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The changes that occur within the cervical stroma are complex and not completely understood symptoms 3 days after conception order dulcolax with a mastercard. However treatment 4 burns purchase dulcolax 5 mg on line, changes are known to occur with regard to the making up of glycosaminoglycans in the ground substance during labor medicine bow wyoming order dulcolax visa. Hyaluronic acid levels increase, binding more water, whereas concentrations of dermatan sulfate decrease, reducing the number of cross linkages between extracellular fibers within the stroma. In addition, the collagen and elastic fibers within the stroma are shortened and rearranged in such a way as to decreased tensile strength and resistance allowing the dilatation to occur. Deepest is the basal layer (stratum germinativum); followed by an intermediate (spinous) layer and a superficial layer (stratum corneum) from which cells are shed. Desquamated cervical cells can be recovered from vaginal secretions, or cells can be obtained more directly by gentle abrasion of the exocervix. In normal women, four types of cells usually are recognized cytologically, loosely corresponding to the layers of the cervicovaginal epithelium. These include basal (lower basal) cells, parabasal (outer basal) cells, intermediate (precornified) squamous cells, and superficial (cornified) squamous cells. Germinal cells from the basal layer are exceedingly rare in smears from normal adults, and the basal and parabasal cells recognized cytologically are derived from different levels of the intermediate layer. They do represent less mature cells, and their presence indicates that immature cells are at higher than normal levels in the epithelium. These cells are associated with marked deficiency of estrogens and are common before puberty and during menopause. Basal cells arise from the lower levels of the transitional zone and are rounded or oval cells, about 4 to 5 times the size of a granular leukocyte. The central nucleus is deeply stained, but a pattern of fine chromatin granules and dense patches can be made out. Parabasal cells arise higher up in the transitional zone and also are round or oval cells, but they are larger than basal cells with a more abundant cytoplasm that is less basophilic and often shows a somewhat "blotchy" pattern. The central nucleus remains about the same size but may be more dense than that of a basal cell. Vagina the vagina is the lower-most portion of the female reproductive tract and is a muscular tube that joins the uterus to the exterior of the body. Ordinarily the lumen is collapsed and the anterior and posterior walls make contact. The mucosa is thrown into folds (rugae) and consists of a thick surface layer of nonkeratinized stratified squamous epithelium overlying a lamina propria. The glycogen of sloughed cells is broken down by commensal lactobacilli within the vaginal lumen and results in lactic acid being formed. The acid pH creates an environment favorable to the commensal bacterial flora and deters growth of fungi (Candida albicans) and bacterial pathogens. The lamina propria consists of a fairly dense connective tissue that becomes more loosely arranged near the muscle coat. Diffuse and nodular lymphatic tissues are found occasionally, and many lymphocytes, along with granular leukocytes, invade the epithelium. The vagina lacks glands, and the epithelium is kept moist by secretions from the cervix. The muscularis consists of bundles of smooth muscle cells that are arranged circularly in the inner layer and longitudinally in the outer layer. The longitudinally oriented smooth muscle cells become continuous with similarly oriented cells in the myometrium. It merges imperceptibly 248 Intermediate squamous cells vary in size, but all appear as thin, polygonal plates with abundant transparent cytoplasm. The cytoplasm stains somewhat variably and may be lightly basophilic or show some degree of eosinophilia. They are large, with voluminous eosinophilic cytoplasm that is thin and transparent with sharply defined borders. The nucleus is very small - about one-half to one-third that of an intermediate squamous cell - and is densely stained and pyknotic.

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Joint fluid is difficult to collect and a new sample is likely to have the same problem medicine 770 order 5 mg dulcolax otc. A Cellular distortion caused by centrifugation is a common problem symptoms carpal tunnel discount dulcolax 5mg free shipping, and can be reduced by adding 22% bovine albumin or 10% dextran to the cytospin cup along with the sample medicine pills buy dulcolax once a day. A Electronic cell counters are validated for body fluid cell counts with specific minimum detection limits. Semisolid transport media such as Amies, Stuart, that the skin be cleansed with: A. It functions as a preservative Microbiology/Apply knowledge of standard operating procedures/Media/1 is the collection device of choice for recovery of which organism from the nasopharynx Streptococcus pneumoniae Microbiology/Select methods/Reagents/Media/Specimen collection and handling/2 2. B In order to attain asepsis of the skin, 70% alcohol followed by 2% iodine is used for obtaining blood cultures. C the iodine should remain on the skin for 1 min because instant antisepsis does not occur when cleansing the skin for a blood culture. A flexible calcium alginate nasopharyngeal swab is the best choice for collecting a specimen from the posterior nares and pharynx. Select the method of choice for recovery of anaerobic bacteria from a deep abscess. C Anaerobic specimens are easily contaminated with organisms present on the skin or mucosal surfaces when a swab is used. Needle aspiration of an abscess following surface decontamination provides the least exposure to ambient oxygen. B Hektoen agar selectively isolates pathogenic coliforms, especially Salmonella and Shigella. Campy agar contains the antibiotics cephalothin, trimethoprim, vancomycin, polymyxin B, and amphotericin B to prevent growth of Enterobacteriaceae, Pseudomonas spp. This medium is especially useful for stool and wound cultures because these may contain large numbers of gram-negative rods. Sheep blood does not support the growth of Haemophilus haemolyticus, eliminating the possibility of confusing it with -hemolytic streptococci in throat cultures. Clostridium difficile Microbiology/Select methods/Reagents/Media/Stool culture/1 isolation of: A. Microbiology/Select methods/Reagents/Media/Stool culture/1 selective medium used for the recovery of which bacteria Cycloserine and cefoxitin inhibit growth of gram-negative coliforms in the stool specimen. The media contain lactose and neutral red, allowing differentiation of lactose fermenters (pink colonies) from nonfermenters (colorless). The medium contains xylose, lactose, and sucrose, which are fermented by most normal intestinal coliforms producing yellow colonies. Some Salmonella produce hydrogen sulfide (H2S) from sodium thiosulfate and therefore appear as red colonies with black centers. A sheep blood agar plate is used as a primary isolation medium when all of the following organisms are to be recovered from a wound specimen except: A.

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Pulmonary congestion the thickness of left ventricular wall in left ventricular hypertrophy is at least: A medicine 93832 purchase dulcolax with amex. Left ventricular hypertrophy Post-ductal coarctation of aorta has following features except: A treatment concussion order discount dulcolax. Claudication in lower legs Non-infarct effects of myocardial ischaemia are as under except: A treatments for depression dulcolax 5 mg fast delivery. Chronic ischaemic heart disease the most thrombogenic constituent of atheroma is: A. Smooth muscle cells the most important and common complicated atheromatous lesion in coronary artery in acute myocardial infarction is: A. Stenosis of coronary ostia In hypertensive heart disease left ventricular hypertrophy is correlated with: A. Severity of coronary atherosclerosis In rheumatic heart disease, antibodies against the following streptococcal products are seen in the serum except: A. Endocardial surface in the posterior wall of left ventricle Systemic Pathology 17. Subcutaneous nodules Haematoxylin bodies of Gross may be seen in vegetations of: A. Atherosclerotic valvular disease Vegetations of the following types of endocarditis are generally not friable except that of: A. Non-bacterial thrombotic endocarditis Mitral stenosis causes the following effects on the heart except: A. Dilatation of right atrium In the following heart disease, there is generally involvement of valves of right heart: A. Subacute bacterial endocarditis the following type of cardiomyopathy is classically characterised by four chamber dilatation: A. Infiltrative cardiomyopathy Most common location for performing endomyocardial biopsy is: A. Left ventricle A one month old male baby is brought to paediatric emergency due to difficulty in feeding and lethargy. The weight of the normal adult left lung is 325 to 450 gm (average 400 gm) and has one fissure dividing it into two lobes-the upper and lower lobes, while the middle lobe is represented by the lingula. The trachea, major bronchi and their branchings possess cartilage, smooth muscle and mucous glands in their walls, while the bronchioles have smooth muscle but lack cartilage as well as the mucous glands. Between the tracheal bifurcation and the smallest bronchi, about 8 divisions take place. The bronchioles so formed further undergo 3 to 4 divisions leading to the terminal bronchioles which are less than 2 mm in diameter. Several (usually 3 to 5 generations) respiratory bronchioles originate from a terminal bronchiole. Each alveolar duct opens into many alveolar sacs (alveoli) which are blind ends of the respiratory passages. The lungs have double blood supply-oxygenated blood from the bronchial arteries and venous blood from the pulmonary arteries, and there is mixing of the blood to some extent. The alveolar walls or alveolar septa are the sites of exchange between the blood and air and have the following microscopic features: 1. The capillary endothelium lines the anastomotic capillaries in the alveolar walls. The capillary endothelium and the, alveolar lining epithelial cells are separated by the capillary basement membrane and some interstitial tissue. The alveolar macrophages belonging to mononuclear-phagocyte system are present either free in the alveolar spaces or are attached to the alveolar cells. The pores of Kohn are the sites of alveolar connections between the adjacent alveoli and allow the passage of bacteria and exudate. The respiratory tract is particularly exposed to infection as well as to the hazards of inhalation of pollutants from the inhaled air and cigarette smoke. Intralobar sequestration is the sequestered bronchopulmonary mass within the pleural covering of the affected lung.

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More than 30 years later treatment integrity checklist order dulcolax uk, the particular type of lymphoma that he characterized was named Hodgkin disease in his honor symptoms for pneumonia order 5mg dulcolax with visa. The published descriptions of other hematologic malignancies symptoms thyroid problems buy discount dulcolax 5 mg online, such as leukemia and multiple myeloma, soon followed. Since that time, these malignancies have been further described and attempts made to categorize various subtypes. With the assistance of immunophenotyping and cytogenetic and molecular genetic testing, it is now understood that hematologic malignancies include a very large number of genetically diverse diseases (Lichtman, 2008). To provide specialized care for patients with hematologic malignancies, nurses must keep pace with advances in medicine and science. The purpose of this book is to provide a detailed review of these complex malignancies. Selected myeloid and lymphoid diseases covered in this publication are illustrated in Figures 1-1 and 1-2. History of Hematologic Malignancies Lymphoma the first type of lymphoma was described in "On Some Morbid Appearances of the Absorbent Glands and Spleen," a paper published in 1832 by Thomas Hodgkin. In 1898, Carl Sternberg provided the first description of these malignant cells using a recently discovered staining technique. Just four years later, Dorothy Reed fully described the cells, which were termed Reed-Sternberg cells (Reed, 1902). For the next 60 years, more detailed clinical and pathologic descriptions of many different types of lymphoma emerged (Aisenberg, 2000). In 1942, Gall and Mallory developed the first lymphoma classification to categorize the other lymphomas that were not characterized by the Reed-Sternberg cells (Gall & Mallory, 1942). This classification system was quickly followed by the Rappaport Classification in 1956, which was based on cytology and the presence or absence of follicular structure (Rappaport, Winter, & Hicks, 1956). Almost two decades later, the International Working Formulation was introduced, and lymphoma types were classified based on cell size, cell differentiation, and whether or not the cell was cleaved. In 1965, Hodgkin lymphoma was classified into four staging categories at the Rye conference (Lukes & Butler, 1966). Prior to the development of these classifications, more than 50 different terms had been used in the literature to describe lymphoma (Lukes & Butler, 1966). The foundations of the treatment of lymphoma, in particular Hodgkin lymphoma, began in the early 1900s with the use of radiation therapy. Responses were observed; however, patients were not cured with irradiation until the use of high-dose, extended-field radiation therapy was Copyright by Oncology Nursing Society. Overview of Hematologic Malignancies 3 developed by Henry Kaplan in the 1960s (Kaplan, 1962). In 1946, nitrogen mustard was used to treat Hodgkin lymphoma; however, patients had short remissions without cure (Goodman & Wintrobe, 1946). This four-drug chemotherapy regimen dramatically changed survival outcomes in the Hodgkin disease patient population. Despite the successful cures achieved in patients with Hodgkin lymphoma, treatment toxicities remain a significant source of morbidity and mortality for survivors of this disease (Hoppe, 1997). The most commonly noted causes of mortality are second malignant neoplasms and cardiovascular disease (Hoppe, 1997). They reported that 71% of patients treated achieved complete remissions, and 92% achieved overall responses (McKelvey et al. Flow cytometry, developed in the 1970s, can distinguish various types of hematopoietic cells and their specific antigens. Leukemia and lymphoma cells often express antigens or specific products on their surfaces, making them ideal diseases for therapeutic targets. The manufacture of humanized monoclonal antibodies has allowed for a decrease in immunogenicity, improved pharmacokinetics, and enhanced antibody-dependent cytotoxicity (Kampen, 2012).

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