tag:blogger.com,1999:blog-36189305662677360402024-03-14T06:33:34.869-07:00Healthy Body-Healthy MindServing nature is the best thing in the world..!!Anonymoushttp://www.blogger.com/profile/16555664245806923731noreply@blogger.comBlogger51125tag:blogger.com,1999:blog-3618930566267736040.post-3143485016977340362014-05-17T07:10:00.000-07:002014-05-17T07:10:12.523-07:00Doctor's Heart <div class="separator" style="clear: both; text-align: center;">
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<br />Anonymoushttp://www.blogger.com/profile/16555664245806923731noreply@blogger.com6tag:blogger.com,1999:blog-3618930566267736040.post-20921813136512636362013-07-07T02:07:00.002-07:002013-07-07T02:07:38.069-07:00Biochemistry Quiz (MCQs) and explanation<b><span style="font-family: Arial, Helvetica, sans-serif;">1.</span></b><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Most major metabolic pathways are considered to be either mainly anabolic or catabolic. Which of the following pathways is most correctly considered to be amphibolic?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">A. Lipolysis</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B. Glycolysis</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C. Oxidation of fatty acids</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D. Citric acid cycle</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E. Gluconeogenesis</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<b><span style="font-family: Arial, Helvetica, sans-serif;">2.</span></b><br />
<span style="font-family: Arial, Helvetica, sans-serif;">If a homogenate of liver cells is centrifuged to remove all cell membranes and organelles, which of the following enzyme activities will remain in the homogenate?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">A. Glucose-6-phosphate dehydrogenase</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B. Glycogen synthetase</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C. Aconitase</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D. Acyl CoA hydratase</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E. Hydroxybutyrate dehydrogenase</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<b><span style="font-family: Arial, Helvetica, sans-serif;">3.</span></b><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Which of the following is appropriate for a patient with renal failure?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">A. High-carbohydrate diet</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B. High-protein diet</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C. Low-fat diet</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D. High-fiber diet</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E. Free water of at least 3 L per day</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<b><span style="font-family: Arial, Helvetica, sans-serif;">4.</span></b><br />
<span style="font-family: Arial, Helvetica, sans-serif;">An adolescent presents with abdominal discomfort, abdominal fullness, excess gas, and weight loss. Blood glucose, cholesterol, and alkaline phosphatase levels are normal. There is no jaundice or elevations. The stool tests positive for reducing substances. Which of the following is the most likely diagnosis?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">A. Diabetes mellitus</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B. Starvation</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C. Nontropical sprue</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D. Milk intolerance</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E. Gallstones</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<b><span style="font-family: Arial, Helvetica, sans-serif;">5.</span></b><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Juvenile diabetes mellitus is a disorder of carbohydrate metabolism caused by insulin deficiency. The disease often follows a viral infection with inflammation of the pancreatic cells, but also exhibits genetic predisposition with a 40 to 50% concordance rate in monozygous twins and clustering in families. Juvenile diabetes mellitus is best described as what type of disorder?’</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">A. Congenital disorder</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B. Multifactorial disorder</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C. Mendelian disorder</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D. Sporadic disorder</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E. Sex-limited disorder</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<b><span style="font-family: Arial, Helvetica, sans-serif;">6.</span></b><br />
<span style="font-family: Arial, Helvetica, sans-serif;">A couple is referred to the physician because their first three pregnancies have ended in spontaneous abortion. Chromosomal analysis reveals that the wife has two cell lines in her blood, one with a missing X chromosome (45,X) and the other normal (46,XX). Which of the following is the best description of her chromosomal constitution?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">A. Chimeric</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B. Monoploid</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C. Trisomic</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D. Mosaic</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E. Euploid</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<b><span style="font-family: Arial, Helvetica, sans-serif;">7.</span></b><br />
<span style="font-family: Arial, Helvetica, sans-serif;">A child with cleft palate, a heart defect, and extra fifth fingers is found to have 46 chromosomes with extra material on one homologue of the chromosome 5 pair. This chromosomal abnormality is best described by which of the following terms?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">A. Polyploidy</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B. Balanced rearrangement</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C. Ring formation</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D. Mosaicism</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E. Unbalanced rearrangement</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<b><span style="font-family: Arial, Helvetica, sans-serif;">8.</span></b><br />
<span style="font-family: Arial, Helvetica, sans-serif;">A 10-year-old boy is referred to the physician because of learning problems and a lack of motivation in school. His family history is unremarkable. Physical examination is normal except for single palmar creases of the hands and curved fifth fingers (clinodactyly). The physician decides to order a karyotype. Which of the following indications for obtaining a karyotype would best explain the physician's decision in this case?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">A. A couple with multiple miscarriages, or a person who is at risk for an inherited chromosome rearrangement</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B. A child with ambiguous genitalia who needs genetic sex assignment</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C. A child with an appearance suggestive of Down's syndrome or other chromosomal disorder</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D. A child with mental retardation and/or multiple congenital anomalies</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E. A child who is at risk for</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<b><span style="font-family: Arial, Helvetica, sans-serif;">9.</span></b><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Chromosomal analysis reveals a 47,XYY karyotype. Which of the following descriptions best fits this abnormality?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">A. Autosomal trisomy</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B. A male with Klinefelter's syndrome</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C. Sex chromosome aneuploidy</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D. A female with Turner's syndrome</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E. Sex chromosome triploidy</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<b><span style="font-family: Arial, Helvetica, sans-serif;">10.</span></b><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Which of the following karyotypes is an example of aneuploidy?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">A. 46,XX</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B. 23,X</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C. 69,XXX</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D. 92,XXXX</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E. 90,XX</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<b><span style="font-family: Arial, Helvetica, sans-serif;">11.</span></b><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Which of the following is the proper cytogenetic notation for a female with Down's syndrome mosaicism?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">A. 46,XX,+21/46,XY</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B. 47,XY,+21</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C. 47,XXX/46,XX</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D. 47,XX,+21/46,XX</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E. 47,XX,+21(46,XX)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<b><span style="font-family: Arial, Helvetica, sans-serif;">12.</span></b><br />
<span style="font-family: Arial, Helvetica, sans-serif;">A newborn girl is found to have marked swelling of the dorsal areas of her feet along with a broad (webbed) neck, a broad chest, and a heart murmur that is due to coarctation of the aorta. Her physician suspects a chromosomal disorder and orders a karyotype. Which of the results pictured below is most likely? </span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjHXe7fHPAcU9Yd8E5HCtLHzco_TN1E1SVUkBo6S2IQe8C2WmzpR87oN2rwteSQuJOtQADhAaUIb_VtqE6dh9RsCfKR64WJYq3CF_FH2vd6MP1_jJ2T-ivwsNKV7f-kf73fFIK43lV5F5sD/s1600/A.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: Arial, Helvetica, sans-serif;"><img border="0" height="285" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjHXe7fHPAcU9Yd8E5HCtLHzco_TN1E1SVUkBo6S2IQe8C2WmzpR87oN2rwteSQuJOtQADhAaUIb_VtqE6dh9RsCfKR64WJYq3CF_FH2vd6MP1_jJ2T-ivwsNKV7f-kf73fFIK43lV5F5sD/s400/A.jpg" width="400" /></span></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg7jOkIkLk1XkiQ-7jRx8F7ACQXjNQvVBN6UeCYevDs8t404ILHljekjLxBcT4LOhCfsV9iikGiT8W32lWG_RLM4G8Z8dCe8dWU59I5Wvrgi_nGCjnjslnFX-AlXm9uUJfyIFdi6nee3mzU/s1600/B.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: Arial, Helvetica, sans-serif;"><img border="0" height="278" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg7jOkIkLk1XkiQ-7jRx8F7ACQXjNQvVBN6UeCYevDs8t404ILHljekjLxBcT4LOhCfsV9iikGiT8W32lWG_RLM4G8Z8dCe8dWU59I5Wvrgi_nGCjnjslnFX-AlXm9uUJfyIFdi6nee3mzU/s400/B.jpg" width="400" /></span></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhGhIoaFov_RtZC-PBg3__u0YQQ4mmKMWnANYqcxEwcZ8NOonjazmPM2fj3bPEwnIKXurwmcN1DHM4g2wCiLYJZmgadiZC4rL447V8m2Qufon8qs4QkyjOMZm5oRGauO_E9uLGhbI7CNfAa/s1600/C.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: Arial, Helvetica, sans-serif;"><img border="0" height="291" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhGhIoaFov_RtZC-PBg3__u0YQQ4mmKMWnANYqcxEwcZ8NOonjazmPM2fj3bPEwnIKXurwmcN1DHM4g2wCiLYJZmgadiZC4rL447V8m2Qufon8qs4QkyjOMZm5oRGauO_E9uLGhbI7CNfAa/s400/C.jpg" width="400" /></span></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi6mNqoFNPctSur9_xt5FwIvms8WH2NHmeYofggbUvBnQUlPonrYmoKfTlkg3R7_ZbiAqv1rGhY5jUcY8LRyVUq72OiU8bdrT8GJYcMkTbQPxrUxDB1pg5tY_7XITaYqgDO_r2sAq4wpGwm/s1600/D.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: Arial, Helvetica, sans-serif;"><img border="0" height="292" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi6mNqoFNPctSur9_xt5FwIvms8WH2NHmeYofggbUvBnQUlPonrYmoKfTlkg3R7_ZbiAqv1rGhY5jUcY8LRyVUq72OiU8bdrT8GJYcMkTbQPxrUxDB1pg5tY_7XITaYqgDO_r2sAq4wpGwm/s400/D.jpg" width="400" /></span></a></div>
<span style="font-family: Arial, Helvetica, sans-serif;">A. Result A</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B. Result B</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C. Result C</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D. Result D</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<b><span style="font-family: Arial, Helvetica, sans-serif;">13.</span></b><br />
<span style="font-family: Arial, Helvetica, sans-serif;">A 2-week-old baby is hospitalized for inadequate feeding and poor growth. The parents are concerned by the child's weak cry. An experienced grandmother accompanies them, saying she thought the cry sounded like a cat's meow. The grandmother also states that the baby doesn't look much like either parent. The physician orders a karyotype after noting a small head size (microcephaly) and subtle abnormalities of the face. Which of the results pictured below is most likely? </span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhQk3KLrpgYYKv5icZ6pp7TfcbtfIFsm5WGT4LxVq9hmfgCuNk6StekxkrTN8Uk3mI8cG1ZRYSYKt8IK4bK16TN0pcNvlSmA19XZqpMYy_VqOPvBugZ2QS-SFuN-Xq-ORfcDIdwG_EQTbRq/s1600/A.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: Arial, Helvetica, sans-serif;"><img border="0" height="255" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhQk3KLrpgYYKv5icZ6pp7TfcbtfIFsm5WGT4LxVq9hmfgCuNk6StekxkrTN8Uk3mI8cG1ZRYSYKt8IK4bK16TN0pcNvlSmA19XZqpMYy_VqOPvBugZ2QS-SFuN-Xq-ORfcDIdwG_EQTbRq/s400/A.jpg" width="400" /></span></a></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">A. Result A</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B. Result B</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C. Result C</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D. Result D</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E. Result E</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<b><span style="font-family: Arial, Helvetica, sans-serif;">14.</span></b><br />
<span style="font-family: Arial, Helvetica, sans-serif;">A child with cleft palate, a heart defect, and extra fifth fingers is found to have 46 chromosomes with extra material on one homologue of the chromosome 5 pair. This chromosomal abnormality is best described by which of the following terms?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">A.Polyploidy </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B.Balanced rearrangement </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C.Ring formation </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D.Mosaicism </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E.Unbalanced rearrangement </span><br />
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<b><span style="font-family: Arial, Helvetica, sans-serif;">15.</span></b><br />
<span style="font-family: Arial, Helvetica, sans-serif;">A 10-year-old boy is referred to the physician because of learning problems and a lack of motivation in school. His family history is unremarkable. Physical examination is normal except for single palmar creases of the hands and curved fifth fingers (clinodactyly). The physician decides to order a karyotype. Which of the following indications for obtaining a karyotype would best explain the physician's decision in this case?</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">A. A couple with multiple miscarriages, or a person who is at risk for an inherited chromosome rearrangement </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B. A child with ambiguous genitalia who needs genetic sex assignment </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C. A child with an appearance suggestive of Down's syndrome or other chromosomal disorder </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D. A child with mental retardation and/or multiple congenital anomalies </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E. A child who is at risk for cancer </span><br />
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<b><span style="font-family: Arial, Helvetica, sans-serif;">16.</span></b><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Chromosomal analysis reveals a 47,XYY karyotype. Which of the following descriptions best fits this abnormality?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">A.Autosomal trisomy </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B.A male with Klinefelter's syndrome </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C.Sex chromosome aneuploidy </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D.A female with Turner's syndrome </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E.Sex chromosome triploidy </span><br />
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<b><span style="font-family: Arial, Helvetica, sans-serif;">17.</span></b><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Which of the following karyotypes is an example of aneuploidy?</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">A.46,XX </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B.23,X </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C.69,XXX </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D.92,XXXX </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E.90,XX </span><br />
<b><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></b>
<b><span style="font-family: Arial, Helvetica, sans-serif;">18.</span></b><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Which of the following is the proper cytogenetic notation for a female with Down's syndrome mosaicism?</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">A.46,XX,+21/46,XY </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B.47,XY,+21 </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C.47,XXX/46,XX </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D.47,XX,+21/46,XX </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E.47,XX,+21(46,XX) </span><br />
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<b><span style="font-family: Arial, Helvetica, sans-serif;">19.</span></b><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Gardner's syndrome is an autosomal dominant condition characterized by multiple polyps of the intestines, bony tumors, skin cysts, and a high risk of intestinal cancer. A family is encountered in which a great-grandfather, grandmother, and father are affected with Gardner's syndrome and develop intestinal cancer in their thirties. The father brags that none of his four children have inherited Gardner's syndrome because they lack skin cysts and have not had cancer. The chance that at least one child has inherited the Gardner's syndrome allele, and the reason the children have not manifested cancer, are</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">A.1/4, ascertainment bias </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B.1/2, variable cancer predisposition </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C.3/4, early-onset disease manifestation </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D.13/16, incomplete medical evaluation </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E.15/16, later-onset disease manifestation </span><br />
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<b><span style="font-family: Arial, Helvetica, sans-serif;">20.</span></b><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Ectrodactyly is an autosomal dominant trait that causes missing middle fingers (lobster claw malformation). A grandfather and grandson both have ectrodactyly, but the intervening father has normal hands by x-ray. Which of the following terms applies to this family?</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">A.Incomplete penetrance </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B.New mutation </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C.Variable expressivity </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D.Germinal mosaicism </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E.Anticipation </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: x-large;"><b>ANSWERS</b></span></div>
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<b><span style="font-family: Arial, Helvetica, sans-serif;">1. D</span></b><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">In general, the corresponding pathways of catabolism and anabolism are not identical (glycolysis versus gluconeogenesis, lipolysis and oxidation of fatty acids versus fatty acid synthesis and lipogenesis, glycogenolysis versus glycogenesis). However, the citric acid cycle is a central pathway from which anabolic precursors of biosynthetic reactions may derive or into which the complete catabolism of small molecules to carbon dioxide and water may occur. For these reasons, the citric acid cycle is often called an amphibolic pathway. </span><br />
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<b><span style="font-family: Arial, Helvetica, sans-serif;">2. A</span></b><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Centrifugation of a cellular homogenate at a force of 100,000 × g will pellet all cellular organelles and membranes. Only soluble cellular molecules found in the cytosol will remain in the supernatant. Thus, the enzymes of glycolysis and most of those of gluconeogenesis, fatty acid synthesis, and the pentose phosphate pathway will be in the supernatant. Glucose-6-phosphate dehydrogenase, which results in the formation of 6-phosphoglucono- -lactone from glucose-6-phosphate, is the committed step in the pentose phosphate pathway. In the pellet will be the enzymes within mitochondria, including those of the citric acid cycle (aconitase), fatty acid oxidation (acyl CoA hydratase), and ketogenesis (hydroxybutyrate dehydrogenase). Enzymes of glycogen degradation and synthesis (glycogen synthetase) will also be in the pellet associated with glycogen particles. </span><br />
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<b><span style="font-family: Arial, Helvetica, sans-serif;">3. A</span></b><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">A diet high in carbohydrate and fats spares glucose use and inhibits gluconeogenesis, thereby preventing protein catabolism and nitrogen production. A major function of the kidneys is to excrete nitrogen catabolized from proteins in the form of urea. Indeed, the major clinical measures of renal function are products of protein catabolism [blood urea nitrogen (BUN) and blood creatinine]. A diet for a patient with renal failure should therefore minimize protein and nitrogen load. Although 3 L/day of fluid is a normal intake for adults with healthy kidneys, glomerular filtration and water excretion are decreased in renal failure. Water and salt intake (particularly potassium) must therefore be limited in renal failure. Excess water or salt intake in patients with renal disease is manifest clinically by edema (swollen eyelids, swollen lower limbs). </span><br />
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<b><span style="font-family: Arial, Helvetica, sans-serif;">4. D</span></b><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Milk intolerance may be due to milk protein allergies during infancy, but it is commonly caused by lactase deficiency in older individuals. Intestinal lactase hydrolyzes the milk sugar lactose into galactose and glucose, both reducing sugars that can be detected as reducing substances in the stool. The symptoms of lactose intolerance (lactase deficiency) and other conditions involving intestinal malabsorption include diarrhea, cramps, and flatulence due to water retention and bacterial action in the gut. In nontropical sprue, symptoms seem to result from the production of antibodies in the blood against fragments of wheat gluten. It seems likely that a defect in intestinal epithelial cells allows tryptic peptides from the digestion of gluten to be absorbed into the blood, as well as to exert a harmful effect on intestinal epithelia. </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Gallbladder inflammation (cholecystitis) usually presents with acute abdominal pain (colic) with radiation to the right shoulder. The normal composition of bile is about 5% cholesterol, 15% phosphatidylcholine, and 80% bile salt in a micellar liquid form. Increased cholesterol from high-fat diets or genetic conditions can upset the delicate micellar balance, leading to supersaturated cholesterol or cholesterol precipitates that cause gallstone formation. Removal of the gallbladder is a common treatment for this painful condition. </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Mobilization of fats with the production of ketone bodies occurs during fasting and starvation, but ketone production is well controlled. During uncontrolled diabetes mellitus, ketogenesis proceeds at a rate that exceeds the buffering capacity of the blood to produce ketoacidosis.</span><br />
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<b><span style="font-family: Arial, Helvetica, sans-serif;">5. B</span></b><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Many common diseases are caused by a combination of environmental and genetic factors, and are described as multifactorial diseases. Examples include diabetes mellitus, schizophrenia, alcoholism, and many common birth defects such as cleft palate or congenital dislocation of the hip. The proportion of genetically identical monozygous twins who share a trait such as diabetes mellitus provides a measure of the genetic contribution to etiology (hereditability). Mendelian disorders are completely determined by the genotype of an individual, and exhibit 100% concordance in identical twins. Sporadic disorders have no genetic predisposition and do not cluster in families except by chance or through similar environmental exposure. Congenital disorders are present at birth, in contrast to juvenile diabetes mellitus, which usually presents during childhood. Sex-limited disorders occur predominantly in males or females, in contrast to the approximately equal sex distribution of juvenile diabetes mellitus. </span><br />
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<b><span style="font-family: Arial, Helvetica, sans-serif;">6. D</span></b><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">The case described represents one of the more common chromosomal causes of reproductive failure, Turner mosaicism. Turner's syndrome represents a pattern of anomalies including short stature, heart defects, and infertility. Turner's syndrome is often associated with a 45,X karyotype (monosomy X) in females, but mosaicism (i.e., two or more cell lines with different karyotypes in the same individual) is common. However, chimerism (i.e., two cell lines in an individual arising from different zygotes, such as fraternal twins who do not separate) is extremely rare. Trisomy refers to three copies of one chromosome, euploidy to a normal chromosome number, and monoploidy to one set of chromosomes (haploidy in humans). </span><br />
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<b><span style="font-family: Arial, Helvetica, sans-serif;">7. E</span></b><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Chromosomal abnormalities may involve changes in number (i.e., polyploidy and aneuploidy) or changes in structure (i.e., rearrangements such as translocations, rings, and inversions). Extra material (i.e., extra chromatin) seen on chromosome 5 implies recombination of chromosome 5 DNA with that of another chromosome to produce a rearranged chromosome. Since this rearranged chromosome 5 takes the place of a normal chromosome 5, there is no change in number of the autosomes (nonsex chromosomes) or sex chromosomes (X and Y chromosomes). The question implies that all cells karyotyped from the patient (usually 11 to 25 cells) have the same chromosomal constitution, ruling out mosaicism. The patient's clinical findings are similar to those occurring in trisomy 13, suggesting that the extra material on chromosome 5 is derived from chromosome 13, producing an unbalanced karyotype called dup(13) or partial trisomy 13. </span><br />
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<b><span style="font-family: Arial, Helvetica, sans-serif;">8. D</span></b><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">The hallmarks of children with chromosomal anomalies are mental retardation and multiple congenital anomalies. In this case, the individual has learning problems that have not yet been recognized as mental retardation, and he has minor anomalies rather than major birth defects that cause cosmetic or surgical problems. The physician was astute to suspect a chromosomal anomaly even when the developmental disability and alterations in physical appearance were subtle. Other indications for a karyotype include a couple with multiple miscarriages, an individual at risk for inheriting or transmitting a chromosomal rearrangement, a child with ambiguous external genitalia, or an individual with characteristics of a chromosomal syndrome such as Down's, Turner's, or Klinefelter's syndrome. Chromosome translocations are characteristic of many types of cancer, but these occur in somatic cancer cells rather than in the patient's germ line. </span><br />
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<b><span style="font-family: Arial, Helvetica, sans-serif;">9. C</span></b><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">The 47,XYY karyotype is an example of sex chromosome aneuploidy, as are Klinefelter's syndrome (47,XXY), Turner's syndrome (45,X), and triple X syndrome (47,XXX). Sex chromosome mixoploidy implies mosaicism, such as 45,X/46,XX with two cell lines in one individual. Autosomal trisomies include Down's syndrome [47,XX+21 (trisomy 21)], Patau's syndrome [47,XX+13 (trisomy 13)], and Edwards' syndrome [47,XY+18 (trisomy 18)].</span><br />
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<b><span style="font-family: Arial, Helvetica, sans-serif;">10. E</span></b><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Aneuploidy involves extra or missing chromosomes that do not arise as increments of the haploid chromosome number n. Polyploidy involves multiples of n, such as triploidy (3n = 69,XXX) or tetraploidy (4n = 92,XXXX). Diploidy (46,XX) and haploidy (23,X) are normal karyotypes in gametes and somatic cells, respectively. A 90,XX karyotype represents tetraploidy with two missing X chromosomes, which has been seen in one patient who had features that resembled those of Turner's syndrome.</span><br />
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<b><span style="font-family: Arial, Helvetica, sans-serif;">11. D</span></b><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Mosaicism occurs when a chromosomal anomaly affects one of several precursor cells of an embryo or tissue. The two or more karyotypes that characterize the mosaic cells are separated by a slash in cytogenetic notation. The notation 47,XX,+21 denotes a cell line typical of a female with trisomy 21 (Down's syndrome), while 46,XX is the karyotype expected for a normal female. </span><br />
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<b><span style="font-family: Arial, Helvetica, sans-serif;">12. A</span></b><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">A chromosome study or karyotype delineates the number and kinds of chromosomes in one cell karyon (nucleus). Blood is conveniently sampled, so most chromosomal studies or karyotypes are performed on peripheral leukocytes in blood. A number of leukocytes are karyotyped under the microscope (10 to 25, depending on the laboratory), and a representative photograph is taken. The chromosome images are then arranged (cut out by hand or moved by computer) in order of size from the #1 pair to the #22 pair, and this ordered array is also called a karyotype. Except in cases of mosaicism (different karyotypes in different tissues), the peripheral blood karyotype is indicative of the germ-line karyotype that is characteristic for an individual. In most cases of Turner's syndrome there is a lack of one X chromosome, as in panel A, which shows one X (arrow) and no Y chromosome. Other cases involve mosaicism (45,X/46,XX or 45,X/46,XY) or isochromosomes (e.g., 46,X,isoXq). Correlation of karyotypes and phenotypic features of girls with Turner's syndrome has demonstrated that haploinsufficiency (partial monosomy) of the short arm (Xp) is what generates the characteristic manifestations (web neck, shield chest, puffy feet, coarctation). Women with Turner's syndrome also have short stature and infertility due to maldevelopment of the ovaries (streak gonads). </span><br />
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<b><span style="font-family: Arial, Helvetica, sans-serif;">13. E</span></b><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Children with chromosome abnormalities often exhibit poor growth (failure to thrive) and developmental delay with an abnormal facial appearance. This baby is too young for developmental assessment, but the catlike cry should provoke suspicion of cri-du-chat syndrome. Cri-du-chat syndrome is caused by deletion of the terminal short arm of chromosome 5 [46,XX,del(5p), also abbreviated as 5p–] as depicted in panel e. When a partial deletion or duplication like this one is found, the parents must be karyotyped to determine if one carries a balanced reciprocal translocation. The other karyotypes show (a) deletion of the short arm of chromosome 4 [46,XY,del(4p) or 4p–]; (b) XYY syndrome (47,XYY); (c) deletion of the long arm of chromosome 13 [46,XX,del(13q) or 13q–]; (d) Klinefelter's syndrome (47,XXY). Most disorders involving excess or deficient chromosome material produce a characteristic and recognizable phenotype (e.g., Down's, cri-du-chat, or Turner's syndrome). The deletion of 4p– (panel A) produces a pattern of abnormalities (syndrome) known as Wolf-Hirschhorn syndrome; deletion of 13q– produces a 13q– syndrome (no eponym). The mechanism(s) by which imbalanced chromosome material produces a distinctive phenotype is completely unknown.</span><br />
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<b><span style="font-family: Arial, Helvetica, sans-serif;">14. E</span></b><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">Chromosomal abnormalities may involve changes in number (i.e., polyploidy and aneuploidy) or changes in structure (i.e., rearrangements such as translocations, rings, and inversions). Extra material (i.e., extra chromatin) seen on chromosome 5 implies recombination of chromosome 5 DNA with that of another chromosome to produce a rearranged chromosome. Since this rearranged chromosome 5 takes the place of a normal chromosome 5, there is no change in number of the autosomes (nonsex chromosomes) or sex chromosomes (X and Y chromosomes). The question implies that all cells karyotyped from the patient (usually 11 to 25 cells) have the same chromosomal constitution, ruling out mosaicism. The patient's clinical findings are similar to those occurring in trisomy 13, suggesting that the extra material on chromosome 5 is derived from chromosome 13, producing an unbalanced karyotype called dup(13) or partial trisomy 13.</span><br />
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<b><span style="font-family: Arial, Helvetica, sans-serif;">15. D</span></b><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">The hallmarks of children with chromosomal anomalies are mental retardation and multiple congenital anomalies. In this case, the individual has learning problems that have not yet been recognized as mental retardation, and he has minor anomalies rather than major birth defects that cause cosmetic or surgical problems. The physician was astute to suspect a chromosomal anomaly even when the developmental disability and alterations in physical appearance were subtle. Other indications for a karyotype include a couple with multiple miscarriages, an individual at risk for inheriting or transmitting a chromosomal rearrangement, a child with ambiguous external genitalia, or an individual with characteristics of a chromosomal syndrome such as Down's, Turner's, or Klinefelter's syndrome. Chromosome translocations are characteristic of many types of cancer, but these occur in somatic cancer cells rather than in the patient's germ line.</span><br />
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<b><span style="font-family: Arial, Helvetica, sans-serif;">16. C</span></b><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">The 47,XYY karyotype is an example of sex chromosome aneuploidy, as are Klinefelter's syndrome (47,XXY), Turner's syndrome (45,X), and triple X syndrome (47,XXX). Sex chromosome mixoploidy implies mosaicism, such as 45,X/46,XX with two cell lines in one individual. Autosomal trisomies include Down's syndrome [47,XX+21 (trisomy 21)], Patau's syndrome [47,XX+13 (trisomy 13)], and Edwards' syndrome [47,XY+18 (trisomy 18)].</span><br />
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<b><span style="font-family: Arial, Helvetica, sans-serif;">17. E</span></b><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">Aneuploidy involves extra or missing chromosomes that do not arise as increments of the haploid chromosome number n. Polyploidy involves multiples of n, such as triploidy (3n = 69,XXX) or tetraploidy (4n = 92,XXXX). Diploidy (46,XX) and haploidy (23,X) are normal karyotypes in gametes and somatic cells, respectively. A 90,XX karyotype represents tetraploidy with two missing X chromosomes, which has been seen in one patient who had features that resembled those of Turner's syndrome.</span><br />
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<b><span style="font-family: Arial, Helvetica, sans-serif;">18. D</span></b><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">Mosaicism occurs when a chromosomal anomaly affects one of several precursor cells of an embryo or tissue. The two or more karyotypes that characterize the mosaic cells are separated by a slash in cytogenetic notation. The notation 47,XX,+21 denotes a cell line typical of a female with trisomy 21 (Down's syndrome), while 46,XX is the karyotype expected for a normal female.</span><br />
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<b><span style="font-family: Arial, Helvetica, sans-serif;">19. E</span></b><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">The father is affected with Gardner's syndrome (175100), an autosomal dominant disease. Therefore, each of his four children has a 1/2 chance of receiving the allele that causes Gardner's syndrome and a 1/2 chance of receiving the normal allele. The probability that none of his four children received the allele for Gardner's syndrome is thus the joint probability of four independent events, computed by the product 1/2 × 1/2 × 1/2 × 1/2 = 1/16. The probability that at least one child has received the abnormal Gardner's syndrome allele is thus 1 – 1/16 = 15/16. Gardner's syndrome is one of many genetic disorders that may not be obvious in early childhood. Intestinal cancer in particular has a later onset, with 50% of patients being affected by age 30 to 35. More extensive evaluation of the children for internal signs of disease (e.g., the bony tumors) is required before the father can conclude that he has not transmitted the gene. Late-onset disorders are an important category of adult genetic disease, and presymptomatic testing for these diseases is a novel application of DNA diagnosis.</span><br />
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<b><span style="font-family: Arial, Helvetica, sans-serif;">20. A</span></b><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Incomplete penetrance applies to a normal individual who is known from the pedigree to have an allele responsible for an autosomal dominant trait. Variable expressivity refers to family members who exhibit signs of the autosomal dominant disorder that vary in severity. When this severity seems to worsen with progressive generations, it is called anticipation. A new mutation in the grandson would be extremely unlikely given the affected grandfather. The father could be an example of somatic mosaicism if a back-mutation occurred to allow normal limb development, but there is no reason to suspect mosaicism of his germ cells (germinal mosaicism).</span><br />
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Anonymoushttp://www.blogger.com/profile/16555664245806923731noreply@blogger.com2tag:blogger.com,1999:blog-3618930566267736040.post-86740270203918312132013-07-03T06:17:00.003-07:002013-07-03T06:17:43.744-07:00Neuroscience Quiz (MCQs) with explanation<span style="font-family: Arial, Helvetica, sans-serif;"><b>1. </b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">The proper sensory nucleus is derived from which of the following</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">A.Alar plate </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B.Basal plate </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C.Sulcus limitans </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D.Neural crest </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E.Roof plate </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">F.Mesencephalon </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">G.Floor plate </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">H.Rathke's pouch </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">I.Rhombic lips</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>2.</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">A brain MRI scan taken from a 6-month-old baby revealed that while the overall size of the cerebral cortex was normal, the size of the pyramidal tracts was considerably smaller than normal. Which of the following is the most likely explanation for this defect</span><br />
<br />
<span style="font-family: Arial, Helvetica, sans-serif;">A.Reduction in the numbers of cortical neurons giving rise to pyramidal tract fibers </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B.Reduction in the numbers of synaptic contacts made by pyramidal tract neurons </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C.Reduction in the extent of myelin found on pyramidal tract neurons </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D.Reduction in the amount of neurotransmitter released by pyramidal tract neurons </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E.Reduction in the numbers of glial cells attached to pyramidal tract neurons</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>3.</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Which of the following is the most ubiquitous excitatory neurotransmitter in the brain?</span><br />
<br />
<span style="font-family: Arial, Helvetica, sans-serif;">A.ACh </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B.Glutamate </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C.Norepinephrine </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D.Dopamine </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E.Substance P </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>4.</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Epileptiform activity is believed to include the activation of which of the following</span><br />
<br />
<span style="font-family: Arial, Helvetica, sans-serif;">A.GABA receptors </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B.Glutamate receptors </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C.Nicotinic receptors </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D.Serotonin receptors </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E.Glycine receptors</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>5.</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Which of the following enzymes is directly responsible for the degradation of norepinephrine</span><br />
<br />
<span style="font-family: Arial, Helvetica, sans-serif;">A.Tryptophan hydroxylase </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B.Tyrosine hydroxylase </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C.Dopamine -hydroxylase </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D.Catechol-O-methyltransferase </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E.Choline acetyltransferase</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>6.</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Bladder functions are regulated by which of the following combinations of inputs</span><br />
<br />
<span style="font-family: Arial, Helvetica, sans-serif;">A.Vagal and sacral efferent fibers only </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B.Vagal, sacral, and descending fibers from the cerebral cortex </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C.Lumbar and sacral efferent fibers only </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D.Lumbar, sacral, and descending fibers from the cerebral cortex </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E.Lumbar, thoracic, and cervical fibers only</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>7.</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Synthesis and storage of norepinephrine can be prevented by which of the following substances</span><br />
<br />
<span style="font-family: Arial, Helvetica, sans-serif;">A.Guanethidine sulfate </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B.Reserpine </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C.Phenoxybenzamine hydrochloride </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D.Hexamethonium chloride </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E.Metoprolol </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>8.</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">A 43-year-old male is recovering from an infectious disease and experiences a marked instability in his blood pressure with episodes of spiking of blood pressure. After a series of extensive examinations, it was concluded that this disorder was due to the effects of the infectious agent upon a component of the peripheral nervous system. Logical sites where an infectious agent could produce such an effect include which of the following</span><br />
<br />
<span style="font-family: Arial, Helvetica, sans-serif;">A.Superior ganglia of cranial nerves IX and X </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B.Geniculate and trigeminal ganglia </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C.Otic and superior salivatory ganglia </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D.Carotid sinus and aortic arch </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E.Carotid and aortic bodies </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>9.</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">The lesion at B would most likely result in which of the following deficits? </span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjDYHYsh29fbZK9TpKo9SSrgi1v3dTHllnLbSeoaKF2bWLcApLOcoEac0utfuEQEzuAhtfIuM2fk-C02im6ouvwTqZYoupE2euMGyX827vuiQFeR3uLsxf0lPHQtn9f2iRppipZyDPOR756/s370/paralysis+of+contralateral+limbs.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="288" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjDYHYsh29fbZK9TpKo9SSrgi1v3dTHllnLbSeoaKF2bWLcApLOcoEac0utfuEQEzuAhtfIuM2fk-C02im6ouvwTqZYoupE2euMGyX827vuiQFeR3uLsxf0lPHQtn9f2iRppipZyDPOR756/s320/paralysis+of+contralateral+limbs.jpg" width="400" /></a></div>
<br />
<span style="font-family: Arial, Helvetica, sans-serif;"> A.Paralysis of the contralateral limbs </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> B.Loss of conscious proprioception of the contralateral side of the body </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> C.Nystagmus </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> D.Lateral gaze paralysis </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> E.Facial paralysis</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>10.</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">A patient with the lesion at A will generally show which of the following deficits? </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"> A.Partial blindness </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> B.Loss of ability to gaze medially </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> C.Loss of ability to show tracking movements </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> D.Loss of accommodation reflex </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> E.Nystagmus</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>11.</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">A person is told that he has astigmatism. To correct this defect, the optometrist prescribes which of the following lenses</span><br />
<br />
<span style="font-family: Arial, Helvetica, sans-serif;">A.Cylindrical lens because the cornea or lens is oblong </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B.Concave lens because the eyeball is too long </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C.Convex lens because the lens is too short </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D.Neutral lens because the eyeball is normal but the cornea is too thin </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E.Concave lens because the cornea is opaque</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>12.</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">As a result of calcification of the internal carotid artery, which impinges upon the lateral half of the right optic nerve prior to its entrance to the brain of a 68-year-old woman, resulting in certain visual deficits. Which of the following is the most likely visual deficits</span><br />
<br />
<span style="font-family: Arial, Helvetica, sans-serif;">A.Total blindness of the right eye </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B.Right nasal hemianopsia </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C.Right homonymous hemianopsia </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D.Right bitemporal hemianopsia </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E.Right upper homonymous quadrantanopia</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>13.</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">A 55-year-old woman complains of headaches and is subsequently diagnosed as having a tumor localized to the left parietal lobe. In addition to a variety of sensory deficits, further examination also reveals a reduction in her visual fields. Which of the following is the most likely visual deficit</span><br />
<br />
<span style="font-family: Arial, Helvetica, sans-serif;">A.Left homonymous hemianopsia </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B.Right homonymous hemianopsia </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C.Left upper quadrantanopia </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D.Right upper quadrantanopia </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E.Right lower quadrantanopia </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>14.</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">The conscious perception of movement is mediated by which of the following receptors</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"> A.Meissner's corpuscles </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> B.Free nerve endings </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> C.Merkel's receptors </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> D.Joint capsules </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> E.Pacinian corpuscles </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>15.</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">An impairment in the ability to perform certain types of learned, complex movements (referred to as apraxia) usually results from a lesion of which of the following?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"> A.Precentral gyrus </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> B.Postcentral gyrus </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> C.Premotor cortex </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> D.Prefrontal cortex </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> E.Cingulate gyrus </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>16.</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Which of the following is the primary transmitter released from terminals of both neostriatal and paleostriatal neurons?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"> A.Glycine </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> B.Enkephalin </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> C.Dopamine </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> D.GABA </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> E.Glutamate </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>17.</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">The neurotoxin 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) has recently been applied experimentally with considerable success as a model for which of the following?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"> A.Huntington's disease </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> B.Hemiballism </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> C.Parkinson's disease </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> D.Tardive dyskinesia </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> E.Dystonia </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>18.</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> A man presents with a wide-based, ataxic gait during his attempts at walking. He also is unsteady and sways when standing and displays a tendency to fall backward or to either side in a drunken manner. A lesion is most likely located in which of the following?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"> A.Hemispheres of the posterior cerebellar lobe </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> B.Anterior limb of the internal capsule </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> C.Dentate nucleus </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> D.Anterior lobe of the cerebellum </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> E.Flocculonodular lobe of the cerebellum</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>19.</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Which one of the following thalamic nuclei makes local connections with other thalamic nuclei and, additionally, projects to the basal ganglia</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"> A.Centromedian thalamic nucleus </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> B.Medial geniculate thalamic nucleus </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> C.Lateral geniculate thalamic nucleus </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> D.Dorsomedial thalamic nucleus </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> E.Anterior thalamic nucleus </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> F.Pulvinar </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>20.</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">The supraoptic nucleus is most closely associated with which of the following?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"> A.Feeding behavior </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> B.Temperature regulation </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> C.Sexual behavior </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> D.Short-term memory functions </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> E.Water balance </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>21.</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Lesions of the lateral hypothalamus will likely produce which of the following</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"> A.Feeding behaviors </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> B.Drinking behaviors </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> C.Sexual behaviors </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> D.Aphagia </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> E.Hypertension</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>22.</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">A number of investigations have provided strong evidence that the suprachiasmatic nucleus plays an important role in which of the following</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"> A.Water intake </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> B.Food intake </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> C.Hypertension </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> D.Circadian rhythms </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> E.Short-term memory </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>23.</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">The CT scan below reveals that the patient has a glioma (T) on the right side of the brain. It is likely that the patient has sustained which of the following? </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"></span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"> A.A UMN paralysis of the left side </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> B.Dyskinesia </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> C.Intention tremor </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> D.Upper left quadrantanopia </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> E.Upper right quadrantanopia </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>24.</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Question 1 of 4</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">A lesion of which region in the diagram below will likely result in receptive aphasia?</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">A.A</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B.B </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C.C </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D.D </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E.E </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">F.F </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">G.G </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">H.H </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><b>25.</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><b>Question 1 of 2</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">An individual who complains about disruption in limb muscle function is diagnosed with a disorder in which the transmitter released at the neuromuscular junction is not removed from the synaptic cleft. </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Which of the following is the primary mechanism involved in removal of the transmitter at the neuromuscular junction</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"> A.Enzymatic degradation </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> B.Diffusion </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> C.Reuptake </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> D.Actions of antibodies </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> E.Distribution of sodium and potassium ions along muscle membrane </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><b>Question 2 of 2</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">An individual who complains about disruption in limb muscle function is diagnosed with a disorder in which the transmitter released at the neuromuscular junction is not removed from the synaptic cleft. </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Which of the following enzymes is required for the metabolism of the transmitter at the neuromuscular junction</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"> A.Choline acetyltransferase </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> B.Glutaminase </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> C.Glutamine synthetase </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> D.Acetylcholinesterase </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> E.Serine hydroxymethyltransferase </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><b><span style="font-size: large;"> </span><span style="font-size: x-large;">ANSWERS</span></b></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><b>1- A</b></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Structures associated with sensory functions, such as the proper sensory nucleus and the spinal nucleus of cranial nerve V, are derived from the alar plate</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><b>2- C</b></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Extensive myelination occurs in postnatal development. The failure of the pyramidal tracts to form myelin would account for the reduction in their size. In this particular situation, the size of the cerebral cortex was approximately normal, suggesting that there was no significant decrease in cortical cells. Variation in the numbers of synaptic contacts, transmitter formation, and glial cells would not account for a reduction in the size of the pyramidal tract</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><b>3- B</b></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">The largest numbers of excitatory synapses in the CNS are mediated by glutamate as it is believed that approximately half of the synapses in the brain release glutamate. For example, functions mediated by fibers that originate from the cerebral cortex and descend to such regions as the neostriatum, thalamus, brainstem, and spinal cord are generally believed to be mediated by glutamate. Many other neuronal systems throughout the brain and spinal cord utilize glutamate as well. Dopaminergic and noradrenergic neurons, while mostly excitatory, can also be inhibitory at some synapses and are less numerous than glutamate. Cholinergic and substance P synapses are also excitatory, but are likewise less numerous than glutamate.</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><b>4- B</b></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Excitatory amino acids and, in particular, the glutamate family of compounds have long been thought to play an important role in epileptiform activity. Epileptiform activity typically includes AMPA-receptor activation. However, as the seizure becomes more intense, there is increased involvement of NMDA receptors. This is evidenced by the facts that NMDA antagonists can reduce the intensity and length of the seizure activity and that, following removal of human epileptic hippocampal tissue, there is an up-regulation of both AMPA and NMDA receptors. Metabotropic glutamate receptors have been shown to be present in the retina but have not yet been demonstrated to be present in regions of the brain that are typically epileptogenic. GABA and glycine are inhibitory transmitters; therefore, seizures would logically block such receptor activation. There has been no substantive evidence concerning the role of cortical nicotinic receptors in epilepsy.</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><b>5- D</b></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Tryptophan hydroxylase, tyrosine hydroxylase, and choline acetyltransferase are enzymes that are critical for the biosynthesis of serotonin, catecholamines, and ACh, respectively. Dopamine -hydroxylase converts dopamine to norepinephrine. Catechol-O-methyltransferase and monoamine oxidase are critical for the metabolic degradation of catecholamines</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><b>6- D</b></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">The smooth muscle of the bladder is innervated by postganglionic fibers of the sympathetic nervous system that arise from the inferior mesenteric ganglion. This ganglion, in turn, receives its inputs from T12–L2 of the intermediolateral cell column of the spinal cord. The smooth muscle of the bladder also receives inputs from postganglionic parasympathetic fibers that are innervated by preganglionic fibers arising from S2–S4. The external sphincter of the bladder (striated muscle) is innervated by ventral horn cells from the spinal cord. These ventral horn cells, in turn, receive inputs from supraspinal neurons that arise, in part, from the cerebral cortex. It is these neurons that form a part of the substrate for voluntary control over bladder functions.</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><b>7- B</b></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Noradrenergic activity can be blocked by a number of mechanisms. Reserpine, for example, prevents the synthesis and storage of norepinephrine in sympathetic nerve terminals. Guanethidine sulfate affects noradrenergic transmission by blocking the release of norepinephrine at the sympathetic endings. Competitive -receptor blockers include phenoxybenzamine hydrochloride and phentolamine, whereas metoprolol blocks 1 receptors. Since ACh is the transmitter at preganglionic synapses of both the parasympathetic and sympathetic nervous systems, hexamethonium chloride is an effective ganglionic blocker at these synapses.</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><b>8- D</b></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Specialized peripheral receptors, which specifically respond to changes in blood pressure, include the carotid sinus (associated with cranial nerve IX) and the aortic arch (associated with cranial nerve X). If these receptors (or the cell bodies associated with these receptors) are damaged, then one of the fundamental regulatory mechanisms for the control of blood pressure would be disrupted. The results of such a disruption would likely lead to increases and instability in blood pressure with evidence of spiking of blood pressure. Because these sensory receptors in these structures respond to increases in blood pressure, they are, in effect, stretch receptors and are consequently referred to as baroreceptors. The principal projection of the axons associated with these baroreceptors is the solitary nucleus of the medulla, which in turn, projects to autonomic nuclei such as the dorsal motor nucleus of the vagus nerve, ventrolateral medulla, and higher regions associated with autonomic functions, which include the PAG, hypothalamus, and limbic system.</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><b>9- A</b></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Since the lesion is restricted to the medial aspect of the basilar part of the pons, the corticospinal tract would be affected, producing paralysis of the contralateral limbs. Although other structures would also be affected and could produce additional deficits, such deficits are not listed in this question. The other dysfunctions listed would not occur because they are associated with structures situated in the pontine tegmentum, which is not included in this lesion.</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><b>10- C</b></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">The lesion involves the superior colliculus. This structure receives inputs from the cerebral cortex and optic tract and its neurons respond to moving objects in the visual field. It is considered essential for the regulation of tracking movements. Lesions of the superior colliculus have not been shown to produce any of the other deficits listed in this question. Nystagmus is not likely to occur because the lesion does not involve the medial longitudinal fasciculus or the pontine gaze center.</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><b>11- A</b></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">In astigmatism, the shapes of the cornea and possibly the lens become oblong, resulting in differences in the curvature of the lens along the long and short axes. Thus, astigmatism is corrected with a cylindrical lens.</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><b>12- B</b></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Calcification of the internal carotid artery could serve to disrupt nerve fibers proximal to it. One such group of fibers includes parts of the optic nerve. In this case, the component of the right optic nerve affected includes the lateral aspect, or those fibers that mediate vision associated with the nasal visual field of the right eye. If the damage were more extensive and if it involved the entire nerve, then total blindness of the right eye would have occurred.</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><b>13- E</b></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Fibers from the left lateral geniculate destined for the upper bank of the calcarine fissure will mediate visual impulses associated with lower quadrants of the right visual fields for both eyes. This deficit is referred to as a right lower quadrantanopia.</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><b>14- D</b></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Meissner's corpuscles, Merkel's receptors, and pacinian corpuscles respond to tactile, pressure, or possibly vibratory stimuli, while free nerve endings are associated with nociceptive stimuli. Joint capsules respond to movement of the limb, and the axons of these receptors contribute to the dorsal column–medial lemniscal system mediating the conscious perception of movement.</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><b>15- C</b></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">The premotor areas play an important role in the programming or sequencing of responses that compose complex learned movements. They receive significant inputs for this process from the posterior parietal lobule and, in turn, signal appropriate neurons in the brainstem and spinal cord (both flexors and extensors). Lesions of the postcentral gyrus produce a somatosensory loss. Lesions of the precentral gyrus produce paralysis. Neither lesions of the prefrontal cortex nor those of the cingulate gyrus have been reported to produce apraxia.</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><b>16- D</b></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">The major transmitter released at terminals of neostriatal and paleostriatal fibers is GABA. Thus, the output of the basal ganglia is mainly inhibitory. This suggests that thalamic influences upon the cortex are generated through the process of disinhibition, whereby neurons of the basal ganglia are inhibited. The presence of glycine in striatal neurons has yet to be demonstrated. Enkephalins are released from terminals of neostriatal-pallidal fibers but not from other efferent neurons of the striatum. Dopamine is released from the brainstem and some adjoining hypothalamic neurons but certainly not from striatal neurons. The neostriatum receives cortical inputs that utilize glutamate, but the release of GABA from terminals of striatal efferent fibers has not been demonstrated.</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><b>17- C</b></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">MPTP was discovered by accident when drug abusers who were using a synthetic heroin derivative developed signs of Parkinson's disease. It was discovered that their drug included the contaminant MPTP. As a consequence, MPTP has been applied systemically in a number of experimental animals, resulting in significant decreases in dopamine content of the brain due to the loss of dopaminergic neurons in the substantia nigra. These animals also developed symptoms similar to those seen in Parkinson's patients. For these reasons, this drug is currently being used for research purposes in order to develop a better understanding of this disease and to establish possible drug therapies for its treatment and eventual cure.</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><b>18- E</b></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Since the flocculonodular lobe receives and integrates inputs from the vestibular system, it is understandable why lesions that disrupt this integrating mechanism for vestibular inputs would result in difficulties in maintaining balance. Indeed, this is a classic feature of lesions of the flocculonodular lobe but is not associated with lesions in the hemispheres of the posterior lobe, anterior limb of the internal capsule, or the dentate nucleus, which are functionally linked to the frontal lobe. Lesions of the anterior lobe also do not affect mechanisms of balance.</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><b>19- A</b></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">The centromedian nucleus is a classical nonspecific thalamic nucleus. It can modulate cortical activity by making local connections with specific thalamic nuclei, and therefore modify the specific thalamic inputs to different regions of the cerebral cortex. In addition, the centromedian nucleus also projects to the putamen. This projection is sometimes referred to as the thalamostriatal projection. Since the centromedian nucleus receives considerable inputs from the cerebral cortex, this connection to the putamen provides a basis by which the cerebral cortex can influence the basal ganglia in addition to its direct projections to the neostriatum.</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><b>20- E</b></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">The supraoptic nucleus, like the paraventricular nucleus, contains magnocellular neurons that synthesize vasopressin and oxytocin and transport these hormones down their axons to the posterior pituitary. For this reason, the supraoptic nucleus plays a significant role in the regulation of water balance. There is no evidence to support the notion that the supraoptic nucleus has a role in feeding behavior, temperature regulation, sexual behavior, or short-term memory functions.</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><b>21- D</b></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Lesions of the lateral hypothalamus are likely to produce aphagia. Feeding behavior is elicited by stimulation of the lateral hypothalamus. Neurons in this region respond to the sight or taste of food. Since drinking is also associated with lateral hypothalamic functions, a lesion of this structure would also disrupt this behavior. Lesions of the lateral hypothalamus do not produce either hypertension or sexual behaviors. The neurons regulating these functions are elsewhere within the hypothalamus.</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><b>22- D</b></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Recent studies have demonstrated that the suprachiasmatic nucleus controls the biologic clock of internal circadian rhythms. During the light phase of the light-dark cycle, metabolic activity (measured by 14C-2-deoxyglucose autoradiography) within the suprachiasmatic nucleus is significantly increased. In contrast, during the dark phase, there is very little metabolic activity.</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><b>23- A</b></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">The tumor is situated in the lentiform nucleus and internal capsule. Therefore, corticospinal fibers will be affected, causing a UMN paralysis of the left side. Dyskinesia would not be seen because any effects normally seen in association with damage to the basal ganglia would be masked by the effects of the damage to the internal capsule. Since the cerebellum was not involved, there would be no intention tremor. Neither would there be any visual deficits from this glioma since optic nerve fibers are not involved. The following schematic diagram indicates the approximate extent of the tumor. Labeled are the caudate nucleus (C), the globus pallidus (GP), the internal capsule (IC), the putamen (P), and the tumor (T).</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><b>24- C</b></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">This figure is a lateral view of the cerebral cortex. Cells in the "arm" area of the primary motor cortex (H) project their axons to the cervical level of the spinal cord. This area receives major input from the ventrolateral nucleus of the thalamus. The leg region of the primary somatosensory cortex (A) lies immediately caudal to the central sulcus, is almost devoid of pyramidal cells, and is referred to as a granulous cortex. Damage to the cells situated in the region of the dorsal border of the superior temporal gyrus and the adjoining area of the inferior parietal lobule (Wernicke's area) (C) causes impairment in the appreciation of the meanings of written or spoken words. </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"> The primary, secondary, and tertiary auditory receiving areas in the cortex are located mainly in the superior temporal gyrus (D). It is the final receiving area for inputs from the medial geniculate nucleus, which represents an important relay in the transmission of auditory signals to the cortex. An additional area of the cortex governing speech (F) is called the motor speech area, or Broca's area. It is situated in the inferior aspect of the frontal lobe immediately rostral and slightly ventral to the precentral gyrus. Lesions of this region produce impairment of the ability to express words in a meaningful way or to use words correctly. The orbital frontal cortex (E) lies in a position inferior and rostral to Broca's motor speech area. This region governs higher-order intellectual functions and some aspects of emotional behavior. </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"> The caudal aspect of the middle frontal gyrus (G) contains cells that, when activated, produce conjugate deviation of the eyes. This action is believed to be accomplished, in part, by virtue of descending projections to the superior colliculus, pretectal region, and horizontal gaze center of the pons. Lesions of the posterior parietal lobe (B) of the nondominant hemisphere will produce a disorder of body image, referred to as sensory neglect. The patient will frequently fail to recognize or neglect to shave or wash those body parts. The patient may even fail to recognize the presence of a hemiparesis involving that part of the body as well. The precentral gyrus (H) constitutes the primary motor cortex. Lesions of this region produce a UMN paralysis involving a contralateral limb.</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><b>25-</b> </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><b>1) A</b></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">There are three basic mechanisms by which the transmitter is removed from the synaptic cleft: (1) enzymatic degradation, (2) reuptake, and (3) diffusion. In the case of the neuromuscular junction, ACh (and not glutamate) is the neurotransmitter and the primary mechanism involves enzymatic degradation. The enzyme involved is acetylcholinesterase, which helps break down ACh into acetate and choline. Choline is then taken up by the presynaptic terminal. Concerning the other choices, choline acetyltransferase is the enzyme involved in the synthesis of ACh, glutaminase, and glutamine synthetase are involved in the formation of glutamate from glutamine and glutamine from glutamate, respectively. Serine hydroxymethyltransferase is the enzyme that converts serine into glycine.</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><b>2) D</b> </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">(see above explanation).</span></div>
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Anonymoushttp://www.blogger.com/profile/16555664245806923731noreply@blogger.com1tag:blogger.com,1999:blog-3618930566267736040.post-72488940207477887932013-06-30T00:25:00.001-07:002013-06-30T00:25:53.547-07:00Microbiology Self-Quiz (MCQs) with explanation<span style="font-family: Arial, Helvetica, sans-serif;"><b>1.</b> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">The latest and most effective therapy for AIDS patients includes azidothymidine (AZT), dideoxyinosine (DDI), and saquinavir or similar agents. Use of these three drugs would inhibit which of the following viral processes? </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">A. <span class="Apple-tab-span" style="white-space: pre;"> </span>RNase, DNase</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B. <span class="Apple-tab-span" style="white-space: pre;"> </span>gp120 formation</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C. <span class="Apple-tab-span" style="white-space: pre;"> </span>p24 antibody expression</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D. <span class="Apple-tab-span" style="white-space: pre;"> </span>All membrane synthesis</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E. <span class="Apple-tab-span" style="white-space: pre;"> </span>Reverse transcriptase, protease</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><b>2.</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">A tube of monkey kidney cells is inoculated with nasopharyngeal secretions. During the next 7 days, no cytopathic effects (CPEs) are observed. On the eighth day, the tissue culture is infected accidentally with a picornavirus; nevertheless, the culture does not develop CPEs. Which of the following is the most likely explanation of this phenomenon?</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">A. <span class="Apple-tab-span" style="white-space: pre;"> </span>The nasopharyngeal secretions contained hemagglutinins</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B. <span class="Apple-tab-span" style="white-space: pre;"> </span>The nasopharyngeal secretions contained rubella virus</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C. <span class="Apple-tab-span" style="white-space: pre;"> </span>Picornavirus does not produce CPEs</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D. <span class="Apple-tab-span" style="white-space: pre;"> </span>Picornavirus does not replicate in monkey kidney cells</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E. <span class="Apple-tab-span" style="white-space: pre;"> </span>Monkey kidney cells are resistant to CPEs</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>3.</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Which of the following is the most sensitive test for the diagnosis of herpes simplex (HSV) meningitis in a newborn infant?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">A. <span class="Apple-tab-span" style="white-space: pre;"> </span>HSV IgG antibody</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B. <span class="Apple-tab-span" style="white-space: pre;"> </span>HSV polymerase chain reaction (PCR)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C. <span class="Apple-tab-span" style="white-space: pre;"> </span>HSV culture</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D. <span class="Apple-tab-span" style="white-space: pre;"> </span>Tzanck smear</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E. <span class="Apple-tab-span" style="white-space: pre;"> </span>Cerebrospinal fluid (CSF) protein analysis</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>4.</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">One of the most common sexually transmitted diseases that may lead to cervical carcinoma is caused by which of the following viruses?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">A. <span class="Apple-tab-span" style="white-space: pre;"> </span>Cytomegalovirus</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B. <span class="Apple-tab-span" style="white-space: pre;"> </span>Papillomavirus</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C. <span class="Apple-tab-span" style="white-space: pre;"> </span>Epstein-Barr virus</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D. <span class="Apple-tab-span" style="white-space: pre;"> </span>Herpes simplex virus</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E. <span class="Apple-tab-span" style="white-space: pre;"> </span>Adenovirus</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>5.</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Meningitis is characterized by the acute onset of fever and stiff neck. Aseptic meningitis may be caused by a variety of microbial agents. During the initial 24 h of the course of aseptic meningitis, an affected person’s cerebrospinal fluid is characterized by which of the following?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">A. <span class="Apple-tab-span" style="white-space: pre;"> </span>Decreased protein content</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B. <span class="Apple-tab-span" style="white-space: pre;"> </span>Elevated glucose concentration</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C. <span class="Apple-tab-span" style="white-space: pre;"> </span>Lymphocytosis</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D. <span class="Apple-tab-span" style="white-space: pre;"> </span>Polymorphonuclear leukocytosis</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E. <span class="Apple-tab-span" style="white-space: pre;"> </span>Eosinophilia</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>6.</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Kuru is a fatal disease of certain New Guinea natives and is characterized by tremors and ataxia; Creutzfeldt-Jakob disease (CJD) is characterized by both ataxia and dementia. These diseases are thought to be caused by which of the following?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">A. <span class="Apple-tab-span" style="white-space: pre;"> </span>Slow viruses</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B. <span class="Apple-tab-span" style="white-space: pre;"> </span>Cell wall–deficient bacteria</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C. <span class="Apple-tab-span" style="white-space: pre;"> </span>Environmental toxins</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D. <span class="Apple-tab-span" style="white-space: pre;"> </span>Prions</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E. <span class="Apple-tab-span" style="white-space: pre;"> </span>Flagellates</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>7.</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">An infant, seen in the ER, presents with a fever and persistent cough. Physical examination and a chest x-ray suggest pneumonia. Which of the following is most likely the cause of this infection?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">A. <span class="Apple-tab-span" style="white-space: pre;"> </span>Rotavirus</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B. <span class="Apple-tab-span" style="white-space: pre;"> </span>Adenovirus</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C. <span class="Apple-tab-span" style="white-space: pre;"> </span>Coxsackievirus</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D. <span class="Apple-tab-span" style="white-space: pre;"> </span>Respiratory syncytial virus</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E. <span class="Apple-tab-span" style="white-space: pre;"> </span>Rhinovirus</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>8.</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Which one of the following viruses may be human tumor virus? </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">A. <span class="Apple-tab-span" style="white-space: pre;"> </span>Epstein-Barr virus (EBV)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B. <span class="Apple-tab-span" style="white-space: pre;"> </span>HIV</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C. <span class="Apple-tab-span" style="white-space: pre;"> </span>Papillomavirus</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D. <span class="Apple-tab-span" style="white-space: pre;"> </span>Varicella-zoster virus (VZV)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E. <span class="Apple-tab-span" style="white-space: pre;"> </span>Herpes simplex virus, type 2 (HSV)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>9.</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">There is considerable overlap of signs and symptoms seen in congenital and perinatal infections. In a neonate with "classic" symptoms of congenital cytomegalovirus (CMV) infection, which one of the following tests would be most useful in establishing a diagnosis?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">A. <span class="Apple-tab-span" style="white-space: pre;"> </span>CMV IgG titer on neonate’s serum at birth</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B. <span class="Apple-tab-span" style="white-space: pre;"> </span>CMV IgG titer on mother’s serum at birth of infant</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C. <span class="Apple-tab-span" style="white-space: pre;"> </span>CMV IgM titer on neonate’s serum at birth and at 1 month of age</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D. <span class="Apple-tab-span" style="white-space: pre;"> </span>Total IgM on neonate’s serum at birth</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E. <span class="Apple-tab-span" style="white-space: pre;"> </span>Culture of mother’s urine</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>10.</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Interferon, a protein that inhibits viral replication, is produced by cells in tissue culture when the cells are stimulated with which of the following?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">A. <span class="Apple-tab-span" style="white-space: pre;"> </span>Botulinum toxin</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B. <span class="Apple-tab-span" style="white-space: pre;"> </span>Synthetic polypeptides</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C. <span class="Apple-tab-span" style="white-space: pre;"> </span>Viruses</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D. <span class="Apple-tab-span" style="white-space: pre;"> </span>Chlamydiae</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E. <span class="Apple-tab-span" style="white-space: pre;"> </span>Gram-positive bacteria</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>11.</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Which one of the following viruses would be most likely to establish a latent infection? </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">A. <span class="Apple-tab-span" style="white-space: pre;"> </span>Adenovirus</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B. <span class="Apple-tab-span" style="white-space: pre;"> </span>Measles virus</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C. <span class="Apple-tab-span" style="white-space: pre;"> </span>Influenza virus</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D. <span class="Apple-tab-span" style="white-space: pre;"> </span>Parvovirus</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E. <span class="Apple-tab-span" style="white-space: pre;"> </span>Coxsackievirus group B</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>12.</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Chicken pox is a common disease of childhood. It is caused by which of the following viruses? </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">A. <span class="Apple-tab-span" style="white-space: pre;"> </span>Cytomegalovirus</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B. <span class="Apple-tab-span" style="white-space: pre;"> </span>Rotavirus</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C. <span class="Apple-tab-span" style="white-space: pre;"> </span>Varicella-zoster virus</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D. <span class="Apple-tab-span" style="white-space: pre;"> </span>Adenovirus</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E. <span class="Apple-tab-span" style="white-space: pre;"> </span>Papillomavirus</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>13.</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Human warts are not only cosmetically unsightly but may lead to cancer of the cervix. They are caused by which one of the following viruses?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">A. <span class="Apple-tab-span" style="white-space: pre;"> </span>Cytomegalovirus</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B. <span class="Apple-tab-span" style="white-space: pre;"> </span>Rotavirus</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C. <span class="Apple-tab-span" style="white-space: pre;"> </span>Varicella-zoster virus</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D. <span class="Apple-tab-span" style="white-space: pre;"> </span>Adenovirus</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E. <span class="Apple-tab-span" style="white-space: pre;"> </span>Papillomavirus</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>14.</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">A child has mononucleosis-like symptoms yet the test for mononucleosis and the EBV titers are negative. Which of the following is one cause of heterophile-negative mononucleosis?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">A. <span class="Apple-tab-span" style="white-space: pre;"> </span>Cytomegalovirus</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B. <span class="Apple-tab-span" style="white-space: pre;"> </span>Herpes simplex virus</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C. <span class="Apple-tab-span" style="white-space: pre;"> </span>Varicella-zoster virus</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D. <span class="Apple-tab-span" style="white-space: pre;"> </span>Adenovirus</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E. <span class="Apple-tab-span" style="white-space: pre;"> </span>Coxsackievirus</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><b><br /></b></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>15.</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Malaise and fatigue with increased "atypical" lymphocytes and a reactive heterophil antibody test is most commonly caused by which of the following?</span><br />
<span class="Apple-tab-span" style="white-space: pre;"><span style="font-family: Arial, Helvetica, sans-serif;"> </span></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">A. <span class="Apple-tab-span" style="white-space: pre;"> </span>Toxoplasma</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B. <span class="Apple-tab-span" style="white-space: pre;"> </span>Borrelia burgdorferi</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C. <span class="Apple-tab-span" style="white-space: pre;"> </span>Epstein-Barr virus</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D. <span class="Apple-tab-span" style="white-space: pre;"> </span>Parvovirus</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E. <span class="Apple-tab-span" style="white-space: pre;"> </span>Rubella virus</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>16.</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Which of the following viruses causes progressive multifocal leukoencephalopathy (PML), a disease causing demyelination in the central nervous system?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">A. <span class="Apple-tab-span" style="white-space: pre;"> </span>Human papillomavirus</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B. <span class="Apple-tab-span" style="white-space: pre;"> </span>West Nile virus</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C. <span class="Apple-tab-span" style="white-space: pre;"> </span>Tick-borne encephalitis virus</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D. <span class="Apple-tab-span" style="white-space: pre;"> </span>Polyomavirus</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E. <span class="Apple-tab-span" style="white-space: pre;"> </span>SSPE</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>17.</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Which of the following is the leading cause of bronchiolitis and community-acquired pneumonia in infants?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">A. <span class="Apple-tab-span" style="white-space: pre;"> </span>Measles virus</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B. <span class="Apple-tab-span" style="white-space: pre;"> </span>Influenza virus</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C. <span class="Apple-tab-span" style="white-space: pre;"> </span>Respiratory syncytial virus</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D. <span class="Apple-tab-span" style="white-space: pre;"> </span>Parainfluenza virus</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E. <span class="Apple-tab-span" style="white-space: pre;"> </span>Adenovirus</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>18.</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">A patient with a peptic ulcer was admitted to the hospital and a gastric biopsy was performed. The tissue was cultured on chocolate agar incubated in a microaerophilic environment at 37°C for 5 to 7 days. At 5 days of incubation, colonies appeared on the plate and were curved, Gram-negative rods, oxidase-positive. Which of the following is the most likely identity of this organism?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">A. <span class="Apple-tab-span" style="white-space: pre;"> </span>Campylobacter jejuni</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B. <span class="Apple-tab-span" style="white-space: pre;"> </span>Vibrio parahaemolyticus</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C. <span class="Apple-tab-span" style="white-space: pre;"> </span>Haemophilus influenzae</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D. <span class="Apple-tab-span" style="white-space: pre;"> </span>Helicobacter pylori</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E. <span class="Apple-tab-span" style="white-space: pre;"> </span>Campylobacter fetus</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>19.</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">At a church supper in Nova Scotia, the following meal was served: baked beans, ham, coleslaw, eclairs, and coffee. Of the 30 people who attended, 4 senior citizens became ill in 3 days; 1 eventually died. Two weeks after attending the church supper, a 19-year-old girl gave birth to a baby who rapidly became ill with meningitis and died in 5 days. Epidemiologic investigation revealed the following percentages of people who consumed the various food items: baked beans, 30%; ham, 80%; coleslaw, 60%; eclairs, 100%; and coffee, 90%. Microbiologic analysis revealed no growth in the baked beans, ham, or coffee; many Gram-positive beta-hemolytic, short, rod-shaped bacteria in the coleslaw; and rare Gram-positive cocci in the eclairs. Which of the following is the most likely cause of this outbreak?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">A. <span class="Apple-tab-span" style="white-space: pre;"> </span>Staphylococcus aureus</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B. <span class="Apple-tab-span" style="white-space: pre;"> </span>Listeria</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C. <span class="Apple-tab-span" style="white-space: pre;"> </span>Clostridium perfringens</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D. <span class="Apple-tab-span" style="white-space: pre;"> </span>Clostridium botulinum</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E. <span class="Apple-tab-span" style="white-space: pre;"> </span>Nonmicrobiologic</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>20.</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Group B streptococcus sepsis in an infant is preventable. Which one of the following procedures is most likely to reduce the incidence of group B streptococcal disease?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">A. <span class="Apple-tab-span" style="white-space: pre;"> </span>Intrapartum antibiotic treatment</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B. <span class="Apple-tab-span" style="white-space: pre;"> </span>Use of a polysaccharide vaccine</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C. <span class="Apple-tab-span" style="white-space: pre;"> </span>Screening of pregnant females in the last trimester</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D. <span class="Apple-tab-span" style="white-space: pre;"> </span>Identification of possible high-risk births</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E. <span class="Apple-tab-span" style="white-space: pre;"> </span>Screening of pregnant females at the first office visit, usually during the first trimester</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>21.</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">There has been much speculation on the pathogenesis of group B streptococcal disease in the neonate. Which of the following is the most likely pathogenic mechanisms?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">A. <span class="Apple-tab-span" style="white-space: pre;"> </span>Complement C5a, a potent chemoattractant, activates PMNs</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B. <span class="Apple-tab-span" style="white-space: pre;"> </span>The streptococci are resistant to penicillin</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C. <span class="Apple-tab-span" style="white-space: pre;"> </span>The alternative complement pathway is activated</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D. <span class="Apple-tab-span" style="white-space: pre;"> </span>In the absence of specific antibody, opsonization, phagocyte recognition, and killing do not proceed normally</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><b>22.</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">A man who has a penile chancre appears in a hospital's emergency service. The VDRL test is negative. Which of the following is the most appropriate course of action?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">A. <span class="Apple-tab-span" style="white-space: pre;"> </span>Send the patient home untreated</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B. <span class="Apple-tab-span" style="white-space: pre;"> </span>Repeat the VDRL test in 10 days</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C. <span class="Apple-tab-span" style="white-space: pre;"> </span>Perform dark-field microscopy for treponemes</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D. <span class="Apple-tab-span" style="white-space: pre;"> </span>Swab the chancre and culture on Thayer-Martin agar</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E. <span class="Apple-tab-span" style="white-space: pre;"> </span>Perform a Gram stain on the chancre fluid</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><b>23.</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">In people who have sickle cell anemia, osteomyelitis usually is associated with which of the following organisms?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">A. <span class="Apple-tab-span" style="white-space: pre;"> </span>Micrococcus</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B. <span class="Apple-tab-span" style="white-space: pre;"> </span>Escherichia</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C. <span class="Apple-tab-span" style="white-space: pre;"> </span>Pseudomonas</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D. <span class="Apple-tab-span" style="white-space: pre;"> </span>Salmonella</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E. <span class="Apple-tab-span" style="white-space: pre;"> </span>Streptococcus</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><b>24.</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">A hyperemic edema of the larynx and epiglottis that rapidly leads to respiratory obstruction in young children is most likely to be caused by which of the following?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">A. <span class="Apple-tab-span" style="white-space: pre;"> </span>K. pneumoniae</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B. <span class="Apple-tab-span" style="white-space: pre;"> </span>M. pneumoniae</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C. <span class="Apple-tab-span" style="white-space: pre;"> </span>Neisseria meningitidis</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D. <span class="Apple-tab-span" style="white-space: pre;"> </span>H. influenzae</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E. <span class="Apple-tab-span" style="white-space: pre;"> </span>H. hemolyticus</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><b>25.</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">A 70-year-old female patient was readmitted to a local hospital with fever and chills following cardiac surgery at a major teaching institution. Blood cultures were taken and a Gram-positive coccus grew from the blood cultures within 24 hours. Initial tests indicated that this isolate was resistant to penicillin.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Which of the following is the treatment of choice for the isolate? </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">A. <span class="Apple-tab-span" style="white-space: pre;"> </span>Gentamicin</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B. <span class="Apple-tab-span" style="white-space: pre;"> </span>Gentamicin and ampicillin</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C. <span class="Apple-tab-span" style="white-space: pre;"> </span>Ciprofloxacin</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D. <span class="Apple-tab-span" style="white-space: pre;"> </span>Rifampin</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E. <span class="Apple-tab-span" style="white-space: pre;"> </span>No available treatment</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>26.</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">A 2-year-old infant is brought to the emergency room with hemolytic uremic syndrome and thrombocytopenia. Which one of the following bacteria would most likely be isolated from a stool specimen?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">A. <span class="Apple-tab-span" style="white-space: pre;"> </span>Shigella</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B. <span class="Apple-tab-span" style="white-space: pre;"> </span>Salmonella</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C. <span class="Apple-tab-span" style="white-space: pre;"> </span>Aeromonas</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D. <span class="Apple-tab-span" style="white-space: pre;"> </span>E. coli 0157/H7</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E. <span class="Apple-tab-span" style="white-space: pre;"> </span>Enterobacter</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>27.</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Which of the following is the most effective noninvasive test for the diagnosis of Helicobacter-associated gastric ulcers?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">A. <span class="Apple-tab-span" style="white-space: pre;"> </span>Detection of H. pylori antigen in stool</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B. <span class="Apple-tab-span" style="white-space: pre;"> </span>Growth of H. pylori from a stomach biopsy</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C. <span class="Apple-tab-span" style="white-space: pre;"> </span>Growth of H. pylori in the stool</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D. <span class="Apple-tab-span" style="white-space: pre;"> </span>IgM antibodies to H. pylori</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E. <span class="Apple-tab-span" style="white-space: pre;"> </span>Culture of stomach contents for H. pylori</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>28</b>.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">A patient with symptoms of urinary tract infection had a culture taken, which grew 5 × 103 E. coli. The laboratory reported it as "insignificant." Which of the following is the most clinically appropriate action? </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">A. <span class="Apple-tab-span" style="white-space: pre;"> </span>Do no further clinical workup</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B. <span class="Apple-tab-span" style="white-space: pre;"> </span>Suggest to the laboratory that low colony counts may reflect infection</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C. <span class="Apple-tab-span" style="white-space: pre;"> </span>Determine if fluorescent microscopy is available for the diagnosis of actinomycosis</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D. <span class="Apple-tab-span" style="white-space: pre;"> </span>Consider vancomycin as an alternative drug</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E. <span class="Apple-tab-span" style="white-space: pre;"> </span>Suggest a repeat antibiotic susceptibility test</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>29</b>.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Which of the following is the antibiotic of choice for Lyme disease?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">A. <span class="Apple-tab-span" style="white-space: pre;"> </span>Penicillin</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B. <span class="Apple-tab-span" style="white-space: pre;"> </span>Ampicillin</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C. <span class="Apple-tab-span" style="white-space: pre;"> </span>Erythromycin</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D. <span class="Apple-tab-span" style="white-space: pre;"> </span>Vancomycin</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E. <span class="Apple-tab-span" style="white-space: pre;"> </span>Ceftriaxone</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><b>30.</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">N. gonorrhoeae is a fastidious pathogen and found in sites often contaminated with normal flora. Which of the following is the best medium for isolation?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">A. <span class="Apple-tab-span" style="white-space: pre;"> </span>Sheep blood agar</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B. <span class="Apple-tab-span" style="white-space: pre;"> </span>Löffler's medium</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C. <span class="Apple-tab-span" style="white-space: pre;"> </span>Thayer-Martin agar</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D. <span class="Apple-tab-span" style="white-space: pre;"> </span>Thiosulfate citrate bile salts sucrose medium</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E. <span class="Apple-tab-span" style="white-space: pre;"> </span>Löwenstein-Jensen medium</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><b>Answers</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>1- The answer is: E</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">The advent of triple therapy or a therapeutic "cocktail" has had a marked effect on AIDS patients. The combination of drugs work together as reverse transcriptive inhibitors and a protease inhibitor. Patients improve rapidly, their CD4 lymphocyte counts increase, and their HIV viral load is drastically reduced, often to <50 copies per ml. On the other hand, an untreated HIV-positive patient with a low CD4 and a high viral load (a) is at increased risk of opportunistic infection and (b) has a much greater chance of developing AIDS than if the viral load was <50,000. The patient is infectious and his HIV antibody screening test will be positive. The high viral load, however, is not a predictor of response to therapy. Many patients with high viral loads do very well on triple therapy, although resistance to one or more of the agents may subsequently occur. A low CD4 count does not predict progression to AIDS but does indicate increased chance of opportunistic infection such as those listed. Kaposi’s sarcoma, which has been linked to herpesvirus type 8, pneumocystis, and mycobacterial disease are three of the most prevalent opportunistic infections. While HIV-positive patients contract pneumococcal pneumonia, they are probably at no more risk than the general population, as protection against pneumococcal disease is linked to the presence of anticapsular antibody.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>2- The answer is: B</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">Rubella virus does not produce cytopathic effects (CPEs) in tissue-culture cells. Moreover, rubella-infected cells challenged with a picornavirus are resistant to subsequent infection and thus would not exhibit CPEs. Monkey kidney cells infected only with picornavirus would show CPEs.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>3- The answer is: B</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">HSV meningitis or encephalitis is difficult to diagnose by laboratory tests as there is a low titer of virus present in the CSF. Neonatal HSV infects the child during the birth process. While culture, Tzanck smear, and even antibody tests may be useful in adults, particularly those with HSV-rich lesions, they are not useful for CSF testing. Only PCR is sensitive enough to detect HSV DNA in the CSF. Once diagnosed rapidly, HSV encephalitis or meningitis can be treated with acyclovir.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>4- The answer is: B</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">Human papillomavirus (HPV) is the cause of genital warts. It is one of the most pervasive of all the sexually transmitted diseases. There is no specific cure or vaccine. There are multiple serotypes of papillomavirus and some serotypes are linked to cervical cancer. New techniques for molecular diagnosis of HPV show promise for rapid and sensitive detection and perhaps more aggressive treatment.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>5- The answer is: D</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">Aseptic meningitis is characterized by a pleocytosis of mononuclear cells in the cerebrospinal fluid; polymorphonuclear cells predominate during the first 24 h, but a shift to lymphocytes occurs thereafter. The cerebrospinal fluid of affected persons is free of culturable bacteria and contains normal glucose and slightly elevated protein levels. Peripheral white blood cell counts usually are normal. Although viruses are the most common cause of aseptic meningitis, spirochetes, chlamydiae, and other microorganisms also can produce the disease.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>6- The answer is: D</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">Kuru and Creutzfeldt-Jakob disease (CJD) are similar but not identical diseases with very different epidemiology. Kuru is prevalent among certain tribes in New Guinea who practiced ritual cannibalism by eating the brains of the departed. CJD is found worldwide and has been transmitted by corneal transplants and in pituitary hormone preparations. There is some association between CJD and Mad Cow Disease in England. Prions are unconventional selfreplicating proteins, sometimes called amyloid. It is now thought that CJD, Kuru, and animal diseases such as scrapie, visna, and bovine spongiform encephalopathy (Mad Cow Disease) are caused by prions.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>7- The answer is: D</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">Respiratory syncytial virus (RSV) is the most important cause of pneumonia and bronchiolitis in infants. The infection is localized to the respiratory tract. The virus can be detected rapidly by immunofluorescence on smears of respiratory epithelium. In older children, the infection resembles the common cold. Aerosolized ribavirin is recommended for severely ill hospitalized infants.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>8- The answer is: C</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">Only two human viruses have been confirmed as human tumor viruses. They include human T-cell lymphoma/leukemia virus (HTLV) and papillomavirus. Others, such as EBV, HSV, and hepatitis B and C, have been implicated as tumor viruses. The virus that causes chicken pox (VZV) is not know to be oncogenic.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>9- The answer is: C</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">(See figure below.) Presently, cytomegalovirus (CMV) is the most common cause of congenital and perinatal viral infections. Culture of the virus is a sensitive diagnostic technique; in the case of a neonate with classic symptoms, serum samples from the mother and neonate are obtained at birth. The IgM antibody titer in the infant’s serum should be higher than the mother’s titer, but they may be similar. For this reason, another sample from the infant at 1 month of age is tested simultaneously with the initial sample. The results should indicate a rise in IgM titer. Measurement of total IgM in the infant’s sera at birth is nonspecific and may show false-negative and false-positive reactions.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Cytomegalovirus-infected human embryonic fibroblasts stained with fluorescein-labeled monoclonal antibody to early nuclear antigen (×1000).</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>10- The answer is: C</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">Interferon is a protein that alters cell metabolism to inhibit viral replication. It induces the formation of a second protein that interferes with the translation of viral messenger RNA. Production of interferon has been demonstrated when cells in tissue culture are challenged with viruses, rickettsiae, endotoxin, or synthetic double-stranded polynucleotides. Interferon confers species-specific, not virus-specific, protection for cells.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>11- The answer is: A</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">While the herpesviruses (HSV, CMV, VZV) are all well known for latency, adenovirus can also form a latent infection in the lymphoid tissue. In 50 to 80% of surgically removed tonsils or adenoids, adenovirus can be cultured. The virus has also been cultured from mesenteric lymph nodes, and, in rare cases, viral DNA has been detected in peripheral lymphocytes. Recurrent illness usually does not arise from these latent infections; however, activation can occur in the immunosuppressed.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>12- The answer is: C</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">Varicella-zoster virus is a herpesvirus. Chicken pox is a highly contagious disease of childhood that occurs in the late winter and early spring. It is characterized by a generalized vesicular eruption with relatively insignificant systemic manifestations.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Adenovirus has been associated with adult respiratory disease among newly enlisted military troops. Crowded conditions and strenuous exercise may account for the severe infections seen in this otherwise healthy group.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Papillomavirus is one of two members of the family Papovaviridae, which includes viruses that produce human warts. These viruses are host-specific and produce benign epithelial tumors that vary in location and clinical appearance. The warts usually occur in children and young adults and are limited to the skin and mucous membranes.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Rotavirus is worldwide in distribution and has been implicated as the major etiologic agent of infantile gastroenteritis. Infection with this virus varies in its clinical presentation from asymptomatic infection to a relatively mild diarrhea to a severe and sometimes fatal dehydration. The exact mode of transmission of this infectious agent is not known. Because of severe side effects, the rotavirus vaccine has been recalled and is temporarily unavailable.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Infectious mononucleosis caused by cytomegalovirus (CMV) is clinically difficult to distinguish from that caused by Epstein-Barr virus. Lymphocytosis is usually present with an abundance of atypical lymphocytes. CMV-induced mononucleosis should be considered in any case of mononucleosis that is heterophil-negative and in patients with fever of unknown origin. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>13- The answer is: E</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><b><br /></b></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>14- The answer is: A</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">Varicella-zoster virus is a herpesvirus. Chicken pox is a highly contagious disease of childhood that occurs in the late winter and early spring. It is characterized by a generalized vesicular eruption with relatively insignificant systemic manifestations.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Adenovirus has been associated with adult respiratory disease among newly enlisted military troops. Crowded conditions and strenuous exercise may account for the severe infections seen in this otherwise healthy group.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Papillomavirus is one of two members of the family Papovaviridae, which includes viruses that produce human warts. These viruses are host-specific and produce benign epithelial tumors that vary in location and clinical appearance. The warts usually occur in children and young adults and are limited to the skin and mucous membranes.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Rotavirus is worldwide in distribution and has been implicated as the major etiologic agent of infantile gastroenteritis. Infection with this virus varies in its clinical presentation from asymptomatic infection to a relatively mild diarrhea to a severe and sometimes fatal dehydration. The exact mode of transmission of this infectious agent is not known. Because of severe side effects, the rotavirus vaccine has been recalled and is temporarily unavailable.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Infectious mononucleosis caused by cytomegalovirus (CMV) is clinically difficult to distinguish from that caused by Epstein-Barr virus. Lymphocytosis is usually present with an abundance of atypical lymphocytes. CMV-induced mononucleosis should be considered in any case of mononucleosis that is heterophil-negative and in patients with fever of unknown origin. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>15- The answer is: C</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">Epstein-Barr virus (EBV) is a herpesvirus that causes a number of syndromes; the most common is infectious mononucleosis. It is a ubiquitous enveloped DNA virus. Only one serotype of EBV has been recognized, although molecular methods have reorganized a number of genotypes of EBV.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Infectious mononucleosis is an acute disease most commonly seen in younger people. It is characterized by a proliferation of lymphocytes, lymph node enlargement, pharyngitis, fatigue, and fever. Infection in young children is usually either asymptomatic or characteristic of an acute upper respiratory infection. Diagnosis is usually made by a positive heterophil test. Heterophil antibodies are those that occur in one species (human) and react with antigens of a different species. The heterophil test may be insensitive (30 to 60%) in children. Definitive diagnosis is made by detection of antibodies to EBV components.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">EBV causes a variety of other syndromes including Burkitt’s lymphoma, the most common childhood cancer in Africa, and nasopharyngeal carcinoma, commonly seen in China.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Similar mononucleosis-like diseases are caused by cytomegalovirus (CMV) and Toxoplasma gondii, a parasite. CMV causes fewer than 10% of infectious mononucleosis-like diseases. CMV "mono" is primarily characterized by fatigue. Congenital infection with CMV almost always causes serious sequelae, such as retardation and hearing loss. T. gondii also causes a variety of clinical problems, among them encephalitis in AIDS patients and food poisoning from the ingestion of raw meat. Although CMV and T. gondii are relatively rare causes of infectious mononucleosis, they must be ruled out, particularly when EBV tests are nonreactive.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><b>16- The answer is: D</b></span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Human papillomaviruses (HPV) are the causative agents of cutaneous warts as well as proliferative squamous lesions of mucosal surfaces. Although most infections by human papillomavirus are benign, some undergo malignant transformation into in situ and invasive squamous cell carcinoma. Both HPV and polyomavirus have icosahedral capsids and DNA genomes. JC virus, a polyomavirus, was first isolated from the diseased brain of a patient with Hodgkin’s lymphoma who was dying of progressive multifocal leukoencephalopathy (PML). This demyelinating disease occurs usually in immunosuppressed persons and is the result of oligodendrocyte infection by JC virus. JC virus has also been isolated from the urine of patients suffering from demyelinating disease. Cryotherapy and laser treatment are the most popular therapies for warts, although surgery may be indicated in some cases. At the present time, there is no effective antiviral therapy for treatment of infection with polyomavirus or HPV. West Nile virus is an arbovirus. While prevalent in Europe, Africa, and the Middle East, it was not seen in the United States until the summer of 1999. It is transmitted by mosqitoes and birds, especially crows; these animals are a reservoir. WNV causes a rather mild encephalitis in humans, the exception being older patients or those who may be immunocompromised.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><b>17- The answer is: C</b></span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Orthomyxoviruses and paramyxoviruses are RNA viruses that contain a single-stranded RNA genome. The influenza viruses belong to the orthomyxoviruses. They cause acute respiratory tract infections that usually occur in epidemics. Isolated strains of influenza virus are named after the virus type (influenza A, B, or C) as well as the host and location of initial isolation, the year of isolation, and the antigenic designation of the hemagglutinin and neuraminidase. Both the hemagglutinin and neuraminidase are glycoproteins under separate genetic control, and because of this they can and do vary independently. The changes in these antigens are responsible for the antigenic drift characteristic of these viruses. The paramyxoviruses include several important human pathogens (mumps virus, measles virus, respiratory syncytial virus, and parainfluenza virus). Both paramyxoviruses and orthomyxoviruses possess an RNA-dependent RNA polymerase that is a structural component of the virion and produces the initial RNA. Respiratory syncytial viruses (RSV) are not related to the paramyxoviruses. They are 150-nm single-stranded RNA viruses. There are 2 antigen groups, A and B, which play no role in diagnosis and treatment. While the overall mortality is 0.5%, at-risk groups may be 25 to 35% mortality if untreated. Some parainfluenza virus infections (type 3) may be indistinguishable from RSV, but most parainfluenza infections produce a laryngotracheobronchitis known as croup.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><b>18- The answer is: D</b></span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Helicobacter pylori was first recognized as a possible cause of gastritis and peptic ulcer by Marshall and Warren in 1984. This organism is readily isolated from gastric biopsies but not from stomach contents. It is similar to Campylobacter species and grows on chocolate agar at 37°C in the same microaerophilic environment suitable for C. jejuni (Campy-Pak or anaerobic jar [Gas Pak] without the catalyst). H. pylori, however, grows more slowly than C. jejuni, requiring 5 to 7 days incubation. C. jejuni grows optimally at 42°C, not 37°C, as does H. pylori.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><b>19- The answer is: E</b></span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">There have been a number of outbreaks of food poisoning caused by Listeria monocytogenes. Listeria is a common inhabitant of farm animals and can be readily isolated from silage, hay, and barnyard soil. Humans at the extremes of age are most susceptible to Listeria infection but only recently has food been implicated as a vehicle. In the outbreak in Nova Scotia, it is likely that the cabbage used for the coleslaw was fertilized with animal droppings and not properly washed prior to consumption. Major Listeria outbreaks associated with cheese have been seen in the United States and most likely have originated from contaminated milk. Epidemiologic investigation often will provide data on attack rates in such outbreaks. The eventual solution of the problem always lies in a combination of epidemiologic, microbiologic, and clinical information. For example, in the Nova Scotia case, it should not be assumed that the eclairs were the culprit based on the fact that everyone ate them.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><b>20- The answer is: A</b></span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">The incidence of group B streptococcal disease (GBS) is 1–3 cases per 1000 births. Neonates acquire the disease during birth from mothers who harbor the organism. Risk factors include prematurity, premature rupture of membranes, and group B streptococcal carriage. The Gram's stain of cerebrospinal fluid is a rapid test for GBS disease. Although sensitive, the Gram's stain requires experience to differentiate these streptococci from other Gram-positive cocci. Latex tests for GBS antigen are also available, but sensitivity in CSF is not significantly higher than the Gram's stain. GBS can be reduced by intrapartum administration of penicillin. Experimentally, GBS polysaccharide vaccines have also been used. Screening pregnant females early in pregnancy probably offers little advantage because of the possible acquisition of GBS late in the pregnancy. There has been speculation concerning the pathogenesis of GBS. These include failure to activate complement pathways and immobilization of polymorphonuclear leukocytes (PMNs) due to the inactivation of complement C5A, a potent chemoattractant. While GBS is relatively more resistant to penicillin than group A streptococci, the great majority of GBS isolates are still penicillin-susceptible. An aminoglycoside such as gentamicin may be added to GBS treatment regimens due to the relative reduced susceptibility of some strains.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><b>21- The answer is: D</b></span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">The incidence of group B streptococcal disease (GBS) is 1–3 cases per 1000 births. Neonates acquire the disease during birth from mothers who harbor the organism. Risk factors include prematurity, premature rupture of membranes, and group B streptococcal carriage. The Gram's stain of cerebrospinal fluid is a rapid test for GBS disease. Although sensitive, the Gram's stain requires experience to differentiate these streptococci from other Gram-positive cocci. Latex tests for GBS antigen are also available, but sensitivity in CSF is not significantly higher than the Gram's stain. GBS can be reduced by intrapartum administration of penicillin. Experimentally, GBS polysaccharide vaccines have also been used. Screening pregnant females early in pregnancy probably offers little advantage because of the possible acquisition of GBS late in the pregnancy. There has been speculation concerning the pathogenesis of GBS. These include failure to activate complement pathways and immobilization of polymorphonuclear leukocytes (PMNs) due to the inactivation of complement C5A, a potent chemoattractant. While GBS is relatively more resistant to penicillin than group A streptococci, the great majority of GBS isolates are still penicillin-susceptible. An aminoglycoside such as gentamicin may be added to GBS treatment regimens due to the relative reduced susceptibility of some strains.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><b>22- The answer is: C</b></span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">In men, the appearance of a hard chancre on the penis characteristically indicates syphilis. Even though the chancre does not appear until the infection is 2 or more weeks old, the VDRL test for syphilis still can be negative despite the presence of a chancre (the VDRL test may not become positive for 2 or 3 weeks after initial infection). However, a lesion suspected of being a primary syphilitic ulcer should be examined by dark-field microscopy, which can reveal motile treponemes.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><b>23- The answer is: D</b></span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Many types of infection, notably respiratory tract infections and osteomyelitis, are common in people who have sickle cell anemia. For unknown reasons, Salmonella is implicated frequently in these infections. Osteomyelitis in other persons is caused most often by Staphylococcus.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><b>24- The answer is: D</b></span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Haemophilus influenzae is a Gram-negative bacillus. In young children, it can cause pneumonitis, sinusitis, otitis, and meningitis. Occasionally, it produces a fulminative laryngotracheitis with such severe swelling of the epiglottis that tracheostomy becomes necessary. Clinical infections with this organism after the age of 3 years are less frequent.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><b>25- The answer is: E</b></span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Enterococci causes a wide variety of infections ranging from less serious, for example, urinary tract infections, to very serious, such as septicemia. A Gram-positive coccus resistant to penicillin must be assumed to be enterococcus until other more definitive biochemical testing places the isolate in one of the more esoteric groups of Gram-positive cocci. Once isolated, there are a variety of tests to speciate enterococci. However, penicillin-resistant, non--lactamase-producing, vancomycin-resistant, Gram-positive cocci are most likely Enterococcus faecium. There are a variety of mechanisms for vancomycin resistance in E. faecium and they have been termed Van A, B, or C. These isolates have become one of the most feared nosocomial pathogens in the hospital environment. Unfortunately, no approved antibiotics can successfully treat vancomycin-resistant enterococci (VRE), only some experimental antibiotics such as Synercid.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><b>26- The answer is: D</b></span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Food poisoning with E. coli 0157/H7 causes hemorrhagic colitis; it is often seen after eating beef hamburgers. The same organism also causes a hemorrhagic uremic syndrome. The toxin, called Shiga-like toxin, can be demonstrated in Vero cells, but the cytotoxicity must be neutralized with specific antiserum. With the exception of sorbitol fermentation, there is nothing biochemically distinctive about these organisms.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><b>27- The answer is: A</b></span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">H. pylori antigen tests using an ELISA format and a monoclonal antibody to H. pylori are as sensitive as culture of the control portion of the stomach. Urea breath tests are also widely used. H. pylori has an active enzyme (urease) which breaks down radioactive urea. The patient releases radioactive CO2 if H. pylori are present. H. pylori antibody tests, IgG and IgA, indicate the presence of H. pylori and usually decline after effective treatment. Culture of stomach contents is insensitive and not appropriate as a diagnostic procedure for H. pylori. Direct tests such as antigen or culture of gastric mucosa are preferred because they are the most sensitive indication of a cure.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><b>28- The answer is: B</b></span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">This question demonstrates a commonly occurring clinical infectious disease and microbiologic problem. Enterococci may be resistant to ampicillin and gentamicin. Vancomycin would be the drug of choice. However, laboratory results do not always correlate well with clinical response. The National Committee on Clinical Laboratory Standards recommends testing enterococci only for ampicillin and vancomycin.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Some symptomatic patients may have 10 leukocytes per mL of urine but relatively few bacteria. The patient is likely infected and the organisms, particularly if in pure culture, should be further processed.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><b>29- The answer is: E</b></span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">There are few bacteria for which antimicrobial susceptibility is highly predictable. However, some agents are the drug of choice because of their relative effectiveness. Among the three antibiotics that have been shown to treat legionellosis effectively (erythromycin, rifampin, and minocycline), erythromycin is clearly superior, even though in vitro studies show the organism to be susceptible to other antibiotics.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Penicillin remains the drug of choice for S. pneumoniae and the group A streptococci, although a few isolates of penicillin-resistant pneumococci have been observed. Resistance among the pneumococci is either chromosomally mediated, in which case the minimal inhibitory concentrations (MICs) are relatively low, or plasmid-mediated, which results in highly resistant bacteria. The same is generally true for H. influenzae. Until the mid-1970s, virtually all isolates of H. influenzae were susceptible to ampicillin. There has been a rapidly increasing incidence of ampicillin-resistant isolates, almost 35 to 40% in some areas of the United States. Resistance is ordinarily mediated by -lactamase, although ampicillin-resistant, -lactamase-negative isolates have been seen. No resistance to penicillin has been seen in group A streptococci.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C. difficile causes toxin-mediated pseudomembranous enterocolitis as well as antibiotic-associated diarrhea. Pseudomembranous enterocolitis is normally seen during or after administration of antibiotics. One of the few agents effective against C. difficile is vancomycin. Alternatively, bacitracin can be used.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Lyme disease, caused by B. burgdorferi, has been treated with penicillin, erythromycin, and tetracycline. Treatment failures have been observed. Ceftriaxone has become the drug of choice, particularly in the advanced stages of Lyme disease. </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><b>30- The answer is: C</b></span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">The medium of choice for the isolation of pathogenic neisseriae is Thayer-Martin (TM) agar. TM agar is both a selective and an enriched medium; it contains hemoglobin, the supplement Isovitalex, and the antibiotics vancomycin, colistin, nystatin, and trimethoprim.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">V. cholerae as well as other vibrios, including V. parahaemolyticus and V. alginolyticus, are isolated best on thiosulfate citrate bile salts sucrose medium, although media such as mannitol salt agar also support the growth of vibrios. Maximal growth occurs at a pH of 8.5 to 9.5 and at 37°C incubation.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Löwenstein-Jensen slants or plates, which are composed of a nutrient base and egg yolk, are used routinely for the initial isolation of mycobacteria. Small inocula of M. tuberculosis can also be grown in oleic acid albumin media; large inocula can be cultured on simple synthetic media.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Löffler's medium, which is very rich, supports the growth of C. diphtheriae but suppresses the growth of most other nasopharyngeal microflora. C. diphtheriae colonies on this medium appear small, gray, and granular and have uneven edges.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">S. aureus grows very well on sheep blood agar, which is made up of a nutrient base and 5 to 8% sheep blood; selective and differential media, such as mannitol salt agar, also are available for S. aureus. </span><br />
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<br />Anonymoushttp://www.blogger.com/profile/16555664245806923731noreply@blogger.com0tag:blogger.com,1999:blog-3618930566267736040.post-64754919391763528612013-06-10T00:42:00.000-07:002013-06-10T00:42:01.577-07:00Spinal Cord Anatomy<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">EXTERNAL FEATURES</span><br />
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<li><span style="font-family: Arial, Helvetica, sans-serif;">It is the lower elongated cylindrical part of the CNS and connect with the brain above</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">It occupies upper 2/3rd of the vertebral canal </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">It extends from the foraman magnum to the lower border of the L1 or upper border of the L 2 </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">In neonates, the spinal cord extends approximately to vertebra LIII, but can reach as low as vertebra LIV. </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">The lower end is called the <b>conus medullaris</b></span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">From here a prolongation of pia mater, the <b>filum terminale</b> descends to be attached to the back of the coccyx. </span></li>
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<span style="font-family: Arial, Helvetica, sans-serif;">It has six external longitudinal fissures and sulci. They are a deep anterior median fissure, a shallow posterior median sulcus, a pair of anterolateral sulcus and a pair of posterolateral sulcus lying lateral to them.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">It also has two enlargement called <b>cervical</b> and <b>lumbosacral enlargement</b> which represent the aggregations of cell bodies that supply the muscles and skin of upper limbs and lower limbs. </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><b>The spinal cord gives off 31 pairs of spinal nerves. 8 cervical,12 thoracic, 5 lumbar, 5 sacral, & 1 coccygeal </b></span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Each nerve is attached to the spinal cord by 2 roots,<b> ventral ( motor) , & dorsal ( sensory )</b>, each dorsal root bears a spinal ganglion, the ventral & dorsal nerve unites to form the spinal nerve</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">The part of spinal cord that gives off one pair of spinal nerve we call it <b>a segment of spinal cord</b>. Each segment supply a certain area of the trunk and limbs</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Below the lower end of the spinal cord the roots of spinal nerves form a bundle known as the <b>cauda equina</b> (because of resemblance to the tail of a horse) </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;"><b>Internal structure</b></span></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">The spinal cord ,as seen In transverse section, contains central grey matter and peripheral white matter which contains the long ascending and descending tracts.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><b><u>Gray matter</u></b></span><br />
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<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">When seen in transverse section the grey matter of the spinal cord forms an “ H “ shaped mass.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">It is divisible into 1)</span><b style="font-family: Arial, Helvetica, sans-serif;"> Ventral Horn</b><span style="font-family: Arial, Helvetica, sans-serif;">(column ) 2) </span><b style="font-family: Arial, Helvetica, sans-serif;">Dorsal Horn</b><span style="font-family: Arial, Helvetica, sans-serif;"> (column ) 3) intermediate zone .In some parts of spinal cord it presents as a lateral horn (column ) 4)The right & left halves of spinal cord are connected across the midline by the grey commisure, which is traversed by the central canal</span></li>
</ul>
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<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">In the large ventral horn lie the motor cells which give rise to the fibres of the anterior roots to control the movement of skeleton muscles of trunk and limbs</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">In the dorsal horn terminate many of the sensory fibres entering from the dorsal roots. Neurons in the dorsal horn project to higher levels of the CNS to carry sensations to them</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Sympathetic and parasympathetic neurons locate in the intermediate zone of espacially in the thoracic and sacral part of spinal cord.</span></li>
</ul>
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<span style="font-family: Arial, Helvetica, sans-serif;"><b><u>White matter</u></b></span><br />
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<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">The white matter of the sp cord is divisible into right & left halves in front by the anterior median fissure & behind by the posterior median sulcus </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Each half of the white matter is divided into 1) post funiculus 2)lateral funiculus 3)anterior funiculus</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">The white matter of the rt & lft sides is continuous across the midline through the <b>anterior white commisure</b></span></li>
</ul>
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"> <b>The nerve fibers in the white matter are of two general types:</b></span><br />
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<ol>
<li><span style="font-family: Arial, Helvetica, sans-serif;"> long , ascending fibers deliver sensory information to the brain</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;"> </span><span style="font-family: Arial, Helvetica, sans-serif;">long, descending fibers deliver motor instructions from the brain</span></li>
</ol>
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<span style="font-family: Arial, Helvetica, sans-serif;"> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><b>ASCENDING TRACTS</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">1. <b>Fasiculus gracilis and Fasiculus cuneatus </b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">They convey sensory fibres subserving fine </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">touch and proprioception (position sense), mostly </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">uncrossed, to the gracile and cuneate nuclei in the </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">medulla oblongata.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">2 . <b>The lateral and anterior spinothalamic tracts</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">They transmit information to the thalamus about <b><u>pain</u></b>, <b><u>temperature</u></b> and crude <b><u>touch</u></b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><b><u><br /></u></b></span>
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<span style="font-family: Arial, Helvetica, sans-serif;"><b>DESCENDING TRACTS</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><b><br /></b></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>1-Corticospinal tracts </b>– descends from the cerebral cortex to the sp cord. It consists of 2 parts 1) the lat corticospinal tract, which lies in the lateral funiculus. 2) the ant corticospinal tract which lies in the ant funiculus </span><br />
<span class="Apple-tab-span" style="white-space: pre;"><span style="font-family: Arial, Helvetica, sans-serif;"> </span></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> ★ The corticospinal tracts are responsible for voluntary movements control.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>2 . Rubrospinal tracts</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><b>3 . Olivospinal tracts</b></span><br />
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Anonymoushttp://www.blogger.com/profile/16555664245806923731noreply@blogger.com1tag:blogger.com,1999:blog-3618930566267736040.post-22391157627695673512013-06-01T01:50:00.000-07:002013-06-01T01:50:28.770-07:00Step -1 Pathology Quiz<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Q.1</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">What is the most common site of origin of thrombotic pulmonary emboli?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> A.Deep leg veins </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> B.Lumen of left ventricle </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> C.Lumen of right ventricle </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> D.Mesenteric veins </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> E.Superficial leg veins </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Q.2</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">A young child who presents with megaloblastic anemia is found to have increased orotate in the urine due to a deficiency of orotate phosphoribosyl transferase. This enzyme deficiency decreases the synthesis of which of the following</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> A.Glycogen </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> B.Purines </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> C.Pyrimidines </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> D.Sphingomyelin </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> E.Tyrosine</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Q.3</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">A 6-year-old female is being evaluated for recurrent episodes of lightheadedness and sweating due to hypoglycemia. These symptoms are not improved by subcutaneous injection of epinephrine. Physical examination reveals an enlarged liver and a single subcutaneous xanthoma. An abdominal CT scan reveals enlargement of the liver along with bilateral enlargement of the kidneys. Laboratory examination reveals increased serum uric acid and cholesterol with decreased serum glucose levels. Following oral administration of fructose, there is no increase in blood glucose levels. A liver biopsy specimen reveals increased amounts of glycogen in hepatocytes, which also have decreased levels of glucose-6-phosphatase. Which of the following is the most likely diagnosis?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> A.Andersen’s syndrome (type IV glycogen storage disease) </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> B.Cori’s disease (type III glycogen storage disease) </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> C.McArdle’s syndrome (type V glycogen storage disease) </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> D.Pompe’s disease (type II glycogen storage disease) </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> E.von Gierke’s disease (type I glycogen storage disease) </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Q.4</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">A 2-month-old girl presents with a soft, high-pitched, mewing cry and is found to have microcephaly, low-set ears and hypertelorism, and several congenital heart defects. Which of the following chromosomal abnormalities is most likely to produce these symptoms?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> A.46,XX,4p– </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> B.46,XX,5p– </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> C.46,XX,13q– </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> D.46,XX,15q– </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> E.46,XX,17p– </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Q.5</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">A 6-year-old female with a fair complexion is being evaluated for severe mental retardation and seizures. She is found to have a stiff, ataxic gait characterized by jerky movements. She also displays laughter at inappropriate times. Which of the following is the most likely diagnosis?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> A.Beckwith-Wiedemann syndrome </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> B.Prader-Willi syndrome </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> C.Angelman’s syndrome </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> D.Smith-Margens syndrome </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> E.Wolf-Hirschhorn syndrome </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Q.6</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Which one of the following sequences correctly describes the usual temporal sequence of T-lymphocyte maturation within the cortex and medulla of the thymus?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> A.Double negative double positive single positive </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"> B.Double negative single positive double positive </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"> C.Double positive double negative single positive </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"> D.Double positive single positive double negative </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"> E.Single positive double positive double negative </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Q.7</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">After receiving incompatible blood, a patient develops a transfusion reaction in the form of back pain, fever, shortness of breath, and hematuria. How is this type of immunologic reaction classified?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> A.Systemic anaphylactic reaction </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> B.Systemic immune complex reaction </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> C.Delayed type hypersensitivity reaction </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> D.Complement-mediated cytotoxicity reaction </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> E.T cell–mediated cytotoxicity reaction </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Q.8</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">A 28-year-old woman’s first son dies at 7 months of age due to severe combined immunodeficiency disease (SCID). Subsequent workup reveals a mutation in the gene for the common chain of the interleukin 2 receptor (IL2RG). Lymphocyte and red cell adenosine deaminase (ADA) levels are within normal limits. Workup during the woman’s second pregnancy reveals that the fetus has the same abnormality found in her first son. Bone marrow is obtained from the 29-year-old father and is enriched with CD34+ cells (hematopoietic cell progenitors). It is then injected intraperitoneally by percutaneous, ultrasound-guided injection at 16, 17.5, and 18.5 weeks of gestation. At 11 months of life, the second child is found to be clinically normal. Which of the following is the mode of inheritance of this patient’s disease?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> A.Autosomal dominant </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> B.Autosomal recessive </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> C.Mitochondrial </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> D.X-linked dominant </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> E.X-linked recessive </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Q.9</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">A 4-year-old African boy develops a rapidly enlarging mass that involves the right side of his face. Biopsies of this lesion reveal a prominent “starry sky” pattern produced by proliferating small, noncleaved malignant lymphocytes. Based on this microscopic appearance, the diagnosis of Burkitt’s lymphoma is made. This neoplasm is associated with chromosomal translocations that involve which of the following?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> A.bcl-2 </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> B.c-abl </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> C.c-myc </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> D.erb-B </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> E.N-myc </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Q.10</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Gastric carcinoma is most common in which one of the listed geographic locations?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> A.Canada </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> B.France </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> C.Japan </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> D.United Kingdom </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> E.United States </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Q.11</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">A 23-year-old female presents with the recent onset of vaginal discharge. Physical examination reveals multiple clear vesicles on her vulva and vagina. A smear of material obtained from one of these vesicles reveals several multinucleated giant cells with intranuclear inclusions and ground-glass nuclei. These vesicles are most likely the result of an infection with which of the following</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> A.Cytomegalovirus (CMV) </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> B.Herpes simplex virus (HSV) </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> C.Human papillomavirus (HPV) </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> D.Candida albicans </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> E.Trichomonas vaginalis </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Q.12</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">A 33-year-old male in an underdeveloped country presents with a markedly edematous right foot that has multiple draining sinuses. A Gram stain from one of these draining sinuses reveals gram-positive filamentous bacteria that are partially acid-fast. Which of the following organisms is the most likely cause of this abnormality?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> A.Actinomyces israelii </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> B.Corynebacterium diphtheriae </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> C.Listeria monocytogenes </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> D.Nocardia asteroides </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> E.Pneumocystis carinii </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Q.13</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">A 35-year-old female who lives in the southeastern portion of the United States and likes to hike in the Great Smoky Mountains presents with a spotted rash that started on her extremities and spread to her trunk and face. A biopsy of one of these lesions reveals necrosis and reactive hyperplasia of blood vessels. Which of the following is the most likely causative agent of her disease</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> A.Bartonella henselae </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> B.Bartonella quintana </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> C.Coxiella burnetii </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> D.Rickettsia prowazekii </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> E.Rickettsia rickettsii </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Q.14</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">An apathetic male infant in an underdeveloped country is found to have peripheral edema, a “moon” face, and an enlarged, fatty liver. Which one of the following mechanisms is involved in the pathogenesis of this child’s abnormalities?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> A.Decreased protein intake leads to decreased lipoproteins </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> B.Decreased caloric intake leads to hypoalbuminemia </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> C.Decreased carbohydrate intake leads to hypoglycemia </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> D.Decreased fluid intake leads to hypernatremia </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> E.Decreased fat absorption leads to hypovitaminosis </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Q.15</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">A patient with malabsorption who develops a deficiency of vitamin A is most likely to subsequently develop which of the following?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> A.Acute leukemia </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> B.Intestinal metaplasia </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> C.Megaloblastic anemia </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> D.Night blindness </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> E.Soft bones</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Q.16</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Which one of the following individuals is most likely to have a deficiency of vitamin E?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> A.A premature male infant with skeletal muscle weakness and a hemolytic anemia </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> B.A 36-year-old male with progressive night blindness </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> C.A 45-year-old female with bleeding and a prolonged PT and PTT </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> D.A 48-year-old female with chronic atrophic gastritis and anemia </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> E.A 67-year-old female with osteopenia and bone pain </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Q.17</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">A 62-year-old male alcoholic is brought into the emergency room acting very confused. Physical examination reveals a thin and emaciated male who has problems with memory, ataxia, and paralysis of his extraocular muscles. Extensive workup reveals atrophy and small hemorrhages in the periventricular region of his brain and around the mamillary bodies. These signs and symptoms are most consistent with which of the following deficiencies</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> A.Biotin </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> B.Riboflavin </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> C.Selenium </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> D.Pyridoxine </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> E.Thiamine </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Q.18</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Laboratory examination of a 46-year-old male who presents with decreasing vision and photophobia finds a high anion–gap metabolic acidosis. These findings are most consistent with this individual having ingested which of the following substances?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> A.Cadmium </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> B.Nickel </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> C.Mercury </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> D.Cobalt </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> E.Methanol </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Q.19</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">A newborn female infant develops edema, jaundice, and trouble breathing. The blood type of the mother is AB negative, while the baby and the father are both B positive. The mother’s only other pregnancy was unremarkable, and she has never received any blood or blood products. Laboratory examination reveals a positive Coombs (DAT) test. Which of the following is the most likely diagnosis</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> A.ABO hemolytic disease of the newborn </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> B.Hemoglobin H disease </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> C.Hyaline membrane disease of the newborn </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> D.Hydrops fetalis </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> E.Rh hemolytic disease of the newborn </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Q.20</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Which one of the listed clinical scenarios is most consistent with a diagnosis of SIDS?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> A.A 2-year-old female dies suddenly and no autopsy is performed </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> B.A 3-month-old female dies during sleep and the cause of death is unknown after autopsy </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> C.A 4-week-old female dies from respiratory complications after being born 10 weeks prematurely </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> D.A 9-month-old male dies and an autopsy finds evidence of repeated bone fractures and bilateral retinal hemorrhages </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> E.A male is stillborn at 29 weeks of gestation to a mother with obstetrical complications </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"> Answers & Explanation</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">1-</span>The answer is: A</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">An embolus is a detached intravascular mass that has been carried by the blood to a site other than where it was formed. Emboli basically can be thrombotic or embolic, but most originate from thrombi. These thromboemboli, most of which originate in the deep veins of the lower extremities, may embolize to the lungs. The majority of small pulmonary emboli do no harm, but, if they are large enough, they may occlude the bifurcation of the pulmonary arteries (saddle embolus), causing sudden death. Arterial emboli most commonly originate within the heart on abnormal valves (vegetations) or mural thrombi following myocardial infarctions. If there is a patent foramen ovale, a venous embolus may cross over through the heart to the arterial circulation, producing an arterial (paradoxical) embolus. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Types of nonthrombotic emboli include fat emboli, air emboli, and amniotic fluid emboli. Fat emboli, which result from severe trauma and fractures of long bones, can be fatal as they can damage the endothelial cells and pneumocytes within the lungs. Air emboli are seen in decompression sickness, called caisson disease or the bends, while amniotic fluid emboli are related to the rupture of uterine venous sinuses as a complication of childbirth. Amniotic fluid emboli can also lead to a fatal disease, disseminated intravascular coagulopathy (DIC), which is marked by the combination of intravascular coagulation and hemorrhages. In this setting DIC results from the high thromboplastin activity of amniotic fluid.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">2.</span>The answer is: C</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">The synthesis of pyrimidines begins with the conversion of glutamine to carbamoyl phosphate. This step, which is the committed step in pyrimidine synthesis, is catalyzed by the enzyme carbamoyl phosphate synthetase II (CPSII) and requires 2ATP and CO2. After several biochemical steps orotate is formed; orotate is then converted to orotidine 5'-monophosphate (OMP) by the enzyme orotate phosphoribosyl transferase. Subsequently OMP is converted to uridine 5'-monophosphate (UMP) by the enzyme OMP decarboxylase. A deficiency of either of these two enzymes leads to a disorder called orotic aciduria, which is characterized by orotate in the urine, abnormal growth, and megaloblastic anemia. Next UMP is converted to CTP, while dUMP is converted by thymidylate synthase to dTMP. This latter step also involves folate and is inhibited by the folate analogue methotrexate, while thymidylate synthase is inhibited by the thymine analogue 5-flurouracil (5-FU). Finally, the ribonucleoside diphosphates (ADP, GDP, CDP, and UDP) are converted to deoxyribonucleoside diphosphates by ribonucleotide reductase, an enzyme that is inhibited by increased levels of dATP, as seen in individuals with the autosomal recessive (Swiss type) form of SCID, which is due to a deficiency of adenosine deaminase (ADA).</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">3</span>.The answer is: E</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">The glycogen storage diseases are due to defective metabolism of glycogen, and at least 11 syndromes stemming from genetic defects in the responsible enzymes have been described. Most of these glycogenoses are inherited as autosomal recessive disorders. von Gierke’s disease (type I) results from deficiency of glucose-6-phosphatase, the hepatic enzyme needed for conversion of G6P to glucose, with glycogen accumulation particularly in the enlarged liver and kidney and hypoglycemia. Diagnosis requires biopsy demonstration of excess liver glycogen plus either absent or low liver glucose-6-phosphatase activity, or a diabetic glucose tolerance curve, or hyperuricemia. von Gierke’s disease is the major hepatic or hepatorenal type of glycogenosis. Lysosomal glucosidase deficiency causes Pompe’s disease (type II). Glycogen storage is widespread but most prominent in the heart (cardiomegaly). In brancher glycogenosis (type IV) there is accumulation of amylopectin or abnormal glycogen in the liver, heart, skeletal muscle, and brain. The major myopathic form, McArdle’s disease (type V), is due to lack of muscle phosphorylase.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">4.</span>The answer is: B</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Several genetic diseases are characterized by a deletion of part of an autosomal chromosome. The 5p– syndrome is also called the cri-du-chat syndrome, as affected infants characteristically have a high-pitched cry similar to that of a kitten. Additional findings in this disorder include severe mental retardation, microcephaly, and congenital heart disease. 4p–, also called Wolf-Hirschhorn syndrome, is characterized by pre- and postnatal growth retardation and severe hypotonia. Affected infants have many defects including micrognathia and a prominent forehead. The 11p– syndrome is characterized by the congenital absence of the iris (aniridia) and is often accompanied by Wilms tumor of the kidney. The 13q– syndrome is associated with the loss of the Rb suppressor gene and the development of retinoblastoma. Deletions involving chromosome 15 (15q–) may result in either Prader-Willi syndrome or Angelman’s syndrome depending on whether the defect involves the paternal or the maternal chromosome (genetic imprinting). 17p–, also known as Smith-Margens syndrome, is associated with self-destructive behavior.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">5.</span>The answer is: C</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Genetic imprinting refers to the fact that different diseases may result from the same chromosomal deletion depending on whether that deletion specifically involves either the maternal chromosome or the paternal chromosome. This finding is in sharp contrast to the classic concept of Mendelian inheritance, which states that the phenotype of a certain allele is independent of whether the chromosome is the maternal or the paternal chromosome. The best example of genetic imprinting involves deletions involving chromosome 15 (15q–). If the deletion involves the maternal chromosome, then Angelman’s syndrome results, while deletions involving the paternal chromosome result in Prader-Willi syndrome. Angelman’s syndrome is characterized by severe mental retardation, seizures, a stiff ataxic gait with jerky movements, inappropriate laughter, and occasional oculocutaneous albinism. Because of the combination of ataxic gait and inappropriate laughter, these patients are sometimes referred to as “happy puppets.” Prader-Willi syndrome is characterized by short stature, obesity, mild to moderate mental retardation, small hands and feet, and hypogonadism, which is characterized in males by cryptorchidism and micropenis and in females by hypoplastic labia. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">The cause of genetic imprinting is not known, but it may relate to the degree of methylation of genes. Genes that are more highly methylated are less likely to be transcribed into messenger RNA. Note that a loss of chromosome 15 can also occur if two parental chromosomes of the same type are derived from the same parent. This condition is called uniparental disomy, whereas the normal condition is called biparental disomy. Inheritance of the same (duplicated) chromosome is called isodisomy, while inheritance of homologues from the same parent is called heterodisomy. To illustrate this concept, consider paternal uniparental disomy of chromosome 15. This refers to inheriting two copies of paternal chromosome 15 and no maternal chromosome 15. Therefore, this is essentially the same as a deletion of maternal chromosome 15, which produces Angelman’s syndrome. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Inheriting two copies of paternal chromosome 11 results in Beckwith-Wiedemann syndrome. This is not a trisomy, as the maternal chromosome is lost, and therefore this would be a paternal uniparental disomy for chromosome 11. This syndrome is characterized by exomphalos, macroglossia, and gigantism (EMG). Patients also develop hypoglycemia because the genes for insulin and insulinlike growth factors are located in this region. Smith-Margens syndrome (17p–) is associated with self-destructive behavior, while Wolf-Hirschhorn syndrome (4p–) is characterized by growth retardation, severe hypotonia, and micrognathia.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">6.</span>The answer is: A</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">T cells arise from precursor cells in the bone marrow that migrate to the thymus and mature. Like B cells, T cells originate from a common lymphoid stem cell that includes intranuclear terminal deoxynucleotidyl transferase (TdT) and surface antigens CD34 and CD38. This stage of development occurs prior to the migration of the developing cell to the thymus and is called the prethymus stage. There are three stages of maturation within the thymus. Stage I occurs in the outer cortex of the thymus, where the developing T lymphocytes (thymocytes) obtain the surface antigen CD7 followed by CD2 and CD5. These stage I (or early) thymocytes lack both CD4 or CD8 and are called double-negative cells. These cells make up about 10% of the thymocytes in the thymus. The next step in development, which starts in the cortex and continues into the medulla, involves generation of an intact T cell receptor (TCR) on the cell surface. The TCR is a heterodimer, usually made up of an and a chain, each having a variable (antigen-binding) region and a constant region, analogous to the immunoglobulin molecule. Early in the formation of TCR, called stage II, the intermediate (common) thymocytes acquire both CD4 and CD8 molecules and are called double-positive T cells. They are the majority of thymocytes in the thymus (80%). Stage III occurs in the medulla, where the T cells lose either the CD4 or the CD8 antigen. These mature thymocytes, which are single-positive cells, make up about 15% of the thymus thymocytes. Post-thymus T cells are either CD4+ or CD8+. CD4+ cells function as helper cells, while CD8+ cells function as cytotoxic cells. In normal, healthy individuals, the helper/suppressor ratio (e.g., CD4/CD8 ratio) in the peripheral blood is about 2:1. That is, about 40% of peripheral lymphocytes are helper cells and 20% of peripheral lymphocytes are cytotoxic T cells.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">7.</span>The answer is: D</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">A blood transfusion reaction is a type II hypersensitivity reaction that is mediated by antibodies reacting against antigens present on the surface of blood group antigens or irregular antigens present on the donor’s red blood cells. Type II hypersensitivity reactions result from attachment of antibodies to changed cell surface antigens or to normal cell surface antigens. Complement-mediated cytotoxicity occurs when IgM or IgG binds to a cell surface antigen with complement activation and consequent cell membrane damage or lysis. Blood transfusion reactions and autoimmune hemolytic anemia are examples of this form. Systemic anaphylaxis is a type I hypersensitivity reaction in which mast cells or basophils that are bound to IgE antibodies are reexposed to an allergen, which leads to a release of vasoactive amines that causes edema and broncho- and vasoconstriction. Sudden death can occur. Systemic immune complex reactions are found in type III reactions and are due to circulating antibodies that form complexes upon reexposure to an antigen (such as foreign serum), which then activates complement. This process is followed by chemotaxis and aggregation of neutrophils, which leads to release of lysosomal enzymes and eventual necrosis of tissue and cells. Serum sickness and Arthus reactions are examples of type III reactions. Delayed type hypersensitivity is type IV and is due to previously sensitized T lymphocytes, which release lymphokines upon reexposure to the antigen. This takes time—perhaps up to several days following exposure. The tuberculin reaction is the best-known example. T cell–mediated cytotoxicity leads to lysis of cells by cytotoxic T cells in response to tumor cells, allogenic tissue, and virus-infected cells. These cells have CD8 antigens on their surfaces.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">8.</span>The answer is: E</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Patients with severe combined immunodeficiency disease (SCID) have defects of lymphoid stem cells involving both T cells and B cells. These patients have severe abnormalities of immunologic function with lymphopenia. They are at risk for infection with all types of infectious agents, including bacteria, mycobacteria, fungi, viruses, and parasites. Patients have a skin rash at birth, possibly due to a graft-versus-host reaction from maternal lymphocytes. Patients are particularly prone to chronic diarrhea, due to rotavirus and bacteria, and to oral candidiasis. About 50% of patients with the autosomal recessive form (Swiss type) lack the enzyme adenosine deaminase (ADA) in their red cells and leukocytes. This leads to accumulation of adenosine triphosphate and deoxyadenosine triphosphate, both of which are toxic to lymphocytes. The other form of SCID is an X-linked form due to a defect in the IL-2 receptor.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">9.</span>The answer is: C</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">There are several mechanisms through which proto-oncogenes (p-oncs) can become oncogenic (c-oncs). Normal cellular genes (proto-oncogenes) may become oncogenic by being incorporated into the viral genome (forming v-oncs), or they may be activated by other processes to form cellular oncogenes (c-oncs). These other processes include gene mutations, chromosomal translocations, and gene amplifications. Gene mutations, such as point mutations, are associated with the formation of cancers by mutant c-ras oncogenes. Chromosomal translocations are associated with the development of many types of cancers, one example of which is Burkitt’s lymphoma. The most common translocation associated with Burkitt’s lymphoma is t(8;14), in which the c-myc oncogene on chromosome 8 is brought in contact with the immuno-globulin heavy chain gene on chromosome 14. Two other examples of chromosomal translocations are the association of chronic myelocytic leukemia (CML) with t(9;22), which is the Philadelphia chromosome, and the association of follicular lymphoma with the translocation t(18;14). The former involves the proto-oncogene c-abl, which is rearranged in proximity to a break point cluster region (bcr) on chromosome 22. The resultant chimeric c-abl/bcr gene encodes a protein with tyrosine kinase activity. The t(18;14) translocation involves the bcl-2 oncogene on chromosome 18. Expression of the oncogene bcl-2 is associated with the prevention of apoptosis in germinal centers. Examples of associations that involve gene amplification include N-myc and neuroblastoma, c-neu and breast cancer, and erb-B and breast and ovarian cancer. Gene amplifications can be demonstrated by finding doublet minutes or homogenous staining regions.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">10</span>.The answer is: C</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">There are marked differences in the incidence of various types of cancer in different parts of the world. The highest rates for gastric carcinoma are found in Japan, Chile, China, and Russia, while it is much less common in the United States, the United Kingdom, Canada, and France. The high rates for gastric cancer in Japan might be related to dietary factors, such as eating smoked and salted foods. Other examples of geographic variations in the incidence of neoplasms include nasopharyngeal carcinoma, liver cancer, and trophoblastic disease. Nasopharyngeal carcinoma, associated with the Epstein-Barr virus, is rare in most parts of the world, except for parts of the Far East, especially China. Liver cancer is associated with both hepatitis B infection and high levels of aflatoxin B1. It is endemic in large parts of Africa and Asia. Trophoblastic diseases, including choriocarcinoma, have high rates of occurrence in the Pacific rim areas of Asia. In contrast, Asian populations have a very low incidence of prostate cancer.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">11.</span>The answer is: B</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">The cytopathic effect of viruses is often a clue to the diagnosis of the type of infection that is present. There are several types of herpesviruses, which are relatively large, double-stranded DNA viruses. Infection by herpes simplex virus (HSV) or varicella-zoster virus (VZV) is recognized by nuclear homogenization (ground-glass nuclei), intranuclear inclusions (Cowdry type A bodies), and the formation of multinucleated cells. Herpes simplex type 2, a sexually transmitted viral disease, results in the formation of vesicles that ulcerate and cause burning, itching, and pain. These lesions heal spontaneously, but the virus remains dormant in the lumbar and sacral ganglia. Recurrent infections may occur, and transmission to the newborn during delivery is a feared complication that may be fatal to the infant. Shingles and chickenpox are caused by herpes zoster, which is identical to varicella. Cytomegalovirus (CMV) causes both the nucleus and the cytoplasm of infected cells to become enlarged. Infected cells have large, purple intranuclear inclusions surrounded by a clear halo and smaller, less prominent basophilic intracytoplasmic inclusions. Adenoviruses can produce similar inclusions, but the infected cells are not enlarged. Adenoviruses also produce characteristic smudge cells in infected respiratory epithelial cells. Human papillomavirus (HPV) infection may produce a characteristic effect that is called koilocytosis. Histologic examination reveals enlarged squamous epithelial cells that have shrunken nuclei (“raisinoid”) within large cytoplasmic vacuoles. Candidiasis is the most common fungal infection of the vagina and is especially common in patients who have diabetes or take oral contraceptives. Candida infection causes vulvar itching and produces a white discharge. Microscopic examination of the vaginal discharge reveals yeast and pseudohyphae. T. vaginalis, a large, pear-shaped, flagellated protozoan, causes severe vaginal itching with dysuria. It produces a thick yellow-gray discharge.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">12.</span>The answer is: D</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Nocardia (N. asteroides) and Actinomyces species are classified as filamentous soil bacteria, although they are often described among the fungi. A. israelii is a normal inhabitant of the mouth; it can be seen in the crypts of tonsillectomy specimens. Actinomyces is a branched, filamentous gram-positive bacteria. Two forms of disease produced by Actinomyces are cervicofacial actinomyces and pelvic actinomyces. The former consists of an indurated (lumpy) jaw with multiple draining fistulas or abscesses. Small yellow colonies called sulfur granules may be seen in the draining material. Histologic section reveals tangled masses of gram-positive filamentous bacteria. Cultures of Actinomyces grow as white masses with a domed surface, which is called a “molar tooth” appearance. Another filamentous gram-positive bacteria is N. asteroides. A characteristic that helps to differentiate these two is the fact that Nocardia is partially acid-fast. “Partial” means using weak mineral acids in the acid-fast stain. Nocardiae are aerobic and acid-fast, in contrast to Actinomyces species, which are strict anaerobes and not acid-fast. Inhaled nocardial bacteria produce lung or skin infections. Progressive pneumonia with purulent sputum and abscesses is suggestive of nocardiosis, especially if dissemination to the brain or subcutaneous tissue occurs. Nocardia is also one cause of mycetoma, a form of chronic inflammation of the skin that causes indurated abscesses with multiple draining sinuses. Patients who develop nocardiosis are often immunosuppressed, and transplant rejection, steroid therapy, AIDS, or alveolar proteinosis are often antecedent. Organisms in sputum, pus, or bronchial lavage specimens are gram-positive. A modified acid-fast stain should be used for diagnosis. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C. diphtheriae is a small, pleomorphic gram-positive bacillus that may have club-shaped swellings at either pole. These rods tend to arrange themselves at right angles, producing characteristic V or Y configurations described as “Chinese characters.” C. diphtheriae produces a toxin that blocks protein synthesis by causing irreversible inactivation of elongation factor 2 (EF-2). This toxin can produce a pseudomembrane covering the larynx, which is difficult to peel away without causing bleeding, and heart damage with fatty change. L. monocytogenes is a short, gram-positive, non-spore-forming bacillus that can produce neonatal disease or can result in stillbirth. Characteristics that are unique to Listeria include a tumbling motility on hanging drop and an umbrella-shaped motility pattern when a specimen is stabbed into a test tube agar slant.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">13.</span>The answer is: E</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Rickettsia are obligate intracellular parasites that infect endothelial cells and produce symptoms as a result of vasculitis and formation of microthrombi. Serologic tests for rickettsia include complement fixation tests and the Weil-Felix agglutination reaction. The basis for the latter test is the fact that the sera of infected patients can agglutinate strains of Proteus vulgaris. There are numerous types of rickettsia that produce many different diseases. Examples include Rocky Mountain spotted fever (RMSF, caused by R. rickettsii), epidemic typhus (caused by R. prowazekii and spread by the human body louse Pediculus humanus), endemic typhus (caused by R. typhi and spread by lice), scrub typhus (caused by R. tsutsugamushi and spread by mites), ehrlichiosis, and Q fever (caused by C. burnetii and spread not by vectors but by inhalation of aerosols). RMSF is found not only in the Rocky Mountains, but also the southeastern and south central United States. The vector in the Rocky Mountains is the wood tick (Dermacentor andersoni), while in the southeast it is the dog tick (Dermacentor variabilis) and in the south central United States it is the Lone Star tick. The animal reservoirs for RMSF are wild rodents and dogs. The rash of RMSF characteristically begins peripherally and spreads centrally to the trunk and face. The pathology involves infection of blood vessels producing thrombosis. Intracellular bacilli form parallel rows in an end-to-end arrangement (“flotilla at anchor facing the wind”). Patients also develop muscle pain and high fever. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Bartonella infections are also characterized by proliferations of blood vessels. Examples of Bartonella include B. quintana, B. henselae, and B. bacilliformis, the causative agent of Oroya fever. B. quintana is spread by the human body louse and is the causative agent of trench fever (seen in the trenches of World War I) and bacillary angiomatosis. This latter term refers to a lesion seen in patients with AIDS consisting of a lobular proliferation of capillaries with abundant leukocytoclastic debris. B. henselae is the causative agent of cat-scratch fever. Histologically, this disease is characterized by the formation of stellate microabscesses with necrotizing granulomas.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">14.</span>The answer is: A</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Protein-energy malnutrition (PEM) in underdeveloped countries leads to a spectrum of symptoms from kwashiorkor at one end to marasmus at the other. Marasmus, caused by a lack of caloric intake (i.e., starvation), leads to generalized wasting, stunted growth, atrophy of muscles, and loss of subcutaneous fat. There is no edema or hepatic enlargement. These children are alert, not apathetic, and are ravenous. In contrast, children with kwashiorkor, which is characterized by a lack of protein despite adequate caloric intake, have peripheral edema, a “moon” face, and an enlarged, fatty liver. The peripheral edema is caused by decreased albumin and sodium retention, while the fatty liver is caused by decreased synthesis of the lipoproteins necessary for the normal mobilization of lipids from liver cells. Additionally, these children have “flaky paint” areas of skin and abnormal pigmented streaks in their hair (“flag sign”). In children with marasmus, the skin is inelastic due to loss of subcutaneous fat. In either severe kwashiorkor or marasmus, thymic atrophy may result in the reduction in number and function of circulating T cells. B cell function (i.e., immunoglobulin production) is also depressed, so that these children are highly vulnerable to infections.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">15.</span>The answer is: D</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">The symptoms of vitamin A deficiency result from abnormalities involving the normal functions of vitamin A. These normal functions include maintaining mucus-secreting epithelium, restoring levels of the visual pigment rhodopsin, increasing immunity to infections, and acting as an antioxidant. Deficiencies of vitamin A result in squamous metaplasia of mucus membranes, not intestinal metaplasia. Squamous metaplasia of the respiratory tract leads to increased numbers of pulmonary infections due to lack of the normal protective mucociliary “elevator.” Squamous metaplasia of the urinary tract leads to increased numbers of urinary tract stones, while such metaplasia in sebaceous and sweat glands of dry skin causes follicular hyperkeratosis and predisposes to acne. There are numerous eye changes produced by a vitamin A deficiency. These changes include dry eyes (xerophthalmia), soft cornea (keratomalacia), and elevated white plaques of keratin debris on the conjunctiva (Bitot’s spots). Because vitamin A is important in the normal function of rhodopsin, a visual pigment important for vision in dim light, a deficiency of vitamin A is associated with poor vision in dim light. This night blindness is usually the first symptom seen in patients with a vitamin A deficiency. Rather than causing acute leukemia, vitamin A is used with good results in the treatment of acute promyelocytic leukemia. Megaloblastic anemia is associated with a deficiency of either vitamin B12 or folate, while a deficiency of vitamin D leads to decreased mineralization of bones (soft bones).</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">16.</span>The answer is: A</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Vitamin E ( tocopherol, the most potent form, and tocotrienols) functions primarily as an antioxidant. As such, it protects membranes, especially the membranes of erythrocytes, from peroxidation of polyunsaturated fatty acids. This antioxidation property of vitamin E acts in concert with selenium. Deficiencies of vitamin E may produce spinocerebellar degeneration and skeletal muscle abnormalities. Manifestations of the neuropathologic changes, which affect the posterior columns of the spinal cord, include decreased tendon reflexes, ataxia, and loss of pain, position, and vibration sense. Note that red cells use vitamin E to protect their membranes from oxidation, and a deficiency of vitamin E in newborns can lead to a hemolytic anemia. In contrast, progressive night blindness is associated with a deficiency of vitamin A; bleeding with a prolonged PT and PTT is associated with a deficiency of vitamin K; chronic atrophic gastritis and anemia are associated with a deficiency of vitamin B12; and osteopenia and bone pain are associated with a deficiency of vitamin D.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">17.</span>The answer is: E</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Vitamin B1 (thiamine) has three important functions. It participates in oxidative decarboxylation of a-keto acids; participates as a cofactor for transketolase in the pentose phosphate path; and participates in maintaining neural membranes. The causes of thiamine deficiency include poor diet, deficient absorption and storage, and accelerated destruction of thiamine diphosphate. This deficiency may be seen in alcoholics and prisoners of war because of poor nutrition, or it may be seen in individuals who eat large amounts of polished rice. (Polishing rice removes the outer, thiamine-containing portion of the grain.) Thiamine deficiency (called beriberi) mainly affects two organ systems, the heart and the nervous system. If the heart is affected in a patient with beriberi, it may become dilated and flabby. Patients may also develop peripheral vasodilation that leads to a high-output cardiac failure and marked peripheral edema. This combination of vascular abnormalities is called wet beriberi. The peripheral nerves in beriberi may be damaged by focal areas of myelin degeneration, which leads to footdrop, wristdrop, and sensory changes (numbness and tingling) in the feet and lower legs. These symptoms are referred to as dry beriberi. Thiamine deficiency may produce the central nervous system (CNS) symptoms of Wernicke-Korsakoff syndrome. Wernicke’s encephalopathy consists mainly of foci of hemorrhages and necrosis in the mammillary bodies and about the ventricular regions of the thalamus and hypothalamus, about the aqueduct in the midbrain, and in the floor of the fourth ventricle. Symptoms of Wernicke’s syndrome include progressive dementia (confusion), ataxia, and paralysis of the extraocular muscles—often with bilateral lateral rectus, or sixth nerve, palsies (ophthalmoplegia). Korsakoff psychosis is a thought disorder that produces retrograde memory failure and confabulation.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">18.</span>The answer is: E</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Many environmental chemicals are potential causes of quite serious human diseases. Methanol, originally called wood alcohol, is metabolized in the body by the enzyme alcohol dehydrogenase to formaldehyde and formic acid. These metabolites cause necrosis of retinal ganglion cells, which leads to a metabolic acidosis and blindness. It is interesting to note that the treatment for acute methanol ingestion is IV ethyl alcohol, because it is also metabolized by alcohol dehydrogenase and therefore ties up this enzyme. Cadmium, which can be found in tobacco smoke, has been implicated in producing not only an acute form of pneumonia, but, with chronic exposure to small concentrations of cadmium vapors, diffuse interstitial pulmonary fibrosis and an increased incidence of emphysema as well. Nickel can cause contact dermatitis, which is a type IV hypersensitivity reaction, while mercury toxicity damages the kidneys and the brain. The neurologic symptoms include a tremor due to cerebellar abnormalities, and mental changes. Historically the use of mercury in the hatmaking industry caused these symptoms and resulted in the expression “mad as a hatter.” A famous widespread outbreak of mercury poisoning occurred in the Minamata coastal region of Japan (and led to the term Minamata disease). Cobalt poisoning can produce a dilated cardiomyopathy.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">19.</span>The answer is: E</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Hemolytic disease of the newborn (HDN) is a type of isoimmune hemolytic anemia that is caused by maternal antibodies that react against fetal red blood cells. Once the maternal antibodies cross the placenta, the fetal red cells are destroyed, leading to a hemolytic anemia. The breakdown of hemoglobin leads to hyperbilirubinemia (jaundice), which is due to severe unconjugated hyperbilirubinemia, as the released heme is not easily conjugated by the immature newborn liver, which is deficient in glucuronyl transferase. The unconjugated bilirubin is water-insoluble and has an affinity for lipids. In an infant with a poorly developed blood-brain barrier, the bilirubin may bind to the lipids in the brain and produce kernicterus. The severe anemia may result in congestive heart failure, which, together with hypoproteinemia may lead to generalized edema (anasarca), which in its most severe form is called hydrops fetalis. In the peripheral blood of the newborn, many immature red blood cells may be found (nucleated RBCs or normoblasts). This condition is called erythroblastosis and led to another name for HDN being erythroblastosis fetalis. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">In order for the mother to make antibodies that are directed against fetal erythrocyte antigens, she must lack the erythrocyte antigens that the child has, which were inherited from the father. The most important erythrocyte antigens involved in HDN are the Rh and the ABO antigens. The most important Rh antigen is the D antigen. Therefore, for Rh incompatibility, the mother must be Rh negative (d), the child Rh positive (D). For ABO incompatibility, the mother must be type O (lacking the A and B antigens), the child type A or B. ABO incompatibility is the most common cause of hemolytic disease of the newborn. Usually the disease is less severe than HDN due to Rh incompatibility because there is poor expression of blood group antigens A and B on neonatal red cells.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">20.</span>The answer is: B</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Sudden infant death syndrome (SIDS) is a heterogeneous, multifactorial disorder, but by definition it refers to sudden death of infant under 1 year of age that is unexplained after thorough examination. Most cases of SIDS occur between 2 and 4 months of life, and the child usually dies during sleep (“crib death” or “cot death”). A risk factor for SIDS is sleeping in a prone position. Therefore healthy infants should sleep on their back or side. Maternal factors associated with SIDS include age less than 20, being unmarried, low socioeconomic group, smoking, and drug abuse. Infant factors associated with SIDS include prematurity, low birth weight, male sex, and a history of SIDS in a sibling. In contrast to SIDS, death from respiratory complications after being born 10 weeks prematurely is suggestive of hyaline membrane disease, while evidence of repeated bone fractures and bilateral retinal hemorrhages is suggestive of trauma, child abuse, or “shaken baby” syndrome.</span><br />
<br />Anonymoushttp://www.blogger.com/profile/16555664245806923731noreply@blogger.com0tag:blogger.com,1999:blog-3618930566267736040.post-1819337229239509692013-05-29T06:30:00.003-07:002013-05-29T06:30:40.881-07:00Pathology Quiz<br />
<span style="font-family: Arial, Helvetica, sans-serif;">Q.1</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Increased lipolysis of fat stores, which can result from starvation, diabetes mellitus, or corticosteroid use, is most likely to cause steatosis (fatty liver) through which one of the following mechanisms?</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">A.Decreased free fatty acid excretion from the liver leads to free fatty acid accumulation in hepatocytes </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> B.Excess NADH (high NADH/NAD ratio) causes excess production of lactate from pyruvate, which accumulates in hepatocytes </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> C.Increased free fatty acid delivery to the liver leads to triglyceride accumulation in hepatocytes </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> D.Inhibition of apoprotein synthesis by the liver leads to phospholipid accumulation in hepatocytes </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> E.Inhibition of HMG-CoA reductase activity leads to cholesterol accumulation in hepatocytes </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Q.2</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">An adult patient presents with the sudden onset of massive diarrhea. Grossly, this individual’s stool has the appearance of “rice-water” because of the presence of flecks of mucus. Cultures of this patient’s stool grow Vibrio cholerae, a curved, gram-negative rod that secretes an enterotoxin consisting of a toxic A subunit and a binding B subunit. The cholera enterotoxin causes massive diarrhea by which of the following mechanisms?</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"> A.</span><span style="font-family: Arial, Helvetica, sans-serif;">Inhibiting the conversion of Gi-GDP to Gi-GTP </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> B.</span><span style="font-family: Arial, Helvetica, sans-serif;">Inhibiting the conversion of Gs-GTP to Gs-GDP </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> C.</span><span style="font-family: Arial, Helvetica, sans-serif;">Stimulating the conversion of Gi-GDP to Gi-GTP </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> D.</span><span style="font-family: Arial, Helvetica, sans-serif;">Stimulating the conversion of Gs-GDP to Gs-GTP </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> E.</span><span style="font-family: Arial, Helvetica, sans-serif;">Stimulating the conversion of Gs-GTP to Gs-GDP </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Q.3</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">A 24-year-old female presents with severe pain during menses (dysmenorrhea). To treat her symptoms, you advise her to take indomethacin in the hopes that it will reduce her pain by interfering with the production of which of the following</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> A.</span><span style="font-family: Arial, Helvetica, sans-serif;">Bradykinin </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> B.</span><span style="font-family: Arial, Helvetica, sans-serif;">Histamine </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> C.</span><span style="font-family: Arial, Helvetica, sans-serif;">Leukotrienes </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> D.</span><span style="font-family: Arial, Helvetica, sans-serif;">Phospholipase A2 </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> E.</span><span style="font-family: Arial, Helvetica, sans-serif;">Prostaglandin F2 </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Q.4</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">A 23-year-old female presents with progressive bilateral loss of central vision. You obtain a detailed family history from this patient and produce the associated pedigree (dark circles or squares indicate affected individuals). Which of the following transmission patterns is most consistent with this patient’s family history? </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"> A.</span><span style="font-family: Arial, Helvetica, sans-serif;">Autosomal recessive </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> B.</span><span style="font-family: Arial, Helvetica, sans-serif;">Autosomal dominant </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> C.</span><span style="font-family: Arial, Helvetica, sans-serif;">X-linked recessive </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> D.</span><span style="font-family: Arial, Helvetica, sans-serif;">X-linked dominant </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> E.</span><span style="font-family: Arial, Helvetica, sans-serif;">Mitochondrial </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Q.5</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">An 8-month-old male infant is admitted to the hospital because of a bacterial respiratory infection. The infant responds to appropriate antibiotic therapy, but is readmitted several weeks later because of severe otitis media. Over the next several months, the infant is admitted to the hospital multiple times for recurrent bacterial infections. Workup reveals extremely low serum antibody levels. The infant has no previous history of viral or fungal infections. Which of the following is the most likely diagnosis?</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"> A.</span><span style="font-family: Arial, Helvetica, sans-serif;">Isolated IgA deficiency </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> B.</span><span style="font-family: Arial, Helvetica, sans-serif;">Chronic granulomatous disease </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> C.</span><span style="font-family: Arial, Helvetica, sans-serif;">DiGeorge’s syndrome </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> D.</span><span style="font-family: Arial, Helvetica, sans-serif;">Wiskott-Aldrich syndrome </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> E.</span><span style="font-family: Arial, Helvetica, sans-serif;">linked agammaglobulinemia of Bruton </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Q.6</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> A 35-year-old male living in a southern region of Africa presents with increasing abdominal pain and jaundice. He has worked as a farmer for many years, and sometimes his grain has become moldy. Physical examination reveals a large mass involving the right side of his liver, and a biopsy specimen from this mass confirms the diagnosis of liver cancer (hepatocellular carcinoma). The pathogenesis of this tumor involves which of the following substances?</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"> A.</span><span style="font-family: Arial, Helvetica, sans-serif;">Aflatoxin B1 </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> B.</span><span style="font-family: Arial, Helvetica, sans-serif;">Direct-acting alkylating agents </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> C.</span><span style="font-family: Arial, Helvetica, sans-serif;">Vinyl chloride </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> D.</span><span style="font-family: Arial, Helvetica, sans-serif;">Azo dyes </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> E.</span><span style="font-family: Arial, Helvetica, sans-serif;">naphthylamine </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Q.7</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">A 54-year-old male develops a thrombus in his left anterior descending coronary artery. The area of myocardium supplied by this vessel is irreversibly injured. The thrombus is destroyed by the infusion of streptokinase, which is a plasminogen activator, and the injured area is reperfused. The patient, however, develops an arrhythmia and dies. An electron microscopic (EM) picture taken of the irreversibly injured myocardium reveals the presence of large, dark, irregular amorphic densities within mitochondria, which are referred to as which of the following</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"> A.</span><span style="font-family: Arial, Helvetica, sans-serif;">Apoptotic bodies </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> B.</span><span style="font-family: Arial, Helvetica, sans-serif;">Flocculent densities </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> C.</span><span style="font-family: Arial, Helvetica, sans-serif;">Myelin figures </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> D.</span><span style="font-family: Arial, Helvetica, sans-serif;">Psammoma bodies </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> E.</span><span style="font-family: Arial, Helvetica, sans-serif;">Russell bodies </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Q.8</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Histologic sections of an enlarged tonsil from a 9-year-old female reveal an increased number of reactive follicles containing germinal centers with proliferating B lymphocytes. Which one of the following terms best describes this pathologic process?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> A.</span><span style="font-family: Arial, Helvetica, sans-serif;">B lymphocyte hypertrophy </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> B.</span><span style="font-family: Arial, Helvetica, sans-serif;">Follicular dysplasia </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> C.</span><span style="font-family: Arial, Helvetica, sans-serif;">Follicular hyperplasia </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> D.</span><span style="font-family: Arial, Helvetica, sans-serif;">Germinal center atrophy </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> E.</span><span style="font-family: Arial, Helvetica, sans-serif;">Germinal center metaplasia </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Q.9</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">A 19-year-old female is being evaluated for recurrent facial edema, especially around her lips. She also has recurrent bouts of intense abdominal pain and cramps, sometimes associated with vomiting. Laboratory examination finds decreased C4, while levels of C3, decay-accelerating factor, and IgE are within normal limits. These findings are most likely to be associated with which of the following deficiencies?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> A.</span><span style="font-family: Arial, Helvetica, sans-serif;"> 2-integrins </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> B.</span><span style="font-family: Arial, Helvetica, sans-serif;">C1 esterase inhibitor </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> C.</span><span style="font-family: Arial, Helvetica, sans-serif;">Decay-accelerating factor </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> D.</span><span style="font-family: Arial, Helvetica, sans-serif;">Complement components C3 and C5 </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> E.</span><span style="font-family: Arial, Helvetica, sans-serif;">NADPH oxidase </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Q.10</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Which one of the following laboratory findings is most consistent with an individual who is not taking any medication but has a familial deficiency of coagulation factor VII, assuming all other coagulation factors to be within normal limits? </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"> A.<span class="Apple-tab-span" style="white-space: pre;"> </span>A </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> B.<span class="Apple-tab-span" style="white-space: pre;"> </span>B </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> C.<span class="Apple-tab-span" style="white-space: pre;"> </span>C </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> D.<span class="Apple-tab-span" style="white-space: pre;"> </span>D </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> E.<span class="Apple-tab-span" style="white-space: pre;"> </span>E </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Answers & explanation</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">1-</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">The answer is: C</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Free fatty acids are normally taken up by the liver and esterified to triglyceride, converted to cholesterol, oxidized into ketone bodies, or incorporated into phospholipids that can be excreted from the liver as very-low-density lipoproteins (VLDLs). Abnormalities involving any of these normal metabolic pathways may lead to the accumulation of triglycerides within the hepatocytes. This accumulation of triglycerides is called fatty change or steatosis. Examples of abnormalities that produce hepatic steatosis include diseases that cause excess delivery of free fatty acids to the liver or diseases that cause impaired lipoprotein synthesis. Excess delivery of free fatty acids occurs in conditions that increase lipolysis of adipose tissue, such as starvation, diabetes mellitus, and corticosteroid use. Increased formation of triglycerides can result from alcohol use, as alcohol causes excess NADH formation (high NADH/NAD ratio), increases fatty acid synthesis, and decreases fatty acid oxidation. Impaired apoprotein synthesis occurs with carbon tetrachloride poisoning, phosphorous poisoning, and protein malnutrition. Inhibition of HMG-CoA reductase activity is the mechanism of lovastatin, which indirectly increases liver LDL receptors and increases LDL clearance from the blood.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">2-</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">The answer is: B</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Many extracellular substances cause intracellular actions via second-messenger systems. These second messengers may bind to receptors that are located either on the surface of the cell or within the cell itself. Substances that react with intracellular receptors are lipid-soluble (lipophilic) molecules that can pass through the lipid plasma membrane. Examples of these lipophilic substances include thyroid hormones, steroid hormones, and the fat-soluble vitamins A and D. Once inside the cell these substances generally travel to the nucleus and bind to the hormone response element (HRE) of DNA.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Some substances that react with cell surface receptors bind to guanine-nucleotide regulatory proteins. These proteins, called G proteins, may be classified into four categories, namely Gs, Gi, Gt, and Gq. Two of these receptors, Gs and Gi, regulate the intracellular concentration of cyclic adenosine 5'-monophosphate (cAMP). In contrast, Gt regulates the intracytoplasmic levels of cyclic guanosine 5'-monophosphate (cGMP), and Gq regulates the intracytoplasmic levels of calcium ions. Gs and Gi regulate intracellular cAMP levels by their actions on adenyl cyclase, an enzyme located on the inner surface of the plasma membrane that catalyzes the formation of cAMP from ATP. The adenylate cyclase G protein complex is composed of the following components: the receptor, the catalytic enzyme (i.e., adenyl cyclase), and a coupling unit. The coupling unit consists of GTP-dependent regulatory proteins (G proteins), which may either be stimulatory (Gs) or inhibitory (Gi). When bound to GTP and active, Gs stimulates adenyl cyclase and increases cAMP levels. (Gs can be thought of as the “on switch.”) In contrast, when bound to GTP and active, Gi inhibits adenyl cyclase and decreases cAMP levels. (Gi can be thought of as the “off switch.”) It is important to note that cholera toxin and pertussis toxin both act by altering this adenyl cyclase pathway. Cholera toxin inhibits the conversion of Gs-GTP to Gs-GDP. In contrast, pertussis toxin inhibits the activation of Gi-GDP to Gi-GTP. Therefore, both cholera toxin and pertussis toxin prolong the functioning of adenyl cyclase and therefore increase intracellular cAMP, but their mechanisms are different. Cholera toxin keeps the “on switch” in the “on” position, while pertussis toxin keeps the “off switch” in the “off” position.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">3-</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">The answer is: E</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Certain drugs are important in the control of acute inflammation because they inhibit portions of the metabolic pathways involving arachidonic acid. For example, corticosteroids induce the synthesis of lipocortins, a family of proteins that are inhibitors of phospholipase A2. They decrease the formation of arachidonic acid and its metabolites, prostaglandins and leukotrienes. Aspirin, indomethacin, and other nonsteroidal anti-inflammatory drugs (NSAIDs), in contrast, inhibit cyclooxygenase and therefore inhibit the synthesis of prostaglandins and thromboxanes. The prostaglandins have several important functions. For example, prostaglandin E2 (PGE2), produced within the anterior hypothalamus in response to interleukin 1 secretion from leukocytes, results in fever. Therefore aspirin can be used to treat fever by inhibiting PGE2 production. PGE2 is also a vasodilator that can keep a ductus arteriosus open. At birth, breathing decreases pulmonary resistance and reverses the flow of blood through the ductus arteriosus. The oxygenated blood flowing from the aorta into the ductus inhibits prostaglandin production and closes the ductus arteriosus. Therefore prostaglandin E2 can be given clinically to keep the ductus arteriosus open, while indomethacin can be used to close a patent ductus. Prostaglandin F2 (PGF2) causes uterine contractions, which can result in dysmenorrhea. Indomethacin can be used to treat dysmenorrhea by inhibiting the production of PGF2. Bradykinin is a nonapeptide that increases vascular permeability, contracts smooth muscle, dilates blood vessels, and causes pain. It is part of the kinin system and is formed from high-molecular-weight kininogen (HMWK). Histamine, a vasoactive amine that is stored in mast cells, basophils, and platelets, acts on H1 receptors to cause dilation of arterioles and increased vascular permeability of venules.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">4-</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">The answer is: E</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Almost all genes occur on chromosomes within the nucleus. There are a few genes, however, that are located within the mitochondria. These mitochondrial genes are found on mitochondrial DNA (mtDNA). These genes are all of maternal origin, possibly because ova have mitochondria within the large amount of cytoplasm while sperm do not. This maternal origin means that mothers transmit all of the mtDNA to both male and female offspring, but only the daughters transmit it further. No transmission occurs through males. This mtDNA contains genes that mainly code for oxidative phosphorylation enzymes, such as NADH dehydrogenase, cytochrome c oxidase, and ATP synthase. Symptoms of deficiencies of these enzymes occur in organs that require large amounts of ATP, such as the brain, muscle, liver, and kidneys. The mtDNA of these patients may be composed of either a mixture of mutant and normal DNA (heteroplasm) or of mutant DNA entirely (homoplasmy). The severity of these diseases correlates with the amount of mutant mtDNA that is present. One disease associated with mitochondrial inheritance is Leber hereditary optic neuropathy (LHON), which is characterized by progressive bilateral loss of central vision and usually occurs between 15 and 35 years of age. Other examples of mitochondrial inheritance include mitochondrial myopathies, which are characterized by the presence in muscle of mitochondria having abnormal sizes and shapes. These abnormal mitochondria may result in the histologic appearance of the muscle as ragged red fibers. Electron microscopy reveals the presence within large mitochondria of rectangular crystals that have a “parking lot” appearance.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">5-</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">The answer is: E</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">In X-linked agammaglobulinemia of Bruton, B cells are absent but numbers and function of T cells are normal. This abnormality results from defective maturation of B lymphocytes beyond the pre-B stage. This maturation defect leads to decreased or absent numbers of plasma cells, and therefore immunoglobulin levels are markedly decreased. Male infants with Bruton’s disease begin having trouble with recurrent bacterial infections at about the age of 9 months, which is when maternal antibodies are no longer present in the affected infant. Therapy for Bruton’s disease consists primarily of IV gamma globulin. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Isolated deficiency of IgA is probably the most common form of immunodeficiency. It is due to a block in the terminal differentiation of B lymphocytes. Most patients are asymptomatic, but some develop chronic sinopulmonary infections. Patients are prone to developing diarrhea (Giardia infection) and also have an increased incidence of autoimmune disease, such as Hashimoto’s thyroiditis. In patients with chronic granulomatous disease (CGD), the neutrophils and macrophages have deficient H2O2 production due to abnormalities involving the enzyme NADPH oxidase. These individuals have frequent infections that are caused by catalase-positive organisms, such as S. aureus, because the catalase produced by these organisms destroys the little hydrogen peroxide that is produced. DiGeorge’s syndrome is a T cell–deficiency disorder that results from hypoplasia of the thymus due to abnormal development of the third and fourth pharyngeal pouches. The parathyroid glands are also abnormal, and these individuals develop hypocalcemia and tetany. Congenital heart defects are also present. Wiskott-Aldrich syndrome is also an X-linked recessive disorder, but it is characterized by thrombocytopenia, eczema, and immune deficiency. The immune abnormalities are characterized by progressive loss of T cell function and decreased IgM. The other immunoglobulin levels are normal or increased. There are decreased numbers of lymphocytes in the peripheral blood and paracortical (T cell) areas of lymph nodes. Both cellular and humoral immunity are affected, and, because patients fail to produce antibodies to polysaccharides, they are vulnerable to infections with encapsulated organisms.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">6-</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">The answer is: A</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Many chemicals are associated with an increased incidence of malignancy. These substances are called chemical carcinogens. Although there are direct-acting chemical carcinogens, such as the direct-acting alkylating agents that are used in chemotherapy, most organic carcinogens first require conversion to a more reactive compound. Polycyclic aromatic hydrocarbons, aromatic amines, and azo dyes must be metabolized by cytochrome P450–dependent mixed-function oxidases to active metabolites. Vinyl chloride is metabolized to an epoxide and is associated with angiosarcoma of the liver, not hepatocellular carcinoma. Azo dyes, such as butter yellow and scarlet red, are metabolized to active compounds that have induced hepatocellular cancer in rats, but no human cases have been reported. -naphthylamine is an exception to the general rule involving cytochrome P450, as the hydrolysis of the nontoxic conjugate occurs in the urinary bladder by the urinary enzyme glucuronidase. In the past there has been an increase in bladder cancer in workers in the aniline dye and rubber industries who have been exposed to these compounds. Aflatoxin B1, a natural product of the fungus Aspergillus flavus, is metabolized to an epoxide. The fungus can grow on improperly stored peanuts and grains and is associated with the high incidence of hepatocellular carcinoma in some areas of Africa and the Far East. Hepatitis B virus is also highly associated with liver cancer in these regions</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">7-</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">The answer is: B</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">With prolonged ischemia, certain cellular events occur that are not reversible, even with restoration of oxygen supply. These cellular changes are referred to as irreversible cellular injury. This type of injury is characterized by severe damage to mitochondria (vacuole formation), extensive damage to plasma membranes and nuclei, and rupture of lysosomes. Severe damage to mitochondria is characterized by the influx of calcium ions into the mitochondria and the subsequent formation of large, flocculent densities within the mitochondria. These flocculent densities are characteristically seen in irreversibly injured myocardial cells that undergo reperfusion soon after injury. Less severe changes in mitochondria, such as mitochondrial swelling, are seen with reversible injury. Cytochrome c released from damaged mitochondria can induce apoptosis, a process through which irreversibly injured cells can shrink and increase the eosinophilia of their cytoplasm. These shrunken apoptotic cells (apoptotic bodies) may be engulfed by adjacent cells or macrophages. Myelin figures are derived from plasma membranes and organelle membranes and can be seen with either reversible or irreversible injury. Psammoma bodies are small, laminated calcifications, while Russell bodies are round, eosinophilic aggregates of immunoglobulin.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">8-</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">The answer is: C</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">There are many adaptive mechanisms of cells to persistent stimuli. Hypertrophy is an increase in the size of cells. Examples of hypertrophy include enlarged skeletal muscle in response to repeated exercise or anabolic steroid use and enlarged cardiac muscle in response to volume overload or hypertension. In contrast to hypertrophy, hyperplasia is an increase in the number of cells. Hyperplasia may be the result of a physiologic response or a pathologic process. Examples of physiologic hyperplasia include the increased size of the female breast or uterus in response to hormones. Pathologic hyperplasia may be compensatory to some abnormal process, or it may be a purely abnormal process. Examples of compensatory pathologic hyperplasia include the regenerating liver, increased numbers of erythrocytes in response to chronic hypoxia, and increased numbers of lymphocytes within lymph nodes in response to bacterial infections [follicular (nodular) hyperplasia]. Examples of purely pathologic hyperplasia include abnormal enlargement of the endometrium (endometrial hyperplasia) and the prostate (benign prostatic hyperplasia). Atrophy is a decrease in the size and function of cells. Examples of atrophy include decreased size of limbs immobilized by a plaster cast or paralysis, or decreased size of organs affected by endocrine insufficiencies or decreased blood flow. Metaplasia is a term that describes the conversion of one histologic cell type to another. Examples of metaplasia include respiratory epithelium changing to stratified squamous epithelium (squamous metaplasia) in response to prolonged smoking, the normal glandular epithelium of the endocervix changing to stratified squamous epithelium (squamous metaplasia) in response to chronic inflammation, or the normal stratified squamous epithelium of the lower esophagus changing to gastric-type mucosa in response to chronic reflux. In contrast to metaplasia, dysplasia refers to disorganized growth and is characterized by the presence of atypical or dysplastic cells. Dysplasia can be seen in many organs, such as within the epidermis in response to sun damage (actinic keratosis), the respiratory tract, or the cervix (cervical dysplasia).</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">9-</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">The answer is: B</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Deficiencies of components of the complement system are associated with specific abnormalities. Patients with congenital deficiencies in the early components of the complement cascade have recurrent symptoms resembling those of systemic lupus erythematosus due to the deposition of immune complexes. Patients with deficiencies of the middle complement components (C3 and C5) are at risk for recurrent pyogenic infections, while those lacking terminal complement components (C6, C7, or C8, but not C9) are prone to developing recurrent infections with Neisseria species. A deficiency of decay-accelerating factor (DAF), which breaks down the C3 convertase complex, is seen in paroxysmal nocturnal hemoglobinuria (PNH), a disorder that is characterized by recurrent episodes of hemolysis of red cells because of the excessive intravascular activation of complement. Deficiencies of C1 esterase inhibitor result in recurrent angioedema, which refers to episodic nonpitting edema of soft tissue, such as the face. Severe abdominal pain and cramps, occasionally accompanied by vomiting, may be caused by edema of the gastrointestinal tract. To understand how a deficiency of C1 inhibitor can cause vascularly produced edema (angioedema), note that not only does C1 inhibitor inactivate C1, but it also inhibits other pathways, such as the conversion of prekallikrein to kallikrein and kininogen to bradykinin. A deficiency of C1 inhibitor also leads to excess production of C2, a product of C2 called C2 kinin, and bradykinin. It is the uncontrolled activation of bradykinin that produces the angioedema, as bradykinin increases vascular permeability, stimulates smooth muscle contraction, dilates blood vessels, and causes pain. In contrast, a defect involving 2-integrins is seen with leukocyte adhesion deficiency, while defects involving NADPH of leukocytes are characteristic of chronic granulomatous disease.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">10-</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">The answer is: A</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">The coagulation cascade involves the formation of fibrin through the intrinsic, extrinsic, and common pathways. The intrinsic pathway is initiated by contact of factor XII with several types of biologic surfaces. Activated XII (XIIa) initiates the formation of XIa and IXa. The extrinsic pathway is initiated by contact of tissue factor with factor VII. Activated factor VII acts together with IXa, VIIIa, and platelet factor 3 (PF-3), which is a phospholipid complex located on the surface of platelets, to produce activated factor X. This begins the common pathway, which continues with the interaction of Xa, Va, PF-3, and Ca++ to cleave prothrombin, forming thrombin, which in turn cleaves fibrinogen to form fibrin. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Two laboratory tests that are used to evaluate the functioning of the coagulation cascade are prothrombin time (PT) and partial thromboplastin time (PTT). Abnormalities of the extrinsic pathway prolong (not shorten) the PT, while abnormalities of the intrinsic pathway prolong (not shorten) the PTT. Note that abnormalities of the common pathway prolong both the PT and the PTT. To illustrate, deficiencies of factor VII produce an abnormal (prolonged) PT with a normal PTT. Compare these results to each of the following: a normal PT with an abnormal PTT can be seen with deficiencies of factors XII, XI, IX, or VIII, while abnormal PT and PTT are seen with deficiencies of X, V, prothrombin, or fibrinogen.</span><br />
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I hope this quiz will help you! This is a start more yet to come !</div>
Anonymoushttp://www.blogger.com/profile/16555664245806923731noreply@blogger.com0tag:blogger.com,1999:blog-3618930566267736040.post-76691792739783435302013-05-23T05:42:00.001-07:002013-05-23T05:42:20.961-07:00What is Basic Anatomy?<br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">The definition of anatomy</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Anatomy is a science dealing with morphology and structure of the body. </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Anatomy includes those structures that can be seen grossly (without the aid of magnification) and microscopically (with the aid of magnification). </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Typically, when used by itself, the term 'anatomy' tends to mean gross or macroscopic anatomy-that is, the study of structures that can be seen without using a microscopic. </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Microscopic anatomy, also called 'histology', is the study of cells and tissues using a microscope. </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">The significance of studying anatomy</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Anatomy forms the basis for the practice of medicine. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Anatomy leads the physician towards an understanding of a patient's disease whether he or she is carrying out a physical examination or using the most advanced imaging techniques.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Anatomy is also important for dentists, physical therapists, and all others involved in any aspect of patient treatment that begins with an analysis of clinical signs. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">The ability to interpret a clinical observation correctly is therefore the endpoint of a sound anatomical understanding. </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">The classification of anatomy</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">By the different research methods, anatomy can be divided into micro-anatomy and macro-anatomy.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">People recognize human body at different levels.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Whole body---organs(systems)---tissues---cells---cellular organs---ultramicrostructures---molecular</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Presently, we study macro-anatomy. According to the different purposes, different research methods, macro-anatomy is divided into <u>systematic anatomy and regional anatomy.</u> </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">The differences between systematic anatomy and regional anatomy are as follows: </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">Locomotor system</span></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Protection; support ; movement</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">Digestive system</span></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">To digest foods; to secrete enzymes and hormones( endocrine function ; to absorb the nutrient elements; to eliminate the useless residues</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">Respiratory system</span></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">To supply the blood with oxygen ; to get rid of excess dioxide; </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">Urinary system</span></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">By eliminating the metabolic products to maintain the balance of substances in the body.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Reproductive system</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Keeping maintenance of species.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">secreting hormone</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Circulatory system</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Cardiovascular system </span><span style="font-family: Arial, Helvetica, sans-serif;">to transport the substances with oxygen and nutrition.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Lymphatic system</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">The anatomical position</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">The body is upright, legs together, and directed forwards</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">The palms are turned forward, with the thumbs laterally</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"> Anatomical planes</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>sagittal planes</u>: Refers to any longitudinal</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">planes that divide the human body into a right and a left part.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><u>Coronal planes</u>: Any vertical planes that divide the body into an anterior and a posterior part</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><u>Horizontal (transverse) planes:</u> Any horizontal planes that divide the body into an upper and a lower part.They lie at right angles to both the sagittal and coronal planes.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Terms of direction</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Introduction of locomotor system:</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">The formation of locomotor system, which comprise:</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Bones</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> There are 206 bones in the human body, which can be classified into a number of kinds according to their positions and shapes.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"> <span style="font-size: large;">The shape and classifications of bones</span></span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">1- According to the position,all the bones can be classified into four categories :</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">skull : 29</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">bones of trunk: 51</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">bones of upper limb: 64</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">bones of lower limb: 62</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">The structures of bone</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">1- Periosteum which is a fibrous membrane, containing rich blood vessels and nerves.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Function: </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">A. play an important role in regeneration of bones, having osteoblast. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B. Provide nutrition for the development, growth and reconstruction </span><span style="font-family: Arial, Helvetica, sans-serif;"> of bones</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C. Containing receptor (accepting stimulate)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Parts: periosteum (except articular surface) / endosteum</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">2- Bony substance:</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">The physical properties of bone</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> hard: bone removed organic materials; hard but fragile by demonstration;</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> flexible: bone removed inorganically material specimen, not hard, but flexible</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">The arrangement of bony substance</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">A- Compact substance: </span><span style="font-family: Arial, Helvetica, sans-serif;">consist of regular compact bony plate</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B- Sponge substance: </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> outer plate / diploë / inner plate</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">The arrangement looks like a frame of a house.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Bone marrow</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">i) Which is located within medullary cavity and ‘network-eye’, divided into red and yellow bone marrow.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">ii) 3-5y red bone marrow carrying out the function of blood-forming . For adult most of it become yellow bone marrow, but proximal end of humerus (femur), short bone, flat bone have life-long time red marrow.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">outer plate / diploë / inner plate</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">The structure of bone</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Bone is hard and flexible . It depends on its chemical components and arrangements.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Arthrology</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Definition:</u> The bones are connected together by means of fibrous, cartilaginous or osseous tissues at different parts of their surface. The connection is called articulation or joint.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">1. The classification of articulations</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">i) Synarthrosis (immovable joints, direct joint)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Definition: two or more separated bones are directly connected by fibrous , cartilaginous or osseous tissues.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u><br /></u></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Fibrous joints:</u> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">a. sutures: skull</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">b. syndesmoses: ligmentum flava (yellow lig) { tibiofibular </span><span style="font-family: Arial, Helvetica, sans-serif;">joint}</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">c. Gomphosis</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Cartilaginous</u>:</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">a. synchondrosis: between sternum and 1st costal cartilage</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> b. symphyses : pubic symphysis</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Synosteoses</u>:</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Sacrum</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">ii) <u>Diarthrosis</u> (movable articulations, synovial joints) </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Definition: the bones are connected by the joint capsule and ligaments. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">A- The essential (basical ) structures of synovial joint</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> 1. The articular surface: which is a part of surface of bone covered by hyaline cartilage.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> 2. The articular capsule: it looks like a irregular sac, attaches the periphery of the articular surface and adjacent surface. Articular capsule include two parts: outer layer( fibrous layer ) and inner layer( synovial layer---produce synovial fluid)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> 3. The articular cavity: it is a closed space enclosed by the synovial membrane and the articular cartilage. </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">B. The accessory structures of the synovial joints</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">1. The ligment:</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> intracapsular lig: it is inside the joint , surrounded by synovial membrane\</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> extracapsular lig: which is outside the capsule</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">2. The articular disc (or cartilage): it is fibrocartilaginous, and divides the articular cavity partially or completely into 2 parts.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">3. The articular lip (labrum): it is a fibrocartilaginous ring, which can deepen the articular surface</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">C. The movement of joint</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">1. Flexion and extension: they are performed in the coronal axis. Flexion makes the angle between the adjacent bones decrease; extension increase the angle.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">2. Adduction and abduction: which are performed in sagittal axis. Adduction means the movement toward the midline of the body; abduction means the movement apart from the midline.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">3. Pronation and supination: in standard anatomical position, the pronation means the palm is turned backward; the supination means the palm is turned forward.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">4. Rotation: the movement is performed in the vertical axis. A bone is moving around the vertical axis.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">5. Circumduction: while the proximal end of a bone remains relative stable, the distal end moves in a circle.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">The movement of joint</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Myology</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Skeletal muscle: to move the skeleton</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Cardiac muscle: to form the heart</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Smooth muscle: to constitute viscera</span></li>
</ul>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><u>Over 600 muscles in the body</u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Muscles are grouped by location:</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Muscles of head.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Muscles of neck.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Muscles of thorax.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Muscles of.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Abdomen.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Muscles of upper limb.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Muscles of lower limb.</span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Naming the skeletal muscles by sereral criteria: </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">1. location(brachialis); </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">2. shape (trapezius);</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">3. direction of the muscle fibers(rectus,oblique); </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">4. location ofattachments(brachioradialis); </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">5.number of origins (biceps); </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">6. action(flexor,extensor)</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"> The structures of muscles</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">I) Tendon and belly </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">Belly: the fleshy part of a muscle</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">Tendon: the bundles consisting of connective tissue blending </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> with strong collagen</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">II) The origin and insertion:</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Origin: a fixed (less movable) attachment of a muscle</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">Insertion: a movable attachment of a muscle</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">Generally speaking, the origin is near the midline; the insertion is far from the midline. However, the origin and insertion may be exchanged each other. For example: pectoralis major m.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">III) The relations of muscles to other structures</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Most of muscles are attached to bones,</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">some of muscles are attached to skin, e.g; Platysma m. beneath the skin of neck</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">some of muscles are attached to organs. e.g; eyeball</span></li>
</ul>
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<span style="font-family: Arial, Helvetica, sans-serif;">IV) The shape of muscles</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">Because of functional differences, muscles have different shape.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">The shape of muscles</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">IV) The functional classification of muscles</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">Agonists ( prime movers ): the main muscles which contract to produce desired </span><span style="font-family: Arial, Helvetica, sans-serif;">movement</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Antagonist: the muscles which act to oppose the action of agonist</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">Agonist---contraction; antagonist---relax</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">Synergist: cooperation in a special action as a supporter</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Fixator: fix proximal end of limbs in a special position.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> eg. Tightly making a fist</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> <span style="font-size: large;"><u> Biceps</u></span></span><br />
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<span style="font-size: large;"><u> Brachialis</u></span><br />
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<span style="font-size: large;"><u>Triceps</u></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Fascia and tendinous sheath</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Fascia</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">1) Superficial fascia: lies under skin and covers the entire body containing a lot of fat / increase mobilityof skin; thermal insulation; a store of energy /contain cutaneous nerve, blood vessels and skin muscles </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">2) Deep fascia: dense and inelastic</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> membrane of collagenous fibers</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
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Anonymoushttp://www.blogger.com/profile/16555664245806923731noreply@blogger.com0tag:blogger.com,1999:blog-3618930566267736040.post-31348166743468973192013-05-16T06:41:00.002-07:002013-05-16T06:41:48.942-07:00Most Common DISORDERS OF CONSCIOUSNESS<br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;"> Confusion:</span> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Impairment of the capacity to think with normal</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">speed and clarity, associated with inattentiveness and disori-</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">entation. Delirium is a special example of an acute confu-</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">sional state in which impaired attention and reasoning are</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">associated with agitation, hallucinations, and in some cases,</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">tremor and convulsions.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;"> Drowsiness:</span> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Inability to remain awake without external</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">stimulation; often associated with some degree of confusion.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;"> Stupor:</span> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> State in which only vigorous external stimulation</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">can arouse the patient; once aroused, responses remain</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">markedly impaired.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;"> Coma:</span> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Deep sleep-like state; patient cannot be aroused even</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">with vigorous or repeated external stimulation.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Causes of change in consciousness</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">1. With abnormal CT scan</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">• Hemispheric mass lesions that cross the midline or</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">impinge upon the brainstem.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">• Brainstem lesions that directly affect the reticular forma-</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">tion.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">• Subarachnoid hemorrhage.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">2. With normal CT scan</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">• Inflammatory disorders, such as bacterial meningitis and</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">viral encephalitis.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">• Exogenous toxins,such as sedative drugs,alcohols,opioids,</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">and carbon monoxide.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">• Endogenous metabolic insults, such as global hypoxic-</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">ischemic insults, hypoglycemia, hyperammonemia, and</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">hypercalcemia.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">• Postictal state.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">• Selective brainstem ischemia.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Diagnosis of cause of changes in consciousness:</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Establishing a differential diagnosis for the cause of a patient’s change in</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">consciousness requires evaluation of the history preceding the</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">change,the physical examination,and the effectiveness of initial</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">empirical therapy.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Categories of cause of changes in consciousness</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Toxic and metabolic (e.g., opiate overdose, alcohol).</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Infectious (e.g.,meningitis,encephalitis,septic shock).</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Cerebrovascular (e.g.,stroke).</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Trauma.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Other (e.g.,seizures,neoplasms).</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Role of history in diagnosis of changes in consciousness</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;"> Preceding headache suggests meningitis,subarachnoid hemorrhage, or encephalitis.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;"> Preceding intoxication,confusion,or delirium suggests a diffuse process such as meningitis, endogenous metabolic insults, or exogenous toxins.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;"> Sudden onset of coma suggests brain stem infarct or hemorrhage (e.g., subarachnoid hemorrhage).</span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Role of physical examination in diagnosis of changes in</span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">consciousness</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">> <u>Localizing signs:</u> Suggest focal lesion. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">><u> No localizing signs:</u> Suggests encephalopathy as a result of</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">either an exogenous toxin or an endogenous metabolic<br />insult.<br />> <span style="font-size: large;">Important Structural versus Metabolic causes of COMA</span><br /> Asymmetrical or reflex functioning of the motor system indi-<br />cates a focal mass lesion. Changes in pupillary size and reflexes<br />are also useful in assessing the cause of coma.<br /> A unilaterally dilated nonreactive pupil suggests oculomotor<br />nerve (CN III) compression by an expanding hemispheric<br />mass.<br />> Pinpoint minimally reactive pupils suggests compromise of<br />the pontine tegmentum (e.g., in a pontine hemorrhage);<br />may also be seen in opiate intoxication. Small but reactive<br />pupils are a feature of many metabolic encephalopathies.<br />> Minimally reactive pupils in a mid or slightly dilated posi-<br />tion suggests a midbrain lesion.<br />> Bilaterally dilated, nonreactive pupils can be seen in cases of<br />damage to the midbrain tectum or in global ischemic brain<br />injury. It may also be caused by atropine and similar anti-<br />cholinergic agents.</span><br />
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Anonymoushttp://www.blogger.com/profile/16555664245806923731noreply@blogger.com0tag:blogger.com,1999:blog-3618930566267736040.post-18386900046811390822013-05-10T05:08:00.002-07:002013-05-10T05:08:48.341-07:00How does HUNTINGTON CHOREA present? How to treat the disease?<br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Definition</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Its autosomal dominant disorder characterized pathologically by degeneration of GABA-nergic neurons of caudate nucleus and clinically by chorea and dementia.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Clinical presentation</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Involuntary writhing motions (i.e., choreiform) when pre-</span><span style="font-family: Arial, Helvetica, sans-serif;">senting in adults during the fourth or fifth decades; seizures</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">and rigidity when presenting at a younger age.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Depression and cognitive impairment (i.e., dementia).</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Patients often commit suicide because of the prognosis.</span></li>
</ul>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Mutation</span><br />
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<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;"> Huntingtin gene on chromosome 4.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;"> Mutation is an increase in the number of CAG repeats in the </span><span style="font-family: Arial, Helvetica, sans-serif;">huntingtin gene.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Transcription of the expanded CAG repeats </span><span style="font-family: Arial, Helvetica, sans-serif;">results in the accumulation of excess numbers of polygluta-</span><span style="font-family: Arial, Helvetica, sans-serif;">mine residues in the huntingtin protein. </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">There is an inverse </span><span style="font-family: Arial, Helvetica, sans-serif;">relationship between the number of CAG repeats and the age </span><span style="font-family: Arial, Helvetica, sans-serif;">of onset of disease. </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">The CAG repeats increase in number </span><span style="font-family: Arial, Helvetica, sans-serif;">during spermatogenesis,which results in the disease present</span><span style="font-family: Arial, Helvetica, sans-serif;">ing earlier in successive generations (referred to as anticipa-</span><span style="font-family: Arial, Helvetica, sans-serif;">tion)</span></li>
</ul>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjiv1wkqRqEcnEJ9vg_JYp-c95uGGehlp8mc3UFhrPhzuoxKLHGx75IbvhPOcaElN92j8skeSSwUKD4ZtRNPflPkG_i06cjpIFxaonnWyXGiYMxDSRnXcxPFgDhFrt-pvio9-_7FFfidAiX/s1600/anatomy+of+huntingtons+Disease.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="285" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjiv1wkqRqEcnEJ9vg_JYp-c95uGGehlp8mc3UFhrPhzuoxKLHGx75IbvhPOcaElN92j8skeSSwUKD4ZtRNPflPkG_i06cjpIFxaonnWyXGiYMxDSRnXcxPFgDhFrt-pvio9-_7FFfidAiX/s400/anatomy+of+huntingtons+Disease.jpg" width="400" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Clinical manifestation</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">i. The disease manifests between age 20-40 years.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">ii.Chorea:sudden,unexpected and purposeless contractions of proximal muscles</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">iii. Changes in personality,marked tendency for suicide and dementia</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Microscopic findings</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Loss of medium spiny GABA-nergic neurons in the caudate and putamen,associated with gliosis</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi1ykU3u1PLkxfiix5shMN6FEZU_V0kCyVqmEU6JxjNya5G3Kd-QRf54EIn646Fij84UgcaWK3Q2XHc5DNlqhres8SSvZhinLiJPl7GDE6S3h-xnoQnt4ctiSknCHpAiNj1-O0kQ0K4K9Qq/s1600/CNS-servingnature.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi1ykU3u1PLkxfiix5shMN6FEZU_V0kCyVqmEU6JxjNya5G3Kd-QRf54EIn646Fij84UgcaWK3Q2XHc5DNlqhres8SSvZhinLiJPl7GDE6S3h-xnoQnt4ctiSknCHpAiNj1-O0kQ0K4K9Qq/s400/CNS-servingnature.jpg" width="286" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">Diagnosis:</span></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Genetic diagnosis possible but controversial</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">Treatment:</span></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Antipsychotic drugs (e.g; haloperidol)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
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Anonymoushttp://www.blogger.com/profile/16555664245806923731noreply@blogger.com0tag:blogger.com,1999:blog-3618930566267736040.post-45654827629932479522013-05-03T04:45:00.000-07:002013-05-03T04:45:57.681-07:00Beauty tips for healthy skin<span style="background-color: white; color: #333333; font-family: Arial, Helvetica, sans-serif; font-size: 13px; line-height: 17px;">Walnuts hold alpha-linolenic acid which is an omega-3 fat that helps lubricate the layer of skin that keeps it moist. Just a 1/2 ounce serving gives you all of your daily recommended serving of ALA. Studies show that eating walnuts around dinnertime can also help you get better beauty sleep!</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiQHIrWQw4W43lr_IiMxfMoNv-cYksvM25b9p_ACZ2FcBeCB78UniFByh2PByL0q1hyphenhyphenx-1jeBQ5O2Owm-_dwc2SnjzGLMMxbwR_Jm4hCYUy5ZYubsimVV9vx_EdERjJo8ZGnwU3FE_dFNfW/s1600/walnuts.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: Arial, Helvetica, sans-serif;"><img border="0" height="232" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiQHIrWQw4W43lr_IiMxfMoNv-cYksvM25b9p_ACZ2FcBeCB78UniFByh2PByL0q1hyphenhyphenx-1jeBQ5O2Owm-_dwc2SnjzGLMMxbwR_Jm4hCYUy5ZYubsimVV9vx_EdERjJo8ZGnwU3FE_dFNfW/s400/walnuts.jpg" width="400" /></span></a></div>
<span style="background-color: white; color: #333333; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 13px; line-height: 17px;"><br /></span>
<span style="background-color: white; color: #333333; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 13px; line-height: 17px;">Dark chocolate is high in flavonoids which can rejuvenate your complexion and give you smoother, softer, hydrated skin. It can also increase the blood flow to the brain for up to 2 hours after consuming. Some even suggest that may reduce the risk of dementia later in life.</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiDLQIcv1JrHMXkQQVdYcWLPBxSfxe59Yd-b5axcCRlreYRf2x1LcE4lBUoEvQreUUAilk7oywEpJwpvV8VC_goHUeDKqO18nBfYwOxwf7sdjINXkD70e_vQxiqiOG8fWPO1r1I9jxVjVU_/s1600/chocolates.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="217" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiDLQIcv1JrHMXkQQVdYcWLPBxSfxe59Yd-b5axcCRlreYRf2x1LcE4lBUoEvQreUUAilk7oywEpJwpvV8VC_goHUeDKqO18nBfYwOxwf7sdjINXkD70e_vQxiqiOG8fWPO1r1I9jxVjVU_/s400/chocolates.jpg" width="400" /></a></div>
<span style="background-color: white; color: #333333; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 13px; line-height: 17px;"><br /></span>
<span style="background-color: white; color: #333333; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; line-height: 18px;">Kiwi fruit contain high vitamin C levels that even out skin texture and fight damage and when scrubbed on the face, they act as tiny exfoliators. The best ways to use them? Slice them and apply or mash them into a paste that can be left on to improve your complexion.</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEieDB3TTotUsnDgRoZ5duuDnmcPwmCGJClYEw-PZORbDb0zrLfMWPQKzsSsbzW7B_3mhEhjVZ1MF-oK4PdzV7o-72nbY53cyn32vdbOsaorJNPNlp98cUfntTtnQQKLcHVqU683jFMpt3as/s1600/kiwi-servingnature.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="226" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEieDB3TTotUsnDgRoZ5duuDnmcPwmCGJClYEw-PZORbDb0zrLfMWPQKzsSsbzW7B_3mhEhjVZ1MF-oK4PdzV7o-72nbY53cyn32vdbOsaorJNPNlp98cUfntTtnQQKLcHVqU683jFMpt3as/s400/kiwi-servingnature.jpg" width="400" /></a></div>
<span style="background-color: white; color: #333333; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; line-height: 18px;"><br /></span>Anonymoushttp://www.blogger.com/profile/16555664245806923731noreply@blogger.com2tag:blogger.com,1999:blog-3618930566267736040.post-31244447271855143832013-04-29T11:25:00.000-07:002013-04-29T11:25:00.937-07:00Disorders of water-electrolytes metabolism<br />
<span style="font-size: large;">I- </span><span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">Disorders of water-electrolytes metabolism</span> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">1. Water balance </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> A. Water content and distribution </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> <u>Intracellular fluid (ICF))</u>: </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> The fluid within cells. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> <u>Extracellular fluid (ECF)</u>: </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> The fluid outside the cells = </span><span style="font-family: Arial, Helvetica, sans-serif;"> interstitial fluid + intravascular fluid. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">Body fluid: water + solutes</span> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> <u>Accounts for 60% of body weight?</u></span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjIcp9w5IEkf-9JPgGYZDpej80F3eA9CYd3FXr4eR35rXqByGlWWu6HJfM4fmTVbo5b50tkPUS5jZLk4U49T64bMYsd5Z2Abe34o7deOoMZRTMsc9FxJFz79txbyFk0lsd-eheuwDZi52Hd/s1600/Body+fluids.bmp" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="233" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjIcp9w5IEkf-9JPgGYZDpej80F3eA9CYd3FXr4eR35rXqByGlWWu6HJfM4fmTVbo5b50tkPUS5jZLk4U49T64bMYsd5Z2Abe34o7deOoMZRTMsc9FxJFz79txbyFk0lsd-eheuwDZi52Hd/s400/Body+fluids.bmp" width="400" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Body fluid varies with age, sex and the amount of body fat:</span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">age</span><span style="font-family: Arial, Helvetica, sans-serif;"> </span><span style="background-color: white; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13.333333969116211px; line-height: 20px;">↑ </span><span style="background-color: white; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13.333333969116211px; line-height: 20px;">→</span><span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"> body fluid </span><span style="background-color: white; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13.333333969116211px; line-height: 20px;">↓</span><span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Adult</span><span style="font-family: Arial, Helvetica, sans-serif;"> females have a lower proportion of body fluid than the males of same age </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> fat </span><span style="background-color: white; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; line-height: 20px;">↑ </span><span style="font-family: Arial, Helvetica, sans-serif;"> body fluid </span><span style="background-color: white; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13.333333969116211px; line-height: 20px;">↓</span><span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"> </span><span style="font-family: Arial, Helvetica, sans-serif;"> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> </span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh3FrIqRXYyjvgGC4FHzNg_-XuzVTkOmIR1YliZaNsICXQI_gLg7WZScHNv9ZhzsEU1xhivEWXjw4Ca5iLRaF2FBysjC83SIFJXB5RnPQ49WYzC6-F8k3291Q7fRTUM7RGopL0Kh29U17JZ/s1600/Body+fluids+varies.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="331" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh3FrIqRXYyjvgGC4FHzNg_-XuzVTkOmIR1YliZaNsICXQI_gLg7WZScHNv9ZhzsEU1xhivEWXjw4Ca5iLRaF2FBysjC83SIFJXB5RnPQ49WYzC6-F8k3291Q7fRTUM7RGopL0Kh29U17JZ/s400/Body+fluids+varies.png" width="400" /></a></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">B. Water daily balance</span> </span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjuz4odHItz5Z3mO-_AUVplGLWHpOtFseLznlZQm4LZzlGH16ZZr2d4wADRjNoutUnc_VIa903-Ul-DxkeA5cYOueUIDa1ohQWnEBE4IeNvhxV_3AG5UwscV49UuXaEwHChfiwweMWVAQcg/s1600/water+daily+balance.bmp" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="181" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjuz4odHItz5Z3mO-_AUVplGLWHpOtFseLznlZQm4LZzlGH16ZZr2d4wADRjNoutUnc_VIa903-Ul-DxkeA5cYOueUIDa1ohQWnEBE4IeNvhxV_3AG5UwscV49UuXaEwHChfiwweMWVAQcg/s400/water+daily+balance.bmp" width="400" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">2. Electrolytes in Body fluid</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEikqpKra7ROBrK4hDxD4QtXc5KnVASvR2ct7vhKm29Bef4oG5vbCkDwy-h5WSakVXzt8oG5NN7OIZ1tDckoeJGNvjGOltJSFLzkUujUNbAG8ATVzd1n-gBh4Xjx57HQ1k6rNJ_BWkP4wx6r/s1600/electrolytes-servingnature.bmp" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="228" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEikqpKra7ROBrK4hDxD4QtXc5KnVASvR2ct7vhKm29Bef4oG5vbCkDwy-h5WSakVXzt8oG5NN7OIZ1tDckoeJGNvjGOltJSFLzkUujUNbAG8ATVzd1n-gBh4Xjx57HQ1k6rNJ_BWkP4wx6r/s400/electrolytes-servingnature.bmp" width="400" /></a></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"> --Na+ requirement is about 4-6g/day; </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> --mainly gain from daily salt supplement; </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> --About 90% is eliminated in the urine. </span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEivcWfMKr6CFDtf4oHWSwqhmZUv1F9invZtQFBbHTpnon6IBhNaJLEsajOLdForH83YjA5NVgjU3EKyIkBEMf0JWYKCmcz2wnkEzuOJ-3pvMIm3IwsbvZhyw0-bsaVTWexY3U2h2U305wfn/s1600/servingnature.bmp" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="83" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEivcWfMKr6CFDtf4oHWSwqhmZUv1F9invZtQFBbHTpnon6IBhNaJLEsajOLdForH83YjA5NVgjU3EKyIkBEMf0JWYKCmcz2wnkEzuOJ-3pvMIm3IwsbvZhyw0-bsaVTWexY3U2h2U305wfn/s400/servingnature.bmp" width="400" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"> -- Characteristics of renal Na+ excretion: </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> High intake high excretion, </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Low intake low excretion, </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> No intake no excretion. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> -- Plasma [Na+]: 130~150mmol/L</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">3. Osmotic pressure in the body fluid </span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Osmotic pressure of a solution depends on the amount of dissolved molecules or ions. </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;"> </span><span style="font-family: Arial, Helvetica, sans-serif;">Plasma osmotic pressure contains colloid osmotic pressure and crystal osmotic pressure. </span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Osmosis and Osmotic Pressure</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">When a semi-permeable membrane (a membrane that allows solvent molecules to flow through but not the solute particles) separates two solutions of different concentrations, there will be a net flow of solvent molecules from the solution where its</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">concentration is lower to the solution where its concentration is higher. This phenomenon is called <u>Osmosis</u> and driving pressure is called as<u> Osmotic pressure.</u></span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Osmotic pressure:</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Crystal osmotic pressure</u> is formed by a lot of</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> small molecular weight materials, such as </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> electrolyte,Glucose, BUN and so on. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Colloid osmotic pressure</u> is formed by large</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> molecular weight materials such as proteins. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">>Osmotic pressure of ECF is roughly equivalent to ICF. </span><span style="font-family: Arial, Helvetica, sans-serif;"> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">>Water moves from areas of low osmolatity to areas of high osmolatity. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">>Normal plasma osmotic pressure is <u>280~ 310 mOsm/L. </u></span><br />
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Functions of electrolytes:</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">1.Maintaining the osmotic and acetic-alkali</span><span style="font-family: Arial, Helvetica, sans-serif;"> equilibrium.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">2. Maintaining the resting membrane potential and generating the active membrane potential. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">3. Taking part in metabolism and physiologic action. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Functions of body water:</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">It is essential to metabolism of the body.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">It acts as a transport vehicle.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">It is a good lubricant.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">It is necessary for temperature regulation. </span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">4. Regulation of water-salt metabolism</span> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">--Water balance is regulated primarily by antidiuretic hormone (ADH) and the perception of thirst; </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">-- Sodium balance is regulated by aldosterone. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Regulating mechanism </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"> Thirst center</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">The regulation of ADH</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">The regulation of RAAS</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">II. Disorders of water-sodium metabolism </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> <span style="font-size: large;"> </span></span><br />
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<br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">Dehydration</span> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> An excessive loss of body fluid resulting from various causes is termed dehydration. </span><br />
<br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">1. Hypertonic dehydration</span> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">(1) <u>Concept:</u> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> The dehydration in which water loss is in excess of Na+ loss and remaining ECF of the body is hypertonic is termed <u>hypertonic dehydration</u>. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Characteristics: </u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> a. loss of water > loss of sodium; </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> b. plasma Na+ > 150mmol/L; </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> c. plasma osmotic pressure > 310mOsm/L. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">(2) <u>Causes: </u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> A: <u>Decreased water intake:</u> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> a. Inability to drink or loss of thirst:</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">difficulty in swallowing: esophageal cancer</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">unconsciousness: coma</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">brain injury: impaired thirst sensation</span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif;"> b. <u>Unavailableness of water: </u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> e.g. desert district: desert travelling </span><span style="font-family: Arial, Helvetica, sans-serif;">ocean accident; war, et al.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"> B: <u>Increased water output:</u> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Body fluid lose from: skin, lungs, GI, kidney</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> a. skin and lungs: </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> e.g. profuse sweating, fever </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> b. GI tract: gastrointestinal track (GI)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> e.g. diarrhea, vomiting </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> c. Kidneys: </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> e.g. DM:</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> insipidus: central defect in ADH </span><span style="font-family: Arial, Helvetica, sans-serif;">production or secration </span><span style="font-family: Arial, Helvetica, sans-serif;">a renal insensitivity to ADH</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">(3) Effects on the body</span> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Clinical characteristics:</u> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Obvious thirst; mainly intracellular dehydration; a few patients occur circulatory failure (shock) at early stage. </span><br />
<br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">A. Compensation process:</span> </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">B. Decompensation (Clinical Manifestations)</span> </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Dehydration fever: </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Serious dehydration may lead to increased body temperature due to decreased evaporation from skin and impaired temperature regulatory function. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">Degree of hypertonic dehydration</span> </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Principles of treatment </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> A. To treat primary disease; </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> B. To supply water: </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> --drink water, </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> --transfuse 5% glucose first, then 0.9% NaCl. </span><br />
<br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">2. Hypotonic dehydration</span> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">(1) Concept: </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> The dehydration in which sodium loss is in excess of water loss and remaining ECF of the body is hypotonic is termed hypotonic dehydration. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Characteristics:</u> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> a. loss of sodium > loss of water; </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> b. plasma Na+ < 130mmol/L; </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> c. plasma osmotic pressure < 280mOsm/L. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">(2) Causes: </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>The most common cause:</u> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> fluid loss + replacement of water or intravenous 5% glucose only. </span><br />
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"> Body fluid lose from: </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> A: GI tract: e.g. vomiting, diarrhea. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> B: skin: perfuse sweating, a large area of burn. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> C. Kidneys: </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> a. Administer some diuretics for a long time: </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> b. Lack of aldosterone: e.g. Addison’s disease </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> c. Intrinsic renal disease: </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> e.g. acute renal failure </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> The conditions of a and b can cause excessive renal lose of sodium. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">(3) Effects on the body </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Clinical characteristics:</u> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Mainly extracellular dehydration; circulatory failure (shock) easily occurs at early stage. </span><br />
<br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">A. Compensation process:</span> </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">B. Decompensation (Clinical Manifestations)</span> </span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi8alCSacGbj5ke_tqqc3TM3iD09sx5RrYGNZ1rh9yXTcieNcCiYsTOZBxRCl7opwykxLqCuXuW8J8T3bZtlDkNa6WJbteSb7GOmNQqGh_oy9rE5mBlMjN_UBFBIR5bgJpgXSdzC7ksaQFX/s1600/Hypotonic+dehydration+decompensation.bmp" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="258" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi8alCSacGbj5ke_tqqc3TM3iD09sx5RrYGNZ1rh9yXTcieNcCiYsTOZBxRCl7opwykxLqCuXuW8J8T3bZtlDkNa6WJbteSb7GOmNQqGh_oy9rE5mBlMjN_UBFBIR5bgJpgXSdzC7ksaQFX/s400/Hypotonic+dehydration+decompensation.bmp" width="400" /></a></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">Degree of hypotonic dehydration</span> </span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhQjVR4YlHkpCK3gycOTj5EQT3Q-xoUgCXrORLGh0d5_d0mbpAD_UgnnddtFhqDsSzcc0NnTg5_8TBNN3WpZY4E3YArI-jQdJdfSs7uf5mOpNyjYrKrPvGI2lAUcy-h23sEaOFAoGSDOZh0/s1600/degree+of+hypotonic+dehydration.bmp" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="172" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhQjVR4YlHkpCK3gycOTj5EQT3Q-xoUgCXrORLGh0d5_d0mbpAD_UgnnddtFhqDsSzcc0NnTg5_8TBNN3WpZY4E3YArI-jQdJdfSs7uf5mOpNyjYrKrPvGI2lAUcy-h23sEaOFAoGSDOZh0/s400/degree+of+hypotonic+dehydration.bmp" width="400" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Principles of treatment </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> A. To treat the causes of the disease; </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> B. Administer sodium solution, either orally </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> or intravenously. </span><br />
<br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">3. Isotonic dehydration</span> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">(1) Concept: </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> The dehydration in which water loss is equal to sodium loss and remaining ECF of the body is isotonic is termed isotonic dehydration. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Characteristics:</u> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> a. water and sodium lost proportionally; </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> b. plasma Na+ = 130-150mmol/L; </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> c. plasma osmotic pressure = 280-310mOsm/L. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>(2) Causes: </u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> A. Acute serious vomiting or diarrhea: </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> B. Skin burn in a large area: </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> C. Draw a large amount of ascites: </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> D. Paralytic ileus: </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>(3) Effects on the body </u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">A. Compensation process:</span> </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">B. Decompensation (Manifestations) </span> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEja7lP4_uo8cC8zMCqR4JY4LwWayTF2b5CZnX1vDZmssOQhp2hrUMC4lWfZqjYzbw8ATMOjSGZt2UJA3pUjRzLQ1HHnxYpatjounSmbbxqzqN1vLN0jqmtvxHBU3lgJBR-qkujmHO4C9caY/s1600/isotonic+dehydration+decompensation.bmp" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEja7lP4_uo8cC8zMCqR4JY4LwWayTF2b5CZnX1vDZmssOQhp2hrUMC4lWfZqjYzbw8ATMOjSGZt2UJA3pUjRzLQ1HHnxYpatjounSmbbxqzqN1vLN0jqmtvxHBU3lgJBR-qkujmHO4C9caY/s400/isotonic+dehydration+decompensation.bmp" width="400" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Principles of treatment </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> A. To treat original disease; </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> B. Supply isotonic fluid. </span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi2mCsF6RfMSvZopcow0bqQE21Te-Z5_EabrISFBvt1V5FGy5Wf9wH7O6RJY3-FvSi7T0fVR81S16fUlzylDVaTvCqHwJdlG6_SMA4TqRef7a2K8QnIVg-6Yiq3tk9w5a5LH_FmyD5ELxuE/s1600/dehydration-servingnature.bmp" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="295" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi2mCsF6RfMSvZopcow0bqQE21Te-Z5_EabrISFBvt1V5FGy5Wf9wH7O6RJY3-FvSi7T0fVR81S16fUlzylDVaTvCqHwJdlG6_SMA4TqRef7a2K8QnIVg-6Yiq3tk9w5a5LH_FmyD5ELxuE/s400/dehydration-servingnature.bmp" width="400" /></a></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">Distribution of body fluid in dehydration</span> </span><br />
Anonymoushttp://www.blogger.com/profile/16555664245806923731noreply@blogger.com0tag:blogger.com,1999:blog-3618930566267736040.post-24271655583846136142013-04-22T10:39:00.001-07:002013-04-22T10:39:49.225-07:00Hodgkin's vs Non-Hodgkin's lymphoma<div class="separator" style="clear: both; text-align: center;">
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Lymphoma (malignant lymphoma, ML)</span></div>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Definition:</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Lymphoma is a group of cancers arising primarily from lymph nodes and/or extranodal lymphoid tissues, showing features of lymphocytes.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Classification </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Hodgkin’s lymphoma (HD)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">non-Hodgkin’s lymphoma (NHL)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"> Hodgkin’s lymphoma(HL)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Introduction</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">1. Age:two peaks of incidence</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">young adult: 15-27 years of age about 50 years of age</span><br />
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Hodgkin Lymphoma</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhOigRBgW1fNdOSIuzt2qLreLxOatuSdkSBHRMAPARmbjS7wZ4qrKBxTSFViMW5KsTXFSl2xIxI5j_ruu6XbAf1a7nQcAIWFWGuXPDI5mIRhnJ-51UBUsdiCD5DQgwK1p3HAj11phxQI7CY/s1600/Thomas+Hodgkin-servingnature.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhOigRBgW1fNdOSIuzt2qLreLxOatuSdkSBHRMAPARmbjS7wZ4qrKBxTSFViMW5KsTXFSl2xIxI5j_ruu6XbAf1a7nQcAIWFWGuXPDI5mIRhnJ-51UBUsdiCD5DQgwK1p3HAj11phxQI7CY/s400/Thomas+Hodgkin-servingnature.jpg" width="300" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"> LM</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> 2. Feature </span><span style="color: #00007d; font-weight: bold;">→ </span><span style="font-family: Arial, Helvetica, sans-serif;">Reed-Sternberg cells (R-S c) </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">mixed with rich inflammatory background</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">(1) R-S cell</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">15-45 um in diameter</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Binucleate or multiple nuclei,</span><span style="font-family: Arial, Helvetica, sans-serif;"> acidophilic nucleoli</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Amphophilic cytoplasm</span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">R - S cell</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhrwDwW9-ss82YK8TWQGd7S4l6jb4KzxOtn25CKZhTZyGbsfz-qY35vzHzxsB08ab9laJH100Ae1Hcvl3wbLLM01aQkFc6f_RNFf9s5XaTCDLalXQhAXtfkaJO3dQH9ccRJr2o4hyphenhyphenpDw4HF/s1600/R-S+Cell-servingnature.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="388" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhrwDwW9-ss82YK8TWQGd7S4l6jb4KzxOtn25CKZhTZyGbsfz-qY35vzHzxsB08ab9laJH100Ae1Hcvl3wbLLM01aQkFc6f_RNFf9s5XaTCDLalXQhAXtfkaJO3dQH9ccRJr2o4hyphenhyphenpDw4HF/s400/R-S+Cell-servingnature.png" width="400" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"> <span style="font-size: large;">Mirror image cell</span></span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg6ws2cZjCnNLwOJSaFClsJ9BDD6RWcxKiNQ86AGlC2WANVf96TfuJ4eOmfdz7m-PdNYUn5Ynss0awed8fkamfBwU2EOwcsW808WtKpMIkUSiyYrsmuqs4a74QEiPPfXA8-mBdhpYXQ9jtL/s1600/symmetric+binuclei-servingnature.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="260" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg6ws2cZjCnNLwOJSaFClsJ9BDD6RWcxKiNQ86AGlC2WANVf96TfuJ4eOmfdz7m-PdNYUn5Ynss0awed8fkamfBwU2EOwcsW808WtKpMIkUSiyYrsmuqs4a74QEiPPfXA8-mBdhpYXQ9jtL/s400/symmetric+binuclei-servingnature.jpg" width="400" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif;"> R-S cell </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">with symmetric binuclei</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhNcHZ9tT26_-XVO2KUvQ3S3vx59f59FWU2lFX9iSFJBsU7D1VRm6zJnv-_MVHHrul6yKZRaQAM4acSSLEQE4CfNjXrd2khePeiQy7-NNlogQDr6aznBBQZgLHDEsMHo2AHc2hNGRv17iYn/s1600/R-S.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="224" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhNcHZ9tT26_-XVO2KUvQ3S3vx59f59FWU2lFX9iSFJBsU7D1VRm6zJnv-_MVHHrul6yKZRaQAM4acSSLEQE4CfNjXrd2khePeiQy7-NNlogQDr6aznBBQZgLHDEsMHo2AHc2hNGRv17iYn/s320/R-S.jpg" width="320" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;"> Hodgkin cell single nucleus R-S cell</span> </span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhamUQh7BQrhu-uD6Kdc3GJmZwCoJoNVpPCN1uFBy5ItRsPhHHB-Q39v_APy2zEdKJhDlrPF0HyLr59mMAAWA8Ej1oLLYsouvP9gQ5BcQ0CZZzJ1iuF8kszSKq8nhS-ZWQcwr4U17WuWNO9/s1600/hodgkin+cell.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="301" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhamUQh7BQrhu-uD6Kdc3GJmZwCoJoNVpPCN1uFBy5ItRsPhHHB-Q39v_APy2zEdKJhDlrPF0HyLr59mMAAWA8Ej1oLLYsouvP9gQ5BcQ0CZZzJ1iuF8kszSKq8nhS-ZWQcwr4U17WuWNO9/s400/hodgkin+cell.jpg" width="400" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Others (variants)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">i) Lacunar cell:</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">folded, multilobate nuclei surrounded</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">by pale cytoplasm</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhhty_EQXCQN_Vn757WCd1VI9xdzItF8NJJ3RVhcSeDUdbdwS8r0eCutib0vFy9NMcbwOplSPIoH6G51oVvbDX0N1sVo2eieYfRzxRnYimhFs3HU4_9cGN6OwRHfszj_3GlMG55j6O1h-Pk/s1600/Lacunar+cell.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhhty_EQXCQN_Vn757WCd1VI9xdzItF8NJJ3RVhcSeDUdbdwS8r0eCutib0vFy9NMcbwOplSPIoH6G51oVvbDX0N1sVo2eieYfRzxRnYimhFs3HU4_9cGN6OwRHfszj_3GlMG55j6O1h-Pk/s400/Lacunar+cell.png" width="400" /></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjc35dhk5ASYejXzflssy7wWemhJ_aEkY18C0JE8TKJ2dv-GUxlGeHSVFqpKkhyphenhyphenHH_Q8akcOaon_pPwEZMhK-znfqnFH5TthXGtsxBEnPkZrSZHVNhkLTagQ6LbqIXTzuAKckpkThZETA1r/s1600/Lacunar+cell-servingnature.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjc35dhk5ASYejXzflssy7wWemhJ_aEkY18C0JE8TKJ2dv-GUxlGeHSVFqpKkhyphenhyphenHH_Q8akcOaon_pPwEZMhK-znfqnFH5TthXGtsxBEnPkZrSZHVNhkLTagQ6LbqIXTzuAKckpkThZETA1r/s400/Lacunar+cell-servingnature.png" width="393" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"> ii) <span style="font-size: large;">Type L & H R-S cell </span></span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">(Popcorn cell):</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> have twisted , multilobate nuclei </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> resembling popcorn kernels</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">iii) <span style="font-size: large;">Undifferentiated or </span></span><span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;"> Pleomorphic R-S c</span></span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Popcorn cell</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">(2) Background</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> 1) Inflammatory c infiltration</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Main: lymphocyte</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Others: plasam cells, neutrophil, eosinophil , histocyte</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">2) Fibrosis</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Histological classification</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">1.Nodular lymphocyte predominant</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Hodgkin’s lymphoma </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">2. Classical Hodgkin’s lymphoma</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Classical Hodgkin’s lymphoma</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Features:</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">1-R-S c and Hodgkin c</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">2-Background: lymphocyte Plasma C, neutrophil, eosinophil, histocyte</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">(1)Nodular sclerosis HL</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">(2) Lymphocyte-rich classical HL</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">(3) Mixed cellularity</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">(4) Lymphocyte depletion</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"> Nodular sclerosis HL</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Age</u>:Young woman, </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Common Site</u>:</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">I)cervical LN</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">II)supraclavicular</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">III)mediastinal LN</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Prognosis</u>: excellent</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Features:</u></span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">The presence of a particular variant of R-S c lacunar cells</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">The collagen bands that divided LN into circumscribed nodules</span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Nodular sclerosis HL</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Nodular sclerosis HL :Lacunar cell </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">(2)Lymphocyte-rich classical HL</span><br />
<br />
<ol>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Hodgkin c and mirror image c</span><span style="font-family: Arial, Helvetica, sans-serif;"> </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Background :LC or histocyte</span></li>
</ol>
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Lymphocyte-rich classical HL</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">(3) Mixed cellularity, MC:</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> <u>Most common form of HL</u></span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;"> Plantiful typical R-S cell</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;"> Background: LC, PlasmaC, Eosiphil C, histocyte, fibroblast</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;"> Small areas of necrosis and fibrosis</span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Mixed cellularity</span><br />
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CD30+</div>
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CD15</div>
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CD30</div>
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CD3</div>
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EBV: LMP-1</div>
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EBV: EBER</div>
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Fish: EMER</div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">(4) Lymphocyte depletion, LD</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">i)LC </span><span style="font-family: Arial; font-weight: bold;">↓</span><span style="font-family: Arial, Helvetica, sans-serif;"> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">ii)relative abundance </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">iii)R-S cell</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">iv)pleomorphic variants</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u> Two morphologic forms</u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">i) Diffuse fibrosis</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">-LC </span><span style="font-family: Arial; font-weight: bold;">↓</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">-amorphous protein materials</span><span style="background-color: white; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13.333333969116211px; line-height: 20px;">↑</span><span style="font-family: Arial, Helvetica, sans-serif;"> reticular fiber </span><span style="background-color: white; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13.333333969116211px; line-height: 20px;">↑</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">-R-S cell, histocyte, LC:less</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">ii) Reticular variants</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> rich in cell:</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Highly anaplastic R-S c</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">A few typical R-S cell</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Massive necrosis</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Poorly prognosis</span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Reticular variants</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"> Pathological diagnosis</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">1. Dependent on the LN biopsy</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Diagnostic value </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">-Typical R-S cell </span><span style="font-family: Arial, Helvetica, sans-serif;">---</span><span style="color: #00007d; font-family: Arial; font-weight: bold;">→</span><span style="color: #00007d; font-family: Arial; font-weight: bold;"> </span><span style="font-family: Arial, Helvetica, sans-serif;">HL</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">-Lacunar cell </span><span style="font-family: Arial, Helvetica, sans-serif;">---</span><span style="color: #00007d; font-family: Arial; font-weight: bold;">→ </span><span style="font-family: Arial, Helvetica, sans-serif;">nodular sclerosis</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">2. Immunohistochemistry</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">help to diagnosis</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">BC: CD20 (+) </span><span style="font-family: Arial, Helvetica, sans-serif;">---</span><span style="color: #00007d; font-family: Arial; font-weight: bold;">→</span><span style="font-family: Arial, Helvetica, sans-serif;"> nodular LC predominance</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">HL: CD15 , CD30 (+)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"> <span style="font-size: large;"> Stage of HD</span></span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">The Non- Hodgkin lymphomas </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> The non- Hodgkin lymphoma are solid tumours arising in the peripheral lymphoid tissue particularly of lymphnodes but also of the extranodal sites such as the oro- pharynx, the gut, skin and other sites.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">1. two-third </span><span style="font-family: Arial, Helvetica, sans-serif;">---</span><span style="color: #00007d; font-family: Arial; font-weight: bold;">→</span><span style="font-family: Arial, Helvetica, sans-serif;"> primary in LN</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> one-third </span><span style="font-family: Arial, Helvetica, sans-serif;">---</span><span style="color: #00007d; font-family: Arial; font-weight: bold;">→</span><span style="font-family: Arial, Helvetica, sans-serif;"> primary in </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">extranodal organs and tissues such as digestive , respiratory tract,lung , skin , CNS </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">2.<span style="font-size: large;"><u> Diagnosis:</u></span>dependent on the biopsy of LN or related tissue pathological diagnosis</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">-Histological classification</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">-Immune phenotype of tumor c</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">3. Classification</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Model of LC transformation </span><br />
<br />
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<br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">Gross:</span> </span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">The same as Hodgkin’s diseases but the mass is more soft and a few necrosis.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">The normal architecture of lymph node have been destroyed partly or entirely.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Very numerous monotonous neoplastic cell flood in lymph node.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">The neoplastic cell may be infiltrate to the capsule of node.</span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">B-cell small lymphocytic </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Example of Non-Hodgkin’s lymphoma </span><br />
<br />
<ol>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Follicular lymphoma</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Diffuse large B-cell lymphoma</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Burkitt lymphoma</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Mycosis fungoides</span></li>
</ol>
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"> Follicular lymphoma</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Drive from germinal center BC</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> The most common form in the US</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> (20-45%)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Less in China(10%) </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Age:adult </span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Pathological features</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Nodular growth pattern</u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Tumor follicle:</u> composed of</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">i)Centrocyte:irregular and cleaved nuclear, scant cytoplasm</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">ii)Centroblast:open nuclear chromatin,several nucleoli</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjeX0sO33iQTmBDeybbwyUJH-WZtF9ELSmy-TLmhyintIjY6_Z5aYUKxXpm5a1mp2HLnmouEbM-IwYSLvvOxS8wc6rxrYKVkE6ZbaggtoiGCVYmz5Qj0AG8fAziStLuglOUMk5D64B36Vx/s1600/Follicular+lymphoma.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="263" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjeX0sO33iQTmBDeybbwyUJH-WZtF9ELSmy-TLmhyintIjY6_Z5aYUKxXpm5a1mp2HLnmouEbM-IwYSLvvOxS8wc6rxrYKVkE6ZbaggtoiGCVYmz5Qj0AG8fAziStLuglOUMk5D64B36Vx/s400/Follicular+lymphoma.png" width="400" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"> Diffuse large B-cell lymphoma</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Centroblast lymphoma</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">B immunoblast lymphoma</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Anaplastic large BC lymphoma</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">TC-rich/histocyte BC lymphoma</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Plasmablast lymphoma</span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Pathological features</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Relatively large cell:4-5 times the diameter of small LC</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">A fair degree of morphologic variation: centroblast , immunoblast</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Cell morphology: round or oval nucleus,2-3 nucleoli, margination of chromatin moderate cytoplasm</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Diffuse pattern of growth</span></li>
</ul>
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgNQosFlM6CsuRU7ZI-KOfbS6eZDLtkKMGSBVc_noWnMc-_X-Xv-7btTQrzX7Kx0A_YmbWWQkyV_sItzqGWB8DQ7pMtDqkHduQLThdcB07KKUMVM4vgbwQ54Ph7lWb3Ulv_2k3M7pDuUNWI/s1600/NHL.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em; text-align: center;"><img border="0" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgNQosFlM6CsuRU7ZI-KOfbS6eZDLtkKMGSBVc_noWnMc-_X-Xv-7btTQrzX7Kx0A_YmbWWQkyV_sItzqGWB8DQ7pMtDqkHduQLThdcB07KKUMVM4vgbwQ54Ph7lWb3Ulv_2k3M7pDuUNWI/s400/NHL.jpg" width="400" /></a><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Diffuse large cell,centroblastic</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhRSNmK8xjoaOOpqRrpQXzYYU33T2NrRbvsy86sfXp5EsWjO7a3AvpNf-ND5ffZXpKQYrb34MlTaRkUvC9ztF8jFU3kIWpvBTUWMab5gAkxeoqBeyYgRKk6LeTuH2XpT85C2onRuIYBSIo1/s1600/Diffuse+large+cell,centroblastic.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="275" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhRSNmK8xjoaOOpqRrpQXzYYU33T2NrRbvsy86sfXp5EsWjO7a3AvpNf-ND5ffZXpKQYrb34MlTaRkUvC9ztF8jFU3kIWpvBTUWMab5gAkxeoqBeyYgRKk6LeTuH2XpT85C2onRuIYBSIo1/s400/Diffuse+large+cell,centroblastic.png" width="400" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Burkitt’s lymphoma</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Brukitt’s lymphoma was described initially in </span><u style="font-family: Arial, Helvetica, sans-serif;">Africa</u><span style="font-family: Arial, Helvetica, sans-serif;">, where it is </span><u style="font-family: Arial, Helvetica, sans-serif;">endemic</u><span style="font-family: Arial, Helvetica, sans-serif;"> in some parts, but it is also ocure sporadically in nonendemic area.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Rare cases have been recorded in European and North America.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">This disorder is relationship of the Epstein-Barr viruses.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Both the African and non Africa cases are found largely in children or young adults. </span></li>
</ul>
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">Presentation of disease:</span></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">The disease rarely arises in lymph nodes, but usually appears in the jaw or ovaries (retroperitoneal tissues in males) this disease grows extremely rapidly and spreads extensively, leading quickly to complication.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Histological appearance is typical and striking</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> 1. diffuse proliferation of lymphoblasts (B cell type) cell medium- sized and uniform, mitoses frequent.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> 2. Scattering of macrophages containing debris desired from very rapid cell turnover contributing <u><span style="font-size: large;">‘starry sky’</span></u>. These benign macrophage are diffusely distributed among the tumor cell. The macrophage often sounded by a clear space.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u><span style="font-size: large;">N</span>OTE:</u> <u> Leukemic transformation may occur, but is uncommon</u>, these tumors respond well to aggressive chemotherapy and long remissions have been reported. However, in most cases a relapse occurs, and a majority of patients die with in 5 years.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Burkitt’s lymphoma,starry-sky</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhe7NtFQx_wsxszZo0nYl6Ujv5CFPjoClXFss5e8ZMyORKyVC6yh4mjJ1jtqJMzd6T2GSKTAYGPMqPzSpxBFStHx5LMeeYP5GYVzl0qMKTrfG0Kdl_T7ufo5I0VsqKbgAD3OsCJvtYhp2qZ/s1600/Burkitt%E2%80%99s+lymphoma,starry-sky.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="304" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhe7NtFQx_wsxszZo0nYl6Ujv5CFPjoClXFss5e8ZMyORKyVC6yh4mjJ1jtqJMzd6T2GSKTAYGPMqPzSpxBFStHx5LMeeYP5GYVzl0qMKTrfG0Kdl_T7ufo5I0VsqKbgAD3OsCJvtYhp2qZ/s400/Burkitt%E2%80%99s+lymphoma,starry-sky.png" width="400" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Burkitt’s lymphoma,mitoses</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjAxKkACPjb1ovtLv1gVGP-q0nqQBsigUAcDpvRKjvVdHF7D3sx7wznFRWbrvF5R_GKTFgSlD0xOQMLwUhZ8Lx4k5aNi0izqhpN5etfNr7P0v8eblEFBLDy6jbYGoD7-TPE78Pqqkv43v1p/s1600/Burkitt%E2%80%99s+lymphoma,mitoses.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="286" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjAxKkACPjb1ovtLv1gVGP-q0nqQBsigUAcDpvRKjvVdHF7D3sx7wznFRWbrvF5R_GKTFgSlD0xOQMLwUhZ8Lx4k5aNi0izqhpN5etfNr7P0v8eblEFBLDy6jbYGoD7-TPE78Pqqkv43v1p/s400/Burkitt%E2%80%99s+lymphoma,mitoses.png" width="400" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Mycosis fungoides</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgU68XDxMLIczBErY8e_FU30zWiuXUnUyv2JyLrxvXhVHAxR7tAltjfmCu015tV_7S4vpFGE84MbnnQEcCTCZvAd9XPsQMAPQGDN5moV2lBO9aFKfaEcuyaWNkuAwGTwBecG-IvJmM8-cMX/s1600/Mycosis+fungoides.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="285" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgU68XDxMLIczBErY8e_FU30zWiuXUnUyv2JyLrxvXhVHAxR7tAltjfmCu015tV_7S4vpFGE84MbnnQEcCTCZvAd9XPsQMAPQGDN5moV2lBO9aFKfaEcuyaWNkuAwGTwBecG-IvJmM8-cMX/s400/Mycosis+fungoides.jpg" width="400" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif;"> Mycosis fungoides are uncommon lymphoid malignancies that are primary in the skin. It is infrequent T cell lymphomas. These disease usually affects males 40-60 years of age.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Grossly: The lesions begin as poorly defined areas of eczema, followed by formation of plaques and ultimately of multiple nodules. The nodules often rapture and become ulcer.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> <span style="font-size: large;">Histologically:</span> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> This disease is characterized by dermal infiltrates of atypical lymphoid cell that invade the epidermis. The neoplastic cell (mycosis cells) have deeply lobulated or cerebra-form nuclei. Immunology studies indicate the presence of T cell markers on mycosis cells.</span><br />
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Anonymoushttp://www.blogger.com/profile/16555664245806923731noreply@blogger.com0tag:blogger.com,1999:blog-3618930566267736040.post-74930269428238241772013-04-19T10:28:00.001-07:002013-04-19T10:30:42.944-07:00Anti-anxiety,Sedative - Hypnotics drugs and their effects<br />
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">What is ANXIETY ?</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Anxiety is a state characterized by psychological symptoms, and often accompanied by physical symptoms. </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">The accompanying tension of anxiety is manifested by objective signs: fatigue, dizziness, vague pains, palpitations, headache, irritability, indigestion, etc.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Anxiety may accompany physical illness, such as hypertension, asthma, irritable colon, peptic ulcer, etc. </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Anxiety may be present in schizophrenics and depressed patients are frequently anxious.</span></li>
</ul>
<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhvDPSnow0VIgC0vBhB3Q-2ZXRQbQfB8ox5vrqTFJ3LLsOWazTuyo9PGdYT9lHz16DqgKqvyazLCspkU-OE-YwIv1AT9VCUpfxrEqnAVNAn96D-zdLvFzUXEG_eUsXiDtlGUeXMjPyXIqf4/s1600/Anxiety-servingnature.bmp" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="226" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhvDPSnow0VIgC0vBhB3Q-2ZXRQbQfB8ox5vrqTFJ3LLsOWazTuyo9PGdYT9lHz16DqgKqvyazLCspkU-OE-YwIv1AT9VCUpfxrEqnAVNAn96D-zdLvFzUXEG_eUsXiDtlGUeXMjPyXIqf4/s400/Anxiety-servingnature.bmp" width="400" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Yerksen-Dodson Law</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj_ZIOWX97XouG-L47sEnsOzSGAzBBGTpUGaTG3ikhC2pPY6F_VyzEaqAj-TBwCjf6F5xOHtX2n8W0zNjWj2P9KIHkXLfbCB7pDGJyDB-bi9vA7i3vhVh9DFihULRGZTGmqw0aTSZy04kYm/s1600/Yerksen-Dodson+Law.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="327" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj_ZIOWX97XouG-L47sEnsOzSGAzBBGTpUGaTG3ikhC2pPY6F_VyzEaqAj-TBwCjf6F5xOHtX2n8W0zNjWj2P9KIHkXLfbCB7pDGJyDB-bi9vA7i3vhVh9DFihULRGZTGmqw0aTSZy04kYm/s400/Yerksen-Dodson+Law.png" width="400" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">The Yerksen-Dodson law demonstrates an empirical relationship between arousal and performance. It dictates that performance increases with cognitive arousal, but only to a certain point: when levels of arousal become too high, performance will decrease. A corollary is that there is an optimal level of arousal for a given task. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Classification of Anxiety</span><br />
<br />
<ol>
<li><span style="font-family: Arial, Helvetica, sans-serif;"> Generalized anxiety</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;"> Panic attack</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;"> Phobia</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;"> Obsessive compulsive disorder</span></li>
</ol>
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"> INSOMNIA</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Insomnia is characterized by a relative deficiency in the amount or quality of sleep: inability to induce sleep, inability to stay asleep, premature awakening, interrupted sleep, sleep that is not refreshing.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Sedative-Hypnotic-Anxiolytic Drugs</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">A. An anxiolytic drug reduces anxiety and makes the user feel more peaceful or tranquil. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B. A sedative drug decreases activity, moderates excitement, and calms the recipient. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C. A hypnotic drug produces drowsiness and </span><span style="font-family: Arial, Helvetica, sans-serif;">facilitates the onset and maintenance of a state of sleep that resembles natural sleep, and from which the patient can be easily aroused.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">CNS depression: dose-response curve</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhROTop265UXIKe8Py_UU8HNFDohIP7BGyhC_Ii-e1nam1OjqYdQpDFLG2nxVAHBgbcfgHLalaVlbKipTw3qFraUSTTsINl1AZ-rcmzsw6mWC2EikSHR_Ld_j27WDb_19hjsw4rrWOYa50U/s1600/CNS+depression-dose+response-servingnature.bmp" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="261" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhROTop265UXIKe8Py_UU8HNFDohIP7BGyhC_Ii-e1nam1OjqYdQpDFLG2nxVAHBgbcfgHLalaVlbKipTw3qFraUSTTsINl1AZ-rcmzsw6mWC2EikSHR_Ld_j27WDb_19hjsw4rrWOYa50U/s400/CNS+depression-dose+response-servingnature.bmp" width="400" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">BZs are not general CNS depressants! a general CNS depressant can cause any degree of depression, ranging from the slightest sedation to anesthesia, coma, and death. <u>BZs will not cause anesthesia</u>, and in fact have extensively replaced the barbiturates and other sedative hypnotics because they are much less likely to cause fatal CNS depression.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">An ideal hypnotic drug should:</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">1. promote sleep quickly</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">2. alter the architecture and patterns of sleep only toward the norm</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">3. ensure a complete night's sleep</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">4. produce no residual daytime sedation</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">5. influence no other body system or drug action</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">6. have a wide margin of safety</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">7. be without danger of producing habituation, tolerance and dependence</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Based on time Drugs Classification</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">First generation</span> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">- Prior to 1864</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Alcohol, Bromides, Chloral Hydrate, Opium</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">- Barbiturates (1864)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Purpose: Sedate and calm </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">“Downers” – street-use name in the 60s </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Phenobarbital still used to prevent seizures</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">- Others (no longer used)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Methaqualone (Quaaludes; 1960s) </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Meprobamate (1960s)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">Second Generation</span> </span><br />
<br />
<ol>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Benzodiazepines (1950s)</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Chlordiazepoxide (Librium; 1957) </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Diazepam (Valium; 1963) </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Flunitrazepam (Rohypnol; 1990s)</span></li>
</ol>
<br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">Third Generation</span> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Most prevalent by the 1990s</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">1-Zolpidem </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">2-Zaleplon</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Benzodiazepines</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">1,4-Benzodiazepine nucleus:</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">a benzene ring </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">a seven-member heterocyclic </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">two nitrogens</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>NOTE:</u> Benzodiazepines are the most widely used anxiolytic-hypnotic drugs. (benzene ring ,lateral chain)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">CLASSIFICATION OF BDZs</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Benzodiazepines can be divided into<u> three groups</u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">according to the duration of drug action.</span><br />
<br />
<ol>
<li><span style="font-family: Arial, Helvetica, sans-serif;"><u>Long-acting</u>: diazepam,flurazepam, nitroazepam</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;"><u>Intermediate-acting</u>: chlordiazepoxide, oxazepam</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;"><u>Short-acting:</u> triazolam</span></li>
</ol>
<br />
<span style="font-family: Arial, Helvetica, sans-serif;"> <span style="font-size: large;">Pharmacokinetics</span></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">In this dynamic process, lipophilicity plays a major role.</span><br />
<br />
<ul>
<li><u style="font-family: Arial, Helvetica, sans-serif;">Administration:</u><span style="font-family: Arial, Helvetica, sans-serif;"> orally or iv. injection. im. injection unreliable. </span></li>
<li><u style="font-family: Arial, Helvetica, sans-serif;">Absorption</u><span style="font-family: Arial, Helvetica, sans-serif;">: small intestine. PPBR is high.</span></li>
<li><u style="font-family: Arial, Helvetica, sans-serif;">Distribution</u><span style="font-family: Arial, Helvetica, sans-serif;">: rapidly cross BBB and placenta; </span></li>
<li><u style="font-family: Arial, Helvetica, sans-serif;">Metabolism:</u><span style="font-family: Arial, Helvetica, sans-serif;"> in liver; </span></li>
<li><u style="font-family: Arial, Helvetica, sans-serif;">Elimination:</u><span style="font-family: Arial, Helvetica, sans-serif;"> excreted primarily in the urine ; renal tubular reabsorption, enterohepatic cycle</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Some however are metabolized to products which are active and may have a much longer half life than the parent drug. </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">The major route of metabolism is N-demethylation. N-demethylation is inhibited by concurrent administration of the anti-ulcer drug Cimetidine. This will result in a prolonged duration of action. </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">The rate of N-demethylation is also diminished in the elderly, therefore the dose of BZs is lower in the elderly. </span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Pharmacological effects and Clinical Uses </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">CNS</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">- Anti-anxiety</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">- Sedation and Hypnosis</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">- Amnesic effect</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">- Anti-convulsion and anti-epilepsy</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">- Muscle relaxation</span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"> Anti-anxiety</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">>Benzodiazepines show anti-anxiety at low doses with high potency (efficacy) and rapid onset. (without producing sedation)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">>Action site: the limbic system of the brain (inhibiting the neuronal circuits)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">> Therapeutic uses: to treat anxiety </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Diazepam: for continued state of anxiety</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Chlordiazepoxide: for intermittent severe anxiety.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> >BDZs are less subject to tolerance than the sedative and hypnotic effects when used as anti-anxiety drugs.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"> Sedation and Hypnosis</span><br />
<br />
<ul>
<li><span style="font-family: Arial; font-weight: bold;">↓ S</span><span style="font-family: Arial, Helvetica, sans-serif;">leep latency</span></li>
<li><span style="font-family: Arial; font-weight: bold;">↓ S</span><span style="font-family: Arial, Helvetica, sans-serif;">wakening frequency</span></li>
<li><span style="font-family: Arial; font-weight: bold;">↑ S</span><span style="font-family: Arial, Helvetica, sans-serif;">leep duration</span></li>
<li><span style="font-family: Arial; font-weight: bold;">↓ S</span><span style="font-family: Arial, Helvetica, sans-serif;">tage 3 & 4 NREM sleep</span></li>
<li><span style="font-family: Arial; font-weight: bold;">↑</span><span style="font-family: Arial; font-weight: bold;"> S</span><span style="font-family: Arial, Helvetica, sans-serif;">tage 2 NREM sleep</span></li>
<li><span style="font-family: Arial; font-weight: bold;">↑ T</span><span style="font-family: Arial, Helvetica, sans-serif;">otal sleep time </span></li>
<li><span style="font-family: Arial; font-weight: bold;">↓ R</span><span style="font-family: Arial, Helvetica, sans-serif;">EM sleep, but < older drugs</span></li>
</ul>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Clinical Uses</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Rx: Insomnia </u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Usually a short to medium acting benzodiazepine, administered orally. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">- <u>BZs (lorazepam, triazolam, midazolam ) </u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Day time sedation side effect </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">REM sleep reduced; rebound / bizarre dreams</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">-<u> Zolpidem & Zaleplon </u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Less daytime sedation </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">No effect on REM sleep. No dependence</span><br />
<br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Note:</u> All hypnotics will lose efficacy if taken daily. Nightly use of sedative-hypnotics be limited to < 3 weeks.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"> Hypnosis</span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><u>Advantages (compare with BARBs) </u></span><br />
<br />
<ol>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Greater dose margin </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Higher therapeutic index (1000?)-less effects on respiratory and cardiovascular function. </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Large dosage not induce anesthesia </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">No hepatic enzyme induction effect – less tolerance </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Withdrawal symptoms and rebound is small </span></li>
</ol>
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Disadvantages: (VS 3rd generation drugs) </span><br />
<br />
<ol>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Shorten the REM sleep – rebound </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Little tolerance and dependence</span></li>
</ol>
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"> Amnesic effect</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">- anterograde amnesia</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">- cognitive impairment</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Rx: Preanesthetic and </u></span><span style="font-family: Arial, Helvetica, sans-serif;"><u>preoperative administration </u> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">- Preparation of patients for anesthesia, surgery, and other frightening or unpleasant medical and dental procedures and diagnostic tests (before using endoscope and cardioversion). </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">- Midazolam is a frequently used, i.v.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">why ?</span> Because it;</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">* Reduce anesthetic doses, diminish </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> side- effects</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">* Enhance the safety of anesthetics</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">* Forget unpleasant event during surgical</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> procedures </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> <span style="font-size: large;">Anti-convulsion and anti-epilepsy</span></span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Depressant activity on the brain and spinal cord </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Only inhibit development and spread of epileptiform activity </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Selectivity anticonvulsant -- without CNS general depression</span></li>
</ul>
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">Mechanism: Enhancing GABA-mediated synaptic inhibition,controlling the development and spread of the abnormal neuronal firing to the adjacent normal brain areas. Clonazepam, nitrazepam, and diazepam are more selective in anti-convulsion.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><u>RX: <span style="font-size: large;">Convulsion</span>: high doses</u> </span><br />
<br />
<ol>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Tetanus </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Eclampsia(delivery; in labor ) </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">drug intoxication </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">fever (children) </span></li>
</ol>
<br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>RX: <span style="font-size: large;">Seizures:</span> high doses </u></span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Grand mal and status epileptics </span></li>
<li><u style="font-family: Arial, Helvetica, sans-serif;">Diazepam: status epileptics (primary choice, iv) </u><span style="font-family: Arial, Helvetica, sans-serif;"> </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Nitrazepam and clonazepam: other types of epilepsy</span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif;">NOTE: The long-acting drugs are commonly used for epileptics : clonazepam, diazepam minor seizure;petit mal;PM</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Muscle relaxation (centrally based) </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">BDZs induce muscle hypotonia and relax the spasticity of skeletal muscle without interfering with normal locomotion</span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Mechanism of muscle relaxation</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Depress spinal cord polysynaptic reflexes ; decrease internuncial transmission -at lower dosage </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Depress transmission at the skeletal neuromuscular junction -- high dosage </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">muscle spasm (muscle strain) </span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Clinical Uses</span><br />
<br />
<ol>
<li><span style="font-family: Arial, Helvetica, sans-serif;">muscle rigidity</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">tetanus</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Parkinson’s (stiff-man syndrome)</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">endoscopy, orthopedic manipulations</span></li>
</ol>
<br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Diazepam: i.v.</u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Note : the sedative and anxiolytic properties of the drug also promote relaxation and relieve tension</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Summary </span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Therapeutic indications for BDZs include:</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Anxiety states associated with neurotic, phobic,and depressive disorders,or myocardial infarction;</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Insomnia; </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Preanesthetic (preoperative) medication; </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Epileptic seizures;</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Hypertonia of skeletal musculature </span><span style="font-family: Arial, Helvetica, sans-serif;">(treatment for spasticity,rigidity).</span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"> Mechanism of Action </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Benzodiazepines enhance GABAergic neurotransmission in all areas of the CNS. </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><u> BDZs receptors in brain:</u> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">- spinal cord</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">- cuneate nucleus</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">- cerebellum</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">- brain stem</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">- hippocampus</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">- neocortex</span><br />
<u style="font-family: Arial, Helvetica, sans-serif;">BDZ-R exist parallel to GABAA</u><span style="font-family: Arial, Helvetica, sans-serif;"> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>The four types of receptors:</u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">I) Receptor-operated channels</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">N-AchR, GABAA R, glycine R, EAA ionotropic R, 5-HT3 R</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">II) G protein-linked receptors</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">M-AchR, adrenoceptors, GABAB R</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">III) Receptors that are enzymes</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">insulin R, growth factors R</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">IV) DNA-linked receptors</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">steroid hormone R, thyroid hormone R</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">GABAA receptor is a GABA/Cl- ion channel complex. It consists of a pentamer of homologous subunits. The binding of GABA (?-GABA:Gamma-aminobutyric acid------GABA) to the receptor causes Cl- channel open, induces Cl-inflow and neuronal hyperpolarization. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Mechanism of Action of BZs</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">The mechanism of action of BZs is thought to be due to an allosteric effect on GABA-A receptors which facilitates or amplifies the inhibitory effect of endogenous CNS GABA. BZs do not directly activate GABA-A receptors and require endogenous GABA to express their effects. </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">BDZs potentiate the affinity of GABAA receptor for GABA, increase the frequency of the Cl--channel openning and cause neuronal hyperpolarization. </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">BDZs do not directly gate Cl--channel but require GABA to express their effects, i.e. BDZs produce no effects on Cl--channel conductance in the absence of GABA.</span></li>
</ul>
<br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Summary of MOA </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"> Adverse effects and toxicities</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Inhibition of CNS — most commonly </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">> <u>Hangover</u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> drowsiness, dizziness, headache, fatigue, weakness, poor concentration, motor incoordination, confusion</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">> <u>Development of rebound insomnia</u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Early morning awakening, next-day anxiety</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> More pronounced with short-acting agents (triazolam)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">> <u>Anterograde amnesia</u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> cognitive impairment: decreased long-term recall and acquisition of new knowledge</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> <span style="font-size: large;">Dependence and tolerance — less commonly </span></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Psychological and physical dependence</u> and <u>tolerance</u> on BDZs can develop when drugs are given over a prolonged period. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> </span><span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Withdrawal syndrome: </span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">anxiety</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">tension</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">agitation</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">depression</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">panic</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">insomnia</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">tremor</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">myalgia</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">paranoia</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">convulsions and delirium</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Short-acting agents (triazolam) induce more abrupt and severe withdrawal reactions than long-acting agents do. </span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">Teretogenicity (fetal deformation)</span></span><span style="font-family: Arial, Helvetica, sans-serif;"> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">Prevention of benzodiazepine dependence</span></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">1.Recognize persons likely to become </span><span style="font-family: Arial, Helvetica, sans-serif;">dependent, e.g. alcoholics and those with passive dependent personality traits</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">2.Avoid continuous, high dosage</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">3.Discourage regular consumption for long periods of time</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">4.Encourage flexible dosage up to an agreed maximum</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Acute intoxication</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">More likely in children or some patients; </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">BP and respiration are depressed; </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">nystagmus on lateral gaze; </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">tendon reflexes depressed; </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Ataxia; confusion; coma; shock => Risk of Death (rare).</span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">Treatment </span></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Drug overdose is treated with flumazenil </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Respiratory function should be adequately supported and carefully monitored.<span class="Apple-tab-span" style="white-space: pre;"> </span></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Benzodiazepine binding site ligands</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">1-Agonists (positive modulators)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">benzodiazepines</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">2-Antagonists (null modulators)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">flumazenil</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">3-Inverse agonists (negative modulators)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">ß-carbolines</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">BDZs ANTAGONIST</span>——Flumazenil</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Flumazenil rapidly reverses the effects of benzodiazepines.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Characteristics:</u></span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;"> Rapid onset</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;"> The duration of action is short. The half-life is about 1hr.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;"> Repeated intravenous administration is needed.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;"> Induce withdrawal in dependent patients</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;"> Cause seizures when used to epileptic patients.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;"> Clinic uses: BDZs detoxication, hepatic encephalopathy </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;"> Side effects: dizziness, nausea, vomiting, anxiety.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;"> No antagonistic action on barbiturates. </span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif;"> <span style="font-size: large;"> Drug interactions </span>– carefully </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> - BDZs enhanced depression when combined</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> with other CNS depressants incl. alcohol. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> - oxidation impaired by cimetidine, estrogen,</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> disulfiram, isoniazid, etc. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">Caution: </span></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">potentially dangerous tasks </span><span style="font-family: Arial, Helvetica, sans-serif;"> operating machinery or driver</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<br />
<div style="text-align: center;">
<span style="font-family: Arial, Helvetica, sans-serif; font-size: x-large;">BARBITURATES</span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgWmA8KaFJz1DQnRhM3ohz0rsW97aTfUyXnSAT1J63GYKFDGewS2PQ7SbnfLxi9SOJLwP_qts8bGUFzlGagtQMjqxMgCNoLq8VkL3WoUmHR2KcMkPzqCzt6P-TPDXoTrn7JQaD7Dg1uUyKt/s1600/Barbiturate-servingnature.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgWmA8KaFJz1DQnRhM3ohz0rsW97aTfUyXnSAT1J63GYKFDGewS2PQ7SbnfLxi9SOJLwP_qts8bGUFzlGagtQMjqxMgCNoLq8VkL3WoUmHR2KcMkPzqCzt6P-TPDXoTrn7JQaD7Dg1uUyKt/s400/Barbiturate-servingnature.png" width="400" /></a></div>
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Long-acting: Barbital</span><span style="font-family: Arial, Helvetica, sans-serif;"> Phenobarbital</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Intermediate-acting: Amobarbital</span><span style="font-family: Arial, Helvetica, sans-serif;">Pentobarbital</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Short-acting: Secobarbital</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Ultra-short-acting: Thiopental </span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Pharmacokinetics</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Potent inducers of hepatic enzymes – multiple drug interactions (major reason for tolerance)</span><br />
<div class="separator" style="clear: both; text-align: center;">
</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhfeTJ7AMyqo6CtAxqaESZMEzmwTILFrbCswtRHzwq_4d-FMGCqiKm_8zzUc0uiQyzXc8AUoN2vkU-w1NvIoDfPxp8krN2r9aGJm3kE0jfsmatWlwWiWMSjOHyHtre4QIhUAhkpOIKdx6Xm/s1600/barbiturates.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="255" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhfeTJ7AMyqo6CtAxqaESZMEzmwTILFrbCswtRHzwq_4d-FMGCqiKm_8zzUc0uiQyzXc8AUoN2vkU-w1NvIoDfPxp8krN2r9aGJm3kE0jfsmatWlwWiWMSjOHyHtre4QIhUAhkpOIKdx6Xm/s400/barbiturates.png" width="400" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Pharmacological effects</span><span style="font-family: Arial, Helvetica, sans-serif;"> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">CNS </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">- Depression from mild sedation to</span><span style="font-family: Arial, Helvetica, sans-serif;"> general anesthesia </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">- Sedative and Hypnotic</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">- Anticonvulsive and antiepileptic </span><span style="font-family: Arial, Helvetica, sans-serif;">(phenobarbital)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">- Anesthetic (thiopental)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Note</u>:Bariturates show CNS depression effect ranging from mild sedation to general anesthesia in a dose-dependent fashion. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">obvious individual difference ;</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Decrease sleep latency, increase total sleep time, decrease the number of awakenings;</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Shorten the duration of REMS, cause non-natural sleep</span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"> Clinical Uses </span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><u>Anticonvulsion and antiepilepsy</u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Phenobarbital is mainly used in grand mal epileptic seizures and status epileptics, recurrent febrile seizures for children. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><u>Anesthesia and pre-anesthesia</u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Thiopental: intravenous anaesthesia, inducing anaesthesia.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Phenobarbital: pre-anesthesia.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Long-, intermediate-acting drugs are used in pre-operation to preclude apprehensive emotion. </span><br />
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Mechanism of action </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Enlarging GABA-induced Cl- currents by prolonging periods of individual Cl- channel opening (not frequency)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Reducing glutamate-induced depolarizations, inhibiting voltage-dependent Na+ , K+ channels at higher concentration</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Depressing the reticular ascending activating system</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Simulating the effect of GABA in the absence of GABA <u>(agonists at GABAA) .</u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">MOA of BARBs</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-size: large;"><span style="font-family: Arial, Helvetica, sans-serif;">Difference between </span><span style="font-family: Arial, Helvetica, sans-serif;">BDZs and Barbiturates</span></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Barbiturates</u></span><br />
<br />
<ol>
<li><span style="font-family: Arial, Helvetica, sans-serif;">No change in numbers of Cl- channel opening, but prolonging the duration of the channel opening</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">GABA independent</span></li>
</ol>
<br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Benzodiazepines</u></span><br />
<br />
<ol>
<li><span style="font-family: Arial, Helvetica, sans-serif;"> No change of duration, just increasing the frequency of Cl- channel opening</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;"> GABA dependent</span></li>
</ol>
<br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Safety? Barbiturates and benzodiazepine</u></span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">Barbiturates are general CNS depressants; ie as one increases the dose, one can cause any degree of CNS depression, from the mildest sedation through hypnosis, anesthesia, coma, and death. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Thus, benzodiazepines possess a therapeutic margin considerably wider than that of barbiturates.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">So ?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Benzodiazepines are the Drugs of Choice. Why ? Because;</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">1. Benzodiazepines have a higher </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> therapeutic index</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">2. Slower development of tolerance</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">3. Lower incidence of physical dependence</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">4. Fewer drug interactions</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">5. Not respiratory depressants</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">6. They have few peripheral effects</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>NOTE:</u> Since benzodiazepine intoxication may become life-threatening only when other central nervous depressants(ethanol) are taken simultaneously.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"> Adverse effects</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u> Hangover Effect</u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Drowsiness, fatigue, dizziness, diarrhea, impairment of judgment and fine motor skills, paradoxical excitement</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> <u>Tolerance / dependence:</u> > 4 weeks</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> withdrawl syndromes: tremors, anxiety, weakness, restlessness, insomnia, nausea, vomiting, seizures, delirium</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> <u>Acquired hypersensitivity</u> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> urticaria, skin rash, dermatitis exfoliative</span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Toxicities</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Barbiturates have a relatively <u>low therapeutic index</u> . As a rough rule of thumb, 10 therapeutic doses taken simultaneously will lead to a fatal outcome.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Major cause of death is <u>respiratory depression.</u> </span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">First Aid</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">artificial respiration </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">gastric lavage , purgation ,transfusion, diuresis</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Drug interactions</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Barbiturates induce the hepatic enzymes thus increase the metabolism of many endogenous compounds including steroids and hormones, and many other drugs as well as barbiturates.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Ethanol potentiates the CNS depressant effects of barbiturates, as do some antihistamines, and MAO inhibitors.</span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">MISCELLANEOUS SEDATIVE-HYPNOTIC DRUGS</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Over the years, many drugs with diverse structures have been used for their sedative-hypnotic properties. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Several of these are still marketed now </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">Chloral hydrate</span></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> > Effective sedative and hypnotic</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> > Shorten sleep latency </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> > No hangover</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> > Do not shorten REM</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u> Disadvantage:</u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> > Irritation to the gastrointestinal tract </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> > Unusual, unpleasant taste</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> > Because of rapidly developing tolerance, choral hydrate is suitable only for short-term use. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> > It has very limited uses now.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">Zaleplon and Zolpidem</span> </span><br />
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<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">They are agonists act at the same receptor site as the BDZs (i.e; GABAA). </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Their effects are blocked by flumazenil.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Produce pure sedation (less anxiolytic, anticonvulsive or muscle relaxing effects) .</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">They are used in the relief of sleep onset insomnia. </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Although they act at the same site as the Bzs, their chemical structure does not resemble a benzodiazepine. </span></li>
</ul>
<u style="font-family: Arial, Helvetica, sans-serif;">Characteristics</u><span style="font-family: Arial, Helvetica, sans-serif;">:</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">1. Both drugs have sustained hypnotic efficacy (i.e; little or no tolerance develops) without occurrence of rebound insomnia or withdrawal symptoms on abrupt discontinuation. </span><span style="font-family: Arial, Helvetica, sans-serif;"> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">2. Zolpidem has a longer duration of action and is more likely to cause residual morning side effects including sedation, delayed reaction time, and anterograde amnesia. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">3. The toxicity of these agents is similar to that of the Bzs; ie they have a high therapeutic index unless combined with other CNS depressants & hypnotic doses can exaggerate the deleterious hypoxic and hypercarbic effects of obstructive sleep apnea. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">4. Abuse potential appears to be the same as Bzs.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">ADVANTAGES OF BENZODIAZEPINES VS OTHER SEDATIVE-HYPNOTICS</span><br />
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<ol>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Clearly anti-anxiety at low doses.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Skeletal muscle relaxation effect</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">High therapeutic index (TI; more safe or not? )</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">No induction of hepatic metabolizing enzymes</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">The rebound is slight after withdrawal.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Mild side effects, less tolerance and dependence</span></li>
</ol>
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<span style="font-family: Arial, Helvetica, sans-serif;"> <span style="font-size: large;">Principles of treatment of insomnia</span></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">1-Insomnia is a symptom. It may well be a symptom without recognizable disease, but one should be alert to underlying causes that may require more specific treatment. These include pain (e.g., arthritis, dyspepsia), dyspnea (left ventricular failure, bronchospasm), high frequency of micturition, mood disorders, anxiety.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">2-Common prescription drugs and over-the-counter medication known to cause insomnia include anti-hypertensives (clonidine, β-blockers), anticholinergics (ipratropium), CNS stimulants (methylphenidate), hormones (thyroid preparations, cortisone) sympathomimetic amines (bronchodilators), xanthine derivatives (caffeine, theophylline), decongestants in cough and cold preparations.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">3-Treatment with hypnotics should be on short-term or intermittent basis.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">4-Benzodiazepines and the newer benzodiazepine receptor agonists (e.g. zaleplon) should be considered to be hypnotic drugs of choice for most insomniacs; one or two standard drugs can manage majority of cases.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">5-The smallest dose suitable for obtaining the desired effects should be used.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">6-Hypnotic effect of drug should be exploited by association with habitual activities; habit alone may substitute for the drug or enhance its effect.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">7-Sleep apnea syndrome, heavy use of alcohol, pregnancy and necessity of alert night time performance precludes the use of hypnotics.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">8-Advanced age, heavy snoring, lung disease (preexisting respiratory failure in patients with severe pulmonary insufficiency can be aggravated by a usual dose of any hypnotic), liver disease, tendency of drug abuse, suicidal risk and special job requirements (pilot, driver) constitute relative contraindications of the use of hypnotics.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: x-large;">Study questions</span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Question 1:</span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Benzodiazepine’s mechanism of action is ?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> A. Directly open chloride channels.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> B. Directly inhibit CNS.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> C. Enhance the affinity of GABA receptor for GABA by binding to benzodiazepines receptor. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> D. Act at GABA receptor and increase inhibitory transmitter effects. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">Question 2: How do benzodiazepines affect the action of GABA?</span> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Answer: Benzodiazepines enhance the ability of GABA to activate the GABA-A receptor. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Question 3: What ion channel is associated with the GABA-A receptor? </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Answer: A chloride channel. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Question 4: What are some of the current clinical uses of benzodiazepines? </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Answer: Reducing anxiety, amnesia, muscle relaxants, epilepsy, and producing sedation before surgery.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Question 4: Which drugs, benzodiazepines or barbiturates, are considered safer? Why? </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Answer: Benzodiazepines are considered safer than barbiturates because they work at lower doses, thus producing less sedation, motor impairment and danger of overdose. In addition, tolerance to barbiturates develops quickly and many people become dependent on them.</span><br />
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Anonymoushttp://www.blogger.com/profile/16555664245806923731noreply@blogger.com6tag:blogger.com,1999:blog-3618930566267736040.post-81204448642272398602013-04-15T10:39:00.002-07:002013-04-15T10:48:09.365-07:00What is Filariasis? Filariasis prevention and its treatment.<br />
<span style="font-family: Arial, Helvetica, sans-serif;">Filariasis is caused by nematodes (roundworms) that inhabit the lymphatics and subcutaneous tissues. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Eight main species infect humans. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Three of these are responsible for most of the morbidity due to filariasis</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> 1- Wuchereria bancrofti </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> 2- Brugia malayi </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> cause lymphatic filariasis, </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> 3- Onchocerca volvulus</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> causes onchocerciasis </span><span style="font-family: Arial, Helvetica, sans-serif;">(river blindness). </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">The other five species are</span> :</span><br />
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<ol>
<li><span style="font-family: Arial, Helvetica, sans-serif;"> Loa loa,</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;"> Mansonella perstans,</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;"> Mansonella streptocerca. </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;"> Mansonella ozzardi, </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;"> Brugia timori. </span><span style="font-family: Arial, Helvetica, sans-serif;">(The last species also causes lymphatic filariasis.) </span></li>
</ol>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Geographic Distribution</span><br />
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<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Among the agents of lymphatic filariasis, </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Wuchereria bancrofti is encountered in tropical areas worldwide; </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Brugia malayi is limited to Asia; </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Onchocerca volvulus, the agent of river blindness, occurs mainly in Africa, with additional foci in Latin America and the Middle East. </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Among the other species, Loa loa and </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Mansonella streptocercaare found in Africa;</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Mansonella perstans occurs in both Africa and South America; </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">and Mansonella ozzardi occurs only in the American continent.</span></li>
</ul>
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">Morphology</span> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Adult of <u>Wuchereria bancrofti </u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Adult is milk-white, </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Long and slender, </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Silk thread-like, </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">40-100 mm × 0.1-0.2 mm. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> live in the lymphatic system.</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi0RvSiIJz4xikS5PRTLTvvBETlWhjNNRSOanEvK4ftIpZ_-Iyhk395mMW1KFBiqf3SyMAnsRtES4YLVvuhjQfw_AdMaA3zQ_TeZ-Qcc-BGfuO1Fzw8AhyphenhyphenoebbYN1zG9tRM6u2KV3d41DjE/s1600/Wuchereria-servingnature.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="245" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi0RvSiIJz4xikS5PRTLTvvBETlWhjNNRSOanEvK4ftIpZ_-Iyhk395mMW1KFBiqf3SyMAnsRtES4YLVvuhjQfw_AdMaA3zQ_TeZ-Qcc-BGfuO1Fzw8AhyphenhyphenoebbYN1zG9tRM6u2KV3d41DjE/s320/Wuchereria-servingnature.png" width="320" /></a></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">The female worms measure 80 to 100 mm in length and 0.24 to 0.30 mm in diameter, </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">while the males measure about 40 mm by 0.1 mm. </span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi0_UIw8qB0idBZrVqk7Ou9Xf1ut7Jia3NKRxO2-cWXtgmiS_WtT0-LYPJ1X4EJUvjCGqjEtVRG9I5amDZwqvj01w5mJIgVRRkztHKqqLLj9Gr7hZX84D3ESJ3G9Vn6yM2c5cHJQsb0DH2I/s1600/Wuchereria1-servingnature.png.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="198" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi0_UIw8qB0idBZrVqk7Ou9Xf1ut7Jia3NKRxO2-cWXtgmiS_WtT0-LYPJ1X4EJUvjCGqjEtVRG9I5amDZwqvj01w5mJIgVRRkztHKqqLLj9Gr7hZX84D3ESJ3G9Vn6yM2c5cHJQsb0DH2I/s200/Wuchereria1-servingnature.png.jpg" width="200" /></a></div>
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhUzyknNCpDIu8SQB6E1RgHRFExi-5b-hA1LIYKEUEGK0kGmlMYPIwToXDhzVyYPeRZjCJ0vV71AEHnXTGKxdvjMEjiZZOkkKepQnw8J-lJx5v62bcMtt83NQ1mhh683PuG2KvC3pS4ccvh/s1600/Wuchereria+male-female-servingnature.png" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="116" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhUzyknNCpDIu8SQB6E1RgHRFExi-5b-hA1LIYKEUEGK0kGmlMYPIwToXDhzVyYPeRZjCJ0vV71AEHnXTGKxdvjMEjiZZOkkKepQnw8J-lJx5v62bcMtt83NQ1mhh683PuG2KvC3pS4ccvh/s200/Wuchereria+male-female-servingnature.png" width="200" /></a><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Microfilariae</span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgsVJzAkO-lWRz0Gn-5vCAnAR5jRyHpLpmx0fRjaBy7xwLAde4Hm-UjDmefaIo6uBmUe7KAWqFbzcCdO6-W79hSZ7cXAkDuqtWylOpG1iWgEVLxic9l5EjTGLfS4a19yrKHZ1-HOt7_zQIw/s1600/Microfilaria-servingnature.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="301" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgsVJzAkO-lWRz0Gn-5vCAnAR5jRyHpLpmx0fRjaBy7xwLAde4Hm-UjDmefaIo6uBmUe7KAWqFbzcCdO6-W79hSZ7cXAkDuqtWylOpG1iWgEVLxic9l5EjTGLfS4a19yrKHZ1-HOt7_zQIw/s400/Microfilaria-servingnature.jpg" width="400" /></a></div>
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<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">The microfilariae of W. bancrofti are sheathed </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Measure 240-230 µm and 275-320 µm in 2% formalin. ( in stained blood smears) </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">They have a gently curved body, and a tail that is tapered to a point. </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">The nuclear column (the cells that constitute the body of the microfilaria) is loosely packed; </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">The cells can be visualized individually and do not extend to the tip of the tail. </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;"> Microfilariae circulate in the blood.</span></li>
</ul>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhm713BTiXDXPTU8tzfvtCly4tF-Ku_2nPTQdNMl0CGoNqMVMVhyphenhyphenq5yqc8JThu-mJl02Wd4G70yGwK2TV6ssygWm6vx6lv2zY2y23yzQsJYwR9Yt34GSDaV1Kq5ch5cj3DrVpZbzTaxLSS_/s1600/difference.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="285" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhm713BTiXDXPTU8tzfvtCly4tF-Ku_2nPTQdNMl0CGoNqMVMVhyphenhyphenq5yqc8JThu-mJl02Wd4G70yGwK2TV6ssygWm6vx6lv2zY2y23yzQsJYwR9Yt34GSDaV1Kq5ch5cj3DrVpZbzTaxLSS_/s320/difference.jpg" width="320" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif;">Differentiation of the species of microfilariae found in the human blood, on the basis of posterior ends (left) and anterior ends(right) of the microfilaria</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Microfilariae of Brugia malayi</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjwp10Tt8HMZsVe1VsVmrln2m1rR371rxmWqOz6-1VJweMs-8xl4OeWdAlPpNvol8Rdwe8lsTVN4PA77wZae0iaziQdj8JZj7cg2BHpTOVllovnk_1cnRyE9r47kUgV-1AVGBvZes0OOrO7/s1600/microfilaria+of+brugia.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="231" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjwp10Tt8HMZsVe1VsVmrln2m1rR371rxmWqOz6-1VJweMs-8xl4OeWdAlPpNvol8Rdwe8lsTVN4PA77wZae0iaziQdj8JZj7cg2BHpTOVllovnk_1cnRyE9r47kUgV-1AVGBvZes0OOrO7/s320/microfilaria+of+brugia.jpg" width="320" /></a></div>
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhDnfGVwSXkunZOpz8KH0VK6yJMrTzTWFzWO-ufOdoO06D2LCERyDfAOEZUui7nBlyZ6dHDW_zgpd6BmMfrppTM6JxIVasvSFLdI5DRtyOmYmjaDOTEp8ThQ0vvoiijtVjG4LZZVMhvOcLI/s1600/microfilaria+of+brugia+malayi.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhDnfGVwSXkunZOpz8KH0VK6yJMrTzTWFzWO-ufOdoO06D2LCERyDfAOEZUui7nBlyZ6dHDW_zgpd6BmMfrppTM6JxIVasvSFLdI5DRtyOmYmjaDOTEp8ThQ0vvoiijtVjG4LZZVMhvOcLI/s1600/microfilaria+of+brugia+malayi.jpg" /></a><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><br />
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<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Microfilariae of </span><u style="font-family: Arial, Helvetica, sans-serif;">Brugia malayi</u><span style="font-family: Arial, Helvetica, sans-serif;"> are sheathed</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Measure 175-230 µm or 240-300 µm. </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">The tail is tapered, </span><span style="font-family: Arial, Helvetica, sans-serif;">with a significant gap between </span><span style="font-family: Arial, Helvetica, sans-serif;">the terminal and subterminal </span><span style="font-family: Arial, Helvetica, sans-serif;"> nuclei. </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Microfilaria circulate</span><span style="font-family: Arial, Helvetica, sans-serif;"> in the blood.</span></li>
</ul>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhz3bHtqDqk5n2PzquHNGjg4ikmGBbt24C20zcSzeugRuZ-vDdAUmWPe_5AokbwsHoe4nGvDppSyUKJfvgeCbkHXC0hyjZRMVIQx9wd_pLn7jW-z1y1mOXLYvki3KqDVjmhkI_waOuytk8D/s1600/servingnature.blogspot.com.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="306" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhz3bHtqDqk5n2PzquHNGjg4ikmGBbt24C20zcSzeugRuZ-vDdAUmWPe_5AokbwsHoe4nGvDppSyUKJfvgeCbkHXC0hyjZRMVIQx9wd_pLn7jW-z1y1mOXLYvki3KqDVjmhkI_waOuytk8D/s400/servingnature.blogspot.com.jpg" width="400" /></a></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">It is 200-300 µm long, with a sheath. Nuclei, cephalic space, tail space, nerve ring and excretory pore can be seen.</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgKjYd0HuJJTXXB2WFik4L-S4HWU6a2wWpLOVYShf9uSmEnr855YXABXb6Ub1biU8o6MkP2plesfp2stmf6qcvRyPxjD9mMJQw09ly8-lUpJ9WypURiEuTYGBc2-2PLaen6SuA9xv34CdmM/s1600/differential+characteristics+of+two+microfilariae.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="155" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgKjYd0HuJJTXXB2WFik4L-S4HWU6a2wWpLOVYShf9uSmEnr855YXABXb6Ub1biU8o6MkP2plesfp2stmf6qcvRyPxjD9mMJQw09ly8-lUpJ9WypURiEuTYGBc2-2PLaen6SuA9xv34CdmM/s400/differential+characteristics+of+two+microfilariae.jpg" width="400" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Microfilariae of Onchocerca volvulus</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Microfilariae of Onchocerca volvulus are unsheathed</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">measure 300-315 µm in length. </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">The tail tapers and is often sharply bent. </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">The nuclei do not extend to the tip of the tail. </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Microfilariae typically reside in skin but may be found in blood or urine during heavy infections, or invade the eye and cause a condition known as <u>river blindness</u>.</span></li>
</ul>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEietDTZAe3qVfiZsjAbELBJ5LlY1RSwwYU9m36aeDOlArFTxDF5WsUzEtOsfK6ccXXLDyxAmrm0PxIOlGiEY_z7w8tCuDfEzxKaZnYSwvfcCNv3HBSTgrHpuPZLXApExCXcuevWybtMmBIJ/s1600/microfilariae.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="192" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEietDTZAe3qVfiZsjAbELBJ5LlY1RSwwYU9m36aeDOlArFTxDF5WsUzEtOsfK6ccXXLDyxAmrm0PxIOlGiEY_z7w8tCuDfEzxKaZnYSwvfcCNv3HBSTgrHpuPZLXApExCXcuevWybtMmBIJ/s400/microfilariae.png" width="400" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><u>A:</u> Microfilariae of O. volvulus from a skin nodule of a patient </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">from Zambia, stained with hematoxylin and eosin (H&E). </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>B:</u> Microfilariae of O. volvulus within the uterus of an adult female. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">The specimen was taken from the same patient as in Figure A. </span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhtuAGgRfqK7KJdperJulDR0T77jOlFJdqBPb7mkl0_0_WzfWV6iwsh6rJ1opCsWEnndokN9h3q0CWiWxQ_EfUsXbrM5YIRTyizTOMguVk6HXCXBEGWsvduJaFs_pieGmrd1Po-iBIRceD7/s1600/adult+female-vulvulus.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhtuAGgRfqK7KJdperJulDR0T77jOlFJdqBPb7mkl0_0_WzfWV6iwsh6rJ1opCsWEnndokN9h3q0CWiWxQ_EfUsXbrM5YIRTyizTOMguVk6HXCXBEGWsvduJaFs_pieGmrd1Po-iBIRceD7/s400/adult+female-vulvulus.jpg" width="394" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">Cross-section of an adult female O. volvulus, stained with H&E. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Note the presence of many microfilariae within the uterus. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Microfilariae of Loa loa</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Microfilariae of Loa loa are sheathed </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Measure 230-250 µm long and 270-300 µm in 2% formalin. in stained blood smears </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">The tail is tapered and nuclei extend to the tip of the tail. </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Microfilariae circulate in the blood. </span></li>
</ul>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgwqMXsuYbUvcZM-IvhZt1R2nq88B02k_efe_a5fICSRk466CnCKXA-p_K8bDspsNPpg-lf1xpxNFyDjL6LdWbkQdIqNnNrVXjYOWUV0jwMeByM5oCai3BRwXLvEoBqDG-bypVYvAkZFBP2/s1600/microfilaria+of+L.loa-thin+smear.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgwqMXsuYbUvcZM-IvhZt1R2nq88B02k_efe_a5fICSRk466CnCKXA-p_K8bDspsNPpg-lf1xpxNFyDjL6LdWbkQdIqNnNrVXjYOWUV0jwMeByM5oCai3BRwXLvEoBqDG-bypVYvAkZFBP2/s1600/microfilaria+of+L.loa-thin+smear.jpg" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif;">Microfilaria of L. loa in a thin blood smear, stained with Giemsa.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjvvC4BAVpmvPL0TU_j4ZZJ7Or7YdBRD_3F_jT-YV3vuh4omnw6Fc9EgQ-j7DQctzsvKPYrqIAVCAOTJqsITch_5LLcXfwhLUN71Nn57gSPnFGmi6vWo7jbSnksq1RXKhNYl6ZoODwn4-3n/s1600/microfilaria+of+L.loa-thick+smear.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="208" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjvvC4BAVpmvPL0TU_j4ZZJ7Or7YdBRD_3F_jT-YV3vuh4omnw6Fc9EgQ-j7DQctzsvKPYrqIAVCAOTJqsITch_5LLcXfwhLUN71Nn57gSPnFGmi6vWo7jbSnksq1RXKhNYl6ZoODwn4-3n/s400/microfilaria+of+L.loa-thick+smear.jpg" width="400" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif;">Microfilaria of L. loa a thick blood smear from a patient from Cameroon,</span><span style="font-family: Arial, Helvetica, sans-serif;">stained with Giemsa. </span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiRxzfRQoDGY9cakb3wXtA6b7HFRXomq-e7Wg_6Q30DTcIaS0V_LBH3w33xuwdY2LWXmu1VIKwZIlhzPlsV6-9waCVTRnvFQ05iUKGA0m9F9Z0BCGriEmcEzuemNzO1TPYhNrdlt4l1gits/s1600/L.loa+100X.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="302" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiRxzfRQoDGY9cakb3wXtA6b7HFRXomq-e7Wg_6Q30DTcIaS0V_LBH3w33xuwdY2LWXmu1VIKwZIlhzPlsV6-9waCVTRnvFQ05iUKGA0m9F9Z0BCGriEmcEzuemNzO1TPYhNrdlt4l1gits/s320/L.loa+100X.png" width="320" /></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjxbg4Wu-TrMNeD6STXRO84zU3KMZkysL8GDAsLhD2fvqG8UaXaUZiQsfSbmA_lzuAD4OwNhkj23AJNTA9a8oxjtye7NKRYllllaw0iQjOZlFFt48FGgIJ8nx4m6X3DOF2T7ITauP1fL81S/s1600/500X.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="312" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjxbg4Wu-TrMNeD6STXRO84zU3KMZkysL8GDAsLhD2fvqG8UaXaUZiQsfSbmA_lzuAD4OwNhkj23AJNTA9a8oxjtye7NKRYllllaw0iQjOZlFFt48FGgIJ8nx4m6X3DOF2T7ITauP1fL81S/s320/500X.png" width="320" /></a></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>A:</u> Microfilariae of L. loa</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Image taken at 100× magnification.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>B</u>: Higher magnification of the microfilariae in Figure A,</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> taken at 500 × oil magnification.</span><br />
<br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>C, D</u>: Adults of L. loa removed from the eye of a patient. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Images courtesy of the Georgia State Public Health Laboratory.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Blackfly, Buffalo gnat, Turkey gnat</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Culicoides</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Life Cycle of Wuchereria bancrofti</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjNo0utFhfu0tzZk6gDTcFXwdUZulUN9GHLAKsDL7lh4obSonmf8sw1tOXfH62568r_xP32HuTWlIuIvxvkc1PfwCcAG2skek13rFjEn25GAuKZcuHIirptjnLPzsIq62VmR2lYy3PGmVqJ/s1600/Life+cycle+of+Wuchereria.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="310" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjNo0utFhfu0tzZk6gDTcFXwdUZulUN9GHLAKsDL7lh4obSonmf8sw1tOXfH62568r_xP32HuTWlIuIvxvkc1PfwCcAG2skek13rFjEn25GAuKZcuHIirptjnLPzsIq62VmR2lYy3PGmVqJ/s400/Life+cycle+of+Wuchereria.jpg" width="400" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif;">W. bancrofti filariasis depending on geographical distribution. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Among them are: </span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">Culex</span> <span style="font-size: large;">(</span>C. annulirostris, C. bitaeniorhynchus, C. quinquefasciatus, and C. pipiens<span style="font-size: large;">) </span></span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">Anopheles</span> <span style="font-size: large;">(</span>A. arabinensis, A. bancroftii, A. farauti, A. funestus, A. gambiae, A. koliensis, A. melas, A. merus, A. punctulatus and A. wellcomei<span style="font-size: large;">)</span></span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">Aedes</span> <span style="font-size: large;">(</span>A. aegypti, A. aquasalis, A. bellator, A. cooki, A. darlingi, A. kochi, A. polynesiensis, A. pseudoscutellaris, A. rotumae, A. scapularis, and A. vigilax<span style="font-size: large;">)</span> </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">Mansonia</span> <span style="font-size: large;">(</span>M. pseudotitillans, M. uniformis<span style="font-size: large;">)</span>; <span style="font-size: large;">Coquillettidia</span> <span style="font-size: large;">(</span>C. juxtamansonia<span style="font-size: large;">)</span>. </span></li>
</ul>
<br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Adults inhabit in lymphatic produce sheathed microfilariae </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">The microfilariae migrate into lymph and blood channels moving actively through lymph and blood . </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">A mosquito ingests the microfilariae during a blood meal . </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">After ingestion, the microfilariae lose their sheaths and some of them work their way through the wall of the proventriculus and cardiac portion of the mosquitoes mid-gut and reach the thoracic muscles .</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">There the microfilariae develop into first-stage larvae and subsequently into third-stage infective larvae.</span><span style="font-family: Arial, Helvetica, sans-serif;"> </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">During a blood meal, an infected mosquito introduces third-stage filarial larvae onto the skin of the human host, where they penetrate into the bite wound .</span><span style="font-family: Arial, Helvetica, sans-serif;">They develop into adults that commonly reside in the lymphatics .</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">The third-stage infective larvae migrate through the hemocoele to the mosquitoes proboscis and can infect another human when the mosquito takes a blood meal .</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Adults produce microfilariae measuring 244 to 296 µm by 7.5 to 10 µm, which are sheathed and have nocturnal periodicity, except the South Pacific microfilariae which have the absence of marked periodicity. </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">The microfilariae migrate into lymph and blood channels moving actively through lymph and blood .</span><span style="font-family: Arial, Helvetica, sans-serif;"> </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">The adult worms resemble those of Wuchereria bancrofti but are smaller.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Female worms measure 43 to 55 mm in length by 130 to 170 µm in width.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Males measure 13 to 23 mm in length by 70 to 80 µm in width. </span></li>
</ul>
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Life Cycle of Brugia malayi </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">The typical vector for Brugia malayi filariasis are mosquito species from the genera Mansonia and Aedes. </span><br />
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<span style="font-size: large;"><br /></span></div>
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<span style="font-size: large;">Onchocerca Volvulus</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Some points to explain</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> <u>Nocturnal periodicity of microfilariae</u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;"> (1) Definition</span></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">There is a marked periodicity of microfilariae in the peripheral blood, that is, they can be demonstrated at night and disappear during the day. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">The microfilariae are concentrated in the small blood vessels of the lungs during the day and are liberated into the peripheral circulation at night. This phenomenon is called nocturnal periodicity of microfilarae.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">(2) The time</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">when the microfilarae reach</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> the maximal number in the peripheral blood: </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">W. bancrofti: </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> between 10 P.M. and 2 A.M.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B. malayi: </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> between 8 P.M. and 4 A.M.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">(3) Mechanism (hypotheses)</span></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">A. Suppression of the vagus</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> (nerve activity)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B. Association with oxygen content</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> of blood vessels in the lungs. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Microfilaria infectivity to mosquitoes</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">(1) Species of mosquito vectors of filariae in China For W. bancrofti: </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Culex pipiens pallens , </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Anopheles sinensis.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>For B. malayi:</u> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Anopheles anthropophagus , </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">A. sinensis, and Aedes togoi .</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">(2) Interaction between microfilariae</span><span style="font-family: Arial, Helvetica, sans-serif;"> and mosquitoes: </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Fewer than 15 microfilariae / 20 mm3 will fail to infect mosquitoes; that more than 100 will kill the mosquito.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">(3) Differences in location in human</span><span style="font-family: Arial, Helvetica, sans-serif;"> body between the two filariae.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> I)<u> B.malayi:</u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">superficial lymphatics an </span><span style="font-family: Arial, Helvetica, sans-serif;">nodes in arms and legs. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">II)<u> W.bancrofti: </u>profound lymphatics and </span><span style="font-family: Arial, Helvetica, sans-serif;">nodes in arms, legs and </span><span style="font-family: Arial, Helvetica, sans-serif;"> other parts of the body.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;"><br /></span></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">Pathogenesis</span> </span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Adult worm are found in lymph vessels throughout the body</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">But primarily in or around the axillary, epitrochlear, inguinal and pelvic nodes and the lymphatics dital to them, as well as those of testis, epididymis and cord</span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Clinical Features</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Lymphatic filariasis most often consists of asymptomatic microfilaremia.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Some patients develop lymphatic dysfunction causing lymphedema and elephantiasis (frequently in the lower extremities) and, with Wuchereria bancrofti, hydrocele and scrotal elephantiasis. </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Episodes of febrile lymphangitis and lymphadenitis may occur. </span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">1) Microfilaremia</span> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> (Asymptomatic phase)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">2) Inflammatory (Acute) phase:</span> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> intense inflammation of lymphatics and </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> lymphonoids.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">3) Chronic obstructive phase: </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> elephantiasis, chyluria (lymph in the </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> urine), hydrocele.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">4) Suppressive filariasis</span> (Tropical eosinophilia syndrome) </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<br />
<div style="text-align: center;">
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Symptoms </span></div>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">1) Symptoms in acute phase:</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> lymphatic inflammation </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">(1) <u>Susceptible age:</u> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> young and strong; Location: legs and arms.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> (2) <u>Manifestations:</u> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> “retro-lymphangitis”.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">W. bancrofti sometimes causes spermatitis, </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">architis (inflammation of testis) and epididymitis .</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">(3) <u>Mechanism:</u> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> The acute phase commences when the female worms reach maturity and begin releasing miceofilariae. This phase is actually an allergic response to the products of dying and degenerating adult worms.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">2) Symptoms in chronic obstructive phase</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Repeated attacks of acute lymphatic inflammations result in a chronic lymphedema with much </span><u style="font-family: Arial, Helvetica, sans-serif;">fibrous infiltration,</u><span style="font-family: Arial, Helvetica, sans-serif;"> and consequently </span><u style="font-family: Arial, Helvetica, sans-serif;">lymphatic obstruction. </u></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">The lymph return is obstructed and the lymph “piles up”, greatly dilating the affected duct and forcing the lymph into the surrounding tissues.</span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif;">(1) <u><span style="font-size: large;">H</span>ydrocele,</u> caused by obstruction of lymphatics in testis and <u>spermatic cord</u>. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">(2) <u><span style="font-size: large;">C</span>hyluria</u> (lymph in urine): </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> A. common in W. bancrofti filariasis. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B. Manifestations: The chyle gives the urine a milky appearance. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C. Mechanism: preaortic lymph nodes and intestinal lymphatic ducts anterior to chylocystis are obstructed.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">(3) <u><span style="font-size: large;">E</span>lephantiasis:</u> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> A. The most commonly afflicted organs are</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> scrotum and legs. B. Manifestations C. Mechanism: lymphatic obstruction plus inflammatory hyperplasia </span><br />
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Lymph edema</div>
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<span style="font-size: large;"><u>Elephantiasis </u></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Onchocerca volvulus nodules in scalp</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Patient with hanging groin caused by underlying obstruction onchocercal lymphadenitis and loss of dermal elasticity.</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh6S4ejyqWyQ5sM3lMW3qzv-b7keZsdFmrlBoMFd640ozRVNL1ihLEmeTXnrtwXyroSFkvzoMLWCsA5wfZsHpjoBwpm_k_BkKaXReR984_1OdFZQh61fQBS4WDjqc5VG2GsibIBV0R-9hu4/s1600/onchoceral+lymphadenitis.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh6S4ejyqWyQ5sM3lMW3qzv-b7keZsdFmrlBoMFd640ozRVNL1ihLEmeTXnrtwXyroSFkvzoMLWCsA5wfZsHpjoBwpm_k_BkKaXReR984_1OdFZQh61fQBS4WDjqc5VG2GsibIBV0R-9hu4/s640/onchoceral+lymphadenitis.jpg" width="376" /></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhHUCA4S_8AJJUmNGJo7zB3-l56WA2v4u53d4dwUR-zrFPAlW_5I60Cpga2j9MMhlZiFJYCaMXcB2IB6566Eyj_9zqDHawPIKslt48vbWp_c33nRh4l8hT_r25avs4VQB4fG9QeypiFpoTV/s1600/Onchocera+Vulvulus+nodules.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="267" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhHUCA4S_8AJJUmNGJo7zB3-l56WA2v4u53d4dwUR-zrFPAlW_5I60Cpga2j9MMhlZiFJYCaMXcB2IB6566Eyj_9zqDHawPIKslt48vbWp_c33nRh4l8hT_r25avs4VQB4fG9QeypiFpoTV/s320/Onchocera+Vulvulus+nodules.jpg" width="320" /></a></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Onchocerca volvulus nodules. </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Potions of contained adult worms protruding</span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjgWsevhTxhNS8mtiTueXIFNh5eJJmN-CworeLRAW-yJ06caK_0HNai9K-HLsR_X44CiISx8VaGqRwTNz36zuGeXC4m3sG5F2W2PpjcmskwJny_9N7GhImj7kIN8DwIjAtNvFcnqadXE6Gl/s1600/advanced+elephantiasis.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjgWsevhTxhNS8mtiTueXIFNh5eJJmN-CworeLRAW-yJ06caK_0HNai9K-HLsR_X44CiISx8VaGqRwTNz36zuGeXC4m3sG5F2W2PpjcmskwJny_9N7GhImj7kIN8DwIjAtNvFcnqadXE6Gl/s640/advanced+elephantiasis.jpg" width="584" /></a></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Moderately advanced elephantiasis involving both legs </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">With thickening and verrucous,changes of the skin</span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_EJiuwkXFNzVGZwmya_wt7U6yPwdLo7oxaxzfNAfj9hBY-WUi6Y9Hu4Y06fj_F-uOUq6wpJfsM2f9pTvBBDBKJax5FQ0hU6YDrK5l8JRixq1UxCwtzj-x_biWdZPkSdq3jWs-GlZqWN6b/s1600/extreme+elephantiasis.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_EJiuwkXFNzVGZwmya_wt7U6yPwdLo7oxaxzfNAfj9hBY-WUi6Y9Hu4Y06fj_F-uOUq6wpJfsM2f9pTvBBDBKJax5FQ0hU6YDrK5l8JRixq1UxCwtzj-x_biWdZPkSdq3jWs-GlZqWN6b/s640/extreme+elephantiasis.jpg" width="417" /></a></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Extreme elephantiasis of all four limbs and scrotum</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Filariasis-Epidemiology</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Filariasis is one of the most important parasitic diseases in China. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">1) It is distributed in 16 provinces, cities and autonomous regions in the center and south of China. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">2) Epidemic factors include: </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">(1) Source of infection: patients, carriers (infected humans).</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> (2) Vectors (mosquitoes)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> (3) Susceptible population</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Filariasis-Prevention and treatment</span><br />
<br />
<ol>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Mass examination and treatment</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Mosquito control </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Individual protection Strengthen the epidemiological supervision in the controlled areas.</span></li>
</ol>
Anonymoushttp://www.blogger.com/profile/16555664245806923731noreply@blogger.com0tag:blogger.com,1999:blog-3618930566267736040.post-46906709239178085762013-04-10T13:51:00.000-07:002013-04-10T13:51:24.490-07:00What are NSAIDs? their uses and side effects?<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"> Antipyretic-analgesic and anti-inflammatory agents </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Introduction</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Have strong antipyretic</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Analgesic </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Anti-inflammatory</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Anti-rheumatic effects</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Non-steroidal anti-inflammatory drugs </span><span style="font-family: Arial, Helvetica, sans-serif;">(NSAIDs)</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj3z5yLzuElv86QF2XgSO63zmcL0lkn6X8e5R2XIYtXGPTZ0jMIhz6oNdgEttDbAoVOj0kddZaN_8-AImCdgoA-MP8t556EQxS3NJ9FrNHXeJo2t0kRuanNCmkbwnFnk74ynxboMtkys8lw/s1600/Aspirin-servingnature.bmp" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="302" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj3z5yLzuElv86QF2XgSO63zmcL0lkn6X8e5R2XIYtXGPTZ0jMIhz6oNdgEttDbAoVOj0kddZaN_8-AImCdgoA-MP8t556EQxS3NJ9FrNHXeJo2t0kRuanNCmkbwnFnk74ynxboMtkys8lw/s400/Aspirin-servingnature.bmp" width="400" /></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhxuohCzOvNaDNKC9ga1Xf7eu_5HnetOCU_aV87EW_rKdx35dmjNvB7yRaELPSnaDDfGZVxLcQTu1vfQeWZsMJGiRSM5kNcKNznexTi469TD7Kb57Hqm_aPXXpYNbGv-XotgSXnH29g0hhR/s1600/Glucocorticoids-servingnature.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhxuohCzOvNaDNKC9ga1Xf7eu_5HnetOCU_aV87EW_rKdx35dmjNvB7yRaELPSnaDDfGZVxLcQTu1vfQeWZsMJGiRSM5kNcKNznexTi469TD7Kb57Hqm_aPXXpYNbGv-XotgSXnH29g0hhR/s400/Glucocorticoids-servingnature.jpg" width="393" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"> Mechanism of NSAIDs</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">The basis of antipyretic, analgesic and anti-inflammatory effects of NSAIDs is due primarily to the inhibition of cyclooxygenase (COX) that catalyze the first step in prostanoid biosynthesis. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">This leads to decreased prostaglandins(PGs) synthesis.</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh7TX2_pT3LMvoPn_vKlKcuFIqHcP15owuh_xkAGExfZ9R_5THf4LapWeJzw5lfreJTCE4PL_wo4VatYBqcqkTgfjZoA_ImodqqhasspP6z4EDBMbDRYq0kemkOhfoyXHb-nkEHq95_xNr8/s1600/Mechanism+of+NSAIDs.bmp" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="277" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh7TX2_pT3LMvoPn_vKlKcuFIqHcP15owuh_xkAGExfZ9R_5THf4LapWeJzw5lfreJTCE4PL_wo4VatYBqcqkTgfjZoA_ImodqqhasspP6z4EDBMbDRYq0kemkOhfoyXHb-nkEHq95_xNr8/s400/Mechanism+of+NSAIDs.bmp" width="400" /></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiVsf10E0adGeZqfu6_pNo9rxb6xuZ1Z-ZmvT4YwOYBYK9CjfZHlj9m9iaI4p85xO3ZkLWwrYhVZjVR2thWvK8mFq1T4KBTjH3LMyh1EmWPFkuPQ9jevBc4UTVOkqv0EixRlRu-GGjNyhtC/s1600/NSAIDS-servingnature.bmp" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="290" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiVsf10E0adGeZqfu6_pNo9rxb6xuZ1Z-ZmvT4YwOYBYK9CjfZHlj9m9iaI4p85xO3ZkLWwrYhVZjVR2thWvK8mFq1T4KBTjH3LMyh1EmWPFkuPQ9jevBc4UTVOkqv0EixRlRu-GGjNyhtC/s400/NSAIDS-servingnature.bmp" width="400" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Ways to inhibit COX</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Most NSAIDS : compete the active site of COX with AA, reversible</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Aspirin: irreversibly acetylates (and thus inactivates) COX</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhc0Iwal_zLTgOYyqFbRtuAkmTK54NzR4HyZxmeDagHD05gfZLgkNEqEm329GtnabTFDhgBkpcBx_z1ufL82ZPyxEmih1_gztWL9e6T2OAROIRwh2uwKvnZRFgRGGEXeYXViKoyZhJo1FWB/s1600/COX+inhibitor-servingnature.bmp" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="145" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhc0Iwal_zLTgOYyqFbRtuAkmTK54NzR4HyZxmeDagHD05gfZLgkNEqEm329GtnabTFDhgBkpcBx_z1ufL82ZPyxEmih1_gztWL9e6T2OAROIRwh2uwKvnZRFgRGGEXeYXViKoyZhJo1FWB/s400/COX+inhibitor-servingnature.bmp" width="400" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Common pharmacological effects of NSAIDs</span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">1- Antipyretic action</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Process of pyrexia</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi0RmH7jQZSIT7JptgprrhAb4LA8M8fJKpGMMurp19rMYkyAEfJVeUgwmY5AwjP3n-ScYnWjX5CdQl9FDTbTkd5KsYRwNmTVHKfGyHu9i_-5l8fVKaIYSqr5yluJi-otJ6K6WAoGnmyEblH/s1600/Pharmacological+effects.bmp" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi0RmH7jQZSIT7JptgprrhAb4LA8M8fJKpGMMurp19rMYkyAEfJVeUgwmY5AwjP3n-ScYnWjX5CdQl9FDTbTkd5KsYRwNmTVHKfGyHu9i_-5l8fVKaIYSqr5yluJi-otJ6K6WAoGnmyEblH/s400/Pharmacological+effects.bmp" width="400" /></a></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"> <span style="font-size: large;">Characteristics</span></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">1) </span><span style="font-family: Symbol; font-weight: bold;"><span style="font-size: x-small;">¯<span style="color: #000099;"> </span></span></span><span style="font-family: Arial, Helvetica, sans-serif;">elevated T > normal </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> ( patients with fever );</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">2) independent of environment T; </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">3) mainly influence heat dissipation.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"> <span style="font-size: large;">Compare chlorpromazine with NSAIDs on regulation of T</span></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Chlorpromazine</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> - </span><span style="font-family: Symbol; font-size: x-small; font-weight: bold;">¯ </span><span style="font-family: Arial, Helvetica, sans-serif;">both elevated and normal T</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">- dependent of environment T </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> ( T </span><span style="font-family: Arial, Helvetica, sans-serif;">↑</span><span style="font-family: Arial, Helvetica, sans-serif;"> or </span><span style="font-family: Symbol; font-size: x-small; font-weight: bold;">¯</span><span style="font-family: Arial, Helvetica, sans-serif;"> )</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">- Influence both production and dissipation of heat</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Meaning of pyrexia</u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> <u>Advantages</u>:Defense ,diagnose ;</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> <u>Disadvantages</u>: High fever or durative fever> consume physical force,CNS function disorders . </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> T > 39ºc (especially wean !)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">2- Analgesic action</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Pain transmission</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh-QnS4UR6IPU6tqLPTKJWABjpAZqc0Lqul5kILHuMcFrl13_3PDdQdhTMDIrrRhl7y-S2dy68nJupGerTcZBzOeBwsL7QBaUpXwq3Fl-i2svxtyJK1BM9fFgSJ_6CDEqVn395GV0zXn5Ya/s1600/Analgesic+mechanism.bmp" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="208" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh-QnS4UR6IPU6tqLPTKJWABjpAZqc0Lqul5kILHuMcFrl13_3PDdQdhTMDIrrRhl7y-S2dy68nJupGerTcZBzOeBwsL7QBaUpXwq3Fl-i2svxtyJK1BM9fFgSJ_6CDEqVn395GV0zXn5Ya/s400/Analgesic+mechanism.bmp" width="400" /></a></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Functionary site---- mainly periphery</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj5_1NtMuhqiK11hbWzcjRj0EcVb43-JentiPyohx7TiU0UZLtae1ly2RdO8hqAPSNX0OeurNEQ2ZowdFy-kA26HSc1c0Zkc1KI9ElxCMVAsW2ggfxoSy7GgSeFHf9KZBJxhkZ94NIpmUKy/s1600/Pain+transmission.bmp" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="288" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj5_1NtMuhqiK11hbWzcjRj0EcVb43-JentiPyohx7TiU0UZLtae1ly2RdO8hqAPSNX0OeurNEQ2ZowdFy-kA26HSc1c0Zkc1KI9ElxCMVAsW2ggfxoSy7GgSeFHf9KZBJxhkZ94NIpmUKy/s400/Pain+transmission.bmp" width="400" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"> Characteristics</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> 1) Moderate analgesia:</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Inflammatory pain well, </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> but severe or colic pain useless;</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> 2) No addiction ,</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> No respiratory depression .</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"> Compare Opioids with NSAIDs on analgesic action</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjC9BKg31rWdkW6rIv-1jc13BY1Up5QmVjmOZh2XQl7luEQVzGUXtu517elPPfluuZP5kFaRF8_tBu5mjSNQ7x7_E-2kNx70va1-a6uGorSswxj_Uay1RkILvEQtC1BY2-OR1LVR7SgipVb/s1600/NSAIDs-Opioid-servingnature.bmp" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="221" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjC9BKg31rWdkW6rIv-1jc13BY1Up5QmVjmOZh2XQl7luEQVzGUXtu517elPPfluuZP5kFaRF8_tBu5mjSNQ7x7_E-2kNx70va1-a6uGorSswxj_Uay1RkILvEQtC1BY2-OR1LVR7SgipVb/s400/NSAIDs-Opioid-servingnature.bmp" width="400" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">3-Anti-inflammatory and antirheumatic action</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">In the inflammatory reaction</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">-</span><span style="font-family: Symbol; font-size: x-small; font-weight: bold;">¯</span><span style="font-family: Arial, Helvetica, sans-serif;"> PGs produce:</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> </span><span style="font-family: Symbol; font-size: x-small; font-weight: bold;">¯</span><span style="font-family: Arial, Helvetica, sans-serif;">Vasodilation;</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> </span><span style="font-family: Symbol; font-size: x-small; font-weight: bold;">¯</span><span style="font-family: Arial, Helvetica, sans-serif;">Vascular permeability ;</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> </span><span style="font-family: Symbol; font-size: x-small; font-weight: bold;">¯</span><span style="font-family: Arial, Helvetica, sans-serif;">Tissue edema </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">-</span><span style="font-family: Symbol; font-size: x-small; font-weight: bold;">¯</span><span style="font-family: Arial, Helvetica, sans-serif;"> Cellular adhesion molecule produce</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Exception:</u> Acetaminophen</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Functionary site</u>---- periphery</span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Characteristics</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> NSAIDs may provide symptomatic relief from fever,pain,and other signs of rheumatic or rheumatoid arthritis, but do not arrest the progression of pathological injury to tissue.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Compare SAIDs with NSAIDs on anti-inflammation action</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Other effects of NSAIDs</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">To inhibit platelet aggregation and thrombosis</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Anti-tumor</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">To prevent and delay the onset of Alzheimer's disease</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">To slow down the aging of cornea</span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Development of NSAIDs </span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">1860 Rev.Edmond Stone found the bark and leaves of the </span><span style="font-family: Arial, Helvetica, sans-serif;"> willow tree could effectively relieve pain</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">1863 salicylic acid was synthesized</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">1899 aspirin came into the market </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">1960 a great deal of NSAIDs were gradually developed</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">1971 John Vane lodged the theory of the mechanism of </span></li>
<li><u style="font-family: Arial, Helvetica, sans-serif;">NSAIDs </u><span style="font-family: Arial, Helvetica, sans-serif;">: to inhibit the activity of PG synthase (COX) </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">1991-1995 discovery of COX-1and COX-2, formation of the </span><span style="font-family: Arial, Helvetica, sans-serif;">notion of COX</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Recent years application of COX-2 inhibitors in clinic promote </span><span style="font-family: Arial, Helvetica, sans-serif;">the development of the notion</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">2002 discovery of COX-3</span></li>
</ul>
<br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Effects of NSAIDs on COX-1 and COX-2(IC50:mol/L)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"> Drugs COX-1 COX-2 COX-2/COX-1</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"> Piroxicam 0.0015 0.906 600</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Aspirin 1.6 277.0 173</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Indomethacin 0.028 1.680 68</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Ibuprofen 4.8 72.8 15.16</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Meloxicam 0.214 0.171 0.08</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Naproxen 9.5 5.0 0.58</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Nabumetone 7.0 1.0 0.143</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Nimesulide >10 0.07 <0.007</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Celecoxib 15 0.04 0.0027</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Rofecoxib 0.018 0.0015 <0.0833</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Classification of NSAIDs</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u><br /></u></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><u>According to IC50 of COX-2 / IC50 of COX-1</u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">-<span style="font-size: large;">Non-selectivity COX inhibitors</span></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Naproxen, Flurbiprofen, Diclofenac </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Ibuprofen, Paracetamol</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Aspirin, Indomethacin, Sulindac, Piroxicam, …….</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">-<span style="font-size: large;">Selective COX-2 inhibitors</span></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Celecoxib, Rofecoxib, Nimesulide</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">According to the chemical structures</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Salicylates:aspirin, sodium salicylate</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Anilines:phenacetin, acetaminophen</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Pyrazolons:phenylbutazone</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Others: Indomethacin,</span><span style="font-family: Arial, Helvetica, sans-serif;"> Ibuprofen </span><span style="font-family: Arial, Helvetica, sans-serif;"> ……</span></li>
</ul>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Aspirin (Acetylsalicylic acid , ASA) </span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEimjDM6BNOsf45GcFYSomLdLooRLbjYp93R_Q75U52De2DNA9SidOOKbucLV0I1ycDRX2rBvN33V4-iaWac3ux9ry698wkF-KlkD-lIei_Hj3gDLEvTlBsWhTFI65uNcgYUyiufn8xmCb4N/s1600/Aspirin..png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEimjDM6BNOsf45GcFYSomLdLooRLbjYp93R_Q75U52De2DNA9SidOOKbucLV0I1ycDRX2rBvN33V4-iaWac3ux9ry698wkF-KlkD-lIei_Hj3gDLEvTlBsWhTFI65uNcgYUyiufn8xmCb4N/s640/Aspirin..png" width="420" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><u>History:</u> Centuries ago Greek physician Hippocrates prescribed the bark and leaves of the willow tree to relieve pain and fever. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> The active ingredient, salicin was first isolated in 1829 and was demonstrated to have antipyretic effect. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">A German chemist experimented with salicin and created salicylic acid in 1832. Felix Hoffmann, a chemist at Bayer in Germany, chemically synthesized a stable form of acetylsalicylic acid powder that relieves his father’s rheumatism. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Since 1899 aspirin has been an important drug for an anti-inflammatory indication.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Aspirin—“a” from acetyl, “spir” from the spirea plant (which yields salicin) and “in,” a common suffix for medications. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Pharmacokinetics</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">1、absorb rapidly,distribution wide ;</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">2、metabolism--liver; individual variation ;</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">3、dosage < 1g, linear kinetics , t1/2 2~3h; </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> dosage non-linear kinetics, t1/2 </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> ( >1g, t1/2 15~30h );</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">4、excretion--kidney,</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> influenced by urine pH</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiiCnOrSQ3_DSZ9PMHSd9hp8cO4o7IzTu1PI6yBaWJQs6euDxN0bnkCFK7u_UsJjQwaC-2vNd_AUCZz6Q0RIgbsSrVlf2lqVXcy0vWQNSPc30TGqbDnE-v6mP0IjkkCgMvh3z64gGWExhoA/s1600/NSAIDs.servingnature.blogspot.com.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="273" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiiCnOrSQ3_DSZ9PMHSd9hp8cO4o7IzTu1PI6yBaWJQs6euDxN0bnkCFK7u_UsJjQwaC-2vNd_AUCZz6Q0RIgbsSrVlf2lqVXcy0vWQNSPc30TGqbDnE-v6mP0IjkkCgMvh3z64gGWExhoA/s400/NSAIDs.servingnature.blogspot.com.png" width="400" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"> <span style="font-size: large;">Effects and Uses</span> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> 1. Antipyretic 、analgesic and anti-inflammatory effects</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> usually used for:</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;"> Moderate pain;</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;"> Various inflammatory pain;</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;"> Rheumatic arthritis first choice ;</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;"> Rheumatoid arthritis first choice;</span><span style="font-family: Arial, Helvetica, sans-serif;"> 3-5g / d, qid. </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;"> Rheumatic fever</span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif;">2. Antiplatelet effects (small dose)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> used for:</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;"> Prophylaxis of thromboembolism, </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;"> Stroke,</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;"> Cardiac infarction.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;"> Recommended dosage :</span><span style="font-family: Arial, Helvetica, sans-serif;"> 40mg/day </span><span style="font-family: Arial, Helvetica, sans-serif;"> or </span><span style="font-family: Arial, Helvetica, sans-serif;">80mg every other day</span></li>
</ul>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">3. Other effects and uses</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Gout</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Ascariasis of biliary tract </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Alzheimer's disease</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Kawasaki disease </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Patent ductus arteriosus</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Lower the incidence of Colon cancer</span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"> Adverse reactions</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">1、<u>Gastrointestinal symptoms</u> the most common reaction, induce or aggravate ulcer </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u> Caused by:</u> Direct stimulation, (-) parietal cell COX-1→ PGE2↓, (+) CTZ.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Prevention and cure :</u> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Medicated after a meal</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Use buffered and enteric-coated preparations</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Used with misoprostol, omeprazol,</span><span style="font-family: Arial, Helvetica, sans-serif;">antacids, cimetidine</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Contraindications:</u> Peptic ulcer</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u><br /></u></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><u>2、Coagulation disorders</u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">↓TXA2→ ↓ platelet aggregation→</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> prolonged bleeding time </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">↑dosage→↓prothrombin(Ⅱ)production →bleeding tendency </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Prevention and cure :vitamine K, </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> stop at 1 week before operation.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Contraindications</u>:</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;"> severe hepatic diseases</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;"> hypothrombinemia </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;"> vitamin K deficiency</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;"> hemophilia</span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>3、Hypersensitivity </u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> rash, rhinitis, angioneurotic edema, and anaphylactic shock</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> some asthmatic patients---aspirin asthma (Constrict the bronchial smooth muscle) </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Note: </u>Be avoided in patients receiving anticoagulants such as coumarin and heparin </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Prevention and cure </u>: </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">GCS or H1-R (-) </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Adrenaline --- inefficient !</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Contraindications:</u></span><br />
<br />
<ol>
<li><span style="font-family: Arial, Helvetica, sans-serif;"> asthma</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;"> nasal polyps</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;"> chronic urticaria</span></li>
</ol>
<br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>4、Salicylism </u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> overdosage(>5g/d)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> GI symptoms + CNS symptoms</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Prevention and cure :</u> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> avoid overdosage; </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> withdrawal at once</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> iv.gtt. NaHCO3 </span><span style="font-family: Arial, Helvetica, sans-serif;">→</span><span style="font-family: Arial, Helvetica, sans-serif;"> excretion</span><span style="font-family: Arial, Helvetica, sans-serif;">↑</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u><br /></u></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><u>5、Reye’s syndrome</u></span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;"> Infected with virus, especially in children.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;"> Fulminating hepatitis with cerebral edema.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;"> Rare, but fatal</span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Prevention</u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> use other drugs </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u><br /></u></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><u>6、Other syndromes</u></span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;"> Edema,</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;"> Polyuria, </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;"> Renal function impairment</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;"> Toxic doses→respiratory depression</span><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgAtK2vVJwYndKT_HLPs6EJu-zYsQP19gHFArQ2kau3krj6Vfm4vEa4a5NnOlXI4YePSPQbrmf5jJaxQBdqve3VG1ZEna-XBl2IhTP9rud-ouqLjfWSENeFEx8uxEiq4VBUrUrGmQChoWpK/s1600/lower+extremities.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em; text-align: center;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgAtK2vVJwYndKT_HLPs6EJu-zYsQP19gHFArQ2kau3krj6Vfm4vEa4a5NnOlXI4YePSPQbrmf5jJaxQBdqve3VG1ZEna-XBl2IhTP9rud-ouqLjfWSENeFEx8uxEiq4VBUrUrGmQChoWpK/s640/lower+extremities.png" width="434" /></a></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Acetaminophen ( paracetamol)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Characteristics</u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> 1、Inhibits synthesis of PGs in CNS but not in periphery.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> 2、No anti-inflammatory or anti-platelet </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> effects, but is good for mild pain and fever </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> antipyretic 、analgesic ≈ aspirin</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> 3、<u>Mostly used for</u>:</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> headache、fever can’t take aspirin;</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> first choice for children with virus </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> infections </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> 4、Adverse reaction: mild</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> overdosage ----- hepatic damage, </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> esp in persons who regularly consume </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> alcohol.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Phenylbutazone</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Phenylbutazone,a pyrazolone derivative rapidly gained favor after its introduction in 1949 for the treatment of rheumatic syndromes, but its toxicities,particularly the hematologic effects (including aplastic anemia),have resulted in its withdrawal from many markets.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>NOTE:</u> It is rarely used today.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Indomethacin</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;"> It is an indole derivative.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;"> It is one of the most potent COX inhibitors.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;"> Anti-inflammatory 、antipyretic and analgesic effects are remarkable.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;"> </span><u style="font-family: Arial, Helvetica, sans-serif;">Used to treat</u><span style="font-family: Arial, Helvetica, sans-serif;"> acute gouty arthritis, ankylosing spondylitis, and osteoarthritis of the hip. In addition,it has been used to treat patent ductus arteriosus.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;"><u>Adverse reactions:</u> severe; cross-sensitization with aspirin.</span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Ibuprofen </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">☆ Ibuprofen is a simple derivative of Arylpropionic acid.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">☆ In doses of about 2400 mg daily,ibuprofen is equivalent to 4 g of aspirin in anti-inflammatory effect.Oral ibuprofen is often prescribed in lower doses(<2400mg/d),at which it has analgesic but not anti-inflammatory efficacy.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">☆ It is used for treatment of rheumatoid arthritis and other inflammatory joint conditions</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">☆ It is available over the counter in lower dosage under several trade names.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Selective COX-II Inhibitors</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Anti-inflammatory with less adverse effects, especially GI events. </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Potential toxicities: kidney and platelets - ? increased risk of thrombotic events </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Role in Cancer prevention </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Role in Alzheimer’s disease</span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif;">Data suggested an increased risk for cardiovascular events in patients receiving rofecoxib.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">On the morning of 30 Sep.2004, the U.S. FDA issued a Public Health Advisory about the withdrawal of rofecoxib </span><br />
<div>
<br /></div>
Anonymoushttp://www.blogger.com/profile/16555664245806923731noreply@blogger.com0tag:blogger.com,1999:blog-3618930566267736040.post-91570951196484161502013-04-05T10:33:00.001-07:002013-04-05T10:33:31.742-07:00What is Obsessive–compulsive disorder (OCD) ?<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgSGijuScRIjY72QETgHIbwVvP7FCE9NaI0h1pFal9CI7koopdACSWqSglqa4yL2M0AwocI0HBIl9o81uaGIxNc8exhqxQyq8RLC4rVYitd5QR7RZNx4iauqIO0n13M6bdZBo9yqgLsPmPr/s1600/servingnature+-OCD.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgSGijuScRIjY72QETgHIbwVvP7FCE9NaI0h1pFal9CI7koopdACSWqSglqa4yL2M0AwocI0HBIl9o81uaGIxNc8exhqxQyq8RLC4rVYitd5QR7RZNx4iauqIO0n13M6bdZBo9yqgLsPmPr/s400/servingnature+-OCD.jpg" width="390" /></a></div>
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Obsessive-Compulsive Disorder</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Affects almost 3% of world’s population. </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Start anytime from preschool to adulthood.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Typically between 20-24.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Many different forms of OCD – differ from person to person.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Cause of OCD is still unknown.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Better when diagnosed early.</span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">How to define OCD?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Specific criteria to be clinically diagnosed</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Anxiety disorder with presence of obsessions or compulsions</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">ego dystonic – realize thoughts and actions are irrational or excessive</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Must take up more than 1 hour a day </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Must disrupt daily routine</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Symptoms can’t result from effects of other medical conditions or substances</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Obsessions</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Repetitive and constants thoughts, images, or impulses that cause anxiety or distress.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Thoughts, images, or impulses not about real-life problems.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Try to ignore or counter act thoughts, images, or impulses.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Thoughts, images, or impulses “recognized as a product of one’s own mind and not imposed from without”.</span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Compulsions</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Repetitive behaviors or mental acts person does in reaction to obsessions. </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Behaviors or mental acts done to avoid or decrease distress .</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Behaviors or mental acts are clearly excessive or not realistic .</span></li>
</ul>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEglSem9EWrbZL9nfQpD6_EzP51nsozueZXOIl7TR8g6DqtPNczIhA12x-XC8eAehAesgLwR_lvIVmvgEvynOn_RMcFtnO9auAh0NJ8dEc9ERVxJ9xnCrai0xHJa_skzBGjrdVgJYHIX1nUM/s1600/OCD-servingnature.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEglSem9EWrbZL9nfQpD6_EzP51nsozueZXOIl7TR8g6DqtPNczIhA12x-XC8eAehAesgLwR_lvIVmvgEvynOn_RMcFtnO9auAh0NJ8dEc9ERVxJ9xnCrai0xHJa_skzBGjrdVgJYHIX1nUM/s640/OCD-servingnature.jpg" width="520" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">History</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">14th & 15th century thought people were possessed by the devil and treated by exorcism</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">18th century finally considered medical issue</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">20th century began treating with behavioral techniques</span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Theories</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Scientist split into 2 groups</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Psychological disorder where people are responsible for feelings they have</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Abnormalities in the brain</span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Causes</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Serotonin is involved in regulating anxiety.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Abnormality in the neurotransmitter serotonin.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">In order to send chemical messages serotonin must bind to the receptor sites located on the neighboring nerve cells.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">OCD suffers may have blocked or damaged receptor sites preventing serotonin from functioning to full potential.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Possible genetic mutation .</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Some people suffering have mutation in the human serotonin transporter gene.</span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Cortico-Striatal-Thalamo-cortical loops</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">> <u>Orbitofrontal cortex</u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Personality, emotion, response inhibition, and social behavior</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">> <u>Dorsolateral cortex</u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Executive functioning, planning, attention, working memory</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">> <u>Anterior cingulate cortex</u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Initiative, motivation</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhd-Z5OoJgRu9n5XWyFgoBewwm8ivfI1m9gDoUlHBaauau_d242WrU8Es-_405TE4AqdUCXwQ-iB2AbTM9aAZKJl4iGd_UvGsmONRHXsb1o1Hv_LYo4ljHEpcRsKxle22FjQD-H0vsBdg5v/s1600/O.C.D-servingnature.bmp" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="231" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhd-Z5OoJgRu9n5XWyFgoBewwm8ivfI1m9gDoUlHBaauau_d242WrU8Es-_405TE4AqdUCXwQ-iB2AbTM9aAZKJl4iGd_UvGsmONRHXsb1o1Hv_LYo4ljHEpcRsKxle22FjQD-H0vsBdg5v/s400/O.C.D-servingnature.bmp" width="400" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">OCD and the Brain</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">> PET scans show people with OCD have different brain activity from others</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">> Another theory: miscommunication between the orbital frontal cortex, the caudate nucleus, and the thalamus</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Caudate nucleus</u> doesn't function properly and causes thalamus to become hyperactive and sends “never-ending” worry signals between OFC and thalamus OFC responds by increasing anxiety</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj-bqE0aVZ50-iyPewrPqHMxAMrEf8ZSQGwn9Sr3bcZxvndimHNswFZbqMdMnAIAoMv_nC0dYS20telMOo9hWif2-6X4lLHkBwuG_dXStFB29atxLnxzSBy9TKQKvrRNjq6wH3qTEVKjb9g/s1600/PET+scan-OCD-servingnature.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="315" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj-bqE0aVZ50-iyPewrPqHMxAMrEf8ZSQGwn9Sr3bcZxvndimHNswFZbqMdMnAIAoMv_nC0dYS20telMOo9hWif2-6X4lLHkBwuG_dXStFB29atxLnxzSBy9TKQKvrRNjq6wH3qTEVKjb9g/s400/PET+scan-OCD-servingnature.png" width="400" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Comorbidity </span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Has excessive comorbidity with other diseases</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Common diseases: Depression, Schizophrenia, Tourette Syndrome </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Depression is the most common </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Many people with OCD suffered from depression first</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">2/3 of OCD patients develop depression makes OCD symptoms worse and more difficult to treat</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">People with OCD common diagnosed as Schizophrenic hard to separate obsessions from delusions</span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Treatment</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Only completely curable in rare cases</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Most people have some symptom relief with treatment</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Treatment choices depend on the problem and patients preferences</span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif;">Most common treatments:</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Behavioral Therapy</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Cognitive Therapy</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Medication</span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Cognitive-Behavioral Therapy</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Cognitive:</u> change the way they think to deal with their fears</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Behavioral:</u> change the way they react to “anxiety-provoking” situations</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Exposure and Response Prevention</u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Slowly learning to tolerate anxiety associated with not performing ritual behavior</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Psychotherapy</u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Talking with therapist to discover what causes the anxiety and how to deal with symptoms</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Systematic Desensitization</u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Learning cognitive strategies to deal with anxiety then gradual exposure to feared object </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">> Should be done when people are ready for it</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">> Must be customized for each person’s specific form of OCD and their needs</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">> No side affects except increased anxiety with exposure to fear</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">> Often lasts about 12 weeks</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">> Positive effects off CBT last longer than those of medication</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">> If OCD returns can successfully treat again with same therapy</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">> Best treatment approach for most is CBT combined with medication</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Medication</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;"><u>Anxiolytic benzodiazepine</u> such as<u> chloradiazepoxide</u> or <u>diazepam</u> ===> give temporary relief from anxiety but not really effective on obsessions and compulsions. </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;"><u>Antidepressants</u> because of common depression.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;"><u>Selective Serotonin Reuptake Inhibitors (SSRIs):</u> alter the levels of neurotransmitter serotonin in the brain which helps brain cells communicate with one another .</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Prevents excess serotonin from being pumped back into original neuron that released it</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Then can bind to receptor sites of nearby neurons and send chemical message that can help regulate anxiety and obsessive compulsive thoughts.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Most effective drug treatment helping about 60% of patients.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Ex: Prozac, Zoloft, Lexapro, Paxil</span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Conclusion</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">OCD is a complicated issue</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Most cases are incurable </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Best form of treatment is CBT in combination with medication</span><br />
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Anonymoushttp://www.blogger.com/profile/16555664245806923731noreply@blogger.com0tag:blogger.com,1999:blog-3618930566267736040.post-9451164736922365012013-04-01T13:27:00.003-07:002013-04-01T13:32:03.104-07:00What is Stress and stress related diseases?<br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;"><u><br /></u></span></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;"><u>Hans Selye</u></span> </span><span style="font-family: Arial, Helvetica, sans-serif;">(1907-1982) </span><span style="font-family: Arial, Helvetica, sans-serif;">The father of the </span><span style="font-family: Arial, Helvetica, sans-serif;">study of stress </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">He developed the idea that there is a direct relationship between stress and excessive wear and tear throughout the body.</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhnP40wYj_YPQwmhuo7iIshu7jueCe6Kxm3vv5eeGetcZRc5Igm5TIh9Npbf0kBU2rYtizJWV-5k5HMEOT7ITMI8rLFwAE-t3zMrWj0dAX86CdR1BYtjlvm6HQCFPNgSC34dDjS9E6q6_0P/s1600/Hans+Selye-servingnature.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhnP40wYj_YPQwmhuo7iIshu7jueCe6Kxm3vv5eeGetcZRc5Igm5TIh9Npbf0kBU2rYtizJWV-5k5HMEOT7ITMI8rLFwAE-t3zMrWj0dAX86CdR1BYtjlvm6HQCFPNgSC34dDjS9E6q6_0P/s400/Hans+Selye-servingnature.png" width="320" /></a></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">1.Definition of Stress</span> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Selye described stress as “ a state manifested by a specific syndrome of the body developed in response to any stimuli that made an intense systemic demand on it.”</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Defined as a state of tension that can lead to disharmony or threaten the homeostasis of body.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">The current concept of stress is “Non-specific response of the body to any demand made upon it.”</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Characters of stress</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Non-specific response </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Influenced by some factors </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Double significance of stress</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">eustress >> increase mental and physical alertness, enhance adaptative abilities </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">distress >> disease (peptic ulcers, cardiovascular disease, psychosomatic disease) </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">2. Stressor</span><span style="font-family: Arial, Helvetica, sans-serif;"> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Any stimuli ,or demands ,on body that exceeds a threshold and causes stress response are stressors.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Exogenous stressor</u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Noise, trauma, infection, cold, heat, pollution, </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Endogenous stressor</u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Alternation of blood compositions, disturbance of homeostasis</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Mental-social stressor</u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Competition, overcrowding, loneliness ,great pressure of work</span><br />
<span style="font-size: large;">Acute Stress</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> </span><span style="font-family: Arial, Helvetica, sans-serif;">Acute stress is the reaction to an immediate threat, commonly known as the fight or flight response</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Common acute stressors include</u>:</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">noise, crowding, isolation, hunger, danger, infection, and imagining a threat or remembering a dangerous event.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Under most circumstances, once the acute threat has passed, the response becomes inactivated and levels of stress hormones return to normal, a condition called the relaxation response.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Chronic Stress</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Frequently, however, modern life poses on-going stressful situations that are not short-lived and the urge to act (to fight or to flee) must be suppressed. Stress, then, becomes chronic. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Common chronic stressors include:</u> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">on-going highly pressured work, long-term relationship problems, loneliness, and persistent financial worries. </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">3.General Adaptation Syndrome</span><br />
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<ul>
<li><u style="font-family: Arial, Helvetica, sans-serif;">General</u><span style="font-family: Arial, Helvetica, sans-serif;"> because the effect was a general systemic reaction no matter what stressor is</span></li>
<li><u style="font-family: Arial, Helvetica, sans-serif;">Adaptation</u><span style="font-family: Arial, Helvetica, sans-serif;"> because the response was in reaction to a stressor in order to maintain homeostasis </span></li>
<li><u style="font-family: Arial, Helvetica, sans-serif;">Syndrome</u><span style="font-family: Arial, Helvetica, sans-serif;"> because the physical manifestations were coordinated and dependent on each other.</span></li>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Stages of GAS</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">The body passes through three universal stages of coping. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">First there is an "alarm reaction," in which the body prepares itself for "fight or flight." No organism can sustain this condition of excitement.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Second stage of adaptation ensues (provided the organism survives the first stage). In the second stage, a resistance to the stress is built.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Finally, if the duration of the stress is sufficiently long, the body eventually enters a stage of exhaustion, a sort of aging "due to wear and tear."</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Mechanism-stress response</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Neuroendocrine response</u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">1. Locus ceruleus-nor-epinephrine (LC/NE) /sympathetic-adrenal medulla axis</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">2. Hypothalamic-pituitary-adrenal cortex</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">(HPA) axis</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Humeral response</u>--- Acute phase response </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Increase of Acute phase protein in plasma</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Cellular response</u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Up-expression of heat shock protein </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">1. Neuroendocrine Response</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">The essential function in stress response</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">(1)</span>Locus ceruleus-norepinephrine (LC/NE) /</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">sympathetic-adrenal medulla axis</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;"><br /></span></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">The essential function of </span></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">LC/NE- sympathetic/ adrenal medulla axis</span> </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><u><br /></u></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><u>The effects of the increased catecholamines and sympathetic activity</u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>positive effects</u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">1.Heart function increased: Heart rate↑ ,myocardial contractility ↑</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> cardiac output ↑, blood pressure ↑ → Blood supply to tissues ↑</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">2. Blood redistribution →kidney, skin, viscera receive a decreased blood supply ></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> heart, brain, and skeleton muscles receive an increased blood supply</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">3.Breathing rate↑, bronchodilation →alveolar ventilation ↑,oxygen supply ↑</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">4.glycogenolysis →blood glucose level ↑</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> lipolysis → blood fatty acids level ↑ →energy substrates supply ↑</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">5.Regulate other hormone level: growth hormones(GH)↑, thyroxine ↑, </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> glucagon ↑, and CRH (corticotropin releasing hormone)↑, insulin↓ </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>negative effects</u>: Hypertension, stress ulcer, visceral ischemia</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-size: large;"><span style="font-family: Arial, Helvetica, sans-serif;">(2)Hypothalamic-pituitary-</span><span style="font-family: Arial, Helvetica, sans-serif;">adrenal cortex (HPA) axis</span></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">The essential function of HPA axis </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;"><u>In central:</u> </span>CRH act as a neurotransmitter within the CNS.It can modulate learning, memory, emotion, etc</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">low doses of CRH promote adaptation →</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">excitation or pleased feeling</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">high doses of CRH cause maladaptation →</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">anxiety, depression, and inhibition of feeding,growth</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">CRH→ACTH →GC</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">CRH →promote LC-NE neuron →activate LC-NE axis</span></li>
</ul>
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;"><u>In peripheral</u></span>: GC is the final effector of the HPA axis, and plays a key role in the regulation of stress</span><br />
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<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Increased GC will protect the organism against the effects of stressor.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Excess GC will exert detrimental effects on body</span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">The positive effects of the increased GC </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">1.GC maintains blood glucose levels by antagonizing the effects of insulin and enhances the glycogenolysis 2. GC provides fundamental supports for many other hormones (CA, GH, glycocargon)----“permission roles” 3. GC can stabilize lysosomal membrane and lessen tissue damage 4. GC also suppress inflammation and anaphylaxis</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">All of these functions can protect the organism against the effects of stressor, and focus energy on regaining homeostasis.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">The negative effects of the increased GC</span> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Negative </span><span style="font-family: Arial, Helvetica, sans-serif;">effects</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">alteration of metabolism→negative nitrogen balance</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Suppress immune response → infection</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Suppress thyroid axis → delayed growth</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">result in hormonal resistance → delayed growth</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Suppress gonad axis → delayed development</span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Note:</u> Person with prolonged stress trend to manifest infection, mental depression, increased incidence of peptic ulcer, delayed growth and development.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Alterations of other hormones in stress</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">2.Humoral stress response</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Acute phase response:</u> is a quick mobilized non-specific immune response against infection, injuries and variety of noxious stimuli, which manifests elevation of WBC count, increase of acute phase protein , etc.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Acute phase protein (APP):</u> are a group of plasma proteins which concentrations in plasma increase quickly upon the acute stress. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">APP represents an important adaptive, protective mechanism in humoral level.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Classification and function of APP</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>C-reactive protein and complements</u>: raise the eliminating power for infectious agents, necrotic debris, increase anti-infection and anti-injury capacity of body .</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Protease inhibitors---α1-antichymotrypsin and α1-antitrypsin</u>: protect the tissue from injury by protease </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Coagulating proteins--- fibrinogen</u>: enhance the hemostatic power of body against hemorrhage</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Ceruloplasmin:</u> eliminate oxygen free radical, protect body against oxidative stress injury.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">3.Cellular stress response</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Heat shock protein(HSP</u>): are a family of stress protein whose synthesis is up-regulated in response to a variety of stressors. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Up-expression of HSP during stress represents an important adaptive and protective mechanism in cellular and molecular level.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Classification of HSP</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">HSPs subfamily:HSP110,HSP90,HSP70,HSP60, HSP40,small HSP20, and ubiquitins </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Function of HSP</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">■ The primary role of the HSP----- assist protein folding and repairing in vivo, “Molecular chaperone” </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">In normal, HSP accelerate proper folding of newly synthesized proteins, guide them translocation and assembly</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Under stress conditions, HSP associate with damaged proteins, prevent their abnormal binding with other macromolecules and refold the damaged proteins.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">■ Maintain the homeostasis in vivo : degrade and remove bad-damaged and unreparable protein</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Functional and Metabolic Alteration</span><br />
<br />
<ol>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Central nervous system</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Immune system</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Cardiovascular system</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Digestive system</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Genito-urinary system</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Metabolic alteration</span></li>
</ol>
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Central nervous system (CNS)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">1-CNS is the regulation center of stress response. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Without the sensation, recognition, integration, and interpretation by CNS, many stress will not happen, such as social psychology stress . </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">2. CNS is effected by stress response. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">The moderate stress response will do profit to memory, concentration, and learning. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">The hypo-arousal or hyper-arousal of CNS are both distress state, which may cause depression, sadness, or anxiety, panic, etc. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Immune system</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">1. Immune system is an internal sensory organ that recognizes non-cognitive stimuli such as bacteria, viruses, and other antigens, and relays information to the neuroendocrine system via hormones secreted by immunocytes. </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">The primary Hormones </span><span style="font-family: Arial, Helvetica, sans-serif;">secreted by immunocompetent cells </span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg_SPE1-cyyMQJn2g0VrU5jlMjb4OuFV6WJxVTUKSCeaNmlAR9h9yU6q0hsjBwscKL13pbpPik4AhwlMNkfsIXWFOKQbBQVCVlHCihTuVU_jVN46jYsC1xcZrpZe7rzh7afkniCWae_JrSM/s1600/primary+hormones-secreted+by+immunocytes.bmp" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="210" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg_SPE1-cyyMQJn2g0VrU5jlMjb4OuFV6WJxVTUKSCeaNmlAR9h9yU6q0hsjBwscKL13pbpPik4AhwlMNkfsIXWFOKQbBQVCVlHCihTuVU_jVN46jYsC1xcZrpZe7rzh7afkniCWae_JrSM/s400/primary+hormones-secreted+by+immunocytes.bmp" width="400" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">2. the stress neurohormones have significant impacts on immune system. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">■ the acute stress enhances the no-specific immune function, the number and activity of phagocytes increases, complements, C-reactive protein levels raise, and there is a brief period of immunopotentiation.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">■ But the prolonged stress, variety of distresses are associated with immunosuppression, disturbance of immune system, even autoimmune diseases. </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Cardiovascular system</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Digestive system</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjEFDGLIQXL2xWXoqWS2Mc8QlkJ7Y3hqz0aazUlBKmuiVYgHRTYKo1ojcyNEFuFyb1ViBktgzAMu6U8-N8WK9TrVFdCWT8lQ3hqylANhCaR6qfqXuNA-X6MywRI56tGKYVIpj2N2HphL45O/s1600/Digestive+system-servingnature.bmp" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="241" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjEFDGLIQXL2xWXoqWS2Mc8QlkJ7Y3hqz0aazUlBKmuiVYgHRTYKo1ojcyNEFuFyb1ViBktgzAMu6U8-N8WK9TrVFdCWT8lQ3hqylANhCaR6qfqXuNA-X6MywRI56tGKYVIpj2N2HphL45O/s400/Digestive+system-servingnature.bmp" width="400" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Genito-urinary system</span><br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgGlDirWDEht_iuMNpzCo-fbWMhxQ4DaWjuxsDMqUAXi_-jAOSKKKJA78QILd14qYPAK1Oz2YzlSaOk-80gXCZbyJ6XTo6pcNgh852mxZQpiNK5fuDY3pCCK_mo_-1iJ4ImlFzpq68NkGef/s1600/Genito-urinary+system-servingnature.bmp" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="140" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgGlDirWDEht_iuMNpzCo-fbWMhxQ4DaWjuxsDMqUAXi_-jAOSKKKJA78QILd14qYPAK1Oz2YzlSaOk-80gXCZbyJ6XTo6pcNgh852mxZQpiNK5fuDY3pCCK_mo_-1iJ4ImlFzpq68NkGef/s400/Genito-urinary+system-servingnature.bmp" width="400" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">The reproductive system is inhibited: The signs are typically manifested in ladies upon strong stress, such as menstrual disorder, amenorrhoea, or dysgalactia, galactostasis in breast feeding women, decreased libido, and impotence. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Metabolic Alteration</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">The metabolic demands significantly increase upon stress</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">catabolism increase, anabolism decrease, metabolic rate increase significantly.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Stress and diseases</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>stress disease</u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Directly caused by severe noxious stressors. Stress ulcer is a prototype of stress disease. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>stress related disease:</u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Stress is an involving factor, which may participate or intensify the attack of development of the diseases as a risk factor or precipitating factor. Such as hypertension, post-traumatic stress disorder (PTSD), et al.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Stress Ulcer</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Mucosal damage or lesion of the stomach or duodenum in critical illness or severely stressed situation, such as severe burning, trauma, hemorrhage, respiratory failure, sepsis, and so on. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Incidence</u> of stress ulcer in critical patients:75%~100% </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Develop within 72 hours after a great insult</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Manifestation:</u> mucosal erosion, </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">superficial and multiple ulcer、errhysis. Few ulcer may occur life-threatening hemorrage or perforation. Most of them recovery without any sequela.</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh3LtW6WpyV0RHrBeOHie3GLb0nNdyKZ_BjxzuLhhScsYWXcTQDCS1IYyDtMPzI3OAp6lpcEarefic9fIwkp-_Jqtc1vpACqdexPo5gWYv_5potfINDXftLfpaw5luvnpt44hK3VainFVsT/s1600/stress+ulcer-servingnature.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="293" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh3LtW6WpyV0RHrBeOHie3GLb0nNdyKZ_BjxzuLhhScsYWXcTQDCS1IYyDtMPzI3OAp6lpcEarefic9fIwkp-_Jqtc1vpACqdexPo5gWYv_5potfINDXftLfpaw5luvnpt44hK3VainFVsT/s400/stress+ulcer-servingnature.jpg" width="400" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Mechanisms of stress ulcer</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">1.gastrointestinal mucosal ischemia; </span><span style="font-family: Arial, Helvetica, sans-serif;">the basic pathogenic mechanism</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> 2.counter-diffusion of gastric hydrogen ion to mucosa; </span><span style="font-family: Arial, Helvetica, sans-serif;">the major injurious factor for stress ulcer </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">Post-Traumatic Stress Disorder Symptoms</span> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Post-traumatic Stress Disorder is a psychiatric disorder that can occur following the experience or witnessing of life-threatening events such as military combat, natural disasters, terrorist incidents, serious accidents, or violent personal assaults, like rape.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">People who suffer from PTSD often relive the experience through nightmares and flashbacks, have difficulty sleeping, and feel detached or estranged, and these symptoms can be severe enough and last long enough to significantly impair the person's daily life. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">Gastrointestinal Problems</span> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">(Irritable bowel syndrome,</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Crohn's disease or ulcerative colitis)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Heart Disease </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">(Essential hypertension, coronary artery disease, arrhythmias)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">Immune Disorders</span> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">(Rheumatoid arthritis, multiple sclerosis) </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Sexual and Reproductive Dysfunction</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">(Sexual Dysfunction ,Premenstrual Syndrome Fertility, miscarriage, etc.)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Principles of Stress treatment1, remove or diminish the stressor</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">2, replenish nutrients</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">3, non-pharmacologic methods:</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">acupuncture,music etc</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">4, teaches coping techniques</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">"Fight for your highest attainable aim; but never put up resistance in vain." </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">Some useful techniques</span> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">1.Reduce harmful environmental conditions</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">2.Teaches techniques by which person can develop stress tolerance.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">3.Helps client maintain a positive self-image.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">4.Help maintain emotional equilibrium.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">5.Help client maintain or develop satisfying relations with others.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">General Guidelines</span><br />
<br />
<ol>
<li><u style="font-family: Arial, Helvetica, sans-serif;">Rule One</u><span style="font-family: Arial, Helvetica, sans-serif;"> - Find your own purpose in life, that fits your own personal stress level. </span></li>
<li><u style="font-family: Arial, Helvetica, sans-serif;">Rule Two</u><span style="font-family: Arial, Helvetica, sans-serif;"> - Control your emotional level by recognizing situations as being either life-threatening or non-life-threatening. </span></li>
<li><u style="font-family: Arial, Helvetica, sans-serif;">Rule Three</u><span style="font-family: Arial, Helvetica, sans-serif;"> - Collect the good will and appreciation of others. </span></li>
</ol>
<br />
<div>
<br /></div>
Anonymoushttp://www.blogger.com/profile/16555664245806923731noreply@blogger.com0tag:blogger.com,1999:blog-3618930566267736040.post-22463105573906955472013-03-31T00:50:00.002-07:002013-03-31T00:50:20.347-07:00Antiepileptic and anticonvulsive drugs<div class="separator" style="clear: both; text-align: left;">
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Antiepileptic Drugs</span></div>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">Before knowing anit-epileptic drugs, you must know <u>What is epilepsy</u>?</span><br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhlHgtfUp4mQ2ak9_AzsDmLDQ5B4zfFDBc5MU_sdDaz_2aKOshB1pJ9hXyv8zUiEI6wtBmmwqmHaQ1Nurm2wQfNQ5sUb3OJJRhqQLnSJxVJ1kqIrEJRz0BgpsIZER6maSMnhBWCAl4KVhPJ/s1600/epilepsy-servingnature.blogspot.com.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhlHgtfUp4mQ2ak9_AzsDmLDQ5B4zfFDBc5MU_sdDaz_2aKOshB1pJ9hXyv8zUiEI6wtBmmwqmHaQ1Nurm2wQfNQ5sUb3OJJRhqQLnSJxVJ1kqIrEJRz0BgpsIZER6maSMnhBWCAl4KVhPJ/s400/epilepsy-servingnature.blogspot.com.jpg" width="277" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">Epilepsy</span>: Epilepsy is a neurological disorder characterized by short, recurrent electrical malfunctions of the brain which leads to changes in muscle activity, sensation and consciousness. </span><br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjy8Hr4DHYh0HOzxI7Ts_ah6kOYVzUYBfARUBYVOBrxu9hgvQPf1vD21YxDUI9q937Xvi9kb5P_qESG0vzmTh_9LtRAdYUE285ECRUK_NHy0-TinjLZadLSFhUTXpI_JnHlGBbjBCbFu5Nw/s1600/epilepsy.bmp" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjy8Hr4DHYh0HOzxI7Ts_ah6kOYVzUYBfARUBYVOBrxu9hgvQPf1vD21YxDUI9q937Xvi9kb5P_qESG0vzmTh_9LtRAdYUE285ECRUK_NHy0-TinjLZadLSFhUTXpI_JnHlGBbjBCbFu5Nw/s400/epilepsy.bmp" width="381" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Factors:</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Many factors may contribute to the onset of epilepsy</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Brain damage related to birth </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Brain abnormalities present before birth </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Brain infections </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Brain tumors </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Abnormalities in blood vessels of the brain </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Head injuries </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Drug or alcohol abuse </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Lead poisoning </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Family history of seizure disorders </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Stroke </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Low blood sugar </span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Common seizure types of Epilepsy</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">1-Generalized seizures</span>.</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Absence (petit mal).</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Tonic/clonic (grand mal). </span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">2-Partial seizures.</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Simple partial seizures.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Complex partial seizures</span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>NOTE</u>: The type of epileptic seizure determines the drug selected for therapy.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Generalized seizures:</u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">Absence (petit mal):</span> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">These seizures have abrupt onset and cessation, with impaired consciousness, but with normal posture often retained. The EEG shows a typical ‘spike and wave’ pattern.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">Tonic/clonic (grand mal)</span>: </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Consciousness is impaired and the patient usually falls to the floor. A phase of muscle contraction (‘tonic’) is followed by irregular muscle clonus and then by sleep. Injury may occur.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">Partial seizures:</span></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Simple partial seizures: features depend on the part of the brain affected, result from discharge in the precentral gyrus. Consciousness is unimpaired.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">Complex partial seizures (temporal lobe epilepsy):</span></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Consciousness is impaired with complex, often repetitive action.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">Pathogenesis</span>:</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">The neuron in brain lesion depolarizes together suddenly, and then product high-frequency, out-break discharge.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">The discharge can diffuse to surrounding normal tissue →extensive excitation →the brain function transient aberration.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Therapeutic principle:</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Change the permeability of Na+</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Ca2+and K+ in nerve cell membrane, degrade excitement stage, extend refractory phase.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Directly or indirectly increase CNS levels of GABA.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Classification of Antiepileptic Drugs</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Hydantoins:Sodium Phenytoin</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Barbiturates:Phenobarbital, Primidone</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Succinimide:Ethosuximide</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Benzodiazepine: Diazepam, Nitrazepam</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Others: Sodium Valproate</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Sodium Phenytoin</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Phenytoin is the oldest nonsedative antiseizure drugs, introduced in 1938 following a systematic evaluation of compounds such as phenobarbital that altered electrically induced seizures in laboratory animals. It was known for decades as diphenylhydantoin.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">Pharmacokinetics</span></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Absorption of phenytoin is highly dependent on the formulation of the dosage form. Particle size and pharmaceutical additives affect both the rate and the extent of absorption.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">(1) </span>Absorption of phenytoin sodium from the gastrointestinal tract is nearly complete in most patients, although the time to peak may range from 3 hours to 12 hours.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">(2)</span> Absorption after intramuscular injection is unpredictable, and some drug precipitation in the muscle occurs; this route of administration is not recommended for phenytion. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">In contrast, fosphenytoin, a more soluble phosphate prodrug of phenytoin, is well absorbed after intramuscular administration.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">The elimination of phenytoin is dose-dependent.</span> </span><br />
<br />
<ol>
<li><span style="font-family: Arial, Helvetica, sans-serif;">At very low blood levels, phenytoin metabolism follows first-order kinetics.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">As blood levels rise with in the therapeutic range, the maximum capacity of the liver to metabolize phenytoin is approached.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Further increases in dose, even though relatively small, may pruduce very large changes in phenytoin concentrations.</span></li>
</ol>
<br />
<span style="font-family: Arial, Helvetica, sans-serif;">The <span style="font-size: large;">half-life</span> of phenytoin varies from 12 hours to 36 hours,with an average of 24 hours for most patients, in the low to mid therapeutic range. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">At low blood levels, it takes 5-7 days to reach steady-state blood levels after every dosage change; at higher levels, it may be 4-6 days before blood levels are stable. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Mechanism of action:</span><br />
<br />
<ol>
<li><span style="font-family: Arial, Helvetica, sans-serif;">It can block sodium channels (voltage-, frequency-, and time dependent fashion ) and inhibit the generation of action potentials. It can also block L and N type Calcium channels.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">It can increase the function of inhibitory transmitter GABA, inhibit nerve terminal to uptake GABA and induce the increasing of GABA receptor, thereby enhance GABA-mediated postsynaptic inhibition.</span></li>
</ol>
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhbhf9yCyiT1La8dAyEGNtizQz6V8ZzhylCmX7YP87jSleSGCHZUD8Fjl-vqxr4eNTFumCfyGcwcBOzKes6zwoyqpcKTohso2V28a1e2ahQnDDiNWsU_f6scCGbnffNF-U7MyjBnytU8f1W/s1600/phenytoin-mechanism-servingnature.bmp" imageanchor="1" style="margin-left: 1em; margin-right: 1em; text-align: center;"><img border="0" height="308" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhbhf9yCyiT1La8dAyEGNtizQz6V8ZzhylCmX7YP87jSleSGCHZUD8Fjl-vqxr4eNTFumCfyGcwcBOzKes6zwoyqpcKTohso2V28a1e2ahQnDDiNWsU_f6scCGbnffNF-U7MyjBnytU8f1W/s400/phenytoin-mechanism-servingnature.bmp" width="400" /></a><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Clinical application</span><br />
<br />
<ol>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Anti-epileptic: It can be used for partial seizures and tonic/clonic seizures, but not for other generalized seizure types.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Peripheral neuralgia: ischiadic nerve and cranial nerve.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Arrhythmia: membrane-stabilizing action, especially for the cardiac glycoside poisoning, it is the first choice.</span></li>
</ol>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Adverse effects</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">1-<u>Digestive system</u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">anorexia, nausea, vomiting and abdominal pain(recommend to take it after meal). </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">2-<u>Gingival hyperplasia</u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">It common occurs in children and teenagers after long term use, the incidence rate is about 20%. Generally, this effect can resolve after drug withdraw 3 to 6 months.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">3-<u>Nervous system</u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">diplopia, vertigo, ataxia(usually only at very high concentration). Severe patient occurs language disorder, mental confusion and cataphora</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">4-<u>Hematological system</u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Because it can inhibit the absorption of folinic acid and accelerate its metabolism. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">5-<u>Skeletal system</u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">It can enhance vitamin D metabolism, so Phenytoin may increase the risk of hypocalcemia, rickets and osteomalacia after long-term treatment (pretreat with vitamin D if necessary).</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">6-<u>Allergic response</u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">rash, thrombocytopenia, agranulocytosist can enhance vitamin D metabolism, so Phenytoin may increase the risk of hypocalcemia, rickets and osteomalacia after long-term treatment (pretreat with vitamin D if necessary).and aplastic anemia.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">7-<u>Others</u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Rarely appear male barymastia, female hirsutism and lymphadenectasis</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">1-Phenobarbital</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Aside from the bromides, phenobarbital is the oldest of the currently available antiseizure drugs. Although it has long been considered one of the safest of the antiseizure agents, the use of other medical with lesser sedative effects has been urged. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Mechanism of action:</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Phenobarbital can inhibit the paradoxical discharge of epilepsy focus selectively, enhance stimulation of surrounding tissues and block discharge diffuse to normal tissues.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Phenobarbital facilitate GABA-mediated inhibition of neuronal activity.</span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Clinical application</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Phenobarbital is an effective agent for generalized tonic-clonic and partial seizures. </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">However, its sedative effects and its tendency to disturb behavior in children have reduced its use as a primary agent.</span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Adverse effects</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Somnolence, depression</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Tolerance develops after long-term treatment.</span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">2-Primidone</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Primidone was first marketed in the early 1950s. It was later reported that Primidone was metabolized to phenobarbital and phenylethylmalonamide (PEMA), All three compounds are active anticonvulsants.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Pharmacokinetics</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Primidone is completely absorbed, usually reaching peak concentration about 3 hours after oral administration. </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Primidone is metabolized by oxidation to phenobarbital, which accumulates very slowly, and by scission of the heterocyclic ring to form PEMA. Both Primidone and phenobarbital under go subsequent conjugation and excretion.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Primidone has a larger clearance than most other antiseizure drugs(2L/kg/d), corresponding to a half-life of 6-8 hours. PEMA clearance is approximately half that of primidone, but phenobarbital has a very low clearance. The appearance of phenobarbital corresponds to the disappearance of Primidone. Phenobarbital therefore accumulates very slowly but eventually reaches therapeutic concentrations in most patients when therapeutic doses of primidone are administered.</span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Clinical application</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">It can be used for all types of epilepsy except petit mal. It,s better to use this drug with sodium phenytoin. </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">With regard to grand mal, the effect of primidone is better than phenobarbital, this drug is useless to petit mal. </span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Adverse effects</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Common: somnolence, vertigo, nausea and vomiting</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Rare: megaloblastic anemia, leucopenia and thrombocytopenia</span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">3-Ethosuximide</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Ethosuximide was introduced in 1960 as the third of three marketed succinimides in the USA. Ethosuximide has very little activity against maximal electroshock but considerable efficacy against pentylenetetrazol seizures and was introduced as a “pure petit mal” drug. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Pharmacokinetics</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Absorption is complete following administration of the oral dosage forms. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Peak levels are observed 3-7 hours after oral administration of the capsules. Animal studies indicate that chronic administration of the solution may prove irritating to the gastric mucosa.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Ethosuximide is completely metabolized, principally by hydroxylation, to inactive metablites. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Half Life</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">The drug has a very low total body clearance(0.25/kg/d). This corresponds to a half-life of approximately 40 hours, although values from 18 to 72 hours have been reported.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Clinical application</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Ethosuximide is effective against absence seizures but not tonic-clonic seizures.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Adverse effects</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Gastrointestinal tract: anorexia, nausea, vomiting</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">CNS: headache, dizziness and somnolence</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Rarely appear agranulemia and aplastic anemia</span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">4-Diazepam & Nitrazepam</span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">Pharmacokinetics</span>:</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">The drug are well absorbed, widely distributed, and extensively metabolized, with many active metabolites.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">The rate of distribution of benzodiazepines within the body is different from that of other antiseizure drugs. </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Diazepam and lorazepam in particular are rapidly and extensively distributed to the tissues, with volumes of distribution between 1 L/kg and 3 L/kg.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">The onset of action is very rapid.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Total body clearances of the parent drug and its metabolites are low, corresponding to half-life of 20-40 hours.</span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">Diazepam:</span> given<u> intravenously or rectally</u> is highly effective for stopping continuous seizure activity, especially generalized tonic-clonic status epileptics. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">The drug is occasionally given orally on a chronic basis, although it is not considered very effective in this application, probably because of the rapid development of tolerance. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">Nitrazepam:</span> is not marketed in the USA but is used in many other countries, especially for<u> infantile spasms</u> and <u>myoclonic seizures</u>. It is less potent than clonazepam, and its clinical advantages over that drug have not been documented.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">It’s highly effective in controlling petit mal and myoclonus epilepsy.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">5-Sodium Valproate</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Sodium Valproate, was found to have <u>antiseizure properties</u> when it was used as a solvent in the search for other drugs effective against seizures. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Pharmacokinetics</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Valproate is well absorbed following an oral dose, with bioavailability greater than 80%. Peak blood levels are observed within 2 hours.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Food may delay absorption, and decreased toxicity may result if the drug is given after meals.</span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">Clearance</span> for valproate is low; its <u>half-time</u> varies from 9 hours to 18 hours. At very high blood levels, the clearance of valproate is dose-dependent. There appear to be offsetting changes in the intrinsic clearance and protein binding at higher doses. Approximately 20% of the drug is excreted as a direct conjugate of valproate.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Clinical application</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Valproate is very effective against absence seizures. </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Valproate is unique in its ability to control certain types of myoclonic seizures; in some cases the effect is very dramatic. The drugs is effective in generalized tonic-clonic seizures, especially those which are primarily generalized.</span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">5-Carbamazepine</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Closely related to imipramine and other antidepressants, carbamazepine is a tricyclic compound effective in treatment of bipolar depression. It was initially marketed for the treatment of trigeminal neuralgia but has proved useful for epilepsy as well.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Pharmacokinetics</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">The rate of absorption of carbamazepine varies widely among patients, although almost complete absorption apparently occurs in all.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Peak levels are usually achieved 6-8 hours after administration .</span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Distribution</span><span style="font-family: Arial, Helvetica, sans-serif;"> is slow, and the volume of distribution is rough 1 L/kg.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Carbamazepine has a very systemic clearance of approximately 1 L/kg/d at the start of therapy.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Mechanism of action</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Carbamazepine can block sodium channel, inhibit paradoxical discharge and discharge diffusion. It may relate to the postsynaptic inhibition of GABA.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Clinical application</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Carbamazepine is considered the drug of choice for generalized tonic-clonic seizures. It can be used with phenytoin in many patients who are different to control.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">The drug is also very effective in some patients with trigeminal neuralgia.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Carbamazepine is also useful in some patients with mania.</span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">Adverse effects</span></span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">CNS: somnolence</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Gastrointestinal tract: nausea, vomiting and anorexia</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Rash, thrombocytopenia, aplastic anemia and hepatic lesion.</span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">Principle of Medication</span> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Grand pit (first choice):</u> Sodium phenytoin or phenobarbital, carbamzepine, Primidone.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Petit mal (first choice)</u>: Ethosuximide, clonazepam and sodium valproate.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Status epilepticus</u>: Diazepam or sodium phenytoin (IV), phenobarbital, diazepam, clonazepam.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Psychomotor</u>: Sodium phenytoin or combine with carbamazepine.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Principle of Medication (I)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">The dose can be gradually increased from a low starting dose until reach the best effect.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">In the initial stage, the patients should only be treated with a single antiepileptic drug, if the drug is useless, then it can be changed. When drug changing is necessary, it should be gradually withdrawn after the effect of new drug occurs. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">After the symptom is fully controlled, the patients should continuing be treated for 2 or 3 years. Sudden withdrawal of drugs are likely to precipitate relapse. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Principle of Medication (II)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Enhance therapeutic effect: dosing individually, monitoring drug plasma concentration, examining regularly. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Evaluating efficacy and safety.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Adjusting drug dosage</u>: the therapeutic index of antiepileptic drug is low→easy to be poisoning Therapeutic dose is get close to toxic dose. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Anticonvulsant Drugs</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Convulsions are involuntary skeletal muscular contractions. Convulsions can arise from pathological processes within or outside the brain, toxins, drug overdose, or withdrawal from drug dependence. </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Commonly used anticonvulsant drugs are sedative and hypnotic drugs. Magnesium Sulfate is also used on this disease.</span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Pharmacological Effects</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">1 If used orally, it will have cathartic effect. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">2 It induces bile secretion as choleretic</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">3 Effect on neuromuscular system: reduce muscle contraction</span><br />
<div>
<br /></div>
Anonymoushttp://www.blogger.com/profile/16555664245806923731noreply@blogger.com2tag:blogger.com,1999:blog-3618930566267736040.post-49861165862127452242013-03-27T12:07:00.001-07:002013-03-28T05:45:45.565-07:00What is Hypoxia and its Consequences?<br />
<span style="font-family: Arial, Helvetica, sans-serif;">This is a general process of oxygen entering into tissue ,and cells.</span><br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgcdVbvxWKTS7H6Gc5r7VjTk1YM2eMtxguoLSOXh0rYR0RZQ6d77MmESRWI1ZxB_Hnqi9Wz5nQjUV_F9l5o1c5rHUNG8izL4FRXf-XM-awDbKypFmQjnr7IYapg-vKpC0aNtBUlNKZAcISe/s1600/Hypoxia-servingnature.bmp" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="258" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgcdVbvxWKTS7H6Gc5r7VjTk1YM2eMtxguoLSOXh0rYR0RZQ6d77MmESRWI1ZxB_Hnqi9Wz5nQjUV_F9l5o1c5rHUNG8izL4FRXf-XM-awDbKypFmQjnr7IYapg-vKpC0aNtBUlNKZAcISe/s400/Hypoxia-servingnature.bmp" width="400" /></a></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg3H4wr_ILi5PmztQV7drg72gpdAFEhM9n15YlRcJRht54RhTTD5HyiyfLKwFRkPRBBB448EGZfS0DiikulRqY-sNqQKQTmQ-0eKq8MmXScbIC5tAP4KGnp-LUrIL1pKd2K6k2XGJAXbwPK/s1600/complex+process-servingnature.bmp" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="190" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg3H4wr_ILi5PmztQV7drg72gpdAFEhM9n15YlRcJRht54RhTTD5HyiyfLKwFRkPRBBB448EGZfS0DiikulRqY-sNqQKQTmQ-0eKq8MmXScbIC5tAP4KGnp-LUrIL1pKd2K6k2XGJAXbwPK/s400/complex+process-servingnature.bmp" width="400" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">This process is complex ,troubles in any part will affect the oxygen supply to cell, and lead to hypoxia</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Ventilation Transfer</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">O2</span><span style="font-family: Arial, Helvetica, sans-serif;"> </span><span style="font-family: Arial, Helvetica, sans-serif;">——></span><span style="font-family: Arial, Helvetica, sans-serif;">HbO2 </span><span style="font-family: Arial, Helvetica, sans-serif;"> </span><span style="font-family: Arial, Helvetica, sans-serif;">——></span><span style="font-family: Arial, Helvetica, sans-serif;"> Tissue utilization</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> diffusion Circulatory system</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><u><span style="font-size: large;">Hypoxia</span> is an extremely important and common cause of cell injury and death.</u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Definition</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Hypoxia is a pathological process, in which O2 supply to tissues or organs is inadequate to meet the demand of cells; or the tissue cells can not make use of O2, leading to changes in functions, metabolisms and structures of cells and tissues of the body.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Anoxia:</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> The absence of O2 in the tissues</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Hypoxemia:</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> A deficiency of O2 in blood</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Three key points of Concept :</span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">1. Pathological process</span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">2. Causes </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">I)Can’t obtain enough oxygen</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">II)Can’t fully utilize oxygen</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">3. Changes</span> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Metabolism</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Function</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Structure </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Oxgen supply = CaO2× Q</u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Oxygen consumption =(CaO2-CvO2)× Q</u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Parameters of blood O2</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> 1. Partial pressure of O2 (PO2)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> PO2 is the tension caused by O2 physically dissolved in the blood.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u><br /></u></span>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_E-T9GEQwnUBpawN0Pq5jGZaxrfvdCd2FNaQE17jrSwLWyPSljCRK2nKFH8l0MfGTpSIxO0IMImVmpsjenSNZ22ePpSGqCAhvmdSYFgKhmDQGpmC5AlkUmbV_l6xsM6ORKGgON28O0s9v/s1600/O2.png" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="164" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_E-T9GEQwnUBpawN0Pq5jGZaxrfvdCd2FNaQE17jrSwLWyPSljCRK2nKFH8l0MfGTpSIxO0IMImVmpsjenSNZ22ePpSGqCAhvmdSYFgKhmDQGpmC5AlkUmbV_l6xsM6ORKGgON28O0s9v/s320/O2.png" width="320" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif;"><u>The normal value :</u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> PaO2 : 100mmHg (13.3kPa )</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> PvO2 : 40mmHg (5.33kPa )</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">PO2(in the air) :159mmHg</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">PO2(in alveolar air):104mmHg</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Determinants of PO2 :</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">O2 pressure in the inhaled air</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">respiratory function</span><br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj9k-DaLvp7fbvptxK6JvVIt-sgebreMc0NjiXjoMTprOImiAx1SAi0abmLMv-DrcXTkPcfyoYSEJj9iXusQZJsNNyaGmiextJBGI5DdG0AOY-P8Q9dVpf6DrXAhmH5i4CHPdv8etTxyqt-/s1600/respiratory+syst..jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj9k-DaLvp7fbvptxK6JvVIt-sgebreMc0NjiXjoMTprOImiAx1SAi0abmLMv-DrcXTkPcfyoYSEJj9iXusQZJsNNyaGmiextJBGI5DdG0AOY-P8Q9dVpf6DrXAhmH5i4CHPdv8etTxyqt-/s320/respiratory+syst..jpg" width="313" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">abnormal right-to-left shunt in pathological conditions(e.g. ventricular septal defect)</span><br />
<br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Ventricular septal defect</u> a common congenital heart defect; an abnormal opening in the septum dividing the ventricles allows blood to pass directly from the left to the right ventricle; large openings may cause congestive heart failure .</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">2. Oxygen capacity (CO2max)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">The maximal amount of O2 combined by hemoglobin (Hb) in 100ml blood.</span><br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiVXxrvGJLuuQAV6qvo7ONArFQLZ4YCWOj2HcM1J9LmrDFd98komCBC3s8c-7VqTu9kNaIbq9IEgn6vgTf-x6AoS0aPKoJPJCcgEZiA-0o0Y4bAxIvEbyPNA0sSX4DV32McaCkyTihPjKMW/s1600/Oxygen+capacity.png" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="119" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiVXxrvGJLuuQAV6qvo7ONArFQLZ4YCWOj2HcM1J9LmrDFd98komCBC3s8c-7VqTu9kNaIbq9IEgn6vgTf-x6AoS0aPKoJPJCcgEZiA-0o0Y4bAxIvEbyPNA0sSX4DV32McaCkyTihPjKMW/s200/Oxygen+capacity.png" width="200" /></a><span style="font-family: Arial, Helvetica, sans-serif;">Fully saturated condition:</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> PO2:150mmHg</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> PCO2:40mmHg</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> T:38℃</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">The level of Cp-O2max only depends on Hb :</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> ① quantity of HB</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> ② quality of HB</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> <u>The normal value </u>:</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Cp-O2max = 1.34 ml/g × 15 g/dl = 20 ml/dl</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">3. Oxygen content (C-O2)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">The actual amount of O2 in blood.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">>combined with Hb : 98.5%</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">>physically dissolved:1.5%(can be omitted)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">The level of C-O2 depends on:</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> ①PO2</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> ②The level of Hb (quality and quantity)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> <u>The normal value of C-O2 :</u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> CaO2 ——19ml/dl</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> CvO2 ——14ml/dl</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">CaO2 - CvO2 </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">(Arteriovenous Oxygen content difference) </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><u>normal value:</u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> 19ml/dl -14ml/dl = 5ml/dl </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">4. Oxygen saturation(SO2)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> The percentage of hemoglobin present as oxyhemoglobin . </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"> O2 content</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> SO2 can be calculated by : —–—–—–—–</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> O2 capacity</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">If 100ml blood contains 20ml O2 , the SO2 is 100%</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">when it contains 15ml O2 , how much is SO2 ?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u> The normal value :</u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> SaO2—95% </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> SvO2—75%</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">The level of SO2 only depends on PO2</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><u><span style="font-size: large;">N</span>OTE</u>: When O2 content in arterial blood is 19ml/100ml, the O2 saturation is 95%, When O2 content in venous blood is 14ml/100ml, the O2 saturation is 70%.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Four parameters</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">1. Partial pressure of O2(PO2)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> PaO2 : 100mmHg , PvO2: 40 mmHg </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">2. O2 content(C-O2)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> CaO2 : 19ml/dl , CvO2: 14ml/dl</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">3. O2 capacity(Cp-O2max)= 1.34 ml/g × 15 g/dl</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> C-O2max : 20ml/dl</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">4. O2 saturation(SO2) </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> SaO2 : 95%, SvO2: 70%</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Classification and pathogenesis</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"> 1. Hypotonic hypoxia </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">◆ <span style="font-size: large;">Causes</span></span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">(1) Decreased O2 pressure in the inspired air.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">--- atmospheric hypoxia</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">①In enclosed room</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">② 3000 meters above sea level </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">(2) External respiratory dysfunctions</span></span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Peanuts, jelly or any other soft ,sweet food made from fruit juice and sugar boiled together ,used as a topping.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>can cause</u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Paralysis of respiratory muscles, airway obstruction, asthma, emphysema, tuberculosis, pulmonary cancer, inflammation, and edema.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">(3) Right-to-left shunt—Venous admixture</span></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Some congenital heart diseases, such as ventricular septal defect, or if the foramen oval fails to close after birth.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">◆ C<u>haracteristics of blood O2</u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">PO2:↓</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">-O2 content :↓</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">-O2 capacity:</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">acute cases:N</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">chronic cases:↑</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">-O2 saturation:↓</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><u>NOTE:</u> O2 content ↓(both in arterial and venous blood). </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Oxygen capacity is normal in acute cases and is increased in chronic cases.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">◆ <span style="font-size: large;">Cyanosis</span></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Cyanosis refers to a bluish color of the skin, nail beds and mucous membranes when deoxyhemoglobin concentration of blood in capillary is more than 5g per 100ml blood.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>NOTE:</u> Cyanosis is the most important clinical sign of hypotonic hypoxia.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">The discolor of the skin, nail beds and mucous membrane.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Mechanism of Cyanosis</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">HbO2 (oxygenated Hb) ─bright red</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Hb (unoxygenated Hb) ─bluish</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><u>CAUTION:</u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Not all the cyanosis means hypoxia</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">2. Hemic hypoxia (Isotonic hypoxia)</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">◆ <span style="font-size: large;">C</span>auses</span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">(1) Anemia</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">The concentration of Hb is less than 9g/100ml。</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Patients with severe anemia will have no cyanosis, since their unoxygenated Hb can not reach 5g/100ml</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">(2) Carbon monoxide (CO) poisoning</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><u>Mechanism of CO poisoning</u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">① Hb combine with CO instead of O2 & produce carboxy-hemoglobin (CO-Hb),the CO-Hb can’t carry O2 any more.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">② Hb may combine with both CO and O2 more tightly,so Hb can’t release O2 to tissues.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">CO combines with Hb form carboxyhemoglobin (COHb), the color is cherry-red. The cherry-red/pink color will be visible in the skin, nail beds and mucous membrane during CO poisoning. It will have no cyanosis.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">(3) Methemoglobinemia</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Normal: ferrous state (Fe2+)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">oxidized :ferric state (Fe3+)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">Hb containing Fe3+ : methemoglobin </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Appearance</u>: Methemoglobin is brown, the patients will appear brown color. </span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgioqX6osU5HJI30QPDPeyyxZjIHjx5hQLbXo1E84jIC31RBETNl93gKluaxFC9MZzOJ5-8rf4nrcGbiBT8movPDaifYMV5MdWvNl1ixzt27laxySZrTZ4qr1_GsxdvCymIZQB-d1klWQqV/s1600/methamoglobin.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgioqX6osU5HJI30QPDPeyyxZjIHjx5hQLbXo1E84jIC31RBETNl93gKluaxFC9MZzOJ5-8rf4nrcGbiBT8movPDaifYMV5MdWvNl1ixzt27laxySZrTZ4qr1_GsxdvCymIZQB-d1klWQqV/s320/methamoglobin.jpg" width="320" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><u><span style="font-size: large;">N</span>OTE:</u> Many chemicals and drugs can oxidize the iron in Hb.(such as: amyl nitrite, aniline, nitrobenzene, acetanilid, phenacetin, and salicylates)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Enterogenous cyanosis</u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">◆ Characteristics of blood O2</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> PO2 :N (isotonic hypoxia)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> O2 content : N or ↓</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> O2 capacity : N or ↓</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> O2 saturation: N</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"> <span style="font-size: large;">3. Circulatory hypoxia</span></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">◆ <span style="font-size: large;">C</span>auses</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>circulatory deficiency</u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">e.g;</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">embolism</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">shock, heart failure embolism.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">atherosclerosis</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">thrombosis</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">tourniquet</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Ischemic hypoxia</u></span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg20MQ2T9ruNQdWL_4T-dGrSRbUsZcLXkwVgZWugjDZbygbpBvTodbGp4L0dBkYowQaRKAp6RFFmaehisw7Yif8GnZYoH1x0v1-qH92WdaeTKtgIaVYg8gfURpS8QNs3Y9roPtaYNP3E8V5/s1600/ischemic+hypoxia.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="111" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg20MQ2T9ruNQdWL_4T-dGrSRbUsZcLXkwVgZWugjDZbygbpBvTodbGp4L0dBkYowQaRKAp6RFFmaehisw7Yif8GnZYoH1x0v1-qH92WdaeTKtgIaVYg8gfURpS8QNs3Y9roPtaYNP3E8V5/s400/ischemic+hypoxia.png" width="400" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Stagnant hypoxia</u></span><br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg8CdTMSzqjl_fPxsXFtsC6u2N_c7-MdCE7B8Sg0ASiUJP-lr5RKEcWxeeQMKne4wVhDPdwBfg9muLJWoLcy-OQUwkHVe5PhzlduPXwkC6JtbtIO-Y1dBpbTGgW7Wr1GdN5FZ4QHQYgHNh6/s1600/stagnant+hypoxia.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="110" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg8CdTMSzqjl_fPxsXFtsC6u2N_c7-MdCE7B8Sg0ASiUJP-lr5RKEcWxeeQMKne4wVhDPdwBfg9muLJWoLcy-OQUwkHVe5PhzlduPXwkC6JtbtIO-Y1dBpbTGgW7Wr1GdN5FZ4QHQYgHNh6/s400/stagnant+hypoxia.png" width="400" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">◆ Characteristics of blood O2</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">PaO2 :N</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C-O2 :N</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Cp-O2max :N</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">SO2 : N</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Note</u>: Oxygen supplied for cell in unit time is inadequate.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">PO2 in A and O2 content in A are normal; because when blood flow passes through tissues slowly, the PO2 and O2 content in venous blood are decreased. C(a-v) is increased.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">C(a-v): ↑ blood flow passes through tissues slowly, the PO2 and O2 content in venous blood are decreased. C(a-v) is increased.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"> <span style="font-size: large;">4. Histogenous hypoxia</span></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Histotoxic hypoxia</u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">◆ <span style="font-size: large;">C</span>auses</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">(1) Tissue poisoning</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">(2) cell injured by biological or physical factor</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">(3) vitamin deficiency ---vit B1</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><u>NOTE:</u>The toxic agent substances include cyanide, arsenic, barbiturates.</span><br />
<br />
<span style="font-family: Arial, Helvetica, sans-serif;">◆ Characteristics of blood O2</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">PaO2 :N</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">CO2 :N</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">CO2max :N</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">SO2 : N</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Note</u>: In Histogenous hypoxia;</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Cell can’t fully utilize oxygen</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">The color of skin in hypoxia</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">1.Anemia —————— pale</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">2.CO poisoning ———— cherry red</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">3.Methemoglobinemia—— brown</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">4.Histotoxic hypoxia—— rose red</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Effects on body</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Take “Hypotonic hypoxia” for an example</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">> Functional </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">> Metabolic</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> mild or chronic hypoxia: compensatory response</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> severe or acute hypoxia: organic dysfunction</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"> <span style="font-size: large;"> 1. Respiratory system</span></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">PaO2 > 60mmHg:no obvious changes</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">PaO2 < 60mmHg:compensation</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> decompensation</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">lower segment, Middle, upper segment</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">remain at a high level</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">With the changes in the horizontal axis, vertical axis did not change significantly</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">The slope is very steep. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"> 2. Circulatory system</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">(1)</span> In response to hypoxia</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">I) The heart rate increases (tachycardia),cardiac output increases,due to:</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">1. Myocardial contractility↑ </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">2. heart rate↑ </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">3. venous return↑</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">II) Peripheral vasodilation occurs.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">(2)</span> Pulmonary vasoconstriction</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Due to: Sympathetic nerve(+)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Humoral factors :</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Vasoconstrictive substance ↑↑</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Vasodilative substance↑</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">significance? --- to maintain the VA/Q</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">(3)</span> Redistribution of blood flow</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgLWFnBaN8dyHFSCJKddsV6M5-n1OtCgcBVKHQDU0vsPJgVVmatitiA_sTOsbF-5IQk8EVtVNbA36nPdpqAWS9wEeN5_TzAZULBC81cnkU7ZLwCRH1kJoHtA298NxwK9cb-sK88XAeq8iOu/s1600/c.system.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgLWFnBaN8dyHFSCJKddsV6M5-n1OtCgcBVKHQDU0vsPJgVVmatitiA_sTOsbF-5IQk8EVtVNbA36nPdpqAWS9wEeN5_TzAZULBC81cnkU7ZLwCRH1kJoHtA298NxwK9cb-sK88XAeq8iOu/s400/c.system.png" width="273" /></a></span></div>
<br />
<br />
<span style="font-family: Arial, Helvetica, sans-serif;"> sympathetic nerve(+)---- vasoconstriction</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Local metabolites ----- vasodilation</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">(4)</span> Capillary proliferation</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiBiEV7EWV62M6wyGuqcBOwN_weTOfDS9uiDcSd9AIwnBw7qU1u6De8p6d5KtJlDzXLqToK26M-Sr9yedb0xAipdbKonZ2b3Eo7zxei5R9nWnubziL19glRp22_Ah9nHJfbCDrvdwtxWIPG/s1600/circulation.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="268" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiBiEV7EWV62M6wyGuqcBOwN_weTOfDS9uiDcSd9AIwnBw7qU1u6De8p6d5KtJlDzXLqToK26M-Sr9yedb0xAipdbKonZ2b3Eo7zxei5R9nWnubziL19glRp22_Ah9nHJfbCDrvdwtxWIPG/s320/circulation.png" width="320" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">hypoxia</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> |</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> VEGF ↑</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> |</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Capillary hyperplasia</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Severe hypoxia ---- decompensation</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">• Myocardiac systolic and diastolic dysfunction</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">• Pulmonary hypertension</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">• Cardiac arrhythmia:</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">• Venous return↓</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Hypoxia acidosis hyperkalemia Arrhythmia</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"> 3. Hemic system</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgoTduh0DOK4zF3LLLN1PFpUxg1Iint_YE-SMSLg3bx25Fl5-CEvUTh9T1tpiZQ5Gml__NSKDa58EKlZ4umSX6L7aD6hB2HfrZhiQmHHxoVqQbkbplqcvAtMfv5xvXM9Z4x-Ovh1tRzdf19/s1600/Hemic+System.bmp" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="178" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgoTduh0DOK4zF3LLLN1PFpUxg1Iint_YE-SMSLg3bx25Fl5-CEvUTh9T1tpiZQ5Gml__NSKDa58EKlZ4umSX6L7aD6hB2HfrZhiQmHHxoVqQbkbplqcvAtMfv5xvXM9Z4x-Ovh1tRzdf19/s400/Hemic+System.bmp" width="400" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">Hypoxia can stimulate the function of red bone marrow to produce more red blood cells. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"> <span style="font-size: large;">4.Central nervous system</span></span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhS-xNGeKWZyC2QXiSnqB8XzxIUYwS9faiuDpKLJ4FLYzZ48SbtryLhveHcyoIgmgG-clqa35TQH0D8BRxVqRgnVhJzGtkXsS3Gcqnk5e_hSjyLvaR5uC4_8-MBDEv1euXVAan9-W36MaUu/s1600/CNS.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="239" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhS-xNGeKWZyC2QXiSnqB8XzxIUYwS9faiuDpKLJ4FLYzZ48SbtryLhveHcyoIgmgG-clqa35TQH0D8BRxVqRgnVhJzGtkXsS3Gcqnk5e_hSjyLvaR5uC4_8-MBDEv1euXVAan9-W36MaUu/s320/CNS.jpg" width="320" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;"><br /></span></span>
<span style="font-family: Arial, Helvetica, sans-serif;">• Acute hypoxia : headache、impaired attention </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">• Chronic hypoxia : sleepiness, depression</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">• Severe hypoxia : confusion, coma, convulsion</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Mechanism:</u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">1. energy deficiency </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">2. acidosis </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"> 5. Cellular alterations</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Adaptation</u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">• Ability to use O2↑:</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> number of mitochondia increase</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">• Anaerobic glycolysis↑:</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> phosphofructokinase activity increase</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">• Low metabolic state:</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> caused by acidosis</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">• Myoglobin↑</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">Cellular damage (seen in severe hypoxia)</span> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">(1)Cell membrane </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">(2)Mitochondria</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">(3) Lysosome</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgMomXH05Jj7QyKpTZjTKMMR2lakqdQrLrzsJzCedSSv03ZZrLD0TL33tYxtFA1DF69NsBsEKg4VCT9mlteFmrVqt36HzZOoJ3P0k4fv5b7xSWWq_Mn6B0D4MqJSxCFVqwRtSpNSTpKsBz1/s1600/cellular+damage.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="340" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgMomXH05Jj7QyKpTZjTKMMR2lakqdQrLrzsJzCedSSv03ZZrLD0TL33tYxtFA1DF69NsBsEKg4VCT9mlteFmrVqt36HzZOoJ3P0k4fv5b7xSWWq_Mn6B0D4MqJSxCFVqwRtSpNSTpKsBz1/s400/cellular+damage.jpg" width="400" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Consequences at the cellular level</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Lack of ATP may let the sodium pump have no activity, the result is cellular swelling. Hypoxia can increase the cell-membrane permeability, intracellular enzymes enter the ECF.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Myocardial cells contain the enzymes GOT (glutamic-oxaloacetic transaminase), LDH (lactic dehydrogenase), and CPK (creatine phosphokinase), following myocardial infarction the serum levels of these enzymes rise.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">GOT and LDH are also abundant in the lungs, liver, pancreas, and kidneys.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Only the heart, brain, and skeletal muscles contain CPK.</span><br />
<div>
<br /></div>
Anonymoushttp://www.blogger.com/profile/16555664245806923731noreply@blogger.com0tag:blogger.com,1999:blog-3618930566267736040.post-86068520162320527922013-03-26T00:52:00.002-07:002013-03-26T00:52:53.409-07:00Virology<br />
<span style="font-size: large;">General Properties of Viruses</span><br />
<br />
<span style="font-size: large;">What is virus?</span><br />
The smallest infectious and acellular microbe.<br />
Consisting only one kind of nucleic acid (DNA or RNA), and which obligately replicate inside host cells.<br />
<br />
<span style="font-size: large;">Virions</span> <br />
The complete mature viral particles.<br />
(The intact infectious virus particles.)<br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjOcoY3DyTP5cKKbfKZFeLmLikBpc5FP5zsl6bemsQWw_I_dyAAmlNfW5cf10HydQ95waBUDFPH21thbzFKT_PGtjCOm8C8npHSTlL073ak67AUuSaH_3yOxvqYY8gbSq2o8JEOXKxiTGLj/s1600/virus-servingnature.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="174" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjOcoY3DyTP5cKKbfKZFeLmLikBpc5FP5zsl6bemsQWw_I_dyAAmlNfW5cf10HydQ95waBUDFPH21thbzFKT_PGtjCOm8C8npHSTlL073ak67AUuSaH_3yOxvqYY8gbSq2o8JEOXKxiTGLj/s200/virus-servingnature.jpg" width="200" /></a><br />
<span style="font-size: large;">Distinctive features</span><br />
<br />
<ul>
<li>The simplest: acellular microbes contain either DNA or RNA</li>
<li>The smallest: Pas through 0.2μm filters </li>
<li>Obligatory intracellular parasites.</li>
<li>Self-replication</li>
</ul>
<br /><br />
<span style="font-size: large;"> I. Size, shape and structure</span><br />
<span style="font-size: large;"> A. Size </span><br />
The unit of measurement <span style="font-size: large;"><u>nm</u></span><br />
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<br />
<span style="font-size: large;">Comparative sizes of virions and bacteria</span><br />
<br />
1. Staphylococcus aureus<br />
2. Rickettsia<br />
3. Chlamydia<br />
4. Poxviruses<br />
5. Bacteriophage of E. coli<br />
6. Influenza virus<br />
7. Adenovirus<br />
8. Encephalitis B virus<br />
9. Poliovirus<br />
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<br />
<span style="font-size: large;">B. Shape</span><br />
<u><span style="font-size: large;">T</span>obacco mosaic virus: rod-shaped</u><br />
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<u><br /></u>
<u><span style="font-size: large;">P</span>oxvirus: brick-shaped </u><br />
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<u><br /></u>
<u><span style="font-size: large;">HIV</span>:Spherical</u><br />
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<u><br /></u>
<u><span style="font-size: large;">VSV</span> (Vesicular stomatitis virus): bullet-shaped</u><br />
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<u><br /></u>
<u><span style="font-size: large;">Bacteriophage</span> T4: tadpole-shaped</u><br />
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<u><br /></u>
<u><span style="font-size: large;"><br /></span></u>
<u><span style="font-size: large;"><br /></span></u>
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<u><span style="font-size: large;"><br /></span></u>
<u><span style="font-size: large;"><br /></span></u>
<u><span style="font-size: large;"><br /></span></u>
<u><span style="font-size: large;"><br /></span></u>
<u><span style="font-size: large;"><br /></span></u>
<u><span style="font-size: large;"><br /></span></u>
<u><span style="font-size: large;"><br /></span></u>
<br />
<br />
<u><span style="font-size: large;">Ebola Virus</span>: filamentous shape</u><br />
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<br />
<span style="font-size: large;">C.Structure</span><br />
<span style="font-size: large;">B</span>asic structure:<br />
<span style="font-size: large;">C</span>ore: Viral nucleic acid (DNA or RNA)<br />
<span style="font-size: large;">C</span>apsid: Protein shell<br />
capsomers (morphological subunit)<br />
polypeptide molecules (chemical subunit)<br />
<br />
Core + Capsid → nucleocapsid<br />
<br />
<span style="font-size: large;">Size, shape and structure</span><br />
<u><span style="font-size: large;">N</span>aked virus:</u><br />
Virion: nucleocapsid.<br />
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<u><span style="font-size: large;"><br /></span></u>
<u><span style="font-size: large;">E</span>nveloped virus:</u><br />
Virion: nucleocapsid+Envelope<br />
spikes (peplomers);<br />
<span style="font-size: large;">Others</span>: enzymes, etc.<br />
e.g. Retrovirus has reverse transcriptase<br />
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<br />
<span style="font-size: large;">Symmetry of viral nucleocapsids: </span>Is decided by arrangement of capsomeres<br />
<u>Helical symmetry</u><br />
(e.g., tobacco mosaic virus)<br />
<u>Icosahedral symmetry</u><br />
(e.g., adenovirus)<br />
<u>Complex symmetry</u><br />
(e.g., poxviruses )<br />
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<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Chemical composition</span><br />
Viral nucleic acid: ssDNA, dsDNA, ssRNA, dsRNA<br />
Viral proteins:<br />
protection, mediate the attachment of virue to specific receptors on host cell surface<br />
determine species and organ specificity<br />
important antigens, superantigen<br />
<br />
<span style="font-size: large;">Unconventional viruses</span><br />
<u><span style="font-size: large;">V</span>iroid</u><br />
plant disease<br />
Human Hepatitis D<br />
<u>NOTE:</u> a single circular RNA molecule without a protein coat which mainly cause plant diseases.<br />
<br />
<u><span style="font-size: large;">P</span>rion</u><br />
Proteinaceous infectious particle<br />
Human diseases:<br />
e.g., Kuru<br />
Animal diseases:<br />
e.g.,Scrapie<br />
Bovine spongiform encephalopathy (BSE)<br />
<u>NOTE</u>: infectious agents composed of a single glycoprotein with MW 27-30 kDa.<br />
<br />
<span style="font-size: large;">II. Replication</span><br />
In host cell, virus replicates its nucleic acid and synthesizes<br />
its proteins, then assembles them to form progeny viral<br />
particles that are released by budding or cell lysis.<br />
<br />
<span style="font-size: large;">R</span>eplication---<span style="font-size: large;">Normal Replication</span><br />
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<br />
<ul>
<li>Adsorption /Attachment</li>
<li>Penetration </li>
<li>Uncoating </li>
<li>Biosynthesis</li>
<li>Assembly </li>
<li>Release </li>
</ul>
<br />
<span style="font-size: large;">i. Adsorption / Attachment</span><br />
Specific binding of a viral attachment protein (VAP) with a receptor on the surface of host cell;<br />
VAP (on virion ) --- viral surface protein<br />
Spike – enveloped virus<br />
Capsid protein – naked virus<br />
Viral receptor (on host cell)<br />
Glycoprotein, carbohydrate or glycolipid<br />
e.g., CD4 (HIV), CD46 (measles virus), Sialic acid (influenza virus)<br />
Tropism<br />
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Adsorption/Attachment</div>
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<br />
<span style="font-size: large;">ii. Penetration</span><br />
<u>Mechanisms:</u><br />
<span style="font-size: large;">A</span>. Endocytosis<br />
Some enveloped viruses<br />
Most naked virus<br />
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<br />
<span style="font-size: large;">B.</span> Direct fusion of cell membrane with viral envelope:<br />
Only enveloped viruses<br />
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<br />
<span style="font-size: large;">C.</span> Nucleic acid translocation:<br />
Some bacteriophages and naked virus<br />
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<br />
<span style="font-size: large;">iii. Uncoating</span><br />
The process of removing capsid and releasing viral nucleic acid into the cytoplasm;<br />
Acidification of the content of the endosome<br />
Proteases are needed;<br />
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<br />
<span style="font-size: large;">iv. Biosynthesis</span><br />
Eclipse phase<br />
Biosynthesis includes:<br />
<br />
<ul>
<li> Viral genome replication</li>
<li> Viral protein synthesis</li>
</ul>
The replication strategy depends on the nature of viral genome. <br />
dsDNA; ssDNA; dsRNA; +ssRNA; -ssRNA; retrovirus<br />
+ssRNA with DNA intermediate in life cycle (HIV);<br />
dsDNA with RNA intermediate (HBV);<br />
<br />
<u>Biosynthesis</u><br />
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<br />
<span style="font-size: large;">+ssRNA virus (Poliovirus, HAV)</span><br />
Viral genomic RNA serve as mRNA;<br />
Enzymes for replication are made after infection, not carried in virion;<br />
(Extracted) Viral genomic RNA is infectious<br />
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<br />
<span style="font-size: large;">-ssRNA virus e.g., influenza virus</span><br />
Virion carries RDRP;<br />
First step: Transcription of viral genome;<br />
Extracted -ssRNA not infectious;<br />
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<br />
<span style="font-size: large;">v. Assembly</span><br />
<span style="font-size: large;">N</span>aked virus: capsid + viral genome → nucleocapsid (virion, complete structure)<br />
Enveloped virus: capsid + viral genome → nucleocapsid (incomplete structure)<br />
<span style="font-size: large;">S</span>ite:<br />
a. DNA viruses (except poxvirus): cell nucleus; <br />
b. RNA viruses and poxvirus: cell cytoplasm;<br />
<span style="font-size: large;">M</span>anner:<br />
a. assemble as empty shell (procapsid), then viral genome fill in. <br />
b. Viral capsomeres array around the viral genome to form helical<br />
symmetry.<br />
<br />
<span style="font-size: large;">vi. Release</span><br />
The process of progeny viruses getting out of host cell.<br />
<br />
Naked viruses:released by cell lysis.<br />
Enveloped viruses:usually released by budding.<br />
During budding enveloped viruses acquire their envelope.<br />
Defective measles virus: release from cell to cell via cell bridges.<br />
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<br />
enveloped virus replication (1) <br />
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<br />
enveloped virus replication (2a)<br />
<br />
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<br />
enveloped virus replication (2b)<br />
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<br />
enveloped virus replication (3)<br />
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<br />
enveloped virus replication (4)<br />
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<br />
<span style="font-size: large;">Abnormal replication</span><br />
<u>Two aspect factors:</u><br />
Viruses<br />
Defective viruses<br />
Host cells<br />
non-permissive cells → Abortive infection<br />
<br />
<span style="font-size: large;">Defective viruses</span><br />
are genetically deficient and incapable of producing infectious progeny virions.<br />
Helper virus<br />
can supplement the genetic deficiency and make defective viruses replicate progeny virions when they simultaneously infect host cell with defective viruses. <br />
e.g., HDV & HBV<br />
<br />
<ul>
<li>Defective viruses lack gene(s) necessary for a complete infectious cycle;</li>
<li>helper viruses provide missing functions;</li>
</ul>
<ul><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhT1-3gz9iQdYtUsQbHtHablKCzicyls65mIMOebRICvwBAWcIM-aUYY3klXc6v6IW-YNjp7D9ydQ-A45Suy38K7amUXnvEBbdd1CO5YsclTL8V-cNlmpjn5j4Y5blNxDjTE5KWSAAbzHSe/s1600/defective+virus.bmp" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="133" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhT1-3gz9iQdYtUsQbHtHablKCzicyls65mIMOebRICvwBAWcIM-aUYY3klXc6v6IW-YNjp7D9ydQ-A45Suy38K7amUXnvEBbdd1CO5YsclTL8V-cNlmpjn5j4Y5blNxDjTE5KWSAAbzHSe/s400/defective+virus.bmp" width="400" /></a></ul>
<br /><br /><br /><br /><br /><br /><br /><br /><ul>
<li>100:1 (defective to infectious particles)</li>
<li>DIP (defective interfering particle) : When the defective viruses can not replicate, but can interfere other congeneric mature virion entering the cells, we call them defective interfering particles (DIP).</li>
</ul>
<br />
<span style="font-size: large;">Abortive infection:</span><br />
Virus infection which does not produce infectious progeny because the host cell cannot provide the enzyme, energy or materials required for the viral replication.<br />
<u>non-permissive cells</u><br />
The host cells that cannot provide the conditions for viral replication.<br />
<u>permissive cells</u><br />
The host cells that can provide the conditions for viral replication.<br />
<br />
<span style="font-size: large;"> III. Viral interference:</span><br />
<br />
When two viruses infect simultaneously one host cell, One type of virus<br />
may inhibit replication of another type of virus.<br />
<br />
<span style="font-size: large;">Range of interference occurrence</span><br />
<br />
<ul>
<li> between the different species of viruses;</li>
<li> between the same species of viruses;</li>
<li> between the inactivated viruses and live viruses.</li>
</ul>
<br />
<span style="font-size: large;">Main mechanisms of viral interference:</span><br />
a. One type of virus inhibit or prevent subsequent adsorption and penetration<br />
of another virus by blocking or destroying receptors on host cell.<br />
b. The competition of two viruses for replication materials, e.g., receptor<br />
polymerase, translation initiation factors, etc.<br />
c. One type of virus may induce the infected cell to produce interferon that<br />
can prevent viral replication.<br />
<br />
<span style="font-size: large;">The mechanism of IFN function </span><br />
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<br />
<span style="font-size: large;">Significance of viral interference:</span><br />
<span style="font-size: large;">Advantage</span><br />
a. Stop viral replication and lead to patient recovery.<br />
b. Inactivated virus or live attenuated virus can be used as vaccine to<br />
interfere with the infection of the virulent virus.<br />
<span style="font-size: large;">Disadvantage</span><br />
May decrease the function of vaccine when bivalent/trivalent vaccine is used.<br />
<br />
<span style="font-size: large;">Just for your practice see the answers at the end.</span><br />
<span style="font-size: large;">Fill in the blank</span><br />
1-The surrounding protein coat of a virus is called the _______ and it is composed of protein subunits called _________. <br />
2-Viruses that are only covered with a protein coat outside viral genome are called ______ viruses, while those that have an additional lipid-containing membrane covering are called ________ viruses.<br />
3. The general steps of the viral replication cycle include ( in the order of their occurrence) ___________________, ___________, ____________, __________, _________________.<br />
<div>
<br /></div>
<div>
<br /></div>
<div>
ANSWERS</div>
<div>
1-Capsid. Capsomeres.</div>
<div>
2-Naked, Enveloped.</div>
<div>
3-Attachment, Penetration, Uncoating, Biosynthesis, Assembly and release.</div>
Anonymoushttp://www.blogger.com/profile/16555664245806923731noreply@blogger.com1tag:blogger.com,1999:blog-3618930566267736040.post-44218471910043489832013-03-22T04:18:00.002-07:002013-03-22T04:19:37.994-07:00ANS Receptors<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjLLehI23keRo_adGdpB08o2ePSnFsw6e8Aqh7eGqz9hgEwE7Ca4a4gLZvk9pBIB9jwn9YAxcsRnoUjb4LKvuL6acX6wRND-bw-gOaXy5iTTlGAyax5zgPBSAHRZCbizhidcFTl0-aqDF5l/s1600/Ach+synthesis.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="397" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjLLehI23keRo_adGdpB08o2ePSnFsw6e8Aqh7eGqz9hgEwE7Ca4a4gLZvk9pBIB9jwn9YAxcsRnoUjb4LKvuL6acX6wRND-bw-gOaXy5iTTlGAyax5zgPBSAHRZCbizhidcFTl0-aqDF5l/s400/Ach+synthesis.png" width="400" /></a></div>
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Receptor occupancy model</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">The first model put forward by Clark to explain the activity of drugs at receptors quantified the relationship between drug concentration and observed effect. </span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg7FjboKNqXobjUd7-HqklEMD5WXGVZlcwjPFuCk2dCxZ83Q4jC_D5jfu9z9AL2xPz0fIcOwNa54rIj27hjKugrbB19XPtzvZxcYhQdENXoOiVrI1w3si-VVonm_GFTW5103TxLSmdWSSZ6/s1600/Clark-servingnature.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="318" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg7FjboKNqXobjUd7-HqklEMD5WXGVZlcwjPFuCk2dCxZ83Q4jC_D5jfu9z9AL2xPz0fIcOwNa54rIj27hjKugrbB19XPtzvZxcYhQdENXoOiVrI1w3si-VVonm_GFTW5103TxLSmdWSSZ6/s320/Clark-servingnature.jpg" width="320" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif;">1. Drug + receptor = effect </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">2. The response is directly depend on the proportional to the amount of drug bound receptor</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> <u>how much effect = how many receptor occupied</u> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">3. The maximum response would be elicited once all receptors were occupied at equilibrium. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>Drug + 100%receptor = efficacy</u> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">Another basal theory of agonist and antagonist </span> </span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiuc1wOJONBP-FEFO5Nz1t0sZy2H8qW9j90rvdWA7XA7fm_3RkGQhvH4AdY3Mg8HjNdvibjglgEzfh-KSMsEOdVx-8v7vRL5rsUV9kEPIByqZfN9NDuldKhyNtKbJS9sjeJkNTU51so2GWU/s1600/agonist&antagonist.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="270" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiuc1wOJONBP-FEFO5Nz1t0sZy2H8qW9j90rvdWA7XA7fm_3RkGQhvH4AdY3Mg8HjNdvibjglgEzfh-KSMsEOdVx-8v7vRL5rsUV9kEPIByqZfN9NDuldKhyNtKbJS9sjeJkNTU51so2GWU/s400/agonist&antagonist.png" width="400" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">S</span><span style="font-family: Arial, Helvetica, sans-serif;">pare receptor: </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Not occupied receptors. Maximal effect can be elicited by an agonist at a concentration that not result in occupancy of the full complement of available receptor.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Available receptor and spare receptor are not hidden or unavailable and when they are occupied they can be coupled to response.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">The type of receptors </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Autonomic receptor </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Historically , structure-activity analyses , with careful cpomparisons of the potency of series of autonomic agonist and antagonist analogs , led to the definition of different autonomic receptor subtypes , including Muscarinic and nicotinic cholinoceptors and a, ß and dopamine adrenoceptors .</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">The model of ACh –receptor</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">1. Muscarinic –R ; there are subtypes M1,M2,M3 and so on , All of the parasympathetic postganglionic fibers ------ in the target organ the acetylcholine interacts with muscarinic receptor </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">2. Nicotinic -R: There are at least two types of nicotinic receptors ,they are found at the motor end plate , in all autonomic ganglia , and in the CNS--receptor . </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">NM-R(nicotinic muscle);N2</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">NN-R(nicotinic neuronal):</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Ganglia and CNS-R: N1</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Cholinergic Receptor Mechanisms</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Cholinergic receptors</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Nicotinic receptors (N-receptor)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">L</span>ocations: skeletal muscle-- motor ending-plate (N2 N2), ganglia-postsynaptic membrane(N1),</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">E</span>ffect: N2:exciting skeletal muscle ,</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">N1 exciting the postsynaptic neuron in ganglia</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">A</span>ntagonist:</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">N1:hexamethonium</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">N2:decamethonium</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Muscrinic receptors (M-receptor)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">L</span>ocations:</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">smooth muscle, gland and cardiac muscle </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">M--- smooth muscle,gland</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">M1-- ganglia,gland</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">M2--- heart</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Muscarinic Agonists</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Properties of direct-acting Cholinomimetics</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">ACh: Short half life-no clinical use</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Bethanechol: Rx-ileus(postOP/neurogenic),urinary retention</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Methacholine: Dx-bronchial Hyperreactivity</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Pilocarpine: Rx-glaucoma (Topical),xerostomia</span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Acetylcholinesterase Inhibitors</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Properties of indirect-acting cholinomimetics</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Edrophonium: Short acting, Dx-myasthania</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Physostigmine: Tertiary amine(enters CNS),Antidote in atropine overdose</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Neostigmine: No CNS entry. Rx-ileus,urinary retention,</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Donepezil: Lipid soluble(CNS entry).Rx-Alzheimer disease</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Organophosphates: Lipid soluble,irreversible inhibitors.Rx-glaucoma(Ecothiophate), can be used as <u>Insecticides</u> (malathion,parathion)</span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Side effects of Acetylchoninesterase Inhibitors</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Remember the word "<u>DUMBBELSS</u>"</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">D: Diarrhea</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">U: Urinaion</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">M: Miosis</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B: Bradycardia</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">B: Bronchoconstriction</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E: Excitation(Muscle & CNS)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">L: Lacrimation</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">S: Salivation</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">S: Sweating</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Antagonist</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Atropine</span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Adrenergic Receptors</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">There are two types of the adrenergic receptors binded with norepinephrine and epinephrine. They are divided into a and ß receptors .Each of these receptors is further subdivided into a1 a2, and ß 1 ß 2 and ß 3 ,respectively </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Mechanisms used by Adrenergic Receptors</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Distribution of Adrenoceptor sub-types</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">α1 Agonists</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Phenylephrine (Nasal decongestant&opthalmologic use)</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Methoxamine (Paroxysmal atrial tachycardia through vagal reflex)</span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">α2 Agonists</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Clonidine</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Methyldopa</span></li>
</ul>
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhM6g_PWQ-XsnWvQLpXpzAiY8OjRtSWXHsqeFUogLK-Iiy3JtReHRmgHZXg8cSbhxp8JJlsHyO-naLumgHpeMBO7em3_6d7LAbG3WmeH4xU0MOn_UP_6K5CtiSOTu4nm9WcoekKM0ceRvYA/s1600/alpha2+adrenergic-servingnature.bmp" imageanchor="1" style="margin-left: 1em; margin-right: 1em; text-align: center;"><img border="0" height="287" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhM6g_PWQ-XsnWvQLpXpzAiY8OjRtSWXHsqeFUogLK-Iiy3JtReHRmgHZXg8cSbhxp8JJlsHyO-naLumgHpeMBO7em3_6d7LAbG3WmeH4xU0MOn_UP_6K5CtiSOTu4nm9WcoekKM0ceRvYA/s400/alpha2+adrenergic-servingnature.bmp" width="400" /></a><span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">α Blockers</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;"><u>α1 non-selective blockers</u></span></span><br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Phentolamine</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Phenoxybenzamine</span></li>
</ul>
<br />
<u><span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">α</span><span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">1 selective blockers</span></span></u><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Prazosin</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Doxazosin</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Terazosin</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Tamsulosin</span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">α2 blockers</span>:</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Yohimbine:used in postural hypotension and impotence</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Mirtazapine:used as antidepressant</span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">β Agonists</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Isoproterenol</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Dobutamine</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Salmeterol</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Albuterol</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Terbutaline</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Ritodrine</span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">β Antagonists</span>:</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">propranonol(β)</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">atenolol(β1)</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">butoxamine(β2)</span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u><span style="font-size: large;">N</span>OTE:</u></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">The heart is main site for ß1-receptor</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Activation of ß2-receptor relaxes smooth muscle</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Activation of a receptors causes contraction or constriction , mostly vasoconstriction </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">α</span><span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">2 adrenergic receptors is listed--negative feedback loop</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Regulate release of neurotransmitters</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Control epinephrine, nor-epinephrine</span><span style="font-family: Arial, Helvetica, sans-serif;"> release</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Modulate sympathetic response “negative feedback loop”</span></li>
</ul>
<br />
<br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Classification of agonist</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Full agonist</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Strong affinity</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Strong intrinsic activity</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">(a=1)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Partial agonist</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Strong affinity</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Weak intrinsic activity</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">( 0 <a< 1 )</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">Competitive (reversible ) antagonist</span>:</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">Because antagonism is competitive, the presence of antagonist increases , the agonist concentration required for a given degree of response, and so the agonist concentration-effect curve shifts to the right.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Emax is not changed.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Noncompetitive (Irreversible) antagonist</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Affinity & intrisic activity</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Emax decrease</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">concentration-effect curve shifts to the right.( not parallel)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>For example</u> :</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Atropine has a greater affinity for the muscarinic –R than does acetylcholine but lacks efficacy in initiating activity.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Thus the resultant effects depends upon their relative concentrations and atropine blockade can be overcome by increasing the concentration of acetylcholine ( for example by a cholinesterase inhibitor) . </span><br />
<div>
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Anonymoushttp://www.blogger.com/profile/16555664245806923731noreply@blogger.com3tag:blogger.com,1999:blog-3618930566267736040.post-79824310730605267202013-03-19T12:57:00.001-07:002013-03-19T12:57:05.348-07:00Difference Between Crohn's disease and Ulcerative Colitis<br />
<span style="font-family: Arial, Helvetica, sans-serif;">Crohn's Disease and Ulcerative Colitis are both forms of Inflammatory Bowel Disease (IBD).</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg_L0ICwQK1ZoELw_-VzhhLCwVp5mMkk6LtxsuDoM8O-n-QH7nfus1UTID805Aw1VRViJbDrlxotxMH4QKEfwL0tRjyfZIeIqglWfLzyCPpWRyMrUN4G-N2EW8tBkDXaPnX-v72BaCAQk7c/s1600/Crohn+diseas&Ulcerative+colitis-servingnature.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="350" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg_L0ICwQK1ZoELw_-VzhhLCwVp5mMkk6LtxsuDoM8O-n-QH7nfus1UTID805Aw1VRViJbDrlxotxMH4QKEfwL0tRjyfZIeIqglWfLzyCPpWRyMrUN4G-N2EW8tBkDXaPnX-v72BaCAQk7c/s400/Crohn+diseas&Ulcerative+colitis-servingnature.png" width="400" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Important points regarding Crohn disease</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">p-ANCA is positive in 11% of cases;anti-Saccharomyces cere-</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">visiae antibody is common (rare in ulcerative colitis).</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Approximately 30–50% concordance among monozygotic</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">twins.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Clinical presentation of Crohn disease</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">■ <span style="font-size: large;">S</span>ymptoms: Diarrhea,abdominal pain,weight loss,and fever;</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">bloody diarrhea; also associated with psychiatric symptoms.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">■ <span style="font-size: large;">D</span>iagnosis: Colonoscopy reveals longitudinal ulcerations and</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">cobblestoning; granulomas may be present on biopsy (50%).</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><u>“String sign”</u> on barium contrast studies. <u>“Creeping fat”</u> on</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">CT scan</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"></span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Crohn disease. A, Note the transmural nature of the</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">inflammatory infiltrate. Within the muscularis propria and submu-</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">cosa is a large cluster of lymphocytes associated with multiple</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">granulomas. B, A high-power view of one of the granulomas.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Hematoxylin and eosin,</span><br />
<br />
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Clinical presentation of Ulcerative Colitis</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">■ <span style="font-size: large;">S</span>ymptoms: Profuse watery diarrhea with blood, mucus, and</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">pus; abdominal pain; and <u>hematochezia</u> (bright red blood</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">per rectum). <u>Pyoderma gangrenosum</u> initially presents simi-</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">lar to cellulitis but fails to respond to antibiotics; typically</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">causes deep ulceration with a violaceous border.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">■ <span style="font-size: large;">D</span>iagnosis: Barium enema shows loss of <u>haustra</u>;colonoscopy</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">with biopsy.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"></span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEit96zcb5r3zAALGWYUT3cBU4JkhKd740D_LdBCuGXMsu3_DOBx_uNuX2paDBeM8GEbL5jA55wHVTSy4_UJfVjeRgGFpou29sBGdEU7QUw-BAySeaHpyQlaSBTisIecQpN_XfSthuXbrcaI/s1600/Ulcerative+colitis.bmp" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEit96zcb5r3zAALGWYUT3cBU4JkhKd740D_LdBCuGXMsu3_DOBx_uNuX2paDBeM8GEbL5jA55wHVTSy4_UJfVjeRgGFpou29sBGdEU7QUw-BAySeaHpyQlaSBTisIecQpN_XfSthuXbrcaI/s400/Ulcerative+colitis.bmp" width="400" /></a></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiKzasrVX_aVWuIAtKeNHZwmXPjyurmSTy4bXy22XZe7IKK-CQZkFeZAEhNMjIbXn-i9-repfaW5cuCvYWUcWcdobtGYFpjdYhatLcARVtdjIxhpn-tdotEI76hMnNVOhfFSxOWpz-0GSEF/s1600/Ulcerative+colitis2.bmp" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="307" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiKzasrVX_aVWuIAtKeNHZwmXPjyurmSTy4bXy22XZe7IKK-CQZkFeZAEhNMjIbXn-i9-repfaW5cuCvYWUcWcdobtGYFpjdYhatLcARVtdjIxhpn-tdotEI76hMnNVOhfFSxOWpz-0GSEF/s400/Ulcerative+colitis2.bmp" width="400" /></a></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;">Ulcerative colitis. A and B, The mucosal nature of the</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">inflammatory infiltrate and the near complete loss of mucosa. The</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">residual mucosa is polypoid in appearance, but only because of</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">the loss of the surrounding mucosa; hence, the designation of</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">“pseudopolyp.” B, The arrowhead indicates the loss of mucosa,</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">and the arrow indicates a pseudopolyp. Hematoxylin and eosin.</span><br />
<br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
Anonymoushttp://www.blogger.com/profile/16555664245806923731noreply@blogger.com0tag:blogger.com,1999:blog-3618930566267736040.post-15783134970043166142013-03-13T23:45:00.001-07:002013-03-13T23:56:36.201-07:00Antifungal Drugs<br />
<br />
Both ergosterol and cholesterol synthesis go from squalene to lanosterol to zymosterol, which is their final common precursor.<br />
<br />
<span style="font-size: large;">Amphotericin B</span><br />
<br />
<ul>
<li>This has a special hydrophobic polyene unit that binds ergosterol in the membrane. Forms pores. Selectivity is poor – Amphotericin B also binds cholesterol. </li>
<li>Toxicity is Shake ‘n’ Bake.</li>
<li>Used against deep fungal infections like invasive Aspergillosis or disseminated Candidiasis.</li>
</ul>
<br />
<span style="font-size: large;">Nystatin </span>is a topical preparation of Amphotericin B that treats cutaneous/mucosal Candidiasis.<br />
<span class="Apple-tab-span" style="white-space: pre;"> </span>It is often referred to as “swish and swallow.”<br />
<br />
<span style="font-size: large;">DRUGS THAT INTERFERE WITH ERGOSTEROL SYNTHESIS</span><br />
<span style="font-size: large;">Azoles</span><br />
<br />
<ul>
<li>Block lanosterol ergosterol by inhibiting 14-α-demethylase. Cell membranes <span class="Apple-tab-span" style="white-space: pre;"> </span>increase in permeability.</li>
<li>Side effects: include severe hepatotoxicity.</li>
</ul>
<br />
<span style="font-size: large;">Ketoconazole</span><br />
Orally available, degraded in the liver. Good alternative to Amphotericin B.<br />
<br />
<span style="font-size: large;">Fluconazole</span><br />
<br />
<ul>
<li>Good penetration into CSF and the eye. Half-life of two days. </li>
<li>This fungicide will kill Cryptococcus and prevent Candida infections. </li>
<li>Often used in HIV-positive patients</li>
</ul>
<br />
<span style="font-size: large;">Allylamines:</span><br />
These block an earlier step in ergosterol synthesis (squalene lanosterol), but <span class="Apple-tab-span" style="white-space: pre;"> </span>doesn’t seem to have any effect on cholesterol synthesis.<br />
<br />
<span style="font-size: large;">Flucytosine (5FC):</span><br />
<br />
<ul>
<li>5FC is converted to 5-FU, so it is a uracil analog. It is converted either to 5-FUMP which is incorporated into fungal mRNA, or to 5-F-dUMP which inhibits thymidylate synthase.</li>
<li>*This is an excellent example of selective toxicity, because our cytosine deaminase can’t convert <span class="Apple-tab-span" style="white-space: pre;"> </span>it to 5-FU but fungi can! Toxicity may arise by metabolism of 5FC to 5-FU by normal <span class="Apple-tab-span" style="white-space: pre;"> </span>GI flora.</li>
<li>Resistance is common, so it is used with Amphotericin B. </li>
<li>Treats Candida and Cryptococcus.</li>
</ul>
<br />
<span style="font-size: large;">Griseofulvin: </span><br />
<br />
<ul>
<li>Disrupts all microtubules, but it’s only actively transported into fungal cells, so that’s the selective toxicity. </li>
<li>Unique distribution to keratin, so it is used to treat hair/nail/skin infections.</li>
</ul>
<br />
<span style="font-size: large;">Caspofungin</span><br />
<br />
<ul>
<li>Blocks formation of glucan polymers, so cell walls cannot form.</li>
<li>Broad spectrum, very high specificity.</li>
<li>Fights invasive Aspergillus and Candidiasis infections.</li>
</ul>
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<br />Anonymoushttp://www.blogger.com/profile/16555664245806923731noreply@blogger.com0tag:blogger.com,1999:blog-3618930566267736040.post-7478013396202906522013-03-13T23:35:00.002-07:002013-03-13T23:35:37.537-07:00What are Fungi? What disease they cause?<div class="separator" style="clear: both; text-align: left;">
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Fungi and Human Mycoses</span></div>
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Fungi are eukaryotic cells, with membrane bound organelles, a nucleus, and 18s RNA sequences.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Their cell membrane contains ergosterol where ours has cholesterol.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Their cell wall contains complex polysaccharides that stain with PAS (red) and GMS (black).</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">It also contains chitin, which helps penetrate host tissues.</span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Fungus Morphology</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">T</span>wo major morphologic forms: yeast and hyphae (filamentous).</span><span style="font-family: Arial, Helvetica, sans-serif; white-space: pre;"> </span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Dichotomous hyphae have acute angled forks and septae. They are stiff and narrow like a </span><span class="Apple-tab-span" style="font-family: Arial, Helvetica, sans-serif; white-space: pre;"> </span><span style="font-family: Arial, Helvetica, sans-serif;">tree. </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Dichotomous hyphae often signal Aspergillus.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Right angled hyphae have square angles and no septae. They are broad and ribbony. Right </span><span class="Apple-tab-span" style="font-family: Arial, Helvetica, sans-serif; white-space: pre;"> </span><span style="font-family: Arial, Helvetica, sans-serif;">angled hyphae often signal Zygomycetes.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">C</span><span style="font-family: Arial, Helvetica, sans-serif;">lassic </span><span style="font-family: Arial, Helvetica, sans-serif;">D</span><span style="font-family: Arial, Helvetica, sans-serif;">imorphism is when a fungus is filamentous in the environment, but switches to a </span><span class="Apple-tab-span" style="font-family: Arial, Helvetica, sans-serif; white-space: pre;"> </span><span style="font-family: Arial, Helvetica, sans-serif;">yeast form in the body.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Reverse Dimorphism is the opposite. The fungus is a yeast in the environment, but becomes </span><span style="font-family: Arial, Helvetica, sans-serif;">mixed yeast/filamentous in the body. If you see mixed yeasts and hyphae, it is Candida.</span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">N</span>ote: Yeast with germ tubes are pathognomonic for Candida albicans.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Fungus Structure</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">1. Capsule. The only fungus with a capsule is Cryptococcus. Capsule protects against host <span class="Apple-tab-span" style="white-space: pre;"> </span>immune response, especially neutrophils.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">2. Cell wall. Polysaccharides include glucan, mannan, and chitin. Mannans are more in <span class="Apple-tab-span" style="white-space: pre;"> </span>yeast, chitin in filamentous fungi. Circulating glucans and mannas are markers of <span class="Apple-tab-span" style="white-space: pre;"> </span>fungal invasion. The cell wall is not a barrier to the environment!</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">3. Cell membrane. This is the real barrier to the environment. Remember that fungi use <span class="Apple-tab-span" style="white-space: pre;"> </span>ergosterol where we use cholesterol.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Fungal Reproduction</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Most undergo sexual reproduction through sporulation.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">A few reproduce asexually, also through sporulation. Best example are the Zygomycetes.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Spores are not transmitted person to person. Fungi are normal flora or are encountered in the env.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">1. Zygomycetes reproduce sexually. Good example of a Zygomycete is Rhizopus. These <span class="Apple-tab-span" style="white-space: pre;"> </span>fungi often penetrate the nasopharynx of diabetic patients.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">2. Ascomycetes reproduce sexually. Examples of Ascomycetes include Histoplasma and <span class="Apple-tab-span" style="white-space: pre;"> </span>Dermatophytes.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">3. Basidiomycetes reproduce sexually. Good example is Cryptococcus neoformans.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">4. Deuteromycetes reproduce asexually. A good example of Deuteromycetes is Candida.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Factors associated with infection</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Cell surface receptors, hydrolytic enzymes, host mimicry.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">The polysaccharide capsule of Cryptococcus inhibits phagocytosis.</span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Types of Fungal Infections</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">1. Superficial, no inflammation. Tinea versicolor.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">2. Mucocutaneous, inflammation but non-invasive. Dermatophytosis, mucocutaneous Candida.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">3. Subcutaneous. Often following trauma with natural wood or woody plants like roses.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">4. Deep mycoses:</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-tab-span" style="white-space: pre;"> </span>--Opportunistic deep mycoses are PMN-dependent! These include Candida, <span class="Apple-tab-span" style="white-space: pre;"> </span>Aspergilla, Zygomycetes.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-tab-span" style="white-space: pre;"> </span>--Pathogenic deep mycoses are CMI-dependent! This includes Histoplasmosis.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Common Cutaneous and Mucosal Mycoses</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Superficial Mycoses</span><br />
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<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Fungus is confined to the dead skin and doesn’t illicit inflammation. Cosmetic problem only.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Tinea versicolor is a discoloration of the skin caused by the fungus Malassezia furfur. Under the </span><span class="Apple-tab-span" style="font-family: Arial, Helvetica, sans-serif; white-space: pre;"> </span><span style="font-family: Arial, Helvetica, sans-serif;">microscope it appears as “spaghetti and meatballs” with clumps of yeasts and short hyphae.</span></li>
</ul>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Cutaneous Mycoses</span><br />
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<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Sight: Fungus is confined to the mucosa, skin, hair, and nails, causing minor brisk inflammation.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Mucosal/Cutaneous Candidiasis is most commonly caused by Candida albicans. This is an </span><span class="Apple-tab-span" style="font-family: Arial, Helvetica, sans-serif; white-space: pre;"> </span><span style="font-family: Arial, Helvetica, sans-serif;">opportunistic infection with T-cell deficiency, such as with AIDS or heavy steroids.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">On mucosal surfaces it causes white plaques made up of both yeast and hyphae.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">On cutaneous surfaces it causes red, scalded lesions in intertriginous areas.</span></li>
</ul>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Dermatophytosis </span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Is classically called </span><span style="font-family: Arial, Helvetica, sans-serif;">ringworm</span><span style="font-family: Arial, Helvetica, sans-serif;">, and is the only fungi that is transmitted from </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">person to person. The various manifestations are all caused by T. rubrum (“ringworm”).</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">T. rubrum has long, brancing, septate hyphae.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Tinea capitis is a ringworm of the scalp occuring only in children. Often from infected dogs.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Tinea pedis is ringworm of the feet, also called “athlete’s foot.”</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Tinea unguium is a nail infection with extensive extra keratin production.</span></li>
</ul>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Opportunistic Mycoses</span><br />
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<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Different opportunistic mycoses occur depending on the type of opportunity:</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Altered T-cell function (AIDS) ? Mucocutaneous candida, Cryptococcosis, Pneumocystis, Histo</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Altered phagocytic function (neutropenia) ? Candidiasis, Aspergillosis, Zygomycosis</span></li>
</ul>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Candida</span><br />
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<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">These yeasts are part of our normal flora. The most virulent and common species is </span><span class="Apple-tab-span" style="font-family: Arial, Helvetica, sans-serif; white-space: pre;"> </span><span style="font-family: Arial, Helvetica, sans-serif;">Candida albicans. This is distinguished by the presence of germ tubes on the yeasts.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Candida in general always has hyphae, pseudohyphae, and yeasts all at once.</span></li>
</ul>
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">Mucocutaneous </span></span><span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Candidiasis</span><br />
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<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Occurs in immunosuppressed patients, such as those with </span><span class="Apple-tab-span" style="font-family: Arial, Helvetica, sans-serif; white-space: pre;"> </span><span style="font-family: Arial, Helvetica, sans-serif;">HIV, on steroids, or pregnant.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Invasive candidiasis occurs in hospitalized patients, such as those with burns, trauma, </span><span class="Apple-tab-span" style="font-family: Arial, Helvetica, sans-serif; white-space: pre;"> </span><span style="font-family: Arial, Helvetica, sans-serif;">catheters, or transplant patients. This infection with disseminate in the blood and </span><span class="Apple-tab-span" style="font-family: Arial, Helvetica, sans-serif; white-space: pre;"> </span><span style="font-family: Arial, Helvetica, sans-serif;">seed organs.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Candida albicans has hydrolytic activity and host mimicry. Remember that it has reverse </span><span class="Apple-tab-span" style="font-family: Arial, Helvetica, sans-serif; white-space: pre;"> </span><span style="font-family: Arial, Helvetica, sans-serif;">dimorphism, and converts between yeast and pseudohyphae with germ tubes.</span></li>
</ul>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Aspergilla</span><br />
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<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">All Aspergilla infections are opportunistic. Aspergilla have angular dichotomously </span><span class="Apple-tab-span" style="font-family: Arial, Helvetica, sans-serif; white-space: pre;"> </span><span style="font-family: Arial, Helvetica, sans-serif;">branching septate hyphae.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Invasive Aspergillosis occurs in severely immunosuppressed patients, such as those with </span><span class="Apple-tab-span" style="font-family: Arial, Helvetica, sans-serif; white-space: pre;"> </span><span style="font-family: Arial, Helvetica, sans-serif;">neutropenia, bone marrow transplant recipients, on steroids, or in endstage AIDS.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">The spores are inhaled, and invade lung parenchyma with their hyphae. They can </span><span class="Apple-tab-span" style="font-family: Arial, Helvetica, sans-serif; white-space: pre;"> </span><span style="font-family: Arial, Helvetica, sans-serif;">colonize old TB cavities, creating a fungal ball.</span></li>
</ul>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><br /></span></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Zygomycetes</span><br />
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<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Zygomycetes such as Rhizopus have right angle branching non-septate hyphae.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Invasive Zygomycosis most often seen in diabetics with acidosis!</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Nasocerebral invasion </span><span class="Apple-tab-span" style="font-family: Arial, Helvetica, sans-serif; white-space: pre;"> </span><span style="font-family: Arial, Helvetica, sans-serif;">that starts in sinuses and extends to the brain. Remember it’s in diabetics.</span></li>
</ul>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Cryptococcus</span><br />
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<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Generally, these opportunistic infections are caused by Cryptococcus neoformans.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Cryptococci are encapsulated!! The capsule inhibits phagocytosis.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Cryptococcosis usually strikes T-cell compromised patients such as AIDS patients.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">It disseminates across the blood-brain barrier and causes meningioencephalitis.</span></li>
</ul>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Pneumocystis</span><br />
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<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Generally, these opportunistic infections are caused by Pneumocystis carinii.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">It strikes patients with depleted cell mediated immunity, not neutropenic patients. Generally this means patients with HIV.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Pneumocystosis is an alveolar-interstitial pneumonia.</span></li>
</ul>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Deep Pathogenic Fungi – Histoplasmosis</span><br />
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<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Pathogenic fungi can occasionally cause infection in normal hosts. These fungi include </span><span class="Apple-tab-span" style="font-family: Arial, Helvetica, sans-serif; white-space: pre;"> </span><span style="font-family: Arial, Helvetica, sans-serif;">Histoplasmosis, Coccidioides, and Blastomyces. </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">They are encountered in their natural environments, not person to person. Spores are </span><span class="Apple-tab-span" style="font-family: Arial, Helvetica, sans-serif; white-space: pre;"> </span><span style="font-family: Arial, Helvetica, sans-serif;">inhaled, usually causing chronic inflammation and granuloma formation.</span><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgTz0RI1gBmVAITdGZDCp1c-yKIEXpRLU6r2H6i5F-F06w5MNJhscsYXPzz0U7MvMtOcXlrftRWgS6hG3m60yYjYVjPMCONHuPW-a23GDQMaYX5wBOHanqhokqJQL50jG73DhlkK7TRJUWE/s1600/Coccidioidomycosis03.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em; text-align: center;"><img border="0" height="282" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgTz0RI1gBmVAITdGZDCp1c-yKIEXpRLU6r2H6i5F-F06w5MNJhscsYXPzz0U7MvMtOcXlrftRWgS6hG3m60yYjYVjPMCONHuPW-a23GDQMaYX5wBOHanqhokqJQL50jG73DhlkK7TRJUWE/s400/Coccidioidomycosis03.png" width="400" /></a></li>
</ul>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Histoplasmosis (Histoplasma capsulatum)</span><br /><div class="separator" style="clear: both; text-align: center;">
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<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Spores are inhaled, and usually don’t cause disease. If inoculum is large or patient is </span><span class="Apple-tab-span" style="font-family: Arial, Helvetica, sans-serif; white-space: pre;"> </span><span style="font-family: Arial, Helvetica, sans-serif;">T-cell compromised (HIV), Histoplasmosis may cause respiratory or even </span><span class="Apple-tab-span" style="font-family: Arial, Helvetica, sans-serif; white-space: pre;"> </span><span style="font-family: Arial, Helvetica, sans-serif;">disseminated infection of endothelial cells.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Histoplasmosis is a dimorphic fungus, being filamentous in nature and yeast in the body.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Inhaled spores convert to yeast and are phagocytosed by alveolar macrophages but </span><span class="Apple-tab-span" style="font-family: Arial, Helvetica, sans-serif; white-space: pre;"> </span><span style="font-family: Arial, Helvetica, sans-serif;">replicate inside macrophage lysosomes. In a normal host this will normally cause </span><span class="Apple-tab-span" style="font-family: Arial, Helvetica, sans-serif; white-space: pre;"> </span><span style="font-family: Arial, Helvetica, sans-serif;">a granuloma, with eventual necrosis, fibrosis, or calcification. HIV patients do not form granulomas, and the fungus disseminates.</span></li>
</ul>
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<div>
<span style="font-size: large;">See pharmacology section for drugs related to fungus.</span></div>
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