🔴masseter➡️protraction+elevation.

🔴medial pterygoid➡️protraction+elevation+side.

🔴Lateral pterygoid➡️protection+Depression+side.

🔴Temporalis➡️Retraction+elevation.

❗❗Mcq❗❗

🔴All of them perform elevation except the lateral pterygoid.


🔴All of them perform protraction except the temporalis.

تجميعة مقسمة ل أسئلة د.خالد ميلاد⤴️

#AN234
الاسئلة يلي مكررها د.خالد ميلاد ف الدفعات يلي أعطاها⬇️:

اللهم في هذا اليوم، نسألك أن تفتح علينا فتوح العارفين، وتوفقنا توفيق الصالحين. اللهم لا سهل إلا ما جعلته سهلاً، وأنت تجعل الحزن إذا شئت سهلاً.
اللهم ذكّرنا ما نسينا، وعلّمنا ما جهلنا، وثبّت قلوبنا عند الإجابة. يا رب لا تضيع لنا تعباً،يا ربّ، استودعناك ما قرأنا وما حفظنا وما فهمنا، فردّه إلينا عند حاجتنا إليه. اللهم ارزقنا سرعة الفهم، وصفاء الذهن، وقوة التركيز. بالتوفيق دكاترة☠️ 🧠.

ملاحظات دكاترة الكلية ⬇️:

Para lecture 1:

🔴Endoparasites, such as malaria, live inside red blood cells (RBCs)."

🔴Hydatid disease:
Hydatid disease is common in Libya.
🐶 Dog–Sheep Cycle :
-The adult worm lives in the intestine of the dog.
-Eggs are passed in the dog’s stool.
-The stool contaminates grass.
-Sheep eat the contaminated grass.
-The larvae go to the sheep’s liver and form a hydatid cyst.
-When the dog eats infected sheep liver, the cycle continues.
-This is called the dog–sheep cycle.

👩‍⚕️ Human Infection
Humans get infected by eating food contaminated with dog eggs.
The larvae go to the liver and form hydatid cysts.

🔴Opportunistic Parasitic Infection
Some parasites are controlled when the immune system is strong, so no manifestations appear.
But when immunity decreases, the parasite becomes active and causes manifestations.
This is called an opportunistic infection, because it appears when the immune system is weak.
Causes of Immunosuppression:
HIV/Chemotherapy/Organ transplantation/Long-term corticosteroid therapy/Genetic diseases that cause immunodeficiency.

🔴The reproduction in the mosquito is sexual reproduction, so the mosquito is called the Definitive Host because the sexual stage of the parasite takes place there.
🔴in the human, the parasite undergoes asexual multiplication, so the human is called the Intermediate Host.
🔴The adult worm lives in the intestine of the dog. The dog is the Definitive Host because it contains the adult stage of the parasite.
The worm produces eggs that are passed in the dog’s feces. Sheep ingest these eggs while grazing. After ingestion, the eggs hatch in the intestine of the sheep, release larvae (oncospheres), penetrate the intestinal wall, and travel through the bloodstream to the liver, where they develop into hydatid cysts.
The sheep is considered the Intermediate Host because it contains the larval stage of the parasite.
The life cycle is completed when a dog eats the infected liver of the sheep (for example, during slaughter) that contains hydatid cysts. The larvae then develop into adult worms in the dog’s intestine.
Humans can also become infected by ingesting eggs (usually through contaminated food, water, or contact with dogs). In humans, hydatid cysts develop mainly in the liver . However, humans do not normally transmit the infection back to dogs, so humans are considered a Dead-End Host.
In rare cases reported in some regions where bodies are not buried properly and are eaten by dogs, the life cycle may be completed, but this is not the normal route of transmission.

🔴Endemic → The disease is present at a constant or stable rate all the time in a specific area.
🔴Epidemic → The disease is not constantly present; it occurs occasionally and irregularly.
🔴Pandemic → The disease spreads widely across the world and affects many people (for example, COVID-19).
🔴The Eastern ulcer disease Cutaneous leishmaniasis in Libya is endemic.
It infects humans as well as animals, such as dogs, jerboas, and rats.
These animals are considered reservoirs or sources of infection.
🔴A mosquito that carries bacteria or viruses with any change in their number or not change in form is called a propagative biological vector.
A mosquito that carries Plasmodium (malaria), in which the parasite increases in number and changes its form, is called a cyclo-propagative biological vector.
There is another type in which the parasite changes its form but does not increase in number, called a cyclodevelopmental vector.

🔴Life cycle is mechanism of transmation of parasite to the human.
🔴Children are the most exposed to parasites due to their weaker immune system and low hygiene levels, as they spend most of their time in places with high parasite exposure, such as schools and kindergartens.
🔴The higher the number of parasite, the greater the intensity of the parasite infection.

🔴Protozoa cannot be seen with the naked eye, whereas helminths can be seen with the naked eye. Both are transmitted by vectors.
🔴Protozoa are obligatory parasites; some live intracellularly, and some require a vector.
🔴Protozoa are divided into three groups: Flagellates, Ciliates, and Apicomplexa.

🔴Giardia intestinalis
Infective stage: Cyst
Giardia exists as cysts, not trophozoites, because cysts are more resistant to the external environment.
Transmission:
Mainly through water – contaminated water is the most common source. Water is often used to wash fruits and vegetables, so infection can sometimes be foodborn.
Person-to-person transmission – especially common among children.
Occasionally foodborne or zoonotic – transmitted from animals.
🔴atrophy of intestinal villi Chronic not acute.

🔴Some antigens of IgA resemble the antigens of Giardia, causing the body to produce antibodies that may make it more susceptible to Giardiasis.
🔴The most frequent cause of diarrhea in the pediatric population is Viral .

🔴Case:
A 6-year-old boy, attending kindergarten, presents with acute watery diarrhea. The stool is watery, occurs in multiple bouts, and contains small, fine, egg-like particles. It has a strong odor and occurs frequently. Associated symptoms include nausea, flatulence, and abdominal bloating.
If untreated, the condition can progress from acute to chronic. Chronic infection may lead to:
Protein loss
Villus atrophy, causing malabsorption
Lactose intolerance, resulting in abdominal bloating due to malabsorption of lactose
Over time, additional signs of fat-soluble vitamin deficiencies may appear:
Vitamin D deficiency: legs may become bowed (resembling “pigeon chest” deformity)
Vitamin K deficiency: bleeding gums
Vitamin A deficiency: night blindness
Vitamin E deficiency: ataxia and neurological signs
Other consequences of chronic malabsorption may include:
Zinc deficiency
Rare involvement of the bile ducts, potentially causing jaundice.
🔴Post-Giardia lactose intolerance – not permanent.
🔴Villus atrophy – diagnosed by intestinal biopsy.
🔴patient has villus atrophy and shows failure to thrive, meaning their weight and growth are below what is expected for their age. This is due to malabsorption caused by the underlying condition.
Villus atrophy can occur in patients with Giardiasis or Celiac disease.
People with Celiac disease are sensitive to gluten and must follow a gluten-free diet. Celiac disease is an autoimmune disorder.
🔴Method of Diagnosis – Giardiasis
Stool examination (diarrheic stool):
In acute diarrhea, trophozoites are more commonly found than cysts.
Carriers may not show any manifestations, but they can still transmit the disease because cysts are present in their stool.
Stool sampling considerations:
Not every stool sample will contain both cysts and trophozoites.
To improve detection, it is recommended to examine at least three stool samples collected on different days.
If only one sample is tested, the sensitivity is about 30%, whereas with three samples, sensitivity increases to 70–75%.
Limitations of tests:
Every diagnostic test may have false positives and false negatives.
False positive: the test result is positive, but the patient does not actually have the disease.
False negative: the test result is negative, but the patient actually has the disease.
🔴Serodiagnosis – Giardiasis
In serodiagnosis, we look for antibodies, not antigens, because the antigen does not invade the mucosa.
We typically test for IgM and IgG antibodies.
IgM:
Appears in acute infection, but it rises and falls quickly, so it is not reliable for diagnosis.
IgG:
Persists for a long time, even in chronic or past infections.
A person infected with Giardiasis 10 years ago may still test IgG positive, so it cannot confirm active infection.
🔴Metronidazole (Flagyl) has complications in pregnancy and with alcoholism.

Para|المحاضرة الثانية
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🔴Apicomplexa have a specialized apical complex that helps in cell penetration because the parasite is intracellular.

🔴Cryptosporidium was first discovered in primitive animals. Later, it was found that it can also infect humans. It mainly lives in the small intestine. However, under certain conditions related to weakened immunity, it may also be found in the stomach, appendix, colon, and rectum. Therefore, it is considered an opportunistic parasite.

🔴Cryptosporidium:
Cryptosporidium parvum is transmitted to both humans and animals; therefore, it is considered zoonotic.
Cryptosporidium hominis is considered less important than Cryptosporidium parvum because it is transmitted only between humans. Since it spreads from human to human only, it is described as anthroponotic.

🔴The oocysts contain sporozoites. They are small, oval in shape, and measure 15–20 micrometers in size.
🔴Cryptosporidium, like Giardia, is highly resistant to chlorine disinfection, which represents a major public health concern for water supplies. It can also survive at temperatures up to 60°C.
🔴Cryptosporidium lives in the small intestine; therefore, it is excreted in the stool.
🔴The oocyst is the infective stage and causes direct infection in humans. The oocyst contains four sporozoites.

🔴The life cycle of Cryptosporidium involves both sexual and asexual stages, ending with oocysts that are shed in the stool and can cause direct infection.
In the intestine, some oocysts may rupture and cause autoinfection, especially in immunocompromised individuals. This explains why infections can become chronic in immunocompromised patients, as thin-walled oocysts can rupture and lead to internal autoinfection.
Thick-walled oocysts, on the other hand, are excreted in the feces of an infected person or animal and are the primary source of environmental contamination. These can cause external infection.

🔴Cryptosporidium is widely distributed,If a patient is infected, you should ask about their occupation and other relevant exposures,The infection is considered a notifiable disease, meaning it must be reported to public health authorities.

🔴Acute symptoms of cryptosporidiosis include self-limiting watery diarrhea, which means it does not require treatment.

🔴Cryptosporidiosis in immunocompetent persons usually causes self-limiting watery diarrhea and does not spread to other organs.

🔴CHRONIC SYMPTOMS OF THE DISEASE
In severely immunocompromised patients, particularly those with advanced HIV/AIDS or certain genetic immunodeficiencies, the infection can spread beyond the intestines to other organs, such as:
The biliary tract, causing cholangitis
The lungs
It can even cause jaundice in some cas.
🔴To diagnose cryptosporidiosis, a stool sample is collected. A small amount of the stool is placed on a glass slide, and a drop of normal saline is added.

🔴When we stain the stool sample using Modified Ziehl–Neelsen (ZN) staining, this method is considered more accurate and more sensitive for the diagnosis of Cryptosporidium infection.

🔴the stool sample is reported as negative (free of oocysts), one sample alone is usually not sufficient to rule out infection.

However, a single sample may be enough if it has been properly examined using a stained method (such as Modified Ziehl–Neelsen staining), which increases the sensitivity of detection.

🔴Conjunctin B is usually used as supportive treatment in the eyes for cases of ocular cryptosporidiosis and was recently discovered, but it should be preceded by giving antivirals and increasing T-cell immunity.
🔴The oocyst in Cryptosporidium differs from the oocyst in Isospora belli because the Cryptosporidium oocyst contains sporozoites , while the Isospora belli oocyst contains two sporocysts, each of which has four sporozoites.