WGU D027 – Advanced Pathopharmacology – Final Exam Study Guide | Questions and Answers | A Complete Solution 2023

WGU D027 – Advanced Pathopharmacology – Final Exam Study Guide | Questions and Answers | A Complete Solution 2023. Celiac Disease a. Lining of the small intestine, intolerant of gluten. (avoid BROW) Barley, Rye, Oat, Wheat i. More pronounced in the duodenum and jejunum. b. Signs and Symptoms - abdominal pain/distention; diarrhea (pale, greasy, bulky, foul) i. Malnutrition complications - rickets, occult blood, anemia (early bleeds and/or bruises) ii. Hypomagnesemia and hypocalcemia = Irritability, tremors, convulsions, tetany, bone pain, osteomalacia c. Lab Value: IgA-tTg, total IgA, IgA-EMA, HLA-DQ2 or HLA-DQ8; IgG maybe too. d. IgA is associated with Celiac disease, diagnosis via endoscopy with small intestine biopsy 2. Sjogren’s Syndrome - Dry eyes and dry mouth a. Mostly in older women, primarily those with Rheumatoid arthritis or SLE b. Testing: SSA+ and SSB+ 3. Herbs a. Cinnamon - ↓ blood glucose, ↓ cholesterol, ↓ hypertension, ↓ risk for bleeding i. Adverse Effects - no breastfeeding, no DM drugs/anticoagulants/heart medications. b. Gingko Biloba - ↓ dementia, ↓ erectile dysfunction. ↑ bleeding, ↓ seizure threshold. c. Glucosamine - osteoarthritis d. Green Tea - lose weight, mental clarity. can cause hepatotoxicity. may ↓ the effects of warfarin. i. Avoid taking with vasodilators, stimulants, and psychoactive medications. e. Lavender - ↑ relaxation, ↓ anxiety, stress, and insomnia i. Adverse Effects - constipation, HA, ↑ appetite. may ↓ BP (no antihtn). no depressants f. Saw Palmetto - used for BPH g. Kava - used for anxiety. hepatotoxic h. Comfrey - topical OK, PO is not i. Ma Huang - ephedra/epherdrine. stimulant. 4. Hypoplastic Left Heart Syndrome HLHS - Birth Defect. born with OPEN foramen ovale & ductus arteriosus, ↓developed L ventricle & ↓developed valves (mitral, aortic) (hole between L&R atria) a. Survival rates - 3 to 5y survival is 70% with Stage I repair, 90% survival once they hit 12m. b. Testing: prenatal U/S and echo, after birth s&s (after ductus arteriosus & foramen ovale close). c. Treatment: Surgery. Fetal shunts i. Patent ductus arteriosus: shunt to pulm artery created (from aorta or R ventricle). stage 1 at <2weeks (Norwood). shunt removed at 4-6months (stage 2) ii. patent foramen ovale: hole connecting R atrium to L atrium closed. iii. Stage III (Fontan) at 18-36m - IVC connected to Pulm artery, hole made from the IVC conduit attached to the right atrium. d. S/SX - Tachypnea, SOB, ↑HR (or pounding heart), poor suckling/feeding, poor extremities (cold and cyanotic), weakness, clammy skin e. Medications - tube feedings, meds to strengthen heart muscles, ↓ blood pressure, diuretics 5. Parathyroid - Secretes/regulates serum Ca. ↑ PTH hormone released = ↑ ca released from the bones into the bloodstream, ↓ density/hardness. Maintain low/normal Ca level. a. Hyperparathyroidism S/S - Low PTH (because excess was released into the blood) causes osteoporosis, kidney stones, ↑ urination, abdominal pain, fatigue, forgetfulness, bone/joint pain i. Calcimimetics, to help bones retain calcium, bisphosphonates to slow/prevent bone loss 1 b. Hypoparathyroidism: High PTH (because not released into the bloodstream), low T3/T4, paresthesia, muscle cramps, mood changes, dry/rough skin, twitching facial muscles c. Tests - U/S, Bone densitometry, body CT/MRI; Lab Values - Ca (8.6-10.3), PTH: 11-51 6. Hutchinson-Gilford Progeria Syndrome - genetic. rapid aging (10xs faster), no cure, appears by age 2, live to 13 on average (up to 20) a. LMNA gene protein mutation (protein-progerin). Causing cells to die prematurely. b. Signs and Symptoms - Slow growth (height, hair), alopecia, joint abnormalities, wrinkles, dry skin, FTT, delayed tooth development. c. Treatment - NSAIDs, Statins, Bone health meds. OT/PT 7. Diabetic Neuropathy Treatments - Gabapentin/Neurontin, Duloxetine/Cymbalta, Pregabalin/Lyrica, 8. Hydrotherapy - Used for multiple sclerosis (MS) and Myasthenia Gravis (MG) 9. Pneumothorax vs hemothorax – both decreased or absent lung sounds. a. Patient with Post MVA, with right side decreased lung sounds? PNEUMOTHORAX i. PNUEMOTHORAX (air between lungs and chest cavity) ↑ percussion ii. HEMOTHROAX (blood btwn lungs and chest cavity) ↓ percussion. iii. Tension Pneumothorax- mediastinal shift, decrease Cardiac output, increase HR b. Tx: chest tube Thoracostomy 10. Tuberculosis a. Testing - PPD Tuberculin skin test: forearm. in 48-72h, >15mm induration is positive. i. >5mm for immunocompromised, >10mm for high risk/from countries with TB - prison, nursing homes, etc. ii. Chest Xray or CT scan - White spots in lungs. Immune system walls off TB. b. Medications - Isoniazid, Rifampin (avoid oral contraceptives), Ethambutol, Pyrazinamide i. If BCG vax given for TB - PPD expected to be >10mm but not positive 11.Thyroid labs - TSH: .5 - 5 (with treatment 0.5 to 4), T3: 80-220, T4: 5-12 a. Thyroid peroxidase antibodies (TPO) 1. Hashimoto disease – ↑TSH. hypothyroidism. High thyroglobulin (Tg)/TPO. a. initially high T3, then low T3 2. Graves’ disease – autoimmune. hyperthyroidism. b. Hyperthyroidism - Low TSH, High T4/T3 i. s/s - (thyrotoxicosis), ↑HR/dysrhythmia/angina, Stimulated CNS – nervousness, insomnia, rapid thought flow, rapid speech; weakness/atrophy; ↑ metabolic rate/appetite; Warm/moist skin, Intolerant to heat/↑ body temperature; ii. treatment - Propylthiouracil (PTU) and Methimazole (Papazole), iodine, BB’s c. Hypothyroidism - High TSH, Low T3/T4 i. s/s - Pale, puffy, expressionless face; Cold/dry skin; brittle hair/hair loss; ↓ HR/ temp; Lethargy, fatigue, cold intolerance ii. treatment - Levothyroxine (Synthroid) d. Thyroid storm- death<48hr from internal stress *post thyroid surgery, High T4 T3 levels from stress S&S *Atrial tachy dysrhythmias 12.Crohn’s (worse after meals) vs Ulcerative Colitis a. Crohn’s - Inflammation/scarring of all digestive tract. generally just small intestines. i. Patients with atopic dermatitis/eczema are ↑ risk of inflammatory bowel disease. ii. S/S - Skip lesions (cobblestones), intestinal bleeding/diarrhea/cramping, fistula, fissure, ileus, mouth ulcers; worse after eating c pain by navel or ↓ R abdomen. Malabsorption (anemia) iii. Tests 1. ASCA protein, CBC, H/H, occult blood for bleeding. CRP, ESR inflammation; Electrolytes if diarrhea chronic; Iron, B12 absorption 2 iv. Diagnostics - Kidney/ureter/bladder Xray; Colonoscopy/sigmoidoscopy; barium Xray or video endoscopy of small intestines. v. Medications - Aminosalicylate - Sulfasalazine, Mesalamine; IV corticosteroids for 3- 10d/Oral steroids for exacerbation. 1-2m; Immunosuppressive therapy - Methotrexate; Antibiotics to manage intestinal bacterial overgrowth vi. Diet - Low residue/fiber, low fat, probiotics. Avoid - caffeine/alcohol (dehydration), sharp edges or large grains. b. Ulcerative colitis - Chronic inflammation of large intestine and rectum. i. S/S - diarrhea (blood/pus), cramping, rectal pain/bleeding, urgency plus inability to defecate, weight loss; fatigue, fever, FTT ii. Tests 1. pANCA, colonoscopy, flexible sigmoidoscopy, WBCs in stool 2. Blood tests: Anemia - CBC, LFTs, Electrolytes, ANA – antinuclear antibodies; Inflammation - CRP, ESR 3. Xray: rule out perforated colon, CT: visualize inflammation iii. Diet - avoid dairy, big meals, alcohol, caffeine iv. Medications - Anti-inflammatories, corticosteroids, Immune system suppressors, Antidiarrhea, antispasmodics, iron supplements 13.Sickle Cell a. Newborn Sickle Cell - <5y ↑ risk for pneu due to non-functional spleens and ↓ immune response. Infants are anemic, spleen/liver damage (jaundice), cries from pain b. Crisis i. Vaso Occlusive - Dactylitis – severe pain/swelling in hands/feet; back/chest pain; fever 1. treat - IV fluids, pain meds, transfusion High flow O2 ii. Splenic Sequestration - acute painful enlargement of the spleen. 1. Drop in hemoglobin levels, hypovolemic shock, seen in CT iii. Aplastic Crisis - sudden pallor and weakness, dropping hemoglobin levels, reticulocytopenia (low immature RBCs) c. Prevention - hydrate, avoid being too hot or too cold, avoid high altitudes w low o2 d. Treatments - Pain meds, Hydration, O2, hydroxyurea (prevents abnormal RBCs), avoid Iron meds. Penicillin Prophylaxis for newborns. manage stress. Dont give diuretics. e. Prevention in infants vaccines and antibiotics, folic acid, regular eye exams. 14.UTI and medications a. Pregnancy - Fosfomycin (Monurol): one-time dose; Cefalexin (Keflex); Ofloxacin (Floxin) i. Avoid - Nitrofurantoin (Furadantin, Macrobid), Trimethoprim-sulfamethoxazole (Bactrim), Penicillin, Fluoroquinolones (Levofloxacin/Levaquin, C