Lооk аt the аbоve piece. Compositionаlly the artist divided the scene into two overlapping shapes. What shapes did the artist use?
Whаt is the primаry gоаl оf neоadjuvant chemotherapy?
Whаt is the purpоse оf lоng bones?
Review the fоllоwing pаtient infоrmаtion аnd document complete and thorough Admission Orders in the blank space provided in the next question: Patient: Elias Mahoney Age: 32 yrs old CC: “Right ankle pain” HPI: Mr. Elias Mahoney is a 32 y/o male who presents with a complaint of right ankle pain after falling while skateboarding. He reports going at a fast rate of speed when he hit a rock and fell off the board moving forward, subsequently rolling the ankle that he landed on in an inverted manner. Pt reports hearing and feeling a “snap” then noted significant pain immediately afterwards. Pt that he immediately could not bear weight on this ankle. The pain is worse with attempts at moving the ankle or bearing weight on it. The pain is better with keeping the ankle still and elevating the foot. He was given some ice to place on the ankle which also helped. The pain does not radiate anywhere else. Pt rates pain as 9/10 currently described as “sharp” in nature. No head injury, neck pain, or LOC reported. Associated symptoms include swelling to the affected ankle, some bruising and tenderness to palpation to the lateral ankle area, as well as limited ROM of the affected ankle. Pt also admits to nausea due to pain and sustained superficial abrasions on his hands and elbows bilaterally from the fall. No problems with ROM to B/L fingers/wrists/elbows, however. No active bleeding currently at time of arrival. No numbness or tingling reported. Pt denies prior injury to the affected ankle and notes that he often skateboards but never had anything like this happen before. Past Medical History (PMHx): Illnesses/Injuries: Major depressive disorder (diagnosed at age 22) ADHD (diagnosed at age 16) IgA Nephropathy (diagnosed at age 30) CKD Stage 3a (due to IgA Nephropathy; last eGFR was 40 mL/min per 1.73 m² three months ago) Hospitalizations: None Surgical History: None Screening/Preventive History: Pt is up-to-date on most vaccinations and preventative screenings. Pt admits his last Tetanus immunization was at age 17, greater than ten years ago Medications (Prescription, Over the Counter, Supplements): -Escitalopram 10mg PO daily -Adderall XR 15mg PO qAM -Lisinopril 5mg PO daily (for treatment in reducing CKD progression) -Dapagliflozin 10mg PO daily (for treatment in reducing CKD progression) -Sibeprenlimab SubQ injection 400 mg once every 4 weeks (last received last week - for treatment of IgA Nephropathy) Allergies (e.g. environmental, food, medication and reaction): Penicillins (rash, difficulty breathing) Family Medical History: Mother (alive, age 59) - has history of HTN Father (alive, age 60) - has history of hyperlipidemia Brother (alive, 29) - healthy, no known medical hx Sister (alive, 24) - hx of anxiety and unspecified eating disorder No children No genetic disorders known in family Social History: Substance Use / Alcohol Use: No tobacco use. Occasional marijuana (THC) edible use (1-2 per month) Pt denies alcohol use Diet: No special diet reported Home Environment: Lives with his girlfriend in an apartment just outside of Encinitas Occupation: Small business owner for a pool cleaning service Leisure Activities: Pt likes to skateboard and surf on weekends. Also, walk his dog every day. Exercise: Active 3-4 days per week with above leisure activities Sleep: 6-7 hours per night Religion: Protestantism Sexual: Sexually active only with his girlfriend, who uses oral hormonal contraception as their primary birth control method ROS (Review of Systems): General: No weight loss, fever/chills, or night sweats. Skin: See HPI. Minor abrasions reported to B/L arms as noted in HPI. HEENT: No headache, neck pain/stiffness, no sore throat. No vision changes or double vision. Respiratory: No cough, shortness of breath or wheezing. Cardiovascular: No chest pain or palpitations. Gastrointestinal: See HPI. +Nausea without vomiting. No diarrhea or constipation. No reported abdominal pain or flank pain Musculoskeletal: See HPI. No back pain or neck pain reported. No other injuries reported. Hematologic: No known hx of easy bruising/bleeding, or gum bleeding. Neurologic: See HPI. No dizziness, numbness, tingling, headache, confusion, or disorientation. Physical Exam: General: Pt appears uncomfortable. Pt is a WDWN male otherwise. Pt is cooperative, alert and oriented appropriately. Skin: Superficial abrasions noted B/L hands and elbows without laceration or active bleeding. Ecchymosis is noted at the lateral aspect of the R ankle. Otherwise, the warm skin, no rashes, normal turgor, no pallor or cyanosis throughout, including distal B/L LEs. Head: Normocephalic, atraumatic. No obvious signs of head trauma on exam such as contusion, abrasion, bruising, or laceration. Eyes: PEERLA B/L, EOMI B/L, sclera anicteric, conjunctiva clear. Neck: Non-tender, c-spine ROM intact, no midline TTP, step-offs, or deformity. No visible skin changes, contusion, or abrasion. Pulmonary: Lungs clear to auscultation B/L, no crackles, wheezes, or rhonchi. Cardiac: Tachycardic rate and rhythm. No murmurs, gallops, or rubs. Normal S1 and S2 otherwise. Peripheral Vascular: Capillary refill less than 2 seconds throughout distal extremities bilaterally. Peripheral pulses full and equal bilaterally, most notably DP and PT pulses B/L. Abdomen: Soft, non-distended, non-tender. Normoactive BS presents in all 4 quadrants. Rectal: Deferred GU: Deferred MSK: Right ankle area swelling, TTP, and ecchymoses noted - most notably along the lateral aspect of the ankle. Pt is non-weight bearing due to pain. R ROM is limited and could not be well assessed due to pain. There is also noted medial ankle aspect TTP on exam. Left lower extremity, including L ankle appears without injury, loss of ROM, deformity, or discoloration. B/L upper extremities appear without evidence of significant contusion, deformity, or swelling. ROM intact at all joints of B/L upper extremities. Neuro: Pt is AAOX4, cooperative and answering questions appropriately. Strength 5/5 all extremities, with exception of ankle joint and foot which could not be assessed due to pain Sensation is equal and intact throughout all extremities, including the affected R ankle and foot. CN 2-12 intact. Gait could not be assessed due to non-weight bearing status. Reflexes 2+ in all extremities B/L with exception of Achilles on R which was not assessed.. No tremor or seizure activity noted. Psychiatric: Appropriate mood and affect for situation Additional Case Information: Interventions completed so far in the ER: -20 gauge IV placed in left arm -Ice applied to the affected hand briefly for pain relief -B/L upper arm minor abrasions were irrigated, cleaned, and superficial bandages placed -0.5mg Hydromorphone (Dilaudid) was given once by IV at patient’s arrival to the ER based on his pain level at that time with successful significant reduction in pain -Imaging completed as noted below -Diagnostics completed as noted below (CBC, CMP, PT/INR, aPTT, EKG) Diagnostic Imaging: Right Ankle X-Ray: Interpretation: “The right ankle x-ray series reveals a fracture of the right distal fibular head and fracture of the medial malleolus. Both reveal minimal displacement but involve the joint space. Associated soft tissue swelling is also noted. Findings are consistent with an unstable Weber B / bimalleolar ankle fracture of the right leg.” The following additional radiographs were obtained in the ER: -AP/lateral Right Knee X-ray - Results: “Unremarkable, no acute injury, dislocation, or fracture” -AP/lateral Right Tibia/Fibula X-ray - Results: “No additional fractures or abnormalities noted beyond what was identified in the right ankle x-ray series above”. -Right foot X-ray - Results: “As supplement to the findings reported on the Right Ankle X-ray, there does not appear to be any additional fractures or injuries of the right foot.” Laboratory Diagnostics: *END OF STUDENT CASE INFORMATION*