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Cardiac tamponade is caused by a large or uncontrolled pericardial effusion, i.e. the buildup of fluid inside the pericardium.[2] This commonly occurs as a result of chest trauma (both blunt and penetrating),[3] but can also be caused by myocardial rupture, cancer, uraemia, pericarditis, or cardiac surgery,[2] and rarely occurs during retrograde aortic dissection.
http://en.wikipedia.org/wiki/Cardiac_tamponade
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16. A
An acetylcholinesterase inhibitor (often abbreviated AChEI) or anti-cholinesterase is a chemical that inhibits the cholinesterase enzyme from breaking down acetylcholine, increasing both the level and duration of action of the neurotransmitter acetylcholine.
Some major effects of cholinesterase inhibitors:
Actions on the autonomic nervous system, that is parasympathetic nervous system will cause bradycardia, hypotension, hypersecretion, bronchoconstriction, GI tract hypermotility, and decrease intraocular pressure.
SLUDGE syndrome.
Actions on the neuromuscular junction will result in prolonged muscle contraction.
http://en.wikipedia.org/wiki/Acetylcholi..._inhibitor
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IL 2: Secreted by Th cells. Stimulates growth of helper and cytotoxic T cells ( FA page 205)
is an interleukin, a type of cytokine immune system signaling molecule, which is a leukocytotrophic hormone that is instrumental in the body's natural response to microbial infection and in discriminating between foreign (non-self) and self. IL-2 mediates its effects by binding to IL-2 receptors, which are expressed by lymphocytes, the cells that are responsible for immunity.
http://en.wikipedia.org/wiki/Interleukin_2
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Peripheral vascular disease (PVD), commonly referred to as peripheral arterial disease (PAD) or peripheral artery occlusive disease (PAOD), refers to the obstruction of large arteries not within the coronary, aortic arch vasculature, or brain. PVD can result from atherosclerosis, inflammatory processes leading to stenosis, an embolism, or thrombus formation. It causes either acute or chronic ischemia (lack of blood supply). Often PAD is a term used to refer to atherosclerotic blockages found in the lower extremity.[1]
PVD also includes a subset of diseases classified as microvascular diseases resulting from episodal narrowing of the arteries (Raynaud's phenomenon), or widening thereof (erythromelalgia), i.e. vascular spasms.
Peripheral artery occlusive disease is commonly divided in the Fontaine stages, introduced by René Fontaine in 1954 for ischemia:[2][3]
1. Mild pain when walking (claudication), incomplete blood vessel obstruction;
2. Severe pain when walking relatively short distances ( intermittent claudication ), pain triggered by walking "after a distance of >150 m in stage IIa and after
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ATN: Most common cause of acute renal failure in the hospital. Self reversible, but fatal if left untreated (provide supportive dialysis). Associated with renal ischemia.
Toxic ATN can be caused by free hemoglobin or myoglobin, by medication such as antibiotics and cytostatic drugs, or by intoxication (ethylene glycol, "anti-freeze").
Histopathology: Toxic ATN is characterized by proximal tubular epithelium necrosis (no nuclei, intense eosinophilic homogeneous cytoplasm, but preserved shape) due to a toxic substance (poisons, organic solvents, drugs, heavy metals). Necrotic cells fall into the tubule lumen, obliterating it, and determining acute renal failure. Basement membrane is intact, so the tubular epithelium regeneration is possible. Glomeruli are not affected
http://en.wikipedia.org/wiki/Acute_tubular_necrosis
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ATN, It may be classified as either toxic or ischemic. Toxic ATN occurs when the tubular cells are exposed to a toxic substance (nephrotoxic ATN). Ischemic ATN occurs when the tubular cells do not get enough oxygen, a condition that they are highly sensitive and susceptible to, due to their very high metabolism.
Acute tubular necrosis is classified as a "renal" (i.e. not pre-renal or post-renal) cause of Acute renal failure. Diagnosis is made by a FeNA (fractional excretion of sodium) > 3% and presence of muddy casts in urinalysis. On histopathology, there is usually tubulorrhexis, that is, localized necrosis of the epithelial lining in renal tubules, with focal rupture or loss of basement membrane. Proximal tubule cells can shed with variable viability and not be purely "necrotic".
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Leishmania is a genus of Trypanosomatid protozoa, and is the parasite responsible for the disease leishmaniasis. It is spread through sandflies of the genus Phlebotomus in the Old World, and of the genus Lutzomyia in the New World. Their primary hosts are vertebrates; Leishmania commonly infects hyraxes, canids, rodents, and humans.
Cutaneous leishmaniasis (localized and diffuse) infections appear as obvious skin reactions.
The most common is the Oriental Sore (caused by Old World species L. major, L. tropica, and L. aethiopica). In the New World, the most common culprits is L. mexicana.
Cutaneous infections are most common in Afghanistan, Brazil, Iran, Peru, Saudi Arabia and Syria.
http://upload.wikimedia.org/wikipedia/co...am_en.svgn
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21.DD
-Serum BUN/cr ratio is greater than 15 and this is prerenal azotemia....which is caused by a decrease in cardiac output(evidenced by the increase in heart rate and decreased BP in the question stem)....the decreased cardiac output causes hypoperfusion of the kidneys ...and these causes A decrease in GFR ...this in turn causes An increase in BUN and Cr
posted by yeabiruh
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Hemiballismus is usually characterized by involuntary flinging motions of the extremities. The movements are often violent and have wide amplitudes of motion.They are continuous and random and can involve proximal and/or distal muscles on one side of the body. Some cases even include the facial muscles.
It is common for arms and legs to move together. The more a patient is active, the more the movements increase. With relaxation comes a decrease in movements.
The subthalamic nucleus essentially provides the excitement needed to drive the globus pallidus. Injury to this area or its efferent or afferent connections can induce this disorder. The structure itself is a regulator of motor function and is also involved in associative and limbic functions.
It was traditionally thought that the disorder was only caused by injury to the subthalamic nucleus, but new studies are showing that damage to other areas of the brain can also be responsible for causing this disorder. Hemiballismus caused by lesions in the subthalamic nucleus is more severe than other forms of the disorder
Wikipedia
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23.AA
for q 23...Legally, a patient is incompetent if unable to do the following:
-- (1) respond knowingly and intelligently to questions about recommended treatment;
--(2) participate in treatment decisions by means of rational thought processes; and
-- (3) understand the items of minimum basic medical treatment information with respect to that treatment
--hence the paranoid schizophrenic patient is legally competent and able to decide and refuse treatment....
---here is more explanation
it could be said that even a patient whose 'delusions are plainly irrational 'may be competent to make a treatment decision if he or she fulfills the following criteria
1-comprehending and retaining information relating to the decision
2-believing the information provided by the treating physician
3-weighing it in the balance when making a choice....
posted by yeabiruh
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