New to Meducation?
Sign up
Already signed up? Log In

Category

Preview
3
49

Emphysema - Introduction, Types, Symptoms, Diagnosis

https://www.facebook.com/ArmandoHasudungan  
Nicole Chalmers
almost 8 years ago
Preview
3
264

Bacterial Etiologies of Common Infections (Antibiotics - Lecture 2)

A summary of the role and composition of normal flora, the typical bacterial pathogens causing several common infectious diseases, diagnosis of UTI, and interpretation as to whether a positive blood culture represents true infection or contamination. Bonus points to anyone who can identify the mystery portrait.  
Nicole Chalmers
almost 8 years ago
Preview
0
21

Early Palliative Care: Improving Quality of Life

A landmark study on the integration of palliative care during early onset of a cancer diagnosis was recently published in the New England Journal of Medicine. Here, lead authors Jennifer Temel, MD, and Victoria Jackson, MD, MPH discuss palliative care and the impressive study findings which showed patients experienced a better quality of life and actually lived longer than patients not receiving the same level of care at an early stage. Jim Windhorst, a stage IV, lung cancer patient describes how palliative care has helped him cope with his illness. For more information visit: http://www.massgeneral.org/about/newsarticle.aspx?id=2330  
Nicole Chalmers
almost 8 years ago
Foo20151013 2023 dd0lu2?1444774205
6
227

Male Postnatal Depression - a sign of equality or a load of nonsense?

Storylines on popular TV dramas are a great way of raising the public's awareness of a disease. They're almost as effective as a celebrity contracting an illness. For example, when Wiggles member Greg Page quit the group because of postural orthostatic tachycardia syndrome, I had a spate of patients, mostly young and female, coming in with self-diagnosed "Wiggles Disease". A 30% increase in the number of mammograms in the under-40s was attributed to Kylie Minogue's breast cancer diagnosis. The list goes on. Thanks to a storyline on the TV drama Desperate Housewives, I received questions about male postnatal depression from local housewives desperate for information: "Does it really exist?" "I thought postnatal depression was to do with hormones, so how can males get it?" "First it's male menopause, now it's male postnatal depression. Why can't they keep their grubby mitts off our conditions?" "It's like that politically correct crap about a 'couple' being pregnant. 'We' weren't pregnant, 'I' was. His contribution was five seconds of ecstasy and I was landed with nine months of morning sickness, tiredness, stretch marks and sore boobs!" One of my patients, a retired hospital matron now in her 90s, had quite a few words to say on the subject. "Male postnatal depression -- what rot! The women's liberation movement started insisting on equality and now the men are getting their revenge. You know, dear, it all began going downhill for women when they started letting fathers into the labour wards. How can a man look at his wife in the same way if he has seen a blood-and-muck-covered baby come out of her … you know? Men don't really want to be there. They just think they should -- it's a modern expectation. Poor things have no real choice." Before I had the chance to express my paucity of empathy she continued to pontificate. "Modern women just don't understand men. They are going about it the wrong way. Take young couples who live with each other out of wedlock and share all kind of intimacies. I'm not talking about sex; no, things more intimate than that, like bathroom activities, make-up removal, shaving, and so on." Her voice dropped to a horrified whisper. "And I'm told that some young women don't even shut the door when they're toileting. No wonder they can't get their de facto boyfriends to marry them. Foolish girls. Men need some mystery. Even when you're married, toileting should definitely be kept private." I have mixed feelings about male postnatal depression. I have no doubt that males can develop depression after the arrival of a newborn into the household; however, labelling it "postnatal depression" doesn't sit all that comfortably with me. I'm all for equality, but the simple fact of the matter is that males and females are biologically different, especially in the reproductive arena, and no amount of political correctness or male sharing-and-caring can alter that. Depressed fathers need to be identified, supported and treated, that goes without saying, but how about we leave the "postnatal" tag to the ladies? As one of my female patients said: "We are the ones who go through the 'natal'. When the boys start giving birth, then they can be prenatal, postnatal or any kind of natal they want!" (This blog post has been adapted from a column first published in Australian Doctor http://bit.ly/1aKdvMM)  
Dr Genevieve Yates
almost 8 years ago
8
0
37

Sugar diabetis

A close family friend is diabetic.On diagnosis the sugar levels were above 30mg/l and was later put on long term medication. Since then the levels are within the normal range.Can this person stop taking the treatment for the condion? What will be the consequences?  
Irene Kolosa
almost 8 years ago
0
2
130

Spot Diagnosis Sample Skin

Here's a sample of the latest MRCP PACES Videos in High Definition format. MRCP Video package is divided to 5 stations, each including a Variety of Cases & Clinical Skills essential for all Future Doctors. There's also a lot of extra content including: Spot Diagnosis Videos, Exam Simulation Videos, Quick Cases, Patient Simulator Program, Surgical Skills Videos, Clinical Examination Videos from a Variety of Universities around the World, An Extensive Collection of E-books & Q-Bank including thousands of Questions and simulatory exams. If you interested in buying soft or hard copies shipped to your location, please visit our channel or contact us by e-mail: Jackfree4@hotmail.com Thank you!  
MRCP Videos
almost 8 years ago
13
2
53

Quick Cases Sample Eye Bitemporal Hemianopia

Here's a sample of the latest MRCP PACES Videos in High Definition format. MRCP Video package is divided to 5 stations, each including a Variety of Cases & Clinical Skills essential for all Future Doctors. There's also a lot of extra content including: Spot Diagnosis Videos, Exam Simulation Videos, Quick Cases, Patient Simulator Program, Surgical Skills Videos, Clinical Examination Videos from a Variety of Universities around the World, An Extensive Collection of E-books & Q-Bank including thousands of Questions and simulatory exams. If you interested in buying soft or hard copies shipped to your location, please visit our channel or contact us by e-mail: Jackfree4@hotmail.com Thank you!  
MRCP Videos
almost 8 years ago
12
2
94

Station 1 Sample Abdominal Examination Crohns Disease

Here's a sample of the latest MRCP PACES Videos in High Definition format. MRCP Video package is divided to 5 stations, each including a Variety of Cases & Clinical Skills essential for all Future Doctors. There's also a lot of extra content including: Spot Diagnosis Videos, Exam Simulation Videos, Quick Cases, Patient Simulator Program, Surgical Skills Videos, Clinical Examination Videos from a Variety of Universities around the World, An Extensive Collection of E-books & Q-Bank including thousands of Questions and simulatory exams. If you interested in buying soft or hard copies shipped to your location, please visit our channel or contact us by e-mail: Jackfree4@hotmail.com Thank you!  
MRCP Videos
almost 8 years ago
8
4
196

Station 1 Sample Respiratory Examination Bronchiectasis, Thoracoplasty, Kyhoscoliosis

Here's a sample of the latest MRCP PACES Videos in High Definition format. MRCP Video package is divided to 5 stations, each including a Variety of Cases & Clinical Skills essential for all Future Doctors. There's also a lot of extra content including: Spot Diagnosis Videos, Exam Simulation Videos, Quick Cases, Patient Simulator Program, Surgical Skills Videos, Clinical Examination Videos from a Variety of Universities around the World, An Extensive Collection of E-books & Q-Bank including thousands of Questions and simulatory exams. If you interested in buying soft or hard copies shipped to your location, please visit our channel or contact us by e-mail: Jackfree4@hotmail.com Thank you!  
MRCP Videos
almost 8 years ago
7
2
81

General Examination Sample Cardiovascular 1

Here's a sample of the latest MRCP PACES Videos in High Definition format. MRCP Video package is divided to 5 stations, each including a Variety of Cases & Clinical Skills essential for all Future Doctors. There's also a lot of extra content including: Spot Diagnosis Videos, Exam Simulation Videos, Quick Cases, Patient Simulator Program, Surgical Skills Videos, Clinical Examination Videos from a Variety of Universities around the World, An Extensive Collection of E-books & Q-Bank including thousands of Questions and simulatory exams. If you interested in buying soft or hard copies shipped to your location, please visit our channel or contact us by e-mail: Jackfree4@hotmail.com Thank you!  
MRCP Videos
almost 8 years ago
6
0
55

Quick Cases Sample Endocrinology Goitre

Here's a sample of the latest MRCP PACES Videos in High Definition format. MRCP Video package is divided to 5 stations, each including a Variety of Cases & Clinical Skills essential for all Future Doctors. There's also a lot of extra content including: Spot Diagnosis Videos, Exam Simulation Videos, Quick Cases, Patient Simulator Program, Surgical Skills Videos, Clinical Examination Videos from a Variety of Universities around the World, An Extensive Collection of E-books & Q-Bank including thousands of Questions and simulatory exams. If you interested in buying soft or hard copies shipped to your location, please visit our channel or contact us by e-mail: Jackfree4@hotmail.com Thank you!  
MRCP Videos
almost 8 years ago
3
0
52

Exam Preparation Videos Sample 15 Station4 Candidate Patie 1484

Here's a sample of the latest MRCP PACES Videos in High Definition format. MRCP Video package is divided to 5 stations, each including a Variety of Cases & Clinical Skills essential for all Future Doctors. There's also a lot of extra content including: Spot Diagnosis Videos, Exam Simulation Videos, Quick Cases, Patient Simulator Program, Surgical Skills Videos, Clinical Examination Videos from a Variety of Universities around the World, An Extensive Collection of E-books & Q-Bank including thousands of Questions and simulatory exams. If you interested in buying soft or hard copies shipped to your location, please visit our channel or contact us by e-mail: Jackfree4@hotmail.com Thank you!  
MRCP Videos
almost 8 years ago
Preview
0
54

A Physician's Guide to Progressive Supranuclear Palsy ( PSP ) Part 3

A guide to aid the diagnosis of Progressive Supranuclear Palsy for medical practitioners. PSP is a terminal degenerative brain disease which robs those affected of their ability to walk, talk, eat and see. The PSP Association provides help and support for those living with PSP, whilst funding research into the causes, treatments and eventual cure for the disease. www.pspeur.org  
MRCP Videos
almost 8 years ago
Foo20151013 2023 13vodzp?1444774194
9
174

Is ADHD a difficult diagnosis?

In a recent article in the BMJ the author wonders about the reasons beyond the rising trend diagnosing Attention Deficit Hyperactivity Disorder (ADHD). The article attempts to infer reasons for this. One possible reason was that the diagnostic criteria especially DSM may seem for some to be more inclusive than ICD-10. The speculation may explain the rise of the diagnosis where DSM is used officially or have an influence. In a rather constructive way, an alternative to rushing to diagnosis is offered and discussed in some details. The tentative deduction that the Diagnostic Statistical Manual (DSM) may be one of the causes of rising diagnosis, due to raising the cut-off of age, and widening the inclusion criteria, as opposed to International Classification of Diseases, 10th revision (ICD-10), captured my attention. On reading the ICD-10 diagnostic criteria for research (DCR) and DSM-5 diagnostic criteria, I found them quite similar in most aspects, even the phraseology that starts with 'Often' in many diagnostic criteria, they seem to differ a bit in age. In a way both classification, are attempting to describe the disorder, however, it sounds as if someone is trying to explain a person's behaviour to you, however, this is not a substitute to direct clinical learning, and observing the behaviour, as if the missing sentence is 'when you see the person, it will be clearer'. El-Islam agrees with the notion that DSM-5 seems to be a bit more inclusive than ICD-10. A colleague of mine who is a child psychiatrist and she is doing her MSc. thesis in ADHD told me, that DSM-5 seems to be a substantial improvement as compared to its predecessor. The criteria - to her - though apparently are more inclusive, they are more descriptive with many examples, and she infers that this will payback in the reliability of the diagnosis. She hopes gene research can yield in biological tests for implicated genes and neurotransmitters in ADHD e.g. DRD4, DAT, gene 5,6,11 etc. One child psychiatrist, regretted the fact that misdiagnosis and under-diagnoses, deprive the patient from one of the most effective treatments in psychiatry. It is hoped the nearest forthcoming diagnostic classification (ICD-11), will address the issue of the diagnosis from a different perspective, or else converge with DSM-5 to provide coherence and a generalised newer standard of practice. The grading of ADHD into mild, moderate, and severe seem to blur the border between disorder and non-disorder, however, this quasi-dimensional approach seems realistic, it does not translate yet directly in differences in treatment approaches as with the case of mild, moderate, severe, and severe depression with psychotic symptoms, or intellectual disability. The author states that one counter argument could be that child psychiatrists are better at diagnosing the disorder. I wonder if this is a reflection of a rising trend of a disorder. If ADHD is compared to catatonia, it is generally agreed that catatonia is less diagnosed now, may be the epidemiology of ADHD is not artefact, and that we may need to look beyond the diagnosis to learn for example from environmental factors. Another issue is that there seems to be significant epidemiological differences in the rates of diagnosis across cultures. This may give rise to whether ADHD can be classified as a culture-bound syndrome, or whether it is influenced by culture like anorexia nervosa, or it may be just because of the raising awareness to such disorders. Historically, it is difficult to attempt to pinpoint what would be the closest predecessor to ADHD. For schizophrenia and mania, older terms may have included insanity, for depression it was probably melancholia, there are other terms that still reside in contemporary culture e.g. hypochondriasis, hysteria, paranoia etc. Though, it would be too simplistic to believe that what is meant by these terms was exactly what ancient cultures meant by them, but, they are not too far. ADHD seems to lack such historical underpinning. Crichton described a disorder he refers to as 'mental restlessness'. Still who is most often credited with the first description of ADHD, in his 1902 address to the Royal College of Physicians. Still describes a number of patients with problems in self-regulation or, as he then termed it, 'moral control' (De Zeeuw et al, 2011). The costs and the risks related to over-diagnosis, ring a warning bell, to enhance scrutiny in the diagnosis, due to subsequent stigma, costs, and lowered societal expectations. They all seem to stem from the consequences of the methodology of diagnosis. The article touches in an important part in the psychiatric diagnosis, and classifications, which is the subjective nature of disorders. The enormous effort done in DSM-5 & ICD-10 reflect the best available evidence, but in order to eliminate the subjective nature of illness, a biological test seems to be the only definitive answer, to ADHD in particular and psychiatry in general. Given that ADHD is an illness and that it is a homogeneous thing; developments in gene studies would seem to hold the key to understanding our current status of diagnosis. The suggested approach for using psychosocial interventions and then administering treatment after making sure that it is a must, seems quite reasonable. El-Islam, agrees that in ADHD caution prior to giving treatment is a recommended course of action. Another consultant child psychiatrist mentioned that one hour might not be enough to reach a comfortable diagnosis of ADHD. It may take up to 90 minutes, to become confident in a clinical diagnosis, in addition to commonly used rating scales. Though on the other hand, families and carers may hypothetically raise the issue of time urgency due to scholastic pressure. In a discussion with Dr Hend Badawy, a colleague child psychiatrist; she stated the following with regards to her own experience, and her opinion about the article. The following is written with her consent. 'ADHD is a clinically based diagnosis that has three core symptoms, inattention, hyperactivity and impulsivity in - at least - two settings. The risk of over-diagnosis in ADHD is one of the potentially problematic, however, the risk of over-diagnosis is not confined to ADHD, it can be present in other psychiatric diagnoses, as they rely on subjective experience of the patient and doctor's interviewing skills. In ADHD in particular the risk of under-diagnosis is even more problematic. An undiagnosed child who has ADHD may suffer various complications as moral stigma of 'lack of conduct' due to impuslivity and hyperactivity, poor scholastic achievement, potential alienation, ostracization and even exclusion by peer due to perceived 'difference', consequent feelings of low self esteem and potential revengeful attitude on the side of the child. An end result, would be development of substance use disorders, or involvement in dissocial behaviours. The answer to the problem of over-diagnosis/under-diagnosis can be helped by an initial step of raising public awareness of people about ADHD, including campaigns to families, carers, teachers and general practitioners. These campaigns would help people identify children with possible ADHD. The only risk is that child psychiatrists may be met with children who their parents believe they might have the disorder while they do not. In a way, raising awareness can serve as a sensitive laboratory investigation. The next step is that the child psychiatrist should scrutinise children carefully. The risk of over-diagnosis can be limited via routine using of checklists, to make sure that the practice is standardised and that every child was diagnosed properly according to the diagnostic criteria. The use of proper scales as Strengths and Difficulties Questionnaire (SDQ) in its two forms (for parents SDQ-P and for teachers SDQ-T) which enables the assessor to learn about the behaviour of the child in two different settings. Conner's scale can help give better understanding of the magnitude of the problem. Though some people may voice criticism as they are mainly filled out by parents and teachers, they are the best tools available at hands. Training on diagnosis, regular auditing and restricting doctors to a standard practice of ensuring that the child and carer have been interviewed thoroughly can help minimise the risk of over-diagnosis. The issue does not stop by diagnosis, follow-up can give a clue whether the child is improving on the management plan or not. The effects and side effects of treatments as methylphenidate should be monitored regularly, including regular measurement height and weight, paying attention to nausea, poor appetite, and even the rare side effects which are usually missed. More restrictions and supervision on the medication may have an indirect effect on enhancing the diagnostic assessment. To summarise, the public advocacy does not increase the risk of over-diagnosis, as asking about suicidal ideas does not increase its risk. The awareness may help people learn more and empower them and will lead to more acceptance of the diagnosed child in the community. Even the potential risk of having more case loads for doctors to assess for ADHD may help give more exposure of cases, and reaching more meaningful epidemiological finding. From my experience, it is quite unlikely to have marked over-representation of children who the families suspect ADHD without sufficient evidence. ADHD remains a clinical diagnosis, and it is unlikely that it will be replaced by a biological marker or an imaging test in the near future. After all, even if there will be objective diagnostic tests, without clinical diagnostic interviewing their value will be doubtful. It is ironic that the two most effective treatments in psychiatry methylphenidate and Electroconvulsive Therapy (ECT) are the two most controversial treatments. May be because both were used prior to having a full understanding of their mechanism of action, may be because, on the outset both seem unusual, electricity through the head, and a stimulant for hyperactive children. Authored by E. Sidhom, H. Badawy DISCLAIMER The original post is on The BMJ doc2doc website at http://doc2doc.bmj.com/blogs/clinicalblog/#plckblogpage=BlogPost&plckpostid=Blog%3A15d27772-5908-4452-9411-8eef67833d66Post%3Acb6e5828-8280-4989-9128-d41789ed76ee BMJ Article: (http://www.bmj.com/content/347/bmj.f6172). Bibliography Badawy, H., personal communication, 2013 El-Islam, M.F., personal communication, 2013 Thomas R, Mitchell GK, B.L., Attention-deficit/hyperactivity disorder: are we helping or harming?, British Medical Journal, 2013, Vol. 5(347) De Zeeuw P., Mandl R.C.W., Hulshoff-Pol H.E., et al., Decreased frontostriatal microstructural organization in ADHD. Human Brain Mapping. DOI: 10.1002/hbm.21335, 2011) Diagnostic Statistical Manual 5, American Psychiatric Association, 2013 Diagnostic Statistical Manual-IV, American Psychiatric Association, 1994 International Classification of Diseases, World Health Organization, 1992  
Dr Emad Sidhom
almost 8 years ago
Foo20151013 2023 eztttu?1444774181
3
138

Dealing with Personal Illness in Med School

Hey guys! I’m Nicole and I’m a second year medical student at Glasgow University. I’ve decided to start this blog to write about my experiences as a med student and the difficulties I encounter along the way, hopefully giving you something you can relate to. Since June of last year I have been suffering with a personal illness, with symptoms of persistent nausea, gastric pain and lethargy. At first I thought it was just a bug that would pass on fairly quickly, but as the summer months went on it was clear that this illness wasn’t going to disappear overnight. I spent my summer going through a copious amount of medications in hope that I’d feel better for term starting. I visited my GP several times and had bloods taken regularly. After 2 months, I finally got given a diagnosis; I had a helicobacter pylori infection. I started eradication therapy for a week and although it made my symptoms worse, I was positive would make me better and I’d be well again within the week. The week passed with no improvements in my condition. Frustrated, I went back to my GP who referred me for an endoscopy. Term started back the next week and despite feeling miserable I managed to drag myself out to every lecture, tutorial and lab. Within a few weeks I began to fall behind in my work, doing the bare minimum required to get through. Getting up each morning was a struggle and forcing myself to sit in lectures despite the severe nausea I was experiencing was becoming a bigger challenge each day. In October I went for my endoscopy which, for those of you that don't know, is a horribly uncomfortable procedure. My family and friends assured me that this would be the final stage and I’d be better very very soon. The results came back and my GP gave me a different PPI in hope that it would fix everything. I waited a few weeks and struggled through uni constantly hoping that everything would magically get better. I gave up almost all my extra-circular activities which for me, the extrovert I am, was possibly the hardest part of it all. I wanted to stay in bed all the time and I become more miserable every day. I was stressing about falling behind in uni and tensions began to build up in my personal life. It got to the point where I couldn’t eat a meal without it coming back up causing me to lose a substantial amount of weight. I got so stressed that I had to leave an exam to throw up. I was truly miserable. I seen a consultant just before Christmas who scheduled me in for some scans, but it wasn’t until January. I was frustrated at how long this was going on for and I thought it was about time I told the medical school about my situation. They were very understanding and I was slightly surprised at just how supportive they were. I contacted my head of year who arranged a visit with me for January. During the Christmas break I had a chance to relax and forget about everything that was stressing me. I got put on a stronger anti-sickness medication which, surprisingly, seemed to work. The tensions in my life that had built up in the last few months seemed to resolve themselves and I began to feel a lot more positive! I met with my head of year just last week who was encouraged by my newly found positive behaviour. We’ve agreed to see how things progress over the next few months, but things are looking a lot brighter than before. I’ve taken on a new attitude and I’m determined to work my hardest to get through this year. I’m currently undertaking an SSC so I have lots of free time to catch up on work I missed during the last term. My head of year has assured me that situations like the one I’m in happen all the time and I’m definitely not alone. I feel better knowing that the medical school are behind me and are willing to help and support me through this time. The most important thing I have taken from this experience is the fact that you’ll never know the full extent of what a patient is going through. Illness effects different people in different ways and it may not just be a persons health thats affected, it can affect all aspects of their life. This experience has definitely opened my eyes up and hopefully I’ll be able to understand patients’ situations a little better.  
Nicole Mooney
almost 8 years ago
9
1
37

Surgery Mock MCQ

An obese 63 year old lady presents with jaundice. There is no history of abdominal pain. Examination of her abdomen reveals a palpable gall bladder. There is evidence of extensive pruritis. She tells you she drinks 42 units of alcohol a week. Her blood results are as follows: Albumin 32 (35-50) Alk Phos 456 (<110) ALT 88 (<40) Bilirubin 120 (<20) INR 1.6 GGT 400 (0-70) What’s the most likely diagnosis? a. Gallstones b. Paracetamol Overdose c. Pancreatic cancer d. Alcoholic Hepatitis e. Primary billiary cirrhosis  
Af Del
about 8 years ago
Foo20151013 2023 xta4hx?1444774129
2
345

Cardiff University Research Society (CUReS) Annual Event

The Cardiff University Research Society (CUReS) held its second annual student research symposium on the 13th of November 2013 at the University Hospital of Wales. Medical students were invited to submit posters and oral presentations for the symposium. The event also launched this year’s INSPIRE program, a joint effort between Cardiff, Bristol, Exeter and Plymouth to give students connections to research groups through taster days and summer research programs. CUReS is a research society for medical students in Cardiff. All events and projects are completely free and available to all years. The research society has a particular focus on developing close bonds between researchers and students. In addition to INSPIRE, the society also releases a yearly list of summer research projects where medical students can find researchers interested in hosting projects over the summer. The purpose of the conference was to mark the launch of the INSPIRE taster days and display some of the impressive work that has been accomplished from the taster sessions and the funded summer projects. The symposium aims to give Cardiff medical students valuable experience in presenting their research and to motivate students interested in pursuing an academic career. CUReS president Huw Davies gave the opening speech, while INSPIRE lead Colin Dayan introduced the INSPIRE program. Previous INSPIRE students gave talks on their research and experiences gained from the program. Three successful applicants were invited to give oral presentations that were judged by the Cardiff Dean of Medicine Professor Paul Morgan, Professor Colin Dayan and Professor Julian Sampson, who also gave the keynote speech on his research. The symposium was a great success thanks to the enthusiastic medical students who presented posters and gave oral presentations on their research. First prize for an oral presentation was awarded to Georgiana Samoila for her work on Histological Diagnosis of Lung and Pleural Malignancies, while Lisa Roberts and Jason Chai were awarded runner-ups. The award for best poster was given to Thomas Lemon. Two further awards sponsored by Meducation, assessed by Peter Winter, were given to George Kimpton and Ryan Preece for their poster presentations. There was also a Meducation stall and the Cardiff University Research Society greatly appreciates the support. To get in touch with the CUReS, please email cures@cardiff.ac.uk or visit our website at www.cu-res.co.uk for more information. Written by Robert Lundin  
Nicole Chalmers
about 8 years ago
Foo20151013 2023 qbpcwm?1444774114
2
157

"It’s not art, it’s not science – it’s the same thing" Dr. Mangione

Our most popular tweet this week comes from Forbes contributor, Robert Glatter. Robert discusses how medicine and art are a complementary skill set. EMBED TWEET: https://twitter.com/Meducation/status/394399394210263040 As universities look to improve the selection process for medical school, they are giving increased focus to natural traits that encompass the ideal candidate. In his article Robert looks at how typically “right brain” characteristics, such as artistic flair, are highly valued selection criteria and in some cases rank more favourably than “left brain” thinking. Dr. Mangione, a master of artistic expression and physical diagnosis, agrees that medical students with creative thinking as part of their skillset are likely to excel. Do you agree that this is an important factor to consider when predicting an individual's potential for success in medicine? If not, what traits do you believe are important? The full article can be seen here - it's a very thought provoking read. Nicole  
Nicole Chalmers
about 8 years ago
Foo20151013 2023 qo3u6t?1444774095
3
1014

Prostate and Bladder Cancer Staging and Grading - A review for students

Amended from Wikipedia and other sources T.I Lemon Stage means spread Grade means histology Prostate cancer staging – spread of the cancer There are two schemes commonly used to stage prostate cancer. TMN and Whitmore Jewett Stage I disease is cancer that is found incidentally in a small part of the sample when prostate tissue was removed for other reasons, such as benign prostatic hypertrophy, and the cells closely resemble normal cells and the gland feels normal to the examining finger Stage II more of the prostate is involved and a lump can be felt within the gland. Stage III, the tumour has spread through the prostatic capsule and the lump can be felt on the surface of the gland. In Stage IV disease, the tumour has invaded nearby structures, or has spread to lymph nodes or other organs. Grading - Gleason Grading System is based on cellular content and tissue architecture from biopsies, which provides an estimate of the destructive potential and ultimate prognosis of the disease. TX: cannot evaluate the primary tumor T0: no evidence of tumor T1: tumor present, but not detectable clinically or with imaging • T1a: tumor was incidentally found in less than 5% of prostate tissue resected (for other reasons) • T1b: tumor was incidentally found in greater than 5% of prostate tissue resected • T1c: tumor was found in a needle biopsy performed due to an elevated serum PSA T2: the tumor can be felt (palpated) on examination, but has not spread outside the prostate • T2a: the tumor is in half or less than half of one of the prostate gland's two lobes • T2b: the tumor is in more than half of one lobe, but not both • T2c: the tumor is in both lobes but within the prostatic capsule • T3: the tumor has spread through the prostatic capsule (if it is only part-way through, it is still T2) • T3a: the tumor has spread through the capsule on one or both sides • T3b: the tumor has invaded one or both seminal vesicles • T4: the tumor has invaded other nearby structures It should be stressed that the designation "T2c" implies a tumor which is palpable in both lobes of the prostate. Tumors which are found to be bilateral on biopsy only but which are not palpable bilaterally should not be staged as T2c. Evaluation of the regional lymph nodes ('N') NX: cannot evaluate the regional lymph nodes • N0: there has been no spread to the regional lymph nodes • N1: there has been spread to the regional lymph nodes Evaluation of distant metastasis ('M') • MX: cannot evaluate distant metastasis • M0: there is no distant metastasis • M1: there is distant metastasis • M1a: the cancer has spread to lymph nodes beyond the regional ones • M1b: the cancer has spread to bone • M1c: the cancer has spread to other sites (regardless of bone involvement) Evaluation of the histologic grade ('G') Usually, the grade of the cancer (how different the tissue is from normal tissue) is evaluated separately from the stage; however, for prostate cancer, grade information is used in conjunction with TNM status to group cases into four overall stages. • GX: cannot assess grade • G1: the tumor closely resembles normal tissue (Gleason 2–4) • G2: the tumor somewhat resembles normal tissue (Gleason 5–6) • G3–4: the tumor resembles normal tissue barely or not at all (Gleason 7–10) Of note, this system of describing tumors as "well-", "moderately-", and "poorly-" differentiated based on Gleason score of 2-4, 5-6, and 7-10, respectively, persists in SEER and other databases but is generally outdated. In recent years pathologists rarely assign a tumor a grade less than 3, particularly in biopsy tissue. A more contemporary consideration of Gleason grade is: • Gleason 3+3: tumor is low grade (favorable prognosis) • Gleason 3+4 / 3+5: tumor is mostly low grade with some high grade • Gleason 4+3 / 5+3: tumor is mostly high grade with some low grade • Gleason 4+4 / 4+5 / 5+4 / 5+5: tumor is all high grade Note that under current guidelines, if any Pattern 5 is present it is included in final score, regardless of the percentage of the tissue having this pattern, as the presence of any pattern 5 is considered to be a poor prognostic marker. Overall staging The tumor, lymph node, metastasis, and grade status can be combined into four stages of worsening severity. Stage Tumor Nodes Metastasis Grade Stage I T1a N0 M0 G1 Stage II T1a N0 M0 G2–4 T1b N0 M0 Any G T1c N0 M0 Any G T1 N0 M0 Any G T2 N0 M0 Any G Stage III T3 N0 M0 Any G Stage IV T4 N0 M0 Any G Any T N1 M0 Any G Any T Any N M1 Any G Bladder T (Primary tumour) • TX Primary tumour cannot be assessed • T0 No evidence of primary tumour • Ta Non-invasive papillary carcinoma • Tis Carcinoma in situ (‘flat tumour’) • T1 Tumour invades subepithelial connective tissue • T2a Tumour invades superficial muscle (inner half) • T2b Tumour invades deep muscle (outer half) • T3 Tumour invades perivesical tissue: • T3a Microscopically • T3b Macroscopically (extravesical mass) • T4a Tumour invades prostate, uterus or vagina • T4b Tumour invades pelvic wall or abdominal wall N (Lymph nodes) • NX Regional lymph nodes cannot be assessed • N0 No regional lymph node metastasis • N1 Metastasis in a single lymph node 2 cm or less in greatest dimension • N2 Metastasis in a single lymph node more than 2 cm but not more than 5 cm in greatest dimension,or multiple lymph nodes, none more than 5 cm in greatest dimension • N3 Metastasis in a lymph node more than 5 cm in greatest dimension M (Distant metastasis) • MX Distant metastasis cannot be assessed • M0 No distant metastasis • M1 Distant metastasis. Grade Urothelial papilloma – non cancerous (benign) tumour •Papillary urothelial neoplasm of low malignant potential (PUNLMP) – very slow growing and unlikely to spread •Low grade papillary urothelial carcinoma – slow growing and unlikely to spread •High grade papillary urothelial carcinoma – more quickly growing and more likely to spread  
Thomas Lemon
over 8 years ago
Preview
4
216

Utility of Renal function tests and value in differential diagnosis in renal, metabolic, and endocrine disorders.

RFT are commonly performed investigations to rule out underlying disorders, routinely, and have great value for diagnosis, treatment, and early detection of the disease.  
Ashok Solanki
over 8 years ago