Endo/GI Flashcards
14 month old infant, failure to thrive, developmental delay, macrocitic anemia….high OROTIC ACID in urine…?
Hereditary Orotic Aciduria - disease of de novo pyrimidine synthesis.
Defect in UMP synthetase.
Supplement with Uridine.
Pt with sign of HIV immunosuppresion, with esophegeal scope showing hyperemic esophagus/linear ulcerations….what bug/virus ?
CMV - major clue was LINEAR ULCERATIONS
Man with fatigue, rash, abd cramps, flushing… Maculopap rash, biopsy of skin show mast cells positive for KIT (CD 117), what else is likely to be found?
KIT associated with systemic mastocytosis - proliferation of mast cells.
Increased HISTAMINE leads to increased ACID SECRETION by parietal cells.
Where are Parietal Cells located in stomach?
Gastric Fundus and Body. Pale pink, disc shaped cells in the UPPER GLANDULAR LAYER.
Pernicious anemia, autoimmune gastritis.
Catecholamines, TNF alpha, Glucagon, etc induce insulin resistance by what mechanism?
Activation of serine kinase, which prevents autophosphorylation of tyrosine kinase and phosphosphorylation of IRS.
Question about a pt who reports using herbal supplements/OTC diet supplement. What should you do?
Shit all over supplement (i.e. explain that they are poorly regulated and have side effects)
What should happen to PaCO2 in a pt with DKA?
It should go DOWN. Pts with DKA should compensate with a respiratory alkalosis (Kussmaul).
If you dont see this on the ABG then could indicate RESPIRATORY FAILURE due to altered mental status.
Pt with 46-XY karyotype, phenotypically female, HIGH BP, which is the enzyme defect?
17 alpha hydroxylase.
Leads to increased mineralocorticoids and glucocorticoids.
But bc 17-hydrox is present in adrenals and gonads you get decreased androgens.
Review TD2 diabetes drugs….!!
review
What would a pt with Adrenal Crisis present with? What do you treat with?
Weight loss, fatigue, vomiting, abd pain, HYPERPIGMENTATION (from excess ACTH), HYPOTENSION, HYPOGLYCEMIA.
Treat with corticosteroids (hydrocortisone)
What is “porcelain gallbladder”? Associated with increased risk of what?
porcelain galbladder is when you get hard, palpable gallbladder, with extensive calcification. Shows up on CT. From chronic cholecystitis.
Associated with increased risk of gallbladder adenocarcinoma.
What is Kher Sign?
Referred shoulder pain from peritoneal irritation ( ie from pertonitis, hemoperitoneum, Splenic Rupture/lac)
Trauma pt with rigid abdomen, hypotension, tachycardia referred shoulder pain, hiccups…?
Splenic Rupture and Hemoperitoneum
What is linnitus plastica ?
Diffuse, Leathery, hard stomach.
Signet ring carcinoma (Gastric Adenocarcinoma), signet rings from loss of E-cadherin.
Colon adenoma to carcinoma sequence…?
Loss of APC (tumor suppressor gene) > Loss of K-Ras (oncogene) > Loss of DCC/P53 (tumor suppressor gene)
