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Te following laboratory results were obtained Answers to Questions 5–7 on a 25-year-old woman with menorrhagia after delivery of her second son order lyrica 150mg. In addition order lyrica 150 mg visa, lupus Hemostasis/Correlate clinical and laboratory data/ anticoagulant is not associated with bleeding unless Special tests/3 it coexists with thrombocytopenia buy lyrica discount. C The clinical presentation and laboratory results in and the following laboratory data: this patient are indicative of cirrhosis of the liver. Peripheral blood smear: macrocytosis, target cells 9 Most of the clotting factors are made in the liver. Conjugated bilirubin is excreted into the Tese clinical presentations and laboratory results intestines, where the bilirubin is then converted to are consistent with: urobilinogen and excreted into the stool. In vitro, blood clots result in the most appropriate ﬁrst step to investigate the consumption of the clotting factors and therefore abnormal results? Report the result as obtained If the clotting factors have been activated but the B. Which of the following factors Heparin half-life is decreased in extended thrombosis, may be associated with the lack of response to and the anticoagulant activities of heparin change heparin therapy in this patient? In addition, the platelet count should be monitored regularly during heparin therapy, because Hemostasis/Correlate clinical and laboratory data/ a decrease of the platelet count to 50% below the Inhibitors/3 baseline value is signiﬁcant and may be associated 11. Deep venous thrombosis was suspected, and the patient was started on heparin therapy. Which of the following is (are) the proper protocol to evaluate patients receiving heparin therapy? Monitor the platelet count daily and every other day after heparin therapy is completed D. Patient History: Tese clinical manifestations and laboratory results A 46-year-old female was admitted to the emergency are consistent with: department with complaints of headache, dizziness, A. Diagnostic Hemostasis/Correlate clinical and laboratory data/ procedures indicated recurrence of the carcinoma. The Hct 23% 37%–46% neurological symptoms in this patient are manifested by headache, dizziness, nausea, and vomiting. The platelet count, neutrophils performed on admission, was done on a hematology Band neutrophils 3 0%–10% analyzer and was falsely elevated because of the Lymphocytes 11 20%–50% presence of microcytes or fragmented red cells. Patient History Answer to Question 13 A 1-year-old infant was admitted to the hospital with recurrent epistaxis for the past 5 days. C These clinical manifestations and laboratory results past medical history revealed easy bruising and a are consistent with Glanzmann’s thrombasthenia. Te patient was Laboratory tests reveal a low hemoglobin level due transfused with 2 units of packed red cells upon to epistaxis. The Admission Laboratory Results bleeding time test evaluates in vivo platelet function Reference and number. Patient History: Answers to Questions 14–15 A 30-year-old female was referred to the hospital for evaluation for multiple spontaneous abortions 14. D These clinical manifestations and laboratory results and current complaint of pain and swelling in her are consistent with lupus anticoagulant. Anticardiolipin antibodies K is stored in the liver and is essential for activation of D. Vitamin K needs bile (secreted Hemostasis/Correlate clinical and laboratory data/ by the liver) for its absorption. Te biopsy was scheduled for recommend the following: Start the patient on 11:00 a. A fresh blood sample was sent to the laboratory at Answers to Questions 16–18 8:00 a. B Traditional anticoagulant drugs such as heparin instrument ﬂags the result owing to failure of the and warfarin are well known. Several days later, the patient developed a massive clot in her left leg that necessitated amputation. A 50-year-old female was admitted to a hospital Answers to Questions 19–20 for hip replacement surgery. The low Hgb and Hct in this patient were due to What steps should be taken before releasing these severe bleeding during surgery. No follow-up steps are needed; report the results adjusted according to the following formula: as obtained (0. Report Hgb and Hct results, adjust the in mL; H = patient’s Hct; and C = volume of anticoagulant volume, and redraw a new sample anticoagulant in mL. B The lack of a positive family history in this patient indicates the presence of an acquired coagulopathy. Factor V no history of excessive bleeding during childbirth antibodies are the most common antibodies several years earlier nor during a tonsillectomy in among the clotting factors of the common pathway childhood. Acute bleeding episodes may be treated by platelet Mixing studies (patient transfusions. Hematology of Infancy Hemostasis/Correlate clinical and laboratory data/ and Childhood. From the following, identify a speciﬁc component Answers to Questions 1–4 of the adaptive immune system that is formed in response to antigenic stimulation: 1. Immunoglobulin nonspeciﬁcally as a part of the adaptive immune Immunology/Apply knowledge of fundamental system. These three components do not require biological characteristics/Immune system/1 any type of speciﬁc antigenic stimulation. B The bone marrow and thymus are considered primary lymphoid organs in which immunocompetent lymphoid organs because immunocompetent cells originate and mature? T lymphocytes, after originating in the bone marrow, travel to the thymus to mature and Immunology/Apply knowledge of fundamental diﬀerentiate. What type of B cells are formed after antigen that may cross link a foreign antigen, thus forming stimulation? Immunology/Apply knowledge of fundamental biological characteristics/Immune system/Cells/1 4. B Immature T cells travel from the bone marrow to the thymus to mature into functional T cells. T cells travel from the bone marrow to the thymus in the thymus, T cells undergo a selection and for maturation. What is the correct order of the maturation sequence that begins in the cortex and maturation sequence for T cells in the thymus? Bone marrow to the cortex; after thymic such as thymosin and thymopoietin and cells within education, released back to peripheral circulation the thymus such as macrophages and dendritic cells B. After completion of the migration to the medulla; release of mature maturation cycle, T cells are released to secondary T cells to secondary lymphoid organs lymphoid organs to await antigen recognition and C. Activation and selection occur in the medulla; mature T cells are stored in the cortex until activated by antigen Immunology/Apply knowledge of fundamental biological characteristics/Immune system/Cells/1 77 78 Chapter 3 | Immunology 5. Which complement component is found in both appears during the ﬁrst stage of T-cell the classic and alternative pathways?
Patient grew worse rapidly after the Quinine was given cheap lyrica 150 mg overnight delivery, being very restless discount lyrica 75mg visa, some delirium buy lyrica 75 mg lowest price, and the stomach irritable. Treatment has now occupied seven days - without any benefit - and came to the conclusion that I had better study the case if my patient is to live. A few questions and a little thought point out the menstrual derangement as an important element of the disease. Patient was decidedly better in twelve hours, and the fever declined rapidly, though the menstrual discharge did not commence until the third day after this change of treatment, and when patient was nearly freed from fever. If there is any one thing more than another that I prize, it is the name of being a “good doctor for children. I shudder as I look back on my earlier experience in medicine and recall the many cases where I have seen the innocents tortured, as only doctors can torture, and I wonder that people can believe in special providences, when such things were permitted. Give the little sufferer from the many ills of childhood, good nursing, cleanliness, proper food and rest, and you will have a treatment that at least does not violate the seventh commandment. Supplement this with the mild but direct remedies of our practice, and you relieve disease of half its suffering, shorten its duration, and save life. Remissions in the fever vary in different cases, sometimes but one, at others three, four or more, in twenty-four hours. The second day the child was very restless, its face flushed, the stomach irritable, fever high, and in the afternoon had a convulsion. Symptoms - face flashed, eyes bright, pupils contracted, skin hot and dry, pulse 146, small and sharp, unconscious, moving head from side to side, involuntary movements of hands and feet - bad case. The night passed, and the child was worse, and I was sent for, seeing her about noon. The symptoms now were very distinct - the child was sleeping with its eyes half open, its face expressionless, the eyes dull, pupils dilated; the skin was hot and dry, pulse 130, symptoms of convulsions. The coma gradually passed off, the fever was reduced, and the next morning the child was comparatively comfortable and was discharged on the 9th. Called the next day, found febrile action high, stomach irritable, and some three or four greenish watery discharges from the bowels. Has had the city physician, who gave Quinine, which stopped the fever, and the patient was discharged. Symptoms - Pulse 120; skin sallow and dirty, yellowish around the mouth; complains of pain in the abdomen; tongue broad, moist, and coated with a dirty fur. Better the next morning, has not vomited since the evening before; pulse 90; tongue showing a tendency to clean; rested well the after part of the night. Improved steadily, and was convalescent on the sixth day, no other medicine being given. Called to see her on the morning of the 4th, presented the usual febrile symptoms, with some irritation of the brain. There was relief from the nervous irritation, and some mitigation of fever, but the disease continued. Continued the same treatment to the 9th, when I concluded, as the child had been on a visit to a malarial region, to give Quinine, grs. The next day he had a chill, and following this a very high fever, with but slight remissions. Now there was a complete intermission of eight hours, when it recommenced as severe as before, and continued forty-eight hours, with a second intermission. As he had an utter disgust for nasty medicine (which, by the by, he inherited from his father) I withheld Quinine, and continued the febrifuge. The fever came up as before, and continued again for thirty-six hours, and again an intermission but not as complete. Was now ready to give Quinine, and administered three grains, and ordered it by inunction. I might report a score of cases in which I have administered Quinine early, with the result of increasing the disease. In malarial districts it becomes a part of the treatment of every case: in some being specific to the disease without other treatment, but in the majority the system should be prepared for its use as heretofore named. In our city, malarial disease is the exception, and we don’t use Quinine so frequently or so freely. When called on the 24th found the usual symptoms of continued fever, with no special indication for treatment other than this. As is common with these remedies there was slight abatement of the fever from day to day, until on the 27th it seemed as if but little more would give convalescence. The next day the patient was far worse than he had been, and required constant and careful attention up to the twenty-fourth of the disease. From this, and some other experience of a similar kind, I learned not to give Quinine in large doses in continued fever. Yesterday had a slight chill in the morning, and again in the afternoon, fever at night, gradually increasing. Has the usual symptoms of common continued fever, which is now prevailing, but without any special indication for remedies, other than this. Pulse full and hard, 110; temperature on the third day 103° morning, 105½° evening. No influence upon the fever seemingly, until the morning of the fifth day, though the patient was relieved of suffering. Now the fever seems inclined to yield, pulse 84 in the morning and open, temperature 101°; afternoon pulse 96, temperature 102½°. Morning, pulse 80, temperature a fraction less than 100°; evening, pulse 90, temperature, 102°. Tongue is moist and shows a tendency to clean; skin is soft and occasionally moist. Continued in this way with but little change to the fourteenth day, when the fever ceased, and the patient convalesced rapidly. In some cases, presenting like symptoms, I have added small doses of Quinine to the treatment with the effect of arresting the fever sooner. The first conclusion forced upon me was that a physician is incompetent to prescribe for himself; as the disease came upon me, and assumed its most severe form without my being aware of what was the matter. The simple means employed at first - hot foot bath, spirit vapor-bath and diaphoretics - having failed, on the fourth day, I resolved to try the virtues of Quinine to stop the fever, and to relieve the pain, and accordingly took fourteen grains in six hours, and repeated it the succeeding day. It did seem to arrest all the febrile symptoms, but it was followed by great prostration and exhaustion of the nervous system. Having had enough of my own treatment, Prof King was called to prescribe, and it is the means he used that I wish to notice. To relieve this, he ordered Bicarbonate of Soda, a teaspoonful to a tumbler of water: a swallow to be taken every few minutes during the day. Its taste was very pleasant to me, and its influence agreeable, and though I had not the slightest feeling of acidity of the stomach, I am satisfied that it supplied a material that was deficient.
Renal epithelium: cytoplasm light blue purchase cheap lyrica on line, nucleus extensions buy generic lyrica, they point to infection) discount lyrica 150 mg online. Glitter cells: cytoplasm dark blue, nucleus dark results from contamination by vaginal or skin ﬂora purple that multiply in vitro, especially in unrefrigerated D. Red cells stain very pale pink or not at all and hyaline casts stain faintly pink. Insuﬃcient volume is causing microscopic results unless corrective action is taken. The specimen to be underestimated should be diluted with normal saline to 12 mL, then D. Sediment should be prepared according to the established Body ﬂuids/Apply knowledge to identify sources of procedure and the results multiplied by the dilution error/Urinalysis/3 factor (in this case, 12 ÷ 5, or 2. B Caudate cells are transitional epithelium that have a epithelial cells in the urinary system is correct? Caudate epithelial cells originate from the upper bladder and the pelvis of the kidney. Transitional cells originate from the upper and the ureters as well as the urinary bladder and urethra, ureters, bladder, or renal pelvis renal pelvis. Cells from the proximal renal tubule are usually polyhedral, or oval, depending upon the portion of round in shape the tubule from which they originate. Squamous epithelium line the vagina, urethra, proximal tubule are columnar and have a distinctive and wall of the urinary bladder brush border. Squamous epithelia line the vagina Body ﬂuids/Apply knowledge of fundamental biological and lower third of the urethra. Which of the statements regarding examination and can be confused in unstained sediment. Renal cells can be diﬀerentiated reliably from sheets of transitional and squamous cells. Large numbers of transitional cells are often seen derived from the urinary bladder. Neoplastic cells from the bladder are not found they should be referred to a pathologist for in urinary sediment cytological examination. Which of the following statements regarding cells Answers to Questions 7–11 found in urinary sediment is true? Transitional cells are considered a an eccentric round nucleus normal component of the sediment unless present C. Clumps of bacteria are frequently mistaken for signiﬁcant when seen conclusively in the sediment. Conclusive Body ﬂuids/Apply knowledge of fundamental biological identiﬁcation requires staining. Trichomonas vaginalis characteristics/Urine sediment/2 displays an indistinct nucleus and two pairs of 8. Renal tubular epithelial cells are shed into the when passing through the glomerulus, often urine in largest numbers in which condition? Oval fat bodies are often seen in: approximately 150 × 60 μm and are nonoperculated. B Oval fat bodies are degenerated renal tubular epithelia that have reabsorbed cholesterol from the Body ﬂuids/Correlate clinical and laboratory data/ ﬁltrate. Although they can occur in any inﬂammatory Urine sediment/2 disease of the tubules, they are commonly seen in the nephrotic syndrome, which is characterized by marked proteinuria and hyperlipidemia. All of the following statements regarding urinary Answers to Questions 12–17 casts are true except: A. C Proteinuria accompanies cylindruria because protein jogging or exercise is the principle component of casts. An occasional granular cast may be seen in a exercise, hyaline casts may be present in the normal sediment sediment in signiﬁcant numbers but will disappear C. Hyaline casts will dissolve readily in alkaline urine solute concentration, slow movement of ﬁltrate, and Body ﬂuids/Apply knowledge to recognize sources of reduced ﬁltrate formation. The appearance of a error/Urine casts/2 cast is dependent upon the location and time spent in the tubule, as well as the chemical and cellular 13. Reduced ﬁltrate formation cells, immunoglobulins, light chains, cellular proteins, D. C Pseudocasts are formed by amorphous urates that characteristics/Urine casts/2 may deposit in uniform cylindrical shapes as the 14. Granular casts may form by Body ﬂuids/Apply knowledge of fundamental biological degeneration of cellular casts, but some show no characteristics/Urine casts/1 evidence of cellular origin. Hyaline casts may also be increased in Body ﬂuids/Apply knowledge to identify sources of patients taking certain drugs such as diuretics. Broad error/Urine casts/2 casts form in dilated or distal tubules and indicate 16. Which of the following statements regarding severe tubular obstruction seen in chronic renal failure. Fine granular casts are more signiﬁcant than tubules and signal end-stage renal failure. Cylindroids coarse granular casts are casts with tails and have no special clinical B. Broad casts are associated with severe renal hematuria from ruptured vessels, but not casts. Body ﬂuids/Apply knowledge of fundamental biological Sediment in chronic glomerulonephritis is variable, characteristics/Urine casts/2 but usually exhibits moderate to severe intermittent hematuria. Lower urinary tract obstruction Body ﬂuids/Correlate clinical and laboratory data/ Urine sediment/2 346 Chapter 6 | Urinalysis and Body Fluids 18. Both waxy and broad casts Body ﬂuids/Apply knowledge of fundamental biological form in chronic renal failure when there is severe characteristics/Urine casts/2 stasis, and they are associated with a poor prognosis. Small yellow-brown granular crystals at an are normal with the exception of a positive blood acid pH may be uric acid, bilirubin, or hemosiderin. Prussian blue stain hemosiderin include transfusion reaction, hemolytic Body ﬂuids/Select course of action/Urine sediment/3 anemia, and pernicious anemia. C Epithelial casts are rarely seen but indicate a disease following is considered an abnormal ﬁnding? Acidify a 12-mL aliquot with three drops of glacial acetic acid and heat to 56°C for 5 minutes before centrifuging D. How can hexagonal uric acid crystals be Answers to Questions 23–28 distinguished from cystine crystals? B Flat six-sided uric acid crystals may be mistaken for acid is soluble cystine crystals. Cystine crystals are colorless, while uric reduction with sodium cyanide acid crystals are pigmented (yellow, reddish brown).