Ks bull 2008 gp practice questions

Might also not put you off so easily as you appreciate the more "scientific" approach to writing the essay rather than the relatively flamboyant ones we normally get to see in KS Bull. Is technology the best answer to environmental destruction? Meanwhile, huge swathes of rainforest in the Amazon are destroyed each day to be used as cattle grazing pastures. Given the undeniable fact that human activity is responsible for environmental destruction, it is then not surprising that the best answer to environmental destruction is not the development of new technology to patch up the problem, but instead a fundamental change in mindset and attitudes globally which would address the root of the problem.

Ks bull 2008 gp practice questions

Ks bull 2008 gp practice questions

Its cell membrane is covered by flagella and a loosely-associated outer membrane. The major outer-surface proteins include OspA, OspB and OspC which are highly charged basic proteins of molecular weights of about 31, 34, and 23 kilodaltons, respectivelyas well as the kd flagellar protein, are important targets for the immune response of humans.

Based on studies of its DNA, the organism has been subclassified into several genospecies: Ina total of 19, Lyme disease cases were reported in the United States. In Europe, most cases occur in the Scandinavian countries and in central and eastern Europe especially in Germany, Austria and Sloveniaalthough cases have been reported from throughout the continent.

In endemic areas persons who have either occupational or recreational exposure to tick-infested woodlands or fields are at increased risk of Lyme disease, although the risk is also substantial on the lawns of suburban homes that border wooded areas Acute cases start to occur in the early spring with the incidence peaking typically in early July due to the frequent feeding characteristics Ks bull 2008 gp practice questions nymphal ticks.

Onset of early disease can be seen through the fall until the first hard frost when ticks no longer are active. Due to outdoor predilections, children and middle-aged adults are most commonly afflicted, although ages can range from early childhood to advanced ages.

The rash may begin as a macule or papule at the site of the bite and then often rapidly expands over days if untreated.

Ks bull 2008 gp practice questions

Dimensions greater than five centimeters help differentiate an erythema migrans rash from other processes, including insect bites or tick hypersensitivity reactions than tend to remain quarter-sized or smaller. In the North America, erythema migrans is more commonly identified at earlier stages without central clearing, so actually the most common erythema migrans rash is homogenous in appearance Figure 2 Favored locations include warmer and moist regions of the body such as in the axillae, the inguinal or popliteal regions, the torso and in women under the breasts though the rash may occur anywhere.

The area of rash is usually light to more intensely red and typically flat but may be raised on occasion. Untreated, the rash may expand considerably with sizes up to 20cm or beyond in a circumferential pattern that distinguishes it from typical cellulitis or ringworm.

The rash is usually painless, but may be warm and occasionally pruritic. A central punctum may be seen at the near center where the tick bite occurred Figure 3. Occasionally, erythema migrans may have atypical features including unusual shapes, central duskiness or bluish discoloration, induration, or features of necrosis that may lead to confusion with spider bites Figure 4 Others occasionally show multiple red rings that may be confused with erythema multiforme.

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Most patients have some form of accompanying symptoms including constitutional complaints such as fatigue or fever, or more localized problems such as headache, myalgia, arthralgia or enlarged lymph nodes.

For a minority, the patients feel well with only a rash as a presenting compliant. Many patients have no recollection of a prior tick bite Even if untreated, the erythema migrans rash will resolve within weeks. Occasionally, a patient may present with flu-like illness or headache representing early Lyme disease without evidence of a rash Securing a definite Lyme diagnosis in these patients may be difficult because serological testing along cannot easily distinguish among the possibilities of a viral infection or infection with tick-borne agents such as Ehrlichia or Babesia species.

Culture or PCR identification is mostly limited to research laboratories, so clinical determination of a rash as erythema migrans remains the usual method for identification of Lyme disease at this early, localized stage. If uncertainty exists, options include observing the rash as erythema migrans tends to expand over a period of days, or one can obtain acute and convalescent Lyme serology.

Earl y, Disseminated Lyme Disease Cu taneous The most common manifestation of early disseminated disease is multiple erythema migrans that almost always is accompanied by fever and flu-like symptoms reflecting hematogenous spread of the spirochete.

Fatigue and lethargy are common.

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The lesions of multiple erythema migrans tend to be smaller and fainter with less indurated centers These rashes occur beyond the site of a tick bite and may occur newly with others fading over the course of weeks, anywhere on the body. Antibiotics yield improvement, but the rashes will resolve even without antibiotic therapy Aseptic lymphocytic meningitis, cranial neuropathy especially facial nerve palsy or radiculoneuritis are most commonly encountered in these early stages of neuroborreliosis, and may occur together More rarely encountered early neurological involvement includes transverse myelitis, encephalitis and inflammatory myopathy.

For Lyme-related meningitis, expected symptoms may include severe headache, neck pain and stiffness but on occasional include signs consistent with mild encephalopathy. Though a facial palsy may be a presenting sign of Lyme disease, it usually occurs within four weeks of erythema migrans onset The pain can be severe, disrupting sleep.

Beyond pain, neurologic deficits may accrue including loss of sensation, motor weakness and depressed deep tendon reflexes Lyme radiculoneuritis will need to be differentiated from other causes such as spinal disc or bone impingement of nerves, zoster without rash, so-called zoster sine herpteischemia or virally-induced neuritis.

Ca rdiac Lyme carditis may cause varying degrees of heart block, but only advanced cases resulting in reversible third degree-block causing severe fatigue, dizziness or syncope usually come to medical attention.

Temporary pacemaker insertion may be required. Pericarditis and myocarditis have been rarely described due to Lyme disease; however, there is no convincing evidence linking it as a common cause for cardiomyopathy Oth er Manifestations Diffuse and migratory musculoskeletal pains may occur in the early, disseminated states of Lyme disease.Nov 15,  · Lyme disease is a multisystem illness caused by infection with the spirochete Borrelia burgdorferi and the body's immune response to the infection.

The disease is transmitted to humans via tick bites, from infected ticks of the genus Ixodes. Paper 2: Introduction to the comprehension paper, reading strategies, tone, figurative questions & AQ. Red Bull driver Max Verstappen clocked the fastest lap of the first practice at the Brazilian Grand Prix.

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Search the world's information, including webpages, images, videos and more. Google has many special features to help you find exactly what you're looking for. Endocrine disruptors are chemicals that can interfere with endocrine (or hormone) systems at certain doses.

These disruptions can cause cancerous tumors, birth defects, and other developmental disorders. Any system in the body controlled by hormones can be derailed by hormone disruptors.

Endocrine disruptor - Wikipedia