A40-year-old man presents with chronic diarrhea and peptic ulcer disease refractory to medical management with proton pump inhibitors. An octreotide scan is shown in Figurewhich corresponds to an area near the head of the pancreas. Which of the following factors directly results in the release of the hormone produced by this tumor?
Answer(s): D
This patient has a gastrinoma, seen in Zollinger-Ellison syndrome, and should also be evaluated for possible MEN I. Gastrin is a GI hormone that is released from the antral G cells of the stomach to regulate acid secretion by the gastric parietal cells. It is released when the stomach gets the signal that is needed to initiate the digestion process, and also acts to stimulate chief cells to secrete pepsinogen and to increase gastric mucosal blood flow. Known stimulants for the release of gastrin include: vagal stimulation, calcium, alcohols in the stomach, proteins/amino acids in the stomach, antral distention, and gastric pH greater than3. Antral pH less than 2 inhibits gastrin release, as does somatostatin. Secretin has no effect or decreases gastrin levels in healthy patients, but it increases gastrin release in patients with Zollinger-Ellison syndrome.Glucagon has little or no effect on gastrin release.
An 18-year-old male is brought to the ED after sustaining a stab wound to the left chest that is medial and superior to the nipple. He was unresponsive at the scene and intubated by the emergency medical technician (EMT) team. His pulse is 140 and BP is 60/30 after receiving 1 L of lactated Ringers solution and 2 units of blood during his transport. On auscultation there are no breath sounds on the left. His trachea is midline. He has no evidence of neck vein distention.Which of the following statements is true?
Answer(s): B
One of every four trauma deaths in North America is due to thoracic trauma. Many deaths from thoracic trauma can be prevented with prompt diagnosis and treatment of injuries. The first step in the evaluation of any trauma patient is the primary survey, or ABCDE (airway, breathing, circulation, disability, exposure). First you would evaluate the airway. In this case, an endotracheal tube was placed at the scene. It would be important to evaluate this airway's adequacy of placement using a capnometer to assess end-tidal CO2 and auscultation of the breath sounds. Next you would assess breathing. Auscultation in this patient reveals an absence of breath sounds on the left. This must be resolved before moving on to circulation. This could be the result of placing the endotracheal tube in too far into the right mainstem, which is easily checked by withdrawing the endotracheal tube 2 cm.The other possibilities are life-threatening emergencies, including a tension pneumothorax or a hemothorax. Given the fact that the patient is unstable and there is a history of penetrating chest trauma, a chest tube should be placed immediately without the delay of a chest x-ray. A tube thoracostomy in this patient will be diagnostic and also therapeutic. Ahypovolemic patient with cardiac tamponade may not have neck vein distension. ED thoracotomies should only be performed in a pulseless patient. All other patients requiring thoracotomy should go to the OR. This patient is unstable and as such should not be taken to angiogram.
A23-year-old male is brought by ambulance to the ER after being found in a house fire. He was in a closed room with a large amount of smoke and has sustained burns to his face, torso, arms, and legs. His pulse is 120, BP 110/55, and SpO2 92% on 2 L of oxygen by nasal cannula. Which of the following statements is true?
Like other trauma patients, the initial management of burn patients is crucial in improving survival and function. Inhalation injury should be suspected in anyone with a history of confinement in smoke, facial burns, singed eyebrows or nasal hairs, carbonaceous sputum, or carboxyhemoglobin levels greater than 10%. These patients sometimes look stable initially but soon develop airway edema. These patients should be placed on high-flow oxygen and observed closely. There should be a very low threshold for endotracheal intubation to protect the airway. Burn patients require large volume fluid resuscitation that should begin immediately. If patients develop pulmonary edema, they should be intubated. Fluid resuscitation should not be withheld to prevent intubation. Heat loss is also a major concern in burn patients who have lost their thermoprotective skin covering. They should be wrapped in warm, moist dressings. Depth of burn affects management in resuscitation efforts, as well as need for debridement or escharotomy, and should be evaluated in every patient. The American Burn Association recommends transfer to a burn center for patients with:· Partial thickness and full thickness burns of >10% of total body surface area TBSA in patients with age <10 years old or >50 years old· Partial or full thickness burns of >20% in patients of any other age · Partial or full thickness burns involving face, hands, feet, genitalia, or perineum · Full thickness burns of >5% TBSA in any age group · Significant electrical or chemical burns· Inhalation injury
A 62-year-old man undergoes transplantation of a kidney from a cadaveric donor. The surgery is uncomplicated and his recovery proceeds well for the first week postoperatively. In the second postoperative week, he develops hypertension, peripheral edema, and decreased urinary output. He states that he has been taking his medications as ordered.What is the most likely cause of this condition?
In transplant immunology, a wide variety of immune effector mechanisms are responsible for rejection. Acute rejection typically occurs in the first few days to weeks after organ transplantation.The primary mediator of this immune response is the T cell. Treatment of acute rejection usually involves pulse dose steroids and increased immunosuppression. Other forms of rejection include hyperacute rejection and chronic rejection. Hyperacute rejection is the result of preformed antibodies and occurs within hours of transplantation and leads to graft loss. Chronic rejection occurs on the scale of months to years after transplantation and is characterized by fibrosis and loss of normal histologic architecture.
A 62-year-old man undergoes transplantation of a kidney from a cadaveric donor. The surgery is uncomplicated and his recovery proceeds well for the first week postoperatively. In the second postoperative week, he develops hypertension, peripheral edema, and decreased urinary output. He states that he has been taking his medications as ordered What is the most appropriate management at this time?
In transplant immunology, a wide variety of immune effector mechanisms are responsible for rejection. Acute rejection typically occurs in the first few days to weeks after organ transplantation.The primary mediator of this immune response is the T cell. Treatment of acute rejection usually involves pulse dose steroids and increased immunosuppression. Other forms of rejection include hyperacute rejection and chronic rejection. Hyperacute rejection is the result of preformed antibodies and occurs within hours of transplantation and leads to graft loss. Chronic rejection occurs on the scale of months to years after transplantation and is characterized by fibrosis and loss of normal histologic architecture
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