Freak Out: The 1960s Musical Avant-garde Revisited Essay -- Musicals

Oddity Out: The 1960s Musical Avant-garde Revisited â€Å"This is my occurrence and it monstrosities me out!† Z-man Barzel in Beyond the Valley of the Dolls (1970) The title of this exposition â€Å"Freak Out: The 1960s Musical Avant-garde Revisited† welcomes me to investigate the blast of new thoughts that saturated numerous types of western melodic articulation during the 1960s. At the point when I was given another course to instruct at the University of Guelph called â€Å"The Musical Avant-garde† (2002) nobody could very mention to me what they implied me to instruct, then again, actually it would cover all that â€Å"difficult music† of the second 50% of the twentieth century. By this my associates implied genuine European craftsmanship music by gold-plate writers, for example, Pierre Boulez, Karlheinz Stockhausen, Luigi Nono, Luciano Berio, and Gyorgy Ligeti. Soon after the finish of WWII, the â€Å"new music† mixed around the Darmstadt summer courses in structure where these youthful European authors, cut off from one another during the war, rediscovered the music of mid twentieth century pioneers, for example, Arnold Schoenberg, Alban Berg and particularly Anton von Webern, and were enlivened by their extreme thoughts of making new frameworks for creating music. Youthful European arrangers didn’t attempt to compose music like Schoenberg and Webern, rather they acknowledged these composers’ fundamental standards: the possibility of pre-requesting melodic components (serialization) and regarding each solid as a discrete occasion, autonomous of the sounds around it. From these two premises, a wide range of energizing new ground was opened up †from thorough compositional control to the idea that one could decide to leave things all the way open to risk - so that by the 1960s melodic components, for example, tone sh ading and surface replaced conventional ha... ... our site yet under no conditions are the writings and pictures to be duplicated and mounted onto another site server. Analysts utilizing the site ought to certify it adhering to standard MLA rules on the most proficient method to do as such. Right reference of data from the site is as per the following: Waterman, Ellen. Sounds Provocative: Experimental Music Performance in Canada. College of Guelph. 2005. . This exploration has been endorsed by the Research Ethics Board at the University of Guelph who can be reached at 519-824-4120 x 56606. The undertaking is liberally bolstered by the Social Sciences and Humanities Research Council of Canada, the College of Arts, and the School of Fine Art and Music, University of Guelph. Copyright  © 2005 Waterman, Ellen. Sounds Provocative: Experimental Music Performance in Canada. College of Guelph. All Rights Reserved

Congress of Vienna essays

Congress of Vienna articles The Congress of Vienna, the sorting out gathering of alliance against Napoleon and France, was a significant structure hinder later on for Europe for a long time to come. The Conservative Political and Social perspectives on the pioneers of the time lead to an effective harmony settlement to end this Napoleonic The principal demonstration to end Napoleon's standard was to make some new solidarity after the alliance had walked in Paris and crushed Napoleon. Each nation was starting to seek after their own advantages and float separated from setting up a strategy to keep the force in France from ever developing to such a size once more. The British outside secretary Robert Stewart (Viscount Castereagh) realized the Treaty of Chaumont, reestablishing the Whiskey Dynasty from quite a while ago. It was then chosen for all partners to stay settled until there was a redesign of land that should have been spread out during a Congress of Vienna, to be hung on September of 1814. A great part of the arranging in the Congress of Vienna was not troublesome. The Kingdom of Netherlands was built up, including Belgium and Genoa. Prussia got land along the Rhine river(a insurance against a future French danger). Austria was given quite a bit of Northern Italy. The main struggle came when the control of Eastern Europe got together. Alexander I of Russia was firm in that he needed all of Poland under his rule, Austria was not ready to surrender a lot of Poland either, and Prussia was keen on the place where there is Saxony. This contention went to it's tallness and there was even the dread that another war may eject over the control of these grounds. This was changed by the shrewd Talleyrand, who spoken to France, he proposed that Austria and England may partner themselves to take the land that was easily proven wrong. Under dread, Prussia what's more, Russia both yielded and there was an equivalent dissemination of land. ... <!

The Role of Banking Sector in the Prevention of Money Laundering in Bangladesh

Part One Introduction 1. 0 INTRODUCTION Besides of improvement of Economic exercises, fiscal related wrongdoings are likewise expanding in both created and immature nations. Nearly in every nation unlawful exchange of cash has been expanded and these illicit cash has been likewise utilized on different criminal operations. Tax evasion process alludes to unlawful receipt or move of store starting with one spot then onto the next. This procedure includes the financial arrangement of the nation as well as non-banking system.Bangladesh is moving towards an open economy with a little charged segment by changing the budgetary and monetary approaches. Be that as it may, the illegal tax avoidance systems are making issue for a nation like Bangladesh. Bangladesh Bank as the Central bank of Bangladesh Supervise all the banking and non-banking money related exchanges in the interest of Bangladesh Government. Tax evasion process is an extraordinary deterrent to the execution of fiscal strategy e mbraced by Bangladesh bank to stable the economy of the country.To forestall illegal tax avoidance, tax evasion counteraction bill 2002 was passed in the National Assembly of Bangladesh on 5 April 2002 and Gazette Notification was made on 7 April 2002. What's more, Bangladesh Bank has been assigned to go about as the principle preventive organization. Illegal tax avoidance has genuine unfriendly impact on Economical, Political and Social state of a nation. It increments inconsistent dispersion of salary and accordingly, the work level, yield level of the nation, value security just as monetary turn of events and development can be hampered.So it is promptly required to forestall it. I trust it involves incredible open door for me to concentrate on this point, as Money laundering, is an indication and a facilitator of sorted out wrongdoing, and has pulled in expanding enthusiasm for our nation. Because of tax evasion process, attractive speculation of the nation is impossible, nation al pay decreases and financial development of the nation hampers. 1. Foundation of Money LaunderingThe mafia mobster Al Capone is regularly credited with authoring term â€Å"money laundering† in light of the fact that he utilized interests in coin-worked Laundromats to mask or â€Å"wash† the millions he produced using bootlegging and other unlawful undertakings during the Prohibition in the US-the restricting of mixed beverages in the twentieth century. It is additionally said that the term â€Å"laundering† is utilized in light of the fact that, years prior, the money continues (in U. S. dollars) from tranquilize deals were really washed with cleanser and water to seem old and worn. Launderers would then go to the Federal Reserve Bank and trade the â€Å"laundered† charges in for new bills.Along with the new bills came a took care of receipt, which served to help the â€Å"legitimate† starting point of the money. The trick was at last distinguis hed when somebody at the Fed understood that the sequential numbers on the bills showed that they ought not be as old and worn as they seemed, by all accounts, to be. The term first showed up in quite a while detailing the Watergate outrage in the US in 1973 and in legal/lawful challenge in the US in 1982. While the term â€Å"money laundering† was authored in the twentieth century, it has been continuing for a few thousand years.The history of illegal tax avoidance is joined with the historical backdrop of exchange and of banking. In 1986, the U. S. turned into the main nation on the planet to condemn the â€Å"laundering† of the returns of crime when it passed the U. S. illegal tax avoidance law. The silk street which researchers state previously turned into a genuine connection around 100 BC, ran for 12,000 kilometers and connected probably the best human advancements the world has ever observed †the Chinese, Mongolian, Indian, Persian, Greek, Byzantine, Mesopo tamian and Egyptian †moving merchandise, individuals, thoughts, religions and Money.Chinese creations like explosive and paper originally headed out to Europe as such. Alongside numerous different things, Syrian performers and aerialists, beauty care products, silver, gold, golden, ivory, covers, aroma and glass from Europe, Central Asia, Arabia and Africa headed out toward the east. It went on until the fifteenth century when newfound ocean courses to Asia opened up. Customary strategy for moving cash advanced before Western banking got set up in the locale ensuring early traders along the Silk Road against robbery.In antiquated China it was known as â€Å"fei qian† or â€Å"flying coins†. The framework spread all through the world †to other Asian areas, the Indian Subcontinent, the Middle East, eastern and southern Africa, Europe and North and South America †following migration designs. These customary cash move frameworks are called as Chop, Hawala, H undi, and so on 1970-The US Congress established the Bank Secrecy Act (BSA) in October 1970 after expanding reports of individuals bringing packs loaded with unlawfully †got money into banks for deposit.The BSA is basically an announcing and record-keeping rule. Albeit adamant infringement of its terms are a wrongdoing; it doesn't condemn illegal tax avoidance accordingly. BSA requires banks â€retain monetary subtleties, - report money exchanges over $ 10,000/ - . In this manner in 1986, the U. S. turned into the primary nation on the planet to condemn the â€Å"laundering† of the returns of crime. In this way brought in tax evasion a wrongdoing in its own right, and reinforced the BSA in a few regards, in particular by disallowing â€Å"structuring†. 990 †The Financial Crimes Enforcement Network (FinCEN) made by the US Treasury on April 25, at first to concentrate on the discovery of money related wrongdoings by offering systematic help to law authorizati on examinations. In 1994, the office would be given BSA administrative duties. 1992 †Annunzio-Wylie Money Laundering Act corrected the BSA in a few regards. Maybe generally significant, required any money related foundation, and its officials, chiefs, workers and operators, â€Å"to report any dubious exchange pertinent to a potential infringement of law or guideline. The Annunzio â€Wylie Act, require every single budgetary organization to set up, BSA consistence programs, yet additionally hostile to illegal tax avoidance programs. At the very least, the projects would be required to include: 1) The advancement of inward enemy of illegal tax avoidance strategies, systems and controls; 2) The assignment of a consistence official; 3) A progressing representative preparing 4) An autonomous review capacities to test the program. From the start U. S. A. has stepped up and tax evasion however now the vast majority of the nations of the world know about it. 2. Root of the ReportTh is Research Paper has been set up for the fractional satisfaction of Masters of Business Administration (MBA) Program. For this reason noteworthy instructor and administrator Mr. Md. Nazrul Islam, Head of the Department of Business Administration, Shahjalal University of Science and Technology, Sylhet requested to present a proposition. Subsequent to talking about with him about different issues of tax evasion I have presented a proposition on â€Å"The Role of Banking Sector in the Prevention of Money Laundering in Bangladesh † was submitted and afterward the last research paper is readied. 3.Objective of the Paper The goal of the exploration paper is to enable the understudies to be comfortable with how the hypothetical information acquired in the degree program can be applied by and by. For the most part examine is either issue recognizing or critical thinking device. The destinations of the investigation are as per the following: †1. To comprehend the hypothetical id eas of tax evasion. 2. To show the current situation of against illegal tax avoidance issues in Bangladesh. 3. To watch the arrangement advancement and support by Bangladesh Bank as a manager of against illegal tax avoidance exercises. 4.To make sense of center techniques that Bangladesh Bank embraces to regulate the counter illegal tax avoidance exercises. 5. To remark on the current framework and suggest for development. 1. 4 Methodology Certain strategies and procedures is used to gather information for this examination paper. This examination is for the most part dependent on observational just as hypothetical investigation. Gathered information and data is classified, prepared and examined fundamentally so as to make the report enlightening. Both essential and optional wellsprings of information are picked as successful methods for gathering information applicable for this paper. . To plan initial segment of the exploration paper optional sources were utilized. Productions and database inside Bangladesh Bank and others business bank helped me to get information about illegal tax avoidance and its anticipation. Different kinds of roundabout of Bangladesh Bank in regards to illegal tax avoidance exist in various business banks. This paper additionally required investigation of yearly report, arrangement related brochures, and administration rules, regulatory fliers and other related papers. To get more data, I have likewise gathered a few books about tax evasion and looked through site. 2.Interview of the work force from individuals inside these important associations was the essential strategy to gather essential information. Casual conversation with official associated with the arranging and control works in the different degrees of the Bangladesh Bank was required. To gather information and to dissect these appropriately I must be talked with eye to eye with bank authorities. . 5. Avocation of the Research To forestall tax evasion is extremely perplexing errand particularly in a nation like Bangladesh where the vast majority of the residents are ignorant and their financial terrible condition propelled them to include in illicit activities.This increments monetary hopelessness of the poor and amassed riches in the hands of 10% of the complete populace. The extension and size of illegal tax avoidance has expanded after some time and the way toward tending to the issue has become complex on account of the worldwide idea of the issue. So participation among the law authorizing offices, attention to the general individuals of the check

The Daily PANCE and PANRE Second Midterm ExamQuestions 30 through 60

Questions 30-60 Please wait while the activity loads. If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled. If loading fails, click here to try again Start Congratulations - you have completed Questions 30-60. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rated as %%RATING%% %%FORM%% Have Your Exam Results Emailed to You Enter your name and email address below to have your results as well as the test questions, your answers and the correct answers delivered to your inbox. Name First Last Email mTouch Quiz Populated FieldsmTouch Quiz will automatically populate the fields below. Feel Free to add additional fields for the Quiz Taker to complete using the "Add Fields" options to the right.Quiz NameThe name of the quizResults SummaryScoreThe number of correct answers. 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This iframe contains the logic required to handle Ajax powered Gravity Forms. jQuery(document).ready(function($){gformInitSpinner( 7, 'https://www.thepalife.com/wp-content/plugins/gravityforms/images/spinner.gif' );jQuery('#gform_ajax_frame_7').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_7');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_7').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 var mt = parseInt(jQuery('html').css('margin-top'), 10) + parseInt(jQuery('body').css('margin-top'), 10) + 100;if(is_form){jQuery('#gform_wrapper_7').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_7').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_7').removeClass('gform_validation_error');}setTimeout( function() { /* delay the scroll by 50 milliseconds to fix a bug in chrome */ jQuery(document).scrollTop(jQuery('#gform_wrapper_7').offset().top - mt); }, 50 );if(window['gformInitDatepicker']) {gformInitDatepicker();}if(window['gformInitPriceFields']) {gformInitPriceFields();}var current_page = jQuery('#gform_source_page_number_7').val();gformInitSpinner( 7, 'https://www.thepalife.com/wp-content/plugins/gravityforms/images/spinner.gif' );jQuery(document).trigger('gform_page_loaded', [7, current_page]);window['gf_submitting_7'] = false;}else if(!is_redirect){var confirmation_content = jQuery(this).contents().find('.GF_AJAX_POSTBACK').html();if(!confirmation_content){confirmation_content = contents;}setTimeout(function(){jQuery('#gform_wrapper_7').replaceWith(confirmation_content);jQuery(document).scrollTop(jQuery('#gf_7').offset().top - mt);jQuery(document).trigger('gform_confirmation_loaded', [7]);window['gf_submitting_7'] = false;}, 50);}else{jQuery('#gform_7').append(contents);if(window['gformRedirect']) {gform Redirect();}}jQuery(document).trigger('gform_post_render', [7, current_page]);} );} ); jQuery(document).bind('gform_post_render', function(event, formId, currentPage){if(formId == 7) {} } );jQuery(document).bind('gform_post_conditional_logic', function(event, formId, fields, isInit){} ); jQuery(document).ready(function(){jQuery(document).trigger('gform_post_render', [7, 1]) } ); Your answers are highlighted below. Question 1The most common cause of curable blindness in the United States is:Amacular degeneration.Hint: macular degeneration is not preventable.Bcataracts.Hint: Cataracts are "curable", but the cataract itself is probably not "preventable". Cretinal detachments.Hint: retinal detachments and are not preventable. Dglaucoma.Etrauma. Hint: trauma is not preventable.Question 1 Explanation: Again, the wording is difficult in this question. Macular degeneration, retinal detachments and trauma are not preventable. Cataracts are "curable", but the cataract itself is probably not "preventable". Chronic glaucoma can be treated to prevent blindness this is a matter of semantics.Question 2Which of the following agents is effective in the treatment of Parkinson's?ApenicillinBamantadineCerythromycinDacyclovirEcephalexinQuestion 2 Explanation: Amantadine (Symmetrel) is effective somewhat). It is used in treating Influenza A. Another choice is selegiline, and levodopa/carbidopa. The other antibiotics listed here are not useful in Parkinson's.Question 3Laboratory report: elevated serum free T4 low serum TSH level. Which of the following is the MOST likely diagnosis?Aprimary hypothyroidismHint: Primary hypothyroidism (Hashimoto's) is low T4 with a high TSH. Bsecondary hypothyroidismHint: Secondary hypothyroidism (from pituitary disease) is a low T4 with a low TSH.CT3 thyrotoxicosisDGraves’ diseaseE chronic Hashimoto's thyroiditisQuestion 3 Explanation: High T4 (hyperthyroid), with a low TSH indicates that the pituitary is working normally, and the thyroid is hyperactive, i.e. Grave's disease. Primary hypothyroidism (Hashimoto's) is low T4 with a high TSH. Secondary hypothyroidism (from pituitary disease) is a low T4 with a low TSH.Question 4The results of a barium esophagram reveal esophageal webbing in a woman with long-standing iron deficiency anemia. Her diagnosis is:ABarretts esophagus.Hint: Barrett's causes GERD symptoms and dysplasia of the esophageal mucosa.Bachalasia.CPlummer-Vinson syndrome.DDresslers syndrome.EOgilvies syndrome.Question 4 Explanation: Plummer-Vinson is something to know for those who want a 100% on the exam. There is no need to memorize this. More importantly, webbing in the distal esophagus with no other symptoms but dysphagia would be a Schatzki’s ring (much more common). Barrett's causes GERD symptoms and dysplasia of the esophageal mucosa. Achalasia is a primary neurologic problem of the esophagus causing dysphagia.Question 5Which of the following agents has a mechanism of action that does not involve beta-receptors?AepinephrineHint: Ritodrine and epinephrine cause beta sympathetic stimulationBalbuterolHint: Albuterol is a beta agonist.CpropranololHint: Propranolol is a beta blocker.DprazosinEritodrineHint: Ritodrine and epinephrine cause beta sympathetic stimulationQuestion 5 Explanation: Of these choices, prazosin is an alpha- blocker. Ritodrine and epinephrine cause beta sympathetic stimulation. Albuterol is a beta agonist. Propranolol is a beta blocker.Question 6A 6 year-old male is brought into your office for evaluation of his gait. You note that when ambulatory, the medial aspects of his knees are far apart and his feet are unusually close together. Which of the following best describes this condition?Acubitus valgusBcubitus varusCgenu valgus Hint: Valgus deformity forms an "L" in the knock-kneed child, and has an "L" in the middle of it (try it, it works)Dgenu varum ELegg-Calve-Perthes diseaseQuestion 6 Explanation: This is genu varum (bow legs). Valgus deformity forms an "L" in the knock-kneed child, and has an "L" in the middle of it (try it, it works)Question 7A female presents complaining of a grayish, watery vaginal discharge. The KOH prep does not reveal any hyphae. Clue cells are identified on the wet mount. A paucity of WBCs are noted. What diagnosis is most likely?AGonorrheaBChlamydiaC CandidiasisDbacterial vaginosisETrichomoniasisQuestion 7 Explanation: Clue cells means BVQuestion 8You note polygonal, purple, popular lesions involving the flexor surfaces of a patient's wrists. The patient has no other lesions. The lesions appear to follow a linear pattern of distribution. What is this phenomenon?AAuspitz signHint: Auspitz sign is also present in psoriasis where the scales bleed when removed. BKoebner's phenomenonCDarier's signHint: Darier's sign is in allergic patients who develop urticaria when the skin is rubbed. DGorlin's signHint: Gorlin's sign is seen in Ehlers-danlos when a patient can touch the tip of the nos e with his tongue (I learn something new every day!!)EGottron's papulesHint: Gottron's papules are purple papules on the fingers seen in dermatomyositis. Question 8 Explanation: Koebner's phenomenon is described - it suggests psoriasis. Auspitz sign is also present in psoriasis where the scales bleed when removed. Darier's sign is in allergic patients who develop urticaria when the skin is rubbed. Gottron's papules are purple papules on the fingers seen in dermatomyositis. Gorlin's sign is seen in Ehlers-Danlos when a patient can touch the tip of the nose with his tongue (I learn something new every day!!) These last two are not important to know.Question 9A 6 year-old female presents complaining of right ear pain. The tympanic membrane cannot be well visualized. She complains of pain when the tragus is manipulated. Several periauricular lymph nodes are easily palpable. Which of the following is the most likely diagnosis?Aacute otitis media Hint: OM would not cause periauricular nodes and tragal tenderness. Bacute otitis externaCeustachian tube dysfunctionHint: Eustachian tube dysfn would cause middle ear pain (like when you're up in a plane). DRamsey-Hunt syndromeHint: Ramsey- Hunt is herpes zoster of the ear canal and would be visible. Eperforated tympanic membraneHint: A perforated TM would cause middle ear, not external ear pain (typically).Question 9 Explanation: OE is described here. OM would not cause periauricular nodes and tragal tenderness. Eustachian tube dysfn would cause middle ear pain (like when you're up in a plane). Ramsey- Hunt is herpes zoster of the ear canal and would be visible. A perforated TM would cause middle ear, not external ear pain (typically).Question 10A 51 year-old male with renal artery stenosis and an elevated BUN and creatinine, is newly diagnosed as hypertensive. Which of the following agents should be avoided?Ahydrochlorothiazide-triamtereneBprazosinCnifedipineDverapamilEfurosemideQuestion 10 Explanation: This is a potassium sparing diuretic and should be avoided in anyone with renal disease. ACEI should be avoided as well (but none of these are ACEI's).Question 11A patient at a Christmas party on a cruise ship develops a terrible headache. His blood pressure is 224/158 mm Hg. Which of the following agents is this patient most likely taking regularly?A tricyclic antidepressantsBbarbituratesCbenzodiazepinesDmonoamine oxidase inhibitorsEphenothiazinesQuestion 11 Explanation: This is a typical scenario for MAOI induced malignant hypertension from eating the "wrong" foods, which are frequently found on a Christmas buffet, (cheese, sausages, red w ine, etc.).Question 12A patient with known hyperlipidemia, taking clofibrate, presents to your office complaining of severe myalgias and weakness. He has noted a dark color to his urine. The laboratory calls with a panic value CPK of 8500. He was recently started on a new medication, four days earlier. Which of the following is most likely the new medication?AlovastatinBhydrochlorothiazide.CdexamethasoneDphenytoinEampicillinQuestion 12 Explanation: Statin + fibrate = suspicion for rhabdomyolysis in a patient with myalgias, ALWAYS order a CPK. (statin alone, or fibrate alone may cause it too, but the combination is most likely)Question 13A female patient presents for an evaluation for primary amenorrhea. She is noted to be short of stature and have short fourth metacarpals. What diagnosis do you suspect?AXOBXXYHint: XXY is the genotype for Klinefelter's (which is a tall, mildly retarded male). CXXXHint: Trisomy 21 is Down's. DXXXYETrisomy 21Question 13 Explanation: This is the genotype for Turner's syndrome. XXY is the genotype for Klinefelter's (which is a tall, mildly retarded male). Trisomy 21 is Down's. The other two are not common genotypes.Question 14An 18 year-old female presents after completing her freshman year at college. Two months ago, she developed "bronchitis" which has persisted. She has become increasingly tired and has frequent night sweats. A chest x-ray today reveals a left mediastinal mass. What is the next step in her evaluation?Arepeat the chest x-ray in six monthsBultrasound of the left hemithoraxCbone scanDCT scan of the chestEproceed directly to bronchoscopy with biopsyQuestion 14 Explanation: Any patient presenting with mediastinal nodes should have a CT. This patient may have sarcoid or Hodgkin's or another type of cancer - CT is indicated.Question 15An elderly patient is recovering from a pneumonia caused by Influenza.  Suddenly, the patient's condition deteriorates. You order a chest x-ray that demonstrates an air-fluid level, suggestive of an abscess. You empirically begin treatment for:AStreptococcal pneumoniae.BChlamydia.CHemophilus influenzae.DStaphyl ococcus aureus.ELegionella pneumophila.Question 15 Explanation: Empyema (lung abscess) is almost always staph aureus. While strep pneumo is the most common CAP, when a complication like empyema occurs, it is almost always staph.Question 16A 17 year-old male is stabbed in the anterior chest with an ice pick. He quickly becomes hypotensive, tachycardic and obtunded. His breath sounds are equal, his neck veins are distended, and his chest x-ray is normal. What condition is most likely?ASimple pneumothorax Hint: The "normal CXR" is what rules out the pneumothorax - another common problem in a stabbing injury.)BTension pneumothoraxHint: The "normal CXR" is what rules out the pneumothorax - another common problem in a stabbing injury.CPericardial TamponadeDaortic laceration distal to the origin of the left common carotid arteryEinferior vena cava lacerationQuestion 16 Explanation: This is the typical clinical presentation of tamponade (hypotension, JVD). He was stabbed and probably has a mediastinal bleed (so, I think the mediastinum would be widened on his chest film — but the "normal CXR" is what rules out the pneumothorax - another common problem in a stabbing injury.Question 17A 48 year-old male presents with crushing chest pain for 45 minutes. He is diaphoretic, nauseous and short of breath. His EKG demonstrates 4 mm of ST segment depression in leads I, aVL, V5 and V6. What is the most likely diagnosis?Aesophageal spasmBhiatal herniaCacute lateral wall subendocardial myocardial ischemiaDacute inferior wall myocardial subendocardial ischemiaHint: Inferior AMI is leads II, III, avFEacute anterior wall myocardial transmural ischemiaHint: Anterior wall AMI is leads +- VI, with V2-V4, and maybe V5 It is obvious this patient is having an AMI. The ECG lead abnormalities suggest occlusion of the high lateral and low lateral walls of the LV - typically supplied by the circumflex - there are no Q waves - so subendocardial. Inferior AMI is leads II, III, avF. Anter ior wall AMI is leads +- VI, with V2-V4, and maybe V5 This is a typical presentation of varicella (chicken pox)Question 19A 35 year-old male complains of acute left eye pain immediately after he struck a nail with a hammer. On examination, you note that the left pupil is elliptical. What diagnostic test/procedure will most likely confirm your diagnostic suspicion?Afluorescein staining of the eyeHint: Fluorescein staining is for a corneal abrasion - it should not be done if the globe is penetratedBpressing on the globe to assess intraocular pressureCan X-ray of the orbitsDtesting the extra-ocular eye musclesEhaving the patient finger countQuestion 19 Explanation: This patient struck a nail (think metal splinter), pain was immediate (as the splinter entered his eye). His pupil is elliptical, indicating penetration of the globe. He needs X-ray of the globe to look for the metal splinter. Fluorescein staining is for a corneal abrasion - it should not be done if the globe is penetrated Question 20This drug causes gingival hyperplasia and hirsutism. At high doses it can cause nystagmus, ataxia and diplopia. Which drug is best described by these statementsAaspirinBacetaminophenCacyclovirDphenytoinEvalproic acidQuestion 20 Explanation: Dilantin (phenytoin) causes these typical symptomsQuestion 21Which of the following choices is associated with meconium staining of the amniotic fluid?Abowel obstructionBpeeling of the infant's skinCaspiration pneumonitis and respiratory distress syndromeDinfection with E. coliEintrauterine cataract formation and sensorineural hearing lossQuestion 21 Explanation: When the infant has meconium in the amniotic fluid, he has been in distress, and the meconium is frequently aspirated prior to delivery and can cause pneumonitis and respiratory distress syndrome in the neonate.Question 22A 32 year-old male presents after slipping and falling off the roof of his home and striking his head. He suffered a brief loss of consciousness. Since that t ime, he has noted increasing urination and thirst. His serum chemistries reveal an elevated sodium level. His urine specific gravity is 1.003. Which of the following is the most likely diagnosis?Acerebral contusionBsubarachnoid hemorrhageCepidural hematomaDdiabetes insipidusErenal contusionQuestion 22 Explanation: Diabetes insipidus (ADH deficiency) can occur after acute head trauma. ADH is secreted by the posterior pituitary gland and causes the body to retain fluid (to increase volume). In a patient who has damaged the posterior pituitary, ADH is not secreted, so the body urinates "water". There is frequent large volume urination with a very low specific gravity, and will cause hypernatremia unless the patient is given large quantities of water to drink.Question 23You are educating a patient that has just been advised that he has "polyps" in his colon. Which of the following statements is FALSE?AThe larger the colonic polyp, the greater the risk of malignant transformationBVillous adenomas have a 30-70% risk of malignant transformation.CThe greater the number of concomitant colonic polyps, the greater the risk of malignant transformatioDThe majority of colonic polyps are hyperplastic in originEThe majority of colonic polyps are > 3 cm in size.Question 23 Explanation: Most polyps are, in fact, quite small. All the rest of these statements are true.Question 24Wolf-Parkinson-White (WPW) and Lown-Ganong-Levine (LGL) syndrome are both characterized by:Aleft ventricular dysfunction.Ba shortened PR interval.Cthe presence of delta waves.Dlarge pericardial effusions.Emarked left ventricular hypertrophy.Question 24 Explanation: WPW The fifth finger is ALWAYS innervated by the ulnar nerve, and would not be affected in a true carpal tunnel syndrome.Question 26A 22 year-old female complains of vaginal bleeding for 24 hours. Her last menstrual cycle was seven weeks ago. She has had an IUD, but currently uses no form of contraception.   Her HCG is positive. She denies f ever, chills and vaginal discharge, prior to the onset of the vaginal bleeding. You order a pelvic ultrasound to rule out:Acervicitis.Bpelvic inflammatory disease.Cdysfunctional uterine bleeding.Dan ectopic pregnancy.Evaginitis.Question 26 Explanation: Any patient with an IUD, or with a tubal ligation, or known obstruction of a tube, who has a positive HCG needs an ultrasound to r/o ectopic pregnancy.Question 27The examination of a 26 year-old male demonstrates a "bag of worms" consistency within the left hemiscrotum. This finding is suggestive of a(n):Aacute case of balanitisBvaricocele.Chydrocele.Hint: Hydrocele is just a water collection in the scrotum. Dspermatocele.Hint: Spermatocele is just a fluid collection which happens to contain sperm (sperm are not palpable).Eparaphimosis.Question 27 Explanation: This is a description of varicocele (varicose veins of the scrotum). Hydrocele is just a water collection in the scrotum. Spermatocele is just a fluid collection which happens to contain sperm (sperm are not palpable).Question 28A patient presents with a recurrent history of swelling on the right side of the jaw that begins while eating and subsides within two hours postprandially. You suspect:AhypochondriasisBsialolithiasisCparotitis.Hint: Parotitis would be inflammation and infection of the parotid gland (usually due to a stone that is stuck in the duct). A parotitis patient would be acutely ill with redness of the gland and fever.Dan abscessed tooth.Econjunctivitis manibularis.Question 28 Explanation: Sialo(salivary gland) lithiasis (stone) is described in this question. Parotitis would be inflammation and infection of the parotid gland (usually due to a stone that is stuck in the duct). A parotitis patient would be acutely ill with redness of the gland and fever.Question 29Which of the following is the earliest manifestation of diabetic nephropathy?AproteinuriaBa progressive decline in the creatinine clearanceCan elevated serum haptoglobinDrenal insufficiencyEmicroalbuminuriaQuestion 29 Explanation: Tiny amounts of albumin (microalbumin) show up first - but need a special test ordered to detect it. Intervention at this point with an ACEI prolongs the length of time before the patient progresses to albuminuria (noted on a typical urine "dip")Question 30Fluid from a thoracentesis is grossly purulent. The effusion from which this fluid was aspirated is best described as a(n):Aloculated effusionBchylothorax.Hint: Chylo thorax suggest a transudative effusion (not purulent).Cempyema.Dhydrothorax.Hint: hydro thorax suggest a transudative effusion (not puru lent).Ehemothorax.Hint: hemothorax is blood.Question 30 Explanation: A grossly purulent tap would suggest staph (empyema). Loculated effusion does not describe either a trans or exudative effusion. Chylo and hydro thorax suggest a transudative effusion (not purulent). And hemothorax is blood. Once you are finished, click the button below. Any items you have not completed will be marked incorrect. Get Results There are 30 questions to complete. List Return Shaded items are complete. 123456789101112131415161718192021222324252627282930End Return You have completed questions question Your score is Correct Wrong Partial-Credit You have not finished your quiz. If you leave this page, your progress will be lost. Correct Answer You Selected Not Attempted Final Score on Quiz Attempted Questions Correct Attempted Questions Wrong Questions Not Attempted Total Questions on Quiz Question Details Results Date Score Hint Time allowed minutes seconds Time used Answer Choice(s) Selected Question Text All doneNeed more practice!Keep trying!Not bad!Good work!Perfect! The Daily PANCE and PANRE Second Midterm ExamQuestions 30 through 60 Questions 30-60 Please wait while the activity loads. If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled. If loading fails, click here to try again Start Congratulations - you have completed Questions 30-60. You scored %%SCORE%% out of %%TOTAL%%. 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This iframe contains the logic required to handle Ajax powered Gravity Forms. jQuery(document).ready(function($){gformInitSpinner( 7, 'https://www.thepalife.com/wp-content/plugins/gravityforms/images/spinner.gif' );jQuery('#gform_ajax_frame_7').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_7');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_7').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 var mt = parseInt(jQuery('html').css('margin-top'), 10) + parseInt(jQuery('body').css('margin-top'), 10) + 100;if(is_form){jQuery('#gform_wrapper_7').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_7').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_7').removeClass('gform_validation_error');}setTimeout( function() { /* delay the scroll by 50 milliseconds to fix a bug in chrome */ jQuery(document).scrollTop(jQuery('#gform_wrapper_7').offset().top - mt); }, 50 );if(window['gformInitDatepicker']) {gformInitDatepicker();}if(window['gformInitPriceFields']) {gformInitPriceFields();}var current_page = jQuery('#gform_source_page_number_7').val();gformInitSpinner( 7, 'https://www.thepalife.com/wp-content/plugins/gravityforms/images/spinner.gif' );jQuery(document).trigger('gform_page_loaded', [7, current_page]);window['gf_submitting_7'] = false;}else if(!is_redirect){var confirmation_content = jQuery(this).contents().find('.GF_AJAX_POSTBACK').html();if(!confirmation_content){confirmation_content = contents;}setTimeout(function(){jQuery('#gform_wrapper_7').replaceWith(confirmation_content);jQuery(document).scrollTop(jQuery('#gf_7').offset().top - mt);jQuery(document).trigger('gform_confirmation_loaded', [7]);window['gf_submitting_7'] = false;}, 50);}else{jQuery('#gform_7').append(contents);if(window['gformRedirect']) {gform Redirect();}}jQuery(document).trigger('gform_post_render', [7, current_page]);} );} ); jQuery(document).bind('gform_post_render', function(event, formId, currentPage){if(formId == 7) {} } );jQuery(document).bind('gform_post_conditional_logic', function(event, formId, fields, isInit){} ); jQuery(document).ready(function(){jQuery(document).trigger('gform_post_render', [7, 1]) } ); Your answers are highlighted below. Question 1The most common cause of curable blindness in the United States is:Amacular degeneration.Hint: macular degeneration is not preventable.Bcataracts.Hint: Cataracts are "curable", but the cataract itself is probably not "preventable". Cretinal detachments.Hint: retinal detachments and are not preventable. Dglaucoma.Etrauma. Hint: trauma is not preventable.Question 1 Explanation: Again, the wording is difficult in this question. Macular degeneration, retinal detachments and trauma are not preventable. Cataracts are "curable", but the cataract itself is probably not "preventable". Chronic glaucoma can be treated to prevent blindness this is a matter of semantics.Question 2Which of the following agents is effective in the treatment of Parkinson's?ApenicillinBamantadineCerythromycinDacyclovirEcephalexinQuestion 2 Explanation: Amantadine (Symmetrel) is effective somewhat). It is used in treating Influenza A. Another choice is selegiline, and levodopa/carbidopa. The other antibiotics listed here are not useful in Parkinson's.Question 3Laboratory report: elevated serum free T4 low serum TSH level. Which of the following is the MOST likely diagnosis?Aprimary hypothyroidismHint: Primary hypothyroidism (Hashimoto's) is low T4 with a high TSH. Bsecondary hypothyroidismHint: Secondary hypothyroidism (from pituitary disease) is a low T4 with a low TSH.CT3 thyrotoxicosisDGraves’ diseaseE chronic Hashimoto's thyroiditisQuestion 3 Explanation: High T4 (hyperthyroid), with a low TSH indicates that the pituitary is working normally, and the thyroid is hyperactive, i.e. Grave's disease. Primary hypothyroidism (Hashimoto's) is low T4 with a high TSH. Secondary hypothyroidism (from pituitary disease) is a low T4 with a low TSH.Question 4The results of a barium esophagram reveal esophageal webbing in a woman with long-standing iron deficiency anemia. Her diagnosis is:ABarretts esophagus.Hint: Barrett's causes GERD symptoms and dysplasia of the esophageal mucosa.Bachalasia.CPlummer-Vinson syndrome.DDresslers syndrome.EOgilvies syndrome.Question 4 Explanation: Plummer-Vinson is something to know for those who want a 100% on the exam. There is no need to memorize this. More importantly, webbing in the distal esophagus with no other symptoms but dysphagia would be a Schatzki’s ring (much more common). Barrett's causes GERD symptoms and dysplasia of the esophageal mucosa. Achalasia is a primary neurologic problem of the esophagus causing dysphagia.Question 5Which of the following agents has a mechanism of action that does not involve beta-receptors?AepinephrineHint: Ritodrine and epinephrine cause beta sympathetic stimulationBalbuterolHint: Albuterol is a beta agonist.CpropranololHint: Propranolol is a beta blocker.DprazosinEritodrineHint: Ritodrine and epinephrine cause beta sympathetic stimulationQuestion 5 Explanation: Of these choices, prazosin is an alpha- blocker. Ritodrine and epinephrine cause beta sympathetic stimulation. Albuterol is a beta agonist. Propranolol is a beta blocker.Question 6A 6 year-old male is brought into your office for evaluation of his gait. You note that when ambulatory, the medial aspects of his knees are far apart and his feet are unusually close together. Which of the following best describes this condition?Acubitus valgusBcubitus varusCgenu valgus Hint: Valgus deformity forms an "L" in the knock-kneed child, and has an "L" in the middle of it (try it, it works)Dgenu varum ELegg-Calve-Perthes diseaseQuestion 6 Explanation: This is genu varum (bow legs). Valgus deformity forms an "L" in the knock-kneed child, and has an "L" in the middle of it (try it, it works)Question 7A female presents complaining of a grayish, watery vaginal discharge. The KOH prep does not reveal any hyphae. Clue cells are identified on the wet mount. A paucity of WBCs are noted. What diagnosis is most likely?AGonorrheaBChlamydiaC CandidiasisDbacterial vaginosisETrichomoniasisQuestion 7 Explanation: Clue cells means BVQuestion 8You note polygonal, purple, popular lesions involving the flexor surfaces of a patient's wrists. The patient has no other lesions. The lesions appear to follow a linear pattern of distribution. What is this phenomenon?AAuspitz signHint: Auspitz sign is also present in psoriasis where the scales bleed when removed. BKoebner's phenomenonCDarier's signHint: Darier's sign is in allergic patients who develop urticaria when the skin is rubbed. DGorlin's signHint: Gorlin's sign is seen in Ehlers-danlos when a patient can touch the tip of the nos e with his tongue (I learn something new every day!!)EGottron's papulesHint: Gottron's papules are purple papules on the fingers seen in dermatomyositis. Question 8 Explanation: Koebner's phenomenon is described - it suggests psoriasis. Auspitz sign is also present in psoriasis where the scales bleed when removed. Darier's sign is in allergic patients who develop urticaria when the skin is rubbed. Gottron's papules are purple papules on the fingers seen in dermatomyositis. Gorlin's sign is seen in Ehlers-Danlos when a patient can touch the tip of the nose with his tongue (I learn something new every day!!) These last two are not important to know.Question 9A 6 year-old female presents complaining of right ear pain. The tympanic membrane cannot be well visualized. She complains of pain when the tragus is manipulated. Several periauricular lymph nodes are easily palpable. Which of the following is the most likely diagnosis?Aacute otitis media Hint: OM would not cause periauricular nodes and tragal tenderness. Bacute otitis externaCeustachian tube dysfunctionHint: Eustachian tube dysfn would cause middle ear pain (like when you're up in a plane). DRamsey-Hunt syndromeHint: Ramsey- Hunt is herpes zoster of the ear canal and would be visible. Eperforated tympanic membraneHint: A perforated TM would cause middle ear, not external ear pain (typically).Question 9 Explanation: OE is described here. OM would not cause periauricular nodes and tragal tenderness. Eustachian tube dysfn would cause middle ear pain (like when you're up in a plane). Ramsey- Hunt is herpes zoster of the ear canal and would be visible. A perforated TM would cause middle ear, not external ear pain (typically).Question 10A 51 year-old male with renal artery stenosis and an elevated BUN and creatinine, is newly diagnosed as hypertensive. Which of the following agents should be avoided?Ahydrochlorothiazide-triamtereneBprazosinCnifedipineDverapamilEfurosemideQuestion 10 Explanation: This is a potassium sparing diuretic and should be avoided in anyone with renal disease. ACEI should be avoided as well (but none of these are ACEI's).Question 11A patient at a Christmas party on a cruise ship develops a terrible headache. His blood pressure is 224/158 mm Hg. Which of the following agents is this patient most likely taking regularly?A tricyclic antidepressantsBbarbituratesCbenzodiazepinesDmonoamine oxidase inhibitorsEphenothiazinesQuestion 11 Explanation: This is a typical scenario for MAOI induced malignant hypertension from eating the "wrong" foods, which are frequently found on a Christmas buffet, (cheese, sausages, red w ine, etc.).Question 12A patient with known hyperlipidemia, taking clofibrate, presents to your office complaining of severe myalgias and weakness. He has noted a dark color to his urine. The laboratory calls with a panic value CPK of 8500. He was recently started on a new medication, four days earlier. Which of the following is most likely the new medication?AlovastatinBhydrochlorothiazide.CdexamethasoneDphenytoinEampicillinQuestion 12 Explanation: Statin + fibrate = suspicion for rhabdomyolysis in a patient with myalgias, ALWAYS order a CPK. (statin alone, or fibrate alone may cause it too, but the combination is most likely)Question 13A female patient presents for an evaluation for primary amenorrhea. She is noted to be short of stature and have short fourth metacarpals. What diagnosis do you suspect?AXOBXXYHint: XXY is the genotype for Klinefelter's (which is a tall, mildly retarded male). CXXXHint: Trisomy 21 is Down's. DXXXYETrisomy 21Question 13 Explanation: This is the genotype for Turner's syndrome. XXY is the genotype for Klinefelter's (which is a tall, mildly retarded male). Trisomy 21 is Down's. The other two are not common genotypes.Question 14An 18 year-old female presents after completing her freshman year at college. Two months ago, she developed "bronchitis" which has persisted. She has become increasingly tired and has frequent night sweats. A chest x-ray today reveals a left mediastinal mass. What is the next step in her evaluation?Arepeat the chest x-ray in six monthsBultrasound of the left hemithoraxCbone scanDCT scan of the chestEproceed directly to bronchoscopy with biopsyQuestion 14 Explanation: Any patient presenting with mediastinal nodes should have a CT. This patient may have sarcoid or Hodgkin's or another type of cancer - CT is indicated.Question 15An elderly patient is recovering from a pneumonia caused by Influenza.  Suddenly, the patient's condition deteriorates. You order a chest x-ray that demonstrates an air-fluid level, suggestive of an abscess. You empirically begin treatment for:AStreptococcal pneumoniae.BChlamydia.CHemophilus influenzae.DStaphyl ococcus aureus.ELegionella pneumophila.Question 15 Explanation: Empyema (lung abscess) is almost always staph aureus. While strep pneumo is the most common CAP, when a complication like empyema occurs, it is almost always staph.Question 16A 17 year-old male is stabbed in the anterior chest with an ice pick. He quickly becomes hypotensive, tachycardic and obtunded. His breath sounds are equal, his neck veins are distended, and his chest x-ray is normal. What condition is most likely?ASimple pneumothorax Hint: The "normal CXR" is what rules out the pneumothorax - another common problem in a stabbing injury.)BTension pneumothoraxHint: The "normal CXR" is what rules out the pneumothorax - another common problem in a stabbing injury.CPericardial TamponadeDaortic laceration distal to the origin of the left common carotid arteryEinferior vena cava lacerationQuestion 16 Explanation: This is the typical clinical presentation of tamponade (hypotension, JVD). He was stabbed and probably has a mediastinal bleed (so, I think the mediastinum would be widened on his chest film — but the "normal CXR" is what rules out the pneumothorax - another common problem in a stabbing injury.Question 17A 48 year-old male presents with crushing chest pain for 45 minutes. He is diaphoretic, nauseous and short of breath. His EKG demonstrates 4 mm of ST segment depression in leads I, aVL, V5 and V6. What is the most likely diagnosis?Aesophageal spasmBhiatal herniaCacute lateral wall subendocardial myocardial ischemiaDacute inferior wall myocardial subendocardial ischemiaHint: Inferior AMI is leads II, III, avFEacute anterior wall myocardial transmural ischemiaHint: Anterior wall AMI is leads +- VI, with V2-V4, and maybe V5 It is obvious this patient is having an AMI. The ECG lead abnormalities suggest occlusion of the high lateral and low lateral walls of the LV - typically supplied by the circumflex - there are no Q waves - so subendocardial. Inferior AMI is leads II, III, avF. Anter ior wall AMI is leads +- VI, with V2-V4, and maybe V5 This is a typical presentation of varicella (chicken pox)Question 19A 35 year-old male complains of acute left eye pain immediately after he struck a nail with a hammer. On examination, you note that the left pupil is elliptical. What diagnostic test/procedure will most likely confirm your diagnostic suspicion?Afluorescein staining of the eyeHint: Fluorescein staining is for a corneal abrasion - it should not be done if the globe is penetratedBpressing on the globe to assess intraocular pressureCan X-ray of the orbitsDtesting the extra-ocular eye musclesEhaving the patient finger countQuestion 19 Explanation: This patient struck a nail (think metal splinter), pain was immediate (as the splinter entered his eye). His pupil is elliptical, indicating penetration of the globe. He needs X-ray of the globe to look for the metal splinter. Fluorescein staining is for a corneal abrasion - it should not be done if the globe is penetrated Question 20This drug causes gingival hyperplasia and hirsutism. At high doses it can cause nystagmus, ataxia and diplopia. Which drug is best described by these statementsAaspirinBacetaminophenCacyclovirDphenytoinEvalproic acidQuestion 20 Explanation: Dilantin (phenytoin) causes these typical symptomsQuestion 21Which of the following choices is associated with meconium staining of the amniotic fluid?Abowel obstructionBpeeling of the infant's skinCaspiration pneumonitis and respiratory distress syndromeDinfection with E. coliEintrauterine cataract formation and sensorineural hearing lossQuestion 21 Explanation: When the infant has meconium in the amniotic fluid, he has been in distress, and the meconium is frequently aspirated prior to delivery and can cause pneumonitis and respiratory distress syndrome in the neonate.Question 22A 32 year-old male presents after slipping and falling off the roof of his home and striking his head. He suffered a brief loss of consciousness. Since that t ime, he has noted increasing urination and thirst. His serum chemistries reveal an elevated sodium level. His urine specific gravity is 1.003. Which of the following is the most likely diagnosis?Acerebral contusionBsubarachnoid hemorrhageCepidural hematomaDdiabetes insipidusErenal contusionQuestion 22 Explanation: Diabetes insipidus (ADH deficiency) can occur after acute head trauma. ADH is secreted by the posterior pituitary gland and causes the body to retain fluid (to increase volume). In a patient who has damaged the posterior pituitary, ADH is not secreted, so the body urinates "water". There is frequent large volume urination with a very low specific gravity, and will cause hypernatremia unless the patient is given large quantities of water to drink.Question 23You are educating a patient that has just been advised that he has "polyps" in his colon. Which of the following statements is FALSE?AThe larger the colonic polyp, the greater the risk of malignant transformationBVillous adenomas have a 30-70% risk of malignant transformation.CThe greater the number of concomitant colonic polyps, the greater the risk of malignant transformatioDThe majority of colonic polyps are hyperplastic in originEThe majority of colonic polyps are > 3 cm in size.Question 23 Explanation: Most polyps are, in fact, quite small. All the rest of these statements are true.Question 24Wolf-Parkinson-White (WPW) and Lown-Ganong-Levine (LGL) syndrome are both characterized by:Aleft ventricular dysfunction.Ba shortened PR interval.Cthe presence of delta waves.Dlarge pericardial effusions.Emarked left ventricular hypertrophy.Question 24 Explanation: WPW The fifth finger is ALWAYS innervated by the ulnar nerve, and would not be affected in a true carpal tunnel syndrome.Question 26A 22 year-old female complains of vaginal bleeding for 24 hours. Her last menstrual cycle was seven weeks ago. She has had an IUD, but currently uses no form of contraception.   Her HCG is positive. She denies f ever, chills and vaginal discharge, prior to the onset of the vaginal bleeding. You order a pelvic ultrasound to rule out:Acervicitis.Bpelvic inflammatory disease.Cdysfunctional uterine bleeding.Dan ectopic pregnancy.Evaginitis.Question 26 Explanation: Any patient with an IUD, or with a tubal ligation, or known obstruction of a tube, who has a positive HCG needs an ultrasound to r/o ectopic pregnancy.Question 27The examination of a 26 year-old male demonstrates a "bag of worms" consistency within the left hemiscrotum. This finding is suggestive of a(n):Aacute case of balanitisBvaricocele.Chydrocele.Hint: Hydrocele is just a water collection in the scrotum. Dspermatocele.Hint: Spermatocele is just a fluid collection which happens to contain sperm (sperm are not palpable).Eparaphimosis.Question 27 Explanation: This is a description of varicocele (varicose veins of the scrotum). Hydrocele is just a water collection in the scrotum. Spermatocele is just a fluid collection which happens to contain sperm (sperm are not palpable).Question 28A patient presents with a recurrent history of swelling on the right side of the jaw that begins while eating and subsides within two hours postprandially. You suspect:AhypochondriasisBsialolithiasisCparotitis.Hint: Parotitis would be inflammation and infection of the parotid gland (usually due to a stone that is stuck in the duct). A parotitis patient would be acutely ill with redness of the gland and fever.Dan abscessed tooth.Econjunctivitis manibularis.Question 28 Explanation: Sialo(salivary gland) lithiasis (stone) is described in this question. Parotitis would be inflammation and infection of the parotid gland (usually due to a stone that is stuck in the duct). A parotitis patient would be acutely ill with redness of the gland and fever.Question 29Which of the following is the earliest manifestation of diabetic nephropathy?AproteinuriaBa progressive decline in the creatinine clearanceCan elevated serum haptoglobinDrenal insufficiencyEmicroalbuminuriaQuestion 29 Explanation: Tiny amounts of albumin (microalbumin) show up first - but need a special test ordered to detect it. Intervention at this point with an ACEI prolongs the length of time before the patient progresses to albuminuria (noted on a typical urine "dip")Question 30Fluid from a thoracentesis is grossly purulent. The effusion from which this fluid was aspirated is best described as a(n):Aloculated effusionBchylothorax.Hint: Chylo thorax suggest a transudative effusion (not purulent).Cempyema.Dhydrothorax.Hint: hydro thorax suggest a transudative effusion (not puru lent).Ehemothorax.Hint: hemothorax is blood.Question 30 Explanation: A grossly purulent tap would suggest staph (empyema). Loculated effusion does not describe either a trans or exudative effusion. Chylo and hydro thorax suggest a transudative effusion (not purulent). And hemothorax is blood. Once you are finished, click the button below. Any items you have not completed will be marked incorrect. Get Results There are 30 questions to complete. List Return Shaded items are complete. 123456789101112131415161718192021222324252627282930End Return You have completed questions question Your score is Correct Wrong Partial-Credit You have not finished your quiz. If you leave this page, your progress will be lost. Correct Answer You Selected Not Attempted Final Score on Quiz Attempted Questions Correct Attempted Questions Wrong Questions Not Attempted Total Questions on Quiz Question Details Results Date Score Hint Time allowed minutes seconds Time used Answer Choice(s) Selected Question Text All doneNeed more practice!Keep trying!Not bad!Good work!Perfect!

The Magical Bean Coffee - 558 Words

Coffee has been part of our everyday life for centuries. It is said that Kaldi, a habitant and goatherd of the Ethiopian highlands, centuries ago, noticed that his goats, upon eating the fruits from a certain tree, became so energetic that they did not sleep that night. After this, Kaldi reported his discovery to the abbot of the local monastery. They then decided to make a drink using that â€Å"fruit† (coffee beans) and discovered that it enabled them to stay alert for long hours. What they did not know was that this â€Å"juice† would later be called coffee and that it would be drunk worldwide for the upcoming centuries due to its energy boosting effect. But why is it that coffee has this effect? Coffee is made up of many constituents, these being: caffeine, trigonelline, carbohydrates, chlorogenic acids, lipids, amino acids, organic acids, melanoidins, volatile aroma, ash and others that are unknown. Only one of these components is the reason to why coffee contains the energetic effect that so many people seek. This component is caffeine. Caffeine’s molecular formula is, C8H10N4O2, and therefore it has eight carbon atoms, ten hydrogen atoms, four nitrogen atoms and two oxygen atoms. It is formed by covalent bonds and double bonds (when atoms share two electrons among them) between non-metals (Figure 1). Hydrogen’s electronic configuration is 1s1, Carbon’s electronic configuration is 1s2 2s2 2p2, Nitrogen’s electronic configuration is 1s2 2s2 3p3 and Oxygen’s electronicShow MoreRelatedHistory of Starbucks991 Words   |  4 Pagesstore called Starbucks Coffee, Tea and Spice in Pike Place Market in Seattle. The three academics, writer Gordon Bowker, English teacher Jerry Baldwin, and History teacher Zev Siegel, shared a passion of exotic teas and fine coffees and believed that in Seattle, they would be able to build a clientele. 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If you are like me, I don’tRead MoreTo Build or Buy Bus 402 Essay2095 Words   |  9 PagesTo Build or Buy Strayer University Course: BUS 402 January 29, 2012 My business strategy is to purchase an existing tea and coffee shop which is located a mile away from where I work in Ashburn, Virginia, the business is call Sakasa tea and coffee. Sakasa is located next door to George Washington University and directly across is a chick fil a and a small hotel also it is right off a major highway so it has a great location. The reason the owner is selling is because of health issue and asRead More21 Fun Facts About Coffee Essay1496 Words   |  6 PagesTitle: 21 Fun Facts about Coffee (1600 words) Coffee is one of the most popular beverages on the planet. According to a rough estimate, nearly 400 to 500 billion coffee cups are consumed each year. Astonished? Well, it’s only one of many truly amazing coffee facts. So sit back and enjoy the following list of crazy coffee facts. Crazy Fact 1. 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It is the chemical that gives us a boost after consuming our morning coffee or drinking a soda. It excites our central nervous system which increases heart rate and contracts muscles. Caffeine affects dopamine and adenosine receptors in the brain which release pleasure producing chemicals. Theobromine (C7H8N4O2) is a bitterRead MoreHow Coffee Affects The Environmental Ethics Of The Bean2202 Words   |  9 Pagesof coffee. Weather this coffee is brewed at home, picked up on the way to work or slowly enjoyed at a cafà ©, coffee is a common ground between millions of people. Coffee is estimated to be a $20 billion industry, its impacts reaching almost every corner of the earth. As coffee spread around the world and demand for the bean grew, an industry popped up that led to current day unethical and unsustainable practices surrounding the production and marketing of the bean. 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So you get the true magical flavor of every bean. It is truly amazing. Also Island Bagel feature a huge selection of loose leaf teas, they also has a variety of savory tea and Bagel, assortedRead MoreDifference Between Personal Troubles And Social Issues2609 Words   |  11 PagesSeeing someone holding a cup of coffee on the street is not unusual at all nowadays. In fact, they are starting to get more common. There are now different varieties to choose from. Shops or cafes also provide a lot of different choices or products to consumers. Prices could range from low to high, depending on what type of coffee beans you have chosen to make the coffee. By adopting the sociological imagination to coffee, it gives us a better understanding of what coffee represents in a social context

The Political System Of Democracy Essay - 1697 Words

We the people. The three words that make up the political system of Democracy that has existed since the days of ancient Greece. When applied to the United States of America, two forms of Democracy are presented that clash together in their principles. This is of course, Elite Democracy and Popular Democracy. Through the analysis of the process of the Electoral College, the actions of politically charged people, and various reforms throughout history, we can see how Popular Democracy pales in comparison to the superior philosophy of Elite Democracy. Before we start looking at these subjects, we will build an extended definition around both systems to lay a foundation of each one’s beliefs. Defining Popular and Elite Democracy The debate surrounding both Popular Democracy and Elite Democracy is interesting because they are essentially two sides of the same coin. Popular Democracy is centered around the ideology of â€Å"The People’s Rule†. This ideology refers to the belief that citizens should be involved as much as possible when the government makes decisions that affect their lives. On the other hand, Elite Democracy’s viewpoint is based around the idea of people voting for elected officials that rule as they see fit (Miroff 12). These two different outlooks displayed by both Popular and Elite Democracy were formed through six primary debates in which they differ. Elite and Popular Democracy can be condensed into six central points: Trust in the people, Human nature,Show MoreRelatedDemocracy Is The Best Political System1670 Words   |  7 Pagesall eligible members of a state can define democracy as a system of government, typically through elected representatives (Oxford Dictio nary, December 2014) . 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Bio Of Jonathan Swift Essay Research Paper free essay sample

Bio Of Jonathan Swift Essay, Research Paper Jonathan Swift was born in Dublin on November 30, 1667. His male parent had died before his birth, and shortly after he was born, his female parent returned to Leicestershire. He was left in the attention of his three uncles, peculiarly his Uncle Godwin. It is believed that this state of affairs, along with his unstable homelife, led to a sense of insecurity and forsaking that he carried with him for the remainder of his life. At age 6, he was sent to the best school in Ireland, the Kilkenny School. Then at age 15 he entered Trinity College, located in Dublin. He did non pay much attending to his surveies, and in 1686 he received his degree speciali grata ( by particular favour ) . He continued surveies at Trinity in hopes of deriving an advanced grade, but because of political agitation he was forced to travel to England in 1689. In England, he worked as a secretary to Sir William Temple at Moor Park, Surrey. Swift worked with Temple, a diplomat and author who was fixing his memoirs, for the following 10 old ages. It was here that he met Esther Johnson, the love of his life, whom he nicknamed Stella. Simultaneously, he attended Oxford where he have his M.A. in 1692. He wished to come in political relations but settled alternatively for the church, in which he was ordained in 1694. In January of 1695 he was ordained priest, Prebend of Kilroot. In 1697 he wrote The Battle of the Books, which was subsequently published in 1704. In the ulterior 1690? s he wrote The Tale of the Tub, his first published work. When Temple died in 1699, Swift went back to England every bit chaplain to the Earl of Berkely. In 1700, he became one of the canons of St. Patrick? s Cathedral and wrote articles and letters for the English Whigs. In 1702 he moved back to England in hope of political assignment, and it was here that he published A Tale of the Tub. It was a sarcasm on corruptness in faith and acquisition. Battle of the Books was a mock heroic sarcasm. The eye-popping sarcasm of these plants earned him ill fame but no assignment. The Bickerstaff Papers ( 1707-09 ) , some of which foremost appeared in Richard Steele? s Tatler, a newspaper to which Swift frequently contributed, demolished the pretenses of John Partridge, a popular astrologist. In 1709 he was sent to London to beg financess for his church in Ireland. The Whig leaders refused to allow his petition because they were sympathetic to the Puritans and dissidents. Although Swift had been a member of the Whig party since birth, he was uncomfortable with many of the party? s beliefs. Swift? s fright of the Puritans caused him to exchange si des to the Tory party in 1710. The Tories recognized that Swift was a valuable plus to their cause, and made him editor of their diary, the Examiner. This made him an unofficial power in English political relations, every bit good as a prima author. Later that twelvemonth, he learned of his female parent? s decease, but he was non really affected since she played a minimum function in his life and upbringing. During this clip period, his friends included, Steele, Alexander Pope and John Gay. His life at this clip is recorded in the Journal to Stella, which were his letters to Esther Johnson. In 1713, the Scriblerus Club was founded by Swift, Pope, Parnell, Gay, and Arbuthnot. When the Tories fell in 1714, his political power ended. Swift was so appointed Dean of St. Patrick? s. This station carried great prestigiousness, but it made it impossible for him to go forth Ireland. Ireland in the eighteenth century was a settlement of England, exploited by absentee English landlords and denied self-determination. The spectacle of Irish servitude in general and in peculiar a strategy by one William Wood, who had received a royal patent to publish a new Irish mintage and planned to gain from corrupting it, provoked Swift in 1724 to compose the Drapier? s Letters, cheering the Irish to decline Wood? s mintage and develop their ain economic system. The development of the Irish economic system was besides the subject of his last and most superb sarcasm, A Modest Proposal, ( 1729 ) in which he ironically counseled his c ountrymen to turn their kids into a hard currency harvest. These attempts made Swift a national hero, but even so did non accommodate him to populating in Ireland. In 1726 Jonathan Swift visits England with a manuscript for Gulliver? s Travels, which was published anonymously. This was his last visit to England, that same twelvemonth Gulliver? s Travels was translated into French, German, and Dutch. In 1728, Esther # 8220 ; Stella # 8221 ; Johnson died. In 1731, Verses on the Death of Dr. Swift, was written. In 1732, Swift? s beloved friend John Gay died. In 1735, Faulkner publishes Swift? s plants and the corrected version of Gulliver? s Travels. Swift? s concluding old ages are the topic of some contention. Some have suggested that Swift went insane, but that theory has non been confirmed. It is known that Swift suffered from dizziness, due to an interior ear disease. However he remained inactive throughout the 1730? s, before enduring a shot in 1742. He declined mentally and in 1742 he was declared unfit to pull off himself. For the following three old ages, Swift was cared for by defenders. On October 19, 1745 Jonathan Swift died. He was buried in St. Patrick? s Cathedral, following to Stella. On the wall following to his casket is an epitaph written himself. It reads: # 8220 ; The organic structure of Jonathan Swift, Doctor of Sacred Theology, dean of this cathedral church, is buried here, where ferocious outrage can no more lacerate his bosom. Go, traveller, and imitate, if you can, one who strove with all his strength to title-holder autonomy # 8221 ; . As a ironist Swift? s technique was to make fictional talkers, such as Lemuel Gulliver and the Modest Proposel, who arrant sentiments that the intelligent reader will acknowledge as sinfully self-satisfied, narcissistic, stupid, or mad. Swift is therefore the maestro of unostentatious sarcasm, and his name has become practically synonymous with the type of sarcasm in which the most hideous statements are offered in a straight-faced mode. He has frequently been accused of a morbid preoccupation with physical decay. It should be remembered, nevertheless, that this preoccupation belongs technically to his talkers, of whom Swift did non anticipate the reader to O.K. .