NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022, Exams of Nursing

Download NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 and more Exams Nursing in PDF only on Docsity! NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 WEEK 1: CELLULAR BIOLOGY AND ALTERATIONS Week 1 Instructor Comment: Retinoblastoma • Retinoblastoma is a rare cancer that occurs only in children. It develops either as a hereditary disease, due to an abnormality of the RB1 gene, or sporadically (70% of cases). Located on chromosome 13q14, the RB1 gene is responsible for encoding pRb, which is a tumor suppressor protein. In the heritable form, the RB1 gene mutation is inherited through germinal cells, with a second mutation occurring in somatic retinal cells. The noninherited type of retinoblastoma occurs as a result of two mutations in the somatic retinal cells. The tumor arises from the inner surface of the retina and then spreads into the retina, resulting in leukocoria—a white appearance to the red reflex, commonly called cat-eye reflex—which is most often first identified by the child’s parents. • Normally the RB1 gene (pRB) governs the passage of the restriction point in the cell cycle, thus regulates cell proliferation. Germline mutations are inherited, whereas somatic mutations are acquired. • Tumor suppressors are a class of genes that work to limit cell growth, and they are important for tumor suppression by preventing DNA synthesis until mutations are corrected; preventing cell division if DNA replication introduces new mutations, and inducing programmed cell death when damage cannot be repaired. RB or retinoblastoma protein is one example of a tumor suppressor. They act in the G1/S checkpoint, thereby inhibiting progression to DNA synthesis. RB activity is regulated by many signals, including growth factors and cell differentiation. Clinically, retinoblastoma appears in the first years of life--shining light on the eye gives off an abnormal white reflection. Bilateral retinoblastoma is always due to inherited RB mutations. NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 • Retinoblastoma is a rare cancer that occurs only in children. It develops either as a NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 functional, DNA damage goes unrepaired, and mutations accumulate in cells, leading to other cancer cell characteristics. RB1 represents an additional tumor suppressor gene, and its product, pRb, can stop the cell cycle in G1. The consequence of losing this function is underscored by the typical findings of RB1 mutations in retinoblastoma, osteosarcoma, and carcinomas of breast, lung, and colon. Reference: Quinonez, S. C., & Barsh, G. (2019). Pathophysiology of disease: An introduction to clinical medicine (8th ed.). New York, NY: McGraw-Hill. • Multiple checkpoints are present within the cell cycle machinery to ensure the cell undergoes division appropriately. Cell cycle progression is the ability to halt the cycle when necessary. If a cell experiences alterations to its DNA through damage or mutations, the cell must be prevented from proceeding through cellular division and not produce daughter cells with the same genetic alterations. Additionally, cells must ensure that the necessary nutrients and building blocks are present before proceeding through division steps. One regulatory protein of cell division, the retinoblastoma protein (pRb), inhibits the cell cycle from progressing through G1 checkpoint, also known as the restriction point; by binding and inhibiting the activity of necessary transcription factors. As cyclin D levels rise in response to growth factor—and nutrient-induced signaling—the cyclin D–activated CDKs phosphorylate pRb, leading to a change in its structure; this structural shift causes the release of the bound transcription factors and allows the cell to continue through G1. Reference: McCance, K. L., & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). Elsevier. NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 ADHD • Neuroimaging studies provide much information that currently allows us to expand the neurobiology of ADHD. The neuroimaging studies show disorders of several other brain areas, particularly the anterior cingulum, the dorsolateral and ventrolateral prefrontal cortex, the orbitofrontal cortex, the superior parietal regions, the caudate nucleus, the thalamus, the amygdala, and the cerebellum. • A consequence of leakage of lysosomal enzymes during chemical injury is an enzymatic digestion of the nucleus and nucleolus occurs, halting DNA synthesis. Reference: Kasparek, T., Theiner, P., & Filova, A. (2015). Neurobiology of ADHD from childhood to adulthood: Findings of imaging methods. Journal of Attention Disorders, 19(11), 931–943. doi: 10.1177/1087054713505322 • Down syndrome, Turner Syndrome, and Klinefelter Syndrome are all examples of chromosomal disorders that occur from a literation in the chromosome number. Sex-linked disorders frequently are associated with the X chromosome and are predominantly recessive. The Punnett square can be utilized to describe possible combinations that can occur with the transmission of single-gene dominant and recessive traits. The genetic information needed for protein synthesis is encoded in the DNA contained in the cell nucleus. • A phenotype is the set of characteristics or the clinical presentation of an individual, which results from the particular genotype. Crossing over involves the exchange of genetic material between two homologous chromosomes during meiosis. Messenger RNA carries the instructions for protein synthesis. • The kind of genetic mutation that results in the change of an amino acid sequence in the protein sequence is best described as a missense mutation. Semi conservative replication relates to the concept that as DNA is copied, one NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 original and one newly formed copy of the DNA is inherited together in each of the progeny cells. Reference: McCance, K. L., & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). Elsevier. LVH • Heart failure occurs when the heart is unable to pump enough blood to meet the body's needs. The left ventricle is more prone to develop heart failure than the right ventricle due to its workload and vulnerability to ischemic and other injuries. In left- sided heart failure with reduced ejection fraction, the Frank-Starling mechanism stays intact, but over time the end-systolic and end-diastolic volumes increase, the chamber dilates, and the ventricular wall thins. Reference: McCance, K. L., & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). Elsevier. NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 structure, and function known as ventricular remodeling. The alterations in ventricular function result in further deterioration in cardiac systolic and diastolic functions that further promotes the remodeling process. WINSHIELD Wiper washer POISONING • I want to share that the treatment for methanol toxicity would be hemodialysis which may be necessary to enhance elimination or reduce the duration of therapy since the half-life of MET is 43 hours. Hemodialysis may be required if acidemia or end-organ injury is present. Just off-topic, I would like to share about Alcohol liver disease. There are some labs that are important to evaluate such as Gamma-glutamyl transferase (GGT) and bilirubin. GGT is sensitive to hepatocellular damage caused by alcohol ingestion, which is elevated. Blood concentrations of conjugated and unconjugated bilirubin can indicate liver pathology, as well as help clinicians, identify extrahepatic causes of hyperbilirubinemia. Tung, R. C., & Thornton, S. L. (2018). Characteristics of laboratory-confirmed ethylene glycol and methanol exposures reported to a regional poison control center. Kansas journal of medicine, 11(3), 67–69. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6122883/ • Under normal circumstances, the osmolar gap should be 10 mOsm/kg (mmol/kg) or less. An increased osmolar gap suggests the presence of a small osmotically active agent. It is most commonly seen with alcohol ingestion (ethanol, methanol, ethylene NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 glycol) or medications such as mannitol or lorazepam. Methanol toxicity preferentially affects the retina, where degeneration of retinal ganglion cells may cause blindness. Selective bilateral necrosis of the putamen and focal white-matter necrosis also occur when the exposure is severe. Formate and other metabolites of methanol appear to contribute to toxicity through the disruption of oxidative phosphorylation and non- enzymatic protein modification. Methanol toxicity occurs by ingestion of illicit liquor (moonshine) contaminated with methanol or used as a substitute for ethanol. Reference: Kumar, V., Abbas, A. K., Fausto, N., & Aster, J. C. (2015). Robbins and Cotran pathologic basis of disease, professional edition (9th ed.). Elsevier. • Treatment for methanol toxicity includes either folic acid or leucovorin (folinic acid) parenterally is recommended at the first suspicion of methanol poisoning. Folic acid is most commonly used. About 1 to 2 mg/kg every 4 to 6 hours is appropriate. Case reports demonstrate that plasma formic acid concentrations can rise after leucovorin cessation; it is recommended to continue folic/folinic acid until the methanol and formate are eliminated. Because the first dose is usually administered before hemodialysis, a second dose is recommended after hemodialysis because this highly water-soluble vitamin would have been eliminated. Reference: Lewis, S. N., Howland, M. A., Lewin, N., Smith, S. W., Goldfrank, L. R., & Hoffman, R. (2019). Goldfrank's Toxicologic Emergencies (11th ed.). McGraw-Hill Education. • Methanol is a low-molecular-weight, colorless, and volatile liquid widely used as an industrial solvent; as a chemical intermediate, a fuel source for picnic stoves, racing NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 cars, and soldering torches; an antifreeze agent; and an octane booster for gasoline. Methanol is rapidly absorbed through all routes of exposure (i.e., dermal, inhalation, and oral), easily crosses all membranes, and is distributed to organs and tissues. The highest methanol concentrations are found in the blood, aqueous, and vitreous humor, bile, brain, kidneys, lungs, and spleen. In the liver, Methanol is oxidized to formaldehyde by alcohol dehydrogenase. It is then excreted as formic acid in the urine or oxidized further to carbon dioxide and then excreted by the lungs. Formic acid is the toxic metabolite that mediates the metabolic acidosis and the retinal and optic nerve toxicity observed in humans. Humans are highly sensitive to methanol-induced neurotoxicity due to our limited capacity to oxidize formic acid. The toxicity occurs in several stages. First, there is a mild CNS depression, followed by an asymptomatic 12- to 24-hour latent period, then by a syndrome consisting of formic acidemia, uncompensated metabolic acidosis, ocular and visual toxicity, coma, and possibly death. The treatment of methanol poisoning involves both combating acidosis and preventing methanol oxidation. NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 life. Cigarette smoking accounts one out of every five deaths each year in the United States. Yet it is the single most preventable cause of death and disease. In addition, smoking causes more deaths from vascular, respiratory, and other diseases than from cancer. --- Lorraine Hu- HYPERPLASIA Hyperplasia is an increase in the number of normal cells when estrogen is stimulated, the uterine endometrium grows and thickens in preparation for the ovum’s implantation. Dysplasia or atypical hyperplasia is an abnormal change in the size, shape, or organization of mature cells. It most commonly occurs in the epithelial membranes such as the uterus and is strongly associated with neoplasia (malignant growth). Most frequently, women with uterine dysplasia will have further testing performed that may include a biopsy. Metaplasia has resulted in the replacement of normal columnar ciliated epithelial cells with stratified squamous epithelial cells. These new cells do not have cilia or secrete mucus, which traps and removes bacteria from the upper airways. The lack of these protective mechanisms makes patients more susceptible to upper respiratory infections. Lorraine Hu- ALLERGIC RHINITIS In the clotting process, collagen provides a particularly strong stimulus to activate platelets. Only reduced ferrous iron (Fe2+) can be used in the formation of normal hemoglobin. During an IgE-mediated hypersensitivity reaction is activated by Eosinophils. The life span of platelets is 10 days. White blood cells (granulocytes monocytes and lymphocytes are formed in the bone marrow. The use of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDS) have been identified as a cause of impaired platelet function. Urticaria is a result of Type 1 hypersensitivity. Adaptive immunity (also called natural or native immunity) refers to immunity that is acquired through previous exposure to infections and other foreign agents. NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 DR. HU REPLY- HIV Did you include an article from 1996, and 2000? Please do not include these journals less than 2015, all must be current. Viruses are bits of genetic material (DNA or RNA) with associated proteins and lipids. They are intracellular pathogens that use the host’s energy sources and enzymes to replicate. DNA viruses first produce messenger RNA in the host cell’s nucleus with the host cell’s enzymes, which produces proteins from the messenger RNA that allow the DNA of the virus to replicate. RNA viruses replicate depending on their type: Retroviruses can create messenger RNA and DNA from their own genome. Messenger RNA carries the instructions for protein synthesis. Viral DNA is incorporated into the host cell’s DNA, thus when the host cell replicates, the viral DNA also replicates. In humans factors that are essential in order for protein synthesis to occur is the specific information from the nucleus of the cell. Viruses in which the RNA is a single positive copy use the strand as a direct template to make viral proteins and a complementary RNA strand. The complementary strand then serves as a template for making more positive strands that can be packaged into new viruses. The RNA viruses that possess a negative copy to replicate in the same manner except that the RNA must be transcribed to a positive complimentary copy before it can produce proteins or viral RNA. DR HU REPLY- ALLERGIC RHINITIS I would like to share about the types of hypersensitivity reactions differ according to the immune cell types involved and the mechanism of tissue injury: - Type I hypersensitivity is an immediate allergic or anaphylactic type of reaction mediated primarily by sensitized mast cells. Mast cell degranulation releases chemicals that mediate the signs and symptoms of anaphylaxis, including vascular permeability, vasodilation, hypotension, urticaria, and bronchoconstriction. - Type II hypersensitivity occurs when antibodies are formed against antigens on cell surfaces, usually resulting in lysis of target cells. Cell lysis may be mediated by activated complement fragments or by phagocytic cells that are attracted to target cells by the attached antibodies. NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 - Type III hypersensitivity reactions occur when antigen-antibody complexes are deposited in tissues and result in the activation of complement and subsequent tissue inflammation and destruction. Antigen-antibody complexes activate the complement cascade and subsequently attract phagocytic cells to the tissue. - Type IV hypersensitivity reactions are T-cell–mediated and do not require antibody production. Sensitized T cells react with altered or foreign cells and initiate inflammation. DR HU- HIV HIV infects and depletes a portion of the immune system (T helper [Th] cells), making individuals susceptible to life-threatening infections and malignancies. HIV is a bloodborne pathogen present in body fluids (e.g., blood, vaginal fluid, semen, breast milk) with typical routes of transmission: blood or blood products, intravenous drug abuse, heterosexual and homosexual activity, and maternal-child transmission before or during birth. The primary surface receptor on HIV is the envelope glycoprotein gp120, which binds to the CD4 molecule found mostly on the surface of Th cells. Several other important co-receptors have been identified. The current treatment for HIV infection is a combination of drugs called antiretroviral therapy (ART). DR. HU RHINITIS Thank you for doing an excellent job and writing about sinusitis/rhinitis. These two occur concurrently and sometimes termed rhinosinusitis. Rhinosinusitis is mostly caused by a viral infection such as rhinovirus, influenza, or adenovirus. Rhinosinusitis can be a result of a secondary bacterial infection associated with infectious rhinitis or allergic rhinitis in which the drainage from the sinus cavity has become blocked. Drainage accumulation provides a great medium for bacterial growth. Streptococcus pneumoniae and Haemophillus influenzae are commonly found in the upper airways of healthy people. Eosinophils are particularly associated with an increase in number during allergic reactions, particularly with sinus infections. Neutrophils are seen to increase in numbers related to bacterial and viral infections. Traditionally, the band count has been used to differentiate bacterial from viral infections, and a greater shift to the left is viewed as a more severe infection. Basophils are also involved in wound healing and chronic NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 arteries, thus affecting blood flow. Restriction of coronary artery blood flow to the heart can have a serious negative effect on cardiac health. LDL cholesterol accumulates to form atherosclerotic plaque along the artery walls and directly affects cardiac health. Endothelial injury causes inflammation, which in turn causes the diminished vasodilatory capacity of the artery. This results in LDL cholesterol deposition and clot formation in coronary arteries, resulting in a detrimental effect on cardiac health. PNEUMONIA: Those who have smoked more than 60 pack-years have double the risk of any pulmonary complication and triple the risk of pneumonia compared with those who have smoked less than 60 pack-years. Smoking cessation causes the symptoms of chronic bronchitis to diminish or disappear and eliminates the accelerated loss of lung function observed in those who continue to smoke. Typically, pneumonia results from infection by bacteria. Acute bronchiolitis is a viral infection that has a peak incidence between 3 to 6 months of age and is most commonly caused by respiratory syncytial virus. Influenza is a viral infection that can affect the upper and lower respiratory tracts and is transmitted by aerosol or direct contact. PPT NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 Asthma: Both asthma and COPD are classified as obstructive pulmonary disorders. Obstructive pulmonary disorders are characterized by difficulties in breathing, especially breathing out (exhalation). There is an ‘obstruction’ to airflow which may be airway inflammation as is present in both asthma and COPD or damage to lung tissue which is also characteristic of COPD. An embolus in the lungs will increase the dead space, this is also known as physiological dead space. Other diseases can do this like tumors in the lungs that cause an obstruction in the gas exchange unit. Not only will it increase the dead space (the part where no gas exchange can occur) it can also increase work of breathing for the patient. There are a couple of dead spaces, NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 anatomical and physiological. Anatomical dead space is the area of the lungs that does not contain the alveoli (this is the gas exchange part of the lungs) so no gas exchange can occur – just as the name applies Anatomical – this is the trachea, segmental bronchi and bronchiole (non-respiratory part) does not exchange gas. COPD: I agree that COPD increases airway resistance. The most important variable governing airway resistance is the radius of the airway. An example of a ABG would be for a chronic smoker with COPD who comes into the ED with SOB and confusion would be pH = 7.28 mmHg; pCO2 = 51 mmHg; HCO3 = 32 mmHg; pO2 = 59 mmHg. This would be classified as respiratory acidosis (with metabolic compensation), this is because his pH is low = acidosis; pCO2 is high; bicarb is high, and pO2 is low. The smaller (respiratory) bronchioles and alveoli are the sites of gas exchange. The alveoli are microscopic air sacs. These contain very thin walls made up of a single layer of epithelial cells lined with fluid. There are approximately 500 million air sacs in each lung, providing in total an extensive surface area for the exchange of oxygen and carbon dioxide. Each collection of air sacs is supplied with a network of blood capillaries from the pulmonary circulation. Reference: NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 Graves' may be associated with other autoimmune disorders such as myasthenia gravis and pernicious anemia. STROKE Transient ischemic attack (TIA): a brief period of inadequate cerebral perfusion causing a sudden focal loss of neurologic function; full recovery of function usually occurs within 24 hours. Intracerebral hemorrhage is a hemorrhage within the brain parenchyma and usually occurs in the context of severe and often longstanding hypertension. Risk factors for stroke are similar to those for another atherosclerotic vascular disease. Cardiac disease complicated by atrial fibrillation is an important risk factor for embolic stroke. A sedentary lifestyle is not a risk factor for hemorrhagic stroke. MULTIPLE SCHLEROSIS The regeneration of axonal constituents in the CNS is limited by an increased incidence of scar formation and NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 the different nature of myelin formed by the oligodendrocyte. Nerve regeneration depends on many factors, such as the location of the injury, the type of injury, the presence of inflammatory responses, and the process of scarring. The closer the injury to the nerve's cell body, the greater the chances that the nerve cell will die and not regenerate. A crushing injury allows for fuller recovery compared with a cut injury. Crushed nerves sometimes recover fully, whereas cut nerves form connective tissue scars that block or slow regenerating axonal branches. Peripheral nerves injured close to the spinal cord recover poorly and slowly because of the long distance between the cell body and the axon's peripheral termination. However, this process is limited to myelinated fibers and generally occurs only in the peripheral nervous system (PNS). SPINAL INJURY Spinal shock may occur after injury to the spinal cord and can last from a few hours to a few weeks. Symptoms below the level of injury include flaccid paralysis of all skeletal muscles; loss of all spinal reflexes; loss of pain, proprioception, and other sensations; bowel and bladder dysfunction with NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 paralytic ileus; and loss of thermoregulation. Decorticate posturing is an abnormal flexor response of the arms and wrists, with legs and feet extended and internally NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 generally at rest, unilateral affecting distal extremities. Substantia nigra is anatomically part of the midbrain, however, functionally substantia nigra is considered to be a part of basal ganglia. FYI: Both Parkinson's and Huntington's diseases are associated with defects in the basal ganglia. While the decreased level of dopamine causes Parkinson’s disease, its increased levels in the brain can cause schizophrenia. The incidence of vascular dementia is difficult to estimate because it often coexists with dementia due to other disorders such as Alzheimer's disease. Alzheimer's disease is the most common cause of dementia and vascular dementia is the second most common cause of dementia. Amyloid plaques and neurofibrillary tangles are clearly visible by microscopy in brain tissue from individuals affected with Alzheimer's disease. OPIOID DEPENDENCY Sharp stabbing pain is relayed through the fast myelinated fibers of the sensory tract. Afferent neurons can be categorized as A-delta and C fibers. A- delta fibers are large in diameter and myelinated. These fibers conduct impulses rapidly and NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 cause the first, short-lived acute experience of pain, such as occurs when a finger senses a burn and pulls away from the heat source. C fibers are smaller in diameter and unmyelinated. These fibers conduct impulses slowly and cause a longer-lasting, persistent, dull pain, such as the pain that occurs after a burn has taken place. NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 Maintenance of a constant internal environment and implementation of behavioral patterns are two main functions of the hypothalamus. Migraine is such a relevant topic for discussion. There are literally many patients that suffer migraine headaches. Trigeminal autonomic cephalalgias present as an excruciating unilateral headache with prominent cranial parasympathetic autonomic features. Trigeminal autonomic cephalalgias activate a trigeminal parasympathetic reflex, with the clinical signs of cranial sympathetic dysfunction. The most common kind of headache within this category of trigeminal autonomic cephalalgias, is a cluster headache. It is theorized that vasodilation is responsible for the pain and the autonomic features of trigeminal autonomic cephalalgias. NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 Addison's disease may suffer from hyperpigmentation since excess ACTH stimulates melanocytes. The most severe clinical manifestations of adrenocortical insufficiency occur because of inadequate levels of circulating cortisol. TRICHOMONAS VAGINALIS: Trichomoniasis vaginalis, protozoa, may be isolated from the vagina, urethra, and Bartholin or Skene glands. After attachment to the host cells, it ignites an inflammatory response exhibited as a discharge containing elevated levels of polymorphonuclear leukocytes. The pathogen causes direct damage to the epithelium, leading to microulcerations. Diagnosis is usually performed with a wet mount or Papanicolaou smear. In women, symptoms are characterized by diffuse, malodorous, yellow-green vaginal discharge with vulvar irritation. Some women may be asymptomatic. Metronidazole may be administered PO as a single 2 g dose or 500 mg twice daily for 7 days. Pregnant women should be prescribed the single dose of metronidazole. The cure rates are greater than 90% when metronidazole is administered as either a single 2 g dose or a 7-day regimen. Possible adverse effects include an unpleasant metallic taste, reversible neutropenia, urticaria, rash, flushing, dry mouth, darkened urine, and a disulfiram-like reaction. When using these agents, advise patients to avoid the consumption of alcohol. MALE HYPOGONADISM NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 Hypogonadism may be caused by an inherited (congenital) trait or something that happens later in life (acquired) such as injury or infection. Turner’s syndrome, a disorder that affects females, causes hypogonadism and physical characteristics such as a webbed neck, broad chest, and short stature. Lack of testosterone production by the testes is associated with primary hypogonadism. Hypogonadism in children and young adults causes the loss of the protective effects of estrogen and testosterone, which can result in severe osteoporosis. CRYPTORCHIDISM: Primary hypogonadism is the lack of testosterone production by the testes. Several studies have revealed an increased prevalence of testicular tumors in subjects with a history of cryptorchidism. The incidence of cryptorchidism is about 0.7% to 1.0% of male infants at 1 year of age. Because of the increased risk of malignancy and infertility, treatment at an early age to bring the testis into a normal scrotal position is recommended. The cause of the condition is uncertain but may be related to an intrinsic testicular defect or a subtle hormonal deficiency. A twisting of the spermatic cord with subsequent testicular ischemia and infarction, testicular torsion, commonly presents with sudden onset of severe testicular pain. Prostatitis is manifested by a tender, swollen prostate. Testicular NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 cancer has a slower, less dramatic presentation. Epididymitis can resemble testicular torsion but usually presents with an enlarged, reddened, and tender scrotum instead of a sudden onset of severe pain. PCOS Major symptoms of PCOS include excess weight, hirsutism, and amenorrhea. The most common etiology of ovulatory dysfunction is poly-cystic ovary syndrome, a condition in which the ovaries are filled with follicular cysts and the patient has elevated levels of androgens and estrogen. Hirsutism is commonly observed in these women due to the excessive androgen levels. During embryonic development, the nervous system is derived from the primary germ layer, the ectoderm. During pregnancy, there are a number of hormones that help maintain the pregnancy and prepare for delivery and lactation. Human chorionic thyrotropin is responsible for increasing maternal metabolism during pregnancy. Lack of testosterone production by the testes is associated with primary hypogonadism. NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 of the intrinsic coagulation pathway. Factor VIII-specific assays are required for diagnosis. Hemophilia A is treated with infusions of recombinant factor VIII. DM1 Diabetes Mellitus Type 1 is caused by deficient insulin resulting from T– cell-mediated autoimmune destruction of the pancreas' insulin-secreting beta cells. The individual has circulating autoantibodies to islet cells, insulin, and enzymes involved in insulin production. This form of the disease has a strong genetic influence based on multiple genetic variants. The beta-cell damage rate is variable among affected individuals, being rapid mainly in infants and children and slow mostly in adults. The presenting sign of T1DM is often ketoacidosis, particularly in children. Many affected adults retain some beta-cell function that prevents ketoacidosis for many years, but they eventually become dependent on exogenous insulin for survival. The gold standard laboratory test used to diagnose diabetes is a fasting plasma glucose level. A fasting plasma glucose level greater than 126 mg/dL on two separate days confirms the diagnosis. Random plasma glucose greater than 200 mg/dL repeated on more than one occasion is also a diagnostic of the disorder. The pancreas has a number of endocrine responsibilities including the release of insulin when glucose levels are high to help recruit glucose transporters to the cells. NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 The relationship between insulin and obesity is best described by the phase – insulin resistance leads to excess blood glucose levels that are converted into fat by the liver. Hormones released from the gastrointestinal (GI) tract play a role in insulin resistance, beta-cell function, and diabetes. Ghrelin stimulates GH secretion, controls appetite, and plays a role in obesity and insulin sensitivity regulation. Ghrelin is a peptide produced in the stomach and pancreatic islets that regulate food intake, energy balance, and hormonal secretion. Decreased levels of circulating ghrelin have been associated with insulin resistance and increased fasting insulin levels. The incretins are a class of peptides released from the GI tract in response to food intake and function to increase the secretion of insulin and have many other positive effects on metabolism. The most studied incretin is called glucagon-like peptide 1 (GLP-1), and studies have demonstrated that beta-cell responsiveness to GLP-1 is reduced both in prediabetes and in type 2 diabetes. Incretin therapies include GLP-1 receptor agonists (GLP-1 RAs) and dipeptidyl peptidase IV (DPP-IV) inhibitors, which can help control postprandial glucose levels by promoting glucose-dependent insulin secretion. Wound Healing: Pressure ulcers and severe burns are examples of wounds that require secondary and tertiary intention healing. These wounds have large areas of NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 missing skin, dermis, and deeper tissue replaced by scar tissue. Wound healing consists of four phases: hemostasis, inflammation, proliferation, and remodeling. To perpetuate and stimulate healing, debridement of a wound is often necessary. Debridement is the removal of necrotic tissue to promote and enable re-epithelialization and new growth of tissue. Injurious agents may produce sublethal and reversible cellular damage or may lead to irreversible cell injury and death. Cell death can involve two mechanisms: apoptosis or necrosis. Apoptosis involves controlled cell destruction and is the means by which the body removes and replaces cells that have been produced in excess, developed improperly, have genetic damage, or are worn out. Necrosis refers to cell death characterized by cell swelling, rupture of the cell membrane, and inflammation. DIC DIC is sometimes referred to as a consumptive coagulopathy. There is active stimulation of the coagulation cascade with the formation of fibrin clots. Simultaneously, there is depletion of coagulation factors with unrestrained fibrinolysis causing bleeding. Also, fibrinolysis is suppressed. Episodes of both coagulation and hemorrhage characterize the resultant clinical condition. Many types of conditions can trigger DIC secondary to another disease. Overactivation of the clotting mechanism. Commonly caused by sepsis. NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 release, which retains sodium and hence water to increase the blood volume. The end product of protein metabolism excreted in urine is urea. Innervation of the bladder and internal urethral sphincter is supplied by the parasympathetic nervous system. GERD A patient presents with a history of heavy smoking and obesity and experiences acute pain. Radiologic studies reveal that a small portion of the stomach is above the diaphragm. The most likely cause is a hiatal hernia. A patient with peptic ulcer disease (PUD) may have anemia because of either blood loss or insufficient intrinsic factors. Helicobacter pylori are believed to be the causative bacterial agent of peptic ulcer disease. An elderly patient presents with chronic constipation and an acute episode of lower abdominal pain, fever, and increase white blood cell count. Radiologic images reveal herniation of the colon and there is a concern for NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 peritonitis and possible sepsis. Based on this pathophysiologic information, the most likely diagnosis is diverticulosis. PSGN Acute post-infectious glomerulonephritis typically occurs after streptococcal infection in children and young adults but may occur following infection with many other organisms. It is caused by the deposition of immune complexes, mainly in the subepithelial spaces, with abundant neutrophils and the proliferation of glomerular cells. Most affected children recover; the prognosis is worse in adults. Red blood cell casts in the urine are associated with glomerulonephritis. The primary cause of glomerulonephritis is immune system damage to glomeruli. Group A B-hemolytic Streptococcus infection of the throat (strep throat) frequently is associated with the development of post-infectious acute glomerulonephritis. Nephrotic syndrome is a complication of glomerulonephritis is characterized by proteinuria, hypoalbuminemia, and edema. Glomerulonephritis may result in protein losses into the NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 urine as a consequence of damage to the glomerulus. NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 genetic disposition as well as an immune response to dietary gluten and its related proteins VIT D Deficiency Thank you group 4 for an educational presentation about vitamin D deficiency. During chronic renal failure, the activation of vitamin D is decreased. A daily intake of 800 to 1000 IU of vitamin D is recommended for adults age 50 years and older. Many elderly persons are at high risk for vitamin D deficiency, especially those with chronic illness, malabsorption disorders (e.g., celiac disease), and limited exposure to sunlight. It is recommended that serum vitamin D levels be obtained for persons at risk of a deficiency and that supplemental vitamin D be prescribed for persons with low serum levels. Celiac disease involves an autoimmune reaction. Celiac disease is an immune-mediated disorder triggered by the ingestion of gluten-containing grains such as wheat, barley, and rye. ATOPIC DERMATITIS Atopic dermatitis is common in children with a family history of asthma and allergic rhinitis and is often called eczema. NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 Itching is always present. There is often presented on the face, scalp, and extensor surfaces with skin thickening. POST MENOPAUSAL OSTEOPOROSIS NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022 Good job with the PPT presentation. Phosphate, carbonate, and magnesium are stored in the bone. Osteoblasts - bone cells are responsive to parathyroid hormone, produce osteocalcin when stimulated by 1,24- dihydroxy vitamin D, and synthesize osteoid.When the bone is ‘resorbed’ during the process of growth and repair, the original bone is removed. Osteocytes function to maintain the bone matrix. Tendon attaches skeletal muscle to bone. SUNBURN A patient who suffers a burn that damages the entire epidermis and most of the dermis but did not affect the underlying connective tissue, muscle or bone has a partial thickness burn. Antibiotics increased caloric intake, fluid and electrolyte management are provided to a patient with extensive skin burns.Replacement is the process that involves the healing of damaged tissue that is capable of division and is replaced by identical tissue from the proliferation of nearby cells. During an acute inflammatory response, cells are recruited to the injury site. The chemical signals that NURSING MSN 570 Advanced Pathophysiology STUDY GUIDE REVIEW EXAM 2022