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By O. Grobock. Southern Illinois University at Carbondale. 2018.

GALE ENCYCLOPEDIA OF GENETIC DISORDERS 853 Prognosis Osteoarthritic cartilage is chemically different from nor- mal aged cartilage purchase kemadrin 5 mg mastercard. Prognosis for individuals with OWR is good generic 5mg kemadrin with mastercard, assum- ing they receive appropriate and timely treatments. People with joint injuries from sports, Because many treatments are effective, proper screening work-related activity, or accidents may be at increased is crucial to prognosis. Resources Individuals with mismatched surfaces on the joints that could be damaged over time by abnormal stress may be PERIODICALS prone to osteoarthritis. Demographics ORGANIZATIONS Osteoarthritis is estimated to affect more than 20 HHT Foundation International, Inc. Prevalence of osteoarthritis in most joints is WEBSITES higher in men than women before age 50, but after this Birth Disorder Information Directory. African-American men and women than in Caucasians, possibly because they have a higher bone mineral den- Deepti Babu, MS sity. In the case of knee osteoarthritis, it may be related to occupational and physical demands. African- American women also have a higher risk of developing bilateral knee osteoarthritis and hip osteoarthritis com- pared to women of other races. This difference may be IOsteoarthritis because African-American women generally have a higher body mass index which puts more stress on the Definition joints. Caucasians have a higher risk than Asians, and the risk of osteoarthri- Description tis in the hips is lower in Asia and some Middle East countries than in the United States. Asians appear to have Osteoarthritis is one of the oldest and most common a higher incidence of osteoarthritis in the knee than types of arthritis. With the breakdown of cartilage, the Caucasians, however, and an equal risk in the spine. It does not appear to be caused by aging itself, Genetics plays a role in the development of although osteoarthritis generally accompanies aging. One 854 GALE ENCYCLOPEDIA OF GENETIC DISORDERS study found that heredity may be involved in 30% of peo- ple with osteoarthritic hands and 65% of those with KEY TERMS osteoarthritic knees. Another study found a higher corre- lation of osteoarthritis between parents and children and Cartilage—Supportive connective tissue which between siblings than between spouses. Other research cushions bone at the joints or which connects has shown that a genetic abnormality may promote a muscle to bone. Collagen—The main supportive protein of carti- Abnormal collagen genes have been identified in lage, connective tissue, tendon, skin, and bone. Other research has suggested that mutations in the COL2A1 gene may be associated with osteoarthritis. Any cysts that might develop in susceptibility gene for idiopathic osteoarthritis is located osteoarthritic joints are also detectable by x ray. There is some evidence of genetic abnormality at Additional tests can be performed if other conditions the IL1R1 marker on gene 2q12 in individuals with are suspected or if the diagnosis is uncertain. Blood tests severe osteoarthritis and Heberden nodes (bony lumps on can rule out rheumatoid arthritis or other forms of the end joint of fingers). It is possible to distinguish osteoarthritis from other Signs and symptoms joint diseases by considering a number of factors Although up to 85% of people over 65 show evi- together: dence of osteoarthritis on x ray, only 35-50% experience • Osteoarthritis usually occurs in older people. Symptoms range from very mild to very severe, affecting hands and weight-bearing joints such as • It is usually located in only one or a few joints. The pain of osteoarthritis • The joints are less inflamed than in other arthritic con- usually begins gradually and progresses slowly over ditions. Osteoarthritis is commonly identified by aching pain A few of the most common disorders that might be in one or more joints, stiffness, and loss of mobility. Extensive use of the joint often exacerbates pain in the Treatment and management joints. Osteoarthritis is often more bothersome at night than in the morning and in humid weather than dry There is no known way to prevent osteoarthritis or weather. Some lifestyle changes can reduce may result in stiffness, which can be eased by stretching or delay symptoms. A diagnosis of osteoarthritis is made based on a • Joint protection, which prevents strain and stress on physical exam and history of symptoms. An indi- • Various pain control medications, including corticos- cation of cartilage loss arises if the normal space between teroids and NSAIDs (nonsteroidal anti-inflammatory the bones in a joint is narrowed, if there is an abnormal drugs such as aspirin, acetaminophen, ibuprofren, and increase in bone density, or if bony projections or ero- naproxen).

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Chelation of Ca2+ cannot be used prominently involved in intra-arterial for therapeutic purposes because Ca2+ thrombogenesis (p generic kemadrin 5mg line. For the thera- concentrations would have to be low- py of thrombosis cheap kemadrin 5 mg otc, drugs are used that ered to a level incompatible with life dissolve the fibrin meshwork! There are two ways to initiate the cascade (B): 1) conversion of factor XII into its active form (XIIa, intrinsic system) at intravas- cular sites denuded of endothelium; 2) conversion of factor VII into VIIa (extrin- sic system) under the influence of a tis- sue-derived lipoprotein (tissue throm- boplastin). Some activated factors require the presence of phos- pholipids (PL) and Ca2+ for their proteo- lytic activity. Conceivably, Ca2+ ions cause the adhesion of factor to a phos- pholipid surface, as depicted in C. Phos- pholipids are contained in platelet fac- tor 3 (PF3), which is released from ag- Lüllmann, Color Atlas of Pharmacology © 2000 Thieme All rights reserved. Antithrombotics 143 XII XIIa Synthesis susceptible to inhibition by coumarins XI XIa Reaction susceptible to inhibition by heparin- antithrombin complex IX IXa VIIa VII VIII + Ca2+ + Pl Ca2+ + Pl (Phospholipids) X Xa V + Ca2+ + Pl Prothrombin II IIa Thrombin Fibrinogen I Ia Fibrin A. Inhibition of clotting cascade in vivo Platelets Endothelial Clotting factor defect COO– COO- XII – COO ++ Tissue thrombo- ++ kinase – – XIIa – – – PF3 VIIa VII – Phospholipids e. Inhibition of clotting by removal of Ca2+ Lüllmann, Color Atlas of Pharmacology © 2000 Thieme All rights reserved. Carbox- iologically by complexing with anti- yl groups are required for Ca2+-mediat- thrombin III (AT III), a circulating gly- ed binding to phospholipid surfaces (p. There are several vitamin K de- ting by accelerating formation of this rivatives of different origins: K1 (phy- complex more than 1000-fold. Heparin tomenadione) from chlorophyllous is present (together with histamine) in plants; K2 from gut bacteria; and K3 the vesicles of mast cells; its physiologi- (menadione) synthesized chemically. Therapeutically used All are hydrophobic and require bile ac- heparin is obtained from porcine gut or ids for absorption. Structurally chains of amino sugars bearing -COO– related to vitamin K, 4-hydroxycouma- and -SO4 groups; they contain approx. Antico- min K from vitamin K epoxide, hence agulant efficacy varies with chain the synthesis of vitamin K-dependent length. Synthesis of The numerous negative charges are clotting factors depends on the intrahe- significant in several respects: (1) they patocytic concentration ratio of cou- contribute to the poor membrane pe- marins to vitamin K. The dose required netrability—heparin is ineffective when for an adequate anticoagulant effect applied by the oral route or topically on- must be determined individually for to the skin and must be injected; (2) at- each patient (one-stage prothrombin traction to positively charged lysine res- time). Subsequently, the patient must idues is involved in complex formation avoid changing dietary consumption of with ATIII; (3) they permit binding of green vegetables (alteration in vitamin heparin to its antidote, protamine K levels), refrain from taking additional (polycationic protein from salmon drugs likely to affect absorption or elim- sperm). For effective thromboprophylaxis, a The most important adverse ef- low dose of 5000 IU is injected s. With low dosage of can be counteracted by giving vitamin heparin, the risk of bleeding is suffi- K1. Coagulability of blood returns to ciently small to allow the first injection normal only after hours or days, when to be given as early as 2 h prior to sur- the liver has resumed synthesis and re- gery. In urgent cases, deficient factors bleeding, other potential adverse effects must be replenished directly (e. K3 Menadione Acenocoumarol Carboxylation of glutamine residues II, VII, IX, X 4-Hydroxy- Vit. Vitamin K-antagonists of the coumarin type and vitamin K Activated clotting factor Inacti- Inacti- vation vation Mast cell AT III AT III + + + + + + + + - - - - Heparin 3 x 5000 IU s. Heparin: origin, structure, and mechanism of action Lüllmann, Color Atlas of Pharmacology © 2000 Thieme All rights reserved. Fibrin is formed from fibrinogen Lowering of blood fibrinogen through thrombin (factor IIa)-catalyzed concentration. Ancrod is a constituent proteolytic removal of two oligopeptide of the venom from a Malaysian pit viper. Individual fibrin molecules It enzymatically cleaves a fragment polymerize into a fibrin mesh that can from fibrinogen, resulting in the forma- be split into fragments and dissolved by tion of a degradation product that can- plasmin.

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Systems Pharmacology Lüllmann proven 5mg kemadrin, Color Atlas of Pharmacology © 2000 Thieme All rights reserved order kemadrin 5mg amex. To ensure adequate supply of oxy- This regulatory system consists of the gen and nutrients, blood flow in skeletal CNS (brain plus spinal cord) and two muscle is increased; cardiac rate and separate pathways for two-way com- contractility are enhanced, resulting in a munication with peripheral organs, viz. The somatic nervous system blood vessels diverts blood into vascular comprising extero- and interoceptive beds in muscle. The auto- that peristalsis diminishes and sphinc- nomic (vegetative) nervous system teric tonus increases. However, in order (ANS), together with the endocrine to increase nutrient supply to heart and system, controls the milieu interieur. It musculature, glucose from the liver and adjusts internal organ functions to the free fatty acid from adipose tissue must changing needs of the organism. The bronchi control permits very quick adaptation, are dilated, enabling tidal volume and whereas the endocrine system provides alveolar oxygen uptake to be increased. The ANS operates largely beyond sympathetic fibers (wet palms due to voluntary control; it functions autono- excitement); however, these are excep- mously. Its central components reside tional as regards their neurotransmitter in the hypothalamus, brain stem, and (ACh, p. The ANS also participates in Although the life styles of modern the regulation of endocrine functions. In many organs innervated by both branches, re- spective activation of the sympathetic and parasympathetic input evokes op- posing responses. In various disease states (organ malfunctions), drugs are employed with the intention of normalizing susceptible organ functions. To understand the bio- logical effects of substances capable of inhibiting or exciting sympathetic or parasympathetic nerves, one must first envisage the functions subserved by the sympathetic and parasympathetic divi- sions (A, Responses to sympathetic ac- tivation). In simplistic terms, activation Lüllmann, Color Atlas of Pharmacology © 2000 Thieme All rights reserved. Drugs Acting on the Sympathetic Nervous System 81 CNS: drive Eyes: alertness pupillary dilation Saliva: little, viscous Bronchi: dilation Heart: Skin: rate perspiration force (cholinergic) blood pressure Fat tissue: lipolysis fatty acid liberation Liver: glycogenolysis Bladder: glucose release Sphincter tone detrusor muscle GI-tract: peristalsis sphincter tone blood flow Skeletal muscle: blood flow glycogenolysis A. Responses to sympathetic activation Lüllmann, Color Atlas of Pharmacology © 2000 Thieme All rights reserved. These ganglia represent adrenoceptors located postjunctionally sites of synaptic contact between pre- on the membrane of effector cells or ganglionic axons (1st neurons) and prejunctionally on the membrane of nerve cells (2nd neurons or sympathocy- varicosities. Activation of presynaptic tes) that emit postganglionic axons "2-receptors inhibits norepinephrine terminating on cells in various end or- release. Small portions of norepinephrine are inactivated by the Whereas acetylcholine (see p. This cells and postjunctional cells, to yield second neuron does not synapse with 3,4-dihydroxymandelic acid). At these junctions the nerve axons circulating norepinephrine and epi- form enlargements (varicosities) re- nephrine. Thus, excita- bined actions of MAO and COMT is van- tion of the neuron leads to activation of illylmandelic acid. Excitation of pregan- glionic neurons innervating the adrenal medulla causes a liberation of acetyl- choline. This, in turn, elicits a secretion of epinephrine (= adrenaline) into the blood, by which it is distributed to body tissues as a hormone (A). Adrenergic Synapse Within the varicosities, norepinephrine is stored in small membrane-enclosed vesicles (granules, 0. In the axoplasm, L-tyrosine is Lüllmann, Color Atlas of Pharmacology © 2000 Thieme All rights reserved. Drugs Acting on the Sympathetic Nervous System 83 Psychic or physical stress stress First neuron First neuron Second Adrenal neuron medulla Epinephrine Norepinephrine A. Second neuron of sympathetic system, varicosity, norepinephrine release Lüllmann, Color Atlas of Pharmacology © 2000 Thieme All rights reserved. By stimulating each of which further subtypes can be "1-receptors, hence activation of ade- distinguished pharmacologically. The nylatcyclase (Ad-cyclase) and cAMP different adrenoceptors are differential- production, catecholamines augment all ly distributed according to region and heart functions, including systolic force tissue. Agonists at adrenoceptors (di- (positive inotropism), velocity of short- rect sympathomimetics) mimic the ac- ening (p.

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This probably serves to ceptors by an agonist triggers the release of an intracel- bring the ester linkage of ACh close to the esteratic site lular G-protein complex that can specifically activate of the enzyme purchase kemadrin 5 mg otc. Fortunately discount 5mg kemadrin, residue, which is made more reactive by hydrogen the cellular responses elicited by odd- versus even- bonding to a nearby histidine residue. The nucleophilic numbered receptor subtypes can be conveniently dis- oxygen of the serine reacts with the carbonyl carbon of tinguished. During this re- produces an inosine triphosphate (IP3) mediated re- action, choline is liberated and an acetylated enzyme is lease of intracellular calcium, the release of diacylglyc- formed. The latter intermediate is rapidly hydrolyzed to erol (which can activate protein kinase C), and stimula- release acetic acid and regenerate the active enzyme. These receptors are primarily The entire process takes about 150 microseconds, one of responsible for activating calcium-dependent responses, the fastest enzymatic reactions known. AChE (also known as true, specific, or lyl cyclase, and activation of M2 receptors opens potas- erythrocyte cholinesterase) is found at a number of sites sium channels. The opening of potassium channels hy- in the body, the most important being the cholinergic perpolarizes the membrane potential and decreases the neuroeffector junction. Here it is localized to the pre- excitability of cells in the sinoatrial (SA) and atrioven- junctional and postjunctional membranes, where it rap- tricular (A-V) nodes in the heart. These limitations have been circumvented in Anionic site Esteratic site part by the development of three choline ester derivatives of ACh: methacholine (Provocholine), carbachol (Isopto Carbachol, Miostat) and bethanechol (Urecholine). This modification greatly increases its selectivity for muscarinic receptors (CH3)3N CH2 CH2 OH CH3 C O relative to nicotinic receptors, and it renders methacholine O H resistant to the pseudo-ChE in the plasma and decreases its susceptibility to AChE, thereby increasing its potency and duration of action compared to those of ACh. Carbachol differs from ACh only in the substitution of a carbamoyl group for the terminal methyl group of ACh. This substitution makes carbachol completely resistant to OH degradation by cholinesterases but does not improve its O selectivity for muscarinic versus nicotinic receptors. CH3 C O H Bethanechol combines the addition of the methyl group and the substitution of the terminal carbamoyl group, pro- ducing a drug that is a selective agonist of muscarinic re- FIGURE 12. Simplified scheme of ACh hydrolysis at the active center of All of these drugs are very hydrophilic and mem- ACh. Rectangular area represents the active center of the brane impermeant because they retain the quaternary enzyme with its anionic and esteratic sites. The broken line at right Pilocarpine is a naturally occurring cholinomimetic represents the initial interaction between the serine oxygen alkaloid that is structurally distinct from the choline es- of the enzyme and the carbonyl carbon of ACh. It is a tertiary amine that crosses membranes rela- linkage is broken, choline is liberated, and an acetylated tively easily. Finally, the cornea of the eye, and it can cross the blood-brain bar- acetylated intermediate undergoes hydrolysis to free the rier. Muscarine is an alkaloid with no therapeutic use, but it can produce dangerous cholinomimetic stimulation following inges- tion of some types of mushrooms (e. There is no reuptake sys- Basic Pharmacology of the Directly tem in cholinergic nerve terminals to reduce the con- Acting Parasympathomimetic Drugs centration of ACh in a synaptic cleft, unlike the reup- Methacholine, bethanechol, and pilocarpine are selec- take systems for other neurotransmitters such as tive agonists of muscarinic receptors, whereas carbachol dopamine, serotonin, and norepinephrine. Therefore, in- and ACh can activate both muscarinic and nicotinic re- hibition of AChE can greatly prolong the activation of ceptors. This apparent preference for nonspecific cholinesterase) has a widespread distribu- muscarinic receptors can be attributed to the greater ac- tion, with enzyme especially abundant in the liver, cessibility and abundance of these cholinoreceptors where it is synthesized, and in the plasma. It does, however, Cardiovascular Effects play an important role in the metabolism of such clini- cally important compounds as succinylcholine, pro- Low doses of muscarinic agonists given intravenously caine, and numerous other esters. Activation of these receptors causes the endothe- and reduces cAMP levels, slowing the rate of depolar- lial cells to synthesize and release nitric oxide. Nitric ox- ization and decreasing the excitability of SA node and ide can diffuse into neighboring vascular smooth muscle A-V fiber cells. This results in marked bradycardia and cells, where it activates soluble guanylyl cyclase, thereby a slowing of A-V conduction that can override the stim- increasing the synthesis of cyclic guanosine monophos- ulation of the heart by catecholamines released during phate (cGMP) and relaxing the muscle fibers. In fact, very high doses of a the resistance vasculature is not innervated by choliner- muscarinic agonist can produce lethal bradycardia and gic neurons, and the physiological function of the en- A-V block. However, effects on ventricular function, but they can produce activation of these receptors by directly acting choli- negative inotropy of the atria.

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Ex- amples of such compound words are erythrocyte (red blood cell) and hydrocele (fluid-containing sac) cheap kemadrin 5 mg with amex, and many more difficult words discount kemadrin 5mg amex, such as sternoclavicular (indicating relations to both the sternum and the clavicle). See also - oliguria pileous, piliation, pilonidal mega, mega/o- -oma tumor, swelling: hematoma, sarcoma pin/o to drink: pinocytosis mal- bad, diseased, disordered, abnormal: -one ending for steroid hormone: testos- -plasty molding, surgical formation: malnutrition, malocclusion, malunion terone, progesterone cystoplasty, gastroplasty, kineplasty malac/o, -malacia softening: malacoma, onych/o nails: paronychia, onychoma -plegia stroke, paralysis: paraplegia, hemi- osteomalacia oo, ov/i, ov/o ovum, egg: oocyte, oviduct, plegia mamm/o breast, mammary gland: mam- ovoplasm (do not confuse with oophor- pleur/o side, rib, pleura: pleurisy, pleuro- mogram, mammoplasty, mammal ) tomy man/o pressure: manometer, sphygmo- oophor/o ovary: oophorectomy, oophoritis, -pnea air, breathing: dyspnea, eupnea manometer oophorocystectomy. See also ovar- pneum/o, pneumat/o air, gas, respiration: mast/o breast: mastectomy, mastitis ophthalm/o eye: ophthalmia, ophthalmolo- pneumothorax, pneumograph, pneuma- meg/a-, megal/o, -megaly unusually or gist, ophthalmoscope tocele excessively large: megacolon, mega- -opia disorder of the eye or vision: het- pneumon/o lung: pneumonia, pneumonec- loblast, splenomegaly, megakaryocyte erotropia, myopia, hyperopia tomy melan/o dark, black: melanin, melanocyte, or/o mouth: oropharynx, oral pod/o foot: podiatry, pododynia melanoma orchi/o, orchid/o testis: orchitis, cryp- -poiesis making, forming: erythropoiesis, men/o physiologic uterine bleeding, torchidism hematopoiesis menses: menses, menorrhagia, orth/o- straight, normal: orthopedics, or- polio- gray: polioencephalitis, poliomyelitis menopause thopnea, orthosis poly- many: polyarthritis, polycystic, poly- mening/o membranes covering the brain -ory pertaining to, resembling: respira- cythemia and spinal cord: meningitis, meningocele tory, circulatory post- behind, after, following: postnatal, mes/a, mes/o- middle, midline: mesen- oscill/o to swing to and fro: oscilloscope postocular, postpartum cephalon, mesoderm osmo- osmosis: osmoreceptor; osmotic pre- before, ahead of: precancerous, pre- meta- change, beyond, after, over, near: oss/i, osse/o, oste/o bone, bone tissue: os- clinical, prenatal metabolism, metacarpal, metaplasia seous, ossicle, osteocyte, osteomyelitis presby- old age: presbycusis, presbyopia -meter, metr/o measure: hemocytometer, ot/o ear: otalgia, otitis, otomycosis pro- before, in front of, in favor of: pro- sphygmomanometer, spirometer, isometric -ous pertaining to, resembling: fibrous, dromal, prosencephalon, prolapse, pro- metr/o uterus: endometrium, metroptosis, venous, androgynous thrombin metrorrhagia ov/o egg, ovum: oviduct, ovulation proct/o rectum: proctitis, proctocele, proc- micro- very small: microscope, microbiol- ovar, ovari/o ovary: ovariectomy. See also tologist ogy, microsurgery, micrometer oophor propri/o own: proprioception mon/o- single, one: monocyte, mononucle- ox-, -oxia pertaining to oxygen: hypox- pseud/o false: pseudoarthrosis, pseudos- osis emia, hypoxia, anoxia tratified, pseudopod morph/o shape, form: morphogenesis, oxy sharp, acute: oxygen, oxytocia psych/o mind: psychosomatic, psychother- morphology apy multi- many: multiple, multifactorial, mul- pan- all: pandemic, panacea -ptosis downward displacement, falling, tipara papill/o nipple: papilloma, papillary prolapse: blepharoptosis, enteroptosis, my/o muscle: myenteron, myocardium, para- near, beyond, apart from, beside: nephroptosis myometrium paramedical, parametrium, parathyroid, pulm/o, pulmon/o lung: pulmonic, pul- myc/o, mycet fungi: mycid, mycete, mycol- parasagittal monology ogy, mycosis, mycelium pariet/o wall: parietal py/o pus: pyuria, pyogenic, pyorrhea GL-22 ✦ GLOSSARY OF WORD PARTS pyel/o renal pelvis: pyelitis, pyelogram, sin/o sinus: sinusitis, sinusoid, sinoatrial tetr/a four: tetralogy, tetraplegia pyelonephrosis -sis condition or process, usually abnor- therm-, thermo-, -thermy heat: thermalge- pyr/o fire, fever: pyrogen, antipyretic, py- mal: dermatosis, osteoporosis sia, thermocautery, diathermy, ther- romania soma-, somat/o, -some body: somatic, so- mometer matotype, somatotropin thromb/o blood clot: thrombosis, thrombo- quadr/i- four: quadriceps, quadriplegic son/o sound: sonogram, sonography cyte sphygm/o pulse: sphygmomanometer toc/o labor: eutocia, dystocia, oxytocin rachi/o spine: rachicentesis, rachischis spir/o breathing: spirometer, inspira- tom/o, -tomy incision of, cutting: radio- emission of rays or radiation: ra- tion, expiration anatomy, phlebotomy, laparotomy dioactive, radiography, radiology splanchn-, splanchno- internal organs: ton/o tone, tension: tonicity, tonic re- again, back: reabsorption, reaction, re- splanchnic, splanchnoptosis tox, toxic/o poison: toxin, cytotoxic, tox- generate splen/o spleen: splenectomy, splenic emia, toxicology rect/o rectum: rectal, rectouterine staphyl/o grapelike cluster: staphylococ- trache/o trachea, windpipe: tracheal, tra- ren/o kidney: renal, renopathy cus cheitis, tracheotomy reticul/o network: reticulum, reticular stat, -stasis stand, stoppage, remain at trans- across, through, beyond: transor- retro- backward, located behind: retroce- rest: hemostasis, static, homeostasis bital, transpiration, transplant, transport cal, retroperitoneal sten/o- contracted, narrowed: stenosis tri- three: triad, triceps rhin/o nose: rhinitis, rhinoplasty sthen/o, -sthenia, -sthenic strength: as- trich/o hair: trichiasis, trichosis, trichology -rhage, -rhagia* bursting forth, excessive thenic, calisthenics, neurasthenia troph/o, -trophic, -trophy nutrition, nur- flow: hemorrhage, menorrhagia steth/o chest: stethoscope ture: atrophic, hypertrophy -rhaphy* suturing of or sewing up of a stoma, stomat/o mouth: stomatitis trop/o, -tropin, -tropic turning toward, gap or defect in a part: herniorrhaphy, -stomy surgical creation of an opening acting on, influencing, changing: thy- gastrorrhaphy, cystorrhaphy into a hollow organ or an opening be- rotropin, adrenocorticotropic, go- -rhea* flow, discharge: diarrhea, gonor- tween two organs: colostomy, tra- nadotropic rhea, seborrhea cheostomy, gastroenterostomy tympan/o drum: tympanic, tympanum strept/o chain: streptcoccus, streptobacillus sacchar/o sugar: monosaccharide, polysac- sub- under, below, near, almost: subcla- ultra- beyond or excessive: ultrasound, ul- charide vian, subcutaneous, subluxation traviolent, ultrastructure salping/o tube: salpingitis, salpingoscopy super- over, above, excessive: superego, uni- one: unilateral, uniovular, unicellular sarc/o flesh: sarcolemma, sarcoplasm, sar- supernatant, superficial -uria urine: glycosuria, hematuria, pyuria comere supra- above, over, superior: supranasal, ur/o urine, urinary tract: urology, urogeni- scler/o hard, hardness; scleroderma, scle- suprarenal tal rosis sym-, syn- with, together: symphysis, scoli/o- twisted, crooked: scoliosis, scolio- synapse vas/o vessel, duct: vascular, vasectomy, someter syring/o fistula, tube, cavity: syringec- vasodilation -scope instrument used to look into or tomy, syringomyelia viscer/o internal organs, viscera: visceral, examine a part: bronchoscope, endo- visceroptosis scope, arthroscope tach/o-, tachy- rapid: tachycardia, tachyp- vitre/o glasslike: vitreous semi- partial, half: semipermeable, semi- nea coma tars/o eyelid, foot: tarsitis, tarsoplasty, xer/o dryness: xeroderma, xerophthalmia, semin/o semen, seed: seminiferous, semi- tarsoptosis xerosis nal -taxia, -taxis order, arrangement: ataxia, sep, septic poison, rot, decay: sepsis, sep- chemotaxis, thermotaxis -y condition of: tetany, atony, dysentery ticemia tel/o end: telophase, telomere *When a suffix beginning with rh is added to a word tens- stretch, pull: extension, tensor zyg/o joined: zygote, heterozygous, root, the r is doubled. A-2 ✦ APPENDIX Appendix 2 Celsius–Fahrenheit Temperature Conversion Scale CELSIUS TO FAHRENHEIT Use the following formula to convert Celsius readings to Fahrenheit readings: F 9/5 C 32 For example, if the Celsius reading is 37 F (9/5 x 37) 32 6. WBCs Segmented neutrophils 40%–74% Increased in bacterial infections; low numbers leave person (SEGs, POLYs) very susceptible to infection Immature neutrophils 0%–3% Increased when neutrophil count increases (BANDs) Lymphocytes (LYMPHs) 20%–40% Increased in viral infections; low numbers leave person dangerously susceptible to infection Monocytes (MONOs) 2%–6% Increased in specific infections Eosinophils (EOs) 1%–4% Increased in allergic disorders Basophils (BASOs) 0. Appendix 4•3 Blood Chemistry Tests TEST NORMAL VALUE CLINICAL SIGNIFICANCE Basic panel: An overview of electrolytes, waste product management, and metabolism Blood urea nitrogen (BUN) 7–18 mg/dL Increased in renal disease and dehydration; decreased in liver damage and malnutrition Carbon dioxide (CO2) 23–30 mmol/L Useful to evaluate acid-base balance by measuring (includes bicarbonate) total carbon dioxide in the blood: Elevated in vomiting and pulmonary disease; decreased in diabetic acidosis, acute renal failure, and hyperventilation Chloride (Cl) 98–106 mEq/L Increased in dehydration, hyperventilation, and congestive heart failure; decreased in vomiting, diarrhea, and fever Creatinine 0. When elevated, specific fractions (isoenzymes) are tested for Gamma-glutamyl Men: 6–26 U/L Women: 4–18 Used to diagnose liver disease and to test for transferase (GGT) U/L chronic alcoholism Globulins 2. Staphylococcus aureus and other Boils, carbuncles, impetigo, osteomyelitis, staphylococcal pneumonia, cystitis, staphylococci pyelonephritis, empyema, septicemia, toxic shock, and food poisoning. Streptococcus pyogenes, Streptococcus Septicemia, septic sore throat, scarlet fever, puerperal sepsis, erysipelas, streptococ- hemolyticus, and other streptococci cal pneumonia, rheumatic fever, subacute bacterial endocarditis, acute glomeru- lonephritis Bacilli Bordetella pertussis Pertussis (whooping cough). Acute inflammation of the throat with the formation of a leathery mem- branelike growth (pseudomembrane) that can obstruct air passages and cause death by asphyxiation. Acute infection of the intestine characterized by prolonged vomiting and diarrhea, leading to severe dehydration, electrolyte imbalance, and in some cases, death. Untreated syphilis is seen in the following three stages: primary-formation of primary lesion (chancre); secondary-skin eruptions and infectious patches on mucous membranes; tertiary-development of generalized lesions (gummas) and destruc- tion of tissues resulting in aneurysm, heart disease, and degenerative changes in brain, spinal cord, ganglia, and meninges. Also causes inclusion conjunctivitis, an acute eye infection, and trachoma, a chronic infection that is a common cause of blindness in underdeveloped areas of the world. The same organism causes lymphogran- uloma venereum (LGV), a sexually transmitted infection characterized by swelling of inguinal lymph nodes and accompanied by signs of general infection. Diagnosed by antibody tests, decline in specific (CD4) cells, and presenting disease, including Candida albicans infection, Pneumo- cystis carinii pneumonia, Kaposi sarcoma, persistent swelling of lymph nodes (lymphadenopathy), chronic diarrhea, and wasting. A less severe form of measles, but especially dangerous during the first 3 months of pregnancy because the disease organism can cause heart defects, deafness, mental deficiency, and other permanent damage in the fetus. Patients are prone to the development of dangerous complications, such as bronchopneumonia and other secondary infections caused by staphylococci and streptococci. AGENT DISEASE Chronic wasting disease agent Chronic wasting disease in deer and elk Creuzfeldt-Jakob agent Cruetzfeldt-Jacob disease (CJD), a spongiform encephalopathy in humans Kuru agent Kuru spongiform encephalopathy in humans Mad cow agent Mad cow spongiform encephalopathy, or bovine spongiform encephalopathy (BSE) in cows and humans Scrapie agent Scrapie spongiform encephalopathy in sheep Appendix 5•4 Fungal Diseases DISEASE/ORGANISM DESCRIPTION Actinomycosis “Lumpy jaw in cattle and humans. Histoplasmosis (Histoplasma A variety of disorders, ranging from mild respiratory symptoms or enlargement of liver, capsulatum) spleen, and lymph nodes to cavities in the lungs with symptoms similar to those of tuberculosis. APPENDIX ✦ A-13 Appendix 6 Answers to Chapter Checkpoint and “Zooming In” Questions CHAPTER 1 Answers to Checkpoint Questions 1-6 The three central regions of the abdomen are the 1-1 Study of body structure is anatomy; study of body function epigastric, umbilical, and hypogastric regions; the three is physiology. CHAPTER 3 Answers to Checkpoint Questions 3-6 The two types of organelles used for movement are the 3-1 The cell shows organization, metabolism, cilia, which are small and hairlike, and the flagellum, responsiveness, homeostasis, growth, and reproduction. A-14 ✦ APPENDIX 3-13 An isotonic solution is the same concentration as the fluid 3-11 If diffusion were occurring in the body, the net would be within the cell; a hypotonic solution is less concentrated; a the plasma membrane. CHAPTER 4 Answers to Checkpoint Questions 4-6 The basic cellular unit of the nervous system is the 4-1 The three basic shapes of epithelium are squamous (flat neuron and it carries nerve impulses. CHAPTER 5 Answers to Checkpoint Questions 5-9 Microbiology includes the study of bacteria, viruses, 5-1 Disease is an abnormality of the structure or function of fungi, protozoa, and algae. APPENDIX ✦ A-15 5-19 Stains are used to color cells so that they can be 5-9 The term intracellular means that the parasites are inside examined under the microscope. CHAPTER 6 Answers to Checkpoint Questions 6-10 Epithelial and connective tissues repair themselves most 6-1 The skin and all its associated structures make up the in- easily. CHAPTER 7 Answers to Checkpoint Questions 7-10 The three types of joints classified according to the 7-1 The shaft of the long bone is the diaphysis; the end of a material between the adjoining bones are fibrous, long bone is the epiphysis. A-16 ✦ APPENDIX CHAPTER 8 Answers to Checkpoint Questions 8-11 The muscle that produces a movement is called the 8-1 The three types of muscle are smooth muscle, cardiac prime mover; the muscle that produces an opposite muscle, and skeletal muscle. CHAPTER 9 Answers to Checkpoint Questions 9-12 A reflex arc is a pathway through the nervous system 9-1 Structurally, the nervous system can be divided into a from a stimulus to an effector.

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