数字 Accessory Bronchus 副気管支 Accessory Fissure 副葉間裂
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USMLE – What's It
Purpose of this handout Congratulations on making it to Year 2 of medical school! You are that much closer to having your Doctor of Medicine degree. If you want to PRACTICE medicine, however, you have to be licensed, and in order to be licensed you must first pass all four United States Medical Licensing Exams. This book is intended as a starting point in your preparation for getting past the first hurdle, Step 1. It contains study tips, suggestions, resources, and advice. Please remember, however, that no single approach to studying is right for everyone. USMLE – What is it for? In order to become a licensed physician in the United States, individuals must pass a series of examinations conducted by the National Board of Medical Examiners (NBME). These examinations are the United States Medical Licensing Examinations, or USMLE. Currently there are four separate exams which must be passed in order to be eligible for medical licensure: Step 1, usually taken after the completion of the second year of medical school; Step 2 Clinical Knowledge (CK), this is usually taken by December 31st of Year 4 Step 2 Clinical Skills (CS), this is usually be taken by December 31st of Year 4 Step 3, typically taken during the first (intern) year of post graduate training. Requirements other than passing all of the above mentioned steps for licensure in each state are set by each state’s medical licensing board. For example, each state board determines the maximum number of times that a person may take each Step exam and still remain eligible for licensure. -
Ep001476158b1*
(19) *EP001476158B1* (11) EP 1 476 158 B1 (12) EUROPEAN PATENT SPECIFICATION (45) Date of publication and mention (51) Int Cl.: of the grant of the patent: A61K 31/455 (2006.01) A61P 29/00 (2006.01) 14.11.2007 Bulletin 2007/46 A61P 11/00 (2006.01) C07D 405/12 (2006.01) C07D 213/82 (2006.01) C07D 401/12 (2006.01) (2006.01) (21) Application number: 03739392.3 C07D 451/04 (22) Date of filing: 03.02.2003 (86) International application number: PCT/IB2003/000439 (87) International publication number: WO 2003/068235 (21.08.2003 Gazette 2003/34) (54) NICOTINAMIDE DERIVATIVES USEFUL AS PDE4 INHIBITORS NICOTINAMID-DERIVATE ALS PDE4-HEMMER DERIVES DE NICOTINAMIDE UTILES COMME INHIBITEURS DE PDE4 (84) Designated Contracting States: • HENDERSON, A.J., AT BE BG CH CY CZ DE DK EE ES FI FR GB GR c/o UK Patent Dept., HU IE IT LI LU MC NL PT SE SI SK TR Pfizer Ltd. Designated Extension States: Sandwich, Kent CT13 9NJ (GB) AL LT LV MK RO • MAGEE, T.V., c/o Pfizer Global Res. and Develop. (30) Priority: 11.02.2002 GB 0203196 Groton, CT 06340 (US) 10.09.2002 GB 0220999 • MARFAT, A., 21.10.2002 GB 0224453 c/o Pfizer Global Res. and Develop. 20.11.2002 GB 0227139 Groton, CT 06340 (US) • MATHIAS, J.P., (43) Date of publication of application: c/o Pfizer Global Res. and Develop. 17.11.2004 Bulletin 2004/47 Sandwich, Kent CT13 9NJ (GB) (73) Proprietors: • MCLEOD, D.G., • Pfizer Limited c/o Pfizer Global Res. -
CARDINAL SYMPTOMS of HEART DISEASE Exam 1 | Dr. Donato Marañon | September 24, 2012
OS 213: Cardiovascular System LEC 02: CARDINAL SYMPTOMS OF HEART DISEASE Exam 1 | Dr. Donato Marañon | September 24, 2012 OUTLINE Common Cardiac Symptomatology B. Dyspnea A. Chest Pain C. Palpitations 1. Attributes of Pain D. Edema 2. Definitions E. Cyanosis 3. Chronic Recurrent Chest Pain Syndrome F. Syncope 4. Acute Chest Pain Syndrome II. Importance of History and PE 5. Case Discussion The lecture is similar from block B’s Lecture but we changed the formatting though kasing ang gulo nung topic. So if mas naguluhan kayo sorry. Some changes: 1. All the symptomatology are now under common cardiac symptomatology. 2. Differentials for chest pain have been divided into chronic and acute. I. COMMON CARDIAC SYMPTOMATOLOGY Symptoms: complaints of the patient (most common complaint: pain); Includes chest pain, dyspnea, palpitations, edema, cyanosis, syncope Signs: doctors’ objective findings and observations A. CHEST PAIN Chest pain: most common but not exhaustive - can be caused by other factors such as hypertension ATTRIBUTES OF PAIN (PPQRSTO) Provocative – what provokes/triggers the pain o Is it precipitated by effort (exertional)? o At what time does it appear? When you are trying to get up, moving the body, etc… Palliative – what relieves/palliates the pain o Medications, therapy, etc… Quality – the nature of the pain o Sharp, burning, pricking, stabbing, strangulating, oppressing, ache similar to muscle ache, etc. Region/Radiation – location (primary region where the pain is felt), central region, how wide the coverage is and where the pain radiates or is worst o Central precordial pain where does it radiate? Back? Leg? o Hard to interview Filipinos – “doon, diyan” – vague descriptions of location Severity – intensity: mild, moderate, severe o May use a scale from 0 to 10 (worst) o Give open-ended questions Timing o Onset – abrupt, worse at start, insidious, builds up/gradual Ian, Aca, Hannah UPCM 2016A: XVI, Walang 1 of Kapantay! 14 OS 213: Cardiovascular System LEC 02: CARDINAL SYMPTOMS OF HEART DISEASE Exam 1 | Dr. -
Oral Health and Respiratory Infection
C LINICAL P RACTICE Oral Health and Respiratory Infection • Philippe Mojon, DMD, PhD • Abstract The oral cavity has long been considered a potential reservoir for respiratory pathogens. The mechanisms of infec- tion could be aspiration into the lung of oral pathogens capable of causing pneumonia, colonization of dental plaque by respiratory pathogens followed by aspiration, or facilitation by periodontal pathogens of colonization of the upper airway by pulmonary pathogens. Several anaerobic bacteria from the periodontal pocket have been isolated from infected lungs. In elderly patients living in chronic care facilities, the colonization of dental plaque by pulmonary pathogens is frequent. Notably, the overreaction of the inflammatory process that leads to destruc- tion of connective tissue is present in both periodontal disease and emphysema. This overreaction may explain the association between periodontal disease and chronic obstructive pulmonary disease, the fourth leading cause of death in the United States. These findings underline the necessity for improving oral hygiene among patients who are at risk and those living in long-term care institutions. MeSH Key Words: aged; periodontal diseases/epidemiology; pneumonia, aspiration/epidemiology; pneumonia, aspiration/ prevention & control © J Can Dent Assoc 2002; 68(6):340-5 This article has been peer reviewed. he anatomical continuity between the lungs and the different for the 2 types. CAP is a frequent illness, with an oral cavity makes the latter a potential reservoir of incidence rate estimated at about 8 cases per 1,000 inhabi- Trespiratory pathogens. Yet an infective agent must tants per year in industrialized countries. The mortality rate defeat sophisticated immunological and mechanical is about 7% in hospitalized patients.1 Streptococcus pneumo- defence mechanisms to reach the lower respiratory tract. -
179 the Pre-Operative Assessment of Acyanotic Pediatric Patients
179 ORIGINAL ARTICLE Th e Pre-operative Assessment of Acyanotic Pediatric Patients Presented with Heart Murmur and Role of Surgry in congenital heart diseases, A retrospective analysis Dhafer O Alqahtani, Ali A. Alakfash, Omar R .Altamim Abstract Objectives: Th e aim of this study is to evaluate the incidence of congenital heart disease in patients referred solely because of heart murmur in pediatric age group and to assess the rule of medical and surgical management in patient with heart defects. Study design: It is retrospective analysis of all paediatric cases who presented with cardiac murmur. Materials and Methods:A retrospective database and echocardiographic review. All patients referred to King Abdulaziz Cardiac Center (KA CC) Riyadh, Kingdom of Saudi Arabia dur- ing the period from July 2007 till March 2009 for cardiovascular evaluation because of heart murmur detected during routine physical exam. We included any pediatric patient from the neonatal period till 14 years of age who had echocardiography in our center. Any patient with cyanosis, those with diff erence in the blood pressure between the upper limbs and lower limbs of more than 15 mmHg, preterm neonates, any acquired heart disease and syndromic and critically ill patients were excluded from the study. Results: A total of 245 patients met the inclusion criteria. Median age and weight is 7 months (one day – 12 years), 7.85 Kg (1.9 – 54 Kg) respectively. Normal echocardiography was pres- ent in 163 patients (66.5%). Th e most encountered anomaly found was patent ductus arte- riosious (PDA) which was diagnosed in 27 patients (11 %) followed by atrial septal defect (ASD) secundum in 26 patients (10.6%), then the VSD in 22 patients (9%), atrio-ventricular septal defect (AVSD) in 1 patient (0.4%), Coarctation of Aorta in 3 patients (1.2%), Tortuous of arch in 1 patients (0.4%), Pulmonary stenosis in 10 patients (4%), Mitral valve prolapse in 4 patients (1.6%) and the false tendon in 6 patients (2.4 %). -
Orthopnea : Dyspnoea on Supine Position
PRESENTED BY Dr . G . Subrahmanyam M.D., D.M., Professor of Cardiology Director of Narayana Medical Institutions Ex-Professor of Cardiology SVMC &SVRRH Ex Asst. Professor of Medicine, SVMC & SVRRH S CSSCLASS RANKS BAGGED . DURING 2010 1 FIRST M.B.B.S 1ST, 2ND, 3RD &5TH 2 SECOND M. B. B. S 4TH, 5TH, 6TH &10& 10TH 3 THIRD PART-I 1ST & 9TH 4 THRID PART-II 5th, 8th, 10TH NARAYANA NURSING INSTITUTION S.NO RANKS OBTAINED IN M.Sc(Nursing) during 2010 11st,2nd,3rd, 4th,5th, 6th,7th, 8th NARAYANA PHARMACY COLLEGE NARAYANA DENTAL COLLEGE • In MDS results, 27 out of 28 students passed successfully. • MDS(Prostodontics) is the topper in the University wide during 2010. • The only centre in AP with all the Superspecialities like M. CH( Surgical gastro enterology). • History will give you likely diagnosis over 75% of the time • DO NOT SKIP IT in favour of tests • History will help you immediately – Test s will ta ke time to come bac k an d may resu lt in more questions than answers. Best in the physician’s Quer History is the richest source of information Patient spouse gives good information (Chyne stokes respiration) His tory : 1G1. Genera lMdilHitl Medical History 2. Personal and past history 3. Occupational history 4. Nutritional history DYSPNOEA • Dyspnoea on Exercise • Dyspnoea on deconditioning Normal person. But moderate exercise unaccumastomed causes Dyspnoea • Interstial and alveolar oedema stretches ‘J’ receptors in the lung (CCF) ↓cardiac output (TOF) without lung congestion. Inspiratory Dyspnoea : Obstructive airway disease. Expiratory Dyspnoea: Obstruction to lower airways Exertional Dyspnoea : COPD, Cardiac failure Dyspnoea developing at rest Pheumothorax PlPul.em blibolism Dyspnoea occuring at rest and absent on exertion : Functional DYSPNOEA Cardiac, Renal, Ovarian, Bronchial, Psychogenic Postural – Myxoma Squatting ↓ Tof Trepopnea : Lateral position occurs eg. -
Diffuse Alveolar Hemorrhage Syndrome Secondary to Bocavirus
Case report Diffuse alveolar hemorrhage syndrome secondary to bocavirus and rhinovirus infection in a pediatric patient Síndrome de hemorragia alveolar difusa secundaria a coinfección por Rhinovirus y Bocavirus en un paciente pediátrico Carlos Eduardo Reina1 , Sandra Patricia Concha2, Rubén Eduardo Lasso2, Fernando Bermúdez2, María Teresa Agudelo3 Abstract The diffuse alveolar hemorrhage syndrome is characterized by the presence of blood in the pulmonary alveolus from arterioles, venules and pulmonary Date correspondence: capillaries, as a consequence of the lesion of the alveolar wall and without an Received: February 20, 2015. endobronchial alteration. Its presentation includes a classic triad of hemopty- Revised: September 11, 2017. sis, anemia and diffuse alveolar infiltrates. It´s a rare but potentially fatal entity Accepted: October 31, 2017. and there are no clear data on its real incidence in the pediatric population. We present the case of a previously healthy pediatric patient, immunocompetent, How to cite: who presented diffuse alveolar hemorrhage syndrome with secondary venti- Reina CE, Concha SP, Lasso RE, latory failure. After discarding all possible etiologies, coinfection by Rhinovirus Bermudez F, Agudelo MT. Diffuse and human Bocavirus was detected through the polymerase chain reaction, alveolar hemorrhage syndrome determining them as causal factors of the event. Recently, viral infections secondary to Rhinovirus and have been postulated as causing serious lung disease, especially coinfec- Bocavirus coinfection in a tion in immunocompromised patients, in this case Rhinovirus and human pediatric patient. Rev CES Bocavirus; however there are no reports on the syndrome caused by these Medicina. 2018; 32(1): 53-60. viruses. Open access Keywords: Diffuse alveolar hemorrhage; Respiratory failure; Rhinovirus; © Derecho de autor Human Bocavirus. -
Subclinical Subaortic Stenosis in a Golden Retriever
CASE ROUTES h CARDIOLOGY h PEER REVIEWED Subclinical Subaortic Stenosis in a Golden Retriever Kursten Pierce, DVM, DACVIM (Cardiology) Colorado State University THE CASE THE CASE A 12-month-old intact female golden retriever is pre- Diagnostic investigation of the heart murmur via echo- sented for a wellness examination and to discuss the cardiography is discussed with the owner but declined pros and cons of breeding the patient versus pursuing due to the patient’s lack of clinical signs and the costs ovariohysterectomy. The owner would like her to pro- associated with additional testing. duce one litter of puppies prior to being spayed. What are the next steps? On physical examination, the patient is bright, alert, and responsive. She is extremely energetic with a good THE CHOICE IS YOURS … BCS (4/9) and appropriate musculature. Cardiovascu- CASE ROUTE 1 lar examination reveals pink mucous membranes, no To provide information on breeding and caring for a obvious jugular venous distension, and a normal heart pregnant bitch and neonatal puppies and plan to spay rate and rhythm with normal synchronous femoral the patient after the puppies have been weaned, go to pulses. Auscultation is difficult and brief because the page 28. patient is rambunctious and panting. Despite the pant- ing, she is eupneic with clear bronchovesicular sounds. CASE ROUTE 2 A grade II/VI left basilar systolic heart murmur is aus- To avoid providing additional recommendations cultated. A murmur had not previously been docu- regarding breeding and ovariohysterectomy to the mented at her puppy wellness visits. The owner has not owner until a diagnostic investigation with a cardiolo- observed any coughing, trouble breathing, exercise gist has been pursued, go to page 32. -
Lipid–Protein and Protein–Protein Interactions in the Pulmonary Surfactant System and Their Role in Lung Homeostasis
International Journal of Molecular Sciences Review Lipid–Protein and Protein–Protein Interactions in the Pulmonary Surfactant System and Their Role in Lung Homeostasis Olga Cañadas 1,2,Bárbara Olmeda 1,2, Alejandro Alonso 1,2 and Jesús Pérez-Gil 1,2,* 1 Departament of Biochemistry and Molecular Biology, Faculty of Biology, Complutense University, 28040 Madrid, Spain; [email protected] (O.C.); [email protected] (B.O.); [email protected] (A.A.) 2 Research Institut “Hospital Doce de Octubre (imasdoce)”, 28040 Madrid, Spain * Correspondence: [email protected]; Tel.: +34-913944994 Received: 9 May 2020; Accepted: 22 May 2020; Published: 25 May 2020 Abstract: Pulmonary surfactant is a lipid/protein complex synthesized by the alveolar epithelium and secreted into the airspaces, where it coats and protects the large respiratory air–liquid interface. Surfactant, assembled as a complex network of membranous structures, integrates elements in charge of reducing surface tension to a minimum along the breathing cycle, thus maintaining a large surface open to gas exchange and also protecting the lung and the body from the entrance of a myriad of potentially pathogenic entities. Different molecules in the surfactant establish a multivalent crosstalk with the epithelium, the immune system and the lung microbiota, constituting a crucial platform to sustain homeostasis, under health and disease. This review summarizes some of the most important molecules and interactions within lung surfactant and how multiple lipid–protein and protein–protein interactions contribute to the proper maintenance of an operative respiratory surface. Keywords: pulmonary surfactant film; surfactant metabolism; surface tension; respiratory air–liquid interface; inflammation; antimicrobial activity; apoptosis; efferocytosis; tissue repair 1. -
Sudan's Guidelines for Diagnosis, Management and Prevention
Acute Rheumatic Fever and Rheumatic Heart Disease: Sudan’s Guidelines for Diagnosis, Management and Prevention 1 2 Sudan’s Federal Ministry of Health Sudan Heart Society-Working Group on Pediatric Cardiology Sudanese Association of Pediatricians Sudanese Children’s Heart Society Writing Committee: Sulafa Khalid M Ali, FRCPCH, FACC, Consultant Pediatric Cardiologist Professor-University of Khartoum Mohamed Saeed Al Khaleefa, FRCP, Consultant Cardiologist Professor-University of Al Zaem Al Azhari Siragedeen Mohamed Khair, MD, Consultant Pediatrician Professor- University of Al Zaem Al Azhari Second Edition Jan/2017 3 Contents Chapter Title Page Preface 5 Chapter 1 Rheumatic Heart Disease : General Considerations 6 Chapter 2 Diagnosis and Management of Streptococcal 11 Pharyngitis Chapter 3 Acute Rheumatic Fever 15 Chapter 4 Rheumatic Heart Disease 25 Chapter 5 Rheumatic Heart Disease in Pregnancy 49 Chapter 6 Acute Rheumatic Fever & Rheumatic Heart Disease 57 Control Appendices Rheumatic Heart Disease Protocols, Manuals, 63 Brochures and Educational Websites 4 Preface to the Second Edition: This is the second edition of Sudan’s Guidelines for acute rheumatic fever (ARF) and rheumatic heart disease (RHD) diagnosis, management and prevention. RHD is a devastating sequel of ARF, initiated by a simple throat infection with group A streptococcus in susceptible population. Eradication of RHD can be achieved by improvement of health care system as has been witnessed in developed countries. In many developing countries like Sudan, RHD is still prevalent causing significant mortality and premature cardiovascular death as well as an undesired burden on the health system. An RHD control program has been established in Sudan in 2012 aiming to increase the awareness of both the public and medical personnel, to introduce primary and consolidate secondary prevention and to strengthen the surveillance system. -
Distribution of Bronchial Gland Measurements in a Jamaican Population
Thorax: first published as 10.1136/thx.24.5.619 on 1 September 1969. Downloaded from Thorax (1969), 24, 619. Distribution of bronchial gland measurements in a Jamaican population J. A. HAYES1 From the Pathology Department, University of the West Indies, Mona, Kingston 7, Jamaica Measurements of the gland thickness and Reid index have been made on bronchi obtained at necropsy on 53 male and 52 female Jamaicans. The mean values for the Reid index and mucous gland thickness obtained were 0-314 and 0O192 mm. for males, and 0-302 and 0l170 mm. for females respectively. No significant increase in value was seen with age, although the data suggest this trend. The results have been compared with data published from Montreal and the same overall Gaussian distribution is seen. This supports the suggestion that the gland measurements in non-bronchitic and bronchitic subjects do- not fall into two distinct groups but are part of a continuous distribution. The similarity of the two studies is also of interest as the populations are drawn from two distinct environments, one from a non-industrialized tropical island, the other from a large city in the northern hemisphere. Bronchial mucous gland enlargement is usually The existing evidence, therefore, indicates that associated with the consistent production of atmospheric pollution is connected with enlarge- copyright. mucoid sputum in chronic bronchitis (Reid, 1958). ment of bronchial mucous glands. It was suggested that this mucosal change could Clinical chronic bronchitis is encountered in be recognized by an increase in the ratio of Jamaica, apparently in the absence of atmospheric mucous gland thickness to thickness of the pollution (Walshe and Hayes, 1967). -
Respiratory System
RESPIRATORY SYSTEM Dept.Dept. ofof HistologyHistology andand EmbryologyEmbryology 周莉周莉 教授教授 Respiratory System Nose Pharynx Larynx Trachea Bronchus Lung NASAL CAVITY 1. Mucosa:epithelium and lamina propria 1.1 Vestibular Region: 1.2 Respiratory Region: pseudostratified ciliated columnar epithelium, mixture glands (nasal glands), abundant blood vessels and lymphoid tissue in lamina propria 1.3 Olfactory Region (1) Olfactory epithelium: pseudostratified ciliated columnar epithelium A. supporting cells B. olfactory cells C. basal cells (2) Lamina Propria: olfactory glands (serous type) Olfactory epithelium TRACHEA AND BRONCHUS Mucosa: Pseudostratified ciliated columnar epiothelium Lamina propia Submucosa:LCT Advantitia: cartilage tissue and CT 1. Mucosa 1.11.1 PseudostratifiedPseudostratified ciliatedciliated columnarcolumnar epitheliumepithelium (1)(1) ciliatedciliated cellscells (2)(2) gobletgoblet cellscells (3)(3) basalbasal cellscells (4)(4) brushbrush cellscells (5)(5) diffusediffuse neuroendocrineneuroendocrine cellscells (small(small granulegranule cells)cells) Tracheal Sueface (SEM) Pseudostratified ciliated columnar epithelium(LM) 1.21.2 LaminaLamina PropriaPropria ThickThick basementbasement membrane,membrane, CTCT,, immuneimmune cellscells 2.2. SubmucosaSubmucosa::LCTLCT TrachealTracheal glandsglands (( mixturemixture type)type),, mucousmucous barrierbarrier lymphoidlymphoid tissuetissue thethe effectseffects ofof sIgAsIgA Tracheal wall 3. Advantitia C- shaped rings of hyaline cartilage and LCT membrane portion:ligament rich in