Blissful Life

Author: akshay

  • 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.

  • 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 😀

    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 😛
    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.
    Ok.

    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 😀

    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 😛
    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.
    Ok.

    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 😛
    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 😛 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.

  • Are your parents the best?

    I believe vehemently that our character, intelligence, everything depends on nurture, rather than nature.
    Whatever you do, however you respond in a given situation will have something or the other to do with what your parents/teachers/friends/books/culture/family/siblings/environment taught you at some point in your life.

    And then comes the question. Do you have the best parents? Did you learn in the best school? Did you grow up in the best neighborhood? Did you read all the best books? Where you nurtured in the best way possible?

    And, how will you explain your imperfections? Nurture.

    Realizing that what you’ve been taught as a child may not be the right/best thing to do in a situation helps you also realize the potential for growth.
    And that will lead you to sources – people/books/ideas/cultures/thoughts that will make you grow.
    And then, you become perfect.

    “Where you come from does not determine where you can go”

  • 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
    GROSS
    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?
    Cerebellum
    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!

  • What do you perceive as reality?

    Just saw Shutter Island, and I should tell you it's the most amazing take on memories and how they define reality and what neuropsychiatry is all about and omg, what not!

    SPOILER WARNING: If you've not seen the movie, and are planning to, then don't read ahead.

    So, here's where it all matches what ideas I've been having about how the mind works.

    Recap: There are only memories. Procedural, declarative, everything. And then, a stimulus appears. It rains, or someone talks, or you fall, or a lion appears behind you. And then, the impulse, the message travels from your sense organ to the brain; it's sorted out and sent to whichever memory/neuron it corresponds to; (again sorted) from there to the procedural memory that it demands; and then to the respective effector organ, and finally you have a response.
    [I should tell that I've not yet learned about how this sorting out thing works. I'm assuming it does that, somehow]

    So, that's it. The basics.

    And then there's this experiment, the split-brain experiment, just google it: Someone has his corpus callosum, the main communication between left and right hemisphere, removed; and he's shown an image to his right eye, say that of ice, and he's shown too many other images to choose from, to associate this ice with, and he chooses a shovel (because you needa shovel the ice). And his left hemisphere is out of the story, it knows nothing about what just happened. And then, the guy is asked why he chose the shovel, while being shown a bird to his left eye. (Should tell you, it's the left hemisphere's Wernicke's area that controls all logic, reasons, etc in most people, sure you've heard that left is rationale and right is creativity). Here's a bird, and here's a question why choose shovel. And suddenly, the left side cooks up a story: "Because birds poop, and you need to clean up that"

    Now, that's where Shutter Island comes in. The hero, all he remembers, is from the beginning of the movie, he's in a ship, to shutter island, as a US Marshall. And that's his observation. Now, he's gotta cook up a story consistent with the observations. And he's clever enough to make a perfect one. And there you have! You're insane!

    If that didn't make it clear, lemme explain.
    Right now, you have all your memories, from your age 5 or 4 (or to be very precise, memories begin forming whenever your nervous system develops, right? Because you do remember the first words you were taught while still struggling on your back) or from the beginning, and then you have a consistent story about the reality out there.

    And that reality is based on all your memories. If all of a sudden you were to wake up with none of your memories from the last 2 years, what would you do? How would you feel? If you'd ever fainted for a while you might have experienced this. (Like I fainted, interestingly the first, and as of now the only, time I donated blood, and then I wake up, as people said, 10 seconds later, and all I see is people all around looking at me, and I don't remember what happened, and so instantly, in seconds I am thinking "I've just been in a road accident." And if I was lying down on the road with blood splashed all over my body, I'd just believe that forever. But gladly, I look around and then I remember I was donating blood and the people around, they fill the 10 second void in the memories, and ha! I'm back in my reality.

    What if it was not that easy?
    What if suddenly somewhere inside your brain, a stroke or something knocks out an year or a decade of your memories and nothing, nobody can explain to you or make you remember everything, everything that happened, to fill in that void?
    Suddely your brain, without even letting you* realize it, cooks up a story to fit in all that it remembers and sees. And there you go, you're in a mental asylum which's your home, the psychiatrist is your family friend, and the nurses are your sisters or daughters or servants, and the whole world is crazy!

    *Who's this you? Are your brain, your mind and you three different realities?

  • Biochemistry

    The end

  • Attempting to Solve the Hard Probelm of Consciousness

    I remember asking one of my computer science friends a few months ago when he was coding a small game “When your program plays the game, does it actually know the rules, or does it just act as per your algorithms as to how to proceed at each imaginable point that comes up during the game? Is the program conscious of the game?”

    Now, I think, that question of mine was invalid.

    We go inside the mind of a human baby, an infant.
    It knows nothing – a blank slate. Very importantly, what we call consciousness, or the awareness of the self is absent. Somewhere along the line, it becomes conscious and begins thinking of itself.

    [I’m gonna be putting seemingly random thoughts throughout this post, just make sure each one of them are agreeable]

    How do we learn something?
    As small kids, we are shown or we see everything around us. Cats, people, stones, toys, moving things, immobile things, living things, non-living things, this, that, everything.
    Right from the delivery bed there’s a training process that begins. Mom points at a moving thing and says “DAD”. Then, “CAT”, “DOG”, “PEN”, and so on…
    There can’t possibly be any understanding as to what “dad” or “pen” means at that time. BUT, very importantly there are memories, or conditioned reflexes formed. [Remember Pavlov’s dog? After Pavlov repeatedly struck a bell before feeding a dog for a few times, just striking the bell brought about salivation].
    So, the next time you see the same pen or the same cat, you, as a baby, remembers to associate with the sound “CAT” or “PEN”
    That’s initial variable declaration kind of memory formation.

    Then, you learn categories, methods, activities, etc.
    This is a cat. This doesn’t move. This is not even 3D. This is just a “PICTURE” of a cat. Cats in pictures can’t move.

    Then you go school. Teachers tell you:
    Cat is an animal. Dog is an animal.
    Cat can change its position. Cat can move. Animals are those things that can move.
    And then, all your memories of cats, of movement, and of cats moving surfaces in your mind.
    Of dogs too.
    And then you learn what it takes to be an animal.

    I repeat. A baby knows nothing.
    How does it learn? By conditionally associating words that it hear with the visual (or tactile in a blind person) stimuli that is accompanying the sound always.
    Not just objects. Methods like motion, fall, rise, rolling, everything is associated to the words for it.

    I do mean LANGUAGE IS THE BASIS OF INTELLIGENCE

    Then there are categories. And there are inherited methods, inherited properties.

    A baby learns to categorize things. It learns that if a rat is an animal, it’ll move too. (Even this is taught. You’ve got to remind her “Idiot, it’s an animal. Animals move”)
    So, the baby now learns to identify, categorize, etc.

    Now, we move on to the hard problem of self awareness.
    It’s not really hard.
    The baby is taught about the existence of self.
    It’s taught that whichever part of the universe is under its direct control is called “self”.
    And there always is the unconsciously learned skills like moving own hands, feet, etc. which leads to an image of the body being formed in the brain (cerebellum).

    (I say, if we were to keep something contiguous with the body 24×7, 365 days for a non-leap year, it’d finally form a part of the body image.
    In fact when we grow up, and we start using mobile phones, we get addicted to it, then it becomes so repetitive that even the mobile handset forms a part of the body image. But this is usually prevented by the fact that we keep the sets down at times. But what I mean to say, is that if we were to associate, consciously as the mobile being an extension of our body, it’ll finally become a part of our self. Maybe this is true with prosthetic limbs and all. No, they will tell you it feels alien, but that’s because they have not tried to consciously associate with it, nor do they get sensory stimulus from the prosthetic)

    Thus, the baby begins to identify itself. (Even this is just an information stored in the neurons)

    Now, consciousness.
    The fact that there is something that’s observing my thoughts.

    I am thinking hard.

    It’s hard to solve.

    Emotions, etc can be explained with hormones, and the sense of well being. Like negative words are associated with bad memories, bad memories bring on the be wary mode, leading to release of be wary hormones, which would bring about a bad mood – negative emotion. Vice versa with positive emotions.

    But who is feeling this well being?
    That, is really hard to solve.

    And I go back to the question I asked my friend. He should have retorted with this question: “What do you mean by ‘conscious’ness?”

  • Physiology paper 2

    Click on the image to enlarge

  • Physiology paper 1

  • Anatomy paper 2

    Same applies. No comments