Answer the following questions.A 45-year-old female, gravida 5 para 4, is seen by her physician for suprapubic and lower back pain. She also complains of a burning sensation and pain upon micturition. Her physician orders a urinalysis, intravenous pyelogram, and a cystoscopy.  She is diagnosed with a urinary tract infection, dysuria, and hematuria.

How would you explain to the patient in language she can understand the difference between dysuria and hematuria?
If the physician wants to refer the patient to a specialist, what kind of specialist would she recommend? 
Where can abbreviations be substituted for terms in the above narrative? 
How would the interpretation of the term suprapubic be changed if it were spelled superpubic?  
Explain gravida 5 para 4.

The following paragraphs are taken from theNew England Journal of Medicine, Vol. 360, No. 12, March 19, 2009. Moyamoya Disease/Syndrome: Moyamoya is described as “hypoplasia of the bilateral internal carotid arteries.”  It is named for the characteristic appearance of the abnormally dilated collateral vessels on angiography which are likened to “something hazy, like a puff of cigarette smoke,” which in Japanese, is moyamoya.  There are two major etiologic categories of symptoms: those due to brain ischemia and those due to the response to the ischemia, mainly hemorrhage and headache.Symptoms of cerebral ischemia in moyamoya are typically associated with the regions of the brain supplied by the internal carotid arteries and middle cerebral arteries; these regions include the frontal, parietal, and temporal lobes.  Hemiparesis, dysarthria, aphasia, and cognitive impairment are common.  Patients may also have seizures, visual deficits, syncope, or personality changes that can be mistaken for psychiatric illness.Intracranial hemorrhage is common in adults with moyamoya.  The location of the hemorrhage can be intraventricular, intraparenchymal (frequently in the region of the basal ganglia), or subarachnoid.  Headache is also a frequent presenting symptom and is typically migraine-like in quality and refractory to medical therapies.An ophthalmologic finding occasionally seen in association with moyamoya is the “morning glory disk,” an enlargement of the optic disk with concomitant retinovascular anomalies.

1. Identify, list, and define four symptoms associated with moyamoya disease.
2. What other central nervous system disorder could moyamoya mimic or be similar to?
3. What does the “refractory to medical therapies” tell you?  Is there another term that could have been used in place of refractory?
4. Define concomitant and anomalies. Could other terms have been used in place of these two terms? 

1.  A 50-year-old male had a total thyroidectomy followed by thyroid hormone replacement therapy. Thirty-six hours later he developed laryngeal spasms, a mild tetany, and cramps in the muscles of the hands and arms. His serum calcium level was moderately decreased. What has happened here?