Identify the endocrine gland that is located atop the kidney…
Questions
Identify the endоcrine glаnd thаt is lоcаted atоp the kidneys.
Mаtch the cоrrect fоrmulа tо the correct scenаrio. Caution: Not all formulas will be used.
Using the essаy spаce prоvided: Recоrd cоmplete аnd thorough admission orders for the patient with abdominal pain from Scenario C1. Scenario C1 Reference material below: Patient Door Chart and Note (for reference) Setting: Emergency Room Arrived via ambulance Patient Name: Catalina Remora Age: 15 years old Gender: Female Chief Complaint: “My belly really hurts and I was hoping it would just go away.” Triage Vital Signs: Temperature: 99.9*F / 37.7 *C Heart Rate: 109 beats per minute Blood Pressure: 140/80 mmHg Respiratory Rate: 20 breaths per minute Pulse Oximetry: 98% on RA Weight: 112 lbs / 50.8 kg Height: 63 inches / 160 cm ____________________________________________________________________________________________ History of Present Illness (HPI): Quality/Character: Dull and achy Onset: 12 hours ago Timing/Duration: Constant since onset Region/Radiation: Central abdomen with radiation to the right lower abdominal area Severity/Intensity: 9 out of 10 Aggravating Factors: The pain is aggravated by walking and changing positions Alleviating Factors: Tylenol did not help resolve the pain (last taken 8 hours ago). Precipitating Factors: No preceding trauma, injury, or event. No recent surgery or medical procedure. Associated Symptoms: Pertinent Positive: +Not feeling well overall +Nausea +Nonbilious, non-bloody vomiting (4-5 times since onset of symptoms) +Late attempted to eat solid food 3 hours ago, but has vomited since +Decreased appetite +One episode of nonbloody diarrhea 1 hour ago +Pt last ate any food/liquids last night at 8pm Pertinent Negative: No dysuria No urinary frequency LMP was one a week ago, described as “normal” No unusual vaginal discharge or bleeding No recent or new sexual contact(s) No abdominal distension Past Medical History (PMHx): Illnesses/Injuries: Asthma, L-sided Ovarian Cyst (one time in 2024) no surgical intervention was needed Hospitalizations: None prior Surgical History: None Screening/Preventive History: Pt states she is up-to-date on most vaccinations and preventative screenings, including Tdap/Tetanus (last updated 3 years ago), but denies getting any influenza or COVID vaccinations yet this year Medications (Prescription, Over the Counter, Supplements): -OTC Tylenol for pain (500mg PO TID) -Albuterol MDI inhaler 90mcg/actuation - 1-2 puffs PO PRN asthma symptoms q 4-6 hrs Allergies (e.g. environmental, food, medication and reaction): -Penicillins and cephalosporins (anaphylaxis with facial/throat swelling) Family Medical History: Mother (alive, age 49) has history of “high blood pressure” Father (alive, age 50) has history of “high blood pressure, overweight, and high cholesterol” Brother (alive, 18) healthy No genetic disorders known in family Social History: Substance Use / Alcohol Use: No tobacco/vape, substance use, or alcohol use reported. Diet: Regular diet - (pt last ate last night at 8pm) Home Environment: Lives with parents in a two-story home Occupation: Student Leisure Activities: Running, volleyball, riding her bicycle, and surfing Exercise: Active Sleep: 7-8 hours per night Religion: Jewish Sexual/Women’s Health: Not currently sexually active. LMP 1 week ago, normal menstrual cycles each month. G0P0. ROS (Review of Systems): General: Subjective chills currently. No weight loss/gain or night sweats. Skin: No rashes, jaundice, erythema, eczema, or skin changes reported. HEENT: No headache, neck pain/stiffness, no sore throat. No vision changes or congestion/runny nose. Respiratory: No cough, shortness of breath or wheezing. No DOE or orthopnea. Cardiovascular: No chest pain or palpitations. Gastrointestinal: See HPI and associated symptoms. No BRBPR or melena reported. No constipation. Pt still passing gas. No reported flank pain. Genitourinary: No change in urination, dysuria, hematuria, or increased urinary frequency. Musculoskeletal: No back pain or neck pain reported. No joint swelling, pain, or warmth reported. No ROM limitations reported. Hematologic: No known easy bruising/bleeding, or gum bleeding. Neurologic: No HA, confusion, disorientation. No numbness or weakness. Physical Exam: General: Pt appears uncomfortable, in mild painful distress, and wearing normal street clothes on arrival. Pt is a WDWN female otherwise. Pt is alert, oriented appropriately, and cooperative. Skin: Warm and dry skin, no rashes, lacerations, or abrasions. No ecchymoses of the skin, no jaundice of the skin. Pt has normal skin turgor without pallor or cyanosis throughout, including distal extremities. Head: Normocephalic, atraumatic. Eyes: PEERLA B/L, sclera anicteric, conjunctiva clear. Ears, Nose, Throat: Normal ear, nose, and throat inspection. No pharyngeal erythema or lymphadenopathy noted. Ear canals patent B/L. Hearing grossly intact B/L. No hemotympanum, raccoon eyes, Battle sign, or otorrhea noted. Pulmonary: Lungs clear to auscultation B/L, no crackles, wheezes, or rhonchi. Cardiac: Tachycardic rate noted with normal rhythm. No murmurs, gallops, or rubs otherwise. Normal S1 and S2. Peripheral Vascular: Capillary refill brisk (less than 2 seconds) throughout distal extremities bilaterally. Peripheral pulses full and equal bilaterally at all major pulse points. Abdomen: Soft, non-distended, with tenderness noted to periumbilical and RLQ areas. Some guarding noted when palpating RLQ without rebound. +McBurney’s point tenderness. Negative Rovsing’s sign. Negative Murphy’s sign. Hypoactive bowel sounds present in all 4 quadrants. Rectal: Deferred GU: Normal external genitalia without evidence of trauma or injury. MSK: Full active and passive ROM in UE/LE (upper and lower extremities) bilaterally without pain, stiffness or edema/effusion. Symmetrical musculature without deformities. Adequate muscle size and tone. No tenderness, masses, lesions, or deformities noted throughout all extremities. +Obturator sign of right leg on detailed examination. Neuro: Pt is AAOX4. Sensation equal and intact throughout all extremities. Strength 5/5 all extremities at major joints. Gait slow (due to apparent abd pain with ambulation), but otherwise WNL. No ataxia. Reflexes 2+ in all extremities. No tremor noted. Psychiatric: Appropriate mood and affect; noted anxiety related to current pain and situation. Interventions completed thus far in the ER: -18 gauge IV inserted to R arm with 1L IVF (Lactated Ringer’s) running currently @ 500cc/hr -2.5mg IV Morphine x 1 dose for pain -4mg Zofran IV x 1 dose for nausea that developed after giving pain medication Note: It was shared by the patient’s nurse that the patient’s pain and nausea improved after the above two interventions. -Labs ordered: CBC, CMP, Lipase, Urinalysis, and urine b-hCG (urine pregnancy test); as well as imaging as noted below Diagnostic Imaging: Transabdominal Ultrasound Interpretation: “This transabdominal ultrasound demonstrates a noncompressible, enlarged appendix measuring 1.36 cm in diameter (>6 mm is abnormal), peri-appendiceal free fluid, hyperechoic mesenteric fat, and tenderness of the RLQ with compression of the ultrasound probe. No ovarian cyst(s) noted and no other visualized abnormalities seen.” Additional Learner Materials Pediatric General Surgery Consultant Response and Recommendations (via Text Message to you): “For Catalina Remora (your patient with abdominal pain), it looks like we can add this case for later today once the next available operating room is clean and ready. My team is about to start a cholecystectomy case and will be available afterwards. Please ensure that the patient is NPO effective immediately in preparation for surgery later... Additionally, since I don’t have the pt’s chart in front of me, I’ll also need you to place the following orders prior to this pt’s surgery: Please order and start ceftriaxone and metronidazole IV as empiric antibiotics for this patient. Lastly, please order a blood type and screen lab for pre-op purposes. We will need that lab before we go to surgery. Please add any routine admission orders as you see necessary. For questions or concerns, please contact me.” Dr. Jason Lee, MD - Pediatric General Surgeon