By W. Rocko. North Carolina Wesleyan College. 2017.

Renal autoregulation (B) Gitelman’s syndrome kidney: GFR purchase 50mcg flonase visa, 42 nL/min; glomerular (A) Is associated with increased renal (C) Liddle’s syndrome capillary hydrostatic pressure, 50 mm vascular resistance when arterial blood (D) Nephrogenic diabetes insipidus Hg; hydrostatic pressure in Bowman’s pressure is lowered from 100 to 80 mm (E) Renal glucosuria space, 12 mm Hg; average glomerular Hg 14. In a person with severe central diabetes capillary colloid osmotic pressure, 24 (B) Mainly involves changes in the insipidus (deficient production or mm Hg. What is the glomerular caliber of efferent arterioles release of AVP), urine osmolality and ultrafiltration coefficient? Refresher osmolality of 1,200 mOsm/kg H2O, (A) Creatinine course for teaching renal physiology. Molecu- is about (D) Na lar physiology of renal p-aminohippu- (A) 100 mOsm/kg H2O (E) Urea rate secretion. Total body water is distributed in two major compart- filtration rate, angiotensin II and aldosterone, intrarenal ments: intracellular water and extracellular water. In an av- physical forces, natriuretic hormones and factors such as erage young adult man, total body water, intracellular wa- atrial natriuretic peptide, and renal sympathetic nerves. The corresponding figures for cretion in response to excess Na or Na depletion. Estro- an average young adult woman are 50%, 30%, and 20% of gens, glucocorticoids, osmotic diuretics, poorly reabsorbed body weight. The effective arterial blood volume (EABV) depends on the Volume Amount of indicator Concentration of indicator degree of filling of the arterial system and determines the at equilibrium. Electrical neutrality is present in solutions of electrolytes; to Na retention by the kidneys and contributes to the de- that is, the sum of the cations is equal to the sum of the an- velopment of generalized edema in pathophysiological ions (both expressed in milliequivalents). Cells are the loop of Henle and is secreted by cortical collecting duct typically in osmotic equilibrium with their external environ- principal cells.

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Two forms of lial cells flonase 50 mcg lowest price, which surround the milk-laden alveoli in the lac- vasopressin, one containing arginine and the other con- tating mammary gland, aiding in milk ejection. Arginine va- Oxytocin secretion is also stimulated by neural input sopressin is made in humans. Although AVP and oxytocin from the female reproductive tract during childbirth. Cer- differ by only two amino acid residues, the structural dif- vical dilation before the beginning of labor stimulates ferences are sufficient to give these two molecules very dif- stretch receptors in the cervix. They are similar enough, how- through the CNS to oxytocin-secreting neurons. Oxytocin ever, for AVP to have slight oxytocic activity and for release stimulates the contraction of smooth muscle cells in oxytocin to have slight antidiuretic activity. They code for much larger mary glands and the female reproductive tract are discussed prohormones that contain the amino acid sequences for further in Chapter 39. AVP or oxytocin and for a 93-amino acid peptide called neurophysin (Fig. The neurophysin coded by the AVP gene has a slightly different structure than that coded by the oxytocin gene. Neurophysin is important in the pro- HORMONES OF THE ANTERIOR PITUITARY cessing and secretion of AVP, and mutations in the neuro- The anterior pituitary secretes six protein hormones, all of physin portion of the AVP gene are associated with central which are small, ranging in molecular size from 4. During the passage of the glands; they are called tropic (Greek meaning “to turn to”) or granules from the Golgi apparatus to axon terminals, pro- trophic (“to nourish”) hormones. For example, ACTH main- hormones are cleaved by proteolytic enzymes to produce tains the size of certain cells in the adrenal cortex and stim- AVP or oxytocin and their associated neurophysins. Similarly, TSH AVP or oxytocin secretion, action potentials are gener- maintains the size of the cells of the thyroid follicles and ated in these cells, triggering the release of AVP or oxy- stimulates these cells to produce and secrete the thyroid tocin and neurophysin from the axon terminals. The 4 3 substances diffuse into nearby capillaries and then enter two other tropic hormones, FSH and LH, are called go- the systemic circulation. FSH stimulates the development of follicles in the ovaries and regulates the process of spermatogenesis in the testes.

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The disease leukemia causes the unrestricted Heart murmurs can be congenital or acquired buy 50 mcg flonase with visa. Generally, reproduction of immature leukocytes, which depresses erythro- they are of no clinical significance; nearly 10% of all people have cyte and platelet formation and causes anemia and a tendency to heart murmurs, ranging from slight to severe. Coagulation time, blood sedimentation rates, prothrombin the most common type of congenital heart problem (fig. A ventricu- Several blood diseases are distinguished by their rate of oc- lar septal defect is caused by an abnormal development of the currence. Sickle-cell anemia is an autosomal recessive disease that interventricular septum. This condition may interfere with clo- occurs almost exclusively in blacks. Although about 10% of Ameri- sure of the atrioventricular valves and may be indicated by can blacks have the sickle-cell trait, fortunately fewer than 1% cyanosis and abnormal heart sounds. The distorted shape of the diseased cells re- narrowing of the opening into the pulmonary trunk from the duces their capacity to transport oxygen, resulting in an abnormally right ventricle. It may lead to a pulmonary embolism and is usu- high destruction of erythrocytes. With the decrease in erythrocytes, ally recognized by extreme lung congestion. Mononucleosis is an infectious dis- The tetralogy of Fallot is a combination of four defects in ease that is transmitted by a virus in saliva, and is therefore com- a newborn that immediately causes a cyanotic condition. It affects primarily adolescents, causing defect, (2) an overriding aorta, (3) pulmonary stenosis, and fever, sore throat, enlarged lymph glands, and fatigue. The pulmonary stenosis obstructs blood flow to the lungs and causes hypertrophy of the right ventricle. In an overriding aorta, the ascending por- tion arises midway between the right and left ventricles. Open- Heart Diseases heart surgery is necessary to correct tetralogy of Fallot, and the Heart diseases can be classified as congenital or acquired.

Interactions among health care professionals can be equally problematic for different reasons but with devastating results flonase 50 mcg low price. Much of the information transfer accepted as routine in medical practice is actually of potentially critical importance. It deserves the same focus and attention to process and outcome as other areas of medicine. Chapter 7 / E-Medicine in the Physician’s Office 75 7 E-Medicine in the Physician’s Office Edward Fotsch, MD SUMMARY E-medicine encompasses services including telephone, Internet, telemedicine, and electronic medical records. Each has unique potential to enhance the doctor–patient relationship and to increase physician liability. Key Words: E-medicine; e-mail; risk reduction; telephone; online medical communication; Internet; guidelines for online communi- cations; electronic medicine. INTRODUCTION E-medicine, or electronic medicine, refers to the use of electronic communication and information technology by physicians in the care of patients. Therefore, e-medicine encompasses various services includ- ing telephone, Internet, telemedicine, and electronic medical records. Each of these services has the unique potential to enhance the patient– physician relationship. As with all services that impact patient care, each also has the potential to increase physician liability. TELEPHONE-BASED CARE The use of the telephone in the treatment of patients is neither new nor controversial. However, it does represent a legitimate form of patient care that has clear benefits as well as clear liabilities. When the tele- phone first emerged as a popular form of communication in the early 20th century, it was looked on with concern by many in the medical establishment. Warnings were given to doctors that the role of the tele- phone should not replace a face-to-face office visit and that telephone- based care could lead to suboptimal clinical outcomes and liability. Although the use of the telephone has become an essential compo- nent of medical care, particularly in the outpatient setting, it has largely been relegated to an administrative tool for setting appointments, refill- ing prescriptions, billing, and related administrative requests and ques- tions.

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