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Professor, Perelman School of Medicine at the University of Pennsylvania

It may lead to growth of bacteria bacteria virus 3 mg mectizan free shipping, particularly tubercle bacilli making this part of lungs susceptible for tuberculosis antibiotic prophylaxis dental purchase generic mectizan on-line. Because of this antibiotic xacin buy 3mg mectizan overnight delivery, the blood flow to the alveoli increases during systole and decreases during diastole antibiotics for acne philippines cheapest generic mectizan uk. During inspiration, thoracic cage enlarges and lungs expand so that air enters the lungs easily. During expiration, the thoracic cage and lungs decrease in size and attain the preinspiratory position so that air leaves the lungs easily. During normal quiet breathing, inspiration is the active process and expiration is the passive process. Primary or major respiratory muscles, which are responsible for change in size of thoracic cage during normal quiet breathing 2. Accessory respiratory muscles that help primary respiratory muscles during forced respiration. Inspiratory Muscles Muscles involved in inspiratory movements are known as inspiratory muscles. Primary inspiratory muscles Primary inspiratory muscles are the diaphragm, which is supplied by phrenic nerve (C3 to C5) and external intercostal muscles, supplied by intercostal nerves (T1 to T11). Chapter 120 t Mechanics of Respiration 683 Accessory inspiratory muscles Sternocleidomastoid, scalene, anterior serrati, eleva tors of scapulae and pectorals are the accessory inspiratory muscles. Expiratory Muscles Primary expiratory muscles Primary expiratory muscles are the internal intercostal muscles, which are innervated by intercostal nerves. Accessory expiratory muscles Accessory expiratory muscles are the abdominal muscles. Anteroposterior and transverse diameters of thoracic cage are increased by the elevation of ribs. In general, change in the size of thoracic cavity occurs because of the movements of four units of structures: 1. Thoracic Lid Thoracic lid is formed by manubrium sterni and the first pair of ribs. Due to the con traction of scalene muscles, the first ribs move upwards to a more horizontal position. Upper Costal Series Upper costal series is constituted by second to sixth pair of ribs. Movement of upper costal series increases the anteroposterior and transverse diameter of the thoracic cage. Pump handle movement Contraction of external intercostal muscles causes elevation of these ribs and upward and forward move ment of sternum. Bucket handle movement Simultaneously, the central portions of these ribs (arch es of ribs) move upwards and outwards to a more hori zontal position. This movement is called bucket handle movement and it increases the transverse diameter of thoracic cage. Movement of lower costal series increases the transverse diameter of thoracic cage by bucket handle movement. Bucket handle movement Lower costal series of ribs also show bucket handle movement by swinging outward and upward. Diaphragm Movement of diaphragm increases the vertical dia meter of thoracic cage. Normally, before inspiration the diaphragm is dome shaped with convexity facing upwards. But the central tendinous portion is drawn downwards so the diaphragm is flat tened. During expira tion, the thoracic cavity decreases in size to the preinspiratory position. Factors Causing Collapsing Tendency of Lungs Two factors are responsible for the collapsing tendency of lungs: 1.

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C (6) Dinoflagellates secrete saxitoxin antibiotics quiz pharmacology buy mectizan without a prescription, a blocker of voltagegated Na+ channels in nerves antibiotic resistance due to overuse of antibiotics purchase mectizan once a day. Exposure to this toxin results in block of transmission initially in sensory nerves (causing numbness and tingling) but may extend to block of motor nerves with paralysis of voluntary muscle treatment for fungal uti discount 3 mg mectizan overnight delivery, including the diaphragm antibiotics for uti nitrofurantoin mectizan 3mg otc. Psychotherapeutic interventions are usually required in addition to antidepressants. A (31) With the exception of diphenoxylate and loperamide, which are used for the treatment of diarrhea, constipation is considered an adverse effect of the opioid analgesics. D (23, 31, 32) Naloxone, a nonselective opioid receptor antagonist, is used by individuals recovering from alcoholuse disorders. B (43, 44) Ceftriaxone (or cefixime) is a drug of choice for treatment of gonococcal infections, and chlamydial infections usually respond to a tetracycline. Though not listed, azithromycin as a single agent is considered a co-drug of choice for chlamydial infections and an alternative drug for gonococcal infections. J (9) this question and the following one require a combined knowledge of agonist and antagonist actions. Note that systolic and diastolic blood pressures are increased, but heart rate is decreased by drug 1. This is compatible with a strong -agonist drug such as norepinephrine (choice H) or phenylephrine (choice J). Following drug 2, there is no change in heart rate, suggesting that the bradycardia seen previously was a reflex response to the pressor effect. I (10) As noted in the answer to the previous question, the agonist drug (drug 1) is probably a strong -agonist sympathomimetic. Drug 2 markedly reduces the pressor action of drug 1 (compatible with blockade) and also suppresses the change in heart rate. If drug 1 was norepinephrine, its -agonist effect on heart rate would have been unmasked. B (38) Thyroxine (T4) is preferred over liothyronine (T3) because it has a longer half-life. A (37) this patient has signs and symptoms of hyperprolactinemia, which is caused by prolactin-secreting pituitary adenomas. Dopamine D2 receptor agonists such as bromocriptine can be used to suppress the excessive prolactin secretion. A patient is admitted to the emergency department with signs and symptoms that could be due to either a muscarinic stimulant or an opioid. Which of the following is a common effect of both muscarinic stimulant drugs and opioids A 35-year-old patient is brought to the emergency department in a drug-induced coma. Blood samples taken over the next several hours show a declining drug concentration, as shown in the graph below. In a laboratory study of a new agent, the activity of a membrane-bound enzyme was found to be increased by the drug. Analysis of this enzyme molecule revealed that it is an integral tyrosine kinase, the extracellular domain of which binds ligands while the intracellular domain phosphorylates tyrosine residues. Which of the following receptors communicate their activation by turning on an integral intracellular tyrosine kinase domain This indicates that the final steady state plasma concentration in this patient will be (A) 1. A new drug for the prophylaxis of asthma is under development in a pharmaceutical company. A family with 3 young children during a harsh winter in New York is using their old stove and city gas to heat their apartment. Which of the following most accurately describes the probable autonomic response to the bleeding The drug that is most likely to have therapeutic value for this condition is (A) Ephedrine (B) Isoproterenol (C) Latanoprost (D) Mannitol (E) Propranolol 10. A new drug was administered to a group of normal volunteers in a phase 1 clinical trial. Intravenous bolus doses produced the changes in blood pressure and heart rate shown in the graph below.

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A short-lived radioactive substance called radionuclide combined with sugar is injected into the patient antimicrobial testing buy mectizan with paypal. Radionuclide emits positrons (antiparticle or antimatter counterpart of electron) bacteria under fingernails discount mectizan 3mg amex. Cerebral blood flow is directly proportional to the balance between effective perfusion pressure and the vascular resistance in brain antibiotic resistance of bacterial biofilms purchase mectizan now. Effective Perfusion Pressure Effective perfusion pressure is the balance between the mean arterial blood pressure and venous pressure across the organ antibiotics for uti first trimester order mectizan with mastercard, divided by resistance (Chapter 102). Since venous pressure is zero in brain, mean arterial blood pressure plays an important role in regulating cerebral blood flow. Autoregulation is possible in brain if the mean arterial pressure is within the range of 60 mm Hg and 140 mm Hg. Cerebral Vascular Resistance When the vascular resistance is more, the blood flow to the brain is less. Resistance to blood flow in brain is offered by intracranial pressure, cerebrospinal fluid pressure and viscosity of blood. These pressures are elevated in conditions like head 636 Section 8 t Cardiovascular System injury. However, severe ischemic effects are avoided by some protective reflexes such as Cushing reflex. Cushing reflex Cushing reflex is a protective reflex that helps save the brain tissues from ischemic effects during the periods of reduced cerebral blood flow. When cerebral blood flow decreases by the compression of cerebral arteries, the cerebral ischemia develops. Local hypoxia and hypercapnea activate vasomotor center, resulting in peripheral vasoconstriction and rise in the arterial pressure. Thus, Cushing reflex plays the most important role in maintaining the cerebral blood flow. Cushing reflex operates only when the rise in arterial blood pressure is proportional to increase in intracranial pressure. When the increase in intracranial pressure is very high and if it exceeds the arterial blood pressure, this protective mechanism fails. And the cerebral ischemia becomes severe, leading to irreversible damage of the brain tissues. Monro-Kellie doctrine According to Monro-Kellie doctrine or principle, though the cerebral arteries are compressed by increased intracranial pressure or cerebrospinal fluid pressure, the volume of brain tissue is not affected. Viscosity Increase in the viscosity of blood as in polycythemia, increases the cerebral vascular resistance and blood flow decreases. When viscosity decreases as in the case of anemia, the resistance is decreased and blood flow increases. Thus, the cerebral blood flow is inversely proportional to the viscosity of blood. Carbon dioxide is the most important factor, as it causes dilatation of cerebral blood vessels, leading to increase in blood flow. A moderate increase in carbon dioxide tension does not alter the blood flow due to autoregulation. When arterial partial pressure of carbon dioxide rises above 45 mm Hg, the cerebral blood flow increases. Carbon dioxide combines with water to form carbonic acid, which dissociates into bicarbonate ions and hydrogen ion. But, these fibers do not play any role in regulating cerebral blood flow under normal conditions. In pathological conditions like hypertension, the sympathetic nerves cause constriction of cerebral blood vessels, leading to reduction in blood flow. Ischemic stroke, which occurs due to interruption of blood flow to a part of brain by thrombus or atherosclerotic embolus 2. Hemorrhagic stroke, which develops by the rupture of a blood vessel in the brain and spilling of blood into the surrounding areas.

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Impulses of almost all the sensations reach the thalamic nuclei iv antibiotics for sinus infection order mectizan 3mg without prescription, particularly in the ventral posterolateral nucleus antibiotic young living generic 3 mg mectizan. After being processed in the thalamus infection vaginal purchase on line mectizan, the impulses are carried to cerebral cortex through thalamocortical fibers antibiotics for uti during breastfeeding 3mg mectizan sale. All the peripheral sensory impulses reaching thalamus are integrated and modified before being sent to specific areas of cerebral cortex. This function of thalamus is usually called the processing of sensory information. Functional Gateway for Cerebral Cortex Almost all the sensations are processed in thalamus before reaching cerebral cortex. Very little information of somatosensory function is sent directly to cerebral cortex without being processed by the thalamic nuclei. Discriminative Nature Discriminative nature is the ability to recognize the type, location and other details of the sensations and it is the function of cerebral cortex. Affective Nature Affective nature is the capacity to determine whether a sensation is pleasant or unpleasant and agreeable or disagreeable. Mostly, posteroventral nuclei of thalamus are affected because the thalamogeniculate branch of posterior cerebral artery supplies this part of thalamus. Dejerine-Roussy syndrome Thalamic hyperesthetic anesthesia Thalamic pain syndrome Central pain syndrome Central poststroke pain syndrome Posterior thalamic syndrome Retrolenticular syndrome In thalamic syndrome, whole body becomes hypersensitive to pain. Loss of Sensations Loss of all sensations (anesthesia) occurs as the sensory relay system in thalamus is affected. Astereognosis Astereognosis is the loss of ability to recognize a known object by touch with closed eyes. Thalamic Phantom Limb the patient is unable to locate the position of a limb with closed eyes. The patient may search for the limb in air or may have the illusion that the limb is lost. Anosognosia Anosognosia is the lack of awareness or denial of existance of a neurological defect or general illness or any disability. Pain may be so intense, that it even resists the action of powerful sedatives like morphine. It becomes worst in conditions such as emotional disturbance and exposure to cold or heat. Pain is due to over activity of medial mass of nuclei of thalamus, which escape the lesion. Involuntary Movements Thalamic syndrome is always associated with some involuntary motor movements. Intention tremor Tremor is defined as rapid alternate rhythmic and involuntary movement of flexion and extension in the joints of fingers and wrist or elbow. Intention tremor is the tremor that develops while attempting to do any voluntary act. Thalamic Hand or Athetoid Hand Athetoid hand is the abnormal attitude of hand in thalamic lesion. It is characterized by moderate flexion at wrist and hyperextension of all fingers. Cerebral cortex is connected with brainstem and spinal cord by both afferent and efferent fibers. Fibers arising from different parts of cerebral cortex descend down into white matter of cerebral hemispheres in the form of radiating mass of fibers called corona radiata. While passing down towards the brainstem, corona radiata converges in the form of internal capsule. Contralateral hemihyperesthesia (abnormal sensation in opposite side of the body) 3. Hemianesthesia and hemiparesthesia occur because of lesion of superior thalamic radiation. It also produces hemianopia and deafness, because of the involve ment of the auditory and visual fibers.

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