Preklin done and spirometry

The big preklin (pre-clinical exam) test is finally over. Two weeks of cramming my head full of stuff is over! yeay!

And here is a link on spirometry in Swedish! We had the author of the page as teacher in spirometry. Great guy!

Spirometry - in Swedish

Lipid metabolism

Interactive Concepts in Biochemistry - animations :)

preddy good!

Digestion, Diarrhea and Steatorrhea

"Explain the processing, degradation and absorption of our macronutrients in the GI-tract and how it is regulated hormonally. Also, describe how different disturbances of the processess above can lead to diarrea or steatorrea." 8 points...


Another "phew" question. Took a while to break it down. I had a lot of help from this page which I have linked before Colorado State - digestion.

Protein content in stomach stimulates G-cells to secrete Gastrin. This stimulates pepsinogen and HCL release. Pepsin starts to denature the dietary proteins. The stomach also secretes Gastric Lipase which starts the degradation of fat. The acid food enters the duodenum which stimulates Secretin release. Secretin stimulates the pancreas to release its juice.

Fat and proteins in the duodenum stimulates the release of CCK which stimulates the contraction of the gall bladder and the bile enters the duodenum through papilla vateri.

A common form of carbohydrate is starch, which is broken down by amylase to a disaccharide and later on different enzymes like maltase, sucrase and lactase degrade it further.

Peptides and amino acids are absorbed in the small intestine in a symport with sodium (Na+). Fructose has its own transporter. On the basolateral border of the enterocyte there are GLUT-2s that transport the sugars into the blood.

Fats are broken down and bile emulsifies it to for us to be able to absorb it. In the intestinal cell it is rebuilt and repackaged and distributed via the lymphatic system.

Digestion of Macronutrients

Diarrhea


There are four types of causes for diarrhea. 


1. Osmotic diarrhea. This is where you add something that you can't absorb. For istance, lactose intolerant people lack the enzyme lactase. This leaves more particles in the intestine which osmotically draws out water into the lumen. The lactose is the degraded by colonic bacteria which produces gases.


2. Secretory diarrhea. Here the intestine releases more ions than it should into the lumen and then water follows. A common cause is Cholera. This bugs toxins mess with the cell and make it hyperactive which can give a lethal diarrhea and millions have died from dehydration.


3. Inflammatory and infectious diarrhea. The intestines epithelium is basically damaged by either an inflammatory disease such as Crohn's or Ulcerous Colitis or it is invaded by salmonella or shigella. This leads to destruction of the intestines absorptive capacity. 


4. Decreased motility. Decreased transit time can be said to reduce the intestines possibility to absorb water, leading to diarrea.




Steatorrhea
Decreased absorbtion of fat leads to excessive amounts of fat in the faeces. This could be due to a biliary duct obstruction for instance. Or a defect with the excretion of pancreatic lipase.

GI-tract, what does it look like in there?

So, another question...

"Account for, in a systematic and comparative way, the tissues composition and build in the digestive systems different parts (from the stomach downward). Also describe the function of the parts of the immunsystem that are localized to the digestive system." 

Phew... I kinda choked on that question. But anyway once you break it down it is not so scary anymore. Here is a weird mind map on it.

The epithelium is simple columnar all the way from the stomach down to the anal canal.

Structure of the epithelium in the GI-tract

Upper or Lower Motor Neuron Syndrome

Here is a great page that helped me refresh whether a lesion was in an upper or lower motor neuron.

http://www.neuroexam.com/

Diabetes type II

Freely translated from Läkemedelsboken 2011-2012, published by Läkemedelsverket (the Swedish Medical Products Agency), page 584.


"In Diabetes type II there is a markedly decreased sensitivity to insulin in combination with gradually declining beta-cell function. The insulin resistance is mainly manifested by a lowered glucose uptake in muscles and increased gluconeogenesis in the liver. 


The metabolic syndrome encompasses obesity, hypertension, type-2 diabetes (lowered glucose tolerance), dyslipidemia and raised triglycerid levels and aterogenic changed LDL-particles.


Smoking contributes to a worsened peripheral insulin sensitivity.


2/3 of people with diabetes type 2 pass away in some form of cardio-vascular disease.


The metabolic disturbances tend to get worse over time. This means that patients that initially have coped with dietary restrictions, later need medication or insulin. Today over 50% of patients who suffered from type 2 diabetes for 10 years or more are treated with insulin.
"


The basis for all diabetes treatment is the diet, but here is a mind map of the medications you can take to treat diabetes type 2.

Memory

After a week of cramming stuff into my head I feel that maybe my memory is affected...wonder which part? Probably all :)

Cervical Cancer - Article from Läkartidningen

Swedish Society of Obstetrics and Gynecology publish reports on guidelines for current treatments.

Here are their guidelines for prevention of cervical cancer.

Nya riktlinjer för prevention av cervixcancer - in Swedish

Here is a translation of the summary - in English

Swedish Awesome Site

I just had to post this link at once. http://www.medinsikt.se/ - in Swedish. It only took a few seconds to realize that this was a site with a dedicated father. Lots of work put into it I think.

Muscle Physiology

Simple animations on muscles and neuro-muscular junctions. Good if you're tired of reading. It's narrated :)

http://www.physiol.med.uu.nl/interactivephysiology/ipweb/home/index2.html

Glomerular Filtration Rate

GFR is dependent on blood pressure and is regulated by constricting the afferent vessel to Bowman's capsule. The auto-regulation is set off by either a myogenic response (by stretch sensitive receptors in the juxtaglomerular apparatus), or a Tubuloglomerular feedback loop. The latter is regulated by the sodium content in the filtrate which is sensed by cells in the macula densa.

Bowman's capsule has three barriers:

1. The vascular endothelium is fenestrated allowing smaller molecules through
2. The basal membrane repels negatively charges proteins
3. The podocytes are inside the capsule and lets only small molecules past their slits.

Electrolytes, glucose and urea are among the substances that are filtrated.

Plasma proteins and blood cells are not filtrated and is stopped by the barriers above.

Diuretics are used to control body fluid volume. There are two main types. Loop and Thiazide. Loop is mainly used when there is a lowered kidney function. They work roughly the same way, by keeping the electrolytes in the tubulus they keep the osmolarity higher in the filtrate which draws out fluids.

Hemoglobin

Here is a mind map on Hemoglobin. Thanks to Zephyris for the nice 3D-image of the hb molecule and Diberri for the hb saturation curve!
http://en.wikipedia.org/wiki/File:1GZX_Haemoglobin.png
http://en.wikipedia.org/wiki/File:Hb_saturation_curve.png

Hemoglobin and RBCs

Pain in Swedish

Here is a wiki-page from the College of Dalarna I liked their short and concise articles on pain.

Pain from College of Dalarna - in Swedish

Tibetans Adapt to High Altitude

Here is an interesting article on oxygenation when at high altitudes!

Evolving altitude aptitude

Reproduction

Added a new page on reproduction. It's from a community college in Arizona and gives a nice quick overview of the reproductive system. Good for starters!

Estrella Mountain Community College

Mind Mapping

I googled medical mind mapping and ended up here http://www.medmaps.co.uk/. It looks promising! It can be really useful if enough people contribute. Lovely initiative from the creators.

Thyreotoxicosis

The questions I put up on the blog are all taken from previous pre-clinical tests (preklin) given at the Karolinska Institute in Sweden. This blog seems to have turned in to my study buddy at the moment.

Another practice exam question.


"Explain the etiology behind thyrotoxicosis. Describe the regulation of the thyroid hormones' synthesis and release. Explain why the heart speeds up in thyrotoxicosis. (6 points)"


Thyrotoxicosis can have different causes. Inflammation of the thyroid gland because of a virus or bacterial infection will give a rise in secretion of thyroid hormone, but it will not increase production. You can also get thyrotoxicosis by overdosing och thyroid medicine. Another case is auto-immune reaction as in Grave's disease. Here the body produces antibodies (TRAK i Swedish) against the Thyroid Stimulating Hormone Receptor. The antibodies will fasten on the receptor and stimulate it. That will give an increase in production and release of T3 and T4.

The release of Thyroid Stimulating Hormone (TSH) from the anterior pituitary gland is stimulated by Thyrotropin Releasing Hormone (TRH) that is secreted from the hypothalamus in response to stress, cold, excercise, adrenal activity.

The heart speeds up in response to an increased expression of beta-receptors on the heart muscle cells. T3 stimulates the recruitment of them to the cell membrane.

Thyrotoxicosis

Well Fed and Fasting State

Here are four mind maps regarding metabolism. The first one is on what happens during fasting. The three below that one are organ specific and deal with the well fed state. Falling levels of insulin is the key in the fasting mode. I have not included the brain, but during fasting it is supplied by ketone bodies that are produced in the liver.

Fasting State

Well Fed state in Adipose Tissue

Well Fed state in Muscles

Well Fed state in liver

Enzyme Regulation and Reaction Speed

Here is a small map over the regulation of reaction speed within the body. There are four main types of modifiers.

Allosteric modifiers, for instance is the hemoglobin molecule influenced by binding oxygen molecules. The more oxygen molecules that bind to it, the higher the affinity for oxygen gets.

Covalent bindings, switches many enzymes on or off. The most common molecule involved is phosphate. Glycogen Synthase is shut off by being phosphorylated.

Co-Enzymes, are needed in many reactions. NADH is needed when alcohol dehydrogenase breaks down ethanol.

Enzyme Concentration is also a major factor when it comes to speed of reaction in many cases.

Enzyme Regulation and Reaction Speed

Sex hormones and AAS

In both sexes it is the Gonadotrope Releasing Hormone GnRH that is released from hypothalamus that stimulates the anterior pituitary gland to secrete Follicle Stimulating Hormone and Lutenizing Hormone. So far males and females are identical. Here come the differences.

In men LH stimulates the Leydig Cells in the testes to produce testosterone that is needed for sperm production. FSH stimulates the Sertoli Cells and thereby increases sperm production. The testosterone inhibits GnRH and so does AAS (Anabolic-Androgen Steroids). If you add too much AAS it will inhibit the natural production of LH and FSH which leads to loss of sperm production (reversible).

In women FSH stimulates the maturation of the follicles in the ovary. The follicle then produces estradiol that inhibit FSH and stimulates LH. That will bring about a LH peak which stimulates oocyte maturation and ovulation. AAS of course interferes with the normal menstrual cycle and gives females certain male characteristics.

Kidney Pathology

Clinical aspects of conditions that can affect the kidney.

Clinical Aspects of Kidney Disease

Below you can see a chart over 8 different disease categories that can affect the kidney.

Diseases of the Kidney

Kidney Question

"How do you measure kidney function? Describe and explain the different methods and state their pros and cons"

Neuro Science for Kids!

Wonderful link with very easy and straight forward explanations. Sometimes a bit too simple for med school, but hey who doesn't like it simple. Won't further your PhD, but it will give you some points on that Neuro Science Exam.

Neuro Science for Kids from University of Washington.

Wound healing

Here is another question from the practice exam I am doing.
"Describe what can affect wound healing and what diagnostic tools you can use to verify them."

Bad peripheral circulation can worsen the wound healing. Palpation of peripheral pulses and doppler guided blood pressure taking of the ankle. It can be falsely high in diabetic patients because of media stenosis. Then you can use toe pressure.

Infection. Could be S.aureus, pseudomonas or coliform bacteria. Wound samples could be taken to see if there is an infection.

High blood glucose level (as in poorly maintained diabetes) can be measured by HbA1c.

Penetrate the smoking habits of the patient.

Heart murmurs

These are the most common heart murmurs.

Surfactant

Surfactant is produced in the developing babies lungs. In week 35 most babies have enough to have fully functional lungs. It consists of fosfolipids and proteins. The proteins have antibacterial properties. The fosfolipids reduce the surface tension in the alveoli. When we exhale, the surfactant concentrates which decreases surface tension and prevents the alveoli from collapsing. When we inhale, the surfactant dilutes which increases the surface tension. This mechanism helps even out alveoli size during breathing, which allows for maximum oxygenation.

What goes in must come out...

ADH and Aldosteron

Cartilage vs Bone

	Structure	Nutrition	Turnover
Cartilage (Hyaline)	Collagen type II. Proteo Glycans that contain GAGS. Chondrocytes that produce matrix. 60-80% water content	Alot of GAGS makes the water content high which allows for nutrient diffusion. No blood vessels!	Not able to repair when damaged. It is because the avascular structure. It calcifies instead.
Compact bone	Mineralized extra cellular matrix (ECM). Collagen type I. Osteocytes that recide in lacuna. Each lacuna is connected to the blood vessels through canaliculi.	The blood vessels supply the osteocytes.	Bone remodelling occurs when damaged. Compact bone is an important calcium deposit. There is a constant bone turnover. Osteoblasts build up Osteoclasts tear down.

A comparison between Cartilage and Compact Bone.

Simple immune respons

Here is very simple mindmap to answer the question: "Show that you know how the body recognizes virus and bacteria and how it fights them." Not sure it does answer the question... but I helps me keep track of a few things.

Mindnode

I needed some software to help me draw mindmaps and I found Mindnode (http://mindnode.com/)! Here is a map over the different phases which I adapted from Union Community College.

Digestion neural and hormonal

Antipsychotics in Swedish

Antipsychotic Drugs

This is a little mind map created with Mindnode. Three generations of antipsychotic drugs.

Endocrinology

Exam question: Describe and compare hormonal regulation of growth in a fetus, a child and during puberty. Also describe different conditions that give over or under production of different hormones that affect the developing child's height.

OMG. Need to brush up on that... It was quite hard to find info on the Normal state. Here is the best I could find so far!

http://www.endotext.org/

Anatomy

Here is a link contributed by my class mate Athena, thanks! Lovely site! Just type in your search word and you get a 3D picture of the structure you are interested in.

Anatomy Expert

Biochemistry

Our biochemistry teacher always said: 'Make sure you take a step back and get the big picutre'. It was a great thought...but the further backed I stepped the more I saw! Here I have found a metabolic map, stripped down to only the bear necessities. Very, very nice PDFs pdfs can be found here!

University of St.Benedict and St.John Biomchem Maps

Neuro Science

An awesome page from my school Karolinska Institute.

KI 3D Brain

Embryology

Just found a very promising embryology site with animations. Finally I begin to understand how the complex folding and squeeshing goes down. Thanks to this site!

Indiana University Embryology

Radiology

Two new great sites on radiology. Both MR and CT. Good for practicing anatomy and see what things actually look like in MR or CT.

The Radiology Assistant

HeadNeckBrainSpine

Biomedicine

When studying today I came across a tricky question. How does insulin affect the Sodium-Potassium ATP-ase? After alot of googling I came across this great page from Colorado State University. It explained that indeed insulin affects the Na/K-pump, by increasing the affinity to sodium and overall turnover rate. It would lead to excess potassium intracellularly, which can be fatal.

Biomedicine at Colorado State

Radiology

We have only brushed upon radiology so far. Had maybe 6 classes and some walks around the Radiology Department at Södersjukhuset. It was fun and dark! Fun in the dark :) Here is a link for studying the art of squinting yourself into thinking you know what diagnosis it is.

Learningradiology.com

Added two links in the Scientific developement section. Two must haves for those of you doing your PhD or Exam papers in medicin.


Pubmed - the go to when it comes to medical science articles

Cochrane library - reviews of articles

Physiology training software

Stanford University has really made a good site on physiology. Simple and with practice quizes. Very useful and to the point.

Virtual Labs at Stanford

Blood Cell morphology

Cell Map

This page is in swedish, but I think it might be useful for anyone . Let Google translate the parts you need!

Virus Families

A page that lists all RNA viruses made by Karolinska institutet. There is a link at the bottom of that page to DNA Viruses as well! Simple and efficient.

RNA Virus

Hematology

A nice powerpoint presentation on hematology!

Powerpoint Hematology

Embryology

Here are two links on embryology. They was recommended to us from the department of Cell Biology at the Karolinska institute

McGill's University Embryology

A couple of Swiss Universities embryology pages

Khan academy

When we had Cell Biology during my first semester in med school. I found the videos on DNA-transkription and the like by Khan-academy on youtube invaluable! Check them out! Here is a sample.

Very promising mind map on the relation between neural and hormonal signaling in digestion. A bit messy though! It seems to be made with a specific screen resolution in mind... and it's not the resolution I have. But there is a lot of nice info on the site.

Neural and hormonal regulation of digestion from Union Community College

Added a new histology link!

Added new link on anatomy. Videos of real dissections. Very educational for future surgeons.
Dissection videos from University of Wisconsin

Here is a link on respiration. It sums it up neatly!

Respiration

Added a nice page about metabolism from Elmhurst, which is a well known university with a good reputation. The page is quite good. Very ugly and un-modern. It's filed under Biochemistry!

Metabolism from Elmhurst

I am a 2nd year medical student from Sweden and I have realized that we don't need books. Everything you need to know is already out there. For free. On this blog I collect the best medical training links and hopefully they will help you as they have helped me.

I will keep the links up to date, but please leave a comment if a link is broken.

Study hard, travel light, no books!