Which of the following is correct concerning the Edrophonium (Tensilon) test?
Which of the following is correct concerning the Edrophonium (Tensilon) test?
The onset of action is rapid, and the duration of maximal effect is short.
The effects last for 2-4 hours.
It is a useful test in diagnosing Guillain-Barr� syndrome.
All of the above"
The onset of action is rapid, and the duration of maximal effect is short.
Can you help me develop a case study on diabetes health literacy? The case study's components should include the following.
Can you help me develop a case study on diabetes health literacy? The case study's components should include the following.
A. Learning objective.
b. Medical history of the patient.
c. Social history of the patient.
d. Objective data
e. Subjective data
f. Identify patient problems.
Next.
Please help me develop four questions related to this case study."
Case Study: Self management and health literacy of persons with diabetes
A. Learning Objective
To enhance the knowledge of diabetes care and gain micro-level insight into a patient’s ability to apply diabetes information in his or her environment.
B. Patient’s past medical history
Name: Jane Doe
Age: 58 years
Diagnosis: These include; Type 2 diabetes mellitus (T2DM), hypertension.
Chronic Conditions: Peripheral neuropathy, Hyperlipidämie
Medications: Metformin, Lisinopril, Atorvastatin
Previous Hospitalizations: None recent; history of diabetes mellitus, poorly managed and complicated by an episode.
C. The Role of Social History in the Patient
Occupation: Retired administrative assistant
Marital Status: Widowed
Family Support: Is single; two of the adult children own houses elsewhere in the state.
Health Behaviors: Avoidance of exercise, moderate drinking and non-smoking individual
Health Literacy: That is, poor knowledge about the ways of proper diabetes care and diet
D. Objective Data
Vital Signs: SBP 142/85 mm Hg, PR 78 bpm, RR 18 breaths per minute
Laboratory Results: HbA1c 8. 5%, Fasting Blood Glucose 180 mg/d Lal
Physical Examination: Obese, peripheral neuropathy, no acute symptoms that I am aware of in the feet
E. Subjective Data
Patient Complaint: “I just can not regulate the blood sugar levels any longer and do not know what foods are possible to eat. ”
Patient Reported Symptoms: Fatigue, occasionally mild visual impairment and to maintain the correct gait sensation of enfeeblement in the lower limbs.
Patient's Understanding: “I have been hearing that through diet, people can manage their diabetes but I was never too certain of what this entailed. ”
F. Identify Patient Problems
Uncontrolled Blood Glucose Levels: It consists the outcomes that were manifested by the elevated HbA1c and fasting blood glucose.
Poor Health Literacy: Confusion or disorientation in the issues to do with diabetes and how one should conduct him/herself.
Peripheral Neuropathy: From the aspect of the mobility of the patients and their quality of life.
Risk for Complications: Through uncontrolled diabetes and hypertension as rampant as is well known today.
Questions on the Case
How can Jane ensure that she understands what is required of her in diabetes self management and some of the aspects that relate to dietary modification?
Answer should include: Advisory on exchange of carbohydrate, enhancing client insight on glycemic level, use of figures as well as recommending a dietician.
This papers aims at identifying the strategies the healthcare providers could take to assess and address Jane’s HLM for DM self-management.
Answer should include: First is asking the patient what they know about the disease and then questioning them in order to achieve this Secondly, educating the patient using simple and basic language Third, there is what is called teach back Fourth, come up with a patient specific care plan.
The consequence of uncontrolled diabetes are: Therefore, the following are the ways on how Jane’s complication could be prevented or managed.
Answer should include: Informing patients about possible comorbidities, for instance, cardiovascular disease, peripheral neuropathy, or retinopathy, and about prevention and treatment methods: maintaining optimal blood glucose levels, adhering to medical prescriptions, balanced diet and exercises.
In what manner can the social and support system pose an impact to Jane’s diabetes management and what can be done about it?
Answer should include: Looking for the existing social support, involving the family into patient’s care, seeking for the community assistance, encouraging physician’s check-ups.
I am stuck on this DQ
I am stuck on this DQ- Using the research article selected for DQ 1, identify three key questions you will ask and answer when reading the research study and why these questions are important.
I used this article on pressure ulcers (Permalink): https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=137037259&site=eds-
Can you give me some guidance on how to proceed or possible questions to use?"
1. What is research question or hypothesis in the study?
Why This is Important: The identification of the objective and tasks of the study is possible with the help of knowledge on the research question or hypothesis. That way, it is possible to determine whether the study is focusing on an appropriate problem and whether the results of the study are consistent with the clinical realities of pressure ulcers.
How to Find the Answer: In the top part of the article or what is called the introduction part, you will be able to look at a brief of what the full article is all about. In any case, this section can also point out the research question or hypothesis in a concise and clearly. Otherwise, they can be ‘found’ under the problem statement/area of study section or under the objective section.
2. Which technique was used in the research and how do validity an reliability of the research gets affected by that.
Why This is Important: It lays down how the research was done, and thereby affects the accuracy or truth of the observations made. With such skills, one is in a better position of not Only assessing the reliability and relevance of the study to practice but also being conversant with the design, sample, data collection and data analysis process.
How to Find the Answer: There is no avoidable methodology section in the case article and thus, you should read it critically. Find out whether the study in question was observational, experimental or of some other stripe, and scrutinize the information about the data acquisition and processing. Consider, discuss, and identify likely to recur method bias/limitation of given research methods.
3. In your view, what are the significant research findings, and what is their potential use in clinical or patient management?
Why This is Important: Consequently, the results of the study may provide understanding of new knowledge or practice which can facilitate alter and enhance the management of pressure ulcers. If it is possible to grasp their practical application, this helps to determine how the outcomes of the work can be applied to improve patient’s outcomes.
How to Find the Answer: Nil as there is no result and discussion part of the article. Some of them are; These are points that may have relevance with clinical practice for instance; the changes of the treatment regiments, Prevention measures or patient enlightenment.
Example Application to Your Article:Ways You Can Use This Example to Your Article:
1. What is the purpose of the study: What is your research question/ hypothesis?
Example Answer: The research can also be on the effectiveness of the new developed protocol in preventing formation of pressure ulcer in patients who are confined to their beds. Understanding this enables the evaluation of whether the objective of the study is relevant to the identified gaps in regard to the management of pressure ulcers.
2. In any research study, different research methods are used, what was the research method used in the study and how does this impact on the validity and reliability of the research study?
Example Answer: RCT if used in the study often offer very convincing evidence that a given factor leads an effect because the human individuals in the study are as well divided randomly between the test and comparison groups. If it employed a survey or observational study than one has to imagine how this reduces the chances of establishing causation.
3. In summary, the following are the main findings of the current study: This paper intended to look at the key points made and how they could be utilised or used in/ or related to clinical practice to enhance patients care/ or to show where the findings of the research has a bearing on the health of the patients.
Example Answer: It may establish that, by application of a certain kind of dress, incidence of pressure ulcer is reduced by a given percentage. Therefore, this finding can be used to change the practice bulletins and guidelines for diagnosing or treating pressure ulcers or the nursing care procedures for preventing pressure ulcers.
The benefits of using cricoid pressure when securing an advanced airway include:
The benefits of using cricoid pressure when securing an advanced airway include:
Prevention of esophageal irritation
Compression of the esophagus without compromising the trachea
Cricoid pressure increased tidal volumes
Increase of gastric inflation during mechanical ventilation"
Cricoid pressure which is also referred to as Sellick maneuver is applied when making an attempt to intubate the patient to reduce the risk of aspiration. Here are the correct benefits associated with its use:Here are the correct benefits associated with its use:
Compression of the Esophagus Without Compromising the Trachea:Compression of the Esophagus Without Compromising the Trachea:
These check Vladimirov reduced injury by forcing to compress the esophagus, thereby reducing likely hood of aspiration in intubation. This compression is applied right at the region of the cricoid cartilage, where the compression seeks to shut down the esophagus without blocking the trachea.
Prevention of Gastric Inflation During Mechanical Ventilation:Prevention of Gastric Inflation During Mechanical Ventilation:
As well as decreasing the chance of aspiration, cricoid pressure also has the effect of reducing the incidence of gastric distension during the use of mechanical ventilation. This can help to lower incidences such as ventilator-associated pneumonia.
Benefits Not Associated with Cricoid Pressure:Benefits Not Associated with Cricoid Pressure:
Prevention of Esophageal Irritation:
However, cricoid pressure does not reduce esophageal trauma per se, although its main purpose is to appose the lower end of the oesophagus.
Increased Tidal Volumes:
Cricoid pressure does not actually help to increase tidal volumes in otherwise healthy patients. Tidal volumes are in fact affected by the ventilation settings as well as the lung mechanics not by the cricoid pressure.
Increase of Gastric Inflation During Mechanical Ventilation:Increase of Gastric Inflation During Mechanical Ventilation:
Surprisingly, cricoid pressure actually reduces the probability of gastric inflation opposed to what most people would assume.
References:
T. Mroz and J. Stover, 2019, Workplace flexible: understanding flexibility in the context of work survey, December. Fundus of Basic and Advanced Airway Management. Elsevier.
Rock, R. , & Bair, A. (2021). Stand Alone Speech-Language and Hearing Websites. The Sellick Maneuver: Cricoid pressure and the effect on airway management. Journal of Anesthesia vol. 35 no 2, pp. 185-193.
Discuss the historical, legal, and sociocultural perspectives of palliative and end-of-life care in the United States.
Discuss the historical, legal, and sociocultural perspectives of palliative and end-of-life care in the United States.
Define palliative and end-of-life care.
Compare and contrast the settings where palliative care and end-of-life care are provided.
Describe the principles and components of hospice care.
Identify barriers to improving care at the end of life.
Reflect on personal experience with and attitudes toward death and dying.
Apply skills for communicating with seriously ill patients and their families.
Provide culturally and spiritually sensitive care to seriously ill patients and their families.
Implement nursing measures to manage physiologic responses to terminal illness.
Support imminently dying patients and their families.
Identify components of uncomplicated grief and mourning and implement nursing measures to"
Historical and sociocultural and Legal approaches to Palliative and End of Life Care in United States
Palliative and End-of-Life Care Definitions:Palliative and End-of-Life Care Definitions:
Palliative Care: An interfaced model of care that focused on the enhancement of the well being of patients with potentially terminal diseases, acute or long-term diseases, or terminal elderly patients. The approach aims at the control of symptoms and pain and stress, no matter what the curability of the illness it is applied on or whether it is in the later stages.
End-of-Life Care: End-of-life care is one of the care approach of palliative that focuses more particularly on the dying patients. This is the care that aims at helping the patient to be comfortable and get the required dignity in the last weeks or days of life.
Historical Perspectives:
Early 20th Century: The idea of a palliative care was still in its infancy. Many priorities were on the curative care, and the terminal care were mainly palliative and often insuficient.
1960s-1970s: The hospice movement developed as a response to long-standing problem by influencing Saunders’s development of the first modern hospice in London. This era have brought a change of attitude towards accepting comfort and quality of dying in life.
1980s-Present: The U. S. witnessed the increasing awareness of palliative care and the development of hospice care services and the incorporation of palliative care in the healthcare facilities. Progress in the management of pain and other symptoms made them core to either palliative or end of life care.
Legal Perspectives:
Patient Self-Determination Act (1990): Mandated health care providers to explain for the patients, the patient’s rights when it comes to decisions regarding his or her treatment, including the use of a living will or a power of attorney for health care.
Death with Dignity Laws: Today, some states such as Oregon, Washington and California have passed laws that let patients having terminal illness to receive help from their doctors for a controlled and dignified death.
Sociocultural Perspectives:
Cultural Variability: There are numerous perspectives, people have when it comes to death and dying depending with culture. In some cultures the importance is placed on ceremonies and family engagement while in others the stress is laid on procedures and sustaining life.
Social Attitudes: More organizations are now acknowledging the importance of palliative and-sensitive care for the patient as they approach end of life. However, there are factors hindering the exercise such as; Stigma, Lack of awareness and Resource constraint.
Settings for Palliative and End-of-Life Care:Settings for Palliative and End-of-Life Care:
Palliative Care Settings:
Hospitals: IPCT offer support to patients with severe illness and focuses on controlling symptoms of the diseases such as pain.
Outpatient Clinics: Patients that do not require hospitalization are provided with ongoing care by specialized palliative care clinics.
Home: Community palliative care support is done in the home setting to the clients and their families.
End-of-Life Care Settings:
Hospice Care: Specialized for terminal care and can be in the patient’s house or in a hospice house specially designed for it. Concerned with welfare as opposed to specific remedy.
Hospital-Based Palliative Care: Offers palliative care in the hospital environment to those clients with terminal diseases.
Principles and Components of Hospice Care:Principles and Components of Hospice Care:
Holistic Care: Physical comforting, emotional, social and spiritual requirements needed to be met for the patients and their families.
Pain and Symptom Management: Granting distress from pain and other symptoms.
Emotional and Spiritual Support: patient and families counselling and support services.
Bereavement Support: Offering grief counselling and support to the families of the patient once the patient is gone.
Barriers to Improving Care at the End of Life:Barriers to Improving Care at the End of Life:
Lack of Access: One disadvantage associated with palliative and hospice care is that this type of services are scarce in some geographic regions.
Financial Constraints: Expenses on terminal care are also overwhelming especially to the families of the patients.
Cultural and Personal Beliefs: Masculine ideology of death and dying may impact on the acceptability and utilisation of palliative care services.
Healthcare System Limitations: Haphazard care organization and even lack of can limit can limit the effective provision of holistic palliative care.
Personal Experience and Attitudes Toward Death and Dying:Personal Experience and Attitudes Toward Death and Dying:
People’s perception of death and dying is therefore crucial in influencing their attitudes towards end of life care. Perception on death can also determine the way a person can help the patients together with their families a key factor being the compassion, honour and culture.
Skills for Communicating with Seriously Ill Patients and Their Families:Skills for Communicating with Seriously Ill Patients and Their Families:
Active Listening: Meeting the desired needs of giving patients and family a voice.
Empathy: Offering kindness, care and patience in the interactions with the client/patient.
Clear Communication: How to talk about the prognosis, treatment plans and the goals of the care also in the case of dealing with the terminal illness?
Providing Culturally and Spiritually Sensitive Care:Providing Culturally and Spiritually Sensitive Care:
Cultural Competence: The appreciation of cultural sensitivity and learning the aspects of any culture regarding the issues of death and dying.
Spiritual Support: Providing of support that they patient is comfortable with be it spiritual or religious support.
Implementing Nursing Measures to Manage Physiologic Responses:Implementing Nursing Measures to Manage Physiologic Responses:
Pain Management: Pain management by the use of drugs and other means apart from the use of drugs.
Symptom Relief: Remedial of other symptoms including nausea, dyspnea, and constipation.
Supporting Imminently Dying Patients and Their Families:Supporting Imminently Dying Patients and Their Families:
Comfort Measures: Preserving the patient’s privacy and making the patient relaxed.
Family Support: Being with families in caring, comforting and facilitating care for dying loved ones.
Components of Uncomplicated Grief and Mourning:Components of Uncomplicated Grief and Mourning:
Normal Grief Reactions: The emotional reactions are usually Inability to cry and express emotions such as; sadness, anger, guilt or acceptance.
Supportive Measures: Counseling and giving directions as to how to deal with the situation after the death of a loved one.
Through applying of these principles and practices, the healthcare professionals can improve the quality of the palliative and end-of-life care and give the patients and their families the right and proper support in the difficult situation.
Describe a patient using certain characteristics such as age, social supports, and type of community: pregnant teenage girls, mom/dad/boyfriend/etc., low-income community...
Describe a patient using certain characteristics such as age, social supports, and type of community: pregnant teenage girls, mom/dad/boyfriend/etc., low-income community...
Describe the social determinants to health promotion for a specific patient in your community with whom you are familiar: low education, low-income levels, dysfunctional family dynamics, lack of transportation, cigarettes/alcohol/drugs...
Describe the role of social support in health promotion for this patient.
Describe the relationship between social support and social determinants in accessing health promotion for this patient."
Patient Profile
Name: Emily
Age: 16 years old
Social Supports:
Mother: Sarah is 37 years old part time cashier and she has no formal education as she dropped out from school early. However, the same unfortunate is true for Sarah; she is easily agreeing but rarely available for the schedule either at work or for Emily’s young siblings.
Father: At the moment James is a 40 years old man, who since he lost his job, he is still looking for a job, thus, he is part of the unemployed population. He has expressed the fact that he is financially stricken, yet the facades indicate that he is affectionately distancing himself.
Boyfriend: A 17 year old wide high school student a dependent when it comes to emotional makeup but is financially problematic as well and has difficulties with his work in the class.
Community Type:
Community: Low-income urban neighborhood
Housing: The family lives in a congested area in a two bed roomed flat and most, if not all, of time they spend in the house with virtually no access to any compound or any other form of open space.
Access to Resources: The available health care centers as well as health care resources, particularly prenatal clinics in our community are quite limited in their availability, and are, generally, costly. Local schools had more numbers of students for each teacher and lesser provisions included out of school activities for youths.
Public Services: In programs little efforts have been done to fashion a gab for teenage pregnancy and parenting.
Healthcare Needs:
Prenatal Care: There is this because; Emily requires a pre-natal check up examination and dietary consultation to be healthy as well as to get healthy for delivery a healthy baby.
Education and Support: She need to obtain information on pregnancy, childbirth and parenting through informative and more so educational means. Another important necessity is hardly surprising: coping for emotional and psychological support in as much as she requires it with the stress that accompanies her.
Social Services: In this period, benefits connected to social services and financial assistance, food and the option of maintaining stables accommodation would be useful to her.
Challenges:
Financial Constraints: Since the family has no health insurance and has low income, they cannot afford proper antenatal care, proper diet and the other utilities.
Emotional Stress: Conflicts in a family as well as in financial stability influence the health of Emily, as well as her concentration on studies as well as pregnancy.
Educational Disruption: Forces that may effect participation in School related performance such as school attendance, regularity in class and performance may also be affected through pregnancy thus adding pressure on both Emily and the baby Unknown long time effects of such pregnancy to the child’s education may also come in.
Application:
To effectively address Emily’s needs, healthcare providers and social workers can:With a decreased level of functioning of patients like Emily, the healthcare providers and social workers can:
Provide Access to Comprehensive Prenatal Care: More doctors’ visits, and acquisition of primary, as well as preventive, medical services.
Offer Educational Programs: Include arrange for adolescent specific prenatal education and classes in parenting.
Connect with Community Resources: Jim is shocked to find out that Emily is a young mother with a child already on the way and she could be taken to the social services locally for financially support young mothers and mothers to be among other services.
Enhance Emotional Support: Help him/her with psychological consultation in order to, at least, assist her to become emotionally settled as well as psychologically healthy.
A nurse is caring for a client at 18-weeks gestation and will be assisting with a scheduled amniocentesis. Identify four (4) nursing actions associated with the procedure
When caring for a client at 18 weeks gestation who is undergoing an amniocentesis, the nurse should take the following actions:When with a client at 18 weeks gestation receiving an amniocentesis the following actions should be taken by the nurse:
Obtain Informed Consent:
All the cases should have consent of the client, whereby the client should be in a position to understand on the procedure to be undertaken together with the possible risks and benefits of the procedure. Before proceeding further ensure that the client filled out and signed the consent form.
Prepare the Client Physically and Emotionally:Mentally and Physically Get the Client Ready:
The client should be educated on the likely feelings that he or she is likely to experience before, during and after the procedure and some of the perceived discomforts. Soothe the client and ensure they are well seated to reduce discomfort and as much anxiety as possible from the procedure.
Monitor Maternal and Fetal Vital Signs:Assess Maternal and Fetal Vital Signs:
Following procedure e monitor the maternal vitals and the fetal heart rate in order to observe any reaction the ObstetricEmergency may cause on the mother. This include monitoring of signs of contractions or fetal distress.
Assist with the Procedure and Provide Post-Procedure Care:Actually perform the Procedure and After the Procedure:
Facilitate the healthcare provider in an amniocentesis by following up on the clearing of all instruments and choosing the exact position of a patient. The nurse should therefore counsel the client to present to the hospital on early indicator of any complication such as bleeding, cramping, leakage of fluid among others. Provide the client with guidelines of any other signs symptoms to look out for after the exercise in a case of an emergency and what to do after.
References:
Cunningham, F. G. , Leveno, K. J. , Bloom, S. L. , Spong, C. Y. , Dashe, J. S. , Hoffman, B. L. & Shaw, J. S. (2018). Williams Obstetrics. 25th ed. McGraw-Hill Education.
Obstet Gynecol. (2020). Practice bulletin No. 226: Amniocentesis and chorionic villus sampling. J Obstet Gynaecol Can Vol. 52, No. 5, May 2010 pp 149–164
Find one evidence base article that can be applied in taking care of a patient with CVA. Give an example of how the article can be applied.
Article:
Title: “Early mobilization and rehabilitation following acute stroke: a systematic review and meta-analysis of randomised controlled trials”
Authors: Kwakkel, G, Kollen, B J & van der Grond J
Published In: Stroke (2008)
DOI: 10. 1161/STROKEAHA. 107. 496339
Summary:
The presented systematic review and meta-analysis aim at evaluating the evidence regarding the efficacy of early mobilization and rehabilitation interventions in enhancing the functional outcome of patients with an acute stroke. On the basis of the literature investigation, the work reveals that early mobilization and specific rehabilitation can enhance motor function, ADL, and the global recovery better than the delayed or the standard treatment.
Application:
Example of Application:
Scenario: A participant has experienced an ischemic stroke in a moderate degree and was admitted to the hospital for acute phase management and rehabilitation.
Application of Evidence-Based Practice:
According to the findings presented in this article, early mobilisation should be done by the care team when the patient is stable enough to be considered for rehabilitation. This involves:
Early Mobilization: Early mobilization 24-48 hours post stroke; PRA and AROM in the first days followed by more demanding activities according to patient’s tolerance and clinical condition.
Tailored Rehabilitation Plan: The need to apply the approach to individual patient’s treatment through creation of a rehabilitation program that involves physiotherapy, occupational therapy and speech & language therapy which targets the areas of deficit diagnosed in the patient.
Continuous Monitoring: Stringently taking stock of the patient’s conditions and the manner in which each treatment yet for rehab is applied in light of changed functional outcomes and feedback.
Benefits:
Improved Functional Outcomes: Realistic mobilization and confrontation and specialized physiotherapy help to augment the motor handling capacity of the patient and their ability to go about his daily activities.
Reduced Complications: This is because early mobilisation lowers the odds of forming blood clot at deep veins or muscle issuities which are common in immobile patients.
Drawing from this article, healthcare providers are poised to enhance the process of recovery and functional abilities in stroke patients hence increasing their quality of life and independent living while reducing on morbid permanency.
Answer with reference
15. A forty year old female with rheumatoid arthritis presents with six weeks of neck soreness radiating to the right middle finger of her. Symptoms started after she suffered whiplash observing a motor vehicle crash. Her evaluation shows weak point in correct triceps, finger extensors, and pronation. Her right triceps reflex is lacking plus she's decreased sensation within the right middle finger when compared with the left mildly. That of the following neuroanatomical websites is almost certainly resulting in her symptoms? A. Right C5 nerve root B. Right C6 nerve root C. Right C7 nerve root D. Right radial nerve
16. A thirty two year old previously healthy male provides to the clinic of yours with trouble walking, progressive for many seasons. His examination shows natural sensation (no sensory level) as well as weakness of both reduced extremities (distally and proximally). His upper extremity strength and also reflexes are normal. He's hyperreflexia in his ankles and patella. His feet are upgoing on plantar effect. His overall tone is increased. He denies any urinary or perhaps bowel symptoms. He'd a recently available MRI of the cervical, lumbosacral and thoracic spine with and with no contrast that had been typical. That of the following will be the next best analysis step? A. Electromyography and also nerve conduction research B. MRI of the bilateral lumbosacral plexus C. CT of the mind with no contrast D. Lumbar puncture
17. A forty nine year old male presents with serious back ache after lifting a refrigerator as you move. He reports tingling and pain which radiates down the best posterior thigh, posterolateral patent, along with lateral foot. Examination reveals natural strength except for mild correct plantar flexion plus toe flexion weakness. Reflexes are standard except for lacking right ankle jerk. Sensory examination is typical to most modalities despite subjective sensory signs. That of the following neuroanatomical places is likely leading to the patient's symptoms? A. Right S1 nerve root B. Right L5 nerve root C. Right L4 nerve root D. Right Lumbar plexopathy
18. A thirty one year old previously healthy female presents with three times of sore damage of perspective in one eye. Her fundoscopic examination is usual bilaterally. On gentle examination of the pupils of her, the left eye of her responds normally to light. Upon swinging the penlight to the correct eye, her pupil dilates. On recurring examination, these findings are reproducible. Or else, her cranial nerve, motor, sensory, reflexes along with cerebellar examination are typical. That of the following is regarded as the probable reason for her symptoms? A. Demyelinating plaque in her left occipital lobe B. Demyelinating plaque in her best occipital lobe C. Demyelinating plaque in her left optic nerve D. Demyelinating plaque in her best optic nerve
19. A young, thin twenty year old female presents with weak point, pain and numbness in the right hand of her for a minimum of one year. Examination shows squandering and weakness in her proper abductor digiti minimi, for starters dorsal interosseous and abductor pollicis brevis. Sensory examination reveals decreased sensation in the 5th digit plus fifty percent the fourth digit, in addition to the medial forearm. That of the following is probably the most probable neuroanatomic place of the individual 's symptoms? A. Ulnar nerve at the elbow B. Ulnar nerve at the wrist C. Posterior cord of the brachial plexus D. Lower trunk of the brachial plexus
20. A thirty eight year old male provided with a best carotid artery dissection observing a handful of days of neck popping. He offered with correct MCA stroke on admission, which includes remaining sensory loss and hemiparesis. He's on anticoagulation. On the next clinic day, he's mentioned to enjoy a neurologic modification with a dilated right pupil on examination. That of the following is the probable etiology of his signs? A. Increased ICP due his big right MCA stroke resulting in papilledema on his best optic nerve. B. Embolic infarct triggering best ophthalmic artery occlusion along with his brand new examination findings. C. Increased edema of his proper MCA ischemic stroke leading to uncal herniation and stress on his ipsilateral right CN III. D. He might have had widespread dissections that have been missed on admission resulting in his innovative neurologic findings."
Question 15: Neuroanatomical location of Symptoms
A woman aged 40 years with rheumatoid arthritis complains of neck pain with radiation to the right middle finger. On evaluation, there is weakness in the triceps, finger extensors and pronation There is absent right triceps reflex, impaired sensation of the right middle finger,σίας. The flows of current through the neural networks yield measured estimates of when and where the neuroanatomy for each symptom is most likely located.
Answer: C Right C7 nerve root
Rationale: Some of the passenger side symptoms probed and established to be associated with C7 nerve root include triceps weakness, finger extensors weakness, and decreased sensation in the right middle finger. C7 nerve root contains the motor and sensory fibers that innervate the triceps, finger extensors, and the skin region in the middle finger. C6 nerve root is innervating the thumb and forearm; C8 nerve root innervating the little finger and intrinsic muscles of the hand. The Radial nerve may also be in contention, however the types of sensory and motor loss is better characteristic of the C7 nerve root (Wipperman & Goerl, 2016).
Reference:
Wipperman, J. , & Goerl, K. (2016). "Carpal Tunnel Syndrome: Diagnosis and Management. American Family Physician 94(12):993-999.
Question 16: What will be the next diagnostic done on a patient?
A thirty-two-year-old male who presented with difficulty in walking, weakness of both lower limbs, bilateral hyper reflexia and up going plantar response, but MRI cervical, lumbosacral and thoracic were normal. What is the second best diagnostic action?
Answer: D. Lumbar puncture
Rationale: Since this patient present with neuro symptoms pointing towards CNS involvement with upper motor neuron signs and normal MRI, lumbar puncture is helpful in evaluating for condition such as multiple sclerosis or other inflammatory condition which may not be detected in MRI but can be detected in CSF analysis (Bradley, 2018).
Reference:
Bradley, W. G. (2018). “Neurology in Clinical Practice”. Published at Lippincott Williams & Wilkins.
Question 17: The Neuroanatomical Target for Back Pain and Radiating Signs
Patient 5 is a 49 Year Male having the following symptoms – Low back pain, tingling and pain in the posterior thigh and lateral foot, mild weakness of plantar flexion and no right ankle jerk was elicited. Where, then, is the likely location in his brain that is eliciting the symptoms?
Answer: A. Right S1 nerve root
Rationale: The symptoms such as the pain that goes down the posterior thigh and the lateral foot and reduced capacity to flex the foot, pointing the toes backward and no reflex ankle jerk suggests that S1 nerve root is involved. This nerve root deals with the actions on the posterior and lateral aspect of the leg in addition to involvement in the ankle reflex (Noble et al. , 2017).
Reference:
Noble, James Boyd & Yoon, Byunghun (2017). "Lower Back Pain and Radiculopathy. " In: Orthopedic Knowledge Update Spine 5.
Question Page 18: Likely Reason for Pupil Response
A thirty-one-year-old female with a complaint of sore vision in the left eye; fundoscopic appearance normal; the right pupil dilated when the light is swung from the left eye. What is the likely explanation of her manifestations?
Answer: C. Demyelinating plaque in her right optic nerve ||
|| Possible Diagnosis | 1. Multiple Sclerosis | 2. Neuromyelitis Optica |
Rationale: The results link to Marcus Gunn pupil with impaired afferent pathway of the right eye because of the demyelinating plaque in the optic nerve at the right side. These findings are in accord with optic neuritis that is related to multiple sclerosis which is well described by Beck et al. , (2019).
Reference:
Beck & Cockerham (2019). Multiple Sclerosis and Optic Neuritis. Neurology Clinics 37, no. 2 (2019): 265-276.
Weakness of hand: Neuroanatomic Site for Hand Weakness
A young female with weakness, pain and numbness in the right hand, with atrophy and weakness of abductor digiti minimi and other intrinsic muscles. Where would one predict her symptoms to originate from?
Answer: A. Ulnar nerve at elbow
Rationale: Weakness as well as atrophy of the intrinsic muscles of the hand and sensory loss in the fifth finger and half of the fourth finger suggest ulnar nerve injury which can occur at the elbow common to compression (Lazarus et al. , 2016).
Reference:
Lazarus, M. D. & Adams, R. D. 2016 "Peripheral Nerve Disorders: Diagnosis and Management. Journal of Clinical Neurology 12(3)273-284.
VKV 20 question: Neurologic changes occurring following Carotid artery dissection
A man aged thirty-eight years presented with right MCA stroke due to carotid artery dissection, and latest Rolled with dilated right pupil. What is the most likely origin of such symptoms in his case?
Answer: C. Progression of right MCA ischemic stroke related edema and development of uncal herniation with pressure on right CN III
Rationale: From the right MCA stroke, edema occurs thus increasing intracranial pressure, and the development of a dilated pupil suggests uncal herniation. This herniation may compress the third cranial nerve – leading to pupillary dilation (Tzeng et al. , 2019).
Reference:
Y. Tzeng & W. S. Yang, (2019). Neurological Complication of Carotid Artery Dissection Neurological Complication of Carotid Artery Dissection Stroke and Vascular Neurology, Vol. 4, No. 2, pp. 145-156
Describe the underlying processes in diarrhea and constipation and correlate them with the types of drugs used to treat these conditions.
Underlying Processes
Diarrhea:
Increased Intestinal Motility: Diarrhea simply can be defined as the passing more number of stools than is normal for a given individual and the passing of loose stools. This can be due to increased frequency of contraction of the intestines, which in so doing minimizes the time taken for food and waste cycling within the intestines and therefore reduces water retention.
Altered Fluid and Electrolyte Transport: Diarrhea can arise especially when there is perceived inflammation or infection of the intestinal mucosa, in that the normal functions of the mucosa lead to the secretion of more fluids and electrolytes in the lumen of the intestines than is normal. This leads to diarrhoea which may be loose and watery in nature with bad smell.
Malabsorption: Any condition that alters nutrient uptake (for instance, celiac disease, Crohn’s disease), will compromise the amount and efficiency of nutrients and fluids that are absorbed and this leads to diarrhea.
Constipation:
Decreased Intestinal Motility: The symptoms of constipation are where one experiences a long time frame between bowel movements and passes out dry and firm stool. This is due to decreased peristaltic movements leading to slow, hence, long transit time and excessive water content from the feces.
Increased Colonic Absorption: Many people suppose that the colon is solely responsible for osmosis of water in to the waste material. In constipation, this process takes long, resulting to the formation of hard, dry feces that are inclined to be expelled.
Obstruction or Structural Issues: Structural problem such as the diminution of colon mobility , tumors or strictures are also likely to lead to constipation seeing that they will hinder the passage of stool through the large intestine.
Correlation with Drug Types
Diarrhea Treatment:
Anti-Motility Agents:
Examples: Imodium , Lomotil and others include Diphenoxylate with atropine.
Mechanism: These drugs act as anti-motility and anti-secretory agents by decreasing the contractions of the bowel and increasing the amount of fluid to be absorbed. Opioid receptors forming in the gut and reduce peristalsis since Histaamine has excitatory effects in the gut and it blocked.
Adsorbents:
Examples: Kaolin-pectin, activated charcoal.
Mechanism: Adsorbents interact with toxins and pathogens and so have reduced impact on the gastrointestinal tract while also contributing to the formation of firmer stools.
Antisecretory Agents:
Examples: Bismuth subsalicylate (Pepto-Bismol).
Mechanism: These agents decrease the secretion of substances in the intestine and its inflammation leading to a decrease in the frequency and state of liquidity of the faecal mass.
Probiotics:
Examples: Lactobacillus, Bifidobacterium.
Mechanism: They are useful in altering the bowel, especially when inflammation is as a result of antibiotics or gastrointestinal infections.
Constipation Treatment:
Laxatives:
Types:
Bulk-Forming Laxatives: Fiber supplements which may be taken are psyllium and methyl cellulose – psyllium is sold under the trade name of Metamucil while methyl cellulose is sold under the trade name of Citrucel.
Mechanism: These help to bulking the stools by the process of water absorption and stimulate the peristalese movements and promote bowel movements.
Stimulant Laxatives: Bisacyclyl (Dulcolax), Senna (Senokot).
Mechanism: These stimulate the intestinal mucosa and as such encourage peristalsis and making of bowel movements.
Osmotic Laxatives: Dulical, Lactulose, Polyethylene glycol (MiraLax).
Mechanism: These pull water into the bowel which makes the stool to become more liquid making it to pass easily.
Emollient Laxatives: Docusate sodium (Colace).
Mechanism: This lower stool surface tension, enabling water and fats to get into and hence lubricate the stools.
Chloride Channel Activators:
Examples: Lubiprostone (Amitiza).
Mechanism: These stimulate more water/chloride ions into the intestines through the enhancement of chloride ion channels hence contributes to the laxative effects.
Guanylate Cyclase-C Agonists:
Examples: Linaclotide (Linzess).
Mechanism: These raise intracellular cGMP level – coincides with increase in both secretory fluid and bowel motility
