Answer:
calcimimetics, hormone replacement, biphospho- nates
Q: Parathyroid – treatment
Answer:
maintain low serum calcium level in hypoparathyroid
Q: Hutchinson-Gilford Progeria Syndrome – definition
Answer:
progressive genetic dis- order causing children to age rapidly – no cure – appears in first two
years of life
Q: Hutchinson-Gilford Progeria Syndrome – causes
Answer:
abberant splicing of the
LMNA making protein – progerin
Causes the nuclear envelope to surround the nucleus to be unstable and damages
it, causing it to die
test for LMNA mutation
Q: Hutchinson-Gilford Progeria Syndrome – assessment
Answer:
measure height\/weight, plot measurements on normal growth curve chart, test hearing and
vision
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<\/a><\/figure>\n\n\n\nCeliac Disease – definition
intolerance of gluten – more pronounced in the duodenum and jejunum<\/p>\n\n\n\n
Celiac Disease – s\/s
Abdominal pain\/distention, diarrhea (pale, greasy, bulky, foul), malnutrition complications (rickets, occult blood, anemia), early bleeds\/bruises, hypomagnesemia\/hypocalcemia (irritability, tremors, convulsions, tetany, bone pain)<\/p>\n\n\n\n
Celiac Disease – labs
IgA-tTg, IgA-EMA, total IgA<\/p>\n\n\n\n
Celiac Disease – testing
serologic measurements of IgA antibodies and HLA-DQ2 or HLA-DQ8, endoscopy with small intestine biopsy, duodenal biopsy<\/p>\n\n\n\n
Sjoren’s Syndrome – definition
immune disorder characterized by dry mouth and dry eyes, mostly in older women<\/p>\n\n\n\n
Sjoren’s Syndrome – testing
SSA+ and SSB+<\/p>\n\n\n\n
Cinnamon – Uses
Lowers BG, Cholesterol, hypertension, risk of bleeding<\/p>\n\n\n\n
Cinnamon – adverse efects
avoid use with diabetic drugs, anticoagulants, and heart meds – breastfeeding women should avoid as a treatment<\/p>\n\n\n\n
Gingko Biloba – uses
halt progression of dementia, used for erectile disfunction<\/p>\n\n\n\n
Gingko Biloba – adverse effects
increases risk of bleeding (avoid using with anticoagulants) and lowers seizure threshold<\/p>\n\n\n\n
Glucosamine – uses
osteoarthritis<\/p>\n\n\n\n
Green Tea – uses
lose weight, mental clarity<\/p>\n\n\n\n
Green Tea – adverse effects
hepatotoxicity, avoid taking with vasodilators\/stimulants\/psychoactive medications, contains small amounts of vitamin K<\/p>\n\n\n\n
Lavender – uses
increases relaxation, helps with anxiety\/stress\/insomnia<\/p>\n\n\n\n
Lavender – adverse effects
constipation, headache, increase appetite, decrease BP, caution with CNS depressants<\/p>\n\n\n\n
Hypoplastic Left Heart Syndrome – structure
LEFT ventricle is underdeveloped
Mitral valves not formed properly
Aortic valve not formed properly
Ascending aorta underdeveloped
Atrial septal defect<\/p>\n\n\n\n
Hypoplastic Left Heart Syndrome – fetal shunts
patent ductus arteriosus – artery connecting aorta to pulmonary artery
patent foramen ovale – hole connecting right atrium to left atrium<\/p>\n\n\n\n
Hypoplastic Left Heart Syndrome – survival rates
3-5 year survival rates of 70% for infants with stage 1 repari
Children who survive 12 months have 90% survival rate<\/p>\n\n\n\n
Hypoplastic Left Heart Syndrome – treatment stage 1
1-2 weeks old (norwood procedure)
Enlarges aorta and connects to the right ventricle, shunt to pulmonary artery is created, patent ductus arteriosus is closed<\/p>\n\n\n\n
Hypoplastic Left Heart Syndrome – treatment stage 2
4-6 months old (glenn procedure)
SVC is connected to pulmonary artery, shunt from norwood is removed<\/p>\n\n\n\n
Hypoplastic Left Heart Syndrome – treatment stage 3
18-36 months old (fontan procedure)
IVC is connected to pulmonary artery, hole is made from the IVC conduit attached to the right atrium<\/p>\n\n\n\n
Hypoplastic Left Heart Syndrome – s\/s
cyanosis, pallor, sweaty\/clammy\/cool skin, trouble breathing, rapid HR, cold feet, poor pedal pulses, poor feeding<\/p>\n\n\n\n
Hypoplastic Left Heart Syndrome – testing
during pregnancy – prenatal tests to check for birth defects, ultrasound to identify HLLS, echocardiogram to show structures of heart
after birth – based on s\/s through pallor and cyanosis, newborn will experience s\/s once ductus arteriosus and foramen ovale close
echocardiogram<\/p>\n\n\n\n
Hypoplastic Left Heart Syndrome – medication
tube feedings, medications to strengthen heart muscles, lower BP, and remove extra fluid<\/p>\n\n\n\n
Parathyroid – function
produces parathyroid hormone that regulates calcium in the bloodstream\/tissue – more PTH released = more calcium in bones released to blood\/tissue = losing density and strength<\/p>\n\n\n\n
Parathyroid – labs
calcium (8.6-10.3 mg\/dL)
PTH (11-51 pg\/mL)<\/p>\n\n\n\n
Parathyroid – s\/s hyperparathyroid
osteoporosis, kidney stones, excessive urination, abdominal pain, fatigue, forgetfulness, bone\/joint pain<\/p>\n\n\n\n
Parathyroid – s\/s hypoparathyroid
High PTH, low T3\/T4
paresthesia, twitching of facial muscles, muscle pains\/cramps, mood changes, dry\/rough skin<\/p>\n\n\n\n
Parathyroid – testing
ultrasound, bone densitometry, body CT\/MRI<\/p>\n\n\n\n
Parathyroid – medications
calcimimetics, hormone replacement, biphosphonates<\/p>\n\n\n\n
Parathyroid – treatment
maintain low serum calcium level in hypoparathyroid<\/p>\n\n\n\n
Hutchinson-Gilford Progeria Syndrome – definition
progressive genetic disorder causing children to age rapidly – no cure – appears in first two years of life<\/p>\n\n\n\n
Hutchinson-Gilford Progeria Syndrome – causes
abberant splicing of the LMNA making protein – progerin
Causes the nuclear envelope to surround the nucleus to be unstable and damages it, causing it to die
test for LMNA mutation<\/p>\n\n\n\n
Hutchinson-Gilford Progeria Syndrome – assessment
measure height\/weight, plot measurements on normal growth curve chart, test hearing and vision<\/p>\n\n\n\n
Hutchinson-Gilford Progeria Syndrome – s\/s
short stature or slow growth, slow hair growth, alopecia, joint abnormalities, wrinkle\/dry skin, FTT and delayed tooth development<\/p>\n\n\n\n
Hutchinson-Gilford Progeria Syndrome – treatment
statins – decrease liver’s production of harmful cholesterol, NSAID – relieve pain, bone medications – strengthen\/build bones, OT\/PT<\/p>\n\n\n\n
Hutchinson-Gilford Progeria Syndrome – life expectancy
Age 10x faster
13-20 years of age – average is 13<\/p>\n\n\n\n
Neuropathy – medications
Gabapentin (Neurontin)
Duloxetine (Cymbalta)
Pregabalin (Lyrica)<\/p>\n\n\n\n
Hydrotherapy – uses
Helps with multiple sclerosis and myasthenia gravis<\/p>\n\n\n\n
Pneumothorax – definition\/testing
collapsed lung – air between lungs and chest cavity – percussion is hyper-resonant<\/p>\n\n\n\n
Hemothorax – definition\/testing
collapsed lung – blood between lungs and chest cavity – percussion is dullness on both anterior and posterior<\/p>\n\n\n\n
Tuberculosis – testing
Tuberculin skin test – inject 0.1 of tuberculin PPD into forearm ID, after 48-72 hours if induration is >15mm the test is positive(if >5mm = positive to immunocompromised, if >10mm = positive to people born in countries with TB and\/or work in areas with high-risk
Chest X-Ray or CT – white spots in lungs where the immune system has walled off TB<\/p>\n\n\n\n
Tuberculosis – medications
Isoniazid
Rifampin – don’t take with oral contraceptives
Ethambutol
Pyrazinamide<\/p>\n\n\n\n
Thyroid levels
TSH – 0.5-5.0 mIU\/L
T3 – 80-220 ug\/dL
T4 – 5-12 ug\/dL<\/p>\n\n\n\n
Hyperthyroidism – assessment
Increase HR, dysrhythmia, angina, stimulated CNS (nervous, insominia, rapid thoughts\/speech), skeletal muscles weak\/atrophy, increase metabolic rate, increased appetite, warm\/moist skin, intolerant to heat<\/p>\n\n\n\n
Hyperthyroidism – medications
Propylthiouracil (PTU)
Methimazole (Papazole)<\/p>\n\n\n\n
Hypothyroidism – assessment
Pale, puffy, expressionless face, cold\/dry skin, brittle hair and hair loss, lowered HR and temperature, lethargy, fatigue, cold intolerance<\/p>\n\n\n\n
Hypothyroidism – medications
Levothyroxin (synthroid)<\/p>\n\n\n\n
Crohn’s Disease – defintion
inflammation\/scarring of the digestive tract, throughout intestines (generally small intestine), patients with atopic dermatitis\/eczema have increased risk<\/p>\n\n\n\n
Crohn’s Disease – s\/s
skip lesions (mucosal lesions where inflammation exists), cobble stones on biopsy, intestinal bleeding, chronic diarrhea, abdominal pain\/cramping, fistula, fissure, ileus, mouth ulcers, worse AFTER eating<\/p>\n\n\n\n
Crohn’s Disease – testing
Antibodies – anti-saccharomyces cerevisiae antibody test for ASCA protein
CBC to check h\/h, heme occult for blood in stoole, CRP and ESR for inflammation, electrolyte panel, iron\/b12<\/p>\n\n\n\n
Crohn’s Disease – diagnosis
kidney\/ureter\/blader x-ray, colonoscopy\/sigmoidoscopy to check for lesions, barium xray or video capsule endoscopy<\/p>\n\n\n\n
Crohn’s Disease – medications
Aminosalicylate (sulfasalazine, mesalamine)
Oral steroids if Aminosalicylate is not effective or for exacerbation
Immunosuppresive therapy (methotrexate)
Antibiotics to manage bacterial overgrowth
IV Corticosteroids for 3-5 days<\/p>\n\n\n\n
Crohn’s Disease – diet
low residue (low fiber, lean proteins, refined grains, low fat food)
Avoid caffeine, alcohol, and sharp edged\/large grains<\/p>\n\n\n\n
Ulcerative Colitis – definition
chronic inflammation of the digestive tract – mostly in the innermost lining of the large intestine\/rectum<\/p>\n\n\n\n
Ulcerative Colitis – s\/s
diarrhea (with blood or pus), abdominal pain\/cramping, rectal pain\/bleeding, urgency to defecate and inability despite urgency, weight loss, fatigue, fever, FTT<\/p>\n\n\n\n
Ulcerative Colitis – testing
perinuclear anti-neutrophyil cystoplasmic antibody test for pANCA, colonoscopy or flexible sigmoidoscopy, blood tests for anemia or inflammation (CBC, LFT, electroltyes, ANA, CRP, ESR), stool studies, X-ray, CT<\/p>\n\n\n\n
Ulcerative Colitis – medications
anti-inflammatory drugs, corticosteroids, immune system suppressors, anti-diarrhea, antispasmodics, iron supplements<\/p>\n\n\n\n
Sickle Cell – newborn
under 5 years old increased risk for pneumococcal infections d\/t non-functional spleens and decreased immune response
Infants will be anemic<\/p>\n\n\n\n
Sickle cell – vaso-occlusive crisis
dactylitis – severe pain and swelling of both hands and feet, pain affecting the extremities\/back\/chest, fever<\/p>\n\n\n\n
Sickle cell – splenic sequestration
acute painful enlargment of the spleen, drop in hemoglobin levels, hypovolemic shock, seen in a CT<\/p>\n\n\n\n
Sickle cell – aplastic crisis
sudden pallor or weakness, dropping hemoglobin levels, reticulocytopenia (low immature RBC)<\/p>\n\n\n\n
Sickle cell – prevention
hydrate, avoid being too hot\/cold, avoid high altitudes or places with low oxygen<\/p>\n\n\n\n
Sickle cell – treatment vaso-occlusive crisis
IV fluids for hydration
IV analgesia
High flow O2<\/p>\n\n\n\n
Sickle cell – medications
Ibuprofen or IV analgesia
Hydroxyurea to reduce painful episodes (prevents abnormal RBC but increases risk of infection)
Avoid iron medications
Penicillin for newborns<\/p>\n\n\n\n
UTI – safe pregnancy medications
Fosfomycin (Monurol) – one time dose
Cefalexin (Keflex)
Ofloxacin (Floxin)<\/p>\n\n\n\n
UTI – unsafe pregnancy medications
Nitrofurantoin (Furadantin, Macrobin)
Trimethoprim-sulfamethoxazole (Bactrim)
Penicillin
Levofloxacin (Levaquin)
Ciprofloxacin (Cipro)<\/p>\n\n\n\n
UTI – safe pediatric medications
Trimethoprim-sulfamethoxazole (Bactrim)
Amoxicillin-clavulanate (Augmentin)
Cefixime (Suprax)
Cefpodoxime
Cefporozil (Cefzil)
Cephalexin (Keflex)<\/p>\n\n\n\n
Pregnancy Immunizations – recommended
Influenza
TDAP – 27-36 weeks
Pneumococcal
Hep A and B
Menigococcal<\/p>\n\n\n\n
Pregnancy Immunizations – contraindicated
Varicella vaccine
MMR<\/p>\n\n\n\n
Varicella – definition
contagious disease caused by the varicella-zoster virus<\/p>\n\n\n\n
Varicella – assessment
pleomorphic rash – small itchy blisters eventually scabbing over (start on chest, back, and face)
low grade fever preceeding the skin manifestations by 1-2 days
abdominal pains (in some)<\/p>\n\n\n\n
Varicella – testing
rash assessment
blood tests
culture of lesion sample<\/p>\n\n\n\n
Varicella – treatment
antivirals – Acyclovir (Zovirax)
Immune globulin IV (Privigen) – given within 24 hours after the first rash appears
Tylenol – for pain
Calamine lotion
Cool baths with baking soda, uncooked oatmeal, or colloidal oatmeal<\/p>\n\n\n\n
Schizophrenia – positive s\/s
hallucinations (auditory, visual, olfactor, gustatory, tactile)
Delusions (persecutory, referential, somatic, erotomaniac, religious, grandiose)
Confused thoughts\/disorganized speech<\/p>\n\n\n\n
Schizophrenia – negative s\/s
anhedonia, flat affect, withdrawal, alogia, avolition<\/p>\n\n\n\n
Schizophrenia – first generation medications
Chlorpromazine (Thorazine)
Haloperidol (Haldol)
FLuphenazine (Modecate)<\/p>\n\n\n\n
Schizophrenia – first generation side effects
EPS, Antimuscarinic effects, alpha-1 receptor antagonism, histamine antagonism<\/p>\n\n\n\n
Extra Pyramidal Symptoms
Dystonia (continuous spasms and muscle contractions), Akathisia (restlessness), Parkinsonism (rigidity), Bradykinesia (slowing of movement), Tardive dyskinesia (irregular jerky movements of lower face\/distal extremities)<\/p>\n\n\n\n
Antimuscarinic effects
Dry mouth, constipation, blurred vision, urinary retention<\/p>\n\n\n\n
Alpha-1 Receptor antagonism
orthostatic hypotension<\/p>\n\n\n\n
Histamine antagonism
weight gain, sedation<\/p>\n\n\n\n
Schizophrenia – second generation medications
Risperdal, Aripiprazole (Abilify), Olanzapine (Zyprexa), Quetiapine (Seroquel), Ziprasidone (Geodon)<\/p>\n\n\n\n
Schizophrenia – second generation side effects
Antimuscarinic effects, metabolic side effects, agranulocytosis and neutropenia (clozapine), neuroleptic malignant syndrome<\/p>\n\n\n\n
Metabolic side effects
weight gain, dyslipidemia, hyperglycemia<\/p>\n\n\n\n
Neuroleptic malignant syndrome (NMS)
fever, altered mental status, muscle rigidity, autonomic dysfunction<\/p>\n\n\n\n
Benign Prostatic Hyperplasia – medications
Talmusolin (Flomax) – helps relax the prostate muscles and the bladder (educate on hypotension)<\/p>\n\n\n\n
Congestive Heart Failure – defintion
volume overload in pulmonary area; left ventricular dysfunction<\/p>\n\n\n\n
Congestive Heart Failure – left
pulmonary cause; JVD, FVE, Rales, S3 murmur<\/p>\n\n\n\n
Congestive Heart Failure – right
peripheral vascular cause; LE edema, abdominal distention<\/p>\n\n\n\n
Congestive Heart Failure – assessment
Normal ejection fraction – 55-60%
Reduced ejection fraction, preserved ejection fraction<\/p>\n\n\n\n
Reduced ejection fraction
systolic heart failure; ineffective contraction and less oxygen-rich blood pumped in the body, less than 40%<\/p>\n\n\n\n
Preserved ejection fraction
diastolic heart failure; ineffective relaxation during filling, 40-49%<\/p>\n\n\n\n
Congestive Heart Failure – testing
BNP – over 100% heart failure is present and more severe
Echocardiogram – evaluate structure and function<\/p>\n\n\n\n
Pleural effusion – s\/s
Chest pain, dry\/nonproductuve cough, dyspnea, orthopnea, fever<\/p>\n\n\n\n
Pleural effusion – testing
chest x-ray, CT, ultrasound<\/p>\n\n\n\n
Pleural effusion – medications
Diuretics (CHF and pulmonary edema)
Antibiotics (parapneumonic effusion and empyema)
Anticoagulation (PE)<\/p>\n\n\n\n
Pleural effusion – treatment
Thoracentesis, chest tube, pleural drain, oxygen, positioning, avoid exacerbating activities<\/p>\n\n\n\n
Regular insulin (clear)
30-60min onset; 2-4hr peak; 6-12hr duration<\/p>\n\n\n\n
NPH insulin Humulin N (cloudy)
1-1.5hr onset; 4-12hr peak; 24hr duration<\/p>\n\n\n\n
Ultralente (Humalin Ultralente)
4-8hr onset; 10-30hr peak; 20-36hr duration<\/p>\n\n\n\n
Lispro (Humalog)
<15min onset; 30-90min peak; 2-5hr duration<\/p>\n\n\n\n
Aspart (Novolog)
10-20min onset; 1-3hr peak; 3-5hr duration<\/p>\n\n\n\n
Glargine (Lantus)
60-70min onset; no peak; 24hr duration<\/p>\n\n\n\n
Glulisin (Apidra)
2-5min onset; 30-90min peak; 2hr duration<\/p>\n\n\n\n
Detemir (Levemir)
1-2hr onset; 3-6hr peak;5.7-23.3hr duration<\/p>\n\n\n\n
Diabetes contraindicated medications
Beta-blockers (masks hypoglycemia) and MAOI (glucose reduction)<\/p>\n\n\n\n
Migraine patient – treatment
Botox<\/p>\n\n\n\n
Systemic Lupus Erythematosus (SLE) – definition
inflammatory disease caused when the immune system attacks its own tissues; can affect joints, kidneys, skin, blood cells, brain, heart, and lungs<\/p>\n\n\n\n
Systemic Lupus Erythematosus (SLE) – assessment
Fatigue, joint pain, rash, fever<\/p>\n\n\n\n
Systemic Lupus Erythematosus (SLE) – treatment
Prednisolone and Methyloprednisolone<\/p>\n\n\n\n
Diabetic Ketoacidosis – definition
complication where the body produces excess blood acids (ketones)
BG >250
Serum bicarb <18
Serum pH <7.3
Anion gap
presence of ketones in serum and urine<\/p>\n\n\n\n
Diabetic Ketoacidosis – assessment
fruity scented breath, thirst\/dry mouth, frequent urination, fatigue, dry\/flushed skin, vomiting, confusion<\/p>\n\n\n\n
Diabetic Ketoacidosis – contributing factors
intercurrent illness, infection, trauma, surgery, MI, poor insulin compliance<\/p>\n\n\n\n
Diabetic Ketoacidosis – treatment
insulin to lower BG, fluids to replace volume, monitor potassium levels, monitor sodium\/phosphorus levels<\/p>\n\n\n\n
Cellulitis – definition
infection of dermis and sub cutaneous tissue<\/p>\n\n\n\n
Cellulitis – treatment
IV antibiotics, PO antibiotics, treat temperature, educate on medication regimen, wrap the wound<\/p>\n\n\n\n
Panic attack\/hallucinations\/nightmares – treatment
clonazepam (klonopin) for anxiety, clonidine (catapres) for hypertension, prazosin (minipress) for nightmares<\/p>\n\n\n\n
Multiple Sclerosis – defintion
demyelinating disease that results in damage to the protective covering (myelin sheath) that surrounds nerve fibers in the brain, optic nerves, and spinal cord<\/p>\n\n\n\n
Kidney and BP regulation
BP regulation through hormonse that casue the kidneys to increase the reabsorption of sodium and water into the bloodstream. The kidney contributes renin.<\/p>\n\n\n\n
Antidiuretic hormon (ADH)
Aldosterone
Renin-angiotensin syndrome<\/p>\n\n\n\n
Human Leukocyte Antigen (HLA-B*58:01) allele on allopurinol (Zyloprim) – allopurinol
used to reduce the uric acid to treat gout and kidney stones<\/p>\n\n\n\n
Human Leukocyte Antigen (HLA-B*58:01) allele on allopurinol (Zyloprim) – definition
strongly associated with severe cutaneous adverse reactions (SCAR), such as Steven-Johnson Syndrome and toxic epidermal necrolysis<\/p>\n\n\n\n
common in Koreans, Han-Chinese, and Thai descendants<\/p>\n\n\n\n
Doxycycline (Vibramycin)
enhances anticoagulant effect of warfarin (MONITOR INR – normal is 0.8-1.2)<\/p>\n\n\n\n
Muscle Spasms – medications
Baclofen (Gablofen)
Gabapentin (Neurontin)<\/p>\n\n\n\n
Anatomy of the Skull w\/ hematoma
Skull
Epidural hematoma
Dura mater
Subdural hematoma
Arachnoid mater
Pia mater
Brain<\/p>\n\n\n\n
Epidural hematoma assessment
CN3 Palsy
Lucid Interval (pt comfortable and alert followed by rapid deterioration)
Biconvex disk on CT<\/p>\n\n\n\n
Subdural hematoma
crescent shape on CT<\/p>\n\n\n\n
Tay-Sachs disease
Ashkenazi Jewish patients at a higher risk<\/p>\n\n\n\n
Tay-Sachs disease – definition
lack of enzyme that breaks down fatty substances, building up to toxic levels in the brain effecting the function of nerve cells in the brain and spinal cord<\/p>\n\n\n\n
Tay-Sachs disease – s\/s
loss of muscle control, cherry-red spots in the eyes, vision\/hearing loss<\/p>\n\n\n\n
Chronic Kidney disease – stage 1
normal or high GFR (90-120mL\/min NORMAL), normal renal function with proteinuria for 3+ months<\/p>\n\n\n\n
Chronic Kidney disease – stage 2
GFR 60-89mL\/min, mild loss of renal function with proteinuria<\/p>\n\n\n\n
Chronic Kidney disease – stage 3
GFR 30-59mL\/min, mild hypertension<\/p>\n\n\n\n
Chronic Kidney disease – stage 4
GFR 15-29mL\/min, moderate hypertension, anemia, hyperphosphatemia<\/p>\n\n\n\n
Chronic Kidney disease – stage 5 (end stage)
GFR<15, severe hypertension, hyperphosphatemia, anemia<\/p>\n\n\n\n
Uncomplicated otitis media – causes
mainly caused by Moraxella Catarrhalis<\/p>\n\n\n\n
Uncomplicated otitis media – treatment
amoxicillin is first line treatment in pediatric patients<\/p>\n\n\n\n
Fludrocortisone (Florinef) – indication
used to treat Addisons’s disease and adrenocortical insufficiency<\/p>\n\n\n\n
Fludrocortisone (Florinef) – side effects
Upset stomach, headache, menstrual changes
Color changes of skin or increase in fat
Easy bleeding\/bruising
Slow wound healing, signs of infections
Bone, joint, and muscle pain
Puffy face, swelling of hands\/feet
Increased thirst and urination
Weight gain and muscle weakness<\/p>\n\n\n\n
Prazosin (minipress) – uses
relaxes outflow of the bladder and helps with prostate enlargement with BPH; PTSD associated nightmares; Raynaud’s phenomenon<\/p>\n\n\n\n
Asthma – assessment
dry cough, wheezing, breathing through mouth, tachypnea, chest pressure, fast HR, throat irritation<\/p>\n\n\n\n
Short Acting Beta2 Agonists (SABA) – indications
Step 2
used to treat environmental triggers, exercise-induced, virus-induced, or allergies
Safe in pregnancy
newborn or children should use nebulizers<\/p>\n\n\n\n
Short Acting Beta2 Agonists (SABA) – medications
Albuterol (Salbutamol, Proventil, Ventolin)
Levalbuterol (Xopenex)<\/p>\n\n\n\n
Inhaled Corticosteroids (ICS) – indications
Step 2\/3
worsening respiratory symptoms from asthma, nighttime awakening, no systemic effects from taking oral corticosteroids<\/p>\n\n\n\n
Inhaled Corticosteroids (ICS) – medications
Fluticasone (Flovent)
Budesonide (Pulmicort)
Mometasone (Asmanex)
Beclomethasone (QVar)<\/p>\n\n\n\n
Leukotriene Receptor Antagonist – indications
Step 2
prescribed to growing children d\/t long-term effects of a medium dose of ICS<\/p>\n\n\n\n
Leukotriene Receptor Antagonist – medications
Montelukast (Singulair)<\/p>\n\n\n\n
Mast Cell Stabilizers – indications
Step 2
low-dose ICS or alternatives; given to growing kids d\/t long-term effects of medium dose of ICS<\/p>\n\n\n\n
Mast Cell Stabilizers – medications
Cromolyn (Intal)<\/p>\n\n\n\n
Long Acting Beta2 Agonists (LABA) – indications
Steps 3\/4\/5\/6<\/p>\n\n\n\n
Long Acting Beta2 Agonists (LABA) – medications
Formoterol (Foradil, Perforomist)
Salmeterol (Serevent)
Indacaterol (Arcapta)<\/p>\n\n\n\n
Oral Corticosteroids – indications
all day coughing and wheezing, acute exacerbations<\/p>\n\n\n\n
Oral Corticosteroids – medications
prednisone<\/p>\n\n\n\n
ICS + LABA – medications
Fluticasone\/Salmeterol (Advair)
Fluticasone\/Vilanterol (Breo Ellipta)
Budesonide\/Formoterol (Symbicort)
Mometasone\/Formoterol (Dulera)<\/p>\n\n\n\n
Myasthenia Gravis – definition
autoimmune disorder that causes weakness in the skeletal muscles
antibodies against nicotinic acetylcholine receptors at the junction between the nerve and muscles
Thryroid gland can cause this<\/p>\n\n\n\n
Myasthenia Gravis – s\/s
ocular myasthenia (weak eye muscles), ptosis (eye droop), diplopia (blurred\/double vision), difficulty swallowing\/coughing, SOB, slurred speech, weakness in arms\/hands\/fingers\/legs\/neck, increase HR\/BP<\/p>\n\n\n\n
Myasthenic crisis
severe muscle weakness – respiratory failure<\/p>\n\n\n\n
Myasthenia Gravis – testing
Tensilon test, blood tests (acetylcholine, anti-MuSK antibody), electro diagnostics(Single fiber electromyography), CT\/MRI<\/p>\n\n\n\n
Tensilon test
Edrophonium briefly relieves weakness by blocking the break down of acetylcholine and increasing the leves.
10mg tensilon prepared lasting 10 minutes<\/p>\n\n\n\n
Myasthenia Gravis – medications
Cholinesterase inhibiters (Neostigmine, Pyridostigmine), autoimmune treatments (prednisone)<\/p>\n\n\n\n
Myasthenia Gravis – non-pharmacologic treatment
Plasmapheresis, IV immunglobulin, thymectomy, hydrotherapy<\/p>\n\n\n\n
Cholinergic crisis
Looks like myasthenis crisis but occurs 30-60mins after taking anticholinergic med<\/p>\n\n\n\n
Thyroid storm – definition
worsening of the thyrotoxic state, in which death can occur within 48 hours without treatment; may develop spontaneously but occurs in individuals who have undiagnosed\/partially treated severe hyperthyroidism<\/p>\n\n\n\n
Myasthenia Gravis – causes
Infection, pulmonary\/cardiac disorders, trauma, burns, seizures, surgeries, obstetric complications, emotional distress, dialysis<\/p>\n\n\n\n
Myasthenia Gravis – assessment
sudden release and increased action of T3\/T4
Hyperthermia, tachycardia, high output HF, agitation, delirium, nausea\/vomiting\/diarrhea<\/p>\n\n\n\n
Myasthenia Gravis – treatment
medications that block TH synthesis (propylthiouracil, thiamazole), beta blockers, corticosteroids, iodine, supportive care, plasma exchange, thyroidectomy<\/p>\n\n\n\n
Uncomplicated hypertension – treatment
Hydrochlorothiazide (Microzide)<\/p>\n\n\n\n
Ataxia – definition
degenerative disease of the nervous system – damage to the cerebellum; genetic predisposition or trauma to the spinal cord or other nerves<\/p>\n\n\n\n
Ataxia – assessment
mimic those of being drunk, slurred speech, stumbling, falling, incoordination, wide-based gait, difficulty writing and eating, slow eye movement<\/p>\n\n\n\n
Fragile X Syndrome
Break in X chromosome where there is a folate deficiency<\/p>\n\n\n\n
Repeats of CGG in first exon of the fragile X chromosome.
Most individuals have less than 50. But Fragile X Syndrome has more than 200
repeats.
Late-onset, usually after 50 years old.
Developmental delays, learning disabilities, social and behavior problems.
Problems with movement and cognition.
Second most common cause of genetic intellectual disability after Down
Syndrome.<\/p>\n\n\n\n
Athletic Heart Syndrome
Enlarged heart and lower HR
HR can be as low as 30-40<\/p>\n\n\n\n
Hypertension – definition
Systolic BP >130 or Diastolic BP of >80<\/p>\n\n\n\n
Hypertension – mechanism
lead to increase total peripheral resistance –> increased afterload; sodium absorption resulting in volume expansion; impaired response to renin-angiotensin-aldosterone system; increased activation of SNS<\/p>\n\n\n\n
Hypertension – assessment
two office measurements on two separate occasions
increased BP
Pedal edema
Aortic valve disease (S4)
Renal vascular disease (renal bruit, carotid bruit)
Hypercortisolism (thin skin, easy bruising, hyperglycemia)
Thyroid disorders<\/p>\n\n\n\n
Hypertension – elevated stage
systolic 120-129 and diastolic <80<\/p>\n\n\n\n
Hypertension – stage 1
systolic 130-139 and diastolic 80-89<\/p>\n\n\n\n
Hypertension – stage 2
systolic >140 and diastolic >90<\/p>\n\n\n\n
Hypertension – medications
ACE (-pril)
ARBs (-sartan)
Diuretics
CCBs (-pine)
BBs (-lol)<\/p>\n\n\n\n
Hypertension – non-pharmacologic
weight management, salt restriction, smoking cessation, obstructive sleep apnea management, exercise<\/p>\n\n\n\n
COPD – assessment
breathing difficulty, wheezing, cough, sputum production<\/p>\n\n\n\n
COPD – causes
emphysema, chronic bronchitis<\/p>\n\n\n\n
COPD – testing
Spirometry or PFT, chest x-ray, CT, ABGs<\/p>\n\n\n\n
COPD – medications
SABA, LABA (Formoterol – Performist, Salmeterol – Serevent, Indicaterol – Arcapta), SAMA (Ipratropium bromide), LAMA (Tiotropium (Spiriva)<\/p>\n\n\n\n
COPD – medication order after trials
LAMA then LAMA + LABA
then LABA + ICS
then LAMA + LABA + ICS
then PDE4 inhibitor (Roflumilast – Daliresp or Macrolide)<\/p>\n\n\n\n
Medullary thyroid cancer – definition
occurs in C cells and secretes calcitonin and carcinoemryonic antigen<\/p>\n\n\n\n
Medullary thyroid cancer – assessment
painless lump on the front of the neck<\/p>\n\n\n\n
Medullary thyroid cancer – testing
fine needle aspiration of biopsy, blood test if positive (calcitonin elevated and carcinoembryoni antigen elevated)<\/p>\n\n\n\n
Medullary thyroid cancer – genetic counseling
to patients and first-degree relatives so thyroid if removed before MTC<\/p>\n\n\n\n
Postural Orthostatic Tachycardia Syndrome (POTS) – criteria
HR increase >30 or >120 within first 10mins of standing w\/o hypotension<\/p>\n\n\n\n
Postural Orthostatic Tachycardia Syndrome (POTS) – assessment
may\/may not have hypotension, hypovolemia, high levels of norepinephrine while standing, small fiber neuropathy, fatigue, headache, dizziness, palpitations, nausea, tremors, syncope, chest pain, SOB, coldness, reddish-purple legs when standing<\/p>\n\n\n\n
Postural Orthostatic Tachycardia Syndrome (POTS) – testing
Tilt test, orthostatic vital signs, Quantitative Sudomotor Axon Reflex Test (QSART – measure sweat grand stimulation), thermoregulatory sweat test, skin biopsy, gastric motility studies<\/p>\n\n\n\n
Postural Orthostatic Tachycardia Syndrome (POTS) – pharmacologic treatments
increase blood volume, reduce HR, peripheral vasoconstriction medications<\/p>\n\n\n\n
Color Blindness – definition
OPN1MW on chromosome 23 (X-LINKED); comes from mother to son; disease is dominant<\/p>\n\n\n\n
G6PD (Hemolytic Anemia) – definition
genetic disorder that causes RBC’s to break down prematurely, causing them to be destroyed faster than they can be made; X-LINKED RECESSIVE<\/p>\n\n\n\n
G6PD (Hemolytic Anemia) – s\/s
pale skin, jaundice, dark-colored urine, fever, weakness, dizziness, confusion, trouble with physical activity, enlarged spleen\/liver, increased HR<\/p>\n\n\n\n
G6PD (Hemolytic Anemia) – avoid
beans, moth balls, red wine, blueberries, soya products, tonic water, cmaphor<\/p>\n\n\n\n
G6PD (Hemolytic Anemia) – medications
Aspirin, Ascorbic acid (vitamin C), Chloroquine, Methylene blue, Methyldopa (Aldomet), Fulfisoxazole (Pediazole)<\/p>\n\n\n\n
Transfusion reaction
IGM – (ABO incompatability)
Slow rate of transfusion
Acetaminophen
Diphenhydramine
Steroids
Meperidine (Demerol) given for rigos<\/p>\n\n\n\n
Small cell lung carcinoma – causes
tobacco smoking<\/p>\n\n\n\n
Small cell lung carcinoma – testing
Epidermal Growth Factor Receptor (EGFR)
Chest X-ray<\/p>\n\n\n\n
Thrush (Infants) – assessment
White or yellow irregularly shaped patches or sores in the gums or tongues
Cracked skin in the corners of the mouth<\/p>\n\n\n\n
Thrush (Infants) – causes
Cadida Albicans
May develop if breast is not properly dried after feeding and yeast grows
Common in newborns under 2mo<\/p>\n\n\n\n
Thrush (Infants) – risk factors
Very low birth weight; vaginal birth from mom w\/ yeast infection; taken antibiotics; taken inhaled corticosteroids; pacifier use; weak immune system<\/p>\n\n\n\n
Thrush (Infants) – medications
nystatin applied to inside of mouth multiple times a day for 10 days; liquid antifungal medicine; fluconazole (diflucan)<\/p>\n\n\n\n
CYP3A4
Important in metabolism of codeine
St. John’s Wort induces this; accelerates metabolism of drugs –> loss of therapeutic effect; avoid with digoxin<\/p>\n\n\n\n
Alzheimer’s – assessment
Brain shrinks – nerve cell death and tissue loss; plaques build up – abnormal clusters of these protein fragments; tangles form – twisted strands of another protein<\/p>\n\n\n\n
Alzheimer’s – 10 warning signs
Memory loss that disrupts daily life; challenges in planning\/solving problems; difficulty completing familiar tasks; confusion with time\/place; trouble understanding visual images or spatial relations; new problems with words in speaking\/writing; misplacing things; decreased\/poor judgement; withdrawal from work\/social activities; changes in mood\/personality<\/p>\n\n\n\n
Alzheimer’s – mild stage
Able to function independently; forgetting familiar words, losing everyday objects; trouble remembering names\/performing tasks; forgetting material just read<\/p>\n\n\n\n
Alzheimer’s – moderate stage
Requires increasing care; forgetfulness of personal history; confusion r\/t place\/time; need for help with ADL’s; increased risk of wandering<\/p>\n\n\n\n
Alzheimer’s – severe stage
Longest stage; requires full-time care; loss of awareness of recent experiences; changes in physical abilities (walking, sitting, swallowing); vulnerable to infections<\/p>\n\n\n\n
Alzheimer’s – Cholinesterase Inhibitors
Donapezil (Aricept), Galantamine (Razadyne), Rivastigmine (Exelon)
Treats symptoms r\/t memory loss, thinking, language, judgement, and thought process; prevents breakdown of Ach; delays\/slows worsening symptoms; side effects – nausea, vomiting, loss of appetite, increased bowel movements<\/p>\n\n\n\n
Alzheimer’s – N-Methyl-D-Aspartate receptor antagonist
Memantine (Namenda)
Improves memory, attention, reason, language, and ability to perform simple tasks); regulates glutamate activity; improves mental function\/ability to do ADL’s; side effects – headache, constipation, confusion, dizziness<\/p>\n\n\n\n
Beta Thalassemia – definition
Inherited disorder characterized by reduced\/absent abounts of hemoglobin; found mostly in Mediterranean ancestry<\/p>\n\n\n\n
Beta Thalassemia – s\/s
Yellowing eyes; fatigue, dizziness, fainting; low BP, palpitations, rapid HR; chest pain; paleness, coldness, yellowing of skin; SOB, muscle weakness; changes in stool color, splenic enlargement; delays in growth and development; bone marrow expansion<\/p>\n\n\n\n
Beta Thalassemia – treatment
regular blood transfusions
Epoetin Alfa (epogen) – increased production of RBC<\/p>\n\n\n\n
Chronic Joint Pain – assessment
Joint redness, swelling, tenderness, and warmth; limping, locking of joint; loss of ROM; stiffness, weakness<\/p>\n\n\n\n
Chronic Joint Pain – testing
medical history, physical exam, x-ray, blood tests<\/p>\n\n\n\n
Chronic Joint Pain – medications
NSAIDs
Steroids
Topical analgesics<\/p>\n\n\n\n
Chronic Joint Pain – treatments
Physical therapy; Transcutaneous Electrical Stimulator (TENS) – low voltage current to provide relief; Implanted electric nerve stimulation – sends mild current to spinal cord; Deep brain or spinal stimulation – treat movement problems, eases symptoms; acupuncture\/meditation; weight loss, diet, exercise<\/p>\n\n\n\n
Community Acquired Pneumonia – causes
Streptococcus pneumoniae; influenza A; Mycoplasma pneumoniae; Chlamydiophila pneumoniae<\/p>\n\n\n\n
Community Acquired Pneumonia – s\/s
Cough w\/ or w\/o sputum; dyspnea; pleuritic chest; tachypnea; adventitious breath sounds; tactile fremitus and dullness; fever; malaise; chest pain; chills; fatigue; leukocytosis w\/ leftward shift<\/p>\n\n\n\n
Community Acquired Pneumonia – testing
chest radiograph – pulmonary opacities d\/t WBC and fluid (viral = diffuse widespread whitening; bacterial = patchy and consolidated); blood tests (ESR, CRP, procalcitonin); sputum culture and gram stain<\/p>\n\n\n\n
Community Acquired Pneumonia – treatment
Adequate ventilation and O2; deep breathing; coughing; chest PT; antibiotics w\/i 4 hours of presentation for bacterial<\/p>\n\n\n\n
Contraception – non-hormonal
Condoms; diaphragm; vaginal sponges; natural family planning; withdrawal; spermicides; copper IUD (paragard)<\/p>\n\n\n\n
Contraception – hormonal (progestin)
Levonorgestrel – keeps uterine lining thin to prevent implantation (Mirena or Skyla); Nexplanon – implantable rod under the skin of arm; Depo-Provera – injection every 12 weeks; oral contraceptive<\/p>\n\n\n\n
Contraception – hormonal (combination)
Oral contraceptives; patch and ring<\/p>\n\n\n\n
Contraception – Estrogen contraindications
Smoking; over 35 years old; breast feeding; personal\/family hx of blood clots<\/p>\n\n\n\n
Contraception – Progestin contraindications
Current pregnancy; unexplained vaginal bleeding; breast cancer; use of medications that interact w\/ progestin<\/p>\n\n\n\n
Depression – assessment
depressed\/irritable mood; loss of interest and pleasure; >5% weight gain\/loss in a month; insomnia\/hypersomnia; psychomotor agitation or retardation; fatigue, loss of energy, worthlessness; poor concentration, indecisiveness, thoughts of suicide<\/p>\n\n\n\n
Depression – treatments (SSRI)
Citalopram (Celexa); Escitalopram (Lexapro); Fluoxetine (Prozac); Sertraline (Zoloft)<\/p>\n\n\n\n
Depression – treatments (TCA)
Amitriptyline (Elavil); Imipramine (Tofranil)<\/p>\n\n\n\n
Depression – treatments (MAOI)
Phenelzine (Nardil)<\/p>\n\n\n\n
Depression – treatment
Psychotherapy; electroconvulsive therapy<\/p>\n\n\n\n
Diaper Dermatitis – assesment
Patchwork of bright red tender-looking skin on baby’s bottom; changes in baby’s disposition; fussy or cries when diaper area is washed\/touched<\/p>\n\n\n\n
Diaper Dermatitis – causes
wet\/infrequently changed diapers; irritation from stool\/urine; chafing; irritation from a new product; bacterial\/fungal infection; introduction to new foods; sensitive skin; antibiotics<\/p>\n\n\n\n
Diaper Dermatitis – treatment
keep baby’s skin as clean\/dry as possible; mild hydrocortisone cream; antifungal cream; topical\/oral antibiotics<\/p>\n\n\n\n
General Anxiety Disorder – assessment
Excessive worry\/anticipation of disaster; difficulties controlling worries<\/p>\n\n\n\n
General Anxiety Disorder – 6 major symptoms
Restlessness; muscle tension; irritability; easily fatigued; difficulty concentrating; difficulty sleeping<\/p>\n\n\n\n
General Anxiety Disorder – testing
diagnosed >6mo of excessive worrying and has at least 3 of the 6 major symptoms<\/p>\n\n\n\n
General Anxiety Disorder – medications (SSRI)
Indicated to use for PTSD-related anxiety; Citalopram (Celexa); Escitalopram (Lexapro); Fluoxetine (Prozac); Paroxetine (Paxil); Sertraline (Zoloft)<\/p>\n\n\n\n
General Anxiety Disorder – medications (SNRI)
Duloxetine (Cymbalta); Venlafaxine (Effexor)<\/p>\n\n\n\n
General Anxiety Disorder – medications (NDRI)
Bupropion (Wellbutrin)<\/p>\n\n\n\n
General Anxiety Disorder – medications (antihistamine)
Hydroxyzine (Vistaril\/Atarax)<\/p>\n\n\n\n
General Anxiety Disorder – medications (benzo)
Clonazepam (Klonopin) – first-line treatment; Alprazolam (Xanax); Lorazepam (Ativan); Diazepam (Valium)<\/p>\n\n\n\n
General Anxiety Disorder – medications (2nd gen antipsychotic)
Quetiapine (Seroquel)<\/p>\n\n\n\n
General Anxiety Disorder – non-pharmacologic
Cognitive behavioral therapy<\/p>\n\n\n\n
Influenza – risk factors
age, living\/working conditions; weakened immune system, chronic illnesses; race, aspirin use under 19yo; pregnancy, obesity<\/p>\n\n\n\n
Influenza – assessment
Fever; aching muscles; chills; sweats; headache; dry\/persistent cough; SOB; tiredness\/weakness; sore throat; runny\/stuffy nose; eye pain; vomiting\/diarrhea<\/p>\n\n\n\n
Influenza – testing
Rapid Influenza Diagnostic Test (RIDT) – swab, results in 10-15mins, detects antigens; Rapid Molecular Assays – detect genetic material of virus, more accurate, results in 15-20mins<\/p>\n\n\n\n
Influenza – treatment
Annual flu vaccine; antiviral drugs (best when taken within 48hrs of onset)<\/p>\n\n\n\n
Social determinants of health – economic stability
employment; food insecurity; housing instability; poverty<\/p>\n\n\n\n
Social determinants of health – education access and quality
early childhood education and development; enrollment in higher education; high school graduation; language and literacy<\/p>\n\n\n\n
Social determinants of health – health care access and quality
access to health care; access to primary care; health literacy<\/p>\n\n\n\n
Social determinants of health – neighborhood and built environment
access to foods that support healthy eating patterns; crime and violence; environmental conditions; quality of housing<\/p>\n\n\n\n
Social determinants of health – social and community context
civic participation; discrimination; incarceration; social cohesion<\/p>\n\n\n\n
Strep A Pharyngitis – causes
group A streptococcus<\/p>\n\n\n\n
Strep A Pharyngitis – assessment
sudden-onset fever accompanying a sore throat; inflammation of the pharynx and tonsils with patchy exudates and cervical lymph node adenopathy<\/p>\n\n\n\n
Strep A Pharyngitis – testing
Rapid Antigen Detection Test (RADT) – latex agglutination<\/p>\n\n\n\n
Strep A Pharyngitis – treatment
self-limiting; antibiotics recommended (Macrolides; Amoxicillin for pediatrics)<\/p>\n","protected":false},"excerpt":{"rendered":"
WGU D027 Final Exam Complete Study Guide (Latest 2023\/ 2024 Update) Advanced Pathopharmacological Foundations| Questions and Verified Answers| 100% Correct WGU D027 Final Exam Complete StudyGuide (Latest 2023\/ 2024 Update) AdvancedPathopharmacological Foundations|Questions and Verified Answers| 100%CorrectQ: Hypoplastic Left Heart Syndrome – structureAnswer:LEFT ventricle is underdevel- opedMitral valves not formed properly Aortic valve not formed properly […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[25],"tags":[],"class_list":["post-130889","post","type-post","status-publish","format-standard","hentry","category-exams-certification"],"_links":{"self":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/130889","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/comments?post=130889"}],"version-history":[{"count":0,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/130889\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/media?parent=130889"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/categories?post=130889"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/tags?post=130889"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}