Department of Urology University of North Carolina?hapel Hill
Symptoms associated with it like fever and diarrhea are normal and self limiting unless any other causes can be established best erectile dysfunction pills 2012 effective levitra oral jelly 20 mg. The following conditions usually are associated with tooth eruption and should be referred to dental personnel: eruption cysts erectile dysfunction walgreens purchase 20mg levitra oral jelly amex, gingival cysts of the newborn and pre/natal teeth erectile dysfunction injection discount 20mg levitra oral jelly free shipping. Deciduous/primary teeth should be left to fall out on themselves unless the teeth are carious or there is any other indication impotence blood pressure cheap levitra oral jelly 20mg otc. Parents should be counseled accordingly and be instructed to assist their children to loosen the teeth the already mobile teeth and when there is no success or the permanent teeth are erupting in wrong direction should consult a dentist. Diagnosis There are several forms of malocclusion Class 1 the sagittal arch relationship is normal. The anterior buccal groove of the lower permanent molar should occlude with the anterior buccal cusp of the upper first permanent molar. Treatment Rationale for treatment: Reduce possibility of temporomandibular joint pain dysfunction syndrome especially in case of cross bites Reduce risks of traumatic dental injuries especially in overjet Traumatic occlusion and gum diseases and caries especially in crowing Avoid psychosocial effects resulting from to lack of self esteem, self confidence personal outlook and sociocultural acceptability Removable orthodontic appliances are those designed to be removed by the patient then replaced back. They are very useful in our local settings especially for mild to moderate malocclusion in teenagers. Appliances for active tooth movement fall into two groups Simple removable appliances which have mechanical a component to move the teeth Myofuctional appliances, which harness the forces generated by the orofacial muscles. Passive removable appliances may also save two functions: Retainers used to hold the teeth following active tooth movement Space maintainers, used to prevent space loss following the extraction of teeth. Fixed orthodontic appliances (braces) are useful in malocclusion which have resulted in relapses of failure after use of removable appliances and moderate to severe malocclusion which can not be managed by removable appliances especially adult patients. Adolescents and adult patients requiring fixed appliances should be referred to an orthodontist. The commonest causes are alls (in sports and play) at home or school and motor accidents. Table 1: Diagnosis Type Tooth Concussion Subluxation Luxation Intrusion Avulsion Presentation Injury to supporting tissues of tooth, without displacement. Often accompanied by fracture of alveolar bone Complete loss of the tooth from the socket Soft tissue injuries Abrasion: does a friction between an object and the surface of the soft tissue cause a wound. This wound is usually superficial, denudes the epithelium, and occasionally involves deeper layer. Contusion: is more commonly called a bruised and indicates that some amount of tissue disruption has occurred within the tissues, which resulted in subcutaneous or sub mucosal hemorrhage without a break in the soft tissue surface. It is perhaps the most frequent type of soft tissue injury, is caused most commonly by a sharp object Treatment Give tetanus toxoid (0. Medication prescribed for elimination of pain; give analgesic (paracetamol or diclofenac or ibuprofen). Antibiotic cover in cases of suspected contamination or extensive damage (Amoxicillin (oral) 500 mg 8hrly for 5 days). Extraction is treatment of choice for significantly traumatized primary/deciduous teeth with mobility and or displacement. Refer to a dentist, where available orthodontics or endodontic specialist depending on the need of advanced treatment Note: Referral to oral and maxillofacial surgeon is done to patients with complicated maxillofacial injuries. Prevention Proper design of playing grounds, observe road traffic rules, early orthodontic treatment 12. Benign soft tissues non-Odontogenic tumors Papilloma, Fibroma, Fibrous Epulis, Peripheral Giant Cells, Pregnancy Tumors, Hemangioma, Lymphangioma, Lipoma and Pigmented nerves Treatment: Tumors enucleation or excision in the treatment of choice depending on the type. Can be hemimandibulectomy, total mandibulectomy, hemimaxillectomy or total maxillectomy Note: the tumors or oral and maxillofacial regions are of wide range and variable presentation, a dental surgeon is trained in identification and diagnosis. Treatment of most of these condition need expertise of oral and maxillofacial surgeon and patients should be referred early enough Malignant soft and bone tumors Squamous cell carcinoma, Sarcoma, Lymphosarcoma, Myosarcoma, Chondrosarcoma, Fibrosarcoma, Adenosarcoma, Adenocystic carcinoma and Epidermoid carcinoma. This can be through hematogenous spread as septic emboli from the gut wall or sub diaphragmatic abscess rapture into the pleural space or pericardium. Infective cysts can be found in fecally contaminated food and water supplies and contaminated hands of food handlers. Sexual transmission is possible, especially in the setting of oral-anal practices. Treatment Drug of choice: A: Metronidazole; Adult 400-800mg (O) 8 hourly for 10 days. Aspiration of the abscess may be necessary if there is evidence of impending rapture or a possibility of pyogenic abscess. In few cases malabsorption syndrome may occur Extra intestinal manifestations are rare and include allergic manifestations such as urticaria, erythema multiform, bronchospasm, reactive arthritis, and biliary tract disease Investigation: Microscopic stool examination of Giardia intestinalis trophozoites or cysts of infected patient, sensitivity increases on serial 3 samples examination. Indicatively: 1-3 years 500mg/day; 3-7 years 600-800 mg/day; 7-10 years 1g/day for 3 days. Diagnosis Most patients are asymptomatic When symptoms occur, they are divided into 2 categories: early (larval migration) and late (mechanical effects) In the early phase (4-16 days after egg ingestion): Fever, Nonproductive cough, Dyspnea, Wheezing. In the late phase (6-8 weeks after egg ingestion): Passage of worms (from mouth, nares, anus); diffuse or epigastric abdominal pain, nausea, vomiting; pharyngeal globus, "tingling throat" frequent throat clearing, dry cough; complications - biliary and intestinal obstruction, appendicitis, pancreatitis and malnutrition. It is one of the main causes of anaemia in the tropics which is also the major clinical feature. Diagnosis the majority of patients are asymptomatic 38 P a g e the major clinical manifestations are iron deficiency anemia and hypoalbuminaemia. The most common and clinically important pathogenic species in humans is S stercoralis. Distinctive characteristic of this parasite is its ability to persist and replicate within a host for decades while producing minimal or no symptoms in individuals with an intact immune system and its potential to cause life-threatening infection (hyperinfection syndrome, disseminated strongyloidiasis) in an immunocompromised host associated with high mortality rates. During chronic uncomplicated infections, the larvae may migrate to the skin, where they can cause cutaneous strongyloidiasis, known as larva currens because of the quick migratory rate of the larva. The intestinal infection is usually asymptomatic but patients may have vague symptoms such as abdominal pain, nausea, flatulence, vomiting, diarrhea and even epigastric pain. In malnourished children, strongyloidiasis remains an important cause of chronic diarrhea, cachexia, and failure to thrive. Children give the same dose same as for adults Note: Tablets must be chewed Alternatively A: Albendazole: Adults 400mg (O) 12 hourly for 3 days, the medicines may be repeated after 3weeks. Children over 2 years give 15mg/kg/day in 2 divided doses for 3 days (7-10 days for disseminated infection) Note: Provide antibiotic therapy directed toward enteric pathogens if bacteremia or meningitis is present or suspected Provide supportive treatment as indicated (eg, intravenous fluids if volume depletion, blood transfusion if gastrointestinal or alveolar hemorrhage, mechanical ventilation if respiratory failure) Symptomatic treatment should be initiated 40 P a g e Pruritic dermatologic manifestations should be treated with antihistamines Inhaled beta-agonists may improve wheezing 1. Less commonly cestode includes Diphyllobohrium latum (poorly cooked fish) and Hymenolepsis nana (fecal oral contamination by both human and animals especially dogs). Diagnosis Most tape worm infections are symptomless the commonest way of presentation is the appearance of proglottides or segments in the stool There may be mild epigastric discomfort, nausea, weight loss and diarrhea More specific features depend on the type of the parasite Laboratory Diagnosis: Macro and Microscopic stool examination for ova and parasites. It is indicated for some of the cestodes that release eggs or worm segments directly into the stool. Children 2-6 years, 1g as a single dose after a light meal, followed by a purgative after 2 hours; Children under 2 years, 500mg as a single dose after a light meal, followed by a purgative after 2 hours 41 P a g e For Hymenolepsis nana Adult and children over 6 years C: Niclosamide 2g as a single dose on the first day, then 1g daily for 6 days. Children 2-6 years C: Niclosamide 1g on the first day as a single dose, then 500mg once daily for 6 days. Latum Adults and children over 2 years C: Niclosamide 5- 10mg/kg as a single dose. A: Albendazole 400mg every 12 hours is recommended for 1-3 months before surgical intervention. Note: Administer parenteral vitamin B-12 if evidence of vitamin B-12 deficiency occurs with Diphyllobothrium infections Tablets should be chewed thoroughly before washing down with water. Diagnosis the clinical manifestation and duration of illness vary markedly from one patient to another 42 P a g e the major clinical features are fever, severe headache, drowsiness and muscle pains (myalgia) the course of paratyphoid tend be to shorter and less severe compared to typhoid Untreated, typhoid fever is a grueling illness that may progress to delirium, obtundation, intestinal hemorrhage, bowel perforation, and death Survivors may be left with long-term or permanent neuropsychiatric complications. Laboratory diagnosis: the diagnosis of typhoid fever (enteric fever) is primarily clinical. Culture is the criterion standard for diagnosis of typhoid fever with 100% specificity. Culture of bone marrow aspirate; blood and stool cultures should be done within 1 week of onset. Chloramphenicol is contraindicated in the third trimester of pregnancy; it may also cause aplastic anaemia which is irreversible. Infection is through the larval forms of the parasite which is released by freshwater snails. Some of the eggs are passed out of the body in the feces or urine to continue the parasite life-cycle. Others become trapped in body tissues, causing an immune reaction and progressive damage to organs.
The move has been informed by the realisation that what is conceived and conceptualised for particular contexts in the Western world may not necessarily produce similar effects in other settings erectile dysfunction and diabetic neuropathy cheap levitra oral jelly 20 mg otc. This is due to differences in cultural orientations impotence vs impotence generic 20mg levitra oral jelly with visa, different development stages that imply different sets and magnitudes of social problems erectile dysfunction organic causes buy cheap levitra oral jelly 20mg on-line, as well as differing social erectile dysfunction doctors long island levitra oral jelly 20mg visa, economic, political, and spiritual realities. All these demand locally relevant knowledge, theoretical bases, models, and approaches. The United Nations Declaration on the Rights of Indigenous Peoples (United Nations, 2007) unequivocally recognises that respect for indigenous knowledge, cultures and traditional practices contributes to sustainable and equitable development and proper management of the environment. Spitzer and Twikirize (2014) similarly assert that locally relevant cultural practices, indigenous knowledge systems, and African ethical concepts are very important elements for the success of any social work intervention on the African continent. Many authors have sustained the discourse of indigenisation and kept it on the agenda for social work and social development in Africa. Walton and Abo El Nasr, 1988; Osei-Hwedie, 1993; Mupedziswa, 2001; Gray and Coates, 2008; Gray, Coates and Yellow Bird, 2008; Gray and Coates, 2010; Rankopo and Osei-Hwedie, 2011; Kreitzer, 2012; Twikirize, 2014; Spitzer, Twikirize and Wairire, 2014; Spitzer, 2017). Such gaps emanated from a type of social work education that paid little attention to local knowledge systems and indigenous approaches to problem solving. The quest for indigenisation has also become evident in two recent social work conferences on the African continent. The theme of this conference was Professional Social Work and Sustainable Development in Africa. It was clear that social work cannot effectively contribute towards sustainable social development in Africa, when it is still struggling to find its own domesticated identity. Another conference held in South Africa in 2017 had been exclusively devoted to the theme Rethinking Social Work in Africa: Decoloniality and Indigenous Knowledge in Education and Practice. Generally, the process of developing indigenous knowledge and cultural competence cannot just start with practice but rather with research and education that aim to integrate these knowledges and practices into the mainstream, teach them in the classroom, and competently apply them in practice. The research referred to in this volume as well as the publication itself is an attempt to move towards closing some of these gaps. This chapter provides a general discussion on indigenisation and the importance of researching, analysing, documenting, and mainstreaming indigenous and innovative approaches of helping, healing, and problem solving, thus referring to some empirical evidence of a study conducted in the East African countries of Burundi, Kenya, Rwanda, Tanzania, and Uganda. A brief discussion on practice research as a critical element in indigenisation is provided and the specific methodologies and approaches used in the study upon which most of the chapters of this book are based are laid out. The chapter ends with a mapping of what the reader should expect in the subsequent chapters. As far back as the 1970s, educators in Africa recognised the need to make social work more responsive to the contexts and specific needs of communities, groups, individuals, and development agendas in Africa. It set the stage for social work educators to consider local and regional issues and make the profession relevant to African settings. The authors argue that besides the bid to rid social work of its Eurocentric values and cultural norms, the broader post-colonial political Africanisation movement called for the construction of scholarly knowledge based on African cultures and values in post-independence Africa. In the perspective of social work, the move towards indigenisation and the adoption of culturally appropriate models and knowledge has had to grapple with such challenges. In the context of an education largely informed by the colonial heritage and still attached to the trappings of Western development aid as well as the forces of modernisation and globalisation, there are predominant voices across different population groups in Africa, including the elite, that conspicuously consider Western culture, knowledge and ways of knowing as superior, and, hence, promote these at the expense of their own cultural heritage. Twikirize, 2014) have questioned whether some aspects of social work practice, particularly in East Africa, have been consciously or sub-consciously indigenised or contextualised to suit local realities. Twikirize (2014) raises the issue of the extent to which seemingly localised or indigenised models of 4 Social Work Practice in Africa: Indigenous and Innovative Approaches practice fairly adopted by grassroots community development organisations have found their way into social work curricula. The key argument was that what is relevant to the people of Rwanda was the only means and way of developing Rwanda rather than adopting external models, theories, and practices (Kalinganire and Rutikanga, 2015). In this regard, a number of traditional and innovative models of social development were adopted and mainstreamed into national development plans, poverty reduction papers, and other critical social policies, such as those that relate to the care of orphans and vulnerable children. Such models were also strongly promoted in the post-genocide transitional justice system to rebuild Rwandan society. One argument for not paying much attention to such practices and knowledge might be the lack of scientific study and documentation of these practices. Hence, because there was no authoritative text on such models, they were hardly, if ever, taught and/or discussed in the lecture room. Another argument could be that what is local and traditional is considered common knowledge and can all too often be bypassed until another person, external to the environment and practice, who views it as a novelty, brings it up. Proponents argue that the continued adoption of Western theory, philosophy, and models is in fact inseparable from neo-colonialism that transcends all spheres of society rather than simply leaving its marks in education, social work, or social development practice. Criticism and resistance in this regard have also been empirically documented on the part of ordinary citizens (Thomson, 2013). Indigenous and Innovative Social Work Practice: Evidence from East Africa 5 strings attached, serve as examples of a neo-colonial agenda that potentially keeps the countries and peoples of the Global South in subordination to the Global North (Gray, Kreitzer and Mupedziswa, 2014). In light of the need to break free from the shackles of colonial and neo-colonial ideology, influence, and practice, many authors have consistently sustained the debate on indigenisation, most of them focusing on why this is necessary rather than how it should be done. For example, Spaneas (2011), writing on the example of Cyprus, argues that despite the consensus on the [negative] influence of colonial experience and Western theories of modernisation and economic growth, no meaningful attempts have been made to ensure that the profession fits into the social and economic environment in which it operates, thus leading to a lack of fit between traditional social norms and the Western processes of social welfare. This, he further argues, has resulted in changes that do not take into consideration the cultural differences and social norms. Spitzer (2017) rightly observes that the heritage of imported theories and concepts from the West is still heavily affecting social work education and practice in the 21st century and that these imported models neither provide sufficient responses to contemporary challenges in society nor do they effectively meet the socio-cultural realities of these contexts. During the Kigali social work conference referred to in the introduction, particular examples were provided where Western models on trauma-based interventions, conceived in largely peaceful countries with an emphasis on individual psychological needs, had failed to realise positive impacts in post-genocide Rwanda (King, 2018). King argues that such interventions `lacked background information on the cultural, social, historical, and political contexts in which traumatic incidents occurred and from which appropriate interventions could be conceived, assessed and validated. The author reiterates, as one of the critical differences, the focus on the individual in Western societies as contrasted to collective ideas in African societies. The argument is that in Western societies, the individual as unit per se embraces self-knowledge to understand their place and position in the world. However, in collective or communal societies, priority is given to the interdependence, to the obligations towards the community and their role in it, compared to the constituent elements. They instead responded better to group models of trauma healing that took into account the collective tendencies of that society. According to Gray, Coates and Yellow Bird (2008), the hesitation or slowness by social work to acknowledge non-Western and indigenous worldviews, local knowledge, and traditional forms of healing has, in turn, affected its ability to develop and deliver services in an effective, acceptable, and culturally appropriate manner. Such and other considerations have sustained the call for indigenisation of social work in Africa. Principles of social justice, human rights, collective responsibility and respect for diversities are central to social work. Underpinned by theories of social work, social sciences, humanities and indigenous knowledge, social work engages people and structures to address life challenges and enhance wellbeing. For social work in Africa and other countries of the Global South, this step implies an appreciation and encouragement of increased focus on their own cultural values, support systems, and coping strategies (Spitzer, 2018). A number of difficulties and challenges with indigenising social work have been highlighted in literature. Kreitzer (2012) contends that the task for Africans is to change the perception of their cultures as negative and Western-dependent, to being a positive contributor to the world as a precursor for social work to be developed from within. Maathai (2009, 168) had referred to these negative perceptions as the demonisation of African culture and traditions that goes back to the colonial period, and which subsequently led to a split life and an identity crisis by and among African peoples. From an education perspective, indigenisation is also faced with the pressure to train graduates that fit into the global market and context (Osei-Hwedie and Rankopo, 2008). In this regard, indigenisation is mistakenly construed as limiting the global competitiveness of social work graduates. Counter to this argument, Twikirize (2014) contends that indigenisation does not have to imply a total overhaul and rejection of everything considered Western and non-African, but rather to ensure that the ideology, the theories, practice models, and ethical principles are relevant and align well to the context within which social work is practised. Indigenous and Innovative Models of Practice Official definitions of the concept of indigeneity often link it to First Nations or the Indigenous Peoples of North America, Australia, and other mostly industrialised societies that have pockets of original inhabitants of the land in often secluded 8 Social Work Practice in Africa: Indigenous and Innovative Approaches communities, such as the Aboriginals in Canada and Australia, the Maori of New Zealand, and the Ainu people of Japan.
In addition impotence effects on relationships purchase 20 mg levitra oral jelly with mastercard, you will find practice questions throughout erectile dysfunction over the counter medication buy 20mg levitra oral jelly with amex, so you can hone your test-taking skills while you review each topic does erectile dysfunction get worse with age purchase levitra oral jelly 20mg online. These sample exams use multiple-choice questions just like the ones you will encounter on exam day erectile dysfunction treatment vacuum pump buy levitra oral jelly 20mg on-line. If you know you will need to take one of these tests, contact the testing agencies in each section for more information about registration, testing locations, and dates. Test Overview To begin preparing for the test, you need an overview of the type of exam you are facing, and some tips on how to use this book to achieve your best test score. However, even if the school of your choice uses another exam, you will most likely need to demonstrate the essential skills covered in this book. You must show that you can communicate effectively, read and understand college-level materials, and utilize basic math skills. You may also be asked to demonstrate that you have fundamental knowledge about biology, chemistry, natural science, anatomy, and physiology. Contact the school of your choice immediately to learn about its admissions requirements and test dates and sites in your area. The dates when the test is offered in your area may determine when you take the exam. However, if you have a choice of test dates and have not already applied to take the exam, do not apply until you have conducted the self-evaluation outlined in this chapter. Each school requires the specific sections it would like its applicants to complete. This approximately two-and-ahalf-hour test measures your ability in two general academic areas: your critical reading ability and your knowledge of basic math. The test includes two academic sections: I I Mathematics, 60 questions Reading Comprehension, 33 questions I I Some schools require a different version of this test that includes a written expression section. These nonacademic sections include the following: TestTaking Skills (30 questions); Stress Level (45 questions); Social Interaction Profile (30 questions); and Learning Style (50 questions). These sections are not used to determine whether you will be accepted into a nursing school. The purpose of these sections is to help learning institutions after a student has been accepted to their program-it aids the school in considering how a student will best learn-and to increase the likelihood that a student will complete the program successfully. The LearningExpress Test Preparation System, developed exclusively for LearningExpress by leading test experts, gives you the discipline and attitude you need to succeed. F I I I I I I I irst, the bad news: Taking the nursing school entrance exam is no picnic, and neither is getting ready for it. Your future career depends on passing the test, but there are all sorts of pitfalls that can keep you from doing your best on this all-important exam. Here are some of the obstacles that can stand in the way of your success: Being unfamiliar with the format of the exam Being paralyzed by test anxiety Leaving your preparation to the last minute Not preparing at all! Now the good news: the LearningExpress Test Preparation System puts you in control. In just nine easy-to-follow steps, you will learn everything you need to know to make sure that you are in charge of your preparation and your performance on the exam. Other test takers may let the test get the better of them; other test takers may be unprepared or out of shape- but not you. You will have taken all the steps you need to take to get a high score on the nursing school entrance exam. Each of the steps listed below includes both reading about the step and one or more activities. If you have several hours, you can work through the whole LearningExpress Test Preparation System in one sitting. Otherwise, you can break it up and do just one or two steps a day for the next several days. Step 1: Get Information Activities: Read Chapter 1, "Nursing School Entrance Exam Planner," and use the suggestions there to find out about your requirements. Therefore, first, you have to find out everything you can about the nursing school entrance exam. Part A: Straight Talk about the Nursing School Entrance Exam Why do you have to take this exam, anyway Because an increasing number of people need the kind of care that only a nurse can provide. And, since more and more people need these services, there is growing concern about the quality of care the patients receive. One way to try to ensure quality of care is to test the people who give that care to find out if they have been well trained. It is important for you to remember that your score on the written exam does not determine how smart you are or even whether you will make a good nurse. However, it is easy to evaluate whether you can correctly answer questions about your job duties. This is not to say that correctly answering the questions on the written exam is not important! The knowledge tested on the exam is knowledge you will need to do your job, and your ability to enter the profession for which you have trained depends on your passing this exam. Later, you will have the opportunity to take the sample practice exams in Chapters 3, 10, and 11. Stress Management Before the Test If you feel your level of anxiety getting the best of you in the weeks before the test, here is what you need to do to bring the level down again: I Step 2: Conquer Test Anxiety Activity: Take the Test Anxiety Quiz on page 12. Having complete information about the exam is the first step in getting control of the exam. Next, you have to overcome one of the biggest obstacles to test success: test anxiety. Test anxiety can not only impair your performance on the exam itself; it can even keep you from preparing! In this step, you will learn stress management techniques that will help you succeed on your exam. Learn these strategies now, and practice them as you complete the exams in this book so that they will be second nature to you by exam day. I I Combating Test Anxiety the first thing you need to know is that a little test anxiety is a good thing. Everyone gets nervous before a big exam-and if that nervousness motivates you to prepare thoroughly, so much the better. In fact, anxiety probably gave them a little extra edge- just the kind of edge you need to do well, whether on a stage or in an examination room. Stop here and complete the Test Anxiety Quiz on the next page to find out whether your level of test anxiety is something you should worry about. Use it faithfully, and remind yourself that you are better prepared than most of the people taking the test. Every time someone starts telling you how hard the exam is or how it is almost impossible to get a high score, start telling them your self-confidence messages above. Visualizing success can help make it happen- and it reminds you of why you are working so hard to pass the exam. The following questionnaire will provide a diagnosis of your level of test anxiety. In the blank before each statement, write the number that most accurately describes your experience. I have experienced disabling physical symptoms, such as vomiting and severe headaches, because I was nervous about an exam. Your Test Anxiety Score Here are the steps you should take, depending on your score. If you scored: I I I Below 3, your level of test anxiety is nothing to worry about; it is probably just enough to give you that little extra edge. Between 3 and 6, your test anxiety may be enough to impair your performance, and you should practice the stress management techniques listed in this section to try to bring your test anxiety down to manageable levels.
Pathophysiology Normally in a matured new born the alveoli are kept patent and protected from collapse by a chemical that fills the alveolar mucosa called surfactant erectile dysfunction treatment surgery buy 20 mg levitra oral jelly with mastercard. But erectile dysfunction causes psychological order levitra oral jelly 20mg free shipping, when it is deficient like in premature babies the alveolar mucosal wall adheres and ensue collapse erectile dysfunction 32 years old best 20 mg levitra oral jelly. Clinical features 107 Pathophysiology Dyspnea from the first moment of life and Shallow respiration Lower ribs retraction Grunting Cyanosis (bluish discoloration of the body) 3 erectile dysfunction doctor in nashville tn buy levitra oral jelly 20 mg visa. Obstructive Pulmonary Diseases In general, obstructive pulmonary conditions obstruct airflow with in the lungs, leading to less resistance to inspiration and more resistance to expiration. Expiratory phase is more compromised since expiration is a passive process, while inspiration is assisted by accessory muscle of the respiration and it is less compromised. Obstructive pulmonary diseases are classified into two classes based on durations as: - 3. Acute obstructive Airway Disease the classification of an acute obstructive airway disease is dependent on the episodic nature of the condition. I) Acute Bronchitis o It is a common condition caused by infection and inhalants that result in inflammation of the mucosal lining of the tracheobronchial tree. Causes - Viruses: - Influenza viruses - Adenoviruses - Rhinoviruses - Bacterial: - Mycoplasma pneumoniae - Inhalants: - Smokes Pathophysiology of Acute Bronchitis Inflammation of the tracheobronchial Mucosa Results in increased mucus secretion, bronchial swelling, and dysfunction of the cilia. Leads to increased resistance to expiratory airflow, usually resulting in some air trapping on expiration. Causes the causes of asthma are divided in to two: a) Extrinsic (Allergic) Asthma Allergic asthma usually affects the child or young teenagers who frequently relate family history of allergy, hives, rashes, and eczema. It is usually self-limited and frequently precipitated by exposure to a specific antigen. Attacks are often related to infection of the respiratory tract or to exercise, emotions and other factors may also play a role. When the antigen enters the air ways IgE are produced against the antigens Then, the IgE binds or interacts with mast cells, so that the mast cells are ruptured to release chemical mediators like histamine and others. Inflammatory response, including increased capillary permeability and mucosal edema. Clinical Manifestations the signs and symptoms of asthmatic attack are closely related to the status of the airways. Bronchospasm and accumulation of mucus plugs or edema results in Obstruction of the airways; and air trapping (due to expiratory flow resistance) Then the patients start to manifest with: Hyper inflated alveoli (lungs) (Due to retained air) Expiratory wheezing (Noisy sound on expiration created when air pass through a narrowed air way) Diaphragmatic flattening: - due to pressure created by hyper inflated alveoli and as the result, diaphragmatic function is limited as a major organ of respiration. Once the attack has subsided and underlying precipitators have been cleared or treated, the lung usually return to normal. Continued bronchial inflammation and progressive increase in productive cough and dyspnea not attributable to specific cause. Usually, the inflammation and cough are responses of the bronchial mucosa to chronic irritation from cigarette smoking, atmospheric pollution or infection. These lead to thickening and rigidity of bronchial mucosa with excessive secretion plus narrowing of the passageways first for maximal expiration then to inspiratory air flow. Dysplasia of the respiratory epithelial cells, which may undergo malignant changes. Increased airway resistance with or with out Cough productive of copious sputum: - due to excessive secretion from bronchial mucosa. Right side Heart failure (corpulmonare): - due to effect of chronic hypoxia, pulmonary artery hypertension occurs. B) Bronchiectasis Definition Bronchiectasis is a chronic disease of the bronchi and bronchioles, characterized by irreversible dilatation of the bronchial tree and associated with chronic infection and inflammation of these passageways. Pathophysiology of Bronchiectasis It is usually preceded by bronchopneumonia that causes the bronchial mucosa to be replaced by fibrous scar tissue. This process 117 Pathophysiology leads to destruction of the bronchi and permanent dilatation of bronchi and bronchioles, which allows the affected area to be targets for chronic smoldering infections. Clinical features the disease is usually initiated by infection of the affected bronchi or areas Symptoms of infection are common. Increased volume of mucopurulent sputum and occasionally blood stickled during the acute exacerbation phase. C) Cystic Fibrosis Definition It is a hereditary disorder in which large quantities of viscous material are secreted. It is usually classified with chronic bronchitis because of simultaneous occurrence of the two conditions In anatomic terms, emphysema involves portion of the lung distal to terminal bronchioles (acinus) where gas exchange takes place. Etiology the exact cause of emphysema is unknown but most cases are related to: o o o Smoking Infection Air pollution 119 Pathophysiology o Deficiency of - antitrypsin enzyme. Pathophysiology of Pulmonary Emphysema Emphysema is due to many separate injuries that occur over a long time when the lung is exposed to one of the above causes. The elastin and fiber network of the alveoli and airways are broken down the alveoli enlarge and many of their walls are destroyed. Alveolar destruction also undermines the support structure for the airways, making them more vulnerable to expiratory collapse. Destruction of elastin and fibers results in loss of elastic recoil of lung, so that 120 Pathophysiology air trapping occurs and the resultant alveolar hyperinflation causes compression of the bronchi and bronchioles, which also precipitate expiratory collapse of the airways. Clinical manifestation the onset is insidious It may overlap with those of chronic bronchitis Dyspnea early on exertion later at rest Hyper-inflated lung due to air trapping causes barrel chest (Increased anteroposterior chest diameter) 121 Pathophysiology Review Questions 1. What is the difference between acute obstructive lung disease and chronic chronic obstructive lung diseases Regulation of interstitial fluid volume Introduction Exchange of fluid between the vascular compartment and the interstitial spaces occurs at the capillary level. The capillary filtration pressure pushes fluid out of the capillaries and colloidal osmotic pressure exerted by the plasma proteins and pulls fluid back into the capillaries. Albumin which is the smallest and most abundant of plasma proteins, provide the major osmotic force for the return of fluid to vascular compartments. Edema o o Refers to excess interstitial fluid in the tissues It is not a disease but rather the manifestation of altered physiological function. Mechanisms of Edema formation 124 Pathophysiology There are four major mechanisms of edema formation. The common causes of increased capillary hydrostatic pressures are: Congestive heart failure o Right side heart failure: - increased capillary hydrostatic pressure due to increased systemic venous pressure with increased blood volume. Decreased colloidal osmotic Pathophysiology o Renal failure results in edema by increasing capillary pressure due to salt and water retention which results in vascular congestion. Liver cirrhosis with portal hypertension:o Portal veins hypertension can occur when there is venous obstruction like in the case of cirrhosis, per portal fibrosis, etc. Venous obstruction o Localized edema occurs when there is venous obstruction like in the case of phlebothrombosis (thrombus formation in the vein). Increased gravitational forces: - Increased gravitational force occurs in long standing Leg Edema. Edema develops when plasma protein level become inadequate because of abnormal loss or inadequate productions. When fluid moves to the interstitial space vascular volume decrease, as a result, the kidney responds by secreting renninangiotensin aldosterone hormones that cause salt and water retention to worsen the edema. Protein loss:-in burn excess loss of protein occurs when large area of skin is injured or destroyed. Protein loosing enteropathy:-is a protein malabsorption syndrome, which results in protein loss with stool. Nephrotic syndrome: loss of large amount of protein through urine, when the glomerular capillaries become permeable to plasma proteins. Increased capillary permeability Direct damage to blood vessels, such as with trauma and burns, may cause increased permeability of the endothelial junctions. Inflammation causes vasodilatation, which leads to accumulation of fluids in the affected area. Obstruction of the Lymphatics Osmotically active plasma proteins and other large particles rely on the lymphatic for movements back into the circulatory system from interstitial space.
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The viral E6 protein binds to the cellular p53 tumor suppressor gene, causing it to be degraded. Which of the following best describes the mechanism by which the E6 protein causes cervical cancer Which of the following is the correct sequence of events in the initiation of contraction of a skeletal muscle fiber Conformational Change in Troponin-Tropomyosin Complex 2 5 5 2 3 Release of Ca2+ from Sarcoplasmic Reticulum 3 4 2 5 4 (A) (B) (C) (D) (E) 14. Depolarization of Sarcolemma 1 2 3 4 5 Propagation into Transverse Tubules 4 3 4 3 1 Acetylcholine Binding to Receptors 5 1 1 1 2 A 90-year-old woman is brought to the emergency department 30 minutes after she fell while climbing the steps into her house. Increased activity of which of the following cell types is the most likely cause of the decrease in bone mass in this patient A 50-year-old man comes to the physician because of a cough productive of large quantities of mucus for 6 months. A 65-year-old man with severe atherosclerotic coronary artery disease comes to the emergency department because of a 12-hour history of chest pain. During an experimental study, an investigator finds that the regulation of cell cycle and programmed cell death may be initiated by the mitochondrion. The interaction of the mitochondrion with the activation of the caspase family of proteases and subsequent apoptosis is most likely mediated by which of the following He enrolls in a clinical study of a novel chemotherapeutic agent that, as a side effect, blocks kinesin, a component of the cellular microtubular transport system. An alteration in which of the following components of the neuromuscular junction is the most likely cause of the muscle weakness A pathologist uses monoclonal antibodies against several intermediate filament proteins and finds that a tumor section stains positive for cytokeratin only. 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Which of the following infectious agents is the most likely cause of these findings During an experimental study, an investigator develops a new member of the class of non-nucleoside reverse transcriptase inhibitors. The organism agglutinates with antiserum directed against type B surface carbohydrate. The virulence of this organism is related to a bacterial constituent that interferes with which of the following host phagocyte functions A 33-year-old woman contracts malaria while on a 3-month business trip to a Central American country. Which of the following species of Plasmodium is most likely to have caused the second febrile illness Three weeks after traveling to California to study desert flowers, a 33-year-old man develops fever, chest pain, and muscle soreness. Two days later, red, tender nodules appear on the shins, and the right ankle is tender and painful. At a banquet, the menu includes fried chicken, home-fried potatoes, peas, chocolate eclairs, and coffee. Within 2 hours, most of the diners become violently ill, with nausea, vomiting, abdominal pain, and diarrhea. Analysis of the contaminated food is most likely to yield large numbers of which of the following organisms A 35-year-old woman is admitted to the hospital because of fever and dry cough for 3 days. A 69-year-old woman comes to the emergency department because of a 2-day history of increasingly severe fever and back pain; she also has a burning sensation with urination, and there is an aromatic smell to the urine. She has had three urinary tract infections treated with ciprofloxacin during the past year. A glass coverslip is then placed over the area so that cells attracted to the site attach to the coverslip for assessment.
