Nir Hus Q 4 6 iv

Complex Patient Case Study Note James Flemer Patient Background Information and Assessment Case Study Question: A 53-year-old African American man is in for follow up of his elevated blood pressure. He was seen last week in your office for a Department of Transportation commercial driver’s examination where his blood pressure was 176/92. Subjective questioning is negative. BP today is 174/94. His physical exam is remarkable for a loud S2, sustained PMI at 5icslmcl, an S4 gallop is present. The remainder of his physical exam is unremarkable. Family history is remarkable for high blood pressure. Self describes his lifestyle as pretty sedentary due to driving long hours every day. Diet is often fast food with many cups of coffee. · EKG – NSR with LVH by voltage · CBC – normal · CBP – normal except for glucose 154 (fasting). Fingerstick last week was 152 · A1C – 7.8 1. List five subjective questions. It would be very important to know about this patient. 2. Explain the significance of the loud S2 finding. 3. What does the finding of his PMI indicate? 4. Explain the significance of the PMI in the normal location. 5. Explain the significance of the S4 finding. 6. Explain the finding of LVH, given his current circumstances. 7. What additional diagnostics or testing (if any) you would like to order? 8. What are the top two diagnoses you are going to address at this time? 9. What is your pharmacologic plan for this man? Why did you choose the agent you did? Be sure to state your rationale and references. 10. Identify 5 lifestyle modifications to improve his health that he could implement in his current situation. S Question 2 O Question 1, 4 A Question 3 P Question 5, 6 Question 1 – Subjective Questions The purpose of this paper is to review the patient’s chart and answer the questions above. Below are the five subjective essential questions I would ask the patient in order for me to fully carry out my assessment and diagnoses of his conditions: 1. Do you have a family history of hypertension or diabetes? Hypertension and diabetes tend to run in the family due to different gene mutations (Gabb et al., 2016). 2. Do you currently take any medication for high blood pressure, both prescribed and/or non-prescribed? (some patients already have a diagnose of hypertension but do not follow their treatment. Taking blood pressure medication inadequately could create a rebound effect (Challa et al.,2020). 3. Do you experience any abnormality in your breathing? Do you feel a pounding sensation with your pulses? Especially in your neck vein? And have you been diagnosed with any Coronary Artery Diseases in the past? This question is asked to assess the adverse effect of his conditions that could potentially make him a higher risk for other serious and urgent issues like myocardial infarction, hypertensive retinopathy, and cerebrovascular accidents; for example, the presence of pheochromocytoma can increase the secretion of catechola ...

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Title: Sense of Smell Presenter: Dr. Faiza, Assistant Professor of Physiology Qualifications: MBBS (Best Graduate, AIMC Lahore) FCPS Physiology ICMT, CHPE, DHPE (STMU) MPH (GC University, Faisalabad) MBA (Virtual University of Pakistan) Learning Objectives: Describe the primary categories of smells and the concept of odor blindness. Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction. Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain. Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential. Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes. Key Topics: Olfactory Genes: 3% of the human genome accounts for olfactory genes. 400 genes for odorant receptors. Olfactory Membrane: Located in the superior part of the nasal cavity. Medially: Folds downward along the superior septum. Laterally: Folds over the superior turbinate and upper surface of the middle turbinate. Total surface area: 5-10 square centimeters. Olfactory Mucosa: Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell. Sustentacular Cells: Produce mucus and maintain ionic and molecular environment. Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months. Bowman’s Gland: Secretes mucus. Stimulation of Olfactory Cells: Odorant dissolves in mucus and attaches to receptors on olfactory cilia. Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve. Quality of a Good Odorant: Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble. Facilitated by odorant-binding proteins in mucus. Membrane Potential and Action Potential: Resting membrane potential: -55mV. Action potential frequency in the olfactory nerve increases with odorant strength. Adaptation Towards the Sense of Smell: Rapid adaptation within the first second, with further slow adaptation. Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system. Primary Sensations of Smell: Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid. Odor Detection Threshold: Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm). Some toxic substances are odorless at lethal concentrations. Characteristics of Smell: Odor blindness for single substances due to lack of appropriate receptor protein. Behavioral and emotional influences of smell. Transmission of Olfactory Signals: From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition. Primitive, less old, and new olfactory systems with different path

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