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Isoniazid interferes with pyridoxine metabolism and may result in peripheral neuritis or convulsions. The administration of pyridoxine is generally not necessary for children who have a normal diet because they have adequate stores of this vitamin. Depending on the population studied, efficacy against tuberculosis has ranged from 0% to 80%. Similarly, the efficacy against leprosy has ranged from 20% to 60% in prospective trials. The vaccines were derived from a strain of Mycobacterium bovis in 1906 and were subsequently dispersed to several laboratories around the world, where they were propagated under nonstandardized conditions. If positive, consideration should be given to several factors when deciding who should receive antituberculous therapy. Tuberculosis is transmitted by infected droplets of mucus that become airborne when an individual coughs or sneezes. In addition to tuberculosis, what other airborne microbes can cause respiratory disease Should an asymptomatic infant with a single umbilical artery have a screening ultrasound done for renal anomalies In one study of nearly 35, 000 infants, examination of the placenta showed that only 112 (0. However, isolated single umbilical artery in an otherwise normal infant is associated with a low incidence of renal and urinary tract anomalies, most of which are transient or mild. Doornebal N: Screening infants with an isolated single umbilical artery for renal anomalies: nonsense Rittler M et al: Single umbilical artery and associated malformations in over 5, 500 autopsies. How does the handling of the umbilical cord at birth affect neonatal hemoglobin concentrations At the time of birth, the placental vessels may contain up to 33% of the fetal-placental blood volume. Constriction of the umbilical arteries limits blood flow from the infant, but the umbilical vein remains dilated. The extent of drainage from the placenta to the infant through the umbilical vein is very dependent on gravity. The recommendation is to keep the baby at least 20 to 40 cm below the placenta for about 30 to 60 seconds before clamping the cord. Delayed clamping (>1 minute) resulted in short-term increases in hemoglobin, jaundice requiring phototherapy, and higher ferritin levels at 6 months. What is the best method of umbilical cord care during the immediate neonatal period No single method of cord care has been determined to be superior for preventing colonization and infections. Antimicrobial agents, such as bacitracin or triple dye, are commonly used, but there are no efficacy data (other than reduced colonization). Alcohol accelerates the drying of the cord, but it has not been shown to reduce the rates of colonization or omphalitis. Therefore, simply cleaning with normal saline and allowing the cord to dry normally appears to be as safe and effective as using antibiotics. However, because neutrophilic and monocytic infiltration appear to play a major role in autodigestion, persistence of the cord beyond 30 days should prompt consideration of an underlying functional abnormality of neutrophils (leukocyte adhesion deficiency) or neutropenia. Measuring the distance from the umbilicus to the shoulder (lateral end of clavicle) allows for an estimation of desired length (Table 12-1). Because of secondary migration, the catheter tip should be at least 1 cm from the cardiac silhouette in preterm infants and 2 cm in full-term infants. Catheters inserted through the basilic or cephalic veins will migrate toward the heart with flexion of the elbow, whereas adduction of the shoulder results in migration toward the heart if inserted in the former and away if inserted in the latter. Monozygotic twins (identical twins) arise from the division of a single fertilized egg. Depending on the timing of the division of the single ovum into separate embryos, the amnionic and chorionic membranes can either be shared (if division occurs >8 days after fertilization), separate (if division occurs <72 hours after fertilization), or mixed (separate amnion, shared chorion if division occurs 4 to 8 days after fertilization). Sharing of the chorion and/or amnion is associated with potential problems of vascular anastomoses (and possible twin-twin transfusions), cord entanglements, and congenital anomalies. These problems increase the risk for intrauterine growth restriction and perinatal death. Dizygotic twins, however, result from two separately fertilized ova and, as such, usually have a separate amnion and chorion. Insensible water loss is the loss of water through the lungs during respiration and from the skin by evaporation. A rough guide to the amount of insensible loss in milliliters per kilogram per day (mL/kg/day) for infants in humidified isolettes is given in Table 12-2. Unless there is evidence of dehydration, routine intravenous fluid or other supplementation of term and near-term infants is not necessary. Preterm infants weighing less than 1500 g should receive a 25% increment while receiving phototherapy. The American Academy of Pediatrics recommends that an individual experienced in neonatal ophthalmology and indirect ophthalmoscopy examine the retinas of all neonates with a birthweight of less than 1500 g or a gestational age of less than 32 weeks, and of those selected infants weighing between 1500 and 2000 g who have had unstable clinical courses, including those requiring cardiorespiratory support, placing them at increased risk. The timing of the first examination should be based on gestational age at birth according to Table 12-3. If maternal drug abuse is suspected, which specimen from the infant is most accurate for detecting exposure Although urine has traditionally been tested when maternal drug abuse is a possibility, meconium has a greater sensitivity than urine and positive findings that persist longer. It may contain metabolites gathered over as much as 20 weeks, compared with urine, which represents more recent exposure. Recent studies show that umbilical cord tissue is as equally sensitive in the detection of fetal drug exposure as meconium, which in some cases may be passed in utero and in others not for several days. It is important to remember that maternal self-reporting is notoriously inaccurate as an indicator of drug use. Montgomery D: Testing for fetal exposure to illicit drugs using umbilical cord tissue vs. Recent data suggest that within days of birth, infants experience withdrawal symptoms, including irritability, crying, hypertonia, and seizures. The drug that figures most prominently is paroxetine (Paxil), but similar symptoms have been reported with fluoxetine (Prozac), sertraline (Zoloft), and citalopram (Celexa). Does maternal smoking in pregnancy result in nicotine withdrawal in newborn infants Infants exposed to nicotine before birth as demonstrated by elevated levels of cotinine in blood, urine, and saliva demonstrate increased irritability, tremors, and sleep disturbances during the first five days of life. Godding V, Bonnier C, Fiasse L, et al: Does in utero drug exposure to heavy maternal smoking induce nicotine withdrawal symptoms in neonates This injury, which stems from excessive traction during delivery, generally results in a greenstick fracture (. With the recent increase in late preterm births (33 to 36 weeks), what are the most common causes for hospital readmission of these patients Late preterm infants, who account in large part for the recent increase in prematurity in the United States, are more than twice as likely as their full-term counterparts to be readmitted to the hospital. The most common admission diagnoses are hyperbilirubinemia, feeding problems, respiratory difficulties, fever, and gastroesophageal reflux. With advances in reproductive technology, what have been the recent trends in the incidence of multiple births in the United States In the past decade, for which there is complete data, the frequency of multiple births has increased by 30% to 33.

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Kwashiorkor should be distinguished from the relative deficiency of all calories known as marasmus. Vitamin B12 (cobalamin), folic acid, vitamin B2 (riboflavin), and vitamin B6 (pyridoxine) are all water-soluble vita mins. It should be noted that most patients with chronic pancreatitis also are alcoholics and that alcoholics often have multiple nutritional deficiencies, including lack of water soluble vitamins. Niacin is synthesized from the essen tial amino acid tryptophan, which is particularly deficient in corn-based diets. Isoniazid is a competitive inhibitor of pyridoxine (vitamin B6), which is required for the synthesis of the inhibitory neurotransmitter aminobutyric acid. The history of gastric resection is consistent with a deficiency of intrinsic factor, which is required for absorption of vitamin B12 in the terminal ileum. Hemorrhagic lesions of the mamillary bodies and high-output heart failure occur with thiamine defi ciency. Impaired wound healing and defective osteoid matrix production result from vitamin C deficiency. Because newborns have inadequate intestinal flora, the primary source of vitamin K, vitamin K deficiency is relatively common and is estimated to occur in approximately 3% of neonates. Folic acid deficiency during early embryogenesis can result in neural tube defects. Mutations in genes involved in the synthesis of type I collagen lead to osteogenesis imperfecta, and defects in fibrillin lead to Marfan 121 122 BrS Pathology syndrome. Because vitamin C is a required cofactor for the synthesis of hydroxy proline and hydroxylysine, which are both required for collagen synthesis, vitamin C defi ciency can lead to impaired capillary formation, with consequent bleeding, and impaired wound healing. Patients with cystic fibrosis often have impaired exocrine pancreas func tion, resulting in a deficiency of fat-soluble vitamins. Of the fat-soluble vitamins, vitamin A deficiency results in night blindness, xerophthalmia, keratomalacia, and squamous metaplasia of the urinary tract, contributing to the formation of recurrent renal calculi. Atherosclerosis is the most frequent cause of significant morbidity caused by vascular disease. Atherosclerosis is more common in men in all age groups, although the incidence increases in postmenopausal women. Pathogenesis of atherosclerosis: reaction to injury formulation (1) Current thinking holds that the primary event in atherosclerosis is injury to (or dysfunction of) arterial endothelium, which may be produced by hypercholes terolemia, mechanical injury, hypertension, immune mechanisms, toxins, or viruses or other infectious agents. Atherosclerotic aneurysms most frequently occur in the descending, especially the abdom inal, aorta ure 9-3). Dissecting aneurysms may be clinically confused with acute myocardial infarction, but the electrocardiogram, serum troponin I, and serum myocardial enzymes are normal. The characteristic result is aortic rupture, most often into the pericardial sac, causing hemopericardium and fatal cardiac tamponade. It can be secondary to trauma or other pathologic processes that mechanically pen etrate the walls of both vessels. Resulting changes may include ischemic changes from the diversion of blood, bal looning and aneurysm formation from increased venous pressure, and high-output cardiac failure from hypervolemia. Predisposing factors include venous circulatory stasis or partially obstructed venous return, such as occurs with cardiac failure, pregnancy, prolonged bed rest, or varicose veins. Pulmonary infarcts are characteristically hemorrhagic, subpleural, and wedge-shaped. These abnormally dilated and tortuous veins occur most often in superficial veins of the lower extremities. Predisposing factors include increased venous pressure, such as occurs with pregnancy, obesity, or thrombophlebitis, and in persons whose occupations require prolonged standing. Cystic hygroma is a cavernous lymphangioma that occurs most often in the neck or axilla and is frequently associated with Turner Syndrome. Hemangioendothelioma is intermediate in behavior between a benign and a malignant tumor. It may arise in the skin of the breast following radiation therapy for breast cancer. This condition is characterized by necrotizing immune complex inflammation of small and medium-sized arteries. It is marked by the destruction of arterial media and internal elastic lamella, resulting in aneurysmal nodules. Clinical manifestations often include fever, weight loss, malaise, abdominal pain, head ache, myalgia, and hypertension. This is a necrotizing vasculitis considered by some to be a variant of polyarteritis nodosa. It is manifest by palpable purpura when the skin is involved but can involve any site, including the glomeruli or the gastrointestinal tract. It may be precipitated by exogenous antigens, such as drugs, foods, or infectious organ isms; may also occur as a complication of systemic illnesses, such as connective tissue disorders or malignancies. This disease of unknown etiology is characterized by necrotizing granulomatous vasculitis of the small to medium-sized vessels of the respiratory tract, kid neys, and other organs. Wegener granulomatosis is dominated clinically by respiratory tract signs and symptoms, especially of the paranasal sinuses and lungs, and necrotizing glomerulonephritis (some times with immune complex deposition). Giant cell arteritides are seen in medium to large-sized arteries and are characterized by granuloma formation with giant cells, as well as by infiltrates of mononuclear cells, neutro phils, and eosinophils. Clinical manifestations include: (1) Malaise and fatigue (2) Headache or claudication of the jaw (3) tenderness, absent pulse, and palpable nodules along the course of the involved artery 130 Brs Pathology (4) Visual impairment, especially with involvement of the ophthalmic artery (5) Polymyalgia rheumatica, a complex of symptoms including proximal muscle pain, periarticular pain, and morning stiffness (6) Markedly elevated erythrocyte sedimentation rate 2. Mucocutaneous lymph node syndrome (Kawasaki disease) is an acute, self-limited illness of infants and young children characterized by acute necrotizing vasculitis of small and medium-sized vessels. It most often involves pulmonary vasculature but also has a predilection for vessels of the central nervous system, skin, liver, and kidneys. Genetic factors (1) Family history of hypertensive disease is seen in three of four patients with the disorder. Primary aldosteronism, or Conn syndrome, which is usually associated with an adreno cortical adenoma or bilateral adrenal hyperplasia. Acromegaly, Cushing syndrome of pituitary or adrenocortical origin, pheochromocy toma, and hyperthyroidism c. Diabetes mellitus (when complicated by diabetic glomerulosclerosis; see Chapter 17) 3. It most often results in early death from congestive heart failure, cerebrovascular acci dent, or renal failure. This segment of the arterial intima of a coronary vessel is observed at autopsy in a 56-year old man who died suddenly on rising in the morning. Which of the following abnormalities is considered a major risk factor for the development of this lesion Further workup confirms the to your clinic in Utah with a long history of diagnosis of adult polycystic kidney disease. A 23-year-old man known to have department with tearing chest pain that acquired immunodeficiency syndrome radiates to the back. A 23-year-old man presents with fever, because of an unrelenting, severe, excruciat weight loss, malaise, abdominal pain, and ing headache. Workup reveals that the patient has mm Hg, and bilateral papilledema is evident polyarteritis nodosa. Which of the following on ophthalmoscopic examination of the is associated with this form of vasculitis Despite all interventions, including administration of nitroprusside, the patient (A) Arsenic dies. She (A) Buerger disease subsequently presents with pulmonary com (B) Kawasaki disease plaints and neurologic findings. What mary care physician with malaise, proximal infectious agent is related to this diagnosis Cleft-like spaces indicating the presence of cholesterol crystals are very prominent and help in the identification of the lesion. Coarctation of the aorta is a frequent cause of hypertension limited to the upper extremities.

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East Mediterr Health J influences on adolescent smoking by developmental 1999; 5:440-449. In this study, we reviewed the determined based on tumour subtype, location, and size. Specifcity-sensitivity values Design: Retrospective study according to histopathological group were as follows: Seting: Thoracic Surgery Department of Kocaeli 76. The 5-year survival rate is approximately the diagnostic accuracy is quite high in these cases. Only 16% of lung cancer cases are diagnosed in diagnosis via minimally invasive methods must the early stages[1]. Surgical treatment of lung cancer has a In this study, 162 patients who underwent lung relatively low prevalence rate (20%). There was no statistical cases, extension of bleeding time due to aspirin usage diference between the male and female patients in was observed. When lesions were surgery and control coagulometric measurements evaluated according to location, 56 (34. After determining the path of the needle, 3 5 groups were included in logistic regression analysis ml of 1% lidocaine was injected subcutaneously into between localizations. The same pathologist observed this process (21%) cases had pneumothorax and 11 (6. Complications such as were observed in the emergency department for 6 pneumothorax and haemorrhage were evaluated hours; they were discharged after examined control during the same stage. Normality of distribution of the data was evaluated using the Kolmogorov-Smirnov Test. The efective magnitude thoracic needle biopsy 34 Transthoracic Needle Aspiration Biopsy Experience of 162 Cases Operated for Non-Small. Specifcity-sensitivity values according to followed in the Department of Thoracic Surgery with histopathological group were as follows: 76. Subtypes of Number of cases In particular, determination of histological subtype is adenocarcinoma n (%) important for treatment planning. Biopsy techniques Acinar 30 (35) with a high diagnosis rate and low complication rate Solid 22 (25) are considered to be optimal[6]. In these respects, it is Lepidic 18 (21) clear that the value of transthoracic biopsy is quite Mucinous 5 (6) Papillary 3 (4) high. The pneumothorax rate in our cases was 21% and At this time, targeted inhibitors are used against tube thoracostomy was applied to 3% of these cases. No to determine adenocarcinoma subtype, the number additional surgical intervention was required. Of our 86 post-operative In a previous study, the malignancy potential for adenocarcinoma cases, 30 (35%) were acinar, 22 5 10 mm lesions was 6 28% and 64% 82% for 20 (25%) were solid, 18 (21%) were lepidic, 5 (6%) were mm-sized lesions[9]. Number of passes has a signifcant efect with high malignancy potential, exclusion of small on diagnosis because obtaining insufcient material cell lung cancer is very important. Thus, when the pathologist on our team obtained increases the false-negative rate[11] because, in wide sufcient material for malignancy distinction, the consolidation, it is difcult to distinguish malignant process was considered complete. While the same cells within the primary lesion from atelectasis and approach is used by many clinics, the determination infamed areas[11]. Fassina A, Corradin M, Zardo D, Cappellesso R, areas were determined according to this evaluation. Cytopathology 2011; 22:306biopsy to determine whether sufcient material has 312. In our cases, a pathologist was present guided transthoracic needle biopsy of lung lesions: during the biopsies. The role of bronchoscopy and clinical characterization of false negative results in lung cancer. Conclusions: Only music has efect on reducing anxiety Main outcome measure(s): Anxiety in parity I group and those with under diploma level of Results: There were signifcant diferences between the mean education. Sedatives or antianxiety drugs are normally experience anxiety due to the risk of normally administered before surgery to decrease unpredictable events that may threaten their the anxiety of patients, although, sedatives usually health. High levels of anxiety lead to some negative have adverse efects including sleepiness and outcomes including elevated blood pressure, respiratory depression, and may possibly interfere increased levels of cortisol, elevated heart rate, with anesthetic agents and can prolong the recovery slower wound healing, reduced immune response, and discharge of patients[3]. High anxiety levels anxiety of surgery, more atention is paid to noncould have a negative efect on the induction pharmacological interventions[3, 4]. Previous studies have shown that the were randomly divided into 3 groups: music group, anxiety of being awake during surgery is one of the ear plug group and control group, each including 30 main reasons for choosing general anesthesia[5, 6]. The sample size was determined with the studies have evaluated the efect of playing music confdence interval of 95% and the power of 90%. In another designed by Spielberger et al and contains 40 questions, study by Li et al on women undergoing cesarean among which 20 are related to state anxiety which is delivery, it was demonstrated that preoperative music infuenced by the situation and the other 20 are related intervention can decrease anxiety and pain[8]. In a to trait anxiety that is infuenced by the current feeling study by Gonano et al, in orthopedic surgery after of the subjects. The test retest reliability of the test was sedation with propofol, the case group used earplug from r = 0. After ensuring the correct spinal anesthesia, while the anesthesiologist is required location of the puncture, spinal anesthesia with a to control the anxiety of patients during surgery. This condition in case of high levels of anxiety with the noise reduction rating of 30 db) was used for may lead to rejection of spinal anesthesia, while spinal individuals. In previous studies, the pre-operation interview Headphones or ear plugs were applied after dural and visit, spousal participation in delivery, preparing puncture and went on until the end of surgery and the pamphlet about the surgery, playing music during was only discontinued before starting surgery for surgery and using ear plug were used to decrease the evaluation of anxiety. Therefore, the anxiety levels of the individuals were more studies in this area are needed. March 2018 diference between the scores in three groups in preThe result of the present study revealed that music test, the result of post-test score showed a diference signifcantly reduces the anxiety of pregnant women. The result of Tukey test revealed that the result of this study was consistent with some other the diference was related to the diference between studies. Koelsch et al in 2011 have evaluated the efect the scores of music and ear plug (p = 0. One hundred and sixty seven patients were the results show that only music is efective in randomly divided into broadcast, headphone and score reduction and this efect is signifcant in under control group. It was Table 5 demonstrates that for individuals under 30 revealed that both headphones and broadcast music years of age, there were signifcant diferences between were efective in reducing the anxiety of patients[16]. In a study scores in three groups pre-test, the result of post-test by Merakou et al which evaluated 200 patients who score showed diference among groups. The result underwent cataract surgery, it was demonstrated that of Tukey test revealed that the diference was related meditation music had an efect on preoperative stress to the diference between the scores of music and ear and anxiety and reduced their systolic blood pressure. They recommended that music could be used as an alternative method to stabilize blood pressure in patients undergoing cataract surgery[18]. It also down-regulates Age < 30 (years) the activity of the central nucleus of the amygdale, Pre-Test 21. Many studies have shown that listening In patients 30 years old, there was a signifcant to pleasant music reduces cortisol levels, a hormone related to anxiety[15, 24, 25]. In a study by Gonano et al in Austria in 2010 anxiety of subjects and they may tend to have general on 50 patients who underwent orthopedic surgery, anesthesia. In the present study, we tried to assess the after using propofol, patients of intervention group efect of music and using ear plug on reducing the used ear plugs. Similar to our study, they found that the ear plug has no independent sedative efect[9]. In anxiety of pregnant women who are candidates for elective cesarean section using spinal anesthesia. Efect of earplugs on propofol requirement and were signifcantly diferent before and after the awareness with recall during spinal anesthesia.

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Direct examination of a skin biopsy immunofluorescence showed intercellular igG deposits inthe epidermis. Magnifying lens Ans 2 148 Post mortem lividity is unlikely to develop in a case of 1. Perjury means giving willfull false evidence by a witness while under oath, the witness is liable to be prosecuted for perjury and the imprisonment may extend to seven years. The syndrome of inappropriate antidiuretic hormone is characterized by the following 1. The most frequent cause of recurrent genital ulcertion in a sexually active male is: 1. A 60 year-old man with diabetes mellitus presents with painless, swollen right ankle joint. All of the following drugs are used for management of post partum haemorrhage except: 1. Laporatomy performed in a case of ovarian tumor revealed unilateral ovarian tumor with ascities positive for malignatn cells and positive pelvic lyjph nodes. Ref Dewhurst 6th ed Page 321] [this is an alternative to vessel ligation techniques to compress the uterus in cases of diffuse bleeding from atony or percreta. Pyometra is a complication associated with all of the following conditions except: 1. A 38 year old man is posted for extraction of last molar tooth under general anaesthesia as a day care case. All of the follwing are mechanisms of action of emergency contraception except: 1. A 20 year old woman gives a history of sharp pain in the lower abdomen for 2-3 days every month approximately 2 weeks before the menses. Which one of the following tests will you adopt while examining a knee joint where you suspect an old tear of anterior cruciate ligament A 45 day old infant developed icterus and two days later symptoms and signs of acute liver failure appeared. A 2-month baby presents with history of jaundice, turmeric colored urine and pale stools since birth. What are the chances of their having an affected child and what are the chances of their children being carriers A 63-year-old man presented with massive splenomegaly, lymphadenopathy and a total leucocyte count of 17000 per mm3. All of the following are useful intravenous therapy for hypertensicve emergencies except: 1. It also says that patients with pain at rest / pain on minimal excercise should not be tested. A nineteen year old female with short stature wide spread nipples and primary amenorrhoea most likely has a karyotype of: 1. Which of the following procedures are wsed as routine technique for karyotyping using light microscopy Child was given 3 doses of recombinant hepatitis B vaccine at the age of one year. His mother was treated for chronic hepatitis B infection around the same time the next relevant step for further investigating the child ould be to: 1. Which of the following hepatitis viruses have significant perinatal transmission: 1. Recurrent ischemic events following thrombolysis has been patho-physiologically linked to which of the following factors: 1. Synaptic conduction is mostly orthodromic because: 1 Dendrities cannot be depolarized. The cell junctions allowing exchange of cytoplasmic molecules between the two cells are called: 1. Positive feedback action of estrogen for inducing lulteinizing hormone surge is associated with one of the follwing steroid hormone ratios in peripheral circulation: 1. A 20year-old man has presented with increased alcohol consumption and sexual indulgence. Behaviour therapy to change maladaptive behaviors using reponse as reinforcer uses the principles of: 1. He knows that there is actually no such thing after he has cleaned once but he is not satisfied and is compelled to think so. A classical expansive lytic lesion in the transverse process of a vertebra is seen in: 1. In the presence of vasopressin the greatest fraction of filtered water is re-absorbed which part of the nephron: 1. A child has got a congenital catract involving the visual axis which was detected by the parents right at birth. A 10-mm calculus in the right lower ureter associated with proximal hydrouretero-nephrosis is best treated with: 1. Semen analysis of a young man who presented with primay infertility revealed low volume, fructose negative ejaculate with azoospermia. Which of the following is the most useful imaging modality to evaluate the cause of his infertility Lidocaine concentration are initially higher in relatively well perfused tisseues such as brain and heart. There is a sudden out-burst of release of adreneline, noradreneline and dopamine in brain and heart. A post-operative cardiac surgical patient developed sudden hypotension, raised central venous pressure, pulses paradoxus at the 4th post operative hour. Intracellular potassium is released into extra-cellular space in response to severe injury. Acidosis leads to movement of potassium from extracellular to intracellular fluid compartment. The organism most commonly causing genital filariasis in most parts of Bihar and Eastern U. Non renal retroperitoneal causes including Neuroblastoma, adrenal hemorrhage, and teratoma account together for 10 % of cases. A 27 year old man presents with a left testicular tumor with a 10 cm retroperitoneal lymph node mass. Rajiv, Dr Rajendran Dr Bhuwnesh Kansara, Dr Ashok L & Dr Anand L, Dr Sweetie Sharma, Dr Aseem Khurana, Dr Sujit and many more people. Outdoor Wooden furniture: Sofa Set: Sofa Sets, Shahi Divan, Setti, Corner Sofa Sets, Antique Sofa Sets In Polish & Deco Paint. Dinning Table Set: Oval, Round, Rectangular, Hexagonal, Square, With Glass & Hardtop In Polish & Deco Paint. Bed With Box: Fine Carving, Brass Inlay, Carving & Cushion Work In Polish & Deco Paint. 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Answer 3, As Diaphragmatic breathing is reduced significantly in cervical spinal cord injury. If C3 to C6 are injured vital capacity is 20 % of normal and weak cough is present.

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A cohesive cluster of markedly dyskaryotic small cells showing nuclei with similar changes with those of the cells in A. However, for pregnant women, the colposcopy may be deferred to 6 weeks postpartum. In pregnant women a colposcopically directed biopsy may be performed but an endocervical tissue sampling is contraindicated. In atrophic vaginitis a short course of intravaginal treatment with estrogen cream for 4 to 7 days will be helpful to solve this diagnostic dilemma. This treatment will induce a maturation of squamous cells, but dyskaryotic cells will remain unchanged. Follow-up with repeat Pap tests at 6-month intervals or immediate colposcopy is also acceptable. If the test is negative for high-risk viruses, she should be followed by a repeat Pap smear every 6 months for 2 years. If the cellular atypia is cleared within 2 years, she can return to routine annual screening. On smears these thick tissue fragments may display peripheral cells in vague palisades mimicking those of a cervical adenocarcinoma in situ. However, it should be borne in mind that an adenocarcinoma, either in situ or invasive, may coexist with a squamous lesion of the cervix. If the patient is pregnant, the colposcopy may be deferred until 6 weeks postpartum. They occur mainly in adults with a peak incidence in th th the 5 and 6 decades of life. Their common clinical manifestation is abnormal vaginal bleeding that may occur spontaneously or following a sexual intercourse. Verrucous carcinoma is a very rare and distinctive type of well-differentiated squamous cell carcinoma of the cervix and vagina. It is characterized histologically by an undulating hyperkeratinized surface consisting of pointed papillary projections. Papillary squamous (transitional) cell carcinoma is a rare variant of invasive squamous cell carcinoma of the cervix and vagina, with about 40 cases reported in the literature. Lymphoepithelioma-like carcinoma of the cervix is also a rare tumor with lower rate of lymph node metastasis, potentially radiosensitive and better prognosis. These cells are obscured by heavy inflammation and blood, a background resembles that of a menstrual smear. Immunohistochemical and electron microscopic studies of the tumor tissue obtained by biopsy are necessary for a correct diagnosis. For invasive cervical cancers, the Pap test had a more variable sensitivity, ranging from 16% to 82%; and many patients had one or more negative test result. Accuracy of cervical smears in predicting the grades of intraepithelial neoplasia. Results of prior cytologic screening in patients with Stage I carcinoma of the cervix. Papanicolaou smear history in women with low grade cytology before cervical cancer diagnosis. Results of the College of American Pathologists interlaboratory comparison programs in cervicovaginal cytology. Bethesda 2001 implementation and reporting rates: 2003 practices of participants in the College of American Pathologists Interlaboratory Comparison Program in cervicovaginal cytology. A College of American Pathologists Q-Probe study of 22, 439 correlations in 348 laboratories. Analysis of cervical smears obtained within 3 years of the diagnosis of invasive cervical cancer. Cytology of a low-grade papillary transitional cell carcinoma of the cervix in Pap smear. False-positive squamous cell carcinoma in cervical smears: Cytologic histologic correlation in 19 cases. False-negative cytology rates in patients in whom invasive cervical cancer subsequently developed. Accuracy of the Papanicolaou test screening for and follow-up of cervical cytologic abnormalities: A systemic review. Pathology and cytopathology of microinvasive squamous cell carcinoma of the uterine cervix. Exfoliative cytology of microinvasive squamous cell carcinoma of the uterine cervix. Specimen adequacy evaluation in gynecologic cytopathology: current laboratory practice in the College of American Pathologists interlaboratory comparison program and tentative guidelines for future practice. Prevalence of dysplasia and cancer of the cervix in a nationwide planned parenthood population. Cytologic features of squamous cell carcinoma in situ involving endocervical glands in endocervical cytobrush specimen. The Bethesda classification of squamous intraepithelial lesions: histologic, cytologic and viral correlation. Human papillomavirus testing for triage of women with cytologic evidence of low-grade squamous intraepithelial lesions: baseline data from a randomized trial. Correlation of the histological appearance of intraepithelial neoplasia of the cervix and human papillomavirus types. In contrast to cervical squamous cell carcinoma, the sequential changes of cervical glandular epithelium leading to the development of adenocarcinoma have not been well documented. Histologically, it involves the transformation zone of the cervix in the majority of cases and consists of three main cell types: endocervical, endometrioid and intestinal; with endocervical-type lesions being the most common ones. Each of these features provides a key to an accurate cytodiagnosis which can be made in about 90% of cases. Cytologically, the tumor cells are large and occur singly, in clusters and in large epithelial fragments. They demonstrate single intracytoplasmic mucous vacuoles, resembling colonic epithelial sheets. Efforts should be made to look for endometrial glandular fragments and clusters of endometrial stromal cells to avoid a false-positive diagnosis. An awareness of tubal metaplasia and the potential for cytodiagnostic error is necessary to avoid an unnecessary cone biopsy. These endometrial epithelial fragments are usually mixed or surrounded by endometrial stromal cells. Clinical data will be helpful in avoiding a false-positive diagnosis in this setting. The reader is referred to Chapter 2 for illustrations of lower uterine segment endometrium. The reader is referred to the section on Atypical glandular cells below for discussion and illustrations. Clusters of atypical cervical glandular cells, favor neoplastic displaying nuclear crowding and overlapping. The atypical cells show enlarged, hyperchromatic nuclei and ill-defined cytoplasm. The endometrial cell atypias can be difficult to identify because of cellular degeneration. On the other hand, normal endometrial cells exfoliated in menses may display reactive changes with slight nuclear enlargement and pleomorphism or degeneration that could be misinterpreted as abnormal.


  • Chest injuries
  • Urinary tract infection
  • Short or long-term ear infection
  • Verapamil injection (a medicine used to treat high blood pressure)
  • Wear appropriate sunscreens -- a sunscreen rating of 15 should give adequate protection for most people.
  • Upper GI bleeding: The upper GI tract includes the esophagus (the tube from the mouth to the stomach), stomach, and first part of the small intestine.
  • Osteomyelitis

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Histopathology The primary histologic feature of scleroderma is the deposition of vast amounts of relatively acellular collagen. Minor salivary gland changes include pronounced interstitial fbrosis and acinar atrophy. Patients with progressive disease are likely to succumb to renal, cardiac, or pulmonary failure. Other than supportive therapy, no satisfactory treatment is available for scleroderma. Corticosteroids may provide some beneft early but are not likely to give lasting control in progressive cases. Xerostomia Etiology Dry mouth or xerostomia is a common condition defned as an overall reduction in salivary output. Obviously, excellent ment for thyroid malignancy, and many commonly used oral hygiene, topical fuoride application, and careful dental medications that have anticholinergic efects. In some cases, cholinergic agonists including pilocarof associated salivary dysfunction remains controversial; pine and cevimeline may be helpful, as may the use of however, studies have postulated that, although a demonacupuncture. Moreover, Taste Disturbances it has also been shown that xenogeneic drugs have an Taste or gustation relates to the perception of the fve tradiadverse impact on healthy older adults compared with tional elements sweet, salty, sour, bitter, and umami (sayounger adults, for whom secretory reserve is higher. In concert and in From a dietary perspective, cafeine remains an important combination they form a favor, derived from the collective and the most commonly identifed agent that contributes sense of smell and trigeminal inputs of texture, temperato xerostomia. In addition, the role of alcohol consumpture, and pungency over surfaces of the tongue, oral cavity, tion must be recognized as a modifying factor in xerostoand nasal cavity. Transient dry mouth often may be a more subjective components may become distorted, leading to disturbances symptom, in particular in relation to various psychosocial in taste, including hypogeusia (blunted taste), ageusia (abfactors and anxiety. Patients complain of various symptoms, in tions in taste can be minimal and only slightly bothersome particular difculty in talking or swallowing, altered taste, to incapacitating, with possible resultant depression and generalized oral discomfort, and, if worn, poor retention of anorexia as secondary clinical events. Usually, a reduction in salivary fow of more than Although dental practitioners do not routinely perform 50% is required before clinical symptoms develop. Oral mucosal diseases, indition to being reduced in amount, any saliva that is present cluding candidiasis, must be addressed as important pomay be frothy. Upper airway surgery (paranasal alized erythema of the oral mucosa and a lobulated appearsinus procedures), viral infection, or neoplasia may alter ance on the dorsum of the tongue. Tere is also likely to be olfactory function, thus secondarily afecting taste percepevidence of candidiasis and angular cheilitis. Tonsillectomy and orofacial-orthognathic surgical prone to cervical caries, and existing restorations may fail procedures may produce chorda tympani injury, thus because of recurrent caries. Patients with xerostomia are predisposed to recurrent episodes of suppurative sialadenitis, particularly of the parotid gland. The net reElimination of alcohol and caffeine consumption sult often consists of diminished nutritional status, malnuElimination of alcohol-containing mouth rinses Gustatory salivary stimulation trition, and decreased social interaction. Also seen in assoSugarless candies, gum ciation with dry mouth are oral burning and mucosal Moist sugar-free or complex carbohydrate foods soreness. Oral lubricants Carboxymethylcelluloseor hydroxymethylcellulose-based Treatment products Other polymer-based rinses Management of the patient with xerostomia is generally Scrupulous oral hygiene directed toward palliation and requires a careful multifactorial approach, wherein local and systemic factors are considPrescription Strategies ered, along with analysis of all prescription and over-theCholinergic agonists counter medications and diet. Many diseases Management of this problem remains difcult and limare capable of inducing taste aberrations (Box 8-9), as are ited. Management of any metabolic or endocrine abnorrepresentatives of several drug classes (Box 8-10). Evaluation of diagto incomplete food solubilization, and by diminished nosed olfactory alterations, including anosmia or hyposmia, transport of molecules to taste buds. This problem is often and management of such are important considerations in underreported within the elderly population as a result of the treatment of any taste disturbance. For patients with polypharmacy on one hand and the direct efects of some demonstrable xerostomia, salivary stimulation with sialadrugs on taste sensation, and xenogeneic efects of drugs gogues may be useful. Indidemonstrated improvement with alpha lipoic acid therapy, viduals who have undergone radiation therapy to the oral suggesting a possible neuropathic axis, similar to that proand head and neck regions for malignant tumors often posed in burning mouth syndrome, which occurs with acexperience taste disturbances as a result of both direct companying dysgeusia. In addition, patients must be coundamage to taste buds and salivary dysfunction. This includes those complaining of idiopathic burning mouth syndrome several aspects of food intake such as increasing texture, commonly state a concomitant taste alteration, usually maximizing smell, and avoiding food spoilage. Up to 17% of adults state that halitosis is a Gingivitis, periodontitis concern at one time or another, and 1% or less indicate that Hypothyroidism their lives are disrupted as a result. Multiple sclerosis Parkinsonism Halitosis originates chiefy from the mouth and less so Pernicious anemia (vitamin B12 related) from the nose, tonsils (tonsillitis, tonsilliths), and a wide Renal failure/hemodialysis variety of other sites (Box 8-11). Antidiabetics An objective assessment on the part of the patient is Antihistamines difcult; a third party is often needed to confrm the presAntiasthmatics ence of malodor, its intensity at the time of evaluation, and Antidepressants comparison of the stated odor at other times. Variations in Antipsychotics Antineoplastics breath quality fuctuate with time of day and generally are Chelating agents related inversely to salivary fow rates. The concept of deNeuromuscular/antiseizure drugs lusional halitosis is well-known and likely accounts for a Nitroglycerin signifcant portion of those who complain of oral malodor. Opioids When objectively assessed, these individuals are found not to have halitosis but remain unconvinced. Oral ulcerative and erosive diseases Dietary considerations Volatile sulfur-containing foods (onions, garlic, others) Benign Neoplasms Hydrogen sulfde Dimethyl disulfde At approximately 5 weeks of embryonic development, a Methyl mercaptan characteristic lobular architecture of salivary glands beXerostomia comes established. As branching morphogenesis continues, Nasal cavity Nasal infection terminal tubular elements give rise to striated intralobular Sinusitis ducts, intercalated ducts, acini, and myoepithelial cells. Nasal polyps and nasal foreign bodies Intralobular and interlobular ducts of the excretory system Other airfow obstruction arise from the remaining progenitor stalk cells. Because of Tonsils their relatively undiferentiated ultrastructural appearance, Infection Tonsilliths intercalated duct cells are thought to be capable of giving Neoplasia rise to these neoplasms. The importance of the myoepitheOther sites lial cell in the composition and growth of numerous epitheBronchial and pulmonary infection lial salivary tumors is considerable (Box 8-13). Cells with a Renal failure myoepithelial phenotype can be seen in all salivary gland tumors and are particularly abundant in mixed tumors (pleomorphic adenoma), myoepitheliomas, adenoid cystic carcinomas, and epimyoepithelial carcinomas. The analysis is considered the gold standard but is impractical within the routine patient care setting. Commercial mouthwashes contain high concenSebaceous adenoma trations of alcohol and favoring agents and likely work Ductal papilloma only to temporarily camoufage malodor caused by orInverted ductal papilloma ganic oral disease. The drying efects of alcohol on the Sialadenoma papilliferum Intraductal papilloma oral mucosa ultimately may make the problem worse. Generally, they are mobile, Mixed Tumor (Pleomorphic Adenoma) except when they occur in the hard palate. They appear as The histogenesis of mixed tumor, or pleomorphic adenoma, frm, painless swellings and, in the vast majority of cases, do relates to dual proliferation and comingling of cells with not cause ulceration of the overlying mucosa ure 8-18). The myoepithelial-diferentiated cell assumes an usually located below the ear and posterior to the mandiimportant role in determining the overall composition and ble. A range of cell types and large size, when they may become multinodular or bossemicroscopic patterns are seen in mixed tumors, those comlated. Some tumors may be grooved by the posterior posed almost completely of epithelial (luminal) cells at one extent of the mandibular ramus, with long-standing end of a spectrum and those composed almost completely lesions capable of producing pressure atrophy on this of myoepithelial (abluminal) cells at the other end. When situated within the inferior pole or tail of the these two extremes, less well developed cells with features of parotid, the tumors may present below the angle of the both myoepithelial and luminal elements may be seen. Mixed tumors can range from a few millimeters to sevClinical Features eral centimeters in diameter and are capable of reaching The mixed tumor is the most common tumor of the major giant proportions in the major salivary glands, especially the and minor salivary glands (Box 8-14).

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Survivors from sea-drowning (including serum) has higher concentration of sodium, iii. Excessive sweating (in deserts, heat stroke) homeostasis, the concentration of electrolytes in both these B. Loss of relatively more water than salt compartments should be within normal limits. Diabetes insipidus levels of electrolytes are maintained in the body by a careful ii. Induced water deprivation (non-availability of water, total fasting) balance of 4 processes: their intake, absorption, distribution iii. Disturbance in any of these processes in diverse in conditions causing combined salt and water deficiency pathophysiologic states may cause electrolyte imbalance. Decreased potassium intake imbalance, abnormalities in serum levels of sodium (hypo i. Diet low in potassium beyond the scope of this book to delve into this subject in B. Electrolyte imbalance in a given case may result from one syndrome) or more conditions. For example, of fistula, gastric suction) abnormality in serum levels of sodium and potassium; C. Excessive mobilisation from extracellular into intracellular calcium and phosphate. Alkalosis levels is in the form of metabolic syndrome and clinical features rather than morphological findings in organs. Excessive potassium intake imbalance are related to its pathophysiologic role in that organ i. Decreased potassium excretion A list of important clinical conditions producing i. Oliguric phase of acute renal failure abnormalities in sodium and potassium are given in ii. Use of drugs such as beta-blockers, cytotoxic drugs During metabolism of cells, carbon dioxide and metabolic iv. The role of bicarbonate buffering system in the extracelluar compartment has already been stated above. The arterial Accordingly, the disorders of the pH of the blood, termed Pco2 level is raised. Alterations in the blood bicarbonate levels: these are A rise in the blood pH occurring due to lowered Pco 2 metabolic acidosis and alkalosis. This is encountered in 2 function of the lungs): these are respiratory acidosis and the following conditions: alkalosis. Hysterical overbreathing Thus, abnormalities in acid-base homeostasis produce Working at high temperature following 4 principal metabolic syndromes which have At high altitude diverse clinical manifestations due to pathophysiologic Meningitis, encephalitis derangements: Salicylate intoxication Clinically, the patients with respiratory alkalosis are Metabolic Acidosis characterised by peripheral vasoconstriction and consequent pallor, lightheadedness and tetany. The arterial Pco2 is A fall in the blood pH due to metabolic component is brought lowered. Normal circulatory function requires uninterrupted flow of Uncontrolled diabetes mellitus (diabetic ketoacidosis). Derangements of blood flow or haemodynamic distur bances are considered under 2 broad headings: Metabolic Alkalosis I. These A rise in the blood pH due to rise in the bicarbonate levels of include: hyperaemia and congestion, haemorrhage and plasma and loss of H+ ions is called metabolic alkalosis. Clinically, metabolic alkalosis is characterised by depression of respiration, depressed renal function with uraemia and increased bicarbonate excretion in the urine. This can occur in the following circumstances: Air obstruction as occurs in chronic bronchitis, emphy sema, asthma. The affected tissue or organ is bluish arteriolar dilatation being referred to as hyperaemia or active in colour due to accumulation of venous blood (cyanosis). If the condition Accordingly, venous congestion is of 2 types: develops rapidly it is called acute, while more prolonged and Local venous congestion results from obstruction to the gradual response is known as chronic. Systemic (General) venous congestion is engorgement of the examples of active hyperaemia are seen in the systemic veins. Usually in pneumonia the fluid accumulates upstream to the specific chamber of Blushing i. For emotions example, in left-sided heart failure (such as due to mechanical Menopausal flush overload in aortic stenosis, or due to weakened left Muscular exercise ventricular wall as in myocardial infarction) pulmonary High grade fever congestion results, whereas in right-sided heart failure (such Goitre as due to pulmonary stenosis or pulmonary hypertension) Arteriovenous malformations systemic venous congestion results. The alveolar septa are widened and thickened due to congestion, oedema and mild fibrosis. The alveolar lumina contain heart failure cells (alveolar macrophages containing haemosiderin pigment). The central veins as well as Chronic venous congestion of the lung occurs in left heart the adjacent sinusoids are distended and filled with blood. Long-standing cases may show fine centrilobular fibrosis and regeneration of hepatocytes, Grossly, the lungs are heavy and firm in consistency. The peripheral sectioned surface is dark the sectioned surface is rusty zone of the lobule is less severely affected by chronic brown in colour referred to as brown induration of the hypoxia and shows some fatty change in the hepatocytes lungs. The septa are mildly thickened due to slight increase in fibrous connective tissue. Rupture Chronic venous congestion of the spleen occurs in right heart of dilated and congested capillaries may result in minute failure and in portal hypertension from cirrhosis of liver. The breakdown of erythrocytes liberates haemosiderin pigment which is Grossly, the spleen in early stage is slightly to moderately taken up by alveolar macrophages, so called heart failure enlarged (up to 250 g as compared to normal 150 g), while cells, seen in the alveolar lumina. The brown induration in long-standing cases there is progressive enlargement observed on the cut surface of the lungs is due to the and may weigh up to 500 to 1000 g. Grossly, the liver is enlarged and tender and the capsule ii) There is hyperplasia of reticuloendothelial cells in the is tense. Cut surface shows characteristic nutmeg* red pulp of the spleen (splenic macrophages). The v) Firmness of the spleen in advanced stage is seen more bleeding may occur externally, or internally into the serous commonly in hepatic cirrhosis (congestive splenomegaly) cavities. The centrilobular zone shows marked degeneration and necrosis of hepatocytes accompanied by haemorrhage while the peripheral zone shows mild fatty change of liver cells. The effects of blood loss depend upon 3 main factors: the amount of blood loss; the speed of blood loss; and the site of haemorrhage. The loss up to 20% of blood volume suddenly or slowly generally has little clinical effects because of compensatory mechanisms. A sudden loss of 33% of blood volume may cause death, while loss of up to 50% of blood volume over a period of 24 hours may not be necessarily fatal. However, chronic blood loss generally produces iron deficiency anaemia, whereas acute haemorrhage may lead to serious immediate consequences such as hypovolaemic shock. Sectioned (hypotension); and surface shows that the spleen is heavy and enlarged in size. It may be the result of Gram In routine clinical practice, however, true shock is the negative septicaemia (endotoxic shock) which is more form which occurs due to haemodynamic derangements with common, or Gram-positive septicaemia (exotoxic shock). Shock resulting from trauma is initially Classification and Etiology due to hypovolaemia, but even after haemorrhage has been controlled, these patients continue to suffer loss of plasma Although in a given clinical case, two or more factors may volume into the interstitium of injured tissue and hence is be involved in causation of true shock, a simple etiologic considered separately in some descriptions. Neurogenic shock results from causes of interruption of sympathetic vasomotor supply. Hypoadrenal shock occurs from inadequate circulatory blood volume by various etiologic unknown adrenal insufficiency in which the patient fails to factors that may be either from the loss of red cell mass and respond normally to the stress of trauma, surgery or illness. Acute circulatory failure with sudden In general, all forms of shock involve following 3 fall in cardiac output from acute diseases of the heart without derangements: Reduced effective circulating blood volume. It may result a) Myocardial infarction b) Cardiomyopathies by either of the following mechanisms: c) Rupture of the heart, ventricle or papillary muscle i) by actual loss of blood volume as occurs in hypovolae c) Cardiac arrhythmias mic shock; or ii) Deficient filling. Following reduction in the c) Tension pneumothorax effective circulating blood volume from either of the above d) Dissecting aortic aneurysm two mechanisms and from any of the etiologic agents, there 3. Endotoxins in bacterial wall in septic ii) Neurogenic shock shock stimulate massive release of pro-inflammatory a) High cervical spinal cord injury mediators (cytokines) but a similar process of release of b) Accidental high spinal anaesthesia these agents takes place in late stages of shock from other c) Severe head injury causes.

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Multiple sclerosis is characterized by destruction ofmyelin, with preservation ofaxons. The optic nerve, brain stem, and paraventricular areas are favored sites of demyelination. Folate deficiency with megaloblastic anemia can occur in severely malnourished persons (often alcoholics) or in association with increased demand for folate in pregnancy. Cobalamin (vitamin B12) deficiency megaloblastic anemia can occur in pernicious anemia, in strict vegetarians (vitamin B12 is only found in foods of animal origin), and in associationwith surgically induced intestinal blind loops overgrown with microorganisms with high avidity for cobalamin. The anemia of chronic disease is most often normochromic and normocytic, but can be hypochromic and microcytic. Granulation tissue is formed in healing wounds and consists ofyoung fibroblasts and newly formed capillaries. Cat-scratch disease, foreign body reaction, histoplasmosis, and tuberculosis are all well-known causes of granulomatous inflammation and have nothing to do with granulation tissue. A keloid is a result of excessive production of collagenous fibrous tissue and is characterized by a tumor-like scar consisting of dense bundles of structurally abnormal collagen. Propensity to keloid formation is markedly increased in persons ofAfrican lineage. The combination ofincreased serum calcium and alkaline phosphatase along wth decreased serum phosphorus is most consistent with primary hyperparathyroidism. The karyotype is eitherX (with translocation of at least part of the Y chromosome to an X chromosome or to an autosome) or a mosaicism, such as X/X. Phospholipase A2 catalyzes the release of arachidonic acid from membrane phospholipids. It should be noted that prednisone inhibits both the cyclooxygenase and lipoxygenase pathways by inhibiting the formation of precursors to each pathway. Subacute sclerosing panencephalitis, one ofthe slow virus infections, is thought to be caused by persistent infection with a defective measles virus. The vrus lacks the M component, a protein required for extracellular spread of the virus. Primary adrenocortical deficiency (Addison disease), as distinguished from adrenal cortical insufficiency secondary to pituitary hypofunction, is indicated by the presence of pigmentation. Unlike many autosomal dominant disorders, it manifests later in life, in the fourth to fifth decade of life. In a typical well-differentiated bronchioloalveolar carcinoma, tumor cells line the walls ofterminal air spaces, as shown in the illustration. They are especially prominent in cells that have become atrophic, such as skeletal muscle cells after prolonged immobilization. Kwashiorkor is a form of protein-calorie malnutrition attributed to a relative lack of protein despite a diet relatively high in carbohydrates. Horner syndrome is a consequence of some lung tumors, not of salivary gland tumors. The lungs and pancreas are the most significant sites of involvement, and the disorder is marked by repeated bouts of pneumonia and by pancreatic failure with wasting and steatorrhea. Berry aneurysm occurs at sites of discontinuity of the arterial media, most at bifurcations ofvessels of the circle ofWillis. Berry aneurysm is the most frequent cause of subarachnoid hemorrhage, and there is no association with atherosclerosis. The final steps leading to cell death in severe hypoxic injury are associated with massive infux of extracellular calcium. Rheumatoid factor, an IgM antibody directed against the Fc portion of IgG, is found in about 80% of affected individuals. Vitamin C also maintains the reduced state of metabolically active agents, such as iron and tetrahydrofolate. The maintenance of iron in its divalent ferrous form is required for intestinal iron absorption. Staging is based on clinical evaluation ofthe distribution and extent of the disease process and is contrasted with grading, which is based on histopathologic evaluation of a malignant neoplasm. Granulosa cell tumors are sex cord-stromal tumors that typically secrete estrogen. Maternal antibodies provide passive immunization and protection from bacterial infection during the first months oflife in children with congenital agammaglobulinemia. Acute hematogenous osteomyelitis occurs with peak incidence in children, most commonly affects the metaphyses oflong bones, and is more common in boys. In the acute stage, pyogenic osteomyelitis often resolves with antibiotic therapy. Generalized lower abdominal pain, bloody stools, and signs ofacute infammation in an older patient are classic findings in diverticulitis. Signs of acute infammation would not be expected in carcinoma ofthe rectum or in tubular adenoma. Both of these disorders have a peak incidence in elderly men, and nodular prostatic hyperplasia tends to arise in the central zone of prostatic glands. Bronchial epithelial cells, gastric mucosal cells and skin epithelial cells are labile cells. Subdural hematomas are caused by venous bleeding, most often from laceration of the bridging veins, which join the cerebral vessels to the venous sinuses within the dura. Subarachnoid hemorrhage is most often caused by rupture of a berry aneurysm of the circle ofWillis. Otherhigh-incidence tumors ofearlychildhood include acute leukemia, Wilms tumor, and adrenal neuroblastoma. Idiopathic Parkinson disease is manifest morphologically by depigmentation of cells of the substantia nigra and locus ceruleus. Hypertrophic osteoarthropathy, manifest as clubbing of the fingers and associated periostitis of the distal radius and ulna, is associated with chronic lung disease, cyanotic heart disease, and other systemic disorders. Felty syndrome is the combination of splenomegaly, neutropenia, and rheumatoid arthritis. Androblastoma (Sertoli cell tumor), a nongerm cell tumor derived from the sex cord, is most often benign. Seminoma, a germ cell tumor of the testis with peak incidence in the mid-30s age group, is analogous to (and histologically closely resembles) dysgerminoma ofthe ovary. In the latter, the most frequently occurring underlying illness is rheumatoid arthritis. Diabetic nephropathy is marked by diffuse or nodular mesangial accumulations ofglycosylated basement membrane-like material. See Carbon monoxide Cheilosis, 115 Coagulation cascade, 35, 36f 413A Chemical carcinogenesis, 93-94 Coagulative necrosis, 5t, 150A Chemical cell injury, 4-5 Coagulopathy of liver disease, 188-189 Chemical injuries, 106-108 Coal, 201 Chemotactic factors, 20t Coarctation of aorta, 14lt Chemotaxis, 19 Cobalamin, 115 Chemotherapeutic drugs, 108 Cocaine, 106, 112A folate acid antagonist, 155 Cocarcinogens, 93 Cherry hemangioma, 336 Coccidioidomycosis, 207 t Chlamydia, 276, 285A, 288 Cold agglutinin disease, 159, 167A, 212Q Chloramphenicol, 156 Colitis. See Dihydrotestosterone Echinococcus granulosus, 240 Diabetes, 124, 130, 260, 270Q, 320-322, 331A Echocardiography, 148Q, 149Q anatomic changes in, 321 Eclampsia, 298 bronze, 10 Ectopia lentis, 54, 62Q cardiovascular system in, 322 Ectopic pregnancy, 297 eye in, 322 Ectopic thyroid tissue, 311 kidney in, 321 Eczema, 74, 85Q liver in, 322 Eczematous dermatitis, 332 nervous system in, 322 Edema, 113, 254, 393Q. See Maturity-onset diabetes of the young Myxedema, 312, 329A Molluscum contagiosum, 335 Myxoma, 144, 151A Monckeberg arteriosclerosis, 122 Monoclonality, 90-93 j-Naphthylamine dyes, 107 Monocytes, 18, 74 Nasopharyngeal carcinoma, 195 Monocytosis, 18 Necrosis, 5-6 Monogenic disorders, 52-53 acute tubular, 42 Mononuclear cells, 24 apoptosis v. Nondisjunction, 48 Pancarditis, 137 Nondissecting aortic aneurysm, 140 Pancoast tumo 209 Non-Hodgkin lymphoma, 76, 177-179, 184A Pancreas, 246-247, 399Q Nonimmunologic stimuli. See Platelet-derived growth factor Osteitis fibrosa cystica, 316 Pedunculated polyps, 228 Osteoarthritis, 352, 358A Pellagra, ll5, 120A Osteochondroma, 348, 349 Pemphigus vulgaris, 333 Osteogenesis imperfecta, 347, 357A Penis, 276-277 Osteoid matrix, ll6 neoplasms of, 277 Osteomalacia, ll6. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project. Human Genome Editing: Science, Ethics, and Governance the National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for extraordinary contributions to engineering. Learn more about the National Academies of Sciences, Engineering, and Medicine at


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Acid haematin or following: haemozoin is a haemoprotein-derived brown-black pigment Acute intermittent porphyria is characterised by acute containing haem iron in ferric form in acidic medium. But it episodes of 3 patterns: abdominal, neurological, and psycho differs from haemosiderin because it cannot be stained by tic. Haematin pigment is seen most commonly in chronic Porphyria cutanea tarda is the most common of all malaria and in mismatched blood transfusions. Porphyrins collect in the liver and small quantity malarial pigment can also be deposited in macrophages and is excreted in the urine. Most of the patients have associated Inhaled Pigments 43 haemosiderosis with cirrhosis which may eventually develop the lungs of most individuals, especially of those living in into hepatocellular carcinoma. The skin photosensitivity with acute abdominal and neurological most commonly inhaled substances are carbon or coal dust; manifestations. These substances may produce occupational lung diseases called pneumoconiosis Lipofuscin or lipochrome is yellowish-brown intracellular (Chapter 17). The pigment particles after inhalation are taken lipid pigment (lipo = fat, fuscus = brown). It is seen in the myocardial fibres, in the interstitial tissue of the lung and in the respiratory hepatocytes, Leydig cells of the testes and in neurons in senile bronchioles and pass into lymphatics to be deposited in the dementia. In the heart muscle, the change is provoke low grade inflammation, fibrosis and impaired associated with wasting of the muscle and is commonly respiratory function. The pigment Ingested Pigments can be stained by fat stains but differs from other lipids in being fluorescent and having acid-fastness. The examples are as under: By electron microscopy, lipofuscin appears as intralysoso i) Argyria is chronic ingestion of silver compounds and mal electron-dense granules in perinuclear location. These results in brownish pigmentation in the skin, bowel, and granules are composed of lipid-protein complexes. Lipofuscin represents the collection of indigestible material ii) Chronic lead poisoning may produce the characteristic blue in the lysosomes after intracellular lipid peroxidation and is lines on teeth at the gumline. Unlike in normal iii) Melanosis coli results from prolonged ingestion of certain cells, in aging or debilitating diseases the phospholipid end cathartics. The lipofuscin pigment granules are seen in the cytoplasm of the myocardial fibres, especially around the nuclei. There is presence of abundant coarse black carbon pigment in the septal walls and around the bronchiole. The examples of injected pigments are prolonged use of ointments containing mercury, dirt left accidentally in a wound, and tattooing by pricking the skin with dyes. Autolysis can occur in the living body when it is surrounded by inflammatory reaction (vital reaction), but the term is generally used for postmortem change in which there is complete absence of surrounding inflammatory response. Autolysis is rapid in some tissues rich in hydrolytic enzymes such as in the pancreas, and gastric mucosa; intermediate in tissues like the heart, liver and kidney; and slow in fibrous tissue. Morphologically, autolysis is identified by homogeneous and eosinophilic cytoplasm with loss of cellular details and remains of cell as debris. A, Cell necrosis is identified irreversible cell injury in necrosis of all types (. Morphologically this condensation of nuclear chromatin and fragmentation of the cell into change is identified as homogeneous and intensely membrane-bound apoptotic bodies which are engulfed by macrophages. The common examples are infarct brain 45 cytoplasmic vacuolation or dystrophic calcification. This process is morphologically Grossly, the affected area is soft with liquefied centre seen as characteristic nuclear changes in necrotic cell. Morphologically, there are five types of necrosis: coagulative, liquefaction (colliquative), caseous, fat, and fibrinoid necrosis. This appearance is partly attributed to the histotoxic effects of lipopolysaccharides present in the capsule of the Grossly, foci of coagulative necrosis in the early stage are tubercle bacilli, Mycobacterium tuberculosis. With progression, they Microscopically, the necrosed foci are structureless, become more yellowish, softer, and shrunken. Eventually, occurring at two anatomically different locations but the necrosed focus is infiltrated by inflammatory cells and morphologically similar lesions. These are: following acute the dead cells are phagocytosed leaving granular debris pancreatic necrosis, and traumatic fat necrosis commonly in and fragments of cells (. Lique lipases from injured or inflamed tissue that results in necrosis faction or colliquative necrosis occurs commonly due to of the pancreas as well as of the fat depots throughout the ischaemic injury and bacterial or fungal infections. It occurs peritoneal cavity, and sometimes, even affecting the extra due to degradation of tissue by the action of powerful abdominal adipose tissue. The affected area on right shows cells with intensely eosinophilic cytoplasm of tubular cells but the outlines of tubules are still maintained. The interface between viable and non-viable area shows non specific chronic inflammation and proliferating vessels. The necrosed area on right side of the field shows a cystic space containing cell debris, while the surrounding zone shows granulation tissue and gliosis. Fat necrosis hydrolyses neutral fat present in adipose cells has the staining properties of fibrin. The leaked out free fatty acids immune complex vasculitis, autoimmune diseases, complex with calcium to form calcium soaps (saponification) Arthus reaction etc), arterioles in hypertension, peptic discussed later under dystrophic calcification. Grossly, fat necrosis appears as yellowish-white and firm Microscopically, fibrinoid necrosis is identified by deposits. Formation of calcium soaps imparts the necrosed brightly eosinophilic, hyaline-like deposition in the vessel foci firmer and chalky white appearance. Necrotic focus is surrounded by nuclear debris of Microscopically, the necrosed fat cells have cloudy neutrophils (leucocytoclasis) (. Local haemor appearance and are surrounded by an inflammatory rhage may occur due to rupture of the blood vessel. There is eosinophilic, amorphous, granular material, while the periphery shows granulomatous inflammation. The vessel appearance of adipocytes, coarse basophilic granular debris while the wall shows brightly pink amorphous material and nuclear fragments of periphery shows a few mixed inflammatory cells. Involvement of single cells or small clusters of cells in responsible for mediating cell death in a wide variety of the background of viable cells. The apoptotic cells are round to oval shrunken masses Physiologic Processes: of intensely eosinophilic cytoplasm (mummified cell) 1. Organised cell destruction in sculpting of tissues during containing shrunken or almost-normal organelles development of embryo. Normal cell destruction followed by replacement proliferation such as in intestinal epithelium. Cell death by cytotoxic T cells in immune mechanisms such as in graft-versus-host disease and rejection reactions. The nuclear chromatin is condensed or fragmented on the outer surface of apoptotic cell facilitates early (pyknosis or karyorrehexis). The cell membrane may show convolutions or projections appearance of inflammatory cells. Triggers for signalling program or loosely floating apoptotic cells after losing contact, with med cell death act at the cell membrane, either intra each other and basement membrane as single cells, or may cellularly or extracellularly. These include the following: result in major cell loss in the tissue without significant i) Withdrawal of signals required for normal cell survival change in the overall tissue structure.

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The intern likely reached for which of commonly tested for breast cancer to become the following medications A 44-year-old woman presents with worsening (E) O-negative donor and A-positive recipient fatigue for the past two months. Labo nodefciency disease suffers from chronic re ratory studies are signifcant for a hemoglobin current gastrointestinal infammation, which level of 8 g/dL and a mean corpuscular vol only moderately improves with cyclosporine ume of 110 fL. Which of the following is the most ac evaluation that showed a negative reaction to curate description of the function of folic acid Five experiments are conducted for each department with two weeks of abdominal sample, as shown in the image. The mother denies any nausea, vomit following pairs represents the blood types for ing, or fever in the child. She says the baby is crying more (D) Presenilin than usual, is vomiting, and does not want to (E) Tau eat. The tumor is Opening pressure: 240 mm H2O (normal: 100 centered at the pyloric zone just near the py 200 mm H2O) loric sphincter, on the lesser curvature. A 68-year-old man suffered from a resting neonates as mental retardation, unusual skin tremor and postural instability during his last ridging in the hands, fngers, and toes, and fve years of life. Estimates of world the image was observed during postmortem ex wide prevalence range from 1:100, 000 to amination. If a new genetic test were de netically linked to the disease from which this veloped that was positive in 99 neonates with man suffered A 35-year-old woman is brought to the emer gency department because of diffuse muscle contractions. By which of the following mecha nisms does this organism cause the symptoms associated with this disease A 20-year-old woman is referred to an endo at spinal synapses crinologist for lack of menarche. Laboratory studies show elevated levels of testosterone, estrogen, and luteinizing 22. Which of the (B) Elevated 17-hydroxyprogesterone following results would most likely be seen on (C) Excessive early gestational androgenic ex biopsy A newborn initially is healthy but begins to have bilious emesis and fails to pass meconium during the frst 48 hours of life. An emergent abdominal barium study is performed during this time and results are shown in the image. A 32-year-old woman with schizophrenia presents to the physician with amenorrhea and a milky discharge from both nipples. Laboratory results show an increased serum prolactin level, a de creased serum gonadotropin level, and a nor (A) Failure of neural crest cell migration mal thyroid stimulating hormone level. An 18-year-old woman is brought to the pe (A) Ceftriaxone diatrician by her mother because of changes (B) Cyclophosphamide in her behavior. The patient says she recently, citing for example that he has had feels fne and just wants to be left alone, but trouble remembering the names of his friends. She continues to per feeling depressed, and that he has recently lost form well in school and has few friends, but is a signifcant amount of weight. Which of the (B) Avoidant following are most consistent with his current (C) Borderline presentation A previously healthy 5-year-old boy is brought sulated yeasts in cerebrospinal fuid to the pediatrician with a three-day history of (C) Involuntary, dance-like movements of the sore throat, conjunctivitis, rhinitis, and cough. Blood was drawn from the four (A) Adenovirus men suspected to be the father (F1, F2, F3, (B) Coxsackie A virus F4) as well as from the mother (M) and the (C) Cytomegalovirus infant (C). A 40-year-old woman presents with progressive separated with gel electrophoresis and a South fatigue and bilateral joint infammation char ern blot analysis was performed. According to acterized by pain, swelling, warmth, and morn the Southern blot shown in the image, who is ing stiffness. On further questioning, she also complains 10 Kb of vaginal dryness and occasional hot fashes. A young couple presents to a fertility clinic, (D) F4 reporting that they have been attempting to conceive a child for 16 months without any 31. The 25-year-old wife has undergone ined in the neonatal intensive care unit, and hormonal analysis, and it has been determined shows a wide pulse pressure and a holosys that she menstruates normally and her follicles tolic and holodiastolic murmur. Karyotype following symptoms would the mother have analysis is performed, and reveals the presence experienced during pregnancy to increase the of an extra sex chromosome. After injection of the like to begin an antihypertensive agent but the anesthetic agent, the woman complains of pal patient refuses, fully understanding the risks, pitations and severe dizziness. What ethical principle discovered that the resident did not ensure that has priority in the treatment of this patient A 19-year-old woman with no signifcant past (E) Morphine medical history presents to her primary care physician for a sports physical. Comparing the oxygen-hemoglobin dissocia tion is notable for a brachial artery pressure tion curves in the image, which of the follow of 160/110 mm Hg and a weak femoral pulse. This woman is presenting with a congenital condi B tion that places her at high risk for bacterial endocarditis and which of the following other A conditions A defect in the synthe bin sis of which molecule likely accounts for these (B) An elevated concentration of adult hemo symptoms A 27-year-old woman is involuntarily commit (E) Elastin ted to a psychiatric ward. A 7-year-old girl with no signifcant medical motherapy for colorectal carcinoma develops history presents with a fve-month history of profound nausea and vomiting four hours af persistent weakness despite taking vitamins ter receiving treatments. Laboratory studies show hyponatremia, hypokalemia, (A) Acetylcholine antagonist metabolic alkalosis, and an increased plasma (B) Dopamine agonist renin level. Renal biopsy reveals juxtaglomeru (C) Norepinephrine reuptake inhibitor lar cell hyperplasia. A 15-month-old boy is brought to the pediatri (A) Acetazolamide cian by his parents because they have noticed (B) Furosemide that he has diffculty walking. On physical ex (C) Hydrochlorothiazide amination, the child exhibits a broad-based (D) Spironolactone waddling gait.


  • https://www.muhealth.org/sites/default/files/PDFs/MBS-Vertical.pdf
  • https://www.osha.gov/dts/sltc/methods/partial/pv2139/pv2139.pdf
  • https://plasticsurgery.stanford.edu/content/dam/sm/plasticsurgery/documents/education/microsurgery/FlapsSelectedReadings.pdf
  • http://www.ncpa.co/issues/APOCT15-CE.pdf

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