By V. Faesul. Longwood College. 2018.

False-positive reagent strip test a positive reaction is always considered significant C generic 40mg imdur free shipping. Galactosuria should not be used to confirm a positive glucose oxidase test because it is not as specific or as Body fluids/Evaluate laboratory data to determine sensitive cheap 40 mg imdur overnight delivery. Reducing sugar tests are used to screen possible inconsistent results/Urine glucose/2 infants for inborn errors of carbohydrate metabolism 41 quality imdur 40 mg. A negative glucose oxidase test and a positive test such as galactosuria but are not used to screen for for reducing sugars in urine indicates: glycosuria. Te presence of a nonglucose reducing sugar including several sugars and antibiotics, may react, such as galactose making the test inappropriate as a screening test for D. A positive test for reducing sugars seen with Body fluids/Evaluate laboratory data to determine a negative glucose oxidase test may occur in lactose, possible inconsistent results/Urine glucose/2 galactose, and fructosuria and other disorders of 42. Excessive use of vitamin C low estimate of serum or urine ketones in diabetic Body fluids/Apply knowledge to identify sources of ketoacidosis. Ketonuria has many causes other than error/Urinary ketones/2 diabetic ketoacidosis such as pregnancy, fever, protein calorie malnutrition, and dietary carbohydrate 43. A Urinary ketones are detected using alkaline sodium Body fluids/Apply principles of basic laboratory nitroprusside (nitroferricyanide). Nondiabetic ketonuria can occur in all of the and some antibiotics with the classical tube test. Lactate acidosis carbohydrate restriction, alkalosis, lactate acidosis, and von Gierke disease (glycogen stores cannot Body fluids/Correlate clinical and laboratory data/ be utilized). Ketonuria also occurs in pregnancy, Urinary ketones/2 associated with increased vomiting and cyclic fever. Which of the following statements regarding the Answers to Questions 45–49 classical nitroprusside reaction for ketones is true? It may be falsely positive in phenylketonuria (phenylketonuria) will cause a false-positive D. Te reaction is recommended for diagnosing reaction in the classical nitroprusside reaction but ketoacidosis do not usually interfere with the dry reagent strip test for ketones. Serum ketones can be measured Body fluids/Apply knowledge to identify sources of by gas chromatography, and β-hydroxybutyric acid error/Urinary ketones/2 can be measured enzymatically. Hemoglobin in urine can be differentiated from assay for β-hydroxybutyrate in plasma is the myoglobin using: recommended test for diagnosing ketoacidosis A. Which of the following conditions is associated confirms the presence of myoglobin. Calculi of the kidney or bladder does not rule out hemoglobin as the cause of a B. Extravascular hemolytic anemia lower urinary tract bleeding, intravascular hemolytic Body fluids/Correlate clinical and laboratory data/ anemia, and transfusion reaction. Extravascular Hematuria/2 hemolysis results in increased bilirubin production rather than plasma hemoglobin. Which statement about the dry reagent strip blood increased urobilinogen in urine but not a positive test is true? Hemoglobin has when the reaction is positive peroxidase activity and catalyzes the oxidation of C. Salicylates cause a false-positive reaction whereas visible hemolysis does not occur unless free Body fluids/Apply principles of basic laboratory hemoglobin exceeds 20 mg/dL. Recent urinary tract catheterization pyelonephritis, polycystic kidney disease, renal calculi, bladder and renal cancer, and postcatheterization of Body fluids/Correlate clinical and laboratory data/ the urinary tract. Negative blood, positive protein Therefore, a small blood reaction (nonhemolyzed or moderately hemolyzed trace, trace, or small) usually Body fluids/Apply knowledge to recognize sources of occurs in the absence of a positive protein. A positive test for and posthepatic jaundice protein and a negative blood test occurs commonly B. Te test detects only conjugated bilirubin in conditions such as orthostatic albuminuria, urinary C. Standing urine may become falsely positive due tract infection, and diabetes mellitus. However, a to bacterial contamination negative blood test should not occur if more than D. Very few drugs have been Body fluids/Apply principles of basic laboratory reported to interfere with urine bilirubin tests, which procedures/Urine urobilinogen/1 are based upon formation of azobilirubin by reaction with a diazonium salt. Bacteria may cause hydrolysis of glucuronides, forming unconjugated bilirubin, which does not react with the diazonium reagent. Dry reagent strips use either p-dimethylaminobenzaldehyde or 4-methoxybenzene diazonium tetrafluoroborate to detect urobilinogen. False-positive results may occur in the presence of Pyridium and Gantrisin, which color the urine orange-red. Which of the following statements regarding Answers to Questions 53–56 urinary urobilinogen is true? C Urobilinogen exhibits diurnal variation, and highest in the early morning levels are seen in the afternoon.

King N discount 40 mg imdur with mastercard, Tonge B buy imdur 40 mg mastercard, Heyne D buy imdur 40 mg without a prescription, Pritchard M, Rollings S, Young D, Myerson N, Acad Child Adolesc Psychiatry 2004, 43:46-62. J Am Acad Child Adolesc Psychiatry 1998, of post-traumatic stress disorder in children using cognitive 37:395-403. Richardson T, Stallard P, Velleman S: Computerised cognitive behavioural the role of parental involvement. J Am Acad Child Adolesc Psychiatry therapy for the prevention and treatment of depression and anxiety in 1999, 38:1223-1229. Nauta M, Scholing A, Emmelkamp P, Minderaa R: Cognitive-behavioral delivered cognitive-behavioral therapy for youth with obsessive- therapy for children with anxiety disorders in a clinical setting: no compulsive disorder. Kendall P: Treating anxiety disorders in children: results of a Psychiatry 2003, 42:1270-1278. Kendall P, Flannery-Schroeder E, Panichelli-Mindel S, Southam-Gerow M, and adolescents with clinical anxiety disorders. J Am Acad Child Adolesc Henin A, Warman M: Therapy for youths with anxiety disorders: a Psychiatry 2006, 45:134-141. Geller D, Hoog S, Heiligenstein J, Ricardi R, Tamura R, Kluszynski S, cognitive behavioral therapy for child anxiety disorders. J Am Acad Child Jacobson J: Fluoxetine treatment for obsessive-compulsive disorder in Adolesc Psychiatry 2006, 45:314-321. Riddle M, Scahill L, King R, Hardin M, Anderson G, Ort S, Smith J, therapy and psychoeducation/relaxation training for child obsessive- Leckman J, Cohen D: Double-blind, crossover trial of fluoxetine and compulsive disorder. J Am Acad Child Adolesc Psychiatry 2011, placebo in children and adolescents with obsessive-compulsive 50:1149-1161. J Am Acad Child Adolesc adolescents with obsessive-compulsive disorder: a preliminary report. Levy K, Hunt C, Heriot S: Treating comorbid anxiety and aggression in adolescents with obsessive-compulsive disorder: a randomized, children. Barrett P, Duffy A, Dadds M, Rapee R: Cognitive-behavioral treatment of Reichler R, Katz R, Landau P: Clomipramine hydrochloride in childhood anxiety disorders in children: long-term (6-year) follow-up. Practice parameter on the use of psychotropic medication in children blind crossover comparison. Practice parameter for the assessment and treatment of children and Linnoila M: Clomipramine treatment of childhood obsessive-compulsive adolescents with obsessive-compulsive disorder. Birmaher B, Axelson D, Monk K, Kalas C, Clark D, Ehmann M, Bridge J, Hamilton J, Keable H, Kinlan J, Schoettle U, et al: Practice parameter for Heo J, Brent D: Fluoxetine for the treatment of childhood anxiety the assessment and treatment of children and adolescents with disorders. Bernstein G, Borchardt C, Perwien A, Crosby R, Kushner M, Thuras P, Last C: Anxiety Study Group. Wagner K, Berard R, Stein M, Wetherhold E, Carpenter D, Perera P, Gee M, school refusal. Compton S, Grant P, Chrisman A, Gammon P, Brown V, March J: Sertraline pharmacotherapeutic agents for anxiety disorders in children and in children and adolescents with social anxiety disorder: an open trial. Coskun M, Zoroglu S: Efficacy and safety of fluoxetine in preschool the treatment of children with generalized anxiety disorder. A of children and adolescents with posttraumatic stress disorder: a review of epidemiological studies across the adult life span. Biederman J: Clonazepam in the treatment of prepubertal children with service utilization. Psychiatr Serv 2012, alprazolam in children and adolescents with overanxious and avoidant 63:66-72. Mehta K, Simonsick E, Penninx B, Schulz R, Rubin S, Satterfield S, Yaffe K: a glutamate antagonist, in children with treatment-resistant obsessive- Prevalence and correlates of anxiety symptoms in well-functioning compulsive disorder. Bryant C, Jackson H, Ames D: The prevalence of anxiety in older adults: A randomized controlled trial of telephone-delivered cognitive- methodological issues and a review of the literature. Montgomery S, Chatamra K, Pauer L, Whalen E, Baldinetti F: Efficacy and Psychiatry 2012, 27:549-556. Karaiskos D, Pappa D, Tzavellas E, Siarkos K, Katirtzoglou E, generalized anxiety disorder in primary care. Wylie M, Miller M, Shear M, Little J, Mulsant B, Pollock B, Reynolds C: 60:218-229. Gardner M, Malone D, Sey M, Babington M: Mirtazapine is associated anxiety disorder: two pilot investigations. Am J Geriatr Psychiatry 2003, with less anxiolytic use among elderly depressed patients in long-term 11:24-32. Schatzberg A, Kremer C, Rodrigues H, Murphy G: Double-blind, Cognitive-behavior therapy for late-life generalized anxiety disorder in randomized comparison of mirtazapine and paroxetine in elderly primary care: preliminary findings. Am J aged and older adults with anxiety disorders: a longitudinal and Geriatr Psychiatry 2011, 19:347-356.

This is followed by inhalation of a radiola- beled aerosol for the ventilation portion of the study buy 40 mg imdur fast delivery. The scans are graded as normal generic imdur 40mg otc, very low probability imdur 40 mg without a prescription, low probability, intermediate probability, and high probability (Table 29. When the V/Q scan is intermediate probability, many physicians also obtain a lower extremity venous duplex scan. If that is positive, then the patient should be anticoagulated, if there are no contraindi- cations and no further testing is necessary. High probability ≥2 large (>75% of a segment) segmental perfusion defects without corresponding ventilation or roentgenographic abnormalities or substantially larger than either matching ventilation or chest roentgenogram abnormalities ≥2 moderate segmental (≥25% and £75% of a segment) perfusion defects without matching ventilation or chest roentgenogram abnormalities and 1 large mismatched segmental defect ≥4 moderate segmental perfusion defects without ventilation or chest roentgenogram abnormalities Intermediate probability (indeterminate) Not falling into normal, very low, low-, or high-probability categories Borderline high or borderline low Difficult to categorize as high or low Low probability Nonsegmental perfusion defects (e. The Swollen Leg 519 Treatment Once the diagnosis of a venous thromboembolic event has been con- firmed and, occasionally, before it has been confirmed and, if the index of suspicion is high, the patient should be anticoagulated. In addition to conventional anticoagulation, a small subset of patients may benefit from thrombolytic therapy. Many patients have contraindications or relative contraindications to the use of thrombolysis that obviate their use. It is believed to be due to antibodies directed against platelet complexes with heparin. Response to warfarin is variable depending on the patient’s liver function, diet, age, and concomitant medications. Multiple studies have shown that starting warfarin therapy in addition to heparin is safe and effective. Warfarin has a long half-life, variable depending on the patient, and must be withheld for several days prior to any significant intervention. The weight-based heparin dosing nomogram compared with a “standard care” nomogram: a randomized controlled trial. Comparison of subcutaneous low-molecular-weight heparin with intravenous standard heparin in proximal deep-vein thrombosis. Comparison of once-daily subcutaneous fragmin with continuous intra- venous unfractionated heparin in the treatment of deep vein thrombosis. Subcutaneous low-molecular-weight heparin compared with continuous intravenous unfractionated heparin in the treatment of proximal deep vein thrombosis. Subcutaneous low-molecular-weight heparin compared with continuous intravenous heparin in the treatment of proximal-vein thrombosis. They have a predictable anticoagulant effect based on body weight, so that laboratory moni- toring is unnecessary. Acomparison of six weeks with six months of oral anticoagulant therapy after a first episode of venous thromboembolism. The duration of oral anticoagulant therapy after a second episode of venous thromboembolism. Comparison of once-daily subcutaneous fragmin with continuous intravenous unfractionated heparin in the treatment of deep vein thrombosis. Subcutaneous low-molecular- weight heparin compared with continuous intravenous unfractionated heparin in the treatment of proximal deep vein thrombosis. Subcutaneous low-molecular-weight heparin compared with continuous intravenous heparin in the treatment of proximal-vein throm- bosis. The most commonly performed surgical intervention is the placement of an inferior cava filtration device. Most commonly, cava filters are placed for relative contraindications to anticoagulation or, increasingly, for pulmonary embolus prophylaxis for patients who cannot be anticoagulated safely. Simple procedures, such as high ligation of the greater saphenous vein at the saphenofemoral junc- tion, are reasonable for superficial thrombosis of the greater saphenous vein. More significant operations, such as iliofemoral venous thrombec- tomy or surgical pulmonary embolectomy, have a role, but fortunately they only rarely need to be employed. While the likelihood of this being the case is low in the absence of injury, stasis, or history of a hypercoagulable state, it would be reasonable to interrogate her venous anatomy with a venous duplex scan. Signs include venous telangiectasias, swelling, and varicose veins, as well as lipodermatosclerosis and venous ulceration. Lipoder- matosclerosis represents a constellation of skin changes, including thickening of the skin, hemosiderin deposition of the skin, and a dry scaly dermatitis of the skin. Treatment of venous thrombosis with intravenous unfractionated heparin in the hospital as compared with subcutaneous low- molecular-weight heparin administered at home. Risk factors associated with varicose veins may include prolonged stand- ing, heredity, female sex, parity, and history of phlebitis. The diagnosis of deep venous insufficiency generally is made clinically based on history and clinical exam. Various volumes of the leg are then calculated with the patient in several posi- tions (Fig.

A negative glucose oxidase test and a positive test such as galactosuria but are not used to screen for for reducing sugars in urine indicates: glycosuria imdur 40mg low cost. Te presence of a nonglucose reducing sugar including several sugars and antibiotics imdur 40 mg visa, may react buy imdur 40 mg with mastercard, such as galactose making the test inappropriate as a screening test for D. A positive test for reducing sugars seen with Body fluids/Evaluate laboratory data to determine a negative glucose oxidase test may occur in lactose, possible inconsistent results/Urine glucose/2 galactose, and fructosuria and other disorders of 42. Excessive use of vitamin C low estimate of serum or urine ketones in diabetic Body fluids/Apply knowledge to identify sources of ketoacidosis. Ketonuria has many causes other than error/Urinary ketones/2 diabetic ketoacidosis such as pregnancy, fever, protein calorie malnutrition, and dietary carbohydrate 43. A Urinary ketones are detected using alkaline sodium Body fluids/Apply principles of basic laboratory nitroprusside (nitroferricyanide). Nondiabetic ketonuria can occur in all of the and some antibiotics with the classical tube test. Lactate acidosis carbohydrate restriction, alkalosis, lactate acidosis, and von Gierke disease (glycogen stores cannot Body fluids/Correlate clinical and laboratory data/ be utilized). Ketonuria also occurs in pregnancy, Urinary ketones/2 associated with increased vomiting and cyclic fever. Which of the following statements regarding the Answers to Questions 45–49 classical nitroprusside reaction for ketones is true? It may be falsely positive in phenylketonuria (phenylketonuria) will cause a false-positive D. Te reaction is recommended for diagnosing reaction in the classical nitroprusside reaction but ketoacidosis do not usually interfere with the dry reagent strip test for ketones. Serum ketones can be measured Body fluids/Apply knowledge to identify sources of by gas chromatography, and β-hydroxybutyric acid error/Urinary ketones/2 can be measured enzymatically. Hemoglobin in urine can be differentiated from assay for β-hydroxybutyrate in plasma is the myoglobin using: recommended test for diagnosing ketoacidosis A. Which of the following conditions is associated confirms the presence of myoglobin. Calculi of the kidney or bladder does not rule out hemoglobin as the cause of a B. Extravascular hemolytic anemia lower urinary tract bleeding, intravascular hemolytic Body fluids/Correlate clinical and laboratory data/ anemia, and transfusion reaction. Extravascular Hematuria/2 hemolysis results in increased bilirubin production rather than plasma hemoglobin. Which statement about the dry reagent strip blood increased urobilinogen in urine but not a positive test is true? Hemoglobin has when the reaction is positive peroxidase activity and catalyzes the oxidation of C. Salicylates cause a false-positive reaction whereas visible hemolysis does not occur unless free Body fluids/Apply principles of basic laboratory hemoglobin exceeds 20 mg/dL. Recent urinary tract catheterization pyelonephritis, polycystic kidney disease, renal calculi, bladder and renal cancer, and postcatheterization of Body fluids/Correlate clinical and laboratory data/ the urinary tract. Negative blood, positive protein Therefore, a small blood reaction (nonhemolyzed or moderately hemolyzed trace, trace, or small) usually Body fluids/Apply knowledge to recognize sources of occurs in the absence of a positive protein. A positive test for and posthepatic jaundice protein and a negative blood test occurs commonly B. Te test detects only conjugated bilirubin in conditions such as orthostatic albuminuria, urinary C. Standing urine may become falsely positive due tract infection, and diabetes mellitus. However, a to bacterial contamination negative blood test should not occur if more than D. Very few drugs have been Body fluids/Apply principles of basic laboratory reported to interfere with urine bilirubin tests, which procedures/Urine urobilinogen/1 are based upon formation of azobilirubin by reaction with a diazonium salt. Bacteria may cause hydrolysis of glucuronides, forming unconjugated bilirubin, which does not react with the diazonium reagent. Dry reagent strips use either p-dimethylaminobenzaldehyde or 4-methoxybenzene diazonium tetrafluoroborate to detect urobilinogen. False-positive results may occur in the presence of Pyridium and Gantrisin, which color the urine orange-red. Which of the following statements regarding Answers to Questions 53–56 urinary urobilinogen is true? C Urobilinogen exhibits diurnal variation, and highest in the early morning levels are seen in the afternoon. High levels occurring with a positive bilirubin postprandial afternoon sample is the sample of test indicate obstructive jaundice choice for detecting increased urine urobilinogen.