What is necrobiosis lipoidica?
Which condition causes it?
Papule on Lowerlimb seen in DM.
What's DM?
Diabetes mellitus.
It's not simply a papule. It's necrosis of the skin.
What is necrobiosis lipoidica?
Which condition causes it?
Papule on Lowerlimb seen in DM.
What's DM?
Diabetes mellitus.
It's not simply a papule. It's necrosis of the skin.
What is Cushing Reflex?
It's related to cushing syndrome or disease?
Nah. It consist of signs of Raised I.C.T: Hypertension, bradycardia, dilatation of pupil and pyramidal tract sign.
It is caused due to raised ICT?
There is more entity..Cushing's ulcer and curling ulcer. One of them is caused due to raised ICT I think. The other being a stress ulcer. Both in the stomach.
Curling ulcer is due to burns.
They both are confusing terms.
Cushing ulcer is caused when there's brain injury. With ICT as mention above
Agree.
Does anyone know the mechanism?
Cushing ulcer and Curling ulcer are peptic ulcers caused by CNS injury and burns respectively.
One possible explanation for the development of Cushing ulcers is the stimulation of vagal nuclei due to the increased intracranial pressure which leads to increased secretion of gastric acid.
Curling ulcers may be explained by a reduced plasma volume, which leads to sloughing of the gastric mucosa or secretion of burn toxins (necrotic and carbonaceous materials released from burned cells) by the stomach.
There is the cushing sign too
Must you know the difference between Cushing's disease and Cushing syndrome then?
Cushing disease is the disease caused due to a tumor of the pituitary..With increased secretion of ACTH.
The other is the syndrome caused due to excess cortisol in the blood.. Exogenous commonly. I am not sure whether adrenal tumors are also included in Cushing syndrome or not.
Cushing sign occurs as a result of Cushing reflex.
Here are study links on Cushing's!
Cushing's ulcer mnemonic: http://medicowesome.blogspot.ae/2014/03/ulcers-of-stomach-mnemonic.html
Cushing syndrome notes: http://medicowesome.blogspot.ae/2014/12/how-to-make-concise-medical-notes.html (View image)
What is pyramidal tract sign?
Did you mean Babinski sign ?
There are a specific set of clinical signs for pyramidal tract disease..I haventy heard of just one particular one.. But yes, out of the many..Babinski is the most specific for pyramidal tract disease.
A few days after UMN syndrome, motor signs appear
These include spasticity, hyperactive reflexes, extensor plantar responses.
That's because the CSF will press on the cortical neurons.. And cause a upper motor neuron type of lesion.
UMN lesion is due to lesion in corticospinal tract between cerebral cortex and SC.
Well, not all pyramidal signs are called Babinski. Babinski is the extensor response to plantar reflex when the lateral surface of the feet is striken/scratched.
Achcha what are the components of the positive babinski reflex? - review question.
Extension of great toe, fanning of other toes, contraction of tensor fascia lata.
Plus, dorsiflexion of ankle and knee joint.
Yeah, that.
Other ways to elicit a babinski ?
Plus the equivalent of babinski in the upper limbs?
It's plantar reflex. It can be elicited different ways, one's babinski, others are Oppenheim and Chaddock.
Schaeffer too.
Yep.
And do you elicit Babinski with sharp end or blunt end of the hammer? (Viva question)
In Babinski, you have to produce pain and pressure both at same time so I guess blunt end if the hammer is used.
To support my answer - I have also seen many doctors using their keys (blunt end) for eliciting Babinski.
The tip of a pen can also be used to elicit Babinski.
Yeah, they taught us that we could use keys if we didn't have a hammer handy.
Always red, it looks better on a patient's foot.
In paediatrics.. We used our own nails to elicit Babinski!
I was doubtful that it would work.. But it did.. Especially, children aged below 3-5 years.
Anyone explain Monospot test please!
Heterophile antibodies in the blood?
I was just reading this. The test works with the agglutination of horse's RBC when in contact with heterophile antibodies.
Yes.. Used in detection of these antibodies in infectious mononucleosis.
When you have infectious mononucleosis you produce antibodies anti-epstein barr virus and other unspecific antibodies which are called heterophile antibodies.
Aren't anti sheep antibodies produced in monospot test ?
I mean Heterophile anti sheep red cell antibodies?
That would be Paul Bunnel test.
But infected B cells secrete anti sheep red cell antibodies that are diagnosed for mononucleosis. .
I think the only difference between monospot and paul bunnel test is the origin of the RBC. In monospot they come from horses and on Paul Bunnell, from sheeps.
I have a review question for sarcoidosis.
What is the characteristic appearance of sarcoidosis radiological imaging?
Lambda sign?
Panda sign?
No. Hint..That's also what tuberculosis shows positive.
BL hilar lymphadenopathy.
Tree in the bud sign.
You then differentiate it from TB ..Based on whether the lymph nodes are showing necrosis or not.
Can you elaborate on the tree in bud sign?
It's an appearance on chest CT. I read it is specific for TB and sarcoidosis.
Oh so if there is necrosis, it's Tb? If not, it's sarcoidosis?
Yup. That too can be differentiated on CT.. By looking at the lymph nodes.
I have a review question. Which cells will you see in sputum examination of a patient with sarcoidosis?
Elevated CD4/CD8 ratio.
Why is that?
I don't know exactly but CD 4 + inflammation is specific to sarcoidosis. Helps differentiate it from other non granulomatous interstitial lung diseases.
*A parallel discussion on calcium was going on, since they both are related to each other, I'm posting the calcium discussion here as well*
Percentage of dietary calcium absorbed is inversely related to intake. How is this possible?
If you take more calcium, it absorbs less? I don't know how that is possible.
The body has to maintain a homeostasis for calcium.. If reduced intake..There will be paradoxical increased receptors via Vitamin D. To maintain a constant absorption.
If increased intake..The body reduces the absorption. The mechanism..PTH is stimulated via low serum calcium.. And PTH is the one responsible to make the final active form of vitamin D.
So if calcium in the blood stabilizes, there will be reduced impulses by PTH..conversely less vitD and less absorption.
It means that if your body's need/absorption of calcium equals x.
If your intake equals x, you'd be absorbing 100% of it.
If your intake equals 2x , you'd be absorbing 50% of it.
If it equals 4x you'd be absorbing 25% of it, and so on.
At a normal steady state of absorption, the more the intake is, the less the absorption percentage of it.
Excellente.
Can anyone associate calcium and sarcoidosis?
Hypercalemia.
Why?
Because of increase in Vitamin D by granulomas.
PTH decreases then.
Which enzyme?
And which cell is involved?
It's the interstitial alveolar macrophages that secrete alpha hydroxylase that activates vitamin D.
Is sarcoidosis a cause for dystrophic calcification then?
No, metastatic.
Bravo!
What is the function of the hormone somatostatin? In relation to the regulation of blood sugar level?
Somatostatin is the hormone which keeps the blood glucose level smooth... Prevents fluctuation.
It inhibits both insulin as well as glucagon release, plus decreases the overall transit time of food in your GIT
Somatostatin is the reason why you need only three meals a day... It doesn't allow all the glucose to enter your body at once and maintains a continuous supply.
There is something a professor always says, "Somatostatin never met a hormone it didn't like to inhibit."
coOl.
True. I haven't come across one thing it stimulates ^_^"
Review question time!
Which is the universal donor?
And why?
O negative. No antigens.
But it still has anti-A and and anti-B antibody... Won't they react to the RBC present in the recipient?
Confused at the O negative thing. Will read it.
The things is when you give blood to the recipient.. The plasma in the O- blood is rapidly mixed with the 5 litres of the recipients plasma.
So the antibodies are diluted..they are not effective in causing agglutination of the recipients RBC
Why doesn't this happen with any other mis matched blood groups?
Cause in those cases the RBC's are having antigens... So they are rapidly agglutinated.
Mismatched blood transfusions are due to agglutination of donors RBC, never the recipients RBC.
Oohh yes... Cool.
Drug of choice for Von Willebrand factor deficiency?
I know this! Vasopressin!
Route? :D
I think.. Nasal spray?
Yes! The drug can't be used chronically but cause it just causes release of preformed vWF factors.
vWF is for platelet adhesion.. Right? In normal haemostasis?
Yes, vWF sticks platelets to the blood vessel wall. Gp 1b helps in platelet adhesion.
It's present in Weibel Palade bodies.
What are these bodies?
Weibel–Palade bodies store and release von Willebrand factor and P-selectin. Mnemonic: http://medicowesome.blogspot.ae/2014/01/cell-mnemonic.html
And can any one name another disease related to Von Willebrand's factor? (Indirectly related)
Bernard
Sullivan syndrome.
Umm woah I didn't know so many diseases with vWF.
I was thinking of thrombotic thrombocytopenic purpura.
ADAM TS 13 is defective, which is involved in the degradation of vWF
I didn't find any Sullivan syndrome!
I think he meant Bernard - Soulier syndrome.
Bernard Soulier, you mean?
Yeah. Still spelt it wrongly.
Haha it's okay! I was spelling "Wobble palade" bodies myself. I Googled before typing it though.
Study link! http://medicowesome.blogspot.ae/2013/12/anti-platelet-drugs-receptor-and-their.html
Another one.. Name the substance that stain positive with Ziehl Neelsen staining.
Microbes.
Examples?
Tuberculosis, cryptosporidium.
M. Leprae.
Nocardia!
Others are rhodococcus, isospora, smegma bacillus.
Ooh did not know those!
And?
Sperms!
Why in hyperthyroid states there is loss of weight despite increased appetite?
High metabolism?
There is one more reason to it.
Do they have increased bowel movements? Maybe that reduces nutrient absorption?
Hyperthyroid is a protein catabolic state..Hence no matter the external energy provided..The preformed proteins are broken down.
Aah yes!
If a patient has diabetes..Which drug would you prescribe to reduce the chances of mortality due to heart diseases?
Thiazolidineones?
Metformin? Or pioglitazone?
Nope nope.
It's aspirin.
What? Aspirin is not an anti diabetic drug, is it? You prescribe aspirin in general to lower mortality. What's so special about diabetes?
I am yet to find out why.. I would love it if someone out here knows why.
About the use of aspirin in diabetes.... I read a paragraph online... Here's what it said:
It is found that there is excess release of thromboxane in type 2 diabetes patients... Hence the use of aspirin (TXA inhibitor)
Thanks!
http://m.care.diabetesjournals.org/content/27/suppl_1/s72.full
It never ceases to surprise you. Medicine.
Woah.
What do you know about immortal cells?
Cancer cells are immortal?
Yeah, like HeLa cells.
I had written a blog on it long back. Let me find it!
The blog I wrote isn't really on HeLa cells. But people who reblogged it on tumblr added this to it -
Tumblr reblogs:
I have read some thing like this before in the nonfiction book called the immortal life of Henrietta lacks. They took her cancer cells and studied them finding that the cancer cells were still living even after she past and outside of her body. I think, if I am remember correctly the cells are called HeLa. It's a great read.
Tumblr reblogs:
You’re right. HeLa cells are still used in scientific research. It is the oldest and most commonly used human cell line. The line was derived from cervical cancer cells taken on February 8, 1951, from Henrietta Lacks, a patient who eventually died of her cancer on October 4, 1951.
It doesn't matter if it's not about HeLa cells specifically :)
I just want to understand better how it works.
Oh.. Here's the blog link to immortal cells then http://immense-immunology-insight.blogspot.ae/2014/08/7-reasons-why-cancer-cells-are-immortal.html
The HeLa cell line has a lot of ethical issues.. Because the person from whom the cells were taken from (without consent) didn't get any medical attention or superior care and the companies benefited a lot from it.
Thanks a lot :) and I didn't know any of the history.. It's really interesting
Yes, it's actually pretty wonderful that the cells are still alive. There were a lot of sci fi notes added to the tumblr post, I'll share them here as well.
Tumblr reblogs:
So if somehow we were to find a way to harness the cancer cell’s power, we could possibly live forever. We’d just have to find a way turn turn all the cells in the body into cancer cells, and then take away their ability to divide via mitosis. It sounds like sci-fi, but highly plausible in theory.
Tumblr reblogs:
Well there’s more to it than that, but in theory yes… You also have to consider that tumor cells don’t actually function other than continuously dividing. And often times, tumor cells build up a lot of free radical waste that can damage surrounding tissue.
Tumblr reblogs:
You have a point, but that isn’t entirely true. While most cancer cells are nonfunctional, many actually do function similar to a normal cell (though sub par). The main reason why cancer kills people is because the rapid growth of tumors causes pinched tissues and ruptures/hemorrhages. If we could figure out how to prevent mitosis and make all cancer cells functional, we could possibly become immortal.
Tumblr reblogs:
May I just say, I love sci-fi theories. Immortality through cancer cells.. Now that’s some brilliant imagination, right there!
Yes, some cancer cells can function. But it’s too much for the body to handle. If we could control metastasis, we could send some liver cells and gut cells at every waste generating site and have our free radicals scavenged!
Tumblr reblogs:
It's semi funny however those facts are not entirely true because the cancer cells die, usually you get necrosis in the tumors mostly bc the growth of the tumor is quicker than its ability to grow vessels, or vessels that actually can hold it together. "Cancer cells dont need anything" is another misconception. they are like any other cells but also not every cancer is the same either. Saying like the thing about being mostly anaerobic which is true for some and sometimes they are, however not always, thats why we do such things embolization therapy in tumors. And it can work. The oncogenesis and basically the whole process is way more complicated than it seems.
Tumblr reblogs:
They meant growth factors when they said they don’t need anything. Hell yeah, normal cell requirements without regulatory factors. Necrosis affects only the central portion of the tumor, doesn’t account for the fact that the cells are dividing on the edge of the lesion, making the tumor as a whole, immortal. Embolization cuts off the entire blood supply, artificially. They were talking about how they are immortal without considering interventions like chemotherapy, radiotherapy, resection and many other therapies that we can do, clinically. Biologically, they are immortal. I agree that not all cancers are the same, but the facts given out here are true.
I had only heard about immortal cells as a possible cancer therapy by using telomerase inhibitors or something like that.
As a therapy to treat cancer? Woah.
Let me look for it.
Links online say it's too risky to come true.
This article says telomerase inhibitors would treat cancer.
Or this one... www.ncbi.nlm.nih.gov/pmc/articles/PMC2937180
The article title though <3
Haha I know :)
Immortal army! *_*
My favorite cells come to the rescue.. T cells!
Interesting read. Thanks for the article!
There's another thing I read a while back that made me realise why any form of immortality is or will be problematic..
Remember the adenosine deaminase deficiency treated with gene therapy?
Trials have shown that the kids cured with gene therapy had a predisposition to cancer because of the virus (sarcoma virus or retrovirus, don't remember which) put in to carry the gene that treats the condition.
So it's like you go in to treat this and you come out with another disease.
It's why the gene therapy isn't out of trials yet. They're re-considering the risks vs benefits.
Oh... Well that's unfortunate... It seems like a cool idea. Genetics is only being developed anyway. There's a lot we don't know.
Awesome rock solid last discussion last night guys! Loving this group.
And concept of immortality marvellous!
What's cerebral cortical atrophy?
Shrinking of the brain tissues, ie loss of neurones, can be focal (small part) or generalized (affects all of the brain). Number of causes such as Alzheimer's or stroke.
There is a disease called hydrocephalus ex vacuo, in which the baby has a smaller brain. But the CSF production is normal. But mostly the doctors end up diagnosing it as hydrocephalus.
Hydrocephalus ex-vacuo occurs when there is damage to the brain caused by stroke or injury, and there may be an actual shrinkage of brain substance. Although there is more CSF than usual, the CSF pressure itself is normal in hydrocephalus ex-vacuo.
We had a case of this in my college, the girl was a three year old..With the grasp reflex still present and no stable head control.
Is it the same as normal pressure hydrocephalus?
Nope. Cause medication and surgery for normal pressure hydrocephalus won't work on this.
Revision question: Tell me the triad of normal pressure hydrocephalus!
Dementia
Gait disturbance
Urinary incontinence
In case you guys don't know, triad for NPH mnemonic: Wibbly wobbly, wacky and wet. For gait disturbances, dementia and urinary incontinence respectively.
Hydrocephalus ex vacuo and cortical atrophy are different entities?
Can't exactly say. May have a cause effect relation.
One causes the other?
Yep.
Got it.
Guys, I heard of another cool thing!
Type 3 diabetes!
Which is?
Alzheimers disease, apparently.
How?
Something related to IGF.. AD represents a form of diabetes mellitus that selectively afflicts the brain.
Woah.
Wow.
There is also diabetes type 1.5
What is that?
Latent Autoimmune Diabetes in Adults (LADA)
Interesting.
Can LADA also have a polyneuropathy a symptom like DM? As the link says it a Diabetes cause of Autoimmune reaction?
I would imagine every type of diabetes has the potential to cause secondary effects such as neuropathy.
I'd never heard of Alzheimers as diabetes though.
As an aside other forms of diabetes I've heard of are gestational diabetes and diabetes secondary to pharmaceuticals.
What's MODY and how is it different from LADA?
LADA is autoimmune whereas MODY seems to be related to chromosomal mutations.
I was asked in pathology viva, what is the difference between agglutination and rouleaux formation.
I think rouleax is the RBC's sticking to form a tube or a roll and agglutination with an immunological reaction?
Have to check.
Agglutination clumping of RBC due to Antigen - Antibody reaction,
whereas in rouleaux clumping occurs due to decrease negative charge during rouleaux formation stage in ESR.