Tests for Assessing Arterial and Venous Circulation, Hip Dysfunction, and Meniscal Tear

Buerger’s test is a method used to evaluate the arterial circulation of the lower limb. The test involves observing the angle at which blanching occurs, with a lower angle indicating a higher likelihood of arterial insufficiency. Additionally, the degree of reactive hyperaemia on dependency of the limb after one minute is another positive sign of arterial insufficiency during the test.

Another test used to assess circulation is the Ankle-Brachial Pressure Index (ABPI), which involves using blood pressure cuffs to determine the degree of claudication. McMurray’s test, on the other hand, is used to evaluate for a meniscal tear within the knee joint.

Perthe’s test is a method used to assess the patency of the deep femoral vein prior to varicose vein surgery. Lastly, Trendelenburg’s test is used to evaluate hip dysfunction. These tests are important in diagnosing and treating various conditions related to circulation and joint function.

Malnutrition

Malnutrition refers to a state where the dietary intake is insufficient to maintain a healthy state and stable weight. It can be caused by over- or under-nutrition, but it is commonly used to describe under-nutrition. Malnutrition can be defined as a state of nutrition where a deficiency, excess, or imbalance of energy, protein, and other nutrients causes measurable adverse effects on tissue, function, and clinical outcome. Protein malnutrition is the most severe form of malnutrition, causing significant mortality and clinical effects such as kwashiorkor. Carbohydrate malnutrition is less common as carbohydrate sources are widely grown and cheap. Fat malnutrition rarely results in problems if there is adequate dietary protein and carbohydrate. Deficiencies of fat-soluble vitamins can result in various clinical effects. Body size can give some indication of nutritional status, but many obese patients may have nutritional deficiencies due to their faddy diets.

The Relationship between Alveolar Size and Surface Tension in Respiratory Physiology

In respiratory physiology, the alveolus is often represented as a perfect sphere to apply Laplace’s law. According to this law, there is an inverse relationship between the size of the alveolus and the surface tension. This means that smaller alveoli experience greater force than larger alveoli for a given surface tension, and they will collapse first. This phenomenon explains why, when two balloons are attached together by their ends, the smaller balloon will empty into the bigger balloon.

In the lungs, this same principle applies to lung units, causing atelectasis and collapse when surfactant is not present. Surfactant is a substance that reduces surface tension, making it easier to expand the alveoli and preventing smaller alveoli from collapsing. Therefore, surfactant plays a crucial role in maintaining the proper functioning of the lungs and preventing respiratory distress. the relationship between alveolar size and surface tension is essential in respiratory physiology and can help in the development of treatments for lung diseases.

Abnormal Binding Proteins and Iron Deposition: A Genetic Disorder

Abnormal binding proteins can lead to the deposition of iron in the body, resulting in various health complications. This genetic disorder is inherited in an autosomal recessive manner. The deposition of iron can cause cardiomyopathy, cirrhosis, pancreatic failure due to fibrosis, and skin pigmentation.

In general, disorders that affect metabolism or DNA replication on a cellular or genetic level tend to be autosomal recessive. On the other hand, genetic disorders that affect the structure of the body on a larger level are usually autosomal dominant. While there may be exceptions to these rules, they can serve as a helpful guide for exam preparation. Proper of this genetic disorder can aid in its diagnosis and management.

The Versatility of Pyruvic Acid in Cellular Metabolism

Pyruvic acid is a simple alpha-keto acid that plays a crucial role in several metabolic pathways within the cell. It serves as a central intersection where different pathways converge and diverge. One of the primary ways pyruvic acid is produced is through glycolysis, where glucose is broken down into pyruvic acid. Depending on the cell’s needs, pyruvic acid can be converted back into glucose through gluconeogenesis or used to synthesize fatty acids through the acetyl-CoA pathway. Additionally, pyruvic acid can be used to produce the amino acid alanine.

Pyruvic acid is also involved in respiration, where it enters the Krebs cycle under aerobic conditions. This cycle produces energy in the form of ATP, which is used by the cell for various functions. Under anaerobic conditions, pyruvic acid can ferment into lactic acid, which is used by some organisms as a source of energy.

In summary, pyruvic acid is a versatile molecule that plays a critical role in cellular metabolism. Its ability to be converted into different molecules depending on the cell’s needs makes it an essential component of many metabolic pathways.

The Body Mass Index as a Measure of Nutritional Status

The measurement and assessment of nutritional status can be challenging, and there is no single test that can provide a complete picture. However, the body mass index (BMI) is a commonly used measurement in clinical practice. The BMI is calculated by dividing a person’s weight in kilograms by their height in meters squared. This measure is used to assess adiposity and nutritional status, and it is simple and quick to calculate and interpret.

Although the BMI is a convenient measure, it has limitations for assessing obesity in individual patients. It is best used to track trends in an individual patient’s BMI over time. In some cases, the BMI may overestimate fat mass in patients who are very tall or have a high proportion of lean tissue due to an active lifestyle. Additionally, the BMI may not be accurate for athletes and children.

Other measurements, such as skin fold thickness and weight, can also be useful, but the BMI is generally considered the better option. The ponderal index is used specifically for children. It is important to note that albumin is not a reliable marker of nutritional status, as it can also be affected by inflammation.

Overall, the BMI is a widely used measure of nutritional status and is recommended by the World Health Organization. However, it is important to consider its limitations and use it in conjunction with other measurements to obtain a more complete picture of a patient’s nutritional status.

The Function and Structure of the Mammalian Cell Membrane

The mammalian cell membrane serves as a protective barrier that separates the cytoplasm from the extracellular environment. It also acts as a filter for molecules that move across it. Unlike plant and prokaryotic cells, mammalian cells do not have a cell wall. The main component of the cell membrane is a bilayer of amphipathic lipids, which have a hydrophilic head and a hydrophobic tail. The phospholipids in the bilayer are oriented with their hydrophilic heads facing outward and their hydrophobic tails facing inward. This arrangement allows for the separation of the watery extracellular environment from the watery intracellular compartment.

It is important to note that the cell membrane is not a monolayer and the phospholipids are not linked head-to-tail. This is in contrast to DNA, which has a helical chain formation. Overall, the structure and function of the mammalian cell membrane are crucial for maintaining the integrity and proper functioning of the cell.

Huntington’s Disease

Huntington’s disease is a genetic disorder that typically appears later in life and is characterized by symptoms such as chorea, cognitive decline, and personality changes. It is an autosomal dominant disease, meaning that there is a 50% chance of passing it on to offspring. If the gene is inherited from an unaffected parent, the child will not be affected. This is different from autosomal recessive inheritance, where both parents must pass on the gene for it to affect their children.

The disease is caused by an increase in the length of a repeating trinucleotide sequence (CAG) in the Huntington protein. This sequence can change in length through generations, and longer sequences are associated with earlier onset of symptoms (genetic anticipation). Since Huntington’s disease usually presents itself after people have already started their families, there are many issues associated with genetic testing.

Homologous Recombination: A Mechanism for DNA Repair and Genetic Variation

Homologous recombination is a process that allows for the exchange of nucleotide sequences between two similar or identical DNA molecules. This occurs during meiosis, specifically during the second phase of prophase I, where sister chromatids swap sequences. The primary purpose of homologous recombination is to accurately repair harmful double-strand DNA breaks. This process results in new combinations of DNA sequences that provide genetic variation in daughter cells and, ultimately, the organism’s offspring.

In prokaryotic organisms such as bacteria and viruses, homologous recombination occurs during horizontal gene transfer. This process involves the exchange of genetic material between different strains and species. Homologous recombination plays a crucial role in the evolution of these organisms by allowing for the acquisition of new traits and adaptations.

Overall, homologous recombination is a vital mechanism for DNA repair and genetic variation. It ensures the accuracy of DNA replication and contributes to the diversity of life on Earth.

Sources of Vitamin D

Vitamin D is a type of fat-soluble vitamin that can be found in certain foods such as cheese, butter, eggs, and oily fish. However, vegetable sources of vitamin D are limited, although some foods are fortified with this vitamin. For instance, 100 grams of sundried shiitake mushrooms contain 1600 IU of vitamin D, while one egg contains 20 IU. Wild salmon is also a good source of vitamin D, with 100 grams containing 800 IU, while farmed salmon contains 200 IU.

Aside from food sources, sunlight is also a good source of vitamin D. Exposure of arms and legs to sunlight for 10-15 minutes can provide 3000 IU of vitamin D. However, it is difficult to obtain the daily requirement of 25-50 IU of vitamin D through sunlight alone, especially for people living in temperate climates. As a result, many people may have insufficient vitamin D levels. It is important to ensure that we get enough vitamin D through a combination of food sources and sunlight exposure.

Poiseuille’s Equation and Fluid Flow in Cylinders

Poiseuille’s equation is used to describe the flow of non-pulsatile laminar fluids through a cylinder. The equation states that the flow rate is directly proportional to the pressure driving the fluid and the fourth power of the radius. Additionally, it is inversely proportional to the viscosity of the fluid and the length of the tube. This means that a short, wide cannula with pressure on the bag will deliver fluids more rapidly than a long, narrow one.

It is important to note that even small changes in the radius of a tube can greatly affect the flow rate. This is because the fourth power of the radius is used in the equation. Therefore, any changes in the radius will have a significant impact on the flow rate. Poiseuille’s equation is crucial in determining the optimal conditions for fluid delivery in medical settings.

Techniques in Biochemistry

Over-the-counter urine pregnancy tests use ELISA to detect beta-HCG in a woman’s urine. The test stick contains antibodies that react with beta-HCG, producing a color change that confirms pregnancy. The urinary pregnancy test is a solid-phase ELISA, where the antibody is immobilized on a specialized filter paper. The fluid travels laterally across the paper to bind with the antibody, and if beta-HCG is present, the line turns blue. Electrophoresis characterizes the electrical charge and size of substances, while PCR identifies specific sequences of DNA or RNA. Radioimmunoassay uses radioactivity to identify specific proteins. Enzymatic degradation breaks down large proteins into smaller subunits for which target antibodies may already exist. This method is used to characterize large proteins for which the structure has not yet been described.

The Nucleolus: Structure and Function

The nucleolus is a non-membrane-bound structure that takes up about a quarter of the nuclear volume. It is composed mainly of proteins and nucleic acids and is responsible for transcribing ribosomal RNA (rRNA) and assembling ribosomes in the cell. Nucleoli are formed in nucleolar organizing regions (NORs), which are also the regions of the genes for three of the four eukaryotic rRNAs.

During ribosome assembly, ribosomal proteins enter the nucleolus from the cytoplasm and begin to assemble on an rRNA precursor. As the pre-rRNA is cleaved to produce 5.8S, 18S, and 28S rRNAs, additional ribosomal proteins and the 5S rRNA (which is synthesized elsewhere in the nucleus) assemble to form preribosomal subunits. These subunits then exit the nucleolus into the cytoplasm and combine to produce the final 40S and 60S ribosomal subunits.

Overall, the nucleolus plays a crucial role in protein synthesis by producing the components necessary for ribosome assembly. Its unique structure and function make it an essential component of the cell’s machinery.

Apoptosis and the Role of the Apoptosome

Apoptosis, also known as programmed cell death, is a natural process that occurs in all multicellular organisms. It involves a series of changes in cell morphology, including membrane blebbing, cell shrinkage, nuclear fragmentation, chromatin condensation, and chromosomal DNA fragmentation. The formation of the apoptosome is a crucial part of the apoptosis cascade. It is a large protein structure that is triggered by the release of cytochrome c from the mitochondria in response to various stimuli, such as DNA damage, infections, or developmental signals.

The apoptosome is formed when cytochrome c binds to Apaf-1, a cytosolic protein, in a 1:1 ratio. This triggers the recruitment and activation of the initiator pro-caspase-9, which then activates effector caspases, a family of apoptotic proteases, to initiate the apoptotic cascade. It is important to note that the activation of caspase-9 occurs only after the formation of the apoptosome.

In summary, apoptosis is a natural process that occurs in multicellular organisms, and the apoptosome plays a crucial role in triggering the apoptotic cascade. the mechanisms behind apoptosis and the formation of the apoptosome can provide insights into various diseases and developmental processes.

The Significance of Prometaphase in Cell Division

Prometaphase is a crucial phase in cell division that marks the transition from prophase to metaphase. Although it is often considered as a part of these two phases, it has distinct events that make it an individual phase. During prometaphase, the nuclear membrane disintegrates, and the nucleoli are no longer visible. Additionally, each chromosome forms two kinetochores near the centromere, which serve as attachment points for spindle fibers. These fibers connect to the opposite poles of the cell, forming travelling lines that will separate the sister chromatids during anaphase.

Prophase is characterized by chromatin condensation, while DNA and centrosome duplication occur during interphase. Chromosome alignment takes place during metaphase, and the sister chromatids separate during anaphase. Prometaphase, therefore, plays a crucial role in preparing the chromosomes for separation during anaphase. Its distinct events make it an essential phase in cell division, and its proper execution is necessary for successful cell division.

The Roles of Vitamin K in the Body

Vitamin K plays several important roles in the body. One of its main functions is to modify clotting factors II, VII, IX, and X through a process called carboxylation. This modification allows calcium to bind to the factors, which is necessary for them to participate in the clotting pathway. This principle is used in full blood counts to prevent clotting by adding EDTA, which chelates the calcium. Vitamin K also modifies osteocalcin and matrix proteins in bone, as well as nephrocalcin in the kidney, in a similar way.

In addition to its role in blood clotting and bone health, vitamin K is also important for nervous tissue development and growth. However, vitamin K antagonists such as warfarin are sometimes used as anticoagulants to prevent blood clots. It is important to follow guidelines and instructions carefully when using these medications. Overall, vitamin K plays a crucial role in maintaining the health and function of various systems in the body.

Gas Laws

Gas laws are a set of scientific principles that describe the behavior of gases under different conditions. One of these laws is Avogadro’s law, which states that equal volumes of gases at a standardized temperature and pressure contain the same number of molecules. Another law is Boyle’s law, which explains that gases expand when the temperature is increased. Charles’ law, on the other hand, states that the pressure of a gas is inversely proportional to its volume at a standardized temperature. Lastly, Graham’s law explains that the rate of diffusion of a gas is in inverse proportion to its weight. The specific gas laws that you need to know may vary depending on your syllabus, but you should be able to recognize and apply them if given the formulae. It is unlikely that you will be expected to know the correct formula.

Tests for Varicose Veins and Arterial Insufficiency

The Trendelenburg and tourniquet tests are both used to evaluate the site of incompetence in varicose veins at the sapheno-femoral junction. During the Trendelenburg test, the examiner applies pressure with their fingers over the junction, while in the tourniquet test, a tourniquet is placed just below the junction. If the veins fill rapidly upon standing, it suggests that the sapheno-femoral junction is not the source of the incompetence.

Buerger’s test is used to assess the arterial circulation of the lower limb. The lower the angle at which blanching occurs, the more likely there is arterial insufficiency. This test is important in diagnosing peripheral artery disease.

The ankle-brachial pressure index (ABPI) is another test used to assess arterial insufficiency. Blood pressure cuffs are used to measure the systolic blood pressure in the ankle and arm. The ratio of the two pressures is calculated, and a lower ratio indicates a higher degree of claudication.

Finally, Perthe’s test is used to assess the patency of the deep femoral vein before varicose vein surgery. This test involves compressing the vein and observing the filling of the superficial veins. If the superficial veins fill quickly, it suggests that the deep femoral vein is patent and can be used for surgery.

In summary, these tests are important in diagnosing and evaluating varicose veins and arterial insufficiency. They help healthcare professionals determine the best course of treatment for their patients.

The Relationship between Alveolar Size and Surface Tension in Respiratory Physiology

In respiratory physiology, the alveolus is often represented as a perfect sphere to apply Laplace’s law. According to this law, there is an inverse relationship between the size of the alveolus and the surface tension. This means that smaller alveoli experience greater force than larger alveoli for a given surface tension, causing them to collapse first. This phenomenon is similar to what happens when two balloons of different sizes are attached together, with the smaller balloon emptying into the larger one.

In the lungs, this collapse of smaller alveoli can lead to atelectasis and collapse if surfactant is not present. Surfactant is a substance that reduces surface tension, making it easier to expand the alveoli and preventing smaller alveoli from collapsing. this relationship between alveolar size and surface tension is crucial in respiratory physiology, as it helps explain the importance of surfactant in maintaining proper lung function.

In this scenario, the crude mortality ratio is established by comparing the number of deaths occurring within the hospital in a given year to the total number of admissions, disregarding age or gender-specific mortality rates. For instance, with 1,912 deaths out of 95,071 admissions, the ratio computes to 0.02, or 2.0% when calculated per 100 admissions (1,912/95,071 = 0.02/100= 2.0%. When recalculated per 1,000 admissions, the crude admission rate would be 20 per 1,000.

Carbohydrates: Building Blocks of Energy and Storage

Carbohydrates are organic compounds made up of carbon, hydrogen, and oxygen, with a general formula of Cx(H2O)y. They can be classified as either aldehydes or ketones and contain multiple hydroxyl groups. Monosaccharides are the simplest form of carbohydrates, consisting of a single unit. They are categorized based on the number of carbon atoms they contain, with trioses having three, pentoses having five, and hexoses having six carbon atoms. These monosaccharides are essential for energy production and building larger carbohydrate structures.

Disaccharides are formed when two monosaccharides are joined together through a condensation reaction, releasing a water molecule. The most common disaccharides are lactose, maltose, and sucrose. Polysaccharides, on the other hand, are long, branched polymers made up of multiple single units. They serve as convenient storage molecules for energy reserves, such as glycogen in humans and starch in plants.

In summary, carbohydrates are vital building blocks for energy production and storage in living organisms. Monosaccharides, disaccharides, and polysaccharides all play important roles in maintaining the body’s energy balance and overall health.

Differences between DNA and RNA

DNA and RNA differ in several ways. The primary sugar in DNA is deoxyribose, while in RNA it is ribose. Additionally, DNA is double stranded, while RNA is single stranded. This single stranded structure with un-paired bases allows for transcription to occur when the DNA bases are freed. Each base has a specific pairing, with guanine always binding to cytosine and adenine always binding to thymine in the DNA strand. During transcription, the same complementary RNA bases assemble with the DNA bases, except for thymine, which is not an RNA base. Instead, uracil serves as the RNA pyrimidine base equivalent of thymine. Finally, lysine is an amino acid coded for by the RNA base triplet AAA, where A represents adenine.

Mesenchymal Cells: The Stem Cells of the Human Skeleton

Mesenchymal cells are the primary stem cells of the human skeleton. These multipotent cells originate in the bone marrow and have the ability to differentiate into various cell types. Osteoblasts, responsible for bone formation, chondrocytes, which give rise to cartilage, and adipocytes, specialized in storing energy as fat, are some of the cells that mesenchymal cells can produce. Muscle cells, or myocytes, arise from muscle satellite cells, while skin cells come from epithelial stem cells. Neurons mostly arise from neural stem cells, although some may come from astrocytes. White blood cells, on the other hand, come from hematopoietic stem cells. Mesenchymal cells play a crucial role in the maintenance and repair of the human skeleton, making them an essential area of study in regenerative medicine.

Vitamin A: Forms, Sources, and Functions

Vitamin A is a crucial nutrient that exists in various forms in nature. The primary dietary form of vitamin A is retinol, also known as pre-formed vitamin A, which is stored in animal liver tissue as retinyl esters. The body can also produce its own vitamin A from carotenoids, with beta-carotene being the most common precursor molecule.

The richest sources of vitamin A include liver and fish liver oils, dark green leafy vegetables, carrots, and mangoes. Vitamin A can also be added to certain foods like cereals and margarines.

Vitamin A plays several essential roles in the body, including supporting vision by being a component of rhodopsin, a pigment required by the rod cells of the retina. It also contributes to the growth and development of various types of tissue, regulates gene transcription, and aids in the synthesis of hydrophobic glycoproteins and parts of the protein kinase enzyme pathways.

In summary, the different forms and sources of vitamin A and its vital functions in the body is crucial for maintaining optimal health.

The Role of UV Light and Vitamin D in Calcium and Phosphate Regulation

In order for the body to produce Vitamin D3, UV light at a specific wavelength is required to convert cholesterol in the skin. Vitamin D2 and D3 are then transported in the bloodstream bound to the Vitamin-D Binding Protein and undergo further modifications in the liver and kidney to become the active form, 1,25 (OH)2Vitamin D. This active form plays a crucial role in regulating calcium and phosphate concentrations in the body.

1,25 (OH)2Vitamin D increases calcium absorption in the duodenum and inhibits the secretion and synthesis of PTH, which helps to maintain calcium concentrations. It also increases phosphate absorption in the jejunum and ileum, which is important for maintaining phosphate concentrations. Additionally, 1,25 (OH)2Vitamin D promotes bone turnover by stimulating both osteoblast and osteoclast activity.

Overall, the production and activation of Vitamin D through UV light and dietary sources is essential for proper calcium and phosphate regulation in the body.

The Five Phases of the Cell Cycle

The cell cycle is a complex process that is divided into five main phases, each with its unique cellular events. The first phase is the G0 phase, which is a resting phase where the cell has stopped dividing and is out of the cell cycle. The second phase is the G1 phase, also known as interphase Gap 1, where cells increase in size, and a checkpoint control mechanism prepares the cell for DNA synthesis.

The third phase is the S phase, where DNA replication occurs. The fourth phase is the G2 phase, also known as Gap 2, which is a gap between DNA synthesis and the onset of mitosis. During this phase, the cell continues to grow until it is ready to enter mitosis. Finally, the fifth phase is the M phase, also known as mitosis, where cell growth stops, and the cell focuses its energy to divide into two daughter cells.

A checkpoint in the middle of mitosis, known as the metaphase checkpoint, ensures that the cell is prepared to complete division. the five phases of the cell cycle is crucial in how cells divide and grow.

Cellular Processes and Organelles

Metabolic processes in the cell occur in specific locations. Acetyl-CoA production and the Krebs cycle take place in the mitochondrium, while glycolysis occurs in the cytoplasm. The nucleus is the central structure of the cell that contains DNA and is double membrane-bound. The rough endoplasmic reticulum is responsible for packaging and transporting proteins, while the smooth endoplasmic reticulum performs a similar function but lacks ribosomes.

It is important to understand where these processes occur in the cell to better understand their functions and how they contribute to the overall functioning of the cell. The mitochondrium is responsible for producing energy in the form of ATP, while the cytoplasm is where glucose is broken down during glycolysis. The nucleus is where genetic information is stored and replicated, and the endoplasmic reticulum is involved in protein synthesis and transport.

In summary, the cell is a complex system with various organelles that perform specific functions. where these processes occur in the cell is crucial to how they contribute to the overall functioning of the cell.

The Functions of Endoplasmic Reticulum and Lysosomes

The endoplasmic reticulum (ER) is a complex network of membranes that is divided into two types: rough and smooth. The rough ER is characterized by the presence of ribosomes on its cytosolic side, which makes it an important site for protein production, modification, and transport. On the other hand, the smooth ER is involved in cholesterol and steroid handling, as well as calcium storage in some cells. This type of ER is particularly prominent in cells that produce large amounts of steroid hormones, such as those found in the adrenal cortex.

Lysosomes, on the other hand, are organelles that are responsible for breaking down and recycling cellular waste. They are formed by the Golgi apparatus, which is another complex network of membranes found in eukaryotic cells. Lysosomes contain a variety of enzymes that are capable of breaking down different types of molecules, including proteins, lipids, and carbohydrates.

In summary, the ER and lysosomes are two important organelles in eukaryotic cells that play different roles in cellular metabolism. While the ER is involved in protein production, modification, and transport, the lysosomes are responsible for breaking down and recycling cellular waste.

The Krebs cycle occurs in the mitochondrion and involves the conversion of acetyl-CoA to oxaloacetate. This cycle produces six NADH, two FADH, and two ATP for each molecule of glucose. Pyruvate is converted to acetyl-CoA before entering the Krebs cycle, and water and carbon dioxide are end products. Acetic acid itself has no role in the cycle, but its acetyl group is used to form acetyl-CoA. Some anaerobic bacteria can convert sugars to acetic acid directly.

Acid-Base Imbalances in Different Medical Conditions

Poorly controlled diabetes can cause the breakdown of fatty acids, leading to the production of ketones as an alternative energy source. However, an excess of ketones can result in metabolic acidosis due to their acidic nature. On the other hand, chronic obstructive pulmonary disease (COPD) and suffocation can cause the retention of carbon dioxide, leading to respiratory acidosis. In COPD, there may be a compensatory metabolic alkalosis. Voluntary hyperventilation can cause respiratory alkalosis due to the reduction of carbon dioxide. Vomiting can also lead to metabolic alkalosis. Diabetic ketoacidosis is a complication of type 1 diabetes that results in high blood sugar levels, ketone production, and acidosis.

In summary, different medical conditions can cause acid-base imbalances in the body. It is important to identify the underlying cause of the imbalance to provide appropriate treatment.