Quiz 3

Ref: Harrison 20th p 1789; Harrison 19th ed. / 96e-1t
 Vitamin B1 deficiency causes Beri-Beri which is of twotypes- WET BERI-BERI having cardiac failure and DRY BERI-BERI causing CNS problems like Wernicke encephalopathy and Korsakoff psychosis.
 Gingival bleeding and delayed wound healing (choice A) is seen with scurvy. Memory loss is seen with niacin deficiency.

Ref: Harrison 20th p 1934; Harrison 19th ed. / 253
• Edema is defined as a palpable swelling caused by an increase in interstitial fluid volume. The most likely cause of leg edema in patients over age 50 is venous insufficiency.
• The most important cause of unilateral pedal edema is venous insufficiency which must be evaluated using a Doppler exam.

Ref: Harrison 20th p 2064; Harrison 19th ed. / 1768
 According to AHA 2010 guidelines, the basic life support entails C_A_B and a shift from ABC protocol. Therefore the first thing to be done is chest compressions@100 times per minute. The depth of sternal depression should be 2 inches (5 cm)
 ALSO remember that in Advance cardiac life support the drugs used are epinenphrine, and amiodarone. ATROPINE has been withdrawn and this is a change from 2005 guidelines.

(Ref: None)
• The question is based on common sense. Time of cohabitation will determine how accurately a relative can describe the symptoms of the patient. For example son is staying abroad and is now describing progression of symptoms of Huntington's disease in his father to you. This will not be a reliable history.
• Especially for diseases that have a genetic basis, blood relations are important.
• Educated family members can better verbalize and empathize with the patient

Ref: Harrison 20th p 1895; Harrison 19th p 1617
 Secondary hypertension is much less common accounting to only 5-10 % of all causes of hypertension. Renal disease is the most common cause of secondary hypertension. Both renal parenchymal and reno-vascular diseases can cause secondary hypertension. Accounting for up to 2-5% of all cases of hypertension, renal parenchymal damage is the most common cause of secondary hypertension. As chronic glomerulonephritis has become less common, hypertensive nephrosclerosis and, to an even greater degree, diabetic nephropathy have become the most common causes of chronic renal disease
 Reno-vascular disease is the most common cause of secondary hypertension in the elderly.
 Atherosclerosis is the most common renovascular cause of secondary hypertension in elderly while Fibromuscular dysplasia is the most common renovascular cause of secondary hypertension in young.

Ref: Harrison 20th p 1899; Harrison 19th edition, page 306
• Liddle syndrome exhibits gain of function of epithelialsodium channel at plasma membrane of principal cells.
• This results in net gain of salt and water leading to hypertension
• The corresponding urinary loss of potassium and hydrogenexplains hypokalemic alkalosis.
• Bartter syndrome (defect at TAL) and Gitelman syndrome(defect at DCT) both have hypokalemic alkalosis buthypertension in not present
• RTA is easiest to rule out on account of acidosis.

Ref: Harrison 191 edition, 40e-2
Roth spots are white centered haemorrhage.
Cause of Roth spots
1. Bacteria endocarditis and sepsis
2. Lymphoproliferative disorders
3. Diabetes mellitus
4. Hypertension
5. Anaemia
6. Connective tissue disorders