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 +0  (nbme22#9)

Myofibrils are composed of smaller structures called myofilaments. There are two main types of filaments: thick filaments and thin filaments; each has different compositions and locations. Thick filaments occur only in the A band of a myofibril. Thin filaments attach to a protein in the Z disc called alpha-actinin and occur across the entire length of the I band and partway into the A band.

https://opentextbc.ca/biology/chapter/19-4-muscle-contraction-and-locomotion/

meningitis  isn't letter C the intercalated disc where the gap junctions are?

 +5  (nbme22#18)

Morphine is metabolized in the liver to morphine-6-glucuronide and morphine-3-glucuronide, both of which are excreted by the kidneys. In the setting of renal failure, these metabolites can accumulate, resulting in a lowering of the seizure threshold. Morphine should therefore be used with caution with mild renal impairment and be avoided in the setting of renal failure.

source: https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/morphine-6-glucuronide

they gave a hint of increased creatinine level, plus older age can give a slowed down metabolism and CNS symptoms


 +11  (nbme22#30)

FA p.547 - burning rubber smell hallucination occurs as an aura for temporal lobe epilepsy


 +1  (nbme22#40)

low amount of fecal elastase is common in pancreatic insufficiency (FA 375) - use pancrelipase (combo of lipase, protease and amylase enzymes) to remove malabsoprtion



 +1  (nbme22#18)

increased amount of estrogen compared to androgen activity is physiologic in puberty


 +1  (nbme22#1)

https://www.ncbi.nlm.nih.gov/pubmed/7058822

"syndrome of "dilutional hypo-osmolality" in severe congestive heart failure may be caused by an inappropriately high ADH secretion in which the osmoreceptor system is dominated by nonosmolar stimuli"

hayayah  Apparently, in chronic CHF you see hyponatremia. Because CHF causes a decrease in cardiac output and circulating blood volume, which in turn triggers a compensatory response aimed at preserving blood pressure. This stimulates the body to retain both water and sodium.
seagull  i agree with Hayayah... the RAAS system is activated due to poor perfusion to the kidney due to decomp heart failure.

 +5  (nbme22#32)

loss of fluid triggers aldosterone production, so patient will have hypernatremia and hypokalemia as a result


 +1  (nbme22#1)

just know probably that anatomically SMA runs above third part of duodenum. so if we have a ligament pulling over that side it can obstruct both duodenum (was mentioned in stem) and SMA that lies over it

in GI section they also describe SMA syndrome - when SMA obstructs the duodenum itself so its stuck between SMA and aorta. guessing from there


 +2  (nbme22#38)

this is Wallenberg syndrome - stroke caused by obstruction of PICA - so thats why we get symptoms of dysphagia, hoarseness, absent gag reflex (p. 502 FA)

armymed88  dysphagia from hit of nucleus ambiguus (CN IX/X/XI) Sensation changes due to hit of lateral spinothalamic tract and spinal trigeminal Check out rule of 4s if you haven't already
theecohummer  Yup, lateral meduallary syndrome or Wallenburg Syndrome. Whatever you want to call it. The hemifacial analgesia is from damage to the spinal trigeminal nucleus/tract, and you get the hoarseness from damage to the vagus and the body loss is from the spinal thalamic tract. You can also get Horner’s syndrome with this.
dr.xx  Lateral medullary syndrome = Wallenberg's syndrome




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