I finished my ordeal with surgery and have a couple more exams to go, in which I have to confirm the dates of both.
I start with UW for USMLE studies of the day:
- Actin filaments are anchored at the Z-lines of sarcomere. Z-line is at the center of I-band.
- In sickle cell disease, HbS in hemoglobin electrophoresis can be distinguished because it moves slower than normal hemoglobin, due to loss of negatively charged amino acid, glutamate.
- Ascending loop of Henle is impermeable to water. Reabsorption of water in collecting tubule is regulated by vasopressin (ADH). Osmolarity can reach 1200 mOsm/L.
- Congenital hypothyroidism causes reduced T4 and T4 is very essential for brain development in early life of an infant thus mental retardation.
- Bilateral agenesis in potter syndrome causing oligohydramnios.
- Ataxia-telangiectasia is an autosomal recessive disorder due to defect of DNA repair (can cause cancer). The immune system is compromised and patient may suffer repeated sinopulmonary infection. Ataxia is caused by cerebellar atrophy while oculocutaneus telangiectasia is due to dilated the capillary vessels. Among other DNA repair disorders:
- Xeroderma Pigmentosum = DNA sensitive to UV causing premature skin aging and malignancy (melanoma and squamous cell cancer).
- Fanconi’s anemia = hypersensitivity of DNA to cross-linking agents.
- Bloom syndrome = chromosomal instability, susceptible to neoplasm.
- HNPCC = defect in DNA mismatch repair.
- Pulmonary Hypertension pathogenesis:
ETIOLOGY PATHOGENESIS Left-sided heart failure
reactive pulmonary vasoconstriction due to dysregulation of pulmonary vascular smooth muscle tone and structural remodelling of pulmonary vasculature.
Massive pulmonary embolism
mechanical obstruction of pulmonary tree.
COPD
hypoxia-induced vasoconstriction
Polycythemia
obliteration of vascular flow
Pulmonary vasculitis (Wegener’s, Churg-Strauss)
inflammatory pulmonary vascular reaction
Congenital heart diseases (ASD, VSD)
Flow volume and pressure
Listened to Goljan’s lecture on Liver diseases. Awesome reviews on viral hepatitis, parasitic infections, alcoholic hepatitis, drugs affecting the liver, metabolic liver diseases etc!
I did UW again, and I see little improvement. I am a bit happy but can’t be complacent since 40% of the wrong ones are because of my wrong intuition and carelessness! If I eliminate the 40% by getting most of the facts and ideas organized, I’m sure I will be fine! For the time being, I am targeting that if 60% of UW users answered the question right, I have to get it right too! No excuses!
