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!