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  #1  
Old 02-25-2012
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Default Questions

9 y.o. pain in umbilical area but no increase in pain upon palpation.
what could it be? duodenal ulcer, gastric ulcer, appendicitis, crohn?? dnt remember the 5th choice sorry.
when do u get no pain upon palpation in general?


when there is sepsis what happens to the level of CORTISOL, ACTH, CRH?
i was thinking maybe the infection or fever stimulate hypothalamus?

mentally retarded 19 y,o. pregnant woman wants abortion.
do get informed consent or do you contact supervisor or do you get informed consent? dont remember the other choices but these answer seem to me the most appropriate..
(no info about how severe the retardation is..but if she is clear enough to think about abortion then i guess she is not severely mentally challenged? what do you think?)

IDDM: putting aside the side effect of insulin, do you get post exercise hypoglycemia due to lack of glucagon? or what is the mechanism..


would be of great help if you could try to answer these..couldnt find any source
thanks and good luck
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  #2  
Old 02-25-2012
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Default IDDM

in IDDM,the body does not have its own insulin to be regulated (i.e decreased) during exercise because of increased muscle demands and consumption of glucose and decreased blood glucose.
So externally administered insulin is not dependent on body glucose levels and lowers the glucose during exercise too, inspite of increased muscle use and decreased blood glucose.hence the post exercise hypoglycemia thats common in IDDM.
also if insulin is injected into an the limb which is exercised,the release is faster.
if peak of insulin matches peak of exertion,hypoglycemia is more.
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Old 02-25-2012
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Default sepsis

In sepsis,the levels of cortisol,ACTH and CRH all 3 are increased because the LPS and other cytokines stimulate release of CRH from the hypothalamic paraventricular nucleus.
esp IL-1 beta and IL- 6 act on hypothalamus to increase CRH production.
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  #4  
Old 02-25-2012
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Default Appendicitis

In your 1st question the answer is appendicitis (9 y.o. with umbilical pain)
Since there is no inflammation of the parietal peritoneum, yet, pain shouldn't increase during palpation.
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Old 02-25-2012
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Default

Quote:
Originally Posted by Jasmine1 View Post
in IDDM,the body does not have its own insulin to be regulated (i.e decreased) during exercise because of increased muscle demands and consumption of glucose and decreased blood glucose.
So externally administered insulin is not dependent on body glucose levels and lowers the glucose during exercise too, inspite of increased muscle use and decreased blood glucose.hence the post exercise hypoglycemia thats common in IDDM.
also if insulin is injected into an the limb which is exercised,the release is faster.
if peak of insulin matches peak of exertion,hypoglycemia is more.
thanks jasmine, but lets say there was no insulin adm. prior to exercise, why do IDDM patient get hypoglycemia more than normal people?
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Old 02-26-2012
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Even if there is no insulin administered just prior to exercise the IDDM patient would take his insulin in the scheduled time of the day and it would keep on acting throughout the day irrespective of blood glucose levels.
thats what I had read in uworld explanation.they never mentioned any role of glucagon.
I reckon you stick to the uworld explanation as there's is the most updated.
Also,to orevent post exercise hypoglycemia-
IDDM diabetics should - 1.eat like 35 gm of Carbs just before exercise
2.not inject insulin such that the peak of insulin and the peak of exertion co incide
3.not inject insulin in exercising limb because of abnormally high distribution due to exercise induced increase in blood flow
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  #7  
Old 02-26-2012
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Default

Quote:
Originally Posted by Jasmine1 View Post
Even if there is no insulin administered just prior to exercise the IDDM patient would take his insulin in the scheduled time of the day and it would keep on acting throughout the day irrespective of blood glucose levels.
thats what I had read in uworld explanation.they never mentioned any role of glucagon.
I reckon you stick to the uworld explanation as there's is the most updated.
Also,to orevent post exercise hypoglycemia-
IDDM diabetics should - 1.eat like 35 gm of Carbs just before exercise
2.not inject insulin such that the peak of insulin and the peak of exertion co incide
3.not inject insulin in exercising limb because of abnormally high distribution due to exercise induced increase in blood flow
that was really helpful..much appreciated
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