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question and answer

By Pratyush kumar

THESE ARE THE QUESTIONS ASKED IN OUR 1ST MEDICINE INTERNAL TEST.
Q.1 - Classify aneamia. megaloblastic anemia. {long question}
Q.2 - Metabolic syndrome
Q.3-  Type 1 diabestese mellitus.
answer:-
1) def:- aneamia is defined as decrease in oxygen carrying capacity of blood , decrease number of red cell ,which varies according to age sex and altitude.
classification:-
 aneamia is classified on the basis of reticulocyte index
1> reticulocyte index <2.5 {hypo proliferative aneamia}
                      a> normocytic
                           iron deficiency aneamia
                           marrow supression
                           aplastic aneamia
                     b> microcytic
                          iron deficiency aneamia
                          thallasemia
                          sideroblastic aneamia
2> reticulocyte index >2.5 {hyperproliferative aneamia}
                         macrocytic:-
                          megaloblastic aneamia
                          blood loss
                           
MEGALOBLASTIC ANEAMIA
 aetiology:-

              cobalamin deficiency:-
                vegans
                intrinsic factor deficiency
                post gastrectomy
                decrease intake
                increased demand :- pregnancy, growth spurt
                worm infestation :-diphylobrothum latum
              folate deficiency:-
               anti folate drugs:- methotrexate
              increased demand 
              decrease absorption:- crohn disease, gluten sensitive enteropathy
               increased metabiolism
pathogenesis:-
             necessary for the synthesis of dna
             disparity in the synthesis of nucleotides
             helps in conversion of udp-->tdp
clinical features:-
             symptoms:
              anorexia
               malaise
               constipation
               fever
               weakness
               decrease exercise tolerance
              jaundice
neurological manifestation:-
            demyelination of posterior cord pyramidal tract
            bilateral neuropathy
            muscle weakness
            visual defect
             sluggish reflex
investigation:-
          blood picture:-
          hypersegmented neutrophils
          oval macrocytes
          fragmented rbc
          leukopenia
other test
         schilling test
         methyl malionic aciduria
         serum cobalamin
         serum folate
treatment
        cobalamin -1000mcg for 7 days
        folic acid - 5-15 mg for 7 days
 before giving folic acid therapy cobalamin deficiency must be ruled out..otherwise it may cause cobalamin neuropathy

2) Metabolic syndrome:-
    other names:-insulin resistance syndrme , syndrome X 
  defn:- seen as triad of hypertension, dyslipidemia, and hyperglyceamia
 seen i type 2 diabetese mellitus
  
there are two of insulin resistance 
TYPE A:- Seen in younger people
TYPE B:- Seen in older people.
investigation :-
bmi - >30
blood pressur ->140/90
cholestrol- elevated
hdl- decreased
ldl- elevated
treatment
ace inhibitors and thiazide diuretics are given
3) type 1 diabetese mellitus..
  defn:- it is a group of metabolic disorder sharing the phenotype of hyperglyceamia due to partial or complete
lack of insulin.{earlier it was called insulin dependant diabetese mellitus IDDM }
Aetiology:- autoimmune
                  genetic:- mody 1 ,2,3.4.5
                  endocrinopathies:- acromegaly, cushing syndrome ,
                  infection:- congenital rubella syndrome
                  tumour:- gulacagonoma ,
                  *autoantibody to glyceamic acid decarboxylase (gad) is found
pathogenesis:-
                autoimmune mediated beta cell destruction
                insulinitis:-  t cell  mediated destruction
                                  infiltration of lymphocyte
                                  fibrous change
               genetic:- involvement of HLA-DR6 , CTLA - 4, on chromosome 6
                honeymoon phase:- this is the phase gyceamic control is attained with little or no insulin.
                                               symptom less period..due to compensation by remaining beta cell
               impaired glucose tolerance is seen
investigation:-
              fpg->126 mg/dl
             pp> 200 mg/dl
             presence of c peptide
              glucose tolerance test
              glycosylated hb:- helpful in prognosis of diabetese mellitus 
treatment:-
             insulin infusion
             0.5-1 U/Kg.......50% must be given as basal dose
             various regimes are there:-
             continuous subcutaneous insulin infusion
             types :-
               regular , lispro, aspart
complication:-
              diabetic ketoacidosis:- due to lack of insulin
                      

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