WGU D027 OA Remediation (Michelle's Version)

Celiac Disease

* Lining of small intestine sees gluten as foreign invader

* Testing is IgA-tTG, Total IgA

Sjorgerens Syndrome

* Typically affects older women or patients with RA & Lupus

* Immune disorder with dry eyes and dry mouth

* Testing SSA+ and SSB+

Cinnamon effects

* Decreases glucose by acting like insulin at the cellular level

* Decreases cholesterol

* Decreases blood pressure

Hypoplastic Left Heart Syndrome (HLHS)

* Birth defect changing normal blood flow through heart

* 3-5 year survival for 70% of infants with Stage I repair

* after age 12 months long term survival 90%

Dx: echo Tx: Surgery

* S/S: high HR, SOB, poor feeding, cold/blue skin, weak

* L side heart NOT fully developed (L ventricle, mitral & aortic valve, ascending aorta, Atrial Septal Defect)

* 1st few days of life R side works to make up for L side. Patent Ductus Arteriosus & Patent Foramen Ovale assist with flow during this time.

Parathyroid Function

Produce Parathyroid Hormone and regulate Serum Calcium (Ca+)

Hutchinson-Gilford Progeria Syndrome

* Progressive genetic disorder causing child to age 10x faster than normal

* Caused by defective LMNA making protein Progerin

* S/S: short, slow growth, slow hair growth, 2 year tooth delay, wrinkles, dry skin

* Tx: NSAIDS, Statins, bone health, physical therapy

Diabetic Neuropathy Pain Meds

Cymbalta

Lyrica

Neurontin

Hydrotherapy

Helps with neurological and musculoskeletal diseases. Especially Multiple Sclerosis (MS) and Myasthenia Gravis (MG)

Decreased Lung Sounds Post Trauma (cause and tx)

* Most likely caused by pneumonthorax (air leaks between lungs and chest wall from blunt or penetrating chest injury)

* May do needle compression or chest tube

Rifampin

* Abx

* Affects oral birth control making it not work.

TSH Lab Levels and Indications

* TSH normal range 0.4 - 4.0

* High TSH = HYPOthyroid

* Low TSH = HYPERthyroid

T4 Lab Levels, Indications and Tx

* T4 normal range 5.0 - 12

* High T4 = HYPERthyroid

* Low T4 = Hypothyroid, thyroiditis or toxic multinodular goiter

* Tx: PTU (Propylthiuracil) & Methimazole (Tapazole)

T3 Lab Levels, Indications and Tx

* T3 normal range 80 - 220

* High T3 = HYPERthyroid

* Low T3 = HYPOthyroid

* Can be caused from long term illness

* Tx: Levothyroxine on empty stomach to increase absorption

Thyroid Peroxidase Antibodies (TPO) Indication & S/S

* May indicate Hashimoto Disease

* Autoimmune disease

* Most common cause of hypothyroid

* S/S: Fatigue, overly-tired, increased sensitivity to cold, dry skin, constipation, joint pain/stiffness, muscle aches, tender, stiffness.

Tyroglobulin Antibodies (Tg) Indication

* Can be a s/s of Hashimoto Disease

Crohn's Disease

* Inflammation and scarring in intestine (bowel); lining of digestive tract

* Skip lesion and small bowel cobblestoning

* Worsens after eating with pain around navel and right lower abdomen

* Tx: immunosuppressants

Ulcerative Colitis

* Chronic inflammation of large bowel

* Only in innermost lining of the large intesetine (colon) and rectum

* Tx: immunosuppressants

Sickle Cell Disease Treatments

* Hydroxyurea - decrease pain and decrease need for transfusion

* Hydration - to expand circulatory volume and clear clumps

* 02 - to increase 02 carrying capacity

* Kids should get all vaccines to avoid illness which can exacerbate sickle cell crisis pain

UTI Meds in Pregnancy

* YES - Cefalexin (Keflex)

* NO - Fluroquinolones (Cipro, Levaquin, Floxin, Avelox) because they can cause fetal defects in musculoskeletal formation

Varicella Vaccine

* Live vaccine

* DO NOT give to pregnant women. Can cause fetal defects in 1st trimester.

Treatment of Varicella Rash Pain with Kids

* YES - Acetominophen

* NO - NSAIDS (can worsen lesions)

1st Generation Schizophrenia Meds

Chlorpromazine

Haloperidol

Fluphenazine

2nd Generation Schizophrenia Meds

Risperdal

Abilify

Zyprexa

Seroquel

Geodon

Vitamins to help Schizophrenic Patients

Folic Acid

Thiamine (B Vitamins)

PPD (Purified Protein Derivative) Skin Test

* Read after 48 - 72 hours

* > 10 mm = Positive Result

*** South and Central American patients will receive >10mm reading related to Bacillus Calmette - Guerin (BCG) Vaccine. They should not receive PPD

Benign Prostatic Hyperplasia (BPH) Med

Flomax - relaxes smooth muscle

Define CHF

* Volume overload in pulmonary area (Left Ventricular Dysfunction)

* Normal EF 55 - 60%

* Left Ventricular EF <50% = Reserved

* Left Ventricular EF <40% = Preserved

Pleural Effusion Treatment

* Thoracentesis - needle decompression

* Diuretic is cause is cardiac in nature such as CHF

Treatment for Diabetics with HTN

* ACE Inhibitor or Angiotensin II Blocker (ARB) for protective effect on their kidneys

Asthma Medication Contraindication

* Avoid Non-Selective Beta Blockers as they can cause bronchial spasming

Migraine Treatment

* Chronic condition may be candidate for Botox

* Triptans may help prevent

* AVOID Triptans for patient with history of coronary artery blockage

Define SLE (Lupus)

* Autoimmune inflammatory disease

* Can affect joints, skin, kidneys, blood, brain, heart and lungs

* S/S: Fatigue, joint pain, rash, fever

* Tx: Steroid Prednisolone and Methylprednisolone

Diabetic Ketoacidosis (DKA) Definition and S/S

* Serious diabetic complication where body produces excess blood acids (ketones)

* S/S: increased thirst, increased frequency of urination, nausea, abd pain, weakness, confusion, FRUITY-SMELLING BREATH

If patient is on abx for 3 days to treat cellulitis but has persistent fever, what treatment options should be considered?

* Treat fever

* Start Broad Spectrum IV Antibiotic

* Assess patient for compliance of oral abx at home

* Culture wound (if not done previously - do culture before initiating IV abx when possible)

* Wrap wound

Medications for Panic Attack

* Benzodiazepines to treat anxiety such as Klonopin (Clonazepam)

* Catapres (Clonidine) to treat increased blood pressure and anxiety that occur together with panic attacks

What is demyelinating disease?

* Most common is Multiple Sclerosis

* Condition that results in damage to protective covering that surrounds nerve fibers in brain, optic nerve and spinal cord

How do kidneys regulate blood pressure?

* Anti-diuretic Hormone (ADH), Aldosterone or Renin-Angiotensin System

* Cause kidneys to increase reabsorption of sodium and water into the blood

Human Leukocyte Antigen (hla-b*5801) Allele adverse affect on Zyloprim (Allopurinol)

* If allele is positive then patient will potentially develop life-threatening reaction to Zyloprim (Allopurinol) which is used to treat gout, kidney stones, or increased uric acid

* MONITOR LIVER FUNCTION HEPATOTOXICITY

Medications for muscle spasms

* Baclofen (Gablofen) to treat muscle spasms

* Flexaril (Cyclobenzaprine)

* Neurontin (Gabapentin) - anticonvulsant and nerve pain treatment

Subdural Hematoma

* Pool of blood between dura mater and arachnoid membrane of the brain and spinal core

Epidural Hematoma

* Bleeding occurs between the tough outer membrane covering the brain and the skull

What disease disproportionately impacts Jewish patients?

* Tay - Sachs (GM2 Gangliosodosis)

* Destroys nerve cells in the brain and spinal cord

CKD - Stage 1

* Normal or increased

* GFR >90

* Kidney damage diagnosis and treatment

CKD - Stage 2

* Mild CKD

* GFR 60 -89

* Kidney Damage

* Evaluate progression

CKD - Stage 3

* Moderate CKD

* GFR 30 - 59

* Evaluate and treat complications

CKD - Stage 4

* Severe CKD

* GFR 15 - 29

* Prep for kidney replacement therapy

CKD - Stage 5

* End Stage CKD

* GFR <15

* Kidney failure

* Dialysis Replacement

CKD must remain low for _____ months to receive diagnosis.

3 months

1st line treatment for uncomplicated Otitis Media (OM) without comorbidities

Amoxicillin

Florinef (Fludrocortisone) indications and side effects

* Prescription medication used to treat Addison's Disease (adrenocortical insufficiency) whish is low glucocorticoid levels

* Steroid

* Side effects: increased BP, stomach pain/bloating, facial redness, pitting/scars/bumps on skin, insomnia, stretch marks, increased hair growth on body

Off label use for Prazosin/Minipress

* BPH

* Sleep aid for patient diagnosed with PTSD

Step 2 Asthma Treatment for pediatric patient with shortness of breath at night

* Preferred low dose ICS (inhaled corticosteroids)

* Consider subcutaneous allergen immunotherapy for patients with allergic asthma

Myasthenia Gravis (MG) Diagnosis

Blood test for anti-acetylcholine receptor antibody. Autoimmune neuromuscular disease

Myasthenia Gravis (MG) Signs and Symptoms

* Weakness of eye muscles (Ocular Myasthenia)

* Drooping of eye(s) (Ptosis)

* Difficulty swallowing

* Blurred/Double Vision (Diplopia)

* Dyspnea/SOB

* Change in facial expression

* Impaired speech (Dysarthria)

Myasthenia Gravis (MG) Treatment

* Pyridostigmine - helps electrical signals travel between muscles and nerves

* Corticosteroids - but cause side effects like anxiety, irritability, nausea, vomiting, bone tissue death, cataracts, glaucoma, Cushing's Disease and more

Thyrotoxicosis / Thyrotoxic Crisis (Thyroid Storm) Diagnosis

* Rare and dangerous. Can cause death within 48 hours if not treated

*Can be spontaneous

* Occurs in patients with undiagnosed or undertreated hyperthyroidism and possible excessive stress added to patient such as infection, cardio or pulmonary disorder, trauma, burn, seizure, surgery, etc.

Thyrotoxicosis / Thyrotoxic Crisis (Thyroid Storm) S/S

* Symptoms caused by sudden release and increased action of T4 and T3

* S/S: Hyperthermia, increased HR, Atrial Tachycardia Dysrhythmias, heart failure, agitation or delirium, N/V/D

Thyrotoxicosis / Thyrotoxic Crisis (Thyroid Storm) Treatment

* Drugs that block TH synthesis (PTU or Methimazole)

* Beta blockers for cardiovascular symptoms

* Corticosteroids

* Iodine (saturated solution potassium iodine) SSKI

* Supportive Care: plasma exchange or thyroidectomy may be used when medications fail

1st line of treatment for uncomplicated HTN (and why)

* HCTZ

* Because it has a lot of effect with little side effects

Fragile X Syndrome (FXS) S/S and treatment

* S/S: tremor, ataxia, unstable mood, problems with cognition, numbness to hands and feet

* Treatment: focus on managing symptoms (supportive care)

Bradycardia in different patients

* In athletes it may be normal

* In elderly or symptomatic patients with hypotension and/or decreased LOC we will treat

What is the 1st choice for antihypertensive medication for a Japanese man with HTN and CKD?

* Angiotensin Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker

* If already on ACE in Stage 3 choose Calcium Channel Blocker such as Amlodipine

If patient fails COPD treatment with LABA, what should you try next?

LABA + LAMA

Long acting beta agonist + Long acting muscarinic agonist

Medullary Thyroid Cancer (MTC)

* Occurs in C cells and secretes Calcitonin and Carcinoembryonic Antigen

* Dx with fine needle aspiration biopsy of thyroid nodule or with surgery to remove nodule

RET Proto-Oncogene

* Located on chromosome 10

* Genetic mutation seen in all cells of body when MTC is hereditary

* Genetic testing for 1st degree relatives. If they test positive on blood test, thyroid gland can be removed before MTC develops or at least in early stages.

Postural orthostatic tachycardia syndrome (POTS)

* Dx criteria: increased HR of 30+ bpm or 120 bpm within 10 min of standing in the absence of orthostatic hypotension

* In children & adolescents 40+ bpm

* Often dx with tilt test

* Approximately 25% are disabled & cannot work

* Quality of life comparable to dialysis patient

What gene is mutated in color blindness?

OPN1MW on chromosome 23 (x-linked)

Lantus (insulin glargine)

* Long acting

* Given in large doses/may cause localized burning

* To improve glycemic control with Type 1 & Type 2

* Side effects: dizzy, chills, blurred vision, weakness, HA, fainting

Alternatives for Gabapentin to treat neuropathic pain

* Cymbalta (Duloxetine)

* Lyrica (Pregabalin)

Ginko Biloba and Garlic increase risk of _____________

serious bleeding with concomitant use of anticoagulants or antiplatelet medications

G6PD

* Inherited enzyme deficiency that causes hemolytic anemia

* Body lacks enzyme that is needed to help RBCs work properly

* Tx: remove triggers such as moth balls, fava beans, red wine, all beans, blueberries, soy products, tonic water, camphor.

* Severe cases may need fluid replacement, 02 and/or blood transfusion

Treatment for mild reactions to immunoglobulin infusion

* If infusion is "fast", slow it down

* May try acetaminophen, Benadryl and steroids

* Demerol (Meperidine) for rigors

Ejection Fraction Percentages

* >50% = Normal

* 50-54 = Preserved

* <50% = Reduced

Worst prognosis of all lung cancers

Small Cell

* Survival time if untreated = 8% at 5 years

Small Cell Lung Carcinoma (SCLCs)

* Most common neuroendocrine lung tumor; 15% of all lung CA but 25% of lung CA deaths

* Most tumors start in central part of lung

* Most caused by tobacco smoking

* Rapid growth & metastasize early and widely

Small Cell Carcinoma association with tumor derived hormone production

* Arise from neuroendocrine cells with neurosecretory granules in tracheobronchial tree

* Often associated with tumor derived hormone production

* Hormone production important because S/S called Paraneoplastic Syndromes may be 1st signs of underlying CA. Examples: Hyponatremia (ADH), Cushing's (Adrenocorticotropic Hormone) Hypocalcemia (Calcitonin), Gynecomastia (Gonadotropins), Carcinoid Syndrome (Serotonin), Lamert - Eaton Myasthenic Syndrome

Thrush in infants

* Common in infants 2months or younger

* Yeast infection (candida albicans) with white/yellow irregularly shaped patches on tongue, gums, roof of mouth

* Can be picked up at birth or can be caused by not drying breast well after breast feeding

* Must treat mom and baby

* Nystatin 1st line or Fluconazole if more difficult

Celiac Testing

* Total IgA, IgA-tTG, IgA-EMA

* Possibly IgG/IgA-DGP or IgG-AGA

* Important to continue diet WITH gluten prior to testing

* If blood test is positive then MD will recommend biopsy of lining in small intestine to confirm diagnosis

Lavender Indications

* Restlessness, insomnia, nervousness, depression, headaches and exhaustion

* Digestive uses: Gas/bloating, loss of appetite, N/V, upset stomach

Contraceptives and breastfeeding

Combined contraceptives CANNOT be used

A-fib

* Irregularly irregular heart beat

* If untreated patient will often be tachycardic

CYP3A4

Important in metabolism of codeine

CYP2D6

Important in metabolism of opioids

Pregnancy and TB Treatment

* Isoniazid (INH), Rifampin and Ethambutol for 2 months

THEN

* INH and Rifampin daily or twice weekly for 7 months