WGU D027 Final Exam Comprehensive Study Guide (Latest 2023/ 2024 Update) Advanced Pathopharmacological Foundations| Questions and Verified Answers| 100% Correct| Grade A

WGU D027 Final Exam Comprehensive
Study Guide (Latest 2023/ 2024 Update)
Advanced Pathopharmacological
Foundations| Questions and Verified
Answers| 100% Correct| Grade A
Q: primary malignant tumor
Answer:
lack of organization of cells
Q: glucocorticoids
Answer:
used in combination with other agent to treat lymphoid tissue (leukemia). glucocorticoids are
directly toxic to lymphoid tissues.
Q: Selective estrogen receptor modulators (SERM)
Answer:
for hormone receptor positive and advanced breast cancer. (Tamoxifin reduces risk and
recurrence risk)
Q: Heart failure
Answer:
impairment of the ventricle to fill with or eject blood; heart cannot meet metabolic need of the
body.

Q: CHF
Answer:
heart cannot keep up with metabolic needs; volume overload in pulmonary area
Q: Left Ventricular Dysfunction
Answer:
reduced ejection fraction; ventricle having issue ejecting blood.
Q: normal ejection fraction
Answer:
55 – 60 % (blood pumped out with each heartbeat)
Q: Ejection fraction of 50% – reduced or preserved?
Answer:
preserved
Q: Diastolic CHF
Answer:
preserved ejection fraction, problem is with filling
Q: Systolic CHF

Answer:
reduced ejection fraction, problem is with ejecting
Q: Left sided CHF
Answer:
pulmonary (JVD, fluid volume overload, rails, S-3 murmurs) ** #1 cause of Right sided CHF
Q: BNP
Answer:
gold standard lab test to diagnose CHF
Q: Echocardiogram
Answer:
Diagnostic tool, evaluates heart structure and function
Q: At Risk for HF – Stage A
Answer:
no structural heart disease or symptoms of heart failure
Q: Stage A HF co-morbidities
Answer:
htn, atherosclerotic disease, diabetes, metabolic syndrome, patients using cardiotoxins with
family history

Q: Therapy goals of stage A HF
Answer:
treat htn, encourage smoking cessation, encourage regular exercise, treat lipid disorders,
discourage alcohol intake/drug use, control metabolic syndrome
Meds: ACEI or Angiotensin II RB for vascular disease or diabetes (avapro, losartan, benicar,
diovan, etc)
Q: At Risk for HF – Stage B
Answer:
structural heart disease but no symptoms of heart failure
Q: Stage B HF co-morbidities
Answer:
previous MI, LV remodeling with LV hypertrophy and low EF, asymptomatic valvular disease
Q: Therapy goals of Stage B HF
Answer:
Meds: ACEI or ARB, Beta-blockers, inplantable defibrillators
Q: Stage C heart failure
Answer:
structural heart disease with prior or current symptoms of HF
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Autosomal Dominant
1 parent has, 50% change of child having

Autosomal Recessive
Both parents are carriers, 25% change of child having, 50% chance child is a carrier.

Cystic Fibrosis
affects pancreas causing secretions in lungs

21st Trisomy
Down Syndrome

Klinefelter Syndrome (XXY)
male has extra X, female like qualities

Turner Syndrome
Missing X in females

Alpha Thalassemia
inherited blood disorder; mild to severe anemia

Beta Thallasemia
low hemoglobin; contraindicated medication ferrous sulfate

Prevalence Risk
proportion of the population affected at a certain time

Incidence rate
number of new cases divided by population

Innate immunity
inflammation; increased vascular permeability

B&T lymphocytes
immune response

primary malignant tumor
lack of organization of cells

glucocorticoids
used in combination with other agent to treat lymphoid tissue (leukemia). glucocorticoids are directly toxic to lymphoid tissues.

Selective estrogen receptor modulators (SERM)
for hormone receptor positive and advanced breast cancer. (Tamoxifin reduces risk and recurrence risk)

Heart failure
impairment of the ventricle to fill with or eject blood; heart cannot meet metabolic need of the body.

CHF
heart cannot keep up with metabolic needs; volume overload in pulmonary area

Left Ventricular Dysfunction
reduced ejection fraction; ventricle having issue ejecting blood.

normal ejection fraction
55 – 60 % (blood pumped out with each heartbeat)

Ejection fraction of 50% – reduced or preserved?
preserved

Diastolic CHF
preserved ejection fraction, problem is with filling

Systolic CHF
reduced ejection fraction, problem is with ejecting

Left sided CHF
pulmonary (JVD, fluid volume overload, rails, S-3 murmurs) ** #1 cause of Right sided CHF

BNP
gold standard lab test to diagnose CHF

Echocardiogram
Diagnostic tool, evaluates heart structure and function

At Risk for HF – Stage A
no structural heart disease or symptoms of heart failure

Stage A HF co-morbidities
htn, atherosclerotic disease, diabetes, metabolic syndrome, patients using cardiotoxins with family history

Therapy goals of stage A HF
treat htn, encourage smoking cessation, encourage regular exercise, treat lipid disorders, discourage alcohol intake/drug use, control metabolic syndrome
Meds: ACEI or Angiotensin II RB for vascular disease or diabetes (avapro, losartan, benicar, diovan, etc)

At Risk for HF – Stage B
structural heart disease but no symptoms of heart failure

Stage B HF co-morbidities
previous MI, LV remodeling with LV hypertrophy and low EF, asymptomatic valvular disease

Therapy goals of Stage B HF
Meds: ACEI or ARB, Beta-blockers, inplantable defibrillators

Stage C heart failure
structural heart disease with prior or current symptoms of HF

Presentation of Stage C HF
known structural heart disease and shortness of breath and fatigue, reduced exercise tolerance

Therapy for Stage C HF
dietary salt restriction, MEDS: diuretic, ACEI, beta blockers. Some patients: aldosterone antagonist, ARBs, digitalis, hydralazine/nitrates, biventricular pacing, inplantable defibrillators

Stage D heart failure
refractory HF requiring specialized interventions

Presentation of Stage D HF
marked symptoms at rest despite maximal medical therapy (recurrently hospitalized or cannot be safely discharged without specialized interventions)

Therapy goals for Stage D HF
compassionate end-of-life care/hospice, extraordinary measures ,heart transplant, chronic inotropes, permanent mechanical support, experimental drugs or surgery

Ischemic heart Disease (CAD, MI) presentation
chest discomfort, pain in neck/jaw/chest (crushing, squeezing, sharp), pain worse with exertion (demand requirement is higher), abnormal heart sounds, hypoxia, arrhythmias (afib, ST elevation)

Stable angina goal
decrease cardiac oxygen demand

Meds for stable angina
nitro first choice, then beta blockers (beta blockers if angina occurs with effort)

nitroglycerine dose
sublingual, acts within 5 minutes, max of 3 doses

Cardiac glycosides (Digoxin)
Increased myocardial contractile force (increases output), used in ED, exerts positive inotropic action, can cause severe dysrhythmias

Digoxin Dosing
therapeutic – 0.5-0.8 ng/ml. ASSESS apical pulse before administering, If lethargic and not acting right, see patient FIRST

Goal of Anticoagulant and Antiplatelet Drugs
inactivate and suppress formation of thrombin

Warfarin (coumadin)
PO to prevent blood clots; start with half a dose

Anticoagulants
Warfarin, heparin, lovenox; Caution about hemorrhage, any patients with risks for bleeding

Pneumonia Patho
pathogen reaches airway and overwhelms defenses causing inflammatory cascade; fluid forms, blocking diffusion (gas exchange) causing hypoxia, ultimately leads to respiratory failure

Diagnosing pneumonia
Chest X-ray: viral – diffuse widespread whitening; bacterial – patchy, consolidated, lobar

Emphysema
destruction of alveolar walls; air goes into lungs, can’t get out; leads to hyperinflation

Bronchitis
excess mucus production, smooth muscle hypertrophy

asthma
chronic inflammatory obstruction of bronchi; trigger causing mucus clogging bronchial tubes; is reversable, give beta antagonists and steroids

Foundation meds of asthma and COPD
glucocorticosteroids: Pulmicort and Flovent; taken daily for long term control to suppress inflammation.
Oral glucocorticoids – methylprednisone, prednisone; gradually decrease dose

Bronchodilators (Beta 2-Adrenergic Agonists)
provide symptomatic relief, do not effect inflammation of disease process; taken PRN during attack (Albuterol), long actinb Beta2 can be used in combo with glucocorticoids

Back pain treatment
first 4-6 weeks no imaging needed unless neurologic involved; give NSAIDS and rest, is the #1/2 reason for visits to PCP

Types of Endocrine Disorders
Diabetes
Acromegaly – overproduction of growth hormone, have overbite and buffalo hump
Addison’s – decreased production of hormones by adrenal gland
Cushing – high cortisol levels
Graves – hyperthyroidism (excessive)

Stage 1 Kidney Disease (CKD)
kidney damage with normal or increased GFR, treat comorbid conditions to slow disease progression, CVD risk reduction

Stage 2 CKD
kidney damage with mild decreased GFR (60-89), Estimation of progression

Stage 3 CKD
moderate decreased GFR (30-59), treat complications

Stage 4 CKD
Severely decreased GFR (15-29), prepare for kidney replacement therapy

Stage 5 CKD
Kidney failure
GFR <15 or dialysis, replacement if uremia present

How do you start first dose of antihypertensives/heart failure medications?
start first dose at night; do slow position changes, lay down if hypotension occurs

Ace Inhibiters (ACEI) *pril
reduce angiotensin II, increase bradykinin, hyperkalemia, dry cough, angioedema; contraindicated in pregnancy (fetal death), first dose causes severe hypotension, can cause renal failure

Beta Blockers
prevent chemical messengers; slow HR, relax vessels, lower BP, Class II antidysrhythmic drug

nonselective beta blockers
use with caution in people with lung conditions; do not use with asthma

Cardio selective beta blockers
metoprolol – only beta-1 receptors affected

Third generation beta blockers
labetalol – blocks alpha and beta receptors

Calcium Channel Blockers
vasodilation of arterioles and heart, class IV antidysrhythmic drug

Verapamil
calcium channel blocker, first choice

dihydropyridines CCB
*ine, vasodilators used to treat htn and angina

non-dihydropyridines CCB
*dilt, used for arrhythmias

Statins
lipid lowering agents (LDL), can increase good HDL, muscle pain can lead to rhabdo, kidney failure, and death

Diuretics
2 hours after oral intake, peaks at 4-6 hours, lasts 12 hours

Thiazide Diuretics
block reabsorption (10%) in distal convoluted tubule; not used in kidney failure, can cause hypokalemia, not used in sickle cell disease

Loop diuretics
Furosemide; blocks reabsorption (20%) in loop of Henle

Potassium-sparing diuretics
Spironolactone (Aldactone); distal nephron, holds K, excretes sodium, takes 48 hours to work

Angiotensin II
vasocontraction; increased bp by acting on adrenal cortex secreting aldosterone

Antiotensin II Receptor Blockers (ARBS)
Sartan; blocks action of angiotensin II, second choice if cannot tolerate ACE for htn and HF

Diabetes diagnosis
Hgb A1C is most reliable assessment of blood glucose over 3 month period. Poor control is >9%, goal is <6.5% in healthy people

Short acting insulin
lispro (Humalog)/Aspart (NovoLog)/glulisine (aspirdra)

Long acting insulin
glargine (Lantus) – most painful; detemir (levemir)

Metformin
first drug of choice with new Type 2 Diabetes; inhibits glucose in liver, slightly reduces glycose absorption in gut, increases glucose uptake; DOES NOT drive insulin down, very low risk for hypoglycemia

TSH levels
normal range is 0.4 to 4.0 mu/L. If you are being treated for a thyroid disorder, the normal range is 0.5 to 3.0 mu/L. A value above the normal range indicates that the thyroid is underactive. This indicates hypothyroidism.

Hypothyroidism Presentation
inadequate amounts of hormone; slows body function and processes, cold, pale puffy face, skin cool and dry, low HR, low temp, lethargy, fatigue

Hypothyroidism in pregnancy
must treat to avoid neuro issues in child

Hypothyroidism in newborns
require replacement within a few days, lasts for 3 years, prevents mental development changes and growth patters, dwarfish

How do you take Levothyroxine (t4)
on an empty stomach for increased absorption

Hashimoto disease presentation
weight gain and fatigue; autoimmune disease

Hyperthyroidism (thyrotoxicosis) presentation
elevations in T4 and T3, tachyarrhythmias, anxiety, insomnia, rapid speech, hot

Graves Disease
women 20-40 most susceptible, remove or destroy thyroid tissue or suppress with drugs (methimazole or propylthiouracil), treat with Iodine – I31, beta blockers also used to suppress release of thyroid hormones

Plummer disease (toxic nodular goiter)
result of thyroid adenoma (tumor), same as Graves disease, but absence of exophthalmos (bulging eyes)

Thyroid storm
caused by major surgery or severe illness such as sepsis, 105 F, severe tachycardia, restlessness, tremor, heart failure, coma. Treat with Propylthiouracil (PTU), symptom management

Histamine – 1 antihistamines
cause vasodilation, bronchoconstriction, help with memory and sleep. Relieve itching, pain, secretion, and mucus (allergies). Side effects: sedative, dry mouth, urinary hesitancy,, constipation. Second generation (-ine) are non-sedating

Histamine 2 Receptor Antagonists
secretion of gastric acid; treat gastric and duodenal ulcers

Stage I HTN
130-139/80-89

Stage 2 HTN

140/90

Med used after heart attack
Beta blocker – use for 6 months

Meds for ischemic vascular disease
aspirin or antithrombotic

Cervical cancer screening
21 – 64 cytology every 3 years, 30-64 cytology and HPV every 5 years

Pneumonia CURB
Confusion, Urea >7, RR >30, BP <90 or <60, Age >65
0-1 = home treatment, 2 = short stay hospital, 3+ = severe pneumonia (ICU)

End of Life care
optimize patient’s comfort and function while avoiding unnecessary side effects

First line of depression treatment
SSRIs – low side effects with good effectiveness

Stress
exacerbates many serious health issues, stress cannot cause cancer

broken heart syndrome
mimics MI, no coronary obstruction

SDOH
social determinants of health

Types of SDOHs
access to healthy foods, health literacy, housing stability, socioeconomic status, rural vs. urban healthcare access

Amoxicillin
first line of treatment for uncomplicated otitis media in pediatric patient without comorbidities

POTS
Postural Orthostatic Tachycardia Syndrome

Treatment of POTS
stand slowly, lay back down if needed, add extra salt increase fluids, MEDS: Florinef

Symptoms/Diagnosing POTS
Tilt Test – HR increases by 30 bpm when standing up or over 120 in first 10 minutes, symptoms are related to reduced blood volume when standing up, can cause lightheadedness, fainting

Florinef
Used to treat conditions which glucocorticoids are low. These conditions include Addison’s disease, adrenocortical insufficiency. *Also treats orthostatic hypotension; Side effects: nausea, headache, sleep problems, mood changes

Off label use for prazosin/minipress
sleep aid for patients diagnosed with PTSD

Myasthenia Gravis
a neuromuscular disorder characterized by muscle weakness and rapid fatigue, drooping eyelids, difficulty swallowing, generalized weakness

Meds used to treat myasthenia gravis
corticosteroids – treat diplopia and suppress adrenal function; take 4-6 weeks then taper
Cholinesterase inhibitors – neostigmine

Side effects of cholinesterase inhibitors
excessive salivation, urinary incontinence/urgency, sweating, muscle spasm, bradycardia
Med: neostigmine
therapeutic levels produce mild stimulation
Toxic levels depress CNS (BBB) – treat with respiratory support and atropine

thyrotoxicosis
condition caused by the exposure of body tissue to excessive levels of thyroid hormone

first line treatment for uncomplicated HTN
hydrochlorothiazide, oral with lifestyle changes

Ataxia in pediatric patient
genetic predisposition, Fragile X syndrome, Prader-Willie Syndrome

Prader-Willie Syndrome
deletion of chromosome from father

What should you avoid when breast feeding?
combined oral contraceptives

Appropriate antibiotic for use in pregnancy for treatment of UTI
one time dose of Fosfomycin, cephalexin also appropriate.
AVOID: nitrofurantoin ad bactrim. DO NOT USE: PCN

Drug of choice for pediatric UTI with no comorbidities
trimethoprim/sulfamethoxazole (Bactrim, Septra);
alternatives: augmentin, cephalosporins

Color blindness genetic component
x-linked, only comes from mother, 50% chance; gene: OPN1MW on chromosome 23

Sickle Cell genetics
children with sickle cell: 25%
children without and not carriers: 25%
children who are carriers: 50%

treatment for sickle cell crisis
hydration, heat, oxygen, pain meds

Parental care of the newborn with sickle cell anemia
infant will be anemic, increased risk for infection, may have spleen damage and liver involvement causing jaundice, crying episodes from pain and swelling of extremities.
keep infant hydrated, use vaccines and antibiotics when necessary, folic acid administration, regular eye exams

Treatment of athletic patient with bradycardia
let patient go home; bradycardia is normal in athlete, ok if HR in 50s

Crohn’s Disease
a chronic, inflammatory autoimmune disorder that can occur anywhere in the digestive tract; however, it is most often found in the ileum and in the colon; has skip lesions

Diagnosis of Crohn’s Disease
test blood and stool, X-ray of upper and lower GI with possible contrast, colonoscopy and upper endoscopy, small bowel tissue demonstrates cobble stoning under microscope

Treatment of Crohn’s Disease
Corticosteroids, infliximab
immunosuppressants and steroids; diet and nutrition, surgery.
patients with atopic dermatitis ad eczema have increased risk of inflammatory bowel disease

Diagnostic labs for ulcerative colitis
CBC, CRP, ESR, LFT, electrolyte panel, and ANA (antinuclear antibody)

Japanese man has htn and CKD. What is antihypertensive of choice?
angiotensin converting enzyme inhibitor or angiotensin receptor blocker.

Next course of action is reduced salt diet.

What do you do if COPD/asthma patient has failed long acting beta agonists (LABAs)?
continuous oxygen??

medullary thyroid cancer presentation, diagnosis, and treatment
Presentation: neck pain/lump, dysphagia, SOB
Diagnosis: fine needle aspiration & carcinoembryonic antigen (CEA)
Treatment: surgery, if not removed use chemo to inhibit tyrosine kinases *Nib cancer drugs

PRN meds for anxiety
benzodiazepam, vistaril, seroquel, SSRIs, and Wellbutrin

Diazepam (Valium)
1st choice treatment for anxiety, is a benzodiazepam

Buspirone
treats anxiety, not a benzo

SSRIs (Prozac, Paxil, Zoloft)
treatment of panic disorder to decrease frequency and intensity of attacks

Vistaril
antihistamine that can treat anxiety

Seroquel
treatment of anxiety, antipsychotic effects

Side effect of risperidone
neutropenia

Chlorpromazine
treats schizophrenia

Left hypoplastic heart defect diagnosis and treatment
birth defect that affects normal blood flow
Diagnosis: echocardiogram shows smaller than normal LV and aorta
Treatment: surgery

Alternatives to gabapentin for neuropathic pain
Cymbalta (duloxetine) and Lyrica (pregabalin)

G6PD deficiency
X-linked recessive; hemolytic anemia
AVOID: mothballs, fava beans, red wine, all beans, blueberries, soy products, tonic water and camphor

Treatment of a mild reaction to Igm
slow infusion rate, try tylenol, benadryl, and steroids

PPD skin test
check skin after 48 – 72 hours; >10mm is positive. Induration seen on patient who has had TB immunization is normal and not positive. Someone who has been vaccinated for TB should not receive skin test.

Sjogren’s syndrome
autoimmune destruction of minor salivary glands and lacrimal glands; anti-nuclear antibodies, anti-SSA +SSB

Small cell lung cancer (SCLC)
most common type of lung tumors, 15% of lung cancers, 25% of lung cancer deaths. Arise from central part of lung, cell size range from 6-8mm. strong correlation to tobacco smoking. rapid rate of growth, metastasize early and widely, worst prognosis of all lung cancers. left untreated survival rate is 8% at 5 years.

hormones related to small cell carcinoma
arise from neuroendocrine cells that contain neurosecretory granules, exist throughout the tracheobronchial tree, associated with tumor-derived hormone production.
resultant s/s called paraneoplastic syndromes are first manifestations of the underlying cancer.
examples: hyponatremia (antidiuretic hormone), cushing syndrome (adenocorticotropic hormone), hypocalcemia (calcitonin), gynecomastia (gonadotropins), carcinoid syndrome (serotonin), Lambert-eaton myasthenic syndrome (muscle weakness of limbs)

Diagnosing lung cancer
chest x-ray, mutation in EFGR (gene mutation in people who have never smoked)

Step 1 asthma treatment
(intermittent asthma); Preferred: SABA inhaled

Step 2 asthma treatments (persistent asthma)
Preferred: low dose ICS, Alternative – theophylline

Step 3 asthma treatments
Preferred: low-dose ICS (inhaled corticosteroid) plus LABA or medium dose ICS

Step 4 asthma treatment
Preferred: med dose ICS plus LABA

Step 5 asthma treatment
Preferred: high dose ICS plus LABA

Step 6 asthma treatment
Preferred: high dose ICS plus LABA plus oral systemic corticosteroid

Quick relief medication for all asthma patients
inhaled SABA as needed for symptoms. Intensity of treatment depends on severity of symptoms (up to 3 treatments at 20 minute intervals PRN). Short course of systemic corticosteroids may be needed.

Use of inhaled SABA for more than 2 days/week indicates:
inadequate control and the need to step up treatment