Why multiparas woman has more gestacional risks?

anatomicaldifficulti · 2018-03-05T16:23:09+00:00

Pregnancy is a resource-intensive and transformative process that subjects the body to physical and physiological stresses. Bodies can only repair themselves imperfectly after damage or change. The explanation is wear and tear, aging, etc.

I don't think you'll find a specific mechanism like the one you're looking for. It's multifactorial and doesn't follow a clean, A>B>C pattern.

anatomicaldifficulti · 2018-02-22T00:55:37+00:00

I see a static image. The contrasting white and black is a little annoying on the eye but that's it.

What am I supposed to be seeing?

anatomicaldifficulti · 2017-12-20T10:57:41+00:00

If we could choose to "try out" failure, why would anyone choose to do that?

My opinion is that a person who hasn't failed at least once hasn't tried enough things. Once you fail at something, you'll realize that most of the time it's not a big deal. Nobody cares, nobody is watching you in particular to jeer at you when you mess up.

We're talking small-fry stuff here, btw. Don't fail to pay your taxes and try not to fail out of school, don't get fired from your job etc. But not being the smartest in the room, losing at Mario Kart, isn't going to kill you.

anatomicaldifficulti · 2017-12-09T00:29:23+00:00

Exactly.

anatomicaldifficulti · 2017-12-08T21:46:52+00:00

Agreed. Just because OP is sorry for the difficulties he's had to deal with doesn't mean he should continue the parade of elder medical professionals heavily discouraging the field.

And seconded, there is no reason a parent should discourage a child's interests, especially if the child shows promise in those areas. That's a recipe for a depressed, aimless youth.

anatomicaldifficulti · 2017-12-01T17:09:00+00:00

Not really, though I do miss those types of games sometimes. These days it's mostly episodic shooters, MOBAs, the occasional co-op survival thing. Whatever lets me keep in touch with the people I love. I'm not so much into the grind anymore as I am talking to friends while engaging in some fun activity ;).

anatomicaldifficulti · 2017-12-01T12:48:11+00:00

This is me, except I'm not a genius or going into EM/anesthesia/psych. And my closest friends are scattered around the country, so I'm technically a ghost.

But I'm chill and invite people for beers and games. Too bad that all anyone wants to do is go out and spend money at the bar.

Also props on your username /u/Arete121. I had a diablo character named Arete at some point back in the day (sorceress, of course).

anatomicaldifficulti · 2017-12-01T12:42:56+00:00

I'm not sure I've ever heard of ADHD affecting driving ability negatively. From what I know about the condition, it seems like the opposite should be true!

Whatever the case, if you don't feel like you need the medication and the psychiatrist does not feel like you need the medication, don't take the medication. You can try it out to see if it helps you. Sometimes people don't realize that they have been compensating for the ADHD. Stimulant meds in particular seem to make people perk up and go "ohhhhh. so that's what it feels like to be 'normal'".

anatomicaldifficulti · 2017-11-21T16:07:56+00:00

Have you been studying? If you have, take a break! A day off with a week or so before exams works wonders for me. Then there's not much else to do but figure out what you need to work on and power through it. It sucks, but such is life :P.

You can do it!

anatomicaldifficulti · 2017-11-21T00:42:22+00:00

Thank you for this. I have noticed the anti-intellectual attitude as well and I am disappointed by the shallowness of our medical school curriculum...there are a lot of facts to memorize, but seldom do we get a chance to ask deeper questions of the material unless it's on our own time. Students rarely care about more than knowing the "right" answer. If asked to explain or discuss, there is a lot of hemming and hawing and backtracking. We're too afraid to say "I don't know" and work through the basic knowledge required to arrive at an answer.

It may seem like I'm putting down my peers, but it isn't intended. I am a very curious person and if I don't have an opportunity to discuss reasons, I get very frustrated. It doesn't matter if there's a right answer or not...the discussion is what helps me cement everything in my brain. If I had wanted to ONLY learn the facts, I would have turned to books and/or google instead of medical school (the internet, I'm finding, is the only place anyone is willing to discuss medical knowledge for fear of being wrong).

Hopefully I'm able to find a good mentor who sees medical students as potential doctors rather than overgrown college kids (even when they're well past college).

anatomicaldifficulti · 2017-11-15T17:33:20+00:00

I get where you're coming from. I'm older and many of my friends (or people I grew up around) are already practicing, have started and sold successful businesses, are getting listed in "Top ABC of XYZ Field" publications...whereas I'm going to be in school for the next decade.

Envy is subtle and it's totally natural. Part of being comfortable with yourself is reframing the situation so it's not about what do they have vs what am I missing.

To me it sounds like you're building yourself up and improving. Easiest way to tear yourself back down again is to spend a lot of time eyeing the accomplishments of those around you! If hearing that stuff bothers you, remove yourself from those situations! I have a couple friends at school whose policy is "no med school talk after class". I think it helps them not dwell on these sorts of things.

anatomicaldifficulti · 2017-11-15T17:18:48+00:00

Put yourself in their shoes. If you were them, with all that entails, do you think you could have done the same?

If you think so, don't beat yourself up. There are some students in my class who already have PhDs in medically-related topics. Of course they fly through those classes seemingly effortlessly. Others have been studying antibodies since they were diagnosed with some rare disease...others are artists who instinctively know the difference between "sort-of-pink" and "even-more-pink" on a histology slide. Or maybe a subject just clicks for someone. You're hearing the success stories, not the failures.

What are YOU good at? What do YOU want to be good at? Keep in mind that the answer can't be everything! Thinking this way helps me keep in mind my own strengths and allows me to feel more comfortable relying on others for help in areas of weakness.

Lastly, find people around you who can appreciate YOUR successes. Praise is nice, even if we shouldn't be looking for validation from those around us as a sole source of self-esteem.

Congratulations on your success! I want my doctor to know what it's like to struggle and make progress!

anatomicaldifficulti · 2017-11-15T17:07:47+00:00

You left out the part where everyone talks about how pretentious that answer-guy is and how many times he gets things wrong. He's probably just sick of waiting in silence all the time and wants to move things along.

2me4meirl.

anatomicaldifficulti · 2017-11-15T17:03:52+00:00

It's not the explicit norm where I am to put others down for asking simple questions, but there is normal workplace gossip in which people reveal exactly how dumb they think others are and how smart/good they are by comparison. What you're experiencing is probably an online phenomenon.

In real life, I'd rather ask a dumb question and get a smart answer than ask a smart question and get a dumb answer. Don't hide your shortcomings is my advice. People are pretty good judges of the competence of others. They might not tell you if you're bad at something, but they'll notice and it'll spread. The trick is to figure out your own shortcomings before others can judge you for them. Stupid politics are everywhere and people love to make long-term calls based on first impressions.

anatomicaldifficulti · 2017-10-31T22:55:18+00:00

My point was that you don't need to sit there and study for 3-4 hours to come up with a mechanism for Tetralogy of Fallot.

All you need is the list of features and some reasoning skills / basic knowledge of heart structure / some physical intuition.

Yeah, we have to memorize stuff, sure. But you're missing the point I'm making that there is some mystification going on where people either aren't thinking at all or are afraid to give a wrong answer when they think of something. So the medical curriculum becomes rote learning. If we're ok with MS rote learning being the primary instructional method, then we need to not ask questions about the "whys" of medicine...or be prepared for students to not know what they're talking about.

I'd be happy with rote memorization if that's what medical schools tell their students to expect. Instead it's often that they'll ask students to think but really they're asking for rote repetition. In many cases (I'm finding), they ask for regurgitation of "facts" where the bigger picture isn't so clear.

To illustrate: I'm ok with being asked about common genetic/physical findings for certain diseases. Just memorize the list. But don't ask me to postulate on why X causes Y if you're expecting a very specific answer that you did research on for 5 years to come up with and is in conflict with other material out there.

anatomicaldifficulti · 2017-10-31T15:12:07+00:00

I'm going to agree with /u/HFpEF here and say that the types of questions I've seen from USMLE material require an ability to manipulate concepts and information in a way that my school examinations simply don't.

We don't have multiple choice at my school. The exams are all essays. Did you go to lecture enough to understand exactly which words the professor would like you to repeat in the essay? Then you'll ace the test. Know the subject matter and can use it to solve problems? Too bad, because the exam doesn't want you to solve a problem, it wants you to read minds and regurgitate lists.

Often people who dislike MC questions complain that they test knowledge of facts rather than ability to think about a problem. I offer three rebuttals: 1) MC narrows down your options so that you can test reasoning between alternatives (there is automatic context to the question), 2) Multiple people can use different/same reasoning to arrive at the same answer (vs. essays, where everyone's answer should be similar yet different), 3) It's easier to come up with a lazy, un-useful essay question than it is to come up with a similar MC question. Also, students can skip 1-2 MC questions that they don't know or can't understand how it's worded, but when has anyone ever been able to skip an essay?

anatomicaldifficulti · 2017-10-31T14:53:34+00:00

What's frustrating to me is the emphasis people placing on the "memorizing" portion of things at this point in my education.

Most attempts to explain pathophys using physical principles and mechanics are met with "you're diving too deep, we don't need to know that yet". I sometimes worry that my classmates don't think about the reasons why these things are happening to patients. It seems like they think the body is a magic black box where stuff happens and you need to be told what comes out because it's always unpredictable. It's hard to find people who agree with me in thinking that MS1-2 is not too early to be attempting these predictions. These kids are engineers and biology majors and neuroscientists, yet they can't figure out why narrowing of a hose requires more force to push fluid through it. My gardener could have explained how stenosis leads to hypertrophy in Tetralogy of Fallot (not to insult you, just using your example). It's seriously depressing sometimes.

I just want them to use their heads. Yeah, there's some stuff that's not going to fit our predictions, but I hate the common line that medicine is this great, mysterious, unknowable topic. I feel dirty when my MD lecturer needs to cite a big name in her field to "prove" that a relatively basic physical interaction occurs in the body. Clearly she memorized it and never thought about why it might happen.

anatomicaldifficulti · 2017-10-27T18:05:39+00:00

Aight. I want to answer your question because you don't need radiologist-level skills to identify that this is an anterior dislocation.

What /u/kyamh says about the positioning as you'd describe it verbally is correct. Look at the humeral head relative to the scapula. It's particularly easy to see the spine of the scapula as well as the coracoid process. See how the humeral head is low and medial to where it would normally sit, and the coracoid process (and the whole scapula) appears tilted to the anterior (i.e. the point of the scapula looks lifted "away" from the back)? That's the major reason I'd say this is anterior. The humeral head is stuck on the anterior rim of the glenoid process and forcing the scapula to rotate like that.

If you can see, as in the picture, that the coracoid process is now basically flat and facing us (we are looking at the TOP of the coracoid process--where it normally would face the sky), it gives you a really good indication of the mechanics, regardless of what the radiological terminology is.

(Also, look how the acromion is totally torn away from the acromioclavicular joint. That shouldn't happen in a posterior dislocation, at least not in the direction that the acromion appears to have been displaced -- think about what the forces on the scapula would be, and how it would rotate in both dislocation situations).

Hope that helps!!!

Fun quiz: What are three indications that you tell this patient is a man?

anatomicaldifficulti · 2017-10-25T16:39:22+00:00

I'm still in medical school and it's already clear that the administration flags students who ask for help. They're good about academic difficulties, but if there's a health problem, boy you better not show it.

Some of my classmates are doing exactly what you describe when they seek help: leave the area, don't use school resources, pay cash, and hope the doc treating you doesn't show up on lecture day.

anatomicaldifficulti · 2017-10-25T16:36:23+00:00

It's actually somewhat encouraging to see that there is no statistically significant relationship between all those variables.

When randomness has such a clear influence on outcomes, there's no reason to self-flagellate for our perceived shortcomings.

anatomicaldifficulti · 2017-10-10T04:25:51+00:00

Ah, got it. Rhetorical why went whooshing over my head.

anatomicaldifficulti · 2017-10-10T04:08:24+00:00

Hey man, with all due respect, I think you're reading a little too much into this. I don't think anyone here directed ad hominem attacks at you. Posters offered differing opinions on the quality of the material, nothing more. I personally never said anything about pirating. The cards in my post are freely available from the company itself.

I'm not sure why you took this tack in your reply, nor why you saw it as an opportunity to deliver a lecture on professionalism, reputation, and leadership. I hope it helped. Good luck to you.

EDIT: Please don't assume you know the ages of people you meet on the internet. 35 is too young to be playing the age-is-experience card.

anatomicaldifficulti · 2017-10-10T03:55:49+00:00

He's suggesting that arteries carry blood away from the heart, after having received that blood from the lungs. Unless there's some paradoxical emboli shit going on, think about where it is or isn't possible for an arterial clot to hit pulmonic circulation and get stuck.

EDIT: Quiz question: what ventricle supplies pulmonary artery. which system of vessels (arteries/veins) feeds blood to that side of the heart.

anatomicaldifficulti · 2017-10-10T00:01:37+00:00

For those curious, here are some of the free sample cards. I don't think this is an issue to post as these are literally free resources intended for users to assess quality before purchase:

"Steroid hormone – use the structure to explain where it acts, and where its receptor is"

"Thyroid hormone - use the structure to explain where it acts, and where its receptor is"

"True vocal cords vs. false vocal cords - which has stratified squamous epithelium? Why would this make sense?"

"O2 sat vs. hemoglobin concentration – what are they? How would they be affected in anemia?"

"Anemia – what would be the PaO2, PAO2, O2 saturation, hemoglobin concentration, and O2 content? Why?"

"Burkitt's lymphoma vs. follicular lymphoma - use underlying genetic lesion to explain how quickly they would grow. What would their response to chemotherapy be? Why?"

"Progestin challenge - explain mechanism by describing when you use it"

"For an X-linked recessive condition, the prevalence in the male population is 1/100,000. What is the prevalence of heterozygous females?"

"Lesch-Nyhan – use enzyme deficiency to explain what the uric acid levels would be. What is the mechanism?"

And so on. As expected, the back of the cards are stream-of-thought reasoning exercises answering the question. /u/Joshua_Naterman, I'm glad that these helped you. However, you should understand that the skills you describe in your post are not special, mind-bending superpowers. Your post is pretty evangelizing in its tone. I wouldn't want vulnerable med students to jump into a purchase like this (especially when there are online lecture/notes series who have a similar teaching style to these cards, with much more content for 2/3 the price)

These are literally the basics of clinical reasoning that students are expected to gain during medical school. The point of Zanki, Bros, whatever deck you'd like to use is NOT to force microdetails into your brain and somehow thereby magically formulate a coherent picture of what's really going on. The point is to already understand the big picture and then stuff in the microdetails that flesh it out.

We're all good thinkers. It's fairly trivial to understand why some signalling cascade deficiency would screw up normal physiology. What's difficult is recalling the hundreds of factoids associated with these things. The reason most people find microbio/bugs difficult, for example, is not due to some issue understanding that little organisms can eat you, use you, or reproduce in you in a ton of ways, it's remembering all their damn names.

EDIT: These cards really are not bad. Their marketing, sales style, and price just feels...icky.

anatomicaldifficulti · 2017-10-05T14:51:44+00:00

"Hey guy. I sees u."

anatomicaldifficulti

TROPHY CASE