A 150 lb., 63-year-old man is experiencing exertional dyspnea, shortness of breath, mild cyanosis, and marked slowing of forced expiration. He is chronically fatigued from the action of breathing and appears to have a "barrel chest." In addition, he has been a smoker for 40 years. The doctor describes his condition as a "progressive disease that directly affects the site of gas exchange in his lungs."

What treatments would you recommend for this patient?

If a rat required a high rate of insulin infusion to maintain a specific blood glucose level, you can conclude that it is.....

a) non-sensitive to insulin

b) sensitive to insulin

In a patient with ___________ an infusion of ________ saline could be therapeutic or helpful. A. hypernatremia, hypertonic B. hyponatremia, hypertonic C. hyponatremia, hypotonic

Hypokalemia and hyperkalemia can both cause decreased excitability (of excitable cells). A. True B. False

The way hypokalemia and hyperkalemia affect excitability is both cause Na+ channels to remain inactivated for a prolonged (or a long) time. A. True B. False

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?