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Saturday, July 14, 2012

Biochem practical

The prospect of finishing first year was over compensating for the lack of breakfast today.
The awesome mnemonic I made for protein tests* had no use as I got my permanent question since second internal: pathological constituent of urine.
There was blood, bile salts in it.
The questions were as expected: which are the tests you do? what is the clinical condition in which bile salts appear in urine? Is it necessary that bile pigments are also present? Which are the bile salts? Pigments?
Quantitative, creatinine. The procedure had been submitted in 5 minutes following beginning.
Viva questions included creatinine clearance, normal values, condition in which it gets high, creatinine is synthesized from which amino acids?
The case history was given while we were doing the experiment, mine was about genetic disorders.
The spotters soon followed.
- urinometer, use
- benzidine, use
- Benedict's, constituents
- hay's test identification
- broom stick shaped crystals
The viva began at 2. Took longer than physio and anatomy per person per examiner. At least 5 minutes. All imaginable standard questions were asked.
Pantothenic acid deficiency, scurvy, xerophthalmia, niacin deficiency
Liver functions; test for synthetic function
van Gorke's disease. Why does it affect urea metabolism.

There were a lot more questions asked. (I heard someone being asked of RAS, cancer markers, Criggler Najjar, etc.) I answered HoD the question she had asked me in the morning, and out I came as a free man, like Andy in Shawshank Redemption, the awesome movie I saw right after reaching home the next morning.

 *The mnemonic was:
First you do heat coagulation and if it is albumin, then:
Xanthoproteic test makes people go round (for aromatic amino acids)
yet millions (Millon's) of people try a hand (tyrosine)
hoping for (Hopkins Cole) to be a krypton fan (tryptophan)
Yet, true success (sakaguchi) arguably (arginine)
comes (cystein&cystine) only to certain people
who are posch (Molisch)

If it was casein (protein in milk), first you'll have to do isoelectric pH test, because babies need the exact pH. And then the new man (Neumann) is killed with concentrate nitric acid and sulphuric acid.

Wednesday, July 11, 2012

Physiology practical

So, we go to the lab in the morning at 8.30 without breakfast. And wait there till about 9. I went without a watch and there was no clock like in anatomy hall, so don't know the exact timings.
The group is divided into 3. One group starts with hematology, one goes down for human experiments, while my group starts with clinical physiology.

I get the questions
"Palpate and auscultate axillary and posterior lung fields"
"Examine the sensory system of the subject"
The examiner conveniently lets me skip demonstrating 90% of tests.

Then, I go down to do the perimeter experiment. Easy viva: parts of the instrument, what is blindspot.

Running back to the hematology lab I have the most important segment of the  day in practical side.
Major experiment: Absolute eosinophil count
Minor experiment: Bleeding time, clotting time
Chart: Jugular venous pressure
Problem/case: Hemiplegia

Confronted with all of them simultaneously, I did a small dance :D

Finished off the minor experiment while trying to focus the old worn out Neubar's chamber. And that let me take the viva for that experiment (which included the charts and problems) along with the first set of people who'd been doing hematology from beginning.
Bleeding time method: I answered Duke's method. (What I did was, putting 6 points of decreasing size :D)
Clotting time method: Ans: Slide and nail method :P
What is that thread you're pulling out? Fibrin!
Ok, what stabilizes fibrin? Clotting factors.
Which one? Von Willebrend.
No? No idea.
Factor 13? Stuart Power. ?
No? IDK.

So, jugular venous pressure.
What is the normal right atrial pressure? (I said 14 mmHg, must be even lower)
When is it higher than that? (I said right ventricular hypertrophy and tricuspid valve stenosis)

And this case history, what does it suggest? lesion in the lower part of internal capsule (after crossing has occurred) [copied directly from memory :P]
{I've a vague idea that the facial nerve is also injured, and that the symptoms are that of Bell's palsy}
So when she asks what if the lesion had occurred before crossing, I say partial closing and drooping of eyelids. She asks what happens to eyes, I say IDK :D

Then, I'm left with just the eosinophil count. And I'm still unable to see any lines on the chamber. I wait for people of first set to leave and snatch a newer Neubar's chamber. Should say this one was perfect! All the lines right on my face. Thus I begin the battle. Drains blood, loads the chamber, focuses. Nothing on the slide. New blood, again loading, same result. Finally I think of the number of eosinophil cells, and understand that it would be too diluted. And trade secret idea, I take more of blood, and less of dilution factor. Only to end up with 550 cells/cu mm which's slightly high. But that's not because there were so many cells, it was because I counted every black spot as a cell. Before submission I strike down the numbers to make it 275 cells. Still the examiner couldn't find out any :P
Anyhow, when is eosinophil more in number? eosinophilia: allergy, parasitic infection.
When is eosinopenia? depression of bone marrow
what stain does it take up? eosin.
color? pink. no ma'am blue. I mean pink. Basophils take up blue.
What are the granules? Histamine, serotonin. NO, they're basophilic granules. Don't know.
Fine or coarse granules? Gothilla.
Ok, fine.

Then! viva. after lunch break (but no lunch taken)
First examiner. CNS
Descending tracts? Cortico spinal...
Origin of it? Somatosensory cortex.
Where is it? Precentral gyrus.
Where is that? anterior to central gyrus. Brodmann's area 4.
Ok, what is postcentral's number? 3,1,2
8 is? conjugate movements of eye in frontal lobe
[some other number]? I don't know.
Wernicke's area importance? Ma'am, seat of intelligence, all language comprehension everything.
Aphasia? 3 types - wernicke's, broca's, global.

Second examiner: endocrine.
Anterior pituitary hormones? FSH, LH, ACTH, TSH, Growth Hormone..
Ha! GH. Functions? Promotes growth.
Through? IGF.
Expansion? Insulin like growth factor
also called? somatomedin c
ok, why are african pigmies short? because of deficiency of somatomedins :P
tell me cause of dwarfism. GH axis deficiency, Thyroid axis deficiency.
Then? [thinking...]
Insulin, right? Yeah ma'am.
Ok, is insulin anabolic or catabolic. catabolic. No, anabolic. protein sparing.
Fine, male sex hormones? testosterone....
Klinefelter's, Turner's? I answer.

Examiner 3.
This viva was over in 30 seconds, and I remember answering the respiratory centres, and what deglutition is. That's all :P Ha, she asked nephron also

Examiner 4: CVS.
Normal pulse rate: 72/min
What maintains that? sympathetic, parasympathetic
autonomic. Then? Then what sir?...[thinking]...
Don't know BP? Pressure exerted by flowing blood on the artery walls.
Maintenance?? short term, intermediate term, long term
long term? renal
renal what? renin angiotensin.
ha. what is sarcomere? Functional unit of muscle fibre.
Define it! the smallest unit, consisting of actin band, myosin
just define sarcomere. functional unit of muscle.
heard of z lines? ha sir, between 2 z-lines.
hmm. what is the difference between sarcomere in cardiac muscle and skeletal muscle?
Or tell me, anatomy of cardiac muscle. branching, anastomizing, central nucleus. intercalated discs.
what is syncitium? cells acting together.
hmm. fine.

And I leave to have food.

Monday, July 9, 2012

Anatomy practical

8.15 reporting time
8.20 sticking register number on the name plate, records; sharpening pencils
8.30 time to start, but since first day, it went on to 9.30
9.35 submitting gross record, taking lots, getting assigned the table
9.45 Spotters - hopefully the following
cauda equina, foramen ovale, oblique facial cleft, facial artery, fascia lata
9.55 surface anatomy
I get external carotid and appendix
10 the discussion
front of thigh
I get asked the nerve of the compartment, the quadriceps muscle, their function, femoral sheath contents, sartorius importance, rectus femoris origin.
right lung
borders, surfaces, bronchopulmonary segments of the upper lobe, and yeah the lobes the fissures, [extra question: can bronchopulmonary segment be called bronchovascular segment? The answer, as I found out later is that it can't be because the pulmonary vein is shared by adjacent bronchopulmonary segments (I had it in mind, but as it goes, it never matters if you don't say it)]
+the examiner asks me which book I read and when I say Gray's in my computer she asks me to refer that for the answer and also whether I like anatomy to which I replied "Not more than physiology"
Then blood supply, number of bronchial arteries on right lung, contents of hilum from superior to inferior, importance of pulmonary ligament, identifying impressions on mediastinal surface - venacavas, oesophagus (answered with a clue)
And the lymphatic drainage, its importance (turns out bronchial carcinoma spreads through lymphatics) and when I said yeah it must, because cancer is common because of smoking, she asks me whether I smoke. I don't.
Couple of signs, and we're off to histology lab - no breaks.
11.30 Inside histology lab picking a general slide and a systemic slide, after submitting record
11.35-55 Drawing the diagrams of
White Fibrous Cartilage
Where are they found? How do you differentiate from other cartilages?
What is the shape of Purkinje cells, what is Rosette formation? Which cells take part in its formation? What are the input fibres? Climbing fibres is from?
And then gets called for spotters
10 of them with one chart of Patau's
And I remember seeing Gall bladder (interestingly placed vertical), trachea, tongue, optic nerve, Bone TS, cardiac muscle, Thymus, Thyroid, Kidney

At 12.30 we left the hall returning slides and taking back records for meeting at 1.45 for viva

1.45 everyone assembles in the demonstration room waiting.
4 tables, 4 examiners : above diaphragm soft tissues + osteology, below diaphragm soft tissues + osteology, radiography, embryology.
Radiography: contrast x-ray of oesophagus, lateral view. The implications, the clinical conditions.
Lower than diaphragm: Small intestine : Parts, gross differences between duodenum and ileum
Tibia, side, attachments to upper end
Above diaphragm:
Heart, the branches of aorta, right & left coronary artery, branches of right.
Fetal skull, which are the fontanelles
Thyroid, corresponding tracheal ring, blood supply
Embryology: Arterial arch, derivatives. Ectodermal clefts - derivatives. How is the external ear formed? Mr Spook? Star Trek? Yet to see in vacation. Ok, forget about it. Atrial septum formation.

Bye bye to dissection hall. And while taking back the gross record the attender was asking everyone for Rs 20/- ! Corruption!