النسخة الأخيرة من مرجع دانش.


#Internal_Medicine

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#باطنة
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explanation

#Case 16
A 25-year-old woman presents with nausea and vomiting of 2 days duration. She is not on any medications and was previously well until now. Her physical examination is normal except for a postural drop in her blood pressure from 110/80 mm Hg supine to 90/80 mm Hg standing. Her serum electrolytes are sodium 130 mEq/L, potassium 3 mEq/L, chloride 90 mEq/L, bicarbonate 30 mEq/L, urea 50 mg/dL, and creatinine 0.8 mg/dL. Which of the fol￾lowing electrolytes is most likely to be filtered
through the glomerulus but unaffected by
tubular secretion?

Explanation





.. Urea is filtered at the glomerulus, and thereafter, any movement in or out of tubules is a passive process depending on gradients, not secretion. Reabsorption of urea in the distaltubule and collecting duct, when urine flow is reduced, results in the disproportionate elevation of urea nitrogen over creatinine in prerenal azotemia. (Kasper, p. 246)

#Case 17
A 56-year-old woman presents with feeling light-headed when standing up and 3 days of passing dark black stools. She has past history of chronic viral hepatitis B, and has developed cirrhosis. On examination she is alert, blood pressure is 90/60 mm Hg supine and 76/60 mm Hg
standing. Her abdomen is distended with signs of ascites, nontender, and there are multiple bruises on the legs. Her hemoglobin is 9.0 g/dL,
platelets 90,000/mL, albumin 3 g/dL, bilirubin 1.3 mg/dL, and international normalized ratio (INR) 2.5 (prothrombin time [PT] 25 seconds). Which of the following coagulation factors are most likely deficient in this patient?

.

Explanation





Coagulation factors II, V, VII, IX, X, and XI would most likely be deficient. These are some of the factors that are synthesized in the liver. Factors II, VII, IX, and X are the vitamin Kdependent factors, which are also synthesized in the liver. (Lichtman, p. 1953)

#Note
In asymptomatic individuals, a positive skin or blood test for a particular allergen is not diagnostic of an allergy to that allergen

#Note
Acute invasive fungal rhinosinusitis is a life-threatening diagnosis with a mortality rate of 50–80%. If suspected, immediately admit the patient and consult ENT.

(Hematology-Geriatrics-Infection-Acute medicine-Alternative medicine-Evidence based medicine)

(Immunology-Rheumatology-Neurology)

(Endocrine & metabolism-Nephrology-Genetics-GIT- Hepatology & Pancreas)

(Ethics-Cardiology-Respiratory)

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