The second edition of AIIMS Medicine Quiz was held on 11th September, 2021. This quiz was for residents currently pursuing MD/DNB in Medicine/ Geriatric Medicine/ Emergency Medicine and Infectious Diseases.
algorithmic case-based approach to classify, diagnose and manage different angioedema types in adults and pediatrics with special attention to the emergency room management
The second edition of AIIMS Medicine Quiz was held on 11th September, 2021. This quiz was for residents currently pursuing MD/DNB in Medicine/ Geriatric Medicine/ Emergency Medicine and Infectious Diseases.
algorithmic case-based approach to classify, diagnose and manage different angioedema types in adults and pediatrics with special attention to the emergency room management
The second edition of AIIMS Medicine Quiz was held on 11th September, 2021. This quiz was for residents currently pursuing MD/DNB in Medicine/ Geriatric Medicine/ Emergency Medicine and Infectious Diseases.
An interesting case of recurrent VT/Tdp following chloroquine drug overdose Apollo Hospitals
Chloroquine is a widely available drug, used for the treatment of malaria and as prophylaxis for travelers to endemic countries, rheumatoid disease and systemic lupus erythematosus. Chloroquine has a narrow therapeutic index. Large overdoses are highly fatal and there are no known antidotes. We report, herein, a case of chloroquine poisoning in a 29-year-old lady and recurrent VT/Tdp secondary to it.
COVID-19 Presenting as stroke- mechanisms, diagnosis and treatmentSudhir Kumar
Covid 19 infection can affect nervous system in many ways, including an increased risk of stroke. This presentation looks at the association of COVID 19 infection and stroke. Mechanisms of stroke in COVID 19 have been elucidated. Approach to diagnosis and management has also been discussed via case studies. Prompt diagnosis and early initiation of treatment ensures a good outcome in covid 19 infected patients presenting with stroke.
The second edition of AIIMS Medicine Quiz was held on 11th September, 2021. This quiz was for residents currently pursuing MD/DNB in Medicine/ Geriatric Medicine/ Emergency Medicine and Infectious Diseases.
An interesting case of recurrent VT/Tdp following chloroquine drug overdose Apollo Hospitals
Chloroquine is a widely available drug, used for the treatment of malaria and as prophylaxis for travelers to endemic countries, rheumatoid disease and systemic lupus erythematosus. Chloroquine has a narrow therapeutic index. Large overdoses are highly fatal and there are no known antidotes. We report, herein, a case of chloroquine poisoning in a 29-year-old lady and recurrent VT/Tdp secondary to it.
COVID-19 Presenting as stroke- mechanisms, diagnosis and treatmentSudhir Kumar
Covid 19 infection can affect nervous system in many ways, including an increased risk of stroke. This presentation looks at the association of COVID 19 infection and stroke. Mechanisms of stroke in COVID 19 have been elucidated. Approach to diagnosis and management has also been discussed via case studies. Prompt diagnosis and early initiation of treatment ensures a good outcome in covid 19 infected patients presenting with stroke.
The Six Highest Performing B2B Blog Post FormatsBarry Feldman
If your B2B blogging goals include earning social media shares and backlinks to boost your search rankings, this infographic lists the size best approaches.
Each technological age has been marked by a shift in how the industrial platform enables companies to rethink their business processes and create wealth. In the talk I argue that we are limiting our view of what this next industrial/digital age can offer because of how we read, measure and through that perceive the world (how we cherry pick data). Companies are locked in metrics and quantitative measures, data that can fit into a spreadsheet. And by that they see the digital transformation merely as an efficiency tool to the fossil fuel age. But we need to stretch further…
Instructions· This week’s case study will introduce concepts r.docxmariuse18nolet
Instructions
· This week’s case study will introduce concepts related to the pulmonary system and shock states. Read the scenario and thoroughly complete the questions. Some of the answers will be short answers and may not require a lot of details. For example: what is the most common organism to cause a hospital acquired infection? The answer is pseudomonas aeruginosa. Answers to questions that relate to the pathogenesis of a disease must include specific details on the process. For example: How does hypoxia lead to cellular injury? Simply writing that a lack of blood flow, causes a lack of oxygen available to the cell and the cell cannot function without oxygen is not sufficient. This type of response is NOT reflective of an advanced understanding of the concept or graduate level work. This answer should discuss the cascade of events leading to the lack of oxygen and how it specifically impairs cellular function. All answers to these type of questions should address the effects at the cellular level, then the effects on the organ and then the body as a whole. Additionally describing the normal anatomical and/or physiologic processes underlying the pathogenesis will be necessary to thoroughly answer the question.
It is very likely that you will need to reference multiple sources to answer the questions thoroughly. Your text book will not necessarily have all the answers. Only professional sources may be used to complete the assignment. These include text books, primary and secondary journal articles from peer reviewed journals, government and university websites, and publications from professional societies who establish disease management guidelines and recommendations. Sources such as Wikipedia or other generic websites are not considered professional references and should not be used to complete the case studies.
· Reason for Consultation:
Desaturation to 64% on room air 1 hour ago with associated shortness of breath.
History of Present Illness:
Mrs. X is 73-year-old Caucasian female who was admitted to the general surgery service 3 days ago for a leaking j-tube which was surgically replaced 2 days ago. This morning at 07:30, the RN reported that the patient was sleeping and doing fine, then the CNA made rounds at 0900 and Mrs. X was found to be mildly dyspneic. Vital signs were checked at that time and were; temperature 38.6, pulse 120, respirations 20, blood pressure 138/38. O2 sat was 64% on room air. The general surgeon was notified by the nursing staff of the hypoxia, an order for a chest x-ray and oxygen therapy were given to the RN. The O2 sat is maintaining at 91-92% on 4L NC. The patient was seen and examined at 10:10 a.m. She reported that she has had mild dyspnea for 2 days that has progressively gotten worse. She does not use oxygen at home. Her respiratory rate at the time of this visit was 20 and she feels short of breath. She has felt this way in the past when she had pneumonia. She is currently undergoing radiatio.
Yan 2Yichao YanKara WilliamsESL 10696 April 2019 Rough.docxadampcarr67227
Yan 2
Yichao Yan
Kara Williams
ESL 1069
6 April 2019
Rough Draft Analysis of Argument Essay
In the article “What Else Can I Do to Get the School Supplies My Student Need?” the author discusses that, textbook still plays an important role in today’s class. There are so many debates about weather using online text book or physical textbook in school nowadays. The author as a college teacher claims that physical textbook helps her students have better understanding of knowledges. Also, she thinks physical textbook reduced the financial burden on students. However, online source or online textbook should have more benefit then the physical textbook.
First of all, the author claims that physical textbook could helps student read and understand better of new knowledges. The resources that teachers need for their teaching are so differently. It depended on student’s grade and their teaching style. Even people nowadays assume textbooks are outdated, inefficient and biased, author still think using textbook is very important for students to know about some academic basic information, which could help students master the course better.
APPENDIX I r Reports
DIAGNOSES include:
1. Chronic pelvic pain secondary to pelvic metastatic clear cell carcinoma
of unknown PrimarY location.
2. Yeta cava sy.rdromi post placement of Hickman catheter'
3. Anemia due to chronic disease.
4. Hypertension.
HOSPITAL COURSE: The patient is a 78-year-old female whom we have
been following in our clinic ior hypertension and also chronic pudendal
nerve pain. Shie had been recently biagnosed with pelvic me,tastatic clear
cell caicinoma, which her primaiy location is unknown at this time' She
will be discussing this further after the pathology reports are, read. During
her hospital stalia Hickman catheter was placed in order to have IV access
for pain medication or future cancer therapy. She was also admitted for
chronic pain. she did develop swelling of her arms and neck. She was
broughtio interventional radiology and she did have venography and the
Hickman catheter was removed. Her swelling to her arms and neck have
decreased greatly. She denies any shortness of breath. No choking sensation
as previouily noted. Her pain has been managed well with fentanyl patch at
175 mcg. She has also been on IV heparin therapy for anticoagulation
followitig the vena cava syndrome. Today, the patient hasbeen having
complaiits of nausea. She did get some dexamethasone IV for her nausea,
which did improve later this morning. Her blood plessure has been under
good control. Her labs today include a wBC of 5.18, hemoglobin 7.8,
f,ematocrit 23.7, protime 74.4,INR 1'5, PTT 39'6, BUN 6, sodium 139'
potassium 4.2, CO2 27.2.
DISCHARGE, PLANS:
1. IV heparin is discontinued. She will be switched ovel to Lovenox
r mg/kg subcutaneously daily. The patient will have Home Health to
help her set uP these iniections.
2. She will continue with the fentanyl patch 175 mcg for the pain..
Week 2 Respiratory Clinical CasePatient Setting65 year old C.docxcockekeshia
Week 2: Respiratory Clinical Case
Patient Setting:
65 year old Caucasian female that was discharged from the hospital 10 weeks ago after a motor vehicle accident presents to the clinic today. States she is having severe wheezing, shortness of breath and coughing at least once daily. She can barely get her words out without taking breaks to catch her breath and states she has taken albuterol once today.
HPI
Frequent asthma attacks for the past 2 months (more than 4 times per week average), serious MVA 10 weeks ago; post traumatic seizure 2 weeks after the accident; anticonvulsant phenytoin started – no seizure activity since initiation of therapy.
PMH
History of periodic asthma attacks since early 20s; mild congestive heart failure diagnosed 3 years ago; placed on sodium restrictive diet and hydrochlorothiazide; last year placed on enalapril due to worsening CHF; symptoms well controlled the last year.
Past Surgical History
None
Family/Social History
Family: Father died age 59 of kidney failure secondary to HTN; Mother died age 62 of CHF
Social: Nonsmoker; no alcohol intake; caffeine use: 4 cups of coffee and 4 diet colas per day.
Medication History
Theophylline SR Capsules 300 mg PO BID
Albuterol inhaler, PRN
Phenytoin SR capsules 300 mg PO QHS
HTCZ 50 mg PO BID
Enalapril 5 mg PO BID
Allergies
NKDA
ROS
Positive for shortness of breath, coughing, wheezing and exercise intolerance. Denies headache, swelling in the extremities and seizures.
Physical exam
BP 171/94, HR 122, RR 31, T 96.7 F, Wt 145, Ht 5’ 3”
VS after Albuterol breathing treatment - BP 134/79, HR 80, RR 18
Gen: Pale, well developed female appearing anxious. HEENT: PERRLA, oral cavity without lesions, TM without signs of inflammation, no nystagmus noted. Cardio: Regular rate and rhythm normal S1 and S2. Chest: Bilateral expiratory wheezes. Abd: soft, non-tender, non-distended no masses. GU: Unremarkable. Rectal: Guaiac negative. EXT: +1 ankle edema, on right, no bruising, normal pulses. NEURO: A&O X3, cranial nerves intact.
Laboratory and Diagnostic Testing
Na - 134
K - 4.9
Cl - 100
BUN - 21
Cr - 1.2
Glu – 110
ALT – 24
AST - 27
Total Chol – 190
CBC - WNL
Theophylline - 6.2
Phenytoin - 17
Chest Xray – Blunting of the right and left costophrenic angles
Peak Flow – 75/min; after albuterol – 102/min
FEV1 – 1.8 L; FVC 3.0 L, FEV1/FVC 60%
Week
2
:
Respiratory
Clinical Case
Patient Setting:
65
year old
Caucasian female
that was
discharged from the
hospital
10 weeks ago
after
a
motor vehicle
accident presents to the clinic today.
States she is having severe wheezing, shortness of breath and
coughing at least once daily. She can barely get her words out
without taking breaks to catch her breath
and states she has taken albuterol once today.
HPI
Frequent asthma attacks for the past 2 months
(more than 4 times per week
average
)
, serious MVA 10
weeks ago; post traumatic seizure 2 w
eeks after the accident; anticonvulsant phenytoin started
–
no
seizure activ.
1. CC I have been having terrible chest and arm pain for the p.docxberthacarradice
1. CC: “I have been having terrible chest and arm pain for the past 2 hours and I think I am having a heart attack.”HPI: Mr. Hammond is a 57-year-old African American male who presents to the Emergency Department with a chief complaint of chest pain that radiates down his left arm. He states that he started having pain several hours ago and says the pain “it feels like an elephant is sitting on my chest”. He rates the pain as 8/10. Nothing has made the pain better or worse. He denies any previous episode of chest pain. Denies nausea, dyspnea, or lightheadedness. He was given 0.4 mg nitroglycerine tablet sublingual x 1 which decreased, but not stopped the pain.Lipid panel reveals Total Cholesterol 324 mg/dl, high density lipoprotein (HDL) 31 mg/dl, Low Density Lipoprotein (LDL) 122 mg/dl, Triglycerides 402 mg/dl, Very Low-Density Lipoprotein (VLDL) 54 mg/dlHis diagnosis is an acute inferior wall myocardial infarction.1 of 2 Questions:Why is HDL considered the “good” cholesterol?
QUESTION 2
. CC: “I have been having terrible chest and arm pain for the past 2 hours and I think I am having a heart attack.”HPI: Mr. Hammond is a 57-year-old African American male who presents to the Emergency Department with a chief complaint of chest pain that radiates down his left arm. He states that he started having pain several hours ago and says the pain “it feels like an elephant is sitting on my chest”. He rates the pain as 8/10. Nothing has made the pain better or worse. He denies any previous episode of chest pain. Denies nausea, dyspnea, or lightheadedness. He was given 0.4 mg nitroglycerine tablet sublingual x 1 which decreased, but not stopped the pain.Lipid panel reveals Total Cholesterol 324 mg/dl, high density lipoprotein (HDL) 31 mg/dl, Low Density Lipoprotein (LDL) 122 mg/dl, Triglycerides 402 mg/dl, Very Low-Density Lipoprotein (VLDL) 54 mg/dlHis diagnosis is an acute inferior wall myocardial infarction.2 of 2 Questions:Explain the role inflammation has in the development of atherosclerosis.
QUESTION 3
. A 45-year-old woman with a history of systemic lupus erythematosus (SLE) presents to the Emergency Room (ER) with complaints of sharp retrosternal chest pain that worsens with deep breathing or lying down. She reports a 3-day history of low-grade fever, listlessness and says she feels like she had the flu. Physical exam reveals tachycardia and a pleural friction rub. She was diagnosed with acute pericarditis.
Question:
What does the Advanced Practice Registered Nurse (APRN) recognize as the result of the pleural friction rub?
QUESTION 4.
A 15-year-old adolescent male comes to the clinic with his parents with a chief complaint of fever, nausea, vomiting, poorly localized abdominal pain, arthralgias, and “swollen lymph nodes”. States he has felt “lousy” for a couple weeks. The fevers have been as high as 102 F. His parents thought he had the flu and took him to an Urgent Care Center. He was given Tamiflu® and sent home. He says the Tamiflu.
Clinical ScenarioREASON FOR CONSULTATION Desaturation to 64.docxbartholomeocoombs
Clinical Scenario:
REASON FOR CONSULTATION:
Desaturation to 64% on room air 1 hours ago with associated shortness of breath.
HISTORY OF PRESENT ILLNESS:
Mrs. X is 73-year-old Caucasian female who was admitted to the general surgery service 3 days ago for a leaking j-tube which was surgically replaced 2 days ago and is now working properly. This morning at 07:30, the RN reported that the patient was sleeping and doing fine, then the CNA made rounds at 0900 and Mrs. X was found be mildly dyspneic. Vital signs were checked at that time and were; temperature 38.6, pulse 120, respirations 22, blood pressure 138/38. O2 sat was 64% on room air. The general surgeon was notified by the nursing staff of the hypoxia, an order for a chest x-ray and oxygen therapy were given to the RN. The O2 sat is maintaining at 91% on 4L NC. The patient was seen and examined at 10:10 a.m. She reports that she has been having mild dyspnea for 2 days that has progressively gotten worse. She does not use oxygen at home. Her respiratory rate at the time of visit was 22 and she feels short of breath. She has felt this way in the past when she had pneumonia. She is currently undergoing radiation treatment for laryngeal cancer and her last treatment was 1 to 2 weeks ago. She reports that she has 2 to 3 treatments left. She denies any chest pain at this time and denies any previous history of CHF. Review of her vital signs show that she has been having intermittent fevers since yesterday morning. Of note, she was admitted to the hospital 3 weeks ago for an atrial fibrillation with RVR for which she was cardioverted and has not had any further problems. The cardiologist at that time said that she did not need any anticoagulation unless she reverted back into A-fib.
REVIEW OF SYSTEMS:
Constitutional:
Negative for diaphoresis and chills.
Positive for fever and fatigue.
HEENT:
Negative for hearing loss, ear pain, nose bleeds, tinnitus.
Positive for throat pain secondary to her laryngeal cancer.
Eyes:
Negative for blurred vision, double vision, photophobia, discharge or redness.
Respiratory:
Positive for cough and shortness of breath
. Negative for hemoptysis and wheezing.
Cardiovascular:
Negative for chest pain, palpitations, orthopnea, leg swelling or PND.
Gastrointestinal:
Negative for heartburn, nausea, vomiting, abdominal pain, diarrhea, constipation, blood in stool or melena.
Genitourinary:
Negative for dysuria, urgency, frequency, hematuria and flank pain.
Musculoskeletal:
Negative for myalgias, back pain and falls.
Skin:
Negative for itching and rash.
Neurological:
Negative for dizziness, tingling, tremors, sensory changes, speech changes.
Endocrine/hematologic/allergies:
Negative for environmental allergies or polydipsia. Does not bruise or bleed easily.
Psychiatric:
Negative for depression, hallucinations and memory loss.
PAST MEDICAL HISTORY:
Diabetes mellitus that was diagnosed 12 years ago with neuropathy. This resolved after gastric.
Week 4Problem Assignment Time Value of Money1If you deposit $15,0.docxmelbruce90096
Week 4Problem Assignment: Time Value of Money1If you deposit $15,000 today and earn 8% annual interest, how much will you have in 9 years?Answer:$29,985.072Tiffany will receive a graduation gift of $10,000 from her parents in 3 years. If the discount rateis 7%, what is this gift worth today?Answer:$8,162.983What is the present value of a 20-year ordinary annuity of $30,000 using a 6% discount rate?Answer:$344,097.644You deposit $5,000 in an account that pays 8% interest per annum. How long will it take to double your money?Answer:9 years5The Johnsons have $60,000 to use as a down-payment on a house, and they want to borrow $240,000from the bank. The current mortgage interest rate is 5%. If they make equal monthly payments for 30 years,how much will the monthly payment be?Answer:$1,288.376Tim paid $250 per month into his 401K retirement plan. After 30 years, he had accumulated $500,000. Whataverage annual rate of interest had he earned over the 30 years?Answer:9.42%7Charlotte's firm had sales of $525,000 in the year 2001. By 2012, sales had increased to $1,200,000. What wasthe average annual rate of increase?Answer:7.80%8Alan had saved up $500,000. How much more must he save each year over the next 10 years in order to have atotal of $2 million? Alan earns 5% interest, compounded annually.Answer:$94,257
Instructions
· This week’s case study will introduce concepts related to the pulmonary system and shock states. Read the scenario and thoroughly complete the questions. Some of the answers will be short answers and may not require a lot of details. For example: what is the most common organism to cause a hospital acquired infection? The answer is pseudomonas aeruginosa. Answers to questions that relate to the pathogenesis of a disease must include specific details on the process. For example: How does hypoxia lead to cellular injury? Simply writing that a lack of blood flow, causes a lack of oxygen available to the cell and the cell cannot function without oxygen is not sufficient. This type of response is NOT reflective of an advanced understanding of the concept or graduate level work. This answer should discuss the cascade of events leading to the lack of oxygen and how it specifically impairs cellular function. All answers to these type of questions should address the effects at the cellular level, then the effects on the organ and then the body as a whole. Additionally describing the normal anatomical and/or physiologic processes underlying the pathogenesis will be necessary to thoroughly answer the question.
It is very likely that you will need to reference multiple sources to answer the questions thoroughly. Your text book will not necessarily have all the answers. Only professional sources may be used to complete the assignment. These include text books, primary and secondary journal articles from peer reviewed journals, government and university websites, and publications from professional societies who establish disease management g.
It's a case based approach on ventricular tachycardia and its management. It also highlights the importance and timing to use an AICD in needful patients.
For this homework assignment, you will continue coding for Reports 2.docxalisoncarleen
For this homework assignment, you will continue coding for Reports 2-5, which are located on pages 182-184 of the Step-by-Step Workbook. Using Encoder Pro, create codes for information from Reports 2-5. Additionally, explain how you arrived at that code.
Report 2: Discharge Summary
Diagnoses include:
1. Chronic pelvic pain secondary to pelvic metastatic clear cell carcinoma of unknown primary location.
2. Vena Cava syndrome post placement of Hickman catheter.
3. Anemia due to chronic disease.
4. Hypertension.
HOSPITAL COURSE:
The patient is a 78 year old female whom we have been following in our clinic for hypertension and also chronic pudendal nerve pain. She had been recently diagnosed with pelvic metastatic clear cell carcinoma, which her primary location is unknown at this time. She will be discussing this further after the pathology reports are read. During her hospital stay a Hickman catheter was placed in order to have IV access for pain medication or future cancer therapy. She was also admitted for chronic pain. She did develop swelling of her arms and neck. She was brought to interventional radiology and she did have venography and the Hickman catheter was removed. Her swelling to her arms and neck have decreased greatly. She denies any shortness of breath. No choking sensation as previously noted. Her pain has been managed well with fentanyl patch at 175mcg. She has also been on IV heparin therapy for anticoagulation following the vena cava syndrome. Today, the patient has been having complaints of nausea. She did get some dexamethasone IV for her nausea, which did improve later this morning. Her blood pressure has been under good control. Her labs today include a WBC of 5.18, hemoglobin 7.8, hematocrit 23.7, protime 14.4, INR 1.5, PTT 39.6, BUN 6, sodium 139, potassium 4.2, and CO2 27.2.
DISCHARGE MEDICATIONS:
1. Will continue home medications.
2. Phenergan 12.5 1-2 tabs p.o. p.r.n. every 6 hours for nausea.
3. Lovenox 1 mg/kg subcutaneously every 24 hours.
4. Fentanyl patch 175 mcg to be changed every 3 days.
5. Epogen 40,000 units subcutaneously weekly at the Cancer Center.
REPORT 3. CLINIC CHART NOTE
HISTORY: This 16 year old female is seen today after falling off a curb and twisting her right ankle. She is normally a patient of Dr. Anderson, who is out of town this week. She states that she has pain surrounding the entire foot and ankle. Seems unable or unwilling to bear weight.(Problem focused history)
PHYSICAL EXAM: Ankle and foot examined. Foot is warm to the touch. Some swelling and bruising noted around the lateral aspect of the ankle. X-ray is negative for fracture. (problem focused examination)
IMPRESSION: Sprained right ankle. (MDM complexity straightforward)
PLAN: Elevation; ice to affected area. Weight bearing only as tolerated. Return for follow-up p.r.n.
REPORT 4: ADMIT INPATIENT
This is a 19 year old with a living-related donor kidney transplant as of last month and admitted to hospital fo ...
1.CC I have been having terrible chest and arm pain for the pa.docxcroysierkathey
1.
CC: “I have been having terrible chest and arm pain for the past 2 hours and I think I am having a heart attack.”
HPI: Mr. Hammond is a 57-year-old African American male who presents to the Emergency Department with a chief complaint of chest pain that radiates down his left arm. He states that he started having pain several hours ago and says the pain “it feels like an elephant is sitting on my chest”. He rates the pain as 8/10. Nothing has made the pain better or worse. He denies any previous episode of chest pain. Denies nausea, dyspnea, or lightheadedness. He was given 0.4 mg nitroglycerine tablet sublingual x 1 which decreased, but not stopped the pain.
Lipid panel reveals Total Cholesterol 324 mg/dl, high density lipoprotein (HDL) 31 mg/dl, Low Density Lipoprotein (LDL) 122 mg/dl, Triglycerides 402 mg/dl, Very Low-Density Lipoprotein (VLDL) 54 mg/dl
His diagnosis is an acute inferior wall myocardial infarction.
1 of 2 Questions:
Why is HDL considered the “good” cholesterol?
QUESTION 2
1.
CC: “I have been having terrible chest and arm pain for the past 2 hours and I think I am having a heart attack.”
HPI: Mr. Hammond is a 57-year-old African American male who presents to the Emergency Department with a chief complaint of chest pain that radiates down his left arm. He states that he started having pain several hours ago and says the pain “it feels like an elephant is sitting on my chest”. He rates the pain as 8/10. Nothing has made the pain better or worse. He denies any previous episode of chest pain. Denies nausea, dyspnea, or lightheadedness. He was given 0.4 mg nitroglycerine tablet sublingual x 1 which decreased, but not stopped the pain.
Lipid panel reveals Total Cholesterol 324 mg/dl, high density lipoprotein (HDL) 31 mg/dl, Low Density Lipoprotein (LDL) 122 mg/dl, Triglycerides 402 mg/dl, Very Low-Density Lipoprotein (VLDL) 54 mg/dl
His diagnosis is an acute inferior wall myocardial infarction.
2 of 2 Questions:
Explain the role inflammation has in the development of atherosclerosis.
QUESTION 3
1.
A 45-year-old woman with a history of systemic lupus erythematosus (SLE) presents to the Emergency Room (ER) with complaints of sharp retrosternal chest pain that worsens with deep breathing or lying down. She reports a 3-day history of low-grade fever, listlessness and says she feels like she had the flu. Physical exam reveals tachycardia and a pleural friction rub. She was diagnosed with acute pericarditis.
Question:
What does the Advanced Practice Registered Nurse (APRN) recognize as the result of the pleural friction rub?
1 points
QUESTION 4
1.
A 15-year-old adolescent male comes to the clinic with his parents with a chief complaint of fever, nausea, vomiting, poorly localized abdominal pain, arthralgias, and “swollen lymph nodes”. States he has felt “lousy” for a couple weeks. The fevers have been as high as 102 F. His parents thought he had the flu and took him to an Urgent Care Center. He was given Tamiflu® and sen.
CC I have been having terrible chest and arm pain for the .docxtroutmanboris
CC: “I have been having terrible chest and arm pain for the past 2 hours and I think I am having a heart attack.”
HPI: Mr. Hammond is a 57-year-old African American male who presents to the Emergency Department with a chief complaint of chest pain that radiates down his left arm. He states that he started having pain several hours ago and says the pain “it feels like an elephant is sitting on my chest”. He rates the pain as 8/10. Nothing has made the pain better or worse. He denies any previous episode of chest pain. Denies nausea, dyspnea, or lightheadedness. He was given 0.4 mg nitroglycerine tablet sublingual x 1 which decreased, but not stopped the pain.
Lipid panel reveals Total Cholesterol 324 mg/dl, high density lipoprotein (HDL) 31 mg/dl, Low Density Lipoprotein (LDL) 122 mg/dl, Triglycerides 402 mg/dl, Very Low-Density Lipoprotein (VLDL) 54 mg/dl
His diagnosis is an acute inferior wall myocardial infarction.
1 of 2 Questions:
Why is HDL considered the “good” cholesterol?
2 points
QUESTION 2
CC: “I have been having terrible chest and arm pain for the past 2 hours and I think I am having a heart attack.”
HPI: Mr. Hammond is a 57-year-old African American male who presents to the Emergency Department with a chief complaint of chest pain that radiates down his left arm. He states that he started having pain several hours ago and says the pain “it feels like an elephant is sitting on my chest”. He rates the pain as 8/10. Nothing has made the pain better or worse. He denies any previous episode of chest pain. Denies nausea, dyspnea, or lightheadedness. He was given 0.4 mg nitroglycerine tablet sublingual x 1 which decreased, but not stopped the pain.
Lipid panel reveals Total Cholesterol 324 mg/dl, high density lipoprotein (HDL) 31 mg/dl, Low Density Lipoprotein (LDL) 122 mg/dl, Triglycerides 402 mg/dl, Very Low-Density Lipoprotein (VLDL) 54 mg/dl
His diagnosis is an acute inferior wall myocardial infarction.
2 of 2 Questions:
Explain the role inflammation has in the development of atherosclerosis.
3 points
QUESTION 3
A 45-year-old woman with a history of systemic lupus erythematosus (SLE) presents to the Emergency Room (ER) with complaints of sharp retrosternal chest pain that worsens with deep breathing or lying down. She reports a 3-day history of low-grade fever, listlessness and says she feels like she had the flu. Physical exam reveals tachycardia and a pleural friction rub. She was diagnosed with acute pericarditis.
Question:
What does the Advanced Practice Registered Nurse (APRN) recognize as the result of the pleural friction rub?
1 points
QUESTION 4
A 15-year-old adolescent male comes to the clinic with his parents with a chief complaint of fever, nausea, vomiting, poorly localized abdominal pain, arthralgias, and “swollen lymph nodes”. States he has felt “lousy” for a couple weeks. The fevers have been as high as 102 F. His parents thought.
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Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
1. CC: 53 y/o female with psychosis
HPI: 53 y/o Native American female brought to the ED from a NH this morning with
altered mental status and psychosis. She had been discharged from the hospital 4 days
prior after a right total hip arthroplasty. She was discharged to a rehab facility and was
doing well until the evening prior to admission. At 6am on day of admission, pt refused a
lab draw and stated “they can take it at the hospital, I’m waiting on the ambulance”.
Throughout the day, she continued to make non-sensical comments but remained
cooperative and responsive. She was noted to be talking to herself and to people that were
not present. Because of these symptoms, staff at rehab transferred to Regions for
evaluation. Continued to hallucinate in ED demonstrated as talking to imaginary people.
Became increasingly agitated. Given IV ativan with decreased both agitation and lucidity.
PMH:
Osteoarthritis
DJD
Multiple fractures 2/2 pedestrian vs vehicle MVA in 1980
HCV
Depression
ADHD
PSH:
s/p anterior cervical discectomy and fusion at C5-6, C6-7 May 2006
s/p right THA and hardware removal on 12/6/06 after failure of THA from 1980
s/p c-section 2/2 sepsis 1987
s/p ex lap 2/2 perforated colon 1975
ROS: unable to obtain secondary to mental status
Meds:
Cymbalta 30mg qday
Wellbutrin 300mg qday
Tramadol 40mg qid
Ambienc 10mg qhs
Adderall 20mg qday
Percocet 102 tabs q4h
Lorazepam 1mg qday
Hydroxyzine 25mg, 1-2 tabs q4h prn
Docusate
Hexavitamin
Calcium/vit D
Warfarin 1mg
Shx:
Living at rehab after recent hip surgery. Smokes 1 cigar/day. Divorced. No employment
secondary to MVA injuries from past.
2. Fhx: Mother had CAD and died of ruptured brain aneurysm/stroke. Father died of MI.
Exam:
VS: T 97.2F, BP 116/84, HR 120, RR 19, O2S 95% RA
Gen: Agitated and lying in bed. Opens eyes to voice intermittently. Tremulous and
diaphoretic.
HEENT: Normocephalic and atraumatic. PERRL. Pt will not cooperate with opening
mouth for OP exam.
Neck: No masses. Trachea midline. Carotids 2+
Lungs: CTA bil, no wheezing or rales
CV: Tachycardic, regular. S1 and S2 normal, no m/r/g
Abd: soft/nt/nd. Bowel sounds normal to hyperactive.
Ext: 1-2+ pitting edema in RLE. LLE without edema. Right hip surgical site is c/d/I with
mild serosanginous drainage. DP and PT pulses 2/2.
Neuro: Not able to follow commands. Opens eyes to pain, voice and touch. Visible
tremors in bil lower extremities. Spontaneous clonus in RLE, inducible clonus with
multiple beats in bil LE, but R>L. Patellar reflexes 3+ bilateral. Biceps reflexes 2-3+ bil.
Bil LE exhibit rigidity bilaterally. Unable to illicit babinski sign due to rigiditiy.
Labs:
• CBC: WBC 10.9 (normal diff), HGb 9.2, Plt 256
• BMP: Na+ 138, K+ 4.0, Chl 107, CO2 25, BUN 12, Crt 0.8, Ca2+ 8.0
• Utox: preliminary presumed pos for amphetamines and THC
• CK 662
EKG: sinus tachycardia
Head Ct: exam was limited by motion. Ventricles and sulci normal. No obvious
intracranial abnormality.
Course:
Agitation/psychosis picture consistent with serotonin syndrome (agitation, rigitidy,
neuro findings).
- started CIWA ativan parameters.
- Attemped cyprohepatdine 12mg PO x1 dose.
- Admitted to MICU
- Started NS at 150ml/hr
- Supportive cares
Libby Zion/Work Hours:
3. 18 y/o female who presented to New York Hospital Cornell Medical Center with fever,
agitation, and “strange jerking motions” of her extremities. Ongoing treatment for
depression. Was admitted and evaluated by an intern and a resident. After discussing the
case with the pts PCP, decided she had a viral illness with “hysterical features” and she
was given mepiridine for pain and sedation. Pts status worsened overnight and crosscover
was notified. However, intern was covering 40-50 other patients some of whom were
very ill. Restraints and haldol were administered. Pt developed fever to 107F, had cardiac
arrest and died.
Family sued for inadequate staffing at teaching hospital. Claimed that long hours and too
many patients were to blame for poor care their daughter received. Father was journalist
at NY Times. Blaimed administration of mepiridine interaction with anti-depressant
caused serotonin syndrome and pt died.
After many trials and cases led to the Bell commission with recommendations for no
more than 24hours of patient care, limit of 80 hours in a work week, and presence of
attending physician in house at all time. New York state first to accept these restrictions
ACGME accepted 80 hour work hour restrictions with no more than 24 hours of active
patient care in 2003. Has caused great amount of discussion and changed through medical
training.
DDx:
Neuroleptic malignant syndrome- longer course, bradyreflexis, muscular rigidity, caused
by dopamine antagonist
Anticholinergic toxicity- muscular tone and reflexes are normal in AC toxicity
Malignant hyperthermia
Intoxication with sympathomimetic agents
Neuro:
Meningitis
Encephalitis
ID:
bacteremia from hip
endocarditis
