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abhishek021196
Physiologic
neonatal jaundice
At birth, immature UDP-glucuronosyltransferase = unconjugated hyperbilirubinemia = jaundice/
kernicterus (deposition of unconjugated, lipid-soluble bilirubin in the brain, particularly basal
ganglia).
Occurs after first 24 hours of life and usually resolves without treatment in 1โ2 weeks.
Treatment: phototherapy (non-UV) isomerizes unconjugated bilirubin to water-soluble form.
+1
azharhu786
The water-soluble form is called Lumirubin.
+2
cassdawg
My main thoughts on this is that an actual tear in the sciatic nerve is extremely difficult and further it would present with motor weakness to the muscles innervated by the sciatic nerve as well (the hamsrtings and adductor magnus, FA2020 p452). The sciatica pain that you are referring to is more common with injury to the nerve via herniated disc.
+5
azharhu786
I also thought he was too young for the intervertebral disc rupture so picked sciatica tear :(
+5
sexymexican888
Golijan also talks about this in his lectures he mentions how weight lifting and holding your breath increases intra-abdominal pressure and this pressure will be transferred to the CSF in the spinal cord cause a disc herniation. The pressure in the spinal cord will also go up when you do an LP and ask the patient to do valsalva or hold their breath
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guillo12
How do you know the gracile fasciculus is damage?!?!
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cr
which parte of the image its damage?, the pink? or black?
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hyperfukus
i still don't see where the damage is lol! FML
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hyperfukus
i finally figured it out lol that was a slow moment i hope im not this slow on step yikes!
+1
angelaq11
@hyperfukus I had the same problem at first, marked it and then came back. If you remember, in the spinal cord the white matter and gray matter are "reversed" compared to the brain. That said, if the butterfly shaped region (ie, the gray matter) is colored (in this case) lilac and the rest (ie, white matter) is blackish, the only thing that is actually abnormal, is the region where the dorsal columns are, because it stains just like the normal gray matter. After that, you have to think about which fasciculus is damaged, the gracilis or the cuneatus. The gracilis is medial while the cuneatus is lateral (picture someone with glued legs and open arms). Hope this helped
+16
icedcoffeeislyfe
Check out FA2020 pg 508
Put simply-->
myelin= black --> color of the normal white matter
no myelin= pink --> color of the normal gray matter and the damaged area
Dorsal columns= vibration, proprioception, pressure fine touch
F. graciLis= Lower body
F. cUtaneous= Upper body
+2
champagnesupernova3
They tried to confuse us saying both low dose and high dose dexamethasone didnt suppress it. But when ACTH is low you dont even need to do high dose dexamethasone test. The high dose is only to differentiate between Pituitary adenoma and ectopic ACTH production
+8
hungrybox
@champagnesupernova3 fuck they got me
+16
azharhu786
They got me on that question as well. I thought it was ectopic ACTH production due to some paraneoplastic syndrome and this is why Low/ high dose dexa is unable to suppress it.
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skonys
High dose dexamethasone would rule out Cushing Disease because the adenoma responds to cortisol, just at a higher set point. But even before that, the ACTH is low, so it can't be A or B because they would be high. The problem is downstream; low ACTH -> body saying "NOO! Stop! You can't just keep making cortisol!" but the zona fasciculata is like "haha, negative feedback go brrrrr"
+2
utap2001
Low dose dexamethsone is just for screening of Cushing syndrome(adenoma, ectopic, adrenal). For rule out normal person. High dose dexa is used to D/D adenoma and ectopic.
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ergogenic22
Also corticalspinal tract symptoms are not seen, but dorsal column and spinocerebellar tracts are seen
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sinforslide
In this case, patient's CF also predisposes fat-soluble vitamin deficiency.
+9
usmleuser007
Correction: Read more on this
Vitamin-E deficiency can in fact cause anemia - hemolytic anemia.
This is b/c VitE work as an anti-oxidant; and therefore with reduced anti-oxidation RBCs are more prone to oxidative injuries.
+4
azharhu786
AMBOSS: Hemolytic anemia; increased fragility of erythrocytes and membrane breakdown are also caused by vitamin E.
+1
kcyanide101
Just to add..... Vitamin E in excess can also be toxic as it inhibits Vitamin K, which increases risk if bleeding etc
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yotsubato
Heres a good picture to help with the concept.
https://www.google.com/url?sa=i&source=images&cd=&ved=2ahUKEwjVkIi0yN7iAhWLjqQKHbeXCTUQjRx6BAgBEAU&url=https%3A%2F%2Fwww.herniaclinic.co.nz%2Finformation%2Ftypes-of-hernias%2F&psig=AOvVaw2BzGtQLvSmUN8ymhdvETG5&ust=1560244112252834
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sbryant6
Note that direct inguinal hernias typically happen in older adults. This question presents a younger baby, so it is more like to be indirect.
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jawnmeechell
So a femoral hernia would be inferior to inguinal, but direct/indirect would be superior?
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azharhu786
The direct and indirect hernia are both superior to the inguinal ligament but the femoral hernia is basically inferior to the inguinal ligament.
The direct hernia is medial to the inferior epigastric vessels whereas, the indirect is lateral to the epigastric vessels.
An indirect hernia is seen in young people whereas, direct hernia happens in adults.
+6
athenathefirst
Also FEmoral hernia is more common in FEmales
INdirect more common in INfants or discovered late in adulthood (FA page 364)
+1
This question asks about the mechanism of phototherapy as it relates to neonatal jaundice. With phototherapy, bilirubin is simply converted to water soluble isomers that are then able to be excreted by the kidney. This however does not conjugate the bilirubin.