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Spermatogenesis and androgens

Female reproductive cycle

Preeclampsia

Pregnancy complications

Placenta Previa

Placenta Accreta

Placenta Abruption

Polycystic ovarian syndrome

Sex Chromosomes Disorders

Klinefelters syndrome

Turner’s syndrome
Androgen insensitivity syndrome

5 alpha reductase deficiency

Kallman syndrome

Hydatidiform mole

Ectopic pregnancy

Endometriosis

Endometrial pathology

Myometrial tumors

cervical cancer

Ovarian Tumors

Breast Tumors

Benign Prostatic Hyperplasia

Prostate cancer

Testicular disorders

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Autosomal dominant Polycystic Kidney Disease

Horseshoe Kidney

Angiomyolipoma

Renal Cell Carcinoma

Renal Tubular Acidosis (RTA)

Transitional Cell Carcinoma

Wilms tumor

Rhabdomyolysis

Respiratory Alkalosis

Renin-Angiotensin-Aldosterone system (Blood pressure Regulation)

Nsaids Nephropathy/ Renal Papillary Necrosis

Nephrotic syndrome

Nephritic Syndrome

Chronic Renal Failure Part 2: Uremia Induced bleeding

Chronic Renal Failure Part 1

Acute Tubular Necrosis

Acute Renal Failure

Acute Interstitial Nephritis

Acid-base Disorders: Introduction to the Basics

Acid-Base Disorder: Respiratory Acidosis

Acid-base disorder: Metabolic Alkalosis

Acid-base Disorder: Metabolic Acidosis

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Lymphoid structures

Lymphatic drainage

Secondary Lymphoid structures- The Spleen and Lymph nodes

Innate vs adaptive immunity

MHC class I and II

HLA and disease associations

T cell activation and immunity

B cells-antibodies and humoral immunity

interleukins overview

Active vs passive immunity

vaccinations

Hypersensitivity response

Blood transfusion reactions

T cell disorders

B cells immunodeficiency disorders

B and T cell disorders

Transplant rejection and Grafts

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Introduction to metabolism

Vitamins

Lysosomal storage diseases

Respiratory Burst

Sorbitol

Pyruvate metabolism

Glycolysis

Glycogen synthesis- storage diseases

Fructose metabolism

Citric acid (Kreb) cycle

Electron transport chain

Pyruvate kinase deficiency

Phenylketonuria

Maple syrup urine disease

Urea Cycle

Lactase deficiency

Ketones

Homocysturia

Fatty Acid Synthesis and beta oxidation

Ethanol metabolism

Catecholamine synthesis

Amino acid metabolism

Alkaptonuria

Albinism

Malnutrition

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Types of studies

Clinical Trial

Sensitivity and Specificity

Incidence vs Prevalence.

Quantifying Risk Quantification

Precision vs Accuracy

Bias and Study Errors

Statistical distribution

Statistical hypotheses

Outcomes of Statistical hypothesis testing

Meta Analysis

Confidence interval

Chi square, T-test and analysis of variance

Pearson correlation coefficient (r)

Disease prevention

Medicare and Medicaid

ETHICS

Core ethical principles

Informed consent

Consent for minors

Decision-making capacity

Advance directives

Surrogate decision- maker

Confidentiality

Ethical situations

DEVELOPMENT

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Passing the USMLE exam is mind blowing and needs a thorough knowledge of the subject. The minimum passing score is given forth as a three digit number. The minimum passing score for the USMLE Step 1 is 192. Scores are released every Wednesdays and it usually takes 3 to 4 weeks to receive the score.

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I paused for a minute and realized that if my patient has been diabetic for over 43 years and has no clue what Hemoglobin A1c is, there are probably thousands of patients who are in similar situation. That’s when I had an epiphany of some sort, tons of the terms that we use when speaking with the patients make no sense to them since they are medical jargons. We learn all these things in medical school but no one really teaches us on how to relay them on layman’s terms. It is imperative that we educate our patients in ways that they can relate to so that their knowledge regarding their medical conditions are accurate and they have a clear concept regarding their health status.

I decided to explain what hemoglobin A1c test is, in an easy way for her to remember. I explained to her that there are two types of diabetes. I proceeded to say, “Imagine that the inside of your body are like pipes which are interconnected. Whenever sugar or water goes inside, it reaches the organs, brain, heart and kidneys in your body since there are pipes all over. Normally after eating, your body has all these sugar floating around and the way to get the sugar out of your system is to convert it into energy. But before being able to turn sugar into energy, your organs need a key to unlock its doors, that key is called insulin. When you are diabetic, you have too much sugar floating inside your pipes and there’s no insulin to open the doors for your organs to use those excess sugars in form of energy. Patients whose bodies do not make insulin at all are called type 1 diabetics. We provide insulin for those people since their bodies don’t make it. Some patients have bodies capable of producing insulin. Unfortunately, the insulin produced which serves as a key does not fit the doors of their organs properly, that’s why the sugar can’t be used up. These people are type 2 diabetics.

After that, I explained, “you see, inside your pipes are small donut-shaped called red blood cells, which are like UPS trucks that run around and supply your body with oxygen.” This is the air you breathe in and they collect the remnant, carbon dioxide, which is the air your breath out. If you have a high blood sugar level, the sugar start sticking to these cells, making them look like small sugar crumbs from dunkin doughnut. The more sugar crumbs attached to your UPS truck, the worse your diabetes is. The red blood cells or our bodies’ UPS trucks have a lifespan of 120 days. After that, the truck dies and we can detect how many sugar crumbs are stuck on your trucks.” The percentage of sugar crumbs on your dead UPS truck is your hemoglobin A1c.

Your A1c is used to evaluate how high blood sugar levels and how well your diabetes is controlled. It can determine if you are trying to compensate a day before the test, in order for it to turn well. Let’s say, you have been bad and ate all the sweets you want, then the day before your next doctor’s appointment, tried to eat well and use insulin to keep your sugar under control. Your doctor asks how your sugar levels are, you confidently answer that it has been good and that you have been strictly monitoring your diet. The doctor then will send you this test then if the test comes back and the result is greater than 6.5%, you and your doctor will then both know that your diabetes is not well controlled. So always make it a point to watch what you eat.

She was very grateful on my explanation and even asked if the A1c number is the number that she sees on TV commercials with people who are holding a sign with numbers on them and smiling. I also smiled and said yes. She told me that on the following week, she will ask her doctor regarding her A1c levels and thanked me for the final time.

Next time your patient asks you about A1c, tell them this story and I’m sure that they will never forget it.

Adeleke Adesina, DO

Emergency medicine physician

Houston Methodist Hospital

Founder, ftplectures, smashusmle and crushnclex
Reference to doughtnut

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