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Syncope is usually exertion-related and is caused by a dysrhythmia or a sudden decrease in cardiac output discount 60 mg orlistat with amex weight loss after baby. The murmur associated with hyper- trophic cardiomyopathy is a prominent systolic ejection murmur heard along the left sternal boarder and at the apex with radiation to the axilla 120mg orlistat mastercard weight loss pills zynadryn. It is increased with maneuvers that decrease left ventricular end-diastolic volume, such as the Valsalva maneuver, sudden standing, and exercise. Pericardial effusion is often asymptomatic but with accumulating fluid can cause chest pain, shortness of breath, cough, and fever. Ultimately, it can lead to cardiac tamponade, which develops in up to 10% of all cancer patients. Treatment of nontraumatic pericardial effusion and tamponade is pericardiocentesis to remove the fluid. Because significant time may elapse until the study is performed, and there is a risk that the clot will propagate, anti- coagulant therapy should be initiated. Ventricular tachycardia is the result of a dysrhythmia originating within or below the termination of the His bundle. If the patient shows signs of instability, such as hypotension or altered mental sta- tus, then cardioversion should be performed. However, if the patient is sta- ble, medications can be administered to treat the dysrhythmia. In addi- tion, it can lead to hypotension in patients with ventricular tachycardia sec- ondary to its peripheral dilatory effects. Patients may be pain-free and have nega- tive cardiac biomarkers with unstable angina. In general, unstable angina is treated with oxygen, aspirin, clopidogrel, low molecular weight or unfrac- tionated heparin, and further risk stratification in the hospital. It is sometimes relieved by exercise Chest Pain and Cardiac Dysrhythmias Answers 47 or nitroglycerin. The discomfort is typically predictable and reproducible, with the frequency of attacks constant over time. The dis- comfort is thought to be caused by fixed, stenotic atherosclerotic plaques that narrow a blood vessel lumen and reduce coronary blood flow (d and e). Sinus bradycardia (e) is similar to sinus rhythm except that the rate is less than 60 and generally greater than 45. There are several etiologies of sinus bradycardia; some are normal (eg, young person, well-trained athlete) and some pathologic (eg, β-blocker overdose, cardiac ischemia). The immediate step in managing complete heart block is applying a transcutaneous pacemaker for ventric- ular pacing as a temporizing measure. However, patients need implantable ventricular pacemakers for definitive management. Cardioversion (b) is used to treat unsta- ble patients with reentrant arrhythmias, such as atrial fibrillation. Over the next hour, you notice that not only are her tongue and lips getting more swollen, but her face is starting to swell, too. She states that a few moments after landing she felt short of breath and felt pain in her chest when she took a deep breath. You send her for a duplex ultrasound of her legs, which is positive for deep vein thrombosis. Place patient on a monitor, provide supplemental oxygen, and administer unfractionated heparin. Place the patient on a monitor, provide supplemental oxygen, and administer warfarin. She also describes coughing up “chicken livers” during this time and reports that her symptoms are getting progressively worse. She states that she has a history of alcohol abuse, but denies tak- ing any medications or illicit drugs. Given this patient’s clinical presentation, which of the following is this patient at most risk for contracting? The patient reports sitting at his desk when he felt a sharp pain on the right side of his chest that worsened with inspiration. Which of the following organism is the most common cause of community acquired bacterial pneumonia? Upon returning to the United States, the patient developed a persistent cough associated with dyspnea. She was seen by a pulmonologist, who diagnosed her with bronchitis and prescribed an inhaler. However, over the following weeks, the patient’s symptoms worsened, and she devel- oped pleuritic chest pain. Given this patient’s history and pre- sentation, what is the most likely etiology of her symptoms? Upon arrival, she is tachypneic at 24 breaths per minute with an oxygen saturation of 97% on face mask oxygen administration. Upon physical examination, the patient appears to be in mild distress with supraclavicular retractions.

There’s no such thing as a diploid sperm because as a sex cell buy orlistat 60mg without prescription weight loss on metformin, sperm carries only half the regu- lar complement of 46 chromosomes discount 60mg orlistat free shipping weight loss low carb. And because another division takes place after the initial division in meiosis, the final product of the process is four cells, not two. In the drawing for late prophase I, at least two pairs of homologous chromosomes should be shown grouped into tetrads (in truth, there are 23 pairs, but simplified illustrations tend to show just two). The description for prophase I should include reference to the tetrad for- mation. The drawing for metaphase I should show the equatorial plane (a center horizontal line) with the tetrads aligned along it. The illustration also should show spindles radiating from each pole, with the tetrads attached to them by their centromeres. The description should include reference to the equatorial plane, the poles, and the spindles. The drawing for anaphase I should show the tetrads moving to the top and bottom of the cell along the spindles and the cytoplasm slowly beginning to divide. Chapter 14 Carrying Life Forward: The Female Reproductive System In This Chapter Mapping out the female reproductive parts and what they do Understanding meiosis as the process that makes eggs Explaining embryology Nursing a fetus into a baby Following the process of growth and aging in women en may have quite a few hard-working parts in their reproductive systems, but women Mare the ones truly responsible for survival of the species (biologically speaking, anyway). The female body prepares for reproduction every month for most of a woman’s adult life, producing an ovum and then measuring out delicate levels of hormones to prepare for nurturing a developing embryo. When a fertilized ovum fails to show up, the body hits the biological reset button and sloughs off the uterine lining before building it up all over again for next month’s reproductive roulette. But that’s nothing compared to what the female body does when a fertilized egg actually settles in for a nine-month stay. Strap yourselves in for a tour of the incredible female baby-making machinery — practice questions included. Identifying the Female Reproductive Parts and Their Functions First and foremost in the female reproductive repertoire are the two ovaries, which usually take a turn every other month to produce a single ovum. Roughly the size and shape of large unshelled almonds, the female gonads lie on either side of the uterus, below and slightly behind the Fallopian tubes (also called the uterine tubes). Each ovary has a stroma (body) of connective tissue surrounded by a dense fibrous connective tissue called the tunica albuginea (literally “white covering”); yes, that’s the same name as the tissue surrounding the testes. In fact, the ovaries in a female and the testes in a male are homologous, meaning that they share similar origins. External to the tunica albuginea is a layer of cuboidal cells known as the germinal epithelium. During growth of the ovary in a female fetus prior to birth, the germinal epithelium dips into the body of the ovary in various places. Over time, a mass of epithelial cells called primordial follicles, or primary follicles, becomes separated from the main body of the ovary. The ovaries of a young girl contain from 100,000 to 400,000 of these follicles, most of them present at birth. Usually, only one follicle matures to become a Graafian follicle (twins, triplets, or even more fetuses result if more than one follicle matures to the point of releas- ing an ovum). One cell of this mass, the oocyte (produced by oogenesis, or meiosis), becomes the ovum while the remaining cells surround the ovum as part of the cumulus oophorus and others line the fluid-filled follicular cavity as the membrana granulosa. As the ovum matures, its follicle moves toward the ovary’s surface and begins secreting the hormone estrogen, which signals the endometrium (uterine lining) to build up in preparation for pregnancy. Ringed by follicular cells in what’s called the corona radiata, the ovum enters the coelom (body cavity) and is swept into the Fallopian tube by a fringe of tissue called fimbriae. It takes approximately three days for the ovum to travel from the Fallopian tube to the uterus. Meanwhile, back at the ovary, a clot has formed inside the ruptured follicle and the membrana granulosa cells are being replaced by yellow luteal cells, forming a corpus luteum (literally “yellow body”) on the surface of the ovary. This new endocrine gland secretes progesterone, a hormone that signals the uterine lining to prepare for possible implantation of a fertilized egg, inhibits the maturing of Graafian follicles, ovulation, and the production of estrogen to prevent menstruation; and stimulates further growth in the mammary glands (which is why some women get sore breasts a few days before their periods begin). If pregnancy occurs, the placenta also will release proges- terone to prevent menstruation throughout the pregnancy. If the ovum isn’t fertilized, the corpus luteum dissolves after 10 to 14 days to be replaced by scar tissue called the corpus albicans. If pregnancy does occur, the corpus luteum remains and grows for about six months before disintegrating. Only about 400 of a woman’s primordial follicles ever get a chance to make the trip to the uterus. The rest ripen to various stages before degenerating into what are known as atretic follicles (or corpora atretica) over the course of her lifetime. Fallopian tubes, oviducts, uterine tubes — call them what you will, but they’re where the real business of fertilization takes place. Because an egg must be fertilized within 24 hours of its release from the ovary to remain viable. These small, muscular tubes lined with cilia are nearly 5 inches long and, somewhat surprisingly, aren’t directly connected to the ovaries.

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