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Most fltered Ca is absorbed passively in the proximal tubule and the loop of Henle. Loop diuretcs (furosemide) reduce the tubular resorpton of both Na and Ca, while thiazide diuretcs boost Ca resorpton with increased secreton of Na and Cl. Metabolic acidosis (excreton) of hydrogen ions also prevents Ca resorpton in the distal tubule. Around 88 % of P contained in the plasma is 53 % of dif fusible P in free (ionised) form and 35 % in the form of complexes. Physiology: Phosphorus not only forms an integral part of the skeleton, but is also essental for key cell structures. It forms part of nucleic acids, energy metabolism (high-energy phosphates), bufer systems and the phospholipid membrane. Although phosphorus is essental for many intracellular processes, its permanently elevated serum concentraton is toxic for the body. This accelerates the cell aging process and is, among other things, responsible for vascular calcif catons in chronic dialysed patents. Mg plays a major role in modulaton, maintaining home ostasis and intracellular calcium concentraton. Vitamin D exists in two basic forms: vitamin D2 (ergocalciferol) and vitamin D3 (cholecalciferol). In additon to conversion in the skin, vitamin D is absorbed in the intestne from food. Around 15 % of calcitriol is produced in the kidneys and is supplied to tssues without their own 1-hydroxylase such as enterocytes or pancreas. Its role here is primarily autocrine and paracrine, and it is responsible for non-skeletal efects of vitamin D. Vitamin D production Physiology the main functon of calcitriol produced by the kidneys is calcium and phosphate absorpton regulaton in the small intestne. Calcitriol is presently assumed to have an infuence on the expression of around 2000 genes in the human body, mea ning vitamin D has skeletal (calcium-phosphate metabolism) and non-skeletal efects. Calcitonin also has a slight renal efect where it inhibits reabsorpton of Ca and P. Despite this physio logical efect, calcium-phosphate homeostasis is not greatly dependent on calcitonin. Afer undergoing a complete thyroidectomy medullary cancer, patents display practcally normal calcium levels.

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Several types of presentation are possible: a large axillary, cervical or inguinal mass, or a large abdominal mass causing pain and an occlusive syndrome, or febrile pancytopenia or hyperleukocytosis (leukemia), or affection of a brain nerve, or a testicular tumour, or a kidney failure. This type of lymphoma can grow extremely fast (doubling in less than 48hrs), and can be responsible for a lysis syndrome with kidney failure, hyperuricemia, and requires urgent diagnosis. Its clinical form is different from that of the general population: localized nodal forms are rare and disseminated forms with visceral affections are the most frequent. These diseases and their treatment may influence treatment adherence and retention in care units. Drug use by injection is associated with some communicable infections and local infections including viral hepatitis B and C, septicaemia, bacterial endocarditis. Key interventions for the prevention, treatment and rehabilitation of these drug users are essential. It is particularly important to look for hypersensitivity to cotrimoxazole and interrupt the treatment. In addition, they must deal with the psychological and social disorders marked by the severity of emotional states that may vary with the passing days, by feelings of fear, anger, guilt, shame or depressive anxiety disorders that weaken them. This state of psychological discontent calls on the clinical psychologist who plays two parts: Facilitate the well-being and recovery of patients by helping them to cope well with the disease; Create a relationship in which patients can express their anxiety and fears and talk about their depression related to their situation. From observation, perception and listening of mental processes and their hazards, the clinical psychologist must identify the nature of mechanisms involved in the so-called normal and/or pathological mental functioning and propose a course of action. Such consultations shall be governed by the clinical method comprising: Listening; Observation; 137 Clinical interview with a diagnostic end (psychopathological approach, syndromic approach); Tests. Then list them and process to elimination; Use a systemic approach of reducing behavioural problems; 138 Follow-up and refer the patient to a clinical psychologist if necessary. The clinical psychologist must apply the same methods of psychological management while adapting it to children and adolescents. A provider who ensures counseling should be trained, equipped, respect confidentiality and have the informed consent of his client. Its role is to bring the client to express himself better, to help him understand the difficulties encountered; to be able to assimilate the information received during the interview and make a decision. To start with, the counselor introduces themselves, explains their role and reassures the person on the respect of confidentiality. Note: Pre-test counseling may require several interviews, for example, if the person is not sure they want to do the test or would like to ask more questions. After pre-test counseling, the counselor gives an appointment for post-test counseling.

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The other choices do not cause these Exposure of the extremities to severe cold results in the crys dermal ndings. Localized thrombosis often leads to focal ischemia and gangrene of toes and ngers. The absorption of micro Mechanical disruption of cellular membranes by ice crystals wave energy produces only heat and is not associated with any occurs during both freezing and thawing. The most common cause of death thesis, and its deciency results in poor wound healing. Perifol in seriously burned patients is sepsis after infection of the licular hemorrhages arise from capillaries that have weak walls burned skin. Gastric ulcers (stress or Curling ulcers, choice and are easily damaged by minor trauma. Impaired collagen B) are occasionally encountered in burn patients, but they do synthesis leads to gingivitis and alveolar bone resorption, result not represent a common cause of death. Wound healing requires collagen synthesis stomach (choice C) are associated with trauma to the central and is impaired in patients with vitamin C deciency (scurvy). Diagnosis: Scurvy, vitamin C deciency Diagnosis: Sepsis, thermal injury 19 the answer is E: Pellagra. A swollen, ssured in healthy men during unusually vigorous exercise, particu tongue and chronic watery diarrhea are also characteristic. Lactic acidosis, Dementia reects degeneration of ganglion cells in the cere hypocalcemia, and rhabdomyolysis may be severe problems. Malignant Diagnosis: Pellagra, niacin deciency Environmental and Nutritional Pathology 79 is the rule. In adults, vitamin D deciency results in osteomalacia, a disorder characterized by inadequate mineral 26 the answer is D: Vitamin K. Vitamin ness of bone is associated with a vulnerability to spontaneous K is an important coagulation factor, which is necessary for fractures. Thiamine deciency in deteriorated alcoholics results newborn in encephalopathy, peripheral neuropathy, and other disorders. Atrophy of the mammillary bodies, with loss of ganglion cells 27 the answer is C: Marasmus. Deciency of all elements of the and rupture of small blood vessels, is characteristic. The condition is common throughout cies of the other vitamins are not related to these disorders. The pathological changes are similar to those in starving 22 the answer is A: Vitamin A. Vitamin A deciency causes adults and consist of decreased body weight, diminished sub squamous metaplasia at a number of sites. In the cornea, it cutaneous fat, a protuberant abdomen, muscle wasting, and a leads to xerophthalmia (dry eye), which may progress to soft wrinkled face.

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It is typically indurated with a raised border that is clearly demarcated from normal skin. These forms of infection usually manifest with scaling patches, plaques, or papules. Dened as nodular lesions within the dermis con taining purulent material; commonly referred to as an abscess. Any alteration of normal intact skin such as a wound, ulcer, or dermatologic condition B. However, certain conditions or exposure may provide acquisition of other specic pathogens: A. Vibrio vulnicus (usually presents as sepsis and associated with salt water exposure). Tinea Infections are most commonly caused by three genera of fungi, also known as dermatophytes: Trichophyton (most common), Microsporum, and Epidermophyton. Candidiasis (most commonly Candida albicans) often is represented as an intense erythema (beefy red) with pustules. Malassezia furfur Causes a Supercial Fungal Infection (Known as Tinea Versicolor) That Results in Alteration of Pigmentation. The clinical manifestations of skin and soft-tissue infections are variable and depend on the anatomical site, host comorbid illnesses, immune response, and pathogen. Usually include signs of inammation: redness (rubor; due to increased blood ow to the affected area), warmth (calor; due to increased blood ow to the affected area), swelling (tumor; due to exudation of uid), and tenderness or pain (dolor; due to mechanical and/or chemical mediators of inammation). Often not all of the cardinal ndings are found because of early treatment or the comorbid status of the host. Usually occurs with skin and soft-tissue infections but may be absent owing to early treatment or immunodeciency. Fatigue, malaise, arthralgias, and myalgias (typically in association with Lyme disease) may be present. Mild tenderness and pain are part of the classic ndings, but signicant pain may indicate a necrotizing skin infection. Isolation of group A Streptococcus by culture (from a sterile or nonsterile site) B. Hypotension (systolic blood pressure less than 90 mmHg) and two or more of the following: 1.

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