Mr. Thomas is a 42-year-old man admitted to the hospital with complaints of shortness of breath, fever, fatigue, and oral thrush. The health care provider
Mr. Thomas is a 42-year-old man admitted to the hospital with complaints of shortness of breath, fever, fatigue, and oral thrush. The health care provider reviews the laboratory and diagnostic tests with Mr. Thomas and informs him that he has pneumonia and is HIV positive. Mr. Thomas believes that he contracted HIV while involved in an affair with another woman three years ago. He is afraid to tell his wife, knowing she will be angry and that she may leave him. The nurse assigned to care for Mr. Thomas reads in the medical record (chart) that he learned two days ago that he is HIV positive. There is a note in the record that indicates that Mr. Thomas has not told his wife the diagnosis. To complet a functional health pattern assessment, the nurse asks Mr. Thomas if he may ask him a few questions. Mr. Thomas is willing and in the course of their conversation shares with the nurse that he believes that he contracted the HIV during an affair with another woman. He states, “How can I tell my wife about this? I am so ashamed. It is bad enough that I had an affair, but to have to tell her in this way—I just don’t think I can. She is not sick at all. I will just say I have pneumonia and take the medication my health care provider gave me. I do not want my wife or anyone else to know. If she begins to show signs of not feeling well, then I will tell her. I just can’t tell anyone. will people think of me if they know I have AIDS?” Question 1 How can the Glasgow Coma Scale be assessed in a patient with ___________or _______________? Question 2 How common is it for someone suffering _________ischaemic attack (TIA) to totally lose consciousness? Also, what is the mechanism for losing consciousness with a TIA? Question 3 should the management be for a stenosis in the ___________artery causing transient ischaemic attack (TIA), and when is surgery recommended? Question 4 In a patient with central retinal artery branch occlusion with carotid artery stenosis, what is the best management: warfarin, aspirin or carotid endarterectomy? Question 5 If a young patient who has suffered a stroke has a normal mental state, would this exclude a cerebral venous occlusion as an aetiology? Question 6 Does persistent hiccough following cerebrovascular ischaemic stroke localize to the medulla or to any other site? Question 7 By what mechanism is vertebrobasilar insufficiency associated with circumoral numbness? Question 8 Why does lateral medullary syndrome result in ipsilateral diplopia due to cranial nerve VI? Question 9 I have seen many established ischaemic stroke patients with CTdocumented capsular infarction and hemi-hypotonia despite exaggerated reflexes. How would you explain the hypotonia? Could it be due to a corticorubral fibre lesion? Question 10 Thrombolytic therapy is used in patients with a cerebral infarct within the first 3 hours, whereas stroke by definition lasts 24 hours. So how do we define that it is infarct and not a transient ischaemic attack (TIA) on a CT scan within the first 3 hours in order to start tissue plasminogen activator (tPA) treatment?
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