Questions
Patient Name: Jennifer Markus                                     &nbs

Patient Name: Jennifer Markus                                                                                                                                   MR#: 45879

Attending Physician: Katrina McKenzie, M.D.

Consulting Physician: Erik Anderson, M.D.                                                                                                            Date: 12/4/11

Subjective: Mrs. Markus is a 33-year-old woman with a PMH [past medical history] significant for depression, asthma, hiatal hernia, and migraine headaches. She presents complaining of waking with a pulsing headache on the left side of her head, with 1 day of prior increased sensitivity to light and to noises, as well as nausea, no emesis. The patient notes that work has been increasingly stressful over the past couple weeks and she’s had trouble sleeping. She took two tablets of ibuprofen last night in the hopes of avoiding a migraine, with minimal relief. She is currently taking sertraline for her depression.

She denies any history of seizure, cluster headaches, or tension headaches. She does smoke approximately one half pack of cigarettes daily. She notes that she’s been getting these headaches more frequently, as in two to three times per month. She would like something to decrease the duration of the headache, as well as some suggestions for prevention of future headaches.

Objective: VS: BP 134/80, HR 76, Temp 98.4, wt 155. Physical Exam. General: The patient is sitting with her eyes partially covered by her hands, otherwise, no acute distress. HEENT: Normocephalic/atraumatic, conjunctivae noninjected, pupils equal and round, reactive to light and accommodation (PERRLA), ears with normal cone of light reflex, nose with clear discharge, throat nonerythematous. Neck: No lymphadenopathy, thyroid smooth and symmetric, no nodularity palpated. Lungs: Clear to auscultation bilaterally. Heart: Regular rate and rhythm, no murmurs/grunts/rubs. Abdomen: Soft, nontender, nondistended, no abdominal bruits. Extremities: Warm and well perfused at distal extremities, no edema bilaterally. Musculoskeletal (MSK): Strength of upper and lower extremities equal and 5/5, no loss of sensation at extremities, normal patellar reflexes bilaterally.

Assessment: Patient is a 33 yo female with symptoms and physical exam consistent with migraine headache.

Plan: Migraine Headache Treatment. Begin the patient on a combination treatment of sumitriptan 85 mg and naproxen 500 mg, daily, for the duration of the headache.

Prevention: Continue with the sertraline, as it can have protective effects. Begin a smoking cessation regimen, because smoking can worsen headaches. Recommend some manner of stress-reduction practice, whether it be regular exercise, meditation practice, or relaxation practice.

Follow-up in 3 weeks to evaluate progress and number of headaches. At that time, will reevaluate with the possibility of adding a beta-blocker or calcium channel blocker. Patient was advised that if this headache worsens or fails to improve in the next 24–48 hours, she should call the clinic.

Erik Anderson, M.D.

Discussion Questions

2.     The format of this note is a SOAP note. Using an online search or other research method, describe what a SOAP note is and how it’s used.

In: Anatomy and Physiology

Take a 20-minute walk or ride (or do anything that involves some movement) and think about...

Take a 20-minute walk or ride (or do anything that involves some movement) and think about the organ systems described in the lecture. Take a break from your activity, and note the following:

• Name 4 organ systems that you feel are working during your activity.

• What roles are 2 of these systems playing in your activity?

• What is one system that you know is working but you’re not feeling it work?

• Name 1 way that your body is maintaining “homeostasis” during your activity.

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Describe the electrical activity of the heart to include the electrical activity of the noncontractile auto...

Describe the electrical activity of the heart to include the electrical activity of the noncontractile auto rhythmic cells (pacemaker cells) and the depolarization and repolarization of the myocardium.

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Discuss age-related changes that occur in the remainder of the axial skeleton

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Starting with a fatty acid located in the cytosol of the cell, explain “mechanistically” how an...

Starting with a fatty acid located in the cytosol of the cell, explain “mechanistically” how an iron deficiency may result in reduced acetyl CoA production from beta oxidation of palmitic acid

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Describe the social and public health (PH) challenges that need to be addressed to improve the health of women in low income countries

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Describe the purpose of osteological landmarks (process, fossa, foramen). Identify 1-2 examples of each.

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Which of the following statements is(are) true? (Check all that apply) glp-1 and lin-12 are partially...

Which of the following statements is(are) true? (Check all that apply)

glp-1 and lin-12 are partially redundant

inductive signaling involves signaling between two equivalent cells with the same developmental potentials

lin-12 primarily functions in vulval development, whereas glp-1 primarily functions in germline development

lag-2 encodes a transmembrane protein

In eukaryotes, multiple genes can be expressed simultaneously by

a.

the binding of a mediator complex to several genes at once.

b.

a repressor protein binding to multiple operators.

c.

the binding of a specific transcriptional regulator to several genes.

d.

the arrangement of multiple genes into an operon.

A transcriptional regulator that activates expression of additional transcriptional regulators that induce production of a particular cell type or organ is called a

a.

master regulator.

b.

feedback activator.

c.

reprogramming regulator.

d.

terminal differentiator.

he control of a gene product’s levels or activity after transcription has taken place is called

a.

post-transcriptional control.

b.

combinatorial control.

c.

epigenetic inheritance.

d.

cell memory.

In: Anatomy and Physiology

Good afternoon! Hope you are having a great day. I have a question about HIV treatments....

Good afternoon! Hope you are having a great day.
I have a question about HIV treatments.
Could you please describe Nucleoside or nucleotide reverse transcriptase (NRTIs) and what is the difference between Non-nucleoside reverse transcriptase inhibitors (NNRTIs).
Many thanks!

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compare and contrast the mucosa's between the esophagus and small intestine

compare and contrast the mucosa's between the esophagus and small intestine

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Define the role that calcium, Calcitriol, and parathyroid hormone play in bone remodeling

Define the role that calcium, Calcitriol, and parathyroid hormone play in bone remodeling

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discuss helminthic disease of blood and lymph in 2 pages

discuss helminthic disease of blood and lymph in 2 pages

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pick two of the nervous system pathologies to discuss from the list below.   For each selected...

pick two of the nervous system pathologies to discuss from the list below.  

For each selected pathology, you should provide the following information: an explanation of the underlying functional or structural deficit present in the condition, predicted deficits based on your knowledge of the normal function and structure of the nervous system (these are educated guesses based on your understanding of nervous system function), and an explanation of at least three signs/symptoms that are seen with this condition (based on sources found during research you have conducted into the chosen conditions). Your discussion MUST include an explanation describing how the deficit produces the observable signs/symptoms AND a statement describing how your chosen conditions affect homeostasis within the body.


Choose two of the following nervous system pathologies to discuss:

Parkinson’s disease

Tay-Sachs disease

Multiple sclerosis

Polio

Hydrocephalus

Guillain-Barré syndrome

Bell’s palsy

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State the important distinction between the terms 'serving size' and 'portion'. why do you think that...

State the important distinction between the terms 'serving size' and 'portion'. why do you think that portion sizes of many foods have generally gone up for many people? What might be at least one reason (that might even sound fairly logical) that foods with higher energy densities, and sometimes correspondingly lower nutrient densities, are eaten with greater frequency in many people's diets? .

. If the curve for sufficiency of intake of a given nutrient were narrower (tighter) and the distance between the UL and both the RDA and EAR thus less, how would this impact an individual's approach to attaining an adequate, but not excess, amount of such nutrient?

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