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  1. #1
    Array جوري's Avatar
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    The Medical student Review (OP)


    I don't know how many med students there are on board, or how useful this review will be for you.. I am a firm believer in slow and consistent than an intellectual enema two days before the exam where once released never again to be regained.. So what I plan to do here, is share some things I feel are important..

    In my pre-clinical years, I was president of the pharmacology club, and I enjoyed teaching it and exchanging ideas with others.. so if you have your own forte, quirks mnemonics that you'd like to share we can make a useful compendium..

    I am only going to focus here on pharmacology and diagnostic testings.. so every day I'll give you five of each..

    I am not going to start in any particular order but once in a section, I plan to complete it.. this will be just the high yield..


    __________________________________________________ ___________

    Oncology diagnostic testing
    _____________
    AFP (what disease is associated with it, and when do you answer this for a question?)
    AFP is associated with the development of
    1-hepatocellular ca.
    2-ovarian cancer
    3-non-seminomatous germ cell tumors
    Answer AFP when you see a patient with alcoholic cirrhosis or chronic hepatitis B or V. AFP together with radiological imaging is used to screen for hepatocellular ca

    ____________________________________________
    CEA
    1-A protein elevated in a variety of cancers including colorectal cancer
    2-serum CEA have a prognostic value in pts with newely diagnosed CRC. Those with higher levels have worse prognosis.
    3-CEA level to monitor in colon cancer in pts after a surgical resection, it determines the presence of persistent, recurrent or metastatic disease

    __________________________________________________ ___________
    Colposcopy
    Colposcopy is the direct visualization of the cervix, by use of a magnifying scope with a lamp
    2-The transition zone must be visualized to ensure an adequate colposcopy. The border between squamous and columnar epithelium
    3-a colposcopy is the answer for a pt with an abnromal pap
    Atypical squams can't exclude high grade lesion ASC-II
    low grade squamous intraepithelial lesions LSIL
    high grade intraepithelial lesions HSIL
    Atypical sqams of undetermined significance ASCUS if HPV DNA testing is positive
    __________________________________________________ ___________
    Estrogen and progesterone receptors
    Should be done on all pts with breast cancer, in order to determine who should receive hormone therapy
    2-Therapy with either tamoxifen or raloxifene should be added to any pt. with positive receptors. This is either for estrogen or progesterone positivity alone or in combination. The response to tamoxifen is better if both receptors are positive
    __________________________________________________ ____
    Mammogram
    screening should begin at age 40 and should be performed every 1~2 years, screening at age 50 should be yearly
    2-when mammogram shows abnormalities, a core biopsy including sentinel lymph node biopsy is the next best step. carcinomas of the breast are associated with clustered polymorphic microcalcifications.
    3-screening lowers mortality most after age 50 and the dec is greater than that of a colonscopy or a pap smear
    __________________________________________________ ________________

    Now pharm
    _____________

    will start with infectious disease because it is the longest chunk
    Acyclovir/valcyclovir/famiciclovir

    all the above are the correct answer for
    Herpes simplex including, genital, cutaneous, orolabial
    for Herpes Encephalitis (acyclovir) IV form only in a hospital setting
    Varicella zoster
    shingles: Herpes zoster or reactivation
    Bell's palsy

    the above meds work by inhibition of thymidine kinase
    -most common adverse effects are nephrotoxicity presumably from precipitation of the meds in the kidney tubule, sx of neurological toxicity in the kidney tubule, sx of neurological tox, such as confusion, tremors and hallucination occur rarely
    __________________________________________________ __
    Rifaximin
    used to treat travelers' diarrhea such as that from E.coli, it isn't used for invasive diarrhea. an associated fever and bloody diarrhea indicate and invasive pathogen, such as campylobacter. When fever and bloody diarrhea are described, ciprofloxacin is the best answer.

    rifa is a nonabsorbed version of the rifamycin antibiotic, it inhibits ribosomal RNA production of essential proteins
    There are no major side effects since it isn't absorbed from the GI tract. it doesn't cause C.Diff, and may in fact treat it.
    _________________________________________________
    Daptomycin and Linezolid

    they are both used for gram +ve organisms such as MRSA, streptococci and vanc resistant enterococci. Linezolid is the only oral antibiotic for MRSA. They can both be used for Vanc resistant organisms .

    Liezolid is an oxazolidinone and inhibits protein synthesis at the ribosome. Daptomycin is a cyclic lipopeptide and disrupts cell membrane they are both unique classes of drugs

    Linezolid commonly causes thrombocytopenia, and is a MAO inhibitor, avoid tyramine foods. Dapto caused CPK on liver functiion tests to be elevated!!
    __________________________________________________ _____________
    Tigecycline
    an extremely broad spectrum anti-biotic that covrers MRSA, staph aureus, and well as gram negative bacilli. Tigecycline is the answer for complicated hospital of ICU acquired infections, tigecycline alone is equivalent to vanc and aztreonam in combination, it is also active against resistant enterococci and PCN resistant penumococcus

    tigecycline is a glyclycyline antibiotic that binds to the ribosome and inhibits protein synthesis, it is unique that it covers staph, strep, gram negatives, anerobes and organisms resistant to vanc
    tigecycline is hepatotoxic , caused nausea and diarrhea
    __________________________________________________ ________

    Polymyxin B (PMB) and colistin
    useful for conjunctivitis, infections of the skin, and otitis externa, also correct for multi drug resistant gram negative bacilli, that cause ventilator associated pneumonia and sepsis from pseudomonas or acinetobacter.

    works by disrupting phospholipids in the cell wall membrane
    Polymyxin B (PMB) and colistin are very toxic to the kidney and nerves and is limited to topical applications of the skin and ear, they are also used for multi drug resistant gram negative bacilli when there are no other therapeutic options..

    __________________________________________________ ______
    That is it for today..
    The Medical student Review

    Text without context is pretext
    If your opponent is of choleric temperament, seek to irritate him


  2. #121
    جوري's Avatar
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    Re: The Medical student Review

    Report bad ads?

    here is a good start:

    http://www.amazon.com/High-Yield-Bio...lp_edpp_img_in

    buy it used for seven bucks.. formulas don't change.. but people get greedier...

    The Medical student Review

    Text without context is pretext
    If your opponent is of choleric temperament, seek to irritate him


  3. Report bad ads?
  4. #122
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    Re: The Medical student Review

    Quick note on distinguishing between stress incontinence, urge incontinence and overflow incontinence..
    obviously stress is easy to diagnose with the Q tip test and the patient will complain of loss of small amounts of urine, during coughing, sneezing, this is treated either with kiegel exercises or surgery depending on the severity by attaching the sphincter to the pubic symphysis.

    Overflow incontinence also known as hypotonic incontinence results in involuntary loss of urine, typically due to ineffective detrussor contraction. the hypotonic bladder muscles allow for bladder pressure to exceed urethral pressure , resulting in intermittent emptying of urine in small amounts all throughout the day (the word small here is operative) Think of this etiology with diabetic neuropathy, MS or anticholinergic meds. These pts experience pelvic fullness due to the increased residual volume of urine. RX. is anticholinergic blockers to relax the bladder neck, intermittent cath maybe necessary in refractory cases.

    similarly urge (hypertonic) incontinence also results in loss of urine day or night, but in much larger amounts and without warning due to involuntary rise in bladder pressure from excessive idopathic detrusor muscle contractions. these cases require treatment with anticholinergic meds like oxybutinin, note that this med would exacerbate (overflow) hypotonic incontinence as such it is important to work out the difference.

    I know I have gone over this in the previous pages but thought I'd simplify it even more..
    The Medical student Review

    Text without context is pretext
    If your opponent is of choleric temperament, seek to irritate him


  5. #123
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    Re: The Medical student Review

    Getting back on track with some disorders of the immune system.

    1- Primary immune deficiency also known as (CVID) common variable immune deficiency
    it is an abnormality in B cell function, presents from one year to adulthood, when the onset is in adulthood the patient may have an underlying lymphoid malignancy-- presentation with recurrent bacterial infections involving the sinuses, middle ears, when the lung is involved it means there is systemic disease, treatment is with lifelong IVIG

    2- Hyper IgE syndrome also known as (job's syndrom)
    recurrent skin, and visceral abscesses mostly due to staph with an elevated level of IgE

    3- DiGeorge's syndrome -- secondary to deletion of chromosome 22q11, affecting the development of third and 4th pharyngeal pouch, causing anomalies of face, thymus, parathyroid and cardiac structure like tetraology of fallot. There is an absence of T cells secondary to absence of the thymus. there is also hypocalcemia secondary to hypoparathyroidism so they'll present with tetany and seizures rx is a BMT

    4- Wiscott Aldrich syndrome:
    mix of immunoglobulin defects as well a t cell deficiency, eczema in the early yrs resembling atopic dermatitis, thrombocytopenia, the immunoglobulin pattern is as such IgG normal IgM low, IgA and E very elevated. Infexns from encapsulated organisms. They have an increased incidence of Hodgkins. RX BMT
    if BMT isn't feasible due to absence of HLA matched donor then a splenectomy is the RX of choice (so remember immunizations) and that is reserved for pts whose plts count is less than 50,000 IVIG every three to four weeks.
    ABX prophylaxis with amoxil or tmp-smx daily.

    5- SCID
    absence of both cellular and humoral immunity, starts in the neonate, recurrent diarrhea, infexn and failure to thrive. chronic mucocutaneous candidaiasis is common early finding. attenuated live vaccines such as OPV can cause reversion and severe infxn.
    blood transfusions can cause GVHD -- lab findings are lymphopenia absolute lymphocyte count less than 2000/mm cube, hypoglobulinemia, impaired specific antibody response, cutaneous anergy . RX BMT

    6- ADA deficiency
    profound lymphopenia absolute lymph count less than 500/mm cube
    chondro-osseous dysplasia of constochondral junctions -- verteberal bodies reveal rachitic rosary rib cage

    7- chediack Higashi syndrome
    phagocytic disorder, neutrophis contain abnormal giant granules due to inappropriate fusion of lysosomes and endosomes. Recurrent pyogenic infections, partial oculocuteanous albinism, neurological abnormality photphobia, seizures, disorders of spinal tract and cerebellum.

    8-
    IgA deficiency
    most common primary deficiency -- predominant Ig of nasal secretions. Most pts are asymptomatic but may develop recurrent sino-pulmonary infexns, recurrent gi infexns with giardia, anaphylaxis to transfusion rxn.

    9- Ataxia Telangictasia:
    progressive cebellar ataxia since the beginning of walking, slowly worsening by 10-12 become wheelchair bound
    occular or facial telangiectasia, elevated alpha feto protein in more than 95%.. Immunodeficiency absent or low IgA and IgE level..
    no effective rx
    The Medical student Review

    Text without context is pretext
    If your opponent is of choleric temperament, seek to irritate him


  6. #124
    azzedinefaizan's Avatar
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    Very eloquent. I also find this explanation very profound: "Allah the Almighty, Who is the Maker of the universe and of all beings in it, created the universe for very significant purposes. Quran informs this as follows:

    Not for (idle) sport did we create the heavens and the earth and all that is between. (Anbiyya Surah, 21:16)

    Not without purpose did we create heaven and earth and all between (Sa Surah, 38:27)

    All beings glorify and magnify the Exalted Creator with their languages. They fulfill the tasks with a pleasure and enthusiasm, which are assigned to them. For example, the sun, without falling behind even a second, moves around the orbit, which has been drawn for it. Rivers enthusiastically flow into seas. Animals, which have been given under the command of man, serve him with an absolute obedience.

    Besides, if the universe had not been created, the never-ending perfection and beauty of the names and attributes of Allah Almighty would have never been known. This would have only been known by Allah (SWT). By manifesting the spiritual beauties of His names and attributes, Allah Almighty, besides beholding His own Beauty and Perfection on His own works, also wished to give a share to angels, man, and jinn from this honor and bestowal.

    Regarding the question of whether to create the beings or not to, Allah (SWT) made His Divine preference for creation, and this preference has become an interminable mercy for all creatures. Or else it is unthinkable that Allahs, one of Whose names is Samed (everything is in need of Him but He is in need of nothing), creation of this universe stems from a necessity."

    http://www.questionsonislam.com/arti...reate-universe


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