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Fetal death also occurs from suffocation due to acne gone discount benzoyl 20gr fast delivery a thick edematous placenta that does not rupture at the cervical star acne 30 years old purchase 20gr benzoyl mastercard. The mares are also agalactic with minimal colostrum acne vitamins buy benzoyl 20gr, and if the foal survives to skin care yang bagus dan murah buy benzoyl 20gr online term, they often die due to failure of passive transfer. Contributor: Western University of Health Sciences College of Veterinary Medicine 309 E. Contributor’s Morphologic Diagnosis: Placentitis, necrotizing, acute, multifocal, severe, with Signalment: Adult cow bison, Bison bison. History: Placenta submitted from a bison cow that recently aborted in a capture facility in Yellowstone National Park. Gross Pathology: the non-cotyledonary regions of the chorioallantois were diffusely opaque, edematous and white/pink. Contributor’s Microscopic Description: Placenta: Multifocally, the cotyledons of the chorioallantois are necrotic as characterized by loss of distinct villar architecture with replacement by a granular to fibrillar eosinophilic material containing karyorrhectic debris including necrotic leucocytes. The cotyledons are tan with multifocal hemorrhages and the intercotyledonary portions of the connective tissue is edematous with scattered infiltrates placenta are opaque and edematous. Trophoblasts are shrunken and hypereosinophilic (necrosis) and often contain many lightly basophilic intracytoplasmic coccobacilli. Brucellosis is caused by small gram-negative bacilli of Infections also occur in wild populations and in the the genus Brucella; these bacteria are facultative United States; bison and elk in the Greater Yellowstone intracellular organisms. Disease management practices in are multiple species within the genus and include: B. The disease in susceptible domestic animal populations has significant economic Conference Comment: Transmission of brucellosis is consequences due to calf loss, infertility, decreased by contact with infected tissues, secretions or milk production and disease regulatory consequences. The bacteria penetrate the mucosa and migrate could still act as intermittent shedders that serve as a to local and regional lymph nodes after being engulfed reservoir of infection within the herd. Transmission is by local macrophages or dendritic cells, within which usually through ingestion or contamination of mucous the bacteria grow and replicate. The bacteria kill the membranes after exposure to infected fetuses, fetal phagocytes and incite a pyogranulomatous membranes or contaminated body fluids. Chorionic epithelial cells naturally produce erythritol around the Brucellosis in man has multiple synonyms such as fifth month of gestation, which is a carbohydrate undulant fever and Malta fever. In countries where the growth promoter for Brucella abortus, and the bacteria disease is common, infection in man is normally multiply in the rough endoplasmic reticulum of acquired by ingestion of contaminated dairy products chorionic trophoblasts. Other intratrophoblastic or exposure to infected animal reproductive tissues and bacterial agents causing abortion include Leptospira fluids. Infection can result from exposure to the agent interrogans, Coxiella burnetti, Listeria monocytogenes, after ingestion, inhalation, through open wounds, Campylobacter fetus and C. Effective animal include Toxoplasma gondii, Neospora caninum, and disease control programs and pasteurization of dairy Sarcocystis spp. Laboratory personnel are extremely d i s r u p t i o n a n d e n d o t o x e m i a; f i b r i n o u s vulnerable and can readily be exposed if safety bronchopneumonia, pleuritis and pericarditis are seen precautions are not utilized. In addition to Arcanobacterium pyogenes, Control and Prevention Biosafety in Microbiological B. Reported cotyledonary necrosis; intercotyledonary edema with a infectious doses for immune-competent people with tough, yellow to gray, leathery surface; necrosis and the following species are: B. Brucellosis in captive Rocky Mountain bighorn sheep (Ovis canadensis) caused by Brucella abortus biovar 4. Brucellosis in free ranging bison (Bison bison) in Yellowstone, Grand Teton and Wood Buffalo National Parks: a review. Seminal vesiculitis and orchitis caused by Brucella abortus biovar 1 in young bison bulls from South Dakota. Abortion caused by Brucella abortus biovar 1 in free ranging bison (Bison bison) from Yellowstone National Park. History: Twin female American Alpine dairy goat fetuses were submitted for determination of the cause of abortion. These were from a newly assembled dairy goat herd which had e x p e r i e n c e d m u l t i p l e abortions over the last week. Gross Pathology: On physical exam, the fetuses were moderately autolytic, a n d c o n t a i n e d serosanguinous fluid within their pleural cavities. Chorionic villi are collapsed and largely replaced by necrotic cellular debris, degenerate detected in the fetuses or neutrophils and multifocal mineralization. Contributor’s Microscopic Description: Slides contain sections of chorioallantois. Chorionic villi are necrotic, and the surface has adherent necrotic cellular debris and degenerate neutrophils. A mixed infiltrate of neutrophils, lymphocytes, plasma cells, and histiocytes extends throughout the interstitium of the chorioallantois. Trophoblasts are distended by numerous by intracellular colonies of palely basophilic bacteria. Depending on the section, there is variable partial non-motile gram-negative bacteria that replicate only mineralization of the epithelium. Infection with Coxiella burnetii is relatively common in domestic cattle, sheep and goats, Immunohistochemistry using a generic antibody which serve as the reservoir hosts. Infection is against Coxiella burnetii was strongly immunopositive persistent, and shedding of the organism through urine, for the intracytoplasmic bacterial colonies. Acute infection in domestic ruminants C o n t r i b u t o r ’s M o r p h o l o g i c D i a g n o s i s: may manifest itself as late third trimester abortions, Chorioallantois: Severe acute necrotizing placentitis stillbirths, delivery of weak neonates, retained with intracellular bacterial colonies. When the placenta is infected, the obligate intracellular bacteria Contributor’s Comment: Coxiella burnetii is a are encountered within the cytoplasm of trophoblasts. Acute infection may include mild goats: a histopathological and immunohistochemical flu-like symptoms, pneumonia, or hepatitis. Jubb, Kennedy, and Palmer’s environment, the organism survives as the highly Pathology of Domestic Animals. The more debilitating chronic form of the disease in humans is characterized by endocarditis, hepatitis, and chronic fatigue syndrome. Conference Comment: Coxiella burnetii is transmitted by most tick species and can be acquired by aerosolization and direct contact. Although infection occasionally causes abortions in cattle, abortion is a more common result in small ruminants and typically presents as isolated abortions rather than as an abortion storm. Unless infection is overwhelming, as in this case, the organisms may not be visible with hematoxylin and eosin (H&E) staining, but silver stains and immunohistochemistry are useful. Brucella abortus, another differential for this case, also causes cotyledonary and intercotyledonary necrosis, but the fetus usually has bronchopneumonia, which helps differentiate infection with this organism from Coxiella. Other differential causes for necrotizing placentitis are Chlamydophila abortus, which commonly also causes vasculitis, and Toxoplasma gondii, which primarily affects the cotyledons and spares the intercotyledonary areas. Fibrinous pale exudate was detected in the joint Signalment: 8-day-old female Aberdeen Angus (Bos cavities of the legs. Laboratory Results: Listeria monocytogenes was History: this calf was from a cow-calf herd with 55 isolated in pure growth from the spleen, liver, lung, suckler cows. Clinical signs of this calf included diarrhea, petechiae on the conjunctival and buccal membranes, Contributor’s Microscopic Description: Liver: fever and generalized weakness. Multifocal, disseminated, random, variable sized foci of deeply eosinophilic (coagulation necrosis) Gross Pathology: Weight 39 kg, moderate post hepatocytes, infiltrated with variable, usually mortem changes, moderate fat stores, and severely moderate, numbers of degenerating neutrophils and a dehydrated. The multiple gram-positive short rod shape bacteria in spleen was moderately enlarged. In other tissues (samples not submitted), a multiple disseminated 2-3 mm pale yellow spots all suppurative synovitis and meningitis, and a necrotizing over the parenchyma. The distal parts of the jejunal and the ileal Contributor’s Morphologic Diagnosis: Liver: serosa and mucosa were red, and ileal lymph nodes Multifocal moderate subacute necrotizing hepatitis. There are numerous randomly distributed foci of lytic necrosis bordered by a rimof hepatocytes undergoing coagulative necrosis. Cell-mediated immunity has a role in causing environment, in the soil, plants and feces of animals. Gross pathological findings in is a gram-positive short non-spore forming rod capable septicemic forms of the disease consist of multiple of growing from 1° C to 45° C and pH 4.
Sofware is available to skin care food cost of benzoyl help with calculations – see web resources at the end of the chapter skin care youtube purchase benzoyl online from canada. Surveillance results must be provided regularly and in a timely manner to acne yogurt buy generic benzoyl 20gr the front-line clinical sta in order to acne under a microscope buy benzoyl in india help them choose actions to reduce infection rates. Keep records of rates for the previous surveillance period in order to outline if any change was statistically significant. Four Country Healthcare Associated Infection Prevalence Survey 2006: overview of the results. Post discharge surveillance: can a patient reliably diagnose surgical wound infectionfi Best Practices for Surveillance of Health Care-Associated Infections, 2008, Ontario Ministry of Health and Long-Term Care/Public Health Division/Provincial Infectious Diseases Advisory Commitee, Canada. Early identification of an outbreak is also important to limit spread by healthcare workers or contaminated materials. A potential problem may be initially identified by nurses, physicians, microbiologists, or other health care workers, or through an infection surveillance program. Appropriate investigations are required to identify the source of the outbreak and justify control measures. Definitions Outbreak or epidemic: An excess over the expected (usual) level of a disease within a geographic area; however, one case of an unusual disease. It is calculated by dividing the incidence rate of those exposed to the factor by the incidence rate of those not exposed. Example of case definition: A definite case patient will be defined as a patient hospitalised in the geriatric ward during January, with diarrhoea, cramps, and vomiting and in whom routine culture of faeces identifies Salmonella species. When susceptible individuals travel into an area where the infectious disease is endemic. When humans or animals travel from an endemic area into a susceptible human population in whom the disease is not endemic, or when food, water, or other vehicles become contaminated by an infectious agent not normally present. When a pre-existing infection occurs in an area of low endemicity and reaches susceptible persons as a result of new or unusual social, behavioural, sexual, or cultural practices. Examples include migration of refugees during war time and pilgrimages to religious places. When host susceptibility and response are modified by natural or druginduced immunosuppression. In health care setings, outbreaks are typically related to hand or environmental contamination, invasive devices, and procedures. Healthcare-associated: when two or more cases of infection appear to be epidemiologically related. Find the source of infection by studying the occurrence of the disease among persons, place, or time, as well as determining specific atack rates; and 3. Outbreak investigation tasks the Infection Control Commitee should take the following steps to investigate a suspected outbreak of a communicable disease. Verify if an outbreak really exists Compare the number of current cases with the usual baseline incidence (from previous months or years). If local data are not available, compare to information from national surveillance systems or the literature (however, these data may not be applicable to the local situation). Determine if there were changes in case finding or diagnostics New techniques or laboratory tests may increase identification when historically cases would not have been identified, providing a new ‘baseline’ of disease. Establish diagnosis of reported cases (identify agent) Define cases based on the following common factors: 1. Assemble and organise available information (in terms of time, place, and person) for analysis. Incidence rate: the number of new cases occurring in the population during a specified time / number of persons exposed to the risk of developing the disease during that time. The atack rate = Number of people at risk who are infected / Total number of people at risk. The atack rate can also be stratified by relevant characteristics, such as sex, age, location, or specific exposure. Many investigations do not reach this stage; investigation may end with descriptive epidemiology and then the problem goes away without intervention or does not require a special study. Whether or not an investigation is carried out, the hypothesis testing phase is a function of available personnel, severity of the problem, and resource allocation. For example: during an outbreak of food poisoning the rate of disease in young adults was 40% and in older individuals was 2%. It was 65% for those who ate in a popular cafeteria and only 3% for those who ate in other places. Therefore younger individuals eating in the popular cafeteria are the ones who should be investigated regarding specific foods eaten. Control measures are determined by the results of the initial analysis in consultation with appropriate professionals. They will vary depending on the agent, the mode of transmission, and observations. Use the opportunity of an outbreak to review and correct other health care practices which could contribute to future outbreaks. Communicate and write a final report During the investigation of an outbreak, timely, up-to-date information must be communicated to administration and public health authorities. In some cases, information may be provided to the public and the media with agreement of the outbreak team, administration, and local authorities. Propagated or continuing source (ongoing transmission): Infections are transmited from person to person in such a way that cases identified cannot be atributed to agent(s) transmited from a single source. Both common and propagated source (intermitent source): Intermitent exposure to a common source produces an epidemic curve with irregularly spaced peaks. This is a graph in which cases are ploted according to the time of onset of illness. To determine whether the source of infection was common, propagated, or both; the shape of the curve is determined by the epidemic patern. To identify the probable time of exposure of the cases to the source(s) of infection. Time intervals (on the X axis) must be based on the incubation or latency period of the disease and the length of the period over which cases are distributed. Using the mean or median incubation period: identify the peak of the epidemic or the date of onset of the median case; count back into one incubation period. Using minimum and maximum incubation periods: start with the first case identified and count back in time the minimum incubation period; then using the last case, count back in time the maximum incubation period. Curve approximates to a normal distribution curve if there are enough cases and if they are limited to a short exposure with maximum incubation of a few days (common source). Exposure may be continuous or intermitent; intermitent exposure to a common source produces a curve with irregularly spaced peaks. Determination of the probable period of exposure of cases in a common-source outbreak (See Figure 5. If secondary and tertiary cases occur, intervals between peaks usually approximate to the average incubation period. Control Measures and Follow-up Interventions commonly used to control an outbreak are as follows: o Control the source of the pathogen. Control mosquito or vector transmission using skin repellents, improve personal sanitation. Immunise susceptible hosts, use prophylactic chemotherapy, modify behaviour, or use a barrier. Sometimes when microorganisms pass from one individual to another they change or mutate, becoming less pathogenic, or less capable of producing disease. Conclusion Performing surveillance, monitoring trends, and detecting outbreaks, investigating outbreaks and eliminating sources, providing technical assistance and education to the medical community, and designing and implementing special epidemiologic studies are important for controlling outbreaks of communicable diseases. Lamia Fouad, lecturer of Microbiology and Immunology, Ain Shams School of Medicine, Cairo, Egypt, for assistance in preparation of this chapter. National Center for Infectious Diseases, Centers for Disease Control and Prevention. It examines the actual situation and compares it to writen policies or another benchmark.
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Papules related to skin care natural tips purchase benzoyl amex Escherichia coli bacteremia in a neutropenic patient with acute lymphocytic leukemia acne early sign of pregnancy cheap benzoyl 20 gr overnight delivery. Some Staphylococcus epidermidis catheter-associated infections can be treated with Staphylococcus aureus antibiotics; in others the catheter must be removed Viridans Streptococcus (Table 28-5) acne back buy benzoyl with visa. If the patient has a “tunneled” catheter Enterococcus faecalis Streptococcus pneumoniae (which consists of an entrance site acne 22 years old order benzoyl on line, a subcutaneous tunGram-negative bacilli nel, and an exit site), a red streak over the subcutaneous Escherichia coli part of the line (the tunnel) is grounds for immediate Klebsiella spp. Failure to remove catheters Pseudomonas aeruginosa under these circumstances may result in extensive celNon-aeruginosa Pseudomonas spp. Most authorities recommend Gram-positive bacilli treatment (usually with vancomycin) for an exit-site Diphtheroids infection caused by a coagulase-negative Staphylococcus. The lesions are most common on larly, isolation of Bacillus, Corynebacterium, and Mycobacthe face, neck, and arms. Treatment begins with high doses of glucocorticoids (60 mg/d of prednisone) Infections of the Mouth followed by tapered doses over the next 2–3 weeks. The oral cavity is rich in aerobic and anaerobic bacteria Data indicate that erythema multiforme with mucous that normally live in a commensal relationship with the membrane involvement is often associated with herpes host. Mouth ulcerations affiict most patients receiving Because cancer patients are both immunosuppressed chemotherapy and have been associated with viridans (and therefore susceptible to herpes infections) and streptococcal bacteremia. The use of keratinocyte heavily treated with drugs (and therefore subject to growth factor (palifermin) in a daily dose of 60 µg/kg Stevens-Johnson syndrome), both of these conditions are for 3 days before chemotherapy and total-body irradiacommon in this population. Fluconazole is clearly treatments for cancer, can themselves cause characteristic effective in the treatment of both local infections rashes, further complicating the differential diagnosis. Newer azoles (such as voriconazole) are row transplant recipients, who, in addition to having the similarly effective. Tunnel-site erythema Required Treat for gram-positive Failure to remove the catheter cocci pending culture may lead to complications. Blood Culture–Positive Infections Coagulase-negative Line removal optimal but Usually start with vancomycin. If there are no contraindications staphylococci may be unnecessary if (Linezolid, quinupristin/ to line removal, this course of patient is clinically stable dalfopristin, and daptomycin action is optimal. Other gram-positive cocci Recommended Treat with antibiotics to which the incidence of metastatic. Gram-negative bacteria Recommended Use an agent to which the Organisms like organism is shown to be Stenotrophomonas, sensitive. Fungi Recommended — Fungal infections of catheters are extremely difficult to treat. The charactercompromised patients and is thought to be due to invaistic picture is that of persistent fever unresponsive to sion of the tissues by Bacteroides, Fusobacterium, and other antibiotics; abdominal pain and tenderness or nausea; normal inhabitants of the mouth. Noma is associated and elevated serum levels of alkaline phosphatase in a with debility, poor oral hygiene, and immunosuppression. The diagnosis of this disease morbidity in immunocompromised patients, in whom (which may present in an indolent manner and persist they are associated with severe mucositis. The use of acyfor several months) is based on the finding of yeasts or clovir, either prophylactically or therapeutically, is of value. The pathology (a granulomatous ing as substernal chest pain upon swallowing) includes response) and the timing (with resolution of neutropeherpes simplex and candidiasis, both of which are readnia and an elevation in granulocyte count) suggest that ily treatable. In many cases, although organisms are visible, cultures of biopsied material may Lower Gastrointestinal Tract Disease be negative. The designation hepatosplenic candidiasis or Hepatic candidiasis results from seeding of the liver hepatic candidiasis is a misnomer because the disease often (usually from a gastrointestinal source) in neutropenic involves the kidneys and other tissues; the term chronic patients. It is most common in patients being treated for disseminated candidiasis may be more appropriate. Because 380 of the risk of bleeding with liver biopsy, diagnosis is often suggests a diagnosis of cryptococcal or listerial infection. Amphotericin B is As noted previously, splenectomized patients are susceptraditionally used for therapy (often for several months, tible to rapid, overwhelming infection with encapsulated until all manifestations of disease have disappeared), but bacteria (including S. Other cancer patients, however, because of their defective cellular Typhlitis (also referred to as necrotizing colitis, neuimmunity, are likely to be infected with other pathogens tropenic colitis, necrotizing enteropathy, ileocecal syn(Table 28-3). This syndrome is classically seen in neuEncephalitis tropenic patients after chemotherapy with cytotoxic the spectrum of disease resulting from viral encephalitis drugs. It may be more common among children than is expanded in immunocompromised patients. Although surgery is should be considered when a patient who has received sometimes attempted to avoid perforation from chemotherapy presents with dementia (Table 28-6). Brain Masses Clostridium difficile–Induced Diarrhea Mass lesions of the brain most often present as headache Patients with cancer are predisposed to the development with or without fever or neurologic abnormalities. Thus they may have positive toxin tests before teria (particularly Nocardia), fungi (particularly Cryptococcus receiving antibiotics. A ered as a possible cause of diarrhea in cancer patients biopsy may be required for a definitive diagnosis. The characteristics of the tests and procedures should be undertaken and which infiltrate may be helpful in decisions about further diagtherapeutic options should be considered (Table 28-7). Nodular infiltrates sugthe difficulties encountered in the management of pulgest fungal pneumonia. Such lesions may best be approached by visualized forming diagnostic procedures on the patients involved. Although Aspergillus ation of the fiuid obtained by endoscopic bronchial may cause aspergillomas in a previously existing cavity or lavage is often diagnostic. Lavage fiuid should be culmay produce allergic bronchopulmonary aspergillosis, tured for Mycoplasma, Chlamydophila, Legionella, Nocardia, the major problem posed by this genus in neutropenic more common bacterial pathogens, and fungi. Patients with Aspergillus infection often present with Localized Bacteria, Legionella, Local hemorrhage mycobacteria or embolism, tumor pleuritic chest pain and fever, which are sometimes Nodular Fungi. Chest x-rays may reveal new focal infiltrates or nodDiffuse Viruses (especially Congestive heart ules. This situation is likely to Patients with Hodgkin’s disease are prone to persistent require surgical debridement. Catheter infections with infections by Salmonella, sometimes (and particularly often Aspergillus usually require both removal of the catheter in elderly patients) affecting a vascular site. If the patient has a diffuse intersumably related to valve damage followed by bacteremia. The presentation of an embolic event with a azithromycin) while considering invasive diagnostic pronew cardiac murmur suggests this diagnosis. Noninvasive procedures, such as staining of sputures are negative in this disease of unknown pathogenesis. Candida infection of (which allow physicians to quantitate viruses) have the thyroid may be difficult to diagnose during the neusuperseded simple measurement of serum IgG, which tropenic period. Both infectious and nonthat in normal hosts, with the following caveats: infectious (drugand/or radiation-induced) pneumonitis can cause fever and abnormalities on chest x-ray; thus the 1. In terms of diagnosis, a lack of physical findings resultdifferential diagnosis of an infiltrate in a patient receiving ing from a lack of granulocytes in the granulocychemotherapy encompasses a broad range of conditions topenic patient should make the clinician more (Table 28-7). Because the treatment of radiation pneuaggressive in obtaining tissue rather than relying on monitis (which may respond dramatically to glucocortiphysical signs. In terms of therapy, aggressive debridement of infected of infectious pneumonia, a biopsy may be important in tissues may be required, but it is usually difficult to the diagnosis. Unfortunately, no definitive diagnosis can operate on patients who have recently received be made in ~30% of cases, even after bronchoscopy. A blood culture positive for Clostridium perbiopsy cannot be performed, empirical treatment can be fringens—an organism commonly associated with gas undertaken with a quinolone or erythromycin (or an gangrene—can have a number of meanings. The risks should be weighed carefully polyps); alternatively, these lesions may be harbingers in these cases. The clinical setting must be considempirical treatment may prove toxic or ineffective; either ered in order to define the appropriate treatment for of these outcomes may be riskier than biopsy. Granulocyte count: absolute count < 500/µL; duration Initial Candida, which has a predilection for the kidney, can evaluation of expected neutropenia Blood cultures; chest radiogram; other appropriate invade either from the bloodstream or in a retrograde studies based on history (sputum, urine, skin biopsy) manner (via the ureters or bladder) in immunocompromised patients. The presence of “fungus balls” or persistent Treat with antibiotic(s) effective candiduria suggests invasive disease.
Industrial solvent inhalation causes: a) Quick intoxication skin care victoria bc cheap 20 gr benzoyl otc, lasting only 5-15 minutes b) Euphoria acne laser buy benzoyl 20 gr without a prescription, relaxed “drunk” feeling c) Disorientation acne extraction buy benzoyl 20gr on line, slow passage of time and possible hallucinations d) All of the above 030 skin care products online order benzoyl 20gr without a prescription. The state of “general anesthesia” usually includes: a) Analgesia b) Loss of consciousness, inhibition of sensory and autonomic reflexes c) Amnesia d) All of the above 002. An ideal anesthetic drug would: a) Induces anesthesia smoothly and rapidly and secure rapid recovery b) Posses a wide margin of safety c) Be devoid of adverse effects d) All of the above 005. Indicate the anesthetic, which is used intravenously: a) Propofol b) Halothane c) Desflurane d) Nitrous oxide 007. Sevoflurane has largely replaced halothane and isoflurane as an inhalation anesthetic of choice because: a) Induction of anesthesia is achieved more rapidly and smoothly b) Recovery is more rapid c) It has low postanesthetic organ toxicity d) All of the above 009. Which of the following inhalants lacks sufficient potency to produce surgical anesthesia by itself and therefore is commonly used with another inhaled or intravenous anestheticfi Indicate the inhaled anesthetic, which reduces arterial pressure and heart rate: a) Isoflurane b) Halothane c) Desflurane d) Nitrous oxide 013. Which of the following inhaled anesthetics causes centrally mediated sympathetic activation leading to a rise in blood pressure and heart ratefi Indicated the inhaled anesthetic, which decreases the ventilatory response to hypoxia: a) Sevoflurane b) Nitrous oxide c) Desflurane d) Halothane 015. Which of the following inhaled anesthetics is an induction agent of choice in patient with airway problemsfi Indicate the inhaled anesthetic, which causes the airway irritation: a) Nitrous oxide b) Sevoflurane c) Halothane d) Desflurane 017. Which of the following inhaled anesthetics increases cerebral blood flow least of allfi Indicate the inhaled anesthetic, which should be avoided in patients with a history of seizure disorders: a) Enflurane b) Nitrous oxide c) Sevoflurane d) Desflurane 019. Indicated the inhaled anesthetic, which may cause nephrotoxicity: a) Halothane b) Soveflurane c) Nitrous oxide d) Diethyl ether 021. Which of the following inhaled anesthetics decreases metheonine synthase activity and causes megaloblastic anemiafi Unlike inhaled anesthetics, intravenous agents such as thiopental, etomidate, and propofol: a) Have a faster onset and rate of recovery b) Provide a state of conscious sedation c) Are commonly used for induction of anesthesia d) All of the above 023. Indicate the intravenous anesthetic, which is an ultra-short-acting barbiturate: a) Fentanyl b) Thiopental c) Midazolam d) Ketamine 024. Indicate the intravenous anesthetic, which is a benzodiazepine derivative: a) Midazolam b) Thiopental c) Ketamin d) Propofol 025. Which of the following agents is used to accelerate recovery from the sedative actions of intravenous benzodiazepinesfi Indicate the intravenous anesthetic, which causes minimal cardiovascular and respiratory depressant effects: a) Propofol b) Thiopental c) Etomidate d) Midazolam 029. Indicate the intravenous anesthetic, which produces dissociative anesthesia: a) Midazolam b) Ketamine c) Fentanyl d) Thiopental 030. The mechanism of Cytiton action is: a) Direct activation of the respiratory center b) the reflex mechanism c) the mixed mechanism d) None of the above 003. Indicate the drug belonging to antitussives of narcotic type of action: a) Glaucine hydrochloride b) Aethylmorphine hydrochloride c) Tusuprex d) Libexine 004. Tick out the drug belonging to non-narcotic antitussives: a) Libexine b) Tusuprex c) Codeine d) Aethylmorphine hydrochloride 005. Indicate the expectorant with the reflex mechanism: a) Sodium benzoate b) Derivatives of Ipecacucnha and Thermopsis c) Trypsin d) Ambroxol 006. Tick the antitussive agent with a peripheral effect: a) Codeine b) Tusuprex c) Libexine d) Glaucine hydrochloride 007. Tick the drug belonging to non-selective beta2-adrenomimics: a) Salbutamol b) Isoprenaline c) Salmeterol d) Terbutaline 013. Select the side-effect characteristic for non-selective beta2-adrenomimics: a) Depression of the breathing centre b) Tachycardia c) Peripheral vasoconstriction d) Dry mouth 014. Pick out the bronchodilator drug related to xanthine: a) Atropine b) Orciprenaline c) Adrenaline d) Theophylline 015. Pick out the bronchodilator drug belonging to sympathomimics: a) Isoprenaline b) Ephedrine c) Atropine d) Salbutamol 016. The property of prolonged theophyllines is the prevention of night asthmatic attacks. The mechanism of methylxanthines action is: a) Inhibition of the enzyme phosphodiesterase b) Beta2 -adrenoreceptor stimulation c) Inhibition of the production of inflammatory cytokines d) Inhibition of M-cholinoreceptors 018. Which of the following M-cholinoblocking agents is used especially as an anti-asthmaticfi Indicate the side effect of Theophylline: a) Bradycardia b) Increased myocardial demands for oxygen c) Depression of respiratory centre d) Elevation of the arterial blood pressure 020. Choose the drug belonging to membranestabilizing agents: a) Zileutin b) Sodium cromoglycate c) Zafirlucast d) Montelucast 022. Tick the drug which is a 5-lipoxygenase inhibitor: 70 a) Budesonide b) Sodium cromoglycate c) Zileutin d) Beclometazone 023. Indicate the drug which is a leucotriene receptor antagonist: a) Sodium cromoglycate b) Zafirlucast c) Zileutin d) Triamcinolone 025. Tick the main approach of peptic ulcer treatment: a) Neutralization of gastric acid b) Eradication of Helicobacter pylori c) Inhibition of gastric acid secretion d) All the above 002. Indicate the drug belonging to proton pump inhibitors: a) Pirenzepine b) Ranitidine c) Omeprazole d) Trimethaphan 004. Choose the drug which is a H2-receptor antagonist: a) Omeprazole b) Pirenzepine c) Carbenoxolone d) Ranitidine 007. Indicate the drug belonging to M1-cholinoblockers: a) Cimetidine b) Ranitidine c) Pirenzepin d) Omeprazole 009. Select the drug stimulating the protective function of the mucous barrier and the stability of the mucous membrane against damaging factors: a) De-nol b) Sucralfate c) Misoprostol d) Omeprazole 014. Antacids are weak bases that react with gastric hydrochloric acid to form salt and water. Indicate the drug that cause metabolic alkalosis: a) Sodium bicarbonate b) Cimetidine c) Pepto-Bismol d) Carbenoxolone 017. Choose the drug that causes constipation: a) Sodium bicarbonate b) Aluminium hydroxide c) Calcium carbonate d) Magnesium oxide 018. Select an anorexigenic agent affecting serotoninergic system: a) Fenfluramine b) Fepranone c) Desopimone d) Masindole 021. Choose an emetic drug of central action: a) Ipecacuanha derivatives b) Promethazine c) Tropisetron d) Apomorphine hydrochloride 024. Select the emetic agent having a reflex action: a) Ipecacuanha derivatives b) Apomorphine hydroclorid c) Chlorpromazine d) Metoclopramide 026. Indicate an antiemetic agent which is related to neuroleptics: a) Metoclopramide b) Nabilone c) Tropisetron d) Prochlorperazine 028. Indicate the laxative drug belonging to osmotic laxatives: a) Docusate sodium b) Bisacodyl c) Phenolphthalein d) Sodium phosphate 030. The mechanism of stimulant purgatives is: a) Increasing the volume of non-absorbable solid residue b) Increasing motility and secretion c) Altering the consistency of the feces d) Increasing the water content 031. Choose the drug irritating the gut and causing increased peristalsis: a) Phenolphthalein b) Methyl cellulose c) Proserine d) Mineral oil 032. Tick the stimulant of bile production of vegetable origin: a) Oxaphenamide b) Papaverine c) Cholenzyme d) Cholosas 034. Select the drug which inhibits peristalsis: a) Castor oil b) Bisacodyl c) Loperamide d) Sorbitol 035. Choose the drug depressing erythrogenesis: a) Radioactive phosphorus 32 b) Ferrous sulfate c) Molgramostim d) Folic acid 003. Iron deficiency anemia leads to pallor, fatigue, dizziness, exertional dyspnea and other symptoms of tissue ischemia. Tick the drug for parenteral iron therapy: a) Ferrous sulfate b) Fercoven c) Ferrous lactate d) Ferrous fumarate 007. Indicate the drug which increases absorption of iron from intestine: a) Cyanocobalamin b) Folic acid c) Ascorbic acid d) Erythropoetin 008. Pernicious anemia is developed due to deficiency of: a) Erythropoetin b) Vitamin B12 c) Iron d) Vitamin B6 010. Select the drug used for pernicious anemia: a) Ferrous lactate b) Cyanocobalamin c) Iron dextran d) Ferrous gluconate 011. An adverse effect of oral iron therapy is: a) Anemia b) Thrombocytopenia c) Headache d) Constipation 012. Choose the drug which contains cobalt atom: 74 a) Folic acid b) Iron dextran c) Cyanocobalamine d) Ferrous gluconate 013.