Men Syndromes

Multiple Endocrine Neoplasia Syndromes

•MEN 2A→ Mutation of germline RET ( neural crest cells)

Quike & Vivi's World

Quike & Vivi's World

Patient has facial angiofibroma, ash-leaf spots of skin depigmentation, hx of seizures, and mental retardation.

What condition does this patient have?

What neoplasms is this patient at risk of developing?

Encapsulated bacteria

Mnemonic:
Some Killers Have Pretty Nice Capsules

What organisms do not take gram stain?

Cranial Nerves

Sensitive:  I, II, VIII
Motor: III, IV, VI, XI, XII
Mixed: V, VII, IX, X
Corticobulbar: V, VII, X, XI, XII

• All CN nuclei receive double innervation (from both sides of cortex) → a lesion of tracts innervating CN nuclei won't result in any physical manifestation except CN VII (Nucleus has Upper & lower divisions) & some individuals CN XII (mainly contralateral bulbar innervatoin)

Aminoaciduria
FANCONI SYNDROME	HARTNUP DISEASE
Generalized aminoaciduria Including: ARGININE, PROLINE, HYDROXYPROLINE	Only neutral AA in urine NO: Arginine, Proline, Hydroxyproline
	Alanine, Serine, Threonine, Tyrosine, Tryptophan, Histidine, Valine, Leucine, Isoleucine, Phenylalanine
Proximal Renal Tubular: ·         Acidosis (loss of bicarbonate in Urine) ·         Aminoaciduria ·         Phosphaturia ·         Glucosuria	·         Aminoaciduria ·         Renal & Intestinal Tryptophan absorption defect ·         Pelagra like + ATAXIA + Photosensibilidad               (Dermatitis, Diarrhea, Dementia)

Cystic Tumor in the Cerebellum of a child:

Most likely:

Primary biliar Cirrhosis

Triad: Confusion, Ataxia Ophthalmoplegia

Seen in:

DISEASE Phenylketonuria Alkaptonuria Maple Syrup Urine Disease Homocysteinuria

ENZIME DEFICIENT Phenylalanine Hydroxylase (Cofactor: Tetrahydrobiopterin) Homogentisate Oxidase Branched -Chain Ketoacid DHase (=α-Ketoacid DHase)(TLCFN) Cystathionine Synthase (B6) Homocysteine Methyl Trasferase Methyl THF

Tx/SUPLEMENT Tyrosine Thiamine Cisteine

AVOID Phenylalanine, Aspartate Phenylalanine, Tyrosine Leucine Valine Isoleucine

Neurotransmitter changes

Anxiety:	↑NE,  ↓GABA,  ↓Serotonin (5-HT)
Depression:	↓NE,  ↓Serotonin (5-HT), ↓Dopamine
Alzheimer's dementia:	↓ Ach
Huntington's disease:	↓GABA, ↓Ach
Schizophrenia:	↑Dopamine.
Parkinson's disease:	↓Dopamine,  ↑Ach, ↑Serotonin (5-HT)

Apoyemos a Sisi y Tzuhsi

GANADORAS DEL CONCURSO "HOLIDAY TREAT CONTESTANTS: THE CUTEST PET" CON UN 76.97% DE LOS VOTOS!!!

 Gracias por votar por Sisi y Tzuhsi en el concurso the cutest pet 2011

Gram + Algorithm

Source FA (adapted)

No me doy por vencido en la voz de su autora CLAUDIA BRANT

Clinical and laboratory Findings in Vitamin B12 and Folate deficiencies

Clinical and laboratory Findings in Vitamin B12 and Folate deficiencies

LABORATORY / CLINICAL FINDING	PERNICIOUS ANEMIA	OTHER Vit B12 DEFICIENCIES	FOLATE DEFICIENCY
Achlorhydria	Present	Absent	Absent
Autoantibodies	Present	Absent	Absent
Chronic athrophic gastritis	Present	Absent	Absent
Gastric carcinoma risk	↑	None	None
Hypersegmented neutrophils	Present	Present	Present
Mean corpuscular volume	↑	↑	↑
Neurologic disease	Present	Present	None
Pancytopenia	Present	Present	Present
Plasma homocysteine	↑	↑	↑
Serum gastrin level	↑	Normal	Normal
Urine methylmalonic acid	↑	↑	Normal

Viruses

Lysosomal storage diseases

Cytocrome P450

	INDUCERS	INHIBITORS
Effect on drugs	Decreased (fail to respond)	Increased (risk of toxicity)
Anticonvulsivants	Barbiturates (Phenobarbital) Phenytoin Carbamazepine Ethosuximide	Valproic Acid
Antibiotics	Rifampin	Chloramphenicol Quinolones (Ciprofloxacin) Macrolides (Erythromycin) Sulfonamides (TMT SMX) Isoniazid (INH)
Antifungals	Griseofulvin	Ketoconazole Fluconazole
Alcohol	Chronic alcoholism	Acute alcoholism
Fruits/ Plants	St. John's Wort	Grapefruit
Antiarrythmics	Quinidine
Sterols	Glucocorticois
Antiulcerous		Cimetidine Omeprazole
Antivirals		Ritonavir (HIV protease inhs)
Antitumoral		Cyclosporin

• Patient presents with ↓ pain and temperature sensation over the lateral aspects of both arms.	What is the lesion?	Syringomyelia.
• Penlight in patient’s right eye produces bilateral pupillary constriction. When moved to	What is the defect?	Atrophy of the left optic nerve.
the left eye, there is paradoxical dilatation.
• Woman involved in a motor vehicle accident cannot turn her head to the left and has right shoulder droop.	What structure is damaged?	Right CN XI (runs through the jugular foramen with CN IX and X), innervating the sternocleidomastoid and trapezius muscles.
• Man presents with 1 wild, flailing arm.	Where is the lesion?	Contralateral subthalamic nucleus (hemiballismus).
• Patient with cortical lesion does not know that he has a disease.	Where is the lesion?	Right parietal lobe.
• Patient’s tongue protrudes toward the left side, and	Where is the lesion?	Left medulla, CN XII.
patient exhibits a right-sided spastic paralysis.			<>

The Muppets: Bohemian Rhapsody

Some renal Findings

Multiple myeloma Ischemic tubular necrosis Acute pyelonephritis Hypersensitivity interstitial nephritis Papillary necrosis & Chronic interstitial nephritis Aminoglycoside toxicity Lead nephropathy Urate nephropathy Acute Tubular Necrosis (renal azotemia)

Eosinophilic casts (Bence-Jones prot), in tubular lumens Ischemic tubular necrosis WBC Casts Drug-induced interstitial nephritis NSAID-associated nephropathy Aminoglycoside toxicity Chronic tubulointerstitial nephritis Needle shaped monosodium urate crystals are seen in the interstitium and tubular lumens Heavy metal poisoning with lead or mercury (produces Fanconi Sd)

Steve Jobs Inspiring speech

Steve Jobs - Do Great Work

Steve Jobs on Connecting the Dots, Love & Loss and Doing Great Work

Steve Jobs - Stanford University Commencement Speech Transcript

I am honored to be with you today at your commencement from one of the finest universities in the world. I never graduated from college. Truth be told, this is the closest I've ever gotten to a college graduation. Today I want to tell you three stories from my life. That's it. No big deal. Just three stories.
The first story is about connecting the dots.

Basic ECG concepts...(Arrhythmias Big picture)

 

Here are some basic concepts about ECG, the most important one, the conduction system of the heart which helps to understand why the arrhythmias of the heart are studied in that order. Begining with everything related to the Sinus Node and Atrium, continuing with  the AV node where the conduction is slowed down (that is why the blocks are study here), and then all the main things regarding the ventricles. If you get the big picture of this ECG will become one of the easiest subjects to learn.....

Sarcomere

Respiratory

AIRWAY EXTRATHORACIC (Lips to Glotis) INTRATHORACIC (Glotis tothe alveoli)

Breath IN Narrows Expands

Breath OUT Expands Narrows

•Stridor: narrowing in extrathoracic airway (when breath in - INSPIRATION)
Ex: small, jaw, macroglossia (hypothyroidism, Down Sd., storage Dzz), large tonsils, large tonsils, laryngeal webs, laryngeal warts, peritonsil abscess, retropharyngeal abscess, epiglotitis, crup, diphteria.. DO A NECK FILM
•Wheeze: narrowing in intrathoracic airway (when you breath out - EXPIRATION)
It will expected on Obstructive lung dzz ( Asthmatics )  DO A CXR
Never it's a good thing to find wheezing on inspiration → (Bronchospasm, or mass) → sign of more distress pt probably needs to be in ICU
•Rhonchi: air moving over mucus (Obstructive, Productive cough)
•Crackles: collapsed airways “popping”open (All restrictive will have it) (obstructives later on)
–Surfactant is missing
–Alveoli have been scarred down

*DRUGS THAT CAUSE CRACKLES (Pulmonary Fibrosis)BBAT Busulfan, Bleomycin, Amiodarone, Tocainide
* Which patient will more likely have crackles Strep pneumonia or pneumocystis
  Bacteria → obstructive (airway)→       Fungus → restrictive (interstitium)
-Strep. pneumonia:bacteria, affects airway, obstrucvitve dzz, ronchi (air moving over mucus)
-Pneumocystis Jirovecchi (fungus), affects intertitium, restrictive dzz, crackles

Aspirin Intoxication

Aspirin poisoning will produce respiratory alkalosis initially then will produce metabolic acidosis.

Others producing Metabolic acidosis are:

Increased anion Gap (MUD PILES) M- Methanol U- Uremia D- DKA P- Paraldehyde or phenformin I- Iron tablets or INH L- Lactic Acidosis E- Ethylene glycol S- Salicilates

Normal anion Gap Diarrhea Renal Tubular Acidosis (alkaline urine ph < 5.5) Hyperchloreima