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    By D. Eusebio. Westmont College. 2018.

    However order yasmin 3.03mg line, many specialists have evidence to believe that rise in blood pressure with age is a price we have to pay for our lifestyle discount yasmin 3.03 mg amex, specially the high salt content of our diet. Some experts assert that if no 213 additional salt is added to our food throughout life, the blood pressure will stay constant throughout our life. Since this hypothesis cannot be widely tested on human beings at present stage of our civilization, we have to accept some rise in blood pressure as a part of the aging process. Although the change is gradual, and there is no sharp dividing line between the normal and high blood pressure, an arbitrary dividing line is required for clinical use. The arbitrary upper limits are 140 and 90 mmHg for systolic and diastolic blood pressure respectively. A mean arterial pressure greater than 110 mmHg under resting conditions usually is considered to be hypertensive. Adverse effects of hypertension The lethal effects of hypertension are caused mainly in three ways: (1) Excess workload on the heart leads to early development of congestive heart disease, coronary heart disease, or both, often causing death as a result of heart attack. It is known, however, that a number of factors interact in producing long-term elevations in blood pressure; these factors include: 214 Hemodynamic Neural Humoral Renal Arterial hypertension occurs when the relationship between blood volume and total peripheral resistance is altered. For many of the secondary forms of hypertension, these factors are reasonably well understood. For example, in renovascular hypertension, renal artery stenosis causes decreased glomerular flow and decreased pressure in the afferent arteriole of the glomerulus. Secondary hypertension Only 5% to 10% of hypertensive cases are currently classified as secondary hypertension- that is, hypertension due to another disease condition. The disease states that most frequently give rise to secondary hypertension are: 216 (1) Renal disease (2) Vascular disorders (3) Endocrine disorders (4) Acute brain lesion. Discuss the regulation of erythropoiesis Discribe the functions of different types of leukocytes Discuss leucopoiesis What are physiological responses in hemostasis? Discuss the balance of clotting and anti-clotting mechanism Describe conduction tissue of the heart and origin and spread of cardiac impulse Describe the events of cardiac cycle Discuss cardiac cycle:- Factors influencing cardiac output ; venous return; Factors influencing heart rate, myocardial contractility and stroke volume. Discuss the regulation of arterial blood pressure: Short term control; long term control; role of hormones. Acetylcholine esterase: enzyme present in motor end plate membrane of skeletal muscle that inactivates acetylcholine. Albumin: the smallest and most abundant plasma protein, which binds and transports water, insoluble substances in the blood and contributes predominantly to plasma colloidal osmotic pressure. Antibody: An immunoglobulin produced by a specific activated B-lymphocyte against particular antigen. Antigen: A large complex molecule that triggers a specific immune response against itself when it gains entry in to the body. Aortic Valve: A one-way value that permits flow of blood from the left ventricle in to the aorta during ventricular emptying but/prevents the back flow into the ventricle during ventricular diastole. Arterioles: the highly muscular high-resistance vessels the caliber of which can be altered to control blood flow to each of the various tissues. Atherosclerosis: A progressive degenerative arterial disease that leads to gradual blockage of affected vessel, there by reducing blood flow through them. Atrioventricular valve: Value that permits the flow of blood from the atria to the ventricle during filling of the heart but prevents back flow from the ventricles to the atria during the emptying of the heart. Atrium (Atria, plural): an upper chamber of the heart that receives blood from the veins and transfers it to the ventricle. Autonomic Nervous system: the portion of the different division of the peripheral nervous system that innervates smooth muscles and cardiac muscle and exocrine glands; composed of two divisions: the sympathetic and parasympathetic nervous system. Axon hillock: the first portion of a neuronal axon, the site of action potential in most neurons. Baroreceptor reflex: an autonomically mediated reflex response that influence the heart and blood vessels to oppose change in mean arterial blood pressure. Bundle of His: a tract of specialized cardiac cells that rapidly transmits an action potential down the interventricular septum of the heart.

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    Evaluation of penicillins purchase yasmin 3.03mg line, cephalosporins and macrolides for therapy of streptococcal pharyngitis order yasmin 3.03 mg amex. Penicillin for acute sore throat: randomized double blind trial of seven days versus three days treatment or placebo in adults. Penicillin V and rifampin for the treatment of group A streptococcal pharyngitis: a randomized trial of 10 days penicillin vs 10 days penicillin with rifampin during the final 4 days of therapy. Clindamycin in persisting streptococcal pharyngotonsillitis after penicillin treatment. Azithromycin versus cefaclor in the treatment of pediatric patients with acute group A beta-hemolytic streptococcal tonsillopharyngitis. European Journal of Clinical Microbiology and Infectious Diseases, 1998, 17(4):235–239. The role of the tonsils in streptococcal infections: a comparison of tonsillectomized children and sibling controls. Efficacy of tonsillectomy for recurrent throat infection in severely affected children. Oral penicillin may also be used as an alternative in secondary pro- phylaxis, but the greatest concern with oral administration is non- compliance, since patients often find it difficult to adhere to a daily regimen of antibiotics for many years (2). For those patients who are known to be, or are suspected of being, allergic to penicillin, oral sulfadiazine or oral sulfasoxazole represent optimal second choices (5). In the rare instance where patients are allergic both to penicillin and the sulfa drugs, or if these drugs are not available, oral erythro- mycin may be used (5). Note that while the sulfa drugs should not be used for primary prophylaxis, they are acceptable for secondary pro- phylaxis. Benzathine benzylpenicillin Benzathine benzylpenicillin is a repository form of penicillin G de- signed to provide a sustained bactericidal serum concentration. Early studies indicated that serum levels of penicillin remained above the 91 Table 11. Modified in part from (5) minimum inhibitory concentration for group A streptococci for 3–4 weeks (6). The reconstituted or lyophilized penicillin should be stored at temperatures not exceeding 30 °C and be protected from moisture. Although the activity of benzathine benzylpenicillin remains stable in the vial for several years if appropriately stored, the activity may be affected by the presence of preservatives (4). The physical properties of the solution, if not opti- mal, may also affect its degree of solubility and hence its absorption from the injection site, which can affect its bioavailability (7). Since preparations of benzathine benzylpenicillin are available from phar- maceutical manufacturers around the world, quality control proce- dures are necessary to ensure that the preparations have optimal absorption characteristics and that effective serum levels of penicillin will be maintained between injections. After deep intramuscular injection, peak serum concentrations are usually reached within 12–24 hours and effective concentrations are usually detectable for approximately three weeks in most patients and for four weeks in a smaller proportion (8). Since penicillin V is now as inexpensive as penicillin G, and since penicillin V is available in most countries, it is the preferred form of oral penicillin. Oral sulfadiazine or sulfasoxazole For a patient allergic to penicillin, oral sulfadiazine or sulfasoxazole are acceptable substitutes, unless the patient is also sensitive to sulfa drugs (5). The dose is either one gram daily or 500mg daily, depending on the weight of the patient (Table 11. Duration of secondary prophylaxis It is difficult to formulate “blanket” guidelines for the duration of secondary prophylaxis. For 5 years after the last attack, or until 18 years of age (whichever is longer). Patient with carditis For 10 years after the last attack, or at least until 25 (mild mitral regurgitation or years of age (whichever is longer). These are only recommendations and must be modified by individual circumstances as warranted with benzathine benzylpenicillin. The teenage years present a special problem with adherence to any prophylactic regime; special efforts should be made at this crucial period when the risk of recurrence remains relatively high. Finally, it should be remembered that even though patients have a prosthetic heart valve they remain susceptible to recurrences of rheumatic fever, but caution must be taken in recommending intramuscular benzathine penicillin G for patients with a prosthetic valve receiving warfarin or another form of anticoagulant. Penicillin allergy and penicillin skin testing The incidences of allergic and anaphylactic reactions to monthly benzathine penicillin injections are 3. The risk of a serious reaction is reduced in children under the age of 12 years, and the duration of prophylaxis does not appear to increase the risk of an allergic reaction (1–3). The overall incidence of hypersensitivity reactions has been estimated to be 2–5% (10).

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    Your experience will depend greatly on the residents you work with order 3.03 mg yasmin free shipping, the types of cases involved cheap yasmin 3.03mg on-line, and your interest level and motivation. In general, all of the residents are very excited about teaching medical students and clearly love their field. You can expect to learn a good deal about the induction of anesthesia, general anesthesia, local anesthesia, and the monitoring of physiologic functioning and how to respond to changes in those functions. Clinical experience is supplemented by a highly regarded lecture series covering important topics including local anesthetics, anesthesia risks, pain management and conscious sedation. They come in all formats, and they will all try to convince you that they will give you the best preparation for the shelf exam. All of us learn differently from each other and from you, so you will see quite a bit of variation among recommendations. In general, you will want to spend a good deal of time reading and reviewing, and will also want to do at least one book of practice questions. First, a general overview of the major series of review books: • First Aid o This series generally provides a good overview, covering the basics of the important topics related to the clerkship. The books are dense and full of detailed information; however, they are much more complete than Blueprints. Questions are arranged via topic and 63 explanations to questions are generally fairly complete, so doing the questions and analyzing the answers helps you learn the material. The book contains a couple of 50 question tests for each discipline and more for core rotations like medicine and surgery, and you would be wise to purchase this book and do the relevant questions for each rotation. Questions tend to be difficult, and several people noted that they could be damaging to confidence if done too close to the shelf. Probably unnecessary, but if you’re nervous before starting clerkship year this might be a good thing to flip through at Barnes and Noble. Particularly if you are on an inpatient medicine service in the 8 weeks prior to the test, it’s hard to find time to study. Keep in mind that it is nearly impossible to read the entirety of any of the three general medicine books because they are very long and you simply won’t have enough time. You are better off being selective about which topics require more coverage and using the textbook or online references only for these topics. Harrison’s Internal Medicine is available online through the Biomedical Library website at no cost, and is a fantastic reference when you need more information than you find in your review books. Doing at least one entire book and reading explanations thoroughly will take a good amount of time but is crucial for the medicine shelf. The questions are very similar to the shelf style, you can time yourself, and the explanations are very thorough. You can skim topics for the main points just before you know you’re going to be asked a question, and there is space for your own notes. Focus on medical problems requiring surgical intervention, anatomy, post-operative management/ complications in your reading. It is much more valuable to use your time making it through a review book than looking through a text book, but if you’re going into surgery you might eventually want one of these. Consider doing the medicine questions as well as the surgery questions as the content overlap between the two exams is quite high (60-80%). A few of the answers in the book are incorrect, so if you find a different answer elsewhere, don’t get stressed about it. Nelson’s is a huge book that is available online (from the biomed library page) and is useful for reading about specific patients/ topics. Baby Nelson is more readable; some people found it useful, most noted that it was not an efficient use of time. Whatever book you choose for review, make sure to supplement it with question books and/or Case Files. Ob-Gyn • Most of us recommended using one book for an overview in this course: o Blueprints: The Ob/Gyn part of this series is more detailed than most of the other Blueprints books are. The majority of people felt that this was sufficient for the shelf exam, with the addition of Case Files and a question book.

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    This ventro-dorsal "plate" of mesoderm contributes several structures including: the central tendon of diaphragm and some of the liver buy yasmin 3.03 mg fast delivery. The transverse septum has an important structural role in early embryonic development and is pierced by the gastrointestinal tract discount yasmin 3.03mg with visa. This surface depression lies between the maxillary and mandibular components of the first pharyngeal arch. Note: In humans, these cells and their secretion develop towards the very end of the third trimester, just before birth. Hence the respiratory difficulties associated with premature births (Newborn Respiratory Distress Syndrome, Hyaline membrane disease). The final functional sac of the respiratory tree occurs at the next neonatal period, where gas exchange occurs between the alveolar space and the pulmonary capillaries. Glossary Links A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z | Numbers | Original Glossary (http://embryology. The face has a complex origin arising from a number of head structures and sensitive to a number of teratogens during critical periods of its development. The related structures of upper lip and palate significantly contribute to the majority of face abnormalities. The head and neck structures are more than just the face, and are derived from pharyngeal arches 1 - 6 with the face forming from arch 1 and 2 and the frontonasal prominence. Each arch contains similar Arch components derived from endoderm, mesoderm, neural crest and ectoderm. Because the head contains many different structures also review notes on Special Senses (eye, ear, nose (http://embryology. The thyroid gland being one of the first endocrine organs to be formed has an important role in embryonic development. Early Face and Pharynx Pharynx - begins at the buccopharyngeal membrane (oral membrane), apposition of ectoderm with endoderm (no mesoderm between) Pharyngeal Arch Development branchial arch (Gk. During week 4 a series of thickened surface ectodermal patches form in pairs rostro-caudally in the head region. Recent research suggests that all sensory placodes may arise from common panplacodal primordium origin around the neural plate, and then differentiate to eventually have different developmental fates. These sensory placodes will later contribute key components of each of our special senses (vision, hearing and smell). Other species have a number of additional placodes which form other sensory structures (fish, lateral line receptor). Note that their initial postion on the developing head is significantly different to their final position in the future sensory system Otic placode in the stage 13/14 embryo (shown below) the otic placode has sunk from the surface ectoderm to form a hollow epithelial ball, the otocyst, which now lies beneath the surface surrounded by mesenchyme (mesoderm). The epithelia of this ball varies in thickness and has begun to distort, it will eventually form the inner ear membranous labyrinth. Lens placode lies on the surface, adjacent to the outpocketing of the nervous system (which will for the retina) and will form the lens. Head Growth continues postnatally - fontanelle allow head distortion on birth and early growth bone plates remain unfused to allow growth, puberty growth of face Skull Overview Chondrocranium - formed from paraxial mesoderm cranial end of vertebral column modified vertebral elements occipital and cervical sclerotome bone preformed in cartilage (endochondrial ossification) Cranial Vault and Facial Skeleton - formed from neural crest muscle is paraxial mesoderm somitomeres and occipital somites Calveria - bone has no cartilage (direct ossification of mesenchyme) bones do not fuse, fibrous sutures 1. Embryonic Primary palate, fusion in the human embryo between stage 17 and 18, from an epithelial seam to the mesenchymal bridge. This requires the early palatal shelves growth, elevation and fusion during the early embryonic period. As the tongue develops "inside" the floor of the oral cavity, it is not readily visible in the external views of the embryonic (Carnegie) stages of development. Contributions from all arches, which changes with time begins as swelling rostral to foramen cecum, median tongue bud Arch 1 - oral part of tongue (ant 3/2) Arch 2 - initial contribution to surface is lost Arch 3 - pharyngeal part of tongue (post 1/3) Arch 4 - epiglottis and adjacent regions tongue development animation | Development of the Tongue (http://embryology. Salivary Glands epithelial buds in oral cavity (wk 6-7) extend into mesenchyme parotid, submandibular, sublingual tongue muscle Abnormalities Cleft Lip and Palate 300+ different abnormalities, different cleft forms and extent, upper lip and ant. First Arch Syndrome There are 2 major types of associated first arch syndromes, Treacher Collins (Mandibulofacial dysostosis) and Pierre Robin (Pierre Robin complex or sequence), both result in extensive facial abnormalites. Treacher Collins Syndrome Pierre Robin Syndrome Hypoplasia of the mandible, cleft palate, eye and ear defects. Initial defect is small mandible (micrognathia) resulting in posterior displacement of tongue and a bilateral cleft palate. DiGeorge Syndrome absence of thymus and parathyroid glands, 3rd and 4th pouch do not form disturbance of cervical neural crest migration Cysts Many different types Facial Clefts extremely rare Holoprosencephaly shh abnormality Maternal Effects Retinoic Acid - present in skin ointments 1988 associated with facial developmental abnormalities Fetal Alcohol Syndrome Due to alcohol in early development (week 3+) leading to both facial and neurological abnormalities lowered ears, small face, mild+ retardation Microcephaly - leads to small head circumference Short Palpebral fissure - opening of eye Epicanthal folds - fold of skin at inside of corner of eye Flat midface Low nasal bridge Indistinct Philtrum - vertical grooves between nose and mouth Thin upper lip Micrognathia - small jaw Exposure of embryos in vitro to ethanol simulates premature differentiation of prechondrogenic mesenchyme of the facial primordia (1999) Fetal Alcohol Syndrome (http://embryology. Structures derived from Membranes At the bottom of each groove lies the membrane which is formed from the contact region of ectodermal groove and endodermal pouch.

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