NR507 / NR 507 Final Study Guide (Latest 2024 / 2025): Advanced Pathophysiology – Chamberlain
NR-507 Advanced Pathophysiology
Final Study Guide
Hypoglycemia reactions that occur in patients
Correct Answer:
tachycardia
palpitations
diaphoresis
tremors
pallor
arousal anxiety
Primary hyperparathyroidism is usually caused by
Correct Answer:
Parathyroid tumor
hypercalcemia
secondary hyperparathyroidism is usually caused by
Correct Answer:
increased PTH in response to hypocalcemia
usually caused by CKD
PTH increases can lead to hypercalcemia
hypercalcemia and hypophosphatemia are due to
Correct Answer:
increased PTH
can be asymptomatic
can be seen with Paresthesias and muscle cramps
Other issues of hypercalcemia
Correct Answer:
kidney stones, pathological fractures, ventricular hypertrophy, depression
and gastric issues
Patients with hypercalcemia can be seen to have
Correct Answer:
low bone density
most noted on the distal one third of the radius
Hypomagnesemia inhibits
Correct Answer:
PTH secretions
Hypomagnesemia may be related to
Correct Answer:
chronic alcoholism
malnutrition
malabsorption
increased renal clearance of magnesium caused by aminoglycosides
antibiotics, chemotherapy agents or prolonged magnesium deficient
parenteral nutritional therapy
Symptoms of hypocalcemia
Correct Answer:
dry skin
loss of body and scalp hair
hypoplasia of developing teeth
horizontal ridges on the nails
cataracts
basal ganglia calcifications
bone deformities
bowing of the long bones
Glucose intolerance is associated with
Correct Answer:
Hypercortisolism
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True or False: Acute renal failure is reversible.
True
How is prognosis of kidney function diagnosed?
Kidneys respond to diuretic with good output.
What diagnosis is similar to acute pyelonephritis?
Cystitis.
Diagnosis of acute pyelonephritis includes?
Urinalysis and urine culture.
What indication on urinalysis suspects acute pyelonephritis?
WBC casts (not always present).
What does complicated pyelonephritis require for testing?
Blood cultures and urinary tract imaging.
Signs/Symptoms of pyelonephritis?
Fever, costovertebral angle pain, nausea, vomiting, urinary frequency, hesitancy, lower abdominal pain and urgency.
Goals of a renal calculi diagnosis?
Manage acute pain, promote passage of stone, reduce size of stone that is already formed, prevent new stone formation.
Who is a candidate for dialysis?
Stage 4 and stage 5 kidney disease.
What is chronic kidney disease?
The progressive loss of renal function.
What is chronic kidney disease associated with?
Hypertension, *diabetes mellitus (most significant), SLE, intrinsic kidney disease.
True or False? CKD is determined by estimates of GFR and albuminuria.
True
Stages of CKD
Stage 1: Kidney damage with normal or elevated GFR (90-120)
Stage 2: Kidney damage with mild decrease in GFR
(60-89)
Stage 3: Moderate decrease in GFR (30-59)
Stage 4: Severe decrease in GFR (15-29)- Can no longer be reversed at this stage.
Stage 5: Kidney failure/End stage (GFR <15)
At what stage can CKD not be reversed?
Stage 4: Once this stage is reached, progression to stage 5 is inevitable. Will need kidney transplant or dialysis.
GERD warning signs for patients over the age of 50.
Dysphagia, Odynophagia, nausea, vomiting, weight loss, melena, early satiety.
True or False? Hiatal hernias are often symptomatic?
False: Hiatal hernias are often asymptomatic.
What are symptoms of a hiatal hernia associated with, later in life?
GERD
Is treatment for a sliding hiatal hernia conservative?
Yes.
How can a patient decrease reflux?
Eating small and frequent meals, avoiding recumbent position after eating. Abdominal supports and tight clothing are avoided. Weight control is recommended.
What is the characteristic manifestation of a duodenal ulcer?
Chronic intermittent pain in the epigastric area.
When does the pain occur with a duodenal ulcer?
30 minutes to 2 hours after eating, when the stomach is empty. Not unusual for pain to occur in the middle of night and disappear by morning.
What is a peptic ulcer?
Break or ulceration in the protective mucosal lining of the lower esophagus, stomach or duodenum.
Where is a peptic ulcer least likely to occur?
Large intestine.
What is the standard 1st-line treatment for depression?
SSRIs.
What determines selection of antidepressant?
Assessment of patients symptoms, age, side effects, safety, cost.
What is social anxiety disorder?
Fear and avoidance of social situations such as interaction with others. Patient may feel anxious and uncomfortable and conscious of being humilated.
Positive symptoms of schizophrenia.
Hallucinations, delusions, formal thought disorder, and bizarre behavior.
Negative symptoms of schizophrenia.
Flattened affect, alogia, anhedonia, attention deficits, apathy.
Cognitive symptoms of schizophrenia.
Inability to perform daily tasks requiring attention and planning.
How is schizophrenia diagnosed?
Advanced neuroimaging techniques that reveal structural brain abnormalities.
What is a consistent finding with imaging for a schizophrenia patient?
Enlargement of the lateral and third ventricles, and widening of the frontocortical fissures and sulci.
What is the most common disorder of thyroid function?
Hypothyroidism.
Who does hypothyroidism affect most?
Women and the elderly.
True or False. Hypothyroidism affects between .1% and 2% of the U.S. population?
True.
Which part of the pituitary gland releases TSH?
Anterior pituitary.
Hypothalamic-pituitary axis.
Controls reactions to stress and regulates many body processes including digestion, the immune system, mood, emotions, sexuality, energy storage and expenditure.
What releases thyroid releasing hormone?
Hypothalamus.
What are the two most distinguishing factors of Graves disease?
Pretibial myxedema and exophthalmos.
Two categories of ophthalmopathy that are associated with Graves disease?
Functional abnormality: results from hyperactivity of the sympathetic division of the autonomic nervous system (lag of the globe on upward gaze or a lag of the upper lid on downward gaze).
Infiltrative changes: involves the orbital contents with enlargement of the ocular muscles. These changes affect more than half of individuals with the disease. Increased secretion of hyaluronic acid, adipogenesis, inflammation, and edema of the orbital contents result in exophthalmos (protrusion of eyeball), periorbital edema, and extraocular muscle weakness leading to strabismus and diplopia (double vision).
What is the goal of treatment for hyperthyroidism?
Control excessive TH production, secretion or action.
How is hyperthyroidism treated?
Antithyroid drug therapy (methimazole or propylthiouracil), radioactive iodine therapy ( absorbed only by the thyroid tissue, causing cell death) and surgery.
What is the goal of radioactive iodine ablation for Graves disease?
Destroy overactive thyroid tissue.
What is the treatment of choice for hypothyroidsim?
Hormone replacement therapy with the hormone levothyroxine.
What are environmental factors associated with Type 1 Diabetes?
Viral infections (enteroviruses, coxsackievirus), helicobactor pylori, exposure to cows milk proteins, lack of vitamin D.
What is the diagnostic criteria for Diabetes Mellitus according to the American Diabetes Association?
Hemoglobin A1C greater than or equal to 6.5%.
Where does insulin promote glucose uptake?
Liver, muscle, adipose tissue.
What is a complication of diabetes?
Autonomic neuropathy.
What gastrointestinal symptoms are associated with autonomic neuropathy
Decreased esophageal motility, gastroparesis, delayed gastric emptying.
Neurogenic reactions occur with rapid hypoglycemia. What are the symptoms?
Tachycardia, palpitations, diaphoresis, tremors, pallor, arousal anxiety.
What is primary hyperparathyroidism usually caused by?
Parathyroid gland tumor- hypercalcemia.
What is secondary hyperparathyroidsim?
Increased PTH secretion in response to hypocalcemia.
Usually caused by CKD
As PTH increases, it can lead to hypercalcemia.
How does increased PTH affect calcium and phosphate?
Hypercalcemia and hypophosphatemia.
How does hypercalcemia and hypophosphatemia affect patients?
Causes symptoms related to neuromuscular changes that include paresthesia and muscle cramps.
What do patients with hypercalcemia present with?
Low bone density (osteoporosis) that is most noted in the one-third of the radius.
Kidney stones, pathological fractures, ventricular hypertrophy, depression and gastric issues.
What inhibits PTH secretion?
Hypomagnesemia.
What is hypomagnesemia related to?
Chronic alcoholism, malnutrition, malabsorption, increased renal clearance of magnesium caused by the use of amino glycoside antibiotics or certain chemotherapeutic agents, or prolonged magnesium-deficient parenteral nutritional therapy.
What are the symptoms of hypocalcemia?
Dry skin, loss of body and scalp hair, hypoplasia of developing teeth, horizontal ridges on the nails, cataracts, basal ganglia calcifications, bone deformities, bowing of the long bones.
True or False: Glucose intolerance is associated with hypercortisolism?
True.
Why does glucose intolerance occur?
Cortisol-induced insulin resistance and increased gluconeogenesis and glycogen storage by the liver.
What characterizes Cushing’s syndrome?
Patterns of fat deposition that is described by truncal (central) obesity, moon face, buffalo hump.
What signifies the onset of adrenal crisis?
Hypotension.
What is an adrenal crisis/ addisonian crisis?
Hypotension that progresses to complete vascular collapse and shock.
What can cause an adrenal crisis?
Undiagnosed disease, acute withdrawal of glucocorticoid therapy, or the occurrence of infection or other comorbid stressful events.
What lab work indicates primary hypocortisolism?
Decreased serum and urine levels of cortisol, increased ACTH levels.
Things to remember when prescribing cortisol.
With acute stressors (infection surgery, trauma), additional cortisol must be administered to approximate the amount of cortisol that might be expected to be secreted if normal adrenal function were present.
In Alzheimer’s disease, what happens with a decrease in hippocampus size?
Decreased short-term memory occurs with mild cognitive decline.
What symptoms occur with Parkinson’s disease?
Bradykinesia (shuffling gait), resting tremor, rigidity, postural disturbance, dysarthria, dysphagia.
What risk factors are associated with Multiple Sclerosis?
Smoking, vitamin D deficiency, Epstein-Barr virus infection.
What is happens with a febrile seizure?
Neurons are excited by decreased C02 levels that are caused by hyperventilation during a febrile state.
How is a cluster headache characterized?
Unilateral trigeminal distribution of severe pain with ipsilateral autonomic manifestations that include tearing on the affected side, ptosis of the ipsilateral eye, and congestion of nasal mucosa.
Pain may alternate sides with each headache episode and is severe, stabbing and throbbing. Pain can radiate to midface and teeth.
Who does cluster headaches usually effect?
Men ages 20-50 years old.
True or False: Migraines are an episodic neurologic disorder?
True.
How long does a migraine usually last?
4-72 hours.
How is a migraine diagnosed?
Any two of the following occur:
Unilateral head pain, throbbing pain, pain that worsens with activity, moderate or severe pain intensity.
And one of the following:
nauesa, vomiting, photophobia, phonophobia.
How is 115 Migraine classified?
1) Migraine with aura with visual, sensory, or motor symptoms.
2) Migraine without aura (most common).
3) Chronic migraine.
What is the most prevalent type of recurrent headache?
Tension-type headache (TTH).
True or False: Tension type headaches are vascular or migrainous headaches?
False. They are not.
How is a tension headache described?
Mild to moderate bilateral headache with a sensation of a tight band or pressure around the head. Average onset is during the second decade of life.
What cranial nerve is Bell’s Palsy associated with?
Cranial nerve VII.
What does Bell’s Palsy result in?
Facial asymmetry and inability to close eye, smile or frown on the affected side.
What is trigeminal neuralgia associated with?
Compression of Cranial nerve V.
What are the symptoms of trigeminal neuralgia?
Severe and sharp stabbing pain that can worsen with chewing.
What are the characteristics of bacterial meningitis?
Fever, tachycardia, chills.
What are the characteristics of meningeal irritation?
Severe throbbing headache, severe photophobia, nuchal rigidity, and positive Kernig and Brudzinksi sign.
What motor deficits are associated with an infarct in the ACA?
Contralateral paralysis or paresis (greater in foot and thigh)
What sensory deficits are associated with an infarct in a basilar artery?
Contralateral loss of vibratory sense, sense of position with dysmetria, loss of two-point discrimination, impaired rapid alternating movements.
Is there a familial tendency related to Rosacea?
Yes. Also, several genes have been identified.
What causes Rosacea?
Neurovascular dysregulation, infection, and factors that trigger altered innate and adaptive immune response are involved (chronic sun exposure and damage, heat, drinking alcohol, hot beverages, hormonal fluctuations, demodex folliculorum colonization, mental stress, and anxiety.
What is the most aggressive skin cancer?
Melanoma
What impacts the prognosis of Melanoma?
Thickness of the lesion.
What is the typical lesion of plaque psoriasis?
Well-demarcated, thick, silvery, scaly, erythematous plaque surrounded by normal skin that can appear anywhere on the body.
sources;
https://www.gcu.edu/
https://yaveni.com/
https://www.rasmussen.edu/
https://www.chamberlain.edu/