By Q. Lars. Villanova University.
What is the most likely organism that is responsible for the patient’s presentation? Upon physical examination order 250mg cephalexin, there are decreased breath sounds on the right as compared to the left generic 500 mg cephalexin with amex. A chest radiograph indicates blunting of the right costophrenic angle with a fluid line cheap cephalexin 750 mg without prescription. Given this patient’s history, which of the following most likely describes his effusion? Upon physical examination, the patient appears to be in mild distress with audible wheezing. She is able to speak in partial sen- tences and states that she occasionally uses an inhaler. Given this patient’s history and physical examination, which of the following measures should be taken next? If pharyngeal or laryngeal structures become involved, or there is significant tongue swelling, the patient may begin to compromise their airway and emergent intubation or surgical cricothyroidotomy needs to be performed. All patients need to be on a monitor and should receive supplemental oxygen despite normal oxygen saturation. Heparin is the first-line therapy in this patient and should be administered promptly. Warfarin initially causes a temporary hypercoagulable state because the anticoagulants, protein C and S (inhibited by warfarin), have shorter half-lives compared with the procoagulant vitamin K–dependent proteins that warfarin also inhibits. Classically, it presents with a productive cough with currant jelly sputum, fever, general malaise, and an overall toxic appearance. A dense lobar infiltrate with a bulging fissure appearance on a chest radiograph is often described. Streptococcus pneumoniae (a) is the most common etiology in community- acquired pneumonia among adults. Mycoplasma pneumoniae (c) is a common cause of community-acquired pneumonia in patients under the age of 40. Legionella pneumophila (d) is an intracellular organism that lives in aquatic environments and is not transmitted from person to person. It is a pleomorphic gram-negative rod that can be encapsulated and identified as various serotypes, with type b as the most commonly causing bacteremia. Mild tachycardia, decreased breath sounds to auscultation, or hyperresonance to percussion are the most common findings. It typically occurs in healthy young men of taller than average stature without a pre- cipitating factor. Mitral valve prolapse and Marfan syndrome are also asso- ciated with pneumothoraces. Although suggested by this patient’s symptoms, the diagnosis of pneumothorax is generally made with a chest radiograph. The classic sign is the appearance of a thin, vis- ceral, pleural line lying parallel to the chest wall, separated by a radiolucent band that is devoid of lung markings. If clinical suspicion is high with a negative initial chest x-ray, inspiratory and expiratory films, or a lateral decubitus film may be taken to evaluate for lung collapse. A D-dimer (b) is a blood test used as a screening tool in patients who have a low pretest probability for a thromboembolism. If the chest radiograph is unremarkable in this patient, sending a D-dimer may help in the workup of his dyspnea. An upright abdominal x-ray (d) can assess for abdominal perforation, char- acteristically revealing air under the diaphragm. Streptococcus pneumoniae is the most common cause of community-acquired pneumonia. Auscultation of the lungs reveals decreased breath sounds over the infiltrate and the radiograph shows a lobar pattern. Radiograph findings include a necrotizing right-upper lobe infiltrate or abscess with an air-fluid level. Although the patient in the scenario is an alcoholic, S pneumoniae is still the most common cause of community-acquired pneumonia. She is tachycardic, tachypneic, and hypoxic, cardinal signs of cardiovascular distress. The clas- sic triad of dyspnea, pleuritic chest pain, and hemoptysis is uncommon and present in less than 25% of patients. Most patients have constitutional symptoms, in addition to conjunctivitis, pharyngitis, or bullous myringitis. The hallmark of the disease is the disparity between the patient’s clinically benign appearance and the 66 Emergency Medicine extensive radiographic findings. This is a reversible bronchospasm initiated by a variety of environmental factors that produce a narrowing and inflammation of the bronchial airways. The first-line treatment in order to open the airways includes a β2-agonist, which acts to decrease bronchospasm of the smooth muscle. Corticosteroids (a) are an effective measure for decreasing the late inflammatory changes involved in asthma. Magnesium sulfate (b) is also thought to act in a similar manner, but should be initiated in refractory cases of asthma. Epinephrine (c) decreases bronchospasm, but given its clinical side effects should only be administered in patients deemed to be in severe respiratory distress. This example reminds us of the importance of keep- ing the differential diagnosis broad in patients that present with respiratory distress.
It has only been a bit over a centu- gy has been one of the most popular majors for over ry since scientists and philosophers turned their eyes three decades order cephalexin 750 mg amex, and students are more likely to take an from the planets to people and tried to understand human elective course in psychology than one from any other behavior in a systematic cheap cephalexin 500mg on line, scientific way effective 250mg cephalexin. Not surprisingly, psychology has also become a century, philosophers and physiologists began to exam- popular high school offering. How do individuals use their senses of Initially, psychology courses at the secondary school sight, hearing, and touch to make sense of the world? We are living in In the late second half of the 1800s, a number of times of dramatic social change. Each of us continually young North American men and a few women traveled faces new challenges about how we will make our place in to Germany to study with Wilhelm Wundt, who had es- the world. As the discipline of psychology matured, ad- tablished a laboratory and the first graduate program of justment courses gave way to substantive content courses study in psychology at the University of Leipzig in Ger- that offered not just psychology’s latest findings about de- many. They returned to teach psychology and train other velopmental and identity issues, but also featured those students in the major universities of this country with the more traditional areas of cognitive, experimental, physio- intent of quantifying individual differences and impor- logical, and social psychology. The advances in the scientific side lished a Psychological Clinic at the University of Penn- of psychology were paralleled by the remarkable growth sylvania to help children who were having difficulty in of counseling, clinical, and school psychology. To keep up with the rapidly expanding field, the Being a psychologist, he assumed that his new pro- newly revised second edition of the Gale Encyclopedia fession—dedicated to learning and memory—would of Psychology has added about a third more entries and help him assist children who were having trouble read- biographies. Coverage includes the key concepts on ing, writing, spelling, and remembering information. Clinical information is broadly plex, theoretical notions within the experimental labora- covered, noting the various psychological theories and tories, and he turned to schoolteachers and social work- techniques currently in use and the scientific evidence ers for practical advice. Biographical profiles of major figures in the field of psychology are included, ranging from the Thus began the long struggle between the scientific earliest historical pioneers to current clinicians. On the battle- experiments are valid and replicable (that is, others pur- field, clinicians were helping troops who were experienc- suing the same questions with appropriate methods ing “traumatic neurosis, ” originally called “shell shock” would find the same results). They sometimes feel that in the First World War and now known as post-traumatic clinicians, for example, use psychotherapy techniques stress disorder. When the soldiers returned home, they led that have not been proven to be useful and may even be therapy groups for wounded military personnel. The Veteran’s Hospitals, in The earliest psychologists worked primarily with chil- particular, needed well-trained personnel to provide men- dren, usually those who were delinquent or having trouble tal health services for their patients. They were particularly taken with assessing in- ence held in Boulder, Colorado established standards of telligence and translated a test developed by a Frenchman, education and training for clinical psychologists. They began testing soldiers recruited for the First internship and receive the Ph. According to their tests, they found almost half of newer of training are available for students who want to the young, white male recruits and some 80% of Eastern place more emphasis on practice and less on doing re- European immigrants to be “morons. In addition to university graduate programs, a think the uses of intelligence tests, especially because of large number of professional schools have been estab- opinions like that of journalist Walter Lippman, who rec- lished, often offering a Psy. D (doctor of psychology) de- ommended that the “intelligence testers and their tests gree. Currently, some 4,000 students graduate each year should be sunk without warning in the… sea. The over- denied entrance into this country, and intelligence testing whelming majority of these graduates go into clinical or laid the base for human eugenics laws that allowed individ- applied work, although changing conditions in the health uals who were found “intellectually unfit” to be sterilized. With the introduction of psy- A field as broad as psychology, which stretches from choanalysis into this country, people wanted to “adjust” the study of brain cells to that of prison cells, is an active, through self-examination and the probing of the uncon- argumentative, and exciting adventure that offers oppor- scious. The scientific psychologists were dismayed at the tunities in science, practice, and social policy. Most of the excesses of pseudopsychologists, whose ranks included pressing economic and social issues of our generation, mind readers and charlatans. Psychological clinicians such as the environment, health needs, poverty, and vio- were concerned as well and took steps to develop a stan- lence, will only be alleviated if we understand the ways in dard of ethics and ways of identifying appropriately which people create or creatively solve the problems that trained psychologists. The student who is interested in unraveling the secrets of the human brain to see the mind With the advent of the Second World War, psycholo- at work, who is fascinated about how children grow up gists joined the military effort and were surprised them- and become competent adults, who is dedicated to bring- selves by how much they had to offer. Human factors psy- ing people together to resolve conflict, who is committed chologists designed airplane cockpits and the lighting on to helping people with physical, emotional, or behavioral runways that we still use today. Gestalt psychologists difficulties, or who is challenged by the desire to develop taught American citizens how to identify enemy planes social policy in the public interest is welcomed in psy- should they fly overhead. We hope this encyclopedia will provide useful guide missiles toward enemy targets. Psychologists information that will help students and others understand worked for the Office of Strategic Services (which eventu- this fascinating field and its opportunities. Division of Clinical Psychology and the American Asso- She has been on the faculties of Emory University and the ciation for Applied and Preventive Psychology; she was a University of Massachusetts in Amherst as a teacher, re- Founder and on the first Board of Directors of the Ameri- searcher, administrator, clinician, and consultant. An advocate for minority con- Diplomate in Clinical Psychology, she has also been in cerns, she has published more than a hundred scholarly practice for over 35 years. Abnormal behavior is defined as behavior that is The capacity to learn, commonly known as aptitude, considered to be maladaptive or deviant by the social and the demonstration of skills and knowledge already culture in which it occurs. Though disagreement exists learned, called achievement, are among the factors used regarding which particular behaviors can be classified as to evaluate intelligence. When evaluating or comparing abnormal, psychologists have defined several criteria for subjects, two kinds of abilities are considered: verbal purposes of classification. One is that the behavior oc- ability, including reading comprehension, ability to con- curs infrequently and thus deviates from statistical verse, vocabulary, and the use of language; and problem- norms. Another is that the behavior deviates from social solving ability, which includes a person’s capacity to norms of acceptable behavior. Lastly, abnormal- Relatively straightforward tests of ability are often ity may be defined based on the subjective feelings of used by employers to determine an applicant’s skills.