My journey..

studyblr, A med student, wishing to appreciate life and everything in it... She/her

[mynotes4usmle]

Myocardial infarction

3 cardinal signs:

Elevation of ST segment

Inversion of T wave

Deep & wide Q wave

With reciprocal changes in the leads facing the opposite wall:

Depression of ST segment

Tall, upright T waves

Changes do not appear at the same time. It happens in this order:

Elevation of ST segment stays for 2-3d and gradually goes back to base level in 1-2w

T wave becomes inverted after 2 days, and remains like that for 3w, and gradually becomes flat and then upright over 2-3m

Q wave = muscle death, appears after 1 week, and gradually deepens and remains permanent. Size proportional to size of infarct.

Timeline:

1°d: ST segment elevation + tall T wave

2-3°d: ST segment still elevated + T wave slowly becomes inverted

7°d: ST segment starts returning to base level + T wave inverted + Q wave starts appearing, it deepens. (If ST segment stays elevated >6m, think of development ventricular aneurism)

3°w: Q wave fully developed + T wave starts becoming flat

End of 3m: only Q wave stays the same, ST segm and T wave return to normal. If the size of the infarct was small, Q wave goes back to normal.

Coronary Arteries, branches & supply:

Localization of infarct:

[mynotes4usmle]

Hope it helps @shreeparn  :)

[diseasesinthreewords]

Poeta uruguayo, Mauricio Saravia. Photo from www.lukeford.net posted on Wikimedia Commons in 2008. Another notabe case in a teenager from Haiti.

The three words of McCune-Albright disease:

The most famous (mouthfull) words of the condition: Polyostotic Fibrous Dysplasia. What that means is that the bone will grow tumor-like fibrous (scar) tissue instead of the normal medullary (bone marrow) bone tissue. Irregular Bony trabeculae That will cause the deformities that make the disease famous. It’s caused by mutation in the gene GNAS1 and affects mostly the extremities. Not cancerous. Mosaic G protein signaling mutation 

Premature puberty in girls. It can affect boys as well, but the question stem in exams tend to report female cases, like a 2-year-old with menstrual bleeding. Early puberty is one of the many endocrine problems of these patients and a favorite to put in exams. Other problems include over-reactivity of the thyroid, pituitary and adrenal glands (hyperthyroidism, acromegally and hypercortisolism). 

And, of course, Café-au-lait spots. The interesting feature is the tendency for the lesions to not cross the body’s midline.

[usmle1mikmonics]

McCune AlBright C = Cafe au lait spots E = Early puberty AB = Abnormal Bones (Fibrous Dysplasia)

[mynotes4usmle]

[mynotes4usmle]

Paget Disease or Osteitis Deformans

Disorder in bone remodeling, 3 stages

Osteolytic (osteoclasts)

Mixed (osteclasts & osteoblasts)

Osteosclerotic (osteoblasts, “burn-out”)

Mosaic pattern on lamellar bone, big skull (no hat fits), foraminal narrowing (cranial nerve impingement), bone fractures, bone pain, warmth (increase vascularization).

Complications: AVshunt within bone marrow, can cause high output, cardiac failure, osteosarcoma

Possible underlying mechanism: Paramyxovirus infection of osteoclasts

Lab: Normal Calcium and Phosphate, INCREASED ALKALINE PHOSPHATASE

[mynotes4usmle]

MCC of an isolated, asymptomatic elevation of ALKALINE PHOSPHATASE in an elderly patient.

Laboratory markers for bone turnover are elevated: PINP (procollagen type I N-propeptide or just remeber that song from 50cent “pimp”), urine hydroxyproline

Imaging: XR (osteolytic or mixed lytic/sclerotic lesions), radionuclide bone scan (focal increase in uptake, also for staging)

Tx: bibphosphonates

[mynotes4usmle]

Newborn Respiratory Distress

[mynotes4usmle]

ALCOHOLIC HEPATITIS

Mallory bodies are highly eosinophilic and thus appear pink on H&E stain. The bodies themselves are made up of intermediate keratin filament proteins that have been UBIQUINATED, or bound by other proteins such as heat shock proteins, or p62.

[mynotes4usmle]

Primary Sclerosing Cholangitis (PSC)

Unknown etiology

Chronic Biliary tract disease

Segmental inflammation and fibrosing destruction of INTRA & EXTRAHEPATIC BILE DUCTS.

Micro: concentric bile duct “onion skin” fibrosis, ducts “beaded-appereance” (in cholangiogram) due to segmental stenosis   & periductal chronic inflammation

Males

Hypergammaglobulinemia (IgM)

Associated with: Ulcerative Colitis.

Complications: Secondary Biliary Cirrhosis, Cholangiocarcinoma

[mynotes4usmle]

Primary Biliary Cirrhosis (PBC)

Autoimmune

Chronic liver disease

Inflammation + Granulomas => destruction of INTRAHEPATIC BILE DUCTS

Females, middle-aged

Increased Anti Mitochondrial Antibodies - AMA (90%)

Increased IgM

Associated with other autoimmune diseases (CREST, RA, celiac disease)

[mynotes4usmle]

GI Tract

INNERVATION

Intrinsic: Auerbach & Meissner Plexus (*) 

Extrinsic: Autonomic Parasympathetic (stimulatory: sensory fibers) & Sympathetic (inhibitory: pain fibers)

(*) mutation of neural crest cells, affects its migration into the gut, hence no Auerbach or Meissner plexus => HIRSCHPRUNG DISEASE

GALT Malfunction: Inflammatory Bowel Disease

Chron disease:  ileum

Ulcerative colitis: rectum

Crohn’s disease. Any part of the gastrointestinal tract can be affected, but most commonly, the terminal ileum, cecum, peri-anal area and colon. It is characterized by the presence of segments of normal bowel between affected regions, known as ‘skip’ lesions. The intersection of linear ulcers with islands of normal or oedematous mucosa might produce a ’cobblestone’ appearance.

Ulcerative colitis. the inflammatory process invariably involves the rectum and extends proximally in a continuous fashion, yet remains restricted to the colon. Sometimes, it is limited to the rectum as 'ulcerative proctitis’.

Histology

Crohn’s disease. A transmural (affecting all layers of the bowel wall), dense infiltration of lymphocytes and macrophages; presence of granulomas in up to 60% of patients; fissuring ulceration and submucosal fibrosis (see left-hand figure).

Ulcerative colitis. Inflammation affects superficial (mucosal) layers with infiltration of lymphocytes and granulocytes and loss of goblet cells. Presence of ulcerations and crypt abscesses (see right-hand figure).

LIVER

Blood flow into thee liver: 75% PORTAL VEIN, 25% Hepatic Artery

Blood flow out of the liver: Hepatic Veins + IVC

FEEDING & SATIETY

Lateral hypothalamus: feeding

Ventro medial hpt: satiety

[mynotes4usmle]

[usmlepathslides]

Pseudomembranous colitis due to Clostridium difficile Note the shaggy membrane due to toxin-induced damage of the mucosa and submucosa.

[mynotes4usmle]

Best initial test: stool C. diff toxin assay or PCR

Most accurate test: endoscopy looking for pseudomembranes (not done, bc the toxin assay is good enough)

Tx: 

Oral metronidazole. 

Resolution but days later recurrence? Retreat with metronidazole. 

No resolution after first course of metronidazole? Switch to oral vancomycin or fidaxomicin

[doctornimsblog]

Maddox rod

[motivatemycollegelife]

Clean your desk.

Turn off your phone. Charge it.

Fill a glass with water.

Set 3 easy goals.

Get done as much as you can.

Take a break. Get out of the room.

Fill another glass.

Come back, keep going.

Repeat step 5.

WHY THE FUCK IS THIS SHIT HARD?

Sigh.

[doctornimsblog]

Note to self

Dear future me,

First of all i hope you are fine and alhamdulillah alive and fighting through all your challenges and nailing them.

At this point i think i have been betrayed. So much, by my cousins, by my friends, by my relatives.. This betrayal played a huge role. It affected me, the past as well as present me.

I feel people just take me light, nobody cares about my existence itself,.. Let alone all the other things that people usually do for each othet while carying.

I feel i trust people easily. There is huge contest in the modern world today. I want that attention too. But thats not possible.. As i already said nobody cares whether am dead or alive. Except my parents.

At this point of life as of today.. So many people whom i have trusted have walked out of my life betraying me, without even being sorry.

In my academics too, i work so hard, writing notes, taking notes while classes paying attention to whtever lecturer says.. But when it comes to exams alas! I score less than i wished,that demotivates me a lot.

My finals are around, very near but i havent reach that satisfaction level.

Through this letter i want to express about how every bad thing in my life is, But at the same time i also want to motivate my self to reach that high point where all those people who once judged you, cheated you would also congratulate you.

Now i also feel that i am away from my allah but i dont want to despair from his mercy.

When i look back at this i wish i reach where i want to, establishing close relation to allah and achieving all my dreams and goals, prove everyone what i can be.

Most important of all i have to believe now to see you my future self. I love you. Thats enough, am here in this world to worship allah that should be my first priority, i should note distract myself.

I know you can do it, and when you will read this in future am sure you will feel proud.

Keep going and keep fighting.

Yours truly,

Present me.

[doctornimsblog]

Note to self

Dear future me,

First of all i hope you are fine and alhamdulillah alive and fighting through all your challenges and nailing them.

At this point i think i have been betrayed. So much, by my cousins, by my friends, by my relatives.. This betrayal played a huge role. It affected me, the past as well as present me.

I feel people just take me light, nobody cares about my existence itself,.. Let alone all the other things that people usually do for each othet while carying.

I feel i trust people easily. There is huge contest in the modern world today. I want that attention too. But thats not possible.. As i already said nobody cares whether am dead or alive. Except my parents.

At this point of life as of today.. So many people whom i have trusted have walked out of my life betraying me, without even being sorry.

In my academics too, i work so hard, writing notes, taking notes while classes paying attention to whtever lecturer says.. But when it comes to exams alas! I score less than i wished,that demotivates me a lot.

My finals are around, very near but i havent reach that satisfaction level.

Through this letter i want to express about how every bad thing in my life is, But at the same time i also want to motivate my self to reach that high point where all those people who once judged you, cheated you would also congratulate you.

Now i also feel that i am away from my allah but i dont want to despair from his mercy.

When i look back at this i wish i reach where i want to, establishing close relation to allah and achieving all my dreams and goals, prove everyone what i can be.

Most important of all i have to believe now to see you my future self. I love you. Thats enough, am here in this world to worship allah that should be my first priority, i should note distract myself.

I know you can do it, and when you will read this in future am sure you will feel proud.

Keep going and keep fighting.

Yours truly,

Present me.

[leastudys]

[thestudyingmegan]

Since I’m not studying at the moment, I thought I’d take the time to make this mindmap to give you guys some suggestions for how to study. Let me know if anything here is particularly helpful! Have a wonderful weekend everyone! 😘