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The specificity of these tests varies from approximately Chemistry/Evaluate laboratory and clinical data to 75%–80% generic 50 mg imipramine. Many other tumor markers generic 75 mg imipramine free shipping, including neuron-specific enolase and parathyroid hormone-related protein, are also increased in lung cancers. Which of the following tumor markers is used to Answers to Questions 7–9 monitor persons with breast cancer for recurrence of disease? However, abnormal plasma levels are seen in many nonmalignant Chemistry/Correlate clinical and laboratory data/ conditions, and the test is not used for diagnostic Tumor markers/2 purposes. Which of the following statements regarding the by approximately 75% of ovarian cancers. It is seen exclusively in chronic myelogenous recurrence of ovarian cancer and evaluating the leukemia effectiveness of chemotherapy. It results from a translocation assays are performed to determine the prognosis of C. Overexpression of chromosome 21 cathepsin-D is associated with a higher relapse D. Monitoring for recurrence of cancer translocation of the long arms of chromosomes 9 and 22. The Ph1 chromosome appears on karyotyping as a long-arm deletion of chromosome 22 because only the terminal end of the long arm of chromosome 9 is exchanged for most of the long arm of chromosome 22. Approximately 95% of persons with chronic myelogenous leukemia have the Ph1 chromosome. However, it is present in only 40%–60% of such cancers, is present at low levels (<3. Its clinical use is to detect recurrence and the need for second-look surgery in persons who have been treated and to evaluate the response to treatment. Which tumor marker is used to determine the Answers to Questions 10–13 usefulness of trastuzumab (Herceptin) therapy for breast cancer? Myc more aggressive clinical course but responds to treatment with trastuzumab, which blocks the Chemistry/Apply knowledge of fundamental biological attachment of growth factor to the receptor. Chemistry/Evaluate laboratory data to explain inconsistent results/Tumor markers/3 12. D Treatment of tumors with chemotherapy often causes a transient increase in the production of 13. Fecal trypsin the early stages of colorectal cancer when treatment Chemistry/Correlate clinical and laboratory data/ can be most effective. Which of the following assays is used to determine with benign polyps and has a sensitivity of over 80% the risk of developing cancer? Chemistry/Apply knowledge of fundamental biological characteristics/Tumor markers/1 16. D The p53 gene (tumor suppressor gene) is located on chromosome 17 and produces a protein that 17. What is epidermal growth factor and its overexpression in the most likely diagnosis? Carcinoid tumors of the intestine is a glycoprotein antigen found in the cytoplasm of B. C Neuron-specific enolase is an isoenzyme containing Tumor markers/2 two gamma polypeptides that are specific for nervous tissue and are found in neuroendocrine cells. Plasma levels are increased in neuroblastomas, carcinoid tumors, thyroid medullary carcinomas, and in some lung cancers and seminomas. Chromogranin A is a protein that inhibits release of catecholamines and is increased in pheochromocytoma, neuroblastoma, and carcinoid tumors. Urinary 5-hydroxyindoleacetic acid is increased in carcinoid tumors (enterochromaffin tumors). Although digital rectal examination error/Tumor markers/1 raises the prostatic acid phosphatase level, it does not 19. Which of the following procedures can be used to Answers to Questions 1–3 detect proportional error in a new method for glucose? Compare the standard deviation of 40 patient the expected result, and affects the slope of the samples to the hexokinase method calibration curve. Measure a mixture made from equal parts of (loss of accuracy) as concentration increases. In the known concentration and measure example, the concentration should increase by D. A Bandpass is defined by the range of wavelengths Chemistry/Select course of action/Method evaluation/3 passed through the sample at the specified 2. Assume that wavelength is any solution having a narrow absorbance peak accurately calibrated.

Jason spends much of the afternoon in the mall going from one clerk to another in various stores cheap 50 mg imipramine fast delivery. By the end of the day generic imipramine 25 mg free shipping, he chats easily with a clerk and feels only a fraction of his pre- vious anxiety. Jason knows he needs to continue with this step, but he’s also ready to take on the next one. Jason tracks his progress in the Climb to the Top Exercise shown in Worksheet 9-12. After each attempt at a fearful activity, he records how much anxiety he experiences and jots down his thoughts. He repeats the activity until his anxiety decreases by at least 50 percent, and then he moves to the next step. Worksheet 9-12 Jason’s Climb to the Top Exercise Activity Anxiety Ratings: 0 (no fear) to 100 (terrified) Talking to a female store clerk 30, 30, 25, 20, 20, 15, 10, 10: This was tougher than I thought it would be at first, but it got to be kind of fun. Chapter 9: Facing Feelings: Avoiding Avoidance 143 Activity Anxiety Ratings: 0 (no fear) to 100 (terrified) Volunteering to be on the social 65, 70, 70, 60, 30, 30: This started out committee at work and going a lot harder than I thought it would be, to the meetings but it didn’t take too long to come down. Having a conversation with a 70, 70, 65, 65, 55, 70, 55, 40, 65, 35, woman I don’t know 35: This is still pretty hard for me. I know I need to keep on practicing, but I think I can handle the next step in the meantime. As you can see, the first time Jason carried out an activity, his anxiety wasn’t always at the level he had expected on his Staircase of Fear (see Worksheet 9-5). As he repeated the activ- ities, his anxiety went up and down but generally tended downward. Before you begin exposure, or what we call climbing the staircase, it’s a good idea to start out in a reasonably relaxed state. Practicing this breathing technique gives you a quick way of managing anxiety if it crops up and climbs excessively. In the left-hand column of Worksheet 9-13, write down the activities from your Staircase of Fear (see Worksheet 9-11) in order of difficulty, with the easiest, least fearful items listed first. If the item involves an imaginary scene, find a comfortable place to sit and relax. Lie back, close your eyes, and picture the feared item as though it were occurring. Stay with the image as long as it takes for your fear to diminish at least 50 percent. In the right-hand column of Worksheet 9-13, rate how anxious the activity or imagery makes you feel on a scale of 0 (no anxiety) to 100 (terrifying). Repeat each activity and rate each repetition until your anxiety has dropped by around 50 percent. If the breathing technique doesn’t calm you down, consider backing away from the activity and try to break it down into more manageable steps. Move on to the next, more difficult activity when your anxiety has dropped and you feel you have mastered the preceding item. When you complete the climb of your Staircase of Fear, take a few moments to reflect on the experience and what it’s meant to you in Worksheet 9-14. If you find the task of climbing your staircase daunting, turn to the following helpful sugges- tions for making your climb successful. Consider asking a trusted friend or family member to accompany you on your first attempt at difficult activities. Don’t give in to mind chatter such as, “I can’t do this,” “This is stupid,” “I’ll look like a fool,” or “This exercise won’t help! Notice how interesting this mind chatter is, but don’t be seduced into believing it. Worksheet 9-14 My Reflections If you find yourself avoiding this exposure part of the program, we suggest you flip back to Chapter 3, which discusses ways of identifying and overcoming roadblocks to change. Essentially, obsessions are unwanted images, impulses, or thoughts that flood the mind. These thoughts may take the form of excessive worry about contamination by germs, chemicals, radiation, and so on. Other obsessions include concerns about whether doors were left unlocked or appliances were turned off. Compulsions are undesired actions that people find themselves doing over and over in order to temporarily reduce anxiety. Common compulsions include excessive hand washing, over- cleaning, hoarding objects, arranging objects in a particularly rigid manner, checking and rechecking things (such as locks), and creating strict rituals such as counting stairs or put- ting on clothing in the exact same order every day. Lots of people experience a few minor obsessions or compulsions, and that’s no problem. You can find considerably more information about this particular problem in Overcoming Anxiety For Dummies (Wiley).

For convenience and clarity in this chapter buy 25 mg imipramine with visa, we mostly use the term “loved one” to refer to any partner discount imipramine 25mg amex, friend, or relative that you may be concerned about. Most people try to look and act as well adjusted as they can, because revealing weaknesses, limitations, and vulnerabilities isn’t easy. Two big reasons for hiding them include ✓ Fear: Revealing negative feelings can be embarrassing, especially to someone with an anxiety disorder. People often fear rejection or ridi- cule, even though self-disclosure usually brings people closer together. Understanding whether your partner experiences anxiety promotes better communication and facilitates closeness. The following list of indications may help you to discern whether your part- ner suffers from anxiety. Ask yourself whether your partner ✓ Seems restless and keyed up ✓ Avoids situations for seemingly silly reasons ✓ Ruminates about future catastrophes ✓ Can’t ever seem to throw anything away ✓ Is reluctant to leave the house ✓ Spends inordinate amounts of time arranging things ✓ Has trouble sleeping or staying asleep ✓ Has trouble concentrating ✓ Has frequent nightmares ✓ Avoids situations or places reminiscent of a past traumatic event ✓ Is plagued with self-doubts ✓ Has episodes of noticeable shakiness and distress ✓ Is constantly on alert for dangers ✓ Seems unusually touchy about criticism Chapter 18: When a Family Member or Friend Suffers from Anxiety 267 ✓ Seems plagued by excessive superstitions ✓ Is overly worried about germs, contamination, or dirt ✓ Seems unusually concerned about health ✓ Has frequent, unexplained bouts of nausea, dizziness, or aches and pains ✓ Frequently rechecks whether the doors are locked or the coffee pot is turned off ✓ Constantly worries about everything ✓ Seems terrified by anything specific, such as insects, dogs, driving, thun- derstorms, and so on ✓ Responds with irritation when pushed to attend social functions, such as parties, weddings, meetings, neighborhood functions, or anywhere you may encounter strangers (the resistance could be due to simple dis- like of the activity, but carefully consider whether anxiety may lie at the root of the problem) A couple of the symptoms in the preceding list (especially irritability, poor concentration, poor sleep, and self-doubts) can also indicate depression. Depression is a serious condition that usually includes loss of interest in activ- ities previously considered pleasurable, changes in appetite, and depressed mood. If your loved one seems depressed, talk with her and then consult with a mental-health practi- tioner or your family physician. Now, if you answered yes to any of the questions in the preceding list (and your partner doesn’t seem particularly depressed), we don’t recommend that you approach your loved one and say, “Look at this list — you’re a nut case! Possible ques- tions to ask include: ✓ What’s the biggest stress in your life lately? For example, if you ask your partner whether she’s anxious, she may reply with a simple “No,” and then the discussion is over. Finally, asking “what” or “how” works better than asking “why” someone is feeling anxious — people often can’t answer “why” they feel the way that they do. Our list of questions for you about your loved one’s anxiety and our list of questions to ask your loved one open the door to communicating about anxi- ety. After you broach the subject and confirm that the one you care about struggles with anxiety, you can build a plan from there. Talking Together about Anxiety Talking about a loved one’s vulnerability isn’t always easy. For example, if you find the conversation turning into an argument, it’s not helpful. If so, you may want to check out the “Accepting Anxiety with Love” section later in this chapter. If that’s the case for the two of you, we suggest relationship counseling — read- ing a few pages about talking together won’t solve fundamental communication problems. But if you’re able to talk together about anxiety without experiencing a communication breakdown, we have some general guidelines for you in the following sections. If your loved one has a problem with anxiety, you may find yourself feeling oddly ambivalent about helping. Sometimes, those confusing feelings come from the fact that seeing one’s partner improve can upset the power balance in a relationship. If you prefer being the boss in your relationship, you may feel uncomfortable seeing your partner get better and become more equal to you. If you see that struggle in yourself, we suggest you seek relationship counseling. You’re likely to discover that a more equal relationship feels better than your unconscious mind thinks it will. Helping without owning the albatross The first order of business in a discussion of your partner’s anxiety is to show empathetic concern. That means putting yourself in your partner’s shoes and seeing the world through his eyes. Chapter 18: When a Family Member or Friend Suffers from Anxiety 269 However, expressing empathy and concern doesn’t mean that you need to solve the problem. You may be able to help, as we show in the “Guiding the Way” section later in this chapter, but you don’t control the emotions of other people — they do. Realizing that helpers don’t own the responsibility for making change happen is important. Otherwise, you’re likely to become frustrated and angry if and when efforts to change stall. Avoiding blame Just as you don’t want to blame yourself by owning the problem when your partner becomes anxious, it’s equally important to avoid blaming your part- ner. People sometimes get upset when they try to help and the response they get consists of resistance and a lack of gratitude.