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34--AA
Obstructive sleep apnoea pts have cronic hypoxia and hypercapnea.
Chronic hypoxia produces pulmonary hypoxic vasoconstriction ;endothelial dysfunction and pulmonary HTN.
http://emedicine.medscape.com/article/295807-overview
Obstructive sleep apnea patients often have hypoxemia, reoxygenation, sleep arousals, less sleep time than healthy individuals, elevated negative intrathoracic pressure, and, in some individuals, hypercapnia. The commonly accepted contributions of these obstructive sleep apnea–related pathophysiological factors may affect sympathetic activation, metabolic dysregulation, left atrial enlargement, endothelial dysfunction, systemic inflammation, and hypercoagulability. These mechanisms can lead to hypertension (both systemic and pulmonary), heart failure, cardiac arrhythmias, renal disease, stroke and myocardial infarction, and sudden death in sleep..
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35--CCBs are class IV antiarrhythemic agents
MAc--- primarily affect AV nodal cells and decrese conduction velocity and increase ERP and also increase PR interval
indication - used in nodal arrhythemias like SVT
toxocity-- constipation flushing ; edema ;CVS effects like CHF; AV block ; sinus node depression.
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37--cc
ETEC-- major cause of travellors diarrhea two enterotoxins
1-LT -heat labile stimulates adenylate cyclase by ADP ribosylation of Gs resulting in increased cAMP -cause outflow of chloride ion and watery diarrhea
2-ST - the heat stable toxin causes diarrhea by stimulating guanylate cyclase
E-COLI--
grame negative rod ;motile
facultative anaerobes ;oxidase neagtive and ferment lactose which produces green colonies on EMB .
sorbitol screen
most of the ecoli femrnt sorbitol producing pink colonies except EHEC so macConkey sorbitol agar is used to screen the ecoli..
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38--EE
alpha feto protein is tissue specific marker ..levated levels S/O hepatocellular carcinoma or testis cancer..
AFP is also measured in pregnant women, using maternal blood or amniotic fluid, as a screening test for a subset of developmental abnormalities: it is principally increased in open neural tube defects and omphalocoele & decreased in Down syndrome
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39=CC
Ursodeoxycholic acid helps regulate cholesterol by reducing the rate at which the intestine absorbs cholesterol molecules while breaking up micelles containing cholesterol. Because of this property, ursodeoxycholic acid is used to treat (cholesterol) gallstones non-surgically.
The drug reduces cholesterol absorption and is used to dissolve (cholesterol) gallstones in patients who want an alternative to surgery. The drug is very expensive, however, and if the patient stops taking it, the gallstones tend to recur if the condition that gave rise to their formation does not change.
It is the only FDA approved drug to treat primary biliary cirrhosis
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40--EE
If we just look at the normal values they gave--
All are in normal range except capillary oncotic pressure S/O low protins and nephrotic syndrome is right choice as we loose protein in urine.
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q41- E- BPH- yellow, pink soft nodule formation---hyperplasia of glandualr and stroma cell ldue to DHT ( synthesis in stroma cell) wtih co-mediate of estrogencause symptoms of obstructions and hematuria. complications: onstructive uropathyis the MC with postrenal azotemia, bilateral hydropnephrosis, baldder pressure increaer---. diverticua and hypertrophy of sm of bladder, other compli will be blader infection, prostact infart... this is not riskfopr cancer(pain on DRE with increase PSA
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+ periurethral, PSA normal 0-4ng/ml.
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41--EE
posterenal azotemia
serum urea to creat ratio less than 15
also bladder palpable
bilateral hydronephrosis
Disorder -------FENa+%------BUN:Cr----- UNa+ ----UOsm-------------- Urinalysis
Prerenal --- --15------- 500 ----Normal sediment or few hyaline
azotemia-
Acute GN -- --15 ---------500 ----RBC casts, hematuria
ATN------ --->2 ------------≤15 --------->40 -------2------------ ≤15 ---------->40------
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