The question that needs answering is at the bottom, most of what is here is just

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The question that needs answering is at the bottom, most of what is here is just for the info needed to answer it

Part I—Trouble Sleeping Prompts an Urgent Doctors Appointment Scenario

This morning at 4 a.m. Mary Keeper woke up with yet another throbbing headache and decided she couldn’t stand it anymore—she needed to see a physician. She not only has this headache, but her eyes have been bothering her and her right wrist has hurt constantly for about a week and she does not know why. She did She took some Tylenol® and then spent the rest of the morning lying on her couch drinking several glasses of water (10 glasses altogether) until the physician’s office opened that morning.

She made an urgent appointment to see Dr. Nee. Physical Examination Vital Signs

Age: 41 years old

Weight: 120 lbs

Height: 5 6

Temperature: 36.9°C

Pulse: 90 beats/minute

Respirations: 16 breaths/minute

Blood Pressure: 126/75 (systolic/diastolic) mmHg General Appearance

Skin is warm and moist

Looks fatigued Head and Neck

Bitemporal hemianopsia (blindness in her lateral visual fields) Lungs

Normal Cardiovascular

Normal Abdomina

l No swelling or pain is present but patient mentions she has had diarrhea Musculoskeletal

An X-ray reveals a small hairline fracture in the right scaphoid bone

Physician Comments There is a slight weight loss (10 lbs.) from her last appointment (10 months ago); however, the patient indicates that she has a good appetite and good nutritional habits. She indicates that she has been having re-occurring headaches this past month, which have led to problems sleeping. A blood chemistry, thyroid, and endocrine test are ordered. A follow-up appointment is arranged for the next week to review the blood lab results.

Part II—The Follow-up Visit Scenario Mary has been on “pins and needles ” the past week waiting for her blood results. Finally, Dr. Nee knocked, entered the examination room, and pulled a stool over to Mary. He sat down next to her and opened the manila folder labeled “Keeper, Mary—Blood Results.” Blood Lab Results Abbreviated Blood Chemistry

Osmolality: 240 mOsm/kg/water

Urea nitrogen: value is within normal limits

Calcium: value is above the normal limits Blood Thyroid

T3-total: value is above the normal limits

T4-total: value is above the normal limits

TBG: value is below the normal limits

TSH: value is below normal limits

TSI: present and high Blood Endocrine

ACTH: value is below the normal limits

Physician Comments Additional hematology tests are ordered and a follow-up appointment is arranged for the following week.

Part III—Help Dr. Nee Explain His Diagnosis Scenario Dr. Nee knocked on the examination room door and entered. Immediately, he told Mary that the additional blood work helped immensely with his diagnosis.

Blood Lab Results TRH: value is below the normal limits

PTH: value is above the normal limits

LH: value is above the normal limits

Estrogen: value is above the normal limits

FSH: value is above the normal limits

GHrH: value is above the normal limits

GH: value is below the normal limits

GnRH: value is below the normal limits

5. Provide a good rationale to explain Mary’s particular vision complications

Explanation / Answer

Answer:

5. Mary experiences bitemporal hemianopsia which is a very common result from pituitary tumors. Mary portrays blindness in her lateral visual fields.

A pituitary tumor causes your body to produce a very low level of hormone or too much hormone in Mary’s case. Some symptoms include unexplained weight loss, visual field loss, weakness and headaches. These specific symptoms leading to a pituitary tumor are the primary symptoms Mary has been experiencing the past few weeks.

One of the factors is whether the tumor is causing vision problems due to spreading of the tumor into the brain or spinal cord. Further tests are done to rule out if the tumor is, or is not, spreading into the central nervous system and that is done with an MRI.

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