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Objective 3 Classify bones according to their shapes and give an example of each type cheap detrol 4 mg free shipping. Objective 5 Describe the gross features of a typical long minerals which account for approximately two-thirds of the bone and list the functions of each surface feature. About 95% of the calcium and 90% of the phosphorus within the The shape and surface features of each bone indicate its func- body are deposited in the bones and teeth. Bones that are long, for concentration of these inorganic salts within the blood is example, provide body support and function as levers during kept within narrow limits, both are essential for other body body movement. Calcium is necessary for muscle contraction, blood have large articular surfaces and processes for muscle attachment. Phosphorus is required for the activities of the ligaments, tendons, or muscles. A flattened surface provides an nucleic acids DNA and RNA, as well as for ATP utilization. If mineral salts are not present in the diet in sufficient Grooves around an articular end of a bone indicate where a ten- amounts, they may be withdrawn from the bones until they don or nerve passes, and openings through a bone permit the are replenished through proper nutrition. Shapes of Bones Vitamin D assists in the absorption of calcium and phospho- rus from the small intestine into the blood. As bones develop The bones of the skeleton are grouped on the basis of shape into in a child, it is extremely important that the child’s diet contain an adequate amount of these two minerals and vitamin D. If the diet is four principal categories: long bones, short bones, flat bones, and ir- deficient in these essentials, the blood level falls below that neces- regular bones (fig. Rickets is characterized by soft bones that may re- sult in bowlegs and malformation of the head, chest, and pelvic and function as levers. Skeletal System: © The McGraw−Hill Anatomy, Sixth Edition Introduction and the Axial Companies, 2001 Skeleton 136 Unit 4 Support and Movement TABLE 6.

In these cases purchase detrol 1 mg visa, there was a failure to carry a correct radiographic inter- pretation of possible cancer through the necessary steps that lead to a definitive diagnosis. Despite the myriad pressures of daily medical practice, such lapses are difficult to defend in court. The clinical cir- cumstances of these lapses vary from case to case, and in some the patient bore significant responsibility; however, in each instance a positive mammography finding did not receive appropriate attention. Given the fact that even in the best of hands and using the best available equipment, 15–20% of breast cancers will not be detected by screening mammography, it is critical to institute measures to eliminate these preventable errors. Delay in Diagnosis The majority of claims involving breast cancer involve allegations of delayed diagnosis. However, to be successful a malpractice claim must prove more than a breach in the standard of care that resulted in later diagnosis. It must also be shown that the patient suffered harm as a result of the delay. If the delay is long enough for the cancer to 158 Anderson and Troxel metastasize, the harm is apparent because metastatic breast cancer is essentially incurable. In this series, only 1 of the 80 claimants had metastatic disease at the time of initial diagnosis. In the other 79 cases, inferences about potential harm were made from the size of the cancer and the status of the regional lymph nodes at the time of actual diagnosis compared to their hypothetical status at the time of “missed” diagnosis. Ten litigated cases alleged delays of less than 6 months; 9 of 10 of these cases were won by the defense. This seems a surprisingly large number of claims alleging such a short period of delay. There are several potential explanations: • If the patient is the initial discoverer of the lump, she may resent even very brief “delays” in definitive diagnosis. Too often, patients undergoing annual mammography believe that they should not get breast cancer at all. In our society, there is an increasingly widespread belief that all adversity should be com- pensated.

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The analysis may focus on memory organisation discount 4 mg detrol free shipping, knowledge utilisation, data interpretation, or problem representation (for example3,17,18). In other studies, clinicians are given all the data simultaneously and asked to make a diagnosis. Clinicians differ more in their understanding of problems and their problem representations than in the reasoning strategies employed. This finding of case specificity challenged the hypothetico-deductive model of clinical reasoning for several reasons: both successful and unsuccessful diagnosticians used hypothesis testing, and so it was argued that diagnostic accuracy did not depend as much on strategy as on mastery of domain content. The clinical reasoning of experts in familiar situations frequently does not display explicit hypothesis testing,5,21–23 but is instead rapid, automatic, and often non-verbal. The speed, efficiency, and accuracy of experienced clinicians suggests that they might not even use the same reasoning processes as novices, and that experience itself might make hypothesis testing unnecessary. Pattern recognition implies that clinical reasoning is rapid, difficult to verbalise, and has a perceptual component. Thinking of diagnosis as fitting a case into a category brings some other issues into clearer view. Two somewhat competing accounts have been offered, and research evidence supports both. Category assignment can be based on matching the case either to a specific instance – so-called instance based or exemplar based recognition – or to a more abstract prototype. In instance based recognition a new case is categorised by its resemblance to memories of instances previously seen. This model is supported by the fact that clinical diagnosis is strongly affected by context (for example the location of a skin rash on the body), even when this context is normatively irrelevant. The prototype model holds that clinical experience – augmented by teaching, discussion, and the entire round of training – facilitates the construction of abstractions or prototypes.

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Laryngitis may result from overuse of the voice trusted detrol 1 mg, inhalation of an irritating chemical, or oropharynx. Paired palatine tonsils are located on the pos- a bacterial or viral infection. Mild cases are temporary and seldom of terior lateral wall, and the lingual tonsils are found on the major concern. It extends inferiorly from the level large unpaired structures, and six are smaller and paired. The of the hyoid bone to the larynx and opens into the esopha- largest of the unpaired cartilages is the anterior thyroid cartilage. It is at the lower laryngopharynx that the The laryngeal prominence of the thyroid cartilage is commonly respiratory and digestive systems become distinct. Tonsils are lymphoid organs and tend to be- come swollen and inflamed after persistent infections. The removal of the palatine epiglottis is located behind the root of the tongue where it aids tonsils is called a tonsillectomy, whereas the removal of the pharyn- in closing the glottis, or laryngeal opening, during swallowing. The entire larynx elevates during swallowing to close the glot- tis against the epiglottis. This movement can be noted by cup- Larynx ping the fingers lightly over the larynx and then swallowing. In this case, the abdominal thrust ducting division that connects the laryngopharynx with the trachea. Respiratory System © The McGraw−Hill Anatomy, Sixth Edition Body Companies, 2001 Chapter 17 Respiratory System 609 Posterior Base of tongue Vestibular folds Vocal folds Cuneiform Corniculate cartilage cartilage Anterior (a) Posterior Epiglottis Glottis Inner lining of trachea (c) Anterior (b) FIGURE 17.