Docs In Training Notes

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  Day 1  Quiz 1Cushings syndrome  elevation cortisolConns syndrome  elevation of aldosteroneAddisions  decrease in aldosterone and cortisolGraves disease  increase in thyroid hormoneFunction of Mackonkeys: have crystal violet and bile salts, both inhibit growth of gram positive so onlygram negative will be able to grow in Mackonkeys agar. Lactose is the only carbohydrate found here. Ithas neutral red stain. Combination of these two from pink colonies on Mackonkeys agar by fermenters.While non-fermenters form other color, or white color colonies.Pink colony  lactose fermentors  gram negativeMedication to treat Glaucoma: alpha agaonist, beta blockers, diuretics  carbonic anhydrase inhibitorsor manitol, cholino mimetics, and prostaglandin F2 alpha.Facial angiofibroma, ash leaf spots-skin depigmentation, history of seizure, MR. What condition thispatient have? And what neoplasm the patient at risk of developing?-   T uberouscleorsis-   Neoplasm: cardiac rhabdomyoma, astrocytoma, and angiomyolipomaCause of achalasia?-   It is where you lose your myenteric auer baux pleux, therefore, lower esophageal sphincteris unable to relax.-   How is it diagnosed: bird peak appearance with barium swallowLeading causes of death:-   Ages 15 - 24: injury, homicide, suicide, cancer and heart disease-   Ages 25 to 64: cancer, heart disease, injury, suicide, and strokeWhich glomerular disease would you expect to see in the following changes:-   Anti GBM [glomerular basement membrane] antibodies on immune florescence  Goodpasture syndrome-   Hemyto Wilson lesion on light microscopy  diabetic nephropathy  -   Spike and dump appearance on EM  membranous glomerulonephritis-   T rum tracks of sub endothelial humps on EM  membrano proliferative glomerulonephritis-   Subendothelial humps on EM  acute post streptococcal glomerulonephritisClinical use of metronitrozole:-   GE T GAP ON T HE ME T RO-   GE T : Giardia, Enteromeba, T rachamonoas-   GAP: Gardinella Vaginalis (cause bacteria vaginalis), Anarobes, H. pylori T wo most common complications after an MI:-   (1) cardiac arrhythmia -- ventricular fibrillation-   (2) left ventricular failure  pulmonary edema  CHF symptomsWhat is T ressour syndrome-   It is an autoimmune disease-   It occurs weeks after an MI-   Result in fibrinous pericarditisCause of granulomatitis disease:-   Lack of NADPH oxidase activity which is critical for phagocytosis. T herefore neutrophilcannot phagocytosis things-   Consequences: these individuals are susceptible to opportunistic infections like staph.Aureus, e.coli, and aspergillousWhat is WAGR complex?-   Seen with the Wilms tumor-   W ilms tumor-   A niridia - congenital lack of iris, have huge pupil for an eye-   G enito urinary malformation-   R etardation  both mental and motorWilms tumor:-   Most common tumor of early childhood, ages 2 -4-   May or may not have WAGR complex  5 classes of drug to treat glaucoma:-   Alpha agonist-   Beta blockers-   Cholino memetics-   Diuretics : manitol and carbonic anhydrase inhibitors-   Prostaglandin F2 alphaHow does blood pressure response to administration of phenylephrine:-   Have alpha blockers administered before hand and phenylephrine is an alpha one agonist. T herefore no change in blood pressure. When epinephrine is administered, you get rid of alpha 1 vasoconstriction, un mask the beta 2 dilation, therefore drop in bp whenepinephrine and phenylephrine are on board.Common side effects of beta blockers:-   Amphetanes, asthma exacerbation, bradycardia, AV block, worsening of heart failure,sedation, sleep alteration,-   Asthma/diabetic/low bp/ bradycardia/on CCB  mirapamil  more likely to get heart bloc,not CI but cautioned. Also cocaine users shouldnt go on it-   Dopamine: shock-   Quinidine: hypertension, induce sleep on pediatric patients who are on amphetamines forADHD-   Amphetamines: obesity, ADHD, narcolepsy, major depressive disorder (sometimes)-   T erbutaline  asthma, also turcolysis - to stop uterine contraction-   Epinephrine  anaphylaxis, also for injection during a procedure, for example with lidocaine  vasoconstrict the vessels in the area so lidocaine doesnt disperse fast.Drugs:-   Losartan  angiotensin 2 receptor blocker (ARB)-   Vecuronium  non-depolarizing neuro muscular blocking agents-   T egirocillin  penicillin-   Resepiramine  T CA, anti depressant-   Alopril  ACE inhibitors-   Lorazepam  benzodiazepine-   T rozyquisidone  increases cellular response to insulinArgo Robertson pupil:-   Neurosyphilis-   Doesnt Constrict to light but constrict to accomadation  Antimitochondrial Antibody: Seen in primary biliary cirrohosisBloody tap on LP  sub arachnoid hemmorrhageBabinzki sign: UMN lesionAtrophy of mamillary bodies: cause Wernickes encephalopathy, associated with alcohol useBasophilic stippling of RBC  seen with lead poisoningBenz Johns protein  Multiple myeloma, immunoglobulin in urine. Also seen in Walder strongmacroglobular anemiaCherkovs triad:-   Seen with multiple sclerosis: Nysthagmus, intention tremor, and cant speak-   For choliangitis: jaundice, right upper quandrant pain, and fever-   0steogenesis imperfects  blue scleraNerve damage :-   Claw hand  ulnar nerve-   Wrist drop  radial nerve-   Winged scapula - long thoracic nerve-   Loss of abduction or adduction of fingers: ulnar nerve-   Systemic Dorsai  thoraco dorsai nerve-   Loss of pronation - median nerve-   Weak lateral rotation of the arm  super scapular/axillary nerve-   Loss of abduction beyond 10 degress  axillary nerves (innervates deltoid)-   Loss of arm flexion  musculocutaneous-   Loss of arm extension  radial-   Unable to raise arm above and horizontal - long thoracic or spinal accessory (because longthoracic and trapezius is involved)Day 2  Quiz