Course Hero has millions of student submitted documents similar to the one

below including study guides, practice problems, reference materials, practice exams, textbook help and tutor support.

Course Hero has millions of student submitted documents similar to the one below including study guides, practice problems, reference materials, practice exams, textbook help and tutor support.

Disorders Allergic in the Primary Care Setting
Scott Taylor MD, ABIM, ABP
Asthma & Allergy Clinic of Utah September 20, 2006
History
John is 25-year-old computer programmer who presents in mid-September with acute complaints of nasal discharge, congestion, repetitive sneezing and itching of the eyes. In addition he complains of fatigue and difficulty concentrating although he denies headache or fever. He also complains of increased shortness of breath for the last few weeks when he begins to exercise and reports waking up several times in the middle of the night coughing. The only medications he has tried are over the counter allergy combination preparations with mild benefit.
Based on the History so far the most likely diagnosis is
A) Acute on Chronic Rhinosinusitis with allergic post nasal drip B) Allergic Rhinitis with Exercise Induced Bronchoconstriction C) Allergic Rhinosinusitis with poorly controlled asthma D) Infectious Enterovirus with resulting bronchitis
Physical Exam
Gen: Fatigued appearing man using a nasal voice with faint allergic shiners Heent: Increased conjunctiva erythema with markedly swollen pale turbinates with no noted polyps. Clear discharge noted with no sinus tenderness on palpation. Oropharynx exam reveals no cobblestoning. The rest of the exam including auscultation of the chest is essentially within normal limits
Based on the History and Physical the next most appropriate step would be
A) Trial of non sedating antihistamines and/or nasal steroids with close follow up B) Rast (IgE) testing to ascertain allergen sensitization to recommend avoidance measures C) Referral to an Allergist for appropriate skin testing to recommend avoidance measures D) Spirometry E) CT scan of the paranasal sinuses
Objectives
Allergic Rhinitis pathophysiology/treatment What is Immunotherapy/How does it work? Asthma pathophysiology and treatment (allergic and non allergic) What does an Allergist really do anyway?
Allergic Rhinitis
Affects an estimated 60 million people (20% of the population) Prevalence in industrialized world is increasing Often associated with other co morbidities; Sinusitis (60%) Allergic Conjunctivitis Asthma (50%) Oral Allergy Syndrome Eczema (30%) Recurrent Otitis Media Significant cost to health care ($7 billion) and significant lost school and work days.
Busse W, Lemanske RF Jr. N Engl J Med 2001;344:350-62
http://www.ipm.ucdavis.edu/PMG/WEEDS/russian_thistle.html
http://www.pbase.com/kleb7842/image/45489381
Busse WW, Lemanske RF Jr. N Engl J Med 2001;344:350-62
Rhinitis Classification
Eosinophilic Rhinitis Allergic rhinitis NARES Noneosinophilic rhinitis Infectious (URI) Vasomotor Rhinitis (Gustatory/skier's nose) Atrophic Rhinitis Rhintis Medicamentosa (Common!) Hormonal Rhinitis (Pregnancy, Hypothyroidism) Other Conditions Blockage (structural, foreign body, choanal atresia, angiofibroma) CSF Rhinorrhea Psychiatric Conditions
Other Associations with Rhinitis
Systemic Disease DM, Sarcoidosis, Wegener's, Relapsing Polychondritis, Uremia Infectious Disease TB, Syphilis, leishmaniasis, coccidiomycosis, blastomycosis Medications Ace-inhibitors, B-blockers, OCP, Reserpine
Allergic Rhinitis Diagnosis
History- Sneezing, rhinorrhea, nasal obstruction, itching of the eyes, nose and palate as well as postnasal drip, cough, irritability and fatigue. Seasonal Sxs alone (11%) Perennial Sxs (56%) Perennial with seasonal exacerbations (33%) PE- Allergic salute with nasal crease, allergic shiners, Denie Morgan Lines, Boggy turbinates with a pale bluish hue, clear rhinorrhea anteriorly and/or cobble stoning (lymphoid hyerplasia) from post nasal drip secondary to nasal obstruction
Allergic Rhinitis Diagnosis Continued
Nasal Cytology- Eosinophils vs Neutrophils Skin Testing- In-vivo prick testing of the back or forearm with common allergens and to observe for wheal and flare after 15 minutes. Intradermals can be done on select negative pricks with a high index of suspicion. Immediate results, less expensive risk of systemic reaction small RAST Testing- In-vitro blood work (Immunocap) to check specific IgE levels of suspected allergens. Delayed results, expensive, painful for children, no risk of systemic reaction. Decreased Sensitivity as compared to skin testing
Allergen Avoidance
Pet allergen is found primarily in the dander (skin flakes) and saliva NOT the hair Cat allergen in up to 90% of homes (even if no cat) After removal of cat the allergen level stays significantly elevated for several months (short avoidance trails not effective) Washing cat regularly and HEPA filter +/ Dust Mite and Mold rarely an issue in Utah as there is low humidity
THERAPY FOR ALLERGIC RHINIITIS THERAPY COST/YR
MECHANISM
SIDE EFFECTS
Lifestyle Limitation? Sedation HA Dry Mouth Pharyngitis Epistaxis HA HA Flu Sxs Abdom pain Local Rxn Anaphlaxis (Rare)
DURATION
Allergic Avoidance Antihistimine
Free $-$$$
N/A Block Histamine
(Not help congestion)
Lifetime Lifetime
Nasal Steroids
$$-$$$
AntiInflammation LTRA/LT Syn-Inhib Long termImmunomodulation
Lifetime
LT Modifiers
$$$
Lifetime
*Immuno-Therapy
*If symptoms refractory to avoidance and medications and/or medications not tolerated or desired, consider immunotherapy.
$$$$
(1st Year)
3-5 years
$$-$$$
(2nd3rd yr)
(5-20 yr)
(Also effective in Allergic Asthma)
McKay IR, Rosen FS. N Engl J Med 2001;109-113.
Oral Allergy Syndrome
Oral Pruritis, rapid onset, IgE-mediated, rarely progressive with various fresh fruits/vegetables Found in up to 50% of patients with Birch and/or Ragweed allergy Cross reactive proteins (food/pollen) Birch- apple, cherry, apricot, carrot, kiwi, plum Ragweed- watermelon, cantaloupe, banana, cucumber
Caution with Decongestants
HTN DM CAD BPH Hyperthyroidism Raynauds, APLAS
Asthma Continues to be a Major Problem in the United States
Affects 12-15 million Americans,10-12% of children under 18 More than 5,500 people die from asthma every year Economic impact of asthma is estimated to be close to $3 billion annually The third leading cause of preventable hospitalization in the US
"Hence it may be concluded every inveterate Asthma to be a mixt affection, stir'd up by the default partly of the Lungs ill-formed and partly of the Nerves and nervous Fibers pertaining to the breathing parts" Thomas E.Willis 1684
Current definition of Asthma
"Chronic Inflammatory disorder of the airways in which many cells play a role...In Susceptible individuals, this inflammation causes recurrent wheezing, breathlessness, chest tightness and cough, particularly at night and /or in the early morning. These episodes are usually associated with widespread but variable airflow obstruction that is often reversible...The inflammation also causes as associated increase in the existing bronchial hyperresponsiveness to a variety of stimuli."
Lemanske/Busse JACI Feb 2003
Pathophysiology
Genetics (complex genetic disorder) Airway obstruction (smooth muscle spasm, mucosal edema, mucus hyper secretion, inflammation and remodeling) Airway Hyper responsiveness (methacholine, cold air, exercise hyperventilation)
Other Precipitating Factors of Asthma
Infections Exercise NSAID/ASA GERD Psychosocial Isocyanates Mold proteases Many others
Exercise Induced Bronchoconstriction (EIB)
One of the most common precipitants of airway obstruction in asthmatic patients Wheezing, coughing, shortness of breath, and, children, in chest pain or discomfort Symptoms are most intense 5-10 minutes AFTER the cessation of exercise secondary to progressive bronchospasm Spontaneous remission usually follows within 30-60 minutes Albuterol 2-4 puffs 10-15 minutes prior to exertion and/or use of montelukast. Cromolyn Sodium inhaler 2-4 puffs can be used prior to exertion as well Careful not just incontrolled Asthma (PFT)
Diagnosis
Asthma can be difficult to diagnose Careful history (coughing, wheezing, shortness of breath, chest tightness, symptoms worse at night, precipitants, family history) Thorough physical exam (wheezing, allergic rhinitis, eczema , pulsus paradoxus (Korotkoff's sound) Pulmonary function tests (Spirometry)
Risk of developing Asthma by age 6 in children with recurrent wheezing in the first 3 years
Castro- Rodriguez JA et al. AJRCCM 162: 1403, 2000
1 Major Criteria Eczema Parental Asthma + Allergy Skin Test
OR
2 Minor Criteria Wheezing w/o URI Eosinophilia (>4%) + Food skin test
+ 65% chance of developing asthma by 6 - 95% chance of no asthma by age 6
Spirometry in Asthma
FEV1 N or FVC (increased RV in severe obstr) FEV1/FVC FEF 25-75 (small airway obstruction) PEF FEV1 (>12%) in response to bronchodilator
Mueller GA, Eigen H. Pediatrics in Review 1994; 404-410
Diagnosis continued
Bronchoprovocation Methacholine challenge test (increased sensitivity) CXR CBC Allergy skin testing
History/Physical
19 year-old college student presents with 2-3 month history of cough that is worse at night and sometimes associated with wheezing. He has no known history of asthma but does state that he has had exercise induced symptoms in the past. He describes significant allergic symptoms to cats (they have a cat) but states that Zyrtec seems to help. He says that the cough has worsened since he came home from school and he has mild pain on inspiration. He describes fatigue since he has been on a special diet and lost over 20 pounds. PE reveals mild erythema of the nasal turbinates with lungs clear to auscultation bilaterally. The rest of the exam was noted to be WNL. PFT was performed which showed FEV1 4.39L (96%) with normal FVC and FEF 25-75%
Current Asthma medications
2-Adrenergic agonists Theophylline Cromolyn/Nedocromil Leukotriene Antagonists Glucocorticosteroids Anticholinergics Anti-IgE Antibody
2-Adrenergic agonists
Most potent and rapidly acting bronchodilators Available in multiple forms Relaxes smooth muscle Side effects include tremor, tachycardia and increased anxiety Long acting -agonists salmeterol and formeterol are effective for the treatment of moderate to severe persistent asthma but should not be used as monotherapy. Regular use of 2-agonists results in down-regulation of 2-adrenoceptor function
Theophylline
Methylxanthine with bronchodilator effects that may also have mild antiinflammatory properties. Cheap and can be used as an add-on to inhaled corticosteroids as a controller medication (not as effective as long acting 2-agonists) Requires serum monitoring (5-15 mcg/ml) Side effects include GI symptoms, seizures and adversely affect school performance.
Anticholinergics
Provide bronchodilation Not considered first line drugs in the treatment of acute asthma but are reserved as adjunctive therapy to inhaled 2-agonists. Provide benefit in acute asthma (severe over mild cases) Side effects include anxiety, dizziness, headache and use with caution in narrow-angle glaucoma or bladder neck obstruction.
Leukotriene Antagonists
Cysteinyl leukotrienes (LTC4, LTD4 and LTE4) are generated by eosinophils and other cells. These leukotrienes interact with the CysLt1 receptor which can lead to airway smooth muscle contraction and other effects. 5-lipoxygenase inhibitors (Zileuton) inhibits cysteinyl leukotriene synthesis but requires monitoring of liver enzymes regularly as well as 4x/day of dosing.
Leukotriene Antagonists
Cysteinyl leukotriene receptor antagonists (Zafirlukast and Montelukast) have wider appeal. Can be used in EIB, inhaled allergens and chronic asthma Side effects include headache, abdominal pain and dyspepsia
Glucocorticosteroids
Most potent anti-inflammatory agents available for the treatment of asthma Decrease in inflammatory cell function, stabilization of vascular leakage, decrease in mucus production and an increase adrenergic response. Steroids suppress multiple inflammatory genes by reversing histon...

Textbooks related to the document above:

**Find millions of documents on Course Hero - Study Guides, Lecture Notes, Reference Materials, Practice Exams and more. Course Hero has millions of course specific materials providing students with the best way to expand their education.**

Below is a small sample set of documents:

Utah - GRANDROUND - 2006

Exercise in the elderly: should there be any resistance?Scott Evans, MD Family Medicine Grand Rounds February 15, 2006Learning ObjectivesKnow the effects of resistance training in the geriatric population in regards to improving strength and abil

Utah - GRANDROUND - 2008

Utah Department of Health"Public Health in Utah 2008, Better Than Before, or Losing Ground?Family Medicine Ground Rounds Salt Lake Regional Medical Center September 3, 2008David N. Sundwall M.D. Executive DirectorUtah Department of HealthUDOH

Utah - GRANDROUND - 2007

Hysteroscopic SterilizationShawn E. Gurtcheff, MD Department of Obstetrics and Gynecology The University of UtahChoice of Contraceptive Method By AgeFemale Sterilization Oral Contraceptive Male Sterilization Other Methods Condom Injection% of

Utah - GRANDROUND - 2006

Erectile Dysfunction Among Cyclists: Turning a clinical question into a research projectFAMILY MEDICINE GRAND ROUNDS 5/31/06 Chris Gay Peter WeirFIGHT BACK! With DAVID HORWITZAsking Questions [clarifying the unknown]The Journey The Destinati

Utah - GRANDROUND - 2008

2. Gonzales R, Malone DC, Maselli JH, Sande MA. Excessive antibiotic use for acute respiratory infections in the United States. Clin Infect Dis. 2001;33(6):757-762. 3. Huchon GJ, Gialdroni-Grassi G, Leophonte P, Manresa F, Schaberg T, Woodhead M. Ini

Utah - GRANDROUND - 2006

Helping Your Patients Quit Using TobaccoMarci Nelson, BS, CHES Tobacco Prevention and Control Program Utah Department of Health marcinelson@utah.gov http:/www.tobaccofreeutah.org/healthcare1.html (801) 538-7002ObjectivesPresent healthcare provide

Utah - GRANDROUND - 2005

Utah - GRANDROUND - 2006

Dental BasicsCraige Olson DDS Dental Clinic Director Dental General Practice Residency DirectorSusceptible toothBacteriaDecaySugarDental DecaySusceptible toothBacteriaDecaySugarSugar grows more bacteria Normal like blood sugar

Utah - GRANDROUND - 2008

Physician Recognition, Evaluation, and Treatment of the Female Athlete TriadMary-Marie A. Sullivan, MSIIMentor: Elizabeth Joy, MD, MPHUniversity of Utah Department of Family and Preventive MedicineProject OverviewI.a.PurposeAssess physicia

Utah - GRANDROUND - 2008

Crystal Armstrong June 2008Alicia and ChrisLow-dose OCP (Progesterone only?)Justin2years later, Alicia and Chris decide they would like another child + pregnancy But, early miscarriage at 5-6 weeks Repeated 3 times Internetinformatio

Utah - GRANDROUND - 2006

Initial Diagnosis and Management of Shoulder PainRobert Z. Tashjian, MDAssistant Professor, Department of Orthopaedics University of Utah School of Medicine Salt Lake City, UTMusculoskeletal Education Lack of MSK education in training Frustrati

Utah - GRANDROUND - 2008

Primary Care for Patients with Developmental Disability: An ABCs ApproachWill Lehmann MD, MPH Grand Rounds, Moreau Auditorium September 17, 2008GOALS As a result of this presentation, attendees will be familiar with a differential diagnosis for n

Utah - GRANDROUND - 2005

Parathyroid Hormone in Treating OsteoporosisCarl Whittaker, M.D. Family Medicine Grand Rounds October 26, 2005Learning Objectives Identify the pros/cons of using PTH in treating osteoporosis Evidence supporting the use of PTH in treating osteop

Utah - GRANDROUND - 2007

Hand and Wrist InjuriesLeslie Cooper, MD Assistant Professor Department of Family and Preventive Medicine University of Utah Salt Lake City, UT Grand Rounds December 5, 2007Reasons to Understand the Hand and Wrist Wrist pain is a common complaint

Utah - GRANDROUND - 2005

Sports Medicine Potpourri: Pearls and PitfallsErik L. Schroeder, M.D. University of Utah Sports Medicine FellowPearl SciaticaPearl SciaticaSeated Slump Test Adverse Neural TensionPearl SciaticaRadiculopathy - History Back and Leg Pa

Utah - GRANDROUND - 2006

Mechanical Therapyfor drug refractory CHF & SCD Imran Zubair, MD, FACCSalt Lake Regional Medical Center Salt Lake City, UtHF-A Big ProblemAnnual Incidence Heart Failure Prevalence Annual MortalityU.S.400-550 K5.0 million250,000Wilkerso

Utah - GRANDROUND - 2006

Addictions, Risk Assessment: The Meth and HIV ConnectionJann DeWitt, Ph.D.Director of the Utah AIDS Education and Training Center Assistant Professor Department of Family and Preventive Medicine University of UtahObjectivesTo be able to discuss

Utah - GRANDROUND - 2005

Homocysteine At The Crossroads: Vitamin Status and Disease PreventionDr. Samuel N. Grief, MD, FCFP University of Illinois at Chicago Family Medicine Chair, Panel on Homocysteine and Screening/Treatment RecommendationsOUTLINEHomocysteine and its m

Utah - GRANDROUND - 2005

Metabolic Syndrome IIRichard L. Reed, MD, MPH, Professor and Chair, Department of Family Medicine, United Arab Emirates University, Al Ain, United Arab EmiratesEvolution of ManOverview Discuss metabolic syndrome from the perspective of being a

Utah - GRANDROUND - 2008

Effect of Lower Targets for Blood Pressure and LDL Cholesterol on Atherosclerosis in Diabetes: The SANDS Randomized TrialOnline article and related content current as of October 7, 2008.Barbara V. Howard; Mary J. Roman; Richard B. Devereux; et al.

Utah - PRIMES - 1

Chapter 1: The Primes Library11 The Primes LibraryA prime number is any integer greater than one that has no exact integer divisors other than one and itself. Prime numbers have increasingly important practical applications in cryptography, and

Utah - HASH - 1

Chapter 1: The Hash Table Library11 The Hash Table LibraryThe hash-table library (`hash.el') contains a rich set of functions for dynamic hash tables, but the simplest uses only require the get and put functions.1.1 What are Hash Tables?Hash

Utah - PRE - 2004

A aiaa a L TEX Class and BibTEX Style for AIAA Conference Papers and Journal Submission/Simulation bil kleb 1999/02/22Abstract This document describes the aiaa distribution which is centered around A a modication of the standard L TEX article clas

Utah - BAC - 2

The Interactive Digital Software Association (IDSA) . demanded that this site be taken down immediately for infringing upon the rights held by their member companies: ".We request the removal of these pages as quickly as possible since they are

Utah - BAC - 2

>From webmaster@capcom.co.jp Thu Dec 3 16:43:37 1998 >Received: by gauze.capcom.co.jp; id JAA14728; Fri, 4 Dec 1998 09:43:32 +0900 (JST) >Received: from saturn.head.capcom.co.jp(172.17.250.240) by capcomgw.capcom.co.jp via smap (V3.1.1) > id xma01

Utah - BAC - 2

Account Name: cole.simplenet.comSimpleNet Customer,Your account has been suspended.It is SimpleNet's policies that no content residing on our servers willcontain, or link to any illegally distributed software products. It isagainst the law

University of Hawaii - Hilo - FIN - 311

CHAPTER 1 Investments Background and IssuesMcGrawHill/IrwinCopyright2008TheMcGrawHillCompanies,Inc.,AllRightsReserved.1.1 REAL ASSETS VERSUS FINANCIAL ASSETS1-2Financial Versus Real AssetsEssential nature of investment Reduced current con

University of Hawaii - Hilo - FIN - 311

Spring 2008 Investments S. Ghon Rhee C304, FEI, SCB Tel No.: 956 2535 e-mail: rheesg@hawaii.edu web site: http:/www2.hawaii.edu/~rheesg Class Hours: WF 09:00 - 10:15 a.m. (G-103) WF 10:30 - 11:45 a.m. (G-103) Office Hours: WF 14:00 15:00 p.m. or by

University of Hawaii - Hilo - UH - 313

SOC313:SurveyofSociologyofWorkWednesday,3September2008Mostimportantsoc313 Dotakeownershipofyoureducationinthisclassbycompletingallreadingandwritingassignmentsontime andparticipatinginonlinediscussions. Readeachoftheassignedtextbookchaptersbe

University of Hawaii - Hilo - FIN - 311

CHAPTER 6 Efficient DiversificationMcGrawHill/IrwinCopyright2008TheMcGrawHillCompanies,Inc.,AllRightsReserved.6.1 DIVERSIFICATION AND PORTFOLIO RISK6-2Figure 6.2 Portfolio Risk as a Function of Number of Securities6-36.2 ASSET ALLOCATIO

University of Hawaii - Hilo - SOC - 100

In modern times, the Internet has become an increasingly popular means ofcommunication. This means of communication has many benefits, especially inits role in increasing the number of secondary relationships an individualmay have. The Inter

University of Hawaii - Hilo - ICS - 241

ICS 241 Discrete Mathematics II William Albritton, Information and Computer Sciences Department at University of Hawai'i at Manoa For use with Kenneth H. Rosen's Discrete Mathematics & Its Applications (5th Edition) Based on slides originally cre

University of Hawaii - Hilo - ICS - 212

Program Control Selection Repetition Altering the flow of control Unconditional branch More operators RSI Repetitive Stress InjurySelection 3 Ways1. If structure (single selection) 2. If/else structure (double, multiple selection)if(condi

University of Hawaii - Hilo - ICS - 111

OBJECTS What are Objects? Properties and Capabilities (behaviours) Classes and Instances Making Instances A Sample Programorld le the w jects ru ob cts the obje pray to r true t is you he objec t master bject of the o he path follow t from th

University of Hawaii - Hilo - MATH - 13

Reading Assignment: We'll begin Chapter 13 on Friday. Please read Sections 13.1 and 13.2. Problems: None

University of Hawaii - Hilo - MATH - 23

Reading Assignment: Today we covered 2.8. If you haven't read it, do so. Next week we will finish Chapter 2 with 2.9, and a very brief discussion of the uniqueness part of Theorem 2.2.1 in 2.11. To meet this very specific goal read

University of Hawaii - Hilo - MATH - 23

Reading Assignment: Today (Wednesday) we didn't get as far as expected; we merely completed 6.3 and most of 6.5. On Friday we will definately conclude Chapter 6 by covering Section 6.4 finishing off 6.5. We may also begin Chapter 10.

Utah - MATH - 3210

A proof of the Heine-Borel TheoremTheorem (Heine-Borel Theorem). A subset S ofR is compact if and only if S is closed and bounded.Proof. First we suppose that S is compact. To see that S is bounded is fairly simple: Let In = (-n, n). ThenIn =

Utah - TRIGFALL - 03

Review for Exam 2 Answers.Math 1060-02 October 10, 20031. Your shing bobber oscillates in simple harmonic motion from the waves in the lake where you sh. Your bobber moves a total of 2 inches from its highpoint to its low point and returns to its h

Utah - COLLALGFAL - 05

Review 3 SolutionsNovember 23, 2005Joro, could you go through these solutions in class (Monday, November 28th, 6:00-8:00pm). The classroom is in JFB 101. If they ask you about the formulas they have to know for the test (which is on Wednesday if t

Utah - CALC - 2

Name Student ID #Math 1220 Fall 2002 A. M. Keenan EXAM I Friday, September 20, 2002Problem 1. 2. 3. 4. 5. 6. 7.Points 2 4 6 7 4 8 5 TOTALScore(2 pts) 1. Find the derivative of ln(x3 + 6). Solution. Let u = x3 + 6, then du = 3x2 . So by the

Utah - INTALGSPR - 06

Review 4 AnswersApril 16, 20061. (a) 180 = 9 20 = 3 20 = 3 4 5 = 6 5. (b) 98 = 2 49 = 7 2 (c) 3 54 = 3 27 2 = 3 3 2 5 5 5 (d) x7 = x5 x2 = x x2 (b) x x5/3 = x8/3 2. (a) x1/4 (c) x7/33/7 = x40/21 3. (a) 15 17 (b) 3 x + 2 x

Utah - INTALGSPR - 06

Review for Exam 3March 6, 20061. Simplify the following: (a) (m5 n)(mn)4 (b) (x1 y 2 )2 x2 y (c) x3 x2 x7 (d) x7 y 3 z 4 x4 yz 3 x6 y 2z 4 (e) 3 2 3 x y z2. Write the following in scientic notation: (a) 0.0000000000086 (b) 9800000000000 (c) 1395

Utah - INTALGSPR - 06

Answers for The Final ReviewApril 27, 20061. (a) 4 5 + 16 = 20 9 19 10 + = (b) 15 15 15 4 21 120 147 9 (c) = = 7 30 7 30 70 1 1 (d) 1 + = 2 2 x 2. (a) =4 y (b) y > 0 y+z (c) =3 2 3. 85% of 90 is 76.5. Therefore approximately 77 students passe

Utah - INTALGSPR - 06

Review for Exam 4April 12, 20061. Simplify the following: (a) 180 (b) 98 (c) 3 54 5 (d) x7 2. Rewrite the following expressions using rational exponents: x (a) 3 (b) x x5 3 x7 (c) 7 x3 3. Simplify by combining like terms: (a) 17 - 3 17

Utah - CALC - 2

Math 1220-1Mock Exam 3 Solutions1. Find the Taylor polynomial of order 3 based at 2 for g(x) = x3 2x2 + 5x 7, and show that it is an exact representation. Solution. The Taylor polynomial of order three based at two is P3 (x) = g(2) + g (2)(x 2

Utah - CALC - 2

Math 1220-3Name:Mock Exam 3Show all work. Write your answer in the space provided. 1. (6 pts) One way to nd a root of an equation is the bisection method. Describe how this method works. Solution The rst thing to do is to pick numbers a0 , b0 cl

Utah - INTALGSPR - 06

Review for the FinalApril 23, 20061. Evaluate the following expressions: (a) 4 - 20 4 + (-2)2 4 2 3 (b) + 3 5 4 3 6 (c) - 7 5 7 (d) -|3 - 4| + |1/2| 2. Write the following statements as algebraic expressions: (a) The ratio of x and y is 4. (b)

Utah - BUSALGSUM - 05

Name Student ID #Math 1090 Summer 2005 A. M. Keenan Practice FinalProblem 1. 2. 3. 4. 5. 6.Points 20 20 20 20 20 20 TOTALScoreYou only have to answer ve out of the six questions.1. (a) Find the market equilibrium point for the following s

Utah - COLLALGFAL - 05

Extra problemsDecember 8, 20051. The line perpendicular has slope -1/2. The equation of a line with slope -1/2 has the form y = -x/2 + c. Since the point (2, 1) lies on the line c = 2. 2. The function f (x) = 1/x does have an inverse since we can s

Utah - CALC - 2

Name Student ID #Math 1220 Spring 2003 A. M. Keenan EXAM II Tuesday, March 11, 2003Problem 1. 2. 3. 4. 5. 6. 7. 8.Points 5 7 6 8 10 7 7 10 TOTALScore(5 pts) 1. Find lim2x 1 . x0 xSolution. This is an indeterminate form of type 0/0 so w

Utah - INTALGSPR - 06

Review for Exam 3 SolutionsMarch 22, 20061. (a) (m5 n)(mn)4 = m9 n5 (b) (x-1 y 2 )-2 x-2 y = y -3 (c) x3 x2 x7 = x12 x7 y 3 z 4 (d) 4 3 = x3 y 2z x yz x6 y -2z 4 (e) -3 -2 3 = x9 z x y z 2. (a) 0.0000000000086 = 8.6 10-12 (b) 9800000000000 = 9.8

Utah - TRIGFALL - 03

Formulas You Should Know For Exam 1Math 1060-02 September 20, 2003You should know the following indentites for exam 1:sin tan = cos sin2 + cos2 = 1 1 + tan2 = sec2 1 + cot2 = csc2 You should know the following definitions of the trigonom

Utah - CALC - 2

Math 1220-1Mock Exam 31. Find the Taylor polynomial of order 3 based at 2 for g(x) = x3 - 2x2 + 5x - 7, and show that it is an exact representation. 2. Find the Cartesian equation of the conic with the given properties: Eccentricity5 3and vert

Utah - CALC - 2

Name Student ID #Math 1220 Fall 2002 A. M. Keenan EXAM III Wednesday, November 27, 2002Problem 1. 2. 3. 4. 5. 6.Points 6 8 10 7 11 8 TOTALScore(5 pts) 1. Write the following polar equation in cartesian form r = 4 cos +3 sin . What geometric

Utah - COLLALGFAL - 05

Homework 4 SolutionsOctober 16, 20051. The inverse of the function is f -1 (y) = (y - 1)1/3 . 2. The inverse of the function is f -1 (y) =y-1 . 33. The function does not have an inverse because for each positive value of y there are two solutio

Utah - COLLALGFAL - 05

Review 2 SolutionsOctober 20, 20051. The equation of the line is y = -2x + 1. 2. (f /g)(x) =x2 +1 x+23. The function does have an inverse since you can solve y = x3 + 8 uniquely for x (you can take the cube root of any number). The inverse func

Utah - COLLALGFAL - 05

Section 1.8 1. Find the inverse of the function f (x) = x3 + 1. 2. Find the inverse of the function f (x) = 3x + 1. 3. Explain, without reference to the horizontal line test, why the function f (x) = x4 does not have an inverse. Section 2.1 4. Write

Utah - COLLALGFAL - 05

Section A.1 1. Describe in words the interval [3, 4) and then graph this interval on the real line. 2. What is the distance between 4 and -7? 3. What is 1/2 + 1/3? Section A.2 1. Simplify 12a4 b2 . a3 b2. What is 82/3 ? Section A.3 1. Simplify the

Utah - TRIGFALL - 03

Review for Exam 1 AnswersMath 1060-02 September 20, 20035 lies. 41. Determine the quadrant in which the angle Solution. The angle lies in the third quadrant. 2. What is 270 in radians. Solution. One degree is 180 radians. Therefore 270 degrees

Utah - INTALGSPR - 06

Exam 4 SolutionsApril 27, 2006 1. (a) 2 3 (b) 4 3 (c) 2 3 4 5 (d) x x4 2. (a) x2/3 (b) x1/6 (c) x9/4 (d) x2/3 3. (a) 3 15 (b) 3 3 x - x (c) 9 3x 4. The length of the diagonal is 42 + 52 = 41. The value 41 is less than 7. Therefore, Bob i