LaxativesL is BOOSS
①Lubiprostone (chloride channel agonist)
②Bulk-forming (psyllium)(fiber-supplements)(bulky seaweed binds luminal water to decrease consistency of stool)
③Osmotic laxatives(PEG(polyethylene glycol) drain cover)(★lactulose, magnesium hydroxide)
④Opioid antagonist(eg ☆methylnaltrexone
→ doesn't cross BBB→ ☆doesn't induce withdrawal)
⑤Surfactant(canoe at the DOCK→docusate) reduces the surface tension of stool, enabling water and fat to enter and soften it
⑥Stimulant(bisacodyl, ... gastrointestinal国試直前UWorld HirotoShishido
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medication, other adverse effectslivedo reticularis(☆ lace-like purplish discoloration of the skin)
①septate hyphae (branches at 45°)
②nonsepate hyphae (branches at wide)
③encapsulated, budding yeast
④pseudohyphae and budding yeast(dimorphic)①aspergillus fumigatus
can cause ☆rhinosinusitis
(similar to mucormycosis)
*☆branching septate hyphae on KOH(pic)
→ Tinea★白癬(Trychophyton, Microsporum, and Epidermophyton.)
→topical antifungal therapy(eg ☆azoles, terbinafine(☆inhibit squalene epoxidase)
three types of Chiari malformation
pathogenesis, symptoms, complicationunderdevelopment of posterior fossa
type Ⅰ→herniation of celebellar tonsils
asymptomatic in childhood, manifest in
★adulthood with occipital headache,cerebellar dysfunction
syringomyelia(50-85%), hydrocephalus(10%)
type Ⅱ→herniation of celebellar vermis and tonsils
difficulty in breathing
meningomyelocele(100%)
hydrocephalus(90%)
(type Ⅳ)Dandy Walker syndrome→agenesis of cerebellar vermis leading to cystic enlargement of 4th ventricle(pic)
hydrocephalus
☆progressive skull enlargement neurologyUWorld国試直前 HirotoShishido
