English exam.pdf

The body systems, page 59 1. Nervous System: - Controls all body activities. - Central Nervous System (CNS): Brain and spinal cord. - Peripheral Nervous System (PNS): Spinal and cranial nerves, linking CNS with body receptors and e ectors. - Autonomic Nervous System (ANS): Operates...

The body systems, page 59 1. Nervous System: - Controls all body activities. - Central Nervous System (CNS): Brain and spinal cord. - Peripheral Nervous System (PNS): Spinal and cranial nerves, linking CNS with body receptors and e ectors. - Autonomic Nervous System (ANS): Operates outside the main nervous system. 2. Sensory System: - Comprises the ve senses: touch, sight, hearing, taste, and smell. - Depends on the nervous system. - Includes skin, eyes, ears, tongue, and nose. 3. Respiratory System: - Consists of nose, larynx, windpipe, bronchi, and lungs. - Breathing involves inspiration (air intake) and expiration (air release). - Gas exchange (oxygen and carbon dioxide) occurs in the alveoli. 4. Cardiovascular System: - Includes heart, arteries, veins, capillaries, spleen, lymphatic system, and blood vessels. - Circulates blood, carrying oxygen and nutrients to cells and removing waste products. - Subdivided into systemic, pulmonary, and portal circulation. 5. Digestive System: - Breaks down food into simpler substances for nourishment. - Alimentary canal: mouth, pharynx, esophagus, stomach, small and large intestines. - Assisted by liver and pancreas secretions. 6. Urinary System: - Involves organs for urine production and discharge. - Comprises kidneys, ureters, bladder, and urethra. - Filters waste, balances body uids and electrolytes. 7. Reproductive System: - Includes reproductive organs for species perpetuation. - Male organs: testes, ducts, glands, penis, scrotum, prostate. - Female organs: uterus, uterine tubes, ovaries, vagina, vulva. - Sex hormones play a key role. 8. Musculoskeletal System: - 206 bones, divided into axial and appendicular skeletons. - Provides support, protects organs, and enables movement. - Composed of muscles, bones, and joints. 9. Integumentary System: - Consists of skin, nails, and hair. - Skin layers: epidermis (outer) and dermis (deeper). - Nails protect ngers and toes; hair maintains warmth and protects skin. 10. Endocrine System: - Glands that release hormones (endocrine) or other substances (exocrine). - Includes ovaries, pituitary, thyroid, and adrenal glands. - Hormones regulate body functions. 11. Lymphatic System: - Network of vessels that drain uid back into the bloodstream. - Lymph vessels have valves to prevent back ow. - Consists of lymphatic glands and vessels. 12. Immune System: - Natural and acquired immunity. - Natural immunity: species-speci c. - Acquired immunity: defense against speci c agents via disease or immunization. - Two types: cell-mediated (T-cells) and humoral (B-cells producing antibodies). Page 1 of 12 ff fi fi fl fl fi fi fl  The nervous system, page 64 The Nervous System controls all body activities and is divided into the Central Nervous System (CNS) and Peripheral Nervous System (PNS). The CNS consists of the brain and spinal cord. The brain, made up of billions of neurons and supporting neuroglia cells, sends and receives messages through dendrites and axons. Dendrites pick up messages and pass electrical impulses down the axon to other cells. The spinal cord is a bundle of nerve bers extending from the brain to the lower back, carrying messages between the brain and body. The PNS is divided into the somatic nervous system (SNS) and the autonomic nervous system (ANS). The SNS consists of peripheral nerve bers that send sensory information to the CNS and motor nerve bers that project to every skeletal muscle, coordinating body movements and responding to external stimuli. The ANS operates mostly without conscious control, maintaining homeostasis by regulating smooth muscles in the skin, eyes, blood vessels, heart, intestines, and glands. The ANS is particularly important in emergencies ( ght or ight response) and non- emergencies (rest and digest activities). It is divided into the sympathetic nervous system (responds to stress by increasing heartbeat, blood pressure, and sweating), the parasympathetic nervous system (active during rest, slowing the heart, dilating blood vessels, and stimulating digestive, reproductive, and urinary systems), and the enteric nervous system (controls the gastrointestinal system). The brain processes and stores information, stimulating appropriate bodily reactions. It is a soft, jelly-like structure weighing about 3 pounds (1,380 g), containing neurons and neuroglia. The brain has three main parts: the forebrain, midbrain, and hindbrain. The forebrain includes the cerebrum (largest part, divided into two hemispheres connected by the corpus callosum, further divided into frontal, parietal, occipital, and temporal lobes) and the diencephalon (thalamus and hypothalamus). The frontal lobes control movement, coordination, speaking, and smell; the parietal lobes handle sensory information; the occipital lobes manage vision and reading; the temporal lobes oversee hearing, balance, and speech comprehension. The midbrain, located between the forebrain and hindbrain, is part of the brainstem and controls vision, hearing, eye movement, and body movement. The hindbrain includes the pons (regulates breathing and relays messages between the cerebrum and cerebellum), the medulla oblongata (regulates vital re exes like vomiting, coughing, sneezing, and swallowing), and the cerebellum (coordinates voluntary muscle movements, posture, and balance). The meninges, a system of three protective membranes (dura mater, arachnoid mater, and pia mater), surround the brain. The dura mater is a strong, brous membrane; the arachnoid mater encloses the cerebrospinal uid- lled subarachnoid space; the pia mater is a thin membrane containing numerous minute blood vessels. Nervous bers transmitting signals from the brain are called e erent bers, while those transmitting signals to the brain are called a erent or sensory bers. Nerves can be a erent, e erent, or mixed. The hypothalamus, part of the diencephalon, is a small structure at the base of the brain connected with the limbic system, acting as a link between the nervous and endocrine systems. It controls body temperature, emotions, thirst, hunger, and the pituitary gland, which regulates growth, sexual, and reproductive processes. The thalamus acts as a relay station for sensory information, sorting impulses and directing them to the appropriate areas of the brain and spinal cord. The cardiovascular system, page 67 The cardiovascular system, consisting of the heart, arteries, veins, capillaries, spleen, lymphatic system, and blood vessels, facilitates blood circulation to deliver nutrients and remove waste products. It includes three main circulations: pulmonary (lungs), coronary (heart), and systemic (rest of the body). The cardiovascular system is essential for maintaining homeostasis by delivering oxygen and nutrients to cells and removing carbon dioxide and waste products. The Heart - Structure: A st-sized muscular organ located behind the breastbone and between the lungs, encased in the pericardium, and lined internally by the endocardium with the myocardium as its muscle layer. - Chambers: Four chambers—two atria (upper) and two ventricles (lower). The right side handles deoxygenated blood (pulmonary circulation), while the left side manages oxygenated blood (systemic circulation). Page 2 of 12 fi ff fi fi fi fl ff fl ff fi fi fi fi fi fi fl ff  - Valves: Four valves ensure unidirectional blood ow: tricuspid (right atrium to ventricle), pulmonary (right ventricle to pulmonary artery), mitral (left atrium to ventricle), and aortic (left ventricle to aorta). Circulation Pathway - Pulmonary Circulation: Right atrium → tricuspid valve → right ventricle → pulmonary valve → pulmonary artery → lungs → pulmonary vein → left atrium. - Systemic Circulation: Left atrium → mitral valve → left ventricle → aortic valve → aorta → body → venae cavae → right atrium. - Portal Circulation: Blood from the small intestine to the liver via the portal vein. Blood Vessels - Arteries: Thick-walled, muscular vessels carrying oxygenated blood under high pressure from the heart to the body. They branch into arterioles and then capillaries. - Veins: Thin-walled vessels returning deoxygenated blood to the heart under low pressure. They have valves to prevent back ow and rely on muscle contractions and arterial pulsations for movement. - Capillaries: Tiny vessels where nutrient and gas exchange occurs between blood and tissues. Cardiac Function Heartbeat Regulation: Controlled by the sinoatrial node (natural pacemaker) and the atrioventricular node. The heart beats about 100,000 times daily, with the contraction phase (systole) followed by relaxation (diastole). Electrical Activity: Monitored by electrocardiograms, it coordinates the sequential contraction of atria and ventricles, ensuring e cient blood ow. Major Arteries and Blood Flow Aorta: Largest artery, branching into coronary arteries (heart), carotid arteries (neck and head), subclavian arteries (shoulders and arms), and iliac arteries (pelvic region and legs). Venous Return; Blood travels from capillaries to venules, then veins, and nally back to the heart through the superior and inferior venae cavae. The respiratory system, page 69 The respiratory system comprises two main phases: inspiration (inhaling) and expiration (exhaling). Breathing is facilitated by the diaphragm and intercostal muscles, which expand the chest cavity, creating a vacuum that draws air into the lungs. During inspiration, the pleural cavity enlarges, reducing alveolar pressure below atmospheric levels, allowing air to ow in. External respiration occurs in the lungs, where oxygen and carbon dioxide are exchanged between the alveoli and blood. Blood arrives via pulmonary arteries, moves through arterioles to alveolar capillaries, and then exits through venules to the heart via pulmonary veins. Oxygen di uses from the alveoli into the capillaries, while carbon dioxide moves from the capillaries into the alveoli to be exhaled. The respiratory system includes the lungs, nose, larynx, trachea, and bronchi. The lungs, housed in the chest cavity, are elastic and divided into lobes (two in the left lung, three in the right). They are protected by pleurae, which reduce friction during breathing. The nasal passages lter, warm, and humidify incoming air, while the pharynx directs air to the trachea and food to the esophagus. The larynx, containing vocal cords, is involved in sound production. The trachea, supported by C-shaped cartilages, branches into bronchi that further subdivide into bronchioles, ending in alveoli where gas exchange occurs. The diaphragm and intercostal muscles drive the breathing process, with inspiration expanding the chest cavity and expiration reducing it, expelling air. Gas exchange happens rapidly in the alveoli, with oxygen and carbon dioxide di using across alveolar and capillary walls. Oxygen binds to hemoglobin in red blood cells, forming oxyhemoglobin. The oxygenated blood returns to the heart via the pulmonary veins, while deoxygenated blood is pumped to the lungs via the pulmonary arteries for reoxygenation. The digestive system, page 71 The digestive system is a complex network of organs that convert food into nutrients the body needs. It includes the mouth, pharynx, esophagus, stomach, small intestine (duodenum, jejunum, Page 3 of 12 ff fl ffi fl fl fi fl ff fi  ileum), and large intestine (cecum, ascending colon, transverse colon, descending colon, sigmoid colon, rectum). The liver, gallbladder, and pancreas are also integral parts, producing essential digestive enzymes. The digestive tract is approximately 11 meters long, and food is moved through it by muscle contractions called peristalsis. In the mouth, food is chewed by the teeth and tongue, moistened with saliva (produced by the sub-mandibular, sub-lingual, and parotid glands, containing the enzyme ptyalin), and swallowed. The food then passes through the pharynx and esophagus into the stomach. The stomach, a muscular sac that can hold about 1.5 liters, mixes food with gastric secretions (mucus, hydrochloric acid, pepsin, intrinsic factor, and gastrin) to begin digestion. The partially digested food, now called chyme, is gradually released into the duodenum. The pancreas, located near the duodenum, has both exocrine and endocrine functions. It secretes digestive enzymes (amylase, lipase, trypsin) and hormones (insulin, glucagon) into the duodenum. The liver produces bile, which is stored in the gallbladder and released into the duodenum to aid in fat digestion. Bile emulsi es fats, making them easier to digest and absorb. The small intestine, about 7 meters long, is where most digestion and nutrient absorption occur. It is lined with villi, which increase the surface area for absorption. Nutrients absorbed through the villi are transported to the liver via the bloodstream. The liver processes these nutrients, stores glycogen, produces plasma proteins (albumin, globulin, brinogen), detoxi es substances, and regulates metabolism. The liver also produces bile, which is crucial for fat digestion. The large intestine, approximately 1.5 meters long, absorbs water and salts from the remaining indigestible food matter, forming feces. The colon (ascending, transverse, descending, and sigmoid) and rectum store and then expel feces through the anus. The liver, the largest internal organ, processes digested food, stores vitamins and minerals, produces proteins, and detoxi es harmful substances. It receives blood from the hepatic artery and the hepatic portal vein, which carries nutrient-rich blood from the intestines. The liver's lobules, each with a central vein, lter this blood, processing nutrients and waste products. Bile produced by the liver is stored in the gallbladder and released into the duodenum to aid in the emulsi cation and digestion of fats. Overall, the digestive system e ciently breaks down food, absorbs nutrients, and eliminates waste, ensuring the body's metabolic needs are met and maintaining overall health. Epilepsy, page 93 A. Epilepsy is a chronic brain disorder marked by recurring seizures, which involve abnormal sensory, motor, and psychological activity. Some seizures may lead to a loss of consciousness, though not all such attacks qualify as epilepsy. The disorder is characterized by recurrent convulsions and disrupted brain activity. Seizures are classi ed into two main types: partial (focal) and generalized. Partial seizures a ect only one brain region, while generalized seizures impact the entire brain. Complex partial seizures, a type of focal seizure, cause impaired consciousness and arise from a single brain region, typically the temporal lobe. These seizures can last between twenty seconds and three minutes. During a complex partial seizure, individuals may exhibit decreased responsiveness and awareness of their surroundings. They may not communicate or interact normally with others, follow commands, or remember events occurring during the seizure. Consciousness is altered but not completely lost. These seizures are often characterized by automatisms, such as head turning, lip-smacking, or dgeting with clothing. During the seizure, they might appear dazed, lose awareness, and stare blankly. Other common automatisms include moving the mouth, picking at objects, or engaging in purposeless actions. B. Absence seizures (petit mal) cause brief lapses of consciousness, lasting only a few seconds, typically beginning in childhood or adolescence, and are often genetically linked. These seizures usually show no noticeable symptoms except for brief moments of being "out of it." They can occur frequently, a ecting concentration, but usually have no lasting e ect on intelligence or development. Childhood absence epilepsy usually stops when the child reaches puberty. However, some children may experience behavioral, educational, and social issues. Sensory stimuli like bright lights and loud noises can trigger these seizures. Grand mal seizures are marked by a sti ening (tonic phase) followed by jerking movements (clonic phase) and can last from 30 seconds to ve minutes. Some individuals experience a tonic-clonic- tonic pattern during their seizures, others may experience only the tonic phase or only the clonic phase. The tongue may be bitten during the episode, and breathing may appear labored. These Page 4 of 12 fi fi ff fi fi ffi fi ff ff fi fi fi ff fi  seizures may involve a cry or moan, irregular breathing, and potential loss of bowel/bladder control. They are often preceded by an aura. Recovery can take minutes to hours, with the patient often feeling lethargic and possibly confused afterward. It is important to ensure the patient's safety by turning them on their side and avoiding placing anything in their mouth during a seizure. C. Epilepsy can begin at any age due to various causes, including head trauma, congenital brain malformation, cardiovascular accidents, CNS infections, or idiopathic origins. Symptoms range from twitching and dizziness to hallucinations and loss of consciousness. Seizures can also involve cyanosis, breathing di culties, and muscle contractions. Diagnosis involves a thorough medical history and tests like EEGs, CT scans, and MRIs to pinpoint brain lesions. Anticonvulsant drugs are e ective in controlling epilepsy, though they may require a process of trial and error to nd the best treatment with the fewest side e ects. Prognosis varies; some cases are di cult to control, while others respond well to treatment. Preventive measures include avoiding head injuries, early detection, and avoiding alcohol, smoking, and drug abuse. Approximately 65% of patients with epilepsy are mentally normal, 20% have mild intellectual reduction, and 15% experience moderate to severe impairment. Angina pectoris, page 98 Angina pectoris (AP) is chest pain caused by insu cient oxygen supply to the heart muscle, usually due to narrowed coronary arteries from atherosclerosis, resulting in ischemia (reduced blood ow). Other conditions like hypertension or aortic valve issues can also contribute. AP pain varies from mild discomfort to severe crushing sensations and can radiate to the jaw, neck, arm, or shoulder, often accompanied by nausea, high heart rate, and anxiety. It is typically triggered by physical activity, exertion, cold weather, and stress, lasting less than 15 minutes and no more than 30 minutes. Diagnosis may involve an ECG during the attack and medical history. Treatment includes nitroglycerine, beta blockers, and calcium channel blockers to reduce heart workload, and in severe cases, coronary bypass or coronary angioplasty. With proper medical care, the prognosis is favorable. Patients are advised to avoid stress, overexertion, obesity, hypertension, smoking, diabetes, and sedentary lifestyles to prevent myocardial infarction and heart failure. Myocardial infarction, page 99 Myocardial Infarction (MI), or heart attack, is a critical condition resulting from the blockage of one or more coronary arteries, leading to heart muscle tissue damage due to oxygen deprivation. Atherosclerosis, characterized by cholesterol plaques in arterial walls, is the most common cause, but blood clots can also obstruct arteries. Risk factors include a history of vascular disease, hypertension, smoking, diabetes, obesity, sedentary lifestyle, and chronic stress. Symptoms of acute MI include severe chest pain radiating to the left arm, neck, and jaw, breathlessness, nausea, vomiting, palpitations, sweating, and anxiety. The symptoms are similar to angina pectoris ones but more severe. Diagnosis is made using patient history, physical exams, ECG, radioisotope studies, cardiac markers (CPK, LDH, SGOT), and coronary angiograms (CA). CA, often performed with coronary catheterization (CC), helps visualize artery blockages and guide treatment. Immediate hospitalization, bed rest, sedation, and analgesia are crucial, with CPR initiated if cardiac arrest occurs. The patient is usually discharged after 7/10 days, with a progressive rehabilitation program. Treatment may involve aspirin, beta blockers, ACE inhibitors, and statins. Prognosis depends on the extent of heart damage, with signi cant mortality occurring within the rst few hours. Complications can include arrhythmias, heart failure, cardiogenic shock, myocardial rupture, pericarditis, and ventricular aneurysm. Preventive measures include avoiding smoking, excessive alcohol consumption, obesity, and stress. Regular physical activity and management of chronic conditions like hypertension and diabetes are also vital. The story of amyotrophic lateral sclerosis (ALS), page 132 Amyotrophic Lateral Sclerosis (ALS), commonly referred to as Lou Gehrig's disease, is a progressive neurological disorder that a ects the motor neurons in the brain and spinal cord. It primarily targets both upper motor neurons (UMNs) and lower motor neurons (LMNs), leading to their degeneration over time. ALS typically manifests in adults aged 40-60 years, although onset can occur anywhere from the teenage years to very late in life. It is relatively rare, with an incidence of about 10 cases per 100,000 people in the United States. Page 5 of 12 fi fl fi ff ffi ff ff ffi fi ffi  The initial symptoms often include painless weakness in a limb (usually a hand, arm, or leg), which is observed in about 50% of cases. Other early signs may include muscle twitching (fasciculations), slurred speech (dysarthria), and di culty walking. As the disease progresses, individuals may experience muscle cramps, progressive muscle weakness, incoordination, and eventually di culty with essential functions like breathing (respiratory muscles), speaking, and swallowing (dysphagia). The course of ALS is relentlessly progressive, with a median survival time of 3-5 years from diagnosis, though some patients can live longer. Around 30% of patients survive for 5 years or more, and 10-20% survive for more than 10 years post-diagnosis. The etiology of ALS is not fully understood, but it is categorized into sporadic (75% of cases) and familial (20% of cases) forms. The familial cases are often linked to mutations in speci c genes, such as the SOD-1 gene, although this accounts for only a small percentage of all cases. Diagnosis of ALS is challenging and relies on clinical symptoms, electromyography (EMG) to detect electrical activity in muscles, nerve conduction studies (NCS) to assess nerve function, and exclusion of other conditions with imaging techniques like MRI and sometimes spinal tap (lumbar puncture). Currently, the FDA-approved drug for ALS treatment is Riluzole, which has been shown to modestly prolong survival and slow disease progression. Treatment primarily focuses on managing symptoms and improving quality of life. This includes physical therapy to maintain muscle strength and range of motion, speech therapy to assist with communication and swallowing, and interventions like nighttime breathing assistance and nutritional support as swallowing becomes di cult. Ongoing research into ALS aims to uncover its underlying mechanisms, identify new therapeutic targets, and develop more e ective treatments that can alter the course of this devastating disease. The story of Acute Lymphoblastic Leukemia A. Leukemia is a rapidly developing cancer of the bone marrow and blood. The term "leukemia" comes from the Greek words "leukos" (white) and "haima" (blood). Leukemia is categorized into four main types: acute or chronic myelogenous leukemia and acute or chronic lymphocytic (lymphoblastic) leukemia. Acute lymphocytic leukemia is often referred to as acute lymphoblastic leukemia in children. Speci c cellular features allow further subclassi cation of leukemia types to optimize treatment and disease assessment. Acute myelogenous leukemia has several synonyms, including acute myeloblastic leukemia, acute myeloid leukemia, acute granulocytic leukemia, and acute nonlymphocytic leukemia. B. Acute myelogenous leukemia (AML) results from genetic mutations in the DNA of developing bone marrow cells, leading to an accumulation of immature cells called leukemic blasts. These blasts do not develop properly, cannot ght infections, and block the production of normal blood cells, causing anemia, thrombocytopenia, and neutropenia. AML is the most common type of leukemia, more frequently diagnosed in developed countries and more common among whites. It primarily a ects older adults, with a median age of onset at 65 years, but it can occur in all age groups, including children. Risk factors include myelodysplastic syndromes, occupational exposures, and smoking. Most AML cases are due to acquired mutations from environmental factors like benzene, radiation, and chemotherapy, rather than inherited mutations. The disease shows a marked increase in prevalence with age. C. Individuals with acute myelogenous leukemia (AML) exhibit symptoms due to bone marrow failure and organ in ltration by leukemic cells. Symptoms include frequent infections (due to low white blood cells), anemia (low red blood cells), easy bleeding or bruising (low platelets), and bone or joint pain (high leukemia cell count). Older patients may present with a myocardial infarction. Diagnosis involves blood and marrow examination, including cytogenetic and genetic testing, immunophenotyping, and bone marrow biopsy. AML has eight subtypes, determined by a ected blood cell types. A multidisciplinary team diagnoses AML and assesses organ involvement with tests like chest x-rays, ultrasounds, and lumbar punctures. Immediate treatment aims to achieve remission by eliminating leukemic blast cells and restoring normal blood cell production. Age and general health in uence treatment outcomes. D. Treatment options and outcomes for AML are evaluated based on risk factors such as age and systemic infections. Induction therapy involves intensive chemotherapy to achieve remission, followed by consolidation chemotherapy or stem cell transplant. Transplants, using either the patient’s cells (autologous) or donor cells (allogeneic), aim for long-term remission but come with risks like GVHD. Short-term and long-term side e ects include severe nausea, diarrhea, organ damage, fatigue, and muscle pain. GVHD can be controlled with drugs and has the bene cial e ect of targeting remaining leukemia cells. Page 6 of 12 ff ff ffi fl fi ffi fi fi ff ffi fi ff fi ff fi  The story of Chronic Obstructive Pulmonary Disease, page 138 A. Chronic obstructive pulmonary disease (COPD), also known as chronic obstructive airway disease (COAD), primarily refers to chronic bronchitis and emphysema, which frequently co-exist. COPD is characterized by air ow obstruction that impairs normal breathing and is progressive and not fully reversible, though some cases may partially respond to bronchodilators. COPD can be misdiagnosed as asthma, which is typically reversible but can lead to permanent airway obstruction in some cases. Main symptoms include shortness of breath, cough, and mucus production, and signi cant lung damage can occur before symptoms become noticeable. COPD is usually diagnosed in middle-aged or older individuals through pulmonary function tests and medical history. While treatment can improve comfort, there is no cure. In the U.S., COPD is the fourth leading cause of death, with women experiencing more deaths than men. In 2003, COPD claimed around 130,000 lives, and in 2004, 12.5 million U.S. adults were diagnosed with the disease. B. Cigarette smoking is the leading cause of COPD, responsible for about 90% of COPD-related deaths. Non-smokers face a signi cantly lower risk of COPD, being approximately 13 times less likely to die from the disease compared to smokers. Some smokers develop airway hyper- responsiveness, where their airways become overly sensitive to irritants like second-hand smoke and pollution, exacerbating COPD risk. Other risk factors include childhood respiratory infections, hereditary factors, and exposure to indoor air pollution from solid fuel use. Occupational exposure to substances like coal dust and asbestos also increases COPD risk. Alpha 1-antitrypsin (AAT) de ciency, an inherited condition where the liver produces insu cient AAT protein, is another signi cant risk factor for COPD. AAT de ciency accounts for about 5% of COPD cases in the U.S., primarily causing emphysema. Severe cases of AAT de ciency can lead to early-onset emphysema, with symptoms appearing around age 40 in smokers and age 53 in non-smokers. AAT de ciency is responsible for a small percentage of emphysema cases overall. C. In COPD, the airways and air sacs lose their elasticity and structural integrity. This leads to: - Decreased ability to inhale and exhale due to loss of elasticity. - Destruction of air sac walls. - Thickening and in ammation of airway walls. - Excessive mucus production, which obstructs airways. These changes cause a rapid decline in forced expiratory volume (FEV), resulting in breathlessness and di culty breathing. D. Chronic bronchitis was o cially recognized in the mid-1950s as a distinct condition, prompted by severe British smogs that led to respiratory failure (it was called the English Disease). It involves in ammation and scarring of the bronchial tube linings, causing air ow obstruction and excessive mucus production that is coughed up. Symptoms include a persistent cough with mucus, without other underlying diseases to explain the cough, frequent throat clearing, and shortness of breath. Often neglected until advanced stages, it can lead to serious respiratory problems due to irreversible lung damage. E. Emphysema is a progressive lung disease characterized by the destruction of alveoli, which are essential for oxygen and carbon dioxide exchange. This damage is irreversible and leads to permanent holes in the lower lung tissues, reducing oxygen transfer to the bloodstream and causing shortness of breath. The lungs lose their elasticity, leading to the collapse of small airways and air ow obstruction, making exhalation di cult. Symptoms include cough, shortness of breath, hyperventilation, and an expanded chest. F. Emphysema patients, termed "pink pu ers," often hyperventilate to maintain oxygen levels, avoiding cyanosis seen in "blue bloaters," that have almost normal ventilators drive, are plethoric and cyanotic. The story of Hepatitis, page 141 A. Hepatitis is an in ammation of the liver caused by various factors, including bacterial or viral infections, parasites, toxins, chemicals, drugs, alcohol, inherited diseases like Wilson's disease, or an autoimmune response. It can be acute, resolving in weeks or months, or chronic, lasting for years and potentially leading to severe liver damage such as cirrhosis, liver cancer, or death. Symptoms range from mild, u-like symptoms to severe signs like jaundice, dark urine, and light stools. The liver, located in the upper right abdomen, is crucial for processing nutrients, producing bile, synthesizing proteins, metabolizing drugs, regulating blood clotting, and detoxifying the Page 7 of 12 fl fl fl fl fi fi ffi ffi fi fi fl fl fi ff ffi fi fl fi ffi  body. In ammation can disrupt these functions, causing harmful substances to build up. Hepatitis is primarily associated with ve main viruses: A, B, C, D, and E. B. Hepatitis A virus (HAV) is transmitted through food or water contaminated with fecal matter. About one-third of Europeans are estimated to contract HAV at some point. Symptoms are often u-like and not always linked to hepatitis. HAV rarely causes permanent liver damage, and most individuals recover within six months, remaining immune afterward. Vaccines and good hygiene are essential for prevention. Hepatitis B virus (HBV) is a more serious global health issue and the leading cause of acute viral hepatitis. It spreads through contact with blood or body uids, sharing needles, unprotected sex, and from mother to child during childbirth. High-risk groups include healthcare workers, hemodialysis patients, and those receiving blood products before certain dates. Two billion people are infected worldwide, with 300 million chronically infected. In Europe, there are about 15 million chronic cases and 75,000 new cases annually. Over a million people die from HBV each year. While most people recover without therapy, 1-5% become chronic carriers. Hepatitis C virus (HCV) is transmitted similarly to HBV but is the leading cause of chronic hepatitis. Around 60-80% of those exposed develop chronic hepatitis, and no vaccine exists yet. Hepatitis D virus (HDV) only infects those already infected with HBV, worsening the infection. It spreads through blood contact. Hepatitis E virus (HEV) transmits like HAV and is mainly found in Asia, Africa, and South America. Non A-E hepatitis refers to hepatitis cases not caused by these ve viruses, and researchers continue to study its causes. C. Other forms of hepatitis include chemically-induced hepatitis, caused by exposure to high levels of alcohol, drugs, and environmental toxins, with drugs like anesthetics, antibiotics, anabolic steroids, and seizure medications being common culprits. Inherited diseases such as hemochromatosis (excess iron accumulation) and alpha-1-antitrypsin de ciency can also cause hepatitis, often leading to cirrhosis and liver cancer. Non-Alcoholic Fatty Liver Disease (NAFLD), related to obesity, insulin resistance, and metabolic syndrome, is a major cause of chronic hepatitis, with its severe form known as non-alcoholic steatohepatitis (NASH). Diagnosis of NAFLD or NASH requires a liver biopsy. Autoimmune hepatitis is a chronic form where the immune system attacks the liver, often found in women and associated with other autoimmune disorders like type 1 diabetes, ulcerative colitis, and Sjogren's syndrome. D. Symptoms of hepatitis include jaundice (yellowish skin and eyes due to high bilirubin levels), fever, nausea, vomiting, loss of appetite, upper right abdominal pain, light-colored stools, and dark urine. The incubation period varies by type, and symptoms may not appear immediately. HAV is treated with rest and hydration, while HCV can be treated with medications like pegylated interferon and ribavirin, though a de nitive cure is not guaranteed. HBV can be managed with lamivudine (EPIVIR-HBV), which suppresses viral replication but does not cure chronic HBV or reduce transmission risk. Vaccines are available to protect against HAV and HBV. E. Hepatitis, especially chronic hepatitis, may rst be detected during routine tests such as a Comprehensive Metabolic Panel (CMP). Tests to detect liver injury and assess disease severity include: - Alanine aminotransferase (ALT): An enzyme mainly in the liver, best for detecting hepatitis. - Aspartate aminotransferase (AST): An enzyme in the liver, heart, and muscles. - Bilirubin: A waste product from old blood cells causing jaundice and dark urine when elevated. - Albumin: Indicates liver function by measuring the main protein made by the liver. - Total Protein: Measures albumin and other blood proteins, including antibodies. Other tests, like viral testing for hepatitis A, B, and C, may be ordered to identify speci c types of hepatitis. Diagnosing drug, alcohol, and chemical hepatitis involves a complete medical history and examination, including evaluating potential exposure to chemicals or occupational hazards. The Protime (PT) test, which measures blood clotting proteins made by the liver, helps indicate liver damage severity. A liver biopsy, an invasive procedure where a needle withdraws liver cells for microscopic examination, is the most de nitive diagnostic method, used when other tests are inconclusive or to assess liver damage. The story of Diabetes, page 144 A. Diabetes is a metabolic disorder a ecting carbohydrate metabolism, characterized by insu cient insulin levels and elevated blood and urine sugar levels. The term "diabetes," from the Page 8 of 12 fl ffi fl fi fi fi ff fi fl fi fi fi  Greek word for "siphon," re ects the excessive urination seen in both diabetes mellitus (DM) and the rarer diabetes insipidus (DI). DM, commonly just called "diabetes," includes type 1, type 2, and gestational diabetes, each with distinct causes and characteristics. Diabetes leads to high blood glucose levels, due to the fact that insulin is not present or it doesn’t work properly, which can cause serious complications like blindness and amputations. B. Despite understanding the roles of genetics and lifestyle factors, the exact cause of diabetes remains unclear. Diabetes is the most common endocrine disorder, disrupting the body's ability to use glucose for energy, leading to hyperglycemia and subsequent health issues. C. Type 1 diabetes is an autoimmune disease where the immune system destroys insulin- producing beta cells in the pancreas, requiring daily insulin for survival. The exact causes are unknown, but genetic, autoimmune, and environmental factors, possibly including viruses, are implicated. It accounts for 3 to 10 percent of diabetes cases in the U.S., mainly a ecting juveniles and is more common in whites and in northern European countries. Symptoms develop quickly and include increased thirst, urination, hunger, weight loss, blurred vision, and fatigue. Without treatment, it can lead to diabetic ketoacidosis, a life-threatening condition. Type 2 diabetes, the most common form, accounts for 85 to 95 percent of cases. It is linked to older age, obesity, family history, inactivity, and certain ethnicities, with 90 percent of patients being overweight. It is increasingly seen in children and adolescents. In type 2 diabetes, the body resists insulin or doesn’t use it e ectively, leading to high blood glucose levels. Symptoms develop gradually and may include fatigue, frequent urination, increased thirst and hunger, weight loss, blurred vision, and slow wound healing, with some people showing no symptoms. Gestational diabetes occurs during pregnancy due to hormonal changes and insulin resistance. It is more common in women with a family history of diabetes and often presents without symptoms. D.Pre-diabetes and insulin resistance, which often precede type 2 diabetes, are characterized by elevated blood glucose levels without meeting the threshold for a diabetes diagnosis. Many a ected individuals are asymptomatic, despite being at risk. These conditions are associated with metabolic syndrome, also known as insulin resistance syndrome or Syndrome X. Metabolic syndrome encompasses a cluster of risk factors including abdominal obesity, high LDL (bad) cholesterol, low HDL (good) cholesterol, elevated triglycerides, and high blood pressure. These factors collectively increase the risk of cardiovascular diseases (CVD), such as heart disease and stroke. Research indicates that even during pre-diabetes, long-term damage to the cardiovascular system may occur, further heightening these risks. Diagnosis of pre-diabetes includes impaired fasting glucose (IFG) or impaired glucose tolerance (IGT). IFG is identi ed by fasting blood glucose levels of 100-125 mg/dL, whereas IGT is characterized by blood glucose levels of 140-199 mg/dL following a 2-hour oral glucose tolerance test (OGTT). Individuals with these conditions have a higher likelihood of progressing to type 2 diabetes within 5-10 years, although lifestyle modi cations such as weight loss and increased physical activity can mitigate this risk. E. Healthcare providers use various tests to diagnose pre-diabetes and diabetes, including fasting plasma glucose test (FPGT) and OGTT. A fasting blood glucose level below 100 mg/dL is normal, 100-125 mg/dL indicates pre-diabetes, and 126 mg/dL or higher con rms diabetes upon repeat testing. Similarly, during OGTT, blood glucose levels below 140 mg/dL after 2 hours are normal, 140-199 mg/dL indicate pre-diabetes, and 200 mg/dL or higher con rm diabetes. In pregnancies, gestational diabetes is diagnosed through OGTT, with adjusted diagnostic thresholds due to lower blood glucose levels typical during pregnancy. Diagnosis criteria include fasting blood glucose levels of 95 mg/dL, 1-hour level of 180 mg/dL, 2-hour level of 155 mg/dL, or 3-hour level of 140 mg/dL, highlighting the importance of monitoring glucose levels to manage maternal and fetal health. F. Diabetes is often underestimated, despite being a major cause of death and disability due to its association with heart disease, stroke, blindness, cardiovascular disease (CVD), kidney failure, nerve damage, and peripheral vascular disease (PVD) leading to amputations. Gestational diabetes complicates pregnancies and increases the risk of birth defects in babies. There is no cure for diabetes, but management is essential to maintain normal levels of blood glucose, blood pressure, and cholesterol. Type 1 diabetes management includes healthy eating, G. physical activity, and insulin, rst discovered in 1921 and available in various forms such as vials, pre lled syringes, and cartridges. Insulin types include recombinant human insulin, insulin lispro, insulin aspart, and insulin glargine. Injection sites are rotated to prevent lipodystrophy, with the abdomen being the preferred site. Hypoglycemia is a common side e ect, presenting Page 9 of 12 ff fi fi fl fi ff fi fi fi ff ff symptoms like confusion, nausea, hunger, and fainting, while hyperglycemia can occur if blood glucose levels are too high. People with diabetes must manage their blood glucose levels carefully to avoid complications like neuropathy, infections, and gangrene, potentially leading to leg and foot amputations. Treatments include infection prevention, wound healing, balloon angioplasty, leg bypass surgery, and arterial angiogenesis. Diabetes care requires a multidisciplinary team, including family doctors, endocrinologists, dietitians, nurses, diabetes educators, podiatrists, ophthalmologists, and cardiologists. For pregnant women with diabetes, the team also includes obstetricians and pediatricians or neonatologists experienced in managing such cases. Asthma, page 172 Asthma is now recognized as a chronic in ammatory disorder of the airways, rather than just a condition with isolated acute bronchospasm episodes. This in ammation causes the airways to become chronically sensitive, leading to air ow limitation and symptoms such as coughing, wheezing, chest tightness, and breathing di culties when irritated. The condition involves complex interactions among in ammatory cells, mediators, and airway tissues, resulting in air ow restriction due to acute bronchoconstriction, airway wall swelling, increased mucus production, and airway remodeling. During an asthma attack, patients compensate by breathing at higher lung volumes. In ammation increases airway responsiveness and includes key cells such as mast cells, T-lymphocytes, and eosinophils, which are also involved in allergic responses. Other morphological changes in asthma include mucus plugging, interstitial edema, microvascular leakage, bronchial epithelium destruction, and thickening of the subbasement membrane, as well as hypertrophy and hyperplasia of airway smooth muscle, increased goblet cell numbers, and enlarged submucus glands. The strongest identi ed risk factor for asthma is atopy, an inherited tendency for allergic reactions. Allergens such as domestic dust mites, animals with fur, cockroaches, pollens, and molds, as well as viral respiratory infections, especially in children, can trigger asthma. Avoiding these allergens and triggers, maintaining a clean and well-ventilated home, using air conditioning during high pollen and mold seasons, and getting annual in uenza vaccinations can help reduce asthma attacks. Asthma su erers should also avoid tobacco smoke, which can increase the severity of symptoms and the risk of allergic sensitization, particularly in children. Schizophrenia, page 174 Part 1 Schizophrenia is a serious mental illness a ecting over 2 million American adults, disrupting clear thinking, emotional management, decision-making, and social interactions. Misunderstood and stigmatized, schizophrenia is not caused by poor parenting or personal weakness and does not involve a "split personality." Proper diagnosis requires a thorough medical work-up to di erentiate from other conditions like drug use, Alzheimer’s, or bipolar disorder. Symptoms of Schizophrenia: - Positive Symptoms: delusions: false beliefs that others are reading their thoughts, plotting against them, or that they have special powers; hallucinations. These symptoms indicate a loss of touch with reality and are considered "positive" because they add abnormal experiences. - Negative Symptoms: emotional atness, inability to initiate and follow through with activities, reduced ability to enjoy activities or engage with life. These symptoms re ect an absence of normal behaviors and capabilities. - Cognitive Symptoms: di culty with thinking processes, lack of insight: often, individuals are unaware of their condition. Cognitive symptoms complicate daily functioning and pose challenges for e ective management of the illness. Part 2 Though incurable, schizophrenia is treatable and manageable. Acute psychotic symptoms often require emergency hospitalization and immediate therapy. Treatment includes antipsychotic medications, which primarily address positive symptoms but have little e ect on negative symptoms and cognitive issues. Medication adherence is critical, and long-acting depot injections help ensure compliance. Treatment plans need regular review to adjust to changing needs and manage side e ects. In acute phases, hospitalization may be necessary, especially if individuals Page 10 of 12 ff ff ff fi fl ffi fl ff fl ffi fl fl fl fl fl fl ff ff  are aggressive, violent, or at risk of self-harm or neglect. Immediate therapy in hospitals includes medication and support to stabilize the individual. Antipsychotic medications are key in treatment, helping to correct chemical imbalances in the brain and manage symptoms. Finding the right medication often involves trial and error. Part 3 Recovery support includes peer programs, Cognitive Behavioural Therapy (CBT), and occupational therapy to aid social integration and employment. Family support is crucial to reduce stress and enhance recovery, as the family environment signi cantly in uences prognosis. Intensive treatment and hospitalization may be necessary for acute symptoms, suicidal thoughts, or substance abuse. Eating disorders, page 177 Anorexia Nervosa: - Characterized by intentional starvation and extreme weight loss (at least 15% below normal body weight). - Often begins around puberty and involves severe hunger pains, emaciation, and a distorted body image. - Can cause vital organ damage, menstrual cessation, low blood pressure, slow thyroid function, dehydration, constipation, lowered body temperature, mild anemia, swollen joints, reduced muscle mass, and light-headedness. - May lead to sudden angry outbursts, social withdrawal, and has a high risk of death (10% of cases) from starvation, cardiac arrest, or suicide. Bulimia Nervosa: - Involves consuming large amounts of food followed by purging through vomiting, laxatives, diuretics, enemas, or excessive exercise. - Often maintained in secret, with su erers usually at normal or above-normal weight. - Can cause severe physical damage, such as stomach rupture, heart failure, esophageal in ammation, swollen glands, and irregular menstrual periods. - Associated with compulsive stealing, obsessive-compulsive disorder, and may develop in half of those with anorexia nervosa. Binge-Eating Disorder: - A ects about 2% of the general population, with one-third being men, and occurs less frequently in older women. - Involves eating large quantities of food without purging, leading to feelings of loss of control and discomfort. - Most su erers are overweight or obese, prone to medical issues like high cholesterol, high blood pressure, diabetes, gallbladder disease, heart disease, and certain cancers. - Individuals have high rates of psychiatric illnesses, especially depression, and struggle with weight uctuations and maintaining weight loss. Arteries, page 179 Blocked arteries in the heart, caused by fat and cholesterol plaque, can lead to heart attacks or death. Coronary balloon angioplasty, a procedure to improve blood ow, involves inserting a tiny balloon into the blocked artery and in ating it to compress the plaque against the artery walls. This method is less invasive than bypass surgery, which requires opening the chest and replacing the diseased artery with a healthy one from the leg, resulting in more incisions and higher risks. Angioplasty takes 30 minutes to 3 hours, beginning with injecting a dye into the bloodstream and inserting a catheter through the femoral artery. The balloon in ates to create more space in the artery, and sometimes a stent is implanted to keep it open. The procedure has a 90% success rate with a low risk of death (less than 2%) and heart attack (3-5%). Hospitalization lasts only three days. However, angioplasty treats the condition but does not eliminate the cause, leading to a 20% recurrence of plaque. It is not suitable for all patients; factors like age, medical history, blockage severity, and artery damage are considered before proceeding. Page 11 of 12 fl ff fl ff ff fl fl fi fl fl  E. Coli infection, page 197 E. coli (Escherichia coli) is a germ causing severe cramps and diarrhea, often bloody. Symptoms are more severe in children, the elderly, and those with other illnesses. The infection is more common in summer and northern countries. Infection sources include undercooked ground beef, contaminated water, unpasteurized milk, and contact with cattle. The germ can spread through improper food handling and in places like daycare centers and hospitals if proper hand-washing techniques are not followed. Symptoms start about seven days after infection, beginning with severe abdominal cramps and progressing to watery stools and bright red bloody diarrhea lasting 2-5 days. Severe cases can lead to Hemolytic Uremic Syndrome (HUS), causing hemolytic anemia, low platelet count, and kidney failure, especially in children. Diagnosis is through a stool culture within the rst 48 hours of bloody diarrhea onset. There are no treatments to cure the infection, relieve symptoms, or prevent complications. Treatment typically involves bed rest and uids to prevent dehydration and fatigue. There are no vaccines or medications to prevent E. coli infection, so avoiding risky foods and cross-contamination is essential. Depression, page 198 Depression is an illness with psychological, physical, and sociological symptoms recognizable to both the a ected individuals and those around them. Psychologically, su erers may exhibit sad thoughts, disinterest, mood swings, anxiety, stress, irritability, indecisiveness, and sudden tearfulness. Physically, they often appear unkempt, lack energy, and show signs of psychomotor retardation. Digestive issues, such as constipation or diarrhea, are also common. Some studies suggest that digestive problems may contribute to mild depression, causing feelings of sluggishness and lethargy. Cognitive behavioral therapy, page 200 CBT e ectively treats psychiatric illnesses like bulimia, schizophrenia, bipolar disorder, and depression by addressing social and communication di culties. It helps individuals recognize and replace distorted thoughts and behaviors with positive ones. This therapy improves self-esteem, perception, and problem-solving skills. While CBT is bene cial, it is typically combined with medication for the best results. Vocabulary Clenched st—> pugno chiuso Wringing—> torsione Fumble—> armeggiare Cattle—> bestiame/bovino Dazed—> frastornato, confuso Slaughtering—> macellazione Sti ening—> irrigidimento Polydipsia—> excessive thirsty Abruptly—> bruscamente Jaundice—> ittero Idiopathic—> of unknown origin Emphysema—> a lung disease that results Drowsiness—> sonnolenza from damage to the walls of the alveoli in Dull—> ottusa (vigilanza, alertness) your lungs Ischemia—> restriction in blood supply, Second-hand smoke—> fumo passivo causing a shortage of oxygen Dainty—> fragile Exertion—> sforzo, sovra aticamento Plethoric—> red face/cheeks Depot dose—> an injection formulation of a medication which releases slowly over time to permit less frequent administration Thrombocytopenia—> de ance of platelets Allogeneic transplant—> from a family member or a donor Comorbidity—> the simultaneous presence of two or more diseases in a patient Slurring—> sbiascicare Dysarthria—> di culty speaking Emaciated—> abnormally thin or weak Enema—> clistere Page 12 of 12 fl ff ff fi ff ffi fi ff fi ffi fi ff