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The barrier function of the blood-brain-barrier is established by tight junctions (zonula occludentes) between endothelial cells in the blood vessels of the brain arterial blood gases cheap cardura 4 mg. However hypertension young adults discount generic cardura canada, astrocytes establish and maintain the blood-brain barrier and thus control the entry of compounds into the brain parenchyma. During development the astrocytes are critical to normal migration of developing neurons. Infection can lead to changes in gene expression (of the cell) and some of the released products can have deleterious effects on neurons. Astrocytes integrate neuronal inputs, exhibit calcium excitability, and communicate bidirectionally with neighboring neurons and synapses, but do not synapse with neurons (answer a). The electron micrograph of the synapse shows the presynaptic membrane (C), postsynaptic membrane (D), mitochondria (B), and synaptic vesicles (A). Recycling of synaptic vesicle membrane occurs at the presynaptic membrane in conjunction with neurotransmitter release by exocytosis. Neurotransmitter release is induced by membrane depolarization, leading to transient opening of calcium channels followed by calcium influx. Transmission from neuron to neuron occurs by chemical transmission in the Nervous System Answers 249 form of neurotransmitter release. The neurotransmitter (from the synaptic vesicles) crosses the synaptic cleft (between the pre- and postsynaptic membranes) and interacts with receptors on the postsynaptic membrane (answer b), which results in changes in the permeability of this membrane (answer c). Numerous mitochondria and synaptic vesicles are typically found on the presynaptic side of the synapse. On autopsy, plaques are found that contain lymphocytes and monocytes in infiltrates around small veins in what is known as perivascular cuffing. The main identifying feature on histopathological examination is the paucity of oligodendrocytes. In myasthenia gravis, the postsynaptic muscle membrane is smooth and lacks the normal folded shape. The edrophonium chloride (tensilon) test uses a rapid acting and degrading acetylcholine esterase inhibitor. The physician injects the tensilon and then looks for rapid relief of the symptoms, particularly the eyelids and the diplopia. Other structures labeled in the electron micrograph are: A = nucleus, B = mitochondria, C = myofilaments, and D = nerve terminal. Valves Basal lamina Coronary arteries Endothelial diaphragms Arterioles 251 Copyright © 2007 by the McGraw-Hill Companies, Inc. Myeloblast Proerythroblast Metamyelocyte Myelocyte Promyelocyte Cardiovascular System, Blood, and Bone Marrow 253 153. A newborn girl presents with a mutation in the erythropoietin receptor gene which leads to primary familial erythrocytosis (familial polycythemia). During the 5th to 9th months of fetal development, the primary effect was on red blood cell production in which of the following? A 64-year-old man presents with splenomegaly, lymphadenopathy, persistent fever, night sweats, and weight loss. Organs such as the brain and thymus have a more effective bloodbarrier because their blood capillaries are of which of the following types? Continuous type with few vesicles Fenestrated type with diaphragms Fenestrated type without diaphragms Discontinuous type with diaphragms Discontinuous type without diaphragms 156. On cardiac catheterization there is occlusion of the left anterior descending and the origin of the right coronary artery. Proliferation of smooth muscle cells Formation of an intimal plaque Attraction of platelets to collagen microfibrils Adventitial proliferation Injury to the endothelium 254 Anatomy, Histology, and Cell Biology 157. His lower limbs appear cold, pale, and discolored, and he has a sore on the skin of his left calf. In this patient, which of the following functions would be primarily affected in the blood vessel from the lower extremity shown in the accompanying transmission electron micrograph? Adaptation to systolic pressure Distribution of blood within an organ Blood flow from the aorta to specific organs Return of lymphocytes to the blood Return of venous blood to the heart Cardiovascular System, Blood, and Bone Marrow 255 158. Her fresh blood is drawn and centrifuged in the presence of heparin as an anticoagulant to obtain a hematocrit. Serum, packed erythrocytes, and leukocytes Leukocytes, erythrocytes, and serum proteins Plasma, buffy coat, and packed erythrocytes Fibrinogen, platelets, buffy coat, and erythrocytes Albumin, plasma lipoproteins, and erythrocytes 159. Decreased clotting time Normal blood count Abnormal bruising Hypercoagulation Light menstrual periods 256 Anatomy, Histology, and Cell Biology 160.

The purpose of the procedure is to reduce myopia to eliminate the need for corrective lenses prehypertension examples cheap cardura. The reduction in curvature of the central portion of the cornea results in decreased refractive power of the cornea blood pressure medication hydralazine buy cardura 4 mg overnight delivery. The removal of tissue and the degree of correction required is estimated by computer simulations. In one type of detachment, rhegmatogenous retinal detachment, fluid accumulates after a break occurs in the retina. Detachments without breaks in the retina are called nonrhegmatogenous, or serous, detachments. Vitreous degeneration usually is a prerequisite for retinal detachment that results in the breaking of the retina. The breakdown of the vitreous produces traction on the retina, which may already possess an inherent area of weakness. Rhodopsin is the visual pigment found in the outer segments of rod cells and is composed of retinal, a vitamin A derivative, bound to opsin. When photons strike rhodopsin, 11-cis-retinal is isomerized to 11-trans-retinal resulting in bleaching, which represents the dissociation of retinal from opsin. The signal spreads to the inner segment and through gap junctions to nearby photoreceptor cells. Therefore, the rods and cones differ from other receptors in that hyperpolarization of the cell membranes occurs rather than the depolarization that occurs in other neural systems. It is derived from the outer layer of the optic cup and is continuous from the ora serrata retinae to the optic nerve. Rod and cone perikarya and amacrine cells are found in the photosensitive retina derived from the inner layer of the optic cup. In diabetic retinopathy pathologic changes usually begin with thickening of the basement membrane of small retinal vessels. The abnormal vessels develop microaneurysms, which leak and hemorrhage with resultant ischemia of the retinal tissue. New vessels proliferate in response to ischemia and production of angiogenic factors. Retinopathy also occurs with prematurity when retinal vascularization is disturbed. Blockage of the canal of Schlemm, the trabecular meshwork, or the scleral veins results in glaucoma. The overall figure shows the region of the iridocorneal angle and other associated structures in the eye. This region is extremely important in the production and outflow of the aqueous humor and in the distribution of zonule fibers to the lens. The iris (C) contains both sphincter (D) and Eye and Ear 403 dilator muscles, which work in opposition to one another and are innervated by parasympathetic and sympathetic fibers, respectively. The ciliary muscles stretch the choroid and relax the lens, which is essential for the process of lens accommodation. They are also the origin of the zonule fibers (G), which are similar in structure to elastic fibers and are important for anchorage of the lens. When the ciliary muscles contract, causing forward displacement of the ciliary body, the tension on the zonule fibers is reduced, which leads to an increase in lens thickness and maintenance of focus. The aqueous humor produced by the ciliary processes (F) is transported into the posterior chamber (N) and flows into the anterior chamber (O) through the pupil. Outflow from the anterior chamber occurs through the trabecular meshwork at the iridocorneal angle and flows through the canal of Schlemm. The lens (J) is formed embryologically from a thickening of the surface ectoderm called the lens placode, which eventually forms a lens vesicle. The three compartments of the eye include the posterior and anterior chambers, which are filled with aqueous humor, and the vitreous body (M), which is filled with a gel consisting of hydrated hyaluronic acid and other glycosaminoglycans. The conjunctiva is the mucosa, or lining, of the eyelid and is labeled I in the figure.

Inferences may only be made from scores blood pressure over 180 order cardura on line, through observable attributes to constructs blood pressure medication makes me dizzy cardura 2mg fast delivery, and on to predictions of likely performance, if the target domain is specified. Without that there is no value to the quantity represented in a test result, for there is no theory to relate it to fact. This is why global claims for score meaning lead to validity chaos (Chalhoub-Deville and Fulcher, 2003: 502). It is also why retrofitting tests for new uses must be done with the utmost care (Fulcher and Davidson, 2009). More recent approaches to rating scale development from a data-driven tradition ground the scores in specific domains. To this extent they draw upon a long tradition of observing successful performance in context as a key methodology in the construction of the scoring instrument. This is the way forward for the development of scoring instruments for performance tests, which allies the task of measurement to applied linguistic research. Measurement in language testing is not simply a matter of establishing good psychometric properties, as Messick (1995: 6­7) knew only too well: `. The inferences we make are directly related to a criterion that we wish to predict, and so all score meaning is therefore criterion referenced. The cut score, once arrived at, cannot be altered at whim, but only by changes in the complexities of tasks in the target domain, or a reassessment of risks associated with borderline pass scores. This is inconvenient for policy makers, who wish to move cut scores up or down in order to achieve their policy goals, as frequently happens with tests that are used for immigration purposes. In times of financial crisis when international workers are not required the pass level is raised; it is easily reduced when the economy recovers. Our future work also requires vigilance about claims for score meaning that serve purely political or policy aims. Rating scales and their descriptors can be used to establish barriers to mobility and employment as well as to provide fair access. They can be used to create artificial identities, control educational systems, and hold teachers accountable. There is a growing need for social critiques of rating scale use, and research into their impact upon institutions and individuals (Fulcher, 2004; Vallax, 2010). This extends to the providers of examinations, where there is always the temptation to follow policy makers in generalizing score meaning beyond 388 Scoring performance tests reasonable inference to drive up test volume and therefore increase profit margins, a danger of which some are well aware (Wendler and Powers, 2009). We must insist that there are boundaries to score meaning (Messick, 1995: 7) to avoid validity chaos, for it may trigger gross unfairness to test takers through the inevitability of poor decision making. The issues surrounding rating instruments and scoring performance tests have become much wider in a very short period of time. There is much work here for the language testing profession, language teachers, and postgraduate researchers, for many years to come. It focuses on analysis of discourse from speaking tasks to generate observable categories that can predict student level. These categories are then used with a new sample of learners in order to investigate the usefulness of the categories for future use. Effective rating scale development for speaking tests: Performance decision trees. The paper is concerned with the extent to which scores can be generalized beyond the specific domain envisaged in the test, or restricted by the boundaries of the domain and test purpose. Pollitt considers two paradigms for scoring performance tests: marking and judging. The first is situated within the normative psychometric paradigm, while the latter draws on practices from sport, particular events such as free-style figure skating. The exploration of the two paradigms provides ideas and challenges for designers of scoring instruments without being prescriptive. They are relatively easy to use, and have the added advantage of being easy to construct by teachers for local assessments needs. The Construction and Validation of Rating Scales for Oral Tests in English as a Foreign Language. The measurement of productive skills: doubts concerning the assessment criteria of certain public examinations.

Weakness in the ability to open her mouth fully when eating an apple due to damage to the innervation to the lateral pterygoid muscle d blood pressure 160 over 100 order 4 mg cardura amex. Loss in the ability to taste in the posterior one-third of the tongue and perhaps some difficulty in swallowing hypertension zyrtec cheap cardura 4 mg with visa. Weakened ability to move her jaw from side to side because of loss in innervation of the medial pterygoid muscle 290. The course of the vertebral arteries is best described by which of the following statements? They arise from the common carotid artery on the left and the brachiocephalic artery on the right b. A 43-year-old mother of two watching her son play baseball has been hit in the side of the head with a foul ball that came from another field. She had been knocked unconscious for a few seconds and was taken to the emergency room of a local hospital by her husband. At the emergency room in addition to observing a growing "goose egg" over her right temporal region, examination of her fundi with an ophthalmoscope showed subtle papilledema. She was immediately sent for frontal and lateral skull films, which showed a fracture in the frontal bone near the pterion. What is the most likely diagnosis given to the on call neurosurgeon to bring him into the hospital on a Saturday afternoon? Extracranial hematoma Extracranial and epidural hematomas Extracranial and subdural hematomas Subarachnoid hemorrhage Extracranial hematoma and subarachnoid hemorrhage 292. One time he was almost knocked out by a right "hook" to the head and for about a week he had frequent headaches and a very runny nose, which finally stopped running by itself. Examination reveals a loss of pain and temperature sensation over the right side of the face and the left side of the body. The patient exhibits ataxia and intention tremor on the right in both the upper and lower extremities and is unable to perform either the finger-to-nose or heelto-shin tasks on the right. In addition, he is hoarse and demonstrates pupillary constriction and drooping of the eyelid on the right. In dislocation of the jaw, displacement of the articular disk beyond the articular tubercle of the temporomandibular joint results from spasm or excessive contraction of which of the following muscles? Buccinator Lateral pterygoid Medial pterygoid Masseter Temporalis Head and Neck 417 295. He has reddish spot (in circle) that is in the center of a slightly raised area just anterior to his sternocleidomastoid muscle about one and a half inches superior to his jugular notch. If you push on it, it feels attached to something that extends superiorly from this location. At times it leaks a little clear fluid after he has been heavily exercising for long periods of time. Glossopharyngeal fistula An internal branchial sinus A branchial fistula A hyperactive sebaceous gland Spina bifida occulta Thyroglossal duct cyst 418 Anatomy, Histology, and Cell Biology 296. A 63-year-old woman was brought into the emergency room by her son, who suspected she had suffered a stroke the previous night. The right pupil made direct and consensual responses to light, but the left pupil was fixed and unresponsive. Left motor cortex Right sensory cortex Right midbrain Left thalamus Right thalamus 297. A 75-year-old man was rushed to the hospital from his retirement community when he suddenly became confused and could not speak but could grunt and moan. The patient could follow simple commands and did recognize his wife and children although he could not name them or speak to them. Several days later, a more comprehensive examination revealed weakness and paralysis of the right hand and arm with increased biceps and triceps reflexes. Pain, temperature, and touch modalities were mildly decreased over the right arm, hand, and face, and proprioception was reduced in the right hand. The patient had regained the ability to articulate a few simple words with great difficulty, but could not repeat even simple two or three word phrases.

Three years prior to this referral arteria hepatica discount 2mg cardura fast delivery, he was successfully treated with hyperbaric oxygen and surgery for mandibular and maxillary osteomyelitis arteria znaczenie slowa purchase cardura 2mg otc. A spine x-ray shows "sandwich" vertebrae with thickening of the vertebral endplates. The cell type primarily affected in this patient is shown in the accompanying transmission electron micrograph (A) and labeled as "C" in the light micrograph (B). The activation and stimulation of those cells is involved in which of the following? Analysis of synovial fluid reveals synovitis with a white blood cell count of 2500 (normal less than 2000/mm3). Physical examination shows decreased abduction and external rotation of the right and left shoulders. Loss of the proteoglycan matrix and fibrillation in the articular cartilage during the early stages b. Formation of osteophytes at the articular margins and eburnation of large weightbearing joints in the later stages d. Heterologous autoantibodies directed against the synovium 198 Anatomy, Histology, and Cell Biology 110. A 42-year-old woman who has been a type I diabetic for 30 years falls when she trips over her vacuum cleaner hose. She tried to break her fall by placing her hand out to save herself and in the process her wrist is forced backwards. She arrives in the emergency room and an x-ray of her wrist is shown in the accompanying x-ray. Internal callus External callus Clot Pannus Granulation tissue Specialized Connective Tissues: Bone and Cartilage 199 111. The pain started approximately 6 months ago and is a deep ache that worsens when she stands or walks. X-ray of hips and pelvis shows osteolytic lesions and regions with excessive osteoblastic activity. The patient had felt well except for an increase in fatigue over the past few months. X-rays reveal lytic lesions of the skull and pelvis and a compression fracture of lumbar vertebrae. A potential underlying mechanism for the symptoms observed in this case is which of the following? A 46-year-old woman presents with pain in the left leg that worsens on weight bearing. In addition, laboratory tests show low levels of 1, 25-hydroxyvitamin D, calcium, and phosphorus and elevated alkaline phosphatase. A second bone biopsy, which was not decalcified, shows uncalcified osteoid on all the bone surfaces. Decreased glucocorticoid levels that result in decreased quality of the bone deposited b. A newborn girl is born with a small mouth, rather widely spaced eyes and low-set ears. Absence of the parafollicular cells Increased numbers of cells in the deep cortex of the lymph nodes Tetany Excess activity of osteoclasts Increased Ca2+ levels in the blood Specialized Connective Tissues: Bone and Cartilage 201 116. The patient is hyperparathyroid (parathyroid hormone, 234 pg/mL; normal 10­55 pg/mL) and hypercalcemic (calcium, 12. Serum levels of 1,25-dihydroxyvitamin D are decreased (10 pg/mL; reference range, 24­65 pg/mL). He has been receiving large doses of calcium supplemented with vitamin D to bind the phosphate. The production of calcified soft tissues is mediated by the structures shown in the accompanying transmission electron micrograph. Increased secretion of acid phosphatase Inhibition of alkaline phosphatase Accumulation of calcium and phosphate Increased secretion of osteoprotegerin Increased synthesis of type I collagen 202 Anatomy, Histology, and Cell Biology 117. Growth factor Binding of ionic calcium and physiologic hydroxyapatite Formation of the three-dimensional lattice of the matrix Cell attachment Binding of mineral components to the matrix 118.

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