Sample Lesson – Gilbert Syndrome + LFTs Part 2 (AST/ALT/ALP) – Vignette


 
 

Next Step: Make Cards on the Automatic Key Concepts, and Vignettes

Remember, the more you automatically know what each sentence means on your test, the better you will do. There are 4 stages in making interpretation more automatic:

  • Stage 1: Unable to Make Pathophysiologic Chronologies in Either Timed or Untimed setting
  • Stage 2: Basic Pathophysiologic Chronologies, but with Significant Gaps
  • Stage 3: Detailed Pathophysiologic Chronology Without Time, but Unable to Consistently Generate PC During Timed Setting
  • Stage 4: Consistent Pathophysiologic Chronologies in Timed Setting

My goal with these vignettes is to help you reach Stage 4. How do you do so?

  • With the Automatic Key Concept cards, you can master the underlying information to move past Stages 1 + 2.
  • Then, with the Vignette/Pathophysiologic Chronology cards, you can teach yourself to make these connections on your exam.

summary of key concepts:

 

vignette/pathophysiologic chronologies:

 

A 15-year-old boy comes to his physician for nausea and vomiting for the past 2 days after a school potluck. Several of his classmates and teachers reported similar nausea and vomiting. Temperature is 37 C (98.6 F), blood pressure is 120/80 mmHg, and pulse is 72/min. On exam, there is mild scleral icterus. Abdomen is soft, non-tender, and mildly distended. Labs are significant for:

What is the pathophysiologic chronology?

 

Summary:

Gilbert: Born with UDP-glucuronyltransferase (UGT1A1) activity ↓ → asymptomatic, until has GI illness → conjugation of bilirubin ↓ → isolated unconjugated hyperbilirubinemia

Detailed:

Born with UDP-glucuronyltransferase (UGT1A1) activity ↓ → asymptomatic, until has GI illness → nausea/vomiting/anorexia + illness → UDP-glucuronyltransferase ↓ further → conjugation of bilirubin ↓ → isolated unconjugated hyperbilirubinemia → bilirubin poorly water soluble → bilirubin stays bound to albumin → NOT filtered via nephron → urine not darker (unlike conjugated hyperbilirubinemia which has darker urine)

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