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Two heart sounds are normally clearly Audible per beat order 1pack slip inn visa, the first and second heart sounds discount slip inn 1pack mastercard. The heart sounds can be recorded by a microphone placed on the precordium, and a tracing of the sound is called a phonocardiogram. Anatomical location for best hearing the heart sounds th th Mitral valve: The mitral valve is best heard in the mid-clavicular line of the 4 -5 left intercostals space. Types of heart sounds First heart sound (S1) Heard by a stethoscope Frequency: 100Hz Duration: 0. Third heart sounds (S3) Generally, not heard by a stethoscope Recorded by phonocardiogram only one-third to one half of all persons Very low frequency Cause: Rushing of blood into the relaxing ventricles during early diastole Fourth heart sound (S4) or atrial sound Generally not heard by a stethoscope Recorded by phonocardiogram only one-fourth of all persons Very low frequency (about 20 Hz) Cause: Rushing of blood into the aorta and pulmonary artery from the contracting ventricles. A heart murmur is an abnormal sound that consists of a flow noise that is heard before, between, or after the lubb-dupp or that may mask the normal heart sounds. Mitral stenosis: Narrowing of the mitral valve by scar formation or a congenital defect Mitral insufficiency: Back flow or regurgitation of blood from the left ventricle into the atrium due to a damaged mitral valve or ruptured chordae tendinae. Valves of the heart and heart sounds 163 Hemodynamics The science of hemodynamics concerns the relation between blood flow, pressure, and resistance. The heart is a complicated pump, and its behavior is affected by a variety of physical and chemical factors. The blood vessels are multibranched, elastic conduits of continuously varying dimensions. The blood itself is a suspension of red and white corpuscles, platelets, and lipid globules suspended in a colloid solution of proteins.

For fecal specimen befor innoculatng on the plate agar 1pack slip inn,it is better to use selective broth such as selenit F to enhance the growth of salmonella which is usually found in small number discount slip inn 1pack with amex. Serology For serological examinations, paired acute and convalescent samples of serum should be collected at an interval of about 10 days in suspected enteric fever (17). Several serological tests including the classic Widal test for febrile agglutinins are available; however, it gives high rate of false positivity. The Widal test is a serological test for the presence of salmonella antibodies in patient’s serum when facilities for culturing or antigen testing are not available. Widal test if performed reliably and interpreted with care (with clinical finding) can be of value in diagnosing typhoid and paratyphoid fever. Most widal tests used as slide or tube serial dilution with manufactures providing details for both slide and tube test. Before use the antigen suspension must be allowed to worm at room temperature and well-mixed, sufficient serum for Widal test can be obtained from 3 – 5 ml of patient 113 venous blood collected in to a clean dry tube and allowed to clot. The Widal test is reported by giving the titer from both O and H antibody (antibody titer is the highest dilution of serum in which agglutination occur). In typhoid endemic areas in developing countries active typhoid is suggested if the titers of H or O or both, agglutinins are significantly raised (i. Shigellosis General Characteristics of the causative agents Shigellae are: ¾ Gram negative ¾ Non-sporing non-capsulated rods ¾ Unlike salmonellae and many other enterobacteria, shigellae are non- motile. Microscopy Fecal specimens from patients with shigellosis may be watery and contain little blood and mucus in the early stages of infection, but, consists almost entirely of pus and blood mixed with mucus in the later stages of infection. Serology Serological test can be performed since antibodies to somatic antigens develop early in the acute phase of disease. Cholera General Characteristics of the causative agent ¾ The main species of medically important is Vibro cholerae 01.

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The distinction between gray matter and white matter is most often applied to central nervous tissue safe slip inn 1pack, which has large regions that can be seen with the unaided eye cheap slip inn 1pack line. When looking at peripheral structures, often a microscope is used and the tissue is stained with artificial colors. There is also a potentially confusing use of the word ganglion (plural = ganglia) that has a historical explanation. In the central nervous system, there is a group of nuclei that are connected together and were once called the basal ganglia before “ganglion” became accepted as a description for a peripheral structure. There is an important point to make about these terms, which is that they can both be used to refer to the same bundle of axons. Those axons are called the optic nerve as they leave the eye, but when they are inside the cranium, they are referred to as the optic tract. There is a specific place where the name changes, which is the optic chiasm, but they are still This OpenStax book is available for free at http://cnx. The same axons extend from the eye to the brain through these two bundles of fibers, but the chiasm represents the border between peripheral and central. This is a tool to see the structures of the body (not just the nervous system) that depends on magnetic fields associated with certain atomic nuclei. The utility of this technique in the nervous system is that fat tissue and water appear as different shades between black and white. How do the imaging techniques shown in this game indicate the separation of white and gray matter compared with the freshly dissected tissue shown earlier? The problem with trying to fit functional differences into anatomical divisions is that sometimes the same structure can be part of several functions. For example, the optic nerve carries signals from the retina that are either used for the conscious perception of visual stimuli, which takes place in the cerebral cortex, or for the reflexive responses of smooth muscle tissue that are processed through the hypothalamus. Secondly, control of the body can be somatic or autonomic—divisions that are largely defined by the structures that are involved in the response.

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The radial vein and the ulnar vein parallel the bones of the forearm and join together at the antebrachium to form the brachial vein generic slip inn 1pack visa, a deep vein that flows into the axillary vein in the brachium purchase slip inn 1pack mastercard. The median antebrachial vein parallels the ulnar vein, is more medial in location, and joins the basilic vein in the forearm. As the basilic vein reaches the antecubital region, it gives off a branch called the median cubital vein that crosses at an angle to join the cephalic vein. The cephalic vein begins in the antebrachium and drains blood from the superficial surface of the arm into the axillary vein. It is extremely superficial and easily seen along the surface of the biceps brachii muscle in individuals with good muscle tone and in those without excessive subcutaneous adipose tissue in the arms. The subscapular vein drains blood from the subscapular region and joins the cephalic vein to form the axillary vein. As it passes through the body wall and enters the thorax, the axillary vein becomes the subclavian vein. Many of the larger veins of the thoracic and abdominal region and upper limb are further represented in the flow chart in Figure 20. Veins of the Upper Limbs Vessel Description Digital veins Drain the digits and lead to the palmar arches of the hand and dorsal venous arch of the foot Palmar venous Drain the hand and digits, and lead to the radial vein, ulnar veins, and the median arches antebrachial vein Vein that parallels the radius and radial artery; arises from the palmar venous arches and Radial vein leads to the brachial vein Vein that parallels the ulna and ulnar artery; arises from the palmar venous arches and Ulnar vein leads to the brachial vein Deeper vein of the arm that forms from the radial and ulnar veins in the lower arm; leads to Brachial vein the axillary vein Table 20. Lying just beneath the parietal peritoneum in the abdominal cavity, the inferior vena cava parallels the abdominal aorta, where it can receive blood from abdominal veins. The lumbar portions of the abdominal wall and spinal cord are drained by a series of lumbar veins, usually four on each side. The ascending lumbar veins drain into either the azygos vein on the right or the hemiazygos vein on the left, and return to the superior vena cava. Blood supply from the kidneys flows into each renal vein, normally the largest veins entering the inferior vena cava. Each adrenal vein drains the adrenal or suprarenal glands located immediately superior to the kidneys.