preclinicalnotes

Combining my addiction to tumblr with my need to study: A collection of notes, drawings, and conceptual explanations from my pre-clinical years, by an osteopathic medical student. (Although I almost always combine them with supplementary materials, most of these are based around re-interpretations of the handouts/presentations from my school's faculty. Word-for-word excerpts are rare but belong explicitly to the copyright holder. Sometimes you just can't think of a better way to phrase it.)

[preclinicalnotes]

so your patient has acute pancreatitis

how well do you expect them to do after admission?

fortunately some guy named JH Ranson developed some criteria in 1974. (a quick google search turns up almost nothing about him, making this a rare occasion where the namesake didn’t get nearly enough fanfare. I don’t even know if it’s a him, but the 70s weren’t great on gender equality and clinical research was no exception.)

medicine is full of mnemonics and this is no exception. you’ll want to use “GA LAW and CHOBBS” here.

At admission / 0-hour:

Glucose (blood) >200 mg/dL

Age > 55 y/o

Lactate dehydrogenase (LDH) > 350 IU/L

Aspartate transaminase (AST) > 250 IU/L

WBC > 16000

At 48 hours:

Calcium (serum) < 8mg/dL

Hematocrit falls in excess of 10%

Oxygen (PaO2) < 60mmHg

BUN increase greater than 5 mg/dL (despite adequate hydration)

Base deficit > 4 mEq/L

Sequestration of fluid > 6L

Some societies alter the parameters above if the patient has gallstone pancreatitis--for our purposes (studying/entry-level clinical practice aka medical student) just stick with the criteria as written as I’m not sure the gallstone differentiation is universally accepted.

Anyway, now you have the criteria, how will they fare? What’s their prognosis?

Each criteria is worth one point.

< 2 points: 2% mortality

3-4 points: 16% mortality

5-6 points: 40% mortality

7+ points: 100% mortality

[doctordconline-blog]

Multiple endocrine neoplasia is a group of disorders that affect the body’s network of hormone-producing glands (the endocrine system). Hormones are chemical messengers that travel through the bloodstream and regulate the function of cells and tissues throughout the body. Multiple endocrine neoplasia typically involves tumors (neoplasia) in at least two endocrine glands; tumors can also develop in other organs and tissues. These growths can be noncancerous (benign) or cancerous (malignant). If the tumors become cancerous, the condition can be life-threatening.

#endocrinology #endocrine #neoplasia #oncology #oncologist #hormone #usmle #university #usmlestep1 #usmlestep2 #doctor #doctordconline #nhs #nurse #nursing #hospital #hospitallife #patient #pathology #medstudent #medicine #medlife #mbbs #md #amc #plab @doctordconline

[preclinicalnotes]

Although vasopressin (ADH) is best known for its role in increasing blood pressure and volume, it does have another important role.

Background: In von Willebrand disease, your patient has an inherited deficiency of von Willebrand factor (vWF), an important part of clot formation. This is the most common inherited (autosomal dominant) bleeding disorder. vWF tethers platelets to damaged endothelium, and binds factor VIII to inhibit degradation by protein C (if you know the clotting cascade, you know this helps lyse clots).

Clinical vignette: Often features a post-menarche, pre-menopausal female (take stock of this general age range) with history of frequent nosebleeds and/or heavy menstruation (mucosal bleeds). Lab work will show anemia (low Hgb, Hct) and depleted factor VIII. Restoring factor VIII will fail to improve their symptoms.

Back to vasopressin: Vasopressin (and its analogues) stimulates release of vWF and factor VIII from endothelial stores, and can be given IV (obv since you can use it in a code) or intranasal. Being mindful of the primary effect of vasopressin, you must keep an eye out for hyponatremia as water retention dilutes serum ion concentrations.

Side notes: vWD comes in three types. 1 & 3 result in decreased production, 2 results in abnormal vWF.

[preclinicalnotes]

At 9:20, Dr. Williams draws “chemo man.”

This is an AWESOME way to get a base-level grasp on the different side effects of chemotherapy drugs.

[preclinicalnotes]

ars-scientiaque replied to your post: Vertical growth/depth is the CHIEF fac...

unless it’s in the eye…

[preclinicalnotes]

Vertical growth/depth is the CHIEF factor to look at when determining prognosis of a melanoma.

[medxclusive]

Other Important AA derivatives for USMLE:

Arginine →  Nitric  Oxide

Arginine  + Aspartate → Urea

Glycine  + Arginine + SAM  → Creatine

Glutamate  + Aspartate  → Pyrimidines

Glutamate  + Aspartate + Glycine → Purines

Tyrosine   → Thyroxine,  Melanin

[drchelsearar]

this seems important. please memorize, brain.

[thenotquitedoctor-blog]

Courtesy of a pharmacy school friend ^^

I’m saving this puppy for next year!

[smcgaughey]

[medicalstate]

Gastric Subway by smcgaughey. 

[preclinicalnotes]

saving for later. that middle intersection is medium-high yield boards stuff.

[pleasedotheneedful]

Hey, just an addendum this otherwise awesome creation is missing: The short gastric artery comes off of the splenic artery. It supplies part of the upper greater curvature and anastomoses somewhat with the left gastric and left gastroepiploic. Unlike the left and right gastroepiploics or gastrics, the short gastric has poor anastomoses and so supply through here is reduced with splenic artery impingement. Literally had a question on this exact concept two days ago.

[maptitude1]

The human bodily systems as a transit map

[drchelsearar]

this is the coolest thing I have ever seen.

[preclinicalnotes]

The lipopolysaccharide (LPS) molecule forms the outer membrane of gram negative bacteria (like E. coli). It has three key parts: O antigen, core polysaccharide, and Lipid A.

Lipid A is the endotoxin that causes sepsis and septic shock. It does this by recruiting macrophages and granulocytes, which then increase production of pyrogens like IL-1, PGEs, and inflammatory mediators like TNF-alpha and interferon. These proteins work to induce fever (pyrogen!), hypotension, and increased vascular permeability as well as DIC and death.

This is not a toxin the bacteria actively secretes, but is released when the immune system begins destroying them.

Other relevant components of Gram negative bacteria:

The O antigen is used to classify Gram negative bacteria (as in E. coli O157:H7 outbreaks).

Heat stable exotoxin is specific to ETEC (toxogenic/Traveler’s diarrhea).

K1 capsular antigens cause neonatal meningitis.

Fimbriae/pili are virulence factors that adhere to tissue and create infection in the first place.

[smcgaughey]

[medicalstate]

Gastric Subway by smcgaughey. 

[preclinicalnotes]

saving for later. that middle intersection is medium-high yield boards stuff.

[preclinicalnotes]

beta blockers and hypoglycemia

something to look out for in boards questions and real patients.

hypoglycemia normally presents with tachycardia/palpitations, tremors, and sweating. block the beta receptors and the only overt warning sign you’re left with is sweating [still a sympathetic mechanism, but uses acetylcholine post-ganglionic instead of norepi].

to make matters worse, beta blockers may exacerbate hypoglycemia by preventing adrenergic release of glucagon, so you can’t get glucose out of your stores either.

[thefuturern]

ABG's

Respiratory acidosis:  PCO2 > 45; kidneys conserve HCO3 and eliminate H+ to increase pH

Respiratory alkalosis:  PCO2 < 35; kidneys eliminate HCO3 and conserve H+ to decrease pH

Metabolic acidosis:  PO2 < 22; hyperventilation occurs to “blow off” excess CO2 (acid) in order to increase pH

Metabolic alkalosis:  PO2 > 26; hypoventilation occurs to “hold on” to CO2 (acid) in order to decrease pH

[preclinicalnotes]

because I still struggle with this sometimes.

[docinlimbo]

Burkitt's Lymphoma Mnemonic

Burkitt’s Lymphoma is a lymphoma seen in adolescents and can present as a jaw lesion though it can also occur in the abdomen. It is caused by t(8;14) aka a translocation of c-myc and heavy chain IgG. On histology slides it has a starry sky appearance. It is associated with EBV infection.  

So what’s this silly picture have to do with any of that? Well I’m glad you asked.

Mickey Mouse represents the c-myc (get it Mickey Mouse, C-MYC haha…). The 8 stars represent chromosome #8 where c-myc is normally found. And Van Gogh’s "Starry Night" represents the starry sky appearance that’s supposedly seen under the microscope (personally I don’t see it, but consider it a buzzword). 

[onion-ring-93]

[cosmoshop-deactivated20190228]

FUCK THIS I SPERFECT, IT SHOWS THE ARM PRONATING AND ALL THE MUSCLES SHIFTING ALONG WITH THE WRIST

IT EVEN HIGHLIGHTS THE ULNA BONE  

HEY THIS IS THE ULTIMATE ANATOMY REF, FUCK THOSE MISLEADING TERRIBLE FUCKING “ANATOMY” TUTORIALS THAT GOEAS AROUND TUMBLR, THIS IS ALL OYU NEED, LOOK AT THE LATISIMUS STRETCHING OVER THE SERRATUS, THE PECTORAL MUSCLE MOVESUPWARDS AND OVER THE BICEP AND EXTENDS  ALONG WITH THE ARM THERES EVEN THE CORACOBRACHIALIS;. AAAA OMFG I’M SO HAPPYYYYYY

[nicedaythoughts]

I love how easy this is to visualize.

[mindofamedstudent]

If its not too much trouble, can you post a more detailed picture of your flowcharts? :)

Not at all! Here you go

This is the one I did on the femoral artery (the same one as in my finals are coming/confession post). 

This is a simpler one I did for the superior and inferior gluteal arteries.

I’m not entirely sure they’re clear because I have tiny handwriting but I hope this helps :)

[thisfuturemd]

Detailed Flow Chart Examples for Students - Created by: mindofamedstudent