Diabetic neuropathy symptoms Numbness and tingling of extremities Dysesthesia (abnormal sensation to a body part) Diarrhea Erectile dysfunction

Urinary incontinence (loss of bladder control) Facial, mouth and eyelid drooping Vision changes Dizziness uscle !ea"ness Difficulty s!allo!ing #peech impairment Fasciculation (muscle contractions) $norgasmia %&urning or electric pain%

'lipizide #econd generation sulfonylurea (lose )* channel in +,cell membrane, so cell depolarizes * triggering of insulin release -ia (a.* influx/ #timulate release of endogenous insulin in type . D / 0e1uire some islet function, so useless in type 2 D 3oxicity4 5ypoglycemia

NF,6& $cti-ation occurs !hen it7s inhibitor, 8,6&, is phosphorylated by specific protein "inase (8))) 9 degraded ,:eads to synthesis of prostaglandins and leu"otrienes

86& 0eleases NF,6& after undergoing phosphorylation 8nsulin secretion 2/ 'lucose binds 'lut. receptor on +,cells ./ 'lucose oxidizes to $3; closes ) channels in cell membrane depolarization of +,cells </ Depolerizatino opens (a= channels intracellular >(a=? >name of this card?

'luco"inase :i-er and + cells of pancreas :o! affinity (5igh )m), high capacity (5igh Vm) 8nduced by insulin 8t7s a %glu%ton has high Vmax b@c it can7t be satisfied $t lo! glucose concentration, hexo"inase se1uesters glucose in the tissues/ $h high glucose concentration, excess glucose is stored in the li-er

'lucose,A,phosphatase 8n E0 'lucose,A,; 'lucose :i-er (Not present in muscle) ;robably stimulated by glucacon Deficient in Von 'ier"e7s disease ,#e-ere fasting hypoglycemia , glycogen in li-er , blood lactate ,hepatomegaly

'lycogen phosphorylase 0ate determining enzyme for glycogenolysis #"eletal component deficient in c$rdle7s disease , glycogen in muscle, but can7t brea" it do!n ,;ainful muscle cramps, myoglobinuria !@ strenuous exercise

;hosphoenolpyru-ate carboxy"inase 8rre-ersible enzyme in 'luconeogenesis ;hosphorylase "inase $n early component of 'luconeogenesis &ranchial apparatus

($; (o-ers outside from inside (lefts B ectoderm $rches B mesoderm ;ouches B endoderm

2st &rachial arch (artilage4 ec"el7s ( andible,

alleus,

andibular)

uscles4 uscles of mastication ( asseter, medial pterygoids, ylohyoid) Ne-es4 (N V., V< ,(he!

3reacher (ollins #yndrome 2st arch neural crest fails to migrate , andibular hypoplasia ,Facial abnormalities

.nd &rachial arch (artilage4 0eichert7s (#tapes, #tyloid, #tylohyoid) uscles4 #tapedius, #tylohyoid Ner-es4 (N V88 ,#maile

<rd &rachial arch (artilage4 'reater horn of hyoid uscles4 #tylopharyngeus ,#tylopharyngeus inner-ated by glossopharyngeal ner-e Ner-es4 (N 8C ,#!allo! stylishly

(ongentio pharyngo,cutaneous fistula ;ersistence of cleft and pouch fistula bet!een tonsillar area, cleft in lateral nec"

Dth,Ath &rachial arches (artilage4 3hyroid, cricoid, uscles4 D B pharynheal constrictors A B intrinsic muscles of larynx Ner-es4 D B (N C (superior laryngeal branch) ,#imply s!allo! A B (N C (recurrent laryngeal branch) ,#pea"

$rches < 9 D ;osterior 2@< of tongue &rachial $rches (;neumonic) Ehen at the golden arches, 2/ (he! ./ #mile </ s!allo! stylishly or D/ simply s!allo! A/ spea" 3here is no FG

micrognathia Ha! is undersized glossoptosis Do!n!ard displacement or retraction of the tongue #/ pyogenes ('roup $) 3he bacteria behind post,streptococcal glomerulonephritis ;5aryngitis can results in ;5e-er 9 glomerulone;5ritis

#tratification #trata are constructed based on -alues of prognostic -ariables and a randomization scheme is performed separately !ithin each stratum ;ut another !ay4 $chie-ed by performing a separate randomisation procedure !ithin each of t!o or more subsets of participants

3rapezium bone Forms the radial border of the carpel tunnel Distal to the #caphoid #ome might say it is in close proximity to ,$bductor pollicis longus ,Extensor pollicis bre-is 3hat being side, is not the right ans!er for the 1uestion that you see"G

#caphoid bone ost commonly fractured carpel bone ;rone to a-ascular necrosis due to retrograde blood supply 0ecei-es its blood primarily from the distal end Failure of the fracture to heal (Inon,unionI) can result in loss of blood supply to the proximal pole , (an result in a-ascular necrosis of the proximal segment/

#NoE D0o; #outhern B DN$ Northern B 0N$ Eestern B ;rotein

#outh!estern blot 8dentifies DN$,binding proteins $ffinity column chromatography

ethod of separating biochemical mixtures ,&ased on a highly specific interaction such as that bet!een antigen and antibody, enzyme and substrate, or receptor and ligand/ (an be used to/ 2/ ;urify and concentrate a substance from a mixture into a buffering solution ./ 0educe the amount of a substance in a mixture </ Discern !hat biological compounds bind to a particular substance D/ ;urify and concentrate an enzyme solution/

Density 'radient (entrifuge Used to separate certain organelles from !hole cells for further analysis of specific parts of cells 2/ $ tissue sample is first homogenised to brea" the cell membranes and mix up the cell contents/ ./ 3he homogenate is then subJected to repeated centrifugations, each time remo-ing the pellet and increasing the centrifugal force/ </ Finally, purification may be done through e1uilibrium sedimentation, and the desired layer is extracted for further analysis/

8mmunohistochemistry ;rocess of detecting antigens (e/g/, proteins) in cells of a tissue section by exploiting the principle of antibodies binding specifically to antigens in biological tissues

8ncidence :oo"s at ne! incidents ;re-alence :oo"s at all current cases 8matinib $ small molecular inhibitor of bcr,abl tyrosine "inase 3reatment of ( : 3rade name 'lee-ec

5ydroxyurea 8nhibits ribonucleotide reductase DN$ #ynthesis (#,phase specific) Used !ith4 elanoma, ( :, #ic"le cell disease ( 5bF) 3oxicity4 &one marro! suppression '8 upset

(ytarabine ;yrimidine analog inhibition of DN$ polymerase Used !ith4 :eu"emia, lymphomas 3oxicity4 :eu"openia 3hrombocytopenia egaloblastic anemia

8:,F From 3h cell ;romotes differentiation of &,cell Enhances class s!itching of 8g$/ #timulates the gro!th of and differentiation of eosinophils

8nterferons ;roteins that place uninfected cells in an anti-iral state 8nduce production of ribonuclease that inhibits -iral protein synthesis by degrading -iral m0N$ (but not host m0N$) K 9 +4 inhibit -iral protein synthesis L4 5( 8 9 88 expression and antigen presentation in all cells $cti-ate N) cells to "ill -irus,infected cells

:eu"emia

Unregulated gro!th of leu"ocytes in %bone marro!% or in M of circulating leu"ocytes in blood arro! failure anemia (0&(), infections (E&(), hemorrhage (platelets) 8nfiltrates in li-er, spleen, and lymph nodes possible

:ymphoma Discrete tumor masses arising from lymph nodes/ (hronic myelogenous leu"emia (( :) <N , AN year olds yeloid stem cell proliferation , neutrophils, metamyelocytes, basophils t(OP..) :o! leu"ocyte al"aline phosphatase (as opposed to leu"emoid reaction)

:eu"emoid reaction $cute inflammatory response to infection E&( count !ith neutrophils and neutrophil precursors such as band cells leu"ocyte al"aline phosphatase

Deoxyhemoglobin &etter buffer for 5 than oxyhemoglobin ,$d-antageous that hemoglobin has been deoxygenated by the time it reaches the -enous end of the capillaries

(arbaminohemoglobin (Q bound to hemoglobin ,$ccount for -ery small amount of (Q in blood :oading dose (p x Vd (mass@-olume) x (-olume)

0emember4 8f -olume of distribution is gi-en in :@"g ,Need to multiply by body !eight to find actual -olume distribution

aintenance dose (p x (:@F (p B target plasma concentration 0emember4 8f -olume of distribution is gi-en in :@"g ,Need to multiply by body !eight to find actual -olume distribution

Qxytocin #timulates labour Uterine contraction il" let do!n (ontrols uterine hemorrhage

52 (5istamine) Found on smooth muscle, endothelium, and central ner-ous system tissue (auses4 &ronchoconstriction &ronchial smooth muscle contraction Vasodilation #eparation of endothelial cells (responsible for hi-es) ;ain and itching due to insect stingsP the primary receptors in-ol-ed in allergic rhinitis symptoms and motion sic"nessP sleep and appetite suppression/

5. (5istamine) :ocated on parietal cells and -ascular smooth muscle cells (auses4 ;rimarily in-ol-ed in -asodilation $lso stimulate gastric acid secretion

#almonella enterica ost cases of salmonellosis are caused by food infected !ith !@ this bacteria, !hich often infects cattle and poultry $ remar"able large number of fimbrial and non, fimbrial adhesins are present in #almonella , ediate biofilm formation and contact to host cells #ecreted proteins are also in-ol-ed in host cell in-asion and intracellular proliferation ,3!o hallmar"s of #almonella pathogenesis Usually does not need $&s (Qnly if complicated in people at ris" such as infants, small children, the elderly) ,Eill lead to prolonged fecal excretion of bacteria

(arnitine deficiency 8nability to transport :(F$ (:ong chain fatty acids) into mitochondria 0esults in toxic accumulation in the cytoplasm (auses !ea"ness, hypotonia, hypo"etotic hypoglycemia

;hytanic acid &ranched chain fatty acid that humans can obtain through the consumption of dairy products, ruminant animal fats, and certain fish Undergoes K,oxidation in the peroxisome, !here it is con-erted into pristanic acid by the remo-al of one carbon

;eroxisome embrane,enclosed organelle in-ol-ed in catabolism of -ery long fatty acids (V:F$) 9 amino acids

;ipecolic acid $ccumulates in ;ipecolic acidemia , Very rare autosomal recessi-e metabolic disorder that is caused by a peroxisomal defect

5ypo"inesis Diminished or abnormally slo! mo-ement 0ight (oronary $rtery #upplies blood to right -entricle 9 .F,<NR of left -entricle 8n SFR of patients, gi-es off posterior descending artery #upplies #$ nodal artery in ANR of patients 'i-e off branch to right marginal artery 8f lungs are clear to auscultation, no :VF/ 3hin" 0VFG

5ypoxemia Decrease in arterial ;o $,a gradient Used to compare causes of hypoxemia ;$o , ;ao Normal T 2N ,Q normally e1uilibrates bet!een al-eolar gas and arterial blood (;$o U ;ao) (5igh altitude, hypo-entilation) 8f V 2N ,Q does not e1uilibrate bet!een al-eolar gas and arterial blood (diffusion defect, V@W defect, right to left shunt)

5ypoxia Decreased Q deli-ery to tissues Q deli-ery B (adiac output x Q content of blood Dependes on4 5emoglobin concentration Q,binding capacity of hemoglobin R saturation of hemoglobin by Q (Depends on ;o)

(an be caused by4 cardiac output Q,binding capacity of hemoglobin arterial ;o

cardiac output blood flo! hypoxia

5ypoxemia ;ao causes Rsaturation of hemoglobin hypoxia $nemia 5b concentration causes Q content of blood hypoxia (arbon monoxide poisoning Q content of blood hypoxia (yanide poisoning Q utilization by tissues hypoxia esoblastic nephroma 3ype of "idney tumor that is usually found before birth by ultrasound or !ithin the first < months of life/ 8t contains fibroblastic cells (connecti-e tissue cells), and may spread to the other "idney or to nearby tissue

Nephroblastoma (Eilms tumor) ost common renal malignancy of early childhood ($ge .,D) (ontains embryonic glomerular structure ;resents !ith huge flan" mass @ hematuria Deletion of E32 on chromosome 22 (an be hyper-ascular////

3anner stages 8/ (hildhood (O and under) 88/ ;ubic hair appearsP breast bud forms 888/ ;ubic hair dar"ens and becomes curlyP penis size@length P breast enlarges 8V/ ;enis !idth , dar"er scrotal s"in, de-eloped glansP raised areolae V/ $dultP areolae are no longer raised (2D and o-er)

$nabolic steroids :eads to sex,hormone binding globulin free testosterone ,'ynecomastia results

Ubi1uitin 3ags proteins for destruction by proteasome pV5: $n E< ligase that ubi1uitinates 58F2K and causes its degradation by the proteasome/ 8n lo! oxygen conditions or in cases of V5: disease !here the V5: gene is mutated ,pV5: does not bind to 58F2K/ ,3his allo!s the subunit to dimerise !ith 58F2+ and acti-ate the transcription of a number of genes (-ascular endothelial gro!th factor, platelet,deri-ed gro!th factor &, erythropoietin and genes in-ol-ed in glucose upata"e and metabolism)

3ype 8 error #tating there is an effect !hen none exist 3ype 88 error #tating there is not an effect !hen there is one Fluoxetine ##08 Use4 Depression, generalized anxiety disorder, panic disorder, Q(D, bulimia, social phobias, ;3#D

:orazepam Facilitates '$&$a action by fre1uency of (l channel opening Use4 $nxiety #pasticity #tatus epilepticus Detoxification

Qlanzapine $typical antipsychotic Use4 #chizophrenia , both *-e and ,-e &ipolar, Q(D, anxiety disorder, depression, mania Fe!er extrapyramidal side effects than traditional antipsychotics

Valproic acid $ !ide spectrum seizure medication ,2st line for tonic,clonic Not for status epilepticus

edial :ongitudinal faciculus ;air of tracts that allo! for cross tal" bet!een (N V8 9 (N V888 nuclei (oordinate both eyes to mo-e in the same horizontal direction 5ighly myelinated ((ommunicate 1uic"ly so eye7s mo-e at the same time) :esion4 :ac" of communication such that !hen (N V8 nucleus acti-ates ipsilateral rectus, contralateral (N 888 nucleus does not stimulate medial rectus to fire (impaired abduction) $bducting eye get7s nystagmus ((N V8 o-erfires to stimulate (N 888) (on-ergence normal

$lbinism

(ongenital deficiency in4 3yrosinase Defecti-e tyrosine transporter ( tyrosine melanin) (an result from lac" of migration of neural crest cells :ac" of melanin results in ris" of s"in cancer

#lipped,strand mispairing Denaturation and displacement of the DN$ strands, resulting in mispairing of the complementary bases/ (an result in either insertions or deletions/ 8nsertions are thought to be self,accelerating4 as repeats gro! longer, the probability of subse1uent mispairing e-ents increases

3estosterone ;re,peripubertal4 (auses gro!th spurt @ accelerated bone maturation ;ubertal4 (ompletion of bone maturation @ termination of gro!th

5yperparathyroidism #tone, &ones, and 'roans 5ypercalcemia 5ypercalciuria (#tones) 5ypophosphatemia ;35, $l" ;hos, c$ ; in urine

;35 (a* resorption from )idney (8nhibits ;QD resorption) #timulates Vit D/ synth ,8ncreased (a* absorbed from intestine (a* release from bone serum calcium

5istone deacetylase 0emo-es acetyl groups from $$ ,$llo!s histones to !rap DN$ more tightly $ctions are opposite to that of histone acetyltransferase 3hese !ould affect transcription of DN$GGGG

8nternal urethral orifice Qpening of the urinary bladder into the urethra Ureteric orifice ;laced at the postero,lateral angles of the trigonum -esicae, and are usually slit,li"e in form

#upraspinatus $bduction of the arm at the shoulder Joint , ain agonist muscle for this mo-ement during the first 2N,2F degrees of its arc (an test4 #houlder at ONR Empty can (Erists pronated)

Eound healing 2/ 8nflammatory (immediate) ,;latelets, neutrophils, macrophages ./ ;roliferati-e (.,< days after !ound) ,Fibroblasts, myofibroblasts, endothelial cells, "eratinocytes, macrophages ,'ranulation tissue depostion, angiogenesis, !ound contraction (mediated by myofibroblasts) </ 0emodeling (2 !ee" after !ound) ,Fibroblasts ,3ype 888 collagen replaced by type 8 collagen

yofibroblast (ell that is in bet!een a fibroblast and a smooth muscle cell in differentiation

(an contract by using smooth muscle type actin, myosin complex, rich in a form of actin called alpha,smooth muscle actin ,3hese cells are then capable of speeding !ound repair by contracting the edges of the !ound

#cur-y #!ollen gums &ruising 5emarthrosis $nemia ;oor !ound healing

Vitamin ( 0e1uired fro the hydroxylation of specific purine and lysine residues ,8f deficient, !ill cause scur-y ,,8nade1uate hydroxylation of collagen peptides

8rradiated pac"ed 0&(s Destroys DN$ in E&(s ,;re-ents graft -s host disease occurring from transfusion 8mportant if transfusion is from4 2/ (lose family relation ./ #omeone !ho is immunocompromised (Di 'eorge #yndrome, Eis"ott $ldrich, and #(8D)

;ac"ed 0&(s !ith adenine,saline added $llo!s the blood to flo! readily !ithout the addition of saline Eashed pac"ed 0&(s 0&(s !ashed in sterile saline to remo-e4 E&(s :ytic mediators Non,self antigens ost useful in 8g$ deficient persons !ho ha-e circulating anti,8g$ $bs ,Use febrile, urticarial and anaphylactic reactions

Ehole blood

&lood that is unmodified except for the presence of an anticoagulant Usually not used because the extra plasma can contribute to transfusion associated circulatory o-erload (3$(Q), a potentially dangerous complication

3ransfusion associated 'V5 0esults from transfusion of immunocompetent 3 cells capable of engrafting and initiating an immune response against recipient antigens 3he most susceptible patient groups are those !ho are se-erely immunocompromised 'amma irradiation abolishes the proliferati-e acti-ity of the lymphocytes in the donor blood/ Fresh frozen plasma and cryoprecipitate do not contain -iable lymphocytes and thus do not need to be irradiated

2st &rachial ;ouch iddle ear ca-ity Eustachian tube astoid air cells

.nd &rachial ;ouch Epithelial lining of palatine tonsil <rd &rachial ;ouch Dorsal !ings ,8nferior parathyroids Ventral !ings ,3hymus < structures 3hymus, right 9 left parathyroids

Dth &rachial ;ouch Dorsal !ings ,#uperior parathyroid &rachial pouch pneumonic

Ear, tonsils, bottom to top 2(ear) .(tonsils) < dorsal (bottom for inferior thyroid) < -entral (to B thymus) D (top B superior parathyroids)

Di'eorge syndrome $berrant de-elopment of <rd 9 Dth pouches4 3,cell deficiency (thymic aplasia) 5ypocalcemia (failure of parathyroid de-elopment)

5omonymous hemianopsia Visual field loss that respects the -ertical midline, and usually affects both eyes Vascular and neoplastic (malignant or benign tumours) lesions from the optic tract, to -isual cortex can cause ,8f lesion is in optic tract, !ill be pupillary reflex problemG 3he more posterior the cerebral lesion, the more symmetric (congruous) symptoms !ill be 2/ ;erson !ho has a lesion of the right optic tract !ill no longer see obJects on his left side ./ ;erson !ho has a stro"e to the right occipital lobe !ill ha-e the same -isual field defect, usually more congruent bet!een the t!o eyes, and there may be macular sparing

5emispatial neglect 0esults most commonly from brain inJury to the right cerebral hemisphere, causing -isual neglect of the left,hand side of space $ stro"e affecting the right parietal lobe of the brain can lead to neglect for the left side of the -isual field, causing a patient !ith neglect to beha-e as if the left side of sensory space is nonexistent (although they can still turn left) ,Extreme case, a patient !ith neglect might fail to eat the food on the left half of their plate, e-en though they complain of being hungry

,#omeone !ith neglect is as"ed to dra! a cloc", their dra!ing might sho! only numbers 2. to A, or all 2. numbers on one half of the cloc" face, the other side being distorted or left blan"

3emporal lobe lesion Upper 1uadrantic anopia ;arietal lobe lesion :o!er 1uadrantic anopia Qptic chiasm lesion &itemporal anopia $plasia :ac" of gro!th Excess lymphoblasts $ge T 2F Found in acute lymphoblastic leu"emia ($::) 3d3* ( ar"er of pre,t 9 pre,b cells) ($::$* t(2.P.2) B good prognosis 8ncreased incidence in people !ith Do!n #yndrome

egaloblastosis ( egaloblastic anemia) 0esults from inhibition of DN$ synthesis in red blood cell production , ost often due to hypo-itaminosis, specifically a deficiency of -itamin &2. and@or folic acid (haracterized by4 any large immature and dysfunctional red blood cells (megaloblasts) in the bone marro! 5ypersegmented neutrophils (those exhibiting fi-e or more nuclear lobes (IsegmentsI), !ith up to four lobes being normal)

;ar-o-irus inclusions Fifth disease ,De-elop the illness after an incubation period

of four to fourteen days/ ,Fe-er and malaise !hile the -irus is most abundant in the bloodstream ,;atients are usually no longer infectious once the characteristic rash of this disease has appeared ;ar-o-irus &2O is a cause of chronic anemia in indi-iduals !ho ha-e $8D# $plastic anemia ,;atients ha-e an arrest of erythropoiesis (production of red blood cells) during infection ,;atients !ho ha-e sic"le cell anemia or hereditary spherocytosis are hea-ily dependent on erythropoeisis due to the reduced lifespan of the red cells 8nfection in pregnant !omen is associated !ith hydrops fetalis due to se-ere fetal anemia

0inged sideroblasts &ody has iron a-ailable but cannot incorporate it into hemoglobin, !hich red blood cells need to transport oxygen efficiently $bnormal nucleated erythroblasts (precursors to mature red blood cells) !ith granules of iron accumulated in perinuclear mitochondria ,#een in aspirates of bone marro! ost common cause of is excessi-e alcohol use ;rimary pathophysiology B failure to completely form heme molecules (!hose biosynthesis ta"es place partly in the mitochondrion)

0ouleaux formation #tac"s of red blood cells (0&(s) !hich form because of the uni1ue discoid shape of the cells in -ertebrates (onditions !hich cause4 8nfections ultiple myeloma 8nflammatory and connecti-e tissue disorders (ancers Qccurs in diabetes mellitus (one of the causati-e

factors for micro-ascular occlusion in diabetic retinopathy)

#:E (riteria D out of 22 of the follo!ing 2/ alar rash ./ Discoid rash </ #erositis4 ;leurisy or ;ericarditis D/ Qral ulcers F/ $rthritis A/ ;hotosensiti-ity X/ &lood disorder4 5emolytic anemia, leu"openia, lymphopenia, thombocytopenia, Uhypocomplementemia S/ 0enal disorder O/ $N$ *-e 2N/ 8mmunologic disorder 22/ Neurologic disorder

(ase (ontrol 3!o existing groups differing in outcome are identified and compared on the basis of some supposed causal attribute

(ase series edical research descripti-e study that4 2/ 3rac"s patients !ith a "no!n exposure gi-en similar treatment ./ Examines their medical records for exposure and outcome (an be retrospecti-e or prospecti-e Usually in-ol-es a smaller number of patients than more po!erful case,control studies or randomized controlled trials ay be consecuti-e or non,consecuti-e ,Depends on !hether all cases presenting to the reporting authors o-er a period !ere included, or only a selection ay be confounded by selection bias ,:imits statements on the causality of correlations obser-ed ,;hysicians !ho loo" at patients !ith a certain

illness and a suspected lin"ed exposure !ill ha-e a selection bias in that they ha-e dra!n their patients from a narro! selection (3heir hospital)

$0D# 8nflammation of the lung parenchyma leads to impaired gas exchange !ith systemic release of inflammatory mediators, causing4 8nflammation 5ypoxemia Fre1uently multiple organ failure/ (ondition has a ONR death rate in untreated patients/ Eith treatment, usually mechanical -entilation in an intensi-e care unit, the death rate is FNR/ $ less se-ere form is called acute lung inJury ($:8) < main clinical causes 2/ #epsis (most important) ./ #e-ere multiple trauma </ $spiration of sali-a @ gastric contents $ny cardiogenic cause of pulmonary edema should be excluded ,Done by placing a pulmonary artery catheter for measuring the pulmonary artery !edge pressure D main criteria for $0D#4 2/ $cute onset ./ (hest C,0ay4 &ilateral diffuse infiltrates of the lungs </ No cardio-ascular lesion D/ No e-idence of left atrial hypertension4 ;aQ.@FiQ. ratio e1ual to or less than .NN mm5g/

$l-eolar -entilation 3he -olume of gas per unit time that reaches the al-eoli :eft sided heart failure signs 3achypnea (increased rate of breathing) 8ncreased !or" of breathing (non,specific signs

of respiratory distress) 0ales or crac"les, heard initially in the lung bases, and !hen se-ere, throughout the lung fields ,#uggest the de-elopment of pulmonary edema (fluid in the al-eoli) ,(yanosis !hich suggests se-ere hypoxemia, is a late sign of extremely se-ere pulmonary edema/

;aQ.@FiQ. ratio 3he ratio of partial pressure arterial oxygen and fraction of inspired oxygen (omparison bet!een the oxygen le-el in the blood and the oxygen concentration that is breathed 5elps to determine the degree of any problems !ith ho! the lungs transfer oxygen to the blood 8f e1ual to or less than .NN mm5g is one criteria for diagnosing $0D#

Erythropoietin 8ts primary effect on red blood cell progenitors and precursors (!hich are found in the bone marro! in humans) is promoting their sur-i-al through protecting these cells from apoptosis

&acillus subtilis 'ram,positi-e, catalase,positi-e bacterium 0od,shaped 5as the ability to form a tough, protecti-e endospore, allo!ing the organism to tolerate extreme en-ironmental conditions Qnly "no!n to cause disease in se-erely immunocompromised patients

&acteroides fagilis 'ram,negati-e bacillus bacterium species 8n-ol-ed in ONR of anaerobic peritoneal infections ;redominates in bacteremia associated !ith intraabdominal infections, peritonitis and

abscesses follo!ing rupture of -iscus, and subcutaneous abscesses or burns near the anus

(lostridium perfringens 'ram,positi-e, rod,shaped, anaerobic, spore, forming bacterium 8nfections sho! e-idence of tissue necrosis, bacteremia, emphysematous cholecystitis, and gas gangrene 3oxin in-ol-ed in gas gangrene is "no!n as K, toxin ,8nserts into the plasma membrane of cells, producing gaps in the membrane that disrupt normal cellular function

#taphylococcus aureus Facultati-e anaerobic 'ram,positi-e coccal bacterium $ppears as grape,li"e clusters !hen -ie!ed through a microscope, and has large, round, golden,yello! colonies, often !ith hemolysis, !hen gro!n on blood agar plates (atalase,positi-e ,$ble to con-ert hydrogen peroxide (5.Q.) to !ater and oxygen Virulence factors4 Enzymes ,(oagulase clots plasma and coats the bacterial cell !hich probably pre-ent phagocytosis ,5yaluronidase brea"do!n hyaluronic acid and help in spreading 3oxins ,#uperantigens (3##3,2) induce toxic shoc" syndrome (3##), usually from prolonged tampon use/ (ause non,specific acti-ation of 3, cells resulting in polyclonal 3 cell acti-ation and massi-e cyto"ine release (8FNL) ,Enterotoxin that is the causati-e of gastroenteritis that is self,limiting, characterized by -omiting and diarrhea one to six hours after ingestion of the toxin !ith reco-ery in eight to .D hours/ #ymptoms include nausea, -omiting, diarrhea, and maJor abdominal pain/ ,Exfoliati-e toxins implicated in (####), !hich occurs most commonly in infants and young

children/ ;rotease acti-ity of the exfoliati-e toxins causes peeling of the s"in obser-ed !ith ####/ Qther ,;rotein $, an 8g',binding protein, binds to the Fc region of an antibody

:isteria monocytogenes 'ram,positi-e bacterium otile -ia flagella at <NY( and belo! (an mo-e !ithin eu"aryotic cells by explosi-e polymerization of actin filaments ("no!n as comet tails or actin roc"ets)/ Facultati-e anaerobic bacterium ((apable of sur-i-ing in the presence of oxygen) (an gro! and reproduce inside the host7s cells Qne of the most -irulent food,borne pathogens, !ith .N to <N percent of clinical infections resulting in death Due to its fre1uent pathogenicity, causing meningitis in ne!borns (ac1uired trans-aginally), pregnant mothers are often ad-ised not to eat soft cheeses ,8t is the third,most,common cause of meningitis in ne!borns

;artial hydatidiform mole Qccurs !hen an egg is fertilized by t!o sperm or by one sperm !hich reduplicates itself yielding the genotypes of AO,CCZ

(omplete hydatidiform mole (aused by a single (ONR) or t!o (2NR) sperm combining !ith an egg !hich has lost its DN$ 3he genotype is typically DA,CC (diploid)

;lacenta accreta $bnormally deep attachment of the placenta to the myometrium !ithout penetrating it/ ;lacenta gro!s completely through the endometrium 'reat ris" of haemorrhage during placental

remo-al ,(ommonly re1uires surgery to stem the bleeding and fully remo-e the placenta ,8n se-ere forms can often lead to a hysterectomy or be fatal

Eernic"e7s aphasia Fluent aphasia !ith impaired comprehension/ Eernic"e7s area,superior temporal gyrus of temporal lobe/ Eordy, but ma"es no sense

&roca7s aphasia Nonfluent aphasia !ith intact comprehension/ Diaphoresis Excessi-e s!eating [,$:$ dehydratase :ead poisoning $ccumulates4 ;rotoporphyrin, [,$:$ icrocytic anemia, '8 and "idney disease/ (hildren,exposure to lead paint ,* mental deterioration $dults,en-ironmental exposure (battery@ ammunition@radiator factory) ,* headache, memory loss, demyelination

[,$:$ synthase #ideroblastic anemia Ferrochelatase :ead poisoning $ccumulates4 ;rotoporphyrin, [,$:$ icrocytic anemia, '8 and "idney disease/ (hildren,exposure to lead paint ,* mental deterioration

$dults,en-ironmental exposure (battery@ ammunition@radiator factory) ,* headache, memory loss, demyelination

;orphobilinogen deaminase $cute intermittent porphyria $ccumulates4 ;orphobilinogen, [,$:$, uroporphyrin F ;7s 2/ ;ainful abdomen ./ ;ort !ine,colored urine </ ;olyneuropathy D/ ;sychological disturbances F/ ;recipitated by drugs

Uroporphyrinogen decarboxylase ;orphyria cutanea tarda $ccumulates4 Uroporphyrin (tea colored urine) &listering cutaneous photosensiti-ity/ common porphyria/ ost

5olosystolic murmur 3ricuspid insufficiency ,&est heard o-er the fourth left sternal border, radiates to right sternal border ,8ntensity can be accentuated follo!ing inspiration ,,Due to increased regurgitant flo! in right -entricular -olume ,most often secondary to pulmonary hypertension itral regurgitation ,&est heard at the apex !ith diaphragm, radiates to!ard axilla ,No intensification upon inspiration ,Difference in pressure extends throughout systole and can e-en continue after the aortic -al-e has closed Ventricular septal defect ,&est heard o-er the left third and fourth

intercostal spaces and along the sternal border ,#. Normal (Distinguish from pulmonary stenosis, !hich has a !ide splitting #.) ,No intensification upon inspiration

5yperammonia (an be ac1uired (e/g/, li-er disease) or hereditary (e/g/, urea cycle enzyme deficiencies) excess N5D* depletes a,"etoglutarate inhibition of 3($ cycle 0x4 limit protein in diet

03$2 (IdistalI, 0enal tubular acidosis) Defect in collecting tubule7s ability to excrete 5* urine p5 VF/F hypo"alemia ris" for calcium phosphate "idney stones as a result of urine p5 and bone resorption

03$. (IproximalI, 0enal tubular acidosis) Defect in proximal tubule 5(N<, reabsorption Fanconi7s syndrome urine p5 T F/F hypo"alemia ris" for hypophosphatemic ric"ets

03$D (Ihyper"alemicI, 0enal tubular acidosis) 5ypoaldosteronism or lac" of collecting tubule response to aldosterone 0esulting hyper"alemia impairs ammoniagenesis in the proximal tubule buffering capacity and urine p5

$mmoniagenesis Qccurs !ithin proximal tubular cells 'lutamine made in the li-er, is recei-ed from peritubular capillaries and is metabolized into 2/ $lpha,"eto glutarate ( etabolized further into t!o 5(Q<, ions, !hich then lea-e the cell and

enter systemic circulation by crossing the basolateral membrane) ./ N5D* (#ecreted into renal tubules)

(N 888 ;alsy eye is Ido!n and outI !ith ptosis and pupil dilation ;osterior (ommunicating $rtery (ommon site ofsaccular (berry) aneurysm/ (N 888 ;alsy4 Eye is Ido!n and outI !ith ptosis and pupil dilation :esions are typically aneurysms, not stro"es

$-oidant ;ersonality Disorder Display a per-asi-e pattern of social inhibition, feelings of inade1uacy, extreme sensiti-ity to negati-e e-aluation, and a-oidance of social interaction (onsider themsel-es to be socially inept or personally unappealing and a-oid social interaction for fear of being ridiculed, humiliated, reJected, or disli"ed

Dysthymic disorder ood disorder consisting of the same cogniti-e and physical problems as in depression, !ith less se-ere but longer,lasting symptoms, !hich may persist for at least . years $ serious state of chronic depression, !hich persists for at least . yearsP it is less acute and se-ere than maJor depressi-e disorder #ufferers may experience symptoms for many years before it is diagnosed, if diagnosis occurs at all

aJor depressi-e disorder (haracterized by episodes of all,encompassing lo! mood accompanied by lo! self,esteem and loss of interest or pleasure in normally enJoyable

acti-ities ;resence of a se-erely depressed mood that persists for at least t!o !ee"s

Narcissistic personality disorder &eing excessi-ely preoccupied !ith issues of personal ade1uacy, po!er, prestige and -anity Qbsessi-e compulsi-e disorder (haracterized by intrusi-e thoughts that produce uneasiness, apprehension, fear, or !orry

#chizoid personality disorder (haracterized by a lac" of interest in social relationships, a tendency to!ards a solitary lifestyle, secreti-eness, emotional coldness and apathy ay simultaneously demonstrate a rich, elaborate and exclusi-ely internal fantasy !orld