How Angiotensin Converting Enzyme (ACE) Inhibitors cause increase in bradykinin

• Angiotensin Converting Enzyme (ACE) degrades bradykinin, not only converting angiotensin I to angiotensin II
• So, when ACE inhibitors present, bradykinin is not broken down
• There will be high level of bradykinin
• Causing side effect such as chronic dry cough

Diabetes type I (insulin dependent), beta-blockers and hypoglycemia

• Diabetes type I patients could not produce enough insulin due to destruction of beta-cells in Pancrease that produce insulin.
• These patients will get hyperglycemia (high blood glucose) if they do not take insulin.

• So, they will take insulin, to control the level of glucose.
• The level of glucose in the blood will decrease by doing that.

• Beta-blockers stimulate release of insulin from the remaining beta-cells.

• When these patients take beta-blockers and insulin at the same time, there will be over dose of insulin (own insulin + artificial insulin)
• Patient will get hypoglycemia (low blood glucose)

• Worse, beta-blockers ‘mask’ the hypoglycemic signs such as tremor and palpitation.
• The unlucky patient and the doctors wouldn’t notice that there is hypoglycemia going on.

• If left untreated, patient will die due to hypoglycemia.

Drugs to cure rheumatoid arthritis

These are some of the drug concepts scientists are using to find the cure for rheumatoid arthritis. I wish them all the best to find the cure!

TNF-alpha inhibitors
Tumor necrosis factor-alpha causes inflammation. By blocking the the protein, it will reduce and control the inflammation.

Interleukin-6 (IL-6) inhibitor
This protein causes inflammation with TNF-alpha, though it isn't clear how.

Interleukin-15 (IL-15) inhibitor
This protein activates inflammatory processes in the lining that surrounds your joints (synovium). People with rheumatoid arthritis have high levels of IL-15

Drugs that stop B cells from causing inflammation
B cells cause joint inflammation in people with rheumatoid arthritis

Differences between Crohn’s Disease with Ulcerative Colitis

Crohn’s disease:

• affecting colon and ileum
• affecting mucosa, submucosa and muscularis
• skip lesion distribution
• deep linear ulcers
• granulomas present (50%)
• fistula present
• there are fat and vitamins malabsorption
• responses to surgery is poor

Ulcerative colitis

• affecting colon
• affecting mucosa and submucosa
• diffuse distribution
• superficial ulcers
• no granuloma
• no fistula
• no fat and vitamins malabsorption
• response to surgery is good

Bowel sound and mechanical bowel obstruction

• Mechanical bowel obstruction causes proximal part to the obstructed area to distend.
• This compromises blood flow
• Causing venous obstruction
• Which leads to shortage of arterial supply
• Ischemia happens and leads to infarct
• Infarction means no peristalsis
• No peristalsis, no bowel sound

Smoking and peptic ulcer

Smoking impairs blood flow to mucosa. Impairs healing process. Leads to or worsen the ulcer.

Pathophysiology of colicky pain

• obstruction / blockage of a tube
• increase in peristalsis in order to remove the cause of ibstruction
• leads to vigorous muscular contraction
• cause ischemia
• lactic acid accumulation and spasm
• irritate nerve endings
• pain

Hepatorenal syndrome (HRS)

Definitions

Renal failure
- situation in which the kidneys fail to function adequately

Hepatorenal syndrome
- acute renal failure
- that occurs in the setting of cirrhosis or fulminant liver failure
- sometimes also associated with portal hypertension
- usually in the absence of other disease of the kidney

Pathophysiology

2 Theories

1.

• cirrhosis or fulminant liver failure
• cause portal hypertension
• renal perfusion is maintained by vasodilatory systems
• as liver disease progresses in severity, renal vasodilatory systems are unable to counteract the maximal activation of the endogenous vasoconstrictors and/or intrarenal vasoconstrictors
• leads to uncontrolled renal vasoconstriction.

2.
- unrelated to systemic hemodynamics but is due to either a

• deficiency in the synthesis of a vasodilatory factor OR
• hepatorenal reflex that leads to renal vasoconstriction.

Coombs’ test

What is this test for?
Looks for antibodies that act against your red blood cells.

Types
Direct antiglobulin test; Indirect antiglobulin test

Direct Coombs test

The Concept

• IgG antibodies that specifically bind to antigens on the red blood cell (RBC) surface membrane
• Red blood cells (RBCs) become coated with IgG alloantibodies (an antibody that occurs naturally against foreign tissues from a person of the same species) and/or IgG autoantibodies (An antibody that reacts with the cells, tissues, or native proteins of the individual in which it is produced)
• Complement proteins may subsequently bind to the bound antibodies

So,
- Coombs test is used to detect these antibodies or complement protein
- Red blood cells are taken
- Coombs reagent (antihuman globulin) incubated with the red blood cells
- if there are antibodies or complement proteins bound to red blood cells, agglutination occurs

Indirect Coombs test
- Used in pregnant women, and to test blood in blood tranfusion
- Detects antibodies which are not bound to red blood cells of patients
- If agglutination occurs, the indirect Coombs test is positive.
- rarely used to diagnose a medical condition


Examples

Alloimmune hemolysis

o Rhesus hemolytic diseases of the newborn
o Systemic lupus erythematosus
o Evans' syndrome (antiplatelet antibodies and hemolytic antibodies)
o Etc

Drug-induced immune-mediated hemolysis

o Methyldopa (IgG mediated type II hypersensitivity)
o Penicillin (high dose)
o Quinidine
o Etc

Antistreptolysin O titer (ASOT)

• Group A streptococci produce the enzyme streptolysin O, which can destroy red blood cells.
• Body reacts by producing antistreptolysin O to neutralize it.
• A high titer indicates there isor has been a streptococcal infection or has been present.
• ASO appears in the blood serum one week to one month after the onset of a strep infection.
• Normal value : < 200 Todd units
  

Titer : standard of strength of a volumetric test solution; the assay value of an unknown measure by volumetric means

Jones criteria for Rheumatic Fever (mnemonics included)

Major criteria

Joints : polyarthritis
O : heart-shaped O due to carditis
Nodules : subcutaneous nodules
Erythema marginatum
Sydenham's chorea (St. Vitus' dance)

OR

C : Carditis
A : Arthritis, poly
N : Nodules, subcutaneous
C : Chorea, Sydenham's
ER : ERythema Marginatum

Minor Criteria

- Fever
- Arthralgia (joint pain without swelling)
- Laboratory abnormalities:

increased Erythrocyte sedimentation rate,

increased C reactive protein,

leukocytosis

- prolonged PR interval
- elevated or rising Antistreptolysin O titre, or DNAase (evidence of Group A Strep infection)
- previous rheumatic fever or inactive heart disease

Don't get confused with rheumatic fever with rheumatic heart disease

Rheumatic fever
inflammatory disease
which may develop after a Group A streptococcal infection

Rheumatic heart disease
disease of the heart resulting from rheumatic fever

Acute VS Chronic Heart Failure Presentations

Acute heart failure

• severe dyspnoea
• orthopnea
• fronthy pinkish sputum (pulmonary oedema)
• hypotension
• pallor
• cyanosis

Chronic heart failure

• reduce exercise tolerance
• fatique
• exertional dyspnoea
• peripheral oedema
• JVP distension
• hepatomegaly
• serous effusion

Is reperfusion after myocardial infarction beneficial to all patients?

Myocardial reperfusion may not benefit all patients and may actually be harmful to some. Components of reperfusion injury may occur not only in isolation but also in combination--when more profound consequences might be expected. The exact mechanisms of reperfusion injury are uncertain, but they probably include cellular overload of calcium, osmotic cell swelling, and myocyte or microvascular damage from cytotoxic free radicals derived from oxygen

http://www.bmj.com/cgi/content/full/310/6978/477

Although reperfusion is essential for salvage of the ischemic heart, reperfusion beyond a certain period of ischemia may cause injury to the myocardium. Dramatic changes in contractile function, arrhythmias, and ultrastructure occur in the ischemic-reperfused heart as a consequence of the generation of oxyradicals, loss of cation homeostasis, depletion of energy stores, and changes in subcellular activities. These acute effects of reperfusion appear to be the result of the occurrence of oxidative stress and intracellular Calcium overload in the heart. Alterations in cardiac gene expression may account for delayed recovery of subcellular organelles in the ischemic myocardium.

http://www.heartandmetabolism.org/pdf/37/8.pdf

Necrotizing arteriolitis and malignant hypertension

necrotizing arteriolitis
- necrosis in the media of arterioles
- characteristic of malignant hypertension

malignant hypertension
- a complication of hypertension
- characterized by

• very elevated blood pressure (usually greater than 220/120)
• organ damage in the eyes, brain, lung and/or kidneys

MacConkey agar / McConkey agar concept

What is this for?
designed to grow Gram-negative bacteria and stain them for lactose fermentation.
distinguishes those Gram-negative bacteria that can ferment the sugar lactose from those that cannot

Contents
It contains :

• bile salts and crystal violet dye to inhibit most Gram-positive bacteria
• neutral red dye to stains microbes fermenting lactose
• lactose and peptone.

The concept :

• bacteria that can ferment sugar lactose will produce acid
• lowers the pH
• appearance of red/pink colonies.

• bacteria that cannot ferment sugar lactose will use peptone
• producing ammonia
• raise pH
• appearance of white / colourless colonies

Macconkey agar with lactose (left) and non-lactose (right) fermenters

Why do we use Ziehl-Neelsen stain, not gram stain for mycobacterium tuberculosis?

Ziehl-Neelsen stain, also known as the acid-fast stain, is a special bacteriological stain used to identify acid-fast organisms, mainly Mycobacteria. Acid fast bacteria are stained bright red and other organism and background will be blue. Acid-fast bacteria are bacteria that resistance to decolorization by acids during staining procedures.

Why do we use Ziehl-Neelsen stain, not gram stain?
Acid fast bacteria cell walls contain peptidoglycan but they have a waxy coat on their cell wall too. Gram stain (crystal violet nor the counterstain (safranin)) can not penetrate the waxy layer. Therefore they will not be visible able to see under the microscrope.

Per-rectal examination and prostate enlargement characteristics

Benign (nonmalignant character of a neoplasm) enlargment
- smooth and firm

Prostatic carcinoma
- hard and irregular

Colorectal cancer / colon cancer / large bowel cancer staging systems

Normally used
o Dukes system
o TNM system
o AJCC stage groupings (not covered here)


TNM Classification of Malignant Tumours (TNM)

Common tumors have their own TNM classification.
Not all tumors have TNM classifications, e.g., brain tumors.

Mandatory parameters ('T', 'N', and 'M')

* T : size or direct extent of the primary tumor
o T0 - no evidence of tumor
o Tis- cancer in situ (tumor present, but no invasion)
o T1 - invasion through submucosa into lamina propria (basement membrane invaded)
o T2 - invasion into the muscularis propria (i.e. proper muscle of the bowel wall)
o T3 - invasion through the subserosa
o T4 - invasion of surrounding structures (e.g. bladder) or with tumour cells on the free external surface of the bowel

* N : degree of spread to regional lymph nodes
o N0: tumor cells absent from regional lymph nodes
o N1: tumor cells spread to closest or small number of regional lymph nodes
o N2: tumor cells spread to an extent between N1 and N3.
o N3: tumor cells spread to most distant or numerous regional lymph nodes

* M : presence of metastasis
o M0: no distant metastasis
o M1: metastasis to distant organs (beyond regional lymph nodes)

If a parameter is not accessed, an 'x' will be used.

Other parameters

* G (1-4): the grade of the cancer cells (i.e. they are "low grade" if they appear similar to normal cells, and "high grade" if they appear poorly differentiated)
* R (0/1/2): the completeness of the operation (resection-boundaries free of cancer cells or not)
* L (0/1): invasion into lymphatic vessels
* V (0/1): invasion into vein
* C (1-4): a modifier of the certainty (quality) of the last mentioned parameter

further reading : http://en.wikipedia.org/wiki/TNM


Dukes classification
by British pathologist Dr Cuthbert Dukes

o Dukes A: Invasion into but not through the bowel wall

o Dukes B: Invasion through the bowel wall but not involving lymph nodes
* B1 : extend but note penetrating muscularis propria
* B2 : extend and penetrating muscularis propria

o Dukes C: Involvement of lymph nodes
* C2 : extend but note penetrating muscularis propria
* C2 : extend and penetrating muscularis propria

o Dukes D: Widespread metastases

A sign that you are going to have a wet dream tonight

Talking about prostate, I remember this interesting thing but I have not found any scientific findings proving this but yet, it is still good to know.

So what is it? As a women will experience mood swings etc which could alarm her the next period, a man will fell weirdly-tired before or on the night of the wet dream.

I wrote weirdly tired because a man will get puzzled to find out the causes of this tired feeling, if he did not do any different physical activities than he normally does that day.

This tired feeling will cause him to go bed earlier (if he can).

So if you (men only) feel weirdly tired and try to think the causes, don't forget to include this as one of the causes.

Why our prostates enlarge?

Actually, the reason why prostate enlarges is still a mystery. Several hypothesis were made.

Normal growth process
The prostate gland is highly unusual because it undergoes an increase in size at several stages during most of a man's life. It grows at before or at birth, early and during puberty, mid-20s and in 50s (urinary problems usually occur here). When a man is in his 70s, the prostate gland has reached a maximum weight.

Abnormally high level of dihydrotestosterone (DHT)
DHT, biologically active metabolite of the hormone testosterone promotes prostate cells growth.

Warts what?

What is wart?

• a small, rough tumor
• caused by a viral infection, specifically by the human papillomavirus (HPV)
• contagious when in contact with the skin of an infected person
• typically disappear after a few months but can last for years and can recur
• also known as verruca

Types of wart

1. Common wart (Verruca vulgaris),

• a raised wart with roughened surface

2. Flat wart

• a small
• smooth flattened wart
• tan or flesh coloured
• which can occur in large numbers

3. Filiform or digitate wart

• a thread- or finger-like wart
• most common on the face
• especially near the eyelids and lips

4. Plantar wart

• a hard sometimes painful lump
• often with multiple black specks in the center
• usually only found on pressure points on the soles of the feet

5. Mosaic wart

• a group of tightly clustered plantar-type warts
• commonly on the hands or soles of the feet

6. Genital wart

• a wart that occurs on the genitalia

Ketuat in Medical

Ketuat = wart

Some causes of sudden pallor

• Fainting / Syncope (temporary loss of consciousness due to a sudden decline in blood flow to the brain)
• Shock (Severe condition from reduced blood circulation)
• Motion sickness (condition in which a disagreement exists between visually perceived movement and the vestibular system's sense of movement causing nausea)
• Heart attack
• Arrhythmia
• Hypoglycemic attack
• Severe gastroenteritis (severe inflammation of the gastrointestinal tract)
• Stomach upset
• Acute blood disorder
• Leukemia (cancer of the blood cells, usually white blood cells)
• Clotting disorder

Functions of Prostaglandin

• cause constriction or dilation in vascular smooth muscle cells
• cause aggregation or disaggregation of platelets
• sensitize spinal neurons to pain
• decrease intraocular pressure
• regulate inflammatory mediation
• regulate calcium movement
• control hormone regulation
• control cell growth

NSAIDs and Cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2) inhibitions

Aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) inhibit cyclooxygenase to inhibit prostaglandin synthesis.

Cyclooxygenase-1 inhibition
- reduce platelet aggregation
- unwanted effects mainly on gastrointestinal and kidney
- associated with gastrointestinal toxicity

Cyclooxygenase-2 inhibition
- anti-inflammatory, analgesic and antipyretic effects

• Thus, using NSAIDs with specific Cyclooxygenase-2 inhibition will decrease gastrointestinal irritation.
• But it is better to avoid the usage of NSAIDs (if possible).

Colicky pain, biliary colic and renal colic

Colicky pain

• any pain that comes in waves
• usually for organs with lumens and have peristaltic movement

Biliary colic*

• right upper quadrant pain, right flank pain, or even mid chest pain with cholelithiasis
• pain is steady, starts rapidly and lasts at least 30 minutes
• associated with irritation of the viscera secondary.

Renal colic*

• pain commonly caused by kidney stones.
• radiates through the flank until it reaches the bladder
• remain constant

*are not colicky pain, different things

Signs and symptoms of hypercalcaemia

• fatigue
• depression
• confusion
• anorexia
• nausea
• vomiting

• constipation
• pancreatitis
• increased urination

Causes of mucous in stool

Abdominal Cancer

Andrade's syndrome
- a hereditary form of amyloidosis with accumulation of amyloid in organs and tissues of the body

Bowel Obstruction

Colitis
- a chronic digestive disease characterized by inflammation of the colon
- auto-immune affecting the tissue that lines the gastrointestinal system.
- classed as an inflammatory bowel disease (IBD)

Cystic Fibrosis
- a hereditary disease affecting the exocrine (mucus) glands of the lungs, liver, pancreas, and intestines

Dysentery
- an infection of the digestive system that results in severe diarrhea containing mucus and blood in the feces

Shigellosis
- known as bacillary dysentery

Hemorrhagic proctocolitis
- inflammation of the rectum and colon

Irritable bowel syndrome
- a functional bowel disorder characterized by mild to severe abdominal pain, discomfort, bloating and alteration of bowel habits
- caused by psychosomatic illness, immune reaction, active infections
- not to be confused with inflammatory bowel disease.

Pelvic abscess
- caused by infections, appendicitis, diverticulitis etc
- commonly follows acute appendicitis or after gynaecological infections.

Pelvic lipomatosis
- a benign overgrowth of adipose tissue with a small amount of inflammatory and fibrotic component

Proctitis
- inflammation of the anus and the lining of the rectum

Pseudomembranous Colitis
- infection of the colon

Cyclooxygenase / COX enzyme / prostaglandin synthase / rostaglandin synthetase

• an enzyme for formation prostanoids (including prostaglandins, prostacyclin and thromboxane).

• prostanoids; most are pro-inflammatory
• but prostaglandins have a protective role in preventing acid-insult to the mucosa (COX converts arachidonic acid to prostaglandin H2)

• The two major isoenzyme are COX-1 and COX-2
• Different tissues express varying levels of COX-1 and COX-2

• inhibition of COX can provide relief from the symptoms of inflammation and pain but since it also inhibits prostaglandin, it can causes gastric ulcer

Dressler's syndrome / postpericardiotomy syndrome / postmyocardial infarction syndrome

Dressler's syndrome is
- secondary form of pericarditis that occurs in the setting of injury to the heart or the pericardium
- a complication that can occur after

• a heart attack
• heart surgery
• pericardium becomes inflamed

- thought to develop as an immune system response following a heart attack or heart surgery reaction to myocardial neo-antigens
- easily treated with medications that reduce inflammation
- repeated episodes of Dressler's syndrome can lead to a condition called constrictive pericarditis

sign and symptoms

• fever
• chest pain
• shortness of breath
• fever

*feels like another heart attack

Keloids

• is an overgrowth of tissue at the site of a healed skin injury
• consisting mainly type I and some type III collagen
• form within scar tissue
• benign, non-contagious

characterized by a

• collection of atypical fibroblasts with excessive deposition of extracellular matrix components
• especially collagen
  

1. type I collagen - the most abundant collagen of the human body. It is present in scar tissue, the end product when tissue heals by repair. It is found in tendons, skin, artery walls, the endomysium of myofibrils, fibrocartilage, and the organic part of bones and teeth.
2. type III collagen - the collagen of granulation tissue, and is produced quickly by young fibroblasts before the tougher type I collagen is synthesized

Types of inflammation at a glance

Granulomatous inflammation
Formation of granulomas (a ball-like collection of immune cells trying to destroy a foreign substance)


Fibrinous inflammation
large increase in vascular permeability allows the blood vessels to pass through fibrin


Purulent inflammation
Inflammation resulting in large amount of pus, which consists of neutrophils, dead cells, and fluid


Serous inflammation
Characterized by the copious effusion of non-viscous serous fluid


Ulcerative inflammation
Necrosis of the tissue from the surface, exposing lower layers

Laxatives at a glance

There are 4 types

Bulk forming agents
- swell when mix with water
- adding bulk in stool
- bran, methylcellulose

Stool softeners
- there are two mechanisms of action

stimulate the gut muscle to contract faster so that there will be less water reabsorbed at large intestine, making stool soft. example, docusate sodium

or lining up the faeces (oil based) so that water could not be absorbed. example, paraffin oil

Stimulants
- three ways of action

stimulate intestinal motility

increase fluid secretion

reduce water absorption

- example : senna, bisacodyl

Osmotic laxatives
- draws water into the colon
- example : lactulose

Painless jaundice and pain jaundice

Jaundice caused by extrahepatic obsctruction due to malignant usuallt painless and progressive.

Jaundice caused by intraluminal obstruction by a gall stone may cause severe pain.

Findings suggesting chronic alcohol ingestion

Raised plasma gamma-glutamyltransferase (GGT) activity
- GGT is liver enzyme
- involved in the secretion and absorption of bile
- marker as an indicator of early liver cell damage or cholestatic disease

macrocytosis
- erythrocytes that are larger than normal

hyperuricaemia
- presence of high levels of uric acid in the blood

hypertriglyceridaemia
- increased hypertriglyceride

*non of these findings is diagnostic of alcoholism

Immunoglobulin G and M and relationship with acute and chronic infections

This is what I learned from my colleague.

Acute or 'just now' infections
- IgM is high
- IgM involved in primary response

IgM structure

Chronic infections
- IgG is high
- IgG predominately involved in the secondary antibody response

IgG structure

Steatorrhea

Steat_orr_hea (for memorizing purpose)

- presence of excess fat in feces
- usually due to :

• reduced or no bile secretion
• bacteria
• Abetalipoproteinemia, or Bassen-Kornzweig syndrome (rare autosomal recessive disorder that interferes with the normal absorption of fat and fat-soluble vitamins from food)
• coeliac disease (an autoimmune disorder of the small intestine)
• inflammatory bowel disease
• short bowel syndrome
• cystic fibrosis (hereditary disease affecting the exocrine (mucus) glands of the lungs, liver, pancreas, and intestines)
• abuse of slimming pills.

Caseating (necrosis) and non-caseating granulomas

Granulomas
- nodular inflammatory lesions
- ball-like collection of immune cells trying to destroy a foreign substance
- containing compactly grouped modified phagocytes
- such as epithelioid cells, giant cells, and other macrophages


Caseating granulomas
- necrosis present
- appears cheese-like to unaided eye (don't expect to see this on microscope)
- typically a feature of the granulomas of tuberculosis
- tend to have infectious causes

Caseating lung due to TB

Caseating granulomas microscopic

Non-caseating granulomas
- necrosis not present
- does not appear cheese-like to unaided eye

Non-caseating granulomas microscopic

Hypersensitivity I, II, III, IV and V

Hypersensitivity definition

• undesirable reactions produced by the normal immune system

Hypersensitivity Type I

• Allergy (immediate)
• IgE

Hypersensitivity Type II

• Cytotoxic, antibody-dependent
• Bind to cell surface components
• and to cell receptors (if you do not use Hypersensitivity Type V classification)
• IgM or IgG
• Complement

Hypersensitivity Type III

• Immune complex disease
• IgG
• Complement

Hypersensitivity Type IV

• Delayed-type hypersensitivity, Cell-mediated immune memory response, antibody-independent
• T-cells

Hypersensitivity Type V

• *Additional, some do not use this classification and combine it with Hypersensitivity Type II
• Cytotoxic, antibody-dependent
• Bind to cell receptors
• IgM or IgG
• Complement

od om on bd tds qid prn acronyms in drug prescriptions

• od : omni die / once a day
• om : omni mane / on morning
• on : on nocte / on night
• bd : bis in die / twice a day
• tds : die sumendus / three times daily
• qid : quater in die / four times per day
• prn : pro re nata / when required

Gay Bowel Syndrome

What is this?

• Gastrointestinal discomfort
• occur with unusual frequency in homosexual patients (not gays only)
• includes abdominal pain, cramps, bloating, flatulence, nausea, vomiting, or diarrhoea
• caused by enteric bacteria, viruses, fungi, zooparasites, or trauma.

The clinical diagnoses in decreasing order of frequency :

• condyloma acuminata : a contagious projecting warty growth on the external genitals or at the anus
• hemorrhoids : a varicose condition of the external hemorrhoidal veins causing painful swellings at the anus
• nonspecific proctitis : inflammation of the mucous membrane of the rectum
• anal fistula (an abnormal passage from one epithelial surface to another epithelial surface)
• perirectal abscess
• anal fissure
• amebiasis : infection with the protozoon Entamoeba histolytica.
• benign polyps (any mass of tissue that bulges or projects outward or upward from the normal surface level)
• viral hepatitis
• gonorrhea : a contagious catarrhal inflammation of the genital mucous membrane, transmitted chiefly by coitus and due to Neisseria gonorrhoeae
• syphilis
• anorectal trauma and foreign bodies
• shigellosis : Bacillary dysentery (a disease marked by frequent watery stools, often with blood and mucus, and characterized clinically by pain, tenesmus, fever, and dehydration.) caused by bacteria of the genus Shigella
• rectal ulcers
• lymphogranuloma venereum : a venereal (relating to or resulting from sexual intercourse) infection usually caused by Chlamydia trachomati

*since not only gays get this syndrome, some are against this term

The systole and diastole (arteries) concepts

- arteries are elastic

- when heart pumps, it generates a strong force and cause bulging of the arteries
- the bulging (coincide with peak of force) is what forms the systolic pressure

- since arteries are elastic, they will come back to their original shapes
- during the process, they will squeeze out the extra blood (bulging creates extra spaces for the blood to fill in) and this process generates a force
- the force is what forms the diastolic pressure

How antacids cause Vitamin B12 deficiency

Normally

- vitamin B12 binds to salivary R-binders first
- it needs acidic condition to separate them

- stomach secretes intrinsic factor
- intrinsic factor binds to vitamin B12, which protects vitamin B12 from being degraded by the enzymes and facilitate vitamin B12 absorption in the ileum

When you have chronic gastritis
- your gastric mucosa already atrophied
- causing decrease in intrinsic factor production and decrease in acid production

When you take antacids
- you further decrease the acidic level
- worsen the vitamin B12 absorption
- causing vitamin B12 deficiency

Sputum / Phlegm Colours and What They Mean

Colourless
- healthy
- initial period of flu

Yellow
- bacterial or virus infection
- immune system is responding

Greenish
- bacterial or virus infection

Brown
- smoking particles

Brownish-grey
- dust, other foreign matter

Carcinoma Associated with the Respiratory System

Bronchiogenic carcinoma
- malignant epithelial tumour arising from mucosa of bronchial airways
- classifications :

• Squamos cell carcinoma : malignant tumor of squamous epithelium (epithelium that shows squamous cell differentiation)
• Adenocarcinoma : cancer that originates in glandular tissue
• Small cell carcinoma : also known as oat cell carcinoma. Characterized by small, oat-shaped malignant cells
• Large cell carcinoma : lung cancer in which the cells are large and look abnormal when viewed under a microscope

Bronchioloalveolar carcinoma
- a carcinoma derived from epithelium of terminal bronchioles


Carcinoid Tumours
- slow-growing but malignant type of neuroendocrine tumour, originating in the cells of the neuroendocrine system.

Pulmonary Vascular Disorders at a Glance

Thromboembolism

• Formation in a blood vessel of a clot (thrombus) that breaks loose and is carried by the blood stream to plug another vessel

Pulmonary Infarct

• localized necrosis of lung tissues, due to obstruction of the arterial blood supply.

Pulmonary Edema

• swelling and /or fluid accumulation in the lungs

Pulmonary Hypertension

• an increase in blood pressure in the pulmonary artery, pulmonary vein, or pulmonary capillaries

Chronic Passive Venous Congestion

• chronic : continuing for a long time
• passive : not active or not acting to influence or change a situation
• venous congestion : overfilling and distention of the veins with blood

Cor Pulmonale

• change in structure and function of the right ventricle (Right ventricular hypertrophy or dilation) of the heart as a result of a respiratory disorder

Raynaud's phenomenon

• vasospastic (a condition in which blood vessels spasm, leading to vasoconstriction) disorder
• causing discoloration of the fingers, toes, and occasionally other extremities
• is believed to be the result of vasospasms that decrease blood supply to the respective regions
• emotional stress and cold are classic triggers of the phenomenon
• discoloration follows a characteristic pattern in time: white, blue and red

Obstructive Lung Diseases at a Glance

Emphysema
- abnormal enlargement of airspace
- distal to terminal bronchiole
- with destruction of cell walls
- no obvious fibrosis

Distal acinar emphysema / Paraseptal emphysema : distal part of acini (alveoli) predominantly involved.

Centriacinar emphysema / centrilobular emphysema : central or proximal parts of acini of bronchiole. Associated with smoking and chronic bronchitis

Panacinar emphysema : acini that enlarging, from bronchiole to terminal alveoli. Associated with alpha-1-antitrypsin deficiency

Irregular emphysema : acinus is irregularly involved


Chronic Bronchitis
- hypersecretion of mucous


Bronchiectasis
- permanent dilation of bronchi (one of two subdivisions of the trachea serving to convey air to and from the lungs) and bronchioles (one of approximately six generations of increasingly finer subdivisions of the bronchi)
- due to destruction of muscle and elastic tissue
- which are caused by chronic necrotizing infection


Asthma
- an inflammatory disease of the lungs
- characterized by reversible (in most cases) airway obstruction

Pentalogy of Cantrell

Pentalogy (a combination of five closely related usually simultaneous defects or symptoms)

Pentalogy of Cantrell
- is a rare syndrome
- characteristics :

1. Omphalocele
- abdominal wall defect at the base of the umbilical cord (umbilicus);
- infant is born with sac protruding through the defect which
- contains small intestine, liver, and large intestine.

2. Anterior diaphragmatic hernia
- an abnormal opening in the diaphragm
- that allows part of the abdominal organs to migrate into the chest cavity

3. Sternal cleft
- Fissure of the sternum

4. Ectopia cordis
- heart is exposed on the chest wall
- due to maldevelopment of the sternum and pericardium

5. Intracardiac defect:
- either a ventricular septal defect or
- a diverticulum (a pouch or sac opening) of the left ventricle

First Line Anti-TB drugs

Isoniazid (H)
- inhibit synthesis of mycolic acid (cell wall)
- selective for mycobacterium
- mechanism of action : Inhibit enoyl-CoA reductase of fatty acid synthase and formation of covalent complex with carrier protein

Rifampicin (R)
- broad spectrum
- mechanism of action :bind to Beta subunit of bacterial-DNA-dependent RNA polymerase

Pyrazinamide (Z)
- never used on its own
- mechanism of action : TB has pyrazinamidase (an enzyme). Convert pyrazinamide to pyrazinoica cid. Pyrazinoic acid inhibits fatty acid synthesis of TB

Streptomycin (S)
- aminoglycoside
- mechanism of action : causing misreading and inhibition of protein synthesis on bacterial ribosomes

Ethambutol (E)
- anabinoglycan is a component of mycobacterial cell wall
- mechanism of action : inhibit mycobacterial arabinosyl transferase involve in polymerization of arabinogalactan

Combinations :
Initial / intensive phase : HRZ, HRZS or HRZE
Maintenance phase : HR

Chemoprophylaxis and prophylaxis definitions

Chemoprophylaxis : prevention of a disease by chemical or drugs
Prophylaxis : prevention of a disease

Miliary definition

- looks like millet

Caseating Definition

- necrosis of the tissue
- change into dry mass
- resembling cheese

Sites of Primary Tuberculosis

Lungs : Ghon tubercle / Ghon complex / Ghon focus / Ghon primary lesion.
- calcification seen in pulmonary parenchyma (usually mid lung) resulting from earlier infection of tuberculosis

Systemic : tabes mesenterica
-tuberculosis of the mesenteric and retroperitoneal lymph nodes

Oropharynx : collar stud cold abscess
- Cold abscess an abscess with lack of signs of inflammation
- Collar stud abscess is a bi-locular abscess with one loculus (A small cavity or chamber) deep to the deep fascia and another superficial to it, both inter communicate through a small perforation in the deep fascia and the cross section resembles a collar stud.
- Cold abscess erodes the deep fascia to become the collar stud abscess.

Skin : lupus vulgaris
- cutaneous tuberculosis with characteristic nodular lesions on the face, particularly about the nose and ears.

Drugs for Asthma List

Sympathomimetics (B2 receptor agonits)

• Non selective : adrenaline
• Selective short acting : salbutamol, terbutaline, fenoterol
• Selective long acting : salmeterol, formoterol

Methylxanthine

• Oral : Theophylline
• IV : Aminophylline

Anticholinergics

• ipratropium bromide
• tiotropium

Corticosteroids

• Systemic : hydrocortisone (IV), prednisolone (oral)
• Inhaled : beclomethasone, budesonide, fluticasone, triamcinolone

Anti-IgE monoclonal antibodies

• Omalizumab

Mast cell stabilizers (prevention use only)

• Sodium Cromoglycate
• Nedocromil

Leukotriene pathway inhibitor

• Leukotriene receptor antagonist : montelukast, zafirlukast
• Leukotriene synthesis inhibitor : zileuton

Duke's criteria simple mnemonics for infective endocarditis diagnosis

Bacterial Endocarditis FEVER

Major:
B = blood culture +ve >2 times 12 hr part
E = Endocardial involvement from Echo

Minor:
F = Fever
E = Echo findings (not fulfilling a major)
V = Vascular findings
E = Evidences from microbiological/immunology (2 evidences)
R = Risk factors/predisposing factors - drug abuse, valvular diseases

Roth's spot, Osler's nodes, Janeway lesion and Splinter hemorrhage Potential Mechanism Theories

Roth's spot:

• embolization of bacterial infiltrates from endocardium causing localized retinal abscesses
• embolized bacterial infiltrates to retinal causing anoxia resulting in sudden increase in venous pressure, thus capillary rupture in the inner retinal layers

Osler's nodes (pain)

• Deposit of the septic microemboli from the endocardium
• Nodes due to immunologically-mediated vasculitis (inflammation of a blood vessel or lymphatic vessel) caused by the circulating immune complexes.

Janeway lesion (painless)

• Deposit of the septic microemboli from the endocardium
• Necrotic micro-abscesses with an inflammatory infiltrate that involve the dermis but not the epidermis

Splinter hemorrhage

• very non-specific sign - it can be due to many causes
• In IE, splinter hemorrhage is caused by the engorgement of the capillaries, resulting in hemorrhage.
• But what causes the engorgement and hemorrhage is not known

How drinking grape juice can be dangerous when you take certain drugs?

• In the intestine there is cytochrome P450, which is part of the detoxification system that detoxifies foreign materials (the drugs) going into the body
• Thus, in normal condition, some of the drugs are metabolized (which means becoming less) in the intestine before it goes into the circulation

• Grape juice inhibits cytochrome P450
• The intestine could not metabolized the drugs as it normally does
• There will be high quantity of the drugs going into the circulation
• This means overdose of drugs
• This means danger

Insulin and hypokalemia

Insulin increases the activity of sodium-potassium pump (brings 2 potassium atoms into the cell at the same time send 3 sodium atoms out)
High insulin level = more potassium going into the cell from the blood = hypokalemia

Gentamicin mode of action

• Gentamicin is an aminoglycoside (bacteriocidal antibiotics derived from species of Streptomyces or Micromonosporum), inhibit protein synthesis
• Gentamicin bind to small subunit of ribosomes
• Inhibit ribosomes function
• No protein produced
• Thus there will be no enzymes
• Bacteria die since there are no enzymes produced

Aspirin overdose : acidosis or alkalosis?

Both, but overdose of aspirin usually cause neurological side effects rather than acidosis or alkalosis

Acidosis, metabolic - aspirin is an acid
Alkalosis, respiratory - aspirin can stimulate the respiratory center

Clostridium perfringens and gas gangrene

Clostridium perfringens :

• Survive in the presence of oxygen but
• Multiple well low oxygen pressure

When the bacterium gets into an ischemic wound :

• Produce toxins and tissue-destroying enzymes

This toxins and enzymes are for :

• Disrupts blood supply to the area
• Allows the organism to establish itself and multiply

The gas in gas gangrene :

• By product of the toxins from destroying the surrounding health tissue

Botox and skin wrinkles

• Botox is short for botulinum toxin, a toxin secreted by Clostridium botulinum
• Botulinum toxin blocks the release of acetylcholine (a neurotransmitter) from nerve endings
• Thus muscles (at the wrinkles) do not contract because there are no neurotransmitter
• When muscles do not contract, no wrinkles

How tears is antibacterial?

• Bacteria need cell wall to maintain it's structure

• Tears contain lysozyme
• Lysozymes break bonds between N-acetylglucosamine and N-acetylemuramic acid which make Peptidoglycan, component of all bacterial walls
• When there is no cell wall, bacteria will burst and die due to osmotic force (water coming in)

Penicillin mode of action

• Bacteria need cell wall to maintain it's structure

• Peptidoglycan is made from N-acetylglucosamine and N-acetylemuramic acid
• An oligopeptide is attached to N-acetylemuramic acid and they cross link each other to make a mesh which make the cell wall
• Transpeptidase / penicillin-binding protein catalyze the cross link reaction

• Penicillin binds irreversibly to transpeptidase
• Bacteria could not make cell wall
• Bacteria burst and die due to osmotic force (water moves in)

Why Right Lobe of the Liver More Prone to get Liver Abscess than the Left Lobe

Caecum > Superior Mesenteric Vein > Right Lobe

Bacterial manifestation at caecum = Continuous supply of bacteria to right lobe = Right lobe more prone to get liver abscess

Proving overdosing insulin injection

• Pancreas makes proinsulin
• Proinsulin will be cleaved by an enzyme to form insulin and C-peptide
• Artificial insulin does not include C-peptide
• Thus, if insulin level is high and C-peptide level is low = overdosing insulin injection

What causes raised white cell count?

• Infections
• Inflammation/hypersensitivity
• Drugs - corticosteroids, beta agonists and lithium etc
• Splenectomy
• Haemolytic anaemia - not sure
• Leukaemias
• Myeloproliferative disorders

Aldosterone Hyposecretion and Acidosis

In acid-base regulation context, aldosterone stimulates a pump in the kidney that pumps out H+ ions into the urine

aldosterone hyposecretion > the pump is less stimulated > H+ retention > acidosis

Vomiting and Hypokalemia

Vomiting > loss of acid and water > hypovolemia and alkalosis

distal convoluted tubules

• reabsorb sodium
• sodium will be exchanged with potassium or hydrogen

hypovolemia :

• sodium need to reabsorbed
• since body hydrogen is less due to vomiting (alkalosis), potassium is used
• potassium excreted out in exchange for sodium reabsorption
• thus, hypokalemia occurs

Hypokalemia and Muscle Cells

The concept :

• less positively charged potassium ions on the outside of the cell
• potassium ions leave the cell to replace them
• causing the cell to become even more negatively charged
• the cells become hyperpolarised
• less likely to fire off action potentials
• excitable cells, neurones and muscle cells, affected

Thus, there will be

• Cardiac arrhythmias
• Skeletal muscle weakness
• Smooth muscle weakness (constipation and paralytic ileus etc)

What is Carcinomas and Sarcomas?

Carcinomas
- cancers that originated from epithelial cells.

Sarcomas
- cancers from mesenchymal tissue.

Mesenchymal tissue
- embryological tissue from which all types of supporting connective tissue and vessls are derived
- example : leiomyosarcoma, osteosarcomas

Protein rich meal, insulin, glucagon and hypoglycemia

When we eat protein rich meal:

Insulin is secreted
- stimulates amino acid uptake and
- stimulates protein synthesis.

Since insulin lowers glucose level, there is risk developing hypoglycemia, thus glucagon is secreted

Glucagon
- stimulates hepatic gluconeogenesis, balance the effect from insulin

Acidosis in Diabetic Ketoacidosis

Characterized by

• hyperglycemia
• ketones present in the blood stream
• metabolic acidosis

Biggest contribution for diabetic ketoacidosis is by ketone :
low insulin level (usually in type 1, rarely in type 2 diabetes) > fatty acids from fat mobilized > send to liver> liver use it to make ketone > ketone is acid > lowers pH

Some Signs of Cerebellar Dysfunction

Ataxia
- poorly coordinated movement.

Gait ataxia
- a jerky, unsure gait, where the steps vary in size and the feet are usually widely separated.

Truncal ataxia
- having difficulty keeping his/her trunk upright, whether sitting or standing.

Limb ataxia
- limbs that are clumsy, discoordinated, and that have difficulty with rapidly alternating movements.

An intention tremor
- tremor only occurs when patient is wanting to touch a stationary object, and subsides once it has been reached.

Dysarthria
- slow and monotonous with syllables abnormally separated. It sounds strikingly like limb ataxia looks.

Nystagmus
- abnormal 'to and from' movement of the eyes.

Fetor Hepaticus and the Mechanism

• sweet, faecal smell
• occurs in patients with the portal hypertension of liver failure
• portal hypertension > reduced portal blood flow to the liver > direct shunts between the portal and systemic blood systems bypassing the liver
• action of bacteria on the sulfur containing amino acid methionine produce mercaptans > mercaptans (thiol, is a compound that contains the functional group composed of a sulfur atom and a hydrogen atom (-SH)) > skip the liver using this shunt > lungs > breathed out > odour

Liver and plasma glucose level

- liver; the key organ in maintaining glucose level
- if there is liver failure, there might be hypoglycemia

- hypoglycemia can be fatal
- that is why we check for serum glucose level in liver disease patients
- and to know whether there is liver failure or not

FEME Acronym, Medical

Full Examination & Microscopic Examination

Increased reticulocyte level – bleeding relationship

- bleeding means loss of red blood cells
- trying to reproduce red blood cells
- thus increase in reticulocyte (young red blood cells) in the serum

Differentiating Alcoholic and Hepatitis Cirrhosis

• Micronodular -> alcoholic
• Macronodular -> hepatitis

Vagus nerve (cranial nerve X)

• the only nerve that starts in the brainstem (within the medulla oblongata)
• only parasympathetic
• supplies all the organs from the neck down to the second segment of the transverse colon except the suprarenal (adrenal) glands

main functions : decreases heart rate (innervates the sinoatrial node), gastrointestinal peristalsis, sweating

Anticholinergic (inhibit the muscarinic cholinergic receptor ):
- increase heart rate
- relax the detrusor muscle, causing constipation

BUSE Acronym, Medical

Blood Urea Serum Electrolyte

Diseases Related To Alcohol

Fatty change / steatosis
- fat accumulation in the liver
- alcohol causes : 1. catabolism of fat at peripheral tissues, increase delivery of fatty acids to liver. 2. catabolism of ethanol increase NADH, induce lipid biosynthesis. 3. decrease oxidation of fatty acids. 4. reduce lipoprotein transport from liver. Acetaldehyde move to tubulin, leads to improper function of microtubule
- asymptomatic
- acute, reversible

Alcoholic hepatitis
- ethanol and metabolites are toxic to hepatocytes
- hepatocyte necrosis
- fever, liver tenderness, jaundice

Liver fibrosis
- Formation of fibrous tissue as a reparative or reactive process

Cirrhosis
- alcohol reduces in liver alpha-tocopherol, increase risk of oxidation injury
- irreversible
- liver shrinks

Alcohol Dementia
- dementia is progressive decline in cognitive function due to damage or disease in the body beyond what might be expected from normal aging
- due to thiamine deficiency (alcoholic usually substitutes alcohol for other more nutritive calorie sources)
- resulting in neurological damage and memory loss

Wernicke-Korsakoff syndrome
- confusion and severe impairment of memory, especially for recent events
- due to thiamine deficiency (alcoholic usually substitutes alcohol for other more nutritive calorie sources)
- the precise pathogenesis is uncertain

Fetal alcohol syndrome
- hypothesis : acetaldehyde cross placenta and damage the brain
- thin upper lip, flat nose and mid-face, short stature and small head size of the baby

Delirium tremens
- delirium is an acute and relatively sudden (developing over hours to days) decline in attention-focus, perception, and cognition.
- acute episode of delirium that is usually caused by withdrawal of alcohol

Alcoholic myopathy / alcoholic rhabdomyolysis / alcoholic myoglobinuria
- weakness secondary to breakdown of muscle tissue
- unknown mechanism

Acute gastritis
- direct toxic effect of ethanol

Cancer
- possible role of alcohol in the development of liver cancer is incompletely understood
- there is relation of alcohol abuse with carcinoma of the oropharynx, larynx, esophagus and liver
- although there is no evidence that alcohol itself is a carcinogen, alcohol may act as a cocarcinogen by enhancing the carcinogenic effects of other chemicals
- cytochrome P-450 is an enzyme that normally help to detoxify substances that enter the body can also increase the toxicity of some carcinogens
- alcohol is able to induce cytochrome P-450 in the liver, lungs, esophagus, and intestines

Alcohol-induced pseudo-Cushing syndrome
- result in symptoms similar to a condition called Cushing's syndrome
- Cushing's syndrome (also called hyperadrenocorticism) is an endocrine disorder caused by high levels of cortisol in the blood

Crohn's Disease
- an inflammatory disease of the digestive system which may affect any part of the gastrointestinal tract from mouth to anus

Peptic Ulcer
- not directly
- associated, increase in incidence

Testicular atrophy and decreased fertility
- unknown mechanism

Ischemic Heart Disease Patients and Gastrointestinal Bleeding

• ischemic heart disease patients usually take aspirin
• aspirin is an antiplatelet : prevent heart attacks, strokes and blood clot formation in people at high risk for developing blood clots
• aspirin is also used to reduce the risk of another heart attack or of the death of cardiac tissue
• however aspirin can irritate the stomach mucosa and cause ulcers and stomach bleeding
• so whenever you encounter patient with gastrointestinal bleeding, don’t forget to ask about aspirin consumption

Blood Pressure, Pulse Rate and Bleeding

Blood pressure normal, pulse rate normal
- no significant blood lost

Blood pressure normal, pulse rate increased
- significant blood lost but compensated

Blood pressure decreasing, pulse rate increasing
- significant blood lost, decompensating

Blood pressure decreasing, pulse rate decreasing
- significant blood lost, patient is dying

Atenolol

- beta-1 receptor selective antagonist
- slowing down the heart and reducing its workload
- does not pass through the blood-brain barrier
- hypertension, coronary heart disease, arrhythmias, angina

How to know what triggers you to get asthma?

You can undergo these tests :

• skin prick test
• allergen specific IgE antibody test

What can trigger and stimulate asthma?

Triggers :
- allergens
- respiratory irritation
- exercise / hyperventilation
- weather changes
- sulfur dioxide
- foods
- durgs
- etc.

Stimulators :
- genetic
- high IgE release tendency
- failure in immune response control
- air quality
- upper respiratory tract infections
- stress
- etc

Guillain-Barre Syndrome

- inflammatory disorder of the peripheral nerves
- damage the myelin sheath of the nerves
- causing rapid weakness or even paralysis the muscles
- exact cause : unknown

Influenza and Parainfluenza

Influenza
- an infectious disease of birds and mammals caused by RNA viruses of the family Orthomyxoviridae

Types of influenza virus, the five genera of Orthomyxoviridae

Influenzavirus A
- one species, influenza A virus
- host range : humans, pig, horse, birds, marine mammals

Influenzavirus B
- has one species, influenza B virus
- host range : human only

Influenzavirus C
- one species, influenza C virus
- host range : humans and pig

Isavirus
- has one species, infectious salmon anemia virus (ISAV)
- infect fish, cause severe anemia

Thogotovirus
- a group of unclassified viruses that are similar to the Orthoviruses and share some amino acid homology

Parainfluenza
- viruses of the genus Paramyxovirus, four types

Type 1 (hemadsorption virus type 2),
- causes acute laryngotracheitis in children and occasionally adults

Type 2 (croup-associated virus)
- causes acute laryngotracheitis or croup in young children
- causes minor upper respiratory infections in adults

Type 3 (hemadsorption virus type 1; shipping fever virus)
- causes with pharyngitis, bronchiolitis, and pneumonia in small children
- causes occasional respiratory infection in adults

Type 4
- has been isolated from a very few children with minor respiratory illness.

Otitis Definition

Inflammation of the ear

Alpha-hemolytic streptococci, Beta-hemolytic streptococci and Gamma-hemolytic streptococci

Alpha-hemolytic streptococci
- reduction of iron in hemoglobin
- greenish color on blood agar
- S. pneumoniae, S. mutans, S. mitis, S. sanguinis, S. salivarius, S. viridans, S. salivarius, S. constellatus

Beta-hemolytic streptococci
- complete rupture of red blood cells
- clear patches on blood agar
- S. pyogenes (group A), S. agalactiae (group B), S. equi (group C)

Gamma hemolytic,
- no hemolysis takes place

M protein

- major virulence factor of group A Streptococcus
- hair like projections
- able to resist phagocytosis
- Class 1 : associated with rheumatic fever

Streptococcus and Staphylococcus difference in term of shapes

Staphylococcus
- round and grape like clusters.
*Staphylus - grape / wine


Streptococcus
- spherical and like a chain

Acute Hypoxemic Respiratory Failure (AHRF)

- severe hypoxemia that is relatively refractory to oxygen therapy
- caused by

• homogenous lung lesions, producing pulmonary oedema
• permeability or low pressure oedema (ARDS)
• oedema of unclear or mixed etiology
• non-homogenous AHRF (usually lobar bacterial pneumonia)

Adult Respiratory Distress Syndrome (ARDS)

- acute lung injury from a variety of causes
- characterized by interstitial and/or alveolar edema and hemorrhage
- as well as perivascular pulmonary edema
- associated with hyaline membrane formation, proliferation of collagen fibers, and swollen epithelium with increased pinocytosis
- may involve

• complement system
• neutrophils
• macrophage activation
• oxygen free radicals
• cytokines

- as injury progress, there might be

• hyaline membrane
• extensive necrosis of type I alveolar epithelial cells

- late / proliferative phase is characterized by

• large dead space fraction
• high airway pressures
• pulmonary hypertension
• honeycomb appearance

What is atelactasis?

Decreased or absent air in the entire or part of a lung, with resulting loss of lung volume.

Check out pulmonary collapse

What is contusion?

Any mechanical injury resulting in hemorrhage beneath unbroken skin

Respiratory Failure Classification

Type I
- oxygen level decrease, carbon dioxide level normal

Type II
- oxygen level decrease, carbon dioxide level increase

Type III
- perioperative / paraoperative (around the time of operation)

Type IV
- hypoperfusion

About Phrenic Nerve

- arises from the third, fourth, and fifth cervical spinal nerves
- send motor nerve fibers to diaphragm
- send sensory fibres to the fibrous pericardium, mediastinal pleura and diaphragmatic peritoneum.
- pain arising from structures served by the phrenic nerve (such as myocardial infarction) is often referred to other somatic regions served by spinal nerves C3-C5 (such as right shoulder)

Paraxial, Intermediate, Lateral plate, Somatic, Splanchnic Mesoderm

Mesoderm
- One of the three germ layers found in the embryos of animals


Paraxial mesoderm
- mesoderm that forms just lateral to the neural tube on both sides.

Intermediate mesoderm
- mesoderm that is located between the paraxial mesoderm and the lateral plate.

Lateral plate mesoderm
- mesoderm that is found at the periphery of the embryo. Divided into :

Somatic mesoderm / layer
- forms the future body wall.

The splanchnic mesoderm / layer
- forms the circulatory system and future gut wall.

Difference between pneumocyte type I and type II

Pneumocyte Type I
- responsible for gas exchange in the alveoli and cover a majority of the alveolar surface area
- large, thin and stretched

Pneumocyte Type II
- responsible for the production and secretion of surfactant (dipalmitoylphosphatidylcholine) which reduce surface tension
- granular and roughly cuboidal in shape
- can differentiate into type I

Difference between mesenchyme and epithelium

Mesenchyme refers to loosely organized connective tissue present in the embryo regardless of origin

Epithelium is a tissue composed of cells that line the cavities and surfaces of structures throughout the body

Hypospadias

Definition
- A developmental anomaly
- characterized by a defect on the ventral surface of the penis
- so that the urethral meatus (opening) is proximal to its normal glanular (pertaining to the glans penis) location


Third degree hypospadias
- associated birth defects
- such as chordee (a condition in which the head of the penis curves downward (that is, in a ventral direction) or upward, at the junction of the head and shaft of the penis) or cryptorchidism (failure of one or both of the testes to descend)

Treatment
- surgery

Difference between glucose and dextrose IV fluids

It's the spelling.

Things That Are Hard To The Liver

Found this in healthboards.com forum and I think it is worth to put it here.

Statins are hard on the liver,
Niacin is hard on the liver,
Zetia (Ezetimibe) is hard on the liver,
Alcohol is hard on the liver,
Chemicals are hard on the liver,
Tylenol (Paracetamol) is hard on the liver.

*Statin, Niacin and Ezetimibe = medication which are used to lower cholesterol levels

Why Statin And Niacin Shouldn't Be Taken Together

Statin and Niacin, which are lipid lowering drugs, should not be taken together because
they are toxic to the liver.

And they also will create risk of muscle degradation and kidney failure.

Leukoplakia, Leukonychia and Koilonychia

Leukoplakia (Leuko_plakia) – whitish patches in the mouth. Caused by multifactorial agents, most are from tobacco products

Leukonychia (Leuko_nychia) – whitish nail, caused by severe albumin deficiency

Koilonychia (Koilo_nychia) – spoon nail, caused by severe iron deficiency

Do Added 'Antioxidants' in Vitamin Supplements Help?

No, they don't, yet. A lot of researches have been done and they do not found any prominent findings or strong proves that added antioxidants in the vitamin supplements help the body.

Ulat Charlie in Medicine / Scientific Name

Ulat Charlie = Paederus fuscipes Curtis / Rove Beetle

In the insect body there is pederin (C24 H43 O9 N), a hemolymph toxin, which is 12 times more toxic than viper snake venom. Skin contact with the toxin will cause dermatitis known as 'dermatitis linearis' or 'paederus dermatitis'. If you want to move the insect, air blow it. Don't make a or try to make a skin contact with it.

If you are wondering why the toxin don't kill humans although it is more poisonous than viper snake venom, the answer is the insect don't release the toxin in large quantities as viper snakes do.

How Spider Nevus Looks Like

Spider Nevus syn : spider hemangioma, nevus araneus, spider angioma, arterial spider, vascular spider, spider telangiectasia.

Spider Nevus does not look like a spider, I mean it does not look like the tree branches.

It is more of some reddish area of the skin in which when you press the area, the area will become white, and when you release it, the blood (red color), will start filling from the center and 'crawling' to the periphery.

When You Percuss

Make sure only your hand moves, not your elbow!

Panau in Medicine / Scientific Name

panau = tinea versicolor / pityriasis versicolor

Caused by growth of the fungus Malassezia furfur in the stratum corneum (outermost layer of the epidermis) with minimal inflammatory reaction.

About Ceritalah Doktor

Assalamualaikum and hello to my blog readers. Thanks for dropping by and I hope my blog can help you in any way it can.

Telling the truth, I am not a doctor yet. I am a medical student but I am already at the clinical phase where I go to the wards almost every week. If I do well, I will graduate in 4 years.

Working in the wards in not like reading books. It is very different. It is more fun and challenging. Thus, at this blog, I want to share my experiences as well as my knowledge, which I think are worth to be shared.

Telling is sharing, sharing is caring. That is why I choose my blog name as "ceritalah doktor" which means, "doctor, tell me stories".

That's all for now. Enjoy!