Friday, 5 July 2013

Some general points

What does the allantois become
Umbilical cord and placenta

Reiter's Syndrome
Can't see Can't pee Can't climb a tree

Sjogren's Syndrome
-Dry eyes, dry mouth, arthiritis
-From autoantibodies attacking exocrine glands

Hydatid Cyst
Parasitic infection by echinococcus that causes cysts to form
-Rupture can lead to shock

Gallstone lodged in the common bile duct. What will you see?
-Conjugated hyperbilirubinemia
-Increased urinary secretion of conjugated bilirubin (causing the urine to darken) because the conjugated bilirubin "backs up" and regurgitates into the circulation. Conjugated bilirubin is water soluble so it can be filtered by the kidney and show up in the urine (leading to tea colored urine)
-Decreased secretion of conjugated bilirubin into the gut (causing decreased brown color of stool)
-Decreased urobilinogen production in the gut with resulting decreased absorption and decreased urinary urobilinogen

Urinary urobilinogen
-Bilirubin secreted in bile is metabolized by gut bacteria to urobilinogen
-Most urobilinogen remains in the gut and gives stool its brown color
-Some urobilinogen is absorbed by the ileum and enters the enterohepatic circulation and some of this urobilinogen ends up in the urine
-If there is an obstruction of the common bile duct, less urobilinogen will reach the small intestine and less will enter the hepatic portal vein and urinary urobilinogen will be decreased

Clindamycin
Antibiotic that commonly causes overgrowth of Clostridium Difficile leading to pseudomembrane colitis
Tx with metronidazole (and maybe vancomycin)

In Zollinger-Ellison syndrome, where are most ulcers located?
Multiple duodenal ulcers are more common than gastric ulcers (because the stomach wall can resist the acid)

Apoprotein CII
-Chylomicron protein that turns on liprotein lipase, VLDL, IDL, and HDL.
-Deficiency of CII is found in primary hyperlipidemia with very high chylomicron levels

Primary hyperlipidemia
-Abnormal endothelial cell lipoprotein lipase (responsible for clearing TG from the chylomicron cone and thus producing easily absorbable free fatty acids and glycerol)
-Failure of lipoprotein lipase causes inability to utilize chylomicrons and their persistence in the blood stream

Apolipoprotein A1
Found in HDL

Apolipoprotein B48
-In chylomicrons and is used to combine with TF, phospholipids, and cholesterol esters during chylomicron formation
-Structural role

Apolipoprotein B100
-Found in VLDL, IDL, LDL and provides structural support

Apolipoprotein E
found in all lipoproteins (including chylomicrons) and helps lipoproteins bind to cell surface receptors

How does the secretin test work on patients with Zollinger Ellison syndrome?
Abnormal rise in Gastrin levels after the injection of secretin.

What cancer risks are associated with celiac disease?
Intestinal lymphoma and breast cancer

Where is Type A and B Gastritis located?
Type A: Fundus
Type B: Antral

Choledocholithiasis
Stone in the common bile duct

Charcot's triad is...
1) Fever
2) Jaundice
3) RUQ Pain
indicative of cholangitis (infection of the biliary tree proximal to an obstruction)

Mechanism of Aprepitant (Emend)
-NK1 receptor angagonist
-Neurokinin A and Neurokinin B act on NK1 and NK2 receptors in the CNS (related to substance P) that control the emetic response.
-Used for chemotherapy-induced nausea and vomiting

Bronabinol (Marinol)
-Cannabinoid for chemitherapy induced N/V

Prochlorperazine (Compazine)
Dopamine antagonist used to treat N/V

Lorazepam (Ativan) and diazepam (Valium)
-Benzodiazepines that bind to GABA receptors to enhance GABAergic transmission
-Useful in anticipatory emesis and treatment of vertigo

Scopolamine
-Muscarinic antagonist to treat motion sickness and preoperative nausea
-Not used to treat N/V from chemo

Ondansetron (Zofran) and granisetron (Kytril)
-5-HT3 antagonists used for chemotherapy-induced N/V and for postoperative nausea

Body fuel when starving:
1 -3 days = Hepatic Glycogen or Adipose FFA (to 4hrs diet carbs, 5 to 24hrs glycogenolysis, 25 - 36hrs = hepatic gluconeogensis)

4+ Days = Muscle protein

Weeks = Ketone bodies via fat

Becker and Duchene are different because of what genetic change:
* In-frame deletions/insertions in Becker (live longer) and frameshift deletions/insertions in Duchenne

A micro-deletion in 15q11.2 is:
* Prader-Willi (paternal) -- abnormal parent specific METHYLATION

A kid with microcephaly, wide-set eyes, and mental retardation with a "cat cry" has:
* Cru-du-chat (terminal deletion of 5p)

Kid with high renin, but hypo-kalemia and increased bicarb think:
* Bartters syndrome (hyper reninemia but angio II doesn't respond so there is low aldosterone)

Only gastric hormone that inhibits gastric emptying:
* CCK (from the I cells of duo/jejun)

A pt with a deficient lipoprotein lipase would have eleveated ___ in his serum:
* Chylomicrons

Where in the cell is collagen made/processed:
* Rough ER and Golgi

XR disorder that is defective copper transport d/t ATP7 gene and LYSYL OXIDASE dysfunction:
* Menkes disease

Copper, Lysl oxidase, ATP7

Kid with blood in his urine and renal dysfunction think:
* IgA nephritic syndrome (Berger's)

A man whose dong culture shows "school of fish" pattern, gram neg rod, growns on chocalate agar, and requires protein V and X for growth is:
* Haemophilus ducreyi (Chancre-- painful)

Gram-neg rod, requires the VX to grow

A deletion by the father on chromosome 15 is an example of:
* Imprinting (seen with Prader-Willi)

What is the issue in Brutons Agammaglobulinemia:
* Defective tyrosine kinase blocks B-cell maturation

Finding in the urine of someone with carcinoid syndrome:
* 5-HIAA

Kid with a deficiency of Arylsulfatase A resulting in cerebroside sulfate has:
* Metachromatic Leukodystrophy

M.A.C (Metachrom, Arylsulf, Cerbroside)

Kid with optic atrophy and globoid cells:
* Krabbes disease

Krabby Galactocerebro

Kid with cherry-red spot on macula and foam cells:
* Nieman Pick

Nieman Picks Sphingomyelin

Kids the aseptic necrosis of the femur, and mac's that look like crumpled paper:
* Gauchers

Gauch B-Glucocereb

Kid with peripheral neuropathy, cardio/renal disease, and angiokeratomas:
* Fabrys (alpha-galatosidase A-- accumulates ceramide tihexoside)

Fabry's a(lpha) galaxy of ceramide

Kid with cat like cry, MR, and slant-eyes has:
* Cru-du-chat (5p) and might have a VSD (cardiac defect)

If a person consumes 25g of salt a day, how much is excreted?
* 95% of salt intake is excreted so in this case 25 x .95 = 23g excreted

A person with finger clubbing might have:
* Lung cancer, liver cancer, or cyanotic heart disease

No comments:

Post a comment