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Which of the following is NOT representative of endocrine glands?

Second messenger signaling systems produce small but rapid target cell effects.

Patient anxious and diaphoretic. Complains of 8/10 midsternal chest pain. RR 26. O2 sat 95%. BP 150/90.  Your priority actions should include which of the following? (Select all that apply)

pH: 7.50 PaCO2: 43 PaO2: 88 HCO3: 33 O2 Sat: 90%

A ______________ is a stimulus that becomes a punisher through pairing with an unconditioned or previously conditioned punisher.

A discriminative stimulus (SD) evokes behavior because it signals the availability or non-availability of reinforcement in the [answer1]. Whereas motivating operations (specifically establishing operations) increase the value of a reinforcer in the [answer2].

You are seeing a 68-year-old male with hypertension and non-ischemic cardiomyopathy in the clinic today. He has the diagnosis of heart failure with reduced ejection fraction (HFrEF). An echocardiogram one month ago showed left-ventricular hypertrophy and a left-ventricular ejection fraction (LVEF) of 36%. He takes sacubitril/valsartan 97/103 mg (Entresto) BID and carvedilol (COREG) 12. 5 mg PO BID. His pulse is 68 beats/minute, blood pressure is 134/88 mmHg, and oxygen saturation is 95% on two liters of oxygen by nasal cannula. His weight is up 8 pounds from his last clinic appointment. His physical exam is notable for jugular venous pulse and pressure (JVP) of 12, bilateral leg edema, and crackles at his lung bases. What will be the next step in management of this man?

You have been the PCP for MA, a 72 year old female, for the past 3 years.  Her 2 daughters brought her to clinic today.  MA currently lives in her own home alone and her daughters live in the same town.  Her daughters are concerned because MA has been more forgetful and recently had trouble driving home from church.  She got lost and had to stop several blocks from home to ask how to get to her address, which she did remember. They have noticed these changes for the past year or so, and more often lately.  She denies headaches, chest pain, and palpitations. lightheadedness, SOB or loss of consciousness.  MA states that she has been eating well, sleeping well, she enjoys a glass of wine with friends every other week or so. Her husband of 46 years died 4 years ago.  She has stayed active in her community and in her church.  She has generally been in good health and has regular health care, follow up.  She misses her husband but has generally been in good spirits.  PMH:  Stable hypothyroid – diagnosed 8 years ago Complete PE:  results within normal limits Medications:  Levothyroxine 50 mcg daily, no other medications, herbs or supplements Labs (2 days ago):  CBC, CMP, TSH, vitamin B12, folate:  normal.  Lipids, mildly elevated (you and MA have chosen not to treat with medication) EKG:  NSR, no ectopy You are concerned about the potential for early dementia. You review the chart, talk to the patient and family, and consider the following in your diagnosis:

A 56-year-old female with non-ischemic heart failure and hypertension presents to the office for a routine follow-up. Her last hospitalization for a congestive heart failure (CHF) with HFrEF (reduced ejection fraction) exacerbation was two years ago. She is currently not complaining of shortness of breath, orthopnea, lower leg edema, or chest pain. She has been following a low-salt diet and does not drink alcohol. Medications:  carvedilol, 81 mg asa Home blood pressure measurements have ranged from 140-150/80-90 mmHg Physical exam findings: Blood pressure: 150/90 mmHg Heart rate: 60 beats/minute, S1S2 with no murmurs or gallops Her respiratory rate is 12/minute Her jugular venous pulse and pressure (JVP) is within the normal range and her lungs are clear bilaterally Her point of maximal impulse (PMI) is laterally displaced What medication should you add that can also improve her mortality from heart failure?

A 28-year-old female returns to the clinic to see you. You initially treated her for moderate depression with fluoxetine (Prozac), an SSRI, 20 mg daily. You recommended a follow up visit in 3-4 weeks. She missed that appointment, she was feeling less depressed and canceled her appointment.   Two months have gone by, she called your office this morning and asked to schedule an appointment with you.  She is feeling a bit “crazy and manic” on the fluoxetine.  She is rushing around, laughing a lot, and experiencing more anxiety. She has a family history of severe mood swings, she passed it off as just that. Based on this information, what is the most likely, or leading diagnosis for this person: