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A five-month-old Caucasian female is brought into the clinic as the parent complain that she has been having ongoing foul-smelling , greasy diarrhea. She seems to be small for her age and a bit sickly but, her parent’s state that she has a huge appetite. Upon examination you find that the patient is wheezing and you observe her coughing. 

· Write a differential diagnosis of at least three (3) disorders and explain why each might be a possibility and any potential weaknesses of each differential.

· Why is it that the later in age this disease manifest itself, the less severe the disease is?

· What tests would you run to clarify your differential and potentially come to a definitive diagnosis?

· If the same child was African in ancestry would this change your initial differential? Why or why not? 

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Tammy is a 33-year-old who presents for evaluation of a cough. She reports that about 3 weeks ago she developed a “really bad cold” with rhinorrhea. The cold seemed to go away but then she developed a profound, deep, mucus-producing cough. Now, there is no rhinorrhea or rhinitis—the primary problem is the cough. She develops these coughing fits that are prolonged, very deep, and productive of a lot of green sputum. She hasn’t had any fever but does have a scratchy throat. Tammy has tried over-the-counter cough medicines but has not had much relief. The cough keeps her awake at night and sometimes gets so bad that she gags and dry heaves.

· Write a differential of at least three (3) possible diagnosis’s and explain how each may be a possible answer to the clinical presentation above. Remember, to list the differential in the order of most likely to less likely.

· Based upon what you have at the top of the differential how would you treat this patient?

· Suppose now, the patient has a fever of 100.4 and complains of foul smelling mucous and breath. Indeed, she complains of producing cups of mucous some days. She has some trouble breathing on moderate exertion but this is only a minor complaint to her. How does this change your differential and why? à Bronchiectasis p. 1256 can happen after an infection

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A nursing student comes into your office because they are struggling with the concept of pulmonary function. They know you as an experienced FNP and so they are comfortable asking if you could clarify the terms residual volume (RV), functional reserve capacity (FRC), total lung capacity (TLC) inspiratory reserve volume (IRV), and expiratory reserve volume (ERV).

1. Give her a definition of each?

2. List three (3) disorders that can alter the residual volume and explain how they do so?

1. At the arterial end of capillaries, fluid moves from the intravascular space into the interstitial space because the (Points : 2)

2. Physiologic pH is maintained around 7.4 because bicarbonate (HCO3) and carbonic acid (H2CO3) exist in a ratio of (Points : 2)

3. When thirst is experienced, how are osmoreceptors activated? (Points : 2)

4. Chvostek sign and Trousseau sign indicate (Points : 2)

5. Which are indications of dehydration? (Points : 2)

6. In hyperkalemia, cardiac rhythm changes are a direct result of (Points : 2)

7. Water movement between the intracellular fluid compartment and the extracellular compartment is primarily a function of (Points : 2)

8. In tuberculosis, the body walls off the bacilli in a tubercle by stimulating (Points : 2)

9. Pulmonary edema usually begins at a pulmonary capillary wedge pressure or left atrial pressure of _____ mm Hg. (Points : 2)

10. Which inflammatory mediators are produced in asthma? (Points : 2)

11. The most successful treatment for chronic asthma begins with (Points : 2)

12. Which pleural abnormality involves a site of pleural rupture that act as a one-way valve, permitting air to enter on inspiration but preventing its escape by closing during expiration? (Points : 2)

13. _____ is a fulminant form of respiratory failure characterized by acute lung inflammation and diffuse alveolocapillary injury. (Points : 2)

14. In ARDS, alveoli and respiratory bronchioles fill with fluid as a result of the (Points : 2)

15. Clinical manifestations that include unexplained weight loss, dyspnea on exertion, use of accessory muscles, and tachypnea with prolonged expiration are indicative of (Points : 2)

16. Clinical manifestations of pulmonary hypertension include (Points : 2)

17. Dyspnea is not a result of (Points : 2)

18. High altitudes may produce hypoxemia through (Points : 2)

19. Chest wall compliance in infants is _____ in adults. (Points : 2)

20. What is the primary cause of RDS of the newborn? (Points : 2)

21. An accurate description of childhood asthma is that it is a(n) (Points : 2)

22. Cystic fibrosis (CF) is caused by a(n) (Points : 2)

23. Which of the following statements about the advances in the treatment of RDS of the newborn is incorrect? (Points : 2)

24. Which of the following types of croup is most common? (Points : 2)

25. Which immunoglobulin is present in childhood asthma? (Points : 2)