Tuesday, November 22, 2016
Carbohydrate Loading
Energy for Muscle Contraction
Let us start by subdividing muscle fibers into two types: Type I (Slow twitch, Oxidative) and Type II (Fast twitch, Glycolytic).
Monday, November 21, 2016
Role of Glucocorticoids in Developmental events
Glucocorticoids in the fetus are either of maternal origin or syntheiszed from placental progesterone in the fetal adrenal cortex(which lacks zona reticularis). Glucocorticoids are essential for a lot of developmental events, but three of them are most important which goes as follows.
Sunday, November 20, 2016
Erythropoietin therapy
Here are some important things you should know about erythropoietin therapy.
It is used in patients on dialysis.
Resistance to erythropoietin is most commonly due to iron deficiency.
Adverse effects are associated with rapid rise in hematocrit and hemoglobin - Hypertension, Thrombosis.
Other side effects are: Headache, flu like symptoms, red cell aplasia.
Did you know?
Erythropoietin was the first human hematopoietic growth factor to be isolated.
Erythropoietin was originally purified from urine of patients with severe anemia.
It is banned by the International Olympics Committee.
That's all!
-IkaN
Saturday, November 19, 2016
Gap Junctions and Connexin Mutations
Let's start with a brief description of Gap Junctions. Take two empty cardboard boxes, assume they are cells. Bore a hole in each one of them and then enter a small straw in it. Then arrange the two boxes(cells) in such a way that the two straws are aligned perfectly with each other and that their cavities form a continuous column, so that if you pour water in one box it should completely go into the other one without even a single drop falling in between them.
Friday, November 18, 2016
Causes of priapism
Hello lovely medical students!
Priapism is persistent, painful erection that develops without sexual simulation.
Here are a few causes of priapism:
Prazosin
(Mnemonic: PRazosin causes PRiapism)
Trazodone
(Mnemonic: Trazodone causes a boner - TrazoBone)
Perineal or genital trauma
Neurogenic lesions
Sickle cell disease and leukemia
Always check medications first, since it is often drug induced.
That's all!
-IkaN
Nephrotoxic antimicrobials
Hello! In this post, I'll be talking about nephrotoxic antimicrobials.
Let's start with Aminoglycosides!
Aminoglycoside toxicity manifests in the form of tubular necrosis.
Did you know AKI due to Aminoglycosides manifest 5-7 days after therapy even after the drug has been discontinued? :O
Aminoglycosides accumulate in the renal cortex and cause non oliguric AKI. Hypomagnesemia is a common finding.
Amphotericin B also causes tubular necrosis. It binds to tubular membrane cholesterol and introduces pores. Clinical findings include polyuria, hypomagnesemia, hypocalcemia and NAGMA.
Mnemonic for nephrotoxic drugs: Drugs with A!
Aminoglycosides
Amphotericin B
Antivirals like acyclovir, tenofovir, cidofovir, foscarnet, pentamidine.
(Cause tubular toxicity)
Antibiotics like penicillin, cephalosporins, quinolones, sulfonamides, rifampin.
(Cause acute interstitial nephritis)
Remember, in acute interstitial nephritis, WBCs, WBC casts and urine eosinophils will be seen. However, in AKI, the urine sediment will show granular casts.
That's all!
The predominant feeling I have is that if gratitude (=
-IkaN
Thursday, November 17, 2016
Pathophysiology of Absence Seizures
Currently, the best understood of the primary generalized seizures is the Absence Seizure(also called Petit Mal seizure).
To understand the pathophysiology of absence seizures, we first have to be acquainted with the physiology of slow-wave(Stage 3) sleep; since they both have similar EEG reading patterns; i.e., the 3-per-second spike-and-wave activity.
In the awake state, the thalamocortical circuits are in "transmission" mode, whereby incoming sensory informations are faithfully transmitted to the cerebral cortex. Whereas in slow-wave sleep, these circuits are in"burst" mode, because of the bursting activity of a unqiue, dendritic T-type Calcium channel in the thalamus which alters the incoming sensory signals in such a way that the output signals to the cortex have an oscillatory firing rate; but no sensory information is transmitted to the cortex. Something similar happens in Absence Seizure.
In absence seizure, there is abnormal, abrupt activation of this T-type calcium channel in the awake state. This has been postulated to be due to hyperpolarizaion of relay cells in thalamus which in turn is due to increased GABAergic input from the reticular nuclei.
Tuesday, November 15, 2016
Pathophysiology of Secondary Generalized Seizures
Monday, November 14, 2016
Radiolucent stones mnemonic and uric acid calculi
Good morning! =)
I was studying about radiolucent kidney stones and thought of sharing what I learnt with you all.
Mnemonic for radiolucent renal calculi: CATIX URL
Cysteine
Adenine (2,8-Dihydroxyadenine)
Triamterene
Indinavir
Uric acid
RadioLucent
Another mnemonic for medication stones: GUEST MIC
Guaifenesin stones (Radiolucent)
Ephedrine stones (Radiolucent)
Sulphonamides stones (Radiolucent)
Triamterene stones (Poorly radiopaque)
Magnesium trisilicate stones (Poorly radiopaque)
Indinavir stones (Radiolucent)
Cephalosporins stones (Radiolucent)
If you are asked to choose the radiolucent one between Orotic acid stones and cysteine stones, choose orotic acid. It is radiolucent, cystine is poorly radioopaque.
Magnesium ammonia phosphate (struvite) and Cystine calculi are less radiodense and are more difficult to visualize. Uric acid, orotic acid, xanthine, triamterene, dihydroxyadenine, and indinavir calculi are radiolucent and might not be seen on a plain radiograph.
(Source.)
Predisposing factors for uric acid stones:
1. Low urinary pH
2. High uric acid excretion
Treatment for uric acid stones:
1. Alkalinization of urine
(Sodium bicarbonate, potassium citrate)
2. Increase fruits, veggies. Decrease animal flesh.
3. XOI - Allopurinol, Febuxostat
Alkalinization of urine mnemonic: ABC.
Alkalinization. Bicarbonate. Citrate.
(Sodium bicarbonate and potassium citrate are used for alkalinization of urine)
That's all!
-IkaN
Study group discussion: Cold agglutinin disease and extravascular hemolysis in liver
We were discussing a MCQ from pathologystudent.
Here's the question:
On a routine physical examination of an elderly male patient with no other medical problems, you note that his earlobes and fingertips are pale and slightly bluish. A CBC shows a hemoglobin of 10.6 g/dL (12 – 16) and an MCV of 88 (80 -100). Numerous red blood cell agglutinates are seen on the blood smear, made by smart technologists in your laboratory. Which of the following statements is true?
1. The antibody bound to the patient’s red blood cells in this disorder is probably IgG
2. Complement is probably bound to the patient’s red cells
3. The spleen is the main site of red cell destruction in this patient
4. 1 and 3
5. 1, 2, and 3
1 is not true. It's cold agglutinin disease. The main antibody is IgM here.
2 is correct since complement is involved.
The main site of destruction is liver macrophages (Kupffer cells). Therefore, 3 is incorrect.
Is there a specific reason for it?
Liver RECs have loads of C3 specific receptors. So most extravascular hemolysis that occurs in cold agglutinin disease is in the liver.
Another common mechanism of hemolysis in cold agglutinin disease is direct complement mediated intravascular hemolysis.
There's C3b on RBC and macrophage has CR3 (Complement receptor 3).
Liver macrophages lack the capacity of spleen to sequester cells. Hence, here the RBC destruction in liver occurs by phagocytosis predominantly.
Thanks, Divya, for explaining this.
Sunday, November 13, 2016
Tourette syndrome mnemonic
Hello!
For those who don't know -
Tourette syndrome is a disorder involving multiple motor and vocal tics, for at least a year, before 18 years of age.
Mnemonic: T for Tourette, T for Tics!
Tourette syndrome is associated with ADHD and OCD.
Mnemonic: TAO!
Tourette - ADHD, OCD.
Treatment - Antipsychotics like tetrabenazine, risperidone, fluphenazine are preferred.
Clonidine and Clonazepam maybe useful.
That's all!
-IkaN
Friday, November 11, 2016
Step 2 CK: CLL notes and staging mnemonic
Hey!
Chronic lymphocytic leukemia is proliferation of normal B lymphocytes that function abnormally.
The WBC count in CLL is > 20,000/flL with 80-98% lymphocytes.
Smudge cells are seen in CLL.
Staging of CLL mnemonic
High LSAT score :D
Stage 0: High WBC
Stage 1: Lymphadenopathy
Stage 2: Splenomegaly + Hepatomegaly
Stage 3: Anemia
Stage 4: Thrombocytopenia
For stage 0 and stage 1, no treatment is required.
Therapy is indicated for patients with advanced stage disease, high tumor burden, severe disease-related "B" symptoms, or repeated infections.
Hepatosplenomegaly, anemia and thrombocytopenia are preferably treated with fludarabine and rituximab (FR).
For refractory cases, cyclophosphamide can be used (FCR regimen)
Older individuals (> 65 years of age) can be treated with ibrutinib, a bruton’s tyrosine kinase (BTK) inhibitor (preferred) or chlorambucil plus anti-CD20 monoclonal antibodies.
Autoimmune hemolysis or thrombocytopenia is treated with prednisone (Autoimmune warm IgG antibodies)
CLL has a good prognosis compared to other leukemias. Most common cause of death is due to infection.
That's all!
-IkaN
Tuesday, November 8, 2016
Bulbar and pseudobulbar palsy mnemonic
Hello! This is a mini post on bulbar and pseudobulbar palsy.
Bulbar palsy is the paralysis of the muscles supplied by the cranial nerves coming out from the bulb also known as the medulla (Cranial nerves 9, 10, 12) and it is lower motor neuron palsy.
Pseudobulbar palsy is paralysis of the same cranial nerves but the upper motor neuron type. Mostly due to lesions in the brain.
Mnemonic: pseUdo has a U for UMN lesion.
That's all!
-IkaN
Monday, November 7, 2016
Cataplesy and cataplexy mnemonic
A case with dyspnea and blurring of vision
Labs showed:
Hemoglobin concentration of 4.0 g/dL
Total white cell count of 25000/cmm
Platelet count of 60000/cmm
Monoclonal gammopathy (M spike) was seen in gamma globulin region, which turned out to be IgM on immunofixation.
Fundus examination revealed venous dilatation, tortuosity and superficial retinal hemorrhages.
Diagnosis? Treatment?
Saturday, November 5, 2016
Tetanus are Anaerobic! Can Oxygen infusion into the wound, heal tetanus?
Thursday, November 3, 2016
Non-Hodgkins lymphoma treatment (CHOP regimen) mnemonic
If you can't remember the drugs used in the CHOP regimen of Non-hodgkin's lymhoma, I have a mnemonic for you.
Hodgkins lymphoma treatment (ABVD regimen) mnemonic
If you can't remember the drugs used in the ABVD regimen of Hodgkin's lymhoma, I have a mnemonic for you.