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Striated ducts refer to segments of the exocrine ductal system that provide conduits between intercalated ducts and excretory ducts. Urothelial (transitional) cell carcinoma of the bladder typically manifests as sudden hematuria and, less frequently, manifests as dysuria. The cytoplasm is foamy and pale, owing to the extraction of lipids and waxes during tissue preparation. Such infants show signs of respiratory distress and hypoxia, including tachypnea, use of accessory respiratory muscles, and cyanosis. A variety of studies have shown that E-cadherin gene expression is reduced in most epithelial cancers (carcinomas). They are filled with a variety of acid hydrolases that degrade macromolecules to their constituent parts. These types include (1) large or elastic arteries, (2) medium or muscular arteries, and (3) small arteries. The domeshaped apical cells indicate this is a transitional epithelium that lines organs of the urinary system (bladder, ureters, and proximal portion of the urethra). The other male reproductive organs are derived from mesoderm (mesenchyme) of the urogenital ridge. Distally, perineurium contributes to the capsule of many terminal nerve endings and receptors, including Pacinian and Meissner corpuscles, as well as muscle spindles and Golgi tendon organs. Anorexia, weight loss, fatigue and general debility are common in the advanced stages of lung cancer. This degenerative process is mediated by activation of apoptosis in which of the following ovarian cells Injury to the other organs does not lead to increased serum levels of amylase and lipase. Although the other cells are found in diffuse and nodular lymphatic tissue, they do not form germinal centers in secondary lymphoid follicles. If you decide to reinstitute drug therapy in this patient, the best choice would be (A) Amitriptyline (B) Bupropion (C) Fluoxetine (D) Imipramine (E) Venlafaxine 4. A 70-year-old retired businessman is admitted with a history of recurrent heart failure and metabolic derangements. Cells in which of the following anatomic locations secrete this mineralocorticoid Keywords: Neural crest, parafollicular cells 28 the answer is E: Increased thyroglobulin uptake. Like clearance, half-life is a constant for drugs that follow first-order kinetics. These structural changes enable arterioles to regulate (and redistribute) blood flow to capillary beds in regions of the body where arterial blood flow is most needed. It is continuous with the tendon or aponeurosis that anchors a muscle to its attachment site. These junctions provide ionic coupling in the seminiferous epithelium and help coordinate the cycle of spermatogenesis. Cocaine is an important exception because it has intrinsic sympathomimetic action due to its inhibition of norepinephrine reuptake into nerve terminals. High concentrations of unconjugated bilirubin in a neonate can cause irreversible brain injury (referred to as kernicterus). For the majority of patients, asthma is controlled by a combination of a regular inhaled steroid and occasional use of an inhaled bronchodilator 132 Asthma remainder is mainly deposited in the oropharynx and swallowed. Effects-Caffeine (in beverages) and nicotine (in tobacco products) are legal in most Western cultures even though they have adverse medical effects. With continued treatment, dyskinesias may develop at a dose of levodopa that was previously well tolerated. Drug Z causes bradycardia when the ganglia are blocked, indicating that it also has a direct muscarinic action on the heart. This photomicrograph shows the distinctive morphology of colonic glands in cross-section. Two organophosphates used in medicine are malathion (a scabicide) and metrifonate (an antihelminthic agent).

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Progressive lung damage is associated with the development of digital clubbing and progressive airway obstruction, sometimes associated with wheeze. These products are expensive and carry a risk of immunologic reactions and, in the case of factors purified from blood products, infection (although most known blood-borne pathogens are removed by chemical treatment of the plasma extracts. The interstitium is also thickened and contains a chronic inflammatory cell infiltrate. Phenobarbital (or primidone) is now considered to be an alternative agent in adults but continues to be a primary drug in infants. Local anesthetic activity-Local anesthetic activity ("membrane-stabilizing activity") is a disadvantage when blockers are used topically in the eye because it decreases protective reflexes and increases the risk of corneal ulceration. Patients remain on ciclosporin, prednisolone and azathioprine indefinitely and are at ongoing risk from two particular hazards: rejection and infection. Some of these patients develop allergic bronchopulmonary aspergillosis, in which there is intense bronchial inflammation with eosinophilia and high IgE levels in the blood. The scattered black objects represent Kupffer cells that have picked up carbon particles from the circulation. Infections of sebaceous glands of Zeis or glands of Moll, generally caused by Staphylococcus aureus, lead to external styes on the outside of the eyelids. Several receptor subtypes have been identified, but neither agonists nor antagonists of this peptide have found clinical application. Regulation of Iron Stores Although iron is an essential ion, excessive amounts are highly toxic. The heart receives arterial blood supply from the right and left coronary arteries- branches off the initial part of the ascending aorta. Risk factors for cholesterol stones include female sex, diabetes, pregnancy, and estrogen therapy. The other cells process and/or present antigens, but they are not located in the skin. Cotransmitters Many (probably all) autonomic nerves have transmitter vesicles that contain other transmitter molecules in addition to the primary agents (acetylcholine or norepinephrine) previously described. Regular review of patients with lung cancer is essential in providing support and in identifying the nature and origin of symptoms as they arise. American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America. Compared to normal muscle fibers on the left, abnormal muscle fibers on the right side of this biopsy show which of the following histopathologic changes Idiopathic pulmonary hypertension this is a rare disease, affecting about 2 per million of the population per annum, in which pulmonary hypertension occurs without a demonstrable cause. Bladder control and anal sphincter control are also affected in most cases and may require autonomic drugs for management. The cellular and molecular mechanisms responsible for hyperplasia relate to the control of stem cell viability and cell proliferation. Appetite and the perception of hunger are stimulated by ghrelin, a 28-amino-acid (polypeptide) hormone that is secreted by enteroendocrine cells in the stomach and pancreas. Both extrinsic and intrinsic lingual muscles are striated (skeletal) muscles that are arrayed in three dimensions. They cause acute lymphangitis and lymphatic obstruction, leading to severe lymphedema. This neurotransmitter, found in high concentrations in cell bodies in the pons and brain stem, can exert both excitatory and inhibitory actions.

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Asbestos fibres come in two main types, which have different physical and chemical properties: serpentine asbestos fibres (chrysotile (white asbestos)) are wispy, flexible and relatively long, such that they are less easily inhaled to the periphery of the lung; while amphibole asbestos fibres. The sclera is the tough, opaque part of the outer fibrous coat that covers the posterior five-sixths of the eye. Primary adrenal insufficiency (Addison disease) is caused by destruction of the adrenal cortex, usually as a result of an autoimmune response, but it may also be caused by infection. Keywords: Epiphyseal growth plate, endochondral bone formation 47 the answer is A: Cartilage growth plates. Where venous access is difficult, a totally implanted central venous device can be inserted. Netrins (choice C) are secreted proteins involved in axon guidance during development. Lamellae (choice D) are formed by collagen fibers organized into parallel and concentric sheets. Which of the following terms best describes the regions of the cortex that are visible within the rectangular boxes (shown in the image) Interlobular arteries (choice E) arise from the arcuate arteries at a right angle and travel through the cortex toward the surface of the kidney. Pancreatic islets contain a variable number of cells, ranging from only a few cells, to many hundreds of cells. Sebum continues to accumulate and provides a substrate that sustains proliferation of Propionibacterium acnes, a normal constituent of skin flora. Keywords: Pituitary, adenohypophysis 17 the answer is E: Secondary plexus of the pars distalis. Cardiovascular Effects With the exception of cocaine, all local anesthetics are vasodilators. The numerous receptors for cotransmitter substances have not been as fully characterized. Iron is carried in the serum by transferrin, picked up by cell surface transferrin receptors, and internalized via receptormediated endocytosis. Canaliculi (choice A) are barely visible at this magnification; they are small channels within mineralized bone matrix that form a network connecting lacunae. This can occur despite the best efforts of doctors (when high-flow oxygen is inappropriately delivered, it may occur because of the efforts of doctors). Lung transplantation is a major surgical procedure, with substantial mortality and morbidity in patients who are already critically ill, and there is often a short window of opportunity in which patients are sick enough to need transplantation but well enough to undergo the procedure. What is the mechanism by which glucose causes diuresis in patients with untreated diabetes mellitus The metanephros (true kidney) begins to develop during the 5th and 6th weeks of development. This treatment is administered by nebulisation and improves the lung function and reduces the number of exacerbations in some patients. None of the other structures listed is found at the center of the classic liver lobule. The numerous nuclei visible in this image belong to either Schwann cells or fibroblasts. The highly specialized epithelium, the spiral organ of Corti, superimposes on the basilar membrane. More than half of children affected by cystic fibrosis have obvious malabsorption by the age of 6 months, with failure to thrive associated with abdominal distension and 110 Cystic fibrosis Psychosocial problems Reduced life expectancy Coping with complex disease Upper airway Sinusitis Nasal polyps Lungs Infection. In this test, a 1 mm cube of saccharin is placed on the inferior turbinate of the nose and the time to the patient tasting the saccharin is recorded, providing a measure of nasal ciliary clearance. It is an important sensory neuron transmitter in the enteric nervous system and in primary afferents involved in nociception. Total body water homeostasis involves regulating kidney water channels by what mechanism You suggest that cellular and molecular markers would help you answer that question.

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Panacinar emphysema is the characteristic feature of patients with 1 -anti-trypsin enzyme deficiency. The lamina propria of the small intestine is characterized by the presence of large lymphatic channels, termed "lacteals. Nonsteroidal anti-inflammatory drugs, calcium channel blockers, and magnesium are also used for this indication. He has been admitted to the emergency department and antimuscarinic drug overdose is suspected. If this is not successful, options include a 4-week course of ciprofloxacin with nebulised colistin or a course of intravenous antipseudomonas antibiotics. Solitary, yellow, hard gallstones are associated with bile that is supersaturated with cholesterol. During the 5th week of development, the indifferent gonads form finger-like, epithelial cords that project into the underlying mesenchyme. Patients with DiGeorge syndrome exhibit agenesis (or hypoplasia) of the thymus and parathyroid glands, congenital heart defects, dysmorphic facies, and a variety of other congenital anomalies. If the tumor releases only norepinephrine, a compensatory bradycardia may also be present, but most patients release enough epinephrine to maintain heart rate at a normal or even increased level. The pathologist will carefully examine the glandular architecture, to distinguish between the estrogen field effect of benign hyperplasia and a more concerning monoclonal neoplastic growth. Infiltrates of macrophages containing bacilli may be found in other organs, including the lymph nodes and heart. Allele variants are denoted "*3," "*5," etc Representation of the alleles for a specific gene on both chromosomes of a pair. Myelination serves to isolate axons from 90 Chapter 7 their surrounding extracellular environment, thereby enabling rapid, salutatory conduction of nerve impulses. In ophthalmology, topical activity (the ability to enter the eye after conjunctival administration) and duration of action are important in determining the usefulness of several antimuscarinic drugs (see Clinical Uses). The use of lungs from deceased non-heart-beating donors after circulatory death is increasing. The major application is in the treatment of naturally occurring pernicious anemia and anemia caused by gastric resection. Vascular effects-Severe prolonged vasoconstriction can result in ischemia and gangrene. It also occurs in children, when it may be related to enlarged tonsils and adenoids. Alveolar ducts are long, thin-walled tubules whose walls are entirely lined by openings of alveoli and alveolar sacs. The nasal cavities, nasopharynx, larynx, trachea, and paired primary bronchi are air passages external to the lungs (extrapulmonary). None of the other structures encode acoustic information based on sound frequency or amplitude. Eccrine sweat glands are simple, coiled tubular structures consisting of two segments (or portions), 109 namely secretory and excretory. The disorder arises commonly in the fourth and fifth decades of life, and women are six times more likely to be affected than men. Because of their 64 Chapter 5 biconcave disc shape, erythrocytes display an area of central pallor that is approximately one-third the diameter of the cells. They are composed of a single layer of endothelial cells (a simple squamous epithelium) surrounded by a delicate basal lamina. The muscularis externa in this distal portion of the esophagus is composed of smooth muscle; however, the muscularis externa in the upper third of the esophagus is composed of striated skeletal muscle. Phenothiazines such as trifluoperazine cause sedation and are antagonists at muscarinic and adrenoceptors. The enlarged ampulla end of each semicircular duct contains a crista ampullaris, a mechanoreceptor formed by an elongated ridge-like thickening of the epithelium. Effects sought by abusers are increase in muscle mass and strength rather than euphoria. As shown in the image, chronic inflammatory infiltrates in patients with Hashimoto thyroiditis form lymphoid follicles with germinal centers.

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Which of the following pathologic conditions is the most likely underlying cause of death in this patient Upon arrival in a lymph node, T cells meander in the deep cortex, while B cells migrate to the cortex. The high salt content of the airway surface fluid inactivates defensins, which are naturally occurring antimicrobial peptides on the epithelial surface. Aetiology the epidemic spread of lung cancer in the 20th century came about 20 years after increases in tobacco-smoking habits. Inhibition of the release of which of the following neurotransmitters most likely caused paralysis of respiratory muscles in this patient The choroid blocks light from entering the eye except through the pupil, and its melanin helps to limit uncontrolled light reflection to avoid perception of confusing images. This "empty space" indicated by Line 3 represents the myelin sheath in living tissue that is removed during tissue embedding and processing. Proximal straight tubules (choice D) are located in medullary rays within the renal cortex. On the other hand, drugs that induce hepatic drug-metabolizing enzymes (eg, rifampin) may result in plasma levels of the antiseizure agents that are inadequate for seizure control. Emulsified triglycerides in the 145 lumen of the small intestine pass through the simple columnar epithelial lining and enter the lamina propria of the intestinal villi. Treatment of a pleural effusion associated with malignancy is directed against the underlying tumour. The most appropriate additional treatment to recommend is: A long-term oral doxycycline B nebulised colistin or tobramycin 8. The three ossicles convert air vibration into mechanical vibration in the fluid-filled chambers of the internal year through the oval window. Many adult patients with relatively mild asthma achieve good control with a dosage of about 400 g/day beclometasone, but some with chronic severe asthma may require up to 2000 g/day. Identify the distinctive properties of buspirone, eszopiclone, ramelteon, zaleplon, Describe the symptoms and management of overdose of sedative-hypnotics and withdrawal from physiologic dependence. Lamin gene mutations are associated with a variety of diseases (laminopathies) including Hutchinson-Gilford progeria. Other nonadrenergic, noncholinergic fibers have the anatomic characteristics of sensory fibers and contain peptides, such as substance P, that are stored in and released from the fiber terminals. The addition of vasodilators (eg, nitroprusside) or a blocker (eg, esmolol) may be needed to prevent intraoperative hypertension. Smokers develop squamous metaplasia of the respiratory epithelium (choice C) and hyperplasia of submucosal mucous glands (choice E); however, these pathologic changes do not explain the pathogenesis of respiratory distress in patients with emphysema. Blood cell deficiency is a relatively common occurrence that can have profound repercussions. As a result, injections of small to moderate amounts of direct-acting muscarinic cholinomimetics often cause tachycardia, whereas parasympathetic (vagal) nerve discharge to the heart causes bradycardia. Keywords: Kidney, loop of Henle 38 the answer is C: Thick ascending limb of the loop of Henle. None of the other hormones regulate contraction of the gallbladder and/or secretion of pancreatic enzymes. Sebaceous gland secretions increase greatly at the time of puberty under the influence of circulating sex hormones. Sufficient tubing around the home allows the patient to continue ordinary domestic activities during the day. The most common serious adverse effect of the fibrinolytics is bleeding, especially in the cerebral circulation.

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Examination of the surgical specimen reveals normal tissue along the tumor margin (shown in image). Exudates A variety of diseases that affect the pleura are associated with increased capillary permeability or reduced lymphatic drainage. Fenestrations in glomerular capillaries lack intervening extracellular diaphragms, thereby expanding the size range of molecules leaving the vascular space for the primary urine. Calculate the dosage adjustment required for a patient with impaired renal function. DiGeorge syndrome is a congenital T-cell immunodeficiency disorder caused by failure of the third and fourth pharyngeal pouches to develop during embryogenesis. They are widely distributed in many tissues in the form of fiber systems termed microfibrils. Unlike the graded dose-response determination, no attempt is made to determine the maximal effect of the drug. Under these circumstances, atopic individuals with pre-existing asthma or hay fever are particularly vulnerable to the resultant allergen challenge. These arterioles form sheathed capillaries that empty blood directly into splenic cords. Contractions of dilator and sphincter muscles regulate the diameter of the pupil and control the amount of light entering the eye. Describe some of the effects of smoking, liver disease, and kidney disease on drug elimination. Advances in many different areas of scientific research are being brought into clinical practice in order to improve the outlook for patients with cystic fibrosis. A variety of approaches may be used, including rib resection with open drainage and thoracotomy with removal of infected debris and decortication (stripping of the pleura and empyematous sac). Insertion of an inferior vena caval filter prevents major emboli from reaching the lungs, and is indicated in these circumstances. None of the other structures are found in the lamina propria of the small intestine. Albumin is the principal protein in the blood (normal reference range = 3 to 5 g/dL). The lining epithelium is characterized by the presence of tight junctions, apical membrane microvilli, and lateral membrane plications (interdigitations). There are only one to five layers of smooth muscle fibers in the media of an arteriole. In addition to forming different types of cells, the embryo organizes cells into tissues and organs. Patients who have had streptococcal infections may have preformed antibodies to the drug. Lung abscess is a localized accumulation of pus accompanied by the destruction of pulmonary parenchyma. None of the other choices describe histopathologic features of hyaline arteriosclerosis. During cadaver dissection, it is common to notice that the hilar lymph nodes appear black, owing to collections of pulmonary macrophages. The nocturnal oxygen desaturation (and hypercapnia) in these disorders results from the deleterious effect of sleep physiology on pre-existing respiratory insufficiency. Pharmacokinetics After ingestion, ethanol is rapidly and completely absorbed; the drug is then distributed to most body tissues, and its volume of distribution is equivalent to that of total body water (0. Severe tachycardia may require cautious administration of small doses of physostigmine. Fibroblasts synthesize and secrete procollagen molecules of various types, as well as precursor molecules that form elastic fibers. The acinar cells release digestive enzymes into intercalated ducts that originate within the secretory unit. None of the other arteries supplies blood to the stratum functionalis of the uterine endometrium.

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The 2 major nicotinic subtypes are located in ganglia and in skeletal muscle end plates. If this can be achieved, it will have a far greater impact on long-term prognosis than any other intervention. A 76-year-old patient with rheumatoid arthritis and chronic heart disease is being considered for treatment with procainamide. The use of these vasodilator drugs is based on the reduction in cardiac size and improved efficiency that can be achieved with proper adjustment of venous return (preload) and reduction of impedance to ventricular ejection (afterload). How does repeated infection by the parasitic nematode Wuchereria bancrofti cause the gross disfigurements associated with elephantiasis Microtubules and microfilaments are present in nerve axons and dendrites and contribute to cell structure, but they are not composed of neuron-specific fibrous proteins. Progressive loss of liver function occurs with reversible fatty liver progressing to irreversible hepatitis, cirrhosis, and liver failure. In extensive stage disease, chemotherapy improves survival from an average of 6 weeks to 8 months. Because the drug is a weak base, it is more ionized (protonated) at pH values lower than its pKa. Proliferation of astrocytes and microglia in response to injury is referred to as gliosis. Direct invasion of the mediastinum can cause paralysis of the phrenic nerve, manifest by elevation of the hemidiaphragm, or of the recurrent laryngeal nerve, particularly on the left side, where it passes around the aortic arch to the superior mediastinum, causing vocal cord palsy with hoarseness and diminished cough reflex. None of the other choices shows the distinctive histologic features of pulmonary bronchioles. Primary spermatocytes feature highly condensed chromatin that is undergoing homologous recombination and crossing-over during prophase of meiosis I. Post-transplantation complications and treatment In the first few days post-transplantation, reimplantation injury may occur, with infiltrates developing in the donor lung because of increased capillary permeability as a result of surgical trauma, ischaemia, denervation and lymphatic interruption. However, the corticosteroids are too toxic for routine chronic use (Chapter 39) and are reserved for temporary control of severe exacerbations and long-term use in patients with severe disease not controlled by other agents. Along with the cornea, the sclera forms the external fibrous skeleton for the eye, providing shape and resistance, as well as attachment sites for extraocular muscles. It is effective as monotherapy and can be used with levodopa to smooth out response fluctuations. Video-assisted thoracoscopy allows biopsy of the pleura under direct vision, and can be combined with pleurodesis. About 90% of lung cancers are caused by smoking, and smoking prevention and smoking cessation are the crucial issues in dealing with this major public health problem. They are terminal air spaces that form as pocket-like evaginations of the respiratory bronchioles, alveolar ducts, and alveolar sacs. The main reason for hospitalization of this patient was to be able to effectively control (A) Cardiac arrhythmias (B) Delirium (C) Hepatic dysfunction (D) Seizures (E) None of the above 3. Activated pain fibers fire rapidly; thus, pain sensation appears to be selectively blocked by local anesthetics. Keywords: Breast cancer, dense irregular connective tissue 4 the answer is B: Fibroblasts. The kidneys filter blood to remove metabolic waste and excess water and balance concentrations of serum electrolytes. A specific fraction of HbA in circulating erythrocytes is modified by the addition of carbohydrate. If airway obstruction is detected by spirometry, the next step is to assess its reversibility to bronchodilator drugs. Once chondroblasts become surrounded with the cartilage matrix in visible lacunae, they are referred to as chondrocytes. These powerful nonapeptide hormones are synthesized in supraoptic and paraventricular hypothalamic nuclei, respectively. Examples of metaplasia include squamous metaplasia in the lungs of smokers and glandular metaplasia in the esophagus of patients with acid reflux.

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Keywords: Sertoli cells, androgen-binding protein 31 the answer is D: Tunica albuginea. These bands of smooth muscle (three equally spaced bands) are referred to as teniae coli (arrow, shown in the image). Asbestos bodies, consisting of an asbestos fibre coated with an iron-containing protein, are usually seen within areas of fibrosis on light or electron microscopy. Examination of the specimen reveals scattered splenic lymphoid nodules (white pulp) surrounded by small venous sinuses (red pulp). A tight-fitting mask is strapped in place over the nose and connected to a specifically designed ventilating machine. Patients typically present with a classic symptom triad that includes nuchal rigidity, fever, and a change in mental status. Reduced osmotic pressure may contribute to pulmonary oedema, and this occurs in hypoproteinaemic states. The feature that distinguishes respiratory bronchioles from terminal bronchioles (choice E) is the presence of an incomplete wall that is interrupted by alveoli (arrows, shown in the image). Although acetazolamide is rarely used in heart failure, carbonic anhydrase inhibitors are quite valuable in patients with edema and metabolic alkalosis. Visceral motor and autonomic motor neurons (choices A and D) typically provide motor innervation to the viscera and glands; their postsynaptic neurons are located in the sympathetic or parasympathetic ganglia. Transferrin receptors on cells throughout the body import transferrin via receptor-mediated endocytosis. Malignant hypertension and elevated serum levels of aldosterone suggest a diagnosis of Conn syndrome. They are not highly selective in their substrates, so a relatively small number of P450 isoforms are able to metabolize thousands of drugs. Long-term reductions in receptor number (downregulation) may occur in response to continuous exposure to agonists. Both microbes produce neurotoxins that prevent synaptic vesicles fusing with the nerve terminal membrane. Keywords: Liver, bile ducts, portal triad 15 the answer is E: Intrahepatic bile lakes. Sympathetic fibers (choice E) regulate heart rate, but they do not initiate cardiac muscle contraction. Contractions of the muscularis mucosae regulate the diameter of the conducting airways of the respiratory system. It also facilitates the release of norepinephrine from adrenergic nerve endings via presynaptic heteroreceptor action (see Chapter 6). Reversible nephrogenic diabetes insipidus occurs commonly at therapeutic drug levels. Antihistamines and corticosteroids are sometimes used as supplementary agents, but the prompt parenteral use of epinephrine is mandatory. In many cases, the histological features are characteristic of a particular disease. Agenesis during development of which of the following organs would explain the pathogenesis of physical and mental retardation in this infant The pericardial sac is lined by visceral and parietal mesothelia that together are referred to as serous pericardium. Patient quality of life is dramatically improved by a successful lung transplantation, but the long-term prognosis is limited, particularly by the occurrence of bronchiolitis obliterans syndrome. On the other hand, a patient with severe cardiac disease may be very sensitive to the arrhythmogenic effects of agonists and therefore tolerate these agents poorly, while antimuscarinic agents rarely cause arrhythmias. Herring bodies (choice B) are dilated terminal axons of neurons in the posterior pituitary. Upon contact with gastric juice, pepsinogen is converted to pepsin-an aspartate protease. Other amino acids can occur in the other two positions, but the most abundant amino acids in collagen are hydroxyproline and hydroxylysine. Ganglion-Blocking Drugs Blockers of ganglionic nicotinic receptors act like competitive pharmacologic antagonists, although there is evidence that some also block the pore of the nicotinic channel itself.