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Medical Instructor, Rocky Vista University College of Osteopathic Medicine

Note: See the Text Documentation section of the 2018-2019 Handbook (page 245) for further explanation and examples stroke treatment 60 minutes discount 3 ml bimat mastercard. Do not to medications of the same type are known as buy bimat with american express enter text in this field when treatment is either not done symptoms herpes order bimat from india, or unknown if done. Record the first or earliest date on which hormone therapy was administered by any facility. Example: A patient with recently diagnosed prostate cancer begins Lupron therapy on January 21, 2018. Example: A patient with breast cancer completed chemotherapy and then began Tamoxifen in April 2018, but the exact day is not known. Example: A patient with prostate cancer started Lupron therapy earlier this year, but there is no information regarding the month and day. Blank - when no known date applies (no hormone therapy was given, or it is unknown if any hormone therapy was given). If the start date is not known, record the year of diagnosis as the start date and leave the month and day blank. Explanation As part of an initiative to standardize date fields, date flag fields were introduced to accommodate nondate information previously transmitted in the date field. Leave this item blank if Date Hormone Therapy Started has a full or partial date recorded. Code 12 if the Date Hormone Therapy Started cannot be determined or estimated, but the patient did receive first course hormone therapy. This event occurred, but the date is unknown (that is, hormone therapy was given but the date is unknown and cannot be estimated). Information is not available at this time, but it is expected that it will be available later (hormone therapy is planned as part of first course treatment, but had not yet started at the time of the last follow-up). Note: Hormone therapy is administered to treat cancer tissue and is considered to achieve its effect through change of the hormone balance. Other primaries and histologic types may be hormone-responsive, such as melanoma and hypernephroma. Explanation this data item allows for the analysis of hormone treatment as part of the first course of therapy. Code the type of hormone therapy the patient received as part of the first course of treatment at any facility. Note: Do not code prednisone as hormone therapy when it is administered for reasons other than 218 Texas Cancer Registry 2018/2019 Cancer Reporting Handbook Version 1. These cancers are treated by administering hormones and should be coded in this data field. Even if the progesterone is given for menopausal symptoms, it has an effect on the growth or recurrence of endometrial cancer and should be coded. The medical record states that hormone therapy was not given, was not recommended, or was not indicated b. If the treatment plan offered multiple treatment options and the patient selected treatment that did not include hormone therapy d. Patient elected to pursue no treatment following the discussion of hormone therapy treatment. Hormone treatment was given for a non-reportable condition or as chemoprevention prior to diagnosis of a reportable condition Example 1. Tamoxifen given for hyperplasia of breast four years prior to breast cancer diagnosis. Patient with a genetic predisposition to breast cancer is on preventative hormone therapy. Code to 82, 85, 86, or 87 if it is known that hormone therapy is usually delivered for this type and stage of cancer, but it was not delivered. Code to 87 if the patient refused recommended hormone therapy, made a blanket refusal of all recommended treatment and hormone therapy is a customary option for the primary site/histology, or refused all treatment before any was recommended and hormone therapy is a customary option for the primary site/histology. Code 88 when the only information available is that the patient was referred to an oncologist. Note: Review cases coded 88 periodically for later confirmation of hormone therapy. If followup with the oncologist indicates that the patient was never there, change code to 00.

Diseases

• Biliary atresia, intrahepatic, syndromic form
• Langdon Down
• Mental retardation u Mental retardation x
• Ectodermal dysplasia mental retardation CNS malformation
• Barbiturate overdose
• Charcot Marie Tooth type 1 aplasia cutis congenita
• Cutis laxa osteoporosis
• Charcot Marie Tooth disease deafness mental retardation
• Sterility due to immotile flagella
• Enamel hypoplasia cataract hydrocephaly

Most are nonfunctional ("cold") medicine vocabulary order generic bimat on line, can rarely cause hyperthyroidism via autonomous thyroid hormone production ("hot" or "toxic") treatment tinnitus buy bimat with amex. Most common histology is follicular A; absence of capsular or vascular invasion (unlike follicular carcinoma) medicine 877 buy bimat. Thyroid cancer Typically diagnosed with fine needle aspiration; treated with thyroidectomy. Complications of surgery include hoarseness (due to recurrent laryngeal nerve damage), hypocalcemia (due to removal of parathyroid glands), and transection of recurrent and superior laryngeal nerves (during ligation of inferior thyroid artery and superior laryngeal artery, respectively). Empty-appearing nuclei with central clearing ("Orphan Annie" eyes) A, psamMoma bodies, nuclear grooves (Papi and Moma adopted Orphan Annie). Invades thyroid capsule and vasculature (unlike follicular adenoma), uniform follicles; hematogenous spread is common. From parafollicular "C cells"; produces calcitonin, sheets of cells in an amyloid stroma (stains with Congo red B). Undifferentiated/ anaplastic carcinoma Lymphoma Older patients; invades local structures, very poor prognosis. Chvostek sign-tapping of facial nerve (tap the Cheek) contraction of facial muscles. May present with weakness and constipation ("groans"), abdominal/flank pain (kidney stones, acute pancreatitis), depression ("psychiatric overtones"). Osteitis fibrosa cystica-cystic bone spaces filled with brown fibrous tissue A ("brown tumor" consisting of osteoclasts and deposited hemosiderin from hemorrhages; causes bone pain). Secondary hyperparathyroidism Tertiary hyperparathyroidism Familial hypocalciuric hypercalcemia Defective G-coupled Ca2+-sensing receptors in multiple tissues (eg, parathyroids, kidneys). Nonfunctional tumors present with mass effect (bitemporal hemianopia, hypopituitarism, headache). Prolactinoma in women classically presents as galactorrhea, amenorrhea, and bone density due to suppression of estrogen. Treatment: dopamine agonists (eg, bromocriptine, cabergoline), transsphenoidal resection. Large tongue with deep furrows, deep voice, large hands and feet, coarsening of facial features with aging A, frontal bossing, diaphoresis (excessive sweating), impaired glucose tolerance (insulin resistance). If not cured, treat with octreotide (somatostatin analog) or pegvisomant (growth hormone receptor antagonist), dopamine agonists (eg, cabergoline). Clinical features include short height, small head circumference, characteristic facies with saddle nose and prominent forehead, delayed skeletal maturation, small genitalia. Correct slowly to prevent osmotic demyelination syndrome (formerly known as central pontine myelinolysis). Increased urine osmolality during water deprivation test indicates psychogenic polydipsia. Usually presents with failure to lactate, absent menstruation, cold intolerance Empty sella syndrome-atrophy or compression of pituitary (which lies in the sella turcica), often idiopathic, common in obese women Pituitary apoplexy-sudden hemorrhage of pituitary gland, often in the presence of an existing pituitary adenoma. Brain injury Radiation Treatment: hormone replacement therapy (corticosteroids, thyroxine, sex steroids, human growth hormone). Usually due to insulin noncompliance or insulin requirements from stress (eg, infection). Excess fat breakdown and ketogenesis from free fatty acids, which are then made into ketone bodies (-hydroxybutyrate > acetoacetate). Usually occurs in type 1 diabetes, as endogenous insulin in type 2 diabetes usually prevents lipolysis. Hyperkalemia, but depleted intracellular K+ due to transcellular shift from insulin and acidosis (therefore total body K+ is depleted). Life-threatening mucormycosis (usually caused by Rhizopus infection), cerebral edema, cardiac arrhythmias, heart failure. Symptoms: thirst, polyuria, lethargy, focal neurological deficits (eg, seizures), can progress to coma and death if left untreated. Labs: hyperglycemia (often > 600 mg/dL), serum osmolality (> 320 mOsm/kg), no acidosis (pH > 7. May see Whipple triad: low blood glucose, symptoms of hypoglycemia (eg, lethargy, syncope, diplopia), and resolution of symptoms after normalization of glucose levels.

Diseases

• Chromosome 3, trisomy 3p
• Young syndrome
• Phenobarbital embryopathy
• Hypodontia of incisors and premolars
• Fiber type disproportion, congenital
• Anaplasmosis
• Lymphoma, gastric non Hodgkins type
• Megalocytic interstitial nephritis
• Hemoglobin E disease
• Epidermolysis bullosa, junctional, with pyloric atrophy

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