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alfalfaaarya · 5 days

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19 , 20 , 21 , 22 April 2024

Day 3, 4, 5 and 6 of Productivity Streak

I got a couple of things done in these 4 days

Pharmac -

Completed Adrenergic drugs and solved past year questions

Read alpha blockers although I need better revision

Pharmac is a long was to go cause there's soo much to study and sooo little time

Microbiology

I completed General virology

Revised viral replication again.

Patho

Studied Amyloidosis !

Wait , now that I see this isn't much I really need to work more hard :')

Adios

🙏

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alfalfaaarya · 10 days

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18 April 2024 // Thursday

Day 2 of Productivity streak

Got done 4/4 things on my to study list.

I say study list and not to do list because my to do list still has some things which aren't done like cleaning my study space , exercising :')

Anways , I am glad that I got everything on my study list done !!

I'm done with

Revision of part of Sympathomimetics (studied previously)

Finished Studying Sympathomimetics

Studied sympatholytics

Revised Acute Inflammation

I still need to learn these pharmac topics properly but I'm glad I went through them today !

Adios

🙏

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alfalfaaarya · 11 days

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17 April 2024//Wednesday

Day 1 of Productivity streak

Got done with 5/6 things on my to study list .

Completed

Micro : Bacteria anatomy and Physiology

Pathology: Acute Inflammation

RBC , Reticulocyte, Indices and

Hyperproliferative anemias

Also completed patho clinical journal write up and a bit of general patho journal write up .

Felt good to be productive after a long time !

Adios

🙏

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alfalfaaarya · 15 days

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How do you make journals of academic subjects what do you do in it?

Journals of academic subjects have all the practical part of that subject .

For eg, microbiology . In practicals we learn about lab test etc so we write about that in them.

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alfalfaaarya · 15 days

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Hello! I'm fellow second year student. I just came across a post of your which had a picture pathology text book. Can you please tell me which one it is? I'm struggling to find one that I like studying from! I've tried harsh mohan but this far it hasn't hit me in the right way. Also which books do you refer to for other subjects? I'd love to know!

I personally found Sharma and sharma really good for pharmacology (i tried kdt but again didn't like it much) and refer to apurba shastry for microbiology (which is like uncontested choice in the subject, neither of seniors had referred to any other book, i find it okay and because I'm ultimately going to make notes in the subject it really doesn't matter in big run)

Thank you! And sorry for distributing. All the best for your internals! <3

Hello!

I hope you are doing well :)

I'm referring to Robin's for pathology, the southeast asian edition and I also go through Ramdas Nayak which is more exam oriented.

For pharmac I'm mainly reading PV Rataboli sirs clinical pharmacology book, it is like kdt but better oriented and I'm going through kdt as well. Most of my batch mates read shanbag , I've read it , it's good you could give it a try.

For micro, Sastry is the ultimate book .

I hope this helps!

All the best!

#studyblr #productivity #study motivation #study blog #study hard #med school #stdyblr

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alfalfaaarya · 16 days

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Exams in a month .

Time for....

PRODUCTIVITY STREAK !

#studyblr #productivity #study motivation #study blog #study hard #med school #stdyblr #aesthetic #studtblr #study inspiration

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alfalfaaarya · 1 month

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Q Fever

Aka, Query fever. What a weird name for a disease. Imagine telling people that's what you got.

in the 30s-40s, an Australian pathologist in QLD/Brisbane, came across an outbreak of the same or similar illness among abbatoir or slaughterhouse workers.

At the time, he called the disease "Q" fever or query as a temporary name until the pathogen could be identified. Unfortunately it stuck.

decades later, now nobel prize winner and virologist, MacFarlane Burnett isolated and identified the microbe responsible. I think this discovery contributed to his prize. i forget already.

Microbe responsible: Coxiella burnetti. Named for Burnett and HR Cox, the American bacteriologist who found the genus Coxiella where C burnetti falls under.

Initially they felt it was related to Rickettsia, responsible for Rocky Mountain Spotted Fever, but as science progressed, this was disproven.

Now for a Case Report

A 55 yo Italian man with a history of aortic valve replacement was diagnosed with pyrexia of unknown origin twice. Further signs included myalgias/splenomegaly/night sweats. The 2nd time he was admitted for PUO he deteriorated rather dramatically and was put on meropenem and teicoplanin.

A host of organisms was tested for on serological testing based on the man's travel and epidemiological history, all negative. Even a rheumatological panel was done, also less revealing. He also had a history of MGUS (a haem disoder), which is kind of a red herring here.

Cultures were negative, no vegetations were seen on a TTE - so they did consider IE. Which is an important differential for PUO.

Eventually a PET-CT was done (often favoured when investigations do not yield much for a sick patient with fevers), finally revealing a focus of infectious on his ascending aorta, where he'd also had previous surgery done. And in a round about way, they also further identified Coxiella Burnetti. He was treated doxycycline and hydroxychloroquine. As it's so rare in Italy, it wasn't really considered even though he mentioned rural travel.

Bottomline: Q Fever is an important consideration in the work up for culture negative IE. Further to this, always consider IE in the differentials for PUO particularly if they're at increased risk for IE (prosthetic valves, damaged valves, select congenital heart issues, previous IE). IE can present with night sweats, fevers, weight loss and splenomegaly. It can be insidious and chronic in nature. other risk factors can be more suggestive as we'll get into below.

Causative organism

Coxiella burnetti, it's a zoonoses - i.e. transmissible from animals. Special powers: very tough/hardy, can survive extreme environments (high temps and UV light etc.) over prolonged periods and is resistant to many common disinfectants/surface cleaners.

It's an intracellular pathogen and gram negative coccobacilli (PINK!)

name coccobaccili reminds me of cocopuffs.

it's mainly associated with farm animals, which the CDC so wholesomely displays on its website on Q fever (wtf).

goats, sheep, cattle typically (but many other animals, even birds, dogs and horses can be reservoirs)

in particular bodily fluids - amniotic fluid, placenta, faeces/urine, milk etc.

you can get it through unpasteurized milk and through inhaling it if it lands on dust in the area

ever visit a farm or petting zoo lately? OMG WASH YOU HANDS.

That said, it's typically inhaled in inorganic dust. You inhale it, it goes to the lungs, and then the bloodstream.

Increased risk for Coxiella burnetti (What to take on history of exposures and when to strongly consider it)

live on a farm or near one

exposure to a farm

work as a vet on a farm

farm worker, dairy workers, researchers on these animals/facilities

slaughterhouse/abbatoir

Also from CDC:

Clinical presentation

Most won't get sick after exposure and remain asymptomatic, a very small minority does. even though it is highly infectious.

incubation time is 2-3 weeks (consider this time in your history of exposure, did they work on the farm 2-3 weeks ago as opposed to yesterday).

Nonspecific acute infectious symptoms:

nonspecific systemic fevers/malaise/arthralgias/myalgias--> key is high fevers though and can be associated with headache and photophobia.

non specific GI - N/V/diarrhoea

respiratory ones - SOB or cough, consider it as atypical cause of community acquired pneumonia.

rare: hepatitis and jaundice (granulomatous) or encephalitis with neurological complications such as demyelinating disease or CN palsies, also haemolytic anaemia and HLH (yikes)

really it's the history of exposure that will lead you down the garden path to Q fever.

Chronic Q fever is perhaps worse, and can present as culture negative IE/PUO. Months/years later, as B symptoms as above above + LOW/LOA, night sweats. More likely to occur if you are predisposed for IE as above, have a weakened immune system for any reason, including pregnancy.

Chronic Q fever has a mortality of 10% if left untreated. About <5% of those with acute Q fever develop this if left untreated. Speculation is that it's more of an autoimmune process or abnormal immunological response to the bacteria.

To be honest, most who walk in the door with community acquired pneumonia get treated empirically for atypicals anyway, (standard course of doxycycline), so we hardly really ponder the question of Q fever in every patient. But if they present chronically and did not have atypical cover at the onset of acute symptoms, then it's something important to consider.

Other important conditions - can cause complications in pregnant women and 20% will get post Q fever syndrome. like chronic fatigue.

investigations

Serology! nice and easy. Look for IgG antibodies in the chronic presentation. Or PCR. Down side to serology - can take 2-3 days for the body to make said antibodies to the bacteria for detection. PCR can be done on any fluids/tissue sent.

Cultures useless, hence it fall under the umbrella of culture negative (hard to grow outside a host cell, it is an obligate intracellular pathogen).

Other hints on bloods (as serology/PCR takes time to return) - elevated or low platelet's, transaminitis with normal bili, opacities in CXR with hilar lymphadenopathy, CSF will show raised protein levels if done when encephalitis is suspected.

imaging can also support the diagnosis.. as illustrated by the case report.

Treatment

Acute disease - as standard for atypical bugs, doxycycline 100 mg BD for 14 days. Alternatives - TMP SMX or Clarithromycin.

Chronic Q fever or IE:

native valves: doxycycline and hydroxychloroquine (200 TDS) for 18 months

prosthetic: same but 24 months

why hydroxy: enhances the action of doxycycline (increases the pH of the phagolysosome)

Follow-up: look for 4 fold decrease in IGG

Sources:

CDC

Stat Pearls

Wiki as linked above

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alfalfaaarya · 2 months

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To being disciplined and enjoying life ✨️

so I got into grad school today with my shitty 2.8 gpa and the moral of the story is reblog those good luck posts for the love of god

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alfalfaaarya · 2 months

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25 Feb 2024 // Sunday

It was a productive day !

Studied like this after a long time ⌛️

Studied cell injury

>reversible cell injury

>irreversible cell injury

>mitochondrial damage

>membrane damage

> ER stress

> Free radical damage

Read about Examination Of Ulcers .

Completed 2 patho diagrams that were left, journal is ready for submission tomorrow

Adios

🙏

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alfalfaaarya · 2 months

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19.02.2024// Monday

Today was good.

microbiology lecture was interesting, we learnt about Complement ( antigen antibody complement)

Surgery clinics have started and we are just having lectures this week on history taking and special symptoms so it's chill , the teachers are nice.

Patho lecture was boring af.

Patho practicals were okay

I came home and had snacks and started studying

Studied Patho: Cell adaptations -

Hyperteophy

Hylerplasia

Atrophy

Metaplasia

their def, moa, and eg

Went for a run , honestly it feels amazing. From not being able to run for even 40 sec straight to running for 5 mins without stopping, it def sounds less, but for me it's a really big thing cause I'm finally making actual effort to do some physical activity with the little time I get .

Now I'll probably do some micro reading of what was taught today .

Tata

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alfalfaaarya · 3 months

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Felt good after crying though.

#studyblr #productivity #study motivation #study blog #study hard #med school #stdyblr #aesthetic #studtblr #study inspiration #medical student #medical school #med student #med studyblr

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alfalfaaarya · 3 months

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1st Feb 2024

Med school is hard.

Today It got to me. I cried after coming home.

First year was hard but I had never cried.

I guess today everything just got to me.

I had a habit of just brushing the bad things off and focusing on the good part and being optimistic all the time , the bottling up, the stress of catching up with pharmac, micro and patho and studying medicine for the clinical postings and ward leaving has got me.

Every since college started I have been tired , there has been no day I've stayed up past 12 am. I couldn't study properly, but I'm trying . I fall asleep while reading Hutchinson at night, then during clinics I feel very guilty and bad cause I am not well prepared .

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alfalfaaarya · 3 months

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Reading this made me feel less anxious 🤍

move at a gentle pace, let go of your need to hurry 💛

#studyblr #study blog #studyinspo #med studyblr #medical studyblr

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alfalfaaarya · 3 months

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Took me until about halfway through college before I realized “study” means “play with the material in a variety of ways until you understand it” and not just “read the assigned chapters and do the homework” and I think that probably should have been discussed at some point prior to that.

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alfalfaaarya · 3 months

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You'll never be always motivated, so you must learn to be disciplined.

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alfalfaaarya · 3 months

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Studying at a cafe today!

Growing up has made me realise a few things:

Body hair isn’t that big of a deal

Loud music is not exactly great

Alcohol is not needed really to have a great time

Quality sleep>>>>>>

Being available for friends and ignoring your own pending work is going to lead you to failure.

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alfalfaaarya · 3 months

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🎶✨️when you get this, put 5 songs you actually listen to, then publish. Send this ask to 10 of your favorite followers (positivity is cool)🎶✨️

Top 5 songs

Husn by Anuj Jain , I'm obsessed with it

Hymn for the Weekend , Coldplay

Daylight , David Kushner

Tere Naina from My Name Is Khan

Sajiri Gojiri by Sahil Kulkarni , it's a marathi song

#thanks for the ask #desi studyblr

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