1 A- Cisplatin Dose-related and cumulative renal insufficiency, is the major dose-limiting toxicity of Cisplatin.

Renal toxicity has been noted in !" to #$" of patients treated %ith a single dose of &' mg(m . )t is first noted during the second %ee* after a dose and is manifested by elevations in +,- and creatinine, serum uric acid and(or a decrease in creatinine clearance. Renal toxicity becomes more prolonged and severe %ith repeated courses of the drug. Renal function must return to normal before another dose of Cisplatin can be given. .lderly patients may be more susceptible to nephrotoxicity. /he same side effects had the aminoglycosides and the loop diuretics - the patient had a cryptococcal infection, this fungus is heavily encapsulated yest, found in soil, pingeon -droppings. Culture on 0ubouraud agar. 0ain %ith )ndia )n* and %ith the latex agglutination test detects polysaccharide capsular antigen. -A see above explanation. #-A Diabetic nephropathy in light 1icro 2immelstiel-3ilson lesions 4%ire loop4 the basement membrane is thic* and in the pic you can see nodules in the periphery of the glomerulos classic imagine of diabetic 50, the nodules had the name of 2immrdiel3ilson

6- D the ris* of endometrial cancer increased if you used estrogen and don7t have a balance %ith the progesterone hormone, but remember the ris* of 8R/ after five years, to get breast cancer is around #'-6'" &.AA At days # and 9, the mitotic rates of basal cells of regenerating epithelium %ere # times higher than that of controls processes that are involved in active %ound healing can lead to an increased ris* for basal cell carcinoma in the s*in. $.+ p&# :also *no%n as protein &# or tumor protein &#;, is a tumor suppressor protein that in humans is encoded by the /<&# gene. p&# is important in multicellular organisms, %here it regulates the cell cycle and, thus, functions as a tumor suppressor that is involved in preventing cancer.)f the /<&# gene is damaged, tumor suppression is severely reduced. <eople %ho inherit only one functional copy of the /<&# gene %ill most li*ely develop tumors in early adulthood, a disease *no%n as =i->raumeni syndrome. /he /<&# gene can also be damaged in cells by mutagens :chemicals, radiation, or viruses;, increasing the li*elihood that the cell %ill begin decontrolled division. 1ore than &' percent of human tumors contain a mutation or deletion of the /<&# gene.

9- . ?en*er diverticulum often causes clinical manifestations such as dysphagia :difficulty s%allo%ing;, and sense of a lump in the nec*@ moreover, it may fill up %ith food, causing regurgitation :reappearance of ingested food in the mouth;, cough :as some food may be regurgitated into the air%ays;, halitosis :smelly breath, as stagnant food is digested by microrganisms; and involuntary gurgling noises %hen s%allo%ing. )t rarely, if ever, causes any pain. %i*ipedia.org(%i*i(?en*er7sAdiverticulum

!-+ ma*e diagnosis and offer to educate the patient B-D acute 1), t<A catalyCes the conversion of plasminogen into plasmin. /o be most effective in ischemic stro*e, t<A must be administered as early as possible after the onset of symptoms. <rotocol guidelines reDuire its use intravenously %ithin the first three hours of the event, after %hich its detriments may out%eigh its benefits. 1'-C pulmonary edema increases the thic*ness of the alveolo-capillary space, increasing the distance the oxygen must diffuse to reach blood. /his impairs gas exchange leading to hypoxia, increases the %or* of breathing, eventually induces >)+RE0)0 E> /8. A)R0<AC.. httpF((en.%i*ipedia.org(%i*i(AcuteArespiratoryAdistressAsyndrome

11 A 1 -A /he treatment of choice for prolactinomas is dopamine agonist administration, %hich results in tumor shrin*age, normaliCation of prolactin, and restoration of gonadal function in the majority of patients. - bromocriptineF )ts use is limited by a high incidence of side effects, a short duration of action, and a lac* of effectiveness in some patients. - cabergolineF a long-acting oral dopamine agonist specific for the D receptor@ the most interesting feature of cabergoline in terms of patient compliance is its extremely long half-life. 1ost patients can be treated %ith a single %ee*ly dose, is in contrast to the 1-# times daily administration reDuired for brornocriptine.

1#-+ Galproate - bloc*s the voltage-gated sodium channels and /-type calcium channels. - inhibition of the transamination of 5A+A :by inhibiting 5A+A transaminase, then 5A+A %ould increase in concentration; CarbamaCepine - stabiliCes the inactivated state of sodium channels, meaning that fe%er of these channels are available to subseDuently open, ma*ing brain cells less excitable :less li*ely to fire;. - potentiates 5A+A receptors <henytoin - reducing electrical conductance among brain cells by stabiliCing the inactive state of voltage-gated sodium channels

16 -A competitive antagonist cause a parallel shift to the right in the dose response curve for the agonist image for D 16 :competitive antagonist; httpF((%%%.chemistry.emory.edu(justice(test(images(fig1.B.gif

1& .. 5/< is essential to signal transduction, particularly %ith 5-proteins, in secondmessenger mechanisms %here it is converted to 5D< :guanosine diphosphate; through the action of 5/<ases Adenylate cyclase :.C 6.$.1.1, also *no%n as adenylyl cyclase, adenyl cyclase or AC; is a lyase enCyme. )t is a part of the cA1<-dependent path%ay Adenylate cyclase can be activated or inhibited by 5 proteins, %hich are coupled to membrane receptors and thus can respond to hormonal or other stimuli. >ollo%ing activation of adenylate cyclase, the resulting cA1< acts as a second messenger by interacting %ith and regulating other proteins such as protein *inase A and cyclic nucleotide-gated ion channels. 5 proteins :guanine nucleotide-binding proteins; are a family of proteins involved in transmitting chemical signals outside the cell, and causing changes inside the cell. /hey

communicate signals from many hormones, neurotransmitters, and other signaling factors. H1I 5 protein-coupled receptors are transmembrane receptors. 0ignal molecules bind to a domain located outside the cell. An intracellular domain activates a 5 protein. /he 5 protein activates a cascade of further compounds, and finally causes a change do%nstream in the cell. 5 proteins function as molecular s%itches. 3hen they bind guanosine triphosphate :5/<;, they are 7on7, and %hen they bind guanosine diphosphate :5D<;, they are 7off7. 5 proteins regulate metabolic enCymes, ion channels, transporters, and other parts of the cell machinery, controlling transcription, motility, contractility, and secretion, %hich in turn regulate systemic functions such as embryonic development, learning and memory, and homeostasis.H I httpF((en.%i*ipedia.org(%i*i(AdenylateAcyclase image for D 1& :adenylate cyclase activation; httpF((bio%eb.%*u.edu(courses(biol&$$()mages(5prot .jpg

1$. C 1itral RegurgitationF =oudest at apex and radiates to%ard the axilla. .nhanced by maneuvers that J /<R : eg. 0Duatting, hand grip;, or =A return :eg. expiration;. 1R is often due to ischemic heart disease , mitral valve prolapsed, or =G dilation. 0tro*e Golume affected by contractility, afterload and preload. 0tro*e Golume J%henF J <reload, K Afterload, :>A page &1, &&;

19. C =ipopolysaccharides :=<0;, also *no%n as lipoglycans, are large molecules consisting of a lipid and a polysaccharide joined by a covalent bond@ they are found in the outer membrane of 5ram-negative bacteria, act as endotoxins and elicit strong immune responses in animals. 1ost cases of septic shoc* :approximately 9'"; are caused by endotoxin-producing 5ram-negative bacilli. .ndotoxins are bacterial %all lipopolysaccharides :=<0; consisting of a toxic fatty acid :lipid A; core common to all 5ram-negative bacteria, and a complex polysaccharide coat :including E antigen; uniDue for each species. Analogous molecules in the %alls of 5ram-positive bacteria and fungi can also elicit septic shoc*. >ree =<0 attaches to a circulating =<0-binding protein, and the complex then binds to a specific receptor :CD16; on monocytes, macrophages, and neutrophils. .ngagement of CD16 :even at doses as minute as 1' pg(m=; results in intracellular signaling via an associated 4/oll-li*e receptor4 protein 6 :/=R-6;, resulting in

profound activation of mononuclear cells and production of potent effector cyto*ines such as )=-1 and /->-L. )mmune response =<0 function has been under experimental research for several years due to its role in activating many transcription factors. =<0 challenge also produces many types of mediators involved in septic shoc*. 8umans are much more sensitive to =<0 than other animals :e.g., mice;. A dose of 1 Mg(*g induces shoc* in humans, but mice %ill tolerate a dose up to a thousand times higher.H1#I /his may relate to differences in the level of circulating natural antibodies bet%een the t%o species.H16IH1&I 0aid et al. sho%ed that =<0 causes an )=-1'-dependent inhibition of CD6 /-cell expansion and function by upregulating <D-1 levels on monocytes %hich leads to )=-1' production by monocytes after binding of <D-1 by <D-=.

1!. > )nnervationF +oth right and left vagus nerves ascend to the brain in the carotid sheath, lateral to the carotid artery.

/he right vagus nerve gives rise to the right recurrent laryngeal nerve, %hich hoo*s around the right subclavian artery and ascends into the nec* bet%een the trachea and esophagus. /he right vagus then crosses anteriorly to the right subclavian artery and runs posterior to the superior vena cava and descends posterior to the right main bronchus and contributes to cardiac, pulmonary, and esophageal plexuses. )t forms the posterior vagal trun* at the lo%er part of the esophagus and enters the diaphragm through the esophageal hiatus.

/he left vagus nerve enters the thorax bet%een left common carotid artery and left subclavian artery and descends on the aortic arch. )t gives rise to the left recurrent laryngeal nerve, %hich hoo*s around the aortic arch to the left of the ligamentum arteriosum and ascends bet%een the trachea and esophagus. /he left vagus further gives off thoracic cardiac branches, brea*s up into pulmonary plexus, continues into the esophageal plexus, and enters the abdomen as the anterior vagal trun* in the esophageal hiatus of the diaphragm. +oth the vagal nerves have their cell bodies contained in the t%o nodose ganglia.

1B. A Alendronic acid :)--; or alendronate sodium :,0A-, sold as >osamax by 1erc*; is a

bisphosphonate drug used for osteoporosis and several other bone diseases. )t is mar*eted alone as %ell as in combination %ith vitamin D : ,!'' , and &$'' ,, under the name >osamaxND;. 1erc*7s ,.0. patent on alendronate expired in ''! and 1erc* lost a series of appeals to bloc* a generic version of the drug from being certified by the ,.0. >ood and Drug Administration :>DA;. 0ide-effects O 5astrointestinal tractF ulceration of the esophagus@ this may reDuire hospitalition and intensive treatment. 5astric and duodenal ulceration may also occur. December #1, ''!, the >DA reported alendronate and related drugs may carry an increased ris* for esophageal cancer.H#I O 5eneralF infreDuent cases of s*in rash, rarely manifesting as 0tevens-Pohnson syndrome and toxic epidermal necrolysis, eye problems :uveitis, scleritis; and generaliCed muscle, joint, and bone pain H6I :rarely severe; have been seen. )n laboratory tests decreased calcium and phosphate values may be obtained but reflect action of the drug and are harmless. O Esteonecrosis of the Pa% - Deterioration of the /emporomandibular Point :/1P; may occur %hile on this drug, if dental %or* of any *ind is carried out.H&I Although osteonecrosis is uncommon, it occurs primarily in patients being administered intravenous biphosphonates, %ith most cases being reported in cancer patients.Hcitation neededI O -eurologicalF Rare instances of auditory hallucinations and visual disturbances have been associated %ith alendronate and other bisphosphonates.H$I O +oneF Alendronate has been lin*ed in long-term users to the development of lo%impact femoral fractures.H9I >urther, studies suggest that users of alendronate have an increase in the numbers of osteoclasts and develop giant, more multinucleated osteoclasts@ the significance of this development is unclear.H!I <eople %ho have ta*en >osamax has been lin*ed to a rare type of leg fracture that cuts straight across the upper thigh bone after little or no trauma. :0ubtrochanteric fractures; HBI /his is because >osamax ma*es the thigh bone more brittle and stops the cells in the body that remodel the bone. 0tudies are sho%ing that people %ho have ta*en >osamax for more than five years are at ris* for developing these *ind of fractures. )n some cases, patients have reported that, after %ee*s or months of unexplained aching, their thigh bones simply snapped %hile they %ere %al*ing or standing. Ene doctor reports that a &B-year old previously healthy %oman visiting -e% Qor* City %as riding a sub%ay train one morning %hen the train jolted. 0he shifted all her %eight to one leg, felt a bone snap, and fell to the floor of the train. An x-ray in a local emergency room revealed a comminuted spiral fracture involving the upper half of the right femur. 0he had been ta*ing >osamax for 9 years. H1'I En Ect. 1#, '1' the >ood and Drug Administration issued a %arning about these fractures.

httpF((en.%i*ipedia.org(%i*i(AlendronicAacid

'. A A dislocated hip is a condition that can be congenital or acDuired. Congenital hip dislocations are much more common in girls than in boys. /he pelvis and femur are the t%o main bones that form the hip joint. /here is an articulation of the head of the femur and the acetabulum of the pelvis. /ogether, they ma*e the hip joint an enarthrodial joint. /here are t%o pelvic bones :right and left;, each consisting of the )lium, ischium, and the pubis. /hey connect to form the symphysis pubis on the anterior side, %hile the posterior side connects %ith the sacrum and coccyx to form sacroiliac joints.H I /hese bones are joined %ith help of strong ligaments, ma*ing them slightly, movable joints. /here are five strong and dense ligaments that help to reinforce the hip joint. /hey include the iliofemoral ligament, the teres ligament, the pubofemoral ligament, the ischiofemoral ligament, and the Cona orbicularis ligament. /he iliofemoral ligament helps to prevent hip hyperextension, as it is one of the strongest ligaments in the body. /he teres ligament slightly limits hip adduction, %hile the pubofemoral ligament limits excessive extension and abduction. /he ischiofemoral ligament limits internal rotation of the hip, %hile the Cona orbicularis ligament helps maintain contact in the joint. Congenital hip dislocation must be detected early %hen it can be easily treated by a fe% %ee*s of traction. )f it is not detected, the child7s hip may develop incorrectly seen %hen the child begins to %al*. )f one hip is affected the child %ill have a limp and lurch and %ith bilateral dislocation there %ill be a %addling gait. En physical exam, %ith the baby in the supine position, the examiner flexes the hips and *nees both to B' degrees, and, holding the *nees, pushes gently do%n%ard, %hich may induce a posterior dislocation or subluxation. 2eeping the baby in this B' degree flexed position, the examiner then externally rotates the thighs. A normal infant %ill demonstrate no evidence of dislocation. )t can also be detected %ith the 5aleaCCi test. Congenital hip dislocation is much more common in girls than boys. AcDuired hip dislocations are extremely painful and commonly occur during car accidents. /hey may be treated by surgical realignment and traction.

httpF((en.%i*ipedia.org(%i*i(DislocationAofAhip 1. C +enign <rostatic hyperplasia :+<8; Common in men R &' y(o. 8yperplasia : -o hypertrophy; of the prostate gland. 1ay be

due to an age- related J in estradiol %ith possible sensitiCation of the prostate to gro%thpromoting effects of D8/. CharacteriCed by a nodular enlargement of the periurethral :lateral and middle ; lobes, %hich compress the urethra into a vertical slit. Eften present %ith J freDuency of urination, nocturia, difficulty starting and stopping the stream of urine, and dysuria. 1ay lead to distention and hypertrophy of the bladder, hydronephrosis, and ,/)s. -ot considered a premalignant lesion. J<0A. /x F L1 antagonists, : /eraCosin, /amsulosin;, %hich cause relaxation of smooth muscle. : >A page 6B#;

SSSSSSSSSSSSSSS Correction SSSSSSSSSSSSSSSSS 1. +<8 Common in men R &' y(o. 8yperplasia : -o hypertrophy; of the prostate gland. 1ay be due to an age- related J in estradiol %ith possible sensitiCation of the prostate to gro%thpromoting effects of D8/. CharacteriCed by a nodular enlargement of the periurethral :lateral and middle ; lobes, %hich compress the urethra into a vertical slit. Eften present %ith J freDuency of urination, nocturia, difficulty starting and stopping the stream of urine, and dysuria. 1ay lead to distention and hypertrophy of the bladder, hydronephrosis, and ,/)s. -ot considered a premalignant lesion. J<0A. /x F L1 antagonists, : /eraCosin, /amsulosin;, %hich cause relaxation of smooth muscle. : >A page 6B#;

.5 0pecificityF /- ( : /-N ><; 0pecificityT !1'( : B'N !1'; T '.B : B'";

#. + Acute RejectionF Cell mediated due to cytotoxic / lymphocytes reacting against foreign 18Cs. Eccurs %ee*s after transplantation. Reversible%ith immunosuppresants such as cyclosporine and E2/#. : >A page 1#; 8yperacute RejectionF antibody mediated type )) due to presence of presence of performed antidonor antibodies in the transplant recipient. Eccurs %ithin minutesafter

transplantation. Acute RejectionF Cell mediated due to cytotoxic / lymphocytes reacting against foreign 18Cs. Eccurs %ee*s after transplantation. Reversible%ith immunosuppresants such as cyclosporine and E2/#. Chronic rejectionF / cell- antibody mediated vascular damage : obliterative vascular fibrosis;, occurs months to years after transplantation. )rreversible. 5RA> -G.R0,0-8E0/ D)0.A0.. 5RA>/.D )11,-ECE1<./.-/ / C.==0 <RE=)>.RA/. )- /8. RAD)A/.D )11,-ECE1<RE1)0.D 8E0/ A-D R.P.C/ C.==0 3)/8 4 >ER.)-5-4 <RE/.)-0,R.0,=/)-5 )- 0.G.R. ER5ADQ0>,-C/)E-. 1APER 0Q1</E10 )-C=,D. A 1AC,=AR<A<,=AR RA08, PA,-D)C.. hepatomegal and diarrhea. : >A page 1#;

#1.AA 8aemophilus influenCae type +.... /he 8ib conjugate vaccine is an inactivated vaccine. )t is made by chemically bonding a polysaccharide :sugar; to a protein. /his long chain of sugar molecules ma*es up the surface capsule of the bacterium. # ... Absence seiCures or petit mal epilepsy /here is a correlation bet%een 0=E3 3AG. 0=..< :stage # and 6 a*a delta sleep ; and abscence seiCures ....one of the correlation is 0lo%-%ave sleep as %ell as generaliCed absence seiCures are characteriCed by the occurrence of synchroniCed oscillations in thalamocortical systems that spontaneously appear and disappear. 3hat are this synchroniCed oscillations U

-Escillations TRemember from highschool physics ...if u put a load to a spring it oscillates ....the same thing neurons oscillate :another term is repititive variation; ...%hich is called neural oscillation -eural oscillation is rhythmic or repetitive neural activity in the central nervous system .And this can be due to rhythmic increases and decreases in action potential activity,%hich then produce rhythmic activation of synapses in target neurons. /his oscillations can be physiolgical or patholgical.

<athological oscillations T0pecific types of neural oscillations may also appear in pathological situations, such as <ar*inson7s disease or epilepsy. )nterestingly, these pathological oscillations often consist of an aberrant version of a normal oscillation. >or example, one of the best *no%n types is the spi*e and %ave oscillation:synchroniCed oscillation ; , %hich is typical of generaliCed or absence epileptic seiCures, and %hich resembles normal sleep spindle oscillations. ##; C

+lood supply to the testis primarily originates from the testicular artery, %hich arises from the aorta. Ether sources of blood supply include the deferential artery, %hich supplies the epididymis and the vas deferens and the cremasteric artery supplies the peritesticular tissues.

##.CC /he testicular artery :the male gonadal artery, also called the internal spermatic arteries in older texts; is a branch of the abdominal aorta that supplies blood to the testis. )t is a paired artery, %ith one for each of the testes. )t is the male eDuivalent of the ovarian artery. httpF((en.%i*ipedia.org(%i*i(>ileF5ray&#1.png

#6.>> ) go %ith $' " ...for the follo%ing reasons

1-Autosomal dominant diseases occurence is affected by many things ...among those is the number of trinucleotide repeats in the proband...also variable penetrance ...and etc..... 3hich means AD diseases are not al%ays sho%n up 1'' " -Clearly the Duestion gives us the trinucleotide repeat expansion peneterance figures

and for 1& /rinucleotide Repeat .xpansion the ris* is $' " ....

8untington7s Disease is an AD disease %hich means that an affected individual /Q<)CA==Q inherits a defective gene from an A>>.C/.D parent. )f the parent has a trinucleotide repeat count that is normal :6' :full penetrance;. +ac* to the Duestion. it can be any trinuc expansion disorder. +ut used 8unt. disease to illustrate some points. >irst, ris* doesn7t necessarily reflect that the parent has the disorder but the parent can be an unaffected carrier %ith trinuc expansions that %ill not result in full penetrance. 0econd, the graph is very important. )t sho%s that individuals inheriting a gene %ith a trinuc expan. of ' have a 1''" ris* of the disease :full penetrance;, as %ell as those %ith CA5 repeats of B or less have '" ris*. /he curve represents reduced penetrance :%here some individuals fail to exhibit the trait even though they carry the abnormal allele. As the number of CA5 repeats increase there is an increase in the percentage of individuals at ris* of the disease. /his implies that penetrance is increasing up to point %here it becomes full or complete :all individuals %ho have the abnormal allele %ill manifest :signs(symptoms; the disease. /he ans%er that best fits the curve is $'"

#&.CC Clostridium perfringens is a 5ram-positive, rod-shaped, anaerobic, spore-forming bacterium of the genus Clostridium. C. perfringens is ever present in nature and can be found as a normal component of decaying vegetation, marine sediment, the intestinal tract of humans and other vertebrates, insects, and soil. Clostridium perfringens is the most common bacterial agent for gas gangrene, %hich is necrosis, putrefaction of tissues, and gas production. )t is caused primarily by Clostridium perfringens alpha toxin. /he gases form bubbles in muscle :crepitus; and the characteristic smell in decomposing tissu )n the ,nited 2ingdom and ,nited 0tates, C. perfringens bacteria are the third-mostcommon cause of food-borne illness, %ith poorly prepared meat and poultry the main culprits in harboring the bacterium./he clostridium perfringens enterotoxin :C<.; mediating the disease is heat-labile :inactivated at 96 VC; and can be detected in contaminated food, if not heated properly, and feces .

#$; ddddd graph AF =8 graph +F >08 graph CF progesterone

#9.CC 8igh sodium inta*e increases body %eight , plasma volume,cardiac index , and stro*e volume index. )n the body, sodium is processed by the *idneys. 8o%ever, %hen a person eats too much sodium, the *idneys cannot process all of it. /he excess sodium ends up in the bloodstream. +ecause the mineral retains %ater, the volume of blood in the body increases. As a result, the circulatory system has to %or* harder to pump the blood. Ever time, this added strain on the system can result in heart disease and *idney failure

#! - D <atient had C8>, 4=G>4, all%ays if pulmonary edema =8> the main symptom the 0E+ Can7t get blood out of the heart b(c the =G fails, increassed the .DG because all the blood can not get out, then the pressure and volume %ill go bac* to the left atrium, bac* into the pulmonary vessels, increased the hydrostatic pressure and then <,=1E-ARQ .D.1A 3hat happen in the C8>UF Dicreased the cardia output regulated by RAA 0ystem li*e the +lood pressure, the renal perfusion is decreased then the renin increases---- renin convert angiotensinogen into angiotensin ). AC. found mainly in endotelial cells of pulmonary vessels, converts angiotensin ) into angiotensin )). Angiotensin )) has a potent effects to stimulate secretion of aldosterone and to cause arteriolar vasoconstriction. stimulates reabsorption of -aN and A=0E Cause increased renal excretion of potassium affecting the plasma 2A concentration #B-D httpF((%%%.medicalne%stoday.com(releases(#!9!$.php <rostacyclin :<5) ; chiefly prevents formation of the platelet plug involved in primary hemostasis :a part of blood clot formation;. )t does this by inhibiting platelet activation.H6I )t is also an effective vasodilator. <rostacyclin7s interactions in contrast to thromboxane :/WA ;, another eicosanoid, strongly suggest a mechanism of cardiovascular homeostasis bet%een the t%o hormones in relation to vascular damag

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/he 1=> carries information about the direction that the eyes should move.

)t yo*es the cranial nerve nuclei ))) :Eculomotor nerve;, )G :/rochlear nerve; and G) :Abducens nerve; together, and integrates movements directed by the gaCe centers :frontal eye field; and information about head movement :from cranial nerve G))), Gestibulocochlear nerve;. )t is an integral component of saccadic eye movements as %ell as vestibulo-ocular and opto*inetic reflexes.

)t also carries the descending tectospinal tract and medial vestibulospinal tracts into the cervical spinal cord, and innervates some muscles of the nec* and upper limbs

=esions of the 1=> produce internuclear ophthalmoplegia and can be a presenting symptom of multiple sclerosis %here it presents as nystagmus and occasionally diplopia./hese lesions cause damage to the ipsilateral :same side; eye, but nystagmus on the contralateral :opposite side; eye.

to Add X Y 6'-D 8oriContal gaCe to the right results from activation of the right abducens nucleus and the left oculomotor nucleus by fibers in the 1=>. =esions in the 1=> results in an internuclear opthalmoplegia, li*e above explained by maryam, then there is an inability to adduct one eye on attempted gaCe to the opposite side. >or example a lesion in the right 1=> results in an inability to adduct the right eye on attempted gaCe to the left :see figure )G-&-1' Goluntary 8oriContal Conjugate gaCe; in *aplan Report Abuse S ReF-+1. 9 bloc* 6 D 1 to &' Y #B9'6 dna # - '&(1!(11 '9F1#

/he ans%er is + httpF((%%%.radiologyassistant.nl(en(6$6$f1 9!c $f, 4chec* the Y9 in the figure4, subcarinal node is in the area bet%een both main stem bronchus, joinet %ith the paraesophageal nodes and pulmonary ligament node comfort the :)nferior 1ediastinal -odes; 6 -+ =ingual thyroid is a RAR. condition, %ith an incidence of 1F1'','''. /his infreDuent congenital anomaly is often asymptomatic until a pathologic stress such as systemic disease or physiologic stress such as puberty causes enlargement of the

ectopic tissue, leading to dysphagia, dysphonia, and dyspnea. /he %or*-up should include routine blood %or* including thyroid function tests thyrotropin, thyroxine, and thyroid hormone binding ratio@ iodine thyroid scintigraphy@ and computeriCed tomography or magnetic resonance imaging. /he majority of patients reDuire surgical excision of the symptomatic mass and, in case of absence of orthotopic thyroid tissue, long-term thyroid hormone replacement. httpF((onlinelibrary.%iley.com(doi(1'.1'B9(1=5.'b'1#e#1!1$f$B syst...maintenance (abstractU

6# A 0orry guys the ans%er of XY 6# is A Acne vulgaris :or acne; is a common human s*in disease, characteriCed by areas of s*in %ith seborrhea :scaly red s*in;, comedones :blac*heads and %hiteheads;, papules :pinheads;, pustules :pimples;, nodules :large papules; and possibly scarring.H1I Acne affects mostly s*in %ith the densest population of sebaceous follicles@ these areas include the face, the upper part of the chest, and the bac*. 0evere acne is inflammatory, but acne can also manifest in noninflammatory forms.H I /he lesions are caused by changes in pilosebaceous units, s*in structures consisting of a hair follicle and its associated sebaceous gland, changes that reDuire androgen stimulation httpF((en.%i*ipedia.org(%i*i(AcneAvulgaris

66. + >olate defficiencyF megaloblastic anemia : <1- nucleus more that & lobes as is seeng in the fig; /8> is formed from the vitamin >olate through reductions cataliCed by D8> reductase. )t pic* up 1- carbon unit from a variety of donors and enter the active 1- carbon pool. )mportant path%ays reDuiring forms of /8> from this pool include the synthesis of all purines and thymidine, %hich in turn are used for D-A and R-A synthesis during cell gro%th and division. :2aplan +ioch.boo* page $!;. 6&. + 5emfibroCil : fibrate;F J8D=, K=D=, K /5. 1ech of actionF ,pregulate =<=, J/5 clearance. 0ide effectsF 1yositis, 8epatotoxicity : J =>/s;, Cholesterol 5allstones :>A page 9!; 6$. C

Rective Exygen 0pecies :RE0;F 3hen molecular E is partially reduced, unstable products, called :RE0; are formed. /hese react rapidly, %ith lipids to cause, peroxidation, %ith proteins, and %ith other substrates, resulting in denaturation and precipitation in tissues. RE0 includeF 0uperoxide, 8ydrogen peroxide, 8ydroxyl radical. /he rate of RE0 production can increase dramaticallyunder certain conditions, such as reperfusion injury in a tissue that has been temporally deprived of oxygen. A/< levels %ill be lo% and -AD8levels high in a tissue deprived of E : as in an 1);. to add X 6$ C :2aplan +ioch boo* page 1B#;