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A 67-year-old woman with a known history of lung cancer comes to the office due to hoarseness and difficulty swallowing. She has no disturbances in vision or hearing. On examination, there is loss of the gag reflex on the left side; when the patient is prompted to say "ah," the uvula deviates to the right side. a right lower lobe lung mass and several osteolytic rib lesions. MRI of the head also demonstrates multiple Her left shoulder is drooped and strength is reduced during left shoulder shrug testing. Chest x-ray shows lesions consistent with metastasis.

PATHOGENESIS Loop versus thiazide diuretics — The difference in hyponatremic risk between thiazide and loop diuretics may be related to differences in their tubular site of action (see "Mechanism of action of diuretics"): ●Loop diuretics inhibit sodium chloride (NaCl) reabsorption in the thick ascending limb of the loop of Henle. The reabsorption of sodium chloride without water in the medullary aspect of this segment is normally the first step in the generation of the hyperosmotic gradient in the medullary interstitium. In the presence of antidiuretic hormone (ADH), the highly concentrated interstitium allows water to be reabsorbed in the medullary collecting tubule down the favorable osmotic gradient between the tubular lumen and the interstitium, resulting in the excretion of a concentrated urine.Administration of a loop diuretic interferes with this process by impairing the accumulation of sodium chloride in the medulla. Thus, although the loop diuretic can increase ADH levels by inducing volume depletion, responsiveness to ADH is reduced because of the impairment in the medullary gradient [9]. As a result, water retention and the development of hyponatremia will be limited and it would otherwise leads to hypernatremia, unless distal delivery is very low or water intake is very high. ●The thiazides, in comparison, act in the cortex in the distal tubule; as a result, they do not interfere with medullary function or with ADH-induced water retention. In addition, in vitro data indicate that thiazides increase water permeability and water reabsorption in the inner medullary collecting duct, an effect that is independent of ADH [10]. In addition to water retention, the combination of increased sodium and potassium excretion (due to the diuretic) and enhanced water reabsorption (due to ADH) can result in the excretion of urine with a sodium plus potassium concentration higher than that of the plasma [3]. Loss of this fluid can directly promote the development of hyponatremia independent of the degree of water intake

شوفوا يا شباب عندما يكون لديك متسع من الوقت ,أكثر من اللازم, فلا تضيعه في ما لا فائدة منه و لا تجلس تذاكر هذه المادة طول الفترة هذه, شوف موضوع و اقراه ,موضوع مهم ,شاهد له فيديوهات , شوف كتاب و اقراه ,شوف روايه ,شوف اي شيء , المهم لا تجلس فوق هذه المادة و اصل , و اذا انت خايف منها ,كون أقرا نصف يوم و نصف يوم غذ روحك و عقلك بشيء تستفيد منه, سنندم على كل لحظه ضاعت في غير محلها. خصوصا" احنا أصحاب الطب لأن التخصص هذا واسع ,واسع ,واسع بشكل لا يعلم به الا الله, و لكنه غير معقد .

طب المجتمع المادة الي مانقدر نتجمل معاها و لو بلغنا من الدرخ عتيا💔😂

مستوعبين لنا ثلاثة اشهر والرابع بالطيق واحنا نمتحن

الإختبار يوم الاربعاء الفترة الخامسة 😕💔

الزنقة حق أمس تذكرك بمباراة ريال مدريد ومانشستر سيتي الدقيقة 89 وريال مدريد خاسر بهدفين ويرجع يفوز ب 3 أهداف 😂

خلونا نكيف لا تهرمونا بطب المجتمع من الآن