By the Numbers in Software

Printer QR-Code in Software By the Numbers

A d v a n c e d C o n f i g u r a t i o n U s i n g t h e We b A p p l i c a t i o n D e s i g n e r

prevents strong exertion (algesic pseudoparesis). Points against the coexistence of myositis are (a) the inability to document weakness out of proportion to muscle atrophy, (b) normal EMG, (c) normal serum CK and aldolase, and (d) normal muscle biopsy except possibly for areas of in ltration of chronic in ammatory cells in the endomysial and perimysial connective tissue (interstitial myositis). When muscle pain is a prominent feature, polymyalgia rheumatica must be differentiated. This syndrome is characterized by pain, stiffness, and tenderness in the muscles of the neck, shoulders, and arms and sometimes of the hips and thighs; even passive motion of the limbs causes pain because of the periarticular locus of this disease. A high sedimentation rate, usually above 65 mm/h, is a diagnostic feature but more typically the value is close to 100 m/h, levels higher than they are in myositis. Biopsy of the temporal artery frequently discloses a giant-cell arteritis. CK levels and of course muscle biopsy are normal. Rapid disappearance of pain with administration of small doses of prednisone is also diagnostic of polymyalgia rheumatica (see page 1281). The patient with restricted muscle weakness. Weakness or paralysis of the posterior neck muscles, with inability to hold up the head, restricted bilateral quadriceps weakness, and other limited pelvicrural palsies are examples. Most often, the head-hanging or head-lolling syndrome proves to be due to PM and the other syndromes to restricted forms of dystrophy or to motor neuron disease. Inclusion body myositis is the main alternative consideration in cases of neck or quadriceps weakness, particularly if the latter weakness is asymmetric; muscle enzymes in the serum are normal or slightly elevated. Electromyography and biopsy are helpful in diagnosis. The patient with diffuse myalgia and fatigability. Most such patients with diffuse myalgia and fatigability have proved to be neurasthenic or depressed and rarely myopathic. A few cases will be found to be due to a toxic myopathy, particularly from one of the statin class of drugs. Hypothyroidism, McArdle disease, hyperparathyroidism, steroid myopathy, adrenal insuf ciency, hyperinsulinemia, and early rheumatoid arthritis must be ruled out by appropriate studies (these toxic and metabolic myopathies are discussed in Chap. 51). Features that virtually exclude a PM are (a) lack of reduced peak power of contraction and (b) normal EMG, serum enzymes, and muscle biopsy. The muscle biopsy of the patient with a clinical picture of PM discloses a noncaseating granulomatous reaction consistent with sarcoid (see further on).

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Q: A:

8. Rewrite as a product of a number and a variable: a 9. 3 x 4 b 4 x 3 c 3 1 4 x d 4 1 3 x

Reasons This is the equation we are given This will allow us to solve the equation in a streamlined fashion Multiply through by the constant (4a) Simplify both sides Divide each side by 3 Simplify each side

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