easy bruising and hemarthrosis accompanied with Crohn disease☆bile acid malabsorption
→ fat malabsorption
→ vitamine K deficiency gastrointestinalhematologyUWorld Jul 9, 2020, 4:02 AM HirotoShishido
causes of hypokalemia・decreased intake
・intracellular translocation
insulin, β-adrenargic activity(dobutamine, ☆stress-induced(eg. alcohol withdrawal, acute MI)), alkalosis
・GI loss
diarrhea, vomiting, hyperaldosteroeism
・urinary loss
hyperaldosteroeism, diuretics, RTA (type Ⅰ, Ⅱ)
・sweat loss renalendocrinologyUWorld Jul 9, 2020, 2:16 AM HirotoShishido
diagnosis/ causes of rhabdomyolysis☆Positive blood on urine dipstick (a reaction that detects the heme pigment in both hemoglobin and myoglobin) in the absence of red blood cells on microscopic urinalysis suggests myoglobinuria.
contrast agent nephropathyDirect cytotoxicity of intravenous contrast on tubular cells
→ diffuse necrosis of the ☆proximal tubular cells visible on histologic specimens and muddy brown casts on urinalysis
Renal vasoconstriction
→ Renal vasoconstriction causing medullary ischemia and a prerenal injury pattern (ie, fractional excretion of sodium <1%), even in the absence of clinical volume depletion renalUWorld Jul 8, 2020, 6:50 AM HirotoShishido
metanephric mesenchyme, ureteric budMetanephric mesenchyme (ie, metanephric blastema)
→ glomerulus through to distal convoluted tubule (DCT)
Ureteric bud (metanephric diverticulum)
derived from caudal end of mesonephric duct → gives rise to ureter, pelvises, calyces, collecting ducts; renalembryologyUWorld Jul 8, 2020, 3:01 AM HirotoShishido
diabetic retinopathyNonproliferative - damaged capillaries leak blood → lipids and fluid seep into retina (hard exudates) → hemorrhages and macular edema, which can distort vision. Arteriolar obstruction cause ischemic injury → ☆cotton-wool spots
+☆microaneurysm, dot-blot hemor
Treatment: blood sugar control.
Proliferative - chronic hypoxia results in new blood vessel formation with resultant traction on retina → retinal detachment. Treatment: anti-VEGF injections, peripheral retinal photocoagulation, surgery. ophthalmologyUWorld Jul 7, 2020, 11:15 PM HirotoShishido
the first manifestation caused by cavernous carotid aneurysmCNⅥ
→ initially cause diplopia as CNⅥ runs next to the ICA neurologyneurosurgeryUWorld Jul 7, 2020, 7:19 AM HirotoShishido
closed angle glaucoma vs migrane with auraclosed angle glaucoma
→ typically older (> 60yo),
severe pain and conjunctival erythema are common, and vision would not be expected to improve without intervention
H pylori induced GDUantrum
→cause both ↓D cells(somatostatin) and ↓G cells
→overall gastrin production from stomach increases
→☆↑duodenal ulcer
body (corpus)
→ reduction in the number of parietal cells
→ acid prduction decreases (or normal)
→ associated with metaplasia and malignancies(eg gastric lymphoma, adenocarcinoma) gastrointestinalUWorld Jul 7, 2020, 2:54 AM HirotoShishido
cellulitis, impetigo, erysipelas, necrotizing fasciitisimpetigo
epidermis, S aureus, S pyogenes
(☆bullous impetigo→ S aureus)
erysipelas
dermis, S pyogenes
cellulitis
deeper dermis+ subcutaneous tissue, S aureus→ prulent, S pyogenes→ nonpurulent
primary membranous nephropathyantibodies to ☆phospholipase A2 receptor
(highly specific for MN)
titers correlate with disease activity, and serial mesurments can be used to determine the efficacy of immunosuppressive therapy renalUWorld Jul 5, 2020, 11:04 PM HirotoShishido
acidic environment for lipaselipase is inactivated by the acidic environment of the stomach
→ PPI use ☆increases lipase activity , enhancing fat absorption in patients dependent on pancreatrc enzyme replacement therapy gastrointestinalpharmacologyUWorld Jul 5, 2020, 7:01 AM HirotoShishido
hypersensitivity pneumonitis vs IPF(idiopathic pulmonary fibrosis)affected patients by IPF are usually older(>50yo)
HP is associated with (poorly formed) noncaseating granulomas but IPF is not respiratoryUWorld Jul 5, 2020, 5:39 AM HirotoShishido
radiation-induced lung injuryacute(1-3months)
impaired gas exchange due to exudative alveolitis → ☆hyaline membrane formation, pneumocyte sloughing(slúː)
chronic(6-12months)
radiation fibrosis(dense fibrous bands) results in decreased lung volume and dilated bronchi and bronchioles(ie traction bronchiectasis)
(predisposition to chronic infections) respiratoryradiologyUWorld Jul 5, 2020, 5:34 AM HirotoShishido
GI manifestations of diabetic autonomic neuropathygastroparesis, GERD, ☆diabetic diarrhea
Loss of autonomic input to the GI tract results in abnormal peristalsis, leading to ☆disordered small-bowel and colonic motility, which can result in rapid intestinal transport.
→painless, secretory-like diarrhea that persists with fasting(eg ☆nocturnal diarrhea)
Fecal incontinence is particularly common in patients with long-standing diabetes, resulting from both a large volume of watery diarrhea and decreased anorectal sensation. endocrinologygastrointestinalUWorld Jul 5, 2020, 5:15 AM HirotoShishido
relative high lympholyte count in BAL (bronchoalveolar lavage)(normally, 85% alveolar macrophage, 10% lymphocytes, small percentages of neutrophils and eosinophils)
☆hypersensitivity pneumonitis (eg >20%, often >50%), sarcoidosis, lymphoma, chronic fungi or mycobacterial infection respiratorymicrobiologyUWorld Jul 5, 2020, 5:02 AM HirotoShishido
factors which increases the risk of heat stroke in the elderlycontraction of the peripheral vasculature
reduced sweat gland density
☆reduced effective epidermal area available for heat transfer
