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Answer: B Saddle nose deformity results from a depression caused by a decrease in the structural support of the cartilaginous or bony framework deep to the nasal soft tissue envelope acne skin care buy permethrin 30 gm cheap. Answer: A Tyrosinase is responsible for melanin synthesis and absence or reduced tyrosinase will lead to albinism acne while pregnant permethrin 30 gm on line. Galactosaemia is caused by deficiency in galactose-phosphate uridyltransferase skin care salon cheap permethrin 30 gm with mastercard, whereas Refsum disease is caused by deficiency in phytanic acid alpha-hydrolase acne 4 hour 30gm permethrin with mastercard. They usually occur in adults, rarely in childhood, and are mostly isolated but 3% are associated with multiple endocrine neoplasia type. Functioning tumours are associated with hormonal secretion; therefore, they are detected earlier and smaller (microadenoma). The most common type is prolactinoma followed by growth hormone-secreting adenoma. The treatment for prolactinoma is bromocriptine-a dopamine agonist-which inhibits the release of prolactin. On the other hand, non-functioning tumours do not produce excess hormone and may cause hypopituitarism due to mass effect. Most ophthalmologic symptoms and signs are secondary to mass effects caused by macroadenoma. Patients with pituitary adenoma need to be referred to Endocrinology immediately as many patients develop pan-hypopituitarism and need a full review of all the hormone levels. Many patients have a functioning pituitary adenoma which responds to medical treatment and early intervention ensures less comorbidity such as hypertension and cardiovascular disease. If the pituitary tumour is nonfunctioning, then the patient would be referred for surgery. Answer: D Zika virus is an arbovirus primarily transmitted to humans via the Aedes genus mosquito. Other ophthalmic abnormalities include iris coloboma, glaucoma, cataract, and lens subluxation findings. Griscelli syndrome is characterized by neurologic deficit, with or without immunologic impairment. Waardenburg syndrome is characterized by iris heterochromia, broad nasal root, and white forelock. Answer: D these are several interesting visual phenomenon/syndromes that the candidates should be familiar with. Anton syndrome refers to patients with cortical blindness who deny their blindness. This is due to bilateral retrochiasmal visual pathway diseases such as bilateral occipital lobe infarction. Blue field entoptic phenomenon describes the phenomenon of multiple tiny dots moving rapidly along wavy lines in the visual field, which is caused by the moving white blood cells within the superficial retinal capillaries. Charles Bonnet syndrome refers to formed and unformed visual hallucination in patients with bilateral poor vision. Pulfrich phenomenon refers to patients seeing targets moving towards them when the targets are moving perpendicular to the line of sight. Riddoch phenomenon refers to the preserved awareness of moving but not stationary stimuli. Psychophysical and neuroimaging responses to moving stimuli in a patient with the Riddoch phenomenon due to bilateral visual cortex lesions. Answer: A Migraine is a debilitating chronic neurologic disorder with a global prevalence of 2%. The criteria for migraine with aura are defined by at least two typical attacks of migraine with some form of aura symptoms (e. A recent meta-analysis found an increased risk of ischaemic stroke and myocardial infarction in patients with migraine with aura. Episodic migraine with and without aura: key differences and implications for pathophysiology, management and assessing risks.

Complement fixation test: Wasserman test; Kolmer test Principle: Reagin-containing sera (mixture of IgM and IgA) fix complement in the presence of "cardiolipin-cholestrol-lecithin complex" antigen skin care basics cheap permethrin 30gm amex. Add diluted serum containing antibody to the sensitized gelatin particle in a microdilution tray acne back discount 30 gm permethrin free shipping. Positive result when agglutination occurs Treatment: Penicillin Tetracycline Erythromycin Control measures: Treatment of cases and screen contacts Practice safe sex with condoms Health education T skin care companies discount 30gm permethrin otc. Tightly coiled acne 3 dpo order permethrin 30gm with amex, thin, flexible spiraled spirochetes forming one polared hooked ends. Fatty acid oxidation is major source of energy Antigenic structure: Lipopolysaccharide: Determine the specificity of human immune response to the organism and serologic classification of leptospirae Pathogenesis and clinical features: Essentially zoonotic infection and humans are accidental host Source of infection is contaminated foood and water with leprospia spp. Antigenic structure: Group-specific antigens Species-specific antigens Clinical Features: Clinical illness is due to the invasion and multiplication of rickettsiae in the endothelial cells of small blood vessels. These are: Typhus group Scrub typhus group Spotted fever group headache, malaise, skin rash and Table 2. It causes epidemic or louse-borne typhus and the milder recrudescence form, Brill-Zinser disease. Clinical Features: It is transmitted by self-inoculation of the organism by scratching after bite by infected louse(Pediculous humanus corporis and pediculous humanus capitis). The illness manifests with sudden onset of fever, headache, malaise, prostration and skin rash. Epidemics of the disease are associated with overcrowding, cold weather, lack of washing facilities and fuel, famine and war. The disease is milder than louse-borne typhus and occurs in those individuals living or working in highly rat-infested area. Laboratory diagnosis: Specimen: Serum for serological tests the serological tests to diagnose typhus are: 1. The smallest living micro-organism capable of free living in nature self-replicating on laboratory media. Highly pleomorphic due to absence of rigid cell wall, instead bounded by a triple-layered "unit membrane". Have enzyme systems and make their own proteins, lipids, nucleic acids and vitamins. The elementary body is reorganized into reticulate body in the host cell which is specifically adapted for intracellular growth. The reticulate body grows and divides many times to form inclusions in the host cell cytoplasm. With in 24-48 hours of developmental cycle, the reticulate bodies rearrange them selves into infective elementary bodies and released after host cell rupture. Antigenic structure: Group-specific antigen Species-specific antigen Chlamydia trachomatis. Appearance in iodine stain Brown inclusions in host cell cytoplasm because of glycogen matrix surrounding the particle. Incubation period is 3-10 days Route of transmission is through indirect contact like eye-toeye by infected fingers or sharing towels. It manifests as a chronic keratoconjunctivitis producing scarring and deformity of the eyelids, corneal vascularization and opacities which may lead to blindness. Culture: Mac coy cells or embryonated eggs Serology: Immunofluorescent tests Treatment: Erythromycin Tetracycline Control measures. Male - non-gonococcal urethritis Epididymitis 290 Conjunctival scraping from upper tarsal. Females- Urethritis Cervicitis Pelvic inflamatory diseases If complicated in females, it causes infertility and ectopic pregnancy. Neonatal inclusion conjunctivitis and neonatal pneumonia Transmission is during passage through the infected birth canal. Laboratorydiagnosis: Specimen: Endocervical scraping Culture: mac coy cells Serology: Enzyme immunoassay for group-specific antigen. On the basis of their life habits, microorganism is classified as saprophytes or parasites. Saprophytes: Mode of life of free-living organisms which obtain their nourishment from soil and water. Commensalism: the ability to live on the external or internal surface of the body with out causing disease.

Moreover skin care zarraz paramedical cheap permethrin 30gm with visa, there are not yet (and there will probably never be) established occupational exposure limits for all of the currently utilized substances acne keloid purchase permethrin 30 gm otc. There are also sampling and analytical errors: some can be avoided by careful procedures acne cleanser 30 gm permethrin mastercard, while others are inherent to a certain methodology and have to be accounted for when deciding on the degree of reliability required for the estimation of the true value of the exposure parameter acne in your 30s cheap permethrin 30 gm free shipping. If not, the responsible professional should design and follow a suitable strategy. However, although specific methodological principles have been well established, there are nuances in their application. Also, for the same type of agent and the same type of collecting medium, the recommended duration of sampling will be of the same order. However, specific situations may dictate differences in the number of samples required for an evaluation, because this, together with the quality of the measuring system, will determine the accuracy and precision of the obtained results, and the degree of reliability required will depend on the objective of the hazard evaluation. For the assessment of inhalation exposure, it is necessary to characterize the air that workers are actually inhaling; therefore, the samples should be collected in the "breathing zone," which is usually defined as a hemispherical zone with a radius of approximately 30 cm in front of the head. Some design considerations should include "worst case" exposure sampling or sampling a representative numbers of workers indicative of all job categories. Sampling should be of full-shift duration or for the complete length of a process cycle, if the objective is to determine a time-weighted average concentration. Due to the variability in results and the probable lognormal distribution of dust exposures, sampling needs to be conducted over several shifts and during several days to best characterize the workplace exposures. When assessing exposure to fast-acting substances (seldom the case with dusts) that can cause irreversible damage even on brief high exposures, sampling of very short duration (at the right time) is required, in order to detect concentration peaks, particularly if there are appreciable concentration fluctuations. High concentrations occurring for short periods can remain hidden, and undetected, if a sample is collected over a longer period of time during which very low concentrations also occur. Infrequently performed tasks also need to be characterized so that potential short duration but high concentration or peak exposures can be documented. For the same exposure situation (including the expected environmental fluctuations), if the coefficient of variation of the measuring procedure is known and constant, it is possible, through the application of inductive statistical methods, to determine how reliable an estimate is, or what degree of uncertainty can be expected from a certain number of samples or measurements. This will guide the decision on how many samples to collect or how many measurements to make. The better the sensitivity, accuracy and precision of the measuring system and the greater the number of samples, the closer the estimate will be of the true concentration. It is usually accepted that, if measurements are needed, they should be as accurate and precise, that is as "reliable", as possible. For example, in determining control measures the results should be reliable enough to decide what control action is necessary. A different accuracy may be required if the measurements are part of an epidemiological investigation. If it seems too costly and difficult to establish compliance (or non-compliance) with a standard, it may be better just to reduce the exposure. Considering that new knowledge on risk assessment often leads to a decrease in acceptable exposure limits, good practice should aim at controlling exposures to the lowest possible level. The required reliability depends largely on the consequences of making a wrong decision on the basis of the collected data. Modern exposure limits for dusts are usually expressed in terms of the inhalable or respirable fractions. Sampling for airborne particles requires instruments that extract them from a measured volume of air and collect them in a manner that permits subsequent weighing and/or chemical analysis, or particle counting under a microscope. These instruments comprise a sampling head, an air mover (with a power source) and a flowmeter. It is essential that the air mover (sampling pump) functions at a measurable and practically constant flow rate and that the flow is always checked before and after sampling with a properly calibrated flowmeter. Analysis of air samples should be performed by a qualified laboratory which has an established quality assurance/quality control programme. For exposure assessment, the best practice is to utilize personal samplers, which are portable sampling units carried by the workers as they move around. Care must be taken, however, when evaluating exposures to airborne particles, because it may happen that particles collected in the clothing are re-entrained into the sampling unit thus introducing a bias in the sampling, as demonstrated by Cohen et al. The objective of inhalable or respirable dust sampling is thus to separate out the larger particles from the dust stream, and to collect the remaining dust fraction on a filter or other media.

Syndromes

• If you do not get your period within 3 weeks after taking emergency contraception, you might be pregnant. Contact your health care provider.
• Palpitations
• Nerve blocking medicines injected into the toe area
• Thinning of the bone (osteoporosis)
• Fever
• Washing of the skin (irrigation) -- perhaps every few hours for several days
• Bleeding into the knee joint
• Fluid that collects under the skin
• Diabetes (fruity or sweet chemical smell with ketoacidosis)

Ancient skills the reason I described the menu of moneyless options early in chapter two is because the moment you mention the concept of moneyless living skin care guide purchase permethrin 30 gm overnight delivery, different things spring to mind for different people acne 6 days before period order 30 gm permethrin otc. Some skin care guru 30 gm permethrin with amex, like resource -based economists such as Peter Joseph and Jacques Fresco skin care 77054 generic permethrin 30 gm fast delivery, envisage a technotopia where machines do almost all the work within the context of a world that has conscious ly evolved beyond the concepts of debt and credit, concepts which money represents in physical form. O thers, like Derrick Jensen,(88) believe that the only sustainable way of living is one where the level of technology used is close to that of the palaeolithic era. The ca se Jensen presents in both volumes of Endgame is refreshingly rooted in reality and a place of deep ecological understanding, and it stands in stark contrast to the fantasies held by a people who want it all: an abundant, alive, healthy planet, and at the same time all the gadgetry that can only come at its expense. All of these can often rely on you understanding the art of making fire: food will often n eed to be cooked to make it edible, water may need to be boiled to purify it in a polluted environment, and in cold wet climes fire may be essenti al to avoid freezing and to stay dry. Depending on your personal reasons for wanting to live moneylessly and your unique situation, the ways in which you could go about making fire can vary widely. However, there are many good reasons for you to resist the use of lighters, even one s that are destined for landfill before their time, and other mass produced forms of fire-lighting equipment. I find cognitive dissonance difficult to deal with, and speaking out about the personal, social and ecological consequences of industrialisati on (and the concepts on which it relies) whilst simultaneously benefiting from it causes me quite a lot of cognitive dissonance. Second, it ensures that I have to stay alert about where I am, what the meteorological conditions are, what plants are around me and what time of day it is. The emotional, physical, mental and spiritual benefits of this are substantial and grossly underestimated. Such low levels of technology keep me present in the moment, and deeply aware of my surroundings. In comparison, the lighter is much less beneficial for the overall wellbeing of both the egocentric and h olistic self. Third, the industrialised system that creates such useful little gadgets may not exist at some point in the future. Therefore learning how to create fire without them could save your life in an apocalyptic style scenari o that we would all like to avoid. Likewise, if for some reason you find yourself in the middle of nowhere (like a forest) without a functioning lighter, then knowing how to utilise the natural materials at hand could be the difference between life and death. Mears speaks eloquently about our need to walk very gently in Nature, to leave as little trace as po ssible (which is also a good survival skill in countries with animals who want to eat you), whilst still providing you with all the skills you will need. Lofty is much more of a survivalist, which is understandable given his military background, and his focus is on the basic survival of the egocentric self alone. I strongly recommend doing a course close to wherever you live, with a teacher that has a good reputation and a deep regard for Nature. The longer the course you can do the better, as it will give you the experience of practising and honing these skills in all sorts of scenarios and weather condi tions. Alternatively, why not organise a local group ofbushcraft enthusiasts, where you meet regularly and teach each other whatever skills you know, or ru n a series of Freeskilling evenings or weekends on aspects of bushcraft This skill, tragically almost unheard of now in the global West, was a very important part of the lives of some peoples for over ten thou sand years. Once the flint is broken open, either accidentally or intentionally, it will have smooth surfaces and razor sharp edges. The colour of the inner sur face can range greatly, but black is often deemed best due to its high silicon content. Keeping this in mind, you will be looking to create a shape in the flint that is suitable for whatever its purpose will be, w hilst being safe for the user. This is only achieved with great thought given to the detail of the surface you are going to strike, such as the angle of the flint and the volume you are attempting to detach. Once you can describe the process as controlled, and you have a basic shape, then you will gently abrade the edges to tilt them and produce what we call a platform. This is then struck with the soft hammer, which produces longer and thinner flakes, leaving the edge of the item you are making sharp, as intended.

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