WGU D027 Advanced Pathopharmacological Foundations Quiz Bank (Latest 2023/ 2024 Update) | Questions and Verified Answers| 100% Correct| Grade A
WGU D027 Advanced Pathopharmacological
Foundations Quiz Bank (Latest 2023/ 2024
Update) | Questions and Verified Answers|
100% Correct| Grade A
Q: A 45-year-old Jewish man is visiting a clinic for an adjustment of his diabetes medications.
Though the patient is taking oral medications, his blood sugar levels continue to increase, and a
decision is made to start him on in- sulin. Although the patient is comfortable with the concept of
starting insulin, he is concerned with the formulation of the insulin saying, “I heard insulin was
made from pigs. If that is the case, I cannot take it due to my faith.”
Which response should be given to this patient?
Answer:
While insulin did have porcine sources in the past, it is now synthetically made.
Q: A 45-year-old man reports his preference for natural methods of treating illness. He states he
takes natural supplements that he orders from China to boost his health and well-being. One of
the supplements he takes daily is red yeast rice.
Which medication should be avoided with this patient’s supplement?
Answer:
Lovas- tatin (Mevacor), red yeast rice contains this
Q: A 40-year-old man presents to a clinic with an onset of a frequent cough. The patient states
the cough started when he started his new blood pressure medication two weeks ago. The patient
does not remember the name of the drug that was started. After a thorough assessment, it is
determined the cough is not being caused by an infection. It is determined the likely cause of the
frequent cough is the new blood pressure medication.
Which medication is the likely cause of this patient’s symptoms?
Answer:
Lisinopril
Q: A 68-year-old female patient on a medical surgical floor received a dose of morphine
(Duramorph) 30 minutes ago for postoperative pain into an IV in her left hand. She has been on
the floor for two days and has received several doses of morphine over that time. The patient’s
call light is now lit. When the nurse goes into the room, the patient has several complaints.
Which complaint should be addressed first in this patient?
Answer:
A rash around the injection site going up the left arm
Q: An advanced practice nurse (APN) is floated to a medical or surgical floor midshift to assist
an understaffed unit. After receiving a brief report, the APN assumes care of four individuals for
the remainder of the shift. No recent assessment has been completed on these patients.
Which patient should the APN assess first?
Answer:
A 65-year-old man with dementia who is one day post-operation of a transurethral resection of
his prostate and is sometimes passing blood-tinged urine through his foley, d/t cognitive issues
and being post-op
Q: A 55-year-old female patient presents to a clinic for exacerbation of her chronic low back
pain. She is taking morphine extended-release tablets (MS Contin), hydrocodone (Vicodin) PRN,
and duloxetine (Cymbalta). The patient denies any drug allergies. She rates her pain at a ten out
of ten and is requesting something stronger for pain.
When considering adding a medication for this patient’s pain, which medica- tion could have a
significant interaction with her current medications?
Answer:
tra- madol, d/t serotonin syndrome
Q: A 45-year-old female patient presents to a clinic complaining of chronic generalized pain
and wishes to be evaluated for fibromyalgia and chronic pain syndrome. A thorough history and
physical is conducted, and the findings are negative. The patient is not taking any medications,
has no allergies to medicines, and has a negative past medical history.
What is an appropriate first intervention for this patient?
Answer:
Assess the patient’s sleep hygiene and make recommendations.
Q: A 55-year-old male patient is on a medical floor for respite care. He is currently in hospice
for end-stage pancreatic cancer. During assessment, a nurse notices that he is diaphoretic,
moaning, and clutching his abdomen. He rates his pain at a nine out of ten. The nurse notes that
his abdomen is distended, and he has rebound tenderness in all four quadrants.
What is an appropriate nursing intervention for this patient?
Answer:
Giving a dose of intravenous morphine (Duramorph)
Q: What fluid for nutrient changes/ osmolality changes?
Answer:
0.9 NS
Q: What fluid for hypernatremia, hyperchloremia, dehydration?
Answer:
D5 or 0.45 NS
Q: what fluids for hyponatremia w/o fluid overload/edema?
Answer:
3% NS until Na
130
Q: Med uncomplicated peds otitis media?
Answer:
Amoxicillin
Q: who is at risk for tay-sachs?
Answer:
Ashkenazi Jews
Q: What is Tay-Sachs disease?
Answer:
a dysfunctional enzyme accumulation
causes an of lipids in the brain
Q: s/s of tay-sachs?
Answer:
cherry red spot, loss of muscle skills,
control/ motor vision/hearing loss
Q: What is beta thalassemia?
Answer:
Reduced or absent amounts of hemoglobin
Q: s/s of beta thalsemia?
Answer:
yellow eyes, low BP, palpitaitons, pale, cold, SOB, high
HR, growth delay
Q: bela thalsemia most common in what people?
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A 23-year-old woman comes in for prenatal counseling. While completing her family history, she reports her brother has cystic fibrosis. She does not know if she is a carrier. She asks if her children will be affected by the disease.
What is an accurate way to determine the likelihood of this patient’s children being affected?
A genetic or a carrier test
A 31-year-old man comes into the office for an exam. He is 6′ 5 ” with a high-pitched voice, and he has a moderate degree of mental impairment. It is discovered upon exam that his body hair is sparse, his testes are small, and he has gynecomastia.
Which genetic disorder should this patient be tested for?
kleinfelters
sign of becker muscle dystrophy in kids?
may begin to waddle, walk on their toes or push their abdomen forward when walking
A six-month-old female infant with failure to thrive comes in to the office with her parents. It is noticed upon exam that the patient has facial deformities and is jaundiced. A complete blood count (CBC) is ordered, which reveals anemia. When that patient’s blood is examined under a microscope, the red blood cells appear small and abnormally shaped. A mutational analysis is ordered, and alpha thalassemia is diagnosed.
What is the likelihood of incidence of these parent’s future children having alpha thalassemia?
100%
A 64-year-old male truck driver comes in complaining of pain in his lower left calf. He states he drives eight to ten hours per day. Upon exam, swelling and mottled coloring are noted in the patient’s calf. A D-dimer test is ordered and comes back positive.
Which additional test should be ordered to confirm a diagnosis in this patient?
Doppler U/S
A 54-year-old man comes into a clinic for a routine visit. His initial BP is 148/92. After a recheck 15 minutes later, his BP is 140/90. He states he suffers from “white coat hypertension.” He states he has no history of high blood pressure and no family history of high blood pressure.
Which nursing intervention would assist this patient in receiving a clinical diagnosis of hypertension?
Completing an ambulatory blood pressure assessment
A 58-year-old woman comes in complaining of retrosternal chest pain, worsening with recumbent position. She states she has had a low-grade fever for two days. Upon exam, the patient has a friction rub. An EKG reveals sinus tachycardia with inflammatory changes. An ultrasound is performed, and she is diagnosed with an acute pericarditis.
Which condition would make pericarditis more likely in this patient?
Lupus
A 54-year-old Caucasian man comes in for a lab review. His lipids reveal an LDL of 180, an HDL of 52, and triglycerides of 326. He has no history of atherosclerotic cardiovascular disease (ASCVD) or diabetes. His blood pressure is 118/64. He has a pulse rate of 64, and he weighs 320 lb. He smokes one pack of cigarettes per day, and his ASCVD risk score is 12.8.
Which medication should this patient be started on?
Lipitor 20 mg
A 73-year-old man with Systolic congestive heart failure (CHF) with reduced ejection fraction (HFrEF) comes to a clinic complaining of shortness of breath. He is currently taking 6.25 mg carvedilol (Coreg) twice a day and 50 mg losartan (Cozaar) and 20 mg furosemide (Lasix) daily. His oxygen saturation is 95%, and he has a pulse of 64. His BP is 138/82, and his BNP is 1150.
Using the 2017 heart failure guidelines, which medication change should be recommended for this patient?
Stop angiotensin receptor blockers (ARB) and add sacubitril/valsartan (Entresto), if BNP high replace ARB w/ ACE or ARNI
A 78-year-old man comes in with stable angina. He reports he has been having more angina recently. He is currently taking the following medications: lisinopril (Zestril), atorvastatin (Lipitor), aspirin, and nitrostat PRN for chest pain. He has a history of COPD with bronchospasm. His blood pressure is 145/88, and he has a pulse of 74.
Which class of medications should be avoided for this patient?
BBs, BB contraindicated in pts w/ COPD/ asthma
A 45-year-old Muslim woman presents to a clinic for an intervention for her type 2 diabetes. She is prescribed metformin (Glucophage) 500 mg BID. During a follow-up phone call a week later, it is discovered she has not been taking the metformin. A second visit is scheduled. During this visit, she states that she cannot take the medication as prescribed because it is Ramadan, a month-long period of religious observances. Due to her religious beliefs, she fasts from dawn to sunset. When the pharmacist told her to take metformin with breakfast and dinner, she decided not to start the medication due to her fasting.
Which nursing intervention should be made for this patient?
Start metformin XR (Glucophage XR) 250 mg once a day and reevaluate after Ramadan
A 45-year-old Jewish man is visiting a clinic for an adjustment of his diabetes medications. Though the patient is taking oral medications, his blood sugar levels continue to increase, and a decision is made to start him on insulin. Although the patient is comfortable with the concept of starting insulin, he is concerned with the formulation of the insulin saying, “I heard insulin was made from pigs. If that is the case, I cannot take it due to my faith.”
Which response should be given to this patient?
While insulin did have porcine sources in the past, it is now synthetically made.
A 45-year-old man reports his preference for natural methods of treating illness. He states he takes natural supplements that he orders from China to boost his health and well-being. One of the supplements he takes daily is red yeast rice.
Which medication should be avoided with this patient’s supplement?
Lovastatin (Mevacor), red yeast rice contains this
A 40-year-old man presents to a clinic with an onset of a frequent cough. The patient states the cough started when he started his new blood pressure medication two weeks ago. The patient does not remember the name of the drug that was started. After a thorough assessment, it is determined the cough is not being caused by an infection. It is determined the likely cause of the frequent cough is the new blood pressure medication.
Which medication is the likely cause of this patient’s symptoms?
Lisinopril
A 68-year-old female patient on a medical surgical floor received a dose of morphine (Duramorph) 30 minutes ago for postoperative pain into an IV in her left hand. She has been on the floor for two days and has received several doses of morphine over that time. The patient’s call light is now lit. When the nurse goes into the room, the patient has several complaints.
Which complaint should be addressed first in this patient?
A rash around the injection site going up the left arm
An advanced practice nurse (APN) is floated to a medical or surgical floor midshift to assist an understaffed unit. After receiving a brief report, the APN assumes care of four individuals for the remainder of the shift. No recent assessment has been completed on these patients.
Which patient should the APN assess first?
A 65-year-old man with dementia who is one day post-operation of a transurethral resection of his prostate and is sometimes passing blood-tinged urine through his foley, d/t cognitive issues and being post-op
A 55-year-old female patient presents to a clinic for exacerbation of her chronic low back pain. She is taking morphine extended-release tablets (MS Contin), hydrocodone (Vicodin) PRN, and duloxetine (Cymbalta). The patient denies any drug allergies. She rates her pain at a ten out of ten and is requesting something stronger for pain.
When considering adding a medication for this patient’s pain, which medication could have a significant interaction with her current medications?
tramadol, d/t serotonin syndrome
A 45-year-old female patient presents to a clinic complaining of chronic generalized pain and wishes to be evaluated for fibromyalgia and chronic pain syndrome. A thorough history and physical is conducted, and the findings are negative. The patient is not taking any medications, has no allergies to medicines, and has a negative past medical history.
What is an appropriate first intervention for this patient?
Assess the patient’s sleep hygiene and make recommendations.
A 55-year-old male patient is on a medical floor for respite care. He is currently in hospice for end-stage pancreatic cancer. During assessment, a nurse notices that he is diaphoretic, moaning, and clutching his abdomen. He rates his pain at a nine out of ten. The nurse notes that his abdomen is distended, and he has rebound tenderness in all four quadrants.
What is an appropriate nursing intervention for this patient?
Giving a dose of intravenous morphine (Duramorph)
What fluid for nutrient changes/ osmolality changes?
0.9 NS
What fluid for hypernatremia, hyperchloremia, dehydration?
D5 or 0.45 NS
what fluids for hyponatremia w/o fluid overload/edema?
3% NS until Na 130
Med uncomplicated peds otitis media?
Amoxicillin
who is at risk for tay-sachs?
Ashkenazi Jews
What is Tay-Sachs disease?
a dysfunctional enzyme causes an accumulation of lipids in the brain
s/s of tay-sachs?
cherry red spot, loss of muscle control/ motor skills, vision/hearing loss
What is beta thalassemia?
Reduced or absent amounts of hemoglobin
s/s of beta thalsemia?
yellow eyes, low BP, palpitaitons, pale, cold, SOB, high HR, growth delay
bela thalsemia most common in what people?
Mediteranean and African people
tx for beta thalsemia?
blood transfusions, Epogen
how to check if couples at risk for having child w/ tay-sachs/ beta thalsemia?
genetic testing available
color blindness determined by what gene?
OPN1MW, chrom 23, comes from mother
what is Fragile X syndrome?
long break on X chromosome d/t folate deficiency
s/s fragile X?
late onset 50+ y.o.
developmental delays, learning disability, social/behavior issues, movement cognition problems
what is hemolytic anemia?
RBCs destroyed faster than theyre made
Hemolytic anemia mostly affects who?
men
s/s hemolytic anemia?
pale/ jaundice-enlarged spleen, dark urine, fever, weak, high HR, cardiac murmur
foods do avoid w/ hemolytic anemia?
FAVA BEANS!
moth balls, red wine, soy products, tonic H2O, blueberries
meds to avoid w/ hemolytic anemia?
sulfa drugs i.e. erythromycin, Sulfisoxazole
Vit C
methylene Blue
Methyldopa
tx hemolytic anemia?
transfusions
What is hemochromatosis?
iron overload
s/s hemochromatosis?
liver/ pancreatic damage, fatigue/ malaise, abd pain, arthralgias
tx: hemachromatosis?
phlebotomy remove 550 ml of whole blood, depending on ferritin levels (normal 20-50)
What is HLA-B*58:01 associated with?
high risk of hypersensitivity w/ allopurinol use i.e. steven johnson syndrome, toxic epidermal necrolysis
What is allopurinol used for?
treat gout, kidney stones
What is Stevens-Johnson syndrome?
malaise and fever followed by rapid onset of erythematous/purpuric macules (oral, ocular, genital). Skin lesions progress to epidermal necrosis and sloughing.
What is toxic epidermal necrolysis?
Stevens Johnson w/ skin sloughing
What is Hutchinson-Gilford progeria syndrome?
a genetic condition in which symptoms resembling aging are manifested at a very early age; individuals live 10-15 years with associated heart disease and withering, but no hypertension, stroke, diabetes, or Alzheimer’s
assessment of Hutchinson-Gilford progeria syndrome?
height, weight, growth curve, hearing, vision, short, slow growth, alopecia, joint abnormalities, wrinkles, dryness, delayed tooth development
tx Hutchinson-Gilford progeria syndrome?
statins, nitro, NSAIDS, calcium, occupational/physical therapy
what is hypothalamic hamartoma?
rare, benign tumors on the hypothalmus
what do hypothalmic harmatomas cause?
laughing/ crying fits, cognitive/ mood/ behavior problems
What is Kleinfelter Syndrome?
Occurs in men when they have an extra X chromosome
s/s kleinfelter syndrome?
small testes, gynecomastia, female patterned public hair, long limbs, sparse body hair, high pitched voice, mental impairment
what is Duchene Muscular Dystrophy (DMD)?
-most common type, progressive muscle degeneration, primarily in boys, first affects lower limb muscles then progresses to heart and lung dysfunction
-deletion of the dystrophin gene
sign of muscular dystrophy in children?
children start walking on their tip toes. larger than normal calf muscles
What is Becker Muscular Dystrophy?
Mutated (rather than deleted) dystrophin gene; less severe than DMD because some dystrophin is still produced, hips and pelvic region affected
what is FSHD muscle dystrophy?
begins w/ facial and shoulder muscle weakness, inability to close eyes completely, cant whistle, drooping shoulders
Limb Girdle Muscular Dystrophy
Proximal muscles of pelvis and shoulder initially affected, Progresses slowly
Myotonic Muscle Dystrophy
People with this disorder often have prolonged muscle contractions (myotonia) and are not able to relax certain muscles after use. For example, a person may have difficulty releasing their grip on a doorknob or handle.
What is systemic lupus erythenatosis?
inflammatory disease caused by the immune system attacking its own tissues
s/s lupus?
-butterfly rash (dry, scaly rash on face/upper body)
-joint pain & dec ROM
-fever
-nephritis
-pleural effusion
-pericarditis
-abd pain
-photosensitivity
tx lupus?
prednisone, methylprednisone
What is sickle cell anemia?
A mutation in a gene causes a problem making the hemoglobin of the red blood cells., A genetic disorder causing red blood cells to be rod/sickle shaped. This causes them to get stuck in capillaries and the bodies cells become deprived of oxygen
what are individuals w/ sickle cell anemia under 5 y.o. @ an increased risk of?
pneumococcal infections d/t non-functioning spleen and decreased immune response
infants w/ sickle cell anemia frequently have what s/s?
jaundice d/t non-functioning spleen/ liver damage
What is a sickle cell crisis?
A severe, painful, acute exacerbation of RBC sickling causing a vaso-occlusive crisis, splenic sequestrian, or aplastic crisis
What is a vaso-occlusive crisis?
This is where your RBCs block flow to the point that tissues are O2 deprived, Extreme pain hands and feet, fever
what is a splenic sequestrian?
RBCs block blood flow out of the speen, spleen swells, hypovolemic shock, heme levels drop, Seen on CT scan
what is a aplastic crisis?
Diminished production and increased destruction of RBCs due to rapid red cell turnover, sudden pallor weakness, dropping of heme levels, reticulocytopenia
tx for vaso-occlusive crisis?
IV fluids, IV analgesia, high flow O2, transfusions
meds for vaso-occlusive crisis?
ibuprofan, IV analgesia
hydroxyurea – makes RBCs bigger + rounder
prevent sickle cell crisis?
hydration, dress warm, avoid cold weather, sleep, stress management, avoid high altitudes
what is turner syndrome?
females. missing or deformed x chromosome, hearing loss, ear infection, language and articulation disorders, visual spatial and attentional problems, short, webbed neck, wide spaced nipples, infertility, heart defect
What are X linked genes?
often found in men bc they only need one copy to express disease, women pass to their sons
What is Alzeimers?
most cases of dementia, progressive symptoms worsen over time, brain shrinking dramatically, nerve cell death, tissue loss, plaques, tangles
early onset alzheimers?
younger than 66 y.o.
stages of alzheimers
mild-severe
Meds for alzheimers: cholinesterase inhibitors?
donepezil, galantamine, rivastigimine – poor memory/judgement/thought processes, prevents breakdown of ach, delays worsening of symptoms
Meds for alzheimers: N-Methyl-D-Asparate receptor antagonist?
Memantine – improve memory/attention/reasoning, regulate glutamate, improves mental funx
what is asthma?
Constricting of the airway due to inflammation and muscular contraction of the bronchioles.
s/s asthma?
dry cough, wheezing, chest pressure, high HR, throat irritation
SABA
short acting beta agonist
-ex. Albuterol
ICS, inhaled corticosteroid
ex- fluticasone, budensonide, mometasone, beclomethasone
Leukotriene Receptor Antagonists
Montelukast (Singulair)
Mast Cell Stabilizers
Cromolyn
LABA
Bronchodilators:
Formoterol
Salmeterol
Indacaterol
what does all day wheezing, coughing, acute exacerbations warrant use of w/ asthma?
oral prednisone daily
Combined ICS + LABA
advair, symbicort, breo Ellipta, dulera
asthma medication contraindications?
BBs, CCB d/t worsening of asthma s/s
what is ataxia?
the loss of full control of bodily movements d/t brain damage r/t fragile X
s/s ataxia?
mimic drunk people, slurred speech, stumbling, falling, incoordination, wide-based gait, difficult writing/eating, slow eye movements
what is athletic heart syndrome?
enlarged heart, lower HR 30-40 BPM
what is celiac disease?
Autoimmune disease with inability to digest gluten containing grains (wheat, barley, rye), strong genetic predisposition
s/s celiac disease?
abd pain, distension, diarrhea, malnutrition, rickets, occult blood, anemia, early bleeds/bruises, low mag, low ca
testing for celiac disease
Antibody test – IgA increased
stomach endoscopy and duodenal biopsy
Avoid BROW w/ celiac disease
barley, rye, oats, wheat
What is cellulitis?
An acute, spreading infection of dermal and subcutaneous tissues
tx cellulitis?
IV antx, PO antx, treat temp- compresses/ tylenol, wound drsgs
what is right-sided CHF
caused by left side, dependent edema, weight gain, JVD, peripheral venous pressure
what is left-sided CHF?
pulmonary congestion, SOB, crackles, wheezing, tachy, orthopnea, elevated pulmonary wedge pressure
normal EF
55-60%
reduced EF
EF < 40%
less O2 rich blood pumped throughout body
Preserved EF
EF 40-49%
ineffective relaxation during filling
CHF testing
echo, BNP >100
stage 1 CKD
GFR >90
stage 2 CKD
GFR 60-89
stage 3 CKD
GFR 30-59
stage 4 CKD
GFR 15-29
stage 5 CKD
GFR <15
what is pneumonia?
inflammation of the lungs
PNA causes
strep pna, flu A, chlamydiophila pna, mycoplasma pna
s/s pna
cough w or w/o sputum, dyspnea, pleuritic chest, tachypnea, adventitious b/s-rales, crackles, rhonchi, fever, chills, leukocytosis w/ leftward shift, leukopenia, can lead to sepsis, LOC, organ failure
testing PNA?
CXR-pulm opacities-airspace/groundglass d/t WBC/ fluid accumulation
viral-widespread whitening
bacterial-patchy/consolidated
blood tests=high ESR, CRP, procalcitonin
sputum cultures, gram stain, BCs
tx PNA?
ventilation, O2, deep breathing, coughing, chest physiotherapy, antx w/ in 4hr of presentation
What is Crohn’s disease?
A chronic inflammatory bowel disease that affects the lining of the digestive tract-small intestine
who is at an increased risk of crohns?
ppl w/ atopic dermatitis and eczema
s/s of crohns?
skip lesions/ cobble stone appearance, bleeding, diarrhea, abd pain, cramping, fistula/fissure formation, ileus, pain around navel RLQ, more women than men
testing for crohns?
antibody testing, CBC-heme low, stool occult, CRP/ESR inflammation indicators, BNP, iron/b12 see nutrient absorption
dx testing crohns?
abd XR, colonoscopy, barium XR or video endoscopy small intestine
meds for crohns?
sulfasalazine, mesalamine – anti-inflammatory drugs
oral steroids – taper off in 1-2 months
methotrexate – immunosuppressant
antx – intestinal bacteria
IV corticosteroids
diet for crohns?
low residue, low fiber, lean proteins, refined grains, low fat food
what to avoid w/ crohns?
caffeine, etoh, dehydraiton in general like from diuretics
what is ulcerative colitis?
Ulcerative inflammatory bowel disease, just in the LARGE intestine
s/s of UC?
diarrhea w/ blood/pus, abd pain, cramping, rectal pain/bleeding, urgency to poop but unable to, weight loss, fever
testing for UC?
CBC, LFTs, BNP, ANA antibodies, ESR/CRP-inflammation, stool studies-WBCs, XR-r/o complications, CT scan
meds to tx UC?
anti-inflammatory drugs, corticosteroids, immunosuppressants, diarrheals, antispasmodics, iron supplementation
what is diaper dermatitis?
diaper rash
s/s diaper rash?
irritation from stool/urine, chafing, new prodcut irritation, bacterial/fungal infection, intro of new foods, sensitive skin, antx
tx diaper rash?
keep babys skin clean, frequently change diaper when needed, anti-fungal cream, topical/oral antx, mild hydrocortisone cream
what is considered htn?
SBP >130, DBP >80
best way to measure BP?
ambulation measurement to eliminate masked htn or white coat syndrome
assessment of htn?
2 office measurements on 2 separate visits, increased BP/ pedal edema, AV disease, renal vasc disease, hypercortisolism, thyroid disease
htn meds?
ACE-pril
ARB-sartan
CCDB-pine
BB-lol
htn management?
salt restriction, smoke cessation, OSA management, exercise
hypoplastic LH syndrome?
The left ventricle is underdeveloped and too small.
The mitral valves is not formed or is very small.
The aortic valve is not formed or is very small.
The ascending portion of the aorta is underdeveloped or is too small.
*also have an atrial septal defect, which is a hole between the left and right upper chambers (atria) of the heart.
what are the 3 fetal shunts?
Ductus arteriosus: protects lungs against circulatory overload
Ductus venosus: fetal blood vessel connecting the umbilical vein to the IVC
Foramen ovale: shunts highly oxygenated blood from right atrium to left atrium.
surgical procedures for shunt closure?
norwood- enlarge aorta, shunt to pulm art
glenn-SVC connected to pulm art, norwood shunt removed
fontan-IVC connected to pulm art
s/s of PDA/ PFO (mixing low O2 and O2 rich blood)
cyanotic, pallor, clammy/sweaty, cool skin, SOB, high HR, poor pulses, poor feeding
testing for PFO/PDA during pregnancy?
prenatal testing for birth defects, u/s, echo
meds for infant w/ PFO/ PDA?
tube feeding, meds to strengthen heart muscle, increase BP, removal excess fluid
What is the flu?
An infectious disease that is spread through droplets in the air
s/s flu?
runny/stuffy nose, sore throat, cough, fever, chills, sweats, SOB, tired, weak, eye pain, n/v, diarrhea,
flu testing?
RIDT rapid flu test 10-15 mins, but RMA rapid molecular assay more accurate 15-20 minutes results
flu tx?
annual flu vaccine, antiviral drugs taken w/ in 48hrs of s/s onset
what is POTS postural orthostatic tachy syndrome?
circulation being affected by the act of standing from sitting down
s/s of POTS?
HR increase by 30 bpm or up to 120 bpm within first 10 minutes of standing w/ orthostatic hypotension, hypovolemia, fatigue, h/a, lightheaded, heart palpitations, cannot exercise, n/v, SOB, CP, reddish-purple leg color
testing for POTS
tilt table test, orthostatic BP measurements standing @ 2, 5, 10 minutes
other tests like QSRT, thermoregulatory sweat test, skin biopsy, gastric motility test
meds for POTS?
increase blood volume, reduced HR, vasoconstrictive meds
What is Prinzmetal’s angina?
angina at rest due to coronary artery vasospasm @ night during REM sleep
what to avoid w/ prinzmetal angina?
BBs bc they cause more episodes
What is Sjorgren’s syndrome?
Autoimmune-induced destruction of salivary glands = dry eyes/ dry mouth, typically affects women w/ RA or SLE
What is strep pharyngitis?
Acute inflammation of pharynx/tonsils, associated w/crowding (like school, daycare), patchy exudates and cervical lymph node adenopathy
testing – strep pharyngitis?
RADT rapid antigen detection test
Tx of Step pharyngitis?
adult-penicillin
PEDS-amoxicillan
what is a subdural hematoma?
elderly/ alcoholics, crescent shape on CT
What is an epidural hematoma?
Collection of blood between the dura and the skull, artery involvement, increased intracranial pressure, bioconvex disk on CT
typical sign epidural hematoma?
pt could be comfortable + alert followed by rapid deterioration and unconsciousness
what is thrush in infants?
white/ yellow irregular patches/ sores in babys mouth
cause of thrush?
candida albicans
causes of thrush?
nipple not properly dried after feeding, expose nipples to sunlight a ew minutes each day after feeding, probiotics help, common in new borns under 2 months
risk factors of thrush?
low birth weight, vaginal birth rom mother w/ yeast infection, taking antx, inhaled corticosteroids, pacifier use, weak immune system
meds for mother and baby thrush?
nystatin inside babys mouth, liquid antifungal, PO diflucan via dropper
tx for transfusion reaction?
slow transfusion, tylenol, benadryl, steroids, demerol for shivering
preferred antx for UTI?
nitrofurantoin (macrobid)
UTI meds for pregnant women?
keflex, fosfomycin
avoid these UTI meds in pregnant women?
bactrim, penicillin, levofloxacin, ciprofloxacin, nitrofuratonin -avoid after 3rd trimester
PEDS UTI meds?
bactrim or augmentin, cephalosporins ex- keflex
when vomiting – IV cephalosporin
what is varicella/ chicken pox?
contagious disease caused by varciella-zoster virus
s/s chicken pox?
small, itchy blisters, chest, back, face, low-grade fever, abd pain
assessment chicken pox?
rash assessment, blood test, culture the lesions
tx for chicken pox?
antivirals-acyclovir
immune globuline IV (Privigen)
tylenol for pain (ibuprofan makes rash worse!)
calamine lotion
cool bath w/ baking soda, oatmeal
BPH meds?
flomax to relax the muscles in the prostate and the bladder
what is COPD?
breathing difficulty, cough, wheezing, sputum production
what causes COPD?
emphysema – alveoli destruction
chronic bronchitis – inflammation of the bronchial tubes
testing for COPD?
spirometry or pulm funx test (PFT), CXR, CT, ABG
meds for COPD?
SABA + theophylline to relax smooth muscle
LABA = formoterol, salmeterol, indicaterol
SAMA = bromide
LAMA = spiriva
Roflumilast (Daliresp) w/ bronchitis
macrolides for former smokers w/ COPD?
zithromax, erythromycin, clarithromycin
htn meds for DM pts?
ACE like captopril or ARBs
how to mix insulin?
clear reg into cloudy (NPH)
why cant DM pts take BBs?
masks hypoglycemia
why cant DM pts take MAOIs?
glucose reduction
DKA signs?
glucose >250
bicarb <18
pH <7.3 acidic
anion gap
ketones in urine
assessment DKA?
fruity breath, thirsty, dry mouth, frequent urination, confusion
what causes DKA?
recent surgery, stress, illness/infection, MI
tx for DKA?
insulin, fluids, monitor K (hypokalemia), monitor Na/phos
what is MS?
demyelinating disease of the CNS, damage to protective cover on myelin sheath
What is myasthenia gravis?
-An autoimmune neuromuscular disease leading to fluctuating muscle weakness and fatigue, worsens w/ activity, improves w/ rest
s/s of myasthenia gravis?
-diplopia & ptosis (eyelid drooping)
-weakness of larynx & pharynx: dysphagia, choking, dysphasia, slurred speech
-weakness hands feet legs
-bladder & bowel incontinence
increased HR/BP
myasthenia gravis crisis?
severe muscle weakness and ARF requiring intubation and mechanical ventilation
Testing for Myasthenia Gravis?
Tensilon test via IV edrophonium chloride – temporarily relieves symptoms , differentiate between MG and cholinergic crisis, prepare atropine in case of cholinergic crisis
tests for myasthenia gravis?
acetylcholine, anti-MUSK antibody, EMG study, CT/ MRI
Treatment for Myasthenia Gravis?
cholinterase inhibitor: neostigmine + prednisone for 4-5 weeks then taper
side effects of neostigmine (muscle strengthener)?
-increased salivation, urination
-diarrhea
-nausea/vomiting
-sweating
-bradycardia
-slow slurred speech, decreased pupil size, blurred vision
-Low BP
non-pharma therapy for MG?
plasmapheresis-remove plasma from blood, IV immunoglobulin, thymectomy, hydrotherapy
high levels of cholinesterase cause?
depress the CNS, treat w/ atropine
s/s of cholinesterase crisis?
can occur 30-60 mins after taking the med, increased saliva, sweating, peeing, abd pain, n/v, bronchospasm, tachy, muscle weakness, paralysis resp weakness=resp failure
DM neuropathy meds?
gabapentin
cymbalta
lyrica
what is pleural effusion?
fluid colletion between pleura outside lung tissue
s/s of Pleural effusion?
CP, cough, dyspnea, orthopnea, fever
how to test for pleural effusion?
CXR, CT, u/s
meds to treat pleural effusion?
diuretics, antx-parapneumonic and empyema, anticoags for PE risk
treatment for pleural effusion?
thoracentesis – needle decompression, chest tube, pleural drain long term @ home, O2, positioning, avoid exacerbations through increasing activity
what is pneumothorax?
air between lungs and chest cavity tx with chest tube connected to water seal
what is hemothroax?
blood between lungs and chest cavity treated w/ thoracentesis or chest tube to LCWS
small cell carcinoma
15% of lung ca, 25% of lung ca death, central part of lung 6-8 m, caused by smoking
testing for lung ca?
epidermal growth factor EGR, CXR, biopsy
normal TSH?
0.5-5.0
normal T3
80-200
normal T4
5-12
what is hashimoto disease?
autoimmune disease of the thyroid gland resulting in hypothyroid
what is Graves disease?
an autoimmune disorder that is caused by hyperthyroidism and is characterized by goiter and/or exophthalmos, low TSH, high T3/T4
hyperthyroid s/s?
tachy, eyes popping out, dysthymia, angina, palpitations, weight loss, rapid speech, increased metabolic rate, intolerant to heat, exophthalmus
tx hyperthyroid?
PTU, papazole
hypothyroid s/s?
pale, puffy, expressionless face, cold, dry skin, low HR, low metabolic rate, weight gain, fatigue
meds hypothyroid?
synthroid
what causes thyroid storm?
death can occur w/ in 48hrs, can occur in ppl w/ hyperthyroid experiencing high level of stress- infection, cardiac disease, trauma, burns, seizures, surgeries, dialysis, emotional stress
assessment of thyroid storm?
sudden increase T3/T4, hyperthermia, tachydysrhythmias, agitated, delirium, n/v/ diarrhea
tx thyroid storm?
PTU, tapazole, BB, corticosteroid, iodine, thyroidectomy
what is Medullary thyroid cancer?
painless lump front of neck
testing for medullary lump
fine needle biopsy, elevated calcitonin, elevated CEA, genetic counseling if first degree relative has
normal calcium level
8.6-10.2
normal PTH
11-51
what does PTH do?
increases blood calcium levels
hyperparathyroidism high PTH, high ca, T3, T4
osteoporosis, kidney stones, excessive urination, abd pain, bone/ joint pain
hypoparathyroid low PTH, low ca, T3, T4
paresthesia, tetany, trousseus sign, chvosteks sign
testing for parathyroid dysfunction
u/s, bone densitometry, body CT/MRI
meds hyperparathyroidism
Cinacalcet (lowers PTH) and vitamin D
meds hypoparathyroidism
activated vitamin D (calcitriol) and calcium
TB testing
PPD check 48 to 72 hours later 15mm = (+)
5mm positive and immunocompromised
10mm positive for ppl born in countries w/ TB
dx for tb?
CXR w/ white spots in lungs where immune system has walled off TB, CT scan, sputum cx
meds for TB?
isonizid, rifampin, ethambutol, pyrazinamide – antibiotics for tb
if you had BCG vaccine what happens?
TB tests are positive
chronic pain meds?
NSAIDS, topical analgesics, steroids
tx for chronic pain?
PT, TENS, implanted electric nerve simulation, deep brain or spinal stimulation, acupuncture, meditation, weight loss, diet, exercise
SSRI for depression
celexa, lexapro, prozac, paxil, zoloft
TCAs for depression
elavil, tofranil
MAOIs for depression
Nardil, dont eat aged cheese, smoked meet, cured food, will cause htn crisis d/t tyramine
SSRI for anxiety for PTSD related anxiety
celexa, lexapro, prozac, paxil, zoloft
SNRIs for anxiety
cymbalta, effexor
NDRIs for anxiety
wellbutrin
antihistamine if there is no depression w/ anxiety
hydroxyzine
Benzos
clonzepam, xanax, ativan, valium
antipsychotic
seroquel
migraine
botox
panic attacks, hallucinations, nightmares
clonazepam, clonidine for htn, minipress for nightmares
sleep aid for PTSD
minipress prazosin
Schizophrenia (positive symptoms)
hallucinations, delusions, confused thoughts, disorganized speech, bizarre behavior
Schizophrenia (negative symptoms)
anhedonia, apathy, alogia, avolition, attention deficit, flat affect
Dx of schizophrenia
at least 1 positive symptom and total of 3 symptoms
first gen meds for schizophrenia
chlorpromazine, haldol, fluphenazine
side effects first gen of schizophrenia medication
dystonia, akathisia, Parkinsonism, bradykinesia, tardive dyskinesia
dry mouth, constipation, blurred vision, urinary retention, orthostatic hypotension, weight gain, sedation
second gen schizophrenia meds
ritalin, abilify, zyprexa, seroquel, geodon
side effects second gen schizophrenia meds
weight gain, dyslipidemia, hyperglycemia, agranulocytosis, neutropenia, seizure, myocarditis
Neuroleptic Malignant Syndrome
Adverse reaction to antipsychotics with severe “lead pipe” rigidty, FEVER, and mental status changes
cinnamon uses?
LOWERS : BG, chol, htn, + bleeding risk
dont take cinnomon if?
breastfeeding
taking drugs for DM, AC’s, cardiac
gingko biloba use?
lowers dementia risk, lowers ED chance in men
what is the risk w/ gingko biloba?
bleeding risk, dont take w/ AC’s, lowers seizure threshold
glucosamine use?
oseoarthritis
green tea uses?
weight loss, mental clarity
green tea risks?
hepatoxicity
avoid consuming w/ vasodilators/stimulants/psychoactive drugs
contains vit K, consider increased effect of warfarin
lavender uses?
relaxing, sleep aid, anxiety, tress, insomnia
lavender adverse effects?
h/a, constipation, increased appetite
dont take w/ CNS depressants
dont take w/ htn meds
disrupts hormone development in boys
st johns wort risks?
accelerates drug metabolism causes loss of therapeutic effects
dont take it w/ digoxin increases risk of dig toxicity
dont take w/ SSRIs increases risk of serotonin syndrome
uncomplicated htn med?
hydrochlorothiazide – diuretic
best htn meds for DM pts?
ACE 1st line tx
AVOID:
BB’s mask DM s/s
thiazides/lasix promote hyperglycemia
best htn meds for CKD pt?
ACE/ARB 1st line
if stace 3 CKD on ACE, start amlodapine
AVOID:
spironaldactone (K sparing)
meds for muscle spasms?
baclofen, neurotin
best opioid for constant/ dull pain?
morphine
best moderate opioid?
codeine
COX-inhibitors?
NSAIDs + ASA
NSAIDs risk?
Rye’s syndrome in infants, GI bleed
tylenol risk?
hepatatoxicity + SJS
minipress indications?
BPH, PTSD nightmares, raynaud’s phenomenon
pregnancy immunizations?
flu (INACTIVE)
TDAP 27-36 weeks
PNA
Hep A/B
Meningitis
contra pregnancy vaccines?
flu (ACTIVE)
varicella
MMR
what is acute bronchitis?
uncomplicated may be viral/environmental
green purulent sputum
use antx
asthma contra meds?
BBs and CCB
What to do after using inhaled corticosteriod ICS?
rinse mouth to avoid thrush development
dobutamine
cardiogenic shock, increases HR/BP
synephrine
nasal congestion, increases HR/BP
plavix
anti-platelet, dont take w/ other AC’s
heparin antedote
protamine sulfate, labs: xa, aPTT
Warfarin antidote
Vitamin K
normal INR
2-4
normal aPTT
25-35 seconds
Xarelto antidote
andexanet alfa
alteplase
thrombolytic/ clot dissolving, off label: IV patency
Penicilins/ cephalosporins Adverse effects
hypersensitivity, allergic reaction, GI upset
penicillin interaction?
back up BC needed
cephalosporin risks?
hepatotoxicity, displaces biliruben
vanco trough
10-20
vanco risks?
nephrotoxicity, ototoxicity, rash- RED MAN SYNDROME
flagyl adverse affects?
n/v/diarrhea/ metallic tasting
Augmentin adverse effects
Nausea, vomiting, SEVERE DIARRHEA, hives, itching, and RASH
Cephlasporin ex?
ceftriaxone
macrolides ex?”-mycin”
azithromax, Erythromycin
aminoglycosides ex?”-cin”
gentimicin
Fluoroquinolones ex?”-oxcin”
levoflaxcin
sulfa ex? “-sulfa”
bacrtim
Sulfonamide adverse effects
GI – N/V
Hypersensitivity
Stevens Johnson syndrome
urinary anti-infective?
nitrofurantoin/ macrobid
tamsulosin for?
BPH, insomnia, ptsd, htn
clonidine for?
htn, drug w/d, adhd, pain
Levonorgestrel
Plan B, thins uterine lining
myrena
5 years
skyla
3 years
nexplonon
implantable rod under skin
depo provera
q12w injection
normal dig level
0.5-2
dig toxicity s/s?
Anorexia*
Brady/ arrhythmia
visual changes- HALO
what does doxycycine do to coumadin?
enhances AC effect, monitor INR
what is florinef for?
glucocorticoid to tx addison’s disease + adrenal insufficiency
Fludrocortisone side effects?
h/a, stomach issues, mentral changes, color of skin changes, increase in fat, slow wound healing, s/s infex, bone/joint pain, puffy/swollen face, increased thirst/urination, weight gain, muscles weak
anti-diarrheal for IBS?
imodium
antiemetic drugs ex
benadryl, tigan, meclizine, scopolamine, reglan, phenergan, zofran, dexamethasone
lisinopril s/e?
angioedema
dry cough
hyperkalemia
losartan s/e?
angioedema, hyperkalemia
celiac testing
HLA-DQ2/DQ8 and IgA
Sjorgen’s disease testing?
SSA+ and SSB+
Hutchinson’s Gilford Progeria syndrome splicing protein?
LMNA protein-progerin
antibody testing for Crohn’s disease?
ASCA antisaccharomyces cerevisiae
testing for UC?
pANCA perinucular anti-neutrophil cystoplasmatic antibody
stool studies for WBCs
What is dactylitis in sickle cell?
severe swelling that affects your fingers or toes (your digits)
tx babies w/ sickle cell?
folic acid and regular eye exam
antimusinaric effects of schizophrenia meds?
dry mouth, constipation, blurry vision, urinary retention
vitamins for schizophrenia pts?
folic acid and thiamine
long acting insulin?
NPH, Humulin, Lantus, Levemir
short acting insulin?
regular, humaog, novolog, apidra
HLA-B*5801 allele effects mostly who?
Asian people
Doxycycline enhances the effects of what AC?
warfarin
medium dose ICS?
fluticasone, budensonide
blood tests for MG?
acetylcholine and anti-musk antibody
meds for MG?
prednisone, neostigimine and pyridostigamine
sign of medullary thyroid ca?
elevated calcitonin
hemolytic anemia allelle?
G6PD
what is CYP3A4?
drug metabolizing enzyme for codeine
contra estrogen?
smoking
35 y.o.
breast feeding
family hx blood clots
contra progestin?
pregnancy
breast ca
unexplained vag bleeding
what to assess w/ celiac dx?
endoscopy + stomach biopsy
Pt has elevated ferritin what else to test?
Liver funx test
echo showing low cardiac output, what is contributing to this in pt hx?
MI
Peds pt has temp 101, runny nose, barking cough x3d, what to suggest MD order?
PO steroids + breathing txs
What does Invokana aid in?
lowers BG + lowers risk of MI/stroke
Cushing pt w/ dvt-like s/s related to what?
Elevated Von Willebrand factor (r/t platelet and subendothelial collagen adhesion)
Remeron off-label use?
sleep aid
Assess s/e of Zometa injection?
Ca serum levels + Bone scan
what cant a breastfeeding mom use?
combined contraceptive
what does Lantus injection cause for some pts?
stinging @ injection site A
NSAIDs lower the effectiveness of what class of meds?
ACE