Update README.md

README.md

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-- text: An 18-month-old boy, with complete immunization schedule to date, who consults the Emergency Department for right knee swelling after playing in the park, without obvious trauma. In the directed anamnesis, the mother refers that an uncle of hers had similar problems. The ultrasound examination is compatible with hemarthrosis and in the analytical analysis only an APTT lengthening of 52'' (normal 25-35'') stands out. What is the most probable diagnostic hypothesis?
-  context: Although other hemorrhagic diseases can have a prolonged thromboplastin time, due to the intensity of the lesion and the child's sex and family history, the most likely diagnosis is hemophilia.
-- text: A patient with a history of febrile illness and chest pain comes to the hospital with dyspnea and tachypnea. On physical examination his blood pressure is low, jugular venous pressure is elevated with a deep descending sinus "X" and he has a paradoxical pulse. What pathology should you suspect?
-  context: Paradoxical pulse is a drop in blood pressure > 10 mmHg during inspiration;it represents an exaggeration of the physiological phenomenon consisting ofinspiratory lowering of BP (normal up to 10 mmHg). In cardiac tamponade,inspiration, which causes an increase in blood flow to the right chambers,increasing their volume, secondarily causes a displacement of theinterventricular septum to the left, so that the left heart lodges andexpels less blood during systole and the pulse, therefore, decreases. In anormal heart this exaggerated displacement, caused by the pressure exertedby the tamponade on the RV free wall, does not occur. Sinus X represents thesystolic collapse of the venous pulse, i.e., the pressure drop due to atrialrelaxation (also partly due to a downward displacement of the RV base duringsystole). Sinus Y represents the diastolic collapse of the venous pulse,i.e., the pressure drop that occurs from the moment blood enters thetricuspid valve into the ventricle. In cardiac tamponade, the deep sinus Xis characteristic. In constrictive pericarditis, the deep Y sinus. For allthese reasons, the correct answer is 5.
+- text: Although other hemorrhagic diseases can have a prolonged thromboplastin time, due to the intensity of the lesion and the child's sex and family history, the most likely diagnosis is hemophilia.
+- text: Paradoxical pulse is a drop in blood pressure > 10 mmHg during inspiration;it represents an exaggeration of the physiological phenomenon consisting ofinspiratory lowering of BP (normal up to 10 mmHg). In cardiac tamponade,inspiration, which causes an increase in blood flow to the right chambers,increasing their volume, secondarily causes a displacement of theinterventricular septum to the left, so that the left heart lodges andexpels less blood during systole and the pulse, therefore, decreases. In anormal heart this exaggerated displacement, caused by the pressure exertedby the tamponade on the RV free wall, does not occur. Sinus X represents thesystolic collapse of the venous pulse, i.e., the pressure drop due to atrialrelaxation (also partly due to a downward displacement of the RV base duringsystole). Sinus Y represents the diastolic collapse of the venous pulse,i.e., the pressure drop that occurs from the moment blood enters thetricuspid valve into the ventricle. In cardiac tamponade, the deep sinus Xis characteristic. In constrictive pericarditis, the deep Y sinus. For allthese reasons, the correct answer is 5.
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