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. 

Study group discussion: Venous ulcer

*a picture of an ulcer was posted on which this discussion took place in the group*

Which side is the lesion on? Medial or lateral?

If it is medial, it can be venous ulceration too! Mass obstructing the venous outflow.

Yup could be as it is superficial.. And also it could be venous ulcer because it looks like the ulcer is in gaiters area..above the medial malleolus..

What is gaiters area?

Gaiters area is where venous ulcers are usually seen. Above medial malleolus!

Where there is highest preasure in vein due to gravitational pull! And incompetent valve also in varicose vein

What's the name of the perforator in that area?

They are cockett boyd dodd and hunter from below upwards.

I have a mnemonic for the perforators

Do share!

http://medicowesome.blogspot.ae/2014/09/types-of-perforators-of-lower-limb.html

Study group discussion: Kartageners syndrome

What is Kartagener syndrome?

Immotile cilia syndrome

May result in Situs inversus
Bronchiectasis
Sinusitis

Glue ear too!

Infertiliy? Sperm motility is also affected i guess

Sperm motility is affected.
The protein involved is 'dynein'.

I've seen a case of Kartageners in my hospital. The auscultation and looking at radiographs was fascinating!

Study group discussion: Gallstone ileus

*a picture of gall stone ileus was posted in the group as guess the diagnosis after which this discussion took place*

Commonest position of obstruction by gallstone in ileum

Ileocaecal junction?

Not ileocaecal valve. The position in books have been mentioned terminal ileum. A little proximal to the ileocaecal valve.

Most commonly, obstruction occurs at the distal ileum.

I didn't know gallstone ileus could be this big. I imagined them to be tiny!

Me too!

I've heard there has to be a fistula for the stone to be that big to obstruct the ileum. Something that connects the gall bladder to the intestine.. Because a stone this big wouldn't pass the common bile duct

I agree with IkaN

Yup I'm sure the patient suffered from a fistula too..

It enters the intestine through cholecystoduodenal fistula commonly..

I've heard my resident mention fistula once

Yep.. And the predisposed patients are those with Crohn's disease! Thanks, just wanted to confirm it :D

Large stones, >2.5 cm in diameter, are thought to predispose to fistula formation by gradual erosion through the gallbladder fundus...

Ohh that makes sense! The huge stone itself causes fistula formation which is why they are common!

"A fistula develops between a gangrenous gallbladder and the duodenum or other parts of the gastrointestinal tract, allowing passage of the stone. Occasionally the stone may enter the intestine through a fistulous communication between the bile duct and the gastrointestinal tract."

Study group discussion: Colorful amino acids and pH

Colorful aminoacids?

Donno. Maybe tyrosine because they add pigment?

Trytophan phenylalanine tyrosine. Tryptophan is major!

They add color to us! Makes sense. At first, I have to admit, I was imagining colors of the rainbow xD

Yeah and remaining are colorless!

At physiological pH what is the charge of amino group and Carboxyl group?

Positive amino negative carboxyl
PANCard

That's a good mnemonic! Will never forget this!

I just remember histidine is the one who is neutral at physiological pH.

Name the positively charged amino acids!

Basic are positively charged I guess. Histidine lysine arginine.

Mnemonic! http://medicowesome.blogspot.ae/2013/11/amino-acids-with-electrically-charged.html

IkaN mnemonic wow <3
Lady gaga is always negative hahaha!

Study group discussion: Cytochrome c

What is moonlight effect of cytochrome c?

Sounds interesting!

Cytochrome c in cytosol cause cell death by apoptosis. Cytochrome c in mitochondria helps in electron transport. This dual function!

Ooo.. Yes, the life maintainer and the killer! Why moonlight though?

Moon light means a job on the side, one that you wouldn't wanna disclose.
I have a question, what is the differences between cytochrome c1 and cytochrome c?

I think cyt c is mobile and the other is not.

Yep.

Study group discussion: Agranular cytoplasmic reticulum

What are the functions of agranular cytoplasmic reticulum?

Synthesise lipids, transportation of proteins,enzymes for detoxification of drugs,enzymes of glycolysis.