What's short course chemotherapy?
Earlier Tb treatment was given for 1.5 to 2 years, Tb drugs have lots of side effects and patient adherence to such long treatment is not good either. So after various research WHO introduced short course chemotherapy treatment for Tb under the name of Dots which gives treatment for 6-8 months. Good patient adherence and compliance.
Could you share with me tips to study pre med subject? Like physiology perhaps?
Physiology is my major, I draw diagrams basically. Understanding the stimulus and response first, then learn the steps in the middle.
Yup, flow charts for physiology!
Physiology is easier when you start at the big picture then elaborate on each pathway.
And make lots of notes. Here's a link on that http://medicowesome.blogspot.ae/2014/12/how-to-make-concise-medical-notes.html
I used to draw a lot of flow charts in physiology..and Youtube, try subscribing to armando hasudungan or medcram..They have nice videos!
Why is LDH non specific for MI?
LDH is elevated in many other diseases too!!
There is a much more specific reason for it.
The LDH -2 isoform is present in RBC, any sort of slight hemolysis will increase it as well.
Oh that's why! Didn't have the faintest idea.
Great!! So LDH -2 Isoform is also the one for MI?
Nope it's LDH-1.
But no one gets the specific enzyme type. Too expensive I guess.
I guess electrophorectically you can't differentiate both. Maybe.
Which poisoning is checked through RBC?
Lead!
Basophilic strippling.
Yes, one more!
Cobalt.
Which other poison then?
OPP. Organophosphorous poisoning.
How?
You check the acetylcholinesterase levels in mature RBC.
Which vitamin levels can be checked through RBCs?
Hint: A vitamin that affects enzymes.
Transketolase, Vitamin B1 deficiency.
How does it affect the RBC the transketolase?
Umm it's just a level that can be checked through RBCs. I don't think they do it in clinical practice.
What is the characteristic feature of mitral stenosis? In terms of murmur? And echo findings?
Opening snap.
Enlarged left atria.
Mid diastolic murmur.
Left heart failure.. Left atrial enlargement.
Sam of mitral leaflet.
Also one more auscultatory finding.
Loud S1
Correct!
One more!
Pre systolic accentuation.
Yes!
Advanced stage S 1 goes soft.
What happens to this murmur in cases of atrial fibrillation?
Disappear.
What disappears?
Psa.
Correct. Now tell me why?
Because presystolic accentuation is due to contraction of the atria.
May be bcoz atria are in tremora!
Correct. The final phase of atrial contraction is absent in afib.
Which auscultatory finding indicates the severity of the disease?
Length of murmur. The longer, the more severe the disease.
Opening snap moves closer to s2 as the severity increases.
When I said OS S2 interval, the examiner wasn't convinced.
I checked..and then I read somewhere about the length of murmur. You see..As the level of stenosis increases..Blood takes a longer time to enter from atria to ventricles. Hence, the length of murmur.
Maybe it's not anymore. I read a research publication on it.. It's not OS A2 anymore. But let's not confuse exam going students :P
Haha. Could be the length of the murmur!
It could be our PG question :O
Here's the paper for those who are interested http://www.ncbi.nlm.nih.gov/pmc/articles/PMC487332/
Interesting.
A 67-year-old man presents to his physician with a 10-day history of fatigue, bleeding gums, cellulitis, and a recent weight loss of 9 kg (20 lb). On physical examination, the patient is pale but has no evidence of lymphadenopathy or hepatosplenomegaly. Results of a complete blood count are as follows: WBC count: 18,300/mm3 (75% blastocytes, 20% lymphocytes) Hemoglobin: 9.1 g/dL Hematocrit: 29% Platelet count: 98,000/mm3 diagnosis?
He has acute myelogenous leukemia. It's acute because of the blasts.
Yes, acute myelogenous leukemia.
What could be find in marrow biopsy?
Lots of cells! Sometimes there could be fibrosis though which would lead to a dry tap.
Can anyone tell why the platelet count is affected? (Conceptual review question)
Isn't it in normal limits? 100k-150k?
Then why did he have bleeding gums?
Megakaryocyte lineage affected.
Yup the excessive growth of myeloid series doesn't not allow growth of megakaryocyte.
It is AML M5.
Isn't the bleeding gums due to thrombocytopenia?
I have seen a patient with type 5 AML in my hospital. They don't have bleeding gums. Rather a swelling of gums due to infiltration of leukemic cells. Gingival infiltration it's called I think.
Chloroma.
What's chloroma?
Infiltration of leukaemic cells in soft tissues.
That happens in ALL too, right? The infiltration of leukaemic cells into tissues?
Yes, I think.
I had seen a picture with a child having a chloroma of the orbit.
I thought the WBC count goes in lakhs in AML.
The count doesn't really help because sometimes the counts are comparable to a normal infection.
Oh.
What do we use for differentiating leukemia from infection?
The LAP.
What are the other causes of leukemoid reaction?
The major causes of leukemoid reactions are severe infections, intoxications, malignancies, severe hemorrhage, or acute hemolysis.
Source: http://www.ncbi.nlm.nih.gov/pubmed/16962944
Sharing some of the knowledge I learnt!
So what is the treatment of Urinary tract infection?
Antibiotic according to urine culture report.
Yeah what's the most common cause?
E.coli
So what the treatment prescribed?
Norfloxacin. It's excreted unchanged in the urine.
The most commonly is trimethoprim sulfamethoxazole. But that's in case of chronic uti, right?
So the question I wanted to ask is what would you prescribe in a pregnant lady? Which drug.. Sulphamethoxazole and trimethoprim?
No. Its a PABA agonist.. Will inhibit folate synthesis. Risk factor for NTD.
NTD means?
Ntd-neural tube defects.
Amoxicillin and ampicillin. Those are the ones preferred for any infection.
Nitrofurantoin too.
That's prophylactically. Atleast that's what we were taught.
Even nalidixic acid.
Yeah! Not to give TMP-SMX that's what was the main point I wanted to convey.
We were told by our Pediatrics teacher that thyroid status and weight changes are not related. Weight gain in hypothyroidism, in fact due to myxoedema and not due to slow metabolism.
But almost every other book I read say weight changes are a part of symptomatology of thyroid disorders.
Would someone enlighten me about this?
In myxedema there is reduced breakdown of glycosoamimoglycans. Plus there is free fluid retention. A lot of factors come into play. I'll look it up and send a good resource on it.
And haan..also iy read in a book..that in thyrotoxicosis..30% of patients will have weight gain. So therefore, maybe the weight status are not characteristic to changes in thyroid profile.
Maybe.
The cause of the weight gain in hypothyroid individuals is also complex, and not always related to excess fat accumulation. Most of the extra weight gained in hypothyroid individuals is due to excess accumulation of salt and water.
Source: http://www.thyroid.org/weight-loss-and-thyroid
So, 'obesity' should not ideally be mentioned in symptoms of hypothyroidism?
Weight gain should be mentioned
Along with the various other signs and symptoms. The complete clinical picture is specific to thyroid diseases.
The mechanism maybe varied but weight gain is a symptom and should always be a differential for hypothyroidism.
Yup.
Also, in Grave's ophthalmopathy, GSGs are deposited in the retro orbital space. Shouldn't this be seen instead in hypothyroidism where there is reduced breakdown of GSGs?
It's because of autoimmunity
The antibodies stimulate deposition of GAGs. Has nothing to do with the effect of thyroid hormones. That's why, ophthalmoplegia can not be treated by anti thyroid medications.
Oh!
What is the treatment of ophthalmoplegia in Grave's?
It is symptomatic. Lubricants, steroids is all what we can prescribe.
Yes, steroids. To suppress the immune system.
Steroids are especially given in retinal pathologies.
What about a permanent cure?
I don't know about any permanent cure.
It's radioactive iodine 131 or thyroidectomy.
Permanent cure for opthalmopathy?
Hemithyroidectomy. Or if the graves is not too bad, we can give thyroid peroxidase inhibitors? And sometimes it will resolve by itself?
I was told the retro-orbital lipofibroblasts requires surgical removal of the mass behind the eye, but the lid lag will resolve once the thyrotoxicosis resolves?
Yes.
There are different surgeries for the opthalmoplegia..Don't remember the names.
Which all troponins are used as cardiac biomarkers?
I and T.
Troponin- T type 2.
Correct!
Which biomarker is used to differentiate breathlessness of cardiac origin from that of COPD?
BNP.
Correct!
BNP?
Brain natriuretic peptide.
Woah. I didn't know this.
Yeah. BNP is a marker for heart failure.
It's also used to monitor COPD patients.. That is the levels will increase if there is cor pulmonale
Also pro BNP.
BNP is present in ventricles. The ANP (Atrial natriuretic peptide) version in atria.
Amazing!
