Glucose-6-Phosphate central to the 4 major metabolic pathways of glucose, i.e. glycolysis, gluconeogenesis, glycogenesis, glycogenolysis and HMP shunt (Pentose phosphate pathway). Glucose is immediately phosphorylated inside the cells to Glucose-6-Phsophate to trap them inside cell and prevent diffusion out of the cell. Glucose-6-Phosphate is the key intermediate to understand the…
Author: Epomedicine
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Granular contents of Neutrophils and Platelets
Neutrophil Granules Azurophilic (Primary) Granules These are lysosomes that occur in all granulocytes, as well as in lymphocytes and monocytes. In addition to expected lysosomal hydrolases, they also contain peroxidases (used to demonstrate azurophilic granules chemically). Develop earlier than specific granules. Stains blue/purple by Romanowsky stain. Mnemonic: ABCDE MnOP Acid hydrolase…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Morphology of Granuloma
Concentric layers of Granuloma There are 4 concentric layers in a granuloma, however the clear distinction is difficult in reality due to overlapping. From inside to out: 1. Necrosis Caseating necrosis: Tuberculosis, Leprosy Coagulative necrosis: Buruli ulcer (M.ulcerans), Gumma containing central blood vessels (Syphilis) Fibrinoid necrosis: Aschoff bodies (Rheumatic granuloma),…
Clinical Skills and Approaches 
Milkmaid’s grip in Chorea
Milkmaid’s Grip Milk maids grip is appreciated as an alternating squeezing and releasing of the finger like a milking motion, when asked to maintain a constant, firm grip of examiner’s fingers. This may reflect a combination of Chorea and Motor impersistence. As a result of poor grip, patients often involuntarily…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Tissue Specific and Named Macrophages
Subtle differences in the morphology and functions of macrophages develop as a result of the influence of a particular microenvironment. Appearance of macrophages to histologists have been described as a kind of mythological Proteus, “a creature who had the power of changing his appearance at will”. The life-span of these fixed…
Clinical Skills and Approaches 
Ascitic Paracentesis : Practical Essentials
Absolute contraindications to Ascitic Tapping (Paracentesis) While some authors have claimed ascitic paracentesis to be free from absolute contraindications, others have listed following as absolute contraindications: Clinically evident fibrinolysis Disseminated Intravascular Coagulation (DIC) Clinically apparent oozing from needle sticks Acute abdomen requiring surgery Relative contraindications to Blind Paracentesis Ultrasound guided…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Difference between Sarcoidosis and Tuberculosis
Sarcoidosis and tuberculosis are both granulomatous disease with similar constitutional symptoms, respiratory symptoms and multiple organ involvement with hilar and mediastinal lymph node involvement. Hence, the diagnosis of one from the other may pose significant difficulties. Sarcoidosis vs Tuberculosis (TB) IFN-gamma release assays (IGRA)Tuberculosis can be reliably excluded if both…
Clinical Skills and Approaches 
Prescribing Opioids for Chronic Pain
Recommendations for Prescribing Opioid in Chronic pain 1. 1st line of therapy in chronic pain outside of active cancer, palliative or end of life care must be nonpharmacologic therapy and nonopioid pharmacologic. Consider opioid therapy in combination with nonpharmacologic or nonopioid pharmacologic therapy if benefits outweighs risk. 2. Ordinarily 2…