't keep up. So everything is not published (Sorry!) but I have posted most of the important discussions (Yaay?)

Since there is a time zone difference, we have a lot of messages every morning. Some members (Including me) read like over 200 messages at once and reply to them together which is adorable!

We changed our original plan of making a separate group for every 50 members and added new people to the same group. The new comers fit in well, were excited and didn't feel like aliens to a new world (Sweet!)

People who found the main group giving too many notifications because of discussions were added to the mini group for strict study discussions. However, the mini group is very inactive (Probably because the participants are focused on the upcoming exam they have to study for!) I post stuff from the mini group to the main group so that no one misses out on anything!

A few people left without even having the courtesy of informing or letting me know why. It took a lot of work for me to organize this - Reply emails, verify identity, save numbers and then add on the group. I felt they should've at least left a message.

People at times ask me how many spots are left, I can't really answer that because some people leave and new people are always coming in. Send us your number though, we'll squeeze you in like we did for the extra 30 people! :)

-IkaN

Saturday, January 31, 2015

Study group discussion: Extrapyramidal effects of antipsychotics and treatment

Guys do you know the side effect/time line of antipsychotics?

I mix up akathisa  akinesia etc. Then there's tardive dyskinesia and dystonia!
So confusing.

4 hours dystonia
4 days akinesia
4 weeks akathesia
4 months tardive dyskinesia

Thank you!

I was discussing timeline of extra pyramidal side effects of antipsychotics earlier and got a doubt - Some books say akinesia comes before akathesia while others say akathesia comes before akinesia.
Like my book says opposite of the image of a book posted by someone on the group and I couldn't find a good resource online.
Anyone has an insight on what we actually see clinically?

Well after asking around it seems the general consensus is that akathisia precedes akinesia. At since it has logic to it that's what I'm sticking with.

Thanks! Why is it logical though? Because Parkinsonian symptoms take longer to appear?

Well akathisia is restlessness and agitation, and akinesia is when you start losing voluntary movements, and it seems logical that it would precede dyskinesia.

Makes sense to me now, thanks!

Hey concerning the extrapiramidal effects of antipsychotics, I consulted my Goodman and Gilman and found this:
Akathesia: 5-60 days.
Parkinsonian symptoms: 5-30 days.
There we go. Basically the argument could be made for either order since their appearance overlaps.

Oh. So you can't have a clear cut line. Thanks for this!

You use anticholinergics for akinesia, right?

Yes, right. And for akathisia beta blockers like propanolol is drug of choice.

Ohh and what's the treatment for dystonia?

Probably Anticholinergics or muscle relaxant like baclofen. Not confirmed.

Dopaminergic drugs
Anticholinergic drugs
GABA Agonists
Carbamazepine
They all can be used in dystonia!

Woah. I didn't know this.

Dopaminergic drugs like?

Levodopa

Here's a post I wrote after this discussion - Antipsychotics: Timing of evolution of extra pyramidal symptoms mnemonic  http://medicowesome.blogspot.com/2015/01/antipsychotics-timing-of-evolution-of.html

Antipsychotics: Timing of evolution of extra pyramidal symptoms mnemonic

Greetings people!

The timing of evolution of extra pyramidal symptoms of antipsychotics is something you should be thorough with:

4 hours dystonia
4 days akathesia
4 weeks akinesia
4 months tardive dyskinesia

I made a mnemonic for it because I have been struggling with it since forever!

The mnemonic is, "Distant people are Restless. Parking cars is Stereotyped and Retarded."

"Distant" is for Dystonia which comes first!

"Restless" is for akathesia (Compelling desire to move restlessly!)

"Parking" is for the Parkinsonian like symptoms seen in akinesia.

Sterotypical ("Sterotyped") movements are seen in tardive ("Retarded") dyskinesia.

Lastly, a mnemonic to remember the treatment of Neuroleptic Malignant Syndrome!

The mnemonic is, "BAD NMS"
Bromocriptine
Amantidine
Dantrolene

That's all!

-IkaN
Related post:
Extrapyramidal effects of antipsychotics and treatment (Link: http://medicowesome.blogspot.com/2015/01/study-group-discussion-extrapyramidal.html)

Study group discussion: Oculogyric crisis

What's oculogyric crisis?

I have read it a couple of times as a side effect of a couple of drugs, I don't remember the drugs though.

Neuroleptic drugs.

It's antipsychotic induced.

But what happens in it.. How does the patient present?

Sounds like deviation of the eye.

These are the ones I came accross:
Mutism, palilalia, eye blinking, lacrimation, pupil dialation, drooling, increased BP and HR, flushed face, headache, vertigo, anxiety, fixed stare or maximal deviation in all direction (usually at one a time), malaise.

Seems like it messes up your autonomic nervous system along with the eyes.

Yeah :-/

General question, what does gyric mean? Like is it a Spanish or Latin word?

Latin. It's like twisting.

Study group discussion: Hybridoma technology

Something about immunology?

What about immunology?

I love immunology. Have a separate immunology comics blog, as you probably know :D

Can you provide the link for the immunology comics blog?

immense-immunology-insight.blogspot.com

I thought you guys knew.

Thanks!

Hybridoma technology. I wanna know about that!

I'll have to read those up. Anyone in the group has an idea on those?

Hybridoma technology. Never knew of this. I'm reading into now. Cool stuff.

Let us know a short summary once you're done!

Yeah sure. I'll try.

If anyone can better explain please feel free.

This is regards to the question of Hybridomas.

Hybridomas are cells that have been specialized to produce a specific antibody in large amounts. Made by exposing the test subject (animal) to an antigen to which your insterested in isolating a antibody against.

Once the animals splenocytes are isolated, the B cells and immortalized myeloma cells are fused.

The new product is incubated in HAT (Hypoxanthine, Aminopetrin, Thymidine) medium. The medium is specialized to allow only the hybrids to survive.

The dilution process and the disired antibody production is then checked.

What ever cells are not producing the antibody they're removed and over a course of weeks the status of the subject is checked.

Oh I remember! We were taught this is first year!

Theres alot more. As far as I got :-/

Ohh thank you.

Glad I could help. Interesting read.

Yo it's really nice of you!

My pleasure.

Study group discussion: Myopia and power mnemonic

Myopia (short sightedness) mnemonic, "Cave May Be Long"

CAVE - We use conCAVE lens
MaY - in MYopia
BE - BEfore image is formed before retina
LONG - eyeball eLONGate

When eye become Myopic it is acting as converging lens (+) convex lens (bend the rays coming from object the rays towards centre) more power more convergence more bending so we use diverging lens which is a concave lens to correct or to neutralise the bending or converging.

Concave lens negative (-ve) power.

Another study link! http://medicowesome.blogspot.ae/2013/10/myopia-and-hypermetropia-mnemonic.html

Study group discussion: Remembering Anatomy

Is there any easy way to remember the relations of the viscera?

Diagrams will help you remember the relations! There are a few mnemonics for arteries and stuff but in general, painting a picture in your head is the best way to remember!

Use Atlas for visualisation, see  videos of anatomy (Acland, Dalhousie) for awesome live experience... Highly recommended.

Seeing the viscera during cadaver dissection also helps in anatomy.

For anatomy, I find it helpful to draw the pictures out and label them. This allows you to appreciate the boundaries. 

I always drew diagrams in anatomy..Netter's helped a lot. 

Dissections are equally important...I  always read anatomy and revised it in my dissection class

Paroxysmal nocturnal hemoglobinuria mnemonic

Here's a mini post on PNH!

P: PIG A gene affected (On X chromosome that makes a glycosyl phosphatidyl inositol anchor)
N: Night. Hemolysis occurs at night.
H: Ham test confirms the diagnosis.

Patient presents with a history of dark coloured urine in the morning.

That's all!

-IkaN

Study group discussion: Succinylcholine

Can someone explain succinylcholine?

Succinylcholine is different than other neuromuscular blockers because it has two phases.

It is broken down in our body by pseudocholinesterase. And this enzyme differs in different people based on genetics. Hence, while using as a muscle relaxant it can prove quite deleterious to some people who have a weaker type of the enzyme.

Deficiency of pseudocholinesterase in some people causes succinyl choline apnoea.

Also, pseudocholinesterase is different than the more common acetyl cholinesterase enzyme.

Hepatitis B serum markers mnemonic

HBsAg: Surface protein of hepatitis B which means the person has infection presently. It's a marker for current infection.
Mnemonic: S antigen Stays in Sick patients (Active or chronic infection, negative in resolved infection).