Wednesday, February 22, 2017

Why do aggregation of platelets with Ristocetin is normal in Glanzmann's thrombasthenia but abnormal in Bernard–Soulier syndrome?



Normally aggregation of platelets is mediated through GpIIb-IIIa receptors on platelets which get attached to multivalent Von willebrand factor (vWF) or divalent fibrin molecules. The aggregation inducers for such type of aggregation (mediated by GpIIb-IIa) are ADP , Collagen and Thrombin (Factor IIa).
Another type of receptors on platelets, GpIb-IX-V are involved in platelet “adhesion” to sub-endothelial matrix or Collagen.
Ristocetin is an antibiotic which seems to have ability to attach itself to these GpIb-IX-V receptors and cause platelet “aggregation”.
Now since these GpIb-IX-V receptors are absent in Bernard–Soulier syndrome, Ristocetin is unable to aggregate platelets in this condition. However aggregation by ADP, collagen and thrombin is normal since it is mediated through GpIIb-IIIa receptors.
In Glanzmann's thrombasthenia due to absence of GpIIb-IIIa receptors aggregation by ADP, Collagen & thrombin is abnormal, but aggregation by Ristocetin is normal since GpIb-IX-V receptors are available.
Hope this clarifies your doubts.

Thursday, December 8, 2016

RxPG Interview with Dr Vaibhav Chintaman Yawalkar, 84th Rank, AIIMS 2012.

"One should make basic concepts clear. It’s good to have detailed understanding of subject which helps in long term" and my advice to the future aspirants is "Believe yourself….study hard….test yourself…rectify mistakes and you will get whatever you want." says Dr Vaibhav Chintaman Yawalkar (RxPG nick: “ @vaibhavyawalkar ”) who has secured 84th Rank in highly competitive AIIMS May 2012. In PGI DEC 2012 he has got an overall rank of 369 with 94 percentile and has also cleared the UPSC CMS. 

Our interviews team contacted him and managed to piece together some of the secrets behind his success in this wonderful interview. Read on...


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RxPG: What is the secret of your success in AIIMS exam? 

Dr Vaibhav Chintaman Yawalkar:
 Consistent study and mastering important topics, I also read some new topics for fresh questions that are often challenging and decide your rank in such highly competitive exam. 


RxPG: How did your parents, family and friends contribute to your success? 

Dr Vaibhav Chintaman Yawalkar:
 They supported me a lot! My friends took whatever they got last year but I decided to study for one more year. There was no pressure from their side and hence I could study to my fullest. 


RxPG: Had you not been successful in AIIMS, what would have been your reaction? Did you have a backup plan? 

Dr Vaibhav Chintaman Yawalkar:
 From my experience in previous aiims exams I came to know the fact that in such exams where thousands of candidates appear for very few seats (within two digits), and where you have to beat best of the best students, you must give an extra-ordinary performance to succeed. In last session I had made few silly mistakes and missed rank by very small margin. So this time I was very cautious and tried my best to avoid those mistakes and when after exam I checked all my answers I was confident about securing at least good rank if not the best. But given the degree of competition I always knew anything can happen, after all Rank is a relative term, it depends on how you have performed relative to others and if you don’t find your result as per expectations this means people have performed better than you, though it is disappointing, it helps to keep cool if you understand the depth of competition, and also helps to update yourself. 
With NEETPG exam soon after aiims, a good backup plan was always available. 


RxPG: Whom do you attribute your success to? 

Dr Vaibhav Chintaman Yawalkar:
 To my parents and friends. When you are not delivering as per your standards you have to face lot of criticism but in these bad times there are only few friends who STILL support you and expect you to succeed, some of my close friends have big role in my success. 


RxPG: Who influenced you to take up Medicine? 

Dr Vaibhav Chintaman Yawalkar:
 I am kind of a techy guy. I was very good at math and physics and had very good ranks in engineering entrance exams. It’s only because of my parents I took up medicine. It was their wish to see their son as doctor. I hated biology like anything but in the end I had to choose this field. In first year I thought I had made biggest mistake by opting for MBBS, it’s only in second year when I read Robbin’s pathology I found interest in this field. And I started to take things seriously. 


RxPG: We appreciate the fact that preparing for an extremely competitive exam must be really challenging. During your preparation, did you ever doubt your ability to succeed in it? 

Dr Vaibhav Chintaman Yawalkar:
 As I said rank is relative term. It’s not like you have to score above any certain cutoff and then only you will succeed, the fact is that you just have to beat others. And in exam like aiims where not even a single mistake is allowed no one can be sure of getting success (of course except few extra-ordinary students). So pressure was always there. And only way to relieve pressure is to secure good rank in all India mock tests consistently. Bad performance in any test and pressure builds up. Finally at some point you get some internal feeling that you can make it big and then you don’t have to look back but just to study consistently. 


RxPG: How much time do you think one requires for serious preparation for this examination? 

Dr Vaibhav Chintaman Yawalkar:
 It depends on what was your approach in UG days. People like me who spent most of their time enjoying and had no orientation for PG entrance hardly succeed in first attempt. Plus I had to do heavy internship in my college so I could not read many subjects during internship. I took one more year after internship to succeed. But planned study during internship can get you good rank in first attempt. Nowadays students are oriented well towards these exams during UG years itself, so we are seeing lot of students cracking these exams in their first attempt. Dedicated study for one full year is must to get a rank in two digits. 


RxPG: When did you seriously start preparing for this exam? 

Dr Vaibhav Chintaman Yawalkar:
 Only after my internship when I had exclusive time to study. 


RxPG: Which books did you read for the theory part? 

Dr Vaibhav Chintaman Yawalkar:
 I had read most of standard reference books in UG for every subject and that helped me a lot. While preparing for PG I didn’t read every topic from theory books, but wherever required I regained understanding of that particular topic from reference books. Some complicated topics must be revised and you should make your concepts clear as these will save your time later and also will help you to answer twisted questions. Particularly for aiims you cannot depend on MCQs books only. According to me Ganong’s physiology is excellent book to build your concepts. I also used Lippincott’s biochemistry, KDT (pharmac), Robbins (pathology), Khurana (ophthalmology) and harrison’s for few topics of medicine. 

I hardly referred theory books for anatomy, micro, FMT, ENT, PSM, surgery, obs & gynecology and pediatrics. 


RxPG: Which books did you read for MCQ revision? Which revision books were the most productive and which were least? 

Dr Vaibhav Chintaman Yawalkar:
 I think Aiims previous year solved papers by Amit-ashish and All India solved papers by dr. mudit khanna are the best books to read for any pg entrance exam. Particularly Amit-ashish is unique source of quality information contained in a single book. The way they have explained their approach for every question helps you to build your understanding of that topic. 
The common problem we face while preparing for pg entrance is that no single book contains all information you must know about that topic. But amit-ashish have given enough of information for every topic. I had made separate notes for each year aiims paper, wherever I thought information is not sufficient I would note down the question no. and page no. from amit-ashish and then add my own points to it. People say that few mistakes are there but then these are very very few and expected from anyone given that question has been asked by aiims board. it’s like marking answer in exam confidently after extensive thinking and realizing that it was your silly mistake as you have forgotten to think on some very trivial aspect regarding that question, authors are no exception to “doing silly mistakes” rule 
I also read subject wise MCQs books. Most productive were Across (anat, biochem, physio, FMT, ortho, ophthalm, skin, anesthesia, radio, psychiatry), Pharmac (Govind garg: Another best book for any PG entrance). 

Micro (Rachana chaurasia): in aiims papers, questions asked in micro are very limited (both in no. and range of topics). Most of the times they are repeated as such from previous years. You can do better in micro by just reading previous years que. Papers. But as you have to appear for different exams (including NEET now) you cannot take chances to miss important subject like micro. I did not use any reference book for this subject as MCQ oriented study is enough for it. You can check out different books available in market, I read rachana chaurasia and found good enough. Just to give you advice, make topics from parasitology and fungi perfect, as you just have to read few pages only and most of the time question asked on these topics looks like a bouncer which in fact is an easy question. Plus exams like NEET and state boards are very fond of these topics unlike aiims. 

Patho: Aiims and all India papers cover this subject almost completely. Most of the questions are asked on neoplasia, inflammation and hematology better to read these topics from Robbins. You can also use subject wise mcq book if you can manage your time. 

ENT: no of questions are increasing in this subject and Arvind arora’s ENT is very good book. You can finish it in just two days. 

PSM: this is the subject where reading a subject wise mcq book is very very important. I had read Arvind arora. Other good books are also available. 

Ophthalmology: though Across is too lengthy to read but you can use it to read selected topics only. 

For medicine, surgery and obgy all India /aiims volumes cover most of the topics. But amit-ashish subject wise book on medicine helped me a lot. You don’t need to do all questions from this book given at the end, but read all explanations. Use internet for getting latest updates on all major subjects. Sakshi arora’s obs and gyanaecology is also a good book to read if you can manage time. 
For major subjects I had discussed most of topics with my friends e.g. treatment protocols and management in surgical problems based on conditions etc.. Major subjects are like general knowledge and you should discuss them rather than just reading, because questions on these subjects will be based on understanding rather than on plain facts. Read topics asked in recent papers from Harrison. 
Also go through first 7 chapters from GHAI (pediatrics) or Nelson. 


RxPG: How important you think is internet in preparation? 

Dr Vaibhav Chintaman Yawalkar:
 Very important as for as new updates in any subject are concerned. Also time is always less when you are preparing for PG. so if you have such a tool which will give you any information within seconds rather than wasting hours to search it in reference books, you can save precious time. And I observed that you often remember things when you have searched that for some question which has troubled you. Sometimes you come to know about new info on the topic you have searched and you can have question on it in aiims. So if use wisely internet is really useful. 


RxPG: What do you think is the better way of preparation between selective, intensive study and wide, extensive study? What did you choose as your style of studying? 

Dr Vaibhav Chintaman Yawalkar:
 Selective study is always good. You don’t need to know every piece of information. Most of questions in aiims are related to clinical scenarios, and you must focus on clinical aspects of each subject. Like this aiims paper (Nov. 2012) was one of the best from aiims, it tested concepts in every subject. And that’s why previous year que. Papers are important; you can predict important topics for upcoming exams. Also syllabus is too extensive that you cannot finish it in time (rather no one can finish it). So target a topic…get reliable source and make it perfect. 


RxPG: Cramming for Indian PG entrances is often taxing for the brain and many people struggle with retention of facts. Did you face this problem as well? If so, how did you deal with it? 

Dr Vaibhav Chintaman Yawalkar:
 Yes it’s true that you need to remember infinite no. of facts. In aiims paper there is fine balance of factual questions and clinical or conceptual questions, so it is not a big problem with aiims as completely new factual questions are not answered by almost all students. But most state exams (and now NEET) ask large no. of questions on factual data. It is impossible to retain everything. So here also selective study helps. Making mnemonics is a good way to lessen this burden, you must know frequently asked factual questions for this we can make charts and paste them on walls of your study room so that the more you read them more you retain. Also discussing with friends helps to retain those facts for longer period. 


RxPG: Indian PG entrances are highly competitive so to compete them students end up in appearing in multiple PG exams , kindly extend your views on this & also their pro’s & con’s of appearing in multiple PG entrances. 

Dr Vaibhav Chintaman Yawalkar:
 It’s good to have single entrance exam, rather than filling applications separately and travelling to various cities to appear for them. But it should be a single paper exam and not like multiple papers as taken by NBE this year. Firstly they are asking fact based questions and also repeating them from session to session, so whatever mathematical equations they may apply but they can’t reach close to assessment done on basis of single paper. Such pattern of multiple papers works when questions are concept based like in mathematics and physics, where approach of individual candidates is tested and not just retention of facts. 
One should appear for all the pg entrance exams conducted in that year, as syllabus is same and you can test yourself and learn from your mistakes. For this more emphasis should be given on subject wise preparation rather than sticking to question bank of any single exam. Due to repeat questions though, one should always go through recent question papers of whatever exam you are appearing for. 


RxPG: How many exams have you appeared? 

Dr Vaibhav Chintaman Yawalkar:
 I appeared for almost all exams. UPSC-CMS, DNB, NIMHANS, AIIMS, PGI, NEET etc. got significant success in each of them. 


RxPG: Had you appeared in more than one exam which one attracted / you liked the most? 

Dr Vaibhav Chintaman Yawalkar:
 Obviously AIIMS. For fine balance of conceptual and factual questions. Every question makes you think, invites you to make silly mistakes and plays with your psychology and sometimes traps you. 


RxPG: Had you appeared in more than one exam which one you think was the most hardest / most difficult one and why did you felt so ? & what would be your advice for future aspirants so that they would be well prepared to face it confidently ? 

Dr Vaibhav Chintaman Yawalkar:
 Due to large no. of candidates appearing for very few seats and competition itself being among best of the best students, AIIMS exam is hardest to crack. Similar is the case with PGI. In PGI you need to know everything from basic to latest research based information. Also to get a good rank in PGI great accuracy is very important as there is relatively higher negative marking. 

To crack AIIMS two most important things are: 

A) You should know correct answer for every repeat question by heart. If you mark even a single repeat wrong it can have significant impact on your rank. 
B) Avoid silly mistakes. 
If you can make above things right there are high chances that you will get good rank. 

Leave completely new questions unmarked as no one can answer them. But take care that you attempt above 190 questions. I had attempted 196 questions in November 2012 aiims exam, and out of them I think I marked around 150 questions right. 

For PGI read recent papers from MANOJ CHAUDHARI’s book, critical medicine from Harrison, Skin from across (in detail), biochem from Lippincott, ENT (from AA in detail), immunology from any good book, and no need of separate preparation for rest of subjects. 

Manage your time well while writing exam, as you won’t get second chance to go through all questions. Keep conservative approach do not mark any option if you know nothing about it. 

Do not mark too many options. Some options can be guessed to be correct depending on the direction of question and with help of other options in that question. 

If you can arrive at conclusion that particular option can’t be correct, your score increases as in that case you lessen your negative marks. 

Make sure that you manage your time well and able to read all questions as if you miss even a single question, then it means you have missed as much as 5 options to deal with. 


RxPG: Did you attend any coaching? Were they useful? 

Dr Vaibhav Chintaman Yawalkar:
 Yes I had joined classes only after failing in first attempt. Classes definitely help you if you manage your time well, though they are not must and many students have got great success with self preparation only. 

Since they teach whole subject in only 2 to 3 days, it is good to have orientation regarding important topics before you attend them. In this regard since I had joined classes after myself preparation, every class was like fast revision of all topics plus I could clear all of my doubts and could discuss imp topics with experts. 

But do not entirely depend on class notes as they do not cover everything, notes are good for new updates and to find answers for controversial questions. Besides classes keep you on track, give sense of competition and your schedule get executed properly. If you think you are weak in any subject, you can attend respective classes for that individual subject. 


RxPG: What was your daily timetable during the preparation? Why did you decide on such a timetable? Were you able to stick to the timetable strictly? 

Dr Vaibhav Chintaman Yawalkar:
 At the start of year I had plenty of time to study. I did not follow any specific time-table in initial months. My aim was to master short subjects first as I found I was very weak in these subjects. I read across for skin, anesthesia, radio and psychiatry first, For 20 straight days. I used to start my study at 8 am and read up to 12 pm. Then again from 1 pm to 5 pm and then 6 pm to 9 pm. And finally from 10 pm to 1 am. 
After I joined classes I had to read according to their schedule and I finished those subjects from all India/aiims volumes. 
After classes got over I had finished each subject from volumes and so in later months I divided my time in two slots. From morning to 5 pm I used to read whole question paper (aiims/all India) covering all subjects and from evening to midnight I used to read subject wise mcq books of those subjects which I found difficult. 
Refreshment is must on weekends. 


RxPG: Which subjects did you focus on? 

Dr Vaibhav Chintaman Yawalkar:
 Short subjects initially and after mastering them I moved to major subjects. Most students do well in major subjects but few bouncers from short subjects do have great impact on your final score. Grand tests cover most questions from major subjects and you automatically remain in touch with them all the time so according to me major subjects are not major problems. But one should be perfect in subjects like physiology, pharmac, patho and PSM. 


RxPG: What was your strategy for the revision? How many revisions did you do? 

Dr Vaibhav Chintaman Yawalkar:
 I could read previous year papers two times up to year 2000 and one more reading for last 3 year papers. Most of subject wise mcq books, I could read only once (but I kept on revising imp topics from each book from time to time). Few books I could read twice, especially govind garg’s pharmacology, PSM and Across (first year subjects). 


RxPG: What was your strategy for the exam day? How many questions did you attempt and why? 

Dr Vaibhav Chintaman Yawalkar:
 I had made special notes to read one day before exam (while in travel); it contained some factual data which I used to forget often. And some important mnemonics. Some previous year questions which I was making wrong all the time. Some illustrative charts so that I could cover maximum information in little time. 
Initially I had attempted 180 questions. But I knew though I will be in the list by attempting this much, I was not sure of getting a good rank. I had 25 more minutes to attempt rest of 20 questions. After going through them I decided not to attempt 4 of them as I had no knowledge about those questions. Most of them were factual questions. Later I attempted remaining 16 questions by carefully excluding options, though I was not sure of correct option in any question. Most of the time I had to choose between two. Later I found I got around 10 of them correct. According to me one should always attempt at least 190. (Still it depends on how much confident you are with your marked answers) 


RxPG: After the exam, you must have checked your answers with textbooks and the community prepared answer key here at RxPG. What was your approximate calculated score? 

Dr Vaibhav Chintaman Yawalkar:
 As per Rxpg key and some answers confirmed by myself I was getting around 63 to 64 %. 


RxPG: What is your impression of the AIIMS exam? Is it fair? 

Dr Vaibhav Chintaman Yawalkar:
 Regarding pattern of exam I really like the paper composition. They largely test you on conceptual and clinical questions with few factual questions. But I feel no. of repeat questions should be minimum. Like this paper (nov 2012) was one of the best from aiims, it contained very few repeats and factual questions, and many questions were based on concepts. 
Regarding malpractices no one knows what happens in the background, but looking at the consistent performance of aiims toppers in various other pg entrance exams it must be fair enough. 


RxPG: Is the pattern of the examination appropriate? Would you recommend any improvement? 

Dr Vaibhav Chintaman Yawalkar:
 It will be good if they keep less number of repeat questions. 


RxPG: What do you want to specialize in, why and where? 

Dr Vaibhav Chintaman Yawalkar:
 I want to do pg in Radio diagnosis. It suits to my lifestyle. Of course from any good institute. 


RxPG: How were you attracted to this speciality you’ve chosen & how you see your future in this specialization ? 

Dr Vaibhav Chintaman Yawalkar:
 I want plenty of spare time to nurture my interests. Besides I love computers and technology and I think I can use this knowledge in this branch well. To be honest it is only because it suits my lifestyle. 


RxPG: What is the potential of your choice of specialisation in future ? 

Dr Vaibhav Chintaman Yawalkar:
 Day by day role of technology is increasing in medicine and early diagnosis can make things easier. It has immense role both in diagnosis and therapy. 


RxPG: Is there a high demand for your specialisation of choice ? 

Dr Vaibhav Chintaman Yawalkar:
 Of course! 


RxPG: RxPG is the largest and most active community website for medical students. How do you visualize the role of RxPG in molding the careers of the medicos? 

Dr Vaibhav Chintaman Yawalkar:
 Rxpg is a great platform for medicos. Both for educational purpose and as medium for social networking exclusively for all doctors all over the world. Lot of information is available regarding various branches and one can go through experiences shared by people already in those branches. It can help you to choose appropriate branch for yourself based on your interests. Beside it has largest collection of mnemonics, various lists for factual questions, discussion regarding controversial questions, tools for revisions, and most importantly you can instantly clear your doubts to save your precious time. 


RxPG: How did RxPG help you in your preparation? 

Dr Vaibhav Chintaman Yawalkar:
 As I said above great mnemonics and lists of factual questions have helped me a lot during my preparation. Rxpg has been source of important updates regarding various exams. Also active discussions, getting answers for controversial questions, answer keys for calculating your score and strategies from toppers helped me a lot! 


RxPG: When did you join RxPG and how did you come to know about it? 

Dr Vaibhav Chintaman Yawalkar:
 I joined it when I was in first year MBBS (2006); don’t know exactly how I came to know about it. May be I found it on my own. 


RxPG: What is your opinion about RxPG & its new support team for interviews ? 

Dr Vaibhav Chintaman Yawalkar:
 It was a great experience to write this interview and yes support team is really helpful. Many interviews are already there on rxpg website which have helped me and I am sure this will help all doctors who are preparing for various entrance exams. 


RxPG: What is your feeling about you being interviewed and your interview going to be published in RxPG the largest and most active community website for doctors and medical students worldwide. 

Dr Vaibhav Chintaman Yawalkar:
 It feels great. I have been part of this community for almost 6 years now. Have used all resources available on this site and now I am really happy that I could contribute to rxpg. 


RxPG: RxPG is developing the website to be able to cater to the needs of students who are doing post-graduation and super-specialization. Can you suggest a few features you would like to see in RxPG which can be useful to you during your post graduation? 

Dr Vaibhav Chintaman Yawalkar:
 How about starting monthly test series for rxpg users both for those preparing for PG and who are doing PG and giving credits for same. And then active discussion for that paper would enrich our knowledge. 


RxPG: RxPG has developed a new forum Grand rounds and Clinical case discussion what is opinion on this new forum & what changes you suggest that may be done to make this forum that every single member takes part in it and discussed his / her’s every day interesting / terrific / unsolvable cases ? 

Dr Vaibhav Chintaman Yawalkar:
 Have not checked it yet. But sounds interesting and I am looking forward to it. 


RxPG: As we see on RxPG website, most of the doctors and medical students Are somewhat disillusioned by medicine as a career and some seriously Think about a career change. What would you like to say to them? 

Dr Vaibhav Chintaman Yawalkar:
 Comparing with our counterparts who graduated in other fields, we have to study for more years and competition is also more. It’s quite frustrating to read for years without job and spending these golden days only reading day and night. I think that is the main reason why most of doctors think about career change. But once you settled in this field things get bigger and you finally reach at that stage which you had dreamed at time of entering in this field. Patience is all that is required. 
But if any doctor is confident enough of changing his career he can go ahead with it. Many of my friends have cracked IAS exam. In medicine we learn art of reading extensively and deal with huge syllabus and it’s not difficult to use these skills in other fields. 


RxPG: If God asked you choose your profession again, what would it be and why? 

Dr Vaibhav Chintaman Yawalkar:
 To be honest I was not very passionate about medicine but I am happy the way things have gone for me. I would choose any field related to medicine but this time any research oriented field such as genetics/ genetic engineering. I found it really interesting. 


RxPG: If a youngster of about 10th – 12th schooling wanted to take up Doctor as a career, how should he proceed ? How should a medical student , in his early years proceed if he wanted to take up such highly competitive exams ? 

Dr Vaibhav Chintaman Yawalkar:
 One should make basic concepts clear. It’s good to have detailed understanding of subject which helps in long term. Basically any subject should be divided in two portions, first: conceptual data (like a processor of a computer) and second: factual data (like hard disc). If your processor is good you will develop interest in that subject and then dealing with factual data is not a big task. 
Any medico should master basic preclinical subjects like anatomy, physio, biochem, pharmac and patho first, and try to read everything from standard reference books. Apply and validate these facts in actual situations so that you will retain them permanently. Also one can go through short MCQ books available for individual subjects. 


RxPG: What is your advice to the future aspirants? 

Dr Vaibhav Chintaman Yawalkar:
 Believe yourself….study hard….test yourself…rectify mistakes and you will get whatever you want. 



RxPG: Please write a paragraph about yourself, your college, your hobbies and extracurricular interests as well. 

Dr Vaibhav Chintaman Yawalkar:
 Myself VAIBHAV CHINTAMAN YAWALKAR, I did my MBBS from Shri. Vasantrao Naik govt. medical college , Yavatmal. State : Maharashtra. 

I am kind of techy guy, love to read novels, spend most of time on internet and like to work with technology. As a doctor I feel it’s really interesting to reach at diagnosis by observing every minute detail in any complicated case and then treating the same.