Apoyemos a Sisi y Tzuhsi

GANADORAS DEL CONCURSO "HOLIDAY TREAT CONTESTANTS: THE CUTEST PET" CON UN 76.97% DE LOS VOTOS!!!

 Gracias por votar por Sisi y Tzuhsi en el concurso the cutest pet 2011

Gram + Algorithm

Source FA (adapted)

No me doy por vencido en la voz de su autora CLAUDIA BRANT

Cyanide Poisoning

Clinical and laboratory Findings in Vitamin B12 and Folate deficiencies

Clinical and laboratory Findings in Vitamin B12 and Folate deficiencies

LABORATORY / CLINICAL FINDING	PERNICIOUS ANEMIA	OTHER Vit B12 DEFICIENCIES	FOLATE DEFICIENCY
Achlorhydria	Present	Absent	Absent
Autoantibodies	Present	Absent	Absent
Chronic athrophic gastritis	Present	Absent	Absent
Gastric carcinoma risk	↑	None	None
Hypersegmented neutrophils	Present	Present	Present
Mean corpuscular volume	↑	↑	↑
Neurologic disease	Present	Present	None
Pancytopenia	Present	Present	Present
Plasma homocysteine	↑	↑	↑
Serum gastrin level	↑	Normal	Normal
Urine methylmalonic acid	↑	↑	Normal

Viruses

Lysosomal storage diseases

Cytocrome P450

	INDUCERS	INHIBITORS
Effect on drugs	Decreased (fail to respond)	Increased (risk of toxicity)
Anticonvulsivants	Barbiturates (Phenobarbital) Phenytoin Carbamazepine Ethosuximide	Valproic Acid
Antibiotics	Rifampin	Chloramphenicol Quinolones (Ciprofloxacin) Macrolides (Erythromycin) Sulfonamides (TMT SMX) Isoniazid (INH)
Antifungals	Griseofulvin	Ketoconazole Fluconazole
Alcohol	Chronic alcoholism	Acute alcoholism
Fruits/ Plants	St. John's Wort	Grapefruit
Antiarrythmics	Quinidine
Sterols	Glucocorticois
Antiulcerous		Cimetidine Omeprazole
Antivirals		Ritonavir (HIV protease inhs)
Antitumoral		Cyclosporin

• Patient presents with ↓ pain and temperature sensation over the lateral aspects of both arms.	What is the lesion?	Syringomyelia.
• Penlight in patient’s right eye produces bilateral pupillary constriction. When moved to	What is the defect?	Atrophy of the left optic nerve.
the left eye, there is paradoxical dilatation.
• Woman involved in a motor vehicle accident cannot turn her head to the left and has right shoulder droop.	What structure is damaged?	Right CN XI (runs through the jugular foramen with CN IX and X), innervating the sternocleidomastoid and trapezius muscles.
• Man presents with 1 wild, flailing arm.	Where is the lesion?	Contralateral subthalamic nucleus (hemiballismus).
• Patient with cortical lesion does not know that he has a disease.	Where is the lesion?	Right parietal lobe.
• Patient’s tongue protrudes toward the left side, and	Where is the lesion?	Left medulla, CN XII.
patient exhibits a right-sided spastic paralysis.			<>

Pharmacology

The Muppets: Bohemian Rhapsody

Some renal Findings

Multiple myeloma Ischemic tubular necrosis Acute pyelonephritis Hypersensitivity interstitial nephritis Papillary necrosis & Chronic interstitial nephritis Aminoglycoside toxicity Lead nephropathy Urate nephropathy Acute Tubular Necrosis (renal azotemia)

Eosinophilic casts (Bence-Jones prot), in tubular lumens Ischemic tubular necrosis WBC Casts Drug-induced interstitial nephritis NSAID-associated nephropathy Aminoglycoside toxicity Chronic tubulointerstitial nephritis Needle shaped monosodium urate crystals are seen in the interstitium and tubular lumens Heavy metal poisoning with lead or mercury (produces Fanconi Sd)

Steve Jobs Inspiring speech

Steve Jobs - Do Great Work

Steve Jobs on Connecting the Dots, Love & Loss and Doing Great Work

Steve Jobs - Stanford University Commencement Speech Transcript

I am honored to be with you today at your commencement from one of the finest universities in the world. I never graduated from college. Truth be told, this is the closest I've ever gotten to a college graduation. Today I want to tell you three stories from my life. That's it. No big deal. Just three stories.
The first story is about connecting the dots.

Basic ECG concepts...(Arrhythmias Big picture)

Here are some basic concepts about ECG, the most important one, the conduction system of the heart which helps us to understand why the arrhythmias of the heart are studied in that order. 

Begining with everything related to the Sinus Node and Atrium, continuing with  the AV node where the conduction is slowed down (blocks are study here also), and then everything regarding the ventricles. If you get the big picture of this ECG will become one of the easiest subjects to learn.....

In all these main places we will have rhythms and arrhythmias that conserve the normal heart rate, and others that are faster or slower depending the location where the impulse is initiatied,.

For example

The normal HR for the Sinus Node  is between 60 and 100, So according to this HR if the patient has:

Normal HR (60-100):  Sinus Rhythm

Faster HR (>100): Sinus Tachycardia

Slower HR(<60 bradycardia="bradycardia" p="p" sinus="sinus">

Sarcomere

Respiratory

AIRWAY EXTRATHORACIC (Lips to Glotis) INTRATHORACIC (Glotis tothe alveoli)

Breath IN Narrows Expands

Breath OUT Expands Narrows

•Stridor: narrowing in extrathoracic airway (when breath in - INSPIRATION)
Ex: small, jaw, macroglossia (hypothyroidism, Down Sd., storage Dzz), large tonsils, large tonsils, laryngeal webs, laryngeal warts, peritonsil abscess, retropharyngeal abscess, epiglotitis, crup, diphteria.. DO A NECK FILM
•Wheeze: narrowing in intrathoracic airway (when you breath out - EXPIRATION)
It will expected on Obstructive lung dzz ( Asthmatics )  DO A CXR
Never it's a good thing to find wheezing on inspiration → (Bronchospasm, or mass) → sign of more distress pt probably needs to be in ICU
•Rhonchi: air moving over mucus (Obstructive, Productive cough)
•Crackles: collapsed airways “popping”open (All restrictive will have it) (obstructives later on)
–Surfactant is missing
–Alveoli have been scarred down

*DRUGS THAT CAUSE CRACKLES (Pulmonary Fibrosis)BBAT Busulfan, Bleomycin, Amiodarone, Tocainide
* Which patient will more likely have crackles Strep pneumonia or pneumocystis
  Bacteria → obstructive (airway)→       Fungus → restrictive (interstitium)
-Strep. pneumonia:bacteria, affects airway, obstrucvitve dzz, ronchi (air moving over mucus)
-Pneumocystis Jirovecchi (fungus), affects intertitium, restrictive dzz, crackles

Aspirin Intoxication

Aspirin poisoning will produce respiratory alkalosis initially then will produce metabolic acidosis.

Others producing Metabolic acidosis are:

Increased anion Gap (MUD PILES) M- Methanol U- Uremia D- DKA P- Paraldehyde or phenformin I- Iron tablets or INH L- Lactic Acidosis E- Ethylene glycol S- Salicilates

Normal anion Gap Diarrhea Renal Tubular Acidosis (alkaline urine ph < 5.5) Hyperchloreima

Insulin Release in Pancreatic β Cell

DO NOT GIVE THIAZIDES TO HYPERGLYCEMIC, HYPERLIPIDEMIC, & HYPERURICEMIC PATIENS
Remember that normally insulin will inhibit HSL (Hormone Sensitive Lipase) required for the breakdown of stored TG in adipose tissue. Since thiazides stop the production of ATP on the pancreatic β cell, preventing the realease of insulin required for keeping TG inside of adipose tissue, this drugs are not given to hyperlipidemic patients.

Renal Physiology

Westin hotel restaurant

Georgia Aquarium, CNN con mis Papis

World of Coca Cola, Atlanta GA

Ybor City con el Flaco

Maine Trip

Rocio's Wedding

The big room

There you go!

There he is ....  Quin @ 5 days old of age.......

New nephew Joaquin

Felicitaciones  para Rober y Vale por el nuevo sobrino está precioso.
This is my new nephew Joaquin, congratulations to my brother Rober and my sister-in-law Vale, good job, he is so cute....!
"Quin" welcome to this crazy world....!

Visita Papis, Miami, Spring Hill, Clearwater, Atlanta, Sorrento

Un cafe para Platon (Ubiergo) by Rober

My brother Roberto performing Fernando Ubiergo's song "Un Cafe para Platon" unplugged. I'm so proud of him. Muy bien Rober felicitaciones, eso es musica....

Las nenas

Antiarrhythmics

Some mnemonics:

Class IB Lido Me Toca
Class IC FEP
Class III SIBAD

•Class I:
IA: Police Department Questioned
IB: The Little Man
IC: For Pushing Ecstasy

•Class I
IA: Double Quarter Pounder
IB: Lettuce, Tomato, Mayo, Pickles
IC: Fries Please

•Also remember:
Beta 1 selective blockers: AMEBA
atenolol
metoprolol
esmolol
betaxolol
acebutalol

IA: Police Department Questioned IB: The Little Man IC: For Pushing Ecstasy

IA: Double Quarter Pounder IB: Lettuce, Tomato, Mayo, Pickles IC: Fries Please

Quito - Ecuador

MURMURS (soplos)

Stenosis = problem in opening the valve

Regurgitation = problem in closing the valve

 

Need to know where valves are heard best – right 2^ndICS (aortic valve), left 2^nd ICS (pulmonic), left parasternal border (tricuspid), apex (mitral) – this isn’t necessarily where the valve is, but where the noise is heard the best.