Random Flashcards
Warburg effect
Cancer cells - producing energy by high rate of glycolysis (200 times higher than the normal counterpart) followed by lactate fermentation in cytosol
Normal cells - low rate of glycolysis followed by oxidation of pyruvate in mitochondria as in most normal cells
SIRS
Sepsis
Severe sepsis
Septic shock
SIRS Two or more of the following: • Temperature >38° C or <35° C • Heart rate >90 beats/min • Respiratory rate >20 breaths/min or Paco2 <32 mm Hg • WBC count >12,000 or <4000/mm3
Sepsis
SIRS + documented infection
Severe Sepsis
Sepsis + organ dysfunction or hypoperfusion (e.g., lacticacidosis, oliguria, altered mental status)
Septic Shock
Sepsis + organ dysfunction + hypotension (SBP <90 mm Hg or SBP >90 mm Hg with vasopressors)
Reason for steroid use in septic shock and dose
Septic shock patients are frequently found to have adrenal insufficiency and resistance to glucocorticoid receptors .
Dose - hydrocortisone 50 mg 6th hourly iv, for 7 days, if the patient SBP remains less than 90 in spite of appropriate fluid and vasopressors therapy.
Cloquet node
Superior most deep inguinal node.
Side effects of octreotide
Gallbladder problems (>60%): Decreased gallbladder contractility, gallstones, cholecystitis, cholestatic hepatitis ->60% Dysglycemia - 25% Hypothyroidism -25% Bradycardia - 25% ECG changes-10% Arrhythmia -9%
Granulation tissue - constitute
Capillary bed Fibroblasts, fibronectin, Collagen (loosely arranged) RBC, WBC, macrophages Hyaluronic acid
Features of healthy granulation tissue
Pulse full Pin head appearance Punctate haemorrhage (bleeds on touch) Pink colour Painless
Normal abdominal pressure in an adult ?
Intra abdominal pressure in a critically ill patient ?
Intra-abdominal hypertension ?
Abdominal compartment syndrome?
0-5 mm hg
5- 7 mm hg
>12 mm Hg
Persistent IAHT >20 mmHg + new onset organ failure
Grading of intra-abdominal hypertension
Grade 1- 12-15 mmHg
Grade 2- 16- 20
Grade 3 - 21- 25
Grade 4 - 25 and above
Child Turcot Pugh score
FACTOR NO. OF POINTS
1 2 3
Bilirubin (mg/dL). <2 2-3 >3
Albumin (g/dL) >3.5 2.8-3.5 <2.8 Prothrombin time (increased seconds) 1-3 4-6 >6
Ascites None Slight Moderate Encephalopathy None Minimal Advanced
Name of the grading system for endoscopic evaluation of caustic ingestion?
Zargar grading
Name of the gastric ulcer classification
Modified Johnson
Modified Johnson classification of gastric ulcer
I - Lesser curve at incisura II - Gastric body with duodenal ulcer III - Prepyloric IV - High on lesser curve V - Anywhere (drug induced)
Zargar endoscopic grading of caustic injury
Grade 0 - a normal mucosa
grade 1 - only slight swelling and redness of the mucosa
grade 2A - presence of superficial ulcers, bleeding, and exudates
grade 2B - local or encircling deep ulceration
grade 3A - focal necrosis
grade 3B - extensive necrosis
Fundal varices classification
Sarin’s classification
GOV -1 : esophageal varices extending into the lesser curvature
GOV -2 : extending into the greater curvature
IGV -1 : varices in gastric fundus alone
IGV-2: varices in fundus and other part of stomach.
Splenic artery anatomy type
Magistrate type (30%) Distributed type (70%)
Splenic artery branches
Superior polar artery Superior terminal artery Middle terminal artery Inferior terminal artery Inferior polar artery
Eastern cooperative oncology group (ECOG) performance status
- 0: fully active and is able to carryout normal activities without any restriction.
- 1: Symptoms restrict strenuous activity but is able to carryout light sedentary activities.
- 2: Ambulatory but unable to carryout normal activities.. Up and about >50% waking hours.
- 3: only limited self care. confined to bed for >50% of waking hours.
- 4: completely confined to bed , disabled, needs assistance.
BMI
Underweight : <18. 5
normal :—18. 5–24. 9
overweight : —25–29. 9
obese :—30 or higher
Bilirubin
Normal - 0.2-0.8 mg%
Latent jaundice - 1 to 1.9 mg%
Clinical jaundice - more than 2mg%
Degree of clubbing
1st degree: There is only increased fluctuation of the nail bed.
2nd degree: in addition to fluctuation, there is increased anteroposterior and transverse diameter of the nail.
3rd degree: Above changes with increased pulp tissue in the terminal phalanges.
4th degree: combination of above changes with subperiosteal thickening of bones of wrist and ankle (hypertrophic osteoarthropathy)
Pyrexia
Normal temperature- 99 degree Fahrenheit
Pyrexia - more than 100.4
Hyper pyrexia - more than 106
Hypothermia - less than 95
