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These patients have "brittle bones" and also typically develop blue scleras and hearing loss doctor for erectile dysfunction in ahmedabad buy generic kamagra super 160mg line. Decreased levels of vitamin D can produce rickets in children or osteomalacia in adults impotence with lisinopril cheap kamagra super 160mg overnight delivery. It may be caused by inflammation (inflammatory edema) or it may be due to abnormalities involving the Starling forces acting at the capillary level (noninflammatory edema or hemodynamic edema) b12 injections erectile dysfunction generic 160 mg kamagra super visa. Inflammatory edema is caused by increased capillary permeability, which is the result of vasoactive mediators of acute inflammation. An exudate is inflammatory edema fluid resulting from increased capillary permeability. It is characterized by a high protein content, much cellular debris, and a specific gravity greater than 1. Pus is an inflammatory exudate containing numerous leukocytes and cellular debris. In contrast, transudates result either from increased intravascular hydrostatic pressure or from decreased osmotic pressure. Noninflammatory edema is the result of abnormalities of the hemodynamic (Starling) forces acting at the level of the capillaries. Increased hydrostatic pressure may be caused by arteriolar dilation, hypervolemia, or increased venous pressure. Hypervolemia may be caused by sodium retention seen in General Pathology Answers 109 renal disease, and increased venous hydrostatic pressure can be seen in venous thrombosis, congestive heart failure, or cirrhosis. Decreased plasma oncotic pressure is caused by decreased plasma protein, the majority of which is albumin. Decreased albumin levels may be caused by loss of albumin in the urine, which occurs in the nephrotic syndrome, or by reduced synthesis, which occurs in chronic liver disease. Lymphatic obstruction may be caused by tumors, surgical resection, or infections (for example, infection with filarial worms and consequent elephantiasis). It may be caused by increased arterial supply (active hyperemia) or impaired venous drainage (passive hyperemia). Examples of active hyperemia include increased blood flow during exercise, blushing (such as embarrassment associated with being asked a question during a lecture), or inflammation. Examples of passive hyperemia, or congestion, include the changes produced by chronic heart failure. The lung changes are characterized by intraalveolar, hemosiderinladen macrophages, called "heart failure cells. In contrast to hyperemia, hemorrhage refers to the leakage of blood from a blood vessel. Blood may escape into the tissue, producing a hematoma, or it may escape into spaces, producing a hemothorax, hemopericardium, or hemarthrosis. Superficial hemorrhages into the skin or mucosa are classified as petechiae (small, pinpoint capillary hemorrhages), purpura (diffuse, multiple superficial hemorrhages), or ecchymoses (larger, confluent areas of hemorrhages). Their procoagulant activities involve activation of the extrinsic coagulation cascade by their production of tissue factor (thromboplastin) and stimulation of platelet aggregation by their production of von Willebrand factor and platelet-activating factor. The contrasting actions of the arachidonic acid metabolites prostacyclin and thromboxane A2 (TxA2) produce a fine-tuned balance 110 Pathology for the regulation of clotting. TxA2, a product of the cyclooxygenase pathway of arachidonic acid metabolism, is synthesized in platelets and is a powerful platelet aggregator and vasoconstrictor. Fibrinogen, which is produced by the liver and not endothelial cells, is cleaved by thrombin to form fibrin. When formed within the heart or the arteries, thrombi may have laminations, called the lines of Zahn, formed by alternating layers of platelets admixed with fibrin, separated by layers with more cells. Mural thrombi within the heart are associated with myocardial infarcts and arrhythmias, while thrombi in the aorta are associated with General Pathology Answers 111 atherosclerosis or aneurysmal dilatations. Arterial thrombi are usually occlusive; however, in the larger vessels they are not. Venous thrombi, which are almost invariably occlusive, are found most often in the legs, in superficial varicose veins or deep veins. The postmortem clot is usually rubbery, gelatinous, and lacks fibrin strands and attachments to the vessel wall. Large postmortem clots may have a "chicken fat" appearance overlying a dark "currant jelly" base. These thromboemboli, most of which originate in the deep veins of the lower extremities, may embolize to the lungs.

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Because of the gross appearance of the liver at necropsy in the photograph below low libido erectile dysfunction treatment buy kamagra super visa, one would also expect to find a erectile dysfunction drugs for heart patients purchase kamagra super 160mg amex. A pulmonary saddle embolus Right heart failure Portal vein thrombosis Biliary cirrhosis Splenic amyloidosis 157 zyprexa impotence order kamagra super cheap. Which one of the listed disorders is the best example of an abnormality that produces systolic dysfunction primarily because of increased afterload? Anemia Aortic regurgitation Mitral regurgitation Mitral stenosis Systemic hypertension 178 Pathology 158. A 64-year-old male presents with recurrent chest pain that develops whenever he attempts to mow his yard. He relates that the pain goes away after a couple of minutes if he stops and rests. He also states that the pain has not increased in frequency or duration in the last several months. Which one of the listed substances has the following characteristic serum changes following a myocardial infarction: levels begin to increase 4 to 6 h after the onset of chest pain, reach maximal serum concentration in about 12 to 24 h, and remain elevated for about 3 to 10 days? A 59-year-old male develops intense substernal, crushing chest pain that is not relieved by nitroglycerin. At autopsy a large necrotic area is found that involves a large portion of the anterior left ventricle. Distal 2 cm of the left anterior descending artery Distal 2 cm of the left circumflex artery Proximal 2 cm of the left anterior descending artery Proximal 2 cm of the left circumflex artery Proximal one-third of the right coronary artery Cardiovascular System 179 161. Arrange the following numbered statements in the correct order of the expected sequence of events that normally occur during healing of a myocardial infarction. Several days following a myocardial infarction, a 51-year-old male develops the sudden onset of a new pansystolic murmur along with a diastolic flow murmur. Workup reveals increased left atrial pressure that develops late in systole and extends into diastole. Aneurysmal dilation of the left ventricle Obstruction of the aortic valve Rupture of the left ventricle wall Rupture of a papillary muscle Thrombosis of the left atrial cavity 163. Three weeks following a myocardial infarction, a 54-year-old male presents with fever, productive cough, and chest pain. The pain is worse with inspiration, better when he is sitting up, and not relieved by nitroglycerin. Physical examination finds a friction rub along with increased jugular venous pressure and pulsus paradoxus (excess blood pressure drop with inspiration). She states that for the past 6 months she has been taking an unauthorized appetite suppressant to try to lose weight. A section from her heart at the time of autopsy reveals marked thickening of the right ventricle, but the thickness of the left ventricle is within normal limits. The endocardium does not appear to be increased in thickness or fibrotic, and the cardiac valves do not appear abnormal. Carcinoid heart disease Cor pulmonale Eccentric hypertrophy Systemic hypertensive heart disease Volume overload to the heart 165. A 71-year-old female presents with increasing chest pain and occasional syncopal episodes, especially with physical exertion. Physical examination reveals a crescendo-decrescendo midsystolic ejection murmur with a paradoxically split second heart sound (S2). Pressure studies reveal that the left ventricular pressure during systole is markedly greater than the aortic pressure. Aortic regurgitation Aortic stenosis Constrictive pericarditis Mitral regurgitation Mitral stenosis 166. Latent syphilis Infective endocarditis Rheumatic fever Aortic dissection Congenital defects Cardiovascular System 181 167. Physical examination of an asymptomatic 29-year-old female with a history of rheumatic fever during childhood finds an early diastolic opening snap with a rumbling late diastolic murmur. Aortic regurgitation Aortic stenosis Mitral regurgitation Mitral stenosis Pulmonic stenosis 168. Acute rheumatic fever classically develops in children 1 to 4 weeks after a group A -hemolytic streptococcal (Streptococcus pyogenes) infection of the a. The most characteristic and frequent feature of chronic rheumatic heart disease is the development of a.

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Several other children in the day-care center he attends 5 days a week have developed similar illnesses erectile dysfunction treatment in trivandrum discount kamagra super master card. Physical examination finds mild liver tenderness erectile dysfunction doctor in houston discount kamagra super online mastercard, but no lymphadenopathy is noted erectile dysfunction bangalore doctor buy kamagra super with paypal. Laboratory examination finds mildly elevated serum levels of liver enzymes and bilirubin. Which one of the following hepatitis profile patterns is most consistent with an asymptomatic hepatitis B carrier? A mononuclear portal inflammatory infiltrate that disrupts the limiting plate and surrounds individual hepatocytes (piecemeal necrosis) is characteristic of a. Ascending cholangitis Chronic active hepatitis Acute alcoholic hepatitis Cholestatic jaundice Nutritional cirrhosis 303. The combination of episodic elevations in serum transaminase levels along with fatty change in hepatocytes is most suggestive of infection with a. Hepatitis A virus Hepatitis B virus Hepatitis C virus Hepatitis D virus Hepatitis E virus Gastrointestinal System 315 304. You follow her in your clinic and find over the next 9 months that her liver enzymes have remained elevated. A liver biopsy reveals chronic inflammation in the portal triads that focally destroys the limiting plate and "spills over" into the adjacent hepatocytes. There are no granulomas present, and there is no evidence of fibrosis surrounding any of the bile ducts within the portal triads. Autoimmune hepatitis Chronic persistent hepatitis Primary biliary cirrhosis Primary sclerosing cholangitis Systemic lupus erythematosus 305. Dilated sinusoids and irregular cystic spaces filled with blood within the liver, which may rupture, leading to massive intraabdominal hemorrhage, are most commonly associated with a. A 49-year-old male presents with symptoms that developed following a long weekend of binge drinking. Cirrhosis, as illustrated in the photomicrograph below, is characterized histologically by finding a. Which of the listed types of cells found within the liver is the major source of the excess collagen deposited in cirrhosis? Hepatocytes Kupffer cells Ito cells Endothelial cells Bile duct epithelial cells 309. A liver biopsy is performed and reveals extensive deposits of hemosiderin in the hepatocytes and Kupffer cells. Defective excretion of copper into the bile Defective synthesis of 1 antitrypsin Defective synthesis of glycogen Excessive absorption of galactose from the small intestines Excessive reabsorption of iron from the small intestines 310. A 5-year-old girl is brought in with severe vomiting that has developed suddenly 5 days after she has had a viral infection. Upon questioning, her parents indicate that she was given aspirin for several days to treat a fever that occurred with the viral illness. Which one of the following tumors is most likely to be associated with primary sclerosing cholangitis? Adenocarcinoma of the gallbladder Adenocarcinoma of the pancreas Cholangiocarcinoma Hepatoblastoma Hepatocellular carcinoma 312. A 26-year-old presents with right upper quadrant abdominal pain and is found to have a large cyst in the right lobe of his liver. Examination of this tissue histologically reveals a thick, acellular, laminated eosinophilic wall. The fluid within the cyst is found to be granular and contain numerous small larval capsules with scoleces ("brood capsules"). Pyogenic liver abscess Amebic liver abscess Hydatid cyst Schistosomiasis Oriental cholangiohepatitis 313. An oval lesion is found in the right lobe of the liver in an otherwise asymptomatic 24-year-old female.

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