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100 years 1920 to 2020

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By: S. Tjalf, M.A.S., M.D.

Associate Professor, Drexel University College of Medicine

The purpose of this treatment is to reduce the levels of which one of the following An 8-month-old baby girl had normal growth and development for the first few months depression scale prozac 60 mg fast delivery, but then progressively deteriorated with deafness depression definition us history order prozac 60 mg overnight delivery, blindness anxiety for dummies buy 10mg prozac with mastercard, atrophied muscle depression medicine order prozac 60mg free shipping, inability to swallow, and seizures. Early on in the diagnosis of the child, it was noticed that a cherry red macula was present in both eyes. Considering the child in the above case, measurement of which one of the following would enable one to determine whether the mutation were in the hex A or hex B gene This drug lowers blood cholesterol levels due primarily to which one of the following A 2-day-old infant born at 32 weeks gestation has had breathing difficulties since birth and is currently on a respirator and 100% oxygen. A person with an intestinal infection caused by a proliferation of bacteria in the gut would most likely have an increase in which one of the following Blood work showed elevated levels of free fatty acids, but low levels of acylcarnitine. A muscle biopsy demonstrated a significant level of fatty acid infiltration in the cytoplasm. The most likely molecular defect in this child is in which one of the following enzymes A 28-year-old man was found to have elevated cholesterol levels of 325 mg/dL on a routine checkup. His father died of a heart attack at the age of 42, and also had greatly elevated cholesterol levels throughout his life. The nature of the elevated cholesterol in this patient is most likely due to a mutation in which one of the following proteins Type 1 diabetes mellitus is caused by a decreased ability of the cells of the pancreas to produce insulin. A person with Type 1 diabetes mellitus who has neglected to take insulin injections will exhibit which one of the following The lab values revealed a blood cholesterol level of 360 mg/dL (the recommended level is below 200 mg/dL) and a blood triglyceride (triacylglycerol) level of 140 mg/dL (the recommended level is below 150 mg/dL). A premature infant, when born, had low Apgar scores and was having difficulty breathing. In addition to proteins, a key component of the mixture was which one of the following The pancreas produces bicarbonate (which neutralizes stomach acid) and digestive enzymes (including pancreatic lipase and colipase, enzymes that degrade dietary lipids). Lower levels of pancreatic lipase will result in the decreased digestion of dietary triacylglycerols, which will lead to the formation of fewer bile salt micelles. The reduced pH will also interfere with the ability of the bile salts to effectively form micelles. Intestinal cells will have less substrate for chylomicron formation, and less fat-soluble vitamins will be absorbed. Malonyl-CoA provides the 2-carbon units that add to the growing fatty acid chain on the fatty acid synthase complex. The synthesis of fatty acids from glucose occurs in the cytosol, except for the mitochondrial reactions in which pyruvate is converted to citrate (pyruvate to oxaloacetate, pyruvate to acetyl-CoA, and oxaloacetate and acetyl-CoA condense to form citrate). Biotin is required for the conversion of pyruvate to oxaloacetate (a carboxylation reaction), which combines with acetyl-CoA to form citrate. Pantothenic acid is covalently bound to the fatty acid synthase complex as part of a phosphopantetheinyl residue. During the reduction reactions on the synthase complex, the growing fatty acid chain is attached to this residue. The lipoprotein lipase is not required to synthesize triglyceride within the adipocyte. Adipose tissue lacks glycerol kinase and cannot use glycerol to directly form glycerol-3-phosphate. After inorganic phosphate is released from phosphatidic acid, the resultant diacylglycerol reacts with another fatty acyl-CoA to form a triacylglycerol, which is stored in the adipose cells. Because chylomicrons contain the most triacylglycerol, they are the least dense of the blood lipoproteins. Triacylglycerols are degraded, and fatty acids and glycerol are released into the blood. In the liver, glycerol is converted to glucose by gluconeogenesis and fatty acids are oxidized to produce ketone bodies. A palmitate residue attached to carbon 1 of a dietary triacylglycerol is released by pancreatic lipase and carried from the intestinal lumen to the gut epithelial cell in a bile salt micelle, which will allow absorption of the fatty acid by the intestinal epithelial cell. Palmitate is absorbed into the intestinal cell and utilized to synthesize a triacylglycerol, which is packaged in a nascent chylomicron and secreted via the lymph into the blood. The chylomicron triacylglycerol is digested by lipoprotein lipase, and the palmitate enters a fat cell and is stored as triacylglycerol. It is released as free palmitate and carried, complexed with albumin, to a muscle cell, where it is oxidized. He is unable to transport blood-borne carnitine into the muscle and liver, thereby blocking fatty acid oxidation in those tissues. Carnitine is required to transfer most fatty acids from the cytoplasm to the matrix of the mitochondria. However, short- and medium-chain fatty acids (up to 10 or 12 carbons) are sufficiently water-soluble such that they can enter cells and be transferred into the mitochondria in the absence of carnitine. Once inside the mitochondria, an acyl-CoA synthetase will activate the fatty acid to an acyl-CoA such that -oxidation can occur. The transfer is not affected whether the fatty acid is saturated or unsaturated; the chain length is the determining factor.

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These amino acids contain carbons that can be converted to glutamate bipolar depression regular depression purchase prozac 10mg line, which can be converted to glucose in the liver depression symptoms hair loss order prozac without prescription. Tyrosine anxiety 504 plan accommodations discount prozac 60mg with amex, the 11th nonessential amino acid depression game buy cheap prozac 40mg on line, is synthesized by the hydroxylation of the essential amino acid phenylalanine in a reaction that requires tetrahydrobiopterin, which is a required cofactor for ring hydroxylation reactions. When the carbon skeletons of amino acids are degraded, the major products are pyruvate, 2. Amino acids that form acetyl-CoA or acetoacetate are ketogenic; that is, they form ketone 4. Some amino acids (isoleucine, tryptophan, phenylalanine, and tyrosine) are both glucogenic and ketogenic. Its sulfur, which was derived from methionine, is converted to H2So4, which is excreted by the kidneys. The earlier cases were reported to be associated with mental retardation, but more recently, deleterious consequences have not been observed. In a different set of reactions, threonine is converted to glycine and acetyl-CoA. The homocysteine that accumulates is oxidized to homocystine and excreted in the urine. Other causes of elevated levels of homocyst(e)ine (homocysteine or homocystine) in the blood or urine are deficiencies of the enzyme methionine synthase (that converts homocysteine to methionine) or dietary deficiencies of the vitamin cofactors for this enzyme (folate and B12). Elevated levels of homocyst(e)ine have been associated with increased risk of coronary artery disease, although this is controversial. The amino acids methionine, threonine, isoleucine, and valine, which form succinyl-CoA via methylmalonyl-CoA, are all essential. The carbons of serine are converted to cysteine and do not form succinyl-CoA by this pathway. The degradation of all three branched-chain amino acids begins with a transamination followed by an oxidative decarboxylation catalyzed by the branched-chain -keto acid dehydrogenase complex. Valine is eventually converted to succinyl-CoA via propionyl-CoA and methylmalonyl-CoA. Three amino acids (phenylalanine, tyrosine, and aspartate) are converted to fumarate. There are a number of disorders associated with phenylalanine and tyrosine metabolism. Phenylalanine accumulates, and is converted to compounds such as the phenylketones, which give the urine a musty odor. In alcaptonuria, homogentisic acid, a product of phenylalanine and tyrosine metabolism, accumulates because homogentisate oxidase is defective. Homogentisic acid auto-oxidizes and the products polymerize, forming dark-colored pigments, which accumulate in various tissues and are sometimes associated with a degenerative arthritis. Some of these amino acids (tryptophan, phenylalanine, and tyrosine) also contain carbons that can form glucose. Tyrosine aminotransferase catalyzes the transamination of tyrosine to 4-hydroxyphenylpyruvate. During fasting, amino acids from muscle protein are released into the blood, predominantly as alanine and glutamine. The gut takes up glutamine from the blood and converts it to alanine, citrulline, and ammonia, which are released. The kidney takes up glutamine from the blood and releases ammonia into the urine and alanine and serine into the blood. The liver takes up alanine and other amino acids from the blood and converts the nitrogen to urea and the carbons to glucose and ketone bodies, which are released into the blood and oxidized by tissues for energy. Thus, amino acids from muscle protein serve as a source of energy for many other tissues. Amino acid metabolism in muscle During fasting, amino acids are released from muscle protein. Some of the amino acids are partially oxidized in muscle and their remaining carbons are converted to alanine and glutamine. Thus, although about 50% of the amino acids released into the blood from muscle are alanine and glutamine, these two amino acids constitute much less than 50% of the total amino acid residues in muscle protein. Some of their carbons are converted to glutamine and alanine before they are released into the blood. Malate can be converted by the malic enzyme to pyruvate, which is transaminated to alanine or oxidatively decarboxylated to acetyl-CoA. Glutamine is converted by the kidney to alanine and serine or by the gut to alanine. The liver converts the carbons of alanine and other amino acids to glucose or to ketone bodies and the nitrogens to urea. The metabolism of the carbon skeletons of branched-chain amino acids in skeletal muscle. The carbon skeletons can also be converted to glutamate and alanine, shown in red, for nitrogen transport to the liver. The pathway for the transfer of the amino group from branched-chain amino acids in skeletal muscle to urea in the liver is shown in red. Pyruvate can be transaminated to alanine, which travels to the liver carrying nitrogen for urea synthesis and carbon for gluconeogenesis.

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The nodule has ulcerated and not healed despite use of antibacterial cream mood disorder rapid cycling purchase 60 mg prozac, and a new nodule is forming above the original lesion depression symptoms boredom buy generic prozac 10 mg online. Although hard to find in the above mentioned nodule anxiety and high blood pressure cheap prozac master card, what form would be present in the tissue Bronchial alveolar fluid shows dichotomously branching (generally with acute angles) depression definition geography order prozac 20mg with visa, septate hyphae. A premature infant on intravenous nutrients and high-lipid fluids has developed septicemia that cultures out on blood agar only when overlaid with sterile olive oil. A patient presents with paranasal swelling and bloody exudate from both his eyes and nares, and he is nearly comatose. Necrotic tissue in the nasal turbinates show nonseptate hyphae consistent with Rhizopus, Mucor, or Absidia (phylum Zygomycot-. To treat a patient with a life-threatening fungal infection, you choose an antifungal drug that causes pore formation in the fungal membrane and actually kills the cells. A 15-year-old dirt-bike rider visiting southern California the first time has developed pneumonia. The causative organism has environmental form that consists of hyphae that break up into arthroconidia, which become airborne. A recent immigrant from rural Brazil presents with a swollen face and extremely poor dental hygiene, including loss of an adult tooth, which appears to be the focus of the current infection. A patient who is a recent immigrant from a tropical, remote, rural area with no medical care is now working with a group of migrant crop harvesters. A patient has splotchy hypopigmentation on the chest and back with only slight itchiness. A premature baby, now 4 days old, has developed a white coating on her buccal mucosa extending onto her lips. Which of the following stains allows differentiation of fungus from human tissue by staining the fungus a pink-red color A normally healthy 8-year-old boy from Florida is visiting friends on a farm in Iowa during the month of July. He presents on July 28 with a fever, cough, and lower respiratory symptoms (no upper respiratory tract symptoms). His chest sounds are consistent with pneumonia, so a chest radiograph is obtained. Which of the following is a polyene antifungal agent used for many life-threatening fungal infections The headache was initially lessened by analgesics, but the analgesics are no longer effective. A logger undergoing chemotherapy for cancer has developed pneumonia and skin lesions. Biopsy of the skin lesions demonstrates the presence of large yeasts with thick cell walls and broad-based buds. This is a classic case oflymphocutaneous sporotrichosis in which a gardener or florist is infected via a puncture wound. The drug of choice is either itraconazole or potassium iodide (administered orally in milk). Topical antifungals are not effective, and the cortisone cream would probably enhance the spread of the disease. Griseofulvin localizes in the keratinized tissues and would not halt the subcutaneous spread of this infection. Sporothrix schenckii is dimorphic; the tissue form is cigar-shaped yeasts, but they are hard to find by histology. Zygomycota are aseptate fungi that cause serious infections, primarily in ketoacidotic diabetic patients and cancer patients. Severely neutropenic patients are most likely to have invasive Aspergillus infections. Pityriasis versicolor would have the clusters of yeasts with shon, septate, curved hyphae (spaghetti and meatballs appearance). A filariform larvae would only be characteristic of dog hookworm, which is usually acquired from walking barefoot where there are dog feces. It would not be acquired from sleeping with the do& and would not cause hair loss in the dog. It causes fungemia, primarily in premature infants on high-lipid intravenous supplements. The fungal subunit, called a hypha, is a filamentous structure with or without cross walls (septae). Although both amphotericin B and nystatin are polyenes, only amphotericin B is used systemically. The imidazoles inhibit ergosterol synthesis, and griseofulvin, which localizes in the keratinized tissues, inhibits the growth of dermatophytes by inhibiting microtubule assembly. Coccidioides immitis is found in desen sand, primarily as arthroconidia and hyphae. Amphotericin Band nystatin both bind to ergosterol and create membrane pores, causing cell leakage and death. Malassezia jurjuThis seen in tissues as clusters of round fungal cells with shon, curved septate hyphae (spaghetti and meatballs appearance) and is the causative agent of pityriasis or tinea versicolor; M. The location of the lesions and presenting signs seen in this patient suggest actinomycotic mycetoma, a bacterial infection caused by the Actinomyces part of the gingival crevices flora. Remember that Actinomyces is a Gram-positive anaerobic bacterium that is not acid-fast. The finding of dematiaceous (dark), yeastlike sclerotic bodies that have sharp planar division lines and the clinical presentation are both characteristic of chromoblastomycosis.

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Syndromes

  • Weight loss or gain
  • Contrast can be given through a vein (IV) in your hand or forearm. If contrast is used, you may also be asked not to eat or drink anything for 4-6 hours before the test.
  • Blisters
  • Weakened bones (osteomalacia)
  • In the male reproductive system
  • Decrease in hormones made by the endocrine glands
  • Washing of the skin (irrigation) -- perhaps every few hours for several days
  • Varicose veins
  • Increased supply of food with reduced cost and longer shelf life
  • Hematoma (collection of blood under the skin after injury)

Dysautonomia

A latex particle agglutination test confirms the etiological cause of the bacterial meningitis depression executive function purchase prozac 10mg line. A 28-year-old neutropenic woman with Pseudomonas aeruginosa septicemia develops shock depression definition quotes buy prozac with american express. A 5-year-old Somali immigrant girl presented to the local Family Medicine Clinic with a 2-day history of headache mood disorder screening test prozac 10mg amex, earache depression test for 16 year olds order prozac 20 mg without a prescription, and swallowing difficulty. She had been in this country for 4 months and had started her childhood vaccinations 2 weeks ago. Repeated Neisseria meningitidis septicemias in an individual should raise physician awareness of what underlying condition The infant shows signs and symptoms of hepatosplenomegaly, jaundice, low birth weight, chorioretinitis, and microcephaly. The mother appears healthy and reports an unremarkable pregnancy except for a period during the third month when she developed a fever, sore throat, and became extremely fatigued for a period of 10 days. Demyelinating lesions, increased IgG in spinal fluid, and chronic relapsing occurrences are characteristic of which autoimmune disease The virus is a (A) Adenovirus (B) Influenza A virus (C) Parainfluenza virus (D) Respiratory syncytial virus 31. A 26-year-old woman presents with high fevelj painful and frequent urination, and left flank pain. The isolate is a Gram-negative, rod-shaped, facultative anaerobe that is oxidase-negative and ferments both glucose and lactose. Infection with which of the following organisms is more often noted for the production of a lymphocytosis rather than a mononucleosis The agent in question 31, which is causing the ascending urinary tract infection and pyelonephritis, has a normal flora "fraternal twin" of the same genus and species. What virulence factor does the pathogen have and the normal flora organism lack even although both are E cob" In which one of the following fungal scalp infections is hair loss most likely to be permanent A 7 -year-old boy develops vesicular skin lesions on his trunk, which quickly spread to his extremities and appear on the scalp. Scrapings from the vesicles show multinucleated cells and Cowdry type A inclusion bodies. An 18-year-old New York dirt bike racer, who recently raced for the first time in races along the Mississippi and also in the desert southwest, presents in September with cough, malaise, low-grade fever, myalgias, and chest pain. Sputum stained with calcofluor white and viewed with an ultraviolet microscope shows hundreds of tiny yeast cells inside white cells. If cultured at room temperature, hyphae with small microconidia and tuberculate macroconidia would grow. A 19-year-old college freshman has a sore throat, sore and enlarging cervical lymph nodes, and a fever. If a series of drug resistance genes are transferred together routinely, what is the most likely method of transfer A Gram-positive, beta-hemolytic, catalasepositive, coagulase-positive coccus is isolated. Intracellular survival and replication are the major virulence factors rather than exotoxin production for which of the following organisms His tuberculin skin test has been greater than 10 mm the three times you have tested him in the 25 years he has been your patient. You order Mycobacterium tuberculosis testing and susceptibilities and start him on standard therapy. A 17-year-old male visiting his grandparents in Louisiana in August develops a severe unrelenting headache that is not relieved by analgesics. He is very sleepy and complains about an odd odor that he thinks is in the whole house. A woman who is an intravenous drug abuser and who has been a prostitute for the past 20 years now has an aortitis. The most likely mechanism for this resistance is (A) Decreased affinity for the M2 protein (B) Inability to phosphorylate the antiviral (C) Mutation in the neuraminidase gene (D) Synthesis of a 13-lactamase 48. A 4-year-old boy has a yearlong history of repeated staphylococcal and streptococcal infections. He was referred to the genetic counseling unit where he was found to have depressed superoxide dismutase activity. A 30-year-old man appears at your office complaining of difficulty in breathing, headache, and joint and lower back pain. During your history taking, only one unusual activity, the thorough cleaning of an old hunting shack, was noted. The cleaning involved removal of old food containers, pots, and bedding, plus some rodent nests. A 23-year-old who just returned from a 2-week missionary trip to rural Haiti presents with a 2-day history of watery diarrhea. The addition of eggs and other ingredients to make fried rice encourages growth if the fried rice is not held at a high enough temperature to inhibit growth. Onset of watery diarrhea may occur within 2 hours or as long as 18 hours after consumption and is in response to the presence of toxin. Streptococcus "~ti#e (group B streptococci) is the most common cause of neonatal meningitis. It is most prevalent in young women who have had multiple partners and is most likely to infect the baby during a protracted delivery. Listeria is a less frequent cause of neonatal meningitis and other severe diseases in newborns.

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