NSG5003 Advanced Pathophysiology
Week 1 Discussion
Myocardial Infarction
Mr. Smith, a 60 year-old man with coronary heart disease, experienced frequent bouts of angina pectoris. One day while moving a piece of heavy furniture, he experienced excruciating pain over his left chest. He began sweating heavily, became short of breath, and then collapsed. He was transferred to the emergency room at a nearby hospital. Mr. Smith’s EKG was diagnostic of myocardial infarction. A coronary angiography was performed and an occlusion was found in a in the descending branch of the left coronary artery. Intravenous drugs were administered to dissolve the clot that was causing the obstruction. His cardiologist informed him that some of his heart muscle had died as a result of the myocardial infarction.
Discussion Questions:
1. Discuss the risk factors for a myocardial infarction.
2. As per your analysis, what type of cell injury did Mr. Smith sustain and why?
3. Differentiate between reversible and non-reversible cell injury.
4. Discuss the pathophysiological changes that occur during a myocardial infarction.
5. Correlate the subjective and objective findings of a myocardial infarction with the disease
NSG5003 Advanced Pathophysiology
Week 2 Discussion
Alterations in Immunity
Janet, a 20 year-old college student, is experiencing a five-week history of itchy eyes and nasal congestion with watery nasal discharge. She also complains of a “tickling” cough, especially at night, and she has had episodes of repetitive sneezing. Janet gets frequent “colds” every spring and fall.
Physical Examination
Vital Signs: Temp, 98.8; BP 110/68; Pulse 72; Respirations 18
Skin: Flaking erythematous rash on the flexor surfaces of both arms
Head, Eyes, Ears, Nose, and Throat: Tender over maxillary sinuses; sclera red and slightly swollen with frequent tearing; outer nares with red, irritated skin; internal nares with red, boggy, moist mucosa and one medium-sized polyp on each side; pharynx slightly erythematous, with clear postnasal drainage
Lungs: Clear to auscultation and percussion
Discussion Questions:
1. Provide three differential diagnoses based on Janet’s subjective and objective data and discuss your reasoning for each.
2. What additional history questions would be useful in your evaluation of Janet?
3. Discuss the pathophysiological process of your primary diagnosis.
4. Differentiate the types of hypersensitivity mechanisms.
5. As per your analysis, what type of hypersensitivity reaction is Janet experiencing?
NSG5003 Advanced Pathophysiology
Week 3 Discussion
Cancer, Genetics, and Genomics
Rachel comes from a family with a history of breast cancer on her mother’s side. Rachel’s mother died of breast cancer when she was very young. Rachel has two sisters, Lisa and Kristin. Rachel has remained close to Lisa, but she no longer has a relationship with Kristin. At a routine checkup, Rachel is told about the availability of genetic testing for identifying a predisposition to breast cancer. Her doctor recommends the test to Rachel given her family history. Rachel has the genetic testing done and finds that she has a mutated breast cancer 1, early onset (BRCA1) gene. Her doctor tells her she is at high risk for developing breast and ovarian cancer. Rachel’s doctor suggests she ask her sisters to be tested also, so they can take the proper preventative measures. Rachel feels comfortable sharing this information with Lisa, but she has not spoken to Kristin in many years. Rachel tells her doctor that she is not in contact with Kristin and will not make an effort to tell her about BRCA1 and genetic testing. Rachel’s doctor feels confident that she can locate Kristin but worries about breaching patient confidentiality if she goes against Rachel’s wishes.
If you were Rachel’s healthcare provider, what would you do? Provide a rationale for your response. Include the pathological processes associated with breast cancer. What role does the BRCA1 gene contribute to managing the patient’s care? Describe and explain the role of the BRCA1 and breast cancer 2, early onset (BRCA2) gene in contribution as a risk factor for breast cancer. Analyze the risk factors for breast cancer and possible interventions to preventive health management for women and men.
NSG5003 Advanced Pathophysiology
Week 4 Discussion
Cardiovascular Case Study
John is a 76-year-old man with a long history of stable angina and hypertension. He is prescribed nitroglycerin tablets as needed for chest pain and lisinopril for his hypertension. John has noticed that his chest pain is occurring with increasing frequency and less activity is required to initiate the symptoms; however, the pain subsides quickly with rest and one or two nitroglycerin tablets.
John is awakened from sleep with chest pain and shortness of breath. The pain is much more severe than his usual anginal pain and radiates to the jaw and the left arm. He experienced some nausea and became diaphoretic and pale. Upon admission to the local emergency department, he was noted to have significant ST-segment elevation on a 12-lead electrocardiogram (ECG).
Discussion Questions:
1. What diagnosis is consistent with John’s history and physical exam?
2. Please differentiate between a STEMI and Non-STEMI.
3. What are the pathophysiological findings specifying an MI?
4.What are the differences between angina, silent ischemia, and myocardial ischemia?
5.Provide a description of the three factors associated with Sudden Cardiac Death.
6.What are the possible complications post-MI might the NP be aware of when caring for John?
NSG5003 Advanced Pathophysiology
Week 5 Discussion
Emphysema
Charlene is a 55-year-old female who has had emphysema problems for many years. She has a 20-year history of tobacco use. Today, Charlene was seen in the clinic due today increased shortness of breath and non-productive cough over the past three days. She has an SaO2 of 90% with most recent pulmonary function test findings indicating the following: FVC- 70% FEV1-69% FEV1/FVC ratio-69%.
Discussion Questions:
1. What physical findings might be indicative of a patient with emphysema?
2. What is the purpose and interpretations of the pulmonary function test?
3. What are the pathophysiological findings specifying emphysema?
4. What are the three functions of the respiratory center located in the brain stem?
5. Please provide a description of the oxyhemoglobin dissociation curve?
6. What are the pathophysiological findings specifying bronchitis?
NSG5003 Advanced Pathophysiology
Week 6 Discussion
Hematological Case Study
Sarah is in today with a chief complaint of feelings of fatigue, pallor, dyspnea on exertion, and palpitations. Her laboratory report indicates that her hematocrit, hemoglobin, and reticulocyte counts are low; that her MCV is high; and that her MCH and MCHC are normal. Her diagnosis is pernicious anemia.
Answer the following questions regarding Sarah’s anemia and provide the pathophysiology associated with the body’s response to this disease process.
1. What are the laboratory tests to be ordered in patients suspected of anemia?
2. What are the clinical manifestations noted in a patient with pernicious anemia?
3. What nonpharmacological therapies are associated with the treatment of pernicious anemia?
4. What the lab findings indicative iron deficiency anemia?
5. Please share possible complications of untreated pernicious anemia.
6. What is the purpose of the Schilling test?
NSG5003 Advanced Pathophysiology
Week 7 Discussion
Digestive System Case Study
DC comes to the emergency room complaining of acute abdominal pain. She states the pain came after dinner at an all-you-can-eat buffet and has been increasing steadily. The pain is located in her right upper quadrant and is “boring” into her back. She says she feels “gassy” and bloated.
What are your differential diagnoses? Include the pathological process involved with your diagnosis. What tests would you order to confirm your diagnosis?
What treatments or interventions would be the first line of protocol for your diagnosis?
NSG5003 Advanced Pathophysiology
Week 8 Discussion
Overview of the Mechanisms of Kidney Function
Ms. Cornwall is admitted with pyelonephritis. She has chills, and her temperature is 101°F. She is complaining of flank pain, frequency, and dysuria. Her urine has white blood cell casts and shows growth of Escherichia coli (E. coli).
Based on the above scenario, answer the following questions:
Why does she have bacteria and white blood cell casts in her urine? Include the pathophysiological response of body for your analysis.
What are the differences when comparing prerenal acute renal injury, intrarenal acute renal injury, and postrenal acute renal injury? Give examples of each and pathological processes related to each disease process.
NSG5003 Advanced Pathophysiology
Week 9 Discussion
Neurological System Case Study – #1
Mrs. Smith is an 85 year female with a history of Hypertension, diabetes and osteoarthritis. Her daughter who cares for her reports that she became suddenly confused beginning last night. She knows her daughter but has been unable to remember her grandchildren’s names. She continuously asks her daughter “What are those kids doing in our house?” .Her mother was in and out of bed all night and slept very little. Her daughter does say that her mother seemed better this morning, but on the way to your office she became more confused again. Review of systems is significant for a dry cough for the past few days. She has not had a fever. Her appetite has been poor. Her exam is normal except for some fine crackles in her left lung base. Mrs. Smith’s daughter says” My dad had Alzheimer’s and now it looks like I am going to have to go through that with my mother”
1) What are the possibilities for change in Mrs. Smith’s current mental status?
2) What is your top differential diagnosis? Give 3 reasons why you chose that diagnosis.
3) How can you differentiate depression, dementia and delirium?
4) Explain to Mrs. Smith’s daughter what treatment is needed and what you think her prognosis is.
Neurological System Case Study – #2
A 40 year old male comes to see you for follow up. He states that he had a seizure at home yesterday and was taken to the emergency room. He is accompanied by his wife who witnessed the seizure. He states he has never had a seizure in the past.
Discussion Questions:
1) What would you ask him and his wife regarding the seizures, and why?
2) What would be the most important parts of a physical exam in this patient and why?
3) What lab or radiology tests would you want to do and why? He tells you he has no insurance so be sure to defend the importance of a particular test.
NSG5003 Advanced Pathophysiology
Week 10 Discussion
Diabetes
1) Describe the 3 types of diabetes Insipidus.
2) What lab values would you expect to see with each type?
3) Describe the causes/potential causes of each type and how the treatment varies between the 3 types and why
4) What would indicate a “red flag “symptom in any of them and require urgent treatment
Case Study:
A 30 yr. old female comes to see you for complaints of fatigue. She is 8 months post-partum and delivered a healthy baby. She thought her fatigue was initially due to post-partum, but states that the fatigue is worsening. She is also bothered by some weight gain over the past few months.
1) What else would you want to ask in her review of systems?
2) What specifics would you look for on physical exam?
3) How would you explain to her the most likely cause of her symptoms and why this is happening?
Case Study:
A 55 year old obese male (BMI 33.1) comes to see you with complaints of weight gain and fatigue. His history is significant for hypertension and hyperlipidemia. These are controlled with medications. You check a random fasting blood sugar in the office and it is 150 fasting. His point of care HgBA1C is 6.6
1) Explain how his obesity contributes to the beta cell dysfunction seen with Type 2 DM
2) Explain how GLP 1 receptor agonists improve glucose control in the diabetic patient.
3) What are the pros can cons of dipeptidyl peptidase IV (DPP-IV) inhibitors versus GLP 1 receptor
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