Medicine Hack

It is a formula used to get an estimated creatinine clearance. It goes as follows: Creatinine clearance : mL/min Age : years constant : 1.23 for males, 1.04 for females normal range: men : 90 - 140 mL/min women : 80 - 125 mL/min

It is a new approach to the treatment of asthma. It  is a recombin ant humanized gamma immunoglobulin (IgG)1 monoclonal antibody  that is targeted against the portion of IgE that binds to its receptors (FC -R1 and FC -R2 receptors) on mast cells and other inflammatory cells. It inhibits the binding of IgE to mast cells but does not activate IgE already bound to these cells and thus does not provoke mast cell degranulation. It may also inhibit IgE synthesis by B lymphocytes.    In addition, omalizumab causes down-regulation of IgE receptors on mast cells and basophils. Administration of omalizumab to asthmatic individuals for 10 weeks lowers plasma IgE to undetectable levels and significantly reduces the magnitude of both the early and the late bronchospastic responses to antigen challenge.  Repeated administration lessens asthma severity and reduces the corticosteroid requirement in patients with moderate to severe disease, especially those with a clear environment

Emphysema is defined as an abnormal, permanent dilatation of the airways distal to the terminal bronchioles due to a destruction in the walls. There are 4 types of emphysema: 1) centriacinar/centrilobular - seen in cigarette smokers 2) panacinar/panlobular - seen in α 1 -antitrypsin deficiency 3) distal acinar 4) irregular. Pathogenesis: Protease- antiprotease imbalance theory as shown in the picture above. On examination: Patient will be dyspneic, hyperventilating and have a prolonged expiration. The chest will be barrel shaped.

From blood to air we have the following structures: 1) The capillary endothelium 2) A basement membrane and surrounding interstitial tissue  3) The pulmonary interstitium is most prominent in thicker portions of the alveolar septum. 4) Alveolar epithelium. The latter contains a continuous layer of two principal cell types: flattened, platelike type I pneumocytes covering 95% of the alveolar surface and rounded type II pneumocytes which produce pulmonary surfactant and are the main cell type involved in repair of alveolar epithelium in the wake of damage to type I pneumocytes.  The alveolar walls are not solid but are perforated by numerous pores of Kohn, which permit passage of bacteria and exudates between adjacent alveoli. Alveolar macrophages, mononuclear cells of phagocytic lineage, usually lie free within the alveolar space.  

Tapping the patellar tendon elicits the knee jerk (L 2,3, 4), a stretch reflex of the quadriceps femoris muscle, because the tap on the tendon stretches the muscle. A similar contraction is observed if the quadriceps is stretched manually. When a skeletal muscle with an intact nerve supply is stretched suddenly, it contracts. This response is called the stretch reflex . It is a type of monosynaptic reflex. The knee jerk reflex is an example of a deep tendon reflex (DTR) in a neurological exam and is graded on the following scale: 0 (absent), 1+ (hypoactive), 2+ (brisk, normal), 3+ (hyperactive without clonus), 4+ (hyperactive with mild clonus), and 5+ (hyperactive with sustained clonus). Absence of the knee jerk can signify an abnormality anywhere within the reflex arc, including the muscle spindle, the Ia afferent nerve fibers, or the motor neurons to the quadriceps muscle. In general the afferent loop is much more critical for reflex function than the efferent l

The Richter hernia occurs when only the antimesenteric border of the bowel herniates through the fascial defect. The Richter hernia involves only a portion of the circumference of the bowel. As such, the bowel may not be obstructed, even if the hernia is incarcerated or strangulated, and the patient may not present with vomiting. The Richter hernia can occur with any of the various abdominal hernias and is particularly dangerous, as a portion of strangulated bowel may be reduced unknowingly into the abdominal cavity, leading to perforation and peritonitis.