The common causes of greenish discolouration of urine are :
(1) Phenol containing compounds: Promethazine, Propofol, Thymol,
(2) Dyes: Indigo-blue, Indigo carmine, Carbolic acid, Flavin derivatives,
(3 Biliverdin (in cases of long standing obstructive jaundice),
(4) Amitryptyline (anti-depressant),
(5) Pseudomonas infection,
(6) Cemetidine,
(7) Indomethacin,
(8) Methylene blue (bluish )
Here's my way out of the necrotising vasculitis. Pan intended ;;).
So depending on the size of the vessel involved you can classify it as -
1. Large Vessel Vasculitis
2. Medium Vessel Vasculitis
3. Small Vessel Vasculitis
For the first two Remember :
TT PK
So Large vessel = TT
Takayasu Arteritis
Temporal Arteritis (Giant cell Arteritis)
And Medium Vessel = PK
Polyarteritis Nodosa
Kawasaki disease
Now Small Vessel Vasculitis can be classified further. It can be positive for a particular antibody called ANCA or it can be negative. This antibody is purely an association and not a causative one.
ANCA Negative : HCC
H - Henoch Schonlein Purpura
C - Cryoglobulinemia related
C - Cutaneous Leukocyto-angiitis
(Think of crying babies.
Cry = Cryoglobulinemia related Vasculitis
And another baby related Vasculitis is HSP).
Now ANCA positive Vasculitis can be either c-ANCA or p-ANCA depending on what part it stains.
Remember - WC
(Like Western commode)
Wegner's is c-ANCA.
Remember - PCM
p-ANCA in Churg Strauss and Microscopic Poly-angiitis.
Please note - The names of Wegner's and Churg Strauss have been changed to Granulomatosis with Polyangiitis , and Eosniophilic GPA respectively. This is said to be because the scientist Wegener had been discovered to be possibly related to some Nazi war time activities and this opportunity was made the most of to also take a step towards a more pathology-specific name-calling by altering the honorific name given to the disease.
That's all!
Happy studying.
And Stay Awesome !
~ A.P.Burkholderia.
1. Flame shaped haemorrhages are seen when they occur in the superficial layers of the retina because the blood can spread as tight junctions are not present there.
2.Dots and blots show up into the deeper layers because the space to spread for the blood is relatively lesser.
That's all!
Sushrut Dongargaonkar
{This might be quite a descriptive post. So read this if you don't have exams upcoming recently}
As a Medical student, or a doctor we all are opting for a profession of care for people. But often we forget that the people who need care includes ourselves too.
How should we take care of ourselves.
1. One should take care of one's self.
2. One should take care of one's colleagues.
Do you eat well? Do you sleep enough? Are you spending time with your family? All these fall into such a level about taking care of your ownself.
As medical students we have long weeks and short sleeps. Let's admit, still we don't have enough time.
1. First of all, don't forget to,
EAT WELL. Food is essential for your sustenance. Eat nutritious food. Not just starch and sugary food. Opt for some fruits, yoghurt and more veges.
Our professor said it is better to get yourself a multivitamin complex if you feel like you are running out of enough nutritious food.
SLEEP WELL. Sleep is one of the most important aspects of your daily life. You probably cant sleep 6hrs straight. But get some decent sleep at least for 4hrs. And if you are taking a powernap, try taking it in multiplies of 90mins. I saw it recently in an article 90mins(180/270 etc) of nap improves your ability to wake up fresh as it is appox 1 sleep cycle.
EXERCISE WELL. You dont have hop into University gym and run on those treadmills for your dear life, but obvio try taking a stroll with your friends in the ground, or get a brisk walk to market instead of getting a taxi or riding there.
RELAX WELL. We surely don't have time to sit on a sedan chair and reflect on life or get a bikini/short picnic to the nearest beach when we have an Internal Medicine exam 3 days away. But surely you have time to go grab a coffee and enjoy it without looking at your jumbled up notes. (They aren't much readable anyways 😜jk...), Sit on a short wall and swing your legs like you remember all the drug regimes of the world. Look at the sky from the terrace and try to find a constellation or two that you learned in Grade school. Listen to a song that uplifts you or soothe you depending on your mood. Sketch something (personal secret : I sketch my crushes when I'm stressed 😜). Do something that makes you feel good. Meditation or yoga or something are good too. If spa, manicure pedicure, massage works for you, by all means go for it too.
CHECK-UPS. What is the last time you checked if you have enough Hgb count? Get your personal body checkups. You are only riding that Car, don't forget to check the oil and water levels too. Even a Benz or a BMW can wreck havoc if they don't have enough care. Get yourself done a teethscaling.
ENVIRONMENT. Look at your desk. Does it look like that you just performed an exocism there? 😂 Clean it up yo! Clean your desk. Your room. Keep some airfreshners, keep stuff that motivate you surrounding you. Not things that make you feel like "I'll rather live in the library!". 😜 Get enough Oxygen into your place and for all the love for Zeus, don't get into a room without enough ventilation.
MENTAL HEALTH. Almost every university provides free mental health counselling to its students. What was the last time you used it? Last time I had stress issues with my Neurology final exams, I went to meet a guidance counsellor. She totally listened to me and made me feel good. And another time when I felt like I'm losing my interest and the passion, I talked to my psychiatry professor.I think you should talk to someone qualified about it. And never think talking to a psychiatrist or a counsellor is a bad thing. In the long run it will help you heaps.
2. How to take care of your colleagues.
Ok we don't even have time for ourselves. I agree. But please don't leave those who are around you.
We all are in the same journey. Look out for them. Check if they ate their meals. If they forgot their attendance. Check if they are okay. If their relationships are going well. If they are performing fine in exam. Look out for people around you. Close friends are the first people are recognize depression and anxiety in a person before it attains to clinical levels. If you notice a difference talk to them. Or lead them to talk to someone qualified about it.
If someone is losing marks and failing exams offer to help them. If they ask for support never refuse.
Be a good person to others, this way you will be a good doctor too.
That's it for now folks. Enjoy and always take care of yourselves and others around you.
With love,
Jay
Clinical vignette:
Young, non smoker, female comes with complaints of sore throath, dry cough, nasal congestion for 10 days. Now, she feels better however she coughs out yellowish expectoration.
There are scattered wheezes and crackles that clear with coughing.
You've ordered relevant labs and meanwhile the patient asks you if she would need antibiotics. What would your next step be?
Answer: Symptomatic management.
Reason: Since there is a history of preceding viral infection and her current situation indicated Acute Bronchitis, the expectant management would be fairly Symptomatic!
Infact, there are articles that state that giving antibiotics could worsen the patient condition! Also, judicious use of antibiotics can help prevent antibiotic resistance.
Let's fight antibiotic resistance!
Stay awesome!
-Rippie
