شرح اسئلة Uworld

عندي اسئلة في قسم Uwolrd هي مشروحة لكن بعض الاسئلة شرحها غير مفهوم ، احتاج فهم السؤال بشرح مفهوم يكون عربي - انجليزي طبعا هي اسئلة كثيرة جدا لذلك اريد اكثر من دكتور يعرف يشرحها بطريقة مفهومة وليس مجرد ترجمة .... و راح ارسل سؤال هنا و الي عنده مهارة في توصيل المعلومة و الشرح طبعا يكون كتابي ، وليس صوتي و يكون في ملف وورد ، اذا لقيت احد من الي يقدم عرض الشرح مفهوم و واضح راح نختاره ، .... لان بعدما اطلب الخدمة الاقي بعض الدكاترة شرحهم ناقص ، او بعضهم ترجمة حرفية ،،،

مثال :

A 66-year-old man is brought to the emergency department with dyspnea, tachypnea, crampy pain, and paresthesias in his extremities. He recent y returned home after a long international flight. His temperature is 36. 7 C (98.5 F), blood pressure is 120/80 mm Hg, pulse is 88/min, and respirations are 24/min. Physical examination is significant for carpopedal spasm and left calf swelling. CT scan reveals a segmental pulmonary embolus. Which of the following alterations in calcium metabolism is most likely present in this patient?

A. Decrease in calcium bound to albumin

B. Decrease in calcium bound to inorganic anions

C. Decrease in total plasma calcium

D. Increase in calcium bound to albumin

E. Increase in calcium bound to inorganic anions

F. Increase in total plasma calcium

Plasma calcium exists in 3 forms: ionized calcium (45%), albumin-bound calcium (40%), and calcium bound to inorganic and organic anions (15%). Homeostasis of these forms is significantly influenced by the extracellular pH level. An increased extracellular pH (due to respiratory alkalosis in this patient) causes hydrogen ions to dissociate from albumin molecules, thereby freeing up the albumin to bind with calcium (Choice A). This increase in the affinity of albumin for calcium leads to decreased levels of ionized calcium.

Ionized calcium is the only physiologically active form, which means that a decrease in ionized calcium can result in the clinical manifestations of hypocalcemia (eg, crampy pain, paresthesias, carpopedal spasm) even though total calcium is unchanged (Choices C and F). Thus, patients can experience signs and symptoms of hypocalcemia due to respiratory alkalosis like y caused by hyperventilation, as may be seen in pulmonary embolism. (Choices B and E) The amount of calcium bound to organic and inorganic anions remains unaltered in patients with acute respiratory alkalosis.

ياريت الي عنده مهارة في شرح السؤال يكتب الشرح هنا و اذا كان مناسب سوف يتم التواصل معه