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Wegener’s granulomatosis (Granulomatosis with polyangitis) Necrotizing vasculitis which is characterized by triad of 1 purchase 100mg viagra capsules with mastercard. Acute necrotizing granulomas of either upper (more commonly) or lower respiratory tract or both discount 100 mg viagra capsules amex. Focal necrotizing or granulomatous vasculitis most commonly affecting lungs and upper airways viagra capsules 100mg overnight delivery. Renal involvement in the form of focal necrotizing, often crescentic glomerulonephritis. Also Know • Secondary Raynaud’s phenomenon patients are older in age and have more severe symptoms and complications • More commonly have dilatation of the capillary bed at the base of the fngernails. Buerger’s disease (Thromboangiitis obliterans) Segmental thrombosing vasculitis • It is usually seen among heavy cigarette smokers. Q • This patient has distal lower extremity vascular insuffciency which may present as Calf, foot or hand intermittent claudication, superfcial nodular phlebitis and cold sensitivity (Raynaud’s phenomenon). Capillary hemangioma • It is the most common type of vascular tumor which occurs in skin, mucus membrane Strawberry hemangioma is a and viscera. Cavernous hemangioma – It is less common than capillary hemangioma with same age and anatomic Cavernous lymphangioma occurs distribution. It more frequently involves deep structures as it shows no tendency in Turner’s syndrome at the to regress. Pyogenic granuloma It is a polypoid form of capillary hemangioma seen attached by a stalk to skin or oral mucosa. Granuloma gravidarum is present in the gingiva of pregnant women and it regresses after delivery. Cavernous lymphangioma (also called as cystic hygroma) Capillary lymphangioma is dis- • This is present in the neck region of the children. Capillary Lymphangioma It is a lesion composed of small lymphatic channels occurring subcutaneously in the head and neck region and in the axilla. Hemangiopericytoma • Tumor derived from pericytes which are the cells present along the capillaries and venules. The (b) Libman Sacks endocarditis histopathological examination is most likely to show (c) Rheumatic heart disease which of the following? A 45 yrs old male had severe chest pain and was admitted to the hospital with a diagnosis of acute myocardial 10. Four days later he died and autopsy (a) May be positive in normal people showed transmural coagulative necrosis. Which of the (b) Major Jones’ criteria following microscopic features will be seen on further (c) May be negative in post streptococcal glomerulone- examination? Which one of the following is not included as major (c) Myxomatous degeneration criteria in Jones criteria? Which of the following is not a complication of infective (b) Arthritis endocarditis? The mechanism of the development of Acute Rheumatic (c) Myocardial infarction Fever is which of the following? Diagnostic feature of rheumatic fever is: (d) Rheumatic fever (a) Antischkow cells (Kolkata 2001) (b) Aschoff’s nodule 17. Rheumatoid factor is: (Bihar 2003) (d) Asbestosis (a) lgM directed against lgG 18. All are the causes of myocarditis except: (a) Pancarditis (a) Trichinosis (Karnataka 2005) (b) Arthritis (b) Mycobacterium tuberculosis (c) Subcutaneous nodule (c) Corynebacterium diphtheriae (d) Systemic lupus erythematosus (d) Erythema nodosum 20. She has been (b) Constrictive cardiomyopathy diagnosed with acute rheumatic fever. Instead of (c) Fibroelastic cardiomyopathy recovering as expected, her condition worsened, and (d) Hypertrophic cardiomyopathy she died. Infective endocarditis is known to be caused by (a) Hurler’s syndrome different bacterial species. Which of the following (b) Marfan’s syndrome scenarios is most consistent with infective endocarditis (c) Syphilis caused by Staphylococcus aureus? Which of the following is the feature of vegetations in (a) Hypercalcemia of malignancy Libmann Sacks endocarditis? A 56-years-old male presented with sudden substernal valve pain, impending doom and died 4 days after. On (d) Small bland vegetations autopsy, there was a large transmural anterior wall 31. All of the following statements regarding subendocar- dial infarction are true, except: 31. The heart revealed presence of a transmural hemorrhagic area over the septum and anterior wall 31. Which of the following increases the susceptibility to (d) Osteoarthritis coronary artery disease? Mitral valve vegetations do not embolise usually to: (b) von Willebrand’s disease (a) Brain (b) Liver (c) Nephrotic syndrome (c) Spleen (d) Lung (d) Systemic lupus erythematosus 31. A myocardial infarct showing early granulation tissue involved in rheumatic fever? A 70-year-old male Rohan with advanced visceral cancer (a) Caseous pecrosis dies of extensive myocardial infarction. Autopsy also (b) Coagulative necrosis reveals sterile non-destructive vegetations along the (c) Fat necrosis (d) Liquefactive necrosis 381381 Review of Pathology 40. He returns to his normal (d) Troponin-I activities, which include sedentary work only. The blood pressure is 130/80 mmHg, pulse is 90 beats per minute temperature is 38. Most common artery involved in myocardial infarction respirations are 20 per minute. Autopsy (c) 1 month reveals hemopericardium secondary to ventricular wall (d) 3 months rupture. Roughly how long before his death did the man probably have a myocardial infarction? In myocardial infarctions, microscopes picture of (d) C reactive protein is independent risk factor for M. Which of the following is the commonest histological seen after: fnding in benign hypertension? The presence of stroke, peripheral vascular disease and (a) Infuenza atherosclerosis is associated with which hormone? Most common benign heart tumor is: (d) Hyperplastic arteriosclerosis (a) Rhabdomyoma 60. Atrial myxoma commonly arises from: (b) Fibrinopeptide A (a) Left ventricle (c) Lipoprotein (A) (b) Left atrium (d) Triglycerides (c) Right ventricle 62. In 2 patients with atherosclerosis, one is diabetic and (c) Syphilis the other is non diabetic.

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A few days later cheap viagra capsules 100mg amex, he is admitted as an2 2 2 outpatient in the hospital’s sleep center viagra capsules 100 mg with mastercard. Within 30 minutes generic 100mg viagra capsules amex, the patient falls asleep, and within another 30 minutes, his SaO2 decreases from 92% to 47%, and his heart rate increases from 92 to 108 beats/min, with two premature ventricular contractions. During this time, his chest wall continues to move, but airflow at the mouth and nose is not detected. This patient is suffering from what has been known as Pickwickian syndrome, a disorder that occurs with severely obese individuals because of their excessive weight. The Pickwickian syndrome was named after Joe, the overweight boy who was always falling asleep in Charles Dickens’ novel The Pickwick Papers. Pickwickian patients suffer from hypoventilation and often suffer from sleep apnea as well. Pickwickian syndrome is no longer an appropriate name because it does not indicate what type of sleep disorder is involved. About 80% of sleep apnea patients are obese, and 20% are of relatively normal weight. Polycythemia is the result of chronic hypoxemia from hypoventilation, as well as from sleep apnea. An increase in sympathetic discharge is often associated with sleep apnea and is responsible for the accelerated heart rate. Explain how glomerular filtration rate is measured and the factors that affect filtration rate. Describe how renal blood flow can be determined from the clearance of p-aminohippurate and the hematocrit and discuss the factors that influence renal blood flow. Determine whether there is net reabsorption or secretion of a plasma substance by the kidneys and quantify its value. Explain what is meant by tubular transport maximum, threshold, and splay for glucose. Explain and contrast the mechanisms of solute and water reabsorption in the proximal convoluted tubule, loop of Henle, and distal nephron. Predict the consequences of impairment of any transport process along the nephron. Explain how water and ion transport in any section of the nephron is altered by a change in sodium reabsorption in that section. Explain mechanisms responsible for secretion of organic anions, cations, acids, and bases by the nephron and how this secretion is altered by urine pH. Explain how countercurrent mechanisms create and maintain the vertical peritubular osmotic gradient surrounding the renal tubules in cortical and juxtamedullary nephrons. The function and survival of cells depend on maintaining normal concentrations of NaCl, acids, and other electrolytes in the internal environment. The functional importance of maintaining a normal cellular and extracellular environment was explained in neurophysiology (Chapter 3), muscles (Chapter 8), and cardiovascular function (Chapter 12). The maintenance of normal hydration in cell function was also illuminated in Chapter 2. In the respiratory chapter (Chapter 19), the importance of maintaining a normal acid–base balance was elucidated. In the next three chapters, you will learn how the kidney regulates body fluids, maintains electrolyte balance, eliminates organic waste, and maintains the long-term regulation of acid–base conditions in the body. As you read about kidney function and regulation, you will encounter numerous examples of physiologic principles that have been presented in the Cellular, Neuromuscular, Cardiovascular, and Respiratory Physiology sections. The ability of the kidney to selectively remove waste and at the same time retain essential electrolytes, water, and nutrients is a hallmark of a general physiological principle of renal function. They maintain normal concentrations of many plasma constituents, especially electrolytes. They are also responsible for the reabsorption of filtered water, glucose, and amino acids. Finally, the kidneys produce hormones, including calcitriol (the activated form of vitamin D), and erythropoietin as well as the enzyme renin. This chapter considers the basic renal processes that determine the excretion of various substances. Peristaltic movements propel the urine down the ureters to the urinary bladder, which stores the urine until the bladder is emptied through the urethra. Each kidney is typically supplied by a single renal artery, which branches into anterior and posterior divisions. In turn, these two divisions give rise to a total of five segmental arteries (Fig. Sympathetic nerve fibers + also innervate tubular cells and may cause an increase in Na reabsorption by a direct action on these cells. In addition, stimulation of sympathetic nerves increases the release of renin by the kidneys. Afferent (sensory) renal nerves are stimulated by mechanical stretch or by various chemicals in the renal parenchyma. The important functions performed by the kidneys include the following: They regulate the osmolarity of the body fluids by altering renal water reabsorption to excrete osmotically dilute or concentrated urine. They eliminate the waste products of metabolism, including urea (the main nitrogen-containing end product of protein metabolism in humans), uric acid (an end product of purine metabolism), and creatinine (an end product of muscle metabolism). They are the major sites of production of certain hormones, including erythropoietin (see Chapter 9) and 1,25-dihydroxy vitamin D (see 3 Chapter 35). They degrade several polypeptide hormones, including insulin, glucagon, and parathyroid hormone. They synthesize ammonia, which plays a role in acid–base homeostasis (see Chapter 24). Dialysis and kidney transplantation are commonly used treatments for advanced (end-stage) renal failure. Each renal corpuscle is derived from a muscular afferent arteriole that forms a tuft of capillaries, the glomerulus, which is surrounded by the Bowman capsule. The Bowman capsule, which cups around the glomerulus, collects the fluid filtered from the glomerulus. The blood leaving the glomerulus that was not filtered is carried via the efferent arteriole. On the left is a long-looped juxtamedullary nephron; on the right is a superficial cortical nephron. Common causes include diabetes mellitus, hypertension, inflammation of the glomeruli (glomerulonephritis), urinary reflux and infections (pyelonephritis), and polycystic kidney disease. Renal damage may occur over many years and may be undetected until a considerable loss of functioning nephrons has occurred. Most of the signs and symptoms of renal failure can be relieved by dialysis, the separation of smaller molecules from larger molecules in solution by diffusion of the small molecules through a selectively permeable membrane. Two methods of dialysis are commonly used to treat patients with severe, irreversible (end-stage) renal failure. In continuous ambulatory peritoneal dialysis, the peritoneal membrane, which lines the abdominal cavity, acts as a dialyzing membrane.

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Two connexons aligned between two neighboring cells then join end to end to form an intercellular channel between the plasma membranes of adjacent cells order viagra capsules in india. Gap junctions allow the flow of ions and small molecules between the cytosol of neighboring cells generic 100 mg viagra capsules, thereby providing rapid transmission of electrical signals between cells in the heart viagra capsules 100 mg amex, smooth muscle cells, and some nerve cells. Gap junctions are thought to play a role in the control of cell growth and differentiation by allowing adjacent cells to share a common intracellular environment. Often when a cell is injured, gap junctions close, isolating a damaged cell from its neighbors. Membrane proteins also have a structural role, for example, maintaining the biconcave shape of the erythrocyte. Finally, some membrane proteins serve as highly specific receptors on the outside of the cell membrane to which extracellular molecules, such as hormones, can bind. If the receptor is a membrane- spanning protein, it provides a mechanism for converting an extracellular signal into an intracellular response. At the same time, specialized cells require mechanisms to transport molecules such as enzymes, hormones, and neurotransmitters. The movement of large molecules is carried out by endocytosis and exocytosis: the transfer of substances into or out of the cell by vesicle formation and vesicle fusion with the plasma membrane. Cells also have mechanisms for the rapid movement of ions and solute molecules across the plasma membrane. These mechanisms are of two general types: passive transport, which requires no direct expenditure of metabolic energy, and active transport, which uses metabolic energy to move solutes across the plasma membrane. Phagocytosis is the ingestion of large particles or microorganisms, usually occurring only in specialized cells such as macrophages (Fig. An important function of macrophages is to remove invading bacteria from the body. The phagocytic vesicle (1 to 2 μm in diameter) is almost as large as the phagocytic cell itself. It occurs only after the extracellular particle has bound to the extracellular surface. Receptor-mediated endocytosis uses membrane receptors at coated pits to bind and internalize specific solutes (ligands). These are packed inside secretory vesicles that fuse with the plasma membrane and release their contents outside the cell. Endocytosis is a general term for the process in which a region of the plasma membrane is pinched off to form an endocytic vesicle inside the cell. During vesicle formation, some fluid, dissolved solutes, and particulate material from the extracellular medium are trapped inside the vesicle and internalized by the cell. It occurs in almost all cells and is termed a constitutive process, because it occurs continually and specific stimuli are not required. In further contrast to phagocytosis, endocytosis originates with the formation of depressions in the cell membrane. The depressions pinch off within a few minutes after forming and give rise to endocytic vesicles inside the cell. The material is trapped inside the endocytic vesicle as it is pinched off inside the cell. The amount of extracellular material internalized by this process is directly proportional to its concentration in the extracellular solution. Receptor-mediated endocytosis is a more efficient process, which uses receptors on the cell surface to bind specific molecules. These receptors accumulate at specific depressions known as coated pits, so named because the cytosolic surface of the membrane at this site is covered with a coat of several proteins. The receptors also increase the uptake of molecules present at low concentrations outside the cell. Receptor-mediated endocytosis is the mechanism by which cells take up a variety of important molecules, including hormones, growth factors, and serum transport proteins such as the iron carrier transferrin. Foreign substances, such as diphtheria toxin and certain viruses, also enter cells by this pathway. Many cells synthesize important macromolecules that are destined for exocytosis or export from the cell. These molecules are synthesized in the endoplasmic reticulum, modified in the Golgi apparatus, and packed inside transport vesicles. The vesicles move to the cell surface, fuse with the cell membrane, and release their contents outside the cell (see Fig. The continuous secretion of mucus by goblet cells in the small intestine is an example of the constitutive pathway of exocytosis that is present in all cells. These vesicles fuse with the cell membrane and release their contents only when a specific extracellular stimulus arrives at the cell membrane. This process, termed the regulated pathway, is responsible for the rapid “on- demand” secretion of many specific hormones, neurotransmitters, and digestive enzymes. This movement, known as diffusion, is a result of the spontaneous Brownian (random) movement that all molecules experience. A drop of ink placed in a glass of water will diffuse and slowly color all the water. The net result of diffusion is the movement of substances from regions of high concentration to regions of low concentration. The speed with which the diffusion of a solute in water occurs depends on the difference of concentration, the size of the molecules, and the possible interactions of the diffusible substance with water. These different factors appear in Fick’s law, which describes the diffusion of any solute in water. Sometimes, J is 2 expressed in units of amount of substance per unit area per unit time, for example, mol/cm /h, and is also referred to as the solute flux. The principal force driving the passive diffusion of an uncharged solute across the plasma membrane is the difference of concentration between the inside and the outside of the cell. In the case of an electrically charged solute, such as an ion, diffusion is also driven by the membrane potential, which is the electrical gradient across the membrane. Movement of charged solutes and the membrane potential will be discussed in greater detail later in this chapter. Diffusion across a membrane has no preferential direction; it can occur from the outside of the cell toward the inside or from the inside of the cell toward the outside. For any substance, it is possible to measure the permeability coefficient (P), which gives the speed of the diffusion across a unit area of plasma membrane for a defined driving force. Fick’s law for the diffusion of an uncharged solute across a membrane can be written as (2) which is similar to equation 1. P includes the membrane thickness, the diffusion coefficient of the solute within the membrane, and the solubility of the solute in the membrane. Dissolved gases such as oxygen and carbon dioxide have high permeability coefficients and diffuse rapidly across the plasma membrane.