Monthly Archives: February 2012

extra toppings

steroids rarely cause PU
BUT
it enhance the ulcerogenic effect of NSAID

carcinoid syndrome is an array of symptoms caused by carcinoid tumours which release serotonin and kallikrein

serotonin increase git motility when any threat is present, to get rid of the inslting agent A.S.A.P

pyoderma gangrenosum in IBD is associated with an aggresive course ( badprognosis)

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sick and tired

procrastination is taking its toll on me. its as if the more you procrastinate, the more likely you will feel your enthusiasm being drained out of your system. i hate this. its an endless cycle.once you start procrastinating you have to break the cycle pronto. delaying further will only make matters worst. im having my osce this thursday and yet i feel hopeless and unprepared.

so i have to wake up and start studying. and maybe i could literally pin my sleepy eyes to keep me awake.

hey hey missdoctorinthehouse!
remember your purpose.
your every second of time wasting could present a risk to your future patients.
any knowledge missed could save your patients life.
you are here to perform your responsibility to study.
you do your best baby.your very best. doing this half-heartedly is not an option.its out of the topic.
you are alive because Allah has sent you down this assignment called life and it is to be presented later in the here after. and you only have this moment. this limited amount of time and its draining fast and it wont come back or add up ,NEVER!

master the time given to you, dont let it make you do the chasing!

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yeahhhhh!!! ( totally unrelated picture, go catss! i must stop lazin around.)

hardcore study mode ON RIGHT NOW

hypopituitarism

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important points

The posterior pituitary does not produce its own hormones. rather, hornones are stored here(oxytocin and vasopressin) .they are produced by the hypothalamus.

pituitary function is assessed by the target gland function, not by measuring the pituitary hormone as an isolated event. This is in contrast to target gland function being assessed by the pituitary hormone

kallmans syndrome is isolated decrease in GnRH + anosmia

in pregnancy pituitary gland is enlarged. when postpartum hge happens this leads to ischemic pituitary necrosis.SHEEHAN’S SYNDROME

revision

Adrenocorticotropic hormone, as its name implies, stimulates the adrenal cortex. More specifically, it stimulates secretion of glucocorticoids such as cortisol, and has little control over secretion of aldosterone, the other major steroid hormone from the adrenal cortex.

i always forget this!!!!!!
rememberrrrr!!!

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low blood glucose stimulates production of growth hormones!!! hence insulin stimulation test causes increase GH IN NORMAL PPL AND GH IS NOT ELEVATED IN THIS CASE!! in hypopituitarism that iss…

extras

ACTH is produced in a process that also generates several other hormones

The major attributes of the hormones other than ACTH that are produced in this process are summarized as follows:

Lipotropin: Originally described as having weak lipolytic effects, its major importance is as the precursor to beta-endorphin.

Beta-endorphin and Met-enkephalin: Opioid peptides with pain-alleviation and euphoric effects.(SUBHANALLAH.ALLAH CREATED INNER PAIN RELIEVERS FOR US HUMANS! syukurillah)

Melanocyte-stimulating hormone (MSH): Known to control melanin pigmentation in the skin of most vertebrates.(take note!!!!! in absence of acth, this process is diminished thus DEPIGMENTATION OCCURS IN ARESS NORMALLY PIGMENTED eg; areola)

psssst: kontot notes. will be updated in the future. OSCE ALARM: 3 MORE DAYS IM RUNNING OUT OF TIME STOP PROCRASTINATING.

lillahitaala! itqan fil ‘amal

for the pleasure of my eyes:

normal mri of pituitary gland. oh my cute lil pituitary looking like an edible M&m.

!

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empty sella synd.

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here
and here

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Liver enlargement

yesterday we were confronted with a patient with the following complains

60 yo man,married,ex smoker, smoked for 35 years

c/o: rt hypochonrium pain, 4 years ago, present all the time, it was stitching pain gradually increasing by time, unrelated to food intake, radiate to both should, aggraveted by lying on his right side and by inspiration, and disappeared during expiration. after 1 y he complains the dyspnea, cough with sputum.
constipation: since 1.5 years. dark brown
urine: tea colored urine

loss weight as much as 10 kg over the past 1.5 years. no fever

( i wanted to analyse the dyspnea and cough but my colleagues ‘assumed’ that it wasnt dyspnea but rather due to the diseased liver. i hesitated this assumption . however since we were running out of time, i didnt analyse further. it turns out that the patient has bronchial carcinoma . so the lesson learnt here , its a mistake to assume a patients complaint and exclude it without analysing. such details may lead us to important findings)

how to dd tea colored urine due to hematuria or presence of bile without lab investigation?
leave the urine in a container for some time and in hematuria, there will be sediments of RBC at the bottom.

if you see a jaundice patient DONT FORGET TO ASK/FIND ABOUT
urine and stool
Tremors
spider angioma
evidence of hemolysis
gynecomastia
oedema
PRURITIS!!!!!!!(obstructive jaundice)
clubbing
alcohol intake!!!!!
blood transfusion!!!!!!(source of hepatitis/ mismatched blood)

in liver failure there is hyperestrogenemia due to?INCREASE CONVERSION OF TESTOSTERONE TO ESTROGEN DUE TO INCREASE IN SEX BINDING HORMONE.
i was always told that hyperestrogenemia is due to failure of metabolism of estrogen due to the impaired liver function. both can be correct i guess?

postive findings: enlarged liver and spleen. State the span of the organs!

during palpation the first thing you have to notice or note at is the tenderness!! look at your patients in the eye!!!

alkaline phosphatase

In humans, alkaline phosphatase is present in all tissues throughout the entire body, but is particularly concentrated in liver, bile duct, kidney, bone, and the placenta

High ALP levels can show that the bile ducts are blocked.[11] Levels are significantly higher in children and pregnant women. Also, elevated ALP indicates that there could be active bone formation occurring as ALP is a byproduct of osteoblast activity (such as the case in Paget’s disease of bone)

Placental alkaline phosphatase is elevated in seminomas[12] and active form of Rickets.-wiki

in this patient, hi level suggests obstruction in the biliary ducts. do GGT to know the source of the hi ALP.

The main value of GGT over ALP is in verifying that ALP elevations are, in fact, due to biliary disease; ALP can also be increased in certain bone diseases, but GGT is not. – wiki source

pssst: Aldactone can also cause gynecomastia!!!!

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hypoglycemia

important notes:
there is no definite numbers. it simply means low blood glucose level or relatively low.
in hypolycemia unawareness, its vital to treat them early because they go into coma faster!

what leads to hypoglycemia?
low levels of counterregulatory hormones
low source of glucose
hi insulin

renal impariment leads of hindered degradation of insulin hence decreasing requirements of insulin intake in diabetic patient! ( esp since they may have DM Nephropathy)

females. have overactive parasympathetic flow hence they are more liable to early postprandial hypoglycemia.

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crohn’s , diarrhea

1st day in git.

CASE 1: CROHN’S DISEASE

our case for today was a man of 50 y of age complaining of chronic diarrhea since 1 y 2 m .he complained of diarrhea at first, and then it was followed by diarrhea with streaks of blood and mucous, also diffuse abdominal pain. not related to eating. irrelevant family history. he had thyroid mass before and did an operation beforehand. also there was nocturnal diarrhea

dx: crohns disease.

ok what i want to ask if i had more time.analyse the abdominal pain. was there vomiting? did he suffer similar conditions before? how frequent did he defecate? consistency of stools? colour? was it fresh blood? any other complains?( think of the extraintestinal manifestations of IBD). effect of fasting( osmotic diarrhea stops but secretory diarrhea persists)?of course drug history is essential( think of antibiotics, laxatives, toxics) other associated diseases? diseases in other systems? ( DM- autonomic neuropathy, endocrinal- hyperthyroidism,) condition improved upon defecation? how severe was his diarrhea? acute chronic intmittent?hx of travel !!! alcohol? fhx! nocturnal diarrhea?(suggests organic disease

DDx diarrhea:
gastroenteritis ac
parasitic infestation( giardia lamblia)
IBS
IBD
CRC
gluten enteropathy
coeliac disease
drugs- antibiotics, laxatives, toxics
malabsorption!!!
autonomic neuropathy!!
SSc
hyperthyroidism!!!!

psst: think of other systems too!

mallory weiss syndrome: tear of the lower end of oesophagus , commonly due to retching.only involves the mucosa and submucosa unlike boerhaave syndrome which is transmural in nature.in this case there is rupture of the oesophagus.there is neuromuscular incoordination. most common site is leftposterolateral part of lower oesophagus. boerhaave synd. is likely to be more severe in presentation- expect shock. however diagnosis can be difficult.

prolonged diarrhea is an indication to perform endoscopy!

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git

ill enter git dept tomorrow. somehow i still possess the need to be inspired by cardiologists.
failing to answer wont completely deny the intelligence i am gifted with. maybe its not as much, but i am blessed and grateful. my intelligence is merely borrowed.i never or truly own it.

wasting time is inevitable nowadays.
i must work harder.
osce is next week!

first post

salam
this is my first ever post in my medic blog. this blog will revolve around the things i do as a medic student. and im already in the sixth year of medical school.its still not too late. i dream to become a cardiologist one day. my inspiration has to be my intelligent professors and my own father, who cant proceed his dream of becoming a cardiologist for some reasons.

everytime you begin to dream of achieving something, renew your intentions, qalbun abyad.

i want to be a cardiologist,lillahitaala.

lets study and work hard like a mad man.