Study group discussion: MAC deficiency in Waterhouse Friedreichson syndrome

Waterhouse Friedrichson syndrome has which immune component deficient?

MAC
C5-C9

And infections with what organisms are the especially susceptible to?

Gonorrhoea also?

No, just meningococcal

And just neisseria? Ideally, shouldn't there be increased susceptibility to all gram -ve organisms?

It is caused due to haemorrhage in adrenal gland. Waterhouse is not just a primarily immune complex deficient state. It is a manifestation of systemic infection due to meningococcal meningitis

Umm. My book says that patients with meningococcemia who develop Waterhouse..... Are generally MAC deficient.

There isn't susceptibility to other gram negatives because membrane attack complex is a defense against bacteria which can survive intracellularly.
So basically, extracellular lysis by MAC is effective in killing only Neisseria species.

You're susceptible to N. meningitis only because Neisseria gonorrhea has an outer membrane protein. MAC interacts with it and fails to insert in the bacterial membrane.

And then E. Coli and Salmonella have long polysaccharide chains in cell wall and these side chains prevent the insertion of MAC into bacterial membrane.

So MAC is good at killing only one thing - N. meningitidis and the deficiency will predispose you to this one infection only!

If you're talking about an infection that hemorrhages into the adrenals - it has to get really out of control to do that. And MAC deficient patients can't control their Neisseria infections leading to Water House Friedreichson syndrome. So the book is fair in saying those who develop WHFS due to meningococcal infections are usually MAC deficient.

Study group discussion: Artery of Percheron

*a picture of artery of Percheron was posted in the group on which this discussion took place *

That's vertebral arteries combining to form basilar. And again dividing to posterior cerebral arteries.

This is an anatomical variant.. Any odd thing in the picture?

The supply from the right branch of posterior cerebral artery. That seems odd! If it was normal.. It should have a bilateral supply.

Exactly.
It's called artery of Percheron.

What is special about it?

A rare anatomical variant where the thalamic perforator branch supplies both sides of the midline.

Any occlusion and you'll have bilateral paramedian thalamic infarction.

Ohh.. What would be the symptoms?

Yup.. How would unilateral infarction differ from bilateral?

I can't figure out which structure the artery is supplying!
They're thalamic peduncles. Unilateral you'll have sparing on one side. In Bilateral, the structures below the thalamus will be totally cut off from the structures above.

And symptomatically we are talking depending on which relay centre is affected? Or is there a very specific pure motor, pure sensory stroke we get?

Bilateral paramedian thalamic strokes are typically characterized by a triad of altered mental status, vertical gaze palsy, and memory impairment.

Altered mental status can present anywhere on the spectrum from drowsiness or confusion to hypersomnolence or coma...most probably due to damage to the reticular formation.

Vertical gaze palsy suggests mesencephalic involvement.

Memory deficits mostly are due to damage to the papez circuit. ..Anterior nucleus of thalamus is a part of the Papez circuit.
And also the thalamus acts as a 'search engine' for memories.

I looked up a few parts on the net...

That's awesome!

This is what I found in Harrison - Occlusion of the artery of Percheron produces paresis of upward gaze and drowsiness, and often abulia.

I liked the search engine bit. Nice info!

By the way, a similar sounding condition, 'Purtscher's retinopathy' is associated with acute pancreatitis.

How to remember lobular carcinoma spreads to contralateral breast

Hello! A short sweet post for today :D

Mnemonic: LOBUlar
Located in
Other
Breast
Usually

That's all!

-IkaN

Intravenous dreams

You know you have done too many blood collections when you say stuff like, "Dreams are collapsible, like a vein. So make sure you put needle in a good one."

Study group discussion: Dua's membrane

Cool fact: A new layer of cornea is discovered. It's called the Dua's membrane.

The Dua's Layer lies between the stroma and the descmets.

It's said to be acellular.

It was discovered last year by an Indian opthalmologist, Dr. Harminder Singh Dua.

Related post: Layers of the cornea mnemonic

Study group discussion: Pleural tap

Which muscles are pierced in midaxillary line during pleural tap?
Answer:
- Serratus anterior
- External intercostals
- Internal intercostals
- Intercostalis muscle

What are the boundaries of the safety area that we chose for pleural tap?

Answer:
Anterior - Lateral border of pectoralis major
Lateral - Lateral border of trapezius
Inferior - 5th intercostal space
Superior - Base of axilla

It's also called safe triangle.

Related post: Why is atropine given before procedures like drainage of pleural effusion aka pleural tap?

Staghorn calculus mnemonic

Staghorn calculus mnemonic

I remember the word, "MAPS"

M: Magnesium Ammonium Phosphate Struvite stones

A: Alkaline pH (AlkAline has 2 A's, Acid has just 1 A.)

P: Proteus

S: Splitting organisms (Urea splitting, urease producing organisms)

Staghorn calculus

Study group discussion: Vitamins and renal stones

Question: Which vitamin is indicated in treatment of calcium stones?

Answer: Pyridoxine

And which vitamin is avoided in a patient with history of calcium stones?

Answer: Vitamin C, it will worsen calcium stones.

Why?

Answer: Vitamin C increases oxalate in body. Pyridoxine decreases oxalate level in body.

Extra: Vitamin A deficiency too causes stones. The desquamated epithelium in tubules acts as a nidus for stone formation.

Study group discussion: Signs in acute appendicitis

Most commonly asked appendicitis signs

Aaron’s sign: A referred pain or feeling of distress in the epigastrium or precordial region, on continuous firm pressure over McBurney’s point, in acute appendicitis.

Dieulafoy’s triad: Tenderness, muscular contraction and skin hyperaesthesia at McBurney’s point in appendicitis.

Obturator sign: It refers to presence of hypogastric pain on stretching the obturator internus due to its irritation in the pelvis. This test is performed by passive internal rotation of the flexed rightthigh with the patient supine.

Bastedo’s sign : Pain and tenderness in the right iliac fossa on inflation of the colon with air, in cases of chronic appendicitis.

Psoas sign  : It is positive in retrocecal appendicitis. In this, irritation of the of the psoas muscle gives rise to pain when the patient’s right thigh is extended from the flexed position.

Rovsing’s sign  : Pain at McBurney’s point induced in cases of appendicitis, by pressure exerted over the descending colon

That's a good summary. Thanks!

Study link! Clinical features of acute appendicitis mnemonic
http://medicowesome.blogspot.ae/2014/11/clinical-features-of-acute-appendicitis.html

Study group discussion: Vitamin K overdose and deficiency

What's the adverse effect of excess dose of vitamin K, if given in new born?

Answer: Neonates - In infants (particularly premature babies), excessive doses of vitamin K analogs during the first few days of life may cause severe hemolytic anemia; this in turn may result in  hyperbilirubinemia, kernicterus, leading to brain damage or even death.

Study group discussion: Serial interval and communicable period

What is the difference bw serial interval and communicable period?

Communicable period is the one in which the disease is transmitted from one case to another. (Also known as infectivity.)
The patient might have the disease but may not be infectious because of latent phase.

Serial interval is the time period in which the disease manifests from one case to another.

It's different from communicable period because the disease doesn't manifest immediately, so the case might present to you late.

Serial interval = Latent period + communicable period (Roughly)

Study group discussion: Temporal arteritis

A 60 year old male presents with headache, scalp tenderness, painful temples, pain on chewing & visual disturbances.. Diagnosis?

Answer: Temporal arteritis

What tests you would do to confirm the diagnosis?

Answer: Raised ESR, temporal artery biopsy

Treatment?

Answer: High dose steroids like prednisolone!

Temporal artery branch of?

Answer: ECA, the external carotid artery!

Study group experience #15

Structures that pass through the diaphragm mnemonic
Purtscher's retinopathy

Biliverdin
Largest protein and the smallest protein in the human body

Hemolytic disease of new born
Evening rise of temperature in tuberculosis and malaria
Causes of edema

Chloroquine and Behcets disease
Drugs contraindicated in myasthenia gravis
Drugs used in the treatment of Alzheimers disease

Smoking and hernia
Eponymous terms in hernia and mnemonics

Correct order of clinical assessment of the abdomen

More information on the study group

It's amazing studying with you guys, I wish I could update - discuss more often, but internship is really draining me. Trying my best to catch up. Love you all! :)

-IkaN

Study group discussion: Correct order of clinical assessment of the abdomen

Question: During clinical examination of abdomen what is the correct sequence of the following events?
Palpation - inspection - auscultation - percussion.

Answer: You first need to auscultate in abdominal examinations because bowel sounds increase after palpation. So it would be inspection -  auscultation -  palpation - percussion.

When assessing most body systems, the appropriate order is inspection, palpation, percussion, and auscultation. However, with the abdominal assessment, auscultate before you manipulate the abdomen with palpation and percussion. The rationale for this is that manipulation of the abdomen with palpation and percussion may stimulate peristalsis and thereby alter your examination findings. So the appropriate order for the abdominal examination is inspection, then auscultation, followed by palpation and percussion.

Research paper: http://www.ncbi.nlm.nih.gov/books/NBK420/

Extra tips: You wanna ask the patient whether it hurts somewhere and palpate that area last.

While examining abdomen always expose the patient from nipples to midthigh. Also one more important thing is that, abdominal examination is never complete without examination of external genitalia.

Organ of Zuckerkandl.

There are several extradrenal sites where pheochromocytoma occurs, and this, the 'organ of Zuckerkandl' is one interesting site.

It actually is a cluster of bodies,located either at the bifurcation of the abdominal aorta or at the origin of the inferior mesentric artery and they contain chromaffin cells derived from the neural crest.

These are also known as 'paraortic bodies' but differ from 'corpora aortica'(also a chromaffin body)which lies near to the thoracic aorta.

The organ of Zuckerkandl is said to be responsible for secreting catecholamines and other vasoactive substances. It has a function of supplying catecholamines to the fetus especially in the first trimester of pregnancy and regresses usually in the third trimester.



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Study group discussion: Largest protein and the smallest protein in the human body

How many amino acids make up a protein ?

>100 ~ proteins
10-100 ~ polypeptide
<10 ~ peptide

Which protein is smallest in the human body?

Thyroid releasing hormone or TRH should be the smallest protein in the human body, with 234 amino acids. (> 100 amino acids is a protein.)

Smallest polypeptide in the human body should be insulin, with 54 amino acids. (10-100 amino acids is a polypeptide.)

Smallest peptide in the human body should be glutathione, with 3 amino acids. (<10 amino acids is a peptide.)

I concluded these on what I found on Google. Correct me if I'm wrong.

Largest protein is titin in the human body!

Interesting virology fact:-
The largest viruses as Poxviruses measuring 300nm are as large as the smallest bacteria (mycoplasma). The smallest viruses as Parvovirus measuring about 20nm are nearly as small as one of the largest protein molecule, hemocyanin.

Study group discussion: Hemolytic disease of new born

What is immunogenic hemolytic disease of new born?

Answer: In immunogenic type, the immune system plays a role in the pathogenesis of the disease. Rh incompatibility is an example.

What are the causes of non-immunogenic erythroblastosis fetalis?

Answer: Examples of non immunogenic erythroblastosis fetalis are iron deficiency anemia, CMV infection in mother, etc.

Can congenital hemolytic anemia be a cause of non-immunogenic erythroblastosis fetalis?

Answer: Yes.
Though usually, hemolytic anemias don't present till later in life (Mostly because of HbF).
Exceptions would be severe alpha thalassemia in which all 4 alpha chain synthesis is deleted. 4 gamma chains combine, leading to the formation of HbH (Bart's hemoglobin!) They die in utero due to severe hypoxia and hydrops.

Study group discussion: Drugs used in the treatment of Alzheimers disease

Can anyone help me with pharmacological classification of anti Alzheimer's agents?

For Alzheimers, cholinesterase inhibitors.. And a drug called memantine.

NMDA receptor antagonists.

Drugs: Tacrine (tetrahydroaminoacridine), donepezil, rivastigmine and galantamine.
Mechanism: Inhibition of cholinesterase, with a resulting increase in cerebral levels of acetylcholine.

Antioxidants, selegiline, tocopherol (vitamin E), estrogen replacement in females, Ginkgo Biloba extracts are other drugs which may benefit in Alzheimers disease.

Study group discussion: Eponymous terms in hernia and mnemonics

Here's a list of eponymous hernia terms I was sent. I added a few mnemonics to where I could. Others you'll have to memorize!

Gibbon's hernia- Hernia with hydrocoele

Berger's hernia - Hernia in Pouch of Douglas
Mnemonic: Burgers are made of dough.

Grynfelt's hernia - Upper lumbar triangle hernia.

Petit's hernia - Lower lumbar triangle hernia

Cloquet's hernia- Hernia through pectineal fascia
Mnemonic: The hernia is cloaked, peccantly.

Narath's hernia - Behind femoral artery

Hesselbach's hernia - Lateral to femoral artery
Mnemonic: hesseLBAch - Lateral to big artery.

Serofini's hernia - Behind femoral vessels
Mnemonic: SeroFini - Supported by femoral vessels.

Laugier's hernia - Through lacunar ligament
L for Laugier's, L for Lacunar

Tealse's hernia - In front of femoral vessels

Richter's hernia - Part of circumference of bowel wall is gangrenous
Mnemonic: Richie rich has a large circumference pocket of money.
Alternatively, riChter Circumference.

Littre's hernia - Hernia with Meckels's Diverticulum
Mnemonic: Meckels is a congenital defect, found in Little babies.

Sliding hernia - Posterior wall of sac is formed by colon or bladder

Maydl's hernia - 'w' hernia
Mnemonic: M upside down is W.
Phantom hernia - Localised muscle buldge following muscular paralysis
Mnemonic: Phantom for Phantom, P for Paralysis

Spigelian hernia - Through spegelian fascia

Obturator hernia - Through obturator foramen

Femoral hernia - Hernia medial to femoral vein

Beclard's hernia - Femoral hernia through saphenous opening

Study group discussion: Biliverdin

Why biliverdin is reduced to bilirubin? It isn't toxic, it is water soluble.. Then why convert it to bilirubin?

According to some, biliverdin works just fine. Mammals have evolved the energetically expensive, potentially harmful and apparently unnecessary capacity to reduce biliverdin.

According to others, the conversion is not a wasteful process. Bilirubin is a cytoprotectant and that's why biliverdin is converted into bilirubin. It's also a physiological anti oxidant!

Source: http://m.pnas.org/content/99/25/16093.full

About me!

Hello there awesomites! Feels great to write this for Medicowesome :-)

Where to start? Well, I am a total  astrophysics geek. Anything -spacetime,dark energy, black holes, wormholes catches my fancy.That type of guy who loves staring at the starry sky. Just finds amazing how the tiny word 'universe' encompasses the massive expanse lying out there. Loves going to the point where physics meets philosophy.

Likes looking into nothing, thinking and imagining.

House MD fan. Sherlocked.
Christopher Nolan worshipper. Interstellar fanatic.

I have a thing for rare, fancy medical syndromes! Dreams include running a diagnostics department like House. :-p

Talking of music,a Linkin Park fan, like the regular Bollywood music too.

Proud of India and its rich heritage.

Hobbies include driving cars, riding bikes and even bicycling. Gaming included.

Finally, an animal lover,dreamer and a bit of foodie..

-Sushrut



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Heme synthesis mnemonic

Hey everyone! Long time no see!

Today we'll be learning about heme synthesis.

The biosynthesis of heme mnemonic 

Study group discussion: Temporal arteritis

A 60 year old male presents with headache, scalp tenderness, painful temples, pain on chewing & visual disturbances.. Diagnosis?

Answer: Temporal arteritis

What tests you would do to confirm the diagnosis?

Answer: Raised ESR, temporal artery biopsy

Treatment?

Answer: High dose steroids like prednisolone!

Temporal artery branch of?

Answer: ECA, the external carotid artery!

Study group discussion: Causes of edema

Today, we'll be talking about causes of edema.

Causes of Edema can be inflammatory and noninflammatory!

Noninflammatory causes:
1) Increased hydrostatic pressure
2) Hypoproteinaema
3) Lymphatic obstruction
4) Sodium retention

Inflammatory causes:
1) Acute inflammation
2) Chronic inflammation
3) Angiogenesis

Here is a mnemonic shared by an awesomite: HILARI IS SAVE (Hilary)
Heart failure
Iatrogenic
Liver causes
Aldosterone increased/ ADH increased
Renal cause
Inadequate protein in blood (hypoalbuminaemia)

Causes for the inadequate protein in blood are:
Intake Inadequate (Kwashiorkor)
Secretion fro pancreas decreased (pancreatitis)
Synthesis decreased (liver failure)
Absorption decreased (Crohn's disease)
Vomit (pyloric stenosis)
Excretion increased (nephrotic)

I remember this in Conrad Fischer's tone, "Cirrhotic, Nephrotic and CHF. Cirrhotic, Nephrotic and CHF!" though.

That's all!

-IkaN

Study group discussion: Drugs contraindicated in myasthenia gravis

Hey everyone!

Today's topic is about drugs that are contraindicated in myasthenia.

Can you guess them all?

Drug a. Myasthenic woman with eclampsia develops ptosis

Drug b. Patient with hepatitis C develops respiratory depression

Drug c. Filmstar drug

Drug d. Wilson's disease

Answers:
a. MgSO4
b. Interferon
c. Botox
d. Penicillamine

Random fact:
The actor, Amitabh Bachchan has interferon induced myasthenia gravis which was used to cure his hepatitis C infection. And because of that he can't use botox.. Hence, his skin looks so wrinkled compared to other film stars of his age. Hence, two important drugs causing myasthenia and who worsen it are interferon and botox.

More information on study group

Here is some more information, since people have been asking!

How do I join?

Click here!

Can I view the group discussions without being on the group?

Yes! View the Study group index. All topics discussed may or may not be posted on the blog, do to time limitation, of course.

Study group discussion: Evening rise of temperature in tuberculosis and malaria

Why is there an evening rise of body temperature in tuberculosis?

Answer: Because endogenous corticosteroid have their levels low in the evening. Cortisol bursts are least frequent in the evening. And steroids are anti-inflammatory!

Why not in all infections? What's special about tuberculosis?
We don't know the answer to this question. If you do, please tell us!

This answer was submitted to us by an awesomite: Increased Cortisol Cortisone Ratio in Acute Pulmonary Tuberculosis: Recent research works regarding TB has revealed that there is increased cortisol level in TB.
Cortisol & IL-1 interaction: At high level cortisol has negative feedback effect on IL-1.
Conclusion: In TB, cytokines, specifically, IL-1 level is markedly increase that leads to fever, but as cortisol level is also high than normal it counteract the action of IL-1 & as a result fever remains low grade.
Due to exaggerated diurnal variation,cortisol effect is very high in late night while very less in evening onwards that leads to evening rise of temperature & night sweating. Normal diurnal variation of body temperature also play a role to make this change more prominent.
Source: http://www.doctorshangout.com/m/blogpost?id=2002836%3ABlogPost%3A423964

Even malarial paroxysms occur in the evening, don't they?

Answer: Yep. Malarial paroxysms have a different reasons. Steroids ain't responsible.

What's the reason for malarial paroxysms then?

Answer: It depends when the entire cycle of trophozoites burst from RBC's.

Here's from one of the members personal experience:
I have had malaria.. I had paroxysms at late night.

Study group discussion: Smoking and hernia

I have a doubt .. Today in surgery ward, my professor asked me how does smoking directly cause hernia! :/

I know the indirect cause! Coughing!

By weakening collagen?

Does smoking affect collagen synthesis or metabolism? At which step does smoking affect collagen?

It causes less production!
The synthesis of subcutaneous collagen in smokers is specifically impeded, indicating an impaired wound-healing process. Because mature collagen is the main determinator of strength of an operative wound, the results support the view that patients should be advised to stop smoking before an operation.
Source: http://www.ncbi.nlm.nih.gov/pubmed/9551072

In conclusion, smoking is an important risk factor for recurrence of groin hernia, presumably due to an abnormal connective tissue metabolism in smokers.
Source: http://www.ncbi.nlm.nih.gov/pubmed/11910469

Oh....ok. Thanks!

Autonomic system drugs mnemonic

Please give some tips on remembering cholinergic and adrenergic drugs.

- ine are beta agonists
(Terbutaline, ritrodine)

Drugs ending in

-sin are alpha antagonists 

(Prazosin, terazosin)

- olol are beta blockers

(Propanolol, metoprolol)

- alol are alpha + beta blockers (Labetalol)

- stigmine are cholinergic drugs
(Neostigmine, physiostigmine)

Alice in Wonderland syndrome

Came across this interesting syndrome a few days back. Described by Dr. John Todd 1955, it is also known as Todd's syndrome or lilliputian syndrome. The causative factors involved are usually migraines, tumors or hallucinogens. Epstein Barr virus is also thought to be associated with it.

Study group discussion: Structures that pass through the diaphragm mnemonic

When we go to thorax or abdomen... It's hard to remember their relation... Are there any tips?

What sort of relation? The relation of structures that pass through the diaphragm?

Yep.

Ok I know one mnemonic for that.

I ate (8) ten eggs at twelve.

I: Inferior vena cava
aTe: T8!
Eggs: Esophagus (Vagus rhymes with it!)
Ten: T10
AT: Azygous vein, Thoracic duct! Twelve: T12

So to summarize:
IVC - T8
Esophagus, vagus - T10
Azygous, thoracic duct - T12

Hope this helps!

Study group discussion: Purtscher's retinopathy

Does anyone know the name of retinopathy occurring in pancreatitis?

Purtscher's retinopathy!

What are it's characteristics?

Signs visible on fundoscopic examination include
pathognomonic Purtscher flecken and cotton-wool spots around the optic nerve n intraretinal h'age

Yes. The macula is affected too. Granulocyte deposition occurs in the posterior retinal artery.

Study group discussion: Chloroquine and Behcets disease

Antimalarial that causes irreversible retinal toxicity??

Chloroquine?

Yes. It's hydroxychloroquine..!!

Also used in...??

DLE, rheumatoid arthritis!

Lepra reactions too!

Also in extra intestinal amoebiasis!

Skin lesions in dermatomyositis!

Okay, so what pathology in the eye does hydroxychloroquine cause..??

It accumulates there because of high volume of distribution?

It causes Bull's eye maculopathy..!!

And the pathogenesis?

It is said that the drug binds to melanin in the RPE, which could explain the persistent toxicity even if after discontinuation of the medication!!!

I remember the use of hydroxychloroquine (Plaquenil) in Behcet's Disease. Follow up with eye exam every 2-3 months.

What's Behcets disease?

Behcets syndrome is inflammatory, multi system disease of small vessels resulting in frequent aneurysms and rupture..!! Eyes, genitals and mucous membranes are involved.

It takes many months to treat genital ulcers!

What is that test to confirm behcets..??

Pathergy test

Pricking the skin with a needle = pathergy test. After one or two days, people with Behçet's can develop a lump or nodule where the needle broke the skin.

Correct!

I had a patient with several mouth ulcer's looking like Aphthous ulcer. No other symptoms, just episodic mouth ulcers!

Okay.. Could be due to stress and vitamin deficiency..

And it turned out to be Behçet's disease.

They have a lot Behçet's disease clinic's in Turkey! Must be genetic which is why it is so common.

The exact cause of the disease remains unclear. But Behçet's disease is thought to involve an autoimmune response. This means the body's defense mechanism begins to attack its own tissues. Something in the environment may trigger this abnormal immune response in susceptible individuals. Genetic factors may also play a role.

It is common in young men in Mediterranean area..

Our patient was a woman.

Oh nice to know, thanks!

Study group experience #14

Cutaneous signs of insulin resistance and lipoproteinemia

Diabetes 

Electrolyte abnormalities that cause constipation 

Biceps femoris reflex

Scissoring posture 

Aspirin 
Cycloserine 
Morphine and atropine 
Drug for neurological manifestations of Wilson's disease 

ACE in lung diseases 
Central trachea in pleural effusion 
Walking pneumonia 

Aortic regurgitation 
Pressure and volume reservoir in the human body 
HOCM 
Cardiac embryology and fetal heart sounds 
Atrial septal defects - Why do they present late? 

Gallstone ileus
Hepatic encephalopathy 
Kartageners syndrome 
Haemosiderosis and haemochromatosis

Thyroid surgery practicals viva questions 
Venous ulcer 

Pre-eclampsia and HELLP syndrome 
Differentials of discharge in a pregnant woman 

Glycogen storage diseases mnemonic
Cytochrome c 
Agranular cytoplasmic reticulum
Colorful amino acids and pH

Difference between antibody and anti-toxin 

Lymph nodes in various diseases 

Chionablepsia and Anisakiasis

It's been a crazy busy week, especially with group 3 and all, I stay on my toes!

-IkaN

Study group discussion: Haemosiderosis and haemochromatosis

Differences between haemosiderosis and haemochromatosis?

Haemochromatosis is iron overload primary and secondary, iron overload is within cells and interstitium, causes tissue damage. Hemochromatosis is primarily genetic!

Where as haemosiderosis  is a form of secondary hemochromatosis due to repeated blood transfusions, deposition of haemosiderin in the cells, with reversible accumulation of iron in RES. I hope its clear!

So heamochromatosis is irreversible?
The tissue damage, I agree, will have consequences. But you can chelate the excess iron?

Yes! But reversible if in the form of secondary- haemosiderosis

Blood letting! Pts encouraged to donate blood it seems, and iron chelating agents would help.

Those untreated develop HCC
Even cardiomegaly
And endocrine issues.. Especially, pituitary and the adrenals

Yeah I think they continuously need to get their iron chelated

So it can be counted as reversible then?

Not reversible..But manageable.

Yes that's a good term actually

Controllable I would say!

Heart failure cells are macrophages laden with haemosiderin in LVF OR pulmonary odema.

Was an episode in house MD. The girl was suspected to have it cause her skin tone had changed several tones darker.

There was this one more episode where they diagnosed Wilson's disease based on the colour change of nailbed on rubbing it with nail remover! I so want to try that.

Really ?

The blood copper level wasn't raised.. No kf rings in cornea.
The lady was a mean woman.. She couldn't feel emotions.. Was manipulative. And the change in personality happened when she was a teenager.

Interesting!

They applied nail remover and behold.. The  nail turned blue.
I had a suspected case of Wilson's disease in my college.. She took discharge before I could experiment this.

There is even one more episode on Wilson's in season 1. They diagnose it by observing KF ring over the cornea.
Also, an another episode on Hemochromatosis with a mean chess playing lad.

Yup.. I remember both the episodes! The alcoholic mom with schizophrenia had Wilson's. And the jerk xD

Yeah! Actually, she did not have schizophrenia. They were the manifestations of Wilson's itself.

It was pretty cool how House figures that self sacrifice isn't a symptom of Schizophrenia

Yeah! I love the way House has epiphanies leading to diagnoses.

Study group discussion: Haemosiderosis and haemochromatosis

Differences between haemosiderosis and haemochromatosis?

Haemochromatosis is iron overload primary and secondary, iron overload is within cells and interstitium, causes tissue damage. Hemochromatosis is primarily genetic!

Where as haemosiderosis  is a form of secondary hemochromatosis due to repeated blood transfusions, deposition of haemosiderin in the cells, with reversible accumulation of iron in RES. I hope its clear!

So heamochromatosis is irreversible?
The tissue damage, I agree, will have consequences. But you can chelate the excess iron?

Yes! But reversible if in the form of secondary- haemosiderosis

Blood letting! Pts encouraged to donate blood it seems, and iron chelating agents would help.

Those untreated develop HCC
Even cardiomegaly
And endocrine issues.. Especially, pituitary and the adrenals

Yeah I think they continuously need to get their iron chelated

So it can be counted as reversible then?

Not reversible..But manageable.

Yes that's a good term actually

Controllable I would say!

Heart failure cells are macrophages laden with haemosiderin in LVF OR pulmonary odema.

Was an episode in house MD. The girl was suspected to have it cause her skin tone had changed several tones darker.

There was this one more episode where they diagnosed Wilson's disease based on the colour change of nailbed on rubbing it with nail remover! I so want to try that.

Really ?

The blood copper level wasn't raised.. No kf rings in cornea.
The lady was a mean woman.. She couldn't feel emotions.. Was manipulative. And the change in personality happened when she was a teenager.

Interesting!

They applied nail remover and behold.. The  nail turned blue.
I had a suspected case of Wilson's disease in my college.. She took discharge before I could experiment this.

There is even one more episode on Wilson's in season 1. They diagnose it by observing KF ring over the cornea.
Also, an another episode on Hemochromatosis with a mean chess playing lad.

Yup.. I remember both the episodes! The alcoholic mom with schizophrenia had Wilson's. And the jerk xD

Yeah! Actually, she did not have schizophrenia. They were the manifestations of Wilson's itself.

It was pretty cool how House figures that self sacrifice isn't a symptom of Schizophrenia

Yeah! I love the way House has epiphanies leading to diagnoses.

Study group discussion: Haemosiderosis and haemochromatosis

Differences between haemosiderosis and haemochromatosis?

Haemochromatosis is iron overload primary and secondary, iron overload is within cells and interstitium, causes tissue damage. Hemochromatosis is primarily genetic!

Where as haemosiderosis  is a form of secondary hemochromatosis due to repeated blood transfusions, deposition of haemosiderin in the cells, with reversible accumulation of iron in RES. I hope its clear!

So heamochromatosis is irreversible?
The tissue damage, I agree, will have consequences. But you can chelate the excess iron?

Yes! But reversible if in the form of secondary- haemosiderosis

Blood letting! Pts encouraged to donate blood it seems, and iron chelating agents would help.

Those untreated develop HCC
Even cardiomegaly
And endocrine issues.. Especially, pituitary and the adrenals

Yeah I think they continuously need to get their iron chelated

So it can be counted as reversible then?

Not reversible..But manageable.

Yes that's a good term actually

Controllable I would say!

Heart failure cells are macrophages laden with haemosiderin in LVF OR pulmonary odema.

Was an episode in house MD. The girl was suspected to have it cause her skin tone had changed several tones darker.

There was this one more episode where they diagnosed Wilson's disease based on the colour change of nailbed on rubbing it with nail remover! I so want to try that.

Really ?

The blood copper level wasn't raised.. No kf rings in cornea.
The lady was a mean woman.. She couldn't feel emotions.. Was manipulative. And the change in personality happened when she was a teenager.

Interesting!

They applied nail remover and behold.. The  nail turned blue.
I had a suspected case of Wilson's disease in my college.. She took discharge before I could experiment this.

There is even one more episode on Wilson's in season 1. They diagnose it by observing KF ring over the cornea.
Also, an another episode on Hemochromatosis with a mean chess playing lad.

Yup.. I remember both the episodes! The alcoholic mom with schizophrenia had Wilson's. And the jerk xD

Yeah! Actually, she did not have schizophrenia. They were the manifestations of Wilson's itself.

It was pretty cool how House figures that self sacrifice isn't a symptom of Schizophrenia

Yeah! I love the way House has epiphanies leading to diagnoses.

Study group discussion: Hepatic encephalopathy

In liver failure, what is the cause of hepatic encephalopathy?

They are not sure yet but they think it's ammonia.

Yes, NH3 and other substances.

They act as pseudotransmitters.

But how do ammonia levels rise?

Liver detoxifies ammonia by forming urea.. Failure to convert ammonia into urea.

Since liver is damaged.. Ammonia rises.

Does it occur on inhaling ammonia?

You mean, inhaling ammonia when liver is damaged or in normal people? Ammonia is an irritant to the 5th nerve, if I am not wrong. Why would anyone inhale it for a long time?

If by an accident?

Umm. I haven't heard of a situation like that

We inhale ammonia everytime we pass an unclean public toilet! :P

Argh.

Hahaha!

Study group discussion: Walking pneumonia

What is walking pneumonia?

Walking pneumonia is generally atypical pneumonia. It's called walking because even though you feel sick, you are not sick enough and you're walking around unlike the usual can't-get-out-of-bed pneumonia patients.

These patients have an interstitial inflammation that does not cause a consolidation like that of typical pneumonia.

Common causes include Mycoplasma pneumoniae and Chlamydia pneumoniae.