Procardia

Richard John Jones, M.D.

• Director Bone Marrow Transplantation Program
• Professor of Oncology

https://www.hopkinsmedicine.org/profiles/results/directory/profile/0000814/richard-jones

Patients with this munosuppressant in transplant recipients and disease normally present with a nephrotic pic patients with autoimmune disease coronary heart disease icd 9 purchase procardia with a mastercard. Common ture of generalized edema due to massive loss adverse effects include alopecia arteries near the stomach 30 mg procardia overnight delivery, myelosuppres of albumin and other proteins cardiovascular consultants of nevada generic procardia 30 mg amex. Cyclophosphamide also can cause membranoproliferative glomerulonephritis capillaries gcse purchase procardia with amex, an renal tubular necrosis, but it is not associated uncommon autoimmune renal disorder that with tubulointerstitial nephritis. The diagnosis is based on a histologic frst-generation H1-antagonist used to treat al presentation that includes mesangial prolif lergic reactions, motion sickness, and dystonic eration and a tram-track appearance on light reactions. Isoniazid decreases the merulonephritis, an autoimmune disease most synthesis of mycolic acids and is used to treat frequently seen in children. It is associated with neuro sents a few weeks after a streptococcal infec toxicity, hepatotoxicity, a lupus-like syndrome, tion (throat or skin) with peripheral and peri and hemolysis in patients with glucose-6 orbital edema, dark, tea-colored urine, and phosphate dehydrogenase defciency. These symptoms are caused by is not associated with acute tubulointerstitial circulating anti-streptococcal antibody-antigen nephritis. This ziness, nephrogenic diabetes insipidus, acne, disease presents within several days of an edema, and hyperthyroidism, as well as many infection (as opposed to poststreptococcal glo others. Lithium has been associated with merulonephritis, which presents weeks after chronic tubulointerstitial nephritis, which infection) with a nephritic picture due to IgA presents after years of chronic lithium therapy. It is the most Proteinuria, hypertension, and anemia may be common global nephropathy, but it is a mild seen in these patients, along with other signs of disease with minimal clinical signifcance. This vignette de port syndrome, a heterogeneous (although scribes a nephrotic syndrome. Membranous glomerulo which leads to a nephritic renal disease and nephritis is an immune complex-mediated to sensorineural hearing loss and ocular disor disease. It is responsible for the fltra ics that specifcally limit calcium loss are the tion of plasma according to size, shape, and thiazides. There are no diuretics of the glomerular basement membrane, and that act at the glomerulus. Carbonic anhydrase in negatively charged heparan sulfate coating the hibitors, which act in the proximal convoluted fltration barrier prevents negatively charged tubule, do not affect calcium excretion. This patient has minimal in the loop of Henle (as well as the proximal change disease manifested by nephrotic syn convoluted tubule and collecting duct), but drome, in which the negatively charged hepa they do not affect ion channels. Loop diuretics, which encourage calcium excretion, act in the thick Answer A is incorrect. It is not and demeclocycline act along the collecting part of the glomerulus and is not affected in tubule, although neither class affects calcium minimal change disease. This patient is suf as previously mentioned, makes up part of the fering an acute overdose of amphetamine. However, it is in should be treated with ammonium chloride to tact in minimal change disease. This phenomenon, called membrane proteins that serve as cell adhesion ion trapping, occurs because increasing the molecules, allowing cells to adhere to the un ratio of ionized to non-ionized drug species in derlying extracellular matrix. In leukocyte ad the renal tubule allows more of the drug to be hesion defciency type 1, a defciency in b-2 retained in the urine and excreted. Weak bases integrin results in an inability on the part of in acidic environments have high ratios of ion leukocytes to adhere to the endothelium for ized species, which are water-soluble and do transmigration into the tissue, resulting in re not cross membranes. Integrins are not involved the levels of ionized amphetamine are high, in the glomerular fltration barrier and play no and therefore more of the drug is trapped in role in the etiology of minimal change disease. Alkalinization with bi collagen component of the basement mem carbonate is used to increase renal clearance brane and is not compromised in nephrotic of weak acids such as phenobarbital, metho syndrome. Naloxone is a treat that increased serum glucose in the mother is ment for opioid overdose. Trisomy 18, or Edwards scribed above is suffering from Potter syn syndrome, also can present with facial defor drome, a constellation of abnormalities in mities such as low-set ears and limb deformi cluding fattened facies, large and low-set ears, ties such as clenched hands. Instead, the syndrome, however, is that these fetuses have pathognomonic features of this syndrome are bilateral renal agenesis, which is incompatible micrognathia and a prominent occiput, along with life. As a result of bilateral renal agenesis, with the aforementioned anomalies in the the fetus cannot urinate. This patient is suf to maintain an adequate glomerular fltration fering from a severe metabolic acidosis, as rate. As a result, the fetus does not make urine indicated by low serum pH, a low plasma bi and oligohydramnios develops. It is defned as partial the anion gap is elevated at 20 mmol/L (nor or complete absence of the fetal brain or cra mal: 3-11 mmol/L). It can be diagnosed using is associated with elevated anion gap metabolic ultrasound to identify the neural tube defect. Aldosterone normally encephaly, because the fetus is unable to swal functions to increase sodium reabsorption, po low amniotic fuid. Polyhydram cause diminished proton excretion and meta nios refers to excessive amounts of amniotic bolic acidosis. Conditions that cause polyhydramnios acidosis would be expected to occur in the set include fetal malformations that impair swal ting of a normal anion gap. Polyhydramnios can be diagnosed are alkaline and operate by neutralizing the with ultrasound imaging, but determining the low pH of the stomach. Thus, overdose would etiology may require additional clinical work be expected to cause a metabolic alkalosis, not up. IgA nephropathy usu results in reduced respiratory drive and subse ally presents with a nephritic picture, which quent hypoventilation. In this situation, a res does not involve the massive proteinuria that is piratory acidosis would have been expected, seen in nephrotic syndromes. This patient has dif glomerulonephritis, which presents weeks af fuse cortical necrosis: generalized infarctions terward. Classically, patients present with a of the cortices of both kidneys, which is a com nephritic picture due to IgA deposition in the mon complication of disseminated intravascu mesangium. IgA nephropathy usually presents niotic fuid embolus and placental abruption, in children with recurrent hematuria that is and affected patients develop the abrupt on of minimal clinical signifcance. Nonlinear set of the triad of anuria, gross hematuria, and mesangial deposits of IgA are evident on im fank pain. Acute poststreptococcal that this patient has a new-onset pericardial glomerulonephritis is an autoimmune disease friction rub indicates uremia and makes dialy most frequently seen in children. Aggressive fuid sup and periorbital edema, dark urine, and protein port is not benefcial for kidney recovery after uria. These symptoms are caused by circulat the development of diffuse cortical necrosis. Aggressive fuid resusci membrane, leading to complement activation tation is contraindicated due to (1) the lack of and glomerular damage. The frst treatment should be dialysis of nucleic acid turnover, which is heightened to counteract renal failure and allow any re in the setting of cell destruction. Broad-spectrum anti with urease-positive microorganisms such as biotics are indicated in cases of shock due to Staphylococcus saprophyticus can form large sepsis. The man is going antibiotic that is renally metabolized should into hypovolemic shock due to hemorrhage. Failure to treat will result response is an increased heart rate and vaso in death. Calcium stones the kidney senses decreased volume and in are the most common cause of kidney stones creases renin production, which will lead to (80%-85%). The stones are made of cal dium and water by facilitating water reabsorp cium oxalate or calcium phosphate, and are tion in the distal collecting duct. Other risk factors are increased be increased in hypovolemic shock, not de vitamin D and milk-alkali syndrome. In a normal patient, re unlikely to be mistaken for ureters, and a full nin is secreted in response to low blood pres rectum would not cause peristaltic pain. Vasopressin levels will to cause fank pain, and pain would not come not be decreased in hypovolemic shock. Renal failure gastrointestinal symptoms of diarrhea, vomit is usually reversible when the drugs are discon ing, and abdominal pain.

What are the potential effects of a strong magnetic field in a patient with a pacer or implantable cardioverter-defibrillator The regions arrowed in the inversion recovery images from the patient in Question 6 heart disease lesson plans generic 30 mg procardia fast delivery. A 50-year-old female patient is referred to the cardiology clinic for complaints of substernal chest pain cardiovascular disease kidney failure purchase procardia online from canada. She has complaints of palpitations blood vessels visible in the posterior view of the heart buy procardia 30 mg visa, and a Holter monitor demonstrated premature ventricular complexes coronary heart zaps buy discount procardia 30mg. Stress-induced myocardial perfusion defect in the septum, anterior and inferior walls B. He has a history of hypertension and chronic smoking and his echo images were suboptimal. There is a slight gradient in X, Y, and Z planes (strength of magnetic field varies from slightly above to below 1. Coronary stents, heart valves, artificial joints, and vertebral plates are not contraindications. The seven unpaired electrons on Gd couple with excited water spins and hasten relaxation, thereby reducing T1. The other numbers indicate the following structures: 2, left ventricle; 3, left atrium; 4, right atrium; 5, descending thoracic aorta; 6, pulmonary vein. Its location in the atrial septum and the absence of a perfusion point to a lipomatous septum. The atrial septum is intact and bowing to the right, indicating high right atrial pressure. The descending aorta (behind left atrium) is normal (1: left ventricle; 2: right ventricle; 3: left pleural effusion). The dark area pointed by the arrows is a perfusion defect during first pass perfusion using Gd chelate. The perfusion defect is seen during vasodilator stress in the lateral wall as well as anterior and inferior walls and completely fills in during rest perfusion. Reversible perfusion defect indicates ischemia and not infarct, and extent indicates multivessel disease. Subendocardial scar indicates an infarct; involvement of inferior septum and inferior wall is consistent with right coronary artery lesion. Scar pattern in myocarditis may be patchy, midmyocardial, subepicardial, or even transmural. Note the heavily trabeculated left ventricle with noncompated to compacted myocardial thickness ratio of >2. The carina is shown well where the trachea branches into the right and left main bronchi. This patient has hypertrophy of his anterior septum and anterior and inferior walls. The upper septum is asymmetrically hypertrophied (arrow) and points more to hypertrophic cardiomyopathy. The short-axis mitral valve view shows a cleft of the anterior mitral valve (arrowed in Figure 6. Both the four and three-chamber views show transmural scar of the apex with a dark filling defect representing thrombus. The stented segment, which measured 30 mm, is clearly seen on both images in Figure 6. Stress-induced myocardial perfusion defect in the septum, anterior and inferior walls. With vasodilator stress there is lack of perfusion in the septum, anterior and inferior walls (dark areas), representing myocardial ischemia. The contrast-enhanced image of the aorta shows contrast in the true lumen (T), while the false lumen (F) does not enhance. This patient had a type A dissection and underwent ascending aortic repair including a hemiarch. Which of the following imaging procedures is likely to be associated with lowest radiation exposure Which of the following imaging procedures is likely to be associated with the highest radiation exposure Patient with a prior myocardial infarction followed by coronary artery bypass grafting D. Spatial and temporal resolution are affected by all of the following except which Which of the following techniques may be helpful for better coronary visualization for those with calcification To check for graft patency in a patient with chest pain after prior coronary artery bypass grafting E. There is severe aortic valve calcification and this may increase risk of coronary occlusion C. The coronary height and size of the sinus and sinotubular junction are not shown and these are important in planning D. Which of the following characteristics is associated with a potentially severe coronary artery stenosis A 35-year-old patient who had undergone a Bentall procedure 2 months earlier presented with chest pain. For left ventricle function assessment the left ventricle has to be opacified; scan should be gated and should have all phases. Dose modulation during prospective gating reduces radiation dose by about 40%, but prospective gating reduces by about 85%. Breast and skin get the highest radiation dose, and then lung, heart, and esophagus in descending order. Hence, compared with a pitch of 1, 3 is associated with a third of the radiation and a pitch of 0. In those with low blood pressure who may not tolerate either of these, ivabradine, which selectively slows the sinus node without lowering blood pressure, is an option. This will reduce radiation dose by about 40%, whereas A and B options reduce radiation dose by only 25%. This affects the amount of coverage during one cardiac cycle, but not temporal or spatial resolution. To reduce noise by half, you have to increase slice thickness fourfold, as noise is inversely proportional to the square of the number of photons. There is an interarterial course between the aorta and pulmonary artery (pulmonary artery not shown). Coronary calcification may impede lumen visualization, but coronary calcium score is not >400. This could be prospectively gated for midsystolic phase or retrospectively gated so that systolic phase can be reconstructed. Amount of calcification and length of aortic leaflets also have a bearing on potential to occlude coronary ostia. Note that the tip of the lead is beyond the right ventricle wall and in epicardial fat or beyond. This course has elevated risk of sudden death, though it is commonly found at routine autopsies. As the patient had syncope and is in a high-risk occupation, this is very justified. If he was asymptomatic, it is controversial what would be the best management, but most would lean toward coronary reimplant or a graft on the coronary. Reimplant may be associated with recurrent ostial stenosis of the left main coronary artery and needs close monitoring. A stress test would be reasonable if the patient was asymptomatic and had normal left ventricular function.

When arisgrade if 5 to 6 points cardiovascular system working with other systems order cheap procardia on line, high grade if 71 points ing centrally in bone coronary artery perforation buy procardia 30mg visa, these lesions have been associated A specifc cytogenetic abnormality has been described in with a 40% recurrence rate after simple curettage 5 arteries circle of willis buy 30mg procardia otc. Polymorphous Low-Grade Adenocarcinoma The presence of this translocation is associated with a relaPolymorphous low-grade adenocarcinoma was frst reported tively better prognosis irrespective of histologic grade coronary heart risk factors cheap 30 mg procardia fast delivery. Prognosis and Treatment Today, the term polymorphous low-grade adenocarcinoma Prognostic signifcance may be generally correlated to histois the accepted term for this entity. Low-grade mucoepidermoid from other salivary tumors, particularly the adenoid cystic carcinomas characteristically follow a benign clinical course; carcinoma, because of its distinct clinical, histomorphohowever, in some instances, low-grade lesions have metastalogic, and behavioral aspects. Clinical confrmation of the aggressiveness of sidered to be a low-grade malignancy with a relatively indohigh-grade carcinomas is generally evident within the frst lent course and lower risk of recurrence and metastasis 5 years after the initial treatment; local and distant metastacompared with adenoid cystic carcinoma. The incidence of source of the polymorphous low-grade adenocarcinoma is metastasis to cervical lymph nodes from mucoepidermoid believed to be reserve cells in the most proximal portion of carcinomas of the parotid gland (excluding low-grade lethe salivary duct. A 5-year survival rate of 95% or in this neoplasm, but only in low to moderate numbers. In Clinical Features follow-up periods extending to 15 years, the cure rate for this neoplasm occurs in the ffth through eighth decades of high-grade carcinoma drops to 25% or less. It accounts for 26% of all The prognosis of intraoral minor salivary gland mucosalivary carcinomas; more than 70% occur in patients beepidermoid carcinomas has been shown to be related to the tween the ages of 50 and 70 with a mean age of 59 years, and immunohistochemical demonstration of a universal cyclinit appears almost exclusively in minor salivary glands, the dependent kinase inhibitor, where low expression was repalate being the most frequently reported site (Boxes 8-19 lated to overall poorer prognosis, whereas expression of the and 8-20). Polymorphous low-grade adenocarcinomas typiproliferative marker Ki-67 was correlated with those histocally present as frm, elevated, nonulcerated nodular swelllogic factors that indicated a generally poorer prognosis, as ings that are usually nontender. The Treatment of low-grade mucoepidermoid carcinomas is slow growth rate is evidenced by the long duration, months typically surgical. Neurologic sympmanaged with surgery plus postoperative radiotherapy to toms usually are not reported in association with this tumor. Few cases reported Metastasis to local nodes is present at the time of diagnosis in approximately 10% of patients. Histopathology Absence of encapsulation together with infltrating streams of cells and a general lobular morphology characterize this group of low-grade adenocarcinomas. Infltration into the surrounding salivary gland and connective tissue is evident at low-power examination. In cases involving the hard palate or jaw-bone, extension into surrounding or adjacent bone may be noted. In most areas, the tumor is composed of a homogeneous population of cells with prominent, bland, uniform, and often-vesicular nuclei surrounded by minimal cytoplasm trabeculae and narrow cords. Tese cells are arranged in lobules, concentric arrangements of individual cells appear around as well as in solid nests. Cribriform structures bearing growth around small nerve twigs is evident in most cases a resemblance to adenoid cystic carcinoma may also but appears to have no clinical relevance. Tumor cells, often spindled, are also arranged in necrosis, and mitotic fgures are absent. With wide surgical excision, the recurrence rate is approximately 10%, and the overall survival rate is excellent. In patients who present with concurrent regional lymph node enlargement, neck dissection should be performed. The role of radiation therapy in the primary treatment of polymorphous lowgrade adenocarcinoma has yet to be fully assessed in the absence of regional nodal spread. This rare entity currently demonstrates minor salivary infltrating tumor composed of single-layered ducts. Important however, is the frequent presentation of metastasis to regional cervical lymph nodes with this entity compared with lowgrade polymorphous adenocarcinomas. Adenoid Cystic Carcinoma Adenoid cystic carcinoma is a high-grade malignancy that has a fair 5-year survival rate but a dismal 15-year survival rate. It is composed of duct-type epithelial cells and myoepithelial cells in variable patterns. Typically showing little cellular atypia and only rare mitotic fgures, it pursues an unrelenting course that defes most therapeutic measures. Clinical Features this lesion accounts for approximately 23% of all salivary gland carcinomas (Box 8-21). Approximately 50% to 70% of all reported cases of adenoid cystic carcinoma occur in minor salivary glands of the head and neck, chiefy of the palate. Most patients with adenoid cystic carcinoma are in the ffth through seventh decades of life, and no gender predilection has been noted. In the major salivary glands, the clinical appearance of a typically behaving adenoid cystic carcinoma is usually that of an infltrative, slow-growing unilobular mass that is frm on palpation, although with occasional pain or tenderness. Tese lesions are generally characterized by a slow growth rate; they are often present for several years before the patient seeks treatment. A helpAdults; palatal mass/ulceration ful diagnostic fnding is that polymorphous low-grade adeCribriform microscopic pattern nocarcinoma consistently shows a p631/p402 immunoSpread through perineural spaces phenotype in contrast to both adenoid cystic carcinoma Local recurrence and metastasis; lung. Bone invasion occurs often, initially without radiographic changes, because of infltration through marrow spaces. Distant spread to the lungs is more common than metastasis to regional lymph nodes. The lesion typically invades perineural spaces, leading to extension of neoplasm well beyond the primary mass. A common feature of intraoral lesions, particularly those arising on the palate, is ulceration of the overlying mucosa, a point often used to help distinguish this lesion clinically from the more common benign mixed tumor ure 8-49). Histopathology Tree basic histomorphologic patterns have been identifed: tubular, cribriform, and solid ures 8-50 to 8-56). The cribriform pattern is the best-recognized pattern and the prototypical one that typifes the tumor. The pseudocystic spaces contain sulfated mucopolysaccharides that are ultrastructurally characterized by multilayered or replicated basal lamina material. The tubular form is composed of smaller islands of cells with distinct duct-like structures centrally. The solid basaloid pattern shows little duct formation and is composed of larger islands of small to medium-sized cells with small, dark nuclei. Areas of central necrosis within solid clusters of cells may indicate a more aggressive form of disease. Treatment and Prognosis Regardless of the site of the primary lesion, surgery is regarded as the treatment of choice for adenoid cystic carcinomas. When the parotid glands are involved, wide resection in the form of a superfcial parotidectomy or superfcial and deep lobectomy is recommended, depending on size and tumor location. In the parotid region, the debate is whether the facial nerve should be spared; most investigators recommend resection if the tumor surrounds or invades this nerve. Radical surgical excision may be justifed to obtain surgical margins that are free of tumor. Radiation therapy has a role in the management of primary disease, as a postoperative modality, and in locally recurrent disease, but to be efective, the radiation felds must be wide, refecting the disseminated nature of the disease. Chemotherapy is generally regarded as inefective, although multiple-agent chemotherapy has shown some promise in the management of widely metastatic disease. The prognosis for patients with adenoid cystic carcinoma must be judged not in terms of 5-year survival rates, but rather, in terms of 15to 20-year survival rates. Factors that negatively infuence the prognosis include the presence of tumor at the line of surgical excision, tumor size greater than 4 cm, the presence of more than 30% of a solid pattern within the tumor, and the presence of facial nerve paralysis at initial presentation.

Elastic tissue 16) Nonsynthetic phase I reaction for drug detoxification is One answer only cardiovascular disease that causes the most deaths buy 30mg procardia fast delivery. Subrachnoid space 22) Which field of vision is last to go in chronic simple glaucoma Presenile dementia 12) Macrocytic anemia may be seen in: Choose 4 of the following options cardiovascular system labeling quiz discount procardia 30 mg with amex. Capitis 6) Most efficiently transmitted virus after needle prick is One answer only heart disease factors discount 30 mg procardia. Diphtheria has long incubation period 11) Heavy water is used for: One answer only heart disease vs heart attack generic 30mg procardia otc. Lateral wall 16) Cleft lip results from failure of fusion between: One answer only. Agar candida is present in normal faeces 13) Buprenorphine is partial agonis of: One answer only. Urethritis 19) One of the following drug does not increase teh serum level of theophylline One answer only. Ventricular tachycardia 11) A patient Chandu presents with eye deviated laterally and slightly downward. All of the above 12) In inter-segmental reflex, afferent is fromOne answer only. Prothrombin 18) After giving treatment for syphilis, the response to treamtment can be best assesse byOne answer only. Immobilizaion 19) In random sampling chance of being picked us isOne answer only. Kidney Liver Heart Spleen 3) Soft, friable node enlargement is seen in: One answer only. Typhoid Thaliasemia Syphillis Lymphoma 4) All of the following is correct about thromboxane A2, except: One answer only. To start bleedings To stop bleedings None Both 6) In which variant of Hodgkin disease lacunar cell is present: One answer only. Testis Lungs Liver Appendix 9) Hypertrophic cardiomyopathy left ventricular ejection fraction is: One answer only. Herpes Genitalis Herper Labialis Herper Gladitorum Zoster 12) Carrier stage of Hepatitis B Virus is for: One answer only. Sea weed African grass Wood portion of bee None of the above 14) Most common cause of renal Infraction is. Histamine Bradykinin Leukotrienes Platelet activating factor 17) Which of the following is not a primitive neuroectodermal tumours: One answer only. Neuroblastoma Glioblastoma Medulloblastoma All of the above 18) Feature of membranous glomerulonephritis is: One answer only. Urine sugar Glycosylatd Haemoglobin Glucose tolerance Post prandial blood sugar 21) Crescent formtion is seen in: One answer only. An electrocardiogram shows right atrial hypertrophy and a ventricular block pattern in the right chest leads. Pulmonic stenosis and a ventricular septal defect(tetralogy of fallot). Autism Micropenis Lax joints Large testes 13) A 2-year-old patient has microscopic and occasionally gross hematuria. D 20) In the newborn period which of the following is the least common sign on meningitis Vomiting Nuchal rididity Jaundice Hypothermia 21) When an infant with diarrhoea has lost about 5 to 10 prcent of his body weight over 2 days, all the following may be expected except for: One answer only. Moderate size fetus Gynecoid pelvis Weak uterine contractions Good levator ani muscle contractions 3) Current modes of investigation for infertility to check functioning of tubes are all of the following execpt: One answer only. Postpartum depression Postnatal blues Puerperal psychosis None of the above. Tansferrin level Serum ferittin level Haemoglobin level Iron binding capacity 6) Genital abnormality is seen in which of following ovarian tumors Lack of collateral circulation Shuting off of blood flow Decrease in arterial pulse pressure Increased capillary clotting 11) A 36-year old lady is in labour with 5 cm dilatation and fetal distress. Hysterectomy Conization Cryotherapy Laser ablation 13) A multiparous woman aged 40 years, presents with menorahagia and progressively increasing dysmenorrhoea. Pain appears after vaginal bleeding There is slight amount of bleeding No enlargement of uterus Histological examination of products of expulsion shows villi: 17) Dysfuctional uterine bleeding is said to present when there is bleeding due to: One answer only. To select a sample of 300 people to analyse food habits, ideal sample would be: One answer only. Simple random Inverse sampling Stratified random Systematic random 21) Engaging diam, in fully extended head: One answer only. Total Hysterectomy Vaginal hysterectomy Subtotal hysterectomy Abdominal Hysterectomy. Thelarche, puberche, growth, menarche Puberty, thelarche, menarche, growth Growth, thelarche, puberche 6) A lady presents with 16 weeks pregnancy with acute appendicitis. Sufficient estrogen Sufficient progesterone Normal ovarian function Intact endometrium Intact pituitary axis 11) In polycystic ovarian diseases, all of the following are seen except: Choose 2 of the following options. Friction Venous congestion Intercourse Trauma 20) A 35 year old woman with dysmenorrhea and menorrhagia of 6 months duration showed an enlarged uterus of 2o weeks which was tender, the possible diagnosis is: One answer only. If you own this account, you may login to this member account and use the service managers in the Members Area to edit and remove the violation from your service(s). Once you are certain that the problem has been resolved, contact the Support Center and our staff will be happy to review your changes and re-activate your account. You may have to register before you can post: click the register link above to proceed. I m not a member of this forum but i have been benefitting from this forum as a guest. Measurement of serum T-3 concentration should be done by radioimmunoassay for diagnosis of hyperthyroidism Increased in: Hyperthyroidism Certain drugs. Short stature, microcephaly, hypogenitalism, strabismus, anomalies of the thumbs, radii, and kidneys, mental retardation, and microphthalmia. Situs inversus, due to impaired ciliary motion during embryogenesis: lateral transposition of lungs, abdominal and thoracic viscera are on opposite sides of the body as normal. Dehydrogenase Dehydrogenase deficiency --> Treatment: Increase intake of Deficiency buildup of lactate and pyruvate --> ketogenic nutrients (leucine, lactic acidosis. Fibrillin Arachnodactyly, dissecting Dominant deficiency --> faulty scaffolding in aortic aneurysms, ectopia Disorders connective tissue (elastin has no lentis (subluxation of lens), anchor). Increased risk for tumors: pheochromocytoma, Wilms tumor, Rhabdomyosarcoma, leukemias. Associated with adenoma sebaceum (facial lesion), myocardial rhabdomyomas, renal angiomyolipomas. Von Hippel-Lindau Autosomal Autosomal Dominant, short arm of (1) Hemangioblastomas of Syndrome Dominant chromosome 3. Inability to Failure to thrive, infantile Metabolism convert galactose to glucose --> cataracts, mental Defect accumulation of galactose in many retardation. Angelman Syndrome Chromosomal Deletion of part of short arm of Mental retardation, ataxic chromosome 15, maternal copy. Low birth-weight, roundface, hypertelorism (wideset eyes), low-set ears, epicanthal folds. Will see associated risk) is translocation t(21, x) epicanthal folds, simian in a minority of cases. Prader-Willi Chromosomal Deletion of part of short arm of Mental retardation, short Syndrome chromosome 15, paternal copy. The cause of mental longer the number of repeats, the worse retardation next to Down the syndrome. Laxity of joints, Syndrome Tissue disease hyperextensibility of skin, Type-I: Autosomal dominant, poor wound healing, mildest form. Multiple fractures after Imperfecta tissue disease birth, blue sclerae, thin skin, progressive deafness in some types (due to abnormal middle ear ossicles). Type V) Disease utilize glycogen in skeletal muscle) -Myoglobinuria with > accumulation of glycogen in skeletal strenuous exercise. Glucose-6Severe fasting (Glycogen Storage Disease Storage Phosphatase deficiency (cannot break hypoglycemia, Type I) Disease down glycogen) --> accumulate hepatomegaly from lots of glycogen in liver and kidney. Chediak-Higashi Immune Defect in polymerization of Recurrent pyogenic Syndrome deficiency microtubules in neutrophils --> infections, Staphylococcus, Phagocyte failure in neutrophil migration and Streptococcus. Selective IgA Immune IgA deficiency may be due to a failure the most common Deficiency deficiency of heavy-chain gene switching.

Microscopically arteries meaning generic procardia 30 mg online, the cyst is lined by stratified squamous this is a deformity in which the head is bent to one side while epithelium and the cyst wall may contain thymic the chin points to the other side arteries ks2 order generic procardia pills. It may be present congenitally myositis capillaries in the lungs order procardia 30 mg visa, and contracture following burns or wound healing cardiovascular drugs 30 mg procardia with amex. It is usually the congenital or primary torticollis appears at birth or within multilocular and may extend into the mediastinum and the first few weeks of life as a firm swelling in the lower pectoral region. The etiology is unknown but about half the cases are associated with breech Microscopically, cystic hygroma is a diffuse lymphan delivery. Primary Tumours Secondary Tumours A few important examples of primary tumours in the neck Cervical lymph nodes are common site for metastases of a are carotid body tumour, torticollis and malignant large number of carcinomas. Carotid body thoracic and abdominal cancers such as of the stomach, lungs, tumour arises in the carotid bodies which are situated at the ovaries, uterus and testis. The oral cavity is the point of entry for digestive and vi) Hairy tongue is not a true developmental defect, but is respiratory tracts. The mucous membrane of the mouth mentioned here because of its similarity with other consists of squamous epithelium covering vascularised conditions discussed here. Sebaceous glands are present in the region of the lips and the buccal mucosa only. Lesions of the oral mucosa occur in many diseases of the the oral cavity is the site of numerous congenital and skin (Chapter 26) and they are similar in morphology. Besides, many systemic diseases have oral of these are listed as under: manifestations. A number of vesicular or bullous alone or in combination, are the commonest developmental diseases of the skin have oral lesions. In about half the cases oral lesions are symmetric, small, light yellow macular spots on the lips and the initial manifestations. Vesicles or bullae appear on oral mucosa They remain undeveloped until puberty but occur quite as well as on conjunctiva in pemphigoid and are seen more commonly in adults. Subepithelial vesicles may occur occurring in children and is characterised by symmetric, grey on the skin as well as mucosae. Histologically, there is iv) Stevens-Johnson syndrome is a rather fatal and severe pronounced intracellular oedema. There is no increased form of erythema multiforme involving oral and other malignant potential compared to leukoplakia discussed mucous membranes occurring following ingestion of sulfa below. Inflammation of the mucous membrane of ii) Microglossia and aglossia are rare congenital anomalies the mouth is called stomatitis. It can occur in the course of representing small-sized and absence of tongue respectively. The etiology is unknown but may be numerous small furrows or grooves on the dorsum of the precipitated by emotional factors, stress, allergy, hormonal tongue. Fungal: Candidiasis (oral thrush) Histoplasmosis ii) Herpetic stomatitis is an acute disease occurring in Cryptococcosis infants and young children. It is the most common Bacterial: Dental caries and periodontitis manifestation of primary infection with herpes simplex virus. Mycobacterial infections Viral: Herpetic stomatitis the lesions are in the form of vesicles around the lips. Recurrent attacks Human papillomavirus occur due to stress, emotional upsets and upper respiratory B. The lesions are Hairy leukoplakia Recurrent aphthous ulcers characterised by necrosis of the marginal gingiva and may extend on to oral mucosa, causing cellulitis of the tissue of the cheek. All types of pigmented naevi as well as disease developing at the angle of the mandible (Chapter 6). Exogenous Candidiasis (moniliasis or thrush) is caused by Candida pigmentation such as due to deposition of lead sulfide can albicans which is a commensal in the mouth. Acute glossitis characterised by swollen Benign and malignant tumours as also a number of tumour papillae occurs in eruptions of measles and scarlet fever. In like lesions and premalignant lesions are encountered in the chronic glossitis, the tongue is raw and red without swollen oral soft tissues. A list of such lesions is presented in papillae and is seen in malnutrition such as in pellagra, Table 19. Squamous papilloma iv) Oral lesions of the congenital syphilis are fissures at the 2. Hyperkeratotic leukoplakia associated with oral manifestations such as opportunistic 2. Dysplastic leukoplakia infections, malignancy, hairy leukoplakia and others; these D. The cyst wall contains sebaceous glands, sweat glands, hair follicles and other mature tissues. Therefore, majority of neoplasms arising from the oral tissues are just like their counterparts in other parts of the body. Papilloma can occur anywhere in the mouth and has the usual papillary or finger-like projections. Microscopically, each papilla is composed of vascularised connective tissue covered by squamous epithelium. Haemangioma can occur anywhere in the mouth; when it occurs on the tongue it may cause macroglossia. Cystic hygroma A number of proliferative lesions arising from the oral tissues is a special variety of lymphangioma occurring in children are tumour-like masses which clinically may resemble on the lateral side of neck. Fibrous growths of the oral soft Microscopically, lymphangioma is characterised by large tissues are very common. These are not true tumours (unlike lymphatic spaces lined by endothelium and containing intraoral fibroma and papilloma), but are instead lymph (Chapter 15). Although most common benign oral mucous membrane mass is fibroma appearing as a discrete superficial i) Fibroepithelial polyps occur due to irritation or chronic pedunculated mass, it appears to be nonneoplastic in nature. These are composed of reparative fibrous tissue, It probably arises as a response physical trauma (discussed covered by a thin layer of stratified squamous epithelium. Giant cell epulis is a variant seen more commonly in females as reactive change to trauma; the lesion shows numerous osteoclast-like giant cells and vascular stroma. The lesion is an inflammatory hyperplasia in response to local irritation by ill-fitting denture or an elongated tooth. This is an elevated, bright red swelling of variable size occurring on the lips, tongue, buccal mucosa and gingiva. Also called mucous cyst or retention cyst, it is a cystic dilatation of the mucous glands of the oral mucosa. The cyst often ruptures on distension and incites inflam matory reaction due to mucous extravasation (. It occurs more frequently in males than 525 fibrous connective tissue covered by stratified squamous females. Therefore, it salivary glands present in the oral cavity may sometimes be is desirable that all oral white patches be biopsied to exclude the site of origin of salivary tumours similar to those seen in malignancy. It has the strongest association with the use of tobacco in myoblastoma, it is benign tumour which now by electron various forms. The most common location is the tongue and in those who chew tobacco as in paan, paan masaala, but may occur in any other location on the oral cavity. A similar lesion seen in infants such as smokers keratosis and stomatitis nicotina. Grossly, the lesions of neurilemmoma, neurofibroma, lipoma, giant cell granuloma, leukoplakia may appear white, whitish-yellow, or red rhabdomyoma, leiomyoma, solitary plasmacytoma, osteoma, chondroma, naevi and vascular oral lesions seen in hereditary velvety of more than 5 mm diameter and variable in haemorrhagic telangiectasia (Osler-Rendu-Weber syndrome) appearance.

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