peripheral neuropathy

Quick LinksQUESTION 11. A 67-year-old Caucasian dame was brought to the clinic by her son who established that his dowager had befit subordinately disorganized balance the departed different days. She had been stumbling at settlement and had fallen unintermittently but was efficient to ambulate delay some awkwardness. She had no other manifest problems and had been eating and drinking. The son became disturbed when she forgot her son’s call, so he infering he ameliorate carry her to the clinic.  PMH-Type II diabetes mellitus (DM) delay peripheral neuropathy x 20 years. COPD. Depression succeeding failure of spouse different months ago Social/race hx - non contributary disclaiming for 30 pack/year narrative tobacco use.  Meds: Metformin 500 mg po BID, ASA 81 mg po qam, escitalopram (Lexapro) 5 mg po q am afloat 2 months ago Labs-CBC WNL; Chem 7- Glucose-92 mg/dl, BUN 18 mg/dl, Creatinine 1.1 mg/dl, Na+120 mmol/L, K+4.2 mmol/L, CO237 m mol/L, Cl-97 mmol/L.  The APRN refers the enduring to the ED and named endocrinology for a consider for individuality and conduct of syndrome of impertinent antidiuretic hormone (SIADH). 
Question:Define SIADH and confirm any enduring characteristics that may own tendd to the outfruit of SIADH.

  QUESTION 21. A 43-year-old feminine gives to the clinic delay a main repining of ardor, chills, sea-sickness and vomiting and feebleness. She has been unefficient to conduct any maintenance, liquids or medications down. The symptoms began 3 days ago and own not responded to ibuprofen, acetaminophen, or Nyquil when she seasoned to grasp them. The sky has reached as proud as 102˚F.  
 Allergies: none notorious to garbages or maintenance or environmental  
 Medications-20 mg prednisone po qd, omeprazole 10 po qam 
 PMH-indicative for 20-year narrative of steroid contingent rheumatoid arthritis (RA). GERD. No other indicative illnesses or surgeries. 
Social-denies alcohol, unfair garbages, vaping, tobacco use 
Physical exam 
Thin, ill appearing dame who is sitting in exam margin chair as she said she was too foolish to senthusiastic on the exam consideration. VS Temp 101.2˚F, BP 98/64, pulse 110, Resp 16, PaO2 96% on margin air.  
ROS disclaiming other than GI symptoms. 
Based on the enduring’s clinical offer, the APRN diagnoses the enduring as having resultant hypocortisolism due to the bankruptcy of prednisone the enduring was entrance for her RA resultant to vomiting.
Question:
Explain why the enduring exhibited these symptoms? 

QUESTION 31. A 64-year-old Caucasian feminine gives to the clinic delay popular symptoms of non- restricted abdominal self-denial, myalgias, constipation, polyuria, and says she handles “fuzzy acmeed” abundantly of the span. She had environing of genus stones a few weeks ago and she fortunately was efficient to ignoring the fine stones delayout requiring lithotripsy or other interventions. She was told by the urologist to prosper up delay her main prevention provider succeeding the genus stones has resolute.  The APRN examining the enduring sign a Chem 7 which inspired a serum Ca++ of 13.1 mg/dl. The APN believes the enduring has main hyperparathyroidism and refers the enduring to an endocrinologist who does a entire composition up and concurs delay the APRN’s individuality. Question:What is the role of parathyroid hormone in the outfruit of main hyperparathyroidism? 

  QUESTION 41. A 64-year-old Caucasian feminine gives to the clinic delay popular symptoms of non- restricted abdominal self-denial, myalgias, constipation, polyuria, and says she handles “fuzzy acmeed” abundantly of the span. She had a fender of her correct metatarsal delayout trauma and currently is wearing a walking boot. She too had a bout of genus stones a few weeks ago and she fortunately was efficient to ignoring the fine stones delayout requiring lithotripsy or other interventions. She was told by the urologist to prosper up delay her main prevention provider succeeding the genus stones has resolute.  
The APRN examining the enduring sign a Chem 12 which inspired a serum Ca++ of 13.1 mg/dl. The APRN believes the enduring has main hyperparathyroidism and refers the enduring to an endocrinologist who does a entire composition up and concurs delay the APRN’s individuality. 
Question 1 of 2:
Explain the processes compromised in the construction of renal stones in endurings delay hyperparathyroidism. 
   QUESTION 51. A 64-year-old Caucasian feminine gives to the clinic delay popular symptoms of non- restricted abdominal self-denial, myalgias, constipation, polyuria, and says she handles “fuzzy acmeed” abundantly of the span. She had a fender of her correct metatarsal delayout trauma and currently is wearing a walking boot. She too had a bout of genus stones a few weeks ago and she fortunately was efficient to ignoring the fine stones delayout requiring lithotripsy or other interventions. She was told by the urologist to prosper up delay her main prevention provider succeeding the genus stones has resolute.  The APRN examining the enduring sign a Chem 12 which inspired a serum Ca++ of 13.1 mg/dl. The APRN believes the enduring has main hyperparathyroidism and refers the enduring to an endocrinologist who does a entire composition up and concurs delay the APRN’s individuality. Question 2 of 2:Explain how a enduring delay hyperparathyroidism is at reason for nuisance fenders.  
   QUESTION 61. A 64-year-old Caucasian feminine who is 4 weeks foundation post aggregate parathyroidectomy delay forearm gland elongation gives to the open surgeon for her post-operative checkup. She says that her hole handles repress and she handles “tingly all balance. The surgeon suspects the enduring has hypoparathyroidism resultant to the parathyroidectomy delay delayed vascularization of the implanted gland. She sign a Chem 20 to say what electrolyte abnormalities may be give. The labs make-notorious a serum Ca++ of 7.1 mg/dl (typical 8.5 mg/dl-10.5 mg/dl) and phosphorous smooth of 5.6 mg/dl (typical 2.4-4.1 mg/dl).  
Question:
What heavinessy consequences of hypoparathyroidism happen and why? 
QUESTION 71. A 17-year-old boy is brought to the pediatrician’s advantage by his parents who are disturbed environing their son’s heaviness waste resisting eating spent, continual urination, unquenchefficient aridity, and jade that is obtrusive delay his discipline/composition activities. He had been lookingly salubrious until environing 3 months ago when his parents afloat noticing these symptoms but put these symptoms down to his occupied list including a keep-akeep-abisect span job. He admits to latent spent and tires very largely. He denies any other symptoms.  
PMH-noncontributory. No surgeries or important medical problems. Wonted indifferents and ear communicated as a child  
Allergies-none know  
Family narrative- affectionate uncle delay “some husk of sugar diabetes problem” but parents unclear on the just murmur process 
Social-denies alcohol, tobacco or unfair garbage use. Not sexually locomotive. Junior at national proud discipline and compositions in a steadsteadsteadfixed maintenance stock succeeding discipline and on weekends. 
Labs in advantage: chance glucose 220 mg/dl.  
Based on his symptoms and the glucose smooth, the pediatrician makes a speculative individuality of Diabetes Mellitus image 1 and refers the boy and his parents to an endocrinologist for prefer composition up and conduct pur-pose.  
Question 1 of 6:
The enduring exhibited fashionable signs of Image 1 diabetes. Explain the pathophysiology of “polydipsia.”
   QUESTION 81. A 17-year-old boy is brought to the pediatrician’s advantage by his parents who are disturbed environing their son’s heaviness waste resisting eating spent, continual urination, unquenchefficient aridity, and jade that is obtrusive delay his discipline/composition activities. He had been lookingly salubrious until environing 3 months ago when his parents afloat noticing these symptoms but put these symptoms down to his occupied list including a keep-akeep-abisect span job. He admits to latent spent and tires very largely. He denies any other symptoms.  
PMH-noncontributory. No surgeries or important medical problems. Wonted indifferents and ear communicated as a child  
Allergies-none know  
Family narrative- affectionate uncle delay “some husk of sugar diabetes problem” but parents unclear on the just murmur process 
Social-denies alcohol, tobacco or unfair garbage use. Not sexually locomotive. Junior at national proud discipline and compositions in a steadsteadsteadfixed maintenance stock succeeding discipline and on weekends. 
Labs in advantage: chance glucose 220 mg/dl.  
Based on his symptoms and the glucose smooth, the pediatrician makes a speculative individuality of Diabetes Mellitus image 1 and refers the boy and his parents to an endocrinologist for prefer composition up and conduct pur-pose.  Question 2 of 6:
The enduring exhibited fashionable signs of Image 1 diabetes. Explain the pathophysiology of “polyuria.”
 QUESTION 91. A 17-year-old boy is brought to the pediatrician’s advantage by his parents who are disturbed environing their son’s heaviness waste resisting eating spent, continual urination, unquenchefficient aridity, and jade that is obtrusive delay his discipline/composition activities. He had been lookingly salubrious until environing 3 months ago when his parents afloat noticing these symptoms but put these symptoms down to his occupied list including a keep-akeep-abisect span job. He admits to latent spent and tires very largely. He denies any other symptoms.  PMH-noncontributory. No surgeries or important medical problems. Wonted indifferents and ear communicated as a child  Allergies-none know  Family narrative- affectionate uncle delay “some husk of sugar diabetes problem” but parents unclear on the just murmur process Social-denies alcohol, tobacco or unfair garbage use. Not sexually locomotive. Junior at national proud discipline and compositions in a steadsteadsteadfixed maintenance stock succeeding discipline and on weekends. Labs in advantage: chance glucose 220 mg/dl.  Based on his symptoms and the glucose smooth, the pediatrician makes a speculative individuality of Diabetes Mellitus image 1 and refers the boy and his parents to an endocrinologist for prefer composition up and conduct pur-pose.  Question 3 of 6:The enduring exhibited fashionable signs of Image 1 diabetes. Explain the pathophysiology of “polyphagia.”

QUESTION 101. A 17-year-old boy is brought to the pediatrician’s advantage by his parents who are disturbed environing their son’s heaviness waste resisting eating spent, continual urination, unquenchefficient aridity, and jade that is obtrusive delay his discipline/composition activities. He had been lookingly salubrious until environing 3 months ago when his parents afloat noticing these symptoms but put these symptoms down to his occupied list including a keep-akeep-abisect span job. He admits to latent spent and tires very largely. He denies any other symptoms.  
PMH-noncontributory. No surgeries or important medical problems. Wonted indifferents and ear communicated as a child  
Allergies-none know  
Family narrative- affectionate uncle delay “some husk of sugar diabetes problem” but parents unclear on the just murmur process 
Social-denies alcohol, tobacco or unfair garbage use. Not sexually locomotive. Junior at national proud discipline and compositions in a steadsteadsteadfixed maintenance stock succeeding discipline and on weekends. 
Labs in advantage: chance glucose 220 mg/dl.  
Based on his symptoms and the glucose smooth, the pediatrician makes a speculative individuality of Diabetes Mellitus image 1 and refers the boy and his parents to an endocrinologist for prefer composition up and conduct pur-pose.  Question 4 of 6:The enduring exhibited fashionable signs of Image 1 diabetes. Explain the pathophysiology of “heaviness waste.”

0.5 points   QUESTION 111. A 17-year-old boy is brought to the pediatrician’s advantage by his parents who are disturbed environing their son’s heaviness waste resisting eating spent, continual urination, unquenchefficient aridity, and jade that is obtrusive delay his discipline/composition activities. He had been lookingly salubrious until environing 3 months ago when his parents afloat noticing these symptoms but put these symptoms down to his occupied list including a keep-akeep-abisect span job. He admits to latent spent and tires very largely. He denies any other symptoms.  PMH-noncontributory. No surgeries or important medical problems. Wonted indifferents and ear communicated as a child  Allergies-none know  Family narrative- affectionate uncle delay “some husk of sugar diabetes problem” but parents unclear on the just murmur process Social-denies alcohol, tobacco or unfair garbage use. Not sexually locomotive. Junior at national proud discipline and compositions in a steadsteadsteadfixed maintenance stock succeeding discipline and on weekends. Labs in advantage: chance glucose 220 mg/dl.  Based on his symptoms and the glucose smooth, the pediatrician makes a speculative individuality of Diabetes Mellitus image 1 and refers the boy and his parents to an endocrinologist for prefer composition up and conduct pur-pose.  Question 5 of 6:The enduring exhibited fashionable signs of Image 1 diabetes. Explain the pathophysiology of “fatigue.” QUESTION 121. A 17-year-old boy is brought to the pediatrician’s advantage by his parents who are disturbed environing their son’s heaviness waste resisting eating spent, continual urination, unquenchefficient aridity, and jade that is obtrusive delay his discipline/composition activities. He had been lookingly salubrious until environing 3 months ago when his parents afloat noticing these symptoms but put these symptoms down to his occupied list including a keep-akeep-abisect span job. He admits to latent spent and tires very largely. He denies any other symptoms.  PMH-noncontributory. No surgeries or important medical problems. Wonted indifferents and ear communicated as a child  Allergies-none know  Family narrative- affectionate uncle delay “some husk of sugar diabetes problem” but parents unclear on the just murmur process Social-denies alcohol, tobacco or unfair garbage use. Not sexually locomotive. Junior at national proud discipline and compositions in a steadsteadsteadfixed maintenance stock succeeding discipline and on weekends. Labs in advantage: chance glucose 220 mg/dl.  Based on his symptoms and the glucose smooth, the pediatrician makes a speculative individuality of Diabetes Mellitus image 1 and refers the boy and his parents to an endocrinologist for prefer composition up and conduct pur-pose.  Question 6 of 6:How do genetics and environimmaterial factors tend to the outfruit of Image 1 diabetes?
1 points   QUESTION 131. A 17-year-old boy recently diagnosed delay Image I diabetes is brought to the pediatrician’s advantage by his parents delay a main repining of “having the flu”. His symptoms began 2 days ago, and he has vomited different spans and has not eaten very abundantly. He can’t bear-in-mind if he took his prescribed insulin for different days accordingly he felt so disgusted. Chance glucose in the advantage make-knowns glucose 560 mg/dl and the pediatrician made arrangements for the enduring to be admitted to the hospitalist advantage delay an endocrinology consider.  
BP 124/80mmHg; HR 122bpm; Respirations 32 breaths/min; Temp 97.2˚F; PaO297% on RA 
Admission labs: Hgb 14.6 g/dl; Hct 58% 
CMP- Na+ 122mmol/L; K+ 5.3mmol/L; Glucose 560mg/dl; BUN 52mg/dl; Creatinine 4.9mg/dl;  
Cl- 95mmol/L; Ca++ 8.8mmol/L; AST (SGOT) 248U/L; ALT 198U/L; CK 34/35 IU/L; Cholesterol 198mg/dl;  
Phosphorus 6.8mg/dl; Acetone Moderate; LDH38U/L; Alkaline Phosphatase 132U/L. 
Arterial class gas values were as prospers: pH 7.09; Paco220mm Hg; Po2100mm Hg; Sao2 98% (margin air) 
HCO3-7.5mmol/L; anion gap 19.4 
A individuality of diabetic ketoacidosis was made, and the enduring was transmitted to the Intensive Prevention Unit (ICU) for cork monitoring.  
Question:
The hormones compromised in intermediary metabolism, esoteric of insulin, that can keep-ajoin-in in the outfruit of diabetic ketoacidosis (DKA) are epinephrine, glucagon, cortisol, fruit hormone. Describe how they keep-ajoin-in in the outfruit of DKA. 
   QUESTION 141. A 67-year-old African American hardy gives to the clinic delay a main repining that he has to “go to the bathmargin all the span and I handle truly foolish.” He says that this has been going on for environing 3 days but couldn’t after to the clinic precedent as he went to the Wound Prevention clinic for a dressing veer to his correct protracted toe that has been chronically rotten, and he now has osteomyelitis. Enduring delay notorious Image II diabetes delay indigent repress. His terminal HgA1C was 10.2 %. He says he can’t give the insulin he was prescribed and barely grasps half of the vocal proxy he was prescribed. Chance glucose in the advantage inspired glucose of 890 mg/dl. He was straightway referred to the ED by the APRN for evaluation of reported hyperosmolar hyperglycemic non ketotic syndrome (HHNKS). Too named hyperglycemic hyperosmolar say (HHS).  
Question:
Explain the underlying processes that direct to HHNKS or HHS.

QUESTION 151. A 32-year-old dame giveed to the clinic fastidious of heaviness create, swelling in her legs and ankles and a puffy aspect. She too recently patent clear hypertension and diabetes image 2. She famous indigent short-term retrospect, excitability, increase hair fruit (women), red-ruddy aspect, extra fat encircling her neck, jade, indigent strain, and menstrual barion in adduction to muscle feebleness. Consecrated her natural exhibition and narrative, a speculative individuality of hypercortical character was made. Diagnostics middle serum and urinary cortisol and serum adrenocorticotropic hormone (ACTH). MRI inspired a pituitary adenoma.  
Question:
How would you mass Cushing’s murmur from Cushing’s syndrome? 

QUESTION 161. A 47-year-old feminine is referred to the endocrinologist for evaluation of her chronically rising class urgency, hypokalemia, and hypervolemia. The enduring’s hypertension has been mutinous to the wonted medications such as beta blockers, diuretics, and angiotensin-converting enzyme (ACE) inhibitors. Succeeding a liberal composition up including serum and urinary electrolyte smooths, aldosterone concealment ordeal, plasma aldosterone to renin ratio, and MRI which inspired an autonomous adenoma, the endocrinologist diagnoses the enduring delay main hyper-aldosteronism.  
Question:
What is the pathogenesis of main hyper-aldosteronism? 

QUESTION 171. A 47-year-old African American hardy gives to the clinic delay main repinings of polyuria, polydipsia, polyphagia, and heaviness waste. He too said that his vison rarely blurs and that his feet rarely handle repress.  He has increased crave resisting heaviness waste and admits to handleing unusually jaded. He too complains of “swelling” and expansion of his abdomen.  
Past Medical Narrative (PMH) indicative for HTN fairly courteous-mannered-mannered repressled delay and ACE inhibitor; convenient corpulency, and dyslipidemia treated delay a statin, Review of systems disclaiming disclaiming for main repining. Natural exam unremarkefficient disclaiming for decreased filament ordeal twain feet. Chance glucose in advantage 290 mg/dl. The APRN diagnoses the enduring delay image II DM and prescribes vocal medication to repress the glucose smooth and too referred the enduring to a dietician for dietary instruction. 
Question:
What is the basic underlying pathophysiology of Image II DM? 

   QUESTION 181. A 21-year-old hardy was compromised in a motorcycle property and sustained a corkd acme impairment. He is dawning up and interacting delay his race and medical team. He complained of aridity that doesn’t look to go detached no stuff how abundantly introduce he drinks. The nurses hush that he has had 3500 cc of pale-yellow urine in the terminal 24 hours. Urine was sent for osmolality which was reported as 122 mOsm/L. A individuality of probefficient neurogenic diabetes insipidus was made.  
Question:
What reasons diabetes insipidus (DI)?   QUESTION 191. A 43-year-old feminine enduring gives to the clinic delay repinings of sensibility, racing heartbeat, misgiving, increased exudation, ardor superstition, hyperactivity and palpitations. She says she had had the symptoms for different months but attributed the symptoms to source to prevention for her patriarchal dowager who has Alzheimer’s Disease. She has spent 15 pounds in the terminal 3 months delayout dieting. Her departed medical narrative is indicative for rheumatoid arthritis that she has had for the terminal 10 years courteous-mannered-mannered repressled delay methotrexate and prednisone. Natural exam is remarkefficient for periorbital edema, enthusiastic silky handleing bark, and palpefficient thyroid nodules in twain lobes of the thyroid. Pending laboratory diagnostics, the APRN diagnoses the enduring as having hyperthyroidism, too named Graves’ Disease.
Question:
Explain how the disclaiming feedback loop represss thyroid smooths.
   QUESTION 201. A 43-year-old feminine enduring delay notorious Graves’ Murmur gives to the clinic delay repinings of sensibility, racing heartbeat, misgiving, increased exudation, ardor superstition, hyperactivity and stern palpitations. She says she had been consecrated a usage for propylthiouracil, an antithyroid medication but she did not rise the usage as she claims she spent it. She had been consecrated the discretion of thyroidectomy which she faded. She too hushs that she is having inconvenience delay her confidence and frequently has blurry eyes. She says that her eyes look “to bug out of her aspect”. She has had reiterated outs of sea-sickness and vomiting. She was recently hospitalized for pneumonia.  Natural exam is indicative for manifest exophthalmos and pretibial myxedema. Vital signs are temp 101.2˚F, HR 138 and riotous, BP 160/60 mmHg. Respirations 24. Electrocardiogram inspired atrial fibrillation delay speedy ventricular vindication. The APRN recognizes the enduring is experiencing symptoms of thyrotoxic opportunity, too named thyroid insult. The enduring was straightway enraptured to a hospital for important prevention conduct. 
Question:
How did the enduring unravel thyroid insult? What were the enduring factors that direct to the outfruit of thyroid insult? 
   QUESTION 211. A 44-year-old dame gives to the clinic delay repinings of final jade, heaviness create, decreased propension, indifferent superstition, dry bark, hair waste, and sleepiness. She too admits that she frequently bursts into whimper delayout any infer and has been disclaimingionally forgetful. Her confidence is rarely blurry, and she admits to being undistinguished delayout any collective or occupational triggers. Departed medical narrative noncontributory. Physicalexam Temp 96.2˚F, pulse 62 and ordinary, BP 108/90, respirations. Dull facial countenance delay common facial features. Periorbital puffiness famous. Based on the clinical narrative and natural exam, and pending laboratory postulates, the ARNP diagnoses the enduring delay hypothyroidism.  
Question:
What reasons hypothyroidism? 
0.5 points   QUESTION 221. A 44-year-old dame is brought to the clinic by her mate who says his spouse has had some immaterial foundation veers balance the departed few days. The enduring had been previously diagnosed delay hypothyroidism and had been placed on thyroid renovation therapy but had been spent to prosper-up due to tender to another city for the mate’s composition approximately 4 months ago. The enduring says she spent the usage bottle during the agitate and didn’t twainer to own the usage riseed gone she was handleing ameliorate. Natural exam inspired non-pitting, boggy edema encircling her eyes, hands and feet as courteous-mannered-mannered as the supraclavicular area. The APRN recognizes this enduring had stern myxedema and referred the enduring to the hospital for medical conduct.  
Question:
What reasons myxedema coma? 

QUESTION 231. A 53-year-old dame gives to the main prevention clinic delay repinings of stern acmeaches, palpitations, proudclass urgency and diaphoresis. She relates that these symptoms after in clusters and when she has these “spells”, she too experiences, excitement, sea-sickness, feebleness, misgiving, and a significance of censure and alarm, epigastric self-denial, and flank self-denial. She had one of these spells when she was at the pharmacy and the pharmacist took her class urgency which was narrative as 200/118. The pharmacist recommended that she straightway be evaluated for these symptoms. Departed medical narrative indicative for a race narrative of neurofibromatosis image 1 (NF1). Based on the giveing symptoms and race narrative of NF1, the APRN suspects the enduring has a pheochromocytoma. Laboratory postulates and computerized tomography of the abdomen confirms the individuality. Question 1 of 2:
What is a pheochromocytoma and how does it reason the fashionable symptoms?
QUESTION 241. A 53-year-old dame gives to the main prevention clinic delay repinings of stern acmeaches, palpitations, proudclass urgency and diaphoresis. She relates that these symptoms after in clusters and when she has these “spells”, she too experiences, excitement, sea-sickness, feebleness, misgiving, and a significance of censure and alarm, epigastric self-denial, and flank self-denial. She had one of these spells when she was at the pharmacy and the pharmacist took her class urgency which was narrative as 200/118. The pharmacist recommended that she straightway be evaluated for these symptoms. Departed medical narrative indicative for a race narrative of neurofibromatosis image 1 (NF1). Based on the giveing symptoms and race narrative of NF1, the APRN suspects the enduring has a pheochromocytoma. Laboratory postulates and computerized tomography of the abdomen confirms the individuality. Question 2 of 2:What are the tenor goals for managing pheochromocytoma? 

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