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By E. Elber. Christian Bible College and Seminary.

PSYCHIATRIC HISTORY AND PHYSICAL The elements of the psychiatric history and physical are identical to those of the basic his- tory and physical outlined earlier purchase 180 mg diltiazem otc. The main difference involves attention to the past psychi- atric history and more detailed mental status examination as described in the following section. Psychiatric Mental Status Examination The following factors are evaluated as part of the psychiatric status examination. The mini mental status exam is a sim- ple, practical test that takes only a few minutes and can be followed over time. The mini mental status exam developed by Folstein, Folstein, and McHugh is discussed in detail in the Journal of Psychiatric Research, 1975, Vol. Table 1–1 is the “Mini Mental State” Examination as outlined by Folstein and associates. HEART MURMURS AND EXTRA HEART SOUNDS Table 1–2 and Figure 1–1 describe the various types of heart murmurs and extra heart sounds. BLOOD PRESSURE GUIDELINES There is a clear association between hypertension and coronary artery and cerebrovascular disease. Hypertension is defined as systolic BP >140 mm Hg or a diastolic BP >90 mm Hg in adults. Use the bell of the stethoscope, the last sounds heard are the Korotkoff sounds, which are low- pitched. Elevated readings on three separate days should be obtained prior to diagnosing hypertension. Many times, the patient may have some intraoral problem that is contributing to the overall medical con- dition (ie, the inability to eat due to a toothache, abscess, or ill-fitting denture in a poorly controlled diabetic) for which a dental consult may be necessary. In addition, in an emergency situa- tion when intubation is necessary, complications may occur if the clinician is unfamiliar with the oral structures. The patient may be able to give some dental history, including recent toothaches, ab- scesses, and loose teeth or dentures. Be sure to ask if the patient is wearing a removable par- tial denture (partial plate), which should be removed before intubation. As lost dentures are a chief dental complaint of hospitalized patients, care must be taken not to misplace the re- moved prosthesis.

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It has been found that about 25–35% adrenal glands may also be affected and in rare cases buy 180mg diltiazem otc, a of individuals with MEN2A will develop parathyroid tumor called a carcinoid may develop. Individuals with MEN2B also develop MTC and Patients with MEN2A experience two main symp- pheochromocytoma. However, the medullary thyroid car- toms, medullary thyroid carcinoma (MTC) and a tumor cinomas often develop at much younger ages, often of the adrenal gland known as pheochromocytoma. About half of the individuals with that is preceded by a condition called C-cell hyperplasia. MEN2B develop a pheochromocytoma with some cases C-cells are a type of cell within the thyroid gland that being diagnosed in childhood. About 40–50% of MEN2B develop additional conditions, which make it individuals with MEN2A develop C-cell hyperplasia fol- distinct from MEN2A. These extra features include a lowed by MTC by the time they are 50 years old and 70% characteristic facial appearance with swollen lips; tumors will have done so by the time they are 70 years old. In of the mucous membranes of the eye, mouth, tongue, and some cases, individuals develop C-cell hyperplasia and nasal cavity; enlarged colon; and skeletal abnormalities, MTC in childhood. Medullary thyroid carcinoma tumors such as long bones and problems with spinal curving. Hyperparathyroidism is not seen in MEN2B as it is in Pheochromocytoma is usually a benign tumor that MEN2A. Unlike the other three MEN syndromes, indi- causes excessive secretion of adrenal hormones, which in viduals with MEN2B may not have a family history of turn can cause life-threatening hypertension (high blood MEN2B. In at least half of the cases and perhaps more, pressure) and cardiac arrhythmia (abnormal heart beats). About 40% of people with MEN2A will develop a Medullary thyroid carcinoma may also occur in fam- pheochromocytoma.

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