The region of the brain that encloses the third ventricle and immediately rostral to the brainstem, and includes the thalamus, epithalamus, and hypothalamus is the diencephalon.
Thalamus is an oval structure within the middle of your brain. It's called a relay station of all incoming motor (movement) and sensory data — hearing, taste, sight and bit (but not smell) — from your body to your brain.
The epithalamus is a posterior (dorsal) phase of the betweenbrain. The epithalamus includes the habenular nuclei and their interconnecting fibers, the habenular commissure, the stria medullaris and therefore the epiphysis cerebri. Epithalamus. medial facet of a brain divided within the median mesial plane.
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The aspect of hearing that declines most significantly in midlife is the ability to __________.
The aspect of hearing that declines most significantly in midlife is the ability to hear a high-pitched sound
Why does the ability to hear a high-pitched sound decline significantly in midlife? Since men are more likely to work in noisy jobs, they experience hearing loss rather than women in their midlife. A high-pitched sound is the first influenced by hearing loss. The condition where middle-aged adults tend to have difficulty hearing in conditions of background noise is characterized as Presbycusis. It might happen due to old hearing.There are some symptoms of hearing loss in middle-aged adults such as reading the lips of others while they are speaking, increasing the volume on the television or radio, and speech difficulty in crowded or noisy environments
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a health care provider in the outpatient department examines a client with chronic heart failure to investigate recent-onset peripheral edema and increased shortness of breath. the nurse documents the severity of pitting edema as 1. what is the best description of this type of edema?
Peripheral edoema is the medical term for leg swelling brought on by fluid retention in the tissues of the leg. It may be brought on by an issue with the kidneys, the lymphatic system, or the venous circulation system.
What is edoema?Edema is an engorgement of fluid in your bodily tissues that results in swelling. Edema can affect any area of your body, although it tends to manifest itself more visibly in the hands, arms, feet, ankles, and legs.
Edema can be brought on by medicine, pregnancy, or an underlying illness, which is frequently cirrhosis of the liver, congestive heart failure, or kidney disease.
Edema is frequently relieved by taking medications to drain extra fluid and consuming less salt. When edoema is a symptom of an underlying illness, that illness needs to be treated separately.
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to ensure that the client's respiratory status is stable upon his arrival on the medical unit, the nurse should complete which assessment first?
To ensure that the client's respiratory status is stable upon his arrival on the medical unit, the nurse should complete breath sounds assessment first.
Respiratory status is outlined as “movement of air in associated out of the lungs and exchange of greenhouse emission and chemical element at the alveolar level”. The traditional rate for an adult is 12-20 breaths per minute at rest, and therefore the traditional vary for oxygen saturation of the blood is 94–98%, and tachypnea is bigger than twenty breaths per minute.
The breath sounds ought to be assessed throughout each quiet and deep respiratory. A full breath ought to be auscultated in every location. The examiner ought to listen for the pitch, intensity, duration, and distribution of breath sounds, also as note any abnormal or accidental sounds.
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a patient is having an angiography to detect the presence of an aneurysm. after the contrast is administered by the interventionist, the patient begins to complain of nausea and difficulty breathing. what medication is a priority to administer at this time?
According to research, the correct answer is epinephrine. If the aneurysm patient begins to complain of nausea and shortness of breath, the medication to be administered at this time is Epinephrine.
What is epinephrine?It is a highly active α and β-adrenergic agonist drug, which is used in conjunction with emergency medical treatment to treat allergic reactions.
In this sense, it is indicated for the treatment of anaphylactic shock or anaphylaxis, which is a severe reaction caused by an allergy to a drug.
Therefore, we can conclude if the patient presents nausea and shortness of breath after a medication, it is an allergic reaction, therefore epinephrine should be administered.
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a cst is assisting a surgeon on a deep abdominal case. the surgeon unexpectedly asks dave for a stick tie. what might the cst ask the surgeon after the case to ensure that the correct items were available the next time he performs this type of procedure?
Following the procedure, the CST could interrogate the surgeon in order to make sure that the appropriate supplies are available the next time he conducts this kind of procedure: What tools are needed for this surgery that wasn’t available today and might be needed for another similar procedure? Please dictate to me a list of the same so that I can guarantee their availability at the following time.
The CST must follow the hospital's OT procurement protocols and notify the OT supervisor or his superiors. Could you kindly let me know the equipment specifications and the business in particular, if any, from which the instruments may be purchased, as these instruments are not available in the operating room and our hospital's setup? May you kindly offer some substitute tools that could be utilized for this process the following time till the sales and buying department is able to obtain the necessary instruments?
Thus, it follows that the CST must set up the instrument tray prior to the deep abdominal surgical procedure by organizing the frequently used tools, suture materials with the length of sutures, and needle types that the surgeon will use.
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Scientists have concluded that repeated exposure to high doses of x-rays can lead to cancer in individuals. How does the x-ray exposure result in cancer?.
Repeated exposure to high doses of x-ray can lead to cancer because the low-dose radiation may accumulate over the years to substantial cancer-causing doses.
Ionizing radiation, which is what an X-ray is, can damage the DNA. When this damage is improperly repaired by our calls, it may result in DNA mutations that may end up as cancer in the following years.
As answered above, repeated exposure to X-rays will accumulate the dose of ionizing radiation in one's body. While it may contribute to cancer over time, long-term radiation exposure can also result in a reduction in platelets, loss of white blood cells, fertility problems, and kidney function changes.
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Occurs when intervertebral disks between spinal vertebrae deteriorate, creating pain and shortening of stature.
A form of medical ailment known as a degenerative disease causes a tissue or organ to degenerate over time. There are a lot of degenerative diseases, and many of them are brought on by ageing or worsen as we become older.
The three main categories of degenerative disorders are cardiovascular, neoplastic, and nervous system. Hypertension, coronary disease, and myocardial infarction are the three most prevalent cardiovascular diseases. Among neoplastic illnesses include cancer and tumours. Parkinson's disease and Alzheimer's disease are two conditions that damage the neurological system.There are numerous degenerative diseases that are brought on by unknown causes. However, thanks to developments in genetics, biochemistry, cell biology, and imaging technology, researchers have been able to find commonalities among a variety of degenerative disorders.
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after performing an ecg on an adult client, the nurse reports that the pr interval reflects normal sinus rhythm. what is the pr interval for a normal sinus rhythm?
The pr interval for a normal sinus rhythm is three to five small squares or 0.12 to 0.20 seconds.
What is PR interval?This is a term which is referred to as the time taken for the electrical impulse to travel from the SA node to the AV node and is commonly used during the process of electrocardiography.
We were told that the nurse reports that the pr interval reflects normal sinus rhythm which means that it is most likely within the range of three to five small squares or 0.12 to 0.20 seconds thereby making it the correct choice.
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extracted teeth without amalgam fillings may be disposed of by: extracted teeth without amalgam fillings may be disposed of by: placing in sharps containers. discarding in the regular office trash. taking them home and placing them in the regular trash. wiping them off and giving them back to the patient.
Extracted teeth without amalgam fillings may be disposed of by placing them in sharps containers.
What are amalgam fillings?
Dental amalgam is a dental filling material used to fill cavities caused by tooth decay. Dental amalgam is a mixture of metals, consisting of liquid (elemental) mercury and a powdered alloy composed of silver, tin, and copper.
What is the safest filling for teeth?
Fillings made from the amalgam are fifty percent mercury, with other metals like copper, tin, and zinc that make up the rest. Amalgam or silver fillings have long been considered the best option for dental fillings because they are affordable and durable. In fact, they can last for years with proper care.
What do you keep extracted teeth in?
All extracted teeth should be stored in a well-constructed container, such as a glass jar, with a secure lid to prevent leaking during transport and labeled with a biohazard symbol. Containers should have a sufficient amount of either of the following: Common household bleach, diluted with water at a 1:10 ratio.
Thus, teeth without amalgam fillings are placed in sharp containers.
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the nurse has a prescription to hang a 1000-ml intravenous (iv) bag of 5% dextrose in water with 20 meq of potassium chloride. the nurse also needs to hang an iv infusion of piperacillin/tazobactam. the client has one iv site. the nurse should plan to take which action first?
The nurse should plan first to check the compatibility of the medication and IV fluids.
What are medications?A medication is described as a drug used to diagnose, cure, treat, or prevent disease.
Most medications have side effects that are unwanted, and usually unpleasant, effects caused by medicines. Most are mild, such as a stomachache, dry mouth, or drowsiness, and go away after you stop taking the medicine.
So in conclusion, if the nurse has a prescription to hang a 1000-ml intravenous (iv) bag of 5% dextrose in water with 20 meq of potassium chloride. the nurse also needs to hang an IV infusion of piperacillin/tazobactam, the nurse should plan first to check the compatibility of the medication and IV fluids.
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what special precautions or practices should a private practitioner adopt in order to minimize professional liability and ensure that their treatment of clients remains soundly within the boundaries of professional practice standards?
These are following special precautions that should be adopted by the private practitioners to minimize professional liability and ensure that their treatment of clients remains soundly within the boundaries of professional practice standards
In the event that carelessness or malpractice is implicated in their work, the private practitioner should be covered by liability insurance. Private practitioners should always uphold appropriate professional and ethical standards.Professional indemnity insurance, also known as professional liability insurance or errors & omissions insurance in the US, is a type of liability insurance that aids in protecting professional practice standards .
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a nurse is assessing a 75-year-old woman who had a total hysterectomy when she was 30 years old and normal pap test results for the past 10 years. the client asks about continuing the pap test. what is the best response by the nurse?
The best response by the nurse is "You may choose to discontinue this test."
What is hysterectomy ?The womb is surgically removed during a hysterectomy (uterus). After the procedure, you won't be able to become pregnant again. No of your age, if you haven't previously experienced the menopause, you won't have periods anymore. Women between 40 to 50 are more likely to experience it.The most frequent causes of hysterectomy are as follows: fibroids may be the reason of heavy periods. Pelvic pain can be brought on by endometriosis, pelvic inflammatory disease (PID) that has not responded to treatment, adenomyosis, or fibroids. the uterus prolapsing. If your ovaries are still producing hormones. Due to the surgery's potential to have obstructed blood flow to the ovaries, you may experience hot flashes, a menopause symptom.Learn more about Hysterectomy refer :
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a nurse is assessing a 10-year-old child who is displaying behaviors that are consistent with oppositional defiance disorder. when conducting the assessment, the nurse should also assess for which co-morbidity?
Co-morbidity of attention deficit hyperactivity disorder should also be evaluated by the nurse.
ODD is the most typical comorbid condition for ADHD. Three subtypes of ADHD are included in the DSM-IV: mixed type (ADHD-IA), mainly hyperactive-impulsive type (ADHD-HI), and predominantly inattentive type (ADHD-IA) (ADHD-C).
Oppositional defiant disorders, enuresis, and language problem, and anxiety & tics in the middle of the school years are the most frequent comorbid diagnoses of ADHD in early childhood. Mood problems and drug use disorders are common throughout adolescents.
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true or false? nursing home care and home health care accounted for more than half of national health expenditures in 2013.
False, More than half of health care spending in 2013 were spent on nursing home and home health care.
What is nursing home care?
A nursing home care is a place where elderly or disabled people can receive residential care. The terms skilled nursing facility (SNF), long-term care centers, old people's homes, assisted living facilities, care homes, rest homes, convalescent homes, or convalescent care may also be used to refer to nursing homes. These terms frequently denote the institutions' public or private status as well as their focus on assisted living, nursing care, or both emergency medical care and assisted living. People who do not require hospitalisation but require care that cannot be provided at home go to nursing homes. Depending on their rank, nursing home care nurses may also be responsible for overseeing other employees in addition to attending to the medical needs of the patients.
Hence, the answer is false.
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the physician has written the following orders for a new client admitted with pancreatitis: bed rest, nothing by mouth (npo), and administration of total parenteral nutrition (tpn) . which does the nurse attribute as the reason for npo status?
The nurse can attribute inflammation of pancreas (pancreatitis) as a reason for the given npo status.
What is pancreatitis?
The redness and swelling (inflammation) of the pancreas are symptoms of pancreatitis. When digestive acids or enzymes damage the pancreas, this occurs.
The pancreas is located on the left side of your belly, behind your stomach. It is in close proximity to the beginning of your small intestine (the duodenum).
A gland, the pancreas is. It performs two key tasks:
Your small intestine receives the enzymes it produces. These enzymes aid in the digestion of meals.It produces and releases the chemicals glucagon and insulin into your system. These hormones manage the blood sugar levels in your body.There are two types of pancreatitis: acute and chronic (chronic).
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the nurse is taking a health history on a new patient. the patient reports experiencing pain in the left lower leg and foot when walking, but claims that the pain is relieved with rest. the nurse notes that the patient's left lower leg is slightly edematous and hairless. what should the nurse suspect that the patient may be experiencing?
The nurse notes that the patient's left lower leg is slightly edematous and hairless with pain therefore he/she should suspect that the patient may be experiencing Intermittent claudication and is denoted as option B.
Who is a Nurse?This is referred to as a healthcare professional who takes care of the sick and ensures that adequate recovery is achieved so as to reduce the risk of complications.
Intermittent claudication is the type of muscle pain that happens when you're active and stops when you rest and in this scenario we were told that there is pain in the left lower leg and foot when walking and the pain is relieved with rest which is why it was chosen.
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The options are:
A) Coronary artery disease (CAD)
B) Intermittent claudication
C) Arterial embolus
D) Raynauds disease
A nurse is caring for a 10-year-old child who has acute glomerulonephritis (AGN). Which of the following findings should the nurse report to the provider?
A. Serum BUN 8 mg/dL
B. Serum creatinine 1.3 mg/dL
C. Blood pressure 100/74 mm Hg
D. Urine output 550 mL over 24 hr
(B.) Serum creatinine 1.3 mg/dL is the correct option of the given findings that the nurse should report to the provider.
Acute glomerulonephritis (AGN) is a kidney disorder that results from inflammation of the glomeruli. The glomeruli are the tiny filters in the kidney that remove waste products from the blood. AGN can cause these filters to become damaged, which can lead to kidney failure.
Serum creatinine is a measure of kidney function. A high serum creatinine level indicates that the kidneys are not functioning properly. This is a serious finding in a child with AGN and should be reported to the child's provider immediately.
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the nurse is conducting a sexual history with a widowed woman who speaks very little english. the nurse recognizes an interpreter is necessary, but a professional interpreter is not available. which person would be best to serve as an interpreter/translator?
Anyone with a formal knowledge of the woman's ethnic language shall help as a translator.
What is a Sexual history?A thorough health examination must include a sexual health assessment. When a patient first comes in for care, during regular checkups, and when they exhibit symptoms or indicators of a sexually transmitted disease, a sexual history must be obtained (STD). A sexual history clarifies pregnancy plans, identifies patients at risk for HIV and other STDs, and reveals other sexual health-related difficulties, providing doctors with the knowledge they need to manage these problems and conditions.
The discourse that occurs promotes healthy behaviour coaching and aids in the development of trust. Assessing risk behaviours and determining reasons for using PrEP require knowledge about one's sexual history. A sexual history should ideally also offer direction and address issues with sexual fulfilment and pleasure.
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to best secure accurate assessment information, the nurse should complete which part of the reproductive history last?
The reproductive history last part is menopause.A reproductive history may include information about menstrual periods, the use of birth control, pregnancies, breastfeeding, and menopause.
What is included in reproductive history?Information on menstrual cycles, birth control use, pregnancies, breastfeeding, and menopause can all be found in a person's reproductive history.Information regarding disorders with the reproductive system, fertility, and difficulties giving birth may also be included. It helps to deliver a healthy baby and safeguards both the mother and the kid from contagious infections.It offers comprehensive information about early pregnancy, infertility, birth control options, pregnancy, postpartum care for both the mother and the infant, etc. Reproductive histories give details on the occasions that affected reproduction from a woman's birth till the data collection period.She does not yet know when she will get married, when she will have her first child, or when she will reach menopause.To learn more about reproductive history refer
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a hospital has been notified that possible bioterrorist activity has taken place at a large sporting event nearby. a nurse has been put in charge of preparing a holding area to meet the needs of victims who report headache, dizziness, anxiety and shortness of breath, and are noted to have a bitter almond odor to their breath. what medication should the nurse be prepared to administer?
Nurse should prepare amyl nitrate to administration.
Anxiety is an emotion characterised by emotions of hysteria, worried thoughts, and bodily adjustments like multiplied blood pressure. People with anxiety problems generally have routine intrusive mind or issues.
Generalised tension sickness (GAD),your demanding is uncontrollable and reasons distress. Your demanding impacts your every day existence, such as college, your activity and your social existence. You can not let pass of your concerns.
Some anxiety signs and symptoms include :
* Feeling nervous, restless or stressful.
* Having a sense of forthcoming danger, panic or doom.
* Having an improved coronary heart rate.
* Breathing rapidly (hyperventilation)
* Sweating.
* Trembling.
* Feeling susceptible or worn-out.
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the nurse is caring for a client who has a unit of whole blood removed every 6 weeks as treatment for polycythemia vera. which laboratory test will the nurse monitor to determine if the procedure is adversely affecting the client?
Therapeutic phlebotomy is the laboratory test, that will the nurse monitor to determine if the procedure is adversely affecting the client.
What is therapeutic phlebotomy procedure?Phlebotomy used for therapeutic purposes involves drawing blood to address a medical condition, such as having too much iron in the body. More blood is taken during a therapeutic blood draw than during a standard blood sample. The amount of blood that will be extracted depends on why you are having the operation, which is decided by your doctor.It's beneficial to have more liquids than normal before your therapeutic phlebotomy operation, if you can. For one day before to your surgery, try to consume 8 to 10 (8-ounce) glasses of liquids.A nurse will take a specific amount of blood during your therapeutic phlebotomy procedure using a needle attached to a blood collection bag. Once the appropriate amount of blood has been drawn, the nurse will withdraw the needle and cover the needle site with a pressure bandage (a bandage that wraps around your arm).Learn more about Therapeutic phlebotomy procedure refer :
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one in 1000 anesthetized patients vomit for unknown reasons, and pre-op procedures always ask if a patient has eaten in the previous 12 hours. given that the swallowing reflex is abolished by anesthesia, why is it so dangerous for these patients to vomit?
Anesthesia inhibits the reflex to swallow. Laryngeal and upper airway reflexes must return quickly after anesthesia recovery in order to prevent aspiration into the lower airway.
What swallowing reflex is abolished by anesthesia?Disinhibition, madness, irrational behavior, lack of the eyelid reflex, hypertension, and tachycardia are characteristics of this stage. During this stage, airway reflexes are still functional and frequently sensitive to stimulation.
A child's ability to move their jaw, tongue, voice box, and throat muscles with strength and/or range of motion may be affected by swelling (edema) near the site of surgery (head and neck).
Therefore, It can cause your youngster to have trouble swallowing. Swallowing discomfort caused by structural alterations or edema.
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A patient i receiving a tube feeding formula called Vivonex, which i infued at a rate of 85ml/hr. What i the total volume of the formula that will be infued per day?
3,240 ml of fluid are injected in total each day, and will be infused.
What is a tube-feeding formula?Given that a patient is getting a normal saline solution that is constantly infused at 85 ml per hour and a tube feeding formula called Vivonex that is continuously infused at 50 ml per hour, the following calculation must be made to estimate the total volume of fluids infused each day:
(85 x 24) + (50 x 24) = X
1,920 + 1,200 = X
3,240 = X
Therefore, as a result, 3,240 ml of fluids are infused altogether each day.
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an informatics nurse specialist is gathering data from electronic health records at the facility about clients who have had central venous catheters inserted for more than the recommended time as specified by the facility's protocol. the nurse specialist is collecting this data most likely for which purpose?
An informatics nurse specialist is gathering data from electronic health records at the facility about clients who have had central venous catheters inserted for more than the recommended time and she is collecting this data most likely to identify clients at risk for infection.
An informatics nurse specialist "is the specialty that integrates nursing science with multiple info and analytical sciences to spot, define, manage and communicate knowledge, info, data and knowledge in nursing follow."
A central venous catheters, conjointly called a central line, may be a tube that doctors place in an exceedingly massive vein within the neck, chest, groin, or arm to offer fluids, blood, or medications or to try to to medical tests quickly.
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which interventions would the nurse implement for a client with a right total hip arthroplasty performed 6 hours ago?
The interventions would the nurse implement for a client with hip arthroplasty are provide proper nursing, provide asset according to the need of the client.
Hip arthroplasty is a surgical procedure in which the damaged part of the hip joint gets removed and replace by an artificial part. The artificial part does the work of a normal hip joint. After the surgery patient needs complete rest. Nurse should remove the dressing when surgery part becomes saturated. pulse of the patient should be checked continuously. Nurse should provide wheel chair, toilet sheets, a special bed in which the head of the patient lied up. Nurse should take care of the patient in the full time basis as the patient cannot do things of their own after the surgery.
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when creating a retention schedule for medical records a medical assistant should consult which of the following
A medical assistant should consult state guidelines.
In the United States, medical errors are a major cause of death and a critical public health issue. Finding a reliable cause of mistakes and then offering a reliable, workable solution that reduces the likelihood of a reoccurring problem are difficult tasks. Patient safety can be raised by acknowledging unfavorable incidents when they occur, learning from them, and attempting to prevent them.
To eliminate the blame culture and maintain accountability, governmental, legal, and medical institutions must cooperate.
To help organizations and healthcare professionals create a safer practice environment for patients and providers, The Joint Commission has proposed many patient safety goals.
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the nurse is assessing a client exposed to viral hepatitis who is thought to be in the prodromal phase. when assessing the client, which symptoms does the nurse recognize are consistent with this phase? select all that apply.
The symptoms of a person with prodromal phase is Lack of energy, Lack of appetite.
The prodrome is a period of subclinical symptoms and signs that precedes the onset of psychosis. Comorbid conditions are commonly prevalent throughout the prodromal , which can last from a few weeks to many years.
Prodromal symptoms might include thoughts of as well as anxiety, sadness, fluctuations, sleeplessness, aggression, and aggressiveness. The patient may also exhibit symptoms of other conditions including obsessive-compulsive disorder and dissociative disorders.
Prodromal labor typically stops before becoming active. It's acceptable if your child isn't yet ready to meet you. The best thing you can do is keep track of your contractions.
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a daily dose of prednisone is prescribed for a client. the nurse provides instructions to the client regarding the administration of the medication and should instruct the client at which time is best to take this medication?
Early morning is the best time to take the medication is to be suggested by the nurse.
Prednisone should be taken with breakfast in the morning if it is only used once daily. Mornings are ideal for working out because cortisol is naturally produced then. You may have problems falling asleep if you take your prednisone dose later in the day.
Breakfast is the best time to take Prednisolone to prevent morning sickness. If taken in the morning, prednisolone is unlikely to keep you awake at night. Prednisolone tablets that have been "gastro resistant" or "enteric coated" can be taken with or without food as long as they are swallowed whole.
Prednisone should be taken with breakfast first thing in the morning if it is only taken once per day.
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the nurse is performing an assessment on a client suspected of having herpes zoster. the nurse would expect to note which types of lesions on inspection of the client's skin?
Any region of your skin that differs abnormally from the surrounding skin is called a skin lesion. Skin lesions are common and frequently the result of harm to your skin, but some of them have the potential to develop into cancer.
What types of lesions on inspection of the client's skin?A wavy or gyrating peripheral border is present in serpiginous lesions. An annular lesion is round or serpiginous (i.e., has an arciform wavy border), and it has a peripheral border that is either higher than the center or a different color from the center.
Therefore, The patients who are most at risk for altered skin integrity include those who are obese, paraplegic, have spinal cord injuries, are bedridden and confined to wheelchairs, and have edema.
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a patient with cushing syndrome who is admitted for adrenalectomy has a nursing diagnosis of disturbed body image related to changes in appearance caused by the effects of the disease. which intervention by the nurse will be most helpful?
A patient with cushing syndrome who is admitted for adrenalectomy has a nursing diagnosis of disturbed body image related to changes in appearance caused by the effects of the disease. The intervention by the nurse which will be most helpful is most physical changes will resolve after surgery.
When your body consistently produces too much cortisol, a disease known as Cushing's syndrome develops. Because it aids in your body's response to stress, cortisol is commonly referred to as the "stress hormone." Cortisol is beneficial.
keep blood pressure steady
control blood sugar, often known as blood glucose
decrease inflammation and convert food into energy
Cortisol is produced by the adrenal glands, two tiny glands located above the kidneys.
Although it can happen to youngsters, Cushing's syndrome typically affects adults, typically between the ages of 30 and 50. About three times as many women as men are afflicted by Cushing's syndrome. 2 Cushing's syndrome may be the root cause in persons with type 2 diabetes, persistently high blood glucose levels, and high blood pressure. Another risk factor for Cushing's syndrome is taking drugs similar to cortisol called glucocorticoids. Exogenous Cushing's syndrome is the term used to describe it. The number of Americans who take glucocorticoids each year3—more than 10 million—and go on to develop Cushing's syndrome is unknown.
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