By U. Boss. Florida Gulf Coast University.

The malformations ranged from As the limb buds elongate buy strattera 18 mg without prescription, migrating mesenchymal tissues micromelia (short limbs) to amelia (absence of limbs). Primary ossifica- tion centers soon form in each bone, and the hyaline cartilage tissue is gradually replaced by bony tissue in the process of endo- micromelia: Gk. Skeletal System: The © The McGraw−Hill Anatomy, Sixth Edition Appendicular Skeleton Companies, 2001 Chapter 7 Skeletal System: The Appendicular Skeleton 193 CLINICAL PRACTICUM 7. On examination, you note a markedly deformed forearm with an open wound. You note that the patient has mildly weakened strength in the hand, normal sensation, as well as normal capil- lary refill and normal radial pulse. Why is it important to evaluate neuromuscular and vascular function in the hand in this case? At the current appointment, she complains of a new pain in her right hip. This pain began approxi- mately one month before and has been slowly progressing. On physical exam, you find nothing remarkable with the exception that the patient is now walking with a no- ticeable limp. A conventional radiograph (left) and a CT scan (right) of the hip are shown here. Skeletal System: The © The McGraw−Hill Anatomy, Sixth Edition Appendicular Skeleton Companies, 2001 194 Unit 4 Support and Movement Chapter Summary Pectoral Girdle and Upper Extremity notch, and the radial notch. Anteriorly, each (b) Proximally, distinguishing features of (a) Proximally, distinguishing features of clavicle articulates with the sternum at the radius include the head and neck the femur include the head, fovea the sternoclavicular joint. Distally, they include the acromial and sternal process and ulnar notch. The hand contains 27 bones including epicondyles, the lateral and medial costal tuberosity. The thumb lacks a middle The linea aspera is a roughened ridge include the spine, acromion, and phalanx.

If the re- Proteins and lipids are the two major components of the ceptor is a membrane-spanning protein purchase 10 mg strattera with amex, it provides a plasma membrane, present in about equal proportions by mechanism for converting an extracellular signal into an weight. The various lipids are arranged in a lipid bilayer, intracellular response. Integral proteins (or intrinsic proteins) are embed- There Are Different Types of Membrane Lipids ded in the lipid bilayer; many span it completely, being ac- cessible from the inside and outside of the membrane. The Lipids found in cell membranes can be classified into two polypeptide chain of these proteins may cross the lipid bi- broad groups: those that contain fatty acids as part of the layer once or may make multiple passes across it. Phospholipids are an membrane-spanning segments usually contain amino acids example of the first group, and cholesterol is the most im- portant example of the second group. The fatty acids present in phospholipids are molecules with a long hydrocarbon chain and a car- Glycoprotein Integral proteins boxyl terminal group. The hydrocarbon chain can be satu- rated (no double bonds between the carbon atoms) or un- Glycolipid saturated (one or more double bonds present). The composition of fatty acids gives them some peculiar char- acteristics. The long hydrocarbon chain tends to avoid contact with water and is described as hydrophobic. The carboxyl group at the other end is compatible with water and is termed hydrophilic. Fatty acids are said to be amphi- pathic because both hydrophobic and hydrophilic regions are present in the same molecule. Phospholipids are the most abundant complex lipids found in cell membranes. They are amphipathic molecules Phospholipid Cholesterol formed by two fatty acids (normally, one saturated and one Channel unsaturated) and one phosphoric acid group substituted on Peripheral protein the backbone of a glycerol or sphingosine molecule. This Cytoplasm arrangement produces a hydrophobic area formed by the two fatty acids and a polar hydrophilic head. In- pholipids are arranged in a bilayer, the polar heads are on tegral proteins are embedded in the bilayer and often span it.

In patients with a portacaval shunt (E) Glycogen phosphorylase which subcellular compartment does (connection between the portal vein 2 generic strattera 25mg on-line. The small intestine secretes various the circulating glucagon in these (E) 300 to 350 mg/dL triglyceride-rich lipoproteins, but the patients (continued) 524 PART VII GASTROINTESTINAL PHYSIOLOGY (C) Liver normally is the major site for (B) Conjugation of drugs with glycine (B) HDL receptors and then the removal of glucagon or taurine internalizing them (D) Small intestine produces more (C) Introduction of one or more polar (C) The albumin present on LDLs and glucagon in these patients groups to the drug molecule then internalizing them (E) Blood flow to the small intestine is (D) Introduction of one or more (D) The transferrin present on LDL compromised hydrophobic groups to the drug and then internalizing them 8. Which protein is made by the liver and molecule (E) The ceruloplasmin on LDLs and carries iron in the blood? The level of circulating 1,25- (B) Haptoglobin dihydroxycholecalciferol is SUGGESTED READING (C) Transferrin significantly reduced in patients with Arias IM. The Liver: Biology and Pathobi- (D) Ceruloplasmin chronic liver disease because ology. New York: Lippincott- (E) Lactoferrin (A) The liver can no longer efficiently Raven, 1994. The level of drug metabolizing convert 25-hydroxycholecalciferol to Black ER. Diagnostic strategies and test al- enzymes in the liver determines how 1,25-dihydroxycholecalciferol gorithms in liver disease. Clin Chem fast a drug is removed from the (B) The liver can no longer efficiently 1997;43:1555–1560. Therefore, it would be convert vitamin D to cholecalciferol Chang EB, Sitrin MD, Black DD. Gas- expected to find drug metabolizing (C) The liver can no longer efficiently trointestinal, Hepatobiliary, and Nutri- enzymes convert vitamin D to 25- tional Physiology. Philadelphia: Lip- (A) Higher in smokers than in hydroxycholecalciferol pincott-Raven, 1996. The detoxification enzyme sys- (B) Similar in smokers and nonsmokers convert cholecalciferol to 1,25- tems. Mechanisms and conse- nonsmokers (E) The intestine has impaired quences of portal hypertension. Drugs (D) Stimulated by malnutrition absorption of 1,25- 1992;44(Suppl 2):1–13, 70–72.

It does not control the supply of glucose buy 40mg strattera overnight delivery, how- about week 4, the anterior pituitary begins its development ever; this is determined by maternal gluconeogenesis and from Rathke’s pouch, an ectodermal evagination from the placental glucose transport. The release of insulin in the fe- roof the fetal mouth (stomodeum), and by week 8, most an- tus is relatively constant, increasing only slightly in re- terior pituitary hormones can be identified. When blood tuitary or neurohypophysis is an evagination from the floor glucose levels are chronically elevated, as in diabetic of the primitive hypothalamus, and its nuclei, supraoptic and women, the fetal pancreas becomes enlarged and circulat- paraventricular with AVP and oxytocin, can be detected ing insulin levels increase. The hypothalamic-pituitary axis is well de- accelerated, and infants of uncontrolled diabetic women veloped by midgestation, and well-differentiated hormone- are overweight (Fig. Whether the fetal pituitary is tightly regulated by growth and large amount of bone formation during preg- hypothalamic hormones or possesses some autonomy is un- nancy. However, the release of pituitary hormones can occur this fetal requirement. During pregnancy, maternal calcium prior to the establishment of the portal system, indicating intake increases, and 1,25 dihydroxyvitamin D3 and PTH that the hypothalamic-releasing hormones may diffuse down increase to meet the increased calcium demands of the fe- to the pituitary from the hypothalamic sites. In the mother, total plasma calcium and phosphate de- Experiments with long-term catheterization of monkey cline without affecting free calcium. The placenta has a fetuses indicate that by the last trimester, both LH and specialized calcium pump that transfers calcium to the fe- testosterone increase in response to GnRH administration. Although PTH and calci- sulin-like growth factors (IGF-I and IGF-II) from the liver. In addition, low GH have normal birth size; therefore, other mecha- the placenta has 1 -hydroxylase and can convert 25-hy- nisms may control the secretion of IGFs in the fetus. At the end levels increase in the fetus until midgestation and decline of gestation, calcium and phosphate levels in the fetus are thereafter when fetal weight is increasing significantly, rep- higher than in the mother. However, after delivery, neona- resenting another dichotomy in GH and IGF in the fetus tal calcium levels decrease and PTH levels rise to raise the versus postnatal life. Although the role of PRL in fetal growth The Sex Chromosomes Dictate the is unclear, it has been implicated in adrenal and lung func- tion, as well as in the regulation of amniotic fluid volume.