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Saladin/Nolan
Clinical Applications Manual
ANSWERS TO END-OF-CHAPTER QUESTIONS
Chapter 1
1. The mental and physiological signs of the disease result from ingestion and inhalation of lead by the
children. These children were exposed to lead (and other heavy metals) at the manufacturing plant where
they scavenged materials.
2. The children’s risk factors for lead poisoning include the presence of lead-based paint, dust containing
crushed and pulverized paint chips, and metal-contaminated soil around the factory. The risk factor for the
elderly woman is her habit of chewing on the lead foil wrapping from wine bottles.
3. Lead is a poison but not a toxin, because toxins are of animal or plant origin.
4. Idiopathic diseases are those with no known cause. Since there is an identifiable cause in all the cases in
this scenario, none of these people has idiopathic lead poisoning.
5. Yes, lead poisoning could be considered a syndrome. The signs, symptoms and changes in physiology are
characteristic of lead poisoning.
6. Since blood is a tissue, the diagnostic findings on the blood (traces of lead and reduced RBC count) are
histopathological.
7. High morbidity? Yes, among the children but not among adults, because a large percentage of children in
the housing project exhibit signs of the disease. High mortality? No, because no deaths were reported. High
prevalence? Yes, high morbidity in this case is equivalent to the high prevalence of the disease among the
children. High incidence? There is insufficient information to evaluate incidence in this case, because no
data were available to document the number of new cases in a given time period.
8. Yes, lead poisoning among the children of this community can be considered an epidemic because it occurs
in a far higher percentage of individuals (more than 70 of the 112 children examined) than it does in the
general population. Lead poisoning is not an infectious disease, however, because it is not caused by an
infectious agent (such as a virus or bacterium) and it is not transmitted from person to person.
9. (a) joint pain = symptom; (b) difficulty walking = sign; (c) excessive salivation = sign; (d) personality
changes = sign; (e) low RBC count = sign; (f) subnormal intelligence = sign; (g) dimness of vision =
symptom; (h) lead in the urine = sign. (Remember that the criterion for a symptom is something that can
only be known by the patient, while a sign is capable of being objectively verified by another observer.)
10. You could advise the daughter to buy wine without lead foil or to dispose of the foil wrappers carefully so
that her mother cannot get at them. You might also do a blood test on the mother to check for iron-
deficiency anemia and prescribe a multivitamin and mineral supplement if necessary. If the mother insists
on chewing on something, you could recommend substituting something nontoxic such as ice or gum.
When I returned to the village, not a person was stirring among the
cabins; an unearthly stillness brooded over the place, and I could
have imagined it to be a town of the dead. Had I not been utterly
fatigued by my night in the open, I might have been struck even
more strongly by the solitude, and have paused to investigate; as it
was, I made straight for my own hut, flung myself down upon my
straw couch, and sank into a sleep from which I did not awaken until
well past noon.
After a confused and hideous dream, in which I lay chained to a
glacier while an arctic wind blew through my garments, I opened my
eyes with the impression that the nightmare had been real. A
powerful wind was blowing! I could hear it blustering and wailing
among the treetops; through my open window it flickered and sallied
with a breath that seemed straight from the Pole. Leaping to my feet,
I hastily closed the great shutters I had constructed of pine wood;
and, at the same time, I caught glimpses of gray skies with a
scudding rack of clouds, and of little white flakes driving and reeling
down.
In my surprise at this change in the weather, I was struck by
premonitions as bleak as the bleak heavens. What of Yasma? How
would she behave in the storm?—she who was apparently
unprepared for the winter! Though I tried to convince myself that
there was no cause for concern, an unreasoning something within
me insisted that there was cause indeed. It was not a minute,
therefore, before I was slipping on my goatskin coat.
But I might have spared my pains. At this instant there came a
tapping from outside, and my heart began to beat fiercely as I
shouted, "Come in!"
The log door moved upon its hinges, and a short slim figure slipped
inside.
"Yasma!" I cried, surprised and delighted, as I forced the door shut in
the face of the blast. But my surprise was swiftly to grow, and my
delight to die; at sight of her wild, sad eyes, I started back in wonder
and dismay. In part they burned with a mute resignation, and in part
with the unutterable pain of one bereaved; yet at the same time her
face was brightened with an indefinable exultation, as though
beneath that vivid countenance some secret ecstasy glowed and
smoldered.
"I have come to say good-bye," she murmured, in dreary tones. "I
have come to say good-bye."
"Good-bye!"—It was as though I had heard that word long ago in a
bitter dream. Yet how could I accept the decree? Passion took fire
within me as I seized Yasma and pressed her to me.
"Do not leave me!" I pleaded. "Oh, why must you go away? Where
must you go? Tell me, Yasma, tell me! Why must I stay here alone
the whole winter long? Why can't I go with you? Or why can't you
stay with me? Stay here, Yasma! We could be so happy together, we
two!"
Tears came into her eyes at this appeal.
"You make me sad, very sad," she sighed, as she freed herself from
my embrace. "I do not want to leave you here alone—and yet, oh
what else can I do? The cold days have come, and my people call
me, and I must go where the flowers are. Oh, you don't know how
gladly I'd have you come with us; but you don't understand the way,
and can't find it, and I can't show it to you. So I must go now, I must
go, I must! for soon the last bird will have flown south."
Again she held out her hands as for a friendly greeting, and again I
took her into my arms, this time with all the desperation of impending
loss, for I was filled with a sense of certainties against which it was
useless to struggle, and felt as if by instinct that she would leave
despite all I could do or say.
But I did not realize quite how near the moment was. Slipping from
my clasp, she flitted to the door, forcing it slightly open, so that the
moaning and howling of the gale became suddenly accentuated.
"Until the spring!" she cried, in mournful tones that seemed in accord
with the tumult of the elements. "Until the spring!"—And a smile of
boundless yearning and compassion glimmered across her face.
Then the door rattled to a close, and I stood alone in that chilly room.
Blindly, like one bereft of his senses, I plunged out of the cabin,
regardless of the gale, regardless of the snow that came wheeling
down in dizzy flurries. But Yasma was not to be seen. For a moment
I stood staring into the storm; then time after time I called out her
name, to be answered only by the wind that sneered and snorted its
derision. And at length, warmed into furious action, I set out at a
sprint for her cabin, racing along unconscious of the buffeting blast
and the beaten snow that pricked and stung my face.
All in vain! Arriving at Yasma's home, I flung open the great pine
door without ceremony—to be greeted by the emptiness within. For
many minutes I waited; but Yasma did not come, and the tempest
shrieked and chuckled more fiendishly than ever.
At last, when the early twilight was dimming the world, I threaded a
path back along the whitening ground, and among cabins with roofs
like winter. Not a living being greeted me; and through the wide-open
windows of the huts I had glimpses of naked and untenanted logs.
II
Blossom and Seed
Chapter XI
THE PRISONER
When I staggered back to my cabin through the snow-storm in the
November dusk, I could not realize the ghastliness of my misfortune.
My mind seemed powerless before the bleak reality; it was not until I
had re-entered the cabin that I began to look the terror in the face.
Then, when I had slammed the door behind me and stood silently in
that frigid place, all my dread and loneliness and foreboding became
concentrated in one point of acute agony. The shadows deepening
within that dingy hovel seemed living, evil things; the wind that
hissed and screeched without, with brief lulls and swift crescendos of
fury, was like a chorus of demons; and such desolation of spirit was
upon me that I could have rushed out into the storm, and delivered
myself up to its numbing, fatal embrace.
It was long before, conscious of the increasing chill and the coaly
darkness, I went fumbling about the room to make a light.
Fortunately, I still had a half-used box of matches, vestiges of the
world I had lost; and with their aid, I contrived to light a little wax
candle.
But as I watched the taper fitfully burning, with sputtering yellow rays
that only half revealed the bare walls of the room and left eerie
shadows to brood in the corners, I almost wished that I had
remained in darkness. How well I remembered Yasma's teaching me
to make the candle; to melt the wax; to pour it into a little wooden
mould; to insert the wick in the still viscid mass! Could it be but a
month ago when she had stood with me in this very room, so
earnestly and yet so gaily giving me instructions? Say rather that it
was years ago, eons ago!—what relation could there be between
that happy self, which had laughed with Yasma, and this forlorn self,
which stood here abandoned in the darkness and the cold?