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What other drugs not used to treat hypercalcemia may produce hypocalcemia?
What are other potential causes of chronic hypocalcemia?
What is a normal serum calcium values in an adult?
Normal serum Ca level ranges from 9 to 11 mg/dL
What is warranted in patients with marked hypocalcemia of less than 6.5 mg/dL?
Immediate medical treatment is indicated
What may help determine the cause of hypocalcemia?
additional laboratory studies are needed?
Trousseau’s sign(carpal spasm)
Trousseau’s sign(carpal spasm)in a patient with severe hypocalcemia
An abnormal unilateral spasm of the facial muscle when the facial nerve is tapped below the zygomatic arch anterior to the earlobe
What interventions are needed if the patient exhibits either Trousseau’s sign or Chvostek’s sign accompanied by respiratory distress (e.g., stridor,loud crowing noises, and cyanosis)?
Require immediate referral for emergency care because the neuromuscular irritation produced by hypocalcemia may progress rapidly to laryngospasms, seizures, and dysrhythmias.
What is found in patients with a gradual decline of serum calcium levels?
muscle cramps & muscle weakness
What symptoms are found in chronic hypocalcemia?
What is the goal of treatment of chronic hypocalcemia?
Restore the serum Ca level to the low to normal range
What does the therapy includes for the treatment of chronic hypocalcemia?
What are the various preparations of Ca and which is the least expensive? Why is that preparation not recommended in the elderly?
Preparations include Ca carbonate, calcium gluconate, calcium citrate,and calcium lactate.
Calcium carbonate is the least expensive formulation; however, it may not be absorbed as well, especially in the elderly.
What is gynecomastia?
It is the enlargement of glandular breast tissue in men, resulting in increased breast size.
What does true gynecomastia involves enlargement of?
the stromal and ductal tissues
How does gynecomastia present itself?
It may present unilaterally and progress to bilateral symmetrical or asymmetrical enlargement.
What does gynecomastia results from?
What hormones stimulate ductal growth in the breasts of males with gynecomastia?
What hormones stimulate alveolar lobular growth of the breasts of males with gynecomastia?
How much of the male population in the United States does gynecomastia affect?
12% to 40% of the male population in the United States
How much of the male population in the United States is gynecomastia present in?
40% to 60% of men older than age 50 years
What population does transient gynecomastia occurs in?
How does gynecomastia present itself in male patients?
Does pain in the nipple or breast and tenderness often accompany gynecomastia? True/False
What is found in gynecomastia lasting longer than 1 year?
How often is nipple discharge found in gynecomastia?
Nipple discharge is rare (present in fewer than 5% of cases)
What is found in gynecomastia associated with puberty?
When should gynecomastia be referred to an endocrinologist for
When it presents before or after puberty and cannot be associated with physiological aging, a drug, or chronic disease
What should be ordered by the provider for gynecomastia that is accompanied by other breast abnormalities, especially if they are unilateral?
a mammogram is indicated to rule out a neoplasm. A disc that is greater than 4 cm in diameter should be evaluated via mammography
45-year-old patient presents for the first time with a sudden onset of intense apprehension, fear, dyspnea, palpitations, and a choking sensation. What is your initial diagnosis?
d) panic attack
In the depressed client, antidepressants are most effective at alleviating:
Which of the following is characteristic of a manic episode?
Which of the following clients is at highest risk for an eating disorder?
Obsessive-compulsive disorder symptoms usually occur:
What is the medication of choice for obsessive-compulsive disorders?
Janice, age 14, is markedly obese and has a poor self-image. How do you differentiate between compulsive eating and bulimia?
Mark, age 29, tells you that he has thought about suicide. Which should you say next?
Dan, age 82, recently lost his wife to breast cancer. He presents with weight loss, fatigue, and difficulty sleeping. What should your first response be?
What is the most sensitive diagnostic test for identifying an alcoholic client?
Julie, age 15, is 5 ft tall and weighs 85 lb. You suspect anorexia and know that the best initial approach is to:
If you suspect that your client abuses alcohol, the most appropriate action would be to:
June, age 79, comes to your office with a recent onset of depression. She is taking several medications. Which medication is safe for her to take, because depression is not one of the side effects?
Major depression occurs most often with which of the following conditions?
In the stages of Elisabeth Kübler-Ross's anticipatory grieving, which stage follows anger?
Jim, a 45-year-old postal worker, presents for the first time with a sudden onset of intense apprehension, fear, dyspnea, palpitations, and a choking sensation. What is your initial diagnosis?
The typical perpetrator in a domestic violence situation is one who:
The most common viral infection causing diarrhea in the United States is:
You elicit costovertebral angle tenderness in Gordon, age 29. Which condition do you suspect?
Ruby has a colostomy and complains that her stools are too loose. What food(s) do you suggest to help thicken the stools?
An infant who is ruminating should be diagnosed and treated for:
You suspect that Harry has a peptic ulcer and tell him that peptic ulcers have been found to be strongly associated with:
Rose has gastroesophageal reflux disease. You know she misunderstands your teaching when she tells you that she will:
One of the alarm signs or symptoms of irritable bowel syndrome that requires prompt investigation is:
Rebound tenderness at McBurney's point would alert you to:
Which of the following pharmacologic agents used to treat constipation may cause flatulence and bloating and requires adequate fluid intake?
Rebound tenderness may indicate:
Which of the following antibiotics causes more episodes of nausea and/or vomiting than the others?
Hyperactive bowel sounds (borborygmi) are present in which of the following conditions?
Morris is in a new relationship and is not sure whether his erectile dysfunction is caused by stress about his performance or is organic. What simple test could you suggest to determine if he has the ability to have an erection?
If a client appears with symptoms of benign prostatic hypertrophy, a digital rectal examination is indicated in order to:
Drew has erectile dysfunction and says that a friend told him about a method that uses a constricting ring around the base of the penis. What is he referring to?
The single-most effective method of treating urinary calculi is:
Herb, a diabetic, is complaining of a rash on his penis. Before examining him, you suspect that he may have:
Which type of urinary incontinence results from Parkinson's disease and multiple sclerosis?
Austin has been on finasteride (Proscar) for 6 months for benign prostatic hypertrophy. The original value of his prostate-specific antigen (PSA), a 5.4, has not decreased. Your initial expectation is:
Jeff, age 20, presents to the college health clinic with complaints of difficulty passing his urine and a discharge from his penis. On further investigation, you note that the discharge is urethral in origin. The most common cause of these symptoms in the young adult male population is:
Harry has benign prostatic hypertrophy and complains of some incontinence. Your first step in diagnosing overflow incontinence would be to order a:
Which statement is true about the use of alpha blockers in the treatment of symptomatic benign prostatic hypertrophy?
Common clinical symptoms of testosterone deficiency include:
Urinary tract infections in the male client are divided into upper- and lower-tract infections. A classic example of an upper-tract infection includes:
This procedure involves taking fecal bacteria from a healthy person and infusing this via enema into the person with the C-difficile infection.
cell low in size
cell low in size
cells large in size
*immature red blood cell
*elevated in anemia, under bone marrow damaged
iron deficiency anemia
microcytic and hypocromic,
most common cause is blood loss
RDW > 15%
normal color hemoglobin
high in color
microcytic and hypocromic....
do not give iron...
their iron will be normal!!!!
rdw is normal
serum iron is normal
What is the most common rosacea trigger?
Elizabeth, 83, presents with a 3-day history of pain and burning in the left forehead. This morning she noticed a rash with erythematous papules in the at site. What do you suspect?
You have diagnosed Tom with contact dermatitis on the left side of the face secondary to poison ivy. You would recommend?
A patient is complaining of severe pruritus that is worse at night. Several family members have the same symptoms. Upon examination, areas of excoriated papules are noted on some of the interdigital webs of both hands and the axillae. This is most consistent with :
Which of the following is positive in a large percentage of patients with systemic lupus erythematosus?
Which of the following is recommended treatment for erythema migrans or early Lyme disease?
Pernicious anemia is a result of?
Caroline, an older adult, is homeless and has iron-deficiency anemia. She smokes and drinks when she can and has an ulcer. Which of the following is not one of the risk factors of iron-deficiency anemia?
Sherri’s blood work returns with a decreased mean cell volume (MCV) and a decreased mean cellular hemoglobin concentration (MCHC). What should you do next?
What does a shift to the left or left shift mean?
Select a statement that is true about the erythrocyte sedimentation rate (ESR)?
Clients with AIDS typically experience the neurological symptomatic triad consisting of:
Your client, age 60, presents with pruritus and complains of lymphadenopathy in his neck. He also complains of night sweats. Not lost any weight and otherwise feels well. On physical exam you notice enlarged supraclavicular nodes.
Rena, age 27, had her spleen removed after a MVA. You are seeing her in the office for the first time since her discharge from the hospital. She asks you how her surgery will affect her in the future.
· Monocytes- 1-10%
o Stored in spleen released to chronic inflammation
§ antigen presentation to Tcells, and
§ Cytokine release
· Work with coagulation cascade to form a plug to stop bleeding
o Aggregation- more platelets group up
· Thrombocytopenia causes
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