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This speeds up the absorption of the radioiodine, lessens the radiation dose to the stomach, and minimizes the volume of any vomit. Once the patient has been correctly identified, patient dose administration may be done. The actual administration method will depend on the radioiodine form and preferred procedure. It is advisable that the whole procedure is documented, for example in the form of a checklist (see example in 10. If a liquid form of patient dose is to be used, the delivered radioiodine should be diluted with water to ensure that the maximum proportion of the radioactivity is actually given to the patient, and to reduce the activity of any droplets, should the patient cough during administration. Liquid administration carries the greatest potential hazards of contamination, and so the procedure used must be rigorous. The patient should be asked to remove any dentures as these will become contaminated. The patient should drink the solution through a straw without removing the straw from the container or their mouth, until the administration is complete. This also has the effect of reducing the remnant activity in the straw and container. Capsules have far fewer problems, but the patient must be told to swallow the capsule, and not to chew it. All steps in the administration process should be checked independently by a knowledgeable person to minimize the risk of errors. Finally, the treatment room, and all items used in the administration, must be checked for contamination, and any necessary warning signs put in place (see later). Contaminated items must be either disposed of correctly and safely, or stored until sufficient radioactive decay has taken place. On a routine check the following day, extremely high activity is noted in the waste bin. It is subsequently determined that the patient did not swallow the capsule, but hid it in the back of her mouth, chewing it when the staff had left, during her meal. This transferred much of the activity to the disposable cutlery and crockery, and napkin. Possible acute side-effects There is a range of possible side-effects which may become apparent within a few hours or days of administration. The medical and nursing staff involved must be aware of these, and how to deal with them if necessary. Gastric As patients already have very low levels of circulating thyroxine, they may feel generally unwell.

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It is also a gramother neurodegenerative disorders including negative diplococcus. Alzheimer disease, Pick disease, and progressive supranuclear palsy present with abnormal Answer E is incorrect. These two topics are inseparable and tive disorder of the substantia nigra and locus are necessary to understanding the etiology of ceruleus that is most often characterized by some symptoms seen in the context of neoTremor, Rigidity, Akinesia, and Postural inplasms. The photomicrograph shows omental foramen, which is formed partly by several neurons from the substantial nigra the hepatoduodenal ligament. This ligament stained with haematoxylin and eosin at 500 contains the common bile duct along with times magnifcation, at least two of which (arthe hepatic artery proper and the hepatic porrows) exhibit large Lewy bodies (eosinophilic tal vein. Obstruction of the common bile duct cytoplasmic inclusions that consist of a dense would lead to cholestasis and subsequently core surrounded by a halo of 10-nm wide raconjugated hyperbilirubinemia. Dystrophin is the gene to bleeding into the stomach, anemia is not a disrupted in Duchenne muscular dystrophy. This disease is characterized by progressive muscle weakness and does not have any signifAnswer B is incorrect. This symptom disease that primarily affects the caudate numay be seen with thyroid or lung cancer. As the disease prevarofbrillary tangles and extracellular amyloid lence decreases, the likelihood of a positive plaques. While cranial nerves are often the frst to a positive predictive value of approximately be affected, the paralysis is faccid rather than 0. Furthermore, the method of transmission is often through improperly canned Answer A is incorrect. As disease prevalence goods and honey (in babies) rather than rusty decreases, the positive predictive value will denails. This leads Positive predictive value is a measure that to toxic shock characterized by fever, rash, and changes as prevalence changes shock. Cowdry A lidity and not reliability, but changes between inclusion bodies are seen in pathology preparadifferent tests instead of between prevalences. They are inPositive predictive value is a measure that tranuclear eosinophilic inclusions surrounded changes as prevalence changes by a clear halo. Auer bodies, or Auer tractions and trismus (contraction of the jaw rods, are rod-shaped bodies in myeloid cells.

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It may be many years since the adult was a child, and recollections of childhood by the adult and any relatives interviewed during the diagnostic assessment may be affected by the accuracy of long-term memory. An aid to memory and discussion may be the perusal of photographs of the adult as a child. Family photographs are usually taken during a social occasion, and this can provide an opportunity to notice if the child appears to be participating in the social interaction. School reports can be useful in indicating any problems with both peer relationships, and learning abilities and behaviour at school. For example, a man was asked about his friends when he was a child and whether other children would come to his home. He replied that children did come to his house, which would suggest some degree of popularity and friendship. His mother affirmed that other children would visit, but not to play with her son, rather to play with his toys. It is possible that the adult or adolescent will deliberately mislead the clinician for reasons of maintaining self-esteem or to avoid a diagnosis that may be perceived as a mental illness. For example, Ben described how: I was always ashamed of who I was, so I never told the truth about anything that would embarrass me. If you had asked me if I have trouble understanding others, I would have said no, even though the true answer was yes. If I thought it was good, I would have said yes, and if I thought it was bad, I would have said no. The cognitive processing required gives the impression of a thoughtful rather than spontaneous response.

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Less frequent is hyperthyroidism due to thyroid autonomy, which is depicted in the literature also as a toxic multinodular goiter or toxic adenoma (solitary hyperfunctioning nodule). In continuation, clinicaly most relevant causes of hyperthyroidism will be discussed. External factors influencing the occurrence of the disease are iodine intake, stress, smoking, infection, trauma, interferon fi. Women get ill 5 to 10-times more frequently than man, commonly at around 40 years of age. Therefore, the symptoms are more dramatic than in the thyroid autonomy where hyperthyroidism develops gradually. Hyperthyroidism the levels of fT4 and fT3 reach very high values amongst the highest in all types of hyperthyroidism. The patients are restless, tired, have palpitations, tremor, lose weight, have warm and moist skin, muscular weakness, and often an enlarged thyroid gland. Mild symptoms and signs of thyroid orbitopathy are lachrymation, mild exophthalmus, mild retraction of the upper lid, photophobia. The moderate form of thyroid orbitopathy is characterized by the edema of the eyelids, chemosis, swollen caruncle, proptosis. In severe orbitopathy, the patients may have double vision because of impaired eye movements, corneal defects or even a pressure on optical nerv associated with a decrease in visual acuity. Namely, low intrathyroidal iodine content presents an additional risk for deleterious effects of iodine. Prevalence of thyroid autonomy is higher in iodine-deficient or previously-iodine-deficient areas. It seems, that in iodine-deficient areas, hyperplasia of the thyroid gland occurs already in youth. In hyperplastic glands, the rate of mutations is increased, resulting in thyroid autonomy or in dedifferentiated cold thyroid nodules. Often it takes many years, before hyperthyroidism aggravates from subclinical to overt. It has been reported that hyperthyroidism develops when the product between the weight of autonomous tissue, the efficiency per gram of tissue, and iodide supply goes above a treshold. Hence it follows that an increase in iodine intake represents a risk factor for aggravation of hyperthyroidism in these patients. Iodine excess often deteriorates subclinical or overt hyperthyroidism to the severe stage. Low intrathyroidal iodine concentration, as observed in patients with toxic adenomas when compared with healthy thyroids, presents an additional risk for deleterious effects of iodine load. Hyperthyroidism Patients with thyroid autonomy may be euthyroid, subclinical or overt hyperthyroid.

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