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Zuhal

Zuhal

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68 yo male patient presents to your clinic with postprandial pain. X-ray below, whats the dx?
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tiedyeddog said:
I am unknowledgable about this, why is microvesicular change important?
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microvesicular fatty change...narrows the diagnosis down quite a bit. Pregnancy and Reyes are notably and two of the few processes associated with microvesicular fatty change.
alcoholism is macrovesicular fatty change
 
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addo said:
microvesicular fatty change...narrows the diagnosis down quite a bit. Pregnancy and Reyes are notably and two of the few processes associated with microvesicular fatty change.
alcoholism is macrovesicular fatty change
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thanks, this is all new to me I think.

I swear to god I am learning more from this thread and the complicated stuff thread than I have learned all year in my classes.
 
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Alright, last one for me today...and it's another Endcrine question:

This woman is at risk for delivering a baby with what specific endocrine abnormality?
 

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SLC said:
Bingo, care to explain why/how it happens?
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It depends on what the woman has. I just went ahead and assumed she wasn't in the U.S. although she might be so iodine deficiency in the baby doesn't allow thyroid hormone to be formed, which is important in brain and skeletal development. If it was Grave's, she could be taking anti-thyroid drugs or radioactive iodine. I think both PTU and Methimazole can cross placenta, but less likely with PTU. Also, idk if this is significant but grave's tissue probably takes in more iodine than a normal thyroid tissue and will leave the baby deficient but the mom in excess. If she was being treated for hashimoto's though, the baby wouldn't get it because i think thyroid hormone crosses the placental barrier (would that be a good question on step? lol). All can cause goiters tho

Edit: scratch that, untreated grave's would still provide T4 through the placental barrier

Iodine deficiency -> mom or baby can't make hormone
Untreated grave's -> baby will be ok as far as thyroid hormone
Treated grave's -> radioactive iodine will kill baby's thyroid. Methimazole is indicated in worse for baby than PTU (not sure if they specifically cause cretinism, but I know they are bad in pregnancy. confirm?)
Untreated hashimoto's -> Antibodies against TBG and thyroid peroxidase can cross placenta (I've read this somewhere, not sure how signfiicant)
Treated hashimoto's -> baby gets thyroid and iodine, will be good
 
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addo said:
elceh0.jpg


2 different ecg patterns... what might be going on?
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so nobody wanted to take a shot at this? the difference is in QT duration. Long QT can be a sign of hypocalcemia, short QT can be a sign of hypercalcemia
 
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I think a cool correlate to that would be arrythmic drugs class 1a and 3 can also cause that and thus torsaddes EXCEPT which drug?

edit: were you telling us the answer or no? lol
 
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they are not the same ecg... different ones demonstrating a long qt and another a short qt
 
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addo said:
so nobody wanted to take a shot at this? the difference is in QT duration. Long QT can be a sign of hypocalcemia, short QT can be a sign of hypercalcemia
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Yeah as with everyone else I figured this was the same person and for the life of me couldn't figure out what would cause paroxysmal long qt. Possibly rhabdomylysis of the heart?
 
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JP2740 said:
I think a cool correlate to that would be arrythmic drugs class 1a and 3 can also cause that and thus torsaddes EXCEPT which drug?

edit: were you telling us the answer or no? lol
Click to expand...

Yea that was the answer... just a nice thing to know the signs of hypo/hypercalcemia on ecg. Also know how hypo/hyperkalemia looks like on the ecg
 
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JP2740 said:
It depends on what the woman has. I just went ahead and assumed she wasn't in the U.S. although she might be so iodine deficiency in the baby doesn't allow thyroid hormone to be formed, which is important in brain and skeletal development. If it was Grave's, she could be taking anti-thyroid drugs or radioactive iodine. I think both PTU and Methimazole can cross placenta, but less likely with PTU. Also, idk if this is significant but grave's tissue probably takes in more iodine than a normal thyroid tissue and will leave the baby deficient but the mom in excess. If she was being treated for hashimoto's though, the baby wouldn't get it because i think thyroid hormone crosses the placental barrier (would that be a good question on step? lol). All can cause goiters tho

Edit: scratch that, untreated grave's would still provide T4 through the placental barrier

Iodine deficiency -> mom or baby can't make hormone
Untreated grave's -> baby will be ok as far as thyroid hormone
Treated grave's -> radioactive iodine will kill baby's thyroid. Methimazole is indicated in worse for baby than PTU (not sure if they specifically cause cretinism, but I know they are bad in pregnancy. confirm?)
Untreated hashimoto's -> Antibodies against TBG and thyroid peroxidase can cross placenta (I've read this somewhere, not sure how signfiicant)
Treated hashimoto's -> baby gets thyroid and iodine, will be good
Click to expand...

Good job, you got it!

And it's iodine deficiency BTW. This was a photo I took of one of our patients on a Volunteer Trip I took before medical school. It's from an extremely poor part of East Timor. Lots of folks had large goiters like this.
 
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tiedyeddog said:
no idea...
Click to expand...

Silver stain

Additional info: http://emedicine.medscape.com/article/213169-workup
- Other Bartonella species are visible only with silver stains[[ (eg, Warthin-Starry, Steiner, Dieterle), if they stain at all. Bacillary forms also exist. These stains are not specific.

- Immunostaining can also aid in the diagnosis of early lesions or atypical manifestations of catscratch disease. Capnetti at al[28] found that immunohistochemical analysis was positive in 25% of cases, PCR in 38% of cases, and Steiner silver stain in 46% of cases of 22 patients with lymphadenopathy and histopathological findings compatible with catscratch disease.

- Late in the course of B henselae infection, organisms may not be found in areas of necrotizing granulomas.
Click to expand...
 
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1z682mw.jpg


29 yo male with 2 month history of intermittent abdominal pain, fever, elevated Cr and urea nitrogen. Negative ANA and ANCA. Angiogram of SMA shown.
 
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polyarteritis nodosa. I knew there was something about the dilation and constrictions lol. or am i wrong
 
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