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These tumors secrete catecholamines, which cause episodic, malignant hypertension. The myocardium is considerably thicker in the ventricles, than in the atria, reflecting the needs of the ventricles to propel blood through pulmonary and systemic circulations. The most likely diagnosis is: A oesophageal rupture B perforated duodenal ulcer C aspiration pneumonia and empyema D pneumothorax with bronchopleural fistula E aspiration pneumonia and parapneumonic effusion 16. This is a longitudinal section of smooth muscle through the muscularis 309 externus of the colon. As they leave the bone marrow, neutrophils exhibit a horseshoe-shaped nucleus and are referred to as "band cells. Conditions associated with generalized edema include lymphatic obstruction secondary to filarial infestations of regional lymph nodes; decreased venous return to the heart due to congestive heart disease; increased capillary hydrostatic pressure; and loss of plasma protein (reduced oncotic pressure). For this reason, bones that develop via the intramembranous ossification pathway, such as flat bones of the neurocranium, appear relatively large. In this situation, other conditions-cardiac disease, or other drugs that change blood flow-may have more dramatic effects on clearance than disease of the organ of elimination. Finally, niacin decreases circulating fibrinogen and increases tissue plasminogen activator. Sympathetic ganglia are composed of clusters of large, multipolar neuronal cell bodies, with eccentric nuclei. The most appropriate additional treatment to recommend is: A long-term oral doxycycline B nebulised colistin or tobramycin 8. Novel developments in the epidemic of human immunodeficiency virus and tuberculosis coinfection. Disruption of either component of the autonomic nervous system results in the loss of pupil diameter regulation. Symptoms of these "mucopolysaccharidoses" depend on the particular enzyme that is deficient. Nitrites in the Treatment of Cyanide Poisoning Cyanide ion rapidly complexes with the iron in cytochrome oxidase, resulting in a block of oxidative metabolism and cell death. The 3 major forms of angina are (1) angina of effort, which is associated with a fixed plaque that partially occludes 1 or more coronary arteries; (2) vasospastic angina, which involves unpredictably timed, reversible coronary spasm; and (3) unstable angina, which often immediately precedes a myocardial infarction and requires emergency treatment. Cartilage plates and glands are no longer present in the walls of these bronchioles (shown in the image). Infection may arise distal to bronchial obstruction caused by a tumour or foreign body. Tunica vaginalis (choice D) and tunica vascularis (choice E) are investing layers of the testes. Although dyspnea can be induced by chemoreceptor activation alone, the other pulmonary (and systemic) receptors contribute, particularly to sensations of chest "tightness. Deviation of the septum transversum (choice A) causes congenital diaphragmatic hernia. Symptoms include a general muscle weakness affecting the myocardium, diaphragm, gastrointestinal tract, and skeletal musculature. In the limbs, the connective tissue is derived from lateral plate parietal (somatic) mesoderm. High doses of vasoconstrictors may worsen shock due to septicemia or myocardial infarction because cardiac reserve is marginal. These nonmotile organelles serve as molecular sensors that continuously monitor the flow of bile. Which of the following anatomic terms best describes the initial portion of a nephron Valves are characteristic features of medium-sized veins, in both superficial and deep veins. Which of the following is most likely to be required by a 5-year-old boy with chronic renal insufficiency In children younger than 8 years, demeclocycline (like other tetracyclines) causes bone and teeth abnormalities. In this isoform, the binding site for benzodiazepines is between an 1 and the 2 subunit.

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A thin layer of elastic tissue forms a boundary between the mucosa (choice D) and the submucosa. Skeletal muscle cells (image 1) form large-diameter fibers with peripheral nuclei. More evidence of both safety and efficacy will be required before the technique can be established as a component of clinical practice. These cells are themselves derived from pluripotent mesenchymal stem cells located in the inner layer of the perichondrium. The respiratory epithelium appears stratified, because the lining cells differ in height; however, all of the cells are attached to the underlying basal lamina. Antibodies (immunoglobulins) are subsequently delivered to the blood through the right lymphatic trunk or the left thoracic duct. The fluid then drains via collecting ducts in the hyperosmotic medullary interstitium. The adventitia is rather inconspicuous and blends with surrounding connective tissue. Which of the following drugs is the most effective in the emergency management of malignant hyperthermia Pralidoxime has a very high affinity for the phosphorus atom in organophosphate insecticides. Prototypes and Mechanism of Action Mannitol, the prototypical osmotic diuretic, is given intravenously. Which of the following most accurately describes the mechanism of action of clopidogrel The dangers of marijuana use concern its impairment of judgment and reflexes, effects that are potentiated by concomitant use of sedative-hypnotics, including ethanol. Mucous cells are filled with heavily glycosylated proteins that do not stain with H&E. Graded and quantal dose-response curves are being used for evaluation of a new antiasthmatic drug in the animal laboratory and in clinical trials. Which of the following best describes the structures that are indicated by the arrowheads Cholestasis is characterized by the presence of bile pigment in hepatocytes and the accumulation of bile "lakes" within dilated canaliculi. Describe the mechanism of selective depression by local anesthetic antiarrhythmic agents. These multipotential stem cells are themselves derived from pluripotential mesenchymal stem cells. The clinical signs of pneumothorax are reduced breath sounds and hyper-resonance on the side of the pneumothorax, but these may be difficult to detect. These mediators cause reperfusion injury and neurologic damage when circulation is restored after an ischemic event. There is often considerable overlap in the clinical features of the various vasculitic syndromes. Keywords: Psoriasis, hyperplasia 10 the answer is B: Accumulation of abnormal cells. This section also shows stratification of the theca folliculi that surrounds a secondary (antral) follicle. Reversible neurologic effects-Dose-dependent extrapyramidal effects include a Parkinson-like syndrome with bradykinesia, rigidity, and tremor. Metalworking fluid alveolitis, for example, has been described in workers in car manufacturing, caused by contamination of fluid used to cool and lubricate metals. The silicotic nodule consists of concentric layers of collagen surrounding a central area of dust, including quartz crystals and dying macrophages. Inhibition of renal prostaglandin synthesis reduces the efficacy of the thiazides. Compact bone (choice B) refers to the outer layer of mature dense bone tissue of a bone where the collagen fibers organize into parallel or concentric lamellae around blood vessels. Most complications associated with cholelithiasis are related to obstruction of the biliary tree.

Syndromes

• You have had an injury to your eye, or if you have a bulging eye or a drooping eyelid.
• To diagnose health conditions that lead to protein in the urine
• Diarrhea
• Breathing noises that may change with position and improve during sleep
• Are obese
• The space in the chest between two lungs (pneumomediastinum)
• Clotting blood

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Good asthma control for most patients does not depend on the latest, expensive, high-tech treatment; it depends on getting the basics right. Common examples of chemical antagonists are dimercaprol, a chelator of lead and some other toxic metals, and pralidoxime, which combines avidly with the phosphorus in organophosphate cholinesterase inhibitors. Toxic effects of penicillamine include gastrointestinal distress, myasthenia, optic neuropathy, and blood dyscrasias. In adults, bronchiectasis may complicate pneumonia resulting from virulent organisms such as Streptococcus pneumoniae, Staphylococcus aureus or Klebsiella pneumoniae. Opioid peptides are also found in the adrenal medulla and neural plexus of the gut. When hay is harvested and stored in damp conditions, it becomes mouldy and generates heat, which encourages the growth of fungi such as Thermoactinomyces vulgaris and Saccharoployspora rectivirgula. Dopamine-Dopamine causes vasodilation in the splanchnic and renal vascular beds by activating D1 receptors. None of the other types of cell division describe the behavior of germ cells within ovarian follicles during fetal development. Bronchi-Parenteral atropine has long been used to reduce airway secretions during general anesthesia. By contrast, milk proteins are released through a merocrine mechanism (choice E) in which small membrane-bound vesicles release their contents by fusing with the overlying plasma membrane. Haematogenous spread of infection results in early generalisation of disease, which may cause miliary tuberculosis and the lethal complication of tuberculous meningitis (particularly in young children). Thrombocytopenia can be treated by administration of platelets or oprelvekin, the recombinant form of the megakaryocyte growth factor interleukin-11 (see Chapter 33). Capillaries arising from the pulmonary arteries travel within these very thin interstitial spaces. The recognition, binding, and internalization of pathogens by phagocytes are greatly enhanced by coating the pathogens with specific plasma components, particularly immunoglobulins and the C3b fragment of complement. In addition to foreign particles, Kupffer cells internalize and degrade which of the following components of portal venous blood Insertion of an inferior vena caval filter prevents major emboli from reaching the lungs, and is indicated in these circumstances. Nitrates interact with sildenafil and similar drugs promoted for erectile dysfunction. Bromocriptine and cabergoline are used in hyperprolactinemia and off label to treat acromegaly. The most likely diagnosis is: A pneumonia B benign pleural thickening C asbestosis D mesothelioma E lung cancer 14. Unlike hyaline cartilage, articular cartilage does not have a superficial perichondrium. Its enzymatic action is markedly accelerated by the heparins System of serine proteases and substrates in the blood that provides rapid generation of clotting factors resulting in a fibrin clot, in response to blood vessel damage A protein complex on the surface of platelets. The deficiency is readily treated with oral or parenteral phytonadione (vitamin K1). A 3-year-old child has been admitted to the emergency department having swallowed the contents of 2 bottles of a nasal decongestant. Laboratory diagnosis Identification of Mycobacterium tuberculosis by laboratory tests can take some time and antituberculosis treatment may have to be commenced based on clinical and radiological features while awaiting the results. Tolerance may develop to nitrates and nitrites if endogenous thiol compounds are depleted. As a result, the mitochondria of the embryo and adult are derived from the ovum at fertilization. The fact that it also markedly increased pulse pressure suggests that it strongly increased stroke volume, a -agonist effect. Meperidine has also been implicated in the serotonin syndrome when used with selective serotonin reuptake inhibitors. Because cancer cells and embryonic cells express high levels of telomerase, reactivation of this enzyme is thought to enable these cells to escape senescence, proliferate, and maintain genomic stability. Sebaceous glands (choice C) are seen in the skin below the lip, and they are associated with hair follicles. A sweat flow rate of at least 100 l/min is required for accurate analysis and sweat chloride levels above 60 mmol/l on repeated tests are highly suggestive of cystic fibrosis.

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The major processes involved in pharmacokinetics are absorption, distribution, and elimination. Hematopoiesis also occurs in blood islands within mesoderm of the extraembryonic yolk sac. This tissue is highly cellular and contains capillary loops that provide nutrients and oxygen to the overlying epithelium. Effects of Other Drugs Coadministration of certain agents may alter the disposition of many drugs. Note that, except for blockers that start with the letter "c," blockers with names starting with letters "a" through "m" are 1 selective. By contrast, sympathetic fibers (choice D) cause relaxation of bronchial smooth muscle and increase airflow to the Respiratory System respiratory alveoli. Atopic individuals demonstrate positive reactions to antigens on skin-prick tests and have a high prevalence of asthma, allergic rhinitis, urticaria and eczema. Keywords: Seminoma, testicular cancer 36 the answer is E: Proliferation of epithelial cells. Echocardiography can assess the structure and dimension of the right heart chambers and the pulmonary artery pressure can be estimated from the velocity of the tricuspid regurgitation jet. It consists of a double-layered cellular sac surrounding a delicate capillary tuft, referred to as the glomerulus (choice B). Their cellular processes provide an efficient system for trapping pathogens and other foreign antigens that enter the body through the skin. Intestinal glands in the appendix and large intestine (choices A and C) lack villi and microvilli. The urethra extends from the internal urethral orifice in the bladder wall to the external urethral orifice located on the glans penis. Most patients with Paget disease remain asymptomatic, but some present with deformities, arthritis, and pain associated with nerve compression and bone remodeling. Ketamine this drug produces a state of "dissociative anesthesia" in which the patient remains conscious but has marked catatonia, analgesia, and amnesia. Nicotine and related neonicotinoids are used as insecticides despite reported toxic effects on bee colonies. Most epidemiological studies have also demonstrated an association with airway obstruction, independent of the effects of smoking. Half of men with intratubular germ cell neoplasia will develop invasive cancer. Long-term oxygen therapy Hypoxia within the lung leads to pulmonary vasoconstriction. The zona glomerulosa is composed of cords of epithelial cells that are continuous with cells of the zona fasciculata. Keywords: Ischemic heart disease, atherosclerosis 25 the answer is C: Endothelial cells. Drug Dose (mg) 5 10 20 50 100 200 Percent Responding to Drug X 1 5 10 50 70 90 Percent Responding to Drug Y 10 20 50 70 90 100 9. The thrombus typically develops in the deep veins of the legs and then travels to the lungs, causing obstruction of the pulmonary vasculature. Some newer techniques can be used to support patients with failing lungs whilst they await transplantation. Tumours in certain specific locations may cause problems by direct invasion of adjacent structures. What is the main site for regulated Ca2 reabsorption, and how is reabsorption controlled Dust exposure varies in different parts of a coal mine and is heaviest at the coalface. These prescriptions are costly and many are of no benefit to the patient whatsoever.

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The most common outcome of bacterial pneumonia is complete resolution, particularly with appropriate antibiotic treatment. Fenestrated capillaries (choices C and D) have many small windows (fenestra) that facilitate the diffusion of biological molecules across the endothelium. The high bicarbonate levels in these patients make them particularly susceptible to the action of carbonic anhydrase inhibitors. Muscarinic blockers can also be used to reduce cramping and hypermotility in transient diarrheas, but drugs such as diphenoxylate and loperamide (Chapters 31, 59) are more effective. Synthetic analogs of oxytocin are used clinically to initiate or accelerate the pace of labor and delivery. Opioid analgesics, benzodiazepines, and certain anticonvulsants (eg, gabapentin) are also used. Clonidine or propranolol may also be of value to suppress sympathetic overactivity. As noted, most older first-generation agents are sedating, and some-not all-first-generation agents have anti-motion sickness effects. Formation of type I collagen fibers in connective tissue involves intracellular procollagen synthesis, as well as extracellular assembly of collagen molecules into fibrils and fibers. Their main role in autonomic function appears to involve modulation of synaptic transmission. None of the other structures exhibit the morphology of afferent lymphatic vessels near the periphery of a lymph node. If a blocker were to be used for prophylaxis in this patient, what is the most probable mechanism of action in angina They have fibrillin gene mutations (choice D) that cause cystic medial necrosis in the tunica media (choice B). On the one hand, it is necessary to be alert to less well recognised presentations of asthma, such as cough without wheeze, and on the other, it is important to be prepared to review the evidence for asthma if the response to treatment is poor or if unusual features emerge. During blood coagulation, fibrinogen (a 340kDa glycoprotein) is converted to insoluble fibrin, forming an adherent intravascular clot (thrombus). The other structures are found in the tunica adventitia of large veins, but they do not show histologic features of smooth muscle fibers. Unfortunately, these selective pulmonary vasodilator agents have not been shown to reduce mortality. Oxygenated blood flows from the left atrium to the right, which is at slightly lower pressure. None of the other cells or tissues are known to regulate the patterning of skeletal muscles during embryonic development. The surgical pathologist directs your attention to waxy/lipid material filling the cytoplasm of secretory cells forming a sebaceous gland (shown in the image). Alkalinization of the urine by these drugs may cause precipitation of calcium salts and formation of renal stones. Biopsy of the skin lesion reveals numerous, benign vascular channels filled with erythrocytes. B cells within germinal centers (plasmablasts) give rise to mature plasma cells that secrete antibody. Maculae represent small areas of thickened neuroepithelial cells in the saccule and the utricle that sense the position of the head and its linear movement. Allele variants are denoted "*3," "*5," etc Representation of the alleles for a specific gene on both chromosomes of a pair. This may be measured by passing a special balloon-tipped pulmonary artery catheter. In obstructive sleep apnea (pickwickian syndrome), obesity is a major risk factor.

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On the other hand, drugs that induce hepatic drug-metabolizing enzymes (eg, rifampin) may result in plasma levels of the antiseizure agents that are inadequate for seizure control. Major waves (P, Q, R, S, and T) are labeled in each electrocardiographic record except in panel 5, in which electrical activity is completely disorganized and none of these deflections are recognizable. Lateral plate somatic mesoderm (choice B) forms the axial skeleton and soft tissues of the limbs. Columnar epithelial cells line the papillary ducts, which drain urine into minor calyces (visible in the image). Which of the following is a vasodilator that increases in the blood or tissues of patients treated with captopril The aetiology is unknown, but it appears to be the result of a failure of repair of lung tissue, whereby epithelial injury culminates in fibrosis rather than a controlled inflammatory and healing process. Keywords: Barrett esophagus, intestinal metaplasia 7 the correct answer is D: Muscularis mucosae. When discussing the diagnosis, it is essential to allow adequate time for questions, to ensure privacy during the interview, to encourage a relative or friend to accompany the patient for support and to have further counselling available from skilled nurses. A 62-year-old woman with advanced colon cancer is treated with intravenous 5-fluorouracil. Mesothelioma is a primary tumour of the pleura related to asbestos exposure (see Chapter 14). A deficiency of the other plasma proteins would not cause a familial bleeding disorder. Intravenous heparin may be preferred to subcutaneous heparin in patients with a massive pulmonary embolism or where rapid reversal of anticoagulation may be needed. None of the other ovarian follicles describe the morphology of secondary (antral) follicles. Keywords: Gonadal cords, testis-determining factor 5 the answer is D: Nuclear transcription factor. Laboratory studies show elevated serum levels of bilirubin (breakdown product of heme). Antibodies to chromogranins are used routinely to identify neuroendocrine neoplasms, such as neuroblastoma and pheochromocytoma. Two anteroposterior mucosal folds, vocal folds, project toward the lumen of the larynx (voice box). Accessory glands of the male reproductive tract include paired seminal vesicles, the prostate gland, and several bulbourethral glands. Extensions of the capsule form connective tissue trabeculae that penetrate the lymph node. In the liver, the portal vein (containing blood from intestinal capillaries) branches into a sinusoid capillary network between cords of hepatocytes. Levodopa and bromocriptine are not useful because dopamine receptors are blocked by the antipsychotic drugs. Nebivolol, a blocker with vasodilator effects approved for the treatment of hypertension, is investigational in heart failure. Treatment of malignant gliomas is hampered by P-glycoprotein, a transporter expressed by capillary endothelial cells that prevents cytotoxic drugs from reaching the tumor. Patients with DiGeorge syndrome exhibit agenesis (or hypoplasia) of the thymus and parathyroid glands, congenital heart defects, dysmorphic facies, and a variety of other congenital anomalies. During this reaction, the sperm plasma membrane fuses with the membrane of the acrosomal cap, thereby liberating acrosomal enzymes. Which of the following organelles initiates the assembly of microtubules in the axoneme of the sperm flagellum during spermiogenesis These connective tissue cells enlarge, store glycogen and lipid, and assume a compact epithelioid morphology (shown in the image). Mediators and cytokines regulate the inflammatory response and result in contraction of airway smooth muscle, increased permeability of blood vessels and mucus secretion.

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Peg cells are so named because they resemble tiny pegs pounded into the epithelium lining the uterine tubes. Concomitant use of certain opioids (eg, meperidine) with monoamine oxidase inhibitors increases the incidence of hyperpyrexic coma. Effect on Skin, Splanchnic Vascular Resistance - Skeletal Muscle Vascular Resistance Renal Vascular Resistance - Mean Blood Pressure Drug Phenylephrine Isoproterenol Norepinephrine a Heart Rate a a, b Compensatory reflex response. Five months later, she presents with profound lethargy, pallor, muscle weakness, failure of lactation, and amenorrhea. You explain that the seminiferous epithelium is divided into basal and adluminal compartments as a result of tight junctions between which of the following testicular cells Nicotine withdrawal can cause irritability, restlessness, anxiety, insomnia and a craving for cigarettes. Large doses of prilocaine may cause accumulation of o-toluidine, a metabolite that converts hemoglobin to methemoglobin. Trauma to localized minor salivary glands causes escape and accumulation of mucus in the surrounding connective tissue. Side effects include tremor and palpitations, but these are uncommon unless very high doses are used. The uterus is a highly muscular organ that provides a substrate for embryonic and fetal development. Bronchoscopy showed the primary tumour partly occluding the left lower lobe bronchus. After steady-state concentration in plasma has been achieved, the extraction ratio is one measure of the elimination of the drug by that organ. When the tumour is confined to one lobe, surgical resection is the treatment of choice. Questioning reveals that she has recently started taking "water pills" (diuretics) for a heart condition. Where there is persistent pain, analgesics need to be given regularly and prophylactically in advance of its return. This patient shows signs of Poland sequence anomaly, a rare congenital birth defect associated with underdevelopment of the chest muscles. Keratin (choice D) is an intermediate filament protein synthesized by epidermal cells of the skin, nails, and hair. A competitive antagonist has an effect illustrated by the shift of the agonist curve to the right. Naloxone is included in some formulations of these agonist-antagonist drugs to discourage abuse. Another effect seen with cholinomimetic drugs but not with parasympathetic nerve stimulation is thermoregulatory (eccrine) sweating; this is a sympathetic cholinergic effect (see Chapter 6). Clouding (opacification) of the lens obstructs the pathway of light to photoreceptors in the back of the eye, leading to vision loss. Focusing occurs when the energy created by eardrum movement is channeled through the stapes foot, which has a much smaller surface area. The decision as to whether anticoagulants should be continued in the long term is made later, based upon the results of subsequent investigations. Prototypes and Mechanism of Action Hydrochlorothiazide, the prototypical agent, and all the other members of this group are sulfonamide derivatives. The spongy urethra is, for the most part, lined by a pseudostratified epithelium; however, the epithelium in this specimen appears stratified. For example, smooth muscle is found in the gastrointestinal tract, blood vessels, urinary bladder, uterus, male/female reproductive tracts, and iris of the eye. Valproic acid may be effective in patients who fail to respond to lithium, and in some instances it has been used in combination with lithium. The darkly bluestained zone immediately surrounding chondrocytes is referred to as pericellular or capsular matrix. What is the mechanism by which glucose causes diuresis in patients with untreated diabetes mellitus

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Prevalence Asthma has been recognised since ancient times, and it is now estimated that 235 million people worldwide have the disease. M phase is divided into prophase, metaphase, anaphase, and telophase (see Question 1). Intravenous H2 blockers are useful in preventing gastric erosions and hemorrhage that occur in stressed patients in intensive care units. Hexamethonium (C6, a prototype), mecamylamine, and several other ganglion blockers were extensively used for this disease. Ichthyosis vulgaris is a relatively common, autosomal dominant genetic disease (afflicting 1/250). Acetaminophen is therefore useful as an aspirin substitute, especially in children with viral infections and in those with any type of aspirin intolerance. Under some conditions, these drugs may have some direct local anesthetic (sodium channel-blocking) effect in the heart, but this is probably rare at the concentrations achieved clinically. However, levels are also often elevated in other hospitalised patients, so that D-dimer assays can be used to exclude, but not to confirm, venous thromboembolism. Keywords: Ovaries, secondary oocytes, ovulation 18 the answer is A: Fertilization. None of the other biological processes describe the essential function of the macula densa. It seems likely that airway inflammation occurs when genetically susceptible individuals are exposed to certain environmental factors, but the exact processes underlying asthma may vary from patient to patient. In a routine tissue preparation, the podocytes always protrude into the urinary space in the Bowman capsule, as seen in this image. Because platelets lack the machinery for synthesis of new protein, inhibition by aspirin persists for several days until new platelets are formed. This system is so-named, because the filtrate flows in opposite directions in the two parallel limbs of the loop of Henle. Stem cells that populate the basal layer of the corneal epithelium and facilitate the healing of corneal abrasions originate from which of the following locations Clinical Uses and Toxicity Asthma (especially in children) was the most important use for cromolyn and nedocromil. These paired images contrast normal cardiac myocytes (image on left) with hypertrophic cardiac myocytes (image on right). Since there is no mechanism for the efficient excretion of iron, regulation of body iron content occurs through modulation of intestinal absorption. Most pulmonary emboli arise in the deep veins of the legs, but they may occasionally arise from thrombus in the inferior vena cava or the right side of the heart, or from indwelling catheters in the subclavian or jugular veins. These proliferative "burstforming units" are committed to which of the following pathways of stem cell differentiation Three semicircular ducts and two connected sacs (the saccule and utricle) comprise the vestibular labyrinth. If a drug is cleared partly by the kidney and partly by other routes, Equation 6 should be applied to the part of the dose that is eliminated by the kidney. Bloodborne infection may occur by intravenous injection of infected material by drug addicts. This slide was most likely colored using which of the following histochemical stains The corpus spongiosum surrounds the spongy urethra along the ventral surface of the penis. The binding curves will show pindolol binding starting at 100% of receptors and going to zero as albuterol concentration increases, with albuterol binding starting at zero and going to 100%. A 40-year-old woman has sporadic attacks of intense anxiety with marked physical symptoms, including hyperventilation, tachycardia, and sweating.

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Synthesis Active eicosanoids are synthesized in response to a wide variety of stimuli (eg, physical injury, immune reactions). Doubt may arise where it is difficult to obtain accurate peak flow or spirometry measurements, as in the case of young children. Keywords: Spleen, red pulp the arrow identifies 35 the answer is D: Myofibroblasts. The serous secretion of the von Ebner glands forms a continuous fluid flow that flushes material from the taste buds, so that taste buds can respond rapidly to new gustatory stimuli. Enlarged pulmonary arteries are a feature of pulmonary hypertension in chronic thromboembolic disease. They are derived from the bone marrow and are members of the mononuclear phagocytic system. Chylomicrons are exocytosed across the basolateral membrane and enter the lymphatic system. None of the other spaces/structures exhibit histologic features of capillaries in the kidney parenchyma. Conjunctiva (choice A) is the transparent mucous membrane covering the internal surface of the eyelids (palpebral conjunctiva) and the anterior part of the sclera (bulbar conjunctiva). Uterus-Ergot alkaloids produce powerful contraction in this tissue, especially near term. Blood vessels and hematopoietic stem cells originate from which of the following tissues/structures during embryogenesis A very powerful vasodilator is necessary to reverse ergotinduced vasospasm; nitroprusside is such a drug (see Chapter 11). The affinity of the receptor site within the sodium channel for the local anesthetic is a function of the state of the channel, whether it is resting, open, or inactivated, and therefore follows the same rules of use dependence and voltage dependence that were described for the sodium channel-blocking antiarrhythmic drugs (see Chapter 14). Once activated, T cells secrete a variety of cytokines that stimulate B-cell proliferation and differentiation. Cyclobenzaprine, a typical member of this group, is believed to act in the brain stem, possibly by interfering with polysynaptic reflexes that maintain skeletal muscle tone. Because cholinergic crisis can result in muscle weakness like that of myasthenic crisis, distinguishing the 2 conditions may be difficult. Toxicity Bleeding is the most important hazard and has about the same frequency with all the thrombolytic drugs. These cells may be divided into two main subsets on the basis of the profile of cytokines that they produce. Blood cell deficiency is a relatively common occurrence that can have profound repercussions. The parietal pleura is perfused by the systemic circulation, and the high systemic capillary pressure, negative intrapleural pressure and pleural oncotic pressure overcome the plasma oncotic pressure, resulting in fluid filtration into the pleural space. Collagen (choice A), elastin (choice B), and laminin (choice E) are extracellular matrix proteins. A rare interaction of succinylcholine with inhaled anesthetics can result in malignant hyperthermia (see Table 16-2). However, workers may be exposed to many agents and it can be difficult to know which is causing asthma. IgM (choice E) serves as an antigen receptor and is most efficient in fixing complement. Microvasculature supplying the outer retina constitutes a less pigmented layer, termed the choriocapillary lamina. Traditional descriptions of tuberculosis divide the disease into two main patterns, primary and post-primary tuberculosis, although these are mainly based upon the characteristic evolution of the disease in the days before effective chemotherapy. By the time of admission, however, the patient may have had progressive symptoms over a few days, with very little sleep. Which of the following is most likely to have adverse effects when used daily over long periods for severe asthma This barrier is composed of (1) capillary endothelial cells, (2) macrophages, and (3) type I epithelioreticular cells.

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Newborn screening Early diagnosis of cystic fibrosis allows specific treatment to be commenced rapidly, and this is associated with an improved prognosis. The transferrin-iron complex binds to transferrin receptors (TfR) in erythroid precursors and hepatocytes and is internalized. Although abortion resulting from the use of ergot for migraine is rare, most obstetricians recommend avoidance or very conservative use of these drugs as pregnancy progresses. Some patients show a significant asthmatic component, with reversible airway obstruction, and some develop colonisation of the bronchi by Aspergillus fumigatus and may show features of allergic bronchopulmonary aspergillosis (see Chapter 8). Withdrawal signs, which may include anxiety, tremors, hyperreflexia, and seizures, occur more commonly with shorter-acting drugs. Calculate loading and maintenance dosage regimens for oral or intravenous admin- istration of a drug when given the following information: minimum therapeutic concentration, minimum toxic concentration, oral bioavailability, clearance, and volume of distribution. Because bone undergoes constant remodeling, new osteons develop and older osteons become incomplete, forming interstitial lamellae (choice D). Ranitidine is a histamine antagonist but blocks the H2 receptor in the stomach and the heart, not H1 receptors in smooth muscle. Describe a therapy that reduces calcium excretion in patients who have recurrent urinary stones. The main clinical features are breathlessness, increased respiratory rate (>20/min), pleuritic pain, haemoptysis and sudden collapse. Lymph nodes filter the lymph, removing macromolecular antigens, and they provide a microenvironment for antigen-driven activation of B and T lymphocytes. Cardiac and skeletal muscles both exhibit cross-striations-their thick and thin contractile filaments exhibit the same organization (choices C, D, E). This patient shows signs of sympathetic autonomic failure: hypotension, inappropriate bradycardia, constricted pupils. An extensive duct/ channel system conveys salivary gland secretions to the oral cavity. The risk of a seizure is increased if the patient abruptly withdraws from ethanol use at the same time. Incomplete transformation of maternal spiral arteries by fetal cytotrophoblast results in flow inadequacy and release of fetal placental factors that damage the maternal vasculature. Treatment of schizophrenia-Antipsychotic drugs reduce some of the positive symptoms of schizophrenia, including hyperactivity, bizarre ideation, hallucinations, and delusions. Concerning the proposed mechanisms of action of antidepressant drugs, which statement is accurate The disorder affects sensory and motor functions and is characterized by exacerbations and remissions over years. Spermatogonial stem cells continuously generate spermatogonia that enter 228 Chapter 16 meiosis to form spermatocytes (primary and secondary), spermatids (early and late), and sperm. Toxicity of Nitrates and Nitrites the most common toxic effects of nitrates are the responses evoked by vasodilation. Within the jejunum and ileum, nutrients and vitamins are transported across the lining epithelium, where they enter vascular and lymphatic vessels. It also allows large doses of aerosol to be inhaled relatively efficiently (see text). Lipases and proteases degrade proteins and complex carbohydrates to amino acids and simple sugars, respectively. The adipose tissue functions as a cushion for the heart as it moves within the pericardial sac. Images generated from virtual microscopic slides contributed by the Thomas Jefferson University Virtual Slide Box Chapter 1 Questions 5, 6, 7, 11, 12, 13, and 15. The staging of this carcinoma is: A T1aN0M0 B T1bN0M0 C T3N1M0 D T1aN0M1 E T2N0M1 12. Keywords: Prostate cancer, adenocarcinoma of the prostate 37 the answer is D: Perinuclear halos. Without anticoagulants, blood removed from the circulation will clot spontaneously.