My Two Cents

Josh Chen

I said: it’s like being a fountain.

Response: polite interest versus disinterest.

So I continued: random people come and flip coins into the water. Some are worth more than others. It can happen anytime – rounds, walking to lunch, in the elevator – I try to write them down so I don’t forget.

No response. 

So I continued: I mean who knows if they’ll be useful in the end but at least they’re interesting! Here are some that I thought were cool:

• Grunting provides PEEP for babies - bearing down on semi-closed epiglottis provides backpressure which props open alveoli

• Mush + push = bowel movement, no mush OR no push = no bowel movement, it can take months for bowels to heal after injury so need to keep supporting mushing + pushing long term

• Methimazole prevents iodine incorporation in thyroid hormone synthesis through thyroid peroxidase inhibition

• Murmurs occurring during the isovolumetric contraction phase (e.g. holosystolic) indicate blood is moving when it shouldn’t be, meaning there’s a defect somewhere

• Erythema toxicum needs a new name

• Echo measures velocity (pressures are estimates), CT is best for anatomy, MRI is needed to determine perfusion

• Urea cycle diseases have absent ketones and hyperammonemia without acidosis

• For patients with Marfan syndrome, losartan inhibits TGF-beta pathway to prevent further aortic root dilation

• If you have a patient who uses alpha lipoic acid who presents with membranous nephropathy, check anti-NELL1

• Short head of biceps tendon has 90% of power, so long head ruptures are almost never repaired. Long live Popeye!

• Romberg was German

• Hypertension causes vascular ‘onion skinning’ to protect end organs

• Not all that wheezes is asthma

• Steroids induce a catabolic state which can increase BUN

Response: weird coins. Strange fountain.