#rthemedstudent

Cardiomyopathy means “diseases of the heart muscle”

Hypertrophic Cardiomyopathy: the walls of the ventricles become thickened and cannot fully relax, the thickened myocardium makes it hard for the heart to pump the blood, thereby resulting in less blood flow

Restrictive Cardiomyopathy: the walls of the ventricles become stiff. The restriction prevents the heart from filling completely, leading to incomplete ventricular filling.

Dilated Cardiomyopathy: commonly affects the left ventricle. As the heart chambers dilate, the heart muscle doesn't contract normally and cannot pump blood very well.

1) First day is awkward for everyone. Actually, the first few weeks are awkward for everyone.

2) Everyone will look like they have their shit together. 

3) After orientation you will suddenly find yourself behind in biochem, physiology, etc. When did we even start the official lecturing? huh?

4) You will discover that people actually don’t have their shit together, including you. (don’t freak out because eventually you’ll get the hang of it)

5) Its alright to skip a class once every while. Seriously, who wants to attend a biochemistry class at whatever ungodly hour they schedule it

6) If you decide to delve into the world of textbooks, it might take you a while to find that one holy textbook that explains things better than any professor. 

7) Don’t be surprised when you come back home and realise you’ve had nothing to eat all day

8) Always carry a granola bar or a light snack and water. Always. ALWAYS.

9) Coffee machines are your best friend. Especially when you don’t have time to take a trip to get decent coffee.

10) If seniors tell you that this class/professor/whatever is hard/mean/whatever, don’t listen to them. Nothing is hard if you work hard enough.

11) Its absolutely okay if you don’t make a hundred friends. 

12) There are people I’ve gone to class with for a year now, yet never spoke to. Thats ok too!!!!!! 

13) It might take a while for you to get comfortable around people because you might be scared, guess what? others are scared too.

14) Try to keep up with lectures everyday because theres no way you’re gonna be able to cram in everything one day before the exam. (this is my #1 advice)

15) You know that one person who sits in the front row and writes down everything the professor says and they don’t share notes and they’re generally assholes? you might know him/her as the gunner. yeah, stay away from them because you will feel like throwing Robbins’ pathology textbook at them and knocking them out. 

16) Someone along the way will piss you off and how you deal with that says a lot about you.

17) Take part in events like awareness days, conferences, etc because you need something to balance out the intensity of studying all day and night.

18) If you do research first year, good for you because you’re getting a head start.

19) There will always be that one professor who will always talk nonsense. Like I said, find that holy textbook.

20) Make time for things you enjoy doing. (exercise, playing an instrument, whatever it is, MAKE TIME FOR IT.)

21) You will meet some genuine people and some not-so genuine people. Stick with the genuine ones.

22) YOU DONT SHOCK PEOPLE WHEN THEIR HEARTS STOP BEATING!!

23) Um, that gigantic pharmacology textbook will give you the creeps.

24) People will first think of themselves before anyone else, and honestly, so will you at some point.

Quick points:

- Intracellular Fluid: 2/3rds of total body fluid

- Major ion of ICF is K+

- Extracellular Fluid: 1/3rd of total body fluid. 3/4th of the ECF is  interstitial fluid and 1/4th is plasma. 

- Major ion of ECF is Na+

Osmolarity: the concentration of a solution

Usually (under normal circumstances), the osmolarity of both the ICF and ECF are equal (about 300 mOsm/L). This equilibrium may get disturbed & the administration of fluid causes a shift in volume from ICF to ECF, or vice versa with the aim of equilibrating osmolarity. 

1) Loss of isotonic fluid (diarrhoea)

Mainly there’s a loss of volume, and no change in osmolarity. Because ECF volume decreases, hematocrit and plasma proteins increase. ICF volume remain unchanged. Because ECF volume decreases, arterial blood pressure decreases.

2) Infusion of isotonic fluid 

ECF volume increases, and theres no change in the osmolarity. Because ECF volume increases,  plasma protein concentration and hematocrit decrease (the addition of fluid to the ECF dilutes the protein and red blood cells) Arterial blood pressure increases because ECF volume increases.

3) Hyperosmotic volume contraction (sweating, diabetes insipidus)

When you sweat, more water than salt is lost. So, the osmolarity of the ECF increases and ECF volume decreases. How does the body create equilibrium again? Water shifts from the ICF to the ECF, thereby increasing ICF osmolarity and decreasing ICF volume. Plasma protein concentration increases because of the decrease in ECF volume. However,  the hematocrit which you might expect  to increase,  actually remains unchanged because water shifts out of the RBCs, decreasing their volume and offsetting the concentrating effect of the decreased ECF volume.

4) Hyperosmotic volume expansion (excessive intake of NaCl)

ECF osmolarity increases because of the intake of NaCl - this results in water shifting from the ICF to the ECF in an effort to increase ICF osmolarity. End result is an overall increase in osmolarity, a decrease in ICF volume and and increase in ECF volume. Because of the increase in ECF volume, plasma proteins and hematocrit decrease .

5) Hyposmotic volume contraction. (loss of NaCl - adrenocortical insufficiency)

The adrenocortical insufficiency results in less aldosterone production and that leads to a decrease in NaCl absorption. So, the kidney excretes more NaCl than water. ECF osmolarity is decreased. Then, water shifts from ECF to the ICF in an effort to decrease the ICF osmolarity. Overall, theres an increase in ICF volume, a decrease in ECF volume, and an overall decrease in both the ICF and ECF osmolarity. Plasma protein concentration and hematocrit increase because of the decrease in ECF volume.

6) Hyposmotic volume expansion (Syndrome of inappropriate antidiuretic hormone(SIADH)—gain of water)

ECF volume increases, which leads to a decrease in the ECF osmolarity. Water then shifts into the cell, decreasing ICF osmolarity and increasing ICF volume.  Plasma protein decreases because of the increase in ECF volume. Also here, the hematocrit remains unchanged because water shifts into the RBCs, increasing their volume and offsetting the diluting effect of the gain of ECF volume.

Chondromas are benign cartilaginous tumours most commonly involving the small bones of the hands and feet. If they are present in the medullar cavity they are termed as “Enchondromas”, and if they arise from the surface of the bone, they're known as perosteal chondromas.  As you all know, cartilage is a form of connective tissue made up of mainly chondrocytes. It is found between vertebrae and also in the nose and ears. Its main function is to support body regions. Cartilage is also avascular and aneural!

Reminder: There are 3 types of Cartilage!

More on Enchondromas:

- As I've mentioned before, Chondromas are of cartilaginous origin, specifically hyaline cartilge.

- Commonly affect the small bones of the hands and feet, but may also affect the femur, humerus, or tibia.

- Flat bones are less commonly affected.

- Usually asymptomatic ( the reason they're discovered incidentally ) - however if the tumor compresses the adjacent structures - symptoms begin to appear (pain)

- Multiple enchondromas may occur in the setting of Ollier disease or Maffuci syndrome.

Radiology:

- Centrally placed mass with focal ring calcifications.

- X-Ray shows typical O-ring.

- Diaphyseal or metaphyseal in long bones.

Macroscopic:

- Bone is covered by a cartilaginous cap.

- Well circumscribed mass, usually a 3-5 cm cartilaginous lesion