Anatomy Lab Checklist QQ
lung adenocarcinoma
lung adenocarcinoma
colon cancer
endometrial cancer
Upper Limb
Clavicle(left)
Clavicle
spinoglenoid notch
(suprascapular notch)
(intertubercular sulcus)
obique line
Ulnar(left?)
(Palmar view of left hand)
carpal arch(tunnel)
Lower Limb
tubercle of the crest
posterior
anterior gluteal line
inferior
感覺iliopubic eminence在pubis?
Greater Sciatic Notch
Ischium
lesser sciatic notch
Acetabular Fossa
Acetabular Notch
pubis(medial view)
pubic symphisis
iliopubic eminence?
quadrate tubercle
malleolar fossa
intercondylar eminence
styloid process
Tarsal Bones
Skull and Facial Skeleton
Sutures
(Bregma)
(Lambda)
External
Lateral
Frankfurt Plane
(zygomatic arch)
styloid process
Anterior
infraorbital foramen
Mandible
lingula
mylohyoid line
mylohyoid groove
Inferior
hard palate
(intermaxillary suture)
incisive fossa(canals inside)
-pterygoid plate(medial, lateral)
pterygoid fossa
greater palatine fpramina
lesserer palatine fpramina
pterygoid hamulus
mandibular fossa
carotid canal
jugular foramen
Pharyngotympanic tube (auditory tube)
stylomastoid foramen
hypoglossal canal
cranial cavity roof
groove for SSS
frontal crest
cranial cavity floor
anterior clinoid process
tuberculum sellae(middle clinoid process)
hypophyseal fossa
dorsum sellae(posterior clinoid process)
clivus
crista galli
Skull and Facial Skeleton
9/19 小組討論
Questions
1. 根據病患抽血結果,請問病患較屬於哪一類型休克?
2. 休克復甦(resuscitation)時要注意哪些狀況?是否會併發其他器官功能異常,及其背後病理機轉為何?
抽血檢驗項目簡簡介
RBC: RBC concentration
HB: Hemoglobin concentration
HCT: volume percentage of RBC in blood
抽血檢驗項目簡簡介
MCV (mean corpuscular volume): RBCHCT, average volume of RBC
MCHC(mean corpuscular hemoglobin concentration): HCTHB, average concentration of hemoglobin in RBC
抽血檢驗項目簡簡介
PLT: platelet concentration
RDW-CV: range of variation of RBC size
WBC: WBC concentration
抽血檢驗項目簡簡介
AST(GOT)/ALT(GPT): indicators of liver inflammation
抽血檢驗項目簡簡介
BUN(blood urea nitrogen)/Cre(creatinine): indicators of kidney health
抽血檢驗項目簡簡介
Lactic acid: increases due to hypoxia or impaired renal/hepatic function
hsCRP(high sensitivity-C reactive protein): a inflammation marker
Blood Test Results in Shocks
Blood Test Results in Shocks
What kind of shock?
A. Distributive Shock
B. Cardiogenic Shock
C. Hypovolemic Shock
D. Obstructive Shock
What kind of shock?
A. Distributive Shock
B. Cardiogenic Shock
C. Hypovolemic Shock (with infection?)
D. Obstructive Shock
Questions
1. 根據病患抽血結果,請問病患較屬於哪一類型休克?
2. 休克復甦(resuscitation)時要注意哪些狀況?是否會併發其他器官功能異常,及其背後病理機轉為何?
Complications of Fluid Resuscitation
Coagulation Disorders
H.P. Pham, B.H. Shaz,Update on massive transfusion,British Journal of Anaesthesia,Volume 111, Supplement 1, 2013
Reperfusion-Mediated Injury
H.P. Pham, B.H. Shaz,Update on massive transfusion,British Journal of Anaesthesia,Volume 111, Supplement 1, 2013
Oxygen-Derived ROS
⟹
plasma membrane damage
Cytokines(IL-1,IL-6,IL-8,TNF-α)
neutrophil activation
⟹
More ROS
Acute Respiratory Distress Syndrome
pulmonary edema
Lee J, Corl K, Levy MM. Fluid Therapy and Acute Respiratory Distress Syndrome. Crit Care Clin. 2021 Oct
⟹
ARDS
pulmonary edema
shock/inflammation
increased vascular permeability
fluid resuscitation
increased hydrostatic pressure
⟹
⟹
⟹
⟹
Other References
[1]Fluid Resuscitation: State of the Science for Treating Combat Casualties and Civilian Injuries. Institute of Medicine (US) Committee on Fluid Resuscitation for Combat Casualties; Pope A, French G, Longnecker DE National Academies Press (US); 1999.
[2]Huppert LA, Matthay MA, Ware LB. Pathogenesis of Acute Respiratory Distress Syndrome. Semin Respir Crit Care Med. 2019
Pathology Lab 1
不太考
不太考
應該會考
(plasma cell)
2. epithelial infoldings and papilla
不太考
不太考
(or lymph node)
4. maturation with descent
3. invaginated respiratory epithelium with cystic dilation
不太考
不太考
3. Dilation of central vein
(maybe with organization)
(including glomerulus)
Pathology Lab 1-2
(Infection)
可能跟ulcer一起
(可以寫多一些)
B Drug
4.0
0.01
1.01
2510
2511
10/3 小組討論
Question
4. 呼吸道病毒感染後常見的細菌感染有哪些?初步的痰液染色如下圖,如何描述以及最可能的致病菌是什麼?
Manna S, Baindara P, Mandal SM. Molecular pathogenesis of secondary bacterial infection associated to viral infections including SARS-CoV-2. J Infect Public Health. 2020
Hugh C. Murray, Michael Muleme, Darcie Cooper, Bridgette J. McNamara, Mohammad A. Hussain, Caroline Bartolo, Daniel P. O'Brien, Eugene Athan, Prevalence, risk factors, and outcomes of secondary infections among hospitalized patients with COVID-19 or post–COVID-19 conditions in Victoria, 2020-2023, International Journal of Infectious Diseases,2024
n = 194,660
Bosch AA, Biesbroek G, Trzcinski K, Sanders EA, Bogaert D. Viral and bacterial interactions in the upper respiratory tract. PLoS Pathog. 2013
NA:neuraminidase
SA: sialic acid
Bosch AA, Biesbroek G, Trzcinski K, Sanders EA, Bogaert D. Viral and bacterial interactions in the upper respiratory tract. PLoS Pathog. 2013
Those Pathogens in Sputum
S. pneumoniae (Gram-positive lancet-shaped diplococci)
S. aureus (Gram-positive cocci in clusters)
Fukuyama H, Yamashiro S, Kinjo K, Tamaki H, Kishaba T. Validation of sputum Gram stain for treatment of community-acquired pneumonia and healthcare-associated pneumonia: a prospective observational study. BMC Infect Dis. 2014
Those Pathogens in Sputum
K. pneumoniae
(Gram-negative rods large sized)
Fukuyama H, Yamashiro S, Kinjo K, Tamaki H, Kishaba T. Validation of sputum Gram stain for treatment of community-acquired pneumonia and healthcare-associated pneumonia: a prospective observational study. BMC Infect Dis. 2014
P. aeruginosa
(Gram-negative rods small sized )
Those Pathogens in Sputum
?
Fukuyama H, Yamashiro S, Kinjo K, Tamaki H, Kishaba T. Validation of sputum Gram stain for treatment of community-acquired pneumonia and healthcare-associated pneumonia: a prospective observational study. BMC Infect Dis. 2014
H. influenzae
(Gram-negative coccobacilli )
H. influenzae
K. pneumoniae
P. aeruginosa
S. pneumoniae
S. aureus
呼吸道病毒感染後常見的細菌感染有哪些?Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae, Pseudomonas aeruginosa
初步的痰液染色如下圖,如何描述以及最可能的致病菌是什麼?
S. aureus (Gram-positive cocci in clusters)
Question
6. 年長者或免疫不全病患建議的呼吸道相關疾病疫苗有哪些?
Vaccines for Respiratory Tract Infections
References:
Vaccines for Respiratory Tract Infections
Vaccines for Respiratory Tract Infections
Vaccines for Respiratory Tract Infections
Vaccines for Respiratory Tract Infections
Popara M, Pendle S, Sacks L, Smego RA, Mer M. Varicella pneumonia in patients with HIV/AIDS. Int J Infect Dis 2002;6:6–8
Vaccines for Respiratory Tract Infections
Vaccines for Respiratory Tract Infections
Vaccines for Respiratory Tract Infections
Vaccines for Respiratory Tract Infections
Live vaccines might be contra-indicated in immunocompromised patients!
Laureates of the Nobel Prize 2024
Zi-Hong Xiao
2024/10/17
Physiology or Medicine
Physics
Chemistry
Literature
Peace
Economic Science
Physiology or Medicine Prize
Before Their Research
(lf)/lin-14(gf)
(lf)
[reiterated L1 stage growth]
[lack of L1 stage growth]
lin-4 negatively regulates lin-14
Victor Ambros
Gary Ruvkun
lin-4 is unlikely to encode a protein.
lin-4 encodes two small RNA transcripts.
There is partial complementarity between the lin-4 noncoding RNA and multiple elements in the lin-14 3’UTR.
Down-regulation of lin-14p occurs at a post-transcriptional step.
lin-4 and lin-14 3'-UTR is involved in the regulation.
John Hopfield: Hopfield Network
A network of "neurons" with memory.
Vj=1,j=i∑Tij
Vj=1,j=i∑Tij
Geoffrey Hinton: Boltzmann Machine
An early generative model.
Pretty much like the Hopfield Network, but...
The edge weights are "trained" using gradient descent.
The update process is random.
amino acid sequence
protein structure
structure prediction
protein design
David Baker: Rosetta Algorithm
A useful tool for structure prediction and protein design.
(published in 2004)
......
Foldit
Demis Hassabis, John Jumper: Alphafold
A deep learning model that "solves the 50-year-old grand challenge in biology".
散文
偏頭痛
Some Novels of Han Kang(韓江)
NIHON HIDANKYO
(日本原水爆被害者団体協議会,日本被団協)
制度
繁榮
Reversal of Fortune?
1500
Richer regions
Densely populated
Less settlers
Extractive institutions
colonized
High tax
discourage investment
1995
Poorer countries
Poorer regions
Sparsely populated
More Settlers
Institutions of private property
More incentive for investment
better economic performance
Richer countries
Want to know more?
Additional References
Pathology Micro-2
(heart, other organs)
描述位置!
(may have heterologous elements, like cartilage or skeletal mescle)
Tumor Description:
1. border(infiltrative到哪裡/circumscribed/capsule)
2. architecture
3. cell 長相
4. stroma
5. 其他周邊異常
5. stromal desmoplasia
(Nabothian cyst)
(apoptosis/prominent nucleoli)
(melanin pigment)
(circumscribed/infiltrative)
4. abrupt transition, depletion of goblet cell
(nuclear pleomorphism)
(elongated, tapered)
(cobweb structure)
localized type: circumscribed
(maybe cavernous or capillary)
(tadpole, spider cell)
(cambium layer?)-TSC
(pagetoid spread)
(hyperchromatic也可)
(只考在這)
(Gamna-Gandy body)
(HAM)
irregular lumen narrowing/intima thickening
11/7 小組討論
Question
4. 周邊動脈疾病的治療有哪些?對胡先生的周邊動脈疾病,在藥物治療上如何調整?
Treatment for PAD
2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.
Treatment for PAD
2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.
Treatment for PAD
2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.
Medication for PAD
2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.
Contradicted in Heart Failure.
Intervention/Surgery for PAD (CLI)
2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.
胡先生藥物治療上如何調整?
Sofat S, Chen X, Chowdhury MM, Coughlin PA. Effects of Statin Therapy and Dose on Cardiovascular and Limb Outcomes in Peripheral Arterial Disease: A Systematic Review and Meta-analysis. Eur J Vasc Endovasc Surg. 2021 Sep;62(3):450-461. doi: 10.1016/j.ejvs.2021.05.025. Epub 2021 Aug 10. PMID: 34389230.
Question
5. 何謂急性後期照護?胡先生是否符合健保署的「急性後期整合照護計畫」的收案標準?是否有其他出院後照護的選擇?
急性後期照護(Post-Acute Care)
林純聿、周怡君:衰弱高齡患者的急性後期照護。內科學誌。2019:30:7-13。
急性後期照護(Post-Acute Care)
健保署 全民健康保險急性後期整合照護計畫
Question
5. 何謂急性後期照護?胡先生是否符合健保署的「急性後期整合照護計畫」的收案標準?是否有其他出院後照護的選擇?
急性後期整合照護計畫
健保署 全民健康保險急性後期整合照護計畫
心臟衰竭?
健保署 全民健康保險急性後期整合照護計畫
?
心臟衰竭?
(治療後)
衰弱高齡?
衰弱高齡?
健保署 全民健康保險急性後期整合照護計畫
?
Question
5. 何謂急性後期照護?胡先生是否符合健保署的「急性後期整合照護計畫」的收案標準?是否有其他出院後照護的選擇?
出院後照護選擇
相關資源
11/28 小組討論
Question
1. 以這位病人的入院診斷為例,如果你遇到一個病人肝硬化,你會再詢問他哪些病史,多做哪些理學檢查、實驗室診斷及影像學檢查,以進一步協助你做鑑別診斷,去判斷這位病人肝硬化的原因?肝硬化的成因有哪些?
Liver Cirrhosis: Etiology
Harrison's Principles of Internal Medicine, 21st Edition
Global Deaths Associated with Cirrhosis in 2019
Huang, D.Q., Terrault, N.A., Tacke, F. et al. Global epidemiology of cirrhosis — aetiology, trends and predictions. Nat Rev Gastroenterol Hepatol 20, 388–398 (2023).
Liver Cirrhosis: Differential Diagnosis
Liver Cirrhosis: Differential Diagnosis
Liver Cirrhosis: Differential Diagnosis
https://cirrhosiscare.ca/cirrhosis-provider/work-up-the-etiology/
https://en.wikipedia.org/wiki/Mallory_body
Alcoholic Hepatitis/NAFLD
https://www.pathologyoutlines.com/topic/liverautoimmune.html
AIH
PSC
https://pubs.rsna.org/doi/epdf/10.1148/rg.2019180213
https://www.aasld.org/liver-fellow-network/core-series/pathology-pearls/pathology-pearls-post-8-primary-sclerosing
Question
2. 請問腹水的成因如何?如何解釋她腹水檢驗的結果?
Ascites: Cause
Harrison's Principles of Internal Medicine, 21st Edition
Why does Cirrhosis cause Ascites?
Harrison's Principles of Internal Medicine, 21st Edition
hypoalbuminemia
(RAAS, sympathetic)
serum-ascites albumin gradient (SAAG)
正常值
測量值
Serum
Ascites
Spontaneous Bacterial Peritonitis (SBP)
intestinal bacterial overgrowth, alterations of the intestinal mucosal barrier, deficiencies of the local immune response
Common Pathogen: E. coli, Klebsiella, Streptococcus
Harrison's Principles of Internal Medicine, 21st Edition
Spontaneous Bacterial Peritonitis: Pathogenesis, Diagnosis, Treatment. Florin Alexandru Cãruntu , Loredana Benea, 2006
Ascitic Fluid Analysis
Conclusion?
The patient's ascites and SBP are complications of liver cirrhosis, where the SBP might contribute to the development of ascites.
Questions
1. Why did the ascites developed so quickly after the surgery?
2. Why were there two organisms cultured? May the peritonitis be secondary?
(Harrison : If more than two organisms are identified, secondary bacterial peritonitis due to a perforated viscus should be considered.)
Complications of laparoscopic cholecystectomy?
abscess (0.14 to 0.3 percent), bile leak (0.3 to 0.9 percent), biliary injury (0.26 to 0.6 percent), and bowel injury (0.14 to 0.35 percent)
12/8 小組討論
Question
1. 你是幫林小姐看診的消化內科醫師,請問你會如何跟林小姐解釋她眾多的消化系統問題,及建議她後續接受何種治療呢?
Steatohepatitis
"脂肪在肝臟過度堆積,並且肝臟發炎"
UpToDate, Management of metabolic dysfunction-associated steatotic liver disease (nonalcoholic fatty liver disease) in adults
https://www.fda.gov/news-events/press-announcements/fda-approves-first-treatment-patients-liver-scarring-due-fatty-liver-disease
https://www.nejm.org/doi/full/10.1056/NEJMoa2309000
Gallstones
"膽囊中有結石"
UpToDate, Approach to the management of gallstones
GERD
"胃酸從胃跑到食道,食道因此有發炎及黏膜受損"
https://www.grepmed.com/images/13202/egd-losangeles-esophagitis-diagnosis-grading
GERD
Katz, Philip O. MD, MACG1; Dunbar, Kerry B. MD, PhD2,3; Schnoll-Sussman, Felice H. MD, FACG1; Greer, Katarina B. MD, MS, FACG4; Yadlapati, Rena MD, MSHS5; Spechler, Stuart Jon MD, FACG6,7. ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease. The American Journal of Gastroenterology 117(1):p 27-56, January 2022. | DOI: 10.14309/ajg.0000000000001538
Colorectal Polyp
"大腸長了良性的腫瘤,其中有些可能有機會發展成大腸癌"
"為什麼我的身體會有這些問題?"
"這些情形跟遺傳、環境、生活型態等因子都有關係,但..."
"可能跟肥胖有關"
Camilleri M, Malhi H, Acosta A. Gastrointestinal Complications of Obesity. Gastroenterology. 2017 May;152(7):1656-1670. doi: 10.1053/j.gastro.2016.12.052. Epub 2017 Feb 10. PMID: 28192107; PMCID: PMC5609829.
OR:1.94
OR:1.87
OR:1.44
RR:4.66
RR
M: 2.51
F: 2.32
Colorectal polyp/CRC
Mechanisms?
GERD
Lagergren, J. Influence of obesity on the risk of esophageal disorders. Nat Rev Gastroenterol Hepatol 8, 340–347 (2011). https://doi.org/10.1038/nrgastro.2011.73
Bardou M, Barkun AN, Martel M. Obesity and colorectal cancer. Gut. 2013 Jun;62(6):933-47. doi: 10.1136/gutjnl-2013-304701. Epub 2013 Mar 12. PMID: 23481261.
"因此除了以上針對各種狀況的治療之外,或許也可以試試看減重治療"
Question
3. 什麼是傾倒症候群? 發生的原因為何? 要如何預防和治療? 和術後血糖的改善有關嗎?
Dumping Syndrome 傾倒(ㄉㄠˋ?)症候群
a complication of bariatric surgery
symptoms
abdominal pain, nausea, diarrhea
fatigue, the need to lie down after meals, tachycardia, flushing
hypoglycemia
(palpitaion, fatigue, sweating, ...)
Alexandre Nuzzo, Sebastien Czernichow, Alexandre Hertig, Séverine Ledoux, Tigran Poghosyan, Didier Quilliot, Maude Le Gall, André Bado, Francisca Joly. Prevention and treatment of nutritional complications after bariatric surgery. Lancet Gastroenterol Hepatol. 2021 Mar;6(3):238-251. doi: 10.1016/S2468-1253(20)30331-9.
(Postbariatric Surgery Hypoglycemia)
Pathophysiology
Alexandre Nuzzo, Sebastien Czernichow, Alexandre Hertig, Séverine Ledoux, Tigran Poghosyan, Didier Quilliot, Maude Le Gall, André Bado, Francisca Joly. Prevention and treatment of nutritional complications after bariatric surgery. Lancet Gastroenterol Hepatol. 2021 Mar;6(3):238-251. doi: 10.1016/S2468-1253(20)30331-9.
Scarpellini, E., Arts, J., Karamanolis, G. et al. International consensus on the diagnosis and management of dumping syndrome. Nat Rev Endocrinol 16, 448–466 (2020). https://doi.org/10.1038/s41574-020-0357-5
VIP
GIP
GLP-1
GLP-1
Treatment: Diet
Similar for early/late dumping syndromes
Hui C, Bauza GJ. Dumping Syndrome. [Updated 2023 Jun 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470542/
Treatment: Octreotide
a somatostatin analog
Hui C, Bauza GJ. Dumping Syndrome. [Updated 2023 Jun 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470542/
Treatment: Acarbose
α-glucosidase inhibitor
Rosak C, Mertes G. Critical evaluation of the role of acarbose in the treatment of diabetes: patient considerations. Diabetes Metab Syndr Obes. 2012;5:357-67. doi: 10.2147/DMSO.S28340. Epub 2012 Oct 12. PMID: 23093911; PMCID: PMC3476372.
Cadegiani FA, Silva OS. Acarbose promotes remission of both early and late dumping syndromes in post-bariatric patients. Diabetes Metab Syndr Obes. 2016 Dec 7;9:443-446. doi: 10.2147/DMSO.S123244. PMID: 27994477; PMCID: PMC5153290.
Question
3. 什麼是傾倒症候群? 發生的原因為何? 要如何預防和治療? 和術後血糖的改善有關嗎?
Glucose Metabolism After
Sandoval, D.A., Patti, M.E. Glucose metabolism after bariatric surgery: implications for T2DM remission and hypoglycaemia. Nat Rev Endocrinol 19, 164–176 (2023). https://doi.org/10.1038/s41574-022-00757-
Pathology-Micro 3
(or solid/micropapillary)
( )
(keratin pearl/intercellular bridges)
在氣管旁要找,有要寫
(multinucleated giant cell)
lung
(may have necrosis)
(may have exudate)
(難出)
(page)!!!
(plasma cell看到要寫)
不高機率考
(DIPCF)
PPOD
可能沒有!
(USRP)
(TING)
[ ]
may have granulation tissue
(PACCF)
may have autolysis/fat necrosis
Pathology-Micro 3
猜題
(plasma cell)
sulfur granules: actinomycosis
mucormycosis: aspeptate hyphae with wide-angle branching
aspergillosis: fungal hyphae with septa and acute angle branching
candidiasis: fungal yeasts and pseudohyphae
5. stromal desmoplasia
skin?
(melanin pigment)
(circumscribed/infiltrative)
(POV)