U world Review 6/12/23 Flashcards
What organisms are cephalosporin resistant organisms
Listeria Monocytogenes
Methicillin resistant staphylococcous (MRSA)
Enterococci
Atypical like mycoplasma or chlamydia (no cell wall)
what can you use to treat listeria monocytogenes
ampicillin ( remember the amp that was in the background skethcy)
what is a septic abortion
this is when pregnancy termination does not remove all products of conception and leads to retained POCs which causes fever, uterine tenderness, and malorodrous cervical discharge. Bacteria colonizes and gives symptomatology
what are the most common organisms to cause a septic abortion?
anaerobes, group A strep and Staph aures
what is the treatment of septic abortions?
broad spectrum antibiotics and also urgent surgical and uterine evacuatio to remove the necrotic tissue and infection
clinical symptoms of a septic abortion
fever, abdominal pain, uterine tenderness, and malodorous discharge after pregnant termination
what are the systemic mycoses
histoplasmosis, blastomycosis, coccidiomycosis, paracoccidiomycosis
all systemic mycoses are _morphic in the cold they are _ and in the heat they are _ (the only exception to this is coccidoides)
dimrophic
mold in the cold and yeast in the heat
treatment of systemic mycoses includes
flucanzaole or itraconazole for local infections, amphotericin B for systemic infection
histoplasmosis is endemic to what location and what are its pathological features
it is endemic to the ohio river valleys and mississippi it appears as hiding inside of macrophages. it is associated with bird or bat droppings and can cause granulomas, pneumoniae, palatal/tongue ulcers, splenomegaly, pancytopenia, and erythema nodosum
where is blastomycosis endemic to, what are its pathological features
endemic to eastern and central US great lakes it appears as a broad based bud that can disseminate to bone. and the skin and cause verrucous lesions.
It can also cause granulomas, pneumonia, and inflammatory lung disease
coccidiomycosis is endemic where and what are its pathological features
endemic in southwestern US and california it is spheryle that is filled with endospores
it is associated with dust exposures (earthquakes) and can disseminate to bone, cause erythema nodosum, arthralgias, and memningitis
still can cause pneumonia, granulomas etc.
causes san joaquin valley fever
paracoccidiomycosis is endemic where and what are its pathological features
endemic to latin america and it is similar to blastomycosis but affects males more than females and looks like a captains wheel
what is the pathogenesis of mycobaterium tuberculosis causing tuberculosis
the bacteria is transmitted via aerosolized droplets and is inhaled into the lower lobe of the lung where it replicates and in the alveoli. The alveolar macrophages phagocytose the organism but cant eliminate it because sulfatides prevent phagolysosome fusion so m. tuberculosis will replicate unchecked in the alveolar macrophages for the first few weeks
after a few weeks APCs in the lymphatic system will display mycobacterial antigens and release IL-12 which will stimulate CD4+ lymphocytes to become TH1 cells. TH1 will then release IFN-y which activates macrophages to differenitate into epithelioid multinucleated langhans giant cells and form granulomas.
esophageal varices and splenomegaly are signs of?
portal hypertension
(underlying hepatic fibrosis)
what is the pathogenesis of schistosoma spp
when humans swim in fresh water in sub-saharan africa and contaminated snals release parasitic blood flukes that penetrate human skin and migrate to the liver where they mature ( they spread through the portal circulation) and release eggs.
can cause periportal fibrosis and cause portal hypertension with eosinophilia ***
what is a hint for a shistomasis infection on CBC
eosinophilia
pyrrolidonyl arylamidase ezyme (PYR) is used for?
Pyrrolidonyl arylamidase (PYR) enzyme testing is used to differentiate beta- and gamma-hemolytic streptococci. S pyogenes and enterococci are PYR positive (ie, can hydrolyze with PYR), whereas S agalactiae and S gallolyticus are PYR negative (ie, do not produce PYR).
which organisms produce pyrrolindnyl arylamidase
Group A strep and entercococous (faceium etc. )
what are contact precautions
wearing nonsterile gloves for all patient contact and gowns during substantail contact with infective material this is indicated for multidrug resistant bacteria like MRSA
methicillin sensitive does not require contact percautions
isolation precautaions
if there is an airborne infectious disease like tuberculosis with negative air pressure, closed doors and use of respirator masks
what is the single most important measure to reduce the risk of transmissionof hospital acquired infections
hand hygiene
walking pneumonia is usually caused by and what are the symptoms
mycoplasma pneumoniae and there is a low grade fever, malaise,chronic and dry nagging cough, on X ray there will be findings WAY WORSE than clinical apperance of the patient.
Mycoplama pneumoniae requires what to grow
cholesterol
haemophilus influenze requires what to be grown
chocolate agar (heat lysed blood_ and factor X (hematin) and factor V (NAD+)
leginella pneumophilia requires what to be grown
L-cysteine supplemeted agar
staphylococcal foodborne ilnesses can be prevented by?
washing hands before preparing food and proper storage of refridgerated food
chronic hypertension can lead to progressive _ and firbinoid necrosis weakening the vessel wall and predisposing to the formation of _ aneurysms
arteriolar hyalinization
charcot bouchard aneurysms
the most common sites of intracranial hemorrhage is?
deep brain structures like the basal ganglian, thalamus, pons (lenticulostriate arteries)
Deep intraparenchymal hemorrhage is most commonly caused by hypertensive vasculopathy of the small penetrating branches of the cerebral arteries (Charcot-Bouchard aneurysm rupture). This is in contrast to rupture of saccular aneurysms, which typically cause subarachnoid hemorrhage.
injury to the internal capsule
contralateral weakness/numbness, externosir plantar response,
acute bleeding appears as hyperattentuated or bright lesions on _ CT
non contrast head CT
what is the most common cause of intracanial hemorrhage in children
ateriovenous malformations
abnromal connection between arteries and veins bypassing cappularies which develop due to distrupted angiogenesis
what are the associated conditions with saccular or berry aneurysms
ADPKD, ehlers danlos syndrome, hypertension
loacted in the circule of willis ( severe sudden headache)
shoulder flexion cause _ rotation of the clavicle at the SC joint
posterior rotation
shoulder extension causes _ roation of the clavicle and the SC joint
anterior
clavicle rotation occurs with shoulder _
flexion/extension
shoulder elevation causes _ displacement of the distal clavicle and _ displacement of the proximal clavicle
superior
inferior
clavicle superior/inferior displacement occurs with shoulder_
elevation and depression
shoulder depression causes _ displacement of the distal clavicile and _ displacement of the proximal clavicle
inferior
superior
clavicle anterior/posterior displacement occurs with shoulder _
internal/external rotation
shoulder external rotation causes _ displacement of the distal clacivle and _ displacement of the proximal clavicle
posterior
anterior
shoulder internal rotation cause _ displacement of the distal clavicle and posterior displacement of the proximal clavicle
anterior
posterior
psoas syndrome signs
pelvic shift to the opposite side
non neutral lumbar dysfunction
positive thomas test’
L1 SP tenerpoint, medial ASIS tednerpoint
Positive Thomas test: Flexing the hip and knee on the unaffected side in the supine position causes the opposite leg (with the hypertonic psoas) to elevate off the table.
spondyloisthesis osteopathic test
positive step off sign
obvious forward displacement when palpating the spinous processes at the area of the slippage)
iliolumbar ligament sprain tenderpoint location
posterior iliac crest
L4 radiculopathy signs
low radiating low back pain with parathesias of the lateral thigh and medial knee
piriformis syndrome
buttock pain that radiates down the posterior thigh
symptoms of uremia
weakness, nausea, and anorexia with elevated creatinine and blood urea nitrogen
GFR is reduced in chronic kidney disease due to _ and acute kidney injury due to _
loss of functional nephrons
due to decreased renal profusion
the GFR can be directly measured by
a freely filtered not metabolized, secreted or reabsorbed filtration marker (inulin, creatinine)
a portion of creatine is actively secreted by the
proximal tubules
uncorrected creatine clearance _ the GFR by 10-20 %
overestimates
attack rate equation
number of those who become ill divided by those who are at risk of contrating the illness
what is a specific phobia
marked anxiety about an object or situation with avoidance behaviors that has been going on for 6 months or more
Specific phobia is a common anxiety disorder characterized by high levels of anxiety and panic attacks triggered by exposure, or anticipation of exposure, to a feared stimulus. As a result, these patients try to avoid the phobic stimulus whenever possible.
blood, animals, heights
what is the treatment of specific phobias
congnitive behavior therapy with repetitive graded exposure to the fear inducing stimulus
lactose is convereted into
galactose and glucose
lactase synthase converts _ to _ within the _ glands during milk formation
UDP-galactose to lactose
galactose kinase def
can transform glactose into galactose 1 phosphate and galacitol will accumulate
it is autosomal recessive and and galactose will appear in the blood and the urine children may have infantile cataracts and may have failure tracking objects and or failure to develop a social smile
classic galactosemia is a def in?
galactose-1 phosphate uridyltransferase (GALT)
classic galactosemia damage and genetic pattern
autosomal recessive damage caused by accumulation of toxic substances like galactitol that accumulates in the lens of the eye
symptoms begin when the infant is feeding ( lactose in breast milk) can cause FTT, heptomegaly, and infantile cataracts
classic glactosemia predisposes infants to?
E coli sepsis
essential fuctosuria
def in fructokinase (AR) cant convert fructose into Fructose 1-phosphate
fructose is not trapped in cells and hexokinase become the prinmary mechanism of convertinf fructose into fructose 6 phosphate
ASYMPTOMATIC
hereditatry fructose intolerance def
aldolase B def, where fructose 1- phosphate accumulates and decreases available phosphate and inhibits gluconeogenesis and glycogenolysis
symptoms present after consuption of fruit, juice, or honey
will have glucose in urine and reducing sugars in the urine as well
symptoms of hereditary fructose intolerance
hypoglycemia, jaundice, cirrhosis, vomiting
decrease fructose, sucrose, and sorbitol
what should you eliminate to treat hereditary fructose intolerance
fructose, sucrose (fructose + glucose) and sorbitol
what should you eliminate to treat classic galactosemia
galactose and lactose (galactose and glucose)
an alternative method of trapping glucose in the cell is to convert it to its _ counterpart _
alcohol
sorbitol
via aldose reductase
some tissues convert sorbitol to _ using sorbitol dehydrogenase
fructose
intracellular sorbitol accumulation causes _ damage
osmotic
cataracts, retinopathy, peripheral neuropathy
what tissues have the enzyme sorbitol dehydrogenase to convert it into fructose
liver, ovaries, and seminal vesicles
what tissues only have aldose reductase (glucose to sorbitol)
LARKS
lens, retina, kidney, and schwann cells
non stimulate ADHD medications
norepineprhine reuptake inhibitors (atomoxetine and viloxazine) or alpha 2 adrenergic agnosits (clonidine guanfacine)
atomoxetine is the first line non stimulate
pathological changes associated with alzheimer disease
neurofibrillary tangles and amyloid beta plaques
neurofibrillary tangles are composed of
hyperphosphorylated tau protein (intracellular microtubule component)
amyloid beta is an abnormal fragment of?
amyloid precursor protein which is normally involved in synaptic formation and repair
the amyloid precuror protein (APP) is located on chromosme _ and the estra copy leads to accelerated accumulation and earlt onset alzhemier disease
21
(down syndrome0
Patients with trisomy 21 (Down syndrome) have 3 copies of the amyloid precursor protein gene located on chromosome 21. This increases amyloid-beta accumulation in the brain, placing these patients at high risk for developing early-onset Alzheimer disease.
amyloid A protein is?
acute phase reactant associaed with AA amylodisosis in chronic disease states
huntington disease mutation
CAG on HTT gene
islet amyloid polypeptide
beta cells prduce this and can form cytotoxic deposits in type 2 diabetes and impairs beta cell function
neprilysin what is it and what its into MOA
neprylysin is a metalloprotease that inactivates ANP and BNP leading to vasocontriction and retention of water, it also inactivates angiotensin II
neprylipsin inhibitors can be used in heart failure with reduced ejection fraction, what is the MOA
inhibts neprylysin which increases ANP and BNP (diuresis and vasodilation) and increases angiotensin II activities ( vasoconstriction)
why are angiotensin II receptor blockers usually used in combination with a neprylisin inhibitor
because inhibitors inactivate neprylisin which increases angiotensin II activities which is not what we want in heart failure so we use it to offest this deleterious effect
Neprilysin is responsible for the breakdown of the natriuretic peptides and angiotensin II; therefore, inhibition of neprilysin increases the activity of these peptides. For treatment of heart failure, neprilysin inhibition is combined with angiotensin II receptor blockade to optimize the positive effects of the natriuretic peptides (eg, vasodilation, diuresis) while blocking the negative effects of angiotensin II (eg, vasoconstriction, fluid retention).
protease inhibitors in HIV MOA and side effects
inhibit viral protease needed for HIV polyprotein cleavage to form viral proteins
lipodystrophy, hyperglycermia, inhbition of cytocrhome p450
Inhibition of cytochrome P450 may cause interactions with other drugs. Rifampin increases P450 activity and will therefore decrease PI serum levels; as a result, rifampin can be replaced with rifabutin in the treatment of tuberculosis in patients on PIs.
what are the protease inhibitors use to treat HIV
atazanavir, darunavir, indinavir (navir)
what are the NNRTs used to treat HIV
efavirenz, nevirapine
allosteric reverse transcriptase inhibitor
what are the NRTI’s used to treat HIV
tenofovir, emtricitabine, lamivudine, abacavir, zixovudine
competitive nucleoside/nucleotide reverse transcriptas inhbitor
what are the integrase inhibitors that are used to treat HIV
dolutegravir and raltegravir ( gravir)
inhibit HIV DNA integration into host genome
what are the fusion inhibitors that are used to treat HIV
Enfuvirtide
inhits HIV fusion with target cell by binding to HIV gp41
what are the CCR5 antagonsits used to treat HIV
maraviroc
blocks gp120 interaction with CCR5
what is the most common side effect of zidovudine
bone marrow toxicity (anemia)
centriacinar emphysema
smoking induced empysema with exertional dyspnea and dilated airspaces
pathogenesis of smoking induced emphysema
oxidative injury to the respiratory bronchioles and acivation of resident macrophages from smoke. Then inflammatory recruitment of neutrophils into the affected airspaces ensues
activated macrophages and neutrophils release proteases like elastase that degraded the ECM
pan acinar emphysea
caused by alpha 1 antitrypsin deficency
expectorated sputum cultures are often contiminated by?
normal oral flora
candida albicans : budding yeast that forms true hyphae (germ tubes) at warmer temps.
fetal circulation is characterized by _ pulmonary vascular resistance and _ systemic vascular resistance
high
low
there are right to left shunts which means the right ventricle contributes to 60 % of systemic flow
neonatal circulation is characterized by _ PVR and _ SVR
low pulmonary vascualr resistance ( pulmonary aeration–> vasodilation)
and increases systemic vascular resistance (clamping of cord abruptly removes the low resistance placenta from neonatal circulation)
left to right shunts with eventual closure of them and the left ventricle contrinutes to all of systemic blood blow
the 3 main arteries in the GI tract
celiac trunk (stomach, duodenum, gallbladder, liver, spleen, pancreas)
SMA (collateral to colon)
IMA
marginal artery of drummon is the principal anatomosis
DNA MMR impairment increases the rate of _ mutations resulting in alrge quantities of _
frameshift
neoantigens
neoantigens are displayed on MHC I on the cancer cell surface and activates a diverse polyclonal pool of antitumor cytotoxic T cells
Because tumors with defective DNA mismatch repair generate high levels of neoantigens, they are particularly dependent on adaptations (eg, overexpression of immune checkpoints) to avoid cytotoxic T-cell destruction. Treatment with immune checkpoint inhibitors restore antitumor cytotoxic T-cell activity and often dramatically reduce tumor burden.
metalloproteinases allow tumor cells
to open a channel through the basement membrane and disloidge from their site of origin which is important for metastasis
damage to the subthalamic nucleus can decrease excitation of the _ _ _ therby reducing inhibition of the _ this may result in contralateral _
globus pallidus internus
thalamus
hemiballism (flinging movement disorder)
hemiballism usually occurs in the setting of a _ stroke
lacunar
atrophy of the caudate nucleus occurs in _ disease which is characterized by what movement disorder
huntingtons disease
chorea ( involuntary low amplitude movements involving the distal limbs)
damage to the internal capsule would present with?
contralateral pure motor or combined sensorimotor deficits
atrophy of the lentifrom nucleus (putamen and globus pallidus) occurs in _ disease
wilson disease
(liver, psychatric, and neurologic abnormalities
stroke in the VPL (ventral posterior lateral nucleus) and VPM (ventral posterior nucleus ) result in
complete contralateral sensory loss
thalamic syndrome
contralteral burning or stabbing pain over 1 side of the body
_ are the most common cause of E. Coli bacteremia
UTIs
what is the first like treatment of familial hypercholesterolemia
HMG-COA reductase inhibitors (rate limiting step in cholesterol synthesis)
what are the serious side effects of statins and therefore what tests should you condut prior to starting your patient on a statin
Myopathy and hepatitis
get liver function tests done (ALT/AST)
Common side effects of HMG-CoA reductase inhibitors (statins) include muscle and liver toxicity. Hepatic transaminases should be checked prior to initiating therapy and repeated if symptoms of hepatic injury occur.
methotrexate MOA
competitively innhbits dihydrofolate reductase
folate antagonist
affect rapidly dividng cells by limiting precursors essential to DNA synthesis and repair.
what are the side effects of methotrexate
neural tube defects, cardiovascular and urinary tract defects
branchial arches differentiate under _ control
HOX (homeobox) genes
what durg during pregnancy interferes with HOX signaling pathways and can cause branchial arch abnormalities
vitamin A (retinoids)
what is a complication of using Ace inhiitors in the second or third trimester of pregnancy
renal dysplasia
what is a rare malformation that occurs almost exclusively in infants of diabetic mothers
sacral agenesis (caudal regression syndrome)
incomplete development of the sacrum, lumbar vertebrae and lower extremities
thryoid hypoplasia is a complication of inadvertant fetal expsoure to _
radioactive iodine (in moms recieving treatment for hyperthyroidism or thyroid cancer)
what drug can be used in ganciclovir resistant cytomegalovirus
foscarnet
what is foscarnet
a pyrophosphate analong that is used for ganiciclovir resistant CMV infections and can chelate calcium
Foscarnet is an analog of pyrophosphate that can chelate calcium and promote nephrotoxic renal magnesium wasting. These toxicities can result in hypocalcemia and hypomagnesemia, which can cause seizures.
foscarnet side effects
hypomagnesium and reduced parathyroid hormone release leading to hypocalcemia
cidovir is
used in CMV retinitis
can cause nephrotoxicity with proteinuria or elevated creatinine
how does positive end expiratory pressure (PEEP) helo treat acute respiratory distress syndrome
opening collapsed alveoli (increase alveolar pressure), reduce intrapulmonary shunting and increase intrapleural pressurem and increase functional residual capacity (and therefore oxygen stores)
purpose is to reopen collapsed alveoli and decrease time beneath critical closing of alveoli during exhalation
intrapleural pressure is normally _ throughout the respitatory cycle
negative
risk factors for acute respiratory distress syndrome
sepsis, pneumonia, trauma, pancreatitis
pathophysiology of ARDS
cytokine release activates the endothelium and recruits neutrophil to mast cell degranulation in the lung leading to increased capillary permeability, alveolar fluid accumulation and formation of hyaline membranes
clinical features of acute respiratory distress syndrome
hypoxia, bilateral pulmonary infiltrates and normal capillary wedge pressure
acute renal failure and hypertension with red blood cell casts, hematuria , sterile pyuria, and proteinuria suggests
glomerulonephritis
white blood cell casts, sterile pyruia, and urine eosinophils suggest
acute intersitial neprhtitis after new medication
usually has a rash, fever, and eosinophilia
what medication causes neddly shaped cyrstals in the urine
acyclovir
what are transporter associated antigen processing (TAP) proteins
Transporter associated with antigen processing (TAP) proteins are necessary for loading of cytoplasmic (eg, viral) proteins onto major histocompatibility complex (MHC) class I molecules. The MHC class I–peptide complex can then activate CD8+ cytotoxic T cells through interaction with the T cell receptor and CD8 coreceptor.
transmembrane proteins that are necessary for the presentation of cystosolic antigens on major histocompatibility complex molecules
proteins degraded by proteosomes can be transfered into the ER via TAP proteins and then loaded onto MHC I molecules
symptoms of benign intracranail hypertension
headache, vomiting, papilledema with a negative head CT scan
symptoms of vitamin A toxicity
benign intracranial toxicity, bone pain, hepatomegaly, dry skin and mucosa (alopecia) and is teratogenic
vitamin A def symptoms
night blindness, dry eyes, bitot spots, hyperkeratosis, diminished immune response
vitamin A is stored in the _
liver (too much can cause hepatomegaly)
how can vitamin A affect babies in pregnancy
neural crest cell toxicity, microcephaly, craniofacial defects and cardac anomalies
large doses of vitamin E are associated with?
increased risk of bleeding (hemorrhagic stroke)
how is the leg positioned in a posterior hip dislocation
shortened, internally rotated , flexed and adducted
rom will be limited and painful
femoral neck fracture will have the leg in what position
shortened and externally roated
the _ nerve runs posterior to the hip joint and is vulnerable to injury with a posterior hip dislocation
sciatic
sciatic nerve injury signs
weakness on ankle dorsiflexion, decreased ankle reflex and decreased sensation
the _ artery runs anterior to the hip and can be injured in anterior dislocation
femoral
abduction and external rotation of the hip
what is the greatest determinant of symptom severity in tetralogy of falot
degree of right ventricular outflow obstruction
what is tetrology of falot
PROVe (pulmonary stenosis, right ventricule hypertrophy, overrighing aorta, VSD
right ventricular outflow tract obstruction, VSD, overriding aorta, ventricular hypertrophy
Tetralogy of Fallot is a congenital heart defect characterized by right ventricular outflow tract (RVOT) obstruction, a large ventricular septal defect (VSD), an overriding aorta, and right ventricular hypertrophy. The degree of RVOT obstruction is the greatest determinant of symptom severity because it regulates pulmonary arterial blood flow and the magnitude and direction of shunting through the VSD.
glioblastoma
abnormal astrocytes with psuedopalisading , necrosis and microvascular proliferation
-glial origin
associated with EGFR
what is EGFR
epidermal growth factor receptor that is a tyrosine kinase signal transduction system that conducts external growth signals into the nucelus and promotes cellular survival and proliferations
symptoms of glioblastoma
slowly worsening headache, seizures, focal neurological issues
thoracenesis yeilding high erythrocyte concentration and atrypical mucin cells is consistent with
adenocarcinoma
what are the two m ost common causes of malignant pleural effusions
lung and breast
malignant effusions are _ by light criteria
exudative
how can malignancy cause exudative effusions (3 different ways)
lung inflammation can cause increased vascular permeability and increased inflow into the pleural space
malignant cells can go to the pleural space and occlude the plueral lymphatic stroma and prevent pleural fluid reabsorption
the thoracic lymphatic duct disruption which is most commonly seen in lymphoma with a chylothorax
what are the lab findings in hypovolemia due to salt and water loss
uric acid-
plasma volume-
hematocrit-
serum albumin-
uric acid- increased
plasma volume- decreased
hematocrit-increased
serum albumin-increased
Hypovolemia due to loss of sodium and/or water causes increased concentration of red blood cells (ie, hematocrit) and albumin as both of these blood components are trapped within the intravascular space. Hypovolemia also triggers increased absorption of uric acid in the proximal renal tubule, resulting in an increased serum uric acid leve
what artery supplies blood to the cerebral hemispheres including the motor cortez, and controls the contralateral limbs
internal carotid artery
the opthalmic artery which gives rise to the _ artery originates from the. ispilateal _ artery
retinal artery
internal carotid artery
cause same sided vision loss
what are the branches of the aortic arch
on the left: left common carotid and subclavian artery
on the right: brachiocephalic
the brachiocephalic splits into
right subclavian and right common carotid
the right common carotid goes to split into the right external carotid artery and the right internal carotid artery
the external carotid artery supplies blood to the
face and neck
the vertebral arteries supply the
upper spinal cord, brainstem, cerebellum and posterior part of the brain
herpes zoster ophthalmicus is caused by?
reactivation of latent varicellar zoster virus in the V1 division (opthalmic)
Herpes zoster ophthalmicus is caused by reactivation of varicella-zoster virus in the ophthalmic division of the trigeminal nerve (CN V1). It is characterized by a painful, dermatomal rash and ocular involvement (eg, acute keratitis, corneal ulceration). It most commonly occurs in elderly and immunosuppressed patients.
the weight bearing stance phase of gait engases what axis
sacral oblique axis
(the the pelvis rotates about allowing the opposite leg to swing foward and induce forward sacral rotation
the right oblique axis is engaged when the _ leg is in stance phase. The other leg swings forward causing the sacrum to rotate to the _
right
right
all stance phases of gait are foward torsions
