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bradycardia are effect of beta blockers that contribute to their ability to redce

anginal attacks

septum secundum is crescent shaped wedge shaped tissue incompletely

partitions the developing atria leaving a defect called foramen ovale near

floor of right atrium

in congenial the coarctation of aorta thoracic aorta usually obstructed just

past origin of left subclavian artery if constriction reduces diameter of aorta

by more than 50 percent,patient develop sx such as decreased tolearance to

exercise and greater fatigability, because radial artery arises from branches

proximal to coarctation and proximal tibial artery from branches distal to

coarctation, simultaneous palpation of their pulses typicaly reveal posterior

tibial pulses to be delayed and of lesse volume than radial pulses

temprary occlusion of comon carotid arteries decreases vascular pressure

within carotid sinus area, the pripheral baroreceptor, respond to changes inpressure and is important reflex in maintaining relatively constant arterial

presure on short term basis

a decrease in pressure depresses the no of impulses that travel from carotid

sinus nerve, Because these impulses normally inhibit the central

vasoconstrictor area and excite vagal center, decrease in impulses reflexively

causes arterial pressure to rise and heart rate and contractility to increase,

the entire circulation stimulated to constrict and there is reduction in venous

capacitance

46 year male sustain sever head and abdominal injury in motor vehicle

accident, initial emergency assessment of patient establishes his lasgow

coma scale from 6!"5 blod press low and #$ "%%!&'(, the patient is

sucesfuly resuscitated and placed on respirator,% days later he develop noisy

breathing,tachypnea and severe hypoxemia, cxr obtained

showin

endothelial damage ards

)0 year old multiple medical prob,while in hosp, he die from *+, #istological

find of his renal bx shown on slide

long standing &

%- yr old male with rage he recall childhood abuse by his foster father, he

chanel agression into intense basketball matches, this is an example of which

defense mechanism

sublimation

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mature defense mechanism convertin unaceptable socal impulses into socialy

acceptable ones

a cell surface receptor with intracellular tyrosine kinase activity identified on

epithelial cell line,which best normal activty of receptor.

transient dimeri/ation

phospholipase * activation is step i( ip second messenger sstem

%) year mn tell his physician that his drinking has increased over past several

months as result his recnt divorce, job loss and mother1s death, physician

respond , so you are telling excesive drinking related to stress of life, which

foll interviewing techni2ue physician using.

reflection

4- year old with paget disease of bone treated with risedronate, he suferfrom b3l hearing loss, he hasbeen taking low dose predniosone for asthma, his

current complaints include persistent right hip pain that is unresponsive to

ver counter anglgescs, radiograph of right hip mixed lysis and sclerosis with

focal periosteal elevation and new bone formation ,

osteosarcoma

osteopetross occur when osteoclast fail to resorb bone thereby impairing

bone modeling and remodeling, radiographic find include genralised

osteosclerosis and evidenceof fractures

medulloblastoma on cerebellar vermis, it is medial section of cerebellum and

is resp for proximal mscle coordinatin,balance and vestibulo ocular reflex,

clarification statement similar to summary treatment but also include

connection patient may not recognise, the 2uest which is direct rather than

open ended does not need to be confrontational in tone

fall in blood vlume and pressure produced by hemorage elicit baroreceptor

reflex, the reflex increase activity of sympathetic nervs system, decrease

activity of parasympathtic nerves innervating heart

uremia from renal failure comon cause of fibrinous pericarditis3 7 is more

likely to occur in younger patients, but "5 prcent of casses ocur in older

adults

monckeberg sclerosis is degenerative aging diseaseof medium si/e arteries of

upper and lower extremities and the genital tract,calcium depositd in media

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of these vessels often as transverse rings giving railroad track appearance by

8ray,these changes donot have clinical significance and are usually an

incidental finding on x ray

ben/odia/epine withdrawal, intoxication of this is removed, with gastric

lavage

nitric oxide thought to en/ymatically released from nitroglycerin, it then react

and activate guanylyl cyclase to increase cgmp, a vasodilator due to its effect

on increasing calcium efflux, it indirectly causes dephosphorylation of ligt

chains of myosin,these actions lead to vasodilator effect of nitroglycerin

en/ymes that are targeted to lysosomes undergo specific two step

modification in golgi complex, the first step in modification invlves

attachment of (acetylglucosamine" phospgate residue in 6 position of

mannose residue on main nose carbohydrate position of lysosomal en/ymes,

the secnd step involve removal of ( acetylglucosamine residue exposing the

mannose 6 phosphate marker3 the presence of mannose 6 phosphate is

necesary targeting lysosomal en/yme to lysosomes and deficiencies in

en/yme is respnsible for first reaction in modification lead to severe

developmental abnormalities

von gierke disease result from one of several defect in process of

dephosphorylating glucose 6 phospate to free glucose, the actual

dephosphorylation takes placce within lumen of 7$, 9#7$7 glucose 6

phosphate resides emberdded within membrne

powr ":beta probability rejecting null hypothesis when in fact false or

likelihodd finding difference, if one in fact exists, it increases with

increasae sample si/e, increase expected efect si/e, and increased precision

of measurement

case control

comapre grp of people with disease with group without, looks for priorexposure or risk factor ,ask what happend

cohort study

compares a group with given exp or risk factor to a group without such exp3

1look to see if exp increase likelihood of diseasecan be prospective, ;

cross sectional disease

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collect data from a group of people to assess fre2uency of disease at

particular point of time

twin concordance stdy

compare fre2uency with which bothmono/ygotic twin !d/ygotic twin develop

disease

clinical trial

exp stdy involving humans, compre therapuetic benefit % or more tratment or

of treat and placebo, stdy 2uality improves,when study is randomi/ed

controlled and double blinded triple blind refer to additional blinding of

reserchers analy/ing data

phase "

small no healthy volunteers

ases safety toxicity and pharmacokinetics

phase % small no of patient with disease of interest assess treat eficacy and

optimal dosing and adverse effect

phase , large no of patients randomly assigned either to treat ment under

investigation or to best avlble treatment, compare new treat to current treat

of care

;phase 4

post marketing surveillance trial of patient after approvval

detect long term3adverse effect

evaluatiin diagnostic test

sensitivity tp!tp

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relative risk

typically used in cohort study risk of develeping disease in exposed group

divided by risk in unexposed group

attributable risl

the diff in risk between exposed and unexposed group, or proportion of

disease occurences that are attributable to the expsure

;absolute risk

absolute reduction in risk associated with treatemt as compared to control

no patients needed to be treated for " patient to benefit

calculated by "!abs risk reduction

no patient who need to exposed to risk factor for " patient to be harmed,

calculated by "!atrributable risk

precision

consistency and reproducibility of test

absence of random variation in a test

accuracy

trueness of test measurements

selecti bias

non random assignment to parrticipate in control group

recall bias

knowldge of presence alter recall by subjects

sampling bias

subjts are not representative,therefore results are not generli/able

late look bias

information gathered at inappropriate time

procedure bias

subject in diff groups are not treated same

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confounding bias

occur when factor is related to both exposure and outcome

leadtime bis

early detection confused with increased survival3

observer expectancy bias

occur when researchers belief in efficacy of treat changes outcome of

treatment

hawthorne effect

occur when group being studied changes its behavior owing to knowledge of

being studied

statistical hypothesis

null

hypothesis of no difference