“Tagisan ng Talino”
An Academic Quiz Contest

TNT 4 WEBSITE Goal: To challenge the medical students to broaden their knowledge and academic skills by developing interesting and challenging topics into potentially publishable articles or presentable audiovisual documents through reading and research using reference textbooks and published materials, accessing recent publications both written and from  cyberspace, and availing themselves of the assistance and advice of more senior medical professionals including the interns, residents, and faculty members. This is in line with one of the great pillars of Tau Mu Sigma Phi Fraternity, its ideal of academic excellence.

Sponsor: This will be fully and solely funded by the Tau Mu Sigma Phi Fraternity, including the the medical student Tauans, the Tau Mu Alumni Organization (TAO-Philippines) and the Tau Mu Sigma Phi USA Foundation.

Contestants: All legitimately enrolled medical students from freshmen to junior interns can participate as individuals or as teams.

Contests: Quizzes in any imaginable form including but not limited to questions, phrases, graphs, tracings, photographs or any combination thereof can be presented. These will be posted on the Tau Mu bulletin board on a Monday every two weeks. Entries are collected the following Monday for evaluation by a panel of judges. Cash awards are given on alternate Mondays.

Quizzes: Initially Tau Mu Sigma Phi alumni will submit the quizzes but anybody is welcome to submit one for consideration by the Tau Mu TNT committee. We especially welcome the Faculty and the Hospital Staff and members of USTMAA Philippines and the USTMAA America to participate in this educational endeavor.

Judges: At least three specialists appropriate to the quizzes being presented will be invited to act as judges. We again request the Faculty and the Hospital Staff and other Thomasian medical alumni in various specialties to cooperate in this endeavor.

Reward: An unrestricted grant of P 1,000 (one thousand pesos) is given the winner of each academic quiz. This will be awarded the Monday after the posting of the following quiz.

Entries: Tau Mu Sigma Phi recognizes that the entries are the intellectual property of the contestants. However participation in this contest automatically gives the right to Tau Mu Sigma Phi to publish the entry in whatever form it may deem appropriate.

I. Tau Mu TNT is an academic quiz that is going to be launched every other week on a Friday morning. The participants can submit their digitized entry in the succeeding week with deadline of submission being on Friday at 5 PM.
II. The entries are evaluated by the Panel of Experts selected by the TNT Quiz Committee and shall submit its decision on Monday morning. The winner shall be posted on the Tau Mu Sigma Phi bulletin board and the entry made available for reading by any interested party.
III. The TNT Quiz Committee shall be made up of alumni of the Tau Mu Sigma Phi both from the Philippines and the USA.
IV. The Panel of Experts can be consultants or specialists on the topic that is being covered by the quiz and shall never at least three, at least one of whom shall be a member of the Faculty of Medicine and Surgery.
V. The quiz can be in the form of a statement, a question, a graph, an image, an identified specimen or any combination thereof.
VI. The entries shall be judged on the basis of how completely and broadly they are developed and presented, how they are researched and referenced, how much consultation with experts was utilized if necessary, etc. The hope is that the entries are good enough for publication in peer-reviewed journals.
VII. The entries are the property of the participants but Tau Mu Sigma Phi shall have the right to a copy for its permanent records and to publish the entry in any publication it deems appropriate.


Tau Mu TNT is Launched

From the TNT Newsletter dated 03/08/14 by Bro. Dr. Primo Aquino Andres Jr., Lucky 13

The first Tau Mu TNT(Tagisan Ng Talino) academic contest was finally launched after almost a year of planning by the different divisions of Tau Mu Sigma Phi Fraternity, the Medical Student Body that is the face of the fraternity, the Thomasian Alumni Organization(TAO) consisting of Philippine alumni, and the Tau Mu USA, consisting of International alumni mainly coming from USA.

1617416_688738857836773_1285613531_oTau Mu TNT is intended to challenge all the students of UST Faculty of Medicine and Surgery to excel in developing topics that can be presented in any forum including oral presentations, poster sessions and even for possible submission for consideration in peer-reviewed publications. It is hoped that students learn how to research topics that are covered using all their resources including text books, journals, the internet and even consultation with the faculty and consultants of not only UST but anybody that they deem helpful.

Winner in this initial contest is Ms. Danna Marie O. Madura, a sophomore belonging to Section C. She gave an excellent concise yet very complete presentation about a urine specimen of Bence Jones protein. The quiz was submitted by a Tauan Gastroenterologist from Akron, Ohio, USA, Bro. Dr. Reynaldo Carlos Gacad, 12 Tauan Apostles, UST Medicine Class 1983. The full test of Ms. Madura’s winning entry is published in this article. The contest is rolled out every two weeks and is published in the Tau Mu bulletin board and online using the more popular media like Facebook for broader dissemination.

TNT4WS2Entries are expected to be in digital format for easy transmission to members of the panels of consultants who review the entries and recommend winners to the Tau Mu TNT Committee. The entries are properties of the contestants but Tau Mu Sigma Phi is given the right to publish them in any publication it deems appropriate. Unrestricted grants amounting to a minimum of P1000 is awarded to the winners. It is anticipated that larger grants will be given during special events like the Medicine Week. The Tau Mu TNT is in keeping with one of the ideals of the Fraternity, Academic Excellence. The others are Leadership, Service and Brotherhood.

The winning entry by Ms. Danna Marie O. Madura, Section 2C

60 y/o with chronic back pain with anemia, renal failure, severe constipation and dehydration

Urine mircoscopy at 60 degree shown at opposite side:

TNT4WS11. What is the main component of above urine abnormality?
The micrograph shows a birefringent amyloid cast. Amyloid is made up of continuous, nonbranching fibrils 7.5-10 nm in diameter with a beta pleated sheet conformation. This structure is responsible for birefringence on polarized microscopy. In this particular patient, the amyloid is of the AL type and is composed of monoclonal kappa/lambda light chains, also known as Bence Jones proteins.

2. What type of cells produced this abnormality?
The Bence Jones protein is produced by neoplastic plasma cells in the bone marrow. The light chains, especially those of the lambda 6 and lambda 3 families, are toxic to renal epithelial cells, which leads to proteinuria

3. What common OTC medication taken in excessive amount can produce false postive result.?
Bence Jones proteinuria can be determined using sulfosalicyclic acid precipitation, in which 3 ml of supernatant urine is added to an equivalent volume of 3% sulfosalicylic acid. Turbidity with this method indicates a positive result. Albumin, globulins, glycoproteins, and Bence Jones proteins are all detected. Aspirin, otherwise known as acetylsalicylic acid, is excreted in the urine, and in excessive amounts can cause a false positive result by causing precipitation of other protein components in the urine.

4. What laboratory can be ordered to diagnose the cause of constipation and dehydration?
The constipation and dehydration are indicative of hypercalcemia; therefore, the first laboratory examination to carry out is serum calcium and ionized calcium determination. Normal serum calcium levels are 2.2-2.6 mmol/L (SI) and 8.7-10.2 mg/dL(conventional); ionized calcium values are 1.12- 1.32 mmol/L (SI) and 4.5-5.3mg/dl (conventional). Mild hypercalcemia is characterized by serum concentrations of 11-11.5 mg/dL, while severe hypercalcemia exceeds 13mg/dL.

Once true hypercalcemia is established, PTH determination may be undertaken to rule out hyperparathyroidism; normal values are 8-51 ng/L (SI) and 8-51pg/mL. A suppressed PTH level alongside hypercalcemia is consistent with non-parathyroid hypercalcemia, mostlikely due to a malignant cause. However, considering the patient’s clinical presentation, the definitive diagnostic test would be immunoelectrophoresis. In 99% of patients with multiple myeloma, laboratory tests reveal increased immunoglobulins in the blood. Serum electrophoresis would show an M-spot, a homogeneous band in the gamma- or beta-globulin region. The serum M component will be IgG in 53% of patients, IgA in 25%, and IgD in 1%, and only light chains in 20% of patients.

5. What is the the urine microscopy and clinical diagnoses?
Based on the patient’s sex, age, chronic back pain, anemia, renal failure, constipation, and dehydration, the most likely diagnosis is multiple myeloma. Multiple myeloma has a higher incidence in males, and is rare in people under 40. The mean age at diagnosis is 62 years. The tumors of multiple myeloma, plasmacytomas, originate in the medullary cavity and progressively erode bone with characteristic punched out lesions on X-ray.

The most common site affected is the vertebral column, hence the chronic back pain. The lytic lesions result in increased mobilization of calcium from bone, leading to symptomatic hypercalcemia. This manifested as constipation in this patient, as well as dehydration due to polyuria and polydipsia. The renal failure is brought about by hypercalcemia which impairs renal concentrating ability as well as the light chain deposition, which causes tubular damage by their cytotoxic effects. The anemia of multiple myeloma is normocytic and normochromic, and is due both to the encroachment on the bone marrow hematopoietic elements as well as a decrease in erythropoietin caused by renal failure.

Unfortunately for this patient, the prognosis is poor, with a median survival time of 4-6 years. Treatment consists of cytotoxic agents such as melphalan and thalidomide, corticosteroids, and administration of bisphosphonates for fracture prevention. Bone marrow transplant prolongs life but is not curative.

Fauci et al. eds Harrison’s Principles of Internal Medicine. 17th ed. Mc Graw Hill. 2008.
Kumar et al. eds Robbins and Cotran Pathologic Basis of Disease. 8th ed. Saunders Elsevier. 2010.
McPherson, Pincus eds.Henry’s Clinical Diagnosis and Management by Laboratory Methods, 21st ed. Saunders Elsevier. 2007.