gs 83 Ons al 1 22-year-old nulbgavd woman comes wo te physica or evaluation of equa perc. Mnatne was athe ae menstrual prod was 6 months ago. Se as clabeesmelius ype 2 and depesion. She ot senualy ace She diks temperatures 37¢ (9867) pulse 1 62 mn esate are 15min an loos pressure 11875 mm Ha MS 21 nyc exam Shows Seete Suc ane on he ace and Dah That are tk Vee Ihe putes onthe 2m and neck ae exami ic oxmal urn regnaey ts egat. whieh ofthe Flloung would lp Geum he case of his pacen’s mens! Wreguarves? 4a (GH) messrement ot oe-sumatg nomane Progesterone wiharawal est © teroscony (B) Messurerent of hoi semelting Hormone (F) Adminstration o xrogen BOa a gs 83 hone ©) Omns al ‘22-year-old nullgrad woman cores oe psc fr evan of regu periods. Menace was te agect —( y Be eee Peel ee ace eo ‘shea thd depression, Ses ot sesaly active, he ks temperature 37°C 9867 pulse 2i mn respatiens are 15min and ood pressure 11875 rm Ha Pry exam Shows oe Tae an ack Thee ae te examination normal Arne regnaey tit aegatve, Whe fhe flog weal Help Geri he case his patents mens! Wregularves? ‘This patent’ est acne, obesity, ype 2 abt meus, and vebet-e patches point othe cause of her Secondary Stn 2a 1 aves wt amenores, high FSH eels confi the dagross of primar vain isufcncy, whereas low FH eves indeatehypthalamschypoganaim (eg, excessive execn, system ine). However there ha enaence of ovtan Insufiene fe not ashes, vapiral eres, ep esturbances, mood swings) or hypetalamicdstuncion nhs Baten, ‘aking SH an uly cause Mer amen hea “Thi panent alas poheyste oar ymdrame PCOS, ar eideneed by hypeandrogetam ye ane), ri ili Insesiviy (ype 2 aets metus, vet skin dings, bes atl wth PCOS equety have anwar ces ‘endometalshesang, whe lags to menor. ExogenOs fl progesterone should be ane fr 5-10 day 5 par ofthe progesterone chalenge est endometal eesing occurs wth rogestzarecassaion, aovuaton Cae coimed as the ology of snore g [Bh he mens yee and momsOM Ss ap Meigs 1 + amis ‘ropesterane challenge est endometrial leading oeus with progesterone cessation, anovlation Can be confined 35 Me ‘holgy of amenorrhea. Bo “nrauarins ahesons which an be chgnosed via yserscopy cn dra normal endometia growth and esl Dees eater beer cacao pe ‘ahesons. Further, Iau adhesions would not expan er hyperendtogenism er sul sens. ‘Abnormal yrold uncon can cause menstrual le abnomales. Hwee is pabEM has soothe! ence ot Iypatitdem eg, cold naeranc, fatigue, conetpston) or hyperthyrasim (o, avigh xe, tachyear ara) 22 Suggest hyo disease 5 the case of her amano. Her story of Stace, obesity tye 2 betes els red ‘eve poli levels ca caus meornen (veo FSH ard LM ton. However, hs paint snot on ay drugs mst ‘yplally ease polactiora (a antipyehote) and hee fene cides ofa preacinors eg, Resdeches al els ete Her soy of hypetandogensm and insula nserstvy suggest fret cause of amanorhea “Thi patent ety already has excess ulting estroge eels et her undering contin (PCOS. ministration of ‘esronen, would not be of any apres vale45-year-old man is rough a the emergency depamert ater car acient wih pan in te mde oF NS Chest aR some shrines of treath Maat sustanad wn fis ight arm and leg. ne i not se conscousnots. Hs Cemperaie 6 37 8.67, pulses 110/min, espirations ae 18 min and bod pressures 30/60 mm My. Hes alt fn erent operon lice andine. amas sons several ures tthe upper enters and chest There are {gular venous pulsations 10cm above te stoma angle Hea sounds are fant on carlac examination The Ions are ‘dear to auscutaton a ECGs shown. Which fhe long isthe mest appropriate mex sep management?Seeder ey 7 1 ave ve vs et Cee Hob ead et ve pl Li EE BY) ae ake) JALAL All es Poot patton a, sialic aer Fe ee ae tf : ca 2 * = 1 a i a con peeeueee secu ue i ny 1 | AL Atha do haledod Pais ie cee = a" ” “ ee oe i i J pL Be edOmas a <2-/0> /.45-yeur-ol man boughs the emergency eparnet ar aca ace winpin nme mide of necescans (ES Sc ee ear eae pen ee oo lg ad eH (ao {emperae's 37C (98.67, puEIE MOM, respirations ae 18min ana tnd erieted operon place and tine xamiaution shows several nr isis et on care examination. The unas ar (leaf ausclttor a ECGs shows. Which of Be ooug she mes eppoplae Mex Sep I Managemen? “Th patent peti ater car acne wath chet pan horas of rath, hypotension, mud Mer sounde a stended neck vs. Adonai his ECC shows ec atemans. These fetes ae consistent wih prc Can 2a ‘Coeds exophagrar wh gastrin adtnctered toni avopfaeal ptr, wch spor ier an trace ‘weuma Ths pain has pan and dyspnea, 2s would be expected, bu hs lagoss Goes a explan hs ECG abnoxmales, ‘an eta of the es pall cul show a erlarged cardiac oust, Which Would por ome presence ofan “ransesophagelechocariography CED Is sed 0 detect ac sscton in unstable pats. Tis patent’ chest pin andOmn sl <2 10> “ranesophagsalechocariosaphy (ED sued tet are deection i stable patnt. This pata’ chet pla a motor vehi acient shoul ase concen for cot section, bu the muti hea Sounds, CG changes, ajar pavers we nave Bean involved na car acer, CT othe bral can be used to evaluate ead and bran Wau, thor spt hd wor tte conscousecs ade lr ane creed raking 4 CX of hea mrcear a te te “This test woud also nx provide ny insight his pans ECGabrormalis, mulled hea sounds, of distended neck ‘Contast-enhanced CT angograpy I Sed to dagose aor ssectonn a stable pate. This patents chest pam and ‘moto vehicle accident should fase coca or aot asec, but he ue eat sounds, EG Change, an jugular Energeney neal thrarotomy sed to west tension preumthoras. Thies an marian haghoss tale at “onsgering the patent Cum trauma, sores of beat, and chest pan However, psa exam weule be expected Show deceased breath Sounds in the afeced hg and Would nat Show lec aera. “vranthoran echocadoorahy i suck mexpent, side affects, a ell meth for eteting pacar! effaton, rel show an anecoic pace between the prcrdlum and epctcum, disingfid accumulation. In ase he th & FAST examin te ta bey i ly pong ta reveal lao the ehocrdogram is woe deter te sie of tan the best approach for caring te fusion. Fach fdr el ericage 8 Ons al <3 +> 46-year-old woman comes 1 the emergency ceparenantvecause of a lsting ash on Me ands, freums, an ace for mois The lesion re htc. she a seo noted that hr uri has bee dak brow calor ery. Ten ats ag, she was successfull etd or Cots seat ofthe retina via tinal sclerotherapy, She crerly on ormanalrpacersnt therapy for pemencpaurl symptoms, Her aunt and sater have a htory ofa iu sin lens Examination stows mutiplefuc-iledbisters and aczng erosions ane ferears, dorsal side f both has, an Forehead, Thee is hyperplgmented scaring and patches of ald shin along De sides he ste Lavoro Investigators show normal serum feta conenaton- Wich of the flloming I tha meet appropiate atl po naragenen? 2a (@) pee ver waretamazon ©) ain oe sao tharany (© step hormonal epacement serpy BO (©) ai Phebe therapy (©) Ben ora ronychoroqine therapy (7) ines sun-potectve measures (© tesin subcutaneous deferoxamine herapy +Omns al <2+> /.48-yuro woman comes oh rgeny depart caus ofa ing ah on hs Md, ck for 3 wasks. The lesions are not itchy. She has also noticed that har | Twenty a 2: sa sew suceavoy wend fr een iromnerapy se cen on ae esate “eels yperpgmend searing apt of bad sn along he de fe Dt Laortony Carers chow roa coum farm oncaneton Wc fh tse eect apron a manager? ‘This woman ha 2 photosensitvethstering (ash associated wth oni kn chenges and brown dsooraton ofthe Qe effec peal arch ies es oT 2a « Uverrasplaaton could aes he wlogy of porhya cranes ttc, te nsuficency of hepatic enzyme ‘wroporshyrnageI dearboxyie, However, er tanopanatin nth abe would be naproprae ecase f vali of eee ron-nvsn heaps that are Mah eect “Though meres ented edenc hat talomide may reduce producuon of porpytes, thal dome therapy ot a timay (eae es ga tes nce thn rare price er cet: Exogenous stopen ares a suscepti ator fr porhyia cates tac, aits avoidance may help minima are recurrence of symptoms. Honeer, eno efecve for ndvaa remision, Other suscep factors nude ake Smoking, an aces etry Ko,Om Ds at 02 o> Phlebotomy san effective wentmen fr inducing rembsion of porphyoactane tad ans the prefered ini therapy for pairs with and whew ron overoe. works by reaueng Mepabc on stores, Which n turn reduces the AcUMatOn OF oper. Faloug remission, rouunepebown maybe recessary to prever ecutence of SyMBIONS. Jytonyhlroquine fe sno a flaca resent for nding remieson of porphyria eran tds, bu contractions (29, Mtr f renal seas) should be considered, Vor-celatng agen, sch 5 Geeroxamine, may aso be cated F prebotomy i nedequate Bh Poephyis ‘yronymlroquine san etfecove wearer orig remission of porpmacatanea ada works By forming lane colubecompleces th porphyting whch he nye can then enretn weve theres of tinal damage wth Inaroxyenioroguineeatment ar its conramaiated pairs with aso of etal disease 25 ns patient. ‘um protection important for pets with symptomatie porphyria catanes aa, since lait igh aciates porphyrins Inthe sar, which may nage spt Hower increasing sm eroteoon alone irsufient andl rt reduce the ‘devsopmert of porphin, ron-chlating agents, nln Gferonaine can induc emision of pp catnea tarda tough he eduction of Inept ron tren, whieh reduces the accumulation af parprns However they are es fects than phbotomy a hus {72 pL ely used npanens who cannot oleate prebotomy or Rav oot venous cssge 8 Ons al ‘A 7h-yar-old man comes to the pysica for aout St. Hs psychic MSL signa fr mor depression ‘albert overdosed on sesping pil Today, fel wal but sll wakes up fequnty aight and canna seep cess to weapons at local hunting ib. The patent corer mes Suc thoughts or hough of e-harm, He {ates servaine ana olaraupne He des aot smoke or Grn kona. wich ote flowing te tongs ik actor fr| Previous swe steno (ketal eet “ c istry of psicoss desert tears Sleeping anorder i 4 BOOmns al <1 +> ‘87-year-old an comes to the physica for aout st. Hl payne history is signa for major depression Ssh peyton Fetrer. He was dlagnosed aft hi fe ed fom panereste cca four yeas ete Thee ears age,he | “Today, he els wel busi wakes up frequency aight and cane seeo parent an has no ehsen He does ot poe «eam at hore Bat has trough the might He es lene nh cess o weapons at local hunting ib. The patent corer mes Suc thoughts or hough of e-harm, He {ates servaine ana olaraupne He des aot smoke or Grn kona. wich ote flowing te tongs ik actor fr| ‘tod nthe patent “A ior istry of atampted side the strongest ung praicte factor for tds Patents wth such histor are 5-6 times more iely to make anther temp. This paler has mutipleadatoal sk factors incuing a story of mar depress order, ae se, age aces To weapons expen Frama), al acl blaton.Fequen faon-ups ae ‘alt prevent recurrence of staal Getonm ts pater. By seicainy ood sores such 25 major depress order or bipolar asxdericiease the rsk of tlle More tan 90% patents iho atamptuide haves prehotie iorer Homer, mood order ate Atte mast rete ik fate for ue Lack of seca supprt i risk factor for ude The sk of aude varie with mata stat with th highest ik in those who were neve mae flowed by thse wne ae widowed separated or dhoree. Soci Suppor anc family comnecreness ae ‘hough to be protective against suide lack of socal support nomeey, sna the most rede rk fcr er side ‘Maes are mare ay han fale shave 2 competed suede, though females atampt sult more often The ox fren Seems be lated othe thal of the method chosen whereas the mas common Method of Sui Tor males esOm ms : aie nidooe + oe Bae ae : ‘ought be protective aginst ude lack el support. honever, snot the most presicive Hk factor or sue. ales are mor ike than females to havea completed soe, though females atm sue more often, The sx erence Seems o beret to he erally of the methoachsen. whetas the most common Melted of sukide or Maes a eae inte Us, he mot common method or fears poning. al ox Int te most praceterik ator for see telng hem tk hemseis (en, command aucerynalunavon)P}chess, howe, sR the mos rele nk factor “The ek fel erate matt wth acces to feear. The edu othe lethal of festme at 2 method of ue ‘Access toa, however, ot the mest predictive Yk facto or sce, ‘sync dsorders such depression, when ths patent has may rest a lturbance of sen, Buti urlear whether a ‘Seepng cordon sown nase he neko suid. “The nek of sue erate with age im ors groupe (e.g. white male) and decestesin others. Conor physil 2h ‘mena ies (priculary depression, and scl clusion sem to play a mar le Suicide reps inte elder are ‘lly more plnned apd less impalnve than hoe in younger indie crested age, however, nat the serge, preaicve risk facto for sue epardess of sex andre.ge 8 Ons al ‘ne st 24 hous ater celery, 226889 (6.37 ) me newbora snot Teng Wal, has a high-thed ey and laphoroe. He was born a 38 esky gestation 192 30-sear-olg woman, gruca 2, para I, afer an uncomplicated labor nd devery. dogar sores wate Sand 9 at and 5 minutes, respecte The motel dd not eee prenatal cae She fakes codeine yup equenty for dy cough The flan’ tormpeature 37-8 (100P, ple 165) and esd pressures 83/50/mm Hg Examination shows pert, erory and an excess Stare rsponse The Babys Swadaed to prevent exconators and esusetaton tated. Complete blood coun and swum levels of cos, ‘ra morphine hereby BO Therapeutic yore Invavenous apelin and gentamicin combination therapy ‘ra metnmszoetheranyoats Omns al Jn ht note 62 a oe 1 {epee ore ils PR eens seperegmgprmemeeneeepeee wee = Corey en perenne aia en cca Senor isilspeen asa neue comme pee ean “hi neonate Horn oa ether wah a star of opionduee and protene wth rtably, por fading, dence of autonomic dysfunction Glaphores pete, tenors) end hyperefxia wt 2 huts ter ith, These features 20 “ “Thi infant pares with pial =ymptors of ronal bxtimencespcrome, lily aur by he mathe’ codeine ue ng preqancy mints with mid opt withdrawal Symptoms, supporve cree svadding Mids, qe oon) Pretewed Forfar wth mare severe synptoms assent fart, smn for morphine recommended 6 reset nar B opoits ‘at Gordie maybe usd ia the eatment of eoraal abstinence yome. wor by teducing Nrasreneric hyperaciny Induced by oped wihawal wrhout causing respatory depression However, cert not recommended 3 frs-ine "wearer and an aerate therapy would be mre efecve fo Ws condon, IV cle leona used for testment of hypocalcemia which n an fant may alo present wth eb, oor feeang, "wens, a typeretenl, Honerer, is fan doesnot have ay alk aor or hypoccema lg, pee th,oun al. i ai: «aoe “ ‘wean and an alternate therapy would be mre ef fo ondon IV cle leona used for testment of hypocalcemia which nan fant may lo oresar wth eaby, oor feeang, ‘wens, a typeeten, Honever, ts fan doesnot ave any alk aor or ypoccema (gee Dh, Inratena gram reticon) and hs serum clea vl enor “Therap hypothemias used or eae of eat ence hapa, Whe ml cases may aso present wth aby. Inperefena eying. en poor feeding. hs infant does aot have any rk ators or tha eave (eg, stop matenal Bad ‘bressur caus cerebral hypoxa ‘Acombinton of cin and genta canbe ued for resent of cata neat fection (ej, meno) le ‘the presertaton in infants canbe nonspecii and sii to tose sen hee, the absence of lukorteis and lack of Pik {ects for monaal faction eg, maternal fection. premature beh) ake this gross ue ‘wetimazole tery 1 set ret nants wrth symotomane hypertolism. Symptoms maybe sma to these seen inthis paver (29, aay, seating, poor weght ga). However, adic gerard posine material So Weld be ne es nd a ete fp WAG per iy reset sides tain, sweating oor feeding ms Serum glucose eve was normalge 8 Ons al ‘27-year-old man rough ta the emergency depaiment oma ome ser bacause of bizare Beno. He Thre dys age, he plugged vey elecrical appliance or hs floor ofthe ster caus halved thay ware bing hasbeen unable o comply wth is meccatons because of his unstable ving stustion Hs lsnevled ano malodorous Hs thought process is disorganized and he dos ot make ee conc Nic the followings te most appropiate cee ‘ra aazepem nrsmuselrnapenaone ‘ream iphenbyrarineOmns al <5 +> ‘27-uaroldman bought the energey Septet tor a ones shete beauseo BEEBE He “he dasa, anplgged vey eer eprom hs Mer othe shel beessee baled they weebeg eds tort mesnge abst tah The ptt es SEE un es been peed roperone et beer anaio emp WOME eae ere of hs nsaBe ig tus. e Sneed ane males He snoughe process agorganzed rate dos not aka ee cote Uh the alow sth nat spre en “Th patient uoeaba ing sation and mecetonnor-complanc make texting he deste challenging. Spec consideration of is scl ceumstances shuld be aken when choosing a medication fr hi ‘ropranalel, non-selective bata Block, canbe weed orcs holontary movers than aera fect of “mipsyehoicuse However, his patent has no evidence of kaha ‘Clarapin. an atypical antpnychoti, used the management f pater wth reatment-resatantshizophren, prc, ‘thse an persistent sca. Ts patents symptoms are duo ron-complanc athe than eacory seh2epena, ‘ra haope 2 fet generation pianos red the Westen of schizophrnia, However, his patent Mat ‘ieady been prescribed isperdee an aya aisjcheuo, and Nalopeido unite oe benefice remains entre 1 used nthe management of extrapyramidal syrdromes uch as dyson and akaths) assooated wth .& OD Bsa veney 6 + daa z Me ot persistent suc. This patents symptoms af de to non-compance athe ha tractor sehzophren, ‘a haope ast gereratin pi anupsychu uses tbe Wear ofshzophrnia.Howeve, his pant nas “iredy been preseried peridone (an ayes antipeychou) and Halopeida unite oe beac! Fhe rane oncom ‘erctopine sued i the management of extrapyramidal synaromes (uch as stom nd alata anocnted eth mtpsyehetcuse, and nramiscla (iv emma Is preferred nthe acute etn HOMEY, ts Pater hes none of Diazepam, a benzodiazepine, can be sed in the management of acute exrapyanidal sycromes Gch as dystonia and esd eee eng fete eet pute eee ese nore tLong-acananectble anpyehots, such 5 iramuscua MD nsperdon, are the preferred phamacolgl svateay for ‘ueangecizphrenc paves with relapses due to mediation non-complacs1Meperidone une adrnteed every 2 ees, bt conuns to be sbeebed ¢ wens ater notion Bh: Shropieois ‘iphenhyrarine, an antinatamine canbe wae athe management of acute extrapyramidal syndromes uth abate ‘vst and aka) assocated wth ampsyenot use. Howeer, ths PENER fas none of hase manestatonsa a oats Omns al <7 +> 1 52-year-old woman comes 10 the ys fo routine Neal maintenance examination, She apo faing kes has hypertension and type 2 diabetes melitus complicated win diabetic nephropathy, Her curtent medications include ‘noun frosemie, amine, ands multanen Her nepoogist reer atdedervoportn to her medaton regimen. se folows 2 et ow ns, aotom, orasi ana phosporus Mer emperatur Is 3798.67, puss '0,mi, and blood pressures 145/87 mm ig. Physkal ttarraton shows 1 edema sound ie ankles tera emoalotm 9.8 g/t ‘bumin g/dL Ne 135 regi or 00 meat ra on Cretnine 2.1 mgial Uuhch af flowing cmplatone she mos conmion cause of destn in patents rcehang long-term ese fone puvents rea conauon| (© Oconinustion of wesemere (©) intecnon (©) Ganon ading (© ceiver aeace (A) cerebrovascular asease @Omns al <7 +> a ‘.c0-earoid woman comes ote sen fo route heal sence amination Se eps ES ‘timer nig iyi nth ps2 ys < Petree etter tien iain coca eter Pete ener ee ‘tub rere sats s mance epost ee eed vor er meson a ‘nen Ste flan ait nw ns mote rn an porno hrtenpemre sarc 57. pelt {Sirus rsa 0587 rm i Pye araton rows sea sound he a teneabom 9.801 co fhmn gr eae ftom 2 ie - oats Crectnine gid Which of efllonng compiatons isthe mos common cause of death n patents receivg long-term resent fortis w puvents rea conauon| “Ths patents soy of labencnepheopany i combiraton wh olgura, puts, anemia, and azotemia suggests chrome ney cee that il mor aly requre real oplacron heap. Fasens undergoing renal replacement teapy ae atieased sk of developing malignancy (yp 7-fold higher tan he ‘enerl population due to many factor (eg feral repaceen! therapy incest: the ek of sequed renal cyt ese, sich is associated wit eal al carcnena) Howes, mabgnancy ot themes common cause of Gath among theseOm Ds al <7 +0 > ‘auton can deviop in pabets on dass earn noe pales) due 1 many Tacs (9. pression, ‘maabeorton, otvoertina mot dares, area Howse, te Rot the most common case of death aang hese ates. “The dcontnuation af hemodialysis common among paints wth end-stage renal oeae and het mos common ‘aus of eam among pavers recehing Nemo the United Sates. The reasons are numerous, Ieudng advanced age, ‘@scomtor curing ass sesso, and he imted autonomy assocaea wih eguenPeroalas Whe deus newale tn patients requiring rena replacament therapy (Tee me to desh vane wth the nest or BT. Infection (2 shunt nection) she second most common cause af eat mong patents ecg hemodahis and an be ‘e-teaterng, particular for oter patents on lass. These pent art ereasea rk of fecous compat Ons ‘because they have reduced mane function ave wo aging and por sutton aut) intcton also a common cause ot nga aio cp na sn gam meant Yo ne “Ane is common in patents undergoing real elaerant therapy, and hes a muliecoral etiology (a, dcrassed REC prosucian due toluck af entheapsetn in chan dney dase, neers RIC destacton de fo hemels) Hower, rem tenor ne mrt common cause of death among ers ates Fasens on heals are tested rk of mar leding (patie gatrntstina Bleang) du toa aqured ete of primary hemostasis cused by platelet dsfuncion an akered plteletvesel wall erection Howe, tS Cieieatin i rescren eso eek ae ete ‘eraovascuer seas (CVD) the leading aus of death n patents undergoing clays, accourona for almost a ofa ‘ams ms popula, wt a merely tate up to 20-Tld great han the genera population, Sudden carla deaths the sie most common form f death nth popu followed by acuta yor infarction. Th higher oly ete may ben part ue ote raditonl sk factors for CVD fe abe, hypertension, hypeipiemia most of whch re aso Terry chp re aces De he perce ie reise cor eld Eg pits ‘tsi n adiuen to te added sk acrs ue renal ystncton (eg malnrtn, nreseacaabOk tate, Irtunmaion, cv ls alee te most common cuce of eh i att ecehing adn varspan renal pace therapy ‘Cerebrovasculr iseas sok) ean npoanc cause of morality n paints undeging dass, with an incidence fla age han at the geerl population and cae fatty teas 1 ot the mas common cause of death nese patentsge 8 Ons al <5 > ‘22-year-old woman comes othe hysclan because of right-sided bluy Wien and ee pa fr 4s. She as 2 6-day tory of low-grade fever, estate, and mala. One yar ag, she nar agnoned wth Crohn dicate. et ony medication is pednsone He! temperatures 38°C (100-47), pulses 68) min ard Bood pressure 112/75 me Hg. The ‘ight eyeld i erythematous and tener ther re mulpe vesicles ve he igh ened andthe ip ofthe nose. Val cts 2020 ne et ve and 20/80 te ah eye. Exraoclar movements ae normal. The rah eve Shows Conjncial jection and reduced cone! sensi Fueescn staring sons aoa ison wh 2 Wee ke pat Peeudomonsekeati “ © ©) angles lancome 4Omns al a cia ‘22-year-old woman comes othe hysclan because of right-sided bluy Wien and ee pa fr 4s. She as 2 EO Oreniow ty ee foci ied em Cs fa oe reat eae ease Fy 1 medications pednsone He! temperatures 38°C (100-47), pulse 88) min ard Bood pressure 112/75 men Hg. The . "ight eyelid erythematous and tener ther re ules ve the igh oenend andthe it Wend. Vol a cys 2020 ne et ve and 20/80 te ah eye. Exraoclar moveMents ae normal. The MMR eve Sows = onuncial jection and reduced come! snstiny Fuoresce stag Shon 2 CMTISIOR Wi 2 Uhh of he allowing the mos aly agnor 6 “The weatment of ths patent's ID with the rimunosupprassive drug prednisone predeposes har 1 the reactivation of ont somancuies. = ‘of pif bury vision, prem dscharge, and round corneal eration, Akhough ths pate has pin ry vison, he has 1 epee ler with purulent charge and doesnot wear contact lenses, maki this hagas unk alsa would Stee ‘plan the veces, Anterior wei canbe caused by infectious ages fe, HSV, CMY, oF autoimmune processes (9, Crohn Sea) and Imanfests wth enced von, eye pan and cojuncvalzythema a seen ths pabet. though th pain Crohn ‘dszase puts nim 2 5k of developing anterior wets, i lamp examination woul ow inflammatory cas nthe arene ‘rane ths abant ns pasen,OUD s al Anterior wei canbe caused by infectious ages fe, HSV, CMY, oF autoimmune processes (9, Crohn Sea) and Imanfests wth enced von, eye pan and cojuncvalzythema a seen ths pabet. though th pain Crohn ‘dszase puts nim 2 5k of developing anterior wets, i lamp examination woul ow inflammatory cas nthe arene ‘rane ths abant ns pasen, ‘bal euites scaractanzes by aie onset of malas, fever and ey ethers and selina, which aso present tis pater ut se lacing ote ype symptons of orl cls uch as exophalme,cprthamopiegia arpa wi (Se mcveent. This cndton woul ale ot ela the pats veces Herpes zoster errs tay stars wih prodrome fever headache, malaise followed by unter paral mpared vision eh ecucea coreal sensation and vesicles inte aes etaied by Ie opalmic ave Trees baer po the rove) Frets staring telly eet shows punctate sons ante comes surface hat vce Into dene ons a “5 days, 2 een nis case. Treatment consis ofl aycow,vleqjon, of famclow with concomiant use of tpiencedCoceterrOm Ds al <-> Herpes zoster erates tay stars wh prodrome fever heseach, malaise flowed by unter paral mpared vision ie ecucea coreal sensation an vesicles inte aes eae Uy Ie opm ave Trees Bdge an ip othe rove) Frets staring tally et shows puneat sons onthe cores surface that vce ints dene ons a 145 days, a een nis case. THeatment consists ofl acycow,vleqeo,ofamcklow wih concomitant use of tpi Brera “angle-dosure glaucoma wold cause uniter ed, hard, nd severly pall ee onal heaeaces, vomiting, nausea, ena eins onthe comeal surface, hich would nt be explained laucoma HSV keratits causes unter ocular tation eye pln wth educed corneal sensation skin vesicles, and deni wcraton ‘Se uorescein staring, which ae also mere nth pater. However, venes in SN kevatts may ca the peter ‘fed ana wuld ne occur tmoughout he dermstome ofthe ophthalmic nerve forehead, Bags, an tp ofthe 058Ons al <2 a> ‘s19-yer-ol man bough the phys by hima Dacaue se woe abou ange behav Cverche (GE son a ns dns angi anette ay edd spends wf Ws ens ong soot ater than Song hs cuss he pends es of tne naw et preorealhcre one morse sa es neve! ser ary ost somees Were ae ign of er peserce For Sale pen tee conc Wado he flentog he most Bey ages ge 8 ont 2a senza. personaty sore (©) soci ane dsvaer (© oscar persona sorer (© [seas parcmaby cece (© Atti spectrum dcrcer (P) Pas personaly esoree (© serzopmrenia +Omns al ‘19-year-old man is troughe to the psa bys mesh because shes wores abouts stange behavior overte (UE eta fay Hab or rec ot et ‘se nthe summer. The mother reports that her son as always had ificaties ing in ad spends most of Ws timein Ws room plang oor. Rather than ding nis coursework he He ays mat he has nee sean ay Sears, DU Someimes Tee af sins of pase or exami cane aveas ty contact Which of he allowing she most Bly iagnos's? ae 45 « ‘Uke tis yourg man patents wth Schizoid personaly sore prsert with cent behav and fic developing ‘eanngul soul lationship, However, #hey component f shad persnasy acre’ a pervs pater of 3c wear animes rane of emetional expression. Fates are coner we SoCal solaton an do nt sek elton. ‘Altrough hs patent does nat have Herds eh Spenés most of hs ume alone, pales With Shao personaly discret ‘Phenomena, magical thinking, and eccenic clothing would no be explained by this dagnoss, PS SS ea anintense fea of embarrassment nso sustons Furthermore, hs pabents 086 Beles, mac tinking, and unsal ‘Coting could no ue expaes by Wis sora. aces win aoiar parson disorder ae ao uncomfortable around oer people and ao socal sings. Their {Socomforts den by feeling of madesuac aor an ene fet of fection ot ebrfssme® and they tnd ta desiceOm Ma wt <3 > aces win avoidare parson sore ae alo unconforable around oer people and aot socal stings. Their {Sacomforts ven by a feling ef adequacy aor an sense fst of tejection ot eibrfssmet and they tend ta desice Interpersonal relatonsips even ithe are anious about ineractng with ter, However, hs pabens scl Whew) {ppeas volurary and is patents od bales and daring Coes Would rot be explained By ths geass. “schzonypl personaly serdar ia clutr A patzonalty order unullypetnts wth a and acon havior and ‘ppearnce Patients also tend wo have ad bles or magic! thinking that ae inconsistent with utrl Noms Moreover, ‘hceste sci analy od speech, nappropiat lect anak of lve enc are uly ao ate, Bh. Persona sorders “Autism specu aoe ASD) usually lagnsed in young chien who presnt with perstent impart in ‘Coenen ed soc interac ax walle resco erste ater of aver, reste. Ah tis young man Is uncomorabie around oer paople Fis age and she absence of addon sypxons of 80, nlding Fopere lingua 3 rtp ecncat eelbnhre, eks h prels wiiy. Te ogres ASD el os not expiants stents preceapaton we paranormal henomen, Luke is young man, pavens win paranod personality asorder are general emoconlywolatea and have eccentric behave. tomer ake component of parol perevalty ordre sspcon aad chron tenders he ote neat ‘others have maou inetons although ths pater uncomfortable around othr people, hes no described a being Supous of them. Furthermore perano personaly duorder ent ypealy sessed wth od and magia taking. aves wit stzoptenia present wi conic and recrrert ayes fr mor than 6 months, They tnd co nsly present. lena prodrome of ragathe symptoms chaecezed by soa utharaal, hehe then fllged by postive payenote "motos Ge hallinton,dlstors and bizare Behav) Alhouah tis ate oars tobe alone and hs alsom ma 5 <9 40> ‘schzonypl personaly derdor acuta A petznalty dor usually pretnt wth oan acenei havior and “ppeatnce Pais also tend wo have od belies or magic! thirking that ae inconsistent with ufrl norms Moreover, ‘hte sci analy, oa pee, napropiat let anak of lve enc ar uly slo ate, By. Personality dsrders Atm spac acer ASD) sully lagnsed in young chien who presnt wit perstent impart in ‘Garmuntater ed scl neocon ax wall ox reccod erctyped ters of aver, rest, and eee. Athogh this young man Is uncomforabie around oer pope Fis age and ie absence of addon sypxons of 850, nclaing Frrerel lenges stor tpt mecca eek ks hc ipa wiih. Toe prs ASD rl oto rot expiants stent preoccupation we paranormal henomen, Luke is young man, pavens with paranod personality aorder are generally emoconlywolatea ad have eccentric behav, tomer ake component of pero pereoalty ordre sspcon ef and runt toward eters ote eat ‘others have maou ineions although ths pater uncomfortable around other people, he snot described a being Surpcous of them. Furthermore paranoia personel orders nt peal astceated th os and magia taking Paves wit staoptenia present wi conic ad recurrent ayes fr more than 6 months They tnd only present sth prodrome of ragathe symptoms chaacezed by roca utharanl, ue thon flue oy poste pyenote Symptoms ie, hallucnstons,dlsions and bizare behav). lthough this pate pretest be ane ad has oa eles, ‘sorganized speech,Ons al <1 ' 20-year-old woman i brought 1 te emergency department by ne oye fo gh arm an eg weakness, : numbness and tingjing that hat bee eshing gradual. The symptoms started 4 hour ago flere had an =gument ‘her Dyfed during whch she lapped and lacked tm. he sas she es an ping and canoc use right am nye he has never Rod sir symptoms nthe past She ha story of geal herpes ab iehotilrana Shee Siem an avenes Phyl examination shone upper ana ower ace symmetry and nonnal seer te nae 5 5 renath Inaltexvemies ad's igh are plan Non whan|ayng down, sh has 4/5 Sangin nthe igh am a 9 en roprocepton ight ouch sensation, and two-point discrimination all extents. She ass meave Spin et CT . Ste ade can shows ona. Whe eon tm mes arora et a rrarapere ‘Start cognive behavioral hereby {Bagi atl of etiam |e Start pyc eapy Pesce aspin Start bofeecback herepy 4 lOcOmns al <0 > ‘20-year-old woman i trought to he emergency depart by he Boytlend for ah am ane ES that hs been feschng gradual The symptors aed ours 230 es oicacianie sn arncec en eee Ss any ot yea ler: and onerte Physi examination shows per and ower face syrmet and nora speach se nas Intl exvemies ands wight are plana Nexon whan laying down, sh has 4/5 svangih nthe igh arm a 9 wen decrvination nal eee, Sha has a negate Spring ts. CT ‘euttogical symptoms aftr 20 emauloral Suess. Her pysial exam has nconssen Ycal neu igi igs ard ee ONL manng tat shoun no abnormal. in summary, thee ndings sugest the dagron of cmveren eeorde. 2a < Fanents who do nt respond fst-ne management for conversion order may benef fom cogitve behavioral herapy {Coy Sravgies or vesting comersion order win COT include esablening a shared understanding of the dagiose, leering Heart goals chalenging maladaptive ekaoe and thought a thmking of fenetonl impairment a2 permanand, en elsticalyaipating Setbacks the west couse AS Os patent Ns ew onset Conesion Sore anes wi refractory comerson esorder, who 6 rot respond to conservative therapies may Beef fom pharmacotherapy Anudepessats ie aopram may Wea bot Comelson cso and Common Comerbides Such a realized ame) eae ee lela (8) woul be apron hs patent was hving stoke particularly sth patent's symptoms besa 4 hoursOmns al < ora > Aleplase (8) woul be appropiate dhs patent was hing a soke particularly sth patient's symptoms began 4 hours ‘ago, thin he therapeu window fr tomate, ihn #5 Nurs of yma onseb- However, is stents Inconsistent reflogcal exam and CT of he head, nagtve fo ace macatial abaomales, ue agaist a ‘cobroselar cameo her eymptone Faxen eduction she st step of cre in patie with conversion sore’ 25 symptoms may resohe fer explanation ofthe agnosis ana to cauice. Strategies for presenting the diagnose opti sage shang abut ther perspective of he problem, aking ter symtoms serous, exlanng cel features that are Inconsistent win neurlonc ease, 2nd ‘empnasing Pat symptoms ar poten reverie By. Semauc symptom and lated disorders ysl serpy (7) maybe useful as ance eae fox pti wth mer symptoms of conesion disorder bat ot 1 frst-lneapproath. Strategies for wenting conversion antce th PT ede encouraging etal funcional movement ‘eg, warsers and walang) ang teaching patents 0 Suppress abpormal moveets or HES (ey USIng SVAN eainigues. spin would be appropriate fhe patent war hving rks or arson ican tak i), Hwee, he Pate Inconsistent neuclgia evan and CT ofthe head, negative er acute aril abvermaies ague aga 2 aera ake Faves who dono repond to consecuve sof ter connate Leaman approsche or conversion aoe may {funeional tenor Im his patient, anather management approach should be wed fst.sna Ons al ‘A ss-yar-old man s rough the emergency deparmert because of cough and poot appt forthe pas wesk Since ight sweats. He was diagnosed with HIV infecton 5 years ago, He has hypertension, type 2 dabetes melts, and Severe 30 yeas. He rinks 6-10 beers daly Hs temperature 38.7 (102.07, pulses 101 rm, resprations are 25/min ad ood presute 145/92 mm Hg. The pabert appears Wonca ska examination Shows caches an ules Ini-sstlic jecon muri esd long the Upper ght Sera! border Mi COS™T-Imnphocte count 5 280mm? (Norma = 500) An x-ray of the het shows har flat nthe night love lang eld When the Flloing the ros kay cuse of hs patents poms? za (]) sonchosheolr carcinoma BO a (©) Meeewoss (©) Miva vee egugacion (© Pharmacesophagea veraOmns al <> Ntgme seater e eee eae ere Trae oe ee pace ee a aes eo eae ost kay cuse ofthis patents mpm? (| See ee ee es ‘ronchoavelar carcinoma laencarcnoma i su) 1s noni tpe of ung cancer with parcular growth pater tetaned wo as epdc caly me seas, chest 12 Mngs Include soa peipheral Node, Dut in ote advanced "Hage porate fur conslieton wheat hi patent xray show shan flat lcalze othe ight ower abe Furthermore, hs patent’ acute presentation fee, a lack of systemic symptoms of lung cancer woh ss, Pemepys, tae pet bene age ee ie ‘Preamocysts pneumonia (FCF pneumonia) 5 corimon opportuni infection i tents wi MV and the most common ‘aus of eam patent wih a1. However, PCP prevmona maniess with «cou, ase Daa Gry ices, and Irvrstial preumonis on chest ry, he te ptr’ fining. Acton, CD¢" cou» 200 clin! makes thie ‘iagnosis ess bey.Om Maat ‘Coun, malodorous phlegm and fever n te seing of alcohol seeder and efi stor of severe heartburn are ‘Suggest of aspraton pneumonia. This paves nest Xa showing ahazy nieate the ight lower ura Ther suppor thie agro Altered consciouaners srk fear for apr ai clascall een alcool abe, eat, ‘general aestesia and seizures. hs patent’ history of gate refs an atonal isk factor fo aspiration, aces rfc ete feats cep tpi et eae teatre tac ae ronchecats manly sean pales wth yt feos and/or recurent pulmonary infcvons ts chaacerzed by ‘copious mucepurant spun In corast ths pater, uo fas Smal amount of mloaoreas phim. Furtermoce, a5 ‘posed to hs panens hay infra nthe igh loner abe, bronchicats charactanstealy appears a "Wa tes ‘dono clvonc inflammation ad bros of bronchial wal which cn regress ohoneyconting “Tubercle usualy presents wth eer and mah sweats, 35 Sean this patent. tough leahol abuse ana being homeless ae 1S Tacos for development o Te the subacute orto a ough produce of malodorous pkg mote suggest of frat dagnoss. Moreover, chest x-ray patents wth actve TE shows appa lobe cavtary lesions, wheat ts pave’ chest xray shows saz nfliace nthe igh lowe ng el. ial aes epg cae partic crater a te pe TE pai 2/6 apt ec ar ‘best heard alo the upper nan stema orders ik fo be due aor tenoss. Miva reuraation causes pulmonary ‘edema which can be ear on auscultation as bata aces, wefeas spurt has acl localzed ote lower tobe Furthermore, th pater’ chet xa fringe, fue, and acute oneet of symptoms are more suggestive of ferent conditionom ms <0 440 > 9 —— onehceai manly san patent ath ye bose anor recurrant pulmonary infctons ti chaacerzed by ‘copious mucepurlet sputum In convast ths pater to has Smal amounts of malodorous phlegm. Furthermore, 35 ‘posed ths patents hay infra nthe ight leer abe Branchectanscharctertiealy appears Wa eines {be conc ifammaton ard boss of bronchial wal, which en regress 0 honeycombina. “Tubercle (8 ualyproteswth eer and nigh sess, sr this paar Although lehol abs and sing Nomles af isk ators for developmen fT, te subacute onset of «cough produce of malodorous preg Is mere suggestive of «ferent hago Moreover, chet ray inpatients wth ace Ta shows upper abe cavitary lesions, ere {his patents chest ray shows ahaa mate nthe nah omer lng el. ‘Maral vate epurgation causes «paneystolc murmur best etd the apex. Tis paUens 2/6 mid-psONc ejection murmur betes along the upper right seal border ay tb du to ste enon val regurgitation cave pulmonary ‘edema which can be ear on escalation as bilateral races, whereas his patient as cracls localzed othe ih lowe Tobe Furthermore th patent's chest x-ray ings, fver, and acute onbet of symptoms are more suggestive of ferent conston ‘Prarygostophageal dural (Zenker veri) pretent wth ou-smaling regu of undgered fod. although ‘this paver has «cough productive of malodorous phlegm he dos no: complain of fod (equation, Patents wih pPhatygoesophapeldverulum unl eorpain of daphag anda seation a haan a lamp nthe hast, Mich sn resent is att. Moreover, fever and fugue arent explained nya pharmgcesophagal dverculim alone,‘elon sales re seen at he margins of te eyes, wh of teflon she mosey agnosis? Feedback 20 « Orme aaa Ces (©) tome © ri Olivia Cs (H) oermaromyosis B snc anmerPe eonOmns al <2 > 1 26-year-old man comes to the pysican because of 2 2-mown history of 2 RGR UMICRRW GRIT MNASGIR. Ae enor that hear been sing aw shaving crear once weak forthe par 3 month. yar a, he wae cagnored ‘sh Yad is carey receiving ipl atonal egy He Sinks Several si-paks of Det wee. Val sg te are een te margins ofthe eyed Wich ofthe followg Is te most kel agne557| “This photograph shows wel-cetnesenymiemaouspugues wid ne gas yew scales oer the naslabia ls. This condion eaates affacinfans and noun a crac cop. nal, t fe moe common seen in paete wth HV ot Or Faison cea. sora sions can presen as prac erythematous scaly plaques that are recurrent wih symptom-free ras, ke inhi patene. However, te ype lesion wile shapy-demarcted with numerous serie sels and have + peloton to ‘cca on he scalp back and exensrsirTces ofthe elbows and kesCeOm Ds al <> ‘le coat dermtie (ACE) can presen with prt eyematous rash teen inhi pate Hower, era ‘his paver spotted the pas of the kin he ses he shaving clear on the Sealy ahs so Seen ons elds ed Aerehea, and sealer im ACO ae oy and hte rather than gfessy en yellow Moreover, ACD deeoge thin 48 bouts ‘omact wth te lergen, an the 2-morth pred beren his patent chaning shaving ream and veloping ash not ‘onsswencvah te aagrent. “The peal ah of ytemic up enthematons (Sua a amen exthema oer the bige ofthe nose an the cheeks that characters spares the naselalal folds (outer ash) Ts patent’ ash voles the nasolabial Tl, s ru ana ‘as areacy low sales, none of which ae sean in LE adcon, ther ealy manferatone Of SL, suc ate, ya od ahi are sont nth pate, ing ar ulaly agnosis ‘von ecuant cena fac eee nse and media cheek), a Seen ms pln &Common feature of osaca. In fernepationty, the ej ar ab Invove Hepat n oer fare). However, he leone of otaes ano rae ‘nd cles if present, ae dry and white unihein pater in aon, the most character Uc signs ftosaca, uch 38 {elangicase anor popes a pustules inthe fetes arc, ate not een in hepaNera ey Coes aeons catOm Ds al <> ‘von ecuant cena fac eee nse and media cheek), a Seen ms pln &Common feature of osaca. In fernepationty, the ej ar ab Invove Hepat n oer fare). However, he leone of otaes ano rae ‘nd cles if present, ae dry and white unihein pater in aon, the most character Uc signs ftosaca, uch 38 {elangicase anor popes a pustules inthe fetes arc, ate not een in hepa ‘cutancout manfetaons of plague laterally syrmotica| erytheratou lesions that ually afc sun-expored srs (th ace ac the aids andthe at. buring sensation i common playa, his sean his alent but runt not present. Athough hs patients high consumption of dob sx sk ator forthe development of plage eas none of te other features of pelagra les gloss, a0gH8 Pyral versclr presents wth mull, rr, wll-demateated leone that may be milly erythenatou, Iypepigmented oc ypopimentd ana are ypicaly Sen on the Wank 2d shoulders; he fac an uncommon st for Tees peer Te toe Fp foc eins abet etn cl cg te etre ersOM Oa. al, <2 40> ois vette, The sons nave vey in wi lesan oot a, wh why the Decome more apparent sun “This avert resents wth a rune rshaffecing ars of high sebaceous acy his fce eves and scl. These Aeaures a pica of seboubee demas an path, home, lasing cana ha sequent suet HV-posie Bo ‘Cutaneous manfestation of dermstryosti (OM) incl ail erythema that fect the nasolabial folds and the eyelets ‘atoope rsh, which simlart he asrbuton ofthe ran seem this pater. ASIoUgh myopathy an importa and “common symgtom of DM cutaneous featutes can precede te onset of myopaty However, the kn manifestations of DM ae, rising, mating OM ah unily cause of his patent’ symptomseege 8 Ons al a ‘46-year-old man s rough othe physica by hs wie because he nas Become increasingly etess and arious. is Sess that he assures ad anda for he pet 4 orth. He ot ob a sora ek because oft Hed {0 avo werk nd spe most of his dys onthe phe placing bets on focball games. He avid ail amih~elated evens ese cbs eer ey Fem esi elaine Ve bec athe pepe wal gener he le to wn some of hs money bac. He prevousy smoked 6-10 egeretes da but quit 1 month a90 He ks Bee” on te telends, On examination, ek uncooperatne and dma. Hee mid emous, Nerclog examinton eno ete onante to poaon, lace, 2nd tine Which of he allowing i tha mst key agnosie? 1} aor depcessve disorder BO OQ/O|©|©|© ‘po wincraal ‘cut ses sore onal maa 4oma a a ose acatsmani tens me pts ns te bese as deco ~ Ss wr ns pn os os dys one pore es a ed os fee te hp ut yon grr oes he ae a {Sn some of mone oie pert seed 1 ets bt eat mar en snk oh he ‘tle On suru bis nope sunt naa Semele smal ee uray He te onantad 1 person, lar, and ime. Which ofthe following is tha mos Ika agnosis? 6 “Thus patient has deprested mood and his behavior has caused sigafican dysfunction mis Me. = & 2 4a i‘ Aaaiais Majer depressive ordre caratrized by depreted mood andor anhadon ating mare than 2 wes Wh thi patent = Stbstance-relaed and addict orders ‘opioi witharnalscasslallycaractaned by lane, f-ke symptoms, nsomia ITE, ants and even ‘sogresion. Wie thi pater’s presentation dos have some features conser wth thi gos, Meee no EY | ‘eat ses diorer is characterized by nsiety-elaied symptoms occuring wth one mamth flonng «traumatic even. “Ths vert des not have story ofa aumanc ever and MS combinaten of symptoms sugges an aenate aghoss ‘Pavan wi alcool witerawal can presen with maby and vemuleusness. Alcohol wonaval serous conden ee ‘ould not be verloked but hehe ator f ony drinking on the weskende would be nconier wth hs lag ‘polar sede should be on the ferential forth patent, she has sme Fetes of majo depressive spade (eg restessness, depressed mood), enéence for sanficataystincion sing Ms) as well 2s rable mood, However, he Ses ‘noha a hstory of manic episodes and ms crrentsymproms do nat mee cari fora yperancensode (eg [Ea symptoms such se fgh fides, presuted sear, deren need fr sep). Therefore, he does ot met citeria fo ‘eter ype er type bipolar srs, [Adnan nodes characterized by emotional an behavioral changes within 2 months of steal vet and tesaistion wh moms. However, dis pati meets entana fora dren disorder and has no Mistry of traumatic evege 8 Ons al ‘21-year-old colege student comes to te physclanbecaute of dayeme fatigue for 2 months. Me has probleme geting aight and equa falsaslgp dunn class econ he has sated shiping lasses aogaar. ne goes to bad betoeen 17 pm. and 1am but canna falas for 2-3 hors, When he wakes up at 8:30 a, he fel extremely ron, and he test overcome hs faigue by dking 2 cps of coffer ay He nape at varus mes dng te afternoon, often for more nanan Rou He stopped watching videos on is smarthone tight because of suggestions from hs pers. He sates da eae id over-the-counter melatonin ple and exercing 8 pr witout succes He Shows no abronales, Which ofthe alowing ste mes appropree recommendation Forts pan? 2a '@| Taal of agherryaraoe © eating bed OG Complete cate cezeaon BO Oe ee) Sop ug an alarm dock ‘Scheduled ateroon naps =) (¢ 4Omns al <> | 21-year-old cole student comes 1 me pyscan becuse ct FEO TUETOFZ MOREE. He has potiems geting fe slagpatrghe an frequent fl alep uring cae Racary hea stated siping lanes sogeter He gett bed between 11 pun. and 1 mb i flag 25 HOWE. When he wakes up et 630 ame el exteme hoe dhe se cr Ud eto cea pot se _ aed often for mre man an hour. He stopped watching vdeo on Wis smatohone et mote because of SuRgEStENs roms pets. He sates at erase wnout sucess He tare tor of srs Mies. dove noe eo: rs tres fe bwers on wears Fil eramtnaon Shows no abronales, Which ofthe alowing ste mes appropri recommendation Forts pan? ‘Steep esrdes ae one ofthe most common cial complains elfen vp o one tid f the aut population i the fUs heagous nthe paten norma oder, ch shoul mal be Wetec woh deus gee 45 « “The sedating side fc of ciphenhyaamin can hap patients with ceased lp latency fall asleep. However, mst fics bette: elena ies side tet oer corse of roy Mareme dpheiyeeminc weal be oumterproductve for is pave 35 may cause Seaton onthe flowing day avers ong hae alough reading may be helpful oa alep, nds with insomnia dsorder sous be scouagea om engaging (92 ed rstead freacing in bed Inaaduls eh sora disorder should aol sults, suchas cafeated drmks and nicotne, omer, complete cate cssaon snot ecessayCe < 4/0 > However, complet caine Cesatn OU NEES. - atthough rela exercise fora eas 20 minutes beneficial or duns with nsormia Snorer, shoud be veda fe tosh nore before est. Bo “although col mas fling alep ean, ay edo fica manering sleep nightmare, an = beadache the next ‘ay To mprove seep yen, indidals with soma disorder should avoid akc beverages #6 hour preceding seep “Ta improve sep ingens, ndvduals wth insomnia inorder shouldbe advised to wakeup a regular ines ls daring the weekend an hoes. ‘ada wth insomnia rer should be adured to acid afemaon naps im order to impron ep hygiene. Isher, nape Should mot occu ater 3 pm and be no longer tan 1 hot Fieger Sgn eer eters el senegal pee el vesroonge 8 Ons al ‘40-year-old man s rough tothe emergency depaimer by ate ofces ue to appropiate pubic behave. He Siar at a pharmacy damanding ts spat wih the manager ihe coud dco a butiner deal Tue wesks 2g, hao Me ‘ie of 10 yes and moves om athe cy mort to pute is ean of being an enepreneut He has not ep fo free than 2-4 fours ight nthe leet 2 wack, He asa tery of ipl dzerder and diabetes Hehe en hosprabzed tre tes nt last year fr mood stabi, Curent medistions tude Irtm ad isu Mena sats tamination stows acleated Spee wih Might a ess serum ceattteconcentaton 25 mg/d Which of he Following ithe most appropriate ow ap in management th respect tober 1) Varo acd and auenasne ut and olanzapine BOOmns al <> ot 4 0-yarotman srg te aren eprint oe tc dato apsopat pbc banave He ree at atsprarmay eranig peste meagre os anes snes Perea age ete Sie ot 16ers end mover ante yo tpi hs eas of beng on eee hes REST! veteran dubs Hho en a Fospates Wee tenet er mst soi cet meet ge rs ar at eer ee 3 7 a ae SG Septem cape pesca whan sana pss et hasan alton ara cine Tete toca 2 40 im si ‘Cartararpin by sf woud probally not bes sficet treet fer ts patent We he aneplete agent weal can w be used atematiely thm fr maimenance therapy in bpoa order, Msp Yao to monoderapy with & ‘Clozapine snot inicate for he management of goa dra, ileal wed fr reactor shop Wen, ‘Wl thm an apie ace can be gn concaremy in patents wth bpoar sory, te combination fe notated ‘his pave, as his (enal fares corvainicton Tor corinved se of ea. Combination therapy af amondsablize and anantonyhote, eh as valproic and quip respectively fi ‘tara for mawtnancevretmart ofFefacory oF severe Doar sort. Ths acoey mane patent wih teeombs a <5 7/40 > ‘Carbamazepine by itself would probly not bea afcent restment orth patent Whe tha etepletc agent wn can ‘be sea aternately rium for maitenanceteray i iol esrder, hs patents eacor to monetary with. ‘um and tou nes a more tense cerapy fr fg -trm manage Clozapine i ot nated for the managemant of bipolar order te rypealy used for efector sehzopheni. We thm an apie acc can be gn concutey in patents with bipolar sores, this combination f not aad ‘this avert, as ns renal fares a conannleston for ortnes use of eh. ‘Combination therapy of a mood sabizer and an antosychouc, such as vari td and quetiapine respecte Stine thera for mamtanance tesa! of efactoy or save paar uorét. The acbaly ran patent wih three hosplizaons within the ast ya hasbeen veatery fo monotherapy wth he mood stabizeihiom, and reques seid peristalsis ee Whe stl ote eet oe sare le {a5 is lbs inceate rena falar, a canrartetion oii se Further corrangiatons fo um ince severe ‘emyaraion, severe mponavei and signin carhovacelr Gea, Bo ‘combination of thium and clanzapine woud ot be aprepat fot patent. While a combination therapy of a mood tablize and an angechotie i fat-lne herap or he matenence weston of efacory of sever bial epes, this patent's rerlfalure's&convanaicston fr contmued us of Hem.ge 8 Ons al < se mmm com ote candace sta 2 onion toga tag ndancrenst | (IE 20 yas She as hry of ving metbanptamies ad cosine but qutS years goign nol aha. Thres ura 3 ads ud pt, ant canbe ahh gee of ste, Te Soren sah ana nomena. Te tage re enarge diene ce. Tare pong ena wound he Minch of lowing shaw cnim egos? TY ean omnes ooh har aie 2a Ponsommoarapty cr aaiograsy Dole esnecsrsenrpmy [OOOye} ) Righthere catheterzaton ole ®¢ ) Seog teste spwomeny =) ( sroneoscony 4Omns al <5 > o a ‘42-year woman comes othe pan case of 2 month try of rots faxgu nid sore of ES yeu she yg ccna oa aga als oa a Seiten. Tres ora oh rime canbe wt ese re er. Te a {Romer oun nomen The tees ste eniege te as we care Tee bong ea won nay eno ct Which of ie Flowing mos iely wo conrm he agro? ee “ws pe press wh dspnes, eience of ghsided eat fae periperl ede ¥O, pS) ad pronounced ert puonary tere, lo uhich are strongly suggestive pulmonary hyperemsn, HEN relied her story of Grog abuse. caret agro in mperatve 8 eaten options vary swe Noes PumonayRyDReon- a — 45 “ sis Folscrnagraphy is the test of ace to lagose cbse see apes (5A, wich can cause group 3 pulmonary W hypertension end subsequent right-sided hea fale (ee pulmoncl) However, ths patient aks other typi Features of She ‘sen a ess seep with excessive date ieepnesy snot, sbi elsades and nae coantne Freon, Furtermore, er presercauon constr i an allerate subgtoup of pumenryhyperttson ata pohsoneo3/aphy Wa ‘CT angiography (CT con be used to dagrose plenary embolism (FE Chnk hvomboembolc disease can ca5e group Pulmonary peterson, and ould with the dutton Of er mpm owever VG scans actualy prefered a is more Senstve for is claaness Furthermore, hr presentation 1 consstet wth an ernaeSUbgrvp of Pulmonary Fypetension nd cTavil no confirm te agrees, Dopplr echocardiography is auas part ofthe inl agnostic nvesigaon n patents wih suspected pulmonary hipertensiont extinate the pulmony ater state pesure PAD), swell wala and vertical frei, ChromeOm De at < sri > Dopplr echocardiography is auas part ofthe inl agnostic nvesigaon n patents wih suspected pulmonary hypertension t estimate the pulmony ater stl presure PAD), a well walla vertical frei. Chomie lefsced ner flrs the underyngeteoay of rou 2 pulmonary hypertension, while would be import o perform in ‘ths pat spel look fox iva stnoss gn er migration Msn), cea cort he aug tagh-resltion Cr of he ng used nthe dagen festa ang ase (UD, whch can cave group 3 ploy Iyperenson LD may present ith fatigue, dyspnea ard dubbing of te nal, 5 Seen ns patient. Hower, LD pial abo presents eth ann nsatory crackle on suscltation an ec Opaies a chen ay Her Presentation more consistent whan aerate subgroup ard CT wl ot corm the apne. ight heart catbeteizson ie the wet of hoje to confem he cagnot of pulmonay Hypetnson a well atthe specie ‘subgroup, nis case olanary arterial hypertension (AM Diagnosis is made when the men pulmonary aay presse 25 mmiig ares and uncerng pulmonary ane heat condone. velar het crease ote dystuncton. “ial eistanciom ae excude, While PAH 5 ofen pain, amphetamine and cocaine use hae been asses Wi ‘eevsopmer of Pa. Bo Pulmonary hypetesion ana cor pulmonale ‘Serologic esting canbe uted gions crt commttiv tun vena, ech sehr (Se) whic ae areca te group 1 pulmonary hypertesion pulmonary ateral hypertension) This patent lacks ther ypc features of 5, sch 5 hardening fhe skim, serodastiy, Raynaud phenomenon, and dyephapa Moreover, sealoge esting would any cnt the ‘bresnce of connective issue dsrde, rt contm he cleanest of pulmoarymyperenson.OUD a at: Aight-eart catheterization athe teat of oie to cone the dagnons of palmonay hypertension ap wells the specie subgrou, ns case puronar ara! hyperersion PAH, Diagnosis is made wen the mean pulmonary ery pressures 225 mmiig aes ana underving pulmonary ae eat condone, vas heat asease, Sst aur, “cole dytinton ae exces le 2s tan Mlpsth, amphetamine and cosine ute hae est seat th ‘evelopment of Pa. Bo “Serologic tating canbe used to chagnose certain connective tate dneses, seh ap aleve Se) whch are anced ‘wen group 1 pulmonar nyperersion Gulmorary anal hypertension. This patent lacks ther cl features oF 5, sch 5 ardning of te skin, sdetodat,Raynaue phenomenon, ard ayspraga, Moreoet,serelage esa would oly cnt the pretncs of comer ave drder, no confem the agro of pulmonary hypertension “prometry suse to dagnoteabstuctve ling deese eg apts, COFD and etre ang snese whch an ceune ‘arcu 3 pulmonary hypertension, whl her smcong satus and symptoms could consistant wn COPD, her ovr Presentation Suggestive of en aleae Subgroup 0 pulmonaty hpetersion and spomety wl nt con the ages renehoespy teed ra wary of tings, ac as wale of pee malian Fatal chor infection. Fulmanary malignancy or choninfacion could presen th yspren adn rae cats, an case Fup 5 pulmonaly pe ea ter hse ce ter kc cere prs at more consstere rh an alternate Subgroup of pulmonar hypertension an bronenoscoy il ot confi te a5r25.‘obese, 66-year-clé woman comes othe pysidan or routine heath marterance examination. She els well Duc Unhappy about being oversight. she rapa that se fe aut of breath when walking for more then ane lock a le Cinbing sas, She has wed lose weight for several years without Succes. She oes for anak 3 Cinesaweak but she has fey fling a low-calorie dit. Dusing the past 12 mont, be has had to uray act fection ha ete _weated wrth fosfomar, She nas ype 2 lets melts ana osteoarns Her only current medezbon fs mer She hag never sakes, se i 160/cm 5 2 al and weighs 100 kg (220, hg 2.1 Agim, signs re win | formal mts. Physealsxamiaton shows cracking in bth knees on patsne movement. The ramanda f the examination Shows no absolve. Serum Stuces show an HDATCof 8%, ad 2 fasting serum gucose concentration of 158 mg/dL. [AP ECG shows no abormaltes Whe fhe flings the mov appropatepharmacatheray? Feedback 4a © Oren © ence (© Positazene (@) cheande (6 ewroee © essttcan (©) Prevemine (@) smaonoan