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the question hints at a possible parathyroid adenoma with her history of 2 episodes of renal calculi.
Yup, also as a tip for next time, if you see that a patient has some sort of pancreatic cell tumor, such as Zollinger in this case, look for other MEN 1 associated findings.
Going off that, if there's a stem with a patient getting tired quickly during exercise, McArdle should be on the differential. It's an older dude who APPARENTLY never experienced this before but w/e. McArdle is associated w/ glycogen phosphorylase (AKA myophosphorylase) problems
The question stem also mentions that there is no rise in lactic acid. This could be because if we cannot even break down glycogen to glucose to get pyruvate, we can't even turn pyruvate to lactate via lactate dehydrogenase. And also, without anaerobic metabolism, you fatigue quickly.
FA 2020 pg. 87 also says there is a normal rise in ammonia levels during exercise in McArdle patients. They also suffer from arrhythmias from electrolyte abnormalities.
There is also a "second wind phenomenon" where they are able to tolerate exercise better after getting more blood flow to their muscles. This could be due to glucose in bloodstream bringing glucose to muscles?
I think it's because of the last sentence - asks about a defect in an inhibitory neurotransmitter, with glycine being the only possibility. I think it's one of those "here's a stem, but just look at the last sentence" questions.
This actually is not tetanus or botulism. The deficit has been present since birth. He has glycine encephalopathy, a rare disorder (https://en.wikipedia.org/wiki/Glycine_encephalopathy). Definitely could be tricked into thinking botulism but defect in "inhibitory neurotransmitter" points to glycine deficit as glycine is the only inhibitory neurotransmitter listed!
(Disclaimer that I am assuming his deficit is just a weird kind of glycine encephalopathy because normally its a disease of metabolism not receptor; but it presents with the hiccups and seizures like seen in this baby. Big thing is the last sentence as was already said)
Which antibiotics increase photosensitivity?
Several antibiotic classes commonly cause photosensitivity, including tetracyclines (doxycycline), quinolones (ciprofloxacin, norfloxacin), and sulphonamides (trimethoprim/sulfamethoxazole, sulfasalazine). The tetracycline minocycline is not generally associated with photosensitivity.
WHY not damn cipro?
I think it is because Cipro is not commonly used for acne treatment
Why would body respond to water retention with ALDO? ALDO would increase water retention...
@hello, the body's response is to decrease Aldosterone since there is increased volume retention and subsequently increased blood pressure.
This concept confused me a lot, but I ended up just viewing it as separate responses. First, the increased volume retention leads to increase ANP and BNP secretion that lead to decreased Na+ reabsorption in the tubules (page 294 in FA 2019) and second, this increased volume basically leads to increased pressure so lets also decrease aldosterone so there is no Na+ retention (since water comes with it)...
I thought it was counterintuitive to secrete so much Na+ since you're already having decreased serum osmolality (decreased Na+ concentration) because of the water retention, but I'm guessing that this is just another way our body's well intentions end up making us worse XD
see page 344 FA2019 for SIADH.
author pasted text straight from FA but the arrows didn't copy over, inverting the original meaning
The idea of increasing urine Na is getting rid of water, thats why this mechanism end increasing urine Na secretion even when there are very low serum Na levels.