Tamoxifen case on Endometrial Adenocarcinoma (MCQ)

Question

A 46-year-old female presents with irregular menstrual bleeding that has persisted recently. Her medical history consists of
2 full-term pregnancies and
invasive ductal carcinoma of the breast that was successfully treated with tamoxifen. 
She was recently diagnosed with type 1 endometrioid adenocarcinoma.

Which of the following factors most likely increased this patient's risk for developing this cancer?
  • A. Family history of breast cancer.
  • B. Oral contraceptive use.
  • C. Her pre-premenopausal stat.
  • D. multiple pregnancies.
  • E. Tamoxifen used to treat breast cancer.

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Accumulating in this patient’s alveoli (MCQ)

Question

A patient presents with a constant cough. A CT SCAN of the thorax reveals diffuse infiltrates in an alveolar pattern. The patient is known to be suffering from idiopathic pulmonary hemosiderosis.
Which of the following substances would be expected to be accumulating in this patient's alveoli secondary to the disease caused by idiopathic pulmonary hemosiderosis?

  • A. Glandular cells.
  • B. White blood cells.
  • C. Schiff positive materials
  • D. Cardiogenic pulmonary edema
  • E. Red blood cells.

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Help identify this distinct subset of scleroderma!! (MCQ)

Question

A 49-year-old man, full-time ceramic sculptor, presented with increasing numbers of firm indurated plaques that produced a band-like tightening on his abdomen, which diminished his appetite and impaired his ability to breathe. His disease progressed to involve his upper thighs and lower legs, limiting his ability to walk.
He also complained of extensive esophageal reflux but no history suggestive of Raynaud's phenomenon.
On physical examination, the upper extremities demonstrated diffuse firm, indurated plaques from the dorsal hands to the shoulders .
There was extensive tightening and induration of the skin on the abdomen, back upper buttock, and the lower extremities from the hips down to the dorsal feet, with sparing of his face.
He was suspected of having a distinct subset of scleroderma characterised by the absence of vasculopathy, a male predisposition and more frequent tower gastrointestinal in votvements .

Which antibody when negative , helps identify this distinct subset of scleroderma?

  • A. ANCA.
  • B. Rheumatoid factor.
  • C. Anti centromere .
  • D. Antinuclear antibody.
  • E. Anti Fibroblast antibodies.

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Continuous IV Checklist

Administering Intravenous Push Medication Through an Existing Infusion (Continuous IV)

1.

Start hand hygiene and wear a suitable glove.

2.

Check doctor order and review patient file for allergies.

3.

Check medication compatibilities with current active medications.

4.

Verify rate of administration.

5.

Start preparing the required dose.

6.

Verify correct patient.

7.

Assess IV for signs and symptoms of infiltration or phlebitis (and if present, stop until new IV site is obtained).

8.

Turn off IV by turning off pump and/or clamping the tubing directly above the access port.

9.

Swab access port with alcohol or other antiseptic agent according to institutional policy.

10.

If medication is not compatible with IV solution, flush IV line with 2 to 5 mL of normal saline before administration of medication. If medication is compatible with IV solution, normal saline flush is not necessary; continue to next step.

11.

Connect medication syringe to access port via needleless adaptor.

12.

Pull back on plunger of syringe to observe blood return (which verifies placement of IV in vein).

13.

Gently instill medication over required time frame (typically 2 to 5 minutes).

14.

Assess patient carefully during administration for any adverse reactions.

15.

Disconnect syringe when medication is completed.

16.

Flush IV line with 3 to 5 mL of normal saline, instilling at same rate of medication administration in order to administer the medication left in tubing at proper infusion rate.

17.

Turn IV back on or unclamp tubing, then readjust rate appropriately.

18.

Dispose of syringe in sharps container.

19.

Remove gloves, perform hand hygiene, and document medication administration.

How tech is transforming healthcare

How tech is transforming healthcare

1

Wearables

Data captured from health devices could provide precious information to provide accurate care to the patients.
As we noticed wearable gadgets are increasing in numbers as well as accuracy.

2

Augmented Reality

Allowing the healthcare providers to jump instantly between patients, or view organs, or even project radiology images over the body during operations to reduce mistakes.
Combining live video-streaming with Augmented Reality surgeons carrying out operations are able to consult the other side of the world. Who says that you can’t be in two places at once?

3

Online Consultation

The patient, who can afford it, can always consult with their preferred healthcare providers online and even afford a sort of on-call medical service, other than emergency services.

First Order Vs. Zero Order Kinetics

Trying to understand first order and zero order kinetics

{My own study points.}

First Order Kinetics

  • Higher plasma concentrations means higher metabolization rate.
  • Metabolism is directly proportional with drug concentrations.
  • Drug is eliminated from the body related to the plasma levels.
  • Constant half-life. (Metabolize 50% of drug)

Zero Order Kinetics

  • Higher plasma concentrations doesn't mean higher metabolization rate.
  • Metabolism is independent from plasma concentrations.
  • Drug concentration in the body increase with time disregarding the elimination rate leading to toxic side effects.
  • Constant rate of drug metabolism.

Conclusion:

First order is Good, Zero order is BAD.

First order is occurring with most medications.


First order: constant proportion of the drug is eliminated per unit time.
Zero order: constant amount of the drug is eliminated per unit time.

ISBAR

The communication structure Identify, Situation, Background, Assessment and Recommendation (ISBAR) was created to standardise the effective transfer of information in the US armed forces. ISBAR was adopted by the public health service in the 2000s

ISBAR STRUCTURE

POSSIBILITIES

Identify

Introduction (Hello Dr. my name is) 

  • Who are you?
  • Where are you?
  • Patient's name, age, gender and department

Situation

Situation (What’s this about?) 

  • I'm calling because... (describe)
  • I have observed major changes... (ABCDE)
  • I have measured the following values...
  • (RR*, Sp020, pulse/heart rhythm, BPA, capillary refill time, etc...)
  • I have received test results...

Background

Background (Brief & pertinent info) 


If it's urgent and/or you are concerned — speak up.

Brief and relevant case history


Admission diagnosis and date

Previous illnesses of significance

Relevant problems and treatment/interventions to date

Allergies

Assessment

Assessment (Your analysis and consideration of options) 

  • I think the problem/reason for the patient's condition is related to (respiration, circulation, neurology).
  • I don't know what the problem is but the patient's condition has deteriorated.
  • The patient is unstable, we need to do something.
  • I am concerned.

Recommendation

Recommendation (What do you want the physician to do?)

I suggest.../What interventions do you recommend?

  • Immediate intervention
  • Investigation/treatment
  • How often should I...

When should I next make contact? When will you be here?

Confirm messages and interventions with a closed loop.

TUMOR FDG-PET/CT IMAGING

EXAMINATION: TUMOR FDG-PET/CT IMAGING

SCANNER: Biograph mCT flow PET/CT

RADIOPHARMACEUTICAL: 9.9 mCi F-18 Fluorodeoxyglucose (FDG) I.V.

HISTORY: 43 – year – old male with intra-abdominal leiomyosarcoma. S/P laparotomy exploration and removal of tumor on 10/7/2018, followed by 2 cycles of chemotherapy.

Restaging CT dated 17/9/2018 showed peripherally enhancing rounded necrotic residual lesion in the left upper quadrant has decreased from 6.3 x 5.4 cm to 4.8 x 3.6 cm, and stable multiple (at least 5) hypodense hepatic lesions in both liver lobes measuring up to 2.5 x 2.3 cm. The study is requested for restaging , and monitoring response to therapy.

TECHNIQUE: The patient fasted for more than 6 hours. His fasting blood glucose level, measured by glucometer before injection of FDG, was 79 mg/dL. While he lay quietly in a room Plain water (1.2 L) was given as a negative contrast after the FDG injection. A low dose – noncontrast CT scan was acquired for attenuation correction and for fusion with emission PET images to allow for anatomical localization of PET findings, and not for diagnostic purposes. Emission PET images were then obtained. The area imaged spanned the region from the skull vertex to the proximal thighs with the arms positioned above the head. The time from injection of FDG to start of imaging was 40 minutes. Transverse image reconstruction using an iterative algorithm was performed with reoriented tomograms displayed in the transaxial, coronal and sagittal planes.

FINDINGS:

ABDOMEN AND PELVIS:

  • 1
    walled hypodense left hydrochondrial mesenteric cystic lesion noted abutting the wall of splenic flexure of colon. It measures about 4.4 x 3.4 cm and showed only mild peripheral FDG-avidity at its thick wall (SUV max of about 2) with cold non-FDG-avid center.
  • 2
    Preexisting multiple hypodense hepatic lesions noted at both liver lobes, currently has no corresponding pathological FDG-avidity, probably benign i.e. hemangioma.
  • 3
    Mildly FDG-avid midline upper anterior abdominal wall healing surgical scar noted.
  • 4
    The Spleen, pancreas, and adrenal glands are unremarkable regarding any pathological FDG avid lesions.
  • 5
    Both kidneys showing physiological FDG excretion that drains into urinary bladder.
  • 6
    The stomach and bowel show physiological FDG-activity.
  • 7
    There is no sizable FDG-avid lymphadenopathy seen in the abdomen and pelvis

HEAD AND NECK:

  • 1
    On the PET study, physiological FDG activity in the surveyed parts of brain gray matter is noted
  • 2
    Bilateral FDG uptake in the medial and lateral rectus extraoccular muscles, and mylohyoid muscles which is physiological in nature.
  • 3
    Foci of brown fat uptake noted at the neck
  • 4
    Diffuse physiological FDG uptake is noted in the soft palate, tonsils, parotid, submandibular salivary glands, and vocal cords.
  • 5
    No significant FDG-avid sizable cervical or supraclavicular lymph nodes, apart from few small, mildly FDG avid likely reactive nodes.
  • 6
    FDG-avid hypodense right thyroid lobe nodule measures about 1 x 0.7 cm cm and has SUV max of 5.97 noted.

CHEST:

  • 1
    The chest wall is devoid of any metabolic activity or sizable FDG avid pathological lesions
  • 2
    Both lung fields show unremarkable FDG metabolic activity, with no FDG-avid sizable lung nodules.
  • 3
    No FDG-avid sizable lymphadenopathy in the mediastinal, hilar or axillary regions.
  • 4
    Physiological uptake is seen in the myocardium.

CHEST:

  • 1
    There are no FDG-avi​​​​d osseous lesions at the surveyed parts of the skeleton.
  • 2
    Non-FDG-avid few small sclerotic densities noted both iliac wings and neck of left femur, probably benign bone islands for follow up.

CONCLUSION:
The current PET/CT study demonstrates:

  • Thick walled hypodense left hydrochondrial mesenteric cystic lesion noted abutting the wall of splenic flexure of colon, with mild peripheral FDG-avidity at its thick wall, probably residual/recurrent/metastatic lesion vs post-operative sequel for follow up.
  • Preexisting multiple hypodense hepatic lesions noted at both liver lobes, currently has no corresponding pathological FDG-avidity, probably benign i.e. hemangioma for follow up.
  • Non-FDG-avid few small sclerotic densities noted both iliac wings and neck of left femur, probably benign bone islands for follow up.
  • Incidental finding of hypermetabolic right thyroid lobe nodule for further evaluation with high resolution neck U/S, TFT, and serum TG.

Chemotherapy Compatibility Chart

Next update will be adding a new page under projects; that will be including a compatibility chart for chemotherapy preparations versus different intravenous fluids.

It should look like the image below...

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