Sunday, October 9, 2011

Study Session... five men brainstorm the exam notes....

Vsevolod and Kris write the information down: first note cards with the material from the book. Joe prepares to discuss the information. Tony helps Vsevolod. Sam makes comments.  Tony is the organizer.
Vsevolod:  We need to know the historical facts about the Urine. Textbooks refer to the cavemen who had no sophisticated mechanisms to work with the urine.  However, a scientist Fredrick Dekkers discovered albinuria in 1694.
Sam: Should we look details in Wikipedia?
Vsevolod:  Probably, for the organizational purposes we should study the exam without the extra information.  To avoid being confused; let’s focus on the textbook to get the smooth idea of what’s going on; then go in the power point slides. Afterwards, if something is not clear, we use internet. Remember, the term, the textbook wisdom?  I hate this bloody term. We are studying the tools, which are useful in to the world.  Plus, I would be a history major, but we need to eat food, and pay bills right…? We are a bunch of statistical weirdo pseudo-intellectual miscreants.  God help us. 
Tony:  Vsevolod, you should stop pseudo philosophizing. That gets you nowhere; you confuse people, and confuse yourself.  We should know the name and what is the significance. So, the Fredrick Dekkers discovered albinuria. Thomas Bryant: 1627 – exposed the charlatans. We may imagine what those charlatans did. But we should remember the names right? So, Thomas Bryant, and Fredrick Dekkers are the important medieval people, right?  What about the urine composition?
Vsevolod:   Urine composition – 95 percent water, 5 percent solutes, variations depending on the metabolism, the physical activity, and even a body position. Organic composition is epic. They include acids: Creatinine, and Uric Acid.  Inorganic Acids and Salts are included too: Chlorine, Sodium, and Potassium. An increased amount of formed elements indicate the possibility of the disease. Increased presence of bacteria may cause a disease as well.   Also, the terms associated with the amount of urine:  Oliguria – decrease in the urine output due the dehydration, the vomiting, and the severe burns. Nocturia – increase in the night urine, Anuria- cessation of urine due a serious damage such as decrease in blood flow, Polyuria species increase in the flow of urine, associated with diabettis mellitus or diabettis insipidus.
Kris:       Ok, let’s organize the information. With urine:  it has hundreds of elements. The fundamental breakdown is given. Normal urine has a lot of solutes.   It is yellow and clear. If it is cloudy it is not normal.  Table 3.1 provides a collection of Urine.
 Joe:       Guys, this shit should become much clear, once we get experience in the lab. Without the lab experience it is not very useful, it is a practical game. I mean, come on.
Sam:      Ok
Kris:       The instructor may give a situation and ask to determine whether it is Anuria, Nocturia, or Polyuria. So let’s think about it. Numbers are given in the textbook. I would kind of remember them.  For example, infants, children and adults would use a different level of urine intake during the oliguria based on age of a human. So, here it goes: infants – <1 ml/kg/hours; children -  <0.5 ml/kg/hr adults <400 Diabettis Mellitus ml/day. So, kids pee more…. Dudes, I think the urine decreases during the oliguria, but if one of the questions would include which of the following specifies the oliguria, anuria, of Nocturia we should remember the specific characteristics. So, the Nocturia would cause an 2.5 L/day in adults, 2.5-3 ml/kg/day in children often related to diabetes. 
Sam:      True. This is not a fucking rocket science so far. Remember, diabetes mellitus, and diabetes insipidus. What is the difference?
Vsevolod:            caused by the increase in the glucose concentration. High Specific gravity; pancreatic production of insulin is not working well.  So, the glucose concentration goes up.   Diabettis Insipidus results from the decrease of antidiuretic hormone; this the water required for adequate body hydration is not reabsorbed from the plasma filtrate. Urine becomes more dilute, specific gravity
Joe:        Useful in the lab, if we do not work in the lab… we are sledgehammer ass fucked. Song by the German doom-death metal band Ophis…  their 2001 debut. “Silent empty and cold”
Sam:      Those guys had a good 2007 album. The Old school doom death metal! Melancholy filled melodies, sardonic lyrics, sleazy guitar work, and nice changes from slow tempo to mid paced tight riffing.  “Crawl at their feet  To their amusement, sick with disease  Their shining golden masks Conceal the putrid faces Disgusting choirs Swarms of flies darken the bleeding sky For they herald the arrival of Heaven Un climbable monolithic towers Effigies of desolation…”  I love these Middle Eastern sounding riffs in the middle of the song, very sleazy. Awesome vocalist, you can hear what the dude says… and he growls like he means it. Lyrics scorn the Muslim terrorism.  Other good bands:  Officium Triste, and The Morningside from Russia. Those Russian guys are very melodic. Officium Triste has an awesome song “Dream of Sorrow”.  Excellent melodies with those start stop riff constructs in the middle, elegant melodies… the perfect guitar solo towards the end.
Tony:     Joe, stop the vulgar remarks please. Sam, concentrate please, those guys are not a bad German underground metal band, pretty honest music, nice riffs. Let’s be like them, and study hard, just as they worked hard to make a good album in 2007. Russian band The Morningside is epic.   Continue, Vsevolod and Kris. Officium Triste are Dutch band, pretty sad keyboard work with down tuned guitar riffs. Metal mixed with Pink Floyd. Ok, let’s concentrate on the studying. Textbook mentions polydipsia?  Plus if we succeed we get to practice guitar riffs!
Kris:       Epic riffs! With balls! 
Vsevolod:            Fluid loss may be compensated by increased ingestion of water known as polydipsia.   Guys, we are adults…let’s concentrate on the work. Music becomes relevant, once we finish the notes and make a good grade, get a decent employment, and organize our activities, right? But to get there it takes a lot work, right?
Kris:       Polydypsia relates to the Diabettis Insipedus - fluid loss compensated by the increased digestion of water. More Urine comes in, urine volume goes up. If the teacher would describe the scenario with the increased fluid volume, it is a Polydypsia.  Note, the figure 3.4 gives a breakdown of both types of Diabetes, which is the same as we discussed previously, remember this chart folks…
Tony:     Specimen collection and specimen handling….That should be not very difficult. A specimen which contains suspicious stuff should be discarded. Once we get to work in the lab, we will be able to organize requirements better. The textbook provides some basic guidelines. Instructor was ranting about it in class kind of fast…
Sam:      She was… but she knows what she is talking about, come on, at least 10 years of lab work experience. Can we kick her ass intellectually theoretically?
Vsevolod:            What are the details?
Tony:                     Let’s see. Kris, the fat Bulgarian Gladiator… Sam, we do not know… let’s stop those false ambitions. They are counterproductive. We should work with the teacher, become partners. What do you want to win, a pie eating contest maybe?  Make the top grade in the class, and we are in epic shape.
Kris:       Go to hell. Ok… clean dry leak proof containers. The lids should be applied carefully; screw top lids will not leak so easily so they should be applied carefully. The laboratory technician should take time, do not rush…
Joe:        The ladies get special wide mouth containers, right? 
Kris:       Right… name, ID, patient clinical information, possible interfering substances, time the specimen was received, method of collection. Vsevolod got is with highlighter. Errors: unlabeled containers, nonmatching labels, feces, insufficient quantity of the species etc. So far so good; the specimen is handled in a peculiar way. Labs would provide their specialized conditions. Vsevolod, continue…
Vsevolod:            Folks, I propose to study a table 3.2.  Oxidation leads to a darkened color of urine. Clarity decreases due a multiplication of bacteria.  Precipitation of amorphous material occurs.  Odor increases, as the bacteria multiply.  Urea converts to ammonia, so the pH increases. Urease producing bacteria decrease the level of carbon dioxide.  Glycolysis decreases the level of glucose in the urine. Bacterial metabolism decreases the production of ketones in the body. Nitrite increases due a multiplication of nitrate producing bacteria. Alkaline urine disintegrates the red and white blood cells. Folks, are there any problems with those characteristics?
Kris:       What would the ideal specimen would be like? What would the preservatives be?
Vsevolod:            Tony do you have anything?
Tony:     Vsevolod, I let you speak, you Jewish anti bigotry warrior.
Vsevolod:            Ok. The most common specimen is the random specimen. So laboratory will receive a random specimen, it may be collected anytime, but the actual time of holding should be recorded in the container. Physical activity and dietary intake may distort the accuracy of the results. Patient will be responsible to collect the results under more controllable conditions; First morning specimen:  8 hour specimen. Patient collects it in the morning, and delivers it to the laboratory within the next 2 hours. Fasting specimen occurs after a period of not eating anything, useful for glucose monitoring. 2 hour post prandial specimen – the patient is instructed to void shortly before consuming a routing meal, collect a specimen 2 hours after eating…useful for insulin therapy.    Both, the fasting, and postprandial are compared for the glucose level.  Glucose tolerance tests provide an opportunity to test glucose and ketones in the body with a varied time. Institution has an option, whether or not to collect the specimen. Furthermore it evaluates the glucose metabolism. 24 hour specimen has a rather lengthy procedure, which looks kind of abysmal. It is a quantitative test, it must be timed thoroughly.  Diural variations change the metabolism during the day. So, the techs monitor the change by using a 24 hour specimen.   The specimen is collected using a hollow tube known as the catheter through the urethra into the bladder. If a routine urinalysis is requested, the culture should be performed first to prevent the contamination of a specimen.  Bacterial cultures are collected. Midstream clean catch specimen is used to provide a safer less traumatic method for obtaining urine for bacterial culture, and routine urinalysis. I need to take a short break to digest the whole spectrum of the information down. Well, the table 3.4 provides the basic characteristics of the test.
Kris:       I think, we should back up, and review the table.  The teacher may give us a situation, and we must describe the best possible test…. The quantitative tests are performed where?
Vsevolod, Sam, Tony, and Joe: Timed specimens
Kris: Routine urinalysis?  
Vsevolod: First morning specimen… 
Kris: Random specimen would not work to diagnose a Bladder infection… why?
Tony and Vsevolod: This is not an obvious abnormality.
Kris: Why would you think so? Is there a timing problem with 24 hour specimen?
Vsevolod:   I would think so. We should answer the questions on the end of the chapter….   

The team of five met at OCU library. They were preparing to do a few hour study set. Both trained in gym prior to the study sat. Sam, Vsevolod, and Joe run 9.6 miles while Tony and Kris lifted weights.  The team members would spend 10 minutes on a generalized discussion, then the studying.  Medical Laboratory exam preparation is in the agenda, followed by the lab preparation procedures. Resumes and careers should be discussed too.

Chapter 2
A fluff discussion… for the first 20 minutes followed by a 3 hour study set; Sam Vsevolod, and Joe write down the notecards for the exam, while Kris, and Tony listens and makes a corrections.
Sam:  We covered 9.3 miles in 65 minutes…I run from 8 miles per hour to 10 miles per hour, rotated tempos, last mile fucking 12 miles an hour.
Vsevolod: Good workout, but I am fucking tired, bro
Sam:  Rose state college has that thing, when you complete 26.4 miles, and get a shirt. We should do it in 2-3 sets. I am unable to handle a marathon….yet.  Joe, what do you think?
Joe: Let’s run 3 sets of 9 mile workouts in 4 days. The big guys, sorry we confused you.
Kris:  No problems, we both understand, I just walk 3 miles though. I hate fucking running man. But I can bench 320 pounds 5 times. That’s more than 2 Vsevolods; 2.2 Vsevolods or 2.2 Sams
Sam:  Good Lord…
 Vsevolod: Good for you Kris, we are both fit, but we train differently; in a real fight we would back each other up well, right?
Joe: I just saw a milf, dark hair, tall, with a low waist to hip ratio, green eyes…amazing curves in super tight jeans… Bless her heart..… Wow, did you see her?
Tony:  That was a beautiful and a graceful creature….  Most of them are arrogant elitist as hell though… They receive too much attention from the… hm… male apes.
Vsevolod: Well, I agree with Tony, the personality is so much more important…
Kris and Joe: then her big ass and slender waist?
Vsevolod:  Yes, Kris…ok let’s stop the vulgar shenanigans….I think we rested enough…
                Tony:       We have serious financial issues which need to be taken care of by the end of October…
                Vsevolod:  Let’s decide about the program… and take one day out of time…
Tony: We must get to work
                Kris: The resume should be updated, organized and uploaded, Sam Vsevolod and Joe should write notecards; then we should discuss every bloody notecard we write… Understood?
                Everyone: Ok… Compassion and desire to learn unites us… right?
                Kris: Epic shit dude… Epic… with balls!
               

Tony: Guys, you have 2.5 hours to write the notecards based on the material on the book. Information should be organized while keeping in mind the exam. You can listen to music, but not too loud. Listen to In Mourning, their 2009 album “Monolith”. Swedish progressive metal band; rotate with motivational audio, “Attitude activator by Rex Sikes”
Sam: Awesome album, they mix atmospheric Katatonia like melodies, (The Cold Red Distance) with lots of tempo changes, and death metal influences from bands like Amon Amarth, I even heard the Morbid Angel like riffs here and there. And Insomnium too (acoustic breaks); they have 3 guitarists, so a very dense guitar melodies. One guitarist plays a brutal groove riff, while the second and third nail the psychedelic melodies with those elegant changes…epic drummer…”Pale Eye Revelation” has this  closing bloody riff…with so much balls, and those fantastic melodies grab you by the… Metal on, I love this fucking music so much.
Tony: A very good band from Sweden, a lot of good Swedish bands. They do not suck at making music. Swedes In Mourning are a nice band. Their front man resurrected October Tide, the band who made two good albums in 1996, and 1998 and then quit. They had musicians from Katatonia. In Mourning and October Tide are awesome bands: The Melodic Extreme European Metal – Swedish school. I would put Finnish Band Insomnium as the Swedish school musicians; their music is strongly influenced by Early Swedish Metal Bands; the riffs are very elegant yet based on those harsh down tuned guitars, catchy, simple melodies layered a lot…the antidote to the abysmal American Mainstream Hip Hop trash. Let’s study, guys we took a good 30 min break…
Vsevolod: Calm down, will you Brother Sam? You get like counterproductive… relax clear your mind, and use music as a spiritual force…You are not a teeny bopper right, a 20 something adult, fucking hell Sam? Tony is right… let’s study hard, like those guys rock hard, right?
Kris: Calm down, let’s study…


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