By M. Orknarok. Southampton College.
The atonic stomach zithromax 250mg, with increased secretion of mucus 100mg zithromax, and sometimes with considerable accumulations zithromax 500mg. It is marked by the broad tongue 250mg zithromax, heavily coated at its base 500mg zithromax, bad taste in the mouth zithromax 100 mg, and feeling of weight and heaviness in the epigastrium 100 mg zithromax. It needs to be prompt and thorough in action 500 mg zithromax, not producing debility or leaving the organ irritable zithromax 500 mg. If not requiring this 250 mg zithromax, we may accomplish the same object by the use of the Alkaline Sulphites, followed by Nux Vomica. We have many minor lesions that can not be classified under these, to which we will find single remedies specific. Increased mucous secretion with impaired functional activity, minute doses of Podophyllin, etc. We recognize the fact, that just in proportion to the variation of the circulation and temperature from the normal standard is the severity and activity of disease. The more frequent the pulse, and the higher the temperature, the more active a zymotic poison, the more rapid the progress of local or general disease, and the less able the body to protect itself, or expel the cause of disease. In therapeutics we find - that just in proportion as the circulation and temperature can be, brought to, and ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━ * See Practice of Medicine, page 27. These facts must surely have been noticed by observers, and we can only wonder that they have never been clearly stated, and practiced upon. If we take as an example a case of fever, we will find that remedies that will reduce the pulse to a normal frequency, giving freedom to the circulation, will reduce the temperature, and that just in proportion as this is accomplished, the febrile symptoms disappear, and the various vital functions are re-established. If we maintain the circulation and temperature at this point, the fever must certainly cease. In acute inflammation, the rapidity of the local disease and destruction of tissue, is in the ratio of frequency of pulse and increase of temperature. Just in proportion as we get a normal circulation with reference to frequency and freedom, and diminished temperature, just in that proportion the inflammatory process is arrested. In asthenic inflammation we find another element in the pathology of the disease - a want of vital power, either in the whole or in the part. In others there is a zymotic or animal poison, which must be antagonized, destroyed, or removed. The disease, as a general rule, will run its course rapidly to a fatal termination just in proportion to the extent of this deviation. Recovery from chronic disease never takes place until the circulation and temperature approximate a normal standard. In any given case, the probabilities of cure are as the possibility of bringing and maintaining the circulation and temperature at the standard of health. The first evidences of amendment are announced by a diminution of frequency of pulse and a better circulation of blood, and by an equal temperature of the body, approximating 98°. These seem like dogmatic statements, and many will be inclined to dispute them, because opposed or not named by the common authorities on medicine, but it only requires observation without prejudice to prove each position. We may claim then, that remedies influencing the circulation and temperature, toward the normal standard, are the most important of the Materia Medica. In very many cases the lesion of the circulation is a basic lesion, upon which others arise and are continued. When this is the case, the remedy that gives us normal circulation removes all the diseased processes which rest upon it. Conversely, as the pulse comes down to the normal standard, and the blood circulates freely, just in that proportion we have a restoration of the secretions and excretions, better innervation, better digestion and blood-making, and a more active waste and repair. Have we remedies that influence the circulation directly, giving a free and equal circulation, with diminution of frequency? Many of our readers will have asked this question before this, and answered it in the negative. Certain remedies will have been recommended to them as special sedatives, which they have used without the good results named and expected. It is a common failing with physicians to expect a desired result too soon, and endeavor to force it by large doses of medicine. Others have purchased worthless medicines, which will readily account for the failure. Taking the article of Veratrum alone, and excepting Norwood’s Tincture, nine-tenths that has been sold was wholly worthless as a medicine. The theory with regard to the action of the class of special sedatives was erroneous. They were regarded as depressants, and diminished frequency of pulse was supposed to depend upon their depressing influence upon the heart. All of these remedies are active poisons in large doses, and death occurs in all by cardiac syncope. In the case of Aconite, extreme frequency of pulse is produced by the poisonous action. In medicinal doses (small), the influence of these remedies is that of a cardiac stimulant, and is undoubtedly through the sympathetic system of nerves, which controls the entire circulation of the blood - not only the action of the heart, but of all the blood-vessels to the most minute capillary. I contend that this influence removes obstruction to the free circulation of the blood, as well as gives power to heart and muscular fibre of arteries. As obstruction to free circulation is removed, it requires less effort to move the blood; as the power of moving the blood is increased there is less necessity of frequency of contraction upon the part of the heart. As a rule, the time required to effect sedation will bear a distinct relation to the time required for the development of disease, and its average duration. Thus in an acute fever or inflammation from cold, the influence of the sedative may be promptly obtained, and the disease speedily arrested. In continued fever, the accession of the disease (in most cases), is slow in proportion to its duration and severity. Here there are grave lesions of function, possibly of structure, and we expect to obtain the influence of the sedative slowly. Whilst each of the remedies named as arterial sedatives, Aconite, Veratrum, Digitalis, Gelseminum, Lobelia, exert a direct influence in this direction, they are not equally valuable in all cases. The two first are preeminently the sedatives, their action being more definite and stronger, and adapted to a larger number of cases. The special adaptation of each to special forms of diseased action is named in the description of the remedy. The temperature bears such a constant relation to the frequency of pulse, and general condition of the circulation, that a remedy which will correct the one will also correct the other. Thus we find in practice that just as we bring the pulse to the normal standard by the use of an arterial sedative, in the same degree we reduce the temperature. For instance, in a case of phthisis we find a temperature of 101° associated with a pulse above 100 beats per minute; if it is possible to bring the pulse down to 80 the temperature comes down to 98° and a fraction. If this can be maintained we find a cessation of tubercular deposit, and a reparative process set up in the lungs. We have some special means to influence the temperature, outside of the remedies acting upon the circulation. A full description of them would be out of place here, but may be found in my Principles of Medicine, p. Whilst zymotic causes have been recognized in many of the severe acute diseases, but little has been done to determine their character, or the means to antidote them. Polli, with regard to the influence of the Alkaline Sulphites, was the first important step in this direction. The presence of such blood poison is readily detected, and we have advanced so far in our knowledge of remedies, that in many cases we can select the antidote with much certainty. I do not wish to be understood as claiming that we have any remedies that will immediately unite with all of a zymotic poison in the blood, destroy it, and at once restore health. But we have remedies which, introduced into the blood, will antagonize the zymotic poison, as it comes in contact with it, arresting its septic influence, or wholly destroying it. In some cases they act rapidly, in others slowly, but in all, if properly selected, with great certainty. The principal remedies of this class are the Alkaline Sulphites, (Sulphite of Soda being in most common use) and the mineral acids. The rules for the selection of the one or the other of these are quite simple, and very definite: In any given case presenting a pallid tongue, with white, or dirty-white, pasty coating, use the Alkaline Sulphites. Of our indigenous Materia Medica we have but one remedy that markedly possesses these properties, and it possesses it in high degree. This remedy is the Baptisia Tinctoria, which may be used in either of the cases named, but is especially valued in the last. The reader will bear in mind that the activity of a zymotic poison is in exact proportion to the departure from normal function. With a rapid pulse, high temperature, and arrest of secretion, its development is rapid and its devitalizing influence marked. Or in the rare opposite case of congestive intermittent and cholera, as the circulation is enfeebled, and the temperature lowered, its progress is rapid. Hence, in order to antagonize a zymotic process, it is necessary, so far as possible, to obtain a normal circulation and temperature. In a given case, the circulation and temperature being favorably influenced by Aconite and Veratrum, Sulphite of Soda exerts an immediate and marked controlling influence over the fever poison. Whilst if it had been given without such preparation it would have had no influence at all, or but slight influence. Some causes of disease are destroyed and removed by remedies that increase waste and excretion. There are some organic remedies that exert a direct influence upon causes of disease, modifying or destroying them, as may be instanced in the action of Phytolacca in diphtheria. Causes of disease acting in and from the blood, are frequently removed by stimulating the excretory organs. Some are removed principally by the skin, others by the bowels, others by the kidneys. The cause of periodic disease, whatever it may be, plays a very important part in the diseases of some localities. Hence in the treatment of the diseases of the West, antiperiodics become the most important remedies. It fails frequently, possibly it is administered nine times where its specific action is obtained once. If the diagnosis is correctly made, and the system is prepared for its administration, it will rarely fail, even when given in a single sufficient dose. I am satisfied that the study of the direct antagonism of remedies to causes of disease, must advance the progress of rational medicine. It is possible, and I deem it probable, that such research will give us remedies controlling all zymotic disease in its early stage. As this exerts a controlling influence, we should expect that its lesions would form a very important element of the study of pathology. This has not been the case, however, and we find pathologists and therapeutists giving it but very little attention. It is a wide field for study, and its cultivation will greatly advance medical science. A few suggestions may not be out of place here: Those functions which we have been accustomed to speak of as vegetative, are associated together, and to some extent governed by the ganglionic or sympathetic nervous system. It comprises digestion, blood-making, the circulation of the blood, nutrition, and secretion and excretion - these are the essentially vital functions, in the performance of which man has life. If they are properly performed, he has healthy life, if there is an aberration in either of them, one or more, he has diseased life. If this be so, then this ganglionic system of nerves must play an important part in every disease. If there are remedies then that influence the ganglionic nerves directly, and through them the vital ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━ * See Principles of Medicine, page 306. The sedatives, Aconite, Veratrum, Gelseminum, Lobelia, and others, as Cactus, Belladonna, Eryngium, Phytolacca, Hamamelis, Pulsatilla, etc. The association of the spinal-cord with the sympathetic brings vital functions in relation with our conscious life, and through its superior expansion the brain, adds suffering from disease. Conversely, mal-conditions of conscious life are reflected through this association and influence vital processes. Whilst, therefore, it is very important to reach lesions of vegetative life directly through the ganglionic system of nerves, it is no less important to control any disease producing influence that might be extended from the cerebro-spinal centres. In some they form a principal part, in others in less degree, but in all they require to be estimated in diagnosis and therapeutics. They range themselves under the common classification of excess, defect, and perversion, and usually it is not difficult to determine their character, and select means that exert a direct influence. If the material is broken down and removed to the blood, but not carried out by the excretions, we will have an impairment of life from its presence in the blood. Too rapid waste of tissue is sometimes an important element of disease, requiring care in diagnosis and the application of remedies. In the breaking down of a protean body, it passes through many phases, and in its metamorphosis, it assumes forms that are noxious to life, if they have any degree of permanency, or are in any considerable quantity. Lesions in retrograde metamorphosis are therefore to be estimated, and remedies which influence it become important. They are zymotic poisons, or animal matter undergoing change, and influence the blood and life in different degree, in proportion to their quantity, and especially in proportion to their activity in setting up the septic process. These may be antagonized or destroyed in many cases; in others the natural process of retrograde metamorphosis is stimulated, and they are transformed into urea and other innocuous bodies fitted for excretion by kidneys, skin and bowels. The necessity of regarding the nutritive processes during the progress of disease, is now admitted by all advanced physicians, and insisted upon by such writers as Chambers, Anstie, Bennett and others. Experience has conclusively proven that proper food with good condition of the digestive apparatus, without medicine, give a success in the treatment of the graver acute diseases, that was never obtained by any other method of treatment. As we have already seen, the condition of the stomach and digestive apparatus is of first importance in all forms of disease, and its lesions demand first attention in our therapeutics. We have shown that this was essential to the successful administration of remedies, it is no less necessary that the patient may take and appropriate proper food.
Pseudohyponatremia occurs only when Diabetes insipidus and nephrotic syndrome promote undiluted samples are measured hypernatremia by causing water loss 100 mg zithromax. C When serum albumin is low 250 mg zithromax, the equilibrium between heparinized plasma than in serum bound and Cai is shifted 500mg zithromax, producing increased Ca 500 mg zithromax. Hypercalcemia may be induced by low serum from platelets and leukocytes during coagulation zithromax 250 mg, magnesium causing serum levels to be higher than plasma zithromax 100 mg. Chemistry/Correlate clinical and laboratory data/ Pseudohyponatremia is a measurement error caused Electrolytes/2 by diluting samples containing excessive fat or 67 250mg zithromax. The colloids displace plasma water zithromax 100mg, resulting usually associated with cystic ﬁbrosis? Sweat chloride greater than 60 mmol/L Only ion-selective electrodes that measure whole B zithromax 500mg. Therefore 100mg zithromax, hypocalcemia can be associated with either Chemistry/Evaluate laboratory data to recognize health magnesium deﬁciency or magnesium excess. A Cystic ﬁbrosis causes obstruction of the exocrine glands including the sweat glands, mucus glands, and pancreas. Newborns with pancreatic involvement demonstrate fecal trypsin deﬁciency, which may be detected by a low fecal chymotrypsin or immunoreactive trypsin result. More than 98% of aﬀected infants have elevated sweat sodium and chloride and low serum levels. When performing a sweat chloride collection, Answers to Questions 68–70 which of the following steps will result in analytical error? Using unweighed gauze soaked in pilocarpine of pilocarpine to stimulate sweating, and the use nitrate on the inner surface of the forearm to of iontophoresis (application of 0. Collecting more than 75 mg of sweat in iontophoresis, the skin on the inner surface of the 30 minutes forearm is washed with deionized water and dried, C. Rinsing the collected sweat from the gauze pad gauze must be completely covered to prevent using chloride titrating solution contamination and loss of sweat by evaporation. Chemistry/Apply knowledge of fundamental biological A minimum mass of 75 mg sweat is required for characteristics/Electrolytes/2 collection in gauze and 15 μL sweat for collection in macroduct tubing. Chemistry/Calculate/Osmolality/2 Because sodium associates with a counter ion, two times the sodium estimates the millimoles per liter of electrolytes. Dividing glucose by 18 converts from milligrams per deciliter to millimoles per liter. Which of the following biochemical processes is Answers to Questions 1–3 promoted by insulin? Uptake of glucose by cells enzymes, and inhibits formation of glucose from Chemistry/Apply knowledge of fundamental biological pyruvate and Krebs cycle intermediates. Which of the following hormones promotes gluconeogenesis and epinephrine stimulates hyperglycemia? Chemistry/Apply knowledge of fundamental biological Aldosterone is the primary mineralocorticoid hormone characteristics/Carbohydrates/1 and stimulates sodium reabsorption and potassium 3. Requires an oral glucose tolerance test for promotes activation of angiotensinogen and diagnosis aldosterone secretion. Type 1 accounts for only Chemistry/Correlate clinical and laboratory data/ about 10%–20% of cases of diabetes mellitus, Biological manifestation of disease/2 and is usually diagnosed by a fasting plasma glucose. Approximately 95% of patients produce autoantibodies against the beta cells of the pancreatic islets. Which of the following is characteristic of Answers to Questions 4–7 type 2 diabetes mellitus? Hyperglycemia is often controlled without obese and over 40 years of age, although the insulin replacement incidence is increasing in both children and young D. Which of the following results falls within the prevent ketosis and hyperglycemia can be controlled diagnostic criteria for diabetes mellitus? Two-hour plasma glucose of 180 mg/dL following criteria for diagnosing diabetes mellitus: following a 75 g oral glucose challenge fasting glucose ≥ 126 mg/dL, casual (random) D. Random plasma glucose of 250 mg/dL and glucose ≥ 200 mg/dL in the presence of symptoms presence of symptoms (polyuria, increased thirst, weight loss), glucose Chemistry/Evaluate laboratory data to recognize health ≥ 200 mg/dL at 2 hours after an oral dose of 75 g of and disease states/Carbohydrates/2 glucose, and hemoglobin A1c ≥ 6. Select the most appropriate adult reference range of diabetes mellitus is indicated if any one or for fasting blood glucose. Te patient remains ambulatory for 3 days prior for impaired fasting plasma glucose (prediabetes) to the test recommended by the American Diabetes Association. No food, coﬀee, tea, or smoking is allowed associated clinical hypoglycemia, and neonates have a 8 hours before and during the test lower limit of approximately 40 mg/dL owing to D. Such and disease states/Glucose tolerance/2 persons are classiﬁed as having prediabetes and 9. Is diagnosed using the same oral glucose such as respiratory distress syndrome, high birth tolerance criteria as in nonpregnancy weight, and neonatal jaundice. Converts to diabetes mellitus after pregnancy usually screened between 24 and 28 weeks’ in 60%–75% of cases gestation. Presents no increased health risk to the fetus nonfasting and consists of an oral 50-g glucose D. Is deﬁned as glucose intolerance originating challenge followed by serum or plasma glucose during pregnancy measurement at 1 hour. A result ≥ 140 mg/dL is Chemistry/Evaluate laboratory data to recognize health followed by a 2-hour or 3-hour oral glucose and disease states/Glucose tolerance test/2 tolerance test to confirm gestational diabetes. Which of the following ﬁndings is characteristic the 3-hour test, a 100-g dose of glucose is used of all forms of clinical hypoglycemia? A fasting blood glucose value below 55 mg/dL exceeded: fasting, ≥ 95 mg/dL or higher; 1 hour, B. Neuroglycopenic symptoms at the time of low higher; 3 hour, ≥ 140 mg/dL or higher. C Clinical hypoglycemia can be caused by insulinoma, drugs, alcoholism, and reactive hypoglycemia. Reactive hypoglycemia is characterized by delayed or excessive insulin output after eating and is very rare. High fasting insulin levels (usually > 6 μg/L) are seen in insulinoma, and patients with insulinoma almost always display fasting hypoglycemia, especially when the fast is extended to 48–72 hours. In hypoglycemia, low levels indicate an exogenous insulin source, whereas high levels indicate overproduction of insulin. Which statement regarding glycated (glycosylated) Answers to Questions 11–14 Hgb (G-Hgb) is true? C G-Hgb results from the nonenzymatic attachment of the β chain a sugar such as glucose to the N-terminal valine of B. Will be abnormal within 4 days following an are three G-Hgb fractions designated A1a, A1b, and episode of hyperglycemia Alc. Hemoglobin A1c makes up about 80% of glycated hemoglobin, and is used to determine Chemistry/Correlate laboratory data with physiological the adequacy of insulin therapy. The time-averaged processes/Glycated hemoglobin/2 blood glucose is approximated by the formula 12. A glycated hemoglobin test should Chemistry/Evaluate laboratory data to recognize health be performed at the time of diagnosis and every and disease states/Glucose/2 6 months thereafter if the result is < 6. Levels do not need to be done fasting performed every 3 months until control is B. Samples should be measured within 2 hours of 2–3 months prior to blood collection, the dietary collection status of the patient on the day of the test has no D. Refrigerated whole-blood Chemistry/Apply knowledge to recognize sources of samples are stable for up to 1 week. Hgb A is 1C error/Glycated hemoglobin/2 assayed by cation exchange high-performance liquid chromatography or immunoassay 14. Which stationary phase is used for the (immunoturbidimetric inhibition) because both measurement of hemoglobin A1c by high methods are speciﬁc for stable Hgb A1C, and do performance liquid chromatography? Normal hemoglobin A has a weak positive charge at an acidic pH and binds weakly to the resin. Glycated hemoglobin has an even weaker positive charge and is eluted before hemoglobin A. Abnormal hemoglobin molecules S, D, E, and C have a higher positive charge than hemoglobin A and are retained longer on the column. According to American Diabetes Association whole-blood hemolysate, and identify the cause criteria, which result is consistent with a diagnosis and best course of action. Te result is not reportable because labile Chemistry/Evaluate laboratory data to recognize health hemoglobin A1c is present and disease states/Glucose/2 D. Te result is reportable; neither hemoglobin F or C interfere Answers to Questions 15–17 Chemistry/Evaluate laboratory data to recognize problems/Glycated hemoglobin/3 15. Which statement best describes the use of the completely separated from Hgb A and does not 1c Hgb A1C test? Labile hemoglobin is formed initially when the aldehyde of glucose reacts with the N-terminal valine of the β globin chain. This Shiﬀ base is reversible but is converted to Hgb A1c by rearrangement to a ketoamine. A fasting glucose of 126 or higher on two consecutive occasions indicates diabetes. A fasting glucose of 99 mg/dL is considered Peak Calibrated Retention Peak normal. May be used only to monitor persons with type 2 diabetes Chemistry/Correlate clinical and laboratory data/ Glycated hemoglobin/2 210 Chapter 5 | Clinical Chemistry 18. What is the recommended cutoﬀ for the early Answers to Questions 18–21 detection of chronic kidney disease in diabetics using the test for microalbuminuria? The term microalbuminuria is defined as albumin excretion ≥ 30 mg/g creatinine Chemistry/Evaluate laboratory data to recognize health but ≤ 300 mg/g creatinine. The use of the albumin and disease states/Glucose/2 to creatinine ratio is preferred to measures of 19. In addition to measuring blood glucose, Hgb A1c, albumin excretory rate (μg/min) because the latter and microalbumin, which test should be done on is subject to error associated with timed specimen diabetic persons once per year? Estimated glomerular ﬁltration rate have diabetes, it is not sensitive enough to manage Chemistry/Select method/Carbohydrates/2 glucose control on a daily basis, and has been 20. Which testing situation is appropriate for the use replaced by whole-blood glucose monitoring or of point-of-care whole-blood glucose methods? Screening for type 2 diabetes mellitus ketone test is a useful screening test for diabetic and B. Diagnosis of diabetes mellitus other forms of ketosis, the plasma β hydroxybutyrate C. Monitoring of blood glucose control in type 1 test should be used to identify and monitor ketosis in and type 2 diabetics diabetic persons. Monitoring diabetics for hyperglycemic Hgb A1c to identify poor control of blood glucose in episodes only the past 2–4 weeks, but has not been recommended for routine use in all diabetic patients. Which of the following is the reference method glucose monitors for establishing a diagnosis of for measuring serum glucose? Glucose dehydrogenase analytical variance is greater and accuracy less than for Chemistry/Select method/Carbohydrates/2 laboratory instruments. Whole blood glucose meters should be used by diabetics and caregivers to monitor glucose control and can detect both hyper- and hypoglycemic states that result from too little or too much insulin replacement. Therefore, postprandial monitoring with such a device is recommended for all persons who receive insulin therapy. Polarographic methods for glucose analysis are Answers to Questions 22–26 based upon which principle of measurement? As the dissolved O2 oxidized decreases, less is reduced at the cathode, resulting in a decrease in current proportional to glucose Chemistry/Apply principles of basic laboratory concentration. It is important that the H2O2 not procedures/Carbohydrates/2 breakdown to re-form O2. In addition to polarography, what other adding molybdate and iodide that react with electrochemical method can be used to H O, forming iodine and water, and by adding 2 2 measure glucose in plasma? Amperometry is impregnated into the membrane covering the Chemistry/Apply principles of basic laboratory electrode. Select the enzyme that is most speciﬁc for anode of the electrode, where it is oxidized to O2. D Glucose oxidase is the most speciﬁc enzyme reacting characteristics/Biochemical/1 with only β-D-glucose. Select the coupling enzyme used in the hexokinase is subject to positive and negative interference. C Although glucose oxidase is speciﬁc for β-D-glucose, the coupling (indicator) reaction is prone to negative interference from ascorbate, uric acid, acetoacetic acid, and other reducing agents. Which of the following is a potential source Answers to Questions 27–31 of error in the hexokinase method? Therefore, hemolyzed samples require a Chemistry/Apply knowledge to recognize sources of serum blank correction (subtraction of the reaction error/Carbohydrates/2 rate with hexokinase omitted from the reagent). Levels below 40 mg/dL occur in septic glucose is usually 50%–65% of the plasma glucose. Hyperglycorrhachia is caused by dehydration cases of subarachnoid hemorrhage, rheumatoid D. B The coupling step in the Trinder glucose oxidase processes/Cerebrospinal ﬂuid/2 method uses peroxidase to catalyze the oxidation of a dye by H2O2. In peroxidase-coupled glucose methods, which 4-aminoantipyrine are coupled to phenol to form a reagent complexes with the chromogen? For glucose oxidase Chemistry/Apply knowledge of basic laboratory methods, the electrons derive from the oxidation of procedures/Carbohydrates/1 hydrogen peroxide. Other factors include binding of devices oxygen to hemoglobin and the slower diﬀusion of C. Te eﬀect is variable and dependent on the glucose onto the solid phase—both of which occur enzyme/coenzyme system when the hematocrit is high. Low hematocrit raises readings and high hematocrit can be avoided by simultaneously hematocrit lowers readings unless corrected measuring the conductivity of the sample.
If the sound is louder when the tuning fork is next to the ear 100 mg zithromax, hearing in that ear is normal zithromax 500 mg. If the sound is louder when the tuning fork touches the mastoid process zithromax 250 mg, it is an indication of conductive hearing loss zithromax 250mg. Weber Tuning fork test that evaluates bone conduction of sound in both ears at the same time In the Weber test zithromax 100mg, the vibrating tuning fork is placed on the center of the fore- head 250mg zithromax. Disorders of the eyes and ears are commonly treat- Mydriatics and miotics are used not only to treat ed with instillation of drops onto the surface of the eye disorders but also to dilate (mydriatics) and eye or into the cavity of the ear 250 mg zithromax. The eyes and ears contract (miotics) the pupil during eye examina- are typically irrigated with liquid solution to tions zithromax 500mg. Ear medications include antiemetics to remove foreign objects and to provide topical appli- relieve nausea associated with inner ear infections 500 mg zithromax, cation of medications 100mg zithromax. Pharmacological agents used products to loosen and remove wax buildup in the to treat eye disorders include antibiotics for bacter- ear canal, and local anesthetics to relieve pain asso- ial eye infections, beta blockers and carbonic ciated with ear infections. Classification Therapeutic Action Generic and Trade Names Eye antibiotics, Inhibit growth of microorganisms that infect erythromycin base ophthalmic the eye. Mydriatics are commonly used to dilate the pupil to treat inflammatory conditions or in preparation for internal examinations of the eye. Murine,Visine Ophthalmic decongestants are over-the-counter products that temporarily relieve the itching and minor irritation commonly associated with allergy. Abbreviations This section introduces abbreviations related to the eye and ear along with their meanings. Complete each activity and review your answers to evaluate your understanding of the chapter. Learning Activity 15-1 Identifying Eye Structures Label the following illustration using the terms listed below. Learning Activities 491 Learning Activity 15-2 Identifying Ear Structures Label the following illustration using the terms listed below. Enhance your study and reinforcement of word elements with the power of DavisPlus. We recommend you complete the flash-card activity before completing Activity 15–3 below. Complete the termi- nology and analysis sections for each activity to help you recognize and understand terms related to the special senses. Medical Record Activity 15-1 Operative Report: Retained Foreign Bodies Terminology Terms listed below come from the Operative Report: Retained Foreign Bodies that follows. Use a medical dictionary such as Taber’s Cyclopedic Medical Dictionary, the appendices of this book, or other resources to define each term. Then review the pronunciations for each term and practice by reading the medical record aloud. In the supine position under satisfactory general anesthesia via mask, the patient was draped in a routine fashion. A previously placed tympa- nostomy tube was found to be in position and was surrounded with hard cerumen. The edges of the perforation were freshened sharply with a pick, and a paper patch was applied. Patient tolerated the surgery very well, and was sent to recovery in stable condition. Operative Report: Retained Foreign Bodies 499 Medical Record Activity 15-2 Operative Report: Phacoemulsification and Lens Implant Terminology Terms listed below come from Operative report: Phacoemulsification and lens implant that fol- lows. Use a medical dictionary such as Taber’s Cyclopedic Medical Dictionary, the appendices of this book, or other resources to define each term. Then review the pronunciations for each term and practice by reading the medical record aloud. Postoperative care was reviewed, and patient was released with instructions to return to the office the following day. False—To define a medical word, first define Elements the suffix or the end of the word. Chapter 3—Prefixes Learning Activity 3-1 Identifying and Defining Pefixes Word Definition of Prefix Word Definition of Prefix 1. Which cervical vertebrae form the atlantoaxial Radiological Consultation Letter: joint? Cervical and Lumbar Spine The first cervical vertebra (atlas) and the second cer- vical vertebra (axis) 1. What was the pathologist’s diagnosis for the left Pathology Report: Skin Lesion forearm? Provide a brief description of Bowen disease, Skin was obtained from the back, or posterior, surface the pathologist’s diagnosis for the left wrist. What was the significant finding in the laborato- Patient Referral Letter: ry results? Debridement and medication or Sporanox PulsePak History of hypertension and breast cancer 6. The doctor recommended a repeat of the liver Mastectomy enzymes in approximately 4 weeks. While referring to Figure 6–3, describe the loca- tive episode of discomfort (pain) differ from the tion of the gallbladder in relation to the liver. Posterior and inferior portion of the right lobe of the The continuous, deep right-sided pain took a crescen- liver do pattern and then a decrescendo pattern. Why did the patient undergo the cholecy- was intermittent and sharp epigastric pain. Were there any ulcerations or erosions found during the exploratory procedure that might 1. Demerol and Versed administered intravenously During x-ray tomography using the videoendoscope, 6. What did the doctors find when they examined biopsies were taken of the stomach and duodenum. Evaluation Interstitial vascular congestion with possible superim- posed inflammatory change and some pleural reac- 1. Other than the respiratory system, what other Trace of edema without clubbing or murmur body systems are identified in the history of present illness? What two laboratory tests will be used to eval- Chart Note: Acute Myocardial uate the patient? How was the temporal artery located for Operative Report: Right administration of Xylocaine? Down through the subcutaneous tissue and superfi- Rule out arteritis cial fascia 2. What blood product was administered to the and abnormal enhancement pattern in the kidney patient? Operative Report: Right Knee Rotation of the tibia on the femur is used to deter- Arthroscopy and Medial mine injury to meniscal structures. An audible click Meniscectomy during manipulation of the tibia with the leg flexed is an indication that the meniscus has been injured. Because Lachman and McMurray tests were negative (normal), why was the surgery per- The meniscus is the curved, fibrous cartilage in the formed? What is the probable cause of the tear in the inferior surface posterior and mid medial meniscal patient’s meniscus? The surgeon The continuous pressure on the knees from jogging resected the tear, and the remaining meniscus was on a hard surface, such as the pavement contoured back to a stable rim. Diaphysis Nuclear Scan The radiotracer accumulated within the left mid pos- terior tibial diaphysis was delayed. What will be the probable outcome with con- Middle one third of the left tibia tinued excessive repetitive stress? What medication was the patient taking for pain The rate of resorption will exceed the rate of bone and did it provide relief? What imaging technique was used for position- Operative Report: Extracorporeal ing the patient to ensure that the shock waves would strike the calculus? To fragment the remaining calculus and remove the Using grasping forceps and removing it as the scope double-J stent was withdrawn Chapter 12—Female 6. Even though her partner used a condom, how do you think the patient became infected with Ulcerlike lesion on the right labia herpes? Postoperative Consultation: Surgical removal of the uterus through the vagina Menometrorrhagia 5. The surgeon plans to perform a bilateral (relates to How many viable infants did she deliver? An abortion performed when the pregnancy endan- To permit visualization of the abdominal cavity as the gers the mother’s mental or physical health or when ovaries and fallopian tubes are removed through the the fetus has a known condition incompatible with life vagina 3. Patient desires definitive treatment for menometror- rhagia and has declined palliative treatment Chapter 13—Endocrine 4. What does the physician suspect caused the per year, how many packs did she smoke in an patient’s hyperparathyroidism? Discharge Summary: The results were consistent with recurrent subarach- Subarachnoid Hemorrhage noid hemorrhage. In what part of the head did the patient feel It again showed no evidence of an aneurysm. Regarding activity, what limitations were placed Occipital, the back part of the head upon the patient? What imaging tests were performed, and what Avoid activity that could raise the pressure in the was the finding in each test? Fall at work about 15 to 20 years ago and four sub- sequent lumbar surgeries Subarachnoid hemorrhage, epidural abscess, and transverse myelitis 2. How will lymphedema be controlled should Pain management physical therapy be undertaken? What medications did the patient receive and Compression stockings why was each given? What was the nature of the foreign body in the It resulted in a large perforation. Retained tympanostomy tubes The edges were freshened sharply with a pick, and a 3. See Medical words von Recklinghausen disease, 406 Rules for Singular and Plural Suffixes This table presents common singular suffixes, the rules for forming plurals, and examples of each. Questions involving light the content you did not know, and study it until com- combinations of statements (multiple, multiple choice) mitted to memory. The test item classification consists of the presentation used in laboratory science lectures. Taxonomy 2 questions require calculation, correlation, comprehension, or relation. Taxonomy 3 questions require Design of Questions problem solving, interpretation, or decision making. Test questions used in certification examinations are mul- This question design allows you to compute a score, tiple choice. Each consists of a question, incomplete state- which helps you to identify strengths and weaknesses in ment, or problem to be solved called the stem and four various content areas and tasks. One of the alternatives is the correct time on a particular content area or on practicing with response and the remaining three are incorrect (these may questions of a specific taxonomy level. For example, if you be wrong, incomplete, partially correct, or less correct answer several mycology questions incorrectly, then you than the most appropriate response). If, xiii xiv Introduction however, you miss several recall questions (taxonomy minimum passing score usually falls within the range of 1 level) over several different content areas such as hema- 65%–70% correct responses. Poor perfor - you have not mastered the material in this area, and that mance with questions that require mathematical solutions further study is required. Begin with a review of the exam content outline that pretation or problem solving (taxonomy 3 level) is iden- is made available by the certification agency. For example, tified as a weakness, then the best approach is to study the if 20% of the exam is Microbiology but only 2% of the explanation that follows each question in order to under- exam is Laboratory Management, you should spend sig- stand the logic or reasoning behind the answer. Within each Because the answers and explanations appear on the content area will be subcategories (e. If 60% of the tear off the perforated flap and use it as a blocker to cover Microbiology content is Bacteriology and only 10% the answers while answering the questions. When you is Parasitology, then devote significantly more time to have answered a question, slide the blocker down the page studying the former. The blocker is Allow yourself sufficient time prior to the exam to re- printed with a compilation of reference ranges for com- view each content area no less than three times. Begin mon analytes that will assist you with answering some studying your strongest subject, then progress to your questions. Study your class notes first, then use this review book to test your knowledge of the respective content Prepare for Your Certiﬁcation Examination area. Devote time to reading the explanation for each Ideally, an examination score should reflect your knowl- question, regardless of whether you answered it correctly edge of the content without the influence of other or not. However, variables such as stress, wellness, self- view it before answering the questions in this book a confidence, emotional state, and alertness all influence second time. In addition, examination skills often factor questions on your certification exam; however, you are into exam scores and can be decisive. A single question likely to encounter variants of the questions, and the answered correctly can make the difference between pass- explanations will help prepare you to answer these cor- ing or failing, the only two meaningful scores for a certi- rectly. If you There are two types of computer-based examinations, tra- score lower in Clinical Chemistry, devote more time to ditional and adaptive.
Within three weeks I had reliable data re- garding the necessary level of electrical treatment zithromax 100mg. It is not as if you had to use house current which would kill you zithromax 250mg, along with the parasite zithromax 250 mg. Selective Electrocution In twenty minutes (three minutes at six different frequencies) a whole family could get rid of this parasite zithromax 500mg. Cancer cases showed that in a few hours the universal cancer marker 250 mg zithromax, ortho- phospho-tyrosine could be banished from their bodies by killing this same parasite zithromax 500 mg. Most cases of pain got immediate relief if I could identify the correct “bug” and have its frequency found by the next office visit 500 mg zithromax. This seemed to be absolute proof that living things had an essential high frequency output of some kind of energy zithromax 100 mg. If I could kill something as large as an Ascaris worm or intestinal fluke 100 mg zithromax, then perhaps I could kill something even larger 100mg zithromax, like an earthworm or flea, something I could see with my own eyes in- stead of having to imagine its demise inside my body. Ten minutes at a frequency chosen near the top of their broadcast range seemed to anesthetize them. There was no need to experiment, though, because the parasites we want to kill have characteristic frequencies that do not overlap the characteristic frequencies of a human. Find the resonant frequency of a bacterium, virus or parasite using a slide or dead bit. Treat the living invaders inside the human body with this frequency and in a matter of minutes they are no longer transmitting their own bandwidths—they are dead or sick and will be removed by our white blood cells. Perhaps the department of defense would use this knowledge and develop super high voltage de- vices to kill people (“enemies”) somewhere in the world. Possibly a way could be found to shield yourself from frequencies harmful to humans by wearing a choke (inductor) coil which suppresses these frequencies. Meanwhile, people must be alerted that they can safely kill their invaders and heal their chronic illnesses. Invaders that have been increasing exponentially due to lowered immunity in recent decades. Remember, though, that the true challenge is not to kill our invaders but to regain our health and immunity. The ship of “progress”, of increasingly complex, processed foods and products, must be turned around and simplicity become our goal. Or will daily parasite and pathogen electrocution become another crutch that makes us just enough better that we can continue a detri- mental lifestyle? Perhaps it is the same energy as the Asian chi; perhaps it is merely related to it. Perhaps it is the energy that runs along the meridians discovered eons ago by Asian practitioners. Perhaps it is the energy that faith healers and religious teachers know how to harness, perhaps not. Perhaps it is the energy that psychics perceive and that drives occult phenomena, perhaps not. What is truly amazing is that ordinary persons have discov- ered such energy well ahead of scientists. Persons using the “art” of kinesiology, pendulums, radionics, dousing rods and many other forms of “strange energy” have no doubt harnessed a part of this bioradiation. It is a tribute to the generally high intelligence of common people and to their open-mindedness that they discovered this energy, in spite of opposition from scientists of today. Over a century ago the scientists of Europe proposed the existence of a “life force” called “élan vitale. Young scientists, (including myself) were systematically taught to scorn this idea. Of course we were also taught that a good scientist was unemo- tional, does not scorn ideas, has a completely open mind, and does not rule something out until it is disproved to their satis- faction. The youthfulness of college years is so susceptible to prejudices of all kinds, and the desire for acceptance is so great, that special effort needs to be made to teach neutrality. I was indeed inspired with the phrase “search for truth” but then promptly led down the path of “search for acceptance. Only its frequency was noticed and caught (modulated) in such a way as to be measurable. These amazing properties are due to the capacitive and inductive properties of objects all around us, including our- selves. For years I used a commercial frequency generator to “zap” one pathogen after another. First I made a chart of the frequencies for most of the bacteria and viruses in my collection (over 80, see page 561). Even persons with a simple cold typically had a dozen they tested positive to (not just Adenovirus). Next it was time to tune in the frequency generator to a dozen frequencies for three minutes each. Until you killed your roundworm and your virus, you would keep getting the virus back promptly. He programmed a computer controlled frequency gen- erator to automatically cover all the frequencies populated by all the parasites, viruses, and bacteria, from 290,000 Hz to 470,000 Hz. Arthritis pain, eye pain, colds were improved, but not completely cured overnight. Months later I would find that organisms were transmitting as low as 170,000, and as high as 690,000 Hz. To cover this larger range, spending three minutes for every 1000 Hz, would take 26 hours. But even this method of zapping was not 100% effective for reasons yet to become clear. The purpose was to enable everyone to kill the intestinal fluke at 434,000 Hz with a low cost device. Enough benefit would be derived from zapping at various frequencies that I thought everyone should know how to make one. When I tested it on one of my own bacteria, however, three others at much different frequencies died also! When I tested it on others, even though they had dozens of pathogens, all were killed! Subsequent testing showed it was not due to some unique design, or special wave form produced by the device. Before this I had always set my commercial frequency gen- erator to alternate between positive and negative voltage. Now I tried setting it to alternate between positive and zero voltage (positive offset). It was just as effective as the battery operated frequency generator my son designed. Generating positive offset frequencies is the best way to kill all pathogens quickly. I conclude they had been infecting the parasites, and killing the parasites released them. The second zapping kills the released viruses and bacteria, but soon a few viruses appear again. After a third zapping I never find any viruses, bacteria or parasites, even hours later. And it explains why a single treatment with a frequency generator or zapper frequently gives you a cold! Zapping does not kill shielded organisms such as those that may be in the middle of your stomach or intestines. The electricity travels along the stomach or intestine wall, not through their contents. So zapping is still not perfect, but can bring such manifest relief that everyone should buy or make one. The Bioradiation Spectrum Everything emits a characteristic range of frequencies (bandwidth). Fortunately for us we can work on zapping pathogens in the lower ranges without affecting humans in the upper range. Small organisms with narrow band- widths are extinguished quite readily (three minutes at five volts). Positively offset frequencies can kill the entire range of small organisms (viruses, bacteria, parasites) in just seven minutes. No matter what frequency it is set at (within reason), it kills large and small invaders: flukes, roundworms, mites, bacteria, viruses and fungi. I suppose that a positive voltage applied anywhere on the body attracts negatively charged things such as bacteria. Perhaps the battery voltage tugs at them, pulling them out of their locations in the cell doorways (called conductance channels). Such biological questions could be answered by studying the effects of positive frequencies on bacteria in a lab. The most important question, of course, is whether there is a harmful effect on you. Even knowing that the voltage comes from a small 9 volt battery does not prove safety, although it is reas- suring. The clotting of red blood cells, platelet aggregation and functions that depend on surface charges on cells need to be in- vestigated. One need not go beyond this time, although no bad effects have been seen at any length of treatment. The first seven minute zapping is followed by an intermis- sion, lasting 20 to 30 minutes. During this time, bacteria and viruses are released from the dying parasites and start to invade you instead. The second seven minute session is intended to kill these newly released viruses and bacteria. If you omit it, you could catch a cold, sore throat or something else immediately. The zapping current does not reach deep into the eyeball or testicle or bowel contents. It does not reach into your gallstones, or into your living cells where Herpes virus lies latent or Candida fungus extends its fingers. But by zapping 3 times a day for a week or more you can deplete these populations, too, often to zero. Killing The Surviving Pathogens The interior of gallstones may house parasites inaccessible to the zapping. Eliminate this source of reinfection by flushing them out with liver cleanses (page 552). There is no way of distinguishing between “good” and “bad” bacteria with either of these methods. However even good bacteria are bad if they come through the intestinal wall, so zapping targets mostly “bad” bacteria. Home- made yogurt and buttermilk (see Recipes) are especially good at recolonizing the bowel. But it does not seem wise to culture yourself with special commercial preparations and risk getting parasite stages again when you can become normal so soon anyway. If you do decide to take some acidophilus bacteria to replenish your intestinal flora make sure you test for parasites like Eurytrema first. When a large number of parasites, bacteria and viruses are killed, it can leave you fatigued. I believe this is due to the second and third zapping which mops up bacteria and viruses that would otherwise be able to go on a feeding frenzy with so much dead prey available. To build your zapper you may take this list of components to any electronics store (Radio Shack part numbers are given for convenience). Find another parts store or use 276-1995 (but the legs are much shorter and harder to attach clips to). If the metal ends are L-shaped bend them into a U with the long-nose pliers so they grab better. Mount the bolts on the outside about half way through the holes so there is a washer and nut holding it in place on both sides. Find the “top end” of the chip by searching the outside surface carefully for a cookie-shaped bite or hole taken out of it. Align the chip with the socket and very gently squeeze the pins of the chip into the socket until they click in place. Write in the numbers of the pins (connections) on both the outside and inside, starting with number one to the left of the “cookie bite” as seen from outside. On the inside connect pin 5 to one end of this capacitor by simply twisting them together. Loop the capacitor wire around the pin first; then twist with the long-nose pliers until you have made a tight connection. Bend the other wire from the capacitor flat against the inside of the shoe box lid. Pierce two holes ½ inch apart next to pin 3 (again, you can share the hole for pin 3 if you wish), in the direction of the bolt. This resistor protects the circuit if you should accidentally short the terminals. You may need to trim away some paper with a serrated knife before replacing washer and nut on the outside. Next to the switch pierce two holes for the wires from the battery holder and poke them through. They will accommodate extra loops of wire that you get from using the clip leads to make connections. Bend the top ends of pin 2 and pin 6 (which already has a connection) inward towards each other in an L shape.
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