Diabetics get peripheral neuropathy from glucose damaging Schwann cells. For what I believe is an unconfirmed reason, T2DM patients tend to see parasympathetic autonomic neuropathy before sympathetic.

The hypogastric nerve carries sympathetic innervation to the posterior urethra and is responsible for ejaculation.

Inferior rectal nerve is a branch of the pudendal nerve that innervates the external anal sphincter and provides sensation below the pectinate line. A peripheral nerve problem with this nerve would cause the sphincter to remain relaxed and cause incontinence, not constipation.

Pelvic splanchnic nerves are parasympathetics (craniosacral outflow). If he is constipated, his rest and digest (parasympathetic) system is not working.

Perineal nerve is a branch of the pudendal nerve. It has both motor and sensory, is involved in the external anal sphincter, urethral sphincter, and is responsible for conscious sensation of the need to urinate.

Sacral sympathetic inhibits peristalsis, and contracts internal anal sphincter to maintain continence.

Another way to think of this: She has a strong family history, so we are thinking she probably does indeed have this mutation (probably a True Positive). Our fear, would be we do the wrong test and aberrantly tell her that she is in the clear (False Negative). Having a high False Negative would be deleterious to this patient, and plugging this into a 2x2 table gives a low sensitivity (TP/ TP +FN).

A: Anterior to the nasolacrimal duct → angular artery* pic1 pic2

B: Distal to the vestibule → respiratory region/nasal airway proper pic

C: Inferior to the hiatus semilunaris → uncinate process pic

D: Posterior to the middle concha → sphenoid sinus pic

E: Proximal to the fusion of the hard and soft palate → horizontal plate (of palatine bone) pic

F: Superior to the superior concha → sphenoethmoidal recess pic

*I was really conflicted on what this could be referring to. Ultimately, I thought angular artery aligned the best with being anterior to the nasolacrimal duct, but I'm not 100% sure.

other things I considered: maxillary bone, inferior concha

Breast cancers are one of the most common malignancies to be associated with hypercalcemia. Most often the hypercalcemia is due to osteolytic metastases and hence portends a bad prognosis. A significant number of the patients with breast cancers (up to 15%) show hypercalcemia in the absence of metastasis.

Hypercalcemia is relatively common in patients with cancer, occurring in approximately 20 to 30 percent of cases. It is the most common cause of hypercalcemia in the inpatient setting.

Beck's triad: muffled heart sounds, jugular vein distension, and electrical alternans. This patient has cardiac tamponade. The fluid has to be removed.

A pericardial window is a cardiac surgical procedure to create a window from the pericardial space to the pleural cavity. The purpose of the window is to allow a pericardial effusion (usually malignant) to drain from the space surrounding the heart into the chest cavity.

I'd seen a Question just like this one on Amboss and still managed to get this one wrong. So basically a ganglion on the VOLAR (palmar) surface of the wrist could potentially compress the structures within the carpal tunnel (i.e the median nerve, the flexor pollicis longus, the flexor digitorum profundus and superficialis tendons) and cause weakness/paresthesias if it kept growing. A DORSAL ganglion, on the other hand, is a lot less likely to compress on anything, and is more likely to remain asymptomatic and regress spontaneously. P.S. Carole did it.

To diagnose hypertension, there must be a hypertensive emergency >180/120, evidence of hypertension related end organ disease if greater than 160/100, or measurements in the office showing bp of greater than 130/80 at least three times. The measurements must be spaced over a period of weeks to months.

Osmotic diuresis caused by glucosuria is one of the most common causes of excessive renal salt and water loss.