Blood vessel spasms following injury are stimulated by. Ans choice A: release of heparin from eosinophils B: the formation of fibrin clots C: serotonin release from platelets D: all of the above

A 21-year-old male visits with his family doctor at the urging of his parents when home for Spring Break. The parents are concerned because their son has lost a significant amount of weight. The young man is concerned because he is experiencing a heart rate of 120bpm while at rest and much higher when exercising. Additionally, his blood pressure averages 137/82 based upon four recordings. He has a recurring headache, tremors in his hands and suffers dyspnea.

This individual has been generally health for his entire life, eats a reasonably good diet and is very active, thus the above symptoms are concerning. Standard blood tests show normal levels of blood cells, however there is an elevated amount of metadrenalines (metabolite by-product of adrenaline) and the urinalysis also shows an elevated amount of metabolites of catecholamines. The physician then orders a 24-hour urine test where the patient collects urine at regular intervals for a 24-hour period. The patient is warned to avoid stimulants such as cocoa and caffeine during this time period. The results of this test confirm elevated metabolites of catecholamines. The physician suspects a condition called pheochromocytoma, which is a (usually) non-cancerous tumor of the adrenal gland. This tumor causes the excess secretion of catecholamines. To confirm this suspicion, the physician orders a specialized type of CT scan, called MBIG. This type of scan utilizes radioactive iodine as a contrast agent for visualization of masses as described above. A sample of MIBG results is shown below:

The MIBG confirms the presence of a tumor on the adrenal gland and the young man is scheduled for surgery to remove the mass. It is non-cancerous and he resumes his life. As a side note, current estimates are that only about 10% of adrenal tumors are cancerous

7. What is normal heart rate and blood pressure for a healthy, active 21-year-old male? How do the heart rate and blood pressure of this patient compare? Explain the mechanism by which catecholamines modify blood pressure. (2 pts)

CLINICAL CONNECTION ACTIVITY FOR CHAPTER 6 − DIGESTIVE SYSTEM

Objective: Apply and understand how medical terms are used in the clinical environment.

Complete the clinically related sentences by selecting a medical term from the table below.

benign

choledocholithiasis

dyspepsia

gastrectomy

gastroesophagitis

gastromegaly

gastroscopy

hematemesis

hepatomegaly

orthodontist

scope

sialitis

sigmoidoscopy

toxicosis

under

1. The physician informs a patient that she has an inflammation of the saliva-producing glands. This disorder is commonly known as __________________________________.

2. A patient diagnosed with angina pectoris is prescribed sublingual nitroglycerin as needed for chest pain. You explain that sublingual means that the nitroglycerin tablet should be placed __________________________________ the tongue.

3. An adolescent goes to the dentist for a 6-month check-up and cleaning. During the appointment, the dentist recommends she be examined by a specialist who straightens the teeth. This specialist is known as a(n) __________________________________.

4. Sarah M. goes to the clinic complaining of burning in the chest. The physician orders an endoscopy because he suspects the burning is of gastrointestinal origin. The endoscopy reveals inflammation of the stomach and esophagus, which is commonly known as _________________________________.

5. A patient with a history of alcohol abuse comes to the emergency department vomiting blood. You document this finding as __________________________________.

6. While performing a colonoscopy, the physician notes a tumor that appears noncancerous. A noncancerous tumor is referred to as __________________________________.

7. The physician orders a test to visualize the last section of the colon in a patient suspected of having colon cancer. This test is known as a __________________________________.

8. Michael W. comes to the clinic complaining of painful digestion, which he began experiencing after taking a new medication. You report this adverse reaction, known as _________________________, to the physician so that he can discontinue the medication.

9. A patient with a history of alcohol abuse is admitted with shortness of breath. During the admission assessment, you palpate the patient’s abdomen and note an enlarged liver. The term __________________________________ best describes an enlargement of the liver.

10. A 45-year-old obese patient comes to the emergency department complaining of abdominal pain after eating fried food. Diagnostic testing reveals stones or calculi in the common bile duct. The emergency department doctor consults the surgeon and reports his finding, known as __________________________________.

11. John J. comes to the doctors office with complaints of a 20-pound weight loss over the past 2 months and frequent indigestion. Computed tomography scanning reveals a tumor in the stomach. The doctor recommends a surgical procedure that removes a portion of the stomach, known as a __________________________________.

12. A patient with a history of severe depression comes to the hospital after ingesting the poison ethylene glycol. The syndrome that follows the ingestion of a poison is known as a __________________________________.

Consider heparin, antithrombin, prostacyclin, and coumadin. What function do these factors have in common?

A. initiation of coagulation

B. stabilization of fibrin clot

C. prevention of coagulation

Clark Austin is a 75-year-old retired engineer who lives with his wife Ann. He is admitted to your hospital with acute cholecysitis. He has undergone a cholecystectomy and has been transferred to your floor the second day postop. He has a nasogastric (NG) tube to continuous low wall suction, a Foley catheter in place, one peripheral IV, a large abdominal dressing, a history of emphysema. In addition, he is on O2 2L/min per NC and receives a continuous pulse oximetry monitoring. His orders include: D51/2NS with 20 mEq KCI/L at 125 cc/hr. Morphine 5 mg IV q2hr prn, turn, cough, and deep breathe q2h, incentive spirometer q 2h while awake.

This morning, when you enter his room, Mr. Austin appears quite anxious and coughs a lot. He complains of shortness of breath and pain in his chest and his incision site. He states, "I feel hot, and I am extremely tired."

Your assessment reveals the following: His respiration is labored and shallow with the use of accessory muscles of the neck and abdomen. VS: 142/80, P 120, R 26, T 103.4, 02 sat 88% on O2 at 2L/min per NC. There are scattered crackles throughout the right lung fields and LUL, rhonchi over large airways, and breath sounds are diminished from fourth intercostal space to the base on the left side. His IV is running at the prescribed rate and there are no signs of infection of the IV site. His pain level is 5 on a scale of 1-10. The physician prescribes the following order after you called him or her immediately after your assessment: continue IV of D51/2NS with 20 mEq KCL/L at 125 cc/hr; STAT blood culture and sensitivity (C&S) sputum C & S; STAT chest x-ray (CXR) and ECG; Ampicillin/Sulbactam (Unasyn) 1.5 g IVPB q6h; and Acetaminophen 650 mg po for temp over 102 F.

1. Why does the physician order a culture and sensitivity test? How are the results being used?

What is the effect of high levels of heparin in blood?

A patient has recently been diagnosed with asthma. The patient is unsure whether the medication regimen prescribed is actually helping. The physician orders pulmonary function testing. What information might testing provide that will aid in the patient’s treatment regimen? close to 1 page explaination

JT is a 20 year old female on a continuous infusion of an antibiotic. The total dose that will be given is 1500 mg over 24 hours. The volume of distribution is 69 L and the drug half life is 6.7 hours. What is the plasma drug concentration if a blood sample is taken 29 hours after the infusion began? Note: Please provide your answer in units of mg/L.

A physician orders that an amniocentesis be performed to determine whether a woman’s fetus is genetically normal. This procedure will involve

	a.	taking a blood sample from the mother.
	b.	drawing a sample of the fluid that surrounds a fetus in the uterus.
	c.	taking a sample of the placenta between the eighth and eleventh week of pregnancy.
	d.	taking a blood sample from the fetus

Bobby Sue was brought to the ER where she was assessed for trauma. Physicians were worried about a myocardial contusion or other myocardial damage, and ran an EKG. Below is an image of a 6 second strip. They checked her systemic blood pH (7.11; low), blood oxygenation (86%, low), and body temperature (95.8 oF). The broken knees were wrapped, but surgery was put off until her metabolic condition was stabilized. After all, bones can be fixed later—cells are more difficult to replace. This is termed “Damage Control” in trauma: stabilize the patient, schedule major surgeries to repair massive injuries once the patient is stable. In exsanguinating hemorrhage, patients die from coagulopathy, hypothermia, and metabolic acidosis. The metabolic failure is often the terminal condition, and therefore must be dealt with immediately.

The ER physician diagnosed myocardial contusion. A first year Medical student knew that this could cause A-fib, and could lead to blood clotting and stroke. He suggested that they give her heparin. In unison, the ER trauma team yelled “NO!”.

 Given her pH and body temperature what is her blood clotting status?

 How does heparin work to prevent blood clots?

 Why would you not give heparin to Bobby Sue?

1) Physician orders part of a hepatic function panel: serum albumin, total bilirubin, and direct bilirubin. CPT Code(s)

2)Vancomycin assay for peak and trough levels. CPT Code(s)

3) Basic metabolic panel and renal function. CPT Code(s)

4) Hospital blood bank irradiates two units of leukoreduced red cells. CPT Code(s)

A 70 kg 68 y/o male sees his cardiologist for a follow-up following his myocardial infarction 3 months earlier. He has been taking digoxin and Lisinopril^TM since his MI. At the follow-up, he complains of shortness of breath and has to sleep sitting up in his recliner. He also complains of fatigability and swelling of his ankles and hands. A physical examination finds that he has distended jugulars and pitting edema in the lower legs. His breathing was rapid 22 breaths/min) and rales were heard in the both sides at the base of the lungs. He does not have a fever, but his pulse is 116 bpm and his blood pressure is 110/80. The physician immediately admits him and orders a blood and urine analyses with the results as follows:

Blood			Urine
[Na+]	128 mEq/L		[Na+]	150 mEq/L
[K+]	3.0 mEq/L		[K+]	65 mEq/L
[Cl-]	98 mEq/L		[Cl-]	120 mEq/L
[HCO3-]	21 mEq/L		[HCO3-]	15 mEq/L
Creatinine	1.2 mg/dl		Creatinine	128 mg/dl
PCO2	24 mmHg		24 hr volume	750 ml
pH	7.51		Osmolality	600 mOsm

a) Calculate the volumes of ECF and ECV in this Px assuming the total body osmoles of the Px is 12 Osm. Do these volumes have any impact on the symptoms the Px is exhibiting and what is the cause of these changes (ie, what is the pathology)?

b)   How does this pathology alter the renal sodium handling in this Px and what are the mechanism(s) for developing hyponatremia?

c)   The physician orders an infusion of 2L of 3% saline with 40 mg of Lasix^® given twice a day for three days. Calculate how this treatment would impact the Px’s symptoms assuming the osmolarity of the urine dropped to 400 mOsm?

d) What are the renal mechanisms affected by this treatment. Does this treatment impact the Px’s hypokalemia? If so, why?

Describe the process of involution of the uterus