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02/09/2023

A Brazilian man discovered he has a third kidney after going to the doctor with severe low back pain.

A man presented to the outpatient clinic with severe low back pain. As part of the evaluation, computed tomography (CT) was performed. The scan incidentally showed the presence of three kidneys: a normal-appearing left kidney and two fused kidneys in the pelvis. The ureter from the left pelvic kidney joined the ureter from the other left kidney just above its entrance into the bladder. The ureter from the right pelvic kidney entered the bladder on the right side. The CT scan also showed a herniated disk between L4 and L5. Renal function was normal, with a creatinine level of 0.9 mg per deciliter (80 μmol per liter) (normal range, 0.6 to 1.0 mg per deciliter [53 to 88 μmol per liter]). This uncommon congenital abnormality was thought to be the consequence of aberrant processes during embryogenesis. The duplicate left kidney may have resulted from a premature division of the left ureteral bud. In addition, the right and lower left developing kidneys fused and did not ascend during development. Affected persons are commonly asymptomatic, and as in this case, the condition may not become known until imaging is performed for another reason. The patient’s back pain was attributed to the lumbar disk herniation, and he was treated with an oral analgesic agent.

Photo Credit: The New England Journal of Medicine

Reference: https://www.nejm.org

01/09/2023

Circle of willis

31/08/2023

What is your dx?

30/08/2023

The lies we tell ourselves

29/08/2023

28/08/2023

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26/08/2023

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25/08/2023

What is your diagnosis?

24/08/2023

1. Inhibition of HMG-CoA Reductase:
• Statins are competitive inhibitors of the enzyme 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase.
• This enzyme catalyzes the conversion of HMG-CoA to mevalonate, a critical step in cholesterol biosynthesis.

2. Decrease in Hepatic Cholesterol:
• By inhibiting HMG-CoA reductase, statins reduce the conversion of HMG-CoA to mevalonate.
• This leads to a decrease in cholesterol synthesis in the liver.

3. Upregulation of LDL Receptors:
• As hepatic cholesterol levels decrease, the liver increases the expression of LDL receptors on its surface.
• This upregulation is a compensatory response to the reduced intracellular cholesterol levels.

4. Increased LDL Clearance:
• The increased number of LDL receptors on the liver cells enhances the uptake and clearance of circulating LDL cholesterol from the blood.

5. Lowering of Blood Cholesterol Levels:
• As a result of increased LDL clearance, the overall level of LDL cholesterol in the blood decreases.

6. Reduction in VLDL Production:
• Reduced cholesterol availability in hepatocytes also leads to decreased production and secretion of very-low-density lipoprotein (VLDL).

7. Increase in HDL Levels:
• Statins may also lead to a modest increase in the levels of high-density lipoprotein (HDL) cholesterol, which is beneficial.

8. Anti-inflammatory Effects:
• Statins have been shown to exert anti-inflammatory effects, reducing vascular inflammation independent of their lipid-lowering actions.

9. Endothelial Function Improvement:
• Statins improve the function of the endothelium (the inner lining of blood vessels), partly by increasing the availability of nitric oxide, which is a vasodilator.

10. Stabilization of Atherosclerotic Plaques:
• Statins contribute to the stabilization of atherosclerotic plaques, making them less likely to rupture and cause a thrombus (clot).

23/08/2023

During the 2nd trimester of pregnancy, the blood pressure falls due to:- - Paper two 2007
A. Effects of progesterone on the smooth muscles causing relaxation and dilatation of arterial wall
B.: Effects of oestrogen on the smooth muscles causing relaxation and dilatation of arterial wall
C: Effects on oestrogen on smooth muscles causing relaxation

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22/08/2023

The best management of varicose veins during pregnancy is:- -
NCK Paper two 2007
A. Using supporting tights or crepe bandage, resting with feet elevated
B.: Avoiding standing for too long, wearing loose clothing
C: Wearing low heeled shoes, elevating feet when sleeping
D: Wearing low heeled shoes, elevating feet when sleeping

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21/08/2023

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