rogress

orenjineki  asked:

I would like to read some lighter yandere to lift my spirits. Which compromises does the s/o of 1!PAmerica have to make to live as peaceful as possible under the circumstances? (Like marry them, kids, physical contact)

Marrying him was the first thing to do for (s/o), you can say the most possible safe way to go.Now that she is with Alfred, there won’t be no outburst of yandere or hurting people she loved.This was good for both of them but mostly for him, he found this nice and great, like the American dream.Married with the women of your life, next thing, how about having some children running around the house that’ll be great.This will give (s/o) the idea as Alfred took her to shop clothes he will look at the baby clothes.Not taking his eyes of the area as (s/o) slowly look at his direction making her blush, she knew what he was referencing.She thought marriage was enough but she thought having kids is a bigger step. “W-we can take it slowly and pr-rogress from there…..”,(s/o) looked at a blouse as she blushed, catching Alfred’s attention.He stares in disbelief but he listens more. “If you want to…”,(s/o) turn red as she hid her face with her hair.Alfred smiled childishly as he wrapped his strong hands around her waist as he kissed her neck sweetly.  “You know I will love that”, Alfred smiled as (s/o) nodded. “I know”, (s/o) spoke as she felt him rub her tummy. “If it’s a boy I’ll teach him how to play ball!”,Alfred was getting excited by it but (s/o) sound a bit too rushed. “What if it’s a girl?”,(s/o) knew she burst his bubble as he thought. “Then I’ll teach her ball too!Boy, girl, I’ll love them!”, Alfred nuzzled his face into her shoulder as (s/o) smiled and sighed. ‘He’s still the same.’

youtube

P-rogressive Stage: NCT & EXO (MAMA Heavy Metal) @ SAF Gayo Daejun

There are plenty of mnemonics out there to help medics organise the way information about a condition is presented, e.g. Dressed In a Surgeon’s Gown A Physician Might Make Progress. I follow a similar structure when writing notes on conditions, but don’t keep to any mnemonic.

Here’s my structure:

[CONDITION NAME] - one liner definition

  • Aetiology - including relevant pathophysiology (I know they are different…) & risk factors.
  • Epidemiology - only significant demographic details (sex, age, ethnicity, geography)
  • Screening programs / Prevention (e.g. vaccines) - if relevant
  • Clinical presentation - including symptoms/signs and history details (e.g. rate of onset)
    • Diagnostic criteria & other scoring systems
  • Investigations - can be split into:
    • Basic work-up
    • Diagnostic tests
    • Monitoring disease activity
  • Treatment - can be split into:
    • Acute & long-term
    • Conservative (e.g. advice/lifestyle tips), Medical (i.e. drugs), Surgical
  • Prognosis - usually one line (good/bad) & any significant details (e.g. short lifespan)
  • Complications - disease-related & therapy-related

I try to only write things down that are clinically relevant - i.e. what info would help me recognise and manage this condition correctly in the real world? I keep the science pretty basic when comes to aetiology/pathophysiology - enough to offer a robust explanation to a patient and if asked on a ward round. I’m pretty fluid about the level of detail depending on the condition.

Another advantage of digital notes is the ability to add photos/illustrations, especially helpful for x-ray signs or funny rashes. My notes are tailored to me and aim to be concise & comprehensive, which means:

  • Lots of personal abbreviations
  • Very little text - love bullet points, hate reading
  • Only images/words which clarify things I don’t think I will know when I need to revise 

When condensing a complicated disease down into punchy bullet points, keep asking yourself, ‘will I be able to re-piece together how this management plan flows in the real word from these few words?’ I have fallen into a trap of over simplifying.

It’s important to find a system that works for you and stick with it consistently. You’ll thank yourself for it when you’ve made exam revision that little bit more doable.

Autosomal Recessive Diseases List
  • Abetalipoproteinemia: decrease ApoB-48, Apo B-100; pigmentary degeneration of retina, acanthocytes, steatorrhea, cerebellar ataxia.
  • Acute Fatty Liver of Pregnancy: microvesicular steatosis in the liver, mitochondrial dysfunction in the oxidation of fatty acids leading to an accumulation in hepatocytes
  • Alkaptonuria: homogentisate oxidase deficiency, increase homogenistic acid, ochronosis, dark blue urine.
  • AcylCoA Dehydrogenase deficiency (MCAD): fasting hypoglycemia, no ketone bodies, dicarboxilic acidemia.
  • Bernard Soulier Sd: gp1b deficiency, prolonged bleeding time
  • Bloom Sd: chromosome 15, Ashkenazi Jews, BLM gene.
  • Carpenter Sd: craniosynostosis, acrocephaly, craniofacial asymmetry, increased ICP, cutaneous syndactyly, polydactily, mild-profound MR.
  • Chediak Higashi Sd: Lyst gene mutation, microtubule polymerization defect, no phagolysosome formation, albinism.
  • Chondrodystrophy: normal-sized trunk and abnormally short limbs and extremities (dwarfism)
  • Congenital Adrenal Hyperplasia: 17alpha or 21beta or 11 beta hydroxylase deficiency; enlargemente od adrenal glands due to increase ACTH
  • Congenital Hepatic Fibrosis: hepatic (periporta) fibrosis, irregularly shaped proliferating bile duct, portal hypertension, renal cystic disease.
  • Cystic Fibrosis: CFTR gene, Phe508, defective Chloride channel, chromosome 7.
  • Dubin-Johnson Sd: direct hyperBbnemia, cMOAT deficiency, black liver
  • Endocardial Fibroelastosis: restrictive/infiltrative cardiomyopathy, thick fibroelastic tissue in endocardium of young children, <2yo
  • Familial Mediterranean Fever: chromosome 16, recurrent autoinflammatory disease, characterized by F°, PMN disfx, sudden attacks pain/inflammation (7 types of attacks (abdominal, joints, chest, scrotal, myalgias, erysipeloid, fever). Complication: AA-amyloidosis
  • Fanconi Anemia: genetic loss of DNA crosslink repair, often progresses to AML, short stature, ↑incidence of tumors/leukemia, aplastic anemia
  • Friedreich’s Ataxia: GAA triplet repeat, chromosome 9, neuronal degeneration, progressive gait & limb ataxia, arreflexia, hypertrophic cardiomyopathy, axonal sensory neuropathy, kyphoscoliosis, dysarthria, hand clumsiness, loss of sense of position, impaired vibratory sensation.
  • Gaucher’s disease: glucocerebrosidase deficiency, glucocerebroside accumulation, femur necrosis, crumpled paper inclusions in macrophages.
  • Ganzman’s thromboasthenia: gpIIbIIIa deficiency, deficient platelet aggregation.
  • Hartnup Disease: tryptophan deficiency, leads to niacin deficiency, pellagra-like dermatosis
  • Hemochromatosis: HFE gene, C282Y MC mutation, chromosome 6, unrestricted reabsorption of Fe+ in SI, iron deposits in organs, bronze diabetes, DM1, malabsorption, cardiomyopathy, joint degeneration, increased iron, ferritin, TIBC. Complications: liver cirrhosis, hepatocelullar carcinoma
  • Homocystinuria: due to B6 deficiency (defective Cystathionine synthase) or due to B9,B12 deficiency (defective Homocysteine Methyltrasnferase), dislocated lenses (in & down), DVT, stroke, atherosclerosis, MR.
  • Krabbe's Disease: Galactocerebrosidase deficiency, galactocerebroside accumulation, gobloid cells, optic atrophy, peripheral neuropathy.
  • Leukocyte Adhesion Defect (LAD): CD-18+ deficiency, omphalitis in newborns, chronic recurrent bacterial infxs, increase WBC count, no abscess or pus formation.
  • Metachromic Leukodystrophy: Aryl-sulfatase A deficiency, sulfatides accumulation, Demyelination (central & peripheral), Ataxia, Demantia (DAD)
  • Niemann-Pick Disease: sphingomyelinase deficiency, sphingomyelin accumulation, HSM, cherry-red macula, foam cells.
  • Phenylketonuria (PKU): phenylalanine hydroxylase deficiency, Phe accumulation, MR, microcephaly, diet low in Phe!!! also in pregnancy, avoid aspartame, musty odor.
  • Polycystic Kidney Disease (children): ARPKD, rogressive & fatal renal failure, multiple enlarged cysts perpendicualr to renal capsule, association with liver cysts. Bilateral palpable mass.
  • Rotor Sd: direct hyperBbnemia, cMOAT deficiency, no black liver
  • SCID: ADA def. & rag-1, rag-2 def, bubble-boy
  • Shwaman Diamond Sd: exocrine pancreatic insufficiency (2°MCC in children after CF), bone marrow dysfunction, skeletal abnormalities, short stature.
  • Situs inversus: assoc w/ Kartagener sd
  • Sicke Cell Disease and Trait: Hb S, beta globin chain, chromosome 11, position 6, nucleotide codon change (glutamic acid --> valine), vaso-occlusive crisis (pain), autosplenectomy, acute chest pain sd, priapism, hand-foot sd, leg ulcers, aplastic crisis, drepanocytes & Howell-Jolly bodies, hemolytic anemia, jaundice, bone marrow hyperplasia
  • Tay-Sachs Disease: Hexoaminidase A deficiency, GM2 accumulation, cherry-red macula, onion skin lysosomes.
  • Thalasemia: alpha (chromosome 16, gene deletion), beta (chromosome 11, point mutation)
  • Werner Disease: adult progeria
  • Wilson’s Disease: Chromosome 13, WD gene, ATP7B gene (encondes for Copper transporting ATPase), copper accumulation in liver, brain (putamen), eyes (Descemet membrane - Kayser-Fleischer ring), decreased ceruloplasmin.
  • Xeroderma Pigmentosa: defective excision endonuclease, no repair of thymine dymers caused by UV radiation, excessive freckling, multiple skin cancers.
I'm making a change. Today is the first day of summer for me. So far it's been good. I see all this sad stuff on tumblr and posts that I really want to reblog usually but not today. I am going to try and be super positive! I know there will be some nights that they might slip through but for the most part it's Positive Patty!