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    Listening 65

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    Sunrise 2587
    Maria Morgan is a 48-year-old female with a history of pulmonary embolism and gastrointestinal bleeding who presented with sudden dizziness and shortness of breath. Her medical history includes an IVC filter placement and recent ICU stay. On examination, her vitals were stable and labs showed elevated creatinine and hemoglobin. Her chest x-ray was clear. She was assessed with pulmonary embolism and hypertension. Victorya is a 21-year-old female with right shoulder pain for 5 months aggravated by baseball. Her medications include NSAIDs and muscle relaxants. Her mother has arthritis. Examination found tenderness and decreased range of motion in the right shoulder. X-ray revealed cuff

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    Listening 65

    Uploaded by

    Sunrise 2587
    21 views8 pages
    Maria Morgan is a 48-year-old female with a history of pulmonary embolism and gastrointestinal bleeding who presented with sudden dizziness and shortness of breath. Her medical history includes an IVC filter placement and recent ICU stay. On examination, her vitals were stable and labs showed elevated creatinine and hemoglobin. Her chest x-ray was clear. She was assessed with pulmonary embolism and hypertension. Victorya is a 21-year-old female with right shoulder pain for 5 months aggravated by baseball. Her medications include NSAIDs and muscle relaxants. Her mother has arthritis. Examination found tenderness and decreased range of motion in the right shoulder. X-ray revealed cuff

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    Maria Morgan is a 48-year-old female with a history of pulmonary embolism and gastrointestinal bleeding who presented with sudden dizziness and shortness of breath. Her medical history includes an IVC filter placement and recent ICU stay. On examination, her vitals were stable and labs showed elevated creatinine and hemoglobin. Her chest x-ray was clear. She was assessed with pulmonary embolism and hypertension. Victorya is a 21-year-old female with right shoulder pain for 5 months aggravated by baseball. Her medications include NSAIDs and muscle relaxants. Her mother has arthritis. Examination found tenderness and decreased range of motion in the right shoulder. X-ray revealed cuff

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    21 views8 pages

    Listening 65

    Uploaded by

    Sunrise 2587
    Maria Morgan is a 48-year-old female with a history of pulmonary embolism and gastrointestinal bleeding who presented with sudden dizziness and shortness of breath. Her medical history includes an IVC filter placement and recent ICU stay. On examination, her vitals were stable and labs showed elevated creatinine and hemoglobin. Her chest x-ray was clear. She was assessed with pulmonary embolism and hypertension. Victorya is a 21-year-old female with right shoulder pain for 5 months aggravated by baseball. Her medications include NSAIDs and muscle relaxants. Her mother has arthritis. Examination found tenderness and decreased range of motion in the right shoulder. X-ray revealed cuff

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    of 8

    Patient: Maria Morgan

    Age: 48
    Symptoms & disease:

    • sudden (1) _______and had some (2) _____shortness in breath & became
    unconscious
    Medical History:

    • Pulmonary Embolism diagnosed a year ago.


    • had an (3) ______placed due to massive Gastrointestinal Bleeding Diverticulosis,
    Paroxysmal Atrial Fibrillationand no anticoagulation due to history of (4)______
    • Coronary artery disease status was post bypass graft surgery had to stay in the ICU
    for (5) _____ due to lower (6) _______again.
    Medications:

    • (7) _____, Potassium, Lasix, Levothyroxine Lisinopril, Pacerone, Protonix, Toprol,


    Vitamin B, Zetia, Zyrtec.
    Physical examination:

    • blood pressure is 155/57, pulse rate is 61, respirations 18 & (8) ______ is 95% on
    room air.
    • No lymph nodes or masses.
    • No lower extremity edema.
    • No redness or (9) _______
    Diagnosis:

    • laboratory reports show Creatinine 2.1 and (10) ______ 9.6.


    • Your chest x-ray is (11) _____
    Impression:

    • Pulmonary Embolism with Contraindication to anticoagulation due to recurrent


    gastrointestinal bleed, status post IVC filter.
    • pulmonary (12) _____ suspected
    • Mitral Valve disease, coronary artery disease, Peripheral Vascular disease per
    cardiology
    Patient: Victorya
    Age: 21
    Symptoms & disease:

    • pain on right shoulder


    Patient's description of symptoms:

    • throbbing pain on the right shoulder for (13) _______


    • pain aggravates, as he plays baseball regularly also participating in (14) _______
    Medications:

    • non-steroidal anti-inflammatory drugs & (15) ________ medications


    Family history of illness:

    • mother has (16) ______


    Physical Examination:

    • (17) ______ is 116/68, respiratory rate 16, heart rate (18) ______
    • weight 165 lbs
    • right shoulder shows evidence of swelling and tenderness (19) ______ are 2/4
    bilateral.
    • brachial pulses are (20) _______ bilateral
    • range of motion of (21) _____ shoulder shows decreased flexion decreased
    extension
    • decreased adduction rotation decreased internal rotation and decreased external
    rotation
    • rotator cuff impingement is moderate
    Diagnosis:

    • x-ray report reveals presence of cuff arthropathy


    Further treatment:

    • Vioxx 25 Mg tablet (22) ______


    • injection to (23) ______ CelestoneSoluspan (24) _______ cc.
    Part - B

    25) You hear a discussion between a physician and nurse explaining about schistosomiasis
    and its causes.
    Which of the following is the infectious form of schistosomiasis?
    A. Schistosoma mansoni
    B. Cercariae
    C. S. Haematobium

    26) You hear a discussion between two doctors about the importance of measuring serum
    amylase or serum lipase. Which of the following statements is correct?
    A. Measuring only serum amylase is adequate for diagnosing acute pancreatitis.
    B. The sensitivity and specificity of serum amylase is more than serum lipase.
    C. Serum lipase rises more quickly and remains elevated longer.

    27) You hear a discussion between two doctors about the misdiagnosing of acute
    cardiorenal syndrome as renal injury due to hypovolemia. What is the suggested method to
    differentiate acute cardiorenal syndrome & renal injury due to hypovolemia?
    A. Assessing the history of recent diuretic overuse
    B. Evaluating the urine electrolytes
    C. Diagnosing hypervolemia

    28) You hear a physician explaining to his nurse about sepsis & infection. Which of the
    following germs is also called staph?
    A. Escherichia Coli
    B. Streptococcus
    C. Staphylococcus aureus
    29) You hear a discussion between two doctors about brain imaging prior to lumbar
    puncture in the suspected cases of bacterial meningitis. Which of the following statement
    correct?
    A. Lumbar puncture should be delayed for patients with focal neurologic deficits.
    B. Can start the treatment even without a lumbar puncture with obtaining the blood culture
    report.
    C. A brain imaging should be performed for all the patients with bacterial meningitis.

    30) You hear a monologue by a physician about managing aneurysmal subarachnoid


    hemorrhage. Which of the following is a significant symptom of aneurysmal subarachnoid
    hemorrhage?
    A. Rebleeding
    B. Severe headache
    C. Cardiac and pulmonary abnormalities

    Part – C
    Extract -1

    31) Which of the following statements is correct?


    A. If the primary problem of cardiorenal syndrome is in the heart it is called renocardiac
    syndrome.
    B. Acute exacerbation of heart failure is called renocardiac syndrome.
    C. If the primary problem is not in the heart or kidneys then the condition is called
    secondary cardiorenal syndrome.

    32) Which of the following involves the end-stage kidney disease?


    A. RIFLE
    B. AKIN
    C. Acute cardiorenal syndrome
    33) Cardiogenic shock is characterized by;
    A. Worsening pulmonary
    B. Hypoperfusion
    C. Hypervolemia

    34) Which of the following statements is correct?


    A. Hypovolemic is the hallmark of acute heart failure.
    B. Worsening pulmonary is a condition in cardiogenic shock.
    C. Hypoperfusion can cause systemic organ damage.

    35) Renal perfusion is reduced in acute heart failure due to;


    A. Renal venous congestion
    B. Hypoperfusion
    C. Abrupt decrease of cardiac pump function

    36) Which of the following effects is not caused by aggravation in sympathetic


    hyperactivity?
    A. Increased renal perfusion
    B. Constriction of efferent and afferent arterioles
    C. Increased tubular sodium and water reabsorption

    Extract – 2

    37) Which of the following statements is incorrect?


    A. Anticoagulation is inevitable in the patients with endocarditis
    B. Endocarditis alone is not an indication for anticoagulation
    C. Anticoagulation may be suggested if the endocarditis patient has vein thrombosis
    38) According to the studies, anticoagulation therapy;
    A. Increased the cerebrovascular complications
    B. Prevented the growth and propagation of vegetation
    C. Increased the vegetation size

    39) Which of the following statements is incorrect?


    A. Ischemic stroke in patients who received anticoagulation was underestimated.
    B. The beneficial effects at least counterbalance the harmful effects of anticoagulation.
    C. There was no increase in the rate of hemorrhagic lesions in the patients who received
    anticoagulation therapy.

    40) The studies show that anticoagulation was beneficial;


    A. Once antimicrobial therapy had begun
    B. When the patients received warfarin before diagnosis
    C. For the patients with non native valve

    41) Which of the following statements is incorrect?


    A. Patients suspected for stroke should continue with anticoagulation therapy
    B. Patients with pathogens such as Candida spp should suspend anticoagulation therapy
    C. Anticoagulation therapy for the sole purpose of stroke prevention is not advised for the
    patients with newly diagnosed endocarditis.

    42) Low-molecular weight heparin can be given if;


    A. Surgery is considered
    B. Surgery is not anticipated
    C. In both the cases
    Answer

    PART A
    1. dizziness
    2. cold sweats
    3. IVC filter
    4. Gastrointestinal Bleed
    5. 3 weeks
    6. Gl bleed
    7. Aspirin
    8. Oxygen Saturation
    9. hotness
    10. hemoglobin
    11. clear
    12. hypertension
    13. The Past Five Months
    14. Basketball
    15. muscle relaxant
    16. Arthritis
    17. blood pressure
    18. 68
    19. Radial Pulses
    20. 2/4
    21. right
    22. once
    23. shoulder
    24. 1.0
    PART B

    25. B. Cercariae
    26. C. Serum lipase rises more quickly and remains elevated longer.
    27. A. Assessing the history of recent diuretic overuse
    28. C. Staphylococcus aureus
    29. B. Can start the treatment even without a lumbar puncture with obtaining the blood
    culture report.
    30. B. Severe headache

    PART C

    31. C. If the primary problem is not in the heart or kidneys then the condition is called
    secondary
    32. A. RIFLE
    33. B. Hypoperfusion
    34. C. Hypoperfusion can cause systemic organ damage.
    35. A. Renal venous congestion
    36. A. Increased renal perfusion
    37. C. Anticoagulation may be suggested if the endocarditis patient has vein thrombosis
    38. B. Prevented the growth and propagation of vegetation
    39. A. Ischemic stroke in patients who received anticoagulation was underestimated.
    40. B. When the patients received warfarin before diagnosis
    41. A. Patients suspected for stroke should continue with anticoagulation therapy
    42. A. Surgery is considered

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