Happy Halloween!

What's this? What's this?

Jack Skellington looks cachexic and probably has COPD... or CHF... or cancer?

Aspergillus

Or is it ASSpergillus?

Small Cell Carcinoma

What a great show.

Small cell carcinoma: known for it's high N:C ratio and salt and pepper chromatin coloration!

DASH Diet

I actually HATE celery. Wait, that's broccoli. Fail. 

You're probably wondering why I'm acting as a public service announcement this week. Well, the answer is: without classes, I have no idea what to draw! I also like drawing pictures of fruits with smiley faces.

The DASH diet is recommended as one of the main components in the treatment for hypertension (BP >140/90). 

It pretty much consists of eating healthful foods: the whole nine yards of fruit/vegetables. I probably am not the best person to talk about healthful diets (if alcoholics use a drink as an "eye-opener" in the morning, I used to use ice cream as mine), but eating stuff other than only oil drenched cheese (which tastes good) really does wonders for the body. It's also much better to eat well than remember to take a pill everyday.

CAGE Assessment

It'd be kind of cool to get into a bar fight.

This is a picture of a liver. Livers do a lot for your body. Sometimes excessive alcohol consumption makes the liver cry.

Because of my genetics, even the slightest drop of alcohol makes my face turn a bright red color. Actually, it's not only my face that looks like it's terribly sunburned: I get red on my chest too, which is really embarrassing.

I share this story not because I'm trying to say that alcohol is terrible for you; I kind of need drunks around to laugh at on occasion. The purpose of this post is a reminder that binging a couple times of week isn't a good idea. 

So anyway... if you're assessing for an alcohol problem, use the CAGE questions:

C: Have you ever felt like you have to cut down on your drinking?

A: Have people told you that they are annoyed with your drinking?

G: Have you ever felt guilty for your drinking?

E: Do you drink right away in the morning as an "eye-opener"?

Smoking Cessation

There are probably more cigarette smokers in Las Vegas than hookers. That's a lot of smokers.

I don't have many pet peeves, and I do respect what people choose to do to their own bodies, but smoking is just bad. I've seen my grandpa go through lung cancer and it's not a pretty sight. I wouldn't say I'm advocate for smoking cessation per se, but I would love to see more people smoke free in the future. Alright, I'm off of my soapbox now.

Ventilation-Perfusion Ratio (V/Q)

"You have smoked yourself retarded." - Dave Chappelle from Half Baked

Is it just me or does the ventilation-perfusion ratio (V/Q) pictures in physiology books (BRS Physiology in particular) look like a bong?

I'm not an advocate of marijuana or any other mind-altering substance for the matter, but I can't help but place stoner comedies in my top three favorite movie genres. The best stoner films I've seen to date? 1. Half Baked 2. Pineapple Express 3. Harold and Kumar go to White Castle. 

As for actual learning points: when the V/Q ratio approaches 0, arterial blood gas numbers begin to look more like venous blood gas numbers. When the V/Q ratio approaches in infinity (WHO DIVIDES BY ZERO?! WHY WOULD YOU DO THAT?), alveolar blood gas numbers look like the gas numbers found in inspired air. 

More Halloween!

The best part of Disneyland's Haunted Mansion? The crystal ball room. 

Well, I had a line of drawings ready for posting but then I remembered that I care too little to get out and scan everything to the computer. I'm opting for the lazy man's out today.

Also, my coccyx probably broke from the skating last night. If you're wondering how I skate, I skate like I've just had a prolapse. 

1/3 Party

2/3 to go!

You know all those fun activities you were supposed to have accomplished as a child?: sleep-overs with friends, making snowmen, being able to properly use the monkey bars (ie: not flail around and just hang there), roller skate. Well, I've never really done any of them before. But today, everything changes! Well, somewhat.

Today we're going roller skating to celebrate our completion of 1/3 of med school and I'll have the opportunity to make a fool of myself on wheels rather than on foot. So anyway, congrats class of 2013, I'll see you at the rink!

Psittacosis (And Alcoholism)

"Calling all captains!"

In our recent lower respiratory infections lecture, I only remembered two things.

Firstly, having pneumonias with a history of bird exposure (eg. parrots, parakeets, turkeys - happy early Thanksgiving) makes it likely you have Pscittacosis. 

Second, alcoholics are likely to have pneumonias caused by Klebsiella, normal oral flora, S. aureus, or S. pneumoniae. 

And if you're exposed to both (a Captain Morgan-swigging pirate parrot for example)... who knows what caused your pneumonia!

Tension Pneumothorax

"It rubs the lotion on its skin or it gets the hose again." - Buffalo Bill (Silence of the Lambs)

Since all the pulmonologists here seem to go absolutely mental over the fact buffaloes have communicating lung pleura (which apparently made it really easy for Native Americans to ARROW them back in the day), here's a buffalo for your viewing pleasure. I know what you're thinking: it looks like an ox with a fro or an ox with its brains splattered out. Or maybe even a pig.

Anyway here's the fact of the day: a tension pneumothorax occurs where there is a penetrating tear to the pleura. This tear looks like a flap and acts as a check valve in that it allows air into the pleural cavity but not out. Thus with each breath, there is an increase in pleural cavity pressure.

Head Out Like A Fetus

Word up son!

Our class is trying to come up with a motto. This one was my favorite (courtesy of a really fun classmate).

Cri du Chat Syndrome

Sacre bleu!

Cri du chat is French for CRY OF THE CAT! But it's also the name of a genetic syndrome in which there is a congenital microdeletion on the short arm of chromosome 5. Findings include high-pitched crying that sounds much like a cat's mewing at birth, mental retardation, epicanthal folds, and cardiac abnormalities. 

This cat doesn't have a stripey shirt or mankerchief, but does have a beret and sleazy moustache. Stereotypes FTW.

Syphilis

Back then, having syphilis was the cool thing to do. 

Sorry I haven't had time to update the posts with information! I'll update all posts next weekend with relevant facts instead of silly cartoons.

But first off, syphilis can affect the dorsal (posterior) column of the spinal cord. It is also caused by a squiggly bacteria that is part of the group collectively known as spirochetes. 

Folate Deficiency

"Ah-gah-gah-gah-gah-gah" - Popeye

Hypersensitivity Pneumonitis

Watch Hitchcock's "The Birds"! Or North by Northwest. 

When I hear hypersensitivity pneumonitis, I think of bird fancier's disease. I also think of the time back in middle school when my school had a really bad seagull problem and I got bird poo splat all over me a frequent basis. They finally put wires across the buildings to keep the birds out, but not before putting fake owls on top of classrooms to "scare" off the gulls.

Primary Ciliary Dyskinesia

"You can learn a lot of things from the flowers..." - Alice in Wonderland

There are a couple of disorders resulting in bronchiectasis: cystic fibrosis, infections, bronchial obstruction, allergic bronchopulmonary aspergillosus, and also primary ciliary dyskinesia.

In primary ciliary dyskinesia, there is an absence of dynein arms in cilia. Dynein arms contain ATPase for the movement of cilia. As you might guess, the lack of dynein arms will impair the ability of the ciliated epithelial cells in the respiratory tree to clear up mucus and other respiratory secretions.

Kartagener's syndrome is a subset of primary ciliary dyskinesia. It features symptoms including bronchiectasis, situs invertus, and sinusitis. Situs invertus occurs when there's a mirror image of the major organs. CRAZY!

Usual Interstitial Pneumonia (UIP)

The really ugly mascot for Post's Honey Comb cereal!

Honey-combing is found in radiographic images of patients with Usual Interstitial Pneumonia.

Halloween Countdown!

"I am the who when you call who's there" - Nightmare Before Christmas

Using an online photo editing software is cheating but I couldn't be bothered to draw in the spider webs AND I didn't want to draw anything new (I believe in recycling... images).

Only a couple weeks to go until I get a reasonable excuse to gorge on candy.

Desquamative Interstitial Pneumonia (DIP)

Macrophages on the Fun Dip Stick!

Bronchiolitis Obliterans Organizing Pneumonia (BOOP)

Never really got the appeal to Betty Boop.

Bronchiolitis Obliterans Organizing Pneumonia (BOOP), also known as Cryptogenic Organizing Pneumonia (COP). 

I haven't studied this much yet... wait for some information tonight!

10-10-10

I know this deviates from the traditional format I've created for this site but watch this video in honor of 10-10-10. PREASE WATCH IT. 

Diphyllobothrium latum Sushi

itadakimasu!

TAPE WORMS: Diphyllobothrium latum. Ugh. I always found it kind of gross that these tape worm segments (proglottids) break off into your stools, releasing all those little eggs. We were told by our hematopathologist professor that you can get this tapeworm from eating raw fish. Because I really like sushi, this kind of disturbs me. It doesn't stop me from eating sushi though, just like how all the coronary artery disease lectures haven't stopped me from eating fried chicken and pizza.

The relevance behind Diphyllobothrium is its relationship to vitamin B12 deficiency (vitamin B12 is also known as cobalamin). This tape worm will end up absorbing all the body's B12, which will eventually lead to a vitamin B12 deficiency induced macrocytic anemia characterized by the presence of megaloblasts and hypersegmented neutrophils. Remember, B12 is an important for DNA synthesis and is needed in the enzymes L-methylmalonyl-CoA mutase and methionine synthase. You will see elevated levels of both L-methylmalonyl-CoA and homocysteine in a vitamin B12 deficient patient. 

Giardia lamblia Will Give You FATTY DIARRHEA

The Giardia trophozoite form kind of reminds me of the Sentinels in the Matrix. Kind of. Barely.

Protozoans! They're not bacteria, they're not viruses, and they're not fungi either. They're weird little organisms in Kingdom Protista, and they also cause a bunch of diseases.

Giardia lamblia is one of the coolest looking protozoans out there. These protozoans cause Giardiasis, which is characterized by greasy, foul-smelling stool and other GI disturbances. You get Giardiasis from drinking the cyst form in water. Mmm.

This is the trophozoite form of the organism that you can find in your stool if you happen to have Giardiasis. Treatment: Metronidazole, whose mechanism of action ultimately leads to the build-up of toxic metabolites.

Wikipedia also calls Giardiasis BEAVER FEVER?!

Right Upper Lobe Bronchus

Free Willy!

At the request of an awesome friend/classmate, here's an inaccurately drawn CT scan of the thorax (totally not going to be a radiologist) cutting through the right upper lobe bronchus at around the level just below the carina. The right upper bronchus looks like a whale!

Remember when Shamu at Sea World killed that trainer last year?!

The Black Lung

"What is this? A center for ants?"

Derek Zoolander after being in a coal mine for a day: "I think I'm getting the Black Lung, Pop. It's not very well ventilated down there."

I do realize this is a BAD drawing of Zoolander but I can't stop quoting from the movie. *high pitched cough*


Causes of nocturnal cough: GERD, bronchial asthma
Causes of productive cough: chronic bronchitis, bacterial pneumonia, bronchiectasis
Drugs causing cough: ACE inhibitors, aspirin

PEACOCK!

Teaching Point #1  

Without naming any particular names, I really enjoy the infectious disease doctors at the hospital.

Respiratory Epithelium: Goblet Cell

Harry Potter and the Goblet of Mucus.

Yesterday, no one came to microanatomy class. I did though, and this is what I kind of learned:

Respiratory epithelium differs based on where you are along the respiratory tract. In the nasal mucosa, you'll find pseudostratified columnar epithelium with the following cells: goblet cells, ciliated cells, and basal cells. Underneath this is a vascularized lamina propria with mucous/serous glands. 

Goblet cells secrete mucin, ciliated cells beat up all the junk in your airway towards the pharynx, and basal cells are stem cells. 

Down the respiratory tract you'll lose the goblet cells and then you'll see all the cool lung-y stuff. 

Also, I'M TIRED.

Pulmonary Fun Facts

It should really be Woo-Tang Clan. 

Just began studying the respiratory system and what better way to start it off than with a review of structures that pierce through the diaphragm?!

Level at which things pierce through the diaphragm:

T8: Inferior Vena Cava

T10: Esophagus 

T12: Aorta 

The lungs remind me of an upside down Wu-Tang Clan symbol. Word.

We Do It Periodically On The Table

Chuck Norris destroyed the Periodic Table because he only recognizes the element of surprise.

Here's another short post to start off the week, this time celebrating chemical pathology, which I unfortunately know nothing about! I guess pure elements seem more oriented towards radiology sometimes, and remember, iodine and gadolinium contrasts agents can be bad for you! Anyway, chemical pathology exists, according to the AAMC.

This post is also a tribute to my love of chemistry, but too bad I've forgotten everything!

Cocciodiomycosis: San Joaquin Valley Fever

Dream of Californication

California: the Golden State, my old stomping ground, my home. I grew up in LA, yet despite my close proximity to both Hollywood and the beach, I grew up to become a social hermit who really dislikes sunbathing and sunlight. But man do I love California...

Today's post is all about microbiology and I've decided to celebrate California with Cocciodiomycosis!

The San Joaquin Valley is a lovely area in California. I would say it's most famous for being associated with the systemic fungal infection, Coccidiomycosis, but SJV natives would say that there's more to it than just fungal diseases. Other systemic fungal diseases include Blastomycosis and Histoplasmosis. These are found more towards the Mississippi River, which too is a nice place.

Systemic fungal diseases are usually acquired through the inhalation of spores. The presentation may include acute lung disease that may resemble tuberculosis. It may also spread systematically and lead to cutaneous lesions.

All the systemic fungal diseases display dimorphism - they come in two shapes. For Coccidiomycosis, it is shaped as a spherule with endospores within human tissue. In culture one may see some barrel shaped anthrospores.

Graft Vs Host Disease

Mike Tyson bites ears and was brilliant in The Hangover.

Nothing much to say about GVHD for now except that things would work out better if host and graft cells just got along after transplantation. Happy Saturday!

Caesar Says: This Post Makes No Sense

Carpe Diem

I don't know where I was going when I drew Julius Caesar (yes, the resemblance is a little questionable I suppose), but I still felt the need to share him with the world. As I'm currently cramming all the information I can about cardiology, I've decided to fill this post with a cardiology fact of the day!

The difference between eccentric and concentric hypertrophy:

Eccentric hypertrophy: increased preload, hypertrophic sarcomeres added in series.

Associated causes: mitral/aortic regurgitation, left to right shunt

Associated cardiomyopathy: dilated cardiomyopathy

Concentric hypertrophy: increased afterload, hypertrophic sarcomeres added in parallel.

Associated causes: Hypertension, aortic stenosis

Associated cardiomyopathies: hypertrophic and restrictive cardiomyopathies

-----

The difference between systolic and diastolic dysfunction:

Systolic dysfunction: volume overload, decreased ventricular contraction and decreased ejection fraction.

Associated causes: ischemia, myocardial infarction, dilated cardiomyopathy

Diastolic dysfunction: resistance to filling and normal ejection fraction.

Associated causes: hypertension, aortic stenosis, hypertrophic cardiomyopathy, restrictive cardiomyopathies