by Stuart Enoch, PhD, Noor Sash, PhD, Jill Beavers-Kirby u.a. (3022)
Everything you ever wanted to know about medicine – in one package!
Lecturio’s “Medicine Flat Rate” includes all current and prospective medical courses. It will provide you with invaluable guidance and comprehensive support for your study and training – not only for medical students, but also for nurses and non-medical practitioners.
You will get access to an impressive variety of lectures held by renowned experts, such as the editor-in-chief of The American Journal of Medicine, Prof. Joseph Alpert.
Our team of highly qualified medical professionals will guide you through the following main topics:
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In this article, we will be reviewing mainly about the advanced therapies which are available for pulmonary hypertension with the brief coverage of primary therapy. The advanced therapies are especially studied for IPAH.
Without the liver, we would not be able to metabolize some components of the food, drinks, and medications that we eat; there would be problems in hemostasis and we would not be able to properly digest the food that we eat, particularly fatty ones. These are only a few among the many contributions of the liver to homeostasis. However, there are also a lot of factors that can bring damage to the liver. Although the pathogenesis of liver diseases are most likely caused by a combination of a lot of factors, there have been well-studied disorders where genetics play the most crucial role in initiating disease. An example of which is alpha 1 antitrypsin deficiency.
The advances in modern medicine have brought about a lot of changes in how we deal with illnesses. One of these relatively new found technologies is the use of medications. However, this has led many to assume that all of the diseases suffered can be treated with medications alone. The danger is more prominent among those who take these without the consultation of health care providers. A poor understanding of the mechanism of actions of the readily available medications can also bring more harm than good for individuals who prefer to deal with their sickness by themselves. An example of a heavily affected organ during drug toxicities is the liver. In this article, we will understand how excessive and inappropriate intake of medications affect the function of the organ.
The small and large bowels are parts of the digestive tract, they are responsible for digestion and absorption. The large intestine plays a large role in fecal formation and storage, as well as absorption of water, minerals, and vitamins. Any alterations in the integrity of this region of the digestive tract can result in subsequent issues. One of the most prevalent conditions that could lead to this is the development of new growths or neoplasms in any of the layers of the intestines. Among the two, neoplasms occur more commonly in the large intestine. In this article, we shall look into different types of polyps and cancerous growths, particularly hamartomatous polyps and the Lynch syndrome.
Our body is able to make use of the metabolic sources in the environment by way of the alimentary tract. In order for it to serve as a conduit for the food and other essential substances, it has to undergo specific functions such as food propulsion, secretion of digestive juices, and absorption of simplified nutrients and vitamins, among others. Needless to say, any interruptions in the continuity of any portion of the digestive tract would result in a lot of problems, including absorption. Small intestine bacterial overgrowth is an example of a condition that could result in malabsorptive conditions.
There are many illicit and licit drugs that are abused worldwide; it is estimated that approximately 9% of the population above 12 years of age use some form of illicit substance in the United States. Drug addiction and dependence contribute to significant morbidity and reduced quality of life and should be treated appropriately with medications and psychological interventions. Acute poisoning is also common; timely diagnosis and appropriate management could be life-saving. In this chapter, we will study the important pharmacological and clinical characteristics of commonly abused drugs from examination perspective.
How a drug works and what happens to it upon entering the body are important factors in drug design, in order to ensure optimal action in the desired amount of time. Drugs are absorbed from the site of administration into the systemic circulation, where they may interact with the proteins; they then reach their target tissues, changed or unchanged, and act on them. The moment a drug enters the systemic circulation, it starts to be simultaneously eliminated by certain biological processes. All these together constitute pharmacokinetics of the drug.
Multifocal atrial tachycardia is a type of atrial arrhythmia characterized by rapid heart rate with at least 3 or more P wave morphologies. It is termed multifocal since the signals arise exclusively from atrial tissues instead of the sinus node. For an adult, normal heart rate ranges between 60 and 100 beats per minutes. In multifocal atrial tachycardia, the heart rate range between 100 and 250 beats per minute. It is more common in people with serious cardiopulmonary diseases (heart-lungs).
In today's world, smoking is very common, and it is considered as a status symbol. Use of different kinds of tobacco in cigarettes and cigars is becoming a fashion. But most people are unaware of how critical this is for the development of cancerous ulcers. Almost five out of every 10 patients of Buerger's syndrome are smokers. Buerger tried to find the root cause of this particular problem. Here are the facts and figures one should consider when smoking frequently.
Many of the materials we use in our daily lives contain carbonyl compounds – from pharmaceutical agents to cosmetic products. This article will discuss the carbonyl compounds, focusing on their structures and chemical reactions. Carbohydrates will also be discussed in this article.
Hereditary hemochromatosis (HH), also termed “genetic hemochromatosis”, is a genetic autosomal recessive disorder which occurs as a result of genetic mutations of certain genes (HFE gene) involved in the metabolism of iron, resulting in increased intestinal iron absorption. Common initial symptoms comprise abdominal pain, paleness, lethargy, and weight loss. The start of symptoms is between 30 to 50 years in males and afterward menopause in females. If left untreated, hemochromatosis could cause serious disease and early death. The keystone of screening is the level of serum transferrin saturation as well as the serum ferritin level. Definition, risk factors, pathophysiology, clinical features, investigations and treatment of hemochromatosis will be discussed in this article.
Inflammatory bowel disease (IBD) is a chronic inflammatory disease of the gastrointestinal tracts and is comprised of two major disorders: ulcerative colitis (UC) and Crohn's disease (CD). Both diseases have characteristics that may be overlapping while other characteristics may be different. Characteristics which will be discussed in detail throughout this article.
In general, it is possible to distinguish between intramolecular and intermolecular bonds. The first group includes the ionic bond, atomic bond, and metallic bond. The second one includes the Van-der-Waals-bond and hydrogen bridges. These bonds have an important influence on the substance properties, such as solubility.
Nowadays, the human race is becoming more sensitive to the changes in the environment. This sensitivity may result in triggering a number of diseases, including Raynaud’s disease, which constitutes a change in the vascular functions of the human body. Conferring to the facts and figures of Raynaud, every 5 out of 100 Americans suffer from this disease. On the other hand, merely 1 out of 5 would pursue treatment. Raynaud's phenomenon most often affects women, rather than men, exclusively in the ages from 20 to 40. Raynaud's phenomenon can occur on its own or in relation to other medical conditions such as rheumatic diseases. Read on for an extensive explanation of Raynaud’s disease.
Thyroid hormones are amine hormones produced by the thyroid gland. There are two types of thyroid hormones: triiodothyronine (T3) and thyroxine (T4). They are stored in thyroid follicles as a component of thyroglobulin. Once released in the blood, 2/3 of the hormones are transported while bound to Thyroxine-Binding Globulin.
A number of factors can affect the physical and chemical properties of compounds. One important factor is the electronegativity of atoms inside a molecule. Electronegativity is a measure of the tendency of an atom to attract bonding electrons toward itself. This property of atom affects the bond polarity and, in turn, how molecules will interact with other molecules. In this article, electronegativity and its effect on compounds will be discussed.
Congenital hypothyroidism is a condition caused by lack of thyroid hormones. This condition found in newborn infants. If left untreated, it may lead to severe complications including permanent intellectual disability or growth failure.
The human body is capable of many things: from organizing various cells into functioning tissues and organs to housing an entire human being. However, in between these processes, a lot of damages and repairs can occur. Although it is normal for us to employ certain defense mechanisms in order to prevent serious illnesses and to repair damage caused by such, there are some conditions wherein we get to have some trouble with our own immune system. An example of which is having any type of hypersensitivity. Read on to learn everything about it.
Vascular malformation has received large attention in recent years due to the frequent occurance in newborns. Therefore, the clinical features are studied, along with other pathological subtypes, to manipulate the root cause of the disease that seems ordinary but has a great impact on the body.
Pulmonary embolism (PE) is a fatal clinical condition that occurs as a result of mechanical obstruction of the pulmonary artery or its branches by any material (such as thrombus, air or fat) from anywhere in the body. Pulmonary embolism can be an acute condition, in which the signs and symptoms develop immediately after the event (i.e., the obstruction of the pulmonary vessels), or it can be chronic, in which the signs and symptoms develop progressively for years. In this article, you will be able to understand the definition, incidence, pathophysiology, risk factors, symptoms and signs and the prognosis of pulmonary embolism.
Abnormal looking cervix can be seen commonly in gynecology in day to day practice. It becomes necessary to differentiate between normal physiological changes brought by normal menstrual cycle from the anatomical and pathological disorders. Colposcopic examination of cervix with a stereoscopic binocular magnifying glasses is extremely helpful for identification of the possible etiology behind and exclusion of any cancerous growth to establish the diagnosis. The etiologic reasons of abnormal cervix can be physiological, infectious, abnormal growth and iatrogenic. This article provides a step-by-step approach to differentiating them.
Occupational lung disease covers a specific area of knowledge in respiratory medicine. In these cases, information on the patients's history play an important role in the detection of these disorders, guiding investigations and management. Awareness of this topic is essential.
Science has taught us that fats and cholesterols, despite their negative connotation, play a significant role in keeping ourselves in tiptop shape. From structural purposes to that of hormone production, lipids are an essential part of our body’s efforts to maintain homeostasis. However, problems do occur if there is an imbalance in the way that lipids are controlled by our system; this is where disorders such as the dyslipidemias come in. Fortunately, treatment modalities are also available to address this issue. In this case, it is important for us to understand the physiology of how our body maintains a healthy amount of lipids in order for us to gain some insight on how we approach patients with excessive lipid levels.
The availability of fast food and the automation of most daily activities in our society today have predisposed the majority of the world’s population to obesity and its related complications. Although the intermittent nature of our food intake requires us to store carbohydrates, proteins and fats in excess, it is undeniable that resources, particularly those from developed countries, have proven our efforts in doing this somewhat excessive. Fortunately, there are a lot of treatment plans available for people who are already having problems with nutrient metabolism, particularly that of lipids. This includes medications that can hasten our efforts to maintain a healthy level of lipids in the body.
The kidney is a key player in glucose hemostasis by two mechanisms. It filters and reabsorbs glucose from the urine and it releases the sugar during times of fasting through gluconeogenesis. Here you will read everything about it.
Gastrointestinal motility is one of the major roles played by the alimentary canal. In the esophagus, it serves to get the ingested bolus of food from the oropharynx to the stomach. In the stomach, this motility is responsible for the churning and mixing of food and turning it into chyme. This continues in the small and large intestines until the digested food can be excreted out of the anus. There are various anatomical and physiological components of gastrointestinal motility. It is very important for medical students and healthcare professionals to have a clear clinical understanding of these components.
As opposed to pharmacokinetics, pharmacodynamics is what a drug does to the body. When a drug is administered, it acts on the target cell populations by means of certain receptors. There are various types of receptors, and the drug-receptor complexes can produce a specific or a variety of pharmacological effects, based on the mechanisms activated. These effects can be desirable (therapeutic) or toxic/lethal and are often dose dependent. Thus, it is crucial to learn the pharmacodynamics of the drug to arrive at not only an effective, but also a safe dose, to the individual.
Despite its negative connotation, cholesterol actually plays an important role in our body’s homeostasis. It basically makes up the most important parts which keeps us alive and functioning. For example, the membranes that keep our cells together are made up of cholesterol. However, major problems do arise when there is an alteration along its metabolic pathway in the body. For one, an excessive amount of cholesterol in the body has been linked to a lot of disorders, such as atherosclerosis and fatty liver disease. In this article, we will tackle how cholesterol is metabolized in the body and see where, in the pathway, HMG-CoA reductase inhibitors alter the whole process.
From the name itself, lipoproteins are made up of complexes of lipids and proteins that primarily work as the transport system for cholesterol, triglycerides and other significant lipids needed by the body. Previously, the study of conditions related to problems in the metabolism of lipoproteins has been exclusive only for researchers focusing on lipids. However, it has been integrated into the inquiry of internists and other specialties as many researchers have provided a link between dyslipidemia and other highly prevalent conditions, such as atherosclerosis and fatty liver disease.
Hypertension has consistently made its way to the leading causes of morbidity and mortality in recent years. Millions of deaths and disabilities are being documented worldwide because of its complications, such as cerebrovascular accidents and ischemia in various locations in the body. Despite its notorious nature, hypertension is preventable and controllable. This is made possible by making use of various pharmacologic managements that are available today. One of the most common medications used to control blood pressure is a direct vasodilator.
Every day, more and more people are being diagnosed with hypertension. This increase in prevalence worldwide can be attributed to non-modifiable factors other than heredity, age and sex. Without the incorporation of a healthy lifestyle and the promotion of wellness, it would not be shocking for someone to be put at a higher risk for developing complications brought about by the ‘silent killer’. Fortunately, there are already a lot of programs and campaigns that promote lifestyle modifications present in our society. As for the people already stricken with the disorder, many treatment programs are also already available and are tailor made to fit any patient. In connection to this, many drugs are developed to alleviate patients from high blood pressure.
Along with the automation of daily activities and improvement in the availability of food in our society, comes the increasing incidence of persons having chronic lifestyle diseases. One of the most prevalent of these is hypertension. It is also important to emphasize that this ‘silent killer’ is becoming more popular among younger populations nowadays. Fortunately, organizations have come up with ways to tackle this problem, including a wide variety of pharmacologic management that would help lower and maintain blood pressure. One of which is the use of α-adrenergic blockers.
Pharmacokinetics, in simpler terms, is what a body does to a drug. Elimination or excretion of a drug is a part of the pharmacokinetic process. In this article, we will study the elimination kinetics of a drug. Various factors which affect the elimination of a drug are half-life, bioavailability, volume of distribution and first pass metabolism. To understand the pharmacokinetics or elimination kinetics of a drug effectively, these factors need to be understood first.
The calcium levels are regulated by a hormone known as the parathyroid hormone (PTH) which is secreted by the parathyroid gland. If the body fails to maintain the calcium levels within the normal ranges, hypercalcemia or hypocalcemia results. This article will focus on hypocalcemia. Hypocalcemia is the condition in which the serum calcium levels in the blood are low. The presentation of the patients with hypocalcemia can vary from asymptomatic to life threatening situations. Read on to learn about the etiology, symptoms, differential diagnosis, investigations and treatment of hypocalcemia.
Calcium channel blockers have different scopes of application: they are used for the treatment of arterial hypertension or cardiac arrhythmia. Calcium channel blockers are also applied for the treatment of the coronary heart disease. They are often used if beta blockers cannot be applied due to intolerances or adverse effects.
Barometric pressure is also called atmospheric pressure. It presents the pressure applied by the weight of the air in the atmosphere. Changes in barometric pressure experienced by breath-hold divers or mountain climbers have a significant impact on the body’s pulmonary physiology.
Every physician gets in touch with addicted patients, as 5–7 % of the population is addicted to legal or illegal drugs. But studies have revealed that primary care physicians only identify every 10th patient suffering from dependency syndrome. This article is supposed to help you recognize the typical symptoms of the respective drug consume and treat intoxications as well as withdrawal symptoms.
Tumor malignancy is the second leading cause of death in the United States today with increasing incidence. Furthermore, the general public usually associates the term with disease leading to death. Not every diagnosis of a tumor, however, translates to a shortened lifespan in actuality. The following article will define the word “tumor”, will shed light on the mechanism of tumor development and detail means of classification with respect to treatment plans.
The arterial hypertonia can be reduced with general measures often. However, medicinal approaches are also advisable in order to reach target blood pressures, which are in an area, as normal as possible. The most commonly prescribed drug are ACE-inhibitors, as they are cheap in price, followed by sartans. Both substances affect the renin-angiotensine-aldosterone system (RAAS) and reduce the blood pressure by the thereby conveyed effects.
Malignant neoplasms are among the leading causes of death in recent US statistic: death from malignancy is currently only second to cardiovascular diseases. As an aspiring medical professional, you will find cancer in nearly every clinical field. As widely varied as tumors can be, characterization through staging and grading is virtually universally applicable. Both indicators help to make statements regarding prognosis and treatment. Here you will learn the appropriate terminology, and how to classify and differentiate between them.
Diuretics promote the generation of a negative fluid balance in the body. Additionally, nearly all diuretics increase the excretion of sodium in the kidneys, so that water is linked osmotically and also excreted. The different diuretics affect different parts of the tubule system.
Physiology is essentially defined as the study of how biological systems work in order to bring about the development and progression of life. This vast field of science covers all living organisms including viruses, bacteria, plants, humans and much more. Human physiology, in particular, deals with the ways by which the human body carries out its fundamental characteristics, making it a living system. As complex as it may be, an understanding of the basic concepts involved in the study of human functioning can be of help.
Wolff-Parkinson-White Syndrome (WPW) is a term referring to Louis Wolff who published an article in 1930 that describes 11 patients suffering from episodes of tachycardia with characteristic ECG findings (ECG pattern shows bundle branch block and shortened P-R interval). In 1943, anatomical accessory pathway of conducting tissue has been described that bypasses the atrioventricular (AV) conduction system. This article will describe definition, pathophysiology, clinical manifestations, diagnosis and treatment of Wolff-Parkinson-White Syndrome.
Receptors are proteins. They receive signals from outside the cell; when located on the surface of the cell, they are called cell surface receptors. Learn about the different types and their downstream mechanisms in the following article.
The normal calcium level in the body is between 2.2–2.6 mmol/L. The calcium levels are regulated by a hormone known as the parathyroid hormone (PTH) which is secreted by the parathyroid gland. If the body fails to maintain the calcium levels within the normal ranges, hypercalcemia or hypocalcemia results. This article focuses on hypercalcemia. Read on to learn about the causes, symptoms, diagnosis and management of hypercalcemia.
Helicobacter pylori is a type of bacteria, which results in gastric infection. It is estimated to be found in more than 50% of the international population. It is not sure how exactly the bacteria can be spread; however, unclean food or water may aid in the spreading of the infection and result in different gastric diseases or conditions, including peptic ulcer disease or gastric cancer in severe complications.
For the purposes of the USMLE, it is important to be able to identify and understand the pathophysiology of the Paget's disease and how to differentiate it from other musculoskeletal disorders. Throughout this article you will find the details of Paget’s disease and the key points bolded.
Anemia is one of the major reasons why patients present with shortness of breath, fatigue, pallor and weakness in clinics. Anemia is a reduction of the oxygen carrying capacity of the blood that results in decreased oxygen supply to tissue cells. It is of utmost importance for doctors to rule out anemia as a cause of this range of symptoms as not giving prompt medical treatment can result in severer symptoms and even fatality.
Antidiuretic hormone or arginine vasopressin, is a peptide hormone released by the posterior pituitary in response to low plasma volume or increased plasma osmotic pressure. The hormone increases reabsorption of water at the kidney and increases systemic vascular resistance. When ADH is released in an unregulated fashion the circulating plasma becomes diluted, resulting in hyponatremia. This is called syndrome of inappropriate antidiuretic hormone secretion.
This article provides an overview of the cutaneous innervation and venous drainage of the upper limb, reviewing several of the veins in this area of the body. Both superficial and deep veins are presented, giving an overview of the progression of veins in the arms.
Fluid balance is a carefully regulated system with many mechanisms to monitor and modify the absorption and secretion of water. Water is in constant motion between compartments that make up the body. When the body senses a drop in the effective circulating volume it stimulates a response to restore blood pressure and retain fluids. When there is too much fluid the body increases secretion and excretion of the excess.
Embryology plays a vital role in the clear and thorough understanding of how the human body comes into being and the underlying pathophysiology of congenital disorders that affect neonates and people at different stages of their lives. The study of embryology has proven to play a significant role in the clinical understanding and management of such embryological disorders.
Disorders of the digestive tract may result in gastrointestinal bleeding. The blood is not always visible in the stool or vomit; however, it may result in tarry black stools. Bleeding can be life-threatening in some cases. Identifying the source of bleeding is not always easy, especially if its origin is in the small intestines.
The inspiration of oxygen and expiration of carbon dioxide are vital functions of the human body. A decrease in PO2 and increase in PCO2 can alter many normal physiologic processes, and may eventually be fatal. The human body has various reflex mechanisms to manage such changes. Understanding of these reflexes and identification and management of any impairment in them is essential in the management of many respiratory and renal diseases.
The pituitary gland, also known as hypophysis, is a small pea-sized gland about 1 cm in diameter and 0.5 to 1 gram in weight. The pituitary gland resides in a small bony cavity situated at the base of the brain, known as sella turcica, and a pituitary stalk (infundibulum) maintains a connection between the pituitary gland and hypothalamus. The secretion of hormones by the pituitary gland is under the influence of the hypothalamus through its various hormonal and neuronal signals. There are two distinct divisions of the pituitary gland: the posterior pituitary and the anterior pituitary. Between these two, there is a small zone, which is relatively avascular and less well-developed in humans, known as pars intermedia.
Lipid metabolism is the process by which lipids are synthesized and degraded in cells. In this article, important lipids discussed are bile salts, cholesterols, steroids and ketone bodies. Also covered in this article are the structures and functions of these types of lipids. The biosynthesis and metabolism of these lipid molecules are also covered in this article.
Laxatives are an effective treatment for occasional constipation, but laxative abuse and misuse is very common and can damage the intestines and lead to malabsorption and dehydration. Individuals abuse laxatives for a variety of reasons including weight loss (the most common form of laxative abuse), as a method to improve health, and as a part of a factitious disorder. There are gross and histological changes to the intestines that are usually reversible. Treatment consists of laxative sensation and treating the underlying condition.
Inflammatory bowel disease (IBD) is a group of conditions that affect the gastrointestinal system. IBD consists of autoimmune diseases that attack the GI mucosa, resulting in inflammation of the gut wall. For this discussion, we will be focusing on ulcerative colitis (UC) and Crohn’s disease (CD). The main differences between the two are that ulcerative colitis mainly involves the large intestine and rectum while Crohn’s disease can affect the GI system anywhere from the mouth to the anus and usually skips the rectum. Other conditions such as microscopic colitis and Behçet's disease are also types of IBD. IBD is different from irritable bowel syndrome (IBS) which is a functional disorder that is defined as abdominal pain and bowel movement changes.
Angiodysplasia describes abnormal vascular malformations found in the gastrointestinal (GI) tract, especially in the cecum and right colon. These malformations are prone to bleed and may be responsible for painless hematochezia, melena and concomitant anemia. Diagnosis can be made by direct visualization during endoscopy or angiography. Treatment consists of endoscopic interventions, including embolization and coagulation, antifibrinolytic medications and surgery as a last resort.
The carcinoid syndrome describes the signs and symptoms associated with unregulated vasoactive hormone production by neuroendocrine tumors. Carcinoid tumors can be found anywhere throughout the body, but these will not result in carcinoid syndrome unless they form in the liver as a primary tumor or as a metastasis. Symptoms of carcinoid syndrome include flushing, diarrhea, and wheezing. VIPomas usually form in the pancreas and release vasoactive intestinal peptide (VIP) which results in profound chronic diarrhea with concomitant hypokalemia and dehydration, wheezing, and flushing (similar to carcinoid syndrome). VIPomas are often associated with multiple endocrine neoplasia type 1 (MENI). Diagnosis is based off blood or urine measurements of serotonin and VIP. Treatment consists of minimizing symptoms with medication and complete surgical removal of the tumor.
Radiative colitis is an enteropathy syndrome that may develop after radiation therapy to the abdomen or pelvis. Radiation therapy is a treatment option for cancers in that area. Symptoms start weeks to years after initial radiation dose and include diarrhea, malabsorption, abdominal pain, and nausea. Therapy involves treating symptoms and allowing the bowels to heal. In severe cases partial colectomy may provide the best chance at recovery.
Biotechnology is an emerging field that allows scientists to use analytical techniques to study the structure and function of biomolecules. Protein purification is an all but mandatory step for studying macromolecules; but this task is not necessarily easy. Several experimental methods, deductive logic, and even a little bit of luck make this possible. Here you'll read about some of the methods.
Drug and receptor interaction is an important field of study in medicine. Knowing the chemistry behind these interactions leads to understanding how drugs work in the treatment of different ailments. In this article, the basic chemistry of receptors found in biological membranes is discussed. Also included in this article are the different types of interactions possible between the drug and receptors.
Whipple's disease is a rare infection affecting several tissues throughout the body including the GI tract, central nervous system, and heart by the bacteriaTropheryma whipplei. Symptoms include malabsorption, weight loss, and diarrhea with extra GI symptoms including arthritis and joint pain. The following article contains all important facts about the Whipple's disease.
ABG analysis is an indispensable test for critically ill patients or patients treated in an ICU. Interpretation of ABG analysis seems complicated; however, an understanding of the basic physiology can ease the interpretation. In this article, the basic physiology behind ABG analysis and a stepwise approach to interpreting ABG analysis will be discussed in detail.
Pulmonary hypertension (PH) is a clinical condition that is characterized by elevated pulmonary arterial pressure. It can lead to serious clinical consequences, thus early detection and treatment is important before it becomes advanced and less responsive to therapy. PH is a feature of advanced underlying disease that are usually caused by cardiac, pulmonary, or intrinsic vascular diseases. Therefore, suspected cases will undergo diagnostic testing to confirm the condition and identify the underlying cause. The definition, epidemiology, classification and etiologies, pathophysiology, clinical features, diagnostic evaluation and treatment all will be discussed in this article.
Signaling pathways are complex systems in which a single extracellular signal can elicit multiple intracellular events, some of which may also be triggered by other signaling pathways. We will discuss how this process occurs through kinase cascades and second messengers, and then apply these to processes to the regulation of protein expression and the fight or flight response, respectively.
Prodrugs are derivatives of drug molecules that can undergo enzymatic and/or chemical transformation in vivo to release the active drug. Prodrugs are incorporated to improve the physicochemical, pharmacokinetic and pharmacodynamic properties of compounds. In this article, the concept of prodrugs and its properties is discussed. Emphasis is given to the different applications where prodrugs may be applied.
The complete aerobic catabolism of one molecule of glucose yields between 36 and 38 ATP; energy obtained mostly as the reduced coenzymes NADH and FADH2 are conveyed through the electron transport system. Three of the four respiratory complexes comprising the mitochondrial respiratory chain, as well as ATP synthase, are embedded in the inner mitochondrial membrane. Coenzyme Q and cytochrome c transfer electrons between complexes, which will ultimately meet oxygen, the terminal electron acceptor. Metabolic water is the product of oxygen reduction.
For drugs to produce significant effects, they must be able to interact with the body. This interaction is affected by a number of factors which include the properties of the drugs and mechanism by which drugs are absorbed through the body systems. In this article, basics of pharmacokinetics and pharmacodynamics are discussed. Given emphasis are some of the factors affecting drug action, namely lipophilicity, acid sensitivity and BBB penetration.
Carboxylic acids are a group of compounds containing the functional group –COOH. They represent a large class of organic compounds, with varying applications from numerous natural products to synthetic drugs and hormones. In this article, the carboxylic acid family of compounds will be given focus. Covered in this article is the simple nomenclature and reactivity of these compounds. How the compounds participate in nucleophilic substitution reactions and how the different carboxylic acid derivatives are formed.
Acids and bases are groups of compounds that play major roles in different facets of society. They find applications in the food industry and pharmaceutical industries, as well as in human metabolism. This article tackles the basics of acids and bases. Topics discussed include the operational definitions of acids and bases; classification of acids and bases in relation to their strengths; different concepts in acid-base calculations like pH, pOH and equilibrium constants; and buffers and their applications.
Hydrocarbons are simplest organic compounds derived from fatty acids. They contain bond between carbon and hydrogen in linear, branched or cyclin pattern. Substitution of a functional group at one or more positions in a chemical reaction result in the formation of hydrocarbons. Alkanes are saturated hydrocarbons that share single bond between carbon atoms with formula CnH2n+2. Alkenes are unsaturated hydrocarbons that share at least one double bond with formula CnH2n. These molecules are found in living organisms both prokaryotes and eukaryotes.
Cardiac arrhythmia is an abnormal heartbeat, either the heart is beating too fast, too slow, or in an irregular manner. A healthy heart beats in a coordinated and regular way. Electrical and chemical impulses develop into specialized cells. These impulses stimulate the heart muscle cells (myocytes) to contract. When the heart is irritated or damaged, these impulses can develop spontaneously in the atria or the ventricle. Some spontaneous contractions are normal, but certain contraction patterns are very dangerous and can result in permanent heart damage, stroke, or death.
Ribonucleic acid (RNA) is a polymeric molecule, which is implicated in different biological roles such as coding, decoding, expression of genes and regulation. Biological reactions within cells are catalyzed by some RNA molecules, which control gene expression and communicate responses to cellular signals. The structure of RNA is similar to that of DNA, but there are some differences between them.
Approximately 10% of the US population experience peptic ulcer disease, which has significantly impacted the health care system; both men and women appear to be affected equally with the condition. Peptic ulcer disease may lead to several complications, including an upper gastrointestinal hemorrhage.
Hydrocarbons are compounds that are composed of carbon and hydrogen atoms only. Hydrocarbons can be considered as aliphatic or aromatic. Much focus is given in this article to aromatic compounds. Aromatic compounds, in general, are compounds that exhibit aromaticity, or the property in which a conjugated ring of an unsaturated bond, lone pairs, or empty orbitals exhibit a stabilization stronger than stabilization brought about by ordinary conjugation. In this article, the different properties of an aromatic compound are discussed, as well as their different applications. Focus is also given to benzene, C6H5. Unlike in ordinary alkenes, where addition reaction occurs, reactions of aromatic compounds involve electrophilic aromatic substitution (EAS).
Alcohols are functional groups that are characterized by one or more –OH groups attached to a carbon of hydrocarbon chain. They are organic derivatives of water where hydrogen ion is replaced by an alkyl group. They don’t leave their molecular structure by their own. They have high boiling points. They are polar in nature with asymmetrical distribution of charge between oxygen and hydrogen atoms. At room temperature, alcohol are colorless liquids or solids. Ethanol and methanol are common types. They are used in beverages, antifreeze, fuels, and preservatives and for sterilization. Selected reactions of alcohol will also be discussed; namely synthesis of haloalkanes from alcohols, acid-catalyzed dehydration, esterification reactions and redox reactions involving alcohols.
The enteric species of bacteria are gram-negative rods inhabit the gastrointestinal tract. Some species are part of the normal flora that incidentally cause illness while some are regularly pathogenic. Physicians need to familiarize themselves with all members of this bacterial group and their treatment strategies.
Organohalides are organic compounds containing one or more halogen substituent. There are about 5,000 organohalides occurring naturally, some of which are produced and are found in algae and various marine organism. Organohalides are a big family of a compound wherein the halogen can be attached to an alkynyl group (C=C-X), a vinylic group (CC-X), a vinylic group (C=C-X), an aromatic ring (Ar-X) or an alkyl group (C-C-X). This article will focus specifically on haloalkanes.
The pituitary gland also referred to as Hypophysis, or “Master gland” is a pea-sized organ, that lies in a protective bony enclosure called the sella turcica (saddle/chair) at the base of our brain. Read on to learn all about the pituitary gland and its hormones, as well as Hypopituitarism.
Integration of cellular metabolism is controlled by insulin and the opposing actions of glucagon and epinephrine. When food is available in abundance, or when the body needs to make stored energy available, changes in the circulating levels of these hormones allow the body to respond accordingly. This discussion of metabolic regulation will be tailored to fit two scenarios, the fed and fasted states, and highlight how metabolite flux is modulated by the direct activating or inhibiting of enzymes, or by inducing or repressing their transcription in the nucleus.
Chronic bronchitis is characterized by expectoration for a period of more than three months, in more than two consecutive years. Chronic irritation caused by smoking promotes hyperplasia of mucus glands and increases the production of mucus. Central and peripheral airways are involved in the pathophysiology of the disease and it includes inflammation, oxidative stress, inhibited repair processes, and an imbalance of proteinases/anti- proteinases. This article will prepare you perfectly well for your next exam!
Respiratory Distress Syndrome (RDS), also known as "Hyaline membrane disease", is caused by the deficiency of lung surfactant in a pre-term infant due to the immaturity of the lungs. The risk of RDS is inversely related to the gestational age, and, most commonly occurs in infants less than 28 weeks of gestational age. Neonatal respiratory distress syndrome is associated with high morbidity and mortality in pre-term infants and considered one of the most common causes of neonatal death. Respiratory distress syndrome should be differentiated from the other causes of respiratory distress after birth, which will be discussed in details in this article.
Biochemistry is the study of life from a chemical perspective and asks how living organisms arose from biomolecules that are lifeless. These biomolecules can be isolated from organisms and examined individually, and they conform to both the chemical and physical laws that govern inanimate matter. A biochemist studies the properties that organisms have that distinguish them from non-living matter.
In the medical field, the topic of Genetics is of significant importance. The topic explains how an organism is able to pass on its characteristics to its offspring. In this article, you will be able to learn about the structure and function of the human gene. Processes such as replication, transcription and translation are also explained in detail to help you get the required insight on what happens in each process. Furthermore, there are a few questions at the end of the article that will help you to test your understanding. You will find the answers to these questions below the references.
Hypersensitivity pneumonitis (HP), also called "extrinsic allergic alveolitis," is an immunologically-induced inflammatory disease affecting the alveoli and terminal airways (bronchioles), caused by repeated inhalation of a variety of inciting agents in a susceptible host. A wide range of organic antigens have been identified from different occupations. The clinical presentations of hypersensitivity pneumonitis vary depending upon the frequency, length, and intensity of exposure to the inciting agent. Surprisingly, cigarette smoking reduces the risk of developing the disease due to decreased antibody reaction to the antigen.
Biological Membranes are comprised of phospholipid bilayers that are formed when the nonpolar tails of glycerophospholipids and sphingolipids interact with each other in a way that exposes their polar head groups to the aqueous extracellular environment. We will discuss how this thermodynamically driven formation is dictated by the hydrophobic effect and allows the cell to maintain concentration gradients by use of membrane proteins that span the bilayer. In addition to discussing how thermodynamics governs diffusion within the bilayer, we will cover the cytoskeleton, which is composed of actin microfilaments in nonmuscle cells and allows for extracellular movement.
Pulmonary function tests (PFT) are a battery of tests that measure lung function and aid in the management of patients with respiratory disease. They are performed using standardized equipment and can be used for diagnosis, prognostication, management and follow-up of patients with pulmonary pathology. Although PFT may not identify the exact pathology, it broadly classifies respiratory disorders as either obstructive or restrictive. In this article, the role of PFT in the measurement of lung mechanics and diagnosis of various diseases will be discussed in detail.
Vasospastic angina is a variety of angina pectoris (chest pain) occurring at rest in which myocardial ischemia is due to transient vasospasm, with or without any underlying pathology. It is one of the syndromes that cause ischemic myocardial pain (angina pectoris), the other two being stable and unstable angina. Although rare in comparison, students are expected to know about it for the purposes of USMLE, as well as for their clinical knowledge.
The cell is the morphological unit of all modern life forms, of which there are two major classifications: eukaryotes (Greek: eu, good or true, karyon, kernel or nut), which have a nucleus that encloses their DNA, and prokaryotes (Greek: pro, before), which do not have a nucleus. We will discuss the similarities and differences between these two cell types, as well as viruses, which are non-living protein particles. Further, this article will provide all the relevant facts for your medical education turning attention to a key theme in human physiology: the homeostasis.
Dyspnea or shortness of breath is a normal manifestation of heavy exertion, but it can also be caused by different underlying diseases, therefore understanding the etiology, pathophysiology and differential diagnosis of dyspnea is important in the diagnosis of serious underlying clinical conditions. In this article, the etiology, pathophysiology and differential diagnosis of dyspnea will be discussed in detail.
Emphysema is a condition characterized by the dilation of air spaces, with decreased elasticity and increased compliance, due to alveolar wall destruction; capillaries are also destroyed along with the alveoli. The most common cause for developing emphysema is smoking. Alpha-1-antitrypsin deficiency may also result in the development of emphysema.
Adenosine triphosphate is a purine nucleotide with three phosphate groups connected to a carbon ring. It provides energy to the all cells of the human body. It is derived from phosphorylation of ADP. ATP is needed as the storage form of energy needed for cellular respiration. Understanding how ATP can be synthesized, and how it is used by the body, forms a fundamental part of pre-med biochemistry.
Acute Respiratory Distress Syndrome (ARDS) is a severe inflammatory reaction of the lung that is characterized by presence of pulmonary infiltrates due to alveolar fluid accumulation, without evidence suggestive of a cardiogenic etiology. SIRS and sepsis are the major causes of ARDS. The main finding of ARD is respiratory failure. Chest x-ray usually shows diffuse bilateral lung infiltrates described as " (“butterfly opacity”). Management depends mainly on treating the underlying etiology, and maintaining adequate oxygenation, which may requires intubation and mechanical ventilation.
The detection and recognition of heart sounds play an important role in the diagnosis of various cardiac and valvular conditions. Because familiarity with heart sounds has such practical importance, students undertaking the USMLE are expected to have a good understanding of its theory and clinical applications.
The four classes of macromolecules are carbohydrates, proteins, nucleic acids, and lipids. These biomolecules can also be referred to as polymers. In turn, we will discuss how these four classes of macromolecules are synthesized in the cell from their constituent building blocks or monomers. Next, we will review the types of reactions that bring monomers together, namely hydrolysis reactions, where water is used to break chemical bonds. Lastly, we will cover the carbohydrate monomer glucose and delve into a discussion of several types of polysaccharides relevant to your studies.
Whether milk is good or bad for calcium intake is a question that you will often have to answer in clinical practice. Many people think that the consumption of milk and dairy products will prevent osteoporosis—a belief that is being promoted in the media and through advertising campaigns but is also deeply rooted in our cultural heritage. Is there any medical consensus regarding this controversial issue? What have recent studies found out? How can physicians develop a well-founded stance on the subject without falling back on fatalistic platitudes? And most importantly: How can you as a medical practitioner adequately advise your patients on osteoporosis prevention while simultaneously dispelling any unfounded myths?
Ionic reactions occur when two compounds react by transferring electrons and, in the process, may form positively or negatively charged ions. This article focused on different ionic reactions, specifically redox and precipitation reactions. For redox reactions, different topics were discussed, namely assigning oxidation state, basics of the redox process and balancing redox reactions. For the precipitation reactions, the article focused more on the solubility rules in predicting the formation of insoluble precipitates in water.
Ventricular tachyarrhythmias are a group of arrhythmias that result in a heartbeat greater than 100 beats per minute and originate anywhere in the ventricle. There are three main types of ventricular tachyarrhythmias: ventricular fibrillation, monomorphic ventricular tachycardia, and polymorphic ventricular tachycardia. Each one is associated with a high mortality rate. Symptoms include chest pain, palpations, hemodynamic collapse, and end-organ damage. If the ventricular tachyarrhythmia is suspected, start advanced cardiac life support measures immediately.
The cardiovascular exam is one of the most important parts of the physical. You will repeat this exam throughout your training and perform it on almost every patient in a hospital or a clinic. This part of the physical evaluates the heart and peripheral blood vessels (both arteries and veins). We use the stethoscope to auscultate, the fingers and palm to palpate and the eyes to observe.
Stereochemistry is the branch of science which studies all aspects of the three-dimensional shapes of molecules. “Stereo” is Latin for "three-dimension." This article provides a fundamental explanation of the following: basic principles, terminologies, and biological significances of stereochemistry and chirality in real life.
Metabolism is the sum of both catabolism (pathways that break down molecules for generation of cellular energy) and anabolism (pathways that build macromolecules using cellular energy). Here, we will discuss metabolism with regards to the Laws of Thermodynamics, Enzymology, and go over some of the major metabolic pathways utilized by organisms to perfectly prepare you for upcoming exams.
Celiac disease, also called gluten-sensitive enteropathy or nontropical sprue, is a type of malabsorption syndrome. Relevant exam topics include the symptoms of gluten sensitivity and the clinical presentation of chronic malabsorption. Diagnosis is led by the characteristic histological findings and specific autoantibodies.
Diarrheal diseases are a very common reason why patients consult their doctor. Acute diarrhea lasts no longer than 2 weeks and has usually a rather mild course; however, if the diarrhea becomes more severe or is persistent, it can pose a serious health problem. Diarrheal diseases are most commonly due to infections. Chronic diarrhea represents a challenge to any doctor’s diagnostic skills as there are a multitude of differential diagnoses. In the following article, we will present you with all the important information you might need for clinical exams and clinical practice.
A cough is one of the common presenting symptoms in the clinic and is associated with a number of respiratory and non-respiratory diseases. It can have a number of distinguishing characteristics such as quality, sputum production, timing, onset, duration and associated symptoms. The physiological mechanisms underlying cough involve a reflex arc with a command center in the medulla. Common non-respiratory causes include gastroesophageal reflux disease and postnasal drip, whereas, the most common respiratory etiologies are infectious diseases, chronic obstructive pulmonary disease, asthma and interstitial lung disease. Wheezes are high-pitched, loud sounds that usually accompany asthma, while stridor is most prominent with upper respiratory obstruction. In this article, physiology, different causes of cough and wheezing will be discussed in detail.
Colorectal cancer originates from the colon and rectum in the body. It is a very common type of cancer in the United States. The molecular pathogenesis of colorectal cancer involves complex pathways. There are different types of colonic polyps associated with colorectal cancer; mostly are precancerous in nature. In this article, different pathological mechanisms, colonic polyps, symptoms, diagnostic tests, treatment and prognosis of colorectal cancer will be discussed in detail.
Thiazide diuretics are some of the most common diuretics currently in use. Their mechanism of action involves inhibition of the Na/Cl co-transporter channel in the proximal part of the distal convoluted tubule, leading to increased sodium and chloride secretion. Their effects on reducing peripheral vascular resistance further contribute to their antihypertensive properties, in addition to their ability in decreasing effective blood volume. Besides hypertension, they are indicated for the treatment of heart failure exacerbation, hypercalciuria and diabetes insipidus. Important side effects include hypokalemia, hypercalcemia, hyponatremia, hyperglycemia, hyperuricemia and hypomagnesemia.
In a healthy individual blood passes through the deep and superficial veins of the legs into the thighs and then the iliac veins to the inferior vena cava. The blood is pushed by the heart and also by skeletal muscle pumps as the leg muscles contract and relax. Retrograde motion is prevented by organic valves in the veins. As the valves weaken blood begins to pool in the legs and feet resulting in discoloration, vein engorgement, varicose veins, and edema.
Atrial flutter is an irregular heart rhythm of the atria. It is classified as a supraventricular tachycardia. This rhythm is associated with heart disease and hypertension. Symptoms include palpitations. Complications include increased risk of stroke and congestive heart failure. Diagnosis is made by observing sawtooth “flutter” P waves on EKG at a rate of 240–400 contractions per minute. Treatment through ablation is usually curative, though medication can also play a role.
Loop diuretics are one of the important classes of diuretics. Furosemide is the most commonly used loop diuretics. Other loop diuretics used are bumetanide, torasemide and ethacrynic acid. Loop diuretics are the most efficacious in causing diuresis in all the classes of diuretics. All the loop diuretics have the same mechanism of action, but different pharmacokinetic properties. They are used to treat/manage numerous diseases such as edema associated with CHF and liver cirrhosis. Diuretics most commonly cause electrolyte imbalance in the body on prolonged use.
Aldosterone antagonist are diuretic drugs that used in treatment of congestive heart failure or hypertension and increase survival rate in cardiac patients. They act at by competitive antagonism of mineralcorticoid receptors on the distal convoluting tubules and the upper collecting duct of the nephrons. They reduce the edema and workload on heart. Spironolactone is an important and widely used aldosterone antagonist. Other drugs in this category are eplerenone and finerenone.
Idiopathic pulmonary fibrosis (IPF) belongs to a group of diseases whose specific cause is not well known, which keeps clinicians and researchers worried: the often rapid progression of IPF is very distressing. Also the underlying causes are mostly unknown, pathophysiologic explanations and findings are still unsatisfying. With only a 5-year survival rate of 20–40 %, only quick decisions such as initiating a lung transplantation, might help prolong a patient’s life.
Intravenous fluids are most commonly administered in acute and severe hypovolemic conditions. In the therapeutics, two classes of i.v. fluids are most commonly utilized: crystalloids and colloids; both have their own advantages and disadvantages. The effect of various clinical conditions on the volume of ICF and ECG can be best studied by Darrow-Yannet diagrams.
A kidney cyst can arise in any part of the nephron and collecting ducts, and can be found incidentally on imaging tests, or can be part of a renal or systemic disease. Renal cystic diseases consist of a large spectrum of diseases that differ in regards to pathophysiology, prognosis and treatment and that can be usefully divided into hereditary, acquired and developmental conditions. Hereditary renal cystic diseases often lead to kidney failure and are commonly associated with extrarenal manifestations, whereas non-genetic cystic disorders are usually limited to the kidney and rarely result in kidney functional deterioration.
Bradyarrhythmias, an arrhythmia with bradycardia (less than 60 ventricular depolarizations per minute) can result in a drop in cardiac output, low perfusion and hemodynamic instability. Bradycardia is occasionally seen in professional athletes due to their increased vagal tone. It is not a concern in this group, but may pose a risk when found in the general population. There are many causes for a slow heart rate including medication, electrolyte imbalance and physical changes to the heart associated with deterioration or fibrosis.
The kidney is the central filter organ of our body. More specifically, it is the small glomeruli that filter those substances from the blood that have to be excreted and thus produce the primary urine. Various factors may cause damages to the glomeruli, resulting in a malfunctioning filtration process. The type of malfunction can vary, and accordingly, so do its clinical manifestations. Differentiating these variable clinical presentations of glomerulonephritis is for many medical students a rather challenging task. The following article will help you to understand the difficult topic of glomerulonephritides
Urinalysis is the test performed to analyze the physical, chemical and microscopic characteristics of urine. The information from this test might be used to diagnose or rule out diseases based on the findings. Urinalysis is most commonly used in identifying diseases of the urinary tract and diabetes. It includes macroscopic, microscopic/cytological and chemical analysis of the individual elements in urine.
Constrictive pericarditis is characterized by a thickened and scarred pericardial sac that lays around the heart and prevents proper diastolic filling. Diagnosis is very difficult because this condition mimics many other diseases.
Pericarditis is an inflammation of the pericardium resulting from infection, autoimmune disease, radiation, surgery or myocardial infarction, or after cardiac surgery. It is manifested as fever, pleuritic chest pain that increases with lying supine, and audible pericardial rub by auscultation. Diagnosis is made by clinical suspicion with, supported by diffuse ST elevation in ECG and sometimes pericardial effusion by echocardiography. It is usually a self-limiting condition within 2-6 weeks, therefore management is usually conservative. Constrictive pericarditis is a well-known complication that is characterized by thickening and rigidity of the pericardium.
Nephrolithiasis is a clinical condition characterized by the presence of stones in the kidney. Calcium oxalate stones are the most common stones. Clinical presentation is with acute flank pain. Non-contrast CT is the investigation of choice in nephrolithiasis and can diagnose all types of stones. Management depends on the location and size of the stone. Smaller stones have a greater chance to pass spontaneously, while stones larger than 5 mm need surgical management with percutaneous nephrolithotomy, extracorporeal lithotripsy, or open surgery.
Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired defect in the myeloid stem cell lineage and can be seen as a rare, chronic, morbid disorder. Formally known as Marchiafava-Micheli syndrome, it received its current name as a descriptive term for the disease. Individuals afflicted with the disease wake up to dark, “cola” colored urine due to RBC breakdown and release of hemoglobin in the urine overnight. The discoloration of urine is seen in several other disorders, which is why it is important to discern the disease from other hemolytic disorders as the article depicts.
Bronchiectasis can develop from chronic lung diseases or pulmonary infectious diseases. Since it is irreversible, it is most important to diagnose it timely. Only then, it is possible to prevent it from progressing by implementing appropriate measures. This article will introduce you to the pathophysiological and etiological basics of bronchiectasis, and will prepare you for the treatment of affected patients.
Sodium is one of the most important active osmotic solutes in the human body, which is maintained in constant amounts in extracellular and intracellular fluid compartments. Understanding the normal physiological basis of water and sodium balance, and the associated clinical implications of any change in this balance, are of clinical significance, as even small changes can result in emergency conditions. This will be discussed in detail in this article.
Acute blood loss is the leading cause of acute anemia. Damage to blood vessels due to several etiology results in disruption of integrity of blood vessel leading to blood loss. It is of two types, internal and external bleeding. Internal bleeding may not easily diagnosed in many cases because of bleeding inside organs, which may result in hematoma formation. External bleeding occurs through skin from injuries and wounds. Acute blood loss usually requires emergent surgical interventions to avoid further complications.
Sideroblastic anemias are a heterogeneous group of disorders with two common features: ring sideroblasts and affected heme biosynthesis. In this article, the most important forms of sideroblastic anemia are presented as well as their etiology, diagnosis and therapy.
Atrial fibrillation is the most common form of supraventricular arrhythmia. In its chronic form, it poses an increased risk of thromboembolic events, especially for people in advanced age. As this disease entails a reduced quality of life and increased mortality for the affected individuals, it is of the utmost importance that a physician knows the different forms of this widespread disease very well as to be able to make the opportune treatment decisions. The following article will provide you with an overview of the underlying mechanisms of disease and different treatment approaches.
Pericardial effusion is the condition of having an abnormal amount of fluid in the pericardial cavity of the heart. The pericardium does not expand. If enough fluid accumulates it will restrict cardiac filling and lead to acute heart failure, this is called cardiac tamponade. Small effusions are usually asymptomatic. Symptoms of a large effusion include Beck’s triad of distended neck veins, low blood pressure and muffled, distant heart sounds. Larger effusions are treated by pericardiocentesis, carefully removing the fluid with a needle.
This article explains the semiconservative replication of DNA and the role it plays in the cell cycle. The phases of the cell cycle and mitosis (prophase, metaphase, anaphase, and telophase) as well as the regulatory mechanisms associated with cyclins and their antagonists are all relevant topics in medical exams.
Cancer is one of the most widespread and most feared diseases in the world. Its onset is often insidious and initially proceeds without any noticeable symptoms. For treatment to be successful, an early detection is necessary. However, every year about 225,000 people worldwide lose this race against the clock. Tumor markers in the blood—are they an alarm signal of the organism? Are regular blood tests the best prophylaxis against cancer? Read more about this topic in the following article.
Myocardial infarction is one of the most common causes of death in industrialized countries and requires immediate intervention, according to the principle “Time is Muscle”. 40 % of all patients die before their first post-infarction day, and 50 % die in the first four weeks. Early detection and swift action are of crucial significance, especially in the case of ST-segment elevation myocardial infarction.
Mucoviscidosis or Cystic Fibrosis is the most common congenital and early lethal metabolic disease in Europe. Only if diagnosed early do those affected stand a chance of living beyond young age. The following article summarizes all the facts on formation, diagnosis, therapy and prognosis of mucoviscidosis. This will prepare you comprehensively for clinical exams, practical trainings and your final exam.
Hodgkin's disease is one of the first cancerous diseases for which effective treatment options have been developed. While this disease still ended lethally earlier, the prognosis is very good today. This is particularly due to the radiation sensitivity of lymphoma. 80 % of the patients can be cured permanently. This article provides a comprehensive overview of the hematologic disease, the symptoms, diagnosis and therapeutic principles.
Chronic obstructive pulmonary disease (COPD) is the most common chronic disease of the airways that is caused in 90 % of cases by smoking. COPD is a preventable and treatable disease. However, many patients do not know that they suffer from the disease, so the number of unreported cases of patients is very high. In this article, you will find important information on the epidemiology, etiology, pathophysiology and diagnosis, as well as the differential diagnosis and treatment of COPD.
This article treats the mesenteric infarction as a potentially life-threatening disease, which constitutes an emergency in vascular surgery. It includes both, the epidemiology as well as the etiology, symptoms, diagnosis and treatment of this ischemic intestinal disorder. Every doctor should know the mesenteric infarction as a differential diagnosis of the acute abdomen, because the lethality is 90 % due to the often late diagnosis.
In medical school, histology lectures are accompanied by a microscopy course, which allows for practical consolidation of theoretical knowledge. After completing the course, each student should be able to recognize organs based on their histological specimens. This guide helps you understand the extensive discipline of histology and to master it with flying colors.
Iodine deficiency is a major cause of goiter development. However, there are many other causes that can lead to an increase or change in the consistency of the thyroid gland. In order to be able to come to an unambiguous assessment, differential diagnostic skills are essential. Therefore, the following article may help you learn more about the etiology and differential diagnosis of goiter.
The usual course of the blood starts from the heart into the arteries, through the capillaries, then into the veins and back to the heart. In a few cases, however, it does not flow immediately into the venous limp, but instead it flows through a second capillary bed. This is called the portal vessel system. In addition to the liver, it can also be found in the anterior pituitary and in the pancreas.
Diverticulosis (diverticular disease) is an extremely common disease of the colon. The colonic wall is exposed to high luminal pressure which forces the wall outwards to form outpouchings called diverticula. This is a painless condition, but patients can become very worried as it can cause rectal bleeding. This condition is very prevalent in Western society because of the low fiber diet. Diverticulitis is a much more serious condition and occurs when a diverticula becomes inflamed. It is related to diverticulosis as the diverticula in this disease can become obstructed and/or inflamed due to an infection. The outpouching becomes very painful due to the inflammatory response and can continue to grow in size. If the outpouching is not treated rapidly, it can progress to rupture and lead to peritonitis, sepsis and death.
If diagnosed and treated in time, a patient with esophageal carcinoma can be cured. However, the symptoms are often non-specific and only appear once the tumor is already advanced. Therefore, it is all the more important not to overlook any relevant indications in clinical practice. Questions about esophageal carcinoma occasionally come up in exams, especially on etiology and clinical symptoms. Therefore, it pays to read on to learn more!
Human immunodeficiency virus (HIV) disease is caused by single stranded RNA virus of the retroviridae family. It is transmitted through exchange of body fluids such as semen and blood. The presentation is marked by deteriorating immune system organized in WHO stages beginning with constitutional symptoms such as lymphadenopathy in early stages to advance into WHO stage IV characterized by AIDS defining illnesses. The prognosis is good with adherence to HAART.
Phlebothrombosis is a very common and very serious condition. Blood clots in veins can mobilize and cause significant harm and even death in some cases by blocking downstream vessels. This condition needs to be thought of in all new hospital admissions, especially those who will be particularly immobile or those undergoing operations, so they can be given medical prophylaxis to reduce the chance of a blood clot forming in the venous system.
A sudden, violent “thunderclap headache” is the main symptom of subarachnoid hemorrhage (SAH). Mostly, this intracerebral hemorrhage is caused by the rupture of an aneurysm. The lethality rate in SAH cases has fallen in recent years, but not the number of incidences. Patients who survive SAH cases, are at an increased risk of having cardiovascular and neurovascular diseases. All the facts on symptoms, diagnosis and treatment are presented in this article in a compact way, together with all the test-relevant details. This will definitely assist you to be in perfect preparation for your final examinations.
Thyroid cancer is an uncommon cancer that can be managed well if detected early enough. It arises from follicular or parafollicular cells within the thyroid. There are subtypes of cancer depending on the cell involved and the mutations that occur. The most common cure for this cancer is surgical removal of the thyroid, along with chemotherapy or radiotherapy.
The cardiovascular system is the first functional system of the embryo. The deployment starts in the third week. Not infrequently, there are congenital malformations of the heart or to the vessels close to the heart, so that knowledge of embryology is important in order to understand the pathogenesis. The following article explains how the heart is formed out of the trifoliate cotyledon.
Opioids are a class of substances, which are essential for medical fields like oncology, palliative and emergency medicine because of their analgesic effect. Contrary to many preconceptions, they are safe medications that do not cause dependency or the development of tolerance if used correctly. Obviously, opiate dependence is something physicians deal with time and again in their clinical routine and every physician should be familiar with the fundamentals of the Controlled Substances Act, the withdrawal symptoms as well as how to treat said symptoms.
The human chest is a complex assembly of different osseous, ligamentary and muscular structures. It protects vital organs like the heart and lungs and is indispensable for the respiratory function. For medical students, it is advisable to learn the thorax in combination with the thoracic spine, as the thoracic spine and ribs form the rib vertebral joints and, therefore, you can save time studying, which may be urgently needed for other subjects.
The pancreas is an organ that actually consists of two glands: one exocrine and one endocrine gland. The glandular epithelium is a specialized epithelial tissue which produces and excretes substances to control our bodily functions. The exocrine gland secretes its fluids via ducts (into the intestinal lumen), while the endocrine gland secretes its substances via the extracellular space into the vascular- and the lymphatic-system. The two parts of the pancreas differ both in structure and function. The following article should give you an overview about the histological features of the two glandular parts.
Tissue is defined as the compound structure of similar cells performing the same function in the human organism. Recognizing different tissue types is basic for the histology course and essential for the assessment of biopsies. The purpose of this article is to illustrate what kinds of tissue are to be found in the human body, their functions and how they are best distinguished from one another.
None of us can imagine a life without fingers. We would no longer be able to use a computer, play an instrument or greet a friend or colleague with a friendly handshake. Hardly any other joint is as frequently affected by joint rheumatism as the finger joints. Countless metacarpophalangeal joints, like the second knuckles of people living in industrialized nations, are affected by chronic polyarthritis. Knowledge of the anatomy and pathology of the fingers and thumb is thus indispensable for every (aspiring) medical practitioner.
The nervous system serves the regulation and adaptation of the organism to changing conditions of the environment and the internal body. It is a communicating and controlling organ which innervates all organs of the body. The nervous system can be subdivided into an anatomic (CNS and PNS) and a functional (SNS and ANS/VNS) part which, however, are intrinsically tied to each other. The following article will give you detailed insight into the structure, functionality and pathology of the vegetative/autonomic nervous system (VNS or ANS).
Aortic dissection is a rare but serious medical condition. It can be suddenly fatal and needs to be detected early. 40% of people do not survive once the aorta dissects and therefore despite its rare nature, patients with related symptoms should be thoroughly investigated.
Digestion is the mastication and breakdown of nutrients and their subsequent incorporation into an organism. Thereafter, the bloodstream carries all nutrients to the cells of the body. This article is a compact overview of the anatomy of the oral cavity as well as the specific features of the gastro-intestinal tract and the liver.
During pregnancy, it is possible for the tissue surrounding the embryo to degenerate. Such degeneration typically manifests itself in hydatidiform moles and choriocarcinoma. These tumors are difficult to diagnose and are associated with an increased level of beta hCG. Treatment involves the complete removal of the tumorous growth. The characteristics of the tumors are described in more detail below.
For humans, life would be far more complicated without hands. Any right-handed person who has had a broken right hand and subsequently received a cast can remember years later how stressful the simplest of everyday tasks could be. In 2015, 30 % of all fall injuries in sports affected the hand or hand joint. With such a high rate of injury, it is scarcely surprising that students of human medicine must be familiar with the hand joint in all its anatomical and biomechanical details.
Chronic myelogenous leukemia, also called chronic myeloid leukemia (CML), is an acquired monoclonal expansion of white blood cells of myeloid lineage. It is common in middle and old age accounting for 20% of adult leukemia. It is sometimes diagnosed incidentally on routine blood investigations or the presence of splenomegaly on examination. CML is classically associated with the Philadelphia chromosome (BCR-ABL fusion gene) and has excellent prognosis with modern therapy.
One mainly realizes the importance of functioning blood circulation if it suddenly stops working. If the circulation system decompensates and tissue cannot sufficiently be supplied, the state of the patient can severely worsen within very little time – and you have to act quickly. Shock is life threatening. Thus, it is absolutely necessary that you know all about it as a prospective physician. Here you learn the 3 main causes of shock, and how to treat each of them.
The clinical examination of the lungs is important for every patient anamnesis done in internal medicine. As a pulmonologist, your main focus will be on studying and examining the lungs. A dependable strategy to be followed during examinations enables routine work, helps to stay on top of things and prevents a physician from forgetting anything during daily clinical practice. For example, what is auscultated in case of pneumothorax or pleural effusion? What different shapes of thorax are there? How can tuberculosis be recognized from examining the patient's skin? Below you will find a checklist to be used during your practical work and oral exams!
Over the past several years, more and more individuals attract malignant gastric cancer. In many cases, however, the initial symptoms of the disease are so non-specific that the tumor is not diagnosed until it is in an advanced stage, resulting in the prognosis being worse. Which risk factors promote the development of gastric cancer, and what are the treatment options once the diagnosis of gastric carcinoma has been made? In the following article, you will find out everything you need to know about gastric cancer.
Abdominal Aortic aneurysm results from loss of strength and thinning of the aortic wall. It often implies the threat of rupture of aneurysm demanding of emergency interventions. Being asymptomatic, delayed discovery of AAA is a common phenomenon. The exact etiology of AAA is not known. Males develop AAA more commonly than females. The risk factors of AAA involves hyperlipidemia, hypertension, heart disease, smoking and family history. With the proper evolution of the case, elective surgical repair can be opted as definite cure.
Mutations are associated with diseases and defective genes. Mutated genes are actually the cause of many diseases, although they are also necessary. Without permanent change in the genome, evolution is not possible, and purely static DNA would prevent any development. DNA is also the only molecule of the cell that is repaired. The information stored in the DNA is so important that the energy expended by repairing it is worthwhile. The cell must find the correct balance between the loss of evolution by mutation, and evolution by mutation.
During pregnancy, the placenta develops and adapts to the needs of the child. The placenta fulfils numerous tasks, but mainly serves the child’s oxygen and nutrients supply. Due to various causes, a malfunction is possible, whereby the child is under-supplied and can no longer grow properly. Early diagnosis with therapeutic measures is therefore important.
From the trilaminar germ disk, cells join up to form organ systems and to differentiate further. Early on, precursor structures of the central nervous system already develop. At the same time, segmentation of the embryo takes place. This article elucidates the most important steps and also explains the division of body cavities into pericardial, pleural and peritoneal cavities.
A cardiology exam is coming up and you have not studied yet? Indeed, cardiomyopathies are not necessarily among the most studied topics; however, they appear quite often and are actually one of the most common causes of heart insufficiency. Here, you get an overview of important types of cardiomyopathy for exams – easy to understand and a huge time-saver!
In the context of precocious pregnancy, flawed implantation of the placenta is possible. This can remain asymptomatic in the beginning. However, bleeding mostly occurs during the end stages of pregnancy. Also, vaginal bleeding can be the cause of premature placenta detachment. This bleeding is life threatening to both the mother and child, and is very painful. In the following article, the clinical picture of premature placenta detachment and placenta praevia are further explained together with their differential diagnosis.
15 % of all injuries of the elbow joint lead to occupational disability with premature pension. Thus, it is understandable that the health system has great interest to limit the consequences of such injuries, in case previous prevention measures have failed. Hence, there is need for physicians and therapists who invariably master the (functional) anatomy and pathology of the elbow joint, so patients with elbow lesions would be treated appropriately. This article is supposed to help medical students to learn the routine of dealing with the elbow joint – both for the exams in university and for later professional practice.
Chemical reactions occur as chemical compounds form and break apart. In a closed system, an equilibrium results after a certain period of time. From this point forward, no changes in the concentration of the products and reagents can be observed anymore. In the following article, you learn which requirements are necessary for this state, what exactly characterizes this state, which meaning it has, and how one influences and uses it for certain purposes.
In the human organism, proteins undertake multiple and vital functions. Structural proteins are found in each and every cellular compartment. Intracellularly, motor proteins power the energy-dependent transportation of vesicles. Signal proteins receive and transmit information. Transport and storage proteins bind, for example, oxygen, and carry it to a location where it is needed. Of equally great significance are enzyme proteins as, without these biocatalysts, a smooth and “frictionless” exchange of energy and nutrients would be practically impossible. This article illustrates the role of amino acids as building blocks in the structure of proteins, their chemical properties and also presents the ways in which amino acids fulfil their multiple duties.
Increased production of stomach acid or damage of the gastric mucosal barrier may irritate the sensitive gastric mucosa or stomach lining to the degree that gastritis occurs. Gastritis may develop over a longer period of time, but may also occur suddenly and have many causes. As gastritis is one of the most common stomach diseases, this article will provide you with on overview of the various types of gastritis and also address very rare forms of this disease.
Acute lymphoblastic leukemia is a malignant neoplastic disease that arise from lymphoid cell lines. It is the most malignancy in childhood. The disease manifests quickly over a span of days or weeks. Excessive proliferation of immature blasts replaces the normal bone marrow cells resulting in bruises, bleeding and infection that associated with fever. Diagnosis of ALL is established by complete blood count (CBC) which shows leukocytosis , bone marrow study which shows more than 20% blast cells. It has a good prognosis.
Atherosclerosis is an incurable disease, but for which there are clearly defined risk factors that often can be reduced through a change in lifestyle and behavior of the patient. It is the most abundant primary disease of the arterial vascular system and is responsible for coronary heart disease, the leading cause of death worldwide.
The heart is an important organ. Cardiac dysfunction causes both cardiac symptoms as well as pulmonary and other circulatory symptoms and signs. Cardiovascular disease affects the majority of the elderly population and is one of the most common causes of death. Cardiac diagnostics are important to assess whether cardiac disease may be causing symptoms. This article will introduce you to the cardinal symptoms of cardiac disease, as well as associated non-invasive examination techniques.
Regardless which specialization you choose later, you should know the main symptoms and treatment of the most common drug intoxications. Be it older patients with dementia, patients with a history of drug abuse or accidental poisoning in children after playing with the medicine cabinet. Brush up your knowledge for exams and practice and read everything relevant to the 5 major drug intoxications!
With a prevalence of approximately 50 %, arterial hypertension is a very common disease. Blood pressure is a risk factor of secondary diseases such as stroke, CHD and cardiac insufficiency. Social connections as well as a relationship between hypertension, body weight and age are apparent. Many individuals with hypertension are not treated at all or receive insufficient therapy and, in many cases, are not aware they have the disease.
Eccyesis or tubal pregnancy refers to the implantation of the blastocyst outside the uterine cavity. Thereby, affected patients suffer from acute abdominal pain. Eccyesis or tubal pregnancy can be quickly diagnosed by means of an ultrasound and laboratory analysis. In severe cases, in the case of rupture and hemorrhage, the fastest possible action is required. Surgery should be considered as a therapeutical approach.
Acute myeloid leukemia is due to a malignant transformation of the hematopoietic stem cells. It is predominantly seen in the age group of 50 – 60 years and is characterized by the arrest of leukocyte development in the early stage of development. Diagnosis is based on the presence of blast cells in the peripheral circulation. It is treated by chemotherapy, which includes treatment of remission and post-induction remission. Refractory cases of acute myeloid leukemia are treated by bone marrow transplants. Complications of AML include anemia, infections and bleeding, along with acute medical emergencies such as necrotizing enterocolitis, hyperleukocytosis and tumor lysis syndrome.
In clinical practice, Boerhaave and Mallory-Weiss syndromes rarely appear. However, you should have these two syndromes in mind when dealing with patients in acute pain or bleeding after an episode of violent vomiting in order to make a correct diagnosis at the crucial moment. Questions about this subject are also likely to be asked in tests. Therefore, medical students should be able to keep these two syndromes apart, particularly their epidemiology and clinical symptoms.
Diverticula can be found in various organs, in particular in the colon, but also in the duodenum or ileum, and in the esophagus. Every medical student should internalize the differences between true and pseudo-diverticula. Zenker's diverticulum, in particular, is often quizzed in exams.
The human spine has various tasks. It helps us to be upright, ensures stability, provides muscles, tendons and other tissues with osseous starting points and passage openings, can distribute loads and is still flexible and movable. The downside of this is that such a complex structure with so many functionalities is, unfortunately, an equally versatile focus for diseases. In 2011, approximately 230,000 spinal surgeries were performed, and an upward trend has been observed. Students of human medicine should be introduced to the anatomy of the spine early on, to diagnose pathologies timely and spare patients’ problems associated with such an operation.
Its high morbidity and mortality make pneumonia one of the major infectious diseases worldwide. Learn about the pathogenic causes as well as the individual types of pneumonia, in order to be able to reliably differentiate and treat it in clinical practice.
Chronic lymphocytic leukemia (CLL) affects the B-cells of the immune system and is, as the most common leukemia in adults, an important hematological differential diagnosis. It often hardly progresses for years and therefore a CLL does not always need immediate therapy. In the past years especially, a lot has happened with regard to diagnostic options and treatment, so that being informed about cytogenetic diagnostics and new treatment methods is extremely important.
Abnormalities of Female reproductive organs has been matter of concern in females of reproductive age. These abnormalities can be congenital, or acquired. Environmental or genetic anamolies can result in congenital abnormalities in female organs of infants. Acquired abnormalities implies infections, physical damage brought during delivery or surgery or hormonal imblances as their etiology. Amenorrhea and infertility are the important representing symptoms of these abnormalities. Diagnosis and identification of abnormalities such as adenomyosis, uterine fibroids, etc. along with their exact location establishes the accurate treatment procedures.
Movement is a sign of life. It enables voluntary locomotion, reflexive reactions for purposes of protection (such as in the event of flight or a fall) as well as the complex functioning of our metabolism. The many different tasks that are accomplished by the muscle physiology give a glimpse into the complexity of this thematic area. In the following contribution you will learn – after a brief review of the relevant muscle structures – an exact overview of the physiologic sequence of forms, the sliding filament theory and the electro-physiologic and energetic processes during a contraction. Furthermore, the topic of muscle strength, with regards to bodily adjustment to exertion and relaxation, will be broached.
Peripheral artery disease, shortly referred to as PAD, is a condition caused due to atherosclerosis. Estimated to be affecting around 200 million people in 2010, the intermittent claudication is a medical entity of rising impact, which every prospective physician should master. The underlying atherosclerosis is not only the most common arterial vascular disease but also the pathologic substrate for many other common and often life-threatening diseases. These include strokes, heart attacks or aneurysms—comorbidities and risks, which can first manifest as PAD. This article´s purpose is to illustrate how PAD is diagnosed and treated as well as to provide exam-oriented information.
Only a few organs are essential enough that the body owns two of their kind. The kidney, which filters metabolic products, toxins and drugs, is one of them. Modern medicine can replace it but the price dialysis patients have to pay is high. By contrast, the body is able to accomplish this complicated task within the smallest space. Every tissue of the kidney is specially structured depending on its task and the demanding function already manifests in its histology.
Achalasia (cardiospasm) is a functional disorder caused by narrow position of lower esophageal muscles. It is marked by reduced or absent peristaltic movement of esophagus and relaxed lower esophageal sphincterat swallowing. This abnormality result in functional obstruction at the junction of esophagus and stomach with symptoms such as dysphagia, regurgitation, heartburn, stomach pain and weight loss. It is diagnosed by the help of barium swallow, esophageal monitoring and endoscopy. Pharmacological and non-surgical interventions are adopted to treat achalasia.
The von Willebrand disease describes a dysfunction in hemostasis concerning the primary and secondary hemostasis that has a varying clinical picture. It is the most common hereditary hemorrhagic diathesis. Taking into account the primary and secondary hemostasis, this disease excellently suits to test knowledge and comprehension of coagulation and it’s disorders.
The kidney’s physiology is an extremely complex issue in medicine, which is therefore a popular topic in exams. Since the kidney fulfills many important functions in the body in addition to its function as an excretory organ, it can be referred to as a multifunctional organ. The physiology of the kidney derives from the circumstances of its anatomical structures, especially those of the nephrons.
As mammary carcinoma is the most frequent malignant disease in women, early detection is important. There are numerous diagnostic tools available, the mammogram being the gold standard. The next step would be developing a treatment plan that is individualized for the patient and the type of carcinoma. The following article will teach you to accurately diagnose mammary carcinoma and to initiate the appropriate therapy.
The complexity of the musculoskeletal system is often a big issue for medical students. To learn about muscles effectively, a clear and logical grouping into systems with unique structures is needed. In this article, in addition to detailed descriptions of the origin, insertion, action and innervation, medical students will obtain an overview in tabular form for visualization of the muscle groups. Attention: Due to conflicting information in primary literature about the muscles' origins and insertions, it is advisable to always consult the latest copies for studying.
Abortions, or so-called miscarriages, frequently occur in the context of precocious pregnancies. Generally, the affected people consult a gynecologist since vaginal bleeding occurs during pregnancy. There are different forms of abortions, which can be very painful but also asymptomatic. Mostly, removal of the fetus is necessary to avoid infections or further bleeding.
A uterine rupture represents an important complication during pregnancy, as well as during delivery. A uterine rupture can become a life-threatening emergency which requires an immediate Caesarean section. The patient complains about severe, devastating pain. The uterus feels rigid when palpated, and signs of hypovolemic shock are visible. This article presents you with a compact overview of this complication.
The form circle of rheumatic inflammatory systemic diseases includes a number of diseases, whose etiology is mostly unknown. Due to the fact that specific antibodies are often found, diseases such as rheumatoid arthritis are considered autoimmune diseases. Therefore, the diagnosis of antibodies plays a significant role in the diagnosis of rheumatic diseases. The following article features two diseases, rheumatoid arthritis and Still's disease, both from the rheumatic disease form circle.
Thrombocytes are responsible for the initial wound closure in the course of primary hemostasis. If there is a deficiency in thrombocytes the system bleeding time is significantly prolonged after an injury. The causes of the condition are many and have a wide spectrum. Regarding differential diagnosis, one has to consider different (malignant) underlying diseases. It is important to memorize the classification scheme for the sake of future medical occupation!
The male reproductive system with testicles and spermatic duct can be divided into different sections, but are treated as one unit in anatomy. This article is concerned with the anatomy and physiology of the male sexual organs. At the end, final pathology concludes with a general view on the most important dysfunctions.
Gonorrhea is one of the most common sexually transmitted diseases (STDs). Approximately 1 % of the world population is infected annually, which is equivalent to about 60 million people. The severity ranges from asymptomatic infection to disseminated gonococcal infection with sepsis and hematogenic spread. In the following article, you will read everything that is important to you as a physician - from Bonjour-drops to treatment.
In this article, you get an overview of the pathology of the brachial nerves and understand how a hand of benediction or a median claw hand, an ulnar claw and a hand extension loss with the radial nerve paralysis may develop.
In practice, anemia often appears in the blood count, accompanying many acute and chronic diseases. Clarification is definitely recommended because already a lowered hemoglobin value alone can be the first important hint for an undetected underlying disease.
Airway management challenges are the common causes of morbidity and mortality of patients acquiring anesthesia during operation. Airway management is the integral part of general anesthesia that allows ventilation and oxygenation in patient. The prime purpose of airway management is to stabilize and secure the patient during an emergency or operation. Pre-operative assessment of respiratory tract should be done through identification of patient’s relevant factors via standard diagnostic measures prior to anesthesia. This help to evaluate the degree of difficulty with mask ventilation and endotracheal intubation.
Hyperthyroidism is caused by the excess of thyroid hormones T3 and T4. Graves’ disease is the most common cause of hyperthyroidism. Clinical features of hyperthyroidism are mostly due to the increased body’s metabolic rate. Hyperthyroidism is diagnosed by estimation of TSH and free T4 and T3. It is treated by pharmacological and surgical means.
While anesthesia has become safer and safer in past years, there are some rare but dreaded complications, which can rapidly worsen the state of the patients and can even lead to their death. A prospective physician should be familiar with these emergencies. An important complication in the context of anesthesia is malignant hyperthermia, an acute functional disorder of the skeletal muscles. Here, you can learn how it develops and how malignant hyperthermia is treated.
Even though you do not want to become a chemist, as a doctor-to-be you will need some basic knowledge in the field of chemistry. Although this science does not explain the mechanics of life, it helps us to understand it better. In this summary, you get the most important information about test-relevant topics from the atomic structure through the understanding of the PSE to the reaction types.
Breast cancer (mastocarcinoma) is the most common form of cancer among women. Consequently, it will be encountered by doctors as part of their work in hospitals and medical practice. This disease exhibits a heterogeneous pattern including different histological subtypes, which may differ considerably in their degree of malignity and, consequently, in their clinical symptoms and therapy. The following article helps you to understand the clinical picture of mastocarcinoma, identify its symptoms and to classify its histology correctly.
Hypothyroidism is caused by the deficiency of T3 and T4. Hashimoto's disease (autoimmune thyroiditis) is the leading cause of hypothyroidism in non-iodine deficient regions. Clinical features of hypothyroidism are primarily due to the accumulation of matrix substances and a decreased metabolic rate. Hypothyroidism is diagnosed by the estimation of TSH and free T4. It is treated by administration of synthetic T4.
Although there are countless types of bacteria, it is of particular importance for a physician to know the most common ones. Knowing them includes the typical clinical picture they cause, as well as the basics about their structure, virulence, morphology and bacterial culture in order to be able to recognize and distinguish them from other bacteria and to treat and target them properly.
Mycobacterium tuberculosis: Ca. 30 % of humankind are infected with this pathogen, 10 % sicken from manifested tuberculosis. The special feature of these bacteria is that they are very acid-fast, they grow very slowly, and can survive in macrophages. This way, they are a great challenge in terms of therapy and prevention for physicians and scientists. The following article distinctly presents you all the relevant facts for exams concerning tuberculosis which are needed for the second state examination and clinical practice.
Many people suffer from cardiovascular diseases. Stroke and myocardial infarction rank among the most frequent causes of death due to cardiovascular diseases. The causes are blocked vessels and the resulting insufficient blood supply of vital organs and tissue. Surgeries are usually the last resort and, at the same time, the start of a new, safe and hopefully healthier life. In this article, you get to know more about the mechanism of action, the medical application as well as the possible side effects of anticoagulants.
Clinical parameters have to be met for making the diagnosis of shock. However, differential diagnosis are also of great importance since without knowing the cause, this life-threatening condition can recur at any time.
The clinical picture of Huntington’s disease belongs to the category of movement disorders or extrapyramidal disorders and has autosomal dominant inheritance. The disease is characterized by a progressing hyperkinetic syndrome, where an increase in motions or an akathisia occurs. The complete medical picture is characterized by a combined indication of choreatic hyperkinesia, dementia as well as weight loss (anorexia), which is caused by an increased basal metabolic rate.
Hyperuricemia and gout are two of the most common metabolic diseases in industrial countries. The exacerbated forms of uricemia are the acute gout attack and chronic gout. They are caused by the incorporation of crystalloid salts of uric acid (urate) into the joints. In the following article, we will present all relevant facts concerning gout. This way, you are perfectly prepared for all exams in the clinical part of the medical studies and for your final exams.
Almost every clinically active doctor is confronted with fungal infections during their working life. It can be foot or nail fungi if they are a family doctor, fungal pneumonia if they are a haemato-oncologist, or irritant diaper dermatitis if they are a pediatrician. What matters is knowing these mycoses’ typical manifestations, diagnostic methods and therapies in order to treat patients in the best way possible. This article provides a complete insight into the wide field of mycology.
Transcription and translation convert a gene into protein. During this process, the genetic information of a gene, the DNA, is converted into RNA so that protein may be realized later on. This article will provide you with exam-related information regarding this process, thus preparing you ideally for the upcoming exams.
The sense of hearing connects us with our fellow human beings. Every dialogue, every conversation depends on it. Deaf people have the highest suicide risk. They are cut off from their social environment in a much more severe way than blind or paralysed people are. Unfortunately, age-related hearing loss and balance disorders are not rare at all and they have an enormous effect on the quality of life—even without a complete loss of hearing. The diseases and the respective diagnostic tests which are going to be mentioned here will give you an overview of the wide field of diseases of the inner ear, their diagnosis and treatment possibilities.
Physicians encounter ECGs in their clinical routine every day. Additionally, ECGs are frequently the topic of exams, which is reason enough for us to provide an analysis algorithm that will aid students in interpreting an ECG. Learn the seven steps to interpret an ECG and test your knowledge by taking the ECG quiz.
Every physician confronts potential bacterial infections everyday during his or her professional life. Whether to avoid them in the operating room or to treat a patient’s disease, bacteria and their antidotes – antibiotics – should always be treated with the utmost care. To treat microorganisms in the right way, each doctor of medicine must have knowledge and understanding of the basics of these life forms, their virulence factors, and their vulnerability.
Coronary heart disease (CHD) is the leading cause of death in industrialized countries. Numerous risk factors, which can be reduced through both behavioral and lifestyle changes as well as drug therapy, are known for its origin.
Regardless if it’s playing sport, around the home or at work, cuts can happen everywhere in day to day life! There is a short spray of blood then a few minutes later the wound has closed itself with only a plaster reminding us of the little faux pas. But what happens if the apparently minor moment of carelessness suddenly becomes a life threatening event? What is ‘hemophilia’ as it’s commonly known? This article explains the range of blood disorders, which of them are hereditary and how an almost incident free life can still be led despite having one.
Aside from the intrinsic (or primary) muscles of the back, it is particularly the group of extrinsic (or secondary) back muscles that is of great concern for students of medicine as well as physical therapy. This is mostly due to the fact that this group is made up of many individual muscles, and that there are no simple mnemonics available with regard to their origin, insertion, function and innervation. Nevertheless, this article still tries to classify the extrinsic back muscles into logical subgroups in order to simplify studying them. After detailed explanations, an overview table of the muscles and muscle subgroups is provided at the end of the article.
The multiple endocrine syndromes are inherited autosomal dominantly and consist of two superior groups (I and II). The second group can be further divided into three subgroups (IIa, IIb and FMTC-only). The respective upper groups have different causes on moleculargenetic level. Characteristic signature diseases i.a. appear as part of these syndromes.
Sarcoidosis, also referred to as Morbus Boeck or Morbus Besnier-Boeck-Schaumann disease, usually attacks the lungs and is therefore frequently taught within the scope of pulmonary diseases. The bottom line is, however, that this disease can also affect any other organ meaning that medical students may not only encounter its clinical picture in many exams dealing with various specialties but also in their clinical routines in different specialty disciplines. You will learn in this article how to accurately classify the progression and symptoms of sarcoidosis and to take the right steps to diagnose and treat it.
Medical students often encounter patients with pleural effusion during internships and their residency. These patients do not always suffer from dyspnea and an accurate clinical examination is crucial for the diagnosis. In oral and written exams, explaining the difference between transudate and exudate is a frequent task. In this article, you can find all the important information regarding pleural effusion – for clinical practice and your studies!
Acquired valvular heart diseases may manifest as insufficiencies (i.e., the incomplete closure of the valve), as a stenosis (i.e., a narrowing of the valve), or as a combined valvular defect. In principle, all valves can be affected. The aortic valve stenosis and the mitral regurgitation are particularly frequent.
Acquired valvular heart diseases may manifest as insufficiencies (i.e. the incomplete closure of the valve), as a stenosis (i.e. a narrowing of the valve), or as a combined valvular defect. In principle, all valves can be affected. The aortic valve stenosis and the mitral regurgitation are particularly frequent.
Acquired valvular heart diseases may manifest as insufficiencies (i.e., the incomplete closure of the valve), as a stenosis (i.e., a narrowing of the valve), or as a combined valvular defect. In principle, all valves can be affected. The aortic valve stenosis and the mitral regurgitation are particularly frequent.
Acquired valvular heart diseases may manifest as insufficiencies (i.e., the incomplete closure of the valve), as a stenosis (i.e., a narrowing of the valve), or as a combined valvular defect. In principle, all valves can be affected. The aortic valve stenosis and the mitral regurgitation are particularly frequent.
Acquired valvular heart diseases may manifest as insufficiencies (i.e. incomplete closure of the valve), as a stenosis (i.e. a narrowing of the valve), or as a combined valvular defect. In principle, all valves can be affected. The aortic valve stenosis and the mitral regurgitation are particularly frequent.
Many bacteria are inherently resistant (intrinsic resistance), while others develop resistance to common antibiotics such as penicillin or fluoroquinolones. For the treatment of infections caused by these pathogens, selective antibiotics, pathogen-specific narrow-spectrum antibiotics should be used. Life-threatening infections should be treated with broad-spectrum antibiotics before identification of the pathogen. This article provides an overview of reserve antibiotics, their pharmacodynamics, indications and adverse effects.
Mendel’s laws, phenotype and genotype, recessive and dominant. Do these terms sound familiar to you from your biology lessons? This article regarding formal genetics will introduce you to all important genetic fundamentals regarding biology that you need to know as a physician. By studying and revising the contents of this article, you will be in a better position to do well both in your preclinical studies as well as in your preliminary exams. This content will help you master the key fundamentals of Genetics.
When it comes to joint pain, it is mostly the cartilage that is inflamed and chronic headaches often result from neural inflammatory processes. Overcoming this pain will often seem impossible. What is little known: Superhormones, which can regulate the hormonal balance of the body, exist – these are eicosanoids, derivatives of arachidonic acid, an omega-6 fatty acid. What effect do the arachidonic acid derivatives have on the body? How can inflammatory responses be influenced and rheumatic diseases completely cured? You will learn about this and much more, in this article!
Inflammatory and immune-mediated polyneuropathies represent an important differential diagnosis of hereditary and acquired polyneuropathies. In this article, we will provide you with all the relevant facts concerning the Guillain-Barré syndrome, the Miller-Fisher syndrome, and the Elsberg syndrome. Also, we will cover the chronic-inflammatory demyelinating polyneuropathy (CIDP) and multifocal motor neuropathy with conduction blocks. Via the concise, selected preparation of the factual knowledge and through several learning tips, you will be perfectly prepared for your exams.
The chemical structure that carries genetic information is called DNA. In this article, you will learn about the structure, organization and various types of DNA. For exams, the phases of the cell cycle are of great importance. After reading this article, you can test your newly acquired knowledge with a few exam questions on this topic.
In the second part of the article about the spinal cord and peripheral nervous system, the lumbosacral plexus is discussed. Aside from that, medical students receive an insight into some review questions.
There has been a lot of progress in the department of anaesthetics since doctors performed the first etherisations in the 19th century. In the following article, you will gain an overview of the popular anaesthetic procedures, their indications and side effects – just as important in the clinical context as for the examination.
While the brain and the spinal cord make up the Central Nervous System (CNS), the Peripheral Nervous System (PNS) is comprised mainly of nerve fibers and ganglion cells. The two systems cannot be clearly distinguished from one another as they are functionally closely interlinked. The PNS conducts information from the CNS, via numerous nerve fibers, to the effector organs and vice versa. The cranial and spinal nerves belong to the PNS. In this article, we address the spinal nerves and the nerve plexuses that supply the extremities, namely the cervical and brachial plexus.
Gluconeogenesis, which is the body's own synthesis of glucose, confronts some students who just studied glycolysis with the question: Why? Why build up sugar again which has already been split up into its components? However, this metabolic pathway is more than just a reversal of glycolysis; in fact, it is essential to human life. Therefore, the following article will present you a comprehensive overview of the processes of gluconeogenesis, so that you will be able to score with this extensive knowledge in your next biochemistry exam.
The complexity of the musculo-skeletal system is often a great problem for the medical student. To effectively learn muscles, one needs a clear and logical grouping in systems with definite structures. Besides supplying a thorough description of origin, insertion, function and innervation, this article will provide medical students with a tabular overview that will help to better visualize the muscle groups. Attention: Due to contradictory statements in primary literature, it is highly recommended to always use the most current versions for learning.
Hemolytic anemia is characterized by intravascular and extravascular destruction of erythrocytes. It manifests if the production of the erythrocytes in the bone marrow is slower than their degradation. A first good differentiation of the several forms of hemolytic anemia can be made between ‘hereditary’ and ‘acquired’. In this article, the most important forms of hereditary and acquired hemolytic anemia are presented, emphazising on their etiology, clinic and therapy.
Parkinson’s disease is a movement disorder that is characterized by degeneration of dopaminergic neurons of the substantia nigra, which is a part of the basal ganglia. The disease itself mostly has idiopathic causes and is to be distinguished from the symptomatic and the atypical Parkinsonism. The disease has a chronic-progressive course, whereas the life expectancy of those affected generally corresponds to that of the normal population. In this article, you will gain all the exam-relevant facts concerning epidemiology, etiology, pathophysiology, clinic, diagnosis, and therapy of Parkinson’s disease.
Heart insufficiency as a disease of old age constitutes a serious clinical picture as its complications often result in death. Cardiogenic pulmonary edema, as a consequence of heart insufficiency, as well as non-cardiogenic pulmonary edema, are diseases indicating immediate measures as they are accompanied by rapid respiratory insufficiency. This article will provide you with everything you need to know about the epidemiology, etiology, classifications, diagnostics and therapy for cardiac insufficiency and pulmonary edema.
In biochemistry, glycolysis is very important. The knowledge of energy supply is of great significance for medical training. This also applies to the regulation of carbon hydrate deficiency and excess. Even the formation and utilization of lactate plays an important role in this. Physicians who supervise not only people with weight problems but also athletes have to deal with this subject on a daily basis. Glycolysis comprises more than sugar metabolism. In all professional areas, energy metabolism is an important subject. This article enables you to gather extensive knowledge concerning energy metabolism of human beings which will help you to master your medical exams.
The four parathyroid glands (glandulae parathyreoidae, epithelial cells) are each located in close anatomical vicinity of the two thyroid lobes. Here, one differentiates between the upper and the lower pair, which each originate from the endoderm of the third or fourth branchial pouches, respectively. The epithelial cells of the parathyroid glands produce the parathyroid hormone PTH, which plays an important role in the context of calcium homeostasis. In this context, symptoms are, for instance, either increased (hyperparathyroidism) or decreased parathyroid hormone levels (hypoparathyroidism).
Antibiotics are an indispensable part of modern medicine. Many infectious diseases caused by bacteria are fatal without antibiotic treatment. Therefore, the empirical use of antibiotics is the basic component of many therapies. However, due to increasing resistance and the increased incidence of long underestimated problematic bacteria, such as Acinetobacter baumanii complex, every medical student and practitioner should know the common antibiotics, their indications, and frequent side effects.
Multiple sclerosis (encephalitis disseminata) is a chronic inflammatory auto-immune disease of the central nervous system. Due to its wide range of symptoms, it is known as a disease with many manifestations and primarily affects younger female patients. It is not only one of the most common neurological diseases, but is also frequently the topic of questions in exams due to its broad spectrum of symptoms and diagnostics.
Microorganisms play a big role in the pathogenesis of diseases in human beings. Prophylaxis and treatment are only possible if you have an exact understanding of the structure and metabolism of bacteria, viruses, and fungi. Get to know different morphological criteria, important facts concerning structure as well as reproduction and growth of the most important microorganisms. Many tips and important information will help you get a high score in your biology exams.
With the help of catalysts, chemical reactions are accelerated and the entire human metabolism is thereby brought in momentum. Everything about the various biocatalysts and their classification can be found here.
As pain, be it acute or chronic, can severely restrict quality of life, humanity has been striving for pain relief since year zero. Painkillers (analgesics) are thus one of the most frequently ingested forms of medication. For that reason, knowledge of the effects and side effects of analgesics is essential during your medical studies and later work as a physician. The following article shall provide you with an overview of the most important painkillers.
It is the chameleon of pulmonology: With as many different clinical phenotypes, making a diagnosis isn’t always easy, and pathogenesis is complex. In the following article, you will find all the important information about one of the most common chronic diseases in human beings: bronchial asthma.
Cholesterol (Greek for: ‘gall’ and ‘solid’) is a media star: For decades, no other biochemical substrate draws as much attention as cholesterol has. But what are the hard pre-clinical facts? How is cholesterol synthesized and degraded in the human body? How is cholesterol metabolism regulated? The following article presents you with useful information that will aid you in your exam preparation.
The adrenal glands are paired endocrine organs that produce hormones secondary to neuronal influence. The glands are organized into an inner adrenal medulla that secretes Adrenaline and Noradrenaline and an outer cortex consisting of three anatomically and functionally different layers producing mineralocorticoids (aldosterone), glucocorticoids (cortisol) and androgens (androstenedione).The gland may suffer disorders of hyperfunction such as hypercortisolism, pheochromocytoma and hyperaldosteronism or disorders of insufficiency such as Addison’s disease. This article will provide outlines for each disease separately.
Affective or mood disorders are characterized by various types of psychiatric diseases that can be disruptive to patient's life. They can involve abrupt onsets of manic or depressive episodes of mood changes and and often combinations of the two. Patients usually experiences depressive episodes of agitation, sleep disturbance, eating disturbances, lack of interest and feelings of worthlessness or guilt. The mania is usually associated with violence to others. Psychotherapy, medical treatment or even electroconvulsive therapy in extreme cases are the mainstay treatment of affective disorders.
Colpitis and bacterial vaginoses are diseases of the vagina. Apart from the symptoms themselves, there is always the risk of an ascending infection. Also inflammations of the outer genitals are an important clinical issue. For one thing, vulvitis is very frequent and ubiquitous. Furthermore, the outer genitals are so sensitive that diseases can cause great discomfort for the patient, even if they often are harmless. Here you can read all about pathogens, diagnostics and treatment.
Do not fear the pelvic floor—although this topic is popular amongst examiners and seems to be complicated at first glance, there is no need for fear. Here, you get a compact overview and learn everything you need to know about the pelvic floor, the abdominal wall and the inguinal canal.
The understanding of eukaryotic and prokaryotic cells is one of the foundations of medicine. Each cell carries out specific functions depending on its field of application. During the foundation of new lives, two cells are left on their own because cells function in large groups in an organism. If the structure of the cells is similar in principle, important differences arise from the tiniest of changes, enabling the whole organism to function.
Fats or fatty acids represent an important energy source for the human body. Thus, intake, storage and degradation have to be strictly regulated. Fatty acid synthesis is also possible, which is of little significance in industrial countries, but is vital for a body with too little fat intake.
Diabetes mellitus is a metabolic disease in which chronic hyperglycemia can lead to a number of different early and late complications. The high prevalence of the disease with its heterogenic variety of symptoms demands interdisciplinary care including many specialties. Therapy options can be very successful here. Therefore, good knowledge of the clinical picture is absolutely relevant for up-and-coming physicians as contact with diabetics is part of the daily routine.
The hormone balance of the body is often organized in feedback control systems which adjust to the respective demands of the body. The most important example of such a system is the hypothalamus pituitary axis. In the following article, the interaction with the adrenal gland and the synthesis of glucocorticoids like cortisol serve as examples for the explanation of a complete hormonally regulated system. This is especially important in order to exactly classify and understand the genesis of some important endocrine diseases.
For many students, embryology belongs to the more unpleasant topics of preclinical studies. Nonetheless, the knowledge around the branchial arches (Latin: arcus branchiales, synonyms: pharyngeal arches, visceral arches) and their derivatives, are not only a popular exam topic, but are also essential for understanding the anatomy of the face and neck. In order for you to shine in your next anatomy test with your embryological knowledge, you will find detailed information regarding the branchial arches and the structures originating from them in the following article.
"This is genetic!" Which diseases are inherited as an autosomal dominant trait and which as a X-chromosomal recessive trait? What is the purpose of our gonosomes? How do you calculate a risk for inheritance? What do you know about genomic imprinting and the inheritance of blood types? In this article, we offer you everything you need to know about human genetics including the most important facts and genealogical trees of major genetic diseases.
In comparison to the upper extremities, in particular the forearm, the muscles of the lower leg and foot are so much easier to learn for the medical student. Their grouping is simple, and the muscles themselves can be very well distinguished according to their function in the foot. Besides thorough descriptions, this article provides a clear chart of all the muscles and their groups. This chart can be used as a flash card for studying.
Digestion is the process of breaking down large food molecules into smaller ones. This involves the digestive system, which breaks down the nutrients obtained from food into a form that body cells can absorb and that can be used to form ATP and body tissue. Below is a concise overview of the physiology of digestion: from ingestion to the act of swallowing, to the digestive organs that are involved and to the absorption of carbohydrates, fats and proteins.
The hip is one of the strongest joints of the human body. This circumstance is due to the variety of muscles that surrounds, stabilizes and moves it. Medical students often have difficulties to properly understand the large number of individual muscles with their structures and functions. It is, therefore, advisable to divide the muscles into groups in order to obtain a better overview that will, in turn, facilitate the learning process. This article is intended to provide the desired overview.
Blood (Latin: sanguis, Greek: haima) is a suspension of cells in a saline solution containing protein. It makes up 6-8 % of the total body weight and has a pH value of 7.4. The blood carries out many essential functions and is the pivotal point of the whole organism. The following article provides, at a glance, the most important facts about this vital body fluid called blood.
The term ‘lipids’ describes a hotchpotch of heterogeneous structures; yet they all have two things in common: they are fatty, and high in energy. Lipids do not dissolve in water, or only do so partially – which means they are lipophilic or hydrophobic (they do, however, dissolve well in solvents) – and they are all made from energy-rich units of activated ethanoic acid, so-called acetyl-CoA units. These two properties, plus the way lipids appear in many different forms, means they are destined for a variety of important functions within the human body. In addition to other things, they constitute building materials, message-carriers, and combustible materials. You can read about the properties, structure and functions of lipids below.
The telencephalon is made of grey matter, which is mainly the outer-lying part, and white matter, which is the inner part. Grey matter comprises the cerebral cortex (cortex cerebri) and the subcortical nuclei, which are located inside the telencephalon and are surrounded by white matter. White matter is, moreover, subcortical.
Allergies are exaggerated response of the immune system that mediated by IgE antibodies to specific harmful allergens (e.g: pollen, mites, molds, certain foods). Atopic syndrome is a disease of genetic predisposition characterized by high production of IgE. Symptoms appear after the release of certain chemicals from mast cells with their attachment to IgE antibodies. Allergic asthma, allergic rhinitis, allergic conjunctivitis, food allergy and atopic dermatitis are common diseases.
The lymphoid organs, including thymus, spleen, lymph nodes and tonsils are part of the Lymphatic System. The lymphatic system serves a purpose in immune defense. Understanding this system is essential for the diagnosis of many pathological processes. This article deals with the structure, modes of action and a basic overview of the diseases of the lymphatic system.
The large number of different muscles makes the forearm and the hand one of the most complex structures in our musculoskeletal system and can cause issues for both medical professionals and students. The most common arm injuries occur in the upper arm, especially the radius.
The anamnesis is an important and indispensable component of a diagnosis. The term anamnesis originates from the Greek language and translates to memory. Another suitable word is medical history or intake recording. This paper describes the importance of a medical history, its opportunities and limitations.
Besides the shoulder joint, the knee joint is one of the most complex capsuloligamentous structure systems of the human body. Hardly any other joint has as many different stabilizing ligaments and simultaneously such a great degree of movement. Most of all, medical students should be familiar with the functional anatomy since even slight disorders, e.g. in the gliding movements of the menisci, can lead to severe movement impairments and pain. After the hip, the knee is the second most frequent location for the implantation of total endoprostheses.
The language centres of the telencephalon, i.e. the Broca's area and the Wernicke's area, are highly relevant as exam topics. The same goes for the structure of the limbic system and the basal ganglia.
The terms sensitivity, specificity, positive and negative predictive values constitute the statistical quality criteria of diagnostic testing. You should not only know their meaning and interpretation while preparing for your written exams as, if you want to make (responsible) treatment decisions as a doctor, there is no way around these parameters. Incidence rate and pretest probability are further parameters that you need to be familiar with. This article will provide you with an overview of various statistical quality criteria and their interpretation.
Are you able to name the six basic human emotions? Happiness, sadness, anger, fear, surprise, and disgust. How do emotions arise and how can they be measured? What anatomic correlations should you know? What are the most important theories about emotions? The following article answers all of these and even more questions. Moreover, you will learn important clinical connections: anxiety disorders and depression are common diseases that you will encounter in your clinical routine. Make yourself familiar with the basics so that you are perfectly prepared for preclinical exams and your "Physikum".
Every year, a great number of endoprostheses are implanted in the hip joint region. This shows the extreme vulnerability of the capsular ligament complex and, thus, why a physician should be able to know its anatomy, functional anatomy, and pathophysiology. Orthopedists and surgeons hear patients complaining about pain in the hip joint every day. Without sufficient knowledge, it is impossible to help these people competently.
The heart is a hollow muscular organ that contracts approx. 100,000 times a day and pumps approx. five liters of blood into the circulation every minute. It is not only characterized by the unique features of muscle tissue specialized to meet the constant physical demands of pumping blood, but also by muscle cells that send spontaneous rhythmic electrical impulses to stimulate contraction. This article gives an overview of the structure of the heart wall and of cardiac muscle tissue.
Why do you decide in favor of certain actions and behavior but not of others? To get to the bottom of this question, psychology has developed a number of learning models. Classical and operant conditioning, learning by self-control, and observational learning are important basics that psychotherapy is based on. The following article contains, in addition to all facts about learning, knowledge about memory and language that is relevant for your exams.
The skin forms part of the body’s integumentary system. As such, it creates a barrier between the body’s inside and the external environment and protects it against excessive fluid loss. The skin is the body’s largest organ and weighs between 8 and 20 pounds (3 – 10 kg). In an average person of 5 feet 6 inches (170 cm), the skin covers a surface area of almost 20 square feet (1.8 m²). This article offers a compact overview of the body’s outer shell – the skin.
The spinal cord (medulla spinalis) is part of the central nervous system, while simultaneously connecting the body to the brain. On the posterior side of the spinal cord, sensory information from the skin, skeletal musculature, joints and intestines, flows in from the afferent nerves via the dorsal root of the spinal nerves. On the frontal side, in turn, spinal nerve roots exit as efferences and deliver information to the peripheral nervous system – to the skeletal musculature and the intestines, and so forth. The following article will provide you with a first impression of the structure and function of this fascinating organ.
Our heart is a powerful pump that performs its duty around the clock. It pumps 7,000l of blood through the body each day. This is possible due to, among other things, its autonomous regulation and unique musculature. This article covers the aspects of cardiac physiology that are relevant in medical exams and creates a basic understanding of the mechanics of the heart.
In the 3rd week of embryonic development, both the neurulation as well as the development of the cardiovascular system begins. The neurulation denotes the formation of the neural tube in the development of the central nervous system. These complex processes are a combination of numerous factors and interactions. Embryology is always relevant for the understanding of an organ. By understanding the development we can understand the anatomy and possible malformations. The processes relevant for the examination are explained step by step in this article.
The shoulder joint is one of the most mobile joints in the human body and is extremely susceptible to injury, among other reasons, due to its high mobility. Physicians, not only surgeons or orthopedists, should, therefore, be familiar with its anatomy and functional anatomy. This article provides an overview of the osseous and articular structures of the shoulder joint and the subacromial joint space.
Breathing and eating - two skills humans master from birth. The digestive system and the lungs are vital organs, and their complexity still poses many questions to physicians. In order to understand them and also their pathogenesis, one must know how they developed. Embryology helps to elucidate the structure, function and interrelationships of all organs. This article discusses, step by step, the development of the gastrointestinal tract and the bronchial system from the primitive gut tube.
Triacylglycerides are a group of insoluble compounds that serve as energy reserves in the body. Their storage occurs in adipocytes, which are built up or depleted in response to the constantly changing energy demands of the cell. Both of these processes are under tight hormonal regulation. This discussion will also include the absorption and transport of fatty acids, as well as the production of ketone bodies.
Etymologically, the term "sleep" comes from a word meaning "to slack"; the term's similarity to the word "slack" is no accident. Sleep is susceptible to various interferences, and many diseases, some harmless and some serious, first exhibit symptoms during sleep. It is therefore important to deal not only with the scientific findings, but also with possible sleep theories because many facts about sleep remain unknown. In the following guide, you will see what sleep is actually about, what stages it occurs in, and what sleep disturbances individuals may experience.
Genetics and heredity – nowadays, everyone knows that diseases can be inherited. For that very reason, patients seek advice with their doctors because they are concerned about unborn children, family members, or themselves. An aspiring doctor must therefore be able to provide genetic counseling and diagnosis. The following article addresses the different modes of heredity, explains important tools –e.g. family pedigree creation and analysis–, and illustrates their application using the example of cystic fibrosis, a frequent genetic disease.
In this article, you will get an overview of the most important facts concerning the histology of veins and arteries, as well as their functions based on their histology. In addition, we cover the crucial structural and functional differences between veins and arteries, and the way they interact within the circulatory system.
What makes the difference between a human being and a fungus? A fungal network can be split in the middle – and both halves will survive and grow further. This does not happen if a human being split since our faculties and vital functions are spread over several locations within our organism. Our cells are specialized and organized into organs. The system only works if the organs work together and communicate. Hormones are the messengers in this communication system. The most important ones, the hormone receptors, and the signal cascades, are explained in the following article.
The skeletal system has important functions as protection and support during movements, for the mineral balance, blood production and the storage of triglycerides. In this process, bones (latin: os, greek: ost-, oste- or osteo-) give us stability and shape. Now, how many bones do humans have? This is easily answered numerically, 206. However, for exams it is more important for physicians to understand the structure and composition of bones than the amount.
Hardly any other muscle group has so many small intricate complexes as those of the thumb and fingers and causes such a headache to medical students. And yet, the muscles and their functions can be very easily remembered on the basis of their denominations and the majority of them is innervated by the deep branch. It is, therefore, advisable for aspiring doctors to study with the help of mnemonics in order to be able to go relaxed into their next exam.
Human development begins with the fertilization of the oocyte and ends with death. Between these two poles of life, the human being is constantly undergoing changes in shape. At this, the most obvious changes occur in the womb. Here, you will learn about the amazing process of differentiation of the human being in the first three weeks after fertilization, and how a fertilized egg cell becomes an embryo with an already created neural tube and intraembryonic coelom.
The purpose of the blood circulation system of the human body is the convective transport of respiratory gases, nutrients, hormones, and warmth. The blood acts as a vehicle that is pumped by the heart through the blood vessels and back to the heart. The blood circulation is a rapidly adjustable system that is vitally important for maintaining the body functions. High blood pressure (arterial hypertension) is one of the most common diseases in our society. Thus, a physician must know and understand the blood circulation. This article provides an extensive overview.
What motivates you to study for the preliminary examination in medicine? Why do you stay in the library instead of having a nice afternoon? For whatever motives and with what degree of intensity we pursue our goals, is what the psychology of motivation deals with. The term motivation derives from the Latin word motivus = „triggering movement“. In the following article, read all about the topic motivation that closely follows the study guide for the preliminary examination and has been optimally edited.
The diencephalon of the brain consists of four components. These are the thalamus, the epithalamus, the hypothalamus and the subthalamus. Overall, the diencephalon co-ordinates unconscious vegetative and sensomotoric functions.
The biochemical processes that form part of the amino acid metabolism all support the synthesis and breakdown of amino acids. In the following article, the three most important reactions of the metabolism, i.e. transamination, deamination and decarboxylation, are explained in a compact overview, providing you with the perfect preparation for your upcoming exams.
The ventricular system is the extension of the spinal canal (canalis centralis) into the brain and consists of four chambers which are filled with cerebrospinal fluid (liquor cerebrospinalis). The paired lateral ventricles (ventriculi laterales I and II) are two of these four chambers and are connected to the unpaired third and fourth ventricle through the foramen interventriculare. The following article gives an overview on the topography of the ventricles, their structure, as well as the production and re-absorption of liquor.
The gall bladder (Latin: vesica fellea or vesica basilaris) is the storage organ for the bile and has a storage capacity of 40 – 50 ml. On its way from the liver to the duodenum, the bile runs through a duct system which is referred to as the bile ducts. The function of the gall bladder and the bile ducts is an elementary prerequisite for the complex process of digestion and can be impaired by typical diseases which a physician should know and understand. In order to understand the process of digestion, the spleen and the pancreas are also important.
Congenital malformations are developmental disorders that arise before birth during the embryonic (2nd - 8th week of development) or fetal period (9th - 38th week of development) (from the Latin congenitus = "born with"). The cause may be genetic or contingent on external influences. The rate of incidence for children born alive is approximately 3%. Toxic agents that may cause embryonic damage and malformations are called teratogens, and the study of the cause and characteristics of inherent malformations is called teratology (Gr. teras = monstrosity, marvel). Infections such as rubella, medications like thalidomide, drugs such as alcohol and tobacco, or radiation are all teratogens.
In the ranking of most popular study subjects among students, embryology is often near the bottom. In exams, the (admittedly) rare questions on the field can allow the student to shine by knowing only a limited number of facts, and, on a normal day in the clinic, symptoms and malformations stemming from this developmental period are hardly uncommon so it is indeed worthwhile looking into the details of this field, and not just for aspiring pediatricians. This article explains the most important facts about the development of the body cavities and the relevant symptoms.
The gullet (Greek 'oesophagus') is a hollow organ, approximately 25 cm long, assigned the task of actively sending our food to the stomach. The following article will provide you with a compact overview of the anatomy as well as the most important diseases of this organ and explains the physiology of the act of swallowing in understandable steps.
The human shoulder is the most mobile joint of the body. Since it is a muscle-guided and muscle-stabilized joint, it is susceptible to instability and inflammation. It is essential for doctors to learn about the muscular stabilization of the shoulder joint and its functional anatomy. We can imagine how tiring (if not impossible) a life without a properly functioning shoulder joint would be. The muscle groups of the shoulder are distinguished by location and origin: the muscles of the shoulder and the muscles of the upper arm.
Development: a dynamic process that begins with conception and ends with death. Developmental psychology deals with the changes that occur during the course of a human life. In this article, we are going to discuss developmental processes and primary/secondary socialization as well as present the psychosexual theories of Freud and Erikson. With this, you will be optimally prepared for tricky questions about developmental psychology in your medical exams.
A number of hormone-mediated processes take place in the female genitals. The follicle maturation in the uterus, formation of the mammary gland tissue and lactation are processes that are basic knowledge to medical students. In the following, the most important facts are listed. Afterwards you can use the three exam questions to control your knowledge.
As a medical student, you have probably already made experiences with tests, e.g. admission tests for your university. Achievement tests and personality tests, along with observations and interviews, are important methods for data acquisition. In the following article, you can read everything on study designs, types of studies, data acquisition and interpretation. After this, you will be prepared for your next exam and you will know exactly which types of questions you should ask your patient at which point during the anamnesis!
Genital development in the embryonic period can be divided into the development of the gonads, the genital ducts, and the external genitals. It is a popular subject in anatomy exams, which often poses questions concerning the minutest details – as genital development has a decisive impact on the development of human beings, both in the pre-/postnatal state and on into adulthood.
The development of the kidneys and the efferent urinary tract is complex and unalterably interconnected. It is an essential part of embryonic development and closely connected to sexual development. Malformations lead to severe consequences and are often not compatible with postnatal life. In medical studies this is one of the most important themes in embryology.
Learning and the development of memory are processes that cannot be strictly separated from psychology and sociology. Thus, this article deals with the physiology of learning and memory. Topics include understanding the relationship between experience and storage of acquired knowledge, how the brain deals with “useless” knowledge, and how a baby starts to understand its surroundings.
How and why are we different from other people? Many scientists have addressed the answer to this question and developed various models of personality. All models mainly focus on the differences between people, which lead to the term “differential psychology." Here, you will learn about the principal models of personality, personality disorders as well as behavioral styles, and you will be optimally prepared for exams, the preliminary examination and the medical practice.
The special field of endocrinology deals with the hormonal system. This includes, among other things, the function of hormones, the anatomy and physiology of endocrine glands and the feedback mechanisms of hormone regulation. This article explains the physiology of the endocrine system and provides graphical illustrations. The physiology of the endocrine system is a vast field that plays a role in all medical specialties, and it demands a lot of medical students to master it.
Fascinating but also intensive in terms of learning: This is how medical students describe anatomy in the preclinical part of their studies. Knowledge about the human anatomy is absolutely essential during university and after it. The great amount of study matter seems to be insurmountable at first. However, as soon as one realizes the order of the system, a spark of fascination emerges. Thus, the dissection course provides the first contact to a patient – even if he is lifeless. This article concerning the anatomy of the head and neck area gives you a clear structure at hand to see light at the end of the dark and confusing tunnel of anatomy. Also, the parts concerning the ventral and infrahyoid neck muscles will help.
The subject of gametogenesis as the umbrella term for spermatogenesis and oogenesis is a basic part of embryology. Human germ cells are the basis for the development of new life. It is important to understand this development in detail since errors can occur which make postnatal life impossible or severely change it.
Everywhere in biochemistry, there is mention of carbohydrates and sugars; they are a fundamental part of almost all essential biochemical processes and, what's more, they form an extremely important part of medical exams, but what is it that makes carbohydrates so essential for biochemistry?
The brain, as well as the spinal cord, is enveloped by the meninges which, in turn, are composed of three layers of connective tissue. The following text gives you an overview of the structure of the individual meninges.
The sensory organs enable us to interact with our surroundings and perceive things outside our body. As fascinating as their function is, as complex and vast seems the topic during medical studies. Despite the large variety of sensory organs, they all follow a few fundamental principles in their structure and function. From the fundamentals to the necessary detailed knowledge of the different sensory perceptions is only a short way.
The arterial blood supply of the brain occurs primarily via three large arteries (anterior, middle and posterior cerebral arteries). The arterial supply of the brain stem occurs via the basilar and vertebral arteries and their branches. The cerebellum is also supplied by three arteries. (PICA-posterior inferior cerebellar artery, AICA-anterior inferior cerebellar artery and SCA-superior cerebellar artery). The venous drainage of the brain occurs via the dural venous sinuses, which are located between the periosteum of the calvaria and the dura mater.
The stomach (Latin: ventriculus, Greek: gaster) is more than just a muscular sac with storage function. It is also an important organ of the digestive system as it produces enzymes and hydrochloric acid which acts as a disinfectant. Many patients consult their doctor because of "stomach pain" who then has to figure out what the cause of their symptoms is. Here, you will find a compact overview of the structure, functions and diseases of the stomach.
Muscles are the active part of our motor system. They are the focal point of our weekly efforts at the gym. They define our body significantly and are therefore a characteristic of attractiveness. However, even more important is their function. Movements are the results of alternating contraction and relaxation of muscles that amount to approximately 30-40 % of the entire body weight. The primary function of muscles is the conversion of chemical energy into mechanical energy to do their work. Without the support of muscles, we would not be able to keep our back straight, let alone walk straight. In this article you will find a compact overview of the different types of muscles, their structure, how to control movement with their origin and approach and which auxiliary structures they use.
The lung is, similar to the intestines or the skin, an organ that has direct contact with the outside world. Its function is the basis of our existence: gas exchange via diffusion. To perform this enormous task every second of our life, it needs a transport system for waste gasses and fresh air; a room in which the walls are thin enough for gas diffusion, and the transport services for gasses in chemical bonds. To achieve the various functions involved in mechanical respiration, the respiratory tract has adaptation to this function by possessing different histological features.
The endocrine system is an important and complex topic of the preclinical studies. The control of bodily functions through the messengers (hormones) of the endocrine system is the subject of anatomy, physiology and biochemistry; an accurate understanding of the hormones and their functions is essential for the clinical routine as well. The endocrine organs, in the stricter sense, include pituitary, thyroid, parathyroid, adrenal gland and pineal gland. They are easy to identify by their characteristic structure in the histological examination, but there are several things that should be considered. This article summarizes the most important facts about the endocrine organs.
The cell is the basic element of all organisms. It measures only a few µm in size, but is incredible in its biological and organizational functions. The cell is a common exam topic in the studies of biology, biochemistry and histology. This is because of its numerous organelles, the cytoskeleton and the cell-cell contacts. Based on the following overview, you will be able to obtain knowledge that will enable you to answer certain exam questions on topics related to cells.
The pancreas is two in one: exocrine and endocrine gland. It is essential for digestion and the carbohydrate metabolism. Thus, a loss in pancreatic function leads to severe clinical symptoms. In this article, you will get a compact overview of the structure, functions, and diseases of the pancreas.
The large intestine (lat. intestinum crassum) is distally adjacent to the small intestine, extending from the ileo-caecal valve to the anus. It is divided into the caecum with vermiform appendix, colon, and rectum. Thus, it is forming the terminal part of the human digestive tract. Particularly relevant for the exam are the relation of distinct intestinal sections with regard to the peritoneum, the differences between large and small intestine, and the general understanding of anatomy and physiology. The overview below provides all important basics about the large intestine.
The small intestine (Latin: intestinum tenue) spans a range of about 3-5m from the pylorus of the stomach to the Bauhin’s valve located at the passage to the colon. This section of the digestive tract represents the body’s most essential site of nutrient uptake and water resorption. Understanding the small intestine’s structure and processes is a crucial part of any physician’s education. The following article comprehensively sums up the most important facts about this central part of the gastrointestinal tract and its three sections – the duodenum, jejunum and ileum.
The liver (Latin: Iecur, Greek: Hepar) is the generalist among all organs – acting universally as center of metabolism, storage unit, detoxifying- and excreting organ. Medical staff is frequently confronted with diseases such as liver cirrhosis, hepatitis and fatty liver. Therefore, anatomical and biochemical knowledge of the liver is part of every medicine student`s basic training. Read this compact overview on structure, functions and diseases of the liver.
The physiological structure and function of the human immune system are key issues in the academic education of physicians and other medical professionals. In order to recognize pathogeneses on the micro- and macro-biological level at an early stage, and to be able to treat them adequately, a comprehensive knowledge of physiological and pathophysiological processes is required. Due to demographic changes, a continuous increase in psychosomatic diseases by immunosuppression can be observed. Therefore, besides an effective treatment with medication, physicians should also offer their patients possibilities for autonomous strengthening of the immune system, for example by changing their nutrition and lifestyle.
The kidney (Latin: Ren, Greek: Nephrós) is the urinary system’s main organ. In order to understand the microscopic structure of this organ, it is useful to comprehend well its function. And for this, one has to learn about the different cell types and their structure. The nephron is the kidney’s functional unit and shall be particularly discussed here. After studying this article, you will be able to explain its components. These are the renal corpuscles, renal tubules and the collecting duct system. You will now read a short overview of the functions of the human kidney.
The human nervous system weighs “only” about 4.5 pounds, which accounts for approximately 3% of the entire body. It is a small and complex body system that consists of an intricate network of nervous cells (or neurons) and even more glial cells. How many nervous cells does a human have? Billions, is the simple answer. However, from a medical point of view, the more important questions are: how does the nervous system work, and what does its structure look like?
The spleen (from Greek: splen; Latin: lien) has the shape of a coffee bean, weighs about 150 grams, and is located in the left posterior upper abdomen (epigastric region). Next to such large topics as heart, liver, or lung, the spleen is sometimes a bit neglected in the curriculum; therefore, many students struggle in exams when it comes to questions about the ligaments or blood circulation of the spleen. This article provides a compact overview of the anatomy, functions, and diseases of the spleen.
Nerves emerge as spinal nerves from segments of the spinal cord. Cranial nerves emerge directly and without “detour” via the spinal cord from the bony skull because they supply cranial structures or fulfil specific functions. As the 31 pairs of spinal nerves, they are considered components of the peripheral nervous system (PNS). The cranial nerves I and II are exceptions since they do not emerge from the brain and therefore are not considered peripheral nerves. During medical studies, cranial nerves are an essential element of the subjects of the brain and the nervous system. In the following, you will find a concise overview of the classification, the functions and the course of the 12 cranial nerves.
The epithelial tissue is one of the four main types of tissue structures of the human body, along with muscle tissue, nerve tissue and connective tissue. Tissues are cellular organizations with similar specializations. In addition to the systematic structure, it is important for every physician - not only for dermatologists - to know the distribution and function of all types of epithelial tissue in order to transfer this fundamental knowledge into the pathology.
The main task of the lung (Latin: Pulmo) is the oxygenation of the blood and the elimination of carbon dioxide. This gas exchange takes place in the pulmonary alveoli (air sacs). Diseases of the lung are common and seen in every age group. In this context, asthma as a disease of children and teenagers, and the chronic obstructive pulmonary disease (COPD) as a disease of adults should be mentioned. Also, infectious diseases of the lung like pneumonia are part of the everyday-life in practices and hospitals. Anatomic knowledge of the lung is key to be able to classify the different clinical pictures. In the following article, you will get an overview over the location, the structure, and the functions of the lung.
Cardiovascular diseases can be diagnosed and investigated using different tests and methods, such as the measurement of blood pressure using a sphygmomanometer, the cardiac stress test, electrocardiogram, echocardiogram and more. This article provides an overview.
Calcium levels are regulated by a hormone known as the parathyroid hormone (PTH), which is secreted by the parathyroid gland. If the body fails to maintain the calcium levels within the normal ranges, hypercalcemia or hypocalcemia results. Hypocalcemia is the condition in which the serum calcium levels in the blood are low. The presentation of the patients with hypocalcemia can vary from asymptomatic to life threatening situations.
Gallstones are common in the United States, especially among the Hispanic population. They are common among the fatty fertile females in their forties. The gallstones are mostly asymptomatic that do not need treatment except in certain high-risk groups. The symptomatic patients present with right upper quadrant abdominal pain and cholecystectomy is the primary treatment option in these patients.
Gastroesophageal reflux disease and its complications, particularly Barrett’s esophagus, is a much favored exam topic. Due to its high prevalence amongst the west industrial countries and its increasing incidence, medical students are expected to come across symptoms associated with this condition all the more often in daily clinical practice. That is why you should definitely be well-prepared for such an occasion.
Excess production of growth hormone by pituitary gland in the body is given the name Acromegaly. The exact cause behind Acromegaly can be benign, noncancerous tumors formed in the pituitary gland. Middle aged adults are more prone to develop acromegaly. It is often diagnosed very late because of its slow and insidious onset. The symptoms varies from swelling of hands and feet to protruded lower jaws, joint pain, and deep voice. Accurate diagnosis is established by elevated level of growth hormone (GH) and Insulin-like Growth Factor I (IGF-1) in the blood.
Stereotypes are over-simplified ideas about groups of people based on characteristics, which can include race, gender, sexual orientation, or religion. Stereotypes can have both positive as well as negative connotations. Prejudice refers to thoughts, attitudes, and feelings about a group not based on actual experience. Discrimination involves acting in a certain way toward a group.
Amebiasis is caused by Entamoeba histolytica. Infection occurs by ingestion of water and food contaminated with feces (containing cysts of Entamoeba histolytica). In this article, we will study in detail about the various amebicides, their mechanism of action, adverse effects/toxicity, contraindications, drug interactions and drugs of choice. Other important therapeutic aspects of individual drugs will also be studied.
In this article, we will study in detail various anti-herpes drugs, their mechanism of action, adverse effects/toxicity, contraindications, drug interactions and drugs of choice. Other important pharmacological and therapeutic aspects of individual drugs will also be studied.
In this article, we will study in detail about the various sedative and hypnotic drugs, their mechanism of action, adverse effects/toxicity, contraindications, drug interactions and drugs of choice. Other important pharmacological and therapeutic aspects of individual drugs will also be studied.
Testicular tumors are common and potentially annihilating to the male population. With a brief prologue to testicular tumors; this article focuses on the significant, relevant types of testicular tumors such as Germ Cell Tumors (GCTs) and Non-Germ Cell Tumors (NGCT).Various clinical, patho-physiological and prognostic aspects of the same have been expatiated.
Somatoform disorders are a group of psychological conditions where the physical symptoms are present in the patient and it cannot be attributed to any medical condition or substance abuse. The term somatoform disorder has been replaced by a newer term in DSM 5 namely the somatic symptom disorder. The cognitive behavioral therapy constitutes the main mode of treatment of this disorder. The antidepressant has shown beneficial effect in the pain of the somatoform disorder. This disorder would be described in detail in this article.
A number of cellular processes involves transport of materials in and outside the cell. The transport of these materials are governed by a number of factors which include presence of a concentration as well as an electrochemical gradient. This article summarizes the different types of transport that can occur across the cell membrane. Specifically, the article differentiates active and passive transport. The different factors that can affect the transport are also discussed in this article.
Self -presentation is the method acquired by humans to present themselves in the society to control or shape how others think about them. It means expressing oneself and managing behavior in order to create a desired impression. Gender and culture have marked influence on self- presentation which have variable aspects. We will also look at impression management and self-presentation, including a reference to the dramaturgical perspective of the front stage and back stage self. This article will also cover verbal and non-verbal communication in humans, as well as the types of interactions and modes of communication that occur between animals.
Patients with chronic pancreatic insufficiency develop improper digestion due to the lack of digestive pancreatic enzymes. Such patients might complain of diarrhea and multi-nutrient deficiencies. Children with cystic fibrosis are at an increased risk of developing pancreatic insufficiency, while adults can develop chronic pancreatitis due to gallbladder disease or alcohol consumption. Regardless of the etiology, these patients might develop exocrine pancreatic deficiency and are at risk of developing malabsorption. Pancreatic enzyme replacement therapy is indicated in patients with malabsorption due to exocrine pancreatic insufficiency.
Patients with intestinal motility disorders, whether hypomotility or intestinal dysmotility syndromes, might need a diverse array of medications for symptomatic relief. These medications fall into one of the following categories: antibiotics, antidiarrheals, opioid antagonists, cholinergic and promotility drugs. Additionally, antiemetics might be needed as these patients can complain of nausea or vomiting.
Team work has always been found to be effective in solving problems faster and more effectively if the decision-making process is well organized. Therefore, any group or team might need to make decisions about performing a certain surgery for some patient, define their next research project, or financial decisions. The process of group decision making involves multiple individuals who try to act collectively to define the problem needed to be solved, define possible solutions, study and understand the possible methods and tools one can apply to solve the problem and finally define what should be done as a follow-up step to prevent future risks and uncertainties.
The heart – a muscle working without exhaustion and breaks. It ensures the blood’s transport through the circulatory system. However, the conditions under which the heart is working do not always stay the same. An aortic stenosis, or increased blood reflow via the veins, strain the heart. In machines, the settings and scaling would have to be changed. Our organism, however, has its own ways of dealing with that. One of them is the so called Frank-Starling mechanism.
Attitude is the expression of favor or disfavor towards a person, place, thing or event. It is an individual’s own view regarding a certain subject. Multiple factors are responsible for the attitude formation. Additionally, the attitudes can be learned and unlearned through various methods throughout our lives.
Whether you are working in basic science, transitional or clinical research, a set of ethics and morals should guide your decision making process. This collection of ethics can be learned from our supervisors, our colleagues, lab seminars, professional organizations concerned for example for ethical handling of animals, and courses specifically dealing with ethical issues. Finally, our family, friends and our own religious beliefs also help form our moral compass and can make us make ethical decisions related to our research.
Biotechnology is the use of biological organisms or processes to develop products or improve the quality of life. One common technology studied is the Recombinant DNA technology. DNA of two organisms are combined to improve characteristics and properties of an organism. Modification of the DNA also is done to develop new pharmaceutical therapies and diagnostic tests. In this article different techniques in biotechnology are discussed, namely, recombinant DNA technology, Polymerase Chain Reaction, Gel Electrophoresis and CRISPR Cas9.
In many cases, when we encounter a certain behavior from someone, we attribute this negative or positive behavior either to their personality traits or to the situation in hand. Attribution theory in sociology deals with this observation. Attribution theory can be defined as how we perceive behaviors and other information from individuals we interact with and how we link such behaviors to certain causes. These causes can be the events or context, i.e., situational, or can be based on our judgement on the person’s personality, culture and beliefs, i.e., personal.
The Human immunodeficiency virus (HIV) infection occurs in and kills millions of people every year worldwide. The virus enters CD+ cells of the host immune system and replicates, thereby destroying the cells and weakening the immune system. This leaves the host vulnerable to many infections. It is crucial to understand the mechanism of the HIV infection in order to develop effective antiretroviral therapies. Unfortunately, resistance against HIV drugs is common and cross-resistance among the same class of drugs is also common. Measures such as pre- and post-exposure prophylaxis help to combat the spread of infection.
In this article, we will study the details about the various antiviral agents used to treat hepatitis, their mechanism of action, adverse effects/toxicity, contraindications, drug interactions and drugs of choice. Other important pharmacological and therapeutic aspects of individual drugs will also be studied.
Antiviral agents are chemotherapeutic drugs that are effective against different viruses. Influenza is a common infection; anti-influenza agents are useful for both prophylaxis and the treatment of influenza. CMV retinitis is a common opportunistic infection in immunocompromised patients; there are several antiviral drugs effective against CMV. Pharmacology of all the drugs will be discussed briefly.
In this article, we will study the details about various antifungal drugs, their mechanism of action, adverse effects/toxicity, contraindications, drug interactions and drugs of choice. Other important pharmacological and therapeutic aspects of individual drugs will also be discussed.
Antiemetics are used to prevent or stop vomiting; they act on the esophagus, stomach, intestines and even on the central nervous system where the vomiting center is located. In this article, we will cover in detail the various antiemetics, their mechanism of action, adverse effects/toxicity, contraindications, drug interactions and drugs of choice. Other important pharmacological and therapeutic aspects of individual drugs will also be noted.
Scrotal masses are embarrassing and seemingly exigent trouble for males. Benign scrotal lesions present as testicular masses that transilluminate as against solid testicular tumors which do not transilluminate. This article expounds about benign, relevant, common scrotal masses such as congenital and acquired hydrocele and spermatocele.
There is a variety of applications that can be done using recombinant DNA technology. This is why it important to develop libraries for the genomes of organisms so that it will be easier for scientist to isolate desired genes of interest. This topic review discusses DNA libraries and how they are developed. Also given in this article are the applications of biotechnology in the field of forensics, medicine and agriculture. Blotting techniques and how they apply in forensic investigation are included in this article as well.
Amino acids are the simplest unit of a protein. It has distinct structural characteristics that are responsible for the different types of interaction it can make inside the body. It is important to study the structure of amino acids as the functioning of proteins is highly affected by the type of comprised amino acids. In this article, the structural features and properties of an amino acid will be discussed. Also included in this article are the classification of the amino acids based on the side chain it has. Focus is also given to the ionization of amino acids.
Social Interaction is defined by Gettyes and Dawson as a process by which human interpenetrate the minds of each other. According to Corkiness, social interaction is defined as a process that influences the overt state or behavior of individuals minds. Social interaction is usually described as an event that changes the attitude and the behavior of the interacting persons. It is a social relationship between at least two people, which affects and changes the societal conditions of people's lives. This social interaction is the soul of relationship and social life, which produces groups that are the foundation of societies.
Respiration is the process by which our body takes in air containing oxygen into the lungs and exchange oxygen with carbon dioxide in the alveoli. Breathing is an involuntary, rhythmic process of inhalation and exhalation of air. Respiration includes both breathing and ventilation (gas exchange in the alveoli). Lungs along with the respiratory tract are the major organ system involved in respiration. The part of the respiratory tract where gas exchange occurs is the alveolar space. The part of the respiratory tract where no gas exchange occurs is called the dead space.
Pediatric allergic proctocolitis is considered an IgE-mediated allergic reaction to dietary proteins; most commonly is Cow’s milk protein, which represents about 50-65% of the cases. It's a frequent, significant cause of infant colitis. This article explains the main clinic-patho-physiological aspects of the disease.
Meconium originates from the Greek word “mekonion” which stands for poppy. The nomenclature attests to the tarry, black appearance of meconium which resembles raw opium preparation. Meconium ileus implies the presence of an intestinal obstruction in-utero or in neonatal period secondary to abnormally thick meconium. This article expatiates on patho-physiological aspects of meconium ileus and expounds on clinical features of the same. The article concludes with treatment, complications and prognosis of meconium ileus.
The complement system is a part of the innate immunity that functions to identify foreign materials (pathogens, apoptotic cells and cellular debris), and induce immune response to eliminate these materials.
Primary immunodeficiencies differ from secondary immunodeficiencies (acquired immunodeficiencies) in that they arise from birth as a result of genetic defects. However, not all primary immunodeficiencies are present at birth and many present in adolescence or adulthood. In contrast, secondary immunodeficiencies are typically secondary to infection (e.g., HIV) or therapies (e.g., corticosteroids). The following article covers the most important primary immunodeficiencies and their underlying pathophysiology.
Sex hormones are needed for human development, induction of secondary sexual characteristics and reproduction. In males, androgens function to influence sperm production. In females, estrogen and progesterone function during the menstrual cycle and in maintenance of pregnancy. Excess androgens can result in prostatic hyperplasia while loss of testosterone gradually occurs as men age. Excess estrogen can lead to endometrial hyperplasia while a loss of estrogen leads to menopause.
Acid peptic diseases are common gastrointestinal disorders, which include gastroesophageal reflux disease, peptic ulcers, non-ulcer dyspepsia and stress-related gastric mucosal injury. Drugs commonly used in the management of these disorders include antacids, H2 blockers, proton pump inhibitors and mucosal protective agents. In this chapter, pharmacology of these drugs will be discussed, followed by brief description of their roles in the management of common acid peptic diseases.
Asthma is a chronic airway hyperresponsiveness (with acute exacerbations), which is widespread all over the world in both children and adults. In most cases, it is in response to environmental stimuli. The main pathological changes are bronchospasm, edema and mucosal plugging, and the symptoms are wheezing, cough and breathlessness. Asthma therapy is directed against bronchospasms or inhibition of inflammation in general or their mediators such as leukotrienes. The most common drugs used are inhaled β2 agonists and inhaled corticosteroids.
The lymphatic drainage of the abdominopelvic organs can be described easily by dividing the drainage into four groups. The lymphatic drainage from these organs is clinically very important due to its role in the spread of malignancies and infections.
Bone marrow is the type of tissue in the marrow cavities of bones where blood cells are formed and later released into the circulation. The process of production of blood cells is called hematopoiesis. This includes erythropoiesis (the production of red blood cells), leucopoiesis (the production of white blood cells) and thrombopoiesis (the production of platelets).
Suprarenal glands are located on the superior pole of each kidney. Each gland has two distinct developmental origins that divide it into two regions. The catecholamine secreting medulla is derived from the neural crest and is made of chromaffin cells. The cortex is derived from the mesoderm and it consists of three layers: the catecholamine secreting zona glomerulosa, cortisol secreting zona fasciculata and the zona reticularis that secretes androgens.There are many common pathologies that can present, e.g., adrenal hypo-plasia, hyperplasia and adrenal tumors specific to each region.
The heart performs the function of receiving and pumping blood. In order to perform this function, it has four compartments, or chambers – the two atria and the two ventricles. The left atrium receives oxygen-rich blood from the pulmonary circulation and drains it into the left ventricle, which then pumps it to the rest of the body. The right atrium receives oxygen-poor blood from the systemic circulation and drains it into the right ventricle, which then sends it to the pulmonary circulation for oxygenation.
The joints in the lower limb include the sacroiliac joint, hip joint and knee joint, plus two important foot joints: the subtalar and the transverse tarsal joint, which permit inversion and eversion of the foot. The other joints in the foot allow foot and toe movement and include the cuneonavicular joint, the cuboideonavicular joint, the tarsometatarsal joint, the intermetatarsal joint, the metatarsophalangeal joint, the interphalangeal joint and the distal phalangeal joint.
A wound is the loss of the normal integrity of the skin and underlying soft tissue leading to a devitalized structure. Wounds can result from a skin injury, such as in the case of surgery, puncture wounds and abrasions or can be secondary to skin necrosis as a result of ischemia or pressure. People with diabetes mellitus, peripheral ischemia, venous stasis, infection and bad nutritional status are vulnerable to wounds due easy skin disruption and difficult healing processes that may lead to chronic ulcers. The process of wound healing occurs to protect the underlying structures from infection or blood loss. Wound healing occurs through several physiological stages in healthy individuals that include hemostasis, inflammation, epithelialization (granulation) or proliferation and finally fibroplasia or remodeling.
Inflammation is the physiologic body reaction in response to injury. The body tries to protect itself from harmful pathogens and physical or chemical irritants. Immune cells, fibroblasts, intra- and extra-cellular mediators are all involved in protecting the body, clearing the inflammatory products and help with the healing damaged parts. Sometimes the whole pathologic disorder is secondary to the body's reaction and inflammation as in cases of hypersensitivity, granulomas and autoimmune diseases. The following article describes various forms of inflammation as well as the body's reaction to them.
Amebiasis is an infection of colon caused by Entamoeba histolytica. Infection occurs by ingestion of water and food contaminated with feces (containing cysts of Entamoeba histolytica). In this article, we will study in detail the various amebicides, their mechanism of action, adverse effects/toxicity, contraindications, drug interactions and drugs of choice. Other important therapeutic aspects of individual drugs will also be studied.
Inhaled anesthetics are either volatile or gaseous anesthetics used to induce general anesthesia. Volatile anesthetics include halothane, enflurane, isoflurane, desflurane and sevoflurane. These anesthetics are liquid at room temperature. Gaseous anesthetics include nitrous oxide and xenon both of which are gaseous at room temperature.
Secondary immunodeficiency can be defined as the occurrence of cellular or humoral immunodeficiency in an individual who had an intact immune system before the onset of the condition. These acquired forms of immunodeficiency result from a diverse number of environmental causes as a side effect of cytotoxic drugs, malignancy and malnutrition.
Recently, it has become clear that cancer and our immune system communicate with each other. Because of this, our immune system eventually allows cancer cells to go unchecked, and at a certain point, cancer cells ‘escape’ our immune system's response. With this understanding, more recent anti-cancer medications are targeting the different immune checkpoints that are known to fail in identification of cancer cells.
Social institutions are a collection of different sources of knowledge, information, skills and values that affect an individual and define how an individual would behave in his or her society. In this sense, family, schools, religion and economy are considered as institutions to the sociologist. In other words, we tend to look up to our parents, teachers and care-givers in identifying what is right and what is wrong. Additionally, we as humans prefer to always be part of something bigger. We want to be part of our families, our society, our religion and we want to think of a supreme entity that judges us or at least takes care of us.
Our relationships with each other, how we define outsiders, our norms and our values are largely dependent on our ‘culture’. However, culture is a vague word that needs to be defined scientifically before we dive into how culture and the society interact with each other. The simplest definition of culture is that culture is the collectition of language, knowledge, values, norms, beliefs, habits and objects that are passed from one generation to the next in each society. Per this definition, what might be considered as normal or acceptable in one society, might be inappropriate to say the least in another society.
Transplantation medicine can be subdivided into solid organ transplantation and blood transfusion. Blood transfusion examples include packed red blood cells, plasma and platelets concentrates. Solid organ transplantation can be xenograft, autograft, isograft and allograft.
Burkitt lymphoma (small non-cleaved cell lymphoma) is one of the most aggressive and rapidly growing non-Hodgkin's lymphomas, with obvious predominance in children and young adults. This type of tumor requires urgent therapeutic intervention as the CNS and the bone marrow are involved in the malignant process since early stages of the disease.
The human brain is a very complex organ, structurally and functionally. Cognition is a term that psychologists use to describe a wide array of different brain processes and activities that include perception, thinking, reasoning, memory, attention and creating new information or ideas. This is however a limited view of cognition as now it became clear that cognition is the product of interplay between all of these components and more.
The notion that human behavior could be affected and predetermined by genetic basis started to emerge in the 20th century. Unfortunately, during that time, the eugenics movement was associated with the emergence of this theory, which played a part in discrediting it. Recently, several twin studies showed similar behavioral tendencies in monozygotic twins, even if separated at a very early age, again signifying the role of behavioral genetics. Our current understanding of genome-wide associations with different behavioral, psychiatric and medical problems allowed us to confirm that behavioral genetics is a true science and behavior can be affected by genetic, biologic and molecular determinants.
Androgen receptor antagonists are compounds that block androgen receptors and antagonize the effect of androgens such as testosterone. Several conditions such as hirsutism, acne and prostate cancer are known to be dependent on androgens and antiandrogens can help alleviate the symptoms of these condition or even improve the outcome in patients with metastatic prostate cancer.
Before we dive into the effects of selective attention on perception, information integration and our ability to process information precisely, we need to define what we mean by selective attention and why to study attention in the first place.
The endocrine system of the body consists of endocrine glands which produce metabolic changes through the secretion of chemicals called hormones. The Pituitary gland is considered the ‘Master’ gland of the body. Hormones produced by different endocrine glands have different mechanism of actions. The hypothalamic-pituitary- gonadal axis is a system of interrelated endocrine glands that work like a single entity with a series of communications that regulate hormone secretion between them.
Proteins which bind to hormones and carry them to the target tissues to produce a desired effect are called hormone-binding proteins (HBP). There are four major categories of HBPs depending on the type of hormone they carry. These include: sex hormone-binding proteins (SHBG), thyroid hormone-binding proteins, cortisol binding proteins (CBG), steroid hormone-binding protein – serum albumin.
Treponema pallidum is member of family Spirochaetaceae. They are Gram negative bacteria, but some regard them too thin to be Gram stained. It is a delicate, tightly spiraled, motile spirochete having tapered ends. It is microaerophilic bacteria that cannot be grown on standard culture media. These microbes are poorly stained, so not detected by conventional light microscopy.
Pediatric gastrointestinal disturbances are common, often simple to manage and yet, unfortunately, life threatening in some instances. Sometimes, seemingly innocuous vomiting can be a harbinger of a serious underlying disease. This article expounds on various patho-physiological aspects of pediatric vomiting and diarrhea, and expatiates on the rapid aggressive treatment of accompanying dehydration.
Constipation is a very frequent, rather tantalizing presentation in the pediatric population. One needs to be wary of organic causes of constipation and treat the same judiciously. This article expatiates on pediatric constipation and encopresis.
The primitive embryonic foregut, midgut and hindgut form the gastrointestinal tract. The foregut extends from the mouth to the proximal two thirds of the duodenum. The midgut extends from the distal one thirds of the duodenum to the proximal two thirds of the transverse colon, while the hindgut extends from the distal one third of the transverse colon to the anus. The autonomic nervous system with its sympathetic and parasympathetic fibers and their opposing actions control all these organs.
The perineum is a diamond shaped region situated inferior to the pelvic floor which separates it from the pelvic cavity. Several urinary, external genital and lower gastrointestinal structures are located within the perineum. Therefore the perineum plays an important role in bodily functions like defecation, micturition, procreation and parturition. This article will discuss the boundaries of the perineum, the perineal membrane, the Ischioanal fossa and its contents with their clinical relevance.
Acid base balance in the body is mandatory for the proper functioning of body organs. Even a slight alteration in the level of acid or base may severely impact many organs. Balance between acid and base is controlled by different mechanisms occurring in lungs, kidneys and buffer systems. Acid base disturbances are classified into metabolic acidosis, metabolic alkalosis, respiratory acidosis and respiratory alkalosis based on the variations of blood pH and carbon dioxide exhalations respectively. They are diagnosed through blood test and lung function test after evaluation of respective symptoms and etiology behind.
Plasma cells neoplasms are the cancers of plasma cells that are responsible for producing antibodies in our bodies. These abnormal plasma cells proliferate rapidly in the bone marrow causing extensive bone destruction. They also produce increased quantities of monoclonal immunoglobulins (M-protein) that build up in our body, leading to the thickening of the blood and damaging our kidneys.
Splenomegaly is the enlargement of the spleen. The spleen is an integral part of the immune system that provides efficient immunosurveillance (production of WBCs defending the body from various infections) and hematopoiesis (“cemetery” for damaged and worn off erythrocytes). The spleen is allocated in the left upper quadrant of the abdomen behind the ribs 9-11, on the left from the stomach, and the tail of the pancreas, above the left kidney, the splenic flexure of the colon.
Leukemia is blood cancer, this condition is characterized by exceeded amount of immature white blood cells in the blood stream (blasts), which normally remain in the bone marrow for their further maturity or sent to special organs (spleen, thymus) to get ready for their proper functioning. White blood cells are responsible for the adequate immune reaction of the body to various antigens (infections, malignant cells, foreign bodies, allergens); hence, immature cells cannot cover this function fully and fail to perform in the way m proper white cell do. Thus, the body easily contracts different infections as it is not capable to fight them, as the disease advances the bone morrow becomes exhausted shooting even more damaged cells or stops producing blood cells at all (hemogenic collapse).
Penile disorders are heterogenous and desolating to the male population. This article succinctly expounds Hypospadiasis, Epispadiasis, Phimosis, Paraphimosis, Peyronie’s disease, Priapism, Penile carcinoma in situ and Squamous cell carcinoma.
Lymphoid neoplasms are divided into the two main groups: Hodgkin and Non-Hodgkin Lymphomas. The former ones are the most curable due to the specific pathogenesis of the ailment and recent advance in the methods of treatment (5 years survival for the patients with favorable prognosis 98 % and 85 % with a less benign one). The malignant cells form in the lymphatic system; mainly, they are represented by white blood cells, namely, immature B-lymphocytes. HL may take place in any part of the lymphatic system. This disease was described by Dr. Thomas Hodgkin in 1832 as a type of cancer of the lymph nodes.
There are two types of lymphomas - Hodgkin Lymphoma (Hodgkin`s Disease) and Non-Hodgkin Lymphoma. The follicular lymphoma belongs to the second group. It is a slow-growing B-cell lymphoma, and the second most common sub-type of NHL; most often occurs due to chromosomal translocation t(14;18) causing bcl-2 gene rearrangement. Most of the patients with FL are asymptomatic; hence they remain undiagnosed for years and usually detected in the advanced stages.
Diffuse Large B-Cell Lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma (NHL), accounting for one-third of all NHLs in the western world. It is a very aggressive, fast-growing neoplasm unless diagnosed and treated timely (survival is less than one year without a cure). This illness is characterized by painless enlarged lymph nodes. It has a very close affiliation with genetic issues, Epstein-Barr virus (EBV) and immunocompromised conditions (congenital and acquired: HIV, AIDS).
The science of Immunodiagnostics has recently progressed in leaps and bounds. As proficient clinicians, we need to be aware of some of them. This article focuses on core techniques customized for immunodiagnosis, namely Immunodiagnostic Methods (Agglutination, Nephelometry, Immunoprecipitationa and Radial Immunodiffusion), Electrophoresis and Western Blot, Immunoassays (ELISA, RIA and Luminex:tm:), Immunofluorescence and Immunohistochemistry, Flow Cytometry and Fluorescence-Activated Cell Sorter (FACS), Evaluation of Cellular Activity and Preparation of Antibodies.
Proteins are important biomolecules because they serve a number of functions essential to formation, function, and regulation of body’s cells, tissues, and organs. They can act as enzymes, hormones, antibodies, structural component of the cell, and transport medium for different molecules and organs.In this article, the different functions of proteins in the biological system are highlighted. Specifically, the antibodies and their role in immune response, the use of proteins as catalysts for biological reactions and in gene regulation and transport of materials are discussed in this article.
Proteins are important biomolecules because they serve a number of functions essential to metabolism. Discussed in this article are the different functions of proteins in the biological system. Specifically, the article discusses proteins and their structural functions. Another function given emphasis is the use of proteins in communication and signaling. Proteins and their role in movement and mobility are also discussed in this article.
Antipsychotic drugs have been used to treat schizophrenia for many decades. However, they have other uses, too, including the treatment of bipolar disorder. Antipsychotic drugs principally work through their inhibition of post-synaptic dopamine receptors. These drugs are classified as first generation typical antipsychotics and second-generation atypical antipsychotics. Students should be aware of the mechanism of action, side effect profile and uses of these drugs.
The blood pressure is monitored and regulated inside the body and is called mean arterial pressure (MAP). The clinical measurement of the blood pressure with a sphygmomanometer depicts the systolic and diastolic arterial pressures and gives relative information of the mean arterial pressure. MAP is the driving force that propels the blood to organ tissues. As all body tissues require oxygen for the process of respiration and energy, a constant supply of blood is mandatory. MAP, therefore, needs to be regulated for two reasons. Firstly, the driving force created by MAP should be sufficient enough to supply blood to the organs lying above the level of the heart, i.e., against gravity. Secondly, it should not be above the normal limits as it will then cause an extra load on the heart, which will have to pump blood with an extra force.
The female reproductive cycle is interplay of hormones secreted by the hypothalamus, pituitary and ovaries. Together they form the hypothalamic-pituitary-ovarian axis. The primary outcome of this axis is ovulation. If pregnancy occurs, this axis will act through feedback mechanism to maintain the pregnancy. The development of the embryo requires a specific level of hormones in the maternal blood. If there is any disruption, it may result into missed abortion or preterm labor. Similarly, if the female does not conceive, there is a decrease in the amount of one hormone that will initiate the next cycle.
The regulation of arterial blood pressure is essential in order to maintain perfusion to the vital organs. While a drop in blood pressure is dangerous as no blood flows to the brain, at the same time a high blood pressure may result in various unfavorable outcomes such as cerebrovascular accidents and myocardial infarction.
Exercise physiology is the study of effect of exercise on the body systems. Exercise is beneficial for the health. However, as a result, oxygen and nutrient demand increases several folds, a lot of energy is required, which comes from the stored energy resources of the body. In order to provide sufficient oxygen for respiration to occur, the workload on the lungs and heart increases several folds. The blood supply to other organs is also compromised; for example, during exercise, the blood flow to the digestive tract is reduced. This is to allow sufficient blood flow to the skeletal muscles.
The heart pumps the blood to the aorta, which divides into arteries to supply the various organs of the body. Inside an organ, a main artery is divided into smaller arterioles, which further divide into capillaries at tissue level. As the wall of the capillary is only one-celled thick, rapid diffusion of gases and nutrients takes place. The capillaries combine to form venules, which drain into larger veins. Finally all the veins of the body drain either into superior vena cava or inferior vena cava.
A mechanoreceptor is a sensory receptor which detects the mechanical stimulus of stretch and distortion. It is also known as the tactile receptor. In human beings, four types of mechanoreceptors are present in the hairless skin, which will be discussed in this article along with encapsulated and unencapsulated nerve endings and free nerve endings.
A nerve fiber is an extension of a neuron that mainly consists of an axon either myelinated or unmyelinated. These nerve fibers are present in the central nervous system (CNS), as well as in the peripheral nervous system (PNS). Inside CNS, the oligodendrocytes produce the myelin sheath while in the PNS the Schwann cells do the job.
The lower limb connects the body to the foot. It bears the weight of the body when standing and during movement. Altogether, there are 32 bones in the lower limb; this includes the hip bone (with its three components: ilium, ischium, pubis), femur, tibia, fibula, patella, tarsal bones (8), the metatarsals (5) and the phalanges (5) on either side.
Epidemiology is the science of studying distribution with regards to the various determinants that play a significant role in health related issues within a specified population as well as the implications of the study results in order to control health problems. Descriptive epidemiology is intended to classify the details of a disease based on person, place and timing factors. The methods of causal reasoning, which are used to test the hypothesis are carried out mainly using inputs derived out of descriptive epidemiology. The various aspects of descriptive epidemiology are covered in the following article.
According to the Cell Theory, new cells can be produced by the division of existing cells. Two types of cellular division occur in eukaryotes. These are mitosis and meiosis. Mitosis is done to make more of a specific body cell while meiosis is done to create gametes (egg or sperm). Meiosis and the different processes involved in it will be covered by this article. The processes involved in oogenesis and spermatogenesis are also discussed in this article.
Non-Hodgkin's lymphomas (NHL) are hematological malignancies with high prevalence worldwide (accounts for about 4 % of all cancer cases and 2.7 % of all cancer deaths). They are cancers of the lymphatic tissues (mainly lymph nodes), affecting the lymphocytes, either B-cells (70 %) or T-cells/NK cells (30 %). NHLs are five times more common than the Hodgkin's lymphoma (HL). The following article discusses both B-cell type NHLs and T-cell type NHLs.
Malaria is a protozoan infection. Malaria is caused by the bite of female Anopheles mosquito. In this article, we will study the various antimalarial drugs, mechanism of action, adverse effects/toxicity and drugs of choice in detail. Important therapeutic aspects of individual drugs will also be studied.
In 1889, Auguste Ducrey at the University of Naples published his research about the causing agent of chancroid associated with the presence of genital ulcers, Haemophilus ducreyi, which is a gram-negative bacillus, was named after the scientist. Chancroid is a highly contagious sexually transmitted disease (STD) presenting with extremely painful genital ulcers accompanied by enlarged inguinal lymph nodes (buboes).
In 1955, a cause of nonspecific vaginitis (bacterial vaginosis) was described by two scientists: Gardner and Dukes. The bug was named Haemophilus vaginalis, later the name was changed to Corynebacterium vaginale, and finally, the bacterium responsible for the condition obtained the name Gardnerella vaginalis (1980) after the scientist who discovered it. Gardnerella vaginosisis a non-specific infection of the vaginal tract caused by gram negative bacteria named as Gardnerella vaginalis. This condition is not regarded as sexually transmitted disease, but sexual activity enhances the development of the infection.
The causative factor of syphilis is Treponema pallidum (TP), family motile Spirochaetaceae, which is very common all over the world. TP can be transmitted via close sexual contact or transplacentally (vertical way). Also, syphilis can be acquired or congenital, both of them having early and late stages. TP invades the host body through the breaches in the squamous or columnar epithelium affecting lymphatic nodes and disseminates with the blood stream to all parts of the body.
Infection caused by various helminths (worms) is among the most widespread of chronic infections and its occurrence is more common in developing regions with poor personal and environmental hygiene. In this article, we will study in detail the various anthelmintic (anti-parasitic) drugs, mechanism of action, adverse effects/toxicity and drugs of choice. Important therapeutic aspects of individual drugs will also be studied.
Kallmann’s syndrome is one form of reproductive failure due to severe hypogonadism that is associated with complete loss of the sense of smell. Kallmann’s syndrome is a genetic disorder and several genes such as KAL1, FGFR1, FGF8 and PROKR2 have been associated with the condition. While KAL1 is responsible for the x-linked inherited form of the disease, the other genes are found in patients with autosomal dominant Kallmann’s syndrome. Hormonal replacement therapy is indicated to correct the severe hypogonadism.
Chemotherapy (chemo) is the specific systematic treatment administered in oncological practice for malignant neoplasms in order to destroy chaotically dividing abnormal cells. Chemo is a part of anticancer treatment along with radiotherapy, immunotherapy and surgery. The drugs used in chemotherapeutic protocols cannot be purchased over the counter; they can be taken with prescription only. Cancer drugs influence and actions are directed to the malignant cell reproduction, cure, control, palliation or chemoprevention.
The thymus is an important part of our immune system, located in the anterior mediastinum. Due to this fact, the diagnostics, access, and management of its neoplasms (thymomas) are somewhat difficult. The thymomas often involve the contiguous organs and are also frequently associated with other paraneoplastic conditions, making the condition even more complicated.
Abnormal uterine bleeding (AUB) is calamitous for many women. With a brief prologue to AUB, this article focuses on the significantly relevant causes of AUB, such as endometrial polyp, leiomyoma and leiomyosarcoma.
Blood flows through the body in a complex circulatory system supplying even the most complex structures, like brain and heart, in the cerebral and coronary circulation respectively. The skin as the outermost border of the organism requires special conditions of the cutaneous circulation, owing to the external temperature.
The Hypothalamus is located below the thalamus. The brain stem, consisting of midbrain, pons and medulla oblongata follows, connecting the superior brain structures with the spinal cord. A clear, colorless liquid flows in the brain as well as in the spinal cord – the cerebrospinal fluid. Its functions and clinical relevance will be discussed in this article along with the functions of the different circumventricular organs.
A nerve is made up of countless neurons which are responsible for carrying signals from different parts of the body to the nervous system and vice versa. Neurons which carry the signals from the sense organ to the nervous system are called sensory neurons and form the sensory nerve fibers. Similarly, neurons which carry signals from the nervous system to the effector organs, muscles or glands are called the motor neurons. These motor neurons form the motor nerve fibers. Relay neurons carry the signals across the nervous system. The signal transmission from the sense organs to the nervous system and then to the effectors is essential in the maintenance of homeostasis. Any disruption in this pathway leads to the loss of a specific sensation or response.
Endometrial hyperplasia is abnormal growth of the endometrium in the uterus. It is caused by excess estrogen unopposed by progesterone. Pathology shows an increased gland-to-stroma ratio and can show atypia. Atypia is linked to endometrial cancer, the most common gynecological malignancy in the developed world. Treatment includes progesterone therapy and if there is atypic hysterectomy is recommended. Lynch syndrome has a high lifetime risk of developing endometrial cancer.
Lymphocytes are the cornerstone of the adaptive immune system and afford the body a diverse protection against all kinds of pathogens. In this article, we explore the different types of lymphocytes and the processes involved in their development.
The adaptive or acquired immune system is the body’s main line of defense against ever-evolving pathogens. This subsystem of over all immune system comprises of specialized cells to eliminate lethal organisms which otherwise may lead to death. Read on to find where the cells of the adaptive immune system reside, and what their mechanisms of action are.
Gynecomastia is the breast enlargement in males, due to increased glandular proliferation. This is very common condition and mostly physiological in neonates, pubertal boys and elderly persons. Some cases are pathologic and secondary to drugs, chronic liver and kidney disease or hyperthyroidism. Majority are asymptomatic and do not need treatment. If treatment is needed, it should be tailored against the etiology of gynecomastia. Symptomatic gynecomastia that does not resolve with treating the cause can respond to antiestrogens or aromatase inhibitors. Finally, surgical intervention should be offered only to severely symptomatic cases.
Erectile dysfunction is defined as the inability to achieve or maintain a penile erection that would result in the inability to perform vaginal sexual intercourse. Systemic, neurologic and local diseases can cause erectile dysfunction which include but are not limited to diabetes, multiple sclerosis and Peyronie’s disease respectively. History and physical examination are important for the diagnosis of erectile dysfunction. Treatment can be medical with testosterone, sildenafil, or specific medical treatment according to the etiology. Surgical correction might include a penile prosthesis.
Male hypogonadism is a condition characterized by decreased testosterone production and sperm quality or production. This can be the result of primary testicular failure or secondary testicular failure due to pituitary or hypothalamic disorders. Symptoms of hypogonadism include erectile dysfunction, decreased libido, and regression or absence of secondary sexual characteristics. Total testosterone levels are below 300 ng/Dl. Testosterone replacement therapy is the mainstay of treatment.
Ovotesticular disorder of sexual development is characterized by the presence of an ovotesticular gonad that contains both ovarian and testicular elements. Patients are usually born with ambiguous genitalia but the diagnosis is rarely confirmed before puberty. The most common karyotype is 46, XX but 46, XY can be identified in approximately 10% of the cases. Medical treatment of ambiguous genitalia is usually emergency based to treat life threatening conditions such as salt-wasting syndrome in congenital adrenal hyperplasia. Conservative surgery to remove part of the ovotestis gonad is the treatment of choice for this condition.
Sex cord stromal tumors of the testis can originate from either Leydig cells or Sertoli cells. Leydig cells tumors are responsible for 70%. These testicular tumors are known to cause estrogen excess production and a low testosterone-estrogen ratio. Alpha-fetoprotein, human chorionic gonadotropin and lactate dehydrogenase levels are normal in this type of tumors. Ultrasonography confirms the diagnosis of a testicular mass, while biopsy and histologic examination confirm the diagnosis of either Leydig cells or Sertoli cells tumor. Treatment of choice is radical inguinal orchiectomy.
Ductal papillomas are commonly identified in women presenting with pathological nipple discharge. However, pathological nipple discharge can also be identified in patients with breast cancer. Patients with ductal papillomas can have either a solitary lesion or multiple papillomas. Solitary papillomas are usually central and large, while multiple papillomas tend to be peripheral and small in size. Whereas large solitary papillomas are not thought to be precancerous, small multiple papillomas seem to increase the risk of breast cancer. Patients with a single papilloma might benefit from microductectomy while those who have multiple papillomas are possible candidates for surgical intervention due to their increased risk of developing breast cancer.
Fibroadenomas are benign breast tumors that arise in young women. Histological examination of these lesions usually reveals lobular hyperplasia. Known risk factors for breast cancer, such as early age of menarche or nulliparity, do not increase the risk of fibroadenomas. The diagnosis of fibroadenomas is based on the physical finding of a mobile, non-tender breast mass, that is slightly hypoechoic on ultrasonography and that has cell clusters in fine needle aspiration. Fibroadenomas that are asymptomatic and small in size should be treated conservatively, while ones that are growing rapidly in size and are symptomatic should be surgically excised.
Mastitis is the inflammation of the mammary gland tissue, which can be lactational or non-lactational. It is most common in women within child bearing age. Routes of transmitted infection can be from the skin, lymph nodes or primarily in the mammary glands. Organisms isolated include staphylococcus aureus, staph epidemidis or streptococci. Swelling and rupture of mammary ducts will result in an abscess which will mimic breast mass or carcinoma.
A large number of embryological processes must be carried out for the development of a new human being. There are numerous sources of error that can lead to malformations up to stillbirths. However, deviations can also occur within these processes, which lead to the development of two or more children, that is to say, twins or generally multiple births. This article explains how exactly this is done, what forms of multiples exist and how frequently they occur.
In the following article you will learn how to differentiate between medial and lateral pontine syndrome, superior cerebellar artery syndrome, Parinaud's syndrome and Weber's syndrome, what their main characteristics are and where the site of lesion is to be expected.
The limbic system is a cluster of brain structures located on both sides of the thalamus immediately below the cerebrum, mainly responsible for the emotion, behavior, memory, and arousal response. It is thought to be an outcome of the evolutionary response that occurred in all mammals including human beings. It is not a different system, but a group of organs derived from the telencephalon, diencephalon, and mesencephalon.However, the development of this system is far greater in human beings compared to other mammals.
Cell-mediated immunity is an integral part of our body’s immune system. This type of immunity is mediated by T-lymphocytes, also called T-cells. The functions of cell-mediated immunity are important and include defense against intracellular bacterial and viral infections. This is achieved by activating macrophages to destroy phagocytosed microbes via helper T-lymphocytes, or by directly killing infected cells via cytotoxic T-lymphocytes.
All foreign antigens are recognized by the cells via specific receptors called the major histocompatibility complex. These MHC molecules encompass a wide diversity in structure and actions. What follows is a review of the MHC molecules and their interactions with an antigen.
Various infectious agents are constantly attacking and posing a threat to human health. Under normal conditions, our body manages to remain healthy. Our innate immune system provides the first line of protection against such pathogens and harmful agents. Read on to find out the different components of the innate immune system and how they interact with each other to form the body’s primary line of defence.
Ovarian cancer is becoming challenging every year due to the ever increasing number of new diagnoses. It is considered the 5th leading cause of cancer deaths among women; with about 14,000 deaths and more than 20,000 new cases every year.
Lymphocytes have a miraculous ability to get attracted to the site of pathogen attack. This complex process is the interplay of a wide variety of molecules and processes within the body. Read on to find out what constitutes these mechanisms of lymphocyte circulation.
Varicoceles are defined as abnormal dilations of the spermatic vein or the pampiniform plexus and are more common on the left side. Careful physical examination of the contralateral scrotal side is essential as bilateral varicoceles are common. While the diagnosis of varicoceles can be done clinically especially when seminal fluid analysis is impaired, imaging studies with color-flow Doppler remain an important part of the diagnostic workup. Symptomatic varicoceles or subfertile men with varicoceles should have their varicoceles surgically corrected either by a minimally invasive procedure, or by percutaneous embolization.
The immune system is essential for our organism to survive. Without the ability to distinguish friend and foe, we would not stay alive for very long. Functionally we can differentiate between specific and non-specific immune response. The unspecific immune response is like our body’s a first protective shield against pathogens. In the following article, you will get to understand the mechanisms of this immune response in a quick overview.
Thanks to the early detection program, the incidence of cervical cancer is declining. Every woman from the age of 20 is admitted once a year and includes various examinations. If a malignant disease is suspected, further diagnostic steps should be taken and a treatment plan adapted to the patient should be developed. The following article will help you to diagnose cervical cancer reliably and to initiate the right steps in the therapy.
Testicular cancer is an uncommon malignancy. Most of testicular cancers are of the germ cell tumor type and they can be classified into seminomas or nonseminomas. The most common presentation of testicular cancer is a painless testicular nodule. Alpha-fetoprotein can be elevated in nonseminomas, while beta-human chorionic gonadotropin is usually elevated in both seminomas and nonseminomas. Radical inguinal orchiectomy along with retroperitoneal lymph node dissection helps in confirming the diagnosis and can be curative in early stages of testicular seminomas.
Testicular torsion is the most common cause of acute testicular and scrotal emergency pain. Patients usually have unilateral testicular torsion and the most common etiology is a high abnormal attachment of the tunica vaginalis. Abnormal attachment of the tunica vaginalis results in spermatic cord increased mobility and predisposes to spermatic cord twisting and subsequent testicular torsion. Testicular infarction and necrosis can ensue if the testis is not detwisted in the first 8 hours and is usually complete by 24 hours of torsion onset. Bilateral testicular fixation to the tunica vaginalis is recommended.
Prostatitis is a term that indicates inflammation of the prostate which can be infectious or non-infectious. Bacterial prostatitis is easier to identify clinically and their management is better established. The main diagnostic tools for prostatitis are clinical history and physical examination. Prostate massage by digital rectal examination is only recommended in patients with chronic prostatitis and not in acute bacterial prostatitis. Broad spectrum antibiotics are the mainstay therapy for bacterial prostatitis, while symptomatic treatment is indicated for chronic pelvic pain syndrome without evidence for uropathogens.
Cryptorchidism is a term used to describe the failure of descent of the testicle into the scrotum. This condition is common among premature boys, 33% of them, and can still be identified in full-term boys in approximately 5%. Ultrasonography can help localize inguinal testicles, while abdominal magnetic resonance imaging or laparoscopy can identify non-palpable intraabdominal testis. Hormonal treatment is indicated at 6 months of life and surgical correction is needed if hormonal therapy failed. Surgical treatment should be attempted before one year of life to achieve better fertility outcome.
Non-invasive breast cancer can be either ductal carcinoma in situ or less commonly lobular carcinoma in situ. Ductal carcinoma in situ is of epithelial type, and there is usually no basement membrane invasiveness. Because of the lack of invasiveness, these tumors are unlikely to metastasize by the lymphatics or blood vessels. Ductal carcinoma in situ is usually diagnosed by a mammography and not by physical examination. Microcalcifications on mammography are the most common presenting feature. Local excision of the lesion is recommended to obtain histopathologic data and guide treatment. Total mastectomy or breast conservation therapy are the two options for the treatment of ductal carcinoma in situ.
The term urogenital system compromises the genital and urinary organs. Besides having different tasks, they have a common embryological origin and are often discussed in relation to each other in a clinical perspective. The following article focuses on the diverting urinary organs, therefore the part from the ureters to the urinary bladder up to the urethra is regarded. The physiology also attracts attention concerning the micturition process apart from the anatomic aspect.
The posterior pituitary secretes two hormones, oxytocin and vasopressin (anti-diuretic hormone). The word oxytocin literally means "quick birth" in Greek, which is an accurate description of the hormone's action. The following article discusses the positive and negative effects of oxytocin and vasopressin as well as their use as therapeutic options.
Anesthesia as a field has greatly expanded in the recent years. It is progressing in leaps and bounds. The spectrum of anesthesia has now sheltered not only operative patients but also patients with chronic pain, terminal illnesses and cancer. With a brief prologue to changes in the field of anesthesiology, this article focuses on palliative care, chronic pain management and perioperative medicine.
>Anesthesia as a science has massively evolved from ether machines to sophisticated dedicated subspecialty branches, the progress of which equally parallels the booming advancement in corollary fields of surgery. This article encompasses discussion on thoracic anesthesia, endobronchial tube positioning, complications and other issues, cardiac anesthesia and neuroanesthesia.
The reproductive organs in women and men, as well as the urinary bladder, the pelvic part of the colon and the rectum, are located within the pelvic cavity. All these important organs receive their oxygenated blood via the internal iliac artery (formerly known as the hypogastric artery) and its myriad branches. The arrangement of the branches is very variable and, occasionally, a listed branch may originate from a direct branch instead of from the internal iliac artery. The anatomical variations are surgically important for surgery in the pelvic cavity. The uterus, ovaries and fallopian tubes receive their blood supply from the internal iliac. The blood supply to the external genitalia in both sexes is derived from the internal pudendal branch of the internal iliac artery. During sexual arousal, the branches of the internal iliac arteries provide for the increased demand of blood flow which causes the engorgement of the tissues.
The female reproductive system consists of two ovaries, two fallopian tubes, the uterus, cervix and external genitalia. Every female undergoes a monthly cycle of 28 days, in which an egg is released from either ovary and the lining of the uterus is prepared for the implantation of an embryo, which eventually sheds off in case fertilization does not occur. This normal physiological mechanism is controlled by a number of hormones, secreted by the hypothalamus, pituitary gland and ovaries themselves. Any aberration in the release of these hormones may result in menstrual cycle abnormalities or infertility.
Human breast milk is the primary source of nutrition for the newborn, which can solely fulfill the nutrient requirements up to six months of age. When a woman conceives, several physiological changes occur in her body under the influence of hormones. One of them is the development of breasts and the production of milk. Several hormones play a role in this process. The hypothalamus secretes stimulatory or inhibitory factor, the pituitary gland secretes prolactin and oxytocin, while the placenta keeps a regulated level of estrogen and progesterone in the blood by producing these hormones. Other hormones, as mentioned in the text, are also essential for the production of milk as they are required for the provision of the basic nutrient components of the milk.
The process of reproduction is an essential characteristic of all living organisms. While other animals lay eggs, mammals give birth to a newborn. The anatomy and physiology of the new born baby is similar to that of an adult where all the body systems are in a functioning state. The process of embryogenesis is very complex and critical. The developing embryo gets all the nutrients required for its growth and development from the mother; therefore, certain physiological changes occur in the maternal body to be able to support the embryo. Any nutritional or hormonal deficiency at this stage, may not only result in under-weighed babies with birth defects, but also affects the quality of life of the mother after delivery.
Children are not little adults. With a prologue to pediatric anesthesia, this article focuses on the airway of a child and equipment for pediatric anesthesia, and concludes with a final touch on other anesthetic considerations for children.
Pain management is an inseparable part of modern patient care. This article expatiates various aspects of the pathophysiology of pain focusing on definition, pain team, complex regional pain syndrome, neuropathic pain and the latest concept of “NO” analgesics.
The study of anesthesiology has greatly expanded to encompass in its spectrum the care of the most critical patients in the hospital. This article addresses the basic tenets of intensive care unit (ICU); its organization, composition, components, modern technical armamentarium and concludes with a prologue to brain death and its determination.
Vitamin D is a fat-soluble substance vitamin. This vitamin is essential for proper function of the human body and is considered a hormone rather than a vitamin. Its synthesis takes place in the body – under ideal conditions, it may not be required in our diet. In bone tissue, where vitamin D is required the most, it is needed for deposition of calcium in bone and its lack usually leads to various pathologies including rickets in children and osteomalacia in adults. To understand the pathology of these diseases, we must first learn how this vitamin is produced and the effects it has on various systems in the human body.
Wilson disease is an autosomal recessive inherited disorder related with copper metabolism. This rare condition is characterized by excessive deposition of copper in target organs like liver, brain, and other tissues.
The shoulder is the region of the body that connects the upper limb with the trunk. The shoulder girdle (composed of the articulation between the scapula and clavicle) and pelvic girdle are the two points in the body where the axial and the appendicular skeletons meet.
Arm is the region of the upper limb that extends from the shoulder to the elbow joint. It connects inferiorly to the forearm through the cubital fossa (located anterior to the elbow). Axilla, region inferior to the shoulder, lies medially to the arm. The arm contains one long bone, humerus, in addition to numerous muscles, tendons, ligaments and neurovasculature structures that assist in bringing about all its movements.
Forearm is the region of the upper limb located between the elbow and the wrist. Its structure is maintained by two long bones, radius and ulna, along with numerous muscles, tendons and ligaments. Bones of the forearm contribute in the formation of elbow joint proximally, and the wrist distally. Two additional joints found within the forearm are proximal and distal radioulnar joints.
Rickets, though not a common disease in the affiliated population, is one of the diseases which affect the growth of children in the developing countries (where the nutritional deficiency is common). Rickets can be characteristically identified using the clinical features and they can be confirmed using biochemical investigation. In this article, we will discuss the various features of rickets in detail.
When the physicist and Nobel Prize winner Marie Curie died in 1934, her blood was flooded by white blood cells. During her work as a researcher and the years of contact with radioactive substances, she had developed a leukemia. There are various causes and forms for the disease, which is also known as blood cancer. Learn here about these and you will be well versed in the popular examination topic Leukemia.
Autumn time is flu time! A reason for many medical doctors to get vaccinated and to take the opportunity to take a look at their vaccination certificate. But what else do you know about tetanus, diphtheria, and co? And how are the different vaccines different in their nature and preparation?
The autoimmune disease lupus erythematosus belongs to the collagenoses and can show very different clinical symptoms: The symptoms range from mild conditions to severe organ manifestations which makes the diagnosis not easy sometimes. Read all the important facts about lupus erythematosus here to be prepared for the exam and the subsequent medical daily routine.
Chlamydiosis is caused by gram-negative bacteria from the Chlamydiaceae family. The mainly sexually and perinatally transmitted pathogens cause disease in the eye, genital and pulmonary area. Untreated chlamydial infections may have serious consequences. Learn all about pathogenesis, symptoms, diagnosis, and treatment of infections with chlamydia in this article. As a result, we guarantee optimal preparation for clinical examinations and practical medical work.
Pyloric stenosis, also known as infantile hypertrophic pyloric stenosis (IHPS), is a condition that is characterized by pyloric muscle hypertrophy and hyperplasia, which leads to gastric outlet obstruction. Infants usually present in their third week of life with repeated, projectile vomiting, that is often associated by an abdominal olive-like palpable mass. The clinical picture is usually enough to make the diagnosis, but ultrasonography can help confirm the diagnosis of pyloric stenosis in most of the patients. Surgical correction with pyloromyotomy is the treatment of choice.
Pediatric Hirschsprung Disease occurs when there is an absence of the ganglionic layer in the myenteric layer of the anus and the submucosa of the colon. This leads to the failure of relaxation of the colon, delayed passage of meconium, abdominal distension and constipation. Laboratory investigations are helpful if the patient develops enterocolitis where leukocytosis might be evident. Barium enema studies and histologic examination of biopsies confirm the diagnosis of Hirschsprung disease, and surgical resection of the aganglionic part of the colon is the current treatment of choice.
Salpingitis is the inflammation of the fallopian tubes usually due to gonorrheal or chlamydial infections, but other gram-negative and anaerobic bacterial pathogens have been also implicated. Patients can present with lower abdominal pain, fever and an elevated erythrocyte sedimentation rate. Ultrasonography and diagnostic laparoscopy can help confirm the diagnosis of salpingitis and exclude other differential diagnoses or associated complications such as hydrosalpinx, adhesions, and tubo-ovarian abscesses. Antimicrobial management is the mainstay of treatment and surgical management should be reserved to patients with non-responsive tubo-ovarian abscesses or ruptured abscesses.
Anovulatory cycles are a symptom and not a disease. Polycystic ovary syndrome, pituitary microadenoma, impaired GnRH release, and hypothyroidism are common etiologies for anovulation and should be excluded. Patients can present with amenorrhea which needs etiology-specific treatment or with acute dysfunctional uterine bleeding which might need emergency treatment. Emergency treatment can be either medical with estrogen or surgical with dilation and curettage. Oral contraceptive pills can be used in an attempt to make the menstrual cycle more regular before trying more specific treatments.
Fallopian tube tumors are rare with an incidence of 3.6 per one million. Fallopian tube carcinoma is of epithelial origin and share similar pathogenesis mechanisms with epithelial ovarian cancer. Early obstruction of the fallopian tube results in rapid onset of symptoms such as abdominal pain and distension and patients with fallopian tube carcinoma usually present at an early stage. Treatment of choice for early stage fallopian tube carcinoma is surgical removal of the tumor and any involved pelvic structures.
Endometriosis is a common disease in which ectopic normal endometrial tissue is implanted outside the uterus. The ovaries along with other pelvic organs can be involved. While laboratory investigations have a limited utility in the diagnosis, imaging and laparoscopic evaluation can be used to confirm the diagnosis of endometriosis. Medical treatment of endometriosis involves hormonal manipulation with oral contraceptive pills, danazol, GnRH analogues and progesterone supplementation. Surgical treatment can be either conservative or radical, depending on whether reproduction is wished to be preserved or not.
Appendicitis is considered a serious surgical emergency in medicine, therefore early diagnosis and management is important to a successful outcome and preventing serious complications as gangrene and perforation. This article will describe the incidence of appendicitis the younger children, and how can be diagnosed and managed.
Intussusception occurs when a distal segment of bowel telescopes into the lumen of proximal bowel. This can happen at any age, but is most common in infants between three and eighteen months. It is the most common cause of bowel obstruction in three months of age to six year old children. This article gives you brief information about the epidemiology, etiology, pathology, signs and symptoms, diagnosis and treatment of pediatric intussusception.
Pediatric colic is a very common symptom that occurs in infants during the first few months of life, and tends to disappear by the fourth month. Its causes are poorly understood and there are various theories explaining it as a reaction to food allergies, parental stress, gastrointestinal immaturity, maternal smoking and other factors.
This article gives an overview of the condition with its epidemiology, etiology, symptom, diagnosis and differential diagnosis, and treatment.
Acute abdominal pain is common in the pediatric population. Abdominal pain is usually associated with fever, vomiting of bile, bloody diarrhea, rigidity and tenderness in the abdomen. The etiology and differential diagnosis depends on the age of the child. For instance, Infants and toddlers will have congenital anomalies, school aged children may have gastroenteritis and other infectious causes. Appendicitis is the most common cause behind onset of acute abdominal pain in children.
The thyroid gland is an endocrine organ that secretes the hormones triiodothyronine (T3) and thyroxine (T4), which are, in turn, under the influence of the TSH and the TRH. Though hyper- and hypothyroidism remain the common clinically manifesting condition of the thyroid, in some cases, the patient remains symptomless with either excess or decrease in thyroxine levels, along with normal TSH levels. This is termed as euthyroid hyperthyroxinemia and euthyroid hypothyroxinemia, respectively. The cause is altogether different from the thyroid and should not be inappropriately managed as hyperthyroid and hypothyroid states.
Anesthesiology often solicits the management of emergencies, both patient and doctor induced like massive hemorrhage, increased intracranial pressure, cardiac disease, drug-related errors and surgical errors. This article offers a brief prologue, followed by the management of these conditions.
This article will help you understand how the brain develops in a human embryo from the very beginning: gastrulation, the formation and fate of the primitive streak, neurulation with possible neurocristopathies, closure of the neuropores, embryonic folding, regionalization of the brain, and potential birth defects of the brain. After that, the article will focus on the development of the cranium and possible cranial birth defects.
This article aims to provide an overview of the development of the musculoskeletal system, including the processes of somite formation, limb forming and limb outgrowth, genes that control limb development, and the development of complex bones. Finally, it will describe major limb abnormalities, which are caused by a combination of genetic and environmental factors (multifactorial inheritance). Another, complementary article, deals with the topic of skull and brain development. The musculoskeletal system comprises of bone, cartilage, and muscle all which arise from the mesodermal layer via various mechanisms of development.
The abdominal cavity is bounded by the abdominal wall which is divided into an anterior wall, lateral wall and the posterior wall. The posterior abdominal wall is a musculoskeletal structure formed by the posterior abdominal muscles, their fascia, the lumbar vertebrae and the pelvic girdle. It is related to the lower thoracic and lumbar vertebrae, the abdominal aorta, the inferior vena cava as well as important retroperitoneal organs like the kidneys, the suprarenal glands, the pancreas and the duodenum.
Ovarian cancer is of epithelial origin in 60% of the patients. Most patients present at an advanced stage due to the lack of specific symptoms except for mucinous ovarian cancer where abdominal distension is so severe that patients present very early in the disease. Once ovarian cancer is suspected, the patient usually undergoes a transvaginal ultrasonography, abdomen-pelvic CT scan and CA-125 concentration measurement. If an ovarian cyst or mass is identified, its characteristics will be noted and a risk of malignancy index can be calculated. Treatment involves neoadjuvant platinum-based chemotherapy with or without surgery. Newer treatments include antiangiogenic antivascular endothelial growth factor bevacizumab and pazopanib.
Polycystic ovary syndrome or disease is a multisystem endocrinological disorder where there is hyperandrogenism, ovarian dysfunction, obesity, menstrual abnormalities and multiple ovarian cysts. The most common presenting features are hirsutism, acne, metabolic syndrome and biochemical hyperandrogenism. Patients also have hyperlipidemia and an impaired glucose metabolism. Treatment involves oral contraceptive pills for menstrual abnormalities and hyperandrogenism, metformin for hyperandrogenism and infertility and clomiphene for infertility. Infertile women who do not respond to clomiphene might benefit from gonadotropins or laparoscopic ovarian drilling (LOD).
Pre-eclampsia is a condition that is characterized by an elevated blood pressure and proteinuria and that usually happens after 20 weeks of gestation. Women with pre-eclampsia can also develop hemolysis, thrombocytopenia and elevated liver enzymes known as HELLP syndrome or microangiopathic hemolytic anemia. Due to wide-spread endothelial dysfunction, they might also develop brain edema and eclampsia. Laboratory investigations show thrombocytopenia, proteinuria > 30 mg/day, hemolysis and elevated liver enzymes. The only known curative treatment for pre-eclampsia is delivery of the fetus.
GTD are diseases that arise from aberrant fertilization tissue within the maternal host and are identified early due to markedly elevated hCG levels and characteristic ultrasound findings. Uterine evacuation is the recommended treatment, while chemotherapy can be reserved for patients with recurrent disease or neoplastic GTD.
Primary sclerosing cholangitis is a common cause of chronic liver disease in patients with ulcerative colitis. It is an autoimmune disorder and patients usually present with jaundice, fever, abdominal pain and elevated alkaline phosphatase. Endoscopic retrograde cholangiopancreatography is the best diagnostic tool to confirm the diagnosis of primary sclerosing cholangitis. Multiple strictures and dilations of the biliary system is usually observed. Symptomatic treatment, immunosuppression and ursodeoxycholic acid are used in early stage PSC. In later stages, liver transplantation might be the only option available to alter prognosis and survival.
Candidiasis is an opportunistic fungal infection that can affect the gastrointestinal tract, skin, or be systemic in immunocompromised patients. Clinical presentation is different from one patient to another and is dependent on the severity of immunosuppression and the anatomical site of the infection. Patients with candidiasis need topical antifungals for localized disease and systemic antifungals for esophagitis and systemic candidiasis. The important distinction between patients with neutropenia and without neutropenia can affect the choice of antifungals in systemic candidiasis.
Pelvic inflammatory disease is infectious in etiology and is closely linked to sexually transmitted disease. Pelvic inflammatory disease is common in the United States with an estimated incidence of 2.5 million. The condition can be diagnosed clinically, with lower abdominal pain, cervical motion tenderness, an elevated erythrocyte sedimentation rate and fever. Once diagnosed, the patient should be put on empirical antibiotic therapy that should cover gonorrhea, chlamydia, gram-negative organisms and anaerobes. Patients with complications, such as abscess formation or sepsis, might benefit from laparoscopic surgery.
Duodenal atresia is one of the most common inborn defects of the digestive system, namely of the intestine, that is often associated with other congenital malformations and genetic pathologies (21 trisomy). The frequency of occurrence of this disorder is affected by the hypoxia of the fetus in the first trimester of pregnancy and is caused by severe chronic respiratory and cardiovascular diseases, stress, diabetes, drug and alcohol abuse during pregnancy. Nowadays, duodenal atresia is one of the most common congenital defects in the neonates. Moreover, it is well-diagnosed and curable in most of the cases, if timely detected and not neglected.
Local anesthesia is required for many surgical procedures, be it minor or major. Local anesthetics act by blocking the neuronal impulses in the area they have been administered at, and this is achieved primarily by blocking voltage-gated sodium channels. Local anesthetic drugs have a variable onset and duration of action, ranging from a few minutes to a few hours. While they are generally safe, they may cause an allergy, cardiotoxicity or neurotoxicity. In this article, we will study the pharmacodynamics, pharmacokinetics, mechanism of action, important indications and toxicity of local anesthesia.
The article aims to describe the concept of information bias in the experimental research studies and to throw light on the issues concerning the bias, the types of bias, and the methods of disposal of these errors.
The thyroglossal cyst forms one of the most common pathologies of the neck after lymphadenopathy. Though it is a benign condition, the complications which might arise because of it are a major concern. This condition is dealt with in a surgical point of view and is discussed in detail in this article.
Alcoholic liver disease occurs as a result of excessive alcohol consumption. Up to 20% of heavy drinkers will develop liver cirrhosis. The amount, pattern and duration of alcohol consumption along with inflammatory changes in liver, diet, nutritional status and genetic predisposition of the patient predicts the severity and prognosis of the disease. Blood test, liver function test and liver biopsy are helpful to establish the diagnosis. General supportive measures, Prednisolone or Tumor necrosis alpha inhibitors can be used but with caution along with alcohol abstinence is adopted to manage the case. Liver transplantation is preserved for patients with severe liver cirrhosis.
Hemolytic anemia is characterized by intravascular and extravascular destruction of erythrocytes. It manifests if the production of the erythrocytes in the bone marrow is slower than their degradation. A first good differentiation of the several forms of hemolytic anemia can be made between ‘hereditary’ and ‘acquired’. In this article, the most important forms of acquired hemolytic anemia are presented, emphasizing on their etiology, clinic and therapy.
Non-alcoholic steatohepatitis, one form of the non-alcoholic fatty liver disease spectrum, has been associated with obesity and lipid dysregulation. The patient usually presents with abnormal lipid and liver profiles. The most evidence based treatment for non-alcoholic steatohepatitis involves around weight loss, glycemic control and avoiding liver insulting drugs. Our current understanding of the pathogenesis of non-alcoholic steatohepatitis is still limited but novel and more specific treatments are being developed.
The gastrointestinal tract (GIT) is a long tubular structure having an important role in digestion, absorption, and elimination of food and waste. The GIT has a rich arterial blood supply derived embryologically from the three unpaired arteries of the foregut, midgut and the hindgut that are celiac trunk (artery), superior mesenteric artery and inferior mesenteric artery, respectively.
In patients with end-stage liver disease (ESLD), the definitive treatment is a liver transplant. In the United States, the most common indication for liver transplantation is hepatitis C followed by alcoholic liver disease. Immunosuppression is indicated post-implantation and the most common complications are rejection and infection.
A seizure is a brief episode of signs/symptoms resulting due to uncontrolled, abnormal electrical activity in the brain. In this article, we will study in detail about the classification, mechanism of action, and adverse effects and interactions of antiseizure drugs. First and second line drugs for various types of seizures will also be studied.
Ischemic colitis (ischemic disease of the colon) was first described in 1966. It occurs when there is an occlusion of branches of the superior mesenteric (SMA) or inferior mesenteric arteries; the vast majority of cases describe the lesion in the splenic flexure and left colon. This severe illness is very common among the elderly with pronounced cardiovascular disorders. An acute stabbing abdominal pain and rectal bleeding with diarrhea in most of the cases follow the onset. Ischemic disease of the colon requires immediate actions; the sooner the treatment is administered, the more benign the outcome is.
Esophageal rings are the most common esophageal abnormality and Schatzki rings represent the majority of them. Schatzki rings occur in the lower end of the esophagus and can be classified into types A and B rings. Type A ring is a muscular ring while type B is mucosal constriction. Schatzki rings respond very well to dilation therapy.
Patients with diabetes insipidus present with polyuria, urinary output > 3 L per day and can be central or nephrogenic in origin. In central diabetes insipidus, there is a decrease in the secretion of antidiuretic hormone (ADH), while in nephrogenic diabetes insipidus, the kidneys are unable to concentrate the urine due to ADH resistance.
Hospitalized patient receiving broad-spectrum antibiotics are at risk of developing Clostridium difficile infection (CDI). Antibiotics change the normal colonic bacterial flora and C. difficile colonizes the colon in these patients. C. difficile produces toxins that cause inflammation of the colonic mucosa. Even though clindamycin has been traditionally linked to the development of C. difficile colitis, almost all antibiotics can cause the disease.
Pancreatic pseudocysts are a complication of acute pancreatitis, and they are more common when the etiology is alcohol-related. These pseudocysts do not have an epithelial wall, and their fluid content is rich in amylase, lipase and trypsin. Abdominal CT scan is the diagnostic modality of choice to confirm the diagnosis of pancreatic pseudocysts and exclude complications. MRI or ERCP can be used to assess communication between the pseudocyst and the pancreatic duct, and if present, transpapillary drainage of the pseudocyst can be attempted.
Bronchogenic carcinomas include small cell carcinoma, squamous cell carcinoma, adenocarcinoma, large-cell carcinoma and undifferentiated carcinoma. Bronchogenic carcinoma is clearly associated with tobacco smoking. Once the diagnosis of bronchogenic carcinoma is confirmed by a biopsy study, disease staging with CT or FDG-PET is indicated because treatment is stage-based. While stage I and II disease benefit from surgical lobectomy, chemotherapy is essential for patients with stage III and IV.
Endocrinology refers to the study of endocrine system; more specifically, it is the study of hormones, the receptors to which the hormones bind, the intracellular signaling cascade they invoke, and the diseases and conditions associated with them. It is a communication system comprising of endocrine glands and the hormones they produce. The hormones are released into the blood to guide processes such as metabolic activity, growth, sexual development, sleep-wake homeostasis, regulation of emotions, and others. The effect produced by the hormones might rest with a single organ or multiple organs throughout the body.
This article specifically focuses on the intricacies of the steroid hormone receptors, which are generally intracellular in nature and can be found at all three places namely nucleus, cytoplasm and the plasma membrane.
Malignant neoplasms have the ability to invade adjacent structures, spread through the lymphatic system or metastasize to distant organs by the bloodstream. In order for tumorous cells to be able to metastasize, they should first become motile and be able to migrate. This is achieved by altered cell-to-cell and cell-to-matrix adhesion properties in addition to an epithelial-to-mesenchymal transformation process. In addition to this, angiogenesis and lymphangiogenesis play an important role in metastatic disease by providing access for the tumor cells to the bloodstream and lymphatic system respectively.
Teratomas are germ-cell tumors and can be mature “benign” or immature “malignant”. They usually arise in the sacrococcygeal region, ovaries, testes or mediastinum. Sacrococcygeal teratomas can be diagnosed antenatally, while teratomas in other locations are usually diagnosed postnatally. The treatment of teratomas is surgical. Complete excision of benign teratomas can virtually result in a cure with minimal risk of recurrence in the majority of the cases.
AIDS cholangiopathy is an advanced fatal disease caused due to biliary obstruction resulted from opportunistic infections of biliary tract strictures. Choliangiapathy developed in 25 out of 100 patients of AIDS before the arrival of antiretroviral therapy, especially in patients with low CD4 count(<100/μL). Its symptoms are right upper quadrant and epigastric pain, fever, diarrhea and sometimes jaundice. The severity of pain depends on the lesion of biliary tract. Endoscopic retrograde cholangiopancreatography establishes the diagnosis of cholangiographic abnormalities. Antimicrobial therapy is sometimes ineffective and highly active antiretroviral therapy is the best therapy for AIDS cholangiopathy. Surgical intervention is recommended to patients with terminal disease and intractable pain in abdomen.
In this article, we will study in detail about the phases of anesthesia, classification, mechanism of action, and adverse effects/toxicity of general anesthetics. Important therapeutic aspects of individual drugs will also be studied.
Approximately, 5.5 million people in the United States have liver cirrhosis. End-stage liver disease affects mainly the middle-aged population and is considered as the seventh commonest cause of death in the United States. The majority of these patients die due to the limited availability of donor livers. Several complications are encountered in end-stage liver disease and include ascites, hepatic encephalopathy, malnutrition and renal failure. Hepatocellular carcinoma is another possible complication in chronic liver cirrhosis.
Red blood cells perform an important function of supplying adequate oxygen to all tissues. Increased synthesis of these red blood cells, arising either de novo or secondary to other conditions, is called polycythemia. Read on to find out more about the different types of polycythemia and how they may present.
Dehydration is an imbalance in the body fluid environment. The imbalance is due to less water intake while there is more water loss. The body can lose water through normal physiologic processes in respiration, urination and sweating, or some pathologic diseases through vomiting, diarrhea and fever.
Dural venous sinuses are venous blood reservoirs contained between the two layers of the dura mater. Absence of lymphatic drainage in the brain places the venous outflow system at a pedestal of prime importance. Following a prologue to dural venous sinuses, this article focuses on arachnoid granulations, tributaries and the drainage pattern of the venous sinuses.
The cell membrane is a partially permeable membrane that allows only hydrophobic or lipid soluble molecules to move in and out freely. Ions, being polar molecules, are unable to pass freely and therefore channel proteins are responsible for carrying them across the cell membrane. These channel proteins are gated and thus open and close in response to a certain stimulus.
Cell signalling is the process by which cells communicate with each other and the external environment. It is important for the living cells to co-ordinate their actions. This helps them in cell repair, development and maintenance of homeostasis.
The human organism contains different types of tissues, namely muscle tissue, nervous tissue, connective tissue and epithelial tissue. Epithelium forms the lining of body organs, vessels, cavities and the skin. It is therefore the outermost layer that directly comes in contact with other chemical molecules. The epithelial cell membrane has been modified to perform its specific functions like absorption, secretion or act as a barrier.
Integration of vestibular input, vision and proprioceptive feedback is instrumental in maintaining orientation and balance of the body in both static and kinetic environment. In this article, a prelude to organization of vestibular system is followed by discussion on caloric test and control of horizontal gaze.
The cavernous sinus is one of the most important dural venous sinuses located between the endosteal dura and meninges. The roof of the sinus is formed by the inner layer of meningeal dura, which is continuous with the diaphragm sellae covering the pituitary gland.
Cortisol preparations are frequently used drugs in modern-day medicine. A lot of people are durably dependent on their frequent use. Thus, hypercortisolism is a relatively common disease and, therefore, a quite common exam topic. Read all the important facts on hypercortisolism and Cushing’s syndrome in order to correctly diagnose this disease and initiate the main steps of the treatment.
Hepatic encephalopathy syndrome (HES) is a condition which occurs in patients with severely impaired detoxification function of the damaged hepatocytes of the liver because of various reasons, mostly due to cirrhosis or other liver diseases that can lead to fulminant hepatic failure. It is a neuropsychiatric syndrome characterized by disturbances in consciousness, behavior, personality, fluctuating neurologic signs and distinct EEG changes.
The thorax consists of two major organs: the heart and lungs. These are supplied by an extensive network of blood vessels, nerves, and lymphatic vessels. The rib cage surrounds the thorax and provides protection to the delicate organs.
The lifetime prevalence of major depressive disorder falls within 12—17 %. Therefore, every clinician will come in contact with patients suffering from symptoms of depression or taking antidepressant medications. For this reason, it is important to know the indications, adverse effects, and interactions of antidepressants.
The skin of the back is divided into six regions. The central vertebral region is the area of the skin overlying the vertebral column. The deltoid area lies over the shoulder joints. The scapular region encloses the scapula on both sides. The area of the skin beneath the scapula is called infra-scapular region. The area beneath the ribs and above the hip bone forms the lumbar region on both sides. The sacral region is the area of skin between the two hip bones.
The venous system of the lower limb consists of a superficial and a deep system. The superficial veins drain into the deep veins of the lower limb, which eventually drain into common iliac vein and inferior vena cava. This article also provides information about the cutaneous innervation (dermatomes) of the lower limb.
The lower limb is mainly supplied by the femoral artery at the thigh, popliteal artery at the knee and tibial arteries at the lower leg and foot. The femoral artery is an important vessel as it is frequently used to access the arterial circulation during invasive procedures such as coronary angiography. Other vessels such as popliteal, posterior tibial and dorsalis pedis are also palpable.
A cell membrane is a phospholipid bilayer with hydrophilic heads projecting outwards and lipid tails facing each other. Smaller or lipid soluble molecules can easily move in and out of the cell membrane through process of simple diffusion. However, lipid insoluble or hydrophilic molecules require specific carriers for their transportation across the cell membrane. Proteins are embedded in this phospholipid bilayer to move hydrophilic or larger molecules in and out of the cell membrane. This proposed model is called fluid-mosaic model of the cell membrane.
Gastroparesis is defined as a chronic motility disorder where there is a delayed emptying of the stomach without an apparent mechanical obstruction. Usually, both solids and liquids are affected. Gastroparesis is usually of undetermined causes, but can also be linked to previous abdominal surgeries or diabetes mellitus. Symptoms include nausea, vomiting and early satiety. Once diagnosed, the patient is instructed to follow a diet that has more liquid, promotility agents could be prescribed and antiemetics are used for symptomatic relief.
The topic of this article is peptic strictures associated with benign and malignant after-effects of this condition and the management of these ailments as the number of such cases makes up to 80% of all esophageal strictures and represents a great interest for the researchers.
Meckel's diverticulum is named in honor of Johann Friedrich Meckel, who, in 1809, described the intrauterine origin of the condition, which is one of the most common inborn defects of the baby's small intestine stipulated by the partial obliteration of the vitelline duct (omphalomesenteric duct).
Scientific studies in the medical field are done in order to come up with a solution to a particular health problem based on data that is collected during the studies. Data is collected with a very high degree of accuracy and in an authenticated manner. Scientific studies are planned according to evidence which is currently available. This evidence is used to find the solution for unclear problems or the shadow areas in medicine. This remains the overall aim of most studies with a few exceptions.
Diabetes is one of the most common metabolic disorders of the world and is a major cause of morbidity in the elderly population. The treatment of diabetes has gone into a number of refinements, and currently, the majority of people who are suffering from the disease can be treated with the help of oral hypoglycemic drugs. These drugs form the first line of pharmacological treatment for patients with type 2 diabetes mellitus, whereas in patients with type 1 diabetes mellitus, the first line of treatment is insulin. This article discusses in detail the various oral hypoglycemic drugs, which are currently available on the market.
Dumping syndrome, or “too rapid drainage of the stomach,” is a condition most often found in patients post-gastrectomy. Symptoms of this condition can be separated into vasomotor symptoms (such as palpitations, flushing or diaphoresis) and abdominal symptoms (such as diarrhea, nausea or cramps). The symptoms often resolve within several months. Medication is often helpful and surgical intervention is rarely necessary.
Brain stem syndromes are characterized by infliction of precise structural entities with specific consequent clinical manifestations. Relevant appraisal of anatomy and blood supply of medulla is essential to understand the peculiar features of medullary syndromes. In this article, we emphasize on clinical characteristics of medial medullary syndrome and lateral medullary syndrome in perspective of the topographical organization of medulla. We conclude with therapy and prognosis.
Abnormal movements can be presenting features of several neurodegenerative disorders, most commonly parkinsonism, or can occur as side effects of drugs, most commonly antipsychotics. A few other disorders can also present with abnormal movements. Drugs used in treatment of parkinsonism and other movement disorders mainly act on the central nervous system. In this article, we will study the pharmacology of these drugs.
In this article, we will study the important pharmacological aspects of skeletal muscle relaxants such as classification, pharmacokinetics, mechanism of action, clinical uses, drug interactions, adverse effects and toxicity.
Comprised of midbrain, pons and medulla oblongata, the brainstem is the central relay station between the cerebrum and the cerebellum. Cranial nerves originate in the brainstem. This article enhances the understanding of the organization and purpose of the brainstem and its components. Antero-posterior orientation of the brainstem is crucial in the pathogenesis of various diseases – the structures involved and the consequent manifestations. The article concludes with a discussion on glossopharyngeal and vagal nerve nuclei.
The spinal cord is the continuation of the brain stem medulla below the foramen magnum. This article discusses lesions and diseases of the spinal cord, highlighting the Brown-Sequard syndrome and Tabes Dorsalis.
Syringomyelia is characterised by progressive abnormal CSF accumulation in the spinal cord. It causes dissociated suspended anaesthesia affecting pain and temperature sensation predominantly in the upper limbs. Etiology is unclear. There are many theories proposed but the accepted fact is that it is a manifestation of an underlying pathology rather than being a disease itself. Treatment of the primary cause often leads to regression of the syrinx.
Toxicology of cholinomimetics, especially nicotine and cholinesterase inhibitors, is important for clinical implications. In this article, clinical features of adverse effects, resulting from acute and chronic exposures to cholinomimetics, are described. Management of poisoning, including the role of atropine and cholinesterase reactivators, is also discussed.
The sympathetic autonomous system works by the release of neurotransmitters that act on the adrenoreceptors, with their various types and subtypes. The effects produced can be mimicked by drugs that stimulate these receptors, known as sympathomimetics. Some sympathomimetics have a higher affinity for a certain receptor type or subtype while others are rather non-selective.
Cholinomimetics are an important class of drugs affecting the autonomic nervous system. They act on receptors that are activated by acetylcholine. They are broadly classified into direct-acting and indirect-acting drugs. In this article, we will study the mechanism of action and pharmacological actions, specific characteristics and clinical uses of individual cholinomimetic drugs.
In this article, we will study the important pharmacological aspects of alpha and beta blockers such as classification, pharmacokinetics, mechanism of action, important actions on various organ systems, clinical uses and toxicity.
The main role of antiarrhythmic agents is to prevent the occurrence of arrhythmia and, in the case of those patients in which abnormal rhythm has occurred; it helps in the termination of the arrhythmia. Antiarrhythmics are classified in various types by means of many classifications. The Vaughan-Williams classification is one of the widely accepted among those. Class 3 drugs constitute potassium channel blockers. These will be discussed in this article.
The Vaughan-Williams classification is one of the most commonly used classifications for antiarrhythmic drugs. Class 1 consists of sodium channel blockers, which in turn is divided into 3 subgroups namely 1A, 1B and 1C. This article discusses the class 1 antiarrhythmic drugs in detail, along with a description of the salient features of individual drugs.
Diabetes not only causes destruction of the body as a whole but also leads to a lot of psychological stress. The patients need to do a lot of self-care, which remains a vital and essential factor in maintaining the glycemic control. Hence, a thorough understanding is expected from the physician side to explain the intricacies to the patient.
Temporal arteritis, also known as giant cell arteritis (GCA), is the vasculitis of the superficial temporal artery. Inflammation of the vessel wall produces systemic, neurologic and ophthalmologic signs and symptoms.
Carotid artery disease, also called carotid artery stenosis, is the narrowing of the lumen of the carotid arteries due to fats and cholesterol deposition (plaque). The complete blockage of the artery, called carotid artery occlusion, can lead to cerebral ischemia and stroke.
The human body comprises of a single pair of subclavian arteries, one on the right side, the other on the left. Both show different patterns while originating from their source. Right subclavian artery arises from the right brachiocephalic artery while the left subclavian artery arises from the arch of aorta. Both these arteries supply various parts of the brain through the circle of Willis formed at the base of the brain. They also supply the cerebellum, parts of the posterior neck and upper limbs along with the upper chest portion.
The superior thoracic aperture, or thoracic outlet, is an upper chest area located below the clavicles and between the neck and the shoulders. Many important anatomical structures pass from the neck into the thorax and chest cavity from the thoracic outlet.
Thoracic outlet syndrome is caused by the compression of the structures at the thoracic outlet, especially those passing through the inter-scalene triangle.
The circle of Willis, also called circulus arteriosus cerebri, is one of the anastomotic systems of arteries in the body which supplies blood to the brain. It is located at the base of the brain. Willis is the name of the author of Cerebri Anatome, a book that described this ring of blood vessels present at the base of the brain. The circle of Willis is present around the stalk of the pituitary gland. It connects the blood supply of the forebrain and the hindbrain.
Testosterone is a lipid-soluble molecule synthesized mainly from cholesterol in the testes, ovaries, and adrenal glands and is important for spermatogenesis and the development of both primary and secondary male sex characteristics. Anabolic steroids, which have similar properties to testosterone, are commonly taken by athletes and body builders to increase performance, however, they possess dangerous side effects.
The thyroid gland is one of the largest and actively functioning endocrine glands. It is a highly vascular, brownish-red gland located in the visceral compartment of the anterior part of the neck, spanning between the C5 and T1 vertebrae.
Hypertension is the rise in blood pressure beyond the defined set point (conventionally ≥ 140/90 mmHg). Hypertension is the known risk factor for a number of cardiovascular events like myocardial infarction, angina and heart failure, sudden cardiac death. The pharmacological therapy for hypertension is discussed in this section. The therapies have evolved over time and the current line of therapy offers tremendous response and decreases the morbidity and mortality associated with this condition. It should be noted that non-pharmacological therapy like exercise and healthy food habits also play an important part in controlling hypertension.
Autoimmune diseases are a group of disorders that are characterized by abnormal reactions of the immune system against one’s own body. These usually manifest during the middle years and are, most of the time, chronic. Approximately 3.2 % of the global population is composed of people who are afflicted with these, being generally more common among women.
Acute (or fulminant) liver failure is basically the end point of severe liver damage brought about by many different causes. It is characterized by a rapidly developing dysfunction in the hepatocytes. Affected persons may or may not have known past experiences of liver disease. The manifestations of fulminant liver failure can manifest systemically and are caused by changes in the integrity of hemostasis and mental status. Being a fatal condition, a rapid and accurate diagnosis of acute liver failure when a case is present should be done. This can be done clinically by using key observations in the history and physical examination. The timely use of other supplemental tools to reinforce the diagnosis should also be instigated.
Aside from the many metabolic and synthetic functions of the liver, it also plays a crucial part in the maintenance of other organ systems. This is why any alterations in its functions, such as in liver cirrhosis and portal hypertension can result in detrimental effects on the major organs and tissues remote from the liver such as the lungs, heart, and kidneys.
Although liver diseases can affect different extrahepatic organ systems, there is somewhat a similar pattern when it comes to the development of the pathophysiology. One of the many extrahepatic syndromes that can manifest in patients having liver problems such as cirrhosis and portal hypertension is the hepatorenal syndrome.
Humoral immunity, or antibody-mediated beta cellular system, is a type of immunity which is mediated by macromolecules found in fluids such as the secreted antibodies, complement proteins, and bound antimicrobial peptides. In contrast to cell-mediated immunity, the term "humoral" describes the non-cellular compositions of the blood, such as plasma and lymphatics. However, the cellular components of the blood, such as lymphocytes and antigen presenting cells, are important for mediating antigen-specific antibody reaction.
The inotropic agent in the context of heart failure and angina is classified into positive and negative inotropic agent. The positive agent increases the contractility and will be discussed in detail in this article. A brief about the negative inotropic agent, which decreases the myocardial contractility, is mentioned. The inotropic agent, when mentioned alone without any prefix, stands for a positive inotropic agent in this article.
There are so many changes in the anatomy and physiology of the female human body during pregnancy. Aside from the profound reproductive system changes, there are also many reversible modifications in the other internal organ systems, all of which happen in order to accommodate the changing needs of the childbearing woman all throughout the 3 trimesters of pregnancy.
One of the organs that change during pregnancy is the liver. Along with its changes comes the female individual’s predisposition to certain hepatic conditions that could put her and the fetus at increased risk for morbidity or mortality.
The organic nitrate includes drug like nitroglycerin, isosorbide mononitrate, and isosorbide dinitrate. The newer organic nitrate, which has recently been evaluated, is pentaerythrityl tetranitrate. The nitrates are available in various forms like intravenous, oral, sublingual, spray, ointment, patch, transdermal and buccal preparations.
Vascular diseases are any abnormal conditions that affect the circulatory system and are responsible for more mortality and morbidity than any other category of human disease. The spectrum of pathology encompasses congenital and acquired disorders that are arterial, venous, capillary or lymphatic in origin. Vascular disease can affect virtually any vessel in the body and present with different symptoms in different regions of the body. The most commonly involved areas include the heart, head, neck, and upper and lower extremities. Less commonly, vessels supplying the bowel may be involved leading to bowel infarction.
The significant prevalence of mass lesions in the liver among the general population has prompted the emphasis on understanding each of the condition’s clinical presentation, diagnosis, and treatment. Another reason to fully understand the characteristics of the different space-occupying lesions in the liver is the fact that the treatment varies depending on the type of lesion found in the liver.
Here, we briefly discuss the epidemiology and features of the different space-occupying lesions in the liver.
The most prominent complications of having liver diseases such as cirrhosis include ascites. Derived from the Greek word “askos” which means “sack”, ascites is characterized as the collection of fluid in the peritoneal cavity.
Aside from liver diseases, it can also be caused by a wide range of reasons necessitating different means of definitive management. Therefore, the identification of the nature and development of the fluid collection in the peritoneal space of a specific patient is very important.
Once the population of bacteria in the intestinal lumen reaches certain numbers, they tend to translocate to the mesenteric lymph nodes, leading to the eventual invasion and colonization of the bacteria in the ascitic fluid.
The development of varices in the esophagus and the gastrointestinal tract is only one of the 3 complications caused by increased pressure within the portal system, the others being ascites and hepatic encephalopathy. All of these conditions are essentially brought about by diseases that impair the flow of blood through the liver such as in liver cirrhosis.
The presence of collateral blood vessels in the portosystemic circulation allows for a normal blood flow into and out of the liver. However, these collateral do not hold blood well in times of increased portal pressure, making them vulnerable to massive dilatation and rupture.
In any human endeavour within the realm of faith, philosophy or science, history shows that new concepts are rarely accepted and applied. Many innovations in physiological condition are surely falling into this category. Dr J. Leonard Corning, a medical specialist, was the first man who provided a spinal anaesthetic in 1885. There are very little documents showing this claim because Corning never mentioned CSF. His intention was to inject the hard drug into the neighbourhood of the funiculars. However, that attempt of CSF wasn't seen on body parts where the needle is inserted.
Alcoholic hepatitis is a progressive disease characterized by inflammation and damage of liver caused by long term excessive intake of ethanol. Non-Alcoholic fatty liver disease is the also progressive disease of liver characterized by accumulation of fat in liver without the abuse of alcohol. Both the disease show similar pathological changes resulting in fibrosis or scarring of liver. The extensive fibrosis of liver due to continued abuse of alcohol is called alcoholic cirrhosis. These diseases remain asymptomatic at early stages and common symptoms are slight discomfort at right side of upper abdomen with fatigue and unexplained weight loss. Lifestyle modification and alcohol abstinence is essential for management along with required therapeutic and surgical interventions.
The carotid arterial system provides blood supply to the head and neck. The aorta arches towards the left and backward, before going downwards to supply freshly oxygenated blood to the body. Three major vessels branch off from the arch of the aorta to supply blood to the upper limbs and head and neck.
The human skull is a complex combination of several bones ranging from small to large sizes – usually in pairs (right and left side). These bones grow from birth and fuse together to form the skull. This section will discuss the facial bones of the skull.
All the muscles controlling the movement of the eye are known as the extraocular muscles of the eye. The orbit, or eye socket, holds the eye and its muscles, nerves, and blood vessels. There are six extraocular eye muscles. These muscles contract to rotate the eye up, down, and side to side.
Intracranial hemorrhage is a medical emergency that occurs in adults, but can also occur in children and neonates. As the name suggests, intracranial hemorrhage is bleeding and the accumulation of blood within the skull at an abnormal location leading to the formation of a hematoma. A hematoma is the collection of blood outside of blood vessel. Intracranial bleeding can lead to stroke, neurological deficit, brain matter herniation, and even death.
The lung is the major organ of the respiratory system and used to inhale oxygen and remove the metabolic waste in the form of CO2 from the body. Malfunctioning of the lungs can lead to serious complications and disturbs the normal living conditions. Lung cancer is one of the severe conditions which have a relatively high mortality risk. Previously, it was the leading cause of death among men in more than 25 developed countries. Now it has become a worldwide cause of death among men. Most common cause of lung cancer is smoking, especially in men. Prognosis of this condition is still poor for malignant tumors. Read everything important about it here.
Radiological investigations like x-ray and CT scan are required for the confirmation of clinical findings. The field of radiology in the 21st century has become very advanced and through various radiological investigations, even the smallest calcifications and vascular pathologies can be diagnosed. The chest radiograph (CXR) is the most common radiological investigation.
Nowadays, junk foods like burgers, pizzas, and other flour-based meals are more likely consumed by the young generation. Mostly they are unfamiliar with the consequences of the usage, which then may lead to severe and painful irritable bowel conditions. Cramping, bloating, constipation, abdominal pain, gas, and diarrhea are some of the common problems that are to be tackled for the patients of IBS. One must have an eye on the signs and symptoms of IBS to reach to its severe conditions. Have a detailed description of IBS here.
In many diseases, early diagnosis is important for slowing the progression. This also applies to diabetes mellitus. Especially with type 2 diabetes, a timely detection of symptoms may limit the severe consequential damage and help patients to further have an asymptomatic life. Therefore, medical students should have keen senses about the patients with obesity, weight loss, polydipsia and polyuria.
In the case of diabetes mellitus, the primary therapeutic goal is to stabilize the concentration of glucose in the blood. Stabilization is accompanied by various forms of therapy, starting from simple dietary rules and leading to regular insulin injections. As a physician, it is very important to know all the therapeutic measures, and treat patients with an individual approach to protect them from fatal late complications of diabetes mellitus.
Patients who have been suffering for years from high blood sugar concentration can expect serious consequences for their entire bodies. Accurate knowledge of the complications that may arise in the course of the disease is important not only for the exam. Physicians may significantly contribute to the problem, so that amputations, blindness, kidney damage and cardiovascular disease can be avoided.
Liver tumors are some of the more common neoplasms and are classified as either primary or secondary. Management varies depending on several factors such as type, size, and the spread of the cancer. Continue to read this article to learn key facts about the tumors of the liver including incidence, pathology, clinical features, diagnosis, and treatment.
Zollinger-Ellison syndrome is one of the rare conditions that affect the duodenum or the pancreas. Tumors (gastrinomas) form in the duodenum or the pancreas, which secrete huge amounts of gastrin leading to excess acid production in the stomach. This excess acid results in the formation of related symptoms as well as peptic ulcers.
It is quite notable that fluids inside a human being are also compartmentalized into the extracellular and intracellular fluid compartments. Between these spaces comes a difference in terms to the amount of ions, proteins and other substrates dissolved or suspended in them. These substrates are prevented from unnecessarily mixing with each other due to the partitioned nature of the cell’s structure.
A-A Gradient & Alveolar Gas equation are very evident to determine various causes of hypoxemia. Alveolar gas equation is useful for calculation of the partial pressure of oxygen in lung alveoli and A-A Gradient is the value that shows the difference between alveolar oxygen pressure and arterial oxygen pressure. The etiology of hypoxemia can be hypoventilation, diffusion impairment, and presence of shunt, V/Q mismatch and high altitude. The variation in the values of alveolar gas equation and A-A Gradient establish the laboratory diagnosis of the lung pathologies.