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Cardiac involvement consists of interstitial acterized by the muscle fber fbrosis buy genuine seroflo on line allergy and asthma, more prominent in the subendocardial layers purchase 250mcg seroflo free shipping allergy testing gloucester. Enlargement of the calf muscles associated with weakness purchase noroxin without a prescription, a phenomenon termed pseudohypertrophy caused initially by an increase in the size of the muscle fbers later by an increase in fat and connective Perifascicular atrophy: seen tissue. Death results from respiratory insuffciency, pulmonary infection, and cardiac decompensation. Badly Made Dystrophin (reduced formation of an altered protein) 638 Musculoskeletal System Multiple ChoiCe Questions 1. A 9-year-old girl has diffculty in combing hairs and pathological examination reveals a small round cell climbing upstairs since 6 months. Which of the following molecular fndings is sign positive and maculopapular rash over metacarpo- most likely to be present? What should be the next appropriate (a) 22q translocation investigation to be done? A 50-year-old lady presented with a 3-month history of pain in the lower third of the right thigh. Which of the following is false in relation to Osteo- local swelling; tenderness was present on deep pressure. Which of the following histological features (if (c) C-myc gene implicated in the genesis seen) would be most helpful to differentiate the two (d) Codman’s triangle is the characteristic X-ray fnding tumors? Large intracytoplasmic glycogen storage is seen in (a) Rhabdomyosarcoma (Delhi 2010) which malignancy? Osteoblastoma resembles histologically: (b) Chondroblastoma (a) Osteosarcoma (Kolkata 2002,2003) (c) Ewing’s sarcoma (b) Osteoid osteoma (d) Chondromyxoid fbroma (c) Chondroblastoma (d) Chondrosarcoma 17. Syncytial osteoclastic giant cells are seen in All Except: (b) Osteoid osteoma (a) Osteosarcoma (Kolkata 2002,2003) (c) Osteitis deformans (b) Ewing’s sarcoma (d) Osteomalacia (c) Chondroblastoma (d) Aneurysmal bone cyst 18. Which one of the following infammatory markers of muscle biopsy is diagnostic of polymyositis? Tophi in gout are found in all regions, except: (a) Osteogenic sarcoma (a) Bone (Bihar 2004) (b) Ewing’s sarcoma (b) Skin (c) Chondromyxoid fbroma (c) Muscle (d) Giant cell tumor (d) Synovial membrane 20. Dystrophin is lacking in: (b) Osteoid formation by mesenchymal cells with pleo- (a) Polio morphism (b) Duchenne’s muscular dystrophy (c) Codman’s triangle (c) Peroneal muscular atrophy (d) Predominant osteoclast (d) Spinal muscular atrophy 22. Ewings sarcoma arises from: (a) Inverted papilloma (a) G cells (b) Fibro calcifcation (b) Totipotent cells (c) Fibrous dysplasia of bones (c) Neuroectodermal cells (d) Chronic osteomyelitis (d) Neurons 23. Most common malignant bone tumor – (a) Osteoma (a) Osteogenic sarcoma (b) Osteosarcoma (b) Secondaries (c) Fibrosarcoma (c) Osteoma (d) All (d) Enchondroma 640 Musculoskeletal System 30. Joint involvement is symmetric, with the proximal interphalangeal and metacarpophalangeal joints especially involved. In the giant cell tumor of the bone, the cell of origin is: (c) Assertion is true and reason is false. Assertion: Patients with Duchene’s muscular dystrophy (d) Sinusoidal cells have diffculty in walking. Assertion: Osteosarcoma is associated with the radio- (c) Fibrous dysplasia logical appearance of Codman‘s triangle.

This group of disorders can be caused by abnormal function of the nerve cell body buy 250 mcg seroflo free shipping allergy shots permanent, the axon buy seroflo 250 mcg cheap allergy shots birth control, or the myelin sheath discount seroflo 250mcg without prescription. Abnormalities of axon function are the most common cause of peripheral neuropathy. In this type of nerve disease, the longest axons show the effects of the abnormal function first; therefore, the abnormalities appear first in the toes and distal feet. If the condition worsens, the abnormal sensations spread from the toes to the mid-foot and potentially up to the ankle or mid-shin. Neuropathies like our patient’s are said to be “length dependent,” because the longest axons show the abnormalities first. Vincristine (Oncovin) impairs transport along the axons by interfering with the assembly of tubulin into microtubules. Microtubules provide the framework for fast axoplasmic transport from the nucleus to the nerve terminal and also for retrograde transport from the nerve terminal back to the nucleus. The nerve dysfunction effects of the vincristine (Oncovin) are cumulative and usually begin only after several cycles of treatment. If the medication is able to be discontinued, nerve function tends to improve over subsequent months as axoplasmic transport is restored and the axons become able to maintain their structure normally. Explain why sensory receptors have specificity to sense one type of environmental energy over another. Explain why sensory receptors that respond to a selective type of environmental energy can respond to a different type, yet the sensation produced is the same as if the receptor responded to the energy for which it was designed to detect. Postulate the value of adaptation of sensory receptors in relation to the selective type of sensation the receptor is designed to detect. Explain why action potential frequency is the mode of information transmission in sensory systems and how changes in that frequency are related to graded electrical potential changes in sensory receptors. Explain how the processes of adaptation and accommodation permit the processing of a wide-range of stimulus intensities. Distinguish between rod and cone vision and point out the special features of each type. Describe the organization of the retina, relating each layer to its specific and integrated function in the process of vision. Explain, in terms of biochemical events, the process of light and dark adaptation in the retina. Describe the processing of sound by different parts of the auditory system, the mechanism of auditory transduction and how the frequency of sound is represented along the basilar membrane. Explain the roles of the different components of the vestibular system in detecting rotational and linear acceleration.

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This shortening of the systolic interval tends to blunt the potential adverse effects of increases in the heart rate on diastolic flling time generic seroflo 250mcg visa allergy medicine by kirkland. Right Pump �ec�use the ent�re heart is served by a s�ngle lectrical excita ion system cheap seroflo online master card allergy medicine 911,� � stmtlar mechamcal events occur essentially simultaneously m both the left and right sides of the heart buy shallaki 60 caps low cost. Both ventricles have synchronous systolic and diastolic periods, and the valves of the right and left sides of the heart nor­ mally open and close nearly in unison. Because the two sides of the heart are arranged in series in the circulation, they must pump the same amount of blood and therefore must have identical stroke volumes. The major difference between the right and left pumps is in the magnitude of the peak systolic pressure. The pressures developed by the right side of the heart, as shown in Figure 3-2, are considerably lower than those for the left side of the heart (Figure 3-1). This is because the lungs provide considerably less resistance to blood flow than that offered collectively by the systemic organs. Therefore, less arterial pressure is required to drive the cardiac output through the lungs than through the systemic organs. Ty pical pulmonary artery systolic and diastolic pres­ sures are 24 and 8 mm Hg, respectively. These pulsations, shown on the atrial pressure trace in Figure 3-2, can be visualized in the neck over the jugular veins in a recumbent individual. They are collectively referred to as the juglr venous pule and can provide clinically useful information about the heart. The c wave, which follows shortly thereafter, coincides with the onset of ventricular systole and is caused by an initial bulging of the tricuspid valve into the right atrium. Right atrial pressure falls after the c wave because of atrial relaxation and a downward displacement of the tricuspid valve during ventricular emptying. Right atrial pres­ sure then begins to increase toward a third peak, the v wave, as the central veins and right atrium fll behind a closed tricuspid valve with blood returning to the heart from the peripheral organs. With the opening of the tricuspid valve at the conclusion of ventricular systole, right atrial pressure again falls as blood moves into the relaxed right ventricle. Shortly afterward, right atrial pressure begins to rise once more toward the next a wave, as returning blood flls the central veins, the right atrium, and the right ventricle together during diastole. Heart Sounds A phonocardiographic record of the heart sounds, which occur in the cardiac cycle, is included in Figure 3-1. These sounds are normally heard by auscultation with a stethoscope placed on the chest. The second heart sound, S2, arises from the closure of the aortic and pulmonic valves at the beginning of the period of isovolumetric relaxation. Because this discrepancy is enhanced during the inspiratory phase of the respiratory cycle, inspiration causes what is referred to as the physiologcal slitting of the second heart sound. There are at least two factors that lead to this prolonged ejection time from the right ventricle during inspiration.

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Cervical spine-The child sup- in the back and deformity (gibbus) for last two ment of spine? The thoracolumbar spine is the common- under the chin and twists his Pain was gradual in onset buy 250 mcg seroflo free shipping allergy medicine help sore throat, with occasional est site of involvement generic 250mcg seroflo visa food allergy symptoms 6 month old. Toracolumbar spine is the most vides support placing his hands history is present buy discount mentax line. Central type: Here the central part of located by applying gentle blows on Tis is a case of tuberculosis of spine. Adolescent male child with pain in the the weakened vertebrae giving rise to sure on the side of the spinous proc- back and deformity, i. Appendicial or posterior type: In this • Percussion: Over the spine is ofen per- • Kyphosis: Tis is excessive posterior type the posterior complex of the ver- formed to elicit tenderness. All movements become painful a normal lordosis, seldom shows evi- frst three decades of life without any due to muscle spasm. Neurological examination of lower limbs bending with a prominent backward senting symptom. Vibration and joint sense is the frst to muscles in early stages and later on About 10 to 30 percent of patients with recover although this was the last neuro- there is fbrous or bony ankylosis of the caries spine will develop neurological logical involvement. Deformity in the form of kyphosis, during the active phase of the disease, courses form the vertebra, viz. If it passes on the sides, it produces remember the clinical features by paraplegia? The pus can pass along musculofascial Deformity, R = Rigidity, P = Pain, A be compressed by the sof infamma- planes or neurovascular bundles, and = Abscess (cold), N = Neurological tory material, e. Caries spine mostly afects the verte- lary sheath, which is a tubular and destroys it is known as pannus. Pus may gravitate down from poste- entering through a zigzag tract to avoid rior mediastinum behind the medial sinus formation. Evacuation: Here the cold abscess is of Chronic Osteomyelitis become psoas and lumbar abscess drained, its walls curetted and the wound respectively. Paravertebral, lateral or anterior drainage of a pyogenic abscess, where a thoracic abscess may develop fol- postoperative drain is almost always lef. How will you treat a patient with neuro- Age: Acute osteomyelitis is common in nerves. History of present illness: forms in the loin or along femoral rest for dorsolumbar spine. Tere is not improve at a satisfactory rate or expulsion of bone chips through the sinus diminution of the intervertebral space if it deteriorates in spite of conserva- is strongly suggestive of osteomyelitis. Swelling: The site, size, shape, sur- Tere is no cold abscess formation or by sof infammatory material like cold face and pulsation are observed. Sinus: If present, its position, nature lization and antitubercular drugs are to be fcient for the drainage.