Pre-K through Grade 8

Providing spiritual and educational leadership


Phone: 203-269-4477

Fax: 203-294-4983

8:00 A.M. - 2:25 P.M.

Monday to Friday


P: 203-269-4476

F: 203-294-4983

11 North Whittlesey

Wallingford, CT

8:10am - 2:25pm

Monday to Friday


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By: Michael A. Gropper, MD, PhD

  • Associate Professor, Department of Anesthesia, Director, Critical Care Medicine, University of California, San Francisco, CA


Blood Blood is composed of cells (corpuscles) and a liquid intercellular ground substance called plasma medications quizzes for nurses discount frumil 5 mg without prescription. Plasma: Over 90% of plasma is water; the balance is made up of plasma proteins and dissolved electrolytes medications used to treat anxiety buy cheap frumil 5mg, hormones medicine kit buy frumil 5 mg fast delivery, antibodies, nutrients, and waste products. Plasma plays a vital role in respiration, circulation, coagulation, temperature regulation, buffer activities and overall fluid balance. Peripartum cardiomyopathy found in late pregnancy Restrictive cardiomyopathy-limited filling of the heart due to inability to relax heart tissue. Conduction problems, myocardial damage or congenital heart defects can prolong this. Causes: Adrenal gland enzyme deficit causes cortisol and aldosterone to not be produced. Causing male sex characteristics to be expressed prematurely in boys and found in girls. Secondary Hyperaldosteronism: problem found elsewhere causing excessive production of aldosterone. Symptoms: Lymphocyte concentration noted Fatigue with biopsy Menstrual changes Weight loss Treatment: Poor temperature tolerance Varies depending on symptoms. Excessive levels of glucose in the blood stream that cannot be used due to the lack of insulin. Moreover, the patient continues to experience hunger, due to the cells not getting the fuel that they need. Tests: Glucagon may need to be Fasting glucose test administered if hypoglycemia Insulin test conditions are severe. IgD can be located on B cells IgE-main mediator of mast cells with allergen exposure. A more potent drug requires a lower dosage than does a less potent drug to produce a given effect. Maximum efficacy is plateau (or maximum response), but may not be achievable clinically due to undesirable side effects. In general, the steepness of the curve dictates the range of doses that are useful therapeutically. The drugs binding to plasma proteins and intracellular components Membrane Review: 1. Lipid Soluable compounds (many drugs) pass through by becoming dissolved in the lipid bylayer. Usually limited to movement through gap junctions because size too large for pores. Binding to subcellular components Volume of Distribution (Vd) is a calculation of where the drug is distributed. Vd = amount of drug given (mg) concentration in plasma (mg/ml) Calculate the Vd and compare to the total amount of body H20 in a person. Must assume the fetus is subjected to all drugs taken by the mother to some extent. These are the most predominant reactions for biotransforming drugs Phase I reactions are generally more polar and usually inactive-some exceptions.


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Depending on the density medicine 003 cheap frumil 5 mg mastercard, corneal opacities are graded as nebula medicine escitalopram buy discount frumil 5 mg, macula and leukoma symptoms 5dp5dt fet buy frumil 5 mg free shipping. Nebular corneal opacity: When the corneal scar is thin it is known as nebula. The opacity may be so faint that it can be missed on routine examination unless cornea is examined on a slit lamp. Presence of nebula in the pupillary area causes blurring of vision due to irregular astigmatism. Diseases of the Cornea 173the perforation of a sloughing corneal ulcer results in formation of a pseudocornea over the prolapsed iris. The ectasia of pseudocornea with the incarceration of iris tissue is known as anterior staphyloma. The intraocular pressure is often raised due to the development of secondary glaucoma. The summit of the staphyloma may get ulcerated and the aqueous humor may leak out. When the corneal opacity covers the pupillary area an optical iridectomy can improve the vision, but the ideal procedure is either excimer laser phototherapeutic keratectomy or corneal transplantation. The epithelium over It is caused by destruction of less than half the thickness of corneal stroma. Leukomatous corneal opacity: When the opacity is very dense and white, it is called leukoma. The destruction of more than half the thickness of corneal stroma causes leukomatous opacity. Occasionally the corneal scar is weak and thin and bulges under the normal intraocular pressure, the condition is known as keratectasia. When iris tissue is adherent to the back of a leukoma, it is called as leukoma adherence. Gold chloride 4% or platinum chloride ted by timely and adequate treatment of predis 2% solution is applied for 2 to 3 minutes to posing conditions. A freshly prepared hydrazine corticosteroids, thiotepa or irradiation is hydrate 2% solution is instilled over the cornea to effective. Intractable cases are dealt with peritomy reduce gold chloride to dark brown and platinum or corneal grafting. The eye should be Pigmentation of the Cornea bandaged after application of atropine ointment. A partial anterior staphyloma is managed by Pigmentation of the cornea may be due to pro reducing the intraocular pressure and performing longed use of topical drugs, trauma, foreign body, penetrating keratoplasty. Iatrogenic pigmentation of the cornea may occur from prolonged use of silver nitrate. Vascularization of the Cornea Repeated silver nitrate application leads to brownish discoloration of Descemets membranethe cornea is an avascular tissue and presence of owing to impregnation of the salt (argyrosis). A retained copper foreign body in the eye maythe superficial vascularization of cornea is produce a grayish-green or golden-brown discolo common in trachoma, superficial corneal ulcers, ration of the peripheral corneal stroma (chalcosis). Blood staining of the cornea can follow massive hyphema either from a contusion injury or an intraocular surgery. The deeper layers of cornea are stained with blood pigment (hemosiderin) and may develop brown or greenish discoloration simu lating dislocation of the lens in the anterior chamber. A brown horizontal line (Hudson-Stahli line) in the inferior third of the cornea may be seen on slit-lamp in elderly persons. Philadelphia, Stockers line is a golden brown line in the corneal Saunders, 1998. It forms the posterior five-sixths part of the fibrous outer protective tunic of the eyeball. The thickest part is at the posterior pole and the thinnest underneath the insertion of rectusthe episcleral tissue comprises fine loose elastic tissue fibers and contains a large number of small muscles.

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A 70-year-old man presents with fatigue symptoms quadriceps tendonitis order frumil 5 mg amex, (A) Cigarette smoking and chronic alcohol weight loss medicine vile order frumil 5 mg otc, abdominal pain medications like tramadol buy discount frumil 5mg, and overt use are associated risk factors. A complete blood count (8) Gastroesophageal refux disease and reveals anemia with hemoglobin of 10. Which of the following is (e) Histologic findings include disordered, the most likely predisposing lesion that led back-to-back submucosal glands. For the past week, a 65-year-old woman will actively drink his milk, but he forcefully has been treated for a severe infection with vomits after each feeding. The infant shows broad-spectrum antibiotics, and she had signs of failure to thrive, with weight loss, recovered well. Which of (A) Candida esophagitis the following is the mechanism associated (8) Congenital pyloric stenosis with this condition Right lower quadrant (0) Selective killing of Clostridium difcile tenderness is elicited on palpation of the bacteria by antibiotics abdomen. A capsule endoscopy reveals (E) Spread of the previous infection to the thickening of the terminal ileum, edema, colon I1 Gastr ointestinalTr act 233 11. The lesions shown in the figure (Reprinted with permission from Rubin R, Strayer D,et aI. The gastric lesion shown in the figure was resected following initial endoscopic discovery. In a routine colonoscopy, a 76-year-old man is found to have a lesion similar to that shown in the illustration. Approximately 80% to 90% of salivary gland tumors originate in the parotid gland and, of these, approximately 70% are pleomorphic adenomas. The term "mixed tumor" properly applies to this benign tumor, which often demonstrates myxoid and cartilage-like elements in addition to stellate or fusiform epithelial cells. Of course, the immediate problem in this patient is life-threatening upper gastrointestinal hemorrhage, an important complication of peptic ulcer disease. Peptic ulcer disease occurs most frequently in the first portion of the duodenum, the lesser curvature of the stomach, or the distal esophagus. Apparently, H pylori increases gastric acid secretion and impairs mucosal defenses. Barrett esophagus iscolumnar metaplasia ofthe esophageal squamous epithelium (squamous-to-columnar).

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