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11/09/2024

𝐔𝐧𝐝𝐞𝐫𝐬𝐭𝐚𝐧𝐝𝐢𝐧𝐠 𝐜𝐥𝐨𝐜𝐤𝐰𝐢𝐬𝐞 𝐫𝐨𝐭𝐚𝐭𝐢𝐨𝐧
The term “clockwise rotation” describes the apparent rotation of the heart as viewed from below in standard CT/MRI cross-sectional imaging views. High pulmonary pressures in PE cause acute RV pressure overload and dilatation, compressing the interventricular septum (IVS). Ensuing RV dysfunction and hypokinesis worsens these changes, particularly in the apical region. Leads V5-6, which usually face the LV wall and reflect LV depolarisation directly, are subsequently orientated over the IVS. The R/S transition point thus shifts rightwards towards V6.

Image:
Left: Normal cross-sectional configuration of RV/LV
Right: RV dilatation and hypertrophy compressing the LV, creating “clockwise” rotation of the heart

10/09/2024

𝐃𝐎𝐏𝐈𝐍𝐆 𝐀𝐆𝐄𝐍𝐓𝐒 𝐂𝐀𝐍 𝐇𝐀𝐕𝐄 𝐒𝐄𝐕𝐄𝐑𝐄 𝐒𝐈𝐃𝐄 𝐄𝐅𝐅𝐄𝐂𝐓𝐒
𝕆𝕗 𝕥𝕙𝕖 𝟟𝟘𝟘 𝕥𝕠𝕟𝕟𝕖𝕤 𝕠𝕗 𝕒𝕟𝕒𝕓𝕠𝕝𝕚𝕔 𝕤𝕥𝕖𝕣𝕠𝕚𝕕𝕤 𝕤𝕠𝕝𝕕 𝕒𝕟𝕟𝕦𝕒𝕝𝕝𝕪 𝕨𝕠𝕣𝕝𝕕- 𝕨𝕚𝕕𝕖, 𝕥𝕙𝕖 𝕧𝕒𝕤𝕥 𝕒𝕞𝕠𝕦𝕟𝕥 𝕚𝕤 𝕟𝕠𝕥 𝕦𝕤𝕖𝕕 𝕚𝕟 𝕞𝕖𝕕𝕚𝕔𝕚𝕟𝕖, 𝕓𝕦𝕥 𝕚𝕤 𝕞𝕒𝕚𝕟𝕝𝕪 𝕔𝕠𝕟𝕤𝕦𝕞𝕖𝕕 𝕓𝕪 𝕓𝕠𝕕𝕪-𝕓𝕦𝕚𝕝𝕕𝕖𝕣𝕤 𝕒𝕟𝕕 𝕤𝕥𝕣𝕖𝕟𝕘𝕥𝕙 𝕒𝕥𝕙𝕝𝕖𝕥𝕖𝕤.

𝐀𝐧𝐝𝐫𝐨𝐠𝐞𝐧𝐢𝐜 𝐚𝐧𝐚𝐛𝐨𝐥𝐢𝐜 𝐬𝐭𝐞𝐫𝐨𝐢𝐝𝐬 - 𝐀𝐀𝐒
- Reduces HDL cholesterol levels and increase in LDL in within 5 months (40-70%).
- Promote monocyte adhesion to endothelial cells.

𝐄𝐫𝐲𝐭𝐡𝐫𝐨𝐩𝐨𝐢𝐞𝐭𝐢𝐧 𝐚𝐧𝐝 𝐁𝐥𝐨𝐨𝐝 𝐝𝐨𝐩𝐢𝐧𝐠
- Risk of thrombus formation; fatal cerebral and cardiac embolism; renal and splenic infarction.
- Hypertension; haemolytic; anaphylactic transfusion reactions.

𝐁𝐞𝐭𝐚-𝟐 𝐚𝐠𝐨𝐧𝐢𝐬𝐭𝐬
- Cardiac ischaemia; congestive heart failure; arrhythmias; myocardial infarction; sudden death.

𝐒𝐭𝐢𝐦𝐮𝐥𝐚𝐧𝐭𝐬
- Tachycardia; vasoconstriction; hypertension; cardiomyopathy; arrhythmias; myocardial infarction and stroke.

𝐌𝐞𝐥𝐝𝐨𝐧𝐢𝐮𝐦
- Irregular heartbeat; changes in blood pressure; irregular skin conditions; allergic reaction; indigestion.

09/09/2024

Nikolai Anitschkow (1885–1964) fed rabbits with fat-rich diet and induced atherosclerosis in their aorta.

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09/09/2024

The word ‘doping’ appears for the first time in an English dictionary in 1889 and refers to a mixture of o***m and narcotic substances used to stimulate horses in the hippodrome.

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09/09/2024

POSTINFLAMMATORY HYPERPIGMENTATION PIH (Introduce - Pathophysiology - Histology)
𝙄𝙣𝙩𝙧𝙤𝙙𝙪𝙘𝙚
Postinflammatory hyperpigmentation (PIH) is a common acquired cutaneous disorder occurring after skin inflammation or injury. It is chronic and is more common and severe in darker-skinned individuals (Fitzpatrick skin types III-VI).
𝙋𝙖𝙩𝙝𝙤𝙥𝙝𝙮𝙨𝙞𝙤𝙡𝙤𝙜𝙮
📌Postinflammatory hyperpigmentation, or hypermelanosis, results from the overproduction of melanin or abnormal melanin deposition in the epidermis or dermis following inflammation.
📌 Inflammatory mediators trigger melanocyte hypertrophy and activity, which increases melanin production in the epidermis. In deeper processes extending to the dermis, basal keratinocytes are damaged and release large amounts of melanin.
📌The melanin is phagocytosed and deposited, causing a blue-gray discoloration of the skin, which may be permanent. Hyperpigmentation limited to the epidermis has a higher likelihood of resolution than dermal hyperpigmentation.
𝙃𝙞𝙨𝙩𝙤𝙡𝙤𝙜𝙮
If a biopsy is performed, epidermal PIH histopathology is significant for increased melanin in keratinocytes. The presence of melanin in dermal macrophages is noted in dermal melanosis. A biopsy may also be useful in determining the etiology of the underlying inflammation.

01/07/2024

𝐂𝐀𝐍𝐍𝐀𝐁𝐈𝐍𝐎𝐈𝐃 𝐈𝐍 𝐏𝐀𝐑𝐊𝐈𝐍𝐒𝐎𝐍’𝐒 𝐃𝐈𝐒𝐄𝐀𝐒𝐄
𝐒𝐮𝐩𝐩𝐨𝐫𝐭𝐢𝐧𝐠 𝐜𝐨𝐧𝐭𝐞𝐧𝐭: https://surf-theory-ff5.notion.site/CANNABINOID-IN-PARKINSON-S-DISEASE-85d1e662344149b78fff2f3cc2faf953?pvs=74

📇 Parkinson disease is a neurodegenerative disorder that mostly presents in later life with generalized slowing of movements (bradykinesia) and at least one other symptom of resting tremor or rigidity.

Other associated features are a loss of smell, sleep dysfunction, mood disorders, excess salivation, constipation, and excessive periodic limb movements in sleep (REM behavior disorder).

𝐏𝐚𝐭𝐡𝐨𝐩𝐡𝐲𝐬𝐢𝐨𝐥𝐨𝐠𝐲 𝐢𝐧 𝐏𝐚𝐫𝐤𝐢𝐧𝐬𝐨𝐧'𝐬 𝐬𝐲𝐧𝐝𝐫𝐨𝐦𝐞: dopamine deficiency of striatum receptors → Decrease in "disinhibition" → Increasing inhibition of motor skills → Bradykinesis

𝐴𝑝𝑜𝑚𝑜𝑟𝑝ℎ𝑖𝑛𝑒: 𝑎 𝑛𝑜𝑛-𝑠𝑒𝑙𝑒𝑐𝑡𝑖𝑣𝑒 𝑑𝑜𝑝𝑎𝑚𝑖𝑛𝑒 𝑎𝑔𝑜𝑛𝑖𝑠𝑡 𝑤ℎ𝑖𝑐ℎ 𝑎𝑐𝑡𝑖𝑣𝑎𝑡𝑒𝑠 𝑏𝑜𝑡ℎ 𝐷2-𝑙𝑖𝑘𝑒 𝑎𝑛𝑑, 𝑡𝑜 𝑎 𝑚𝑢𝑐ℎ 𝑙𝑒𝑠𝑠𝑒𝑟 𝑒𝑥𝑡𝑒𝑛𝑡, 𝐷1-𝑙𝑖𝑘𝑒 𝑟𝑒𝑐𝑒𝑝𝑡𝑜𝑟𝑠. 𝐼𝑡 𝑎𝑙𝑠𝑜 𝑎𝑐𝑡𝑠 𝑎𝑠 𝑎𝑛 𝑎𝑛𝑡𝑎𝑔𝑜𝑛𝑖𝑠𝑡 𝑜𝑓 5-𝐻𝑇2 𝑎𝑛𝑑 α-𝑎𝑑𝑟𝑒𝑛𝑒𝑟𝑔𝑖𝑐 𝑟𝑒𝑐𝑒𝑝𝑡𝑜𝑟𝑠 𝑤𝑖𝑡ℎ ℎ𝑖𝑔ℎ 𝑎𝑓𝑓𝑖𝑛𝑖𝑡𝑦. 𝑇ℎ𝑒 𝑐𝑜𝑚𝑝𝑜𝑢𝑛𝑑 𝑖𝑠 ℎ𝑖𝑠𝑡𝑜𝑟𝑖𝑐𝑎𝑙𝑙𝑦 𝑎 𝑚𝑜𝑟𝑝ℎ𝑖𝑛𝑒 𝑑𝑒𝑐𝑜𝑚𝑝𝑜𝑠𝑖𝑡𝑖𝑜𝑛 𝑝𝑟𝑜𝑑𝑢𝑐𝑡 𝑚𝑎𝑑𝑒 𝑏𝑦 𝑏𝑜𝑖𝑙𝑖𝑛𝑔 𝑚𝑜𝑟𝑝ℎ𝑖𝑛𝑒 𝑤𝑖𝑡ℎ 𝑐𝑜𝑛𝑐𝑒𝑛𝑡𝑟𝑎𝑡𝑒𝑑 𝑎𝑐𝑖𝑑, ℎ𝑒𝑛𝑐𝑒 𝑡ℎ𝑒 -𝑚𝑜𝑟𝑝ℎ𝑖𝑛𝑒 𝑠𝑢𝑓𝑓𝑖𝑥. 𝐶𝑜𝑛𝑡𝑟𝑎𝑟𝑦 𝑡𝑜 𝑖𝑡𝑠 𝑛𝑎𝑚𝑒, 𝑎𝑝𝑜𝑚𝑜𝑟𝑝ℎ𝑖𝑛𝑒 𝑑𝑜𝑒𝑠 𝑛𝑜𝑡 𝑎𝑐𝑡𝑢𝑎𝑙𝑙𝑦 𝑐𝑜𝑛𝑡𝑎𝑖𝑛 𝑚𝑜𝑟𝑝ℎ𝑖𝑛𝑒 𝑜𝑟 𝑖𝑡𝑠 𝑠𝑘𝑒𝑙𝑒𝑡𝑜𝑛, 𝑛𝑜𝑟 𝑑𝑜𝑒𝑠 𝑖𝑡 𝑏𝑖𝑛𝑑 𝑡𝑜 𝑜𝑝𝑖𝑜𝑖𝑑 𝑟𝑒𝑐𝑒𝑝𝑡𝑜𝑟𝑠.

# # 𝐀𝐩𝐩𝐫𝐨𝐚𝐜𝐡 𝐭𝐨 𝐂𝐚𝐧𝐧𝐚𝐛𝐢𝐧𝐨𝐢𝐝

Cannabis has two main active ingredients Tetrahydrocannabinol THC and cannabidiol (CBD) are obtained from the h**p plant and usually consumed inhaled as twisted ci******es (joints) or orally, e.g. in the form of biscuits (so-called space cookies).

Binding to the specific cannabinoid receptors CB1, CB2 → E.a. Inhibition of a GABAergic interneuron → Inhibition of the inhibitory effect on downstream dopaminergic neurons → Increase in dopamine secretion in the nucleus accumbens of the mesolimbic reward system

**Ma*****na** consists of 85 phytocannabinoids, from which cannabidiol (CBD) and tetrahydrocannabinol (THC) are the main constituents. CBD and THC are responsible for the medicinal effects of ma*****na

- **CBD** is non-psychoactive and is known to have hypnotic, anxiolytic, antipsychotic, and neuroprotective effects
- **THC** is the main component responsible for psychotropic effects of cannabis, and it acts via two types of G protein-coupled receptors, known as cannabinoid type 1 (CB1) and type 2 (CB2)

**Endocannabinoids** are produced in the body and help regulate memory, pleasure, concentration, thinking, movement, sensory and time perception, appetite, and pain. They act on CB1 and CB2 receptors. The main endocannabinoids are **anandamide** and **2-arachidonoyl glycerol**.

Globus pallidus and substantia nigra are major brain areas involved in the control of movements and contain the highest densities of CB1 receptors, as well as the highest levels of anandamide .

Dopaminergic D2 receptors regulate anandamide synthesis in the striatum which gives inhibitory feedback to dopamine-induced motor activity

27/06/2024

While seeing patients in your preceptor’s clinic, you have the opportunity to meet
and examine one of her long-time patients, a 52-year-old woman who presents
for her yearly physical examination. She has been fine and has no complaints
today. Her medical history is notable only for borderline hypertension and moderate obesity. Last year her fasting lipid profile was acceptable for someone without
known risk factors for coronary artery disease. Her mother and older brother have
diabetes and hypertension. At prior visits, you see that your preceptor has counseled heron a low-calorie, low-fat diet and recommended that she start an exercise
program. However, the patient says she has not made any of these recommended
changes. With her full-time job and three children, she finds it difficult to exercise,
and she admits that her family eats out frequently. Today her blood pressure is
140/ 92 mm Hg. Her body mass index (BMI) is 29 kg/m2. Her examination is notable
for acanthosis nigricans at the neck but otherwise is normal. A Papanicolaou (Pap)
smear is performed, and a mammogram is offered. The patient has not eaten yet
today, so on your preceptor’s recommendation, a fasting plasma glucose test is
performed, and the result is 140 mg/dL.

- 𝐖𝐡𝐚𝐭 𝐢𝐬 𝐲𝐨𝐮𝐫 𝐝𝐢𝐚𝐠𝐧𝐨𝐬𝐢𝐬?

- 𝐖𝐡𝐚𝐭 𝐢𝐬 𝐲𝐨𝐮𝐫 𝐧𝐞𝐱𝐭 𝐬𝐭𝐞𝐩?

27/06/2024

𝐂𝐡𝐢𝐥𝐚𝐢𝐝𝐢𝐭𝐢-𝐒𝐲𝐧𝐝𝐫𝐨𝐦

Röntgenaufnahme des Thorax im p.a.-Strahlengang: Unter der rechten Zwerchfellkuppel sind massive Lufteinschlüsse erkennbar, die typisch für das sog. Chilaiditi-Syndrom sind. Dabei kommt es während der Embryonalentwicklung zu einer Verlagerung von Dick- und Dünndarmanteilen zwischen Leber und Zwerchfell. Um ein Chilaiditi-Syndrom von einem Pneumoperitoneum zu unterscheiden, sollte nach einer Haustrierung innerhalb der Luftanteile gesucht werden. Liegt wie in diesem Bild eine solche vor (weiß gestrichelte Markierung), so kann davon ausgegangen werden, dass es sich bei den Lufteinschlüssen um Darmanteile handelt (Ma=Magenblase).

Quelle: © IMPP

26/06/2024

𝐑𝐢𝐠𝐥𝐞𝐫 𝐬𝐢𝐠𝐧 (𝐛𝐨𝐰𝐞𝐥)

The Rigler sign, also known as the double-wall sign, is a sign of pneumoperitoneum seen on an abdominal radiograph when gas is outlining both sides of the bowel wall, i.e. gas within the bowel's lumen and gas within the peritoneal cavity. It is seen with large amounts of pneumoperitoneum (>1000 mL).

Pneumoperitoneum may be a result of perforation or, recent instrumentation or surgery. A false double-wall sign can result from two loops of bowel being in contact with one another, thus the wall thickness is double that of a single loop.

Source: https://radiopaedia.org/articles/rigler-sign-bowel

25/06/2024

Ein 42-jähriger Gärtner stellt sich mit starker Epistaxis in der HNO-Ambulanz vor. Anamnestisch berichtet er über einen seit einigen Tagen bestehenden febrilen Infekt der oberen Atemwege, weswegen ihm vor 3 Tagen Amoxicillin verordnet wurde. Zusätzlich gibt er einen seit Jahren bestehenden vermehrten Alkohol- und Nikotinkonsum an.

Klinischer Untersuchungsbefund: Neben der starken Epistaxis besteht Fieber mit 38,8 °C. Über beiden Lungenunterfeldern hört man bronchitische RG, der kardiale Auskultationsbefund ist bis auf eine Tachykardie von 100/min unauffällig. Leber und Milz lassen sich aufgrund einer ausgeprägten Adipositas nicht tasten. Es finden sich keine Petechien, z. B. an den Unterschenkeln.

Laborbefunde: (das Bild)

𝐖𝐞𝐥𝐜𝐡𝐞 𝐝𝐞𝐫 𝐟𝐨𝐥𝐠𝐞𝐧𝐝𝐞𝐧 𝐀𝐮𝐬𝐬𝐚𝐠𝐞𝐧 𝐭𝐫𝐢𝐟𝐟𝐭 𝐛𝐞𝐢 𝐝𝐞𝐦 𝐏𝐚𝐭𝐢𝐞𝐧𝐭𝐞𝐧 𝐚𝐦 𝐰𝐚𝐡𝐫𝐬𝐜𝐡𝐞𝐢𝐧𝐥𝐢𝐜𝐡𝐬𝐭𝐞𝐧 𝐳𝐮?

A. Die pathologischen Laborwerte sind auf eine cholestatische Schädigung durch die Amoxicillin-Einnahme zurückzuführen.

B. Die Befunde sprechen für das Vorliegen einer Verbrauchskoagulopathie mit Hyperfibrinolyse.

C. Die pathologischen Laborwerte sind am besten durch einen schweren Leberparenchymschaden mit seinen Folgen erklärt.

D. Das klinische Bild und die Laborbefunde sprechen für das Vorliegen einer Autoimmunthrombozytopenie.

E. Die aPTT-Verlängerung ist u. a. durch die Thrombozytopenie erklärbar.

24/06/2024

𝐖𝐞𝐥𝐜𝐡𝐞𝐬 𝐝𝐞𝐫 𝐟𝐨𝐥𝐠𝐞𝐧𝐝𝐞𝐧 𝐬𝐨𝐧𝐨𝐠𝐫𝐚𝐟𝐢𝐬𝐜𝐡𝐞𝐧 𝐙𝐞𝐢𝐜𝐡𝐞𝐧 𝐢𝐬𝐭 𝐠𝐞𝐧𝐞𝐫𝐞𝐥𝐥 𝐚𝐦 𝐰𝐞𝐧𝐢𝐠𝐬𝐭𝐞𝐧 𝐭𝐲𝐩𝐢𝐬𝐜𝐡 𝐟𝐮̈𝐫 𝐋𝐞𝐛𝐞𝐫𝐳𝐢𝐫𝐫𝐡𝐨𝐬𝐞?

A. unregelmäßige Leberoberfläche

B. Aszites

C. inhomogenes Lebergewebe

D. rarefizierte Lebervenen

E. Gallenblasenhydrops

11/06/2024

Eine 27-jährige Frau stellt sich auf Überweisung einer Neurologin ambulant in der endokrinologischen Sprechstunde vor.

Aufgrund unklarer langjähriger Zephalgien wurde von der Neurologin zur weiteren Diagnostik eine MRT des Schädels veranlasst. Hier ergab sich bei ansonsten regelrechtem Befund der Verdacht auf eine im Durchmesser 6 mm große Raumforderung der Adenohypophyse ohne Kontakt zur Sehbahn.

Ansonsten bestehen bei der Patientin keine weiteren Beschwerden, konstantes Körpergewicht 53 kg bei 169 cm Körpergröße, keine Vorerkrankungen, Familienanamnese leer, keine Medikation.

Bei der körperlichen Untersuchung ergeben sich keine wegweisenden Befunde.

Es soll eine weitere Diagnostik bezüglich einer autonomen Hormonproduktion durchgeführt werden.

Die Messung welches der genannten Laborparameter bzw. welches Testverfahren ist hierfür am ehesten geeignet?

A. 5-Hydroxyindolessigsäure im 24-h-Urin

B. Aldosteron-Renin-Quotient im Plasma

C. Metanephrine im Plasma

D. Dexamethason-Kurztest 1 mg

E. Arginin-stimuliertes Copeptin im Plasma