Coffee Addict & Wannabe Medic

Got into Med school, missed my grades, tried again and got in!

[thecoffeeaddictmedic]

Surviving First Year

Well I passed and I was told like last month but yay!

What have I learned:

1. You’ll meet so many different people

Some people will work hard and honesty some of them are snakes and some of them will be happy to help. I met a couple guys in our friendship group called Monty and Vicky, and honestly they work hard, I always tell Vicky that he sleep with his Grey’s. Monty works his arse off and his whole family are medics and he has said his family helps. Of the people I have met they are pretty snakey imo. There’s another guy called Basil, such a lovely guy. I first spoke to him officially when SAS did a revision session on GI and I asked him to send a powerpoint to me and told him I hadn’t revised for our end-of-block test. He gave me loads of recommendations and I started to cry, because during my time in med school I’d never someone who was so willing to give me advice, and we spoke for like 2 hours in the Guild and he dropped me off. He always checked up on me and honestly he is the safest medic I’ve met and Tom but that’s another story. 

I met a rugby lad, on the coach journey back from our army trip thing, and I avoided talking to him because I’m not a fan of rugby lads. He started talking to me and I told him my life plans and he was really friendly and we got along. We then bumped into each other in a hockey prees and he recalled everything I said to him. Later in the year he had a question bank and I asked him out of the blue and he was so willing to give it to me despite my snakey mates having them and denying it throughout.

Some people are snakey, some are nice I just wish I had a filter where I could find out who’s who.

2. You can never learn it all.

I thought Basil knew everything but he told one thing which I believe is very important “You can’t learn everything.” And it is so true it’s almost impossible to do so.

3. Look after yourself

Don’t rely on anybody because you have to look after yourself. Some people will help. Shout-out to Piri for swiping VapourRub on my face. But learn to take care of yourself.

Don’t waste time on people, if they really are your mates they’ll understand, but be by them when they need you.

4. Be organized

In Sixth Form, my teachers despised me because I wasn’t organised, thanks KAH for being peak to me.

Get a diary (Thanks Tom for teaching me kid!), write down lectures and prepare.

5. Do stuff you want to do

Honestly, just do it.

Like I wish I took up boxing, Gaana Dancing and get involved in societies!!!

6. Don’t pay for a gym membership, go monthly

Ask any of my mates and they’d tell you how much I wasted on that thing.

The uni gym hours didn’t cut it out for me.

7. Do the lectures on the day they are taught

It’s so hard to play catch up.

8. Join the second hand book group on facebook!

But only buy the books you need, son’t buy other *new* shit other people have, because they probably didn’t use it and want their money back.

[howtosucceedinschool]

The 5 Day Study Plan

So admittedly, I don’t fully know where the idea of the 5-day study plan came from. I first learned about it during a work training, and it instantly made sense to me as it strikes a good balance between studying too far in advance and doing last minute cramming. As I have touched on in previous blog posts, I find the idea of studying more than a week in advance to be impractical and a waste of time as most people will forget most of what they have studied/learned unless they have pre-determined and implemented a really good system of spaced repetition (click here for my blog post on spaced repetition). At the same time, cramming does not work because it leads to unnecessary stress, panic, lack of sleep, and can undermine your confidence going into the exam. Furthermore, many studies have shown that cramming does not allow for long-term understanding/memory, which may or may not be necessary depending on the subject and your future study/career plans.

I prefer study methods that prioritize spending time on what you don’t know, or which designates different amounts of time to different subjects based on your knowledge level and familiarity with the subject. However, in the event that studying that way does not work for you, or if you are truly unsure of what you do and do not know, I recommend the 5-day study plan as detailed below.

Step 1: Break the material into four (relatively) equal chunks. This can be done in any way that makes sense to you. By chapter is probably easiest, but there are other ways that might also work, such as by lecture topic. It may be useful to look at the syllabus, or at your study guide when deciding on your four chunks.  

Step 2: Plan to spend a minimum of 2.5 hours per day studying for this test, if its hard you might need more time, such as 3 or 4 hours, but make sure you prioritize the minimum of 2.5 hours per day for the five days prior to the test.

Step 3: Each day consists of two important steps: Prepare and Review. You should establish 2-3 prepare and review strategies that work best for you, and stick to these 2-3. Here’s a list of ideas to get you started, with my personal favorites in bold.

Step 4: Now you combine steps 1 and 3 to create your study schedule.

Here is an example:

*In order to maximize your 5-day study schedule I would recommend composing the parts/groupings in such a way so that the hardest material falls into part A, and the easiest into Part D.  Technically all of the 5-day study schedule explanations I have read just randomly separate the topics into the parts, but smarter strategies would be separating them by difficulty level, or by how long ago you initially learned that material.

[biomedicool]

Thyroid function tests

Standard Tests

TSH levels

Free T4 (fT4) levels

Measurements of total T4 + T3 used to be common however detects both bound and free T3 + T4

Elevated total T4 may occur in healthy individuals if there is an increase in binding protein concentrations

Reliable tests now exist for free T4 + T3

T3 = 3.9-6.7 pmol/L

T4 = 12-22 pmol/L

Thyroid-stimulating hormone

Produced by the pituitary gland, not the thyroid, however:

TSH levels are controlled by negative feedback – can be indication of thyroid function (changes in T3+T4 will result in changes in TSH to try compesate)

TSH levels greatly elevated in hypothyroidism – >10 fold increase over reference values

More sensitive marker than decreased fT4 - increased TSH occurs before fT4 decreases

TSH levels greatly supressed in hyperthyroidism

Low concentrations can also occur in non-thyroidal illness

TSH measurement is the first-line test of thyroid function.

Free T4 + T3 Measurements

Desirable as free hormone is clinically relevant

Total levels can change under conditions that alter thyroxine-binding globulin (TBG) levels e.g. pregnancy

Large changes in TBG may still affect fT4 + fT3 levels

fT3 levels often normal in hypothyroidism

fT3 levels usually raised more than fT4 levels in hyperthyroidism

Unless complicated by an illness effecting conversion of T4 to T3

Therefore: – fT4 levels are a better indication of hypothyroidism

fT3 levels are a better indication of hyperthyroidism

[uni-med]

Recap!!!

[lawyerd]

me: runs a studyblr

also me: does not study

[thecoffeeaddictmedic]

Small intestine motility

Motility and Mixing

Migrating Motor Complex

regulated by motilin

in between meals it sweeps food through intestines

Slow waves

PNS

Increase rate

SNS

decrease rate

Segmentation

Intestinal secretions

mucous

lubricate chyme

intestinal protection

aqueous solution

CCK

SECRETIN

[thecoffeeaddictmedic]

Large intestine motility

Movement Patterns

mass movement and peristalsis propel chyme forward

Segmentation

haustra

increase contact between contents and intestinal epithelium

water and ion removal

Sphincters

ileocecal

prevents backflow

orthocolic

defecate after eating

gastrocolic

clear colon ready for new meal

anal

external

somatic NS: pudendal nerve

Skeletal muscle

internal

smooth muscle

[thecoffeeaddictmedic]

A dozen bees: B12 absorption

B12 is a cofactor for methionione synthetase

Found in food: eggs, milk,cheese, milk products, meat, fish

How is it absorbed?

binds to haptocorrin

haptocorrin is broken down by pancreatic proteases

B12 is freed an binds to intrinsic factor form parietal cells

B12/IF complex is absorbed by phagocytosis in the ileum

[thecoffeeaddictmedic]

Absorbing the good stuff: Vitamins & Minerals

Minerals

Sodium

distal colon

ENaC

Chlorine 

Cl- / HCO3- Exchanger

Proximal Colon

Potassium

diffusion

insertion of apical channels - aldosterone

Divalent

small intestine

para/intracellular route

Vitamins

Water soluble

Absorb by water cotransport

Fat soluble

Micelles --> Chylomicrons

[thecoffeeaddictmedic]

Vomiting reflex: The only way is up

poisoning detected by nerves at the level of the pharynx, buccal cavity, oesophagus and stomach.

efferent signals via vagus nerve --> pontine region of medulla oblongata

afferent signals via phrenic nerve via PNS

Retropulsion

abdominal muscles, intercostal muscles and diaphragm contract to raise intrabdominal pressure

[thecoffeeaddictmedic]

Death of an enterocyte

No one cares

they get sloughed off anyway.

Naah jk jk

anywho....

At the bottom of the crypt there are these things called paneth cell which secrete bacterial peptides, cytidine and defensins that prevent stem cell damage.

As they move further up they become differentiated for absorptive function.

Any damaged cells will form apoptic bodies where they pinch off to maintain the barrier.

[itwasaforest]

[thecoffeeaddictmedic]

Basically me all the time....

are they gonna happen? Probs not.

[thecoffeeaddictmedic]

Sleep

I’m addicted to it, I’m not even kidding, I geniunenly am!!! I have 12 hours every other day, which I personally don’t think is healthy.

Any tips?

[biomedicool]

Liver Structure and Function - Flash Card

Hepatobiliary system - refers to the liver, gall bladder & bile ducts 

liver comprises several lobes 

receives blood from the hepatic artery (25%) & the hepatic portal vein (75%) 

blood from spleen and GI tract passes through liver 

largest internal organ (~1.5kg) 

Tissue contains two major cell types: parenchymal and non-parenchymal 

parenchyma (aka hepatocytes): accounts for 80% of liver volume, 60% of cells

hepatocytes in outer areas of lobule are specialised for oxidative functions - well perfused - such as gluconeogenesis and cholesterol synthesis

cells in the inner zone are more important for glycolysis, lipogenesis and cytochrome P-450 based drug detoxification 

cells in the inner areas are less well perfused and more susceptible to ischaemic injury 

hepatic portal vein = poorly oxygenated, high in nutrients 

hepatic artery = highly oxygenated, low nutrients 

The non parenchymal cells of the liver include populations of cholangiocytes (epithelial cells), sinusoidal endothelial cells, stellate cells, Kupffer cells, and intrahepatic lymphocytes.

Functions including: 

detoxification - particularly nitrogenous compounds, hormones & drugs

synthesis 

metabolism 

storage -  glycogen, iron, copper, and fat soluble vitamins

breakdown 

bile production 

Carbohydrate 

storage of glycogen 

main source of blood glucose 

Fat 

dietary fat processing 

lipoprotein synthesis 

Protein 

major site of protein synthesis, especially plasma proteins e.g. albumen, coagulation factors 

protein catabolism and urea production 

[thecoffeeaddictmedic]

Why do I even bother cramming?

[thecoffeeaddictmedic]

Patch things up with Peyers

Peyer’s Patches are aggregate lymphoid tissue, of M cells, which basically moniter the intestine and sample any antigens to immune cells.

M cell present to:

mast cell which innervates the blood i think

macrophages --> T cells --> cytokine --> T cells --> B cells--> antibody production

has thinner mucous so it is easier to sample

inappropriate activation = chronic inflammation 

B cells when stimulated secrete IgA

~ remember Inter Gastric Antibody

[thecoffeeaddictmedic]

My notes are peng but they’re a pain to understand afterwards. Only did this for one block - wish I did it for all of them 😫

[thecoffeeaddictmedic]

Countering acid attack

After stomach distention, signals are sent to the vagus nerve

in response it sends to signals down:

It secretes VIP and Ach

VIP is secreted by K cells and stimulates duct cells to secrete HCO3-

S cells secret secretin which also stimulates duct cells 

[thecoffeeaddictmedic]

Guards up: Stomach

How does the stomach protect itself from the harsh acid environment?

Mucous is secreted

it contains mucins

resistant to proteolytic breakdown

Bicarbonate is trapped within it to neutralise it

Tight junctions in between cells to prevent H+ from entering the epithelium

It has a rich blood supply to take any excess protons away

chemoreceptors can detect this and stimulate the vago vagal reflex which causes:

an increase in blood supply

more growth factors and nutrients to repair any damage

It also has differing phospholipid membrane composition

Rapid cell turnover: Restiution

cells migrate into gaps and form a thinner epithelium within 30 mins

aided by:

gastrin - differentiation

prostaglandin: produce HCO3-

Trefoil peptides

cell migration

mucous flow

Regeneration Proteins

ordered functional structure