Name the vitamins which are anti-oxidants?
Vitamin A, C, E.
Mnemonic: Ace the oxidants!
Which is the anti-oxidant important to prevent lipid peroxidation?
Vitamin E
Monday, February 16, 2015
Study group discussion: Tissues that are exclusively dependent on glucose for metabolism
Which things in our body are exclusively dependent in glucose for energy?
The lens.
Correct
Liver too?
Nope.
Brain?
No. It uses ketone bodies too!
Muscle?
No.
Cornea?
Cornea correct!
Heart.
Heart, no.
Interesting: Heart can use lactate.
Sperm
No. Sperm uses fructose!
It's RBC!
Oh ya. They are exclusively dependent on glucose! RBC can't metabolize anything else!
Study group discussion: Mechanism of hypercoagulability in obesity and smoking
How does smoking and obesity promote hypercoagulability?
Smoking increases reactive oxygen species. ROS reacts with LDLs causing increasing oxidized LDL, when deposited in intima becomes atherosclerotic plaques. Also ROS causes endothelial damage itself, increasing its permability to LDL.
Atherosclerotic plaques can rupture, exposing tissue factor. Or the plaque itself causes turbulent blood flow, increasing chance of thrombosis.
Nicotine causes vasculitis and thus causes turbulence of bood flow!
And obesity?
The various mechanisms by which obesity may cause thrombosis include: the actions of so-called adipocytokines from adipose tissue, e.g. leptin and adiponectin; increased activity of the coagulation cascade and decreased activity of the fibrinolytic cascade; increased inflammation; increased oxidative stress and endothelial dysfunction; and disturbances of lipids and glucose tolerance in association with the metabolic syndrome.
Source: Obesity and Thrombosis — ScienceDirect - http://www.sciencedirect.com/science/article/pii/S107858840600579X
Study group discussion: Virchow's triad
What is Virchow's triad for thrombosis? Explain please.
Virchow's triad... If there is stasis (Blood ain't flowing to wash out the collected coagulation factors), hypercoagulability (More coagulation factors) or endothelial injury (Stuff that activates coagulation factors) there'll be a predisposition to thrombosis.
In Virchow's triad 2 things are missing:
1. Role of platelets
2. Coagulation system
Study group discussion: Most common site of intraperitoneal abscess
Which is the most common site of intraperitoneal abscess?
It's pelvic.
The reason being gravity, common sites are subphrenic, paracolic, pelvic and right iliac fossa.
Pelvic is most common due to pelvic position of appendix and fallopian tubes, and due to leakages from colorectal surgeries.
I had a MCQ asking me to choose between paracolic, subphrenic and pelvic and stuff as options for the most common site.
So in that case, what would be the answer?
Pelvic would be the most common site, according to my teachers.
What is the best way to get to a pelvic abscess sample?
Through rectum? They usually burst into rectum and resolve.
In women, from the umm what do you call it..
Pouch of Douglas!
Nice Ikan :)
I tried so hard to recall the name. Almost blanked out for a moment there!
In women vaginal drainage is done.. Through posterior fornix vaginl drainage in women.
And if the abscess is pointing in rectum, rectal drainage is done.
In males, you would pass a needle through the rectum
Laparotomy is almost never necessary and rectal drainage is preferred over suprapubic which risks exposing the general peritoneal cavity to infection.
Study group discussion: Heparin induced thrombocytopenia and leech therapy
What's Heparin induced thrombocytopenia??
Antibodies are formed in the blood platelets due to heparin in certain individuals. This causes widespread petechia.
You discontinue heparin and give something else in HIT.
Lepirudin
Bivalrudin
Argatroban
And now the cool part :D
The drug Lepirudin is derived from the salivary glands of LEECH!
I know!!!
Haha ain't this cool?
Leech.. Didn't know that!
In school, they used to say if a leech bites you, you die. I never found out the truth though.
Maybe cause it releases these substances in your system..And you are not able to clot inside?
My 12th standard books also mentioned about leech having anticoagulant properties....Now I find out that it's used to prepare drugs!
HIRUDIN is the substance that is secreted by the salivary glands of leech!
I just Googled can a leech bite kill you :D
I don't think they can kill you, they don't take enough blood in a fast amount of time unless you put a few 100,000 on your body and left them there for a while.
100, 000...That's a lot of leech!
Lol I think it was a hyperbole!
I don't remember exactly....but I had heard of alopecia being treated with leech.
How? :O
The leech would suck blood... So keeping them for just the right amount of time they would increase the blood supply... I'm not sure though.
Leech therapy is known to increase blood circulation, therefore when therapy is applied to thinning or bald areas, the increase of blood circulation helps enhance the concentration and delivery of nutrients that assist in making hair follicles strong, thereby assisting in the promotion of hair growth. People suffering alopecia caused by fungal infections or dandruff can also benefit through the antibacterial component in the leeches saliva, which helps combat fungal infections.
It's also used in arthritis :O
The FDA approved the use of leeches in the USA in 2004. In October 2005 the first American hospital 'Beth Israel Medical Center New York' offered Leech Therapy to treat Osteoarthritis of the knee.
Arthritis?! Woah.
Study group discussion: Heparin, warfarin and the anti-fibrinolytics
Name the drugs which inhibit fibrinolysis.
TACA! Tranexaemic acid, amino caproic acid.
Describe the mechanism of action of heparin.
Binds to anti thrombin 3, blocks factor 10.
Which coagulation factors does warfarin affect?
Vitamin K dependent ones: 10, 9, 7, 2, protein C.
Why there is a lag of 2 - 3 days for warfarin to act?
Study group discussion: Management of Parkinson's disease
50 year old male, has no expressions, walks to your office, slowly. He complains of tremor while watching television. He says he can do tasks without the trembling his hands. His fingers keep moving as if he is rolling a pill as he is talking to you. Which drug will you prescribe to relieve his tremor?
It is Parkinson's disease. Anticholinergics will be prescribed.
Why not L-dopa? With carbidopa?
Study group experience #9
How to study pharmacology (Most requested post ever)
Types of hypersensitivity reactions (A simple Q&A at the end!)
It was my birthday this week (13th February, to be precise). One of the awesomites got to know through Google plus and everyone wished me on my birthday which made it really special. Thanks everyone!
Happy belated Valentine's day everyone! May we all love what we do and do what we love.
I'm unable to access tumblr fan mails and ask messages at the moment. Sorry for the delay! I'll be back on tumblr in mid March but I'll try posting the study group experiences as and when possible!
-IkaN
Study group discussion: AV blocks simplified
Tell me little bit about what do you know about AV Block?
They occur when atrial depolarizations fail to reach the ventricles or when atrial depolarization is conducted with a delay. There are 3 degrees which we can recognize.
First degree consists of prolongation of the PR interval on the ECG (>200 msec in adults and >160 msec in young children).
In second degree, we can find atrial impulses that fail to conduct to the ventricles. And variations like mobitz I and II.
And finally, third degree, where we get multiple P waves that don't conduct at all.
Tell me differences in type 1 and 2 mobitz?
Well, in type I there is a prolongation of the PR interval until it drops and doesnt conduct
And in type 2, there is a constant PR interval and then it drops (:
Poem:
If your R is far from P, then you have a 1st degree.
Longer, longer, longer, drop...Then you have a Wenckebach.
If your PS don't go through, then you have a Mobitz 2.
If your PS don't agree, then you have a 3rd degree.
What's the treatment? For all of them?
First and second degree (mobitz I) only require treatment if they are symptomatic.
Mobitz II and 3rd degree usually require temporary and/or permanent cardiac pacing.
This was fun, thanks for the drawings!
*the drawings of medcomic were shared on the group, you should check them out*
Review question:
Which of the following is not a feature of complete heart block on the ECG:
a) Constant RR interval
b) Constant PP interval
c) Constant PR interval
d) PP interval shorter than RR interval
Answer: C
Sunday, February 15, 2015
How to study pharmacology
First, you need to get the concepts right. Speed read and get a big picture, then understand the little details.
I dived into minute things I didn’t understand right away.. Now that I look back, I think I should’ve been patient.
Anyway, lil doubts made great blog posts!
Example: Why is lidocaine preferred in patients with arrhythmias following myocardial infarction?
It’ll take time to get a hang of the names of various drugs.. If mnemonics work for you, you should try making em! Try to put mechanism in the mnemonic to make it simpler (That’s what I do!)
Here are some recent examples of how I make my pharmacology mnemonics -
Antifungal drugs with mechanisms
Antiparkinsonism drugs with mechanisms
There are certain drugs which are unique and that is why remembering mechanism of action or their pharmacological property becomes very difficult :/
I talk about how to remember them in this post --> http://medicowesome.blogspot.ae/2014/06/pharmacology-study-tip.html
I requested my study group awesomites to contribute their tips so that I can share them. Here are the suggestions, tips, tricks, life hacks they told us! :D
One awesome way is to make a self constructed table. Side by side drugs.. Uses. Side effects and specific points. Helps a lot.
- Great tip by Sakkan.
I had small classification charts put up all over my cupboard and wall! I Would revise them at night....Since I found classifications a bit volatile.
- The repetitive memorization trick was submitted by Priyanka. (I made flash cards for the same!)
One useful tip is whenever you see a sachet of drug.. Just read the contents and dosages.
- Awesome tip by Sakkan. (Wish I did that earlier!)
And try explaining uncles and aunties taking them what's going on :D
- I like how Sakkan said, "Try" explaining. (She says she gets a lot off oooo, aaa and even a couple of blank faces too!)
I always discussed pharmacology with my friends, and mostly, taught juniors. You get good karma + revision.
- Manisha (Good karma always helps!)
It is very volatile but this subject manages appear everywhere.. All subjects. Everywhere there are therapeutic drugs mentioned. Makes it really difficult to grab the essence if you don't do pharmacology.
- Sakkan's way of telling us take pharmacology seriously.
I drew small cartoons...Of concepts I found difficult to remember.
- Priyanka (Send us your cartoons soon, girl!)
Book recommendations by awesomites:
A very good book for pharmacology is Colored Atlas pharmacology. For retaining most of it. By thieme. A page of drug and a page of illustration. Very helpful.
And there's at a glance series. Exists for all subjects. Comprises cool diagrams, flowcharts and accompanied with a page of description. Pretty standard text in her very easy format.
Motsbys pharmacology memory note cards. If you like cartoons this little book is great. (It's very adorable.) I have to admit there are drawings which I dont really get. Thats why doing your own drawings also comes in handy :)
I wonder if all international students refer Katzung or whether they have local authors too.
I think Lippincott is the standard, internationally.
Lippincott is simple to understand- standard and interesting book to read.
A book very commonly referred to in India is KD Tripathi.
We have Farrukh Jabbar, here, in Pakistan.
That's all!
I'll keep updating the post, adding new tips and tricks, till then, stay awesome!
-IkaN
Study group discussion: Types of hypersensitivity reactions
*We were discussing lepra reactions when we diverted to hypersensitivity reactions the other day*
I can't remember the types.
Here's a life saver for your soul - http://medicowesome.blogspot.ae/2012/03/hypersensitivity-types-mnemonic.html
Apparently there is type 5 and type 6 hypersensitivity reactions too.
5? What's type 6? Oh my god.
I had received a long fan mail on it a few days back:
We had a test about 4 days ago on hypersensitivity reaction type 5 and a lot of people left it blank because they thought it was a typo. Well, I later found out that it is the same as type 2 non cytotoxic (In fact, there is a type 6. Can you believe it? ). In situations like this, I always imagine there is a bored researcher sitting in a corner of his office, maybe eating a donut and taking a sip of milk from a beaker or conical flask, who thinks the best pass time activity is to screw around with the heads of medical students. So he gets his iPad, types a whole new ( and sometimes unnecessary) classification, sends it to a journal thus forcing medical students to add one more thing to that cramped up space called the head.
Hahahahha. The fanmail is hilarious. Made my day! :D
Myasthenia gravis? Which type of hypersensitivity reaction?
Myasthenia is type 2. So is Grave's.
Nope. It's Type 5.
Why?
Type 5 is an extension of 2.
It is because of it's blocking antibody, right? Or because it doesn't incite any inflammation?
In that case what would Graves be that antibody is stimulating?
Graves and gravis are caused due to effect of cellular functions. Graves - Increase in cellular functions. Gravis decrease in cellular functions.
"Instead of binding to cell surface components, the antibodies recognise and bind to the cell surface receptors, which either prevents the intended ligand binding with the receptor or mimics the effects of the ligand, thus impairing cell signaling.
Some clinical examples:
Graves' disease
Myasthenia gravis
The use of Type 5 is rare. These conditions are more frequently classified as Type 2, though sometimes they are specifically segregated into their own subcategory of Type 2."
- Source: Wikipedia
So type 5 includes autoimmunity, right?
Yes.
I didn't know they had classified it under autoimmunity now. Got it!
Type 6 is Antibody Dependent Cell Mediated Cytotoxicity.. The NK cell stuff.
They kill viruses laden cells and tumors.
Basically, any antibody that causes a effect besides inflammation due to binding to cell receptors is type 5.
Immunology comics on ADCC :D http://immense-immunology-insight.blogspot.ae/2013/10/functions-of-antibodies-simplified.html
Okay, review questions!
Name type of hypersensitivity!
Poison ivy reaction after 48 hours in a camping trip.
Type 4.
Correct!
A person who was given horse serum for something.
Type 3. Type 1 if he presents early!
Good job!
Person underwent a screening test for tuberculosis.
Type 4.
Excellent!
Person develops hemolysis after receiving penicillin.
Type 2.
Oh kid gets a bee sting.
Type 1.
Person with leprosy develops new lesions after starting drug therapy.
Type 3.
Awesome!
Hypersensitivity pneumonitis?
It is both type 3 as well as type 4.
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