001 - Study Diary

• 001 - Genetics and Epigenetics

(2) Recessive vs Dominant & Sex vs Autosomal Inheritance

• Recessive inheritance requires two copies of a gene mutation to show the trait'

• Dominant Inheritance only needs one copy

• Sex-linked traits are determined by genes on sex chromosomes, like X-linked genes passed from mothers to sons. It is a type of autosomal inheritance, but specifically refers to genes on sex chromosomes

• Autosomal inheritance involves genes on non-sex chromosomes and can be recessive or dominant

(3) Haploid, Diploid, Aneuploid, Polyploid

• Haploid cells have half the usual number of chromosomes

• Diploid cells have the full set

• Aneuploidy is when there’s an abnormal number of chromosomes, like 45 or 46 instead of 46

• Polyploidy is having more than two complete sets of chromosomes, common in plants some fish, and amphibians

(4) Aneuploid Conditions

Aneuploid conditions are abnormalities in the number of chromosomes in a cell.

For example, Down Syndrome is caused by trisomy of chromosome 21, when there is an extra copy of this chromosome.

Other Aneuploidy conditions include:

• Patau syndrome (trisomy 13)

• Edward syndrome (trisomy 18)

• Turner syndrome (XO)

• Klinefelter syndrome (XXY)

These conditions result from errors in chromosome segregation during cell division, leading to an abnormal chromosome number.

(5) Epigenetic Factors

Epigenetic factors refer to changes in gene expression that do not involve alterations in the DNA sequence

• These changes can be influenced by various factors such as:

  • diet

  • age

  • gender

  • ethnicity

  • amount of sleep

  • lifestyle

  • environment

Epigenetic modifications like:

• DNA methylations

• histone modifications

• chromatin remodeling

• microRNAs

• non-coding RNAs

- Can impact gene activity and contribute to diseases like:

• diabetes

• cancer

• obesity

• cardiovascular events

• cognitive decline

These modifications can occur at different stages of life, from childhood to adulthood, and even affect future generations through germ cells.

Overall, epigenetic factors play a crucial role in regulating gee expression and can have significant implications for health and disease susceptibility

(6) Microbiome Factors

Microbiome factors refer to the influence of microorganisms living in and on the human body on health and disease.

These factors can impact various aspects such as:

• mood

• weight

• food cravings

• metabolism

• immune system and function

Microbiome factors play a crucial role in preventing diseases like:

• asthma

• obesity

• autism

• metabolic disorders

• liver disease

• stroke

• diabetes

• cancer

The microbiome aids in processes like:

• digestion

• production of antimicrobial chemicals

• lubrication of tissues

• fortifying the immune system

In interacts with:

• genetics

• epigenetics

• environmental factors

- to contribute to overall health

Abnormalities in the microbiome can lead to or exacerbate various diseases, highlighting the importance of understanding and maintaining a healthy microbiome for overall well-being.

• 001 - Atherosclerosis & Cholesterol

(1) Understand the types function of lipoproteins

• Lipoproteins are molecules that transport fats through the blood

• They consist of proteins that wrap around fats to make them water-soluble

• There are different types of lipoproteins including,

  • chylomicrons : are lipoproteins with a diameter of around 1000nm that transport dietary triglycerides and cholesterol from the intestines to the liver and other tissues. They are the largest and least dense lipoproteins, mainly composed of triglycerides

  • VLDL : Very low density lipoproteins. It is a type of lipoprotein that carries triglycerides, cholesterol, and other lipids from the liver to tissues in the body. VLDL is considered a “bad” cholesterol because it can contribute to the buildup of plaque in arteries

  • IDL : Intermediate-Density Lipoproteins. It is a type of lipoprotein that is formed from the breakdown of VLDL in the bloodstream. IDL contains a mix of cholesterol and triglycerides and plays a role in the transportation of lipids in the body

  • LDL : Low Density Lipoproteins. It is a type of lipoproteins that carries cholesterol from the liver to cells in the body. LDL is often referred to as “bad cholesterol” because high levels of LDL can lead to a buildup of cholesterol in the arteries, increasing the risk of heart disease and atherosclerosis

  • HDL : stands for High-Density Lipoproteins. It is considered “good cholesterol” because it helps transport cholesterol from tissues to the liver for excretion or reuse. HDLs are composed of half protein and half lipids, including cholesterol, triglycerides, and phospholipids. They play a crucial role in removing excess cholesterol from the bloodstream, thus reducing the risk of cardiovascular diseases.

• LDL is considered “bad cholesterol” as it carries a higher percentage of cholesterol, while HDL is considered “good cholesterol” as it helps transport cholesterol from tissues to the liver for excretion or reuse.

(2) Review age related changes within the circulatory system.

Age-related changes within the circulatory system include:

• arterial stiffness

• decreased elasticity of blood vessels

• decline in cardiac function

As people age, arteries become thicker and stiffer, leading to conditions like arteriosclerosis

Additionally, the heart muscle may weaken, affecting its ability to pump blood efficiently

These changes can contribute to the development of cardiovascular diseases such as atherosclerosis and hypertension

(3) Describe the role and of cholesterol in the development of atherosclerosis

Cholesterol plays a crucial role in the development of atherosclerosis.

1. Low-density lipoproteins (LDL) enter the arterial wall and become oxidized

2. Leading to the inflammation and the adhesion of monocytes and T lymphocytes

3. Monocytes transform into macrophages, consuming LDL and forming foam cells

4. These foam cells release growth factors that promote atherosclerosis by stimulating smooth muscle cell proliferation and collagen migration, ultimately forming fibrous plaques

5. These plaques can calcify, obstruct blood flow, and even rupture, leading to thrombus formation, ischemia, and infarction

(4) Describe the aetiology, pathophysiology & clinical manifestations of atherosclerosis.

Aetiology of atherosclerosis:

• Atherosclerosis is caused by the buildup of soft deposits of fat and fibrin in the vessel walls, leading to the formation of fatty streaks.

• This process in initiated by the endothelial cell injury, which triggers inflammation and the adherence of monocytes and other inflammatory cells to the damaged endothelium

• The oxidization of LDL by toxic oxygen radicals leads to the formation of foam cells, which penetrate the vessel walls and contribute to the development of fatty streaks

• Over time, smooth muscle cells and collagen migrate over the fatty streaks, forming a fibrous plaque that can calcify, protrude into the vessel lumen, and obstruct blood flow.

• In some cases, the fibrous plaque may rupture, leading to thrombus formation, ischemia, and infarction

Pathophysiology of Atherosclerosis:

• Atherosclerosis begins with endothelial cell injury, leading to inflammation and vasoconstriction

• Inflammatory cells cause further damage, leading to the oxidation of LDL by toxic radicals

• Macrophages engulf oxidized LDL, forming foam cells that penetrate vessel walls, creating fatty streaks

• Smooth muscle cells and collagen cover the streak, forming a fibrous plaque

• This plaque can calcify, obstructing blood flow, or rupture, leading to thrombus formation, causing ischemia and infarction

Clinical manifestations of Atherosclerosis:

• angina

• heart attack

• acute coronary syndromes like unstable angina or myocardial infarction

Atherosclerosis leads to plaque buildup in arteries, causing narrowing and potential blockages, which can result in reduced blood flow to the heart or brain, leading to symptoms like chest pain (angina) or more severe events like heart attacks or sudden death

The progression of atherosclerosis can lead to different clinical outcomes depending on the severity of the arterial obstruction

(5) Describe the role of atherosclerosis in acute coronary syndromes, stroke and PVD

Atherosclerosis plays a critical role in acute coronary syndromes, stroke, and peripheral vascular disease (PVD) by causing blockages in blood vessels.

• In acute coronary syndromes,

  • atherosclerosis leads to plaque buildup in coronary arteries, potentially resulting in angina, myocardial infarction, or sudden death.

  • atherosclerosis, characterized by the buildup of fatty deposits in the arterial walls, can progress to the point where the plaque cracks, leading to the formation of a blood clot that can block the artery, resulting in acute coronary syndromes

• In stroke,

  • atherosclerosis can cause blockages in cerebral arteries, leading to reduced blood flow to the brain and subsequent stroke

  • Atherosclerosis can lead to stroke by causing the formation of fibrous plaques in blood vessels, which may rupture and trigger clotting

  • When a fibrous plaque ruptures, platelets adhere to the site, initiating the clotting cascade and forming a thrombus. If this thrombus obstructs blood flow to the brain, it can lead to ischemia and infarction, resulting in a stroke

• In PVD,

  • Atherosclerosis can contribute to Peripheral Vascular Disease (PVD) by causing the formation of plaques in the arteries supplying blood to the extremities

  • atherosclerosis can lead to reduced blood flow in peripheral arteries, causing symptoms like leg pain, cramping, and potential tissue damage due to lack of oxygen known as claudication

  • In severe cases, atherosclerosis in the peripheral arteries can lead to tissue damage, non-healing wounds, and even amputation due to insufficient blood supply

Overall, atherosclerosis contributes to the development of these conditions by narrowing or blocking blood vessels, compromising blood flow to vital organs and tissues.

• 001 - Obesity / Excess Adiposity

(1) Review the incidence of obesity in New Zealand and understand how these stats are derived

• In New Zealand, about 1 in 3 adults are classified as obese, with Pacifica and Māori ethnicities having higher rates.

• Around 12.7% of children are obese

• These statistics are derived from the New Zealand Health Survey 2020/21, which collects data on obesity prevalence by ethnicity and age groups

• The data provides insights into the incidence of obesity in New Zealand and helps in understanding the distribution of obesity across different demographics

(2) Understand the factors that influence obesity

Factors that influence obesity include:

• unhealthy diet

• physical inactivity

• stress

• smoking

• socioeconomic factors

• genetic factors

• metabolic disorders

• hormone imbalances

• food preferences

• time convenience

• accessibility

• knowledge

• habits

• cost

• social and cultural aspects

• macros

• genetics

• age

• stress

• hormones

• gender

• enjoyment

• safety

• affordability

• motivation

• physical ability

• exercise habits

• post-exercise activity

These factors can impact energy balance, leading to high adiposity when energy intake exceeds expenditure. Obesity is linked to serious health conditions like diabetes, cardiovascular issues, dementia, certain cancers, mental illnesses, and chronic pain

(3) Explain the pathophysiology of obesity

Obesity is a complex condition involving excessive body fat accumulation.

It is associated with adipose tissue dysfunction, altered metabolic health, and systematic inflammation.

• Adipose tissue acts as an endocrine organ, releasing hormones and cytokines that can lead to insulin resistance, cardiovascular disease, and other complications.

• Genetic factors also play a role in obesity development

• Additionally, gut microbiome composition has been linked to obesity

• Free fatty acids can induce cardiac dysfunction and impact insulin signaling pathways.

• Maternal nutrition can influence the risk of obesity in offspring through developmental plasticity

Overall, obesity involves a combination of genetic, metabolic, hormonal, and environmental factors that contribute to its pathophysiology

(4) Understand the complications of obesity and the implications for health and disease

Obesity can lead to various health complications such as:

• cardiovascular disease

• respiratory disorders

• type 2 diabetes

• gallbladder and liver disease

• insulin resistance

• dyslipidemia

• metabolic syndrome

These complications can result in serious health conditions like:

• cardiovascular problems

• diabetes

• cancer

• mental illnesses

• chronic pain

Obesity is linked to increased risk of mortality, particularly in younger age groups

In children, obesity can cause social and psychological issues, changes in bone shape, early onset of puberty, and other conditions like diabetes

Overall, obesity has significant implications for health increasing the risk of various diseases and reducing life expectancy

(5) Identify assessments used to monitor and manage obesity

Assessments used to monitor and manage obesity include:

• Body mass index (BMI)

• waist circumference measurement

• body fat distribution assessment using techniques like:

  • dual-energy X-ray absorptiometry (DXA)

  • blood tests for cholesterol levels (LDL, HDL, Triglycerides)

  • C-reactive protein

  • HbA1c

  • Full blood count

  • Liver function test

These assessments help in evaluating obesity, determining health risks, and guiding in treatment strategies

• 001 - Smoking Effects

(1) Describe both the neural and physical effects of nicotine or cholinergic receptors

Nicotine binds to nicotinic acetylcholine receptors (nAChRs) in the brain, stimulating the release of acetylcholine and dopamine.

This interaction leads to increase dopamine levels in the Nucleus Accumbens, associated with feelings of pleasure and reward, reinforcing addiction.

Physically nicotine’s effects on cholinergic receptors can lead to addiction and long-term health issues related to smoking, such as lung damage.

(2) Describe long term effects of smoke inhalation on lungs

Long-term effects of smoke inhalation on lungs include:

• hyperplasia of goblet cells leading to increased mucous production

• reduction in airway diameter

• destruction of cilia

• coating of lungs in tar

• destruction of alveolar walls

• chronic inflammation

• pre-cancerous changes in cells

• increased lung diseases such as:

  • Chronic Obstructive Pulmonary Disorder (COPD)

  • emphysema

  • chronic bronchitis

Smoking can also lead to:

• cancer

• heart disease

• stroke

• diabetes

(3) Describe effects of vaping substances on lungs

Vaping substances can lead to:

• Dehydration

• damage to the respiratory tract lining

• localised inflammation

• disruption in gas exchange at alveoli

• changes in mucous and surfactant concentrations

• alterations in surface tension

The aerosol particles from vaping penetrate deeply into lung tissue, causing potential long-term effects that are still unknown

• 001 - Hypertension

(1) Understand the significant public health concerns caused by hypertension

Hypertension is a significant public health concern due to its widespread impact on individuals, families, and communities

It is often remains undiagnosed until serious health issues like heart disease, stroke, or kidney problems develop.

In New Zealand, 1 in 5 people are affected by hypertension, with Maori being disproportionately affected.

This condition contributes significantly to heart disease and stroke, leading to a substantial economic burden on the healthcare system.

Families may face financial strain from frequent doctor visits and medication costs

Additionally, caregivers may experience stress and lack of support when caring for individuals with hypertension-related complications

(2) Review the physiology of factors affecting blood pressure

Blood pressure is regulated by various factors

Homeostatic mechanisms through the autonomic nervous system (ANS) plays a crucial role.

1. Baroreceptors in the aorta and carotid arteries detect pressure changes

2. Signaling the sympathetic nervous system (SNS) to increase cardiac output, peripheral resistance, and blood volume when pressure drops

Conversely, when pressure rises: They activate the parasympathetic nervous system (PNS) to decrease these parameters.

Factors that affect blood pressure:

• Cardiac output (CO)

• Heart rate (HR)

• Stroke volume (SV)

• Vascular resistance

• Blood volume

(3) Define primary and secondary hypertension

Primary Hypertension, which accounts for 90-95% of cases.

• Is high blood pressure with no identifiable cause

• It is influenced by genetic and environmental factors, defects in vascular structure, renal sodium handling, and hormonal regulation

Secondary hypertension

• Is caused by underlying conditions like kidney disease, endocrine disorders, or certain medications

It is essential to differentiate between the two types to determine appropriate treatment measures

(4) Discuss modifiable & non-modifiable risk factors

Modifiable risk factors in regards to hypertension:

• Heavy alcohol intake

• High salt intake

• Sedentary lifestyle

• Low intake of potassium, calcium, and magnesium

Non-Modifiable risk factors in regards to hypertension:

• Family history

• age

• gender

• abdominal obesity

Other factors such as glucose intolerance and environmental influences can also contribute to HTN.

Lifestyle changes can help manage modifiable risk factors, while non-modifiable factors may require medical intervention

(5) Explain the pathophysiology and clinical manifestations of hypertension

Physiology of HTN:

• Hypertension in primarily caused by increase peripheral vascular resistance, leading to increased workload for the left ventricle.

• This results in the release of renin-angiotensin-aldosterone and activation of the sympathetic nervous system causing ventricular hypertrophy.

• Overtime, this leads to ventricular remodeling, decreased contractility, and under perfusion of vital tissues, contributing to chronic hypertension

Other factors like genetic influences, environmental factors, defects in vascular structure, and inadequate sodium excretion also play a role in the development in hypertension

Clinical manifestations of HTN:

The clinical manifestations of hypertension can be early with no symptoms, earning it the term “silent condition”

Later, symptoms arise due to organ damage and vascular changes.

These include:

• Heart disease

• renal insufficiency

• brain dysfunction

• impaired vision and mobility

• vascular occlusion

• oedema

Additionally, individuals may experience changes in eyesight, headaches, stroke cardiac or kidney problems due to hypertension

(6) Outline treatment measures

Treatment measures for hypertension include non-pharmacological lifestyle regimens like exercise and diet modifications, as well as pharmacological treatments aiming to reduce stroke volume, total peripheral resistance, and heart rate.

Medications such as:

• diuretics

• ACE-inhibitors

• angiotensin II blockers

• calcium channel blockers

• aplha-blockers

• direct-acting vasodilators

• beta-blockers

Lifestyle changes like:

• reducing salt intake

• maintaining a healthy weight

• exercising regularly

• avoiding excessive alcohol consumption

• 001 - Theories of Mental Health

(1) Describe the natural development of the mind and mental wellbeing

The natural development of the mind mental wellbeing encompasses:

• neurological development

• emotional development

• social development

It involves the growth and maturation of the:

• brain

• ability to regulate emotions

• form relationships

• cope with stress

Factors that influence mental health throughout one’s lifespan, from infancy to old age:

• genetics

• environment

• life experiences

This development can be influenced by various macro determinants such as access to healthcare, education, and social support

(2) Describe the development of dysfunction of the mind and mental illness

The development of dysfunction of the mind and mental illness involves various factors such as:

• genetic predisposition

  • Genetic factors can predispose individuals to conditions like schizophrenia or bipolar disease

• environmental stressors

  • Such as trauma or chronic stress can trigger mental health issues

• neurochemical imbalances

  • imbalances in neurotransmitters like serotonin or dopamine can also contribute to conditions like depression or anxiety disorders

The interaction of these factors can lead to the onset and progression of mental illnesses

• 001 - Addiction and Substance Abuse

(1) What is addiction and what causes its addictive behavior

Addiction is a complex brain disease characterized by compulsive substance use despite harmful consequences

• It involves the overactivation of the brain’s reward circuit, particularly the basal ganglia, leading to euphoria from the drug high

• With repeated exposure, the brain adapts, making it hard to feel pleasure from anything else

• Additionally, the extended amygdala plays a role in motivation individuals to seek the drug again to relieve withdrawal symptoms like anxiety and unease

• The factors contribute to addictive behavior by altering brain function and reinforcing drug-seeking behavior

(2) Substances of mis-use: Alcohol, Amphetamine Type Substances, Opioids, Cannabis

• The substance of mis-use in regards to alcohol is ethanol

  • Ethanol is the main psychoactive ingredient in alcoholic beverages that affects the CNS.

  • It is found beer, wine, and spirits

  • Ethanol can have detrimental effects on the brain, as shown by the differences in cortical gray matter volumes between alcoholic and control subjects

• Amphetamine-like substances, such as methamphetamine and MDMA (ecstasy), are substances of misuse that effect the CNS

  • They can lead to alterations in brain dopamine transporters

  • These substances can have significant impacts on the brain and behavior, leading to addiction and other health issues

• Opioids are substances that have a morphine-like effect on the CNS

  • They can be synthetic, like methadone and fentanyl, semi-synthetic like heroin, or natural opiates derived from poppy juice, such as morphine

  • These substances can have a significant impact on the CNS

• Cannabis is a substance of misuse due to its psychoactive ingredient THC, which affects the CNS

  • Cannabis is known for its mind-altering effects and potential for abuse, leading to its classification as a substance of misuse

  • The psychoactive properties from THC can cause changes in mood, perception, and cognition, making it a popular choice for recreational use but also a substance that can be misused and have negative effects on health and well-being

(3) Nursing Assessment and Management

Nursing Assessment and management of Addiction involves:

• Screening

  • Helps identify addiction issues early

• Assessment

  • determines the severity and underlying causes

• Abstinence

  • focuses on completing cessation of substance abuse

• Harm reduction

  • aims to minimize negative consequences

• Therapy

  • involves counselling and behavioral intervention

• Rehabilitation

  • Rehabilitation programs offer structures support for recovery

• Patient education

  • provides information on addiction, its effects, and coping strategies

Neonates may require specialised care due to maternal substance abuse during pregnancy.

These strategies aim to address addiction comprehensively and support individuals in their recovery journey

• 001 - Alcohol use Disorder

(1) Able to define Alcohol Use Disorder (AUD)

Alcohol Use Disorder (AUD) is a chronic relapsing brain disorder characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational or health consequences

It is commonly referred to as alcoholism and is defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM) 5th Edition through specific through specific criteria

(2) Able to describe the aetiology, diagnosis, and treatment of AUD

The aetiology of AUD involves genetic and environmental factors.

• Research indicates genes contribute to about half of the risk for AUD, while environmental factors and gene-environment interactions play a role in the remaining risk

Diagnosis of AUD is based on criteria such as impaired ability to control alcohol use despite negative consequences

Treatment for AUD typically involves a combination of therapies, including behavioral therapies, medications and support groups to help individuals manage ad overcome their alcohol

(3) Able to describe the basic pathophysiology of short and long term alcohol use

Short-term alcohol use leads to:

• Mild dehydration

• Gastrointestinal issues

• Acetaldehyde exposure

• Sleep disturbances

Long-term alcohol use can result in:

• heart disease

• stroke

• liver disease

• cancer

• pancreatitis

• Fetal Alcohol Spectrum Disorder (FASD) which can lead to:

  • low birth weight

  • distinctive facial features

  • heart defects

  • behavioral problems

  • intellectual disability

Alcohol can cause neurotoxicity through excitotoxicity, acetaldehyde, and inflammatory processes, leading to:

• cognitive decline

• peripheral neuropathy

• increased risk of dementia

(4) Able to discuss the impact of AUD on individual, Whanau and Community

AUD impacts individuals, families (whanau), and communities at physical social, and mental levels

For individuals, AUD can lead to health issues affecting all organs

Within families, it can cause issues like divorce domestic abuse, and homelessness

In communities, AUD can contribute to unemployment, crime, and social problems like homelessness

The effects of AUD are far-reaching and can have detrimental consequences on various levels of society

• 001 - Anxiety

(1) Explain the aetiology, pathophysiology, and presentation of anxiety

Aetiology of Anxiety:

• Anxiety disorders are caused by a combination of genetic vulnerability and stressful or traumatic situations

• Factors like:

  • medications

  • substance abuse

  • trauma

  • childhood experiences

  • - can also contribute to the development of anxiety disorders

• The brain releases stress hormones like adrenaline and cortisol in response to threats, leading to increased arousal and specific behavior patterns associated with anxiety

• Neurotransmitters like:

  • norepinephrine

  • serotonin

  • dopamine

  • GABA

  • - play a role in mediating anxiety symptoms, along with the ANS, particularly the SNS

Pathophysiology of Anxiety:

• Anxiety is a state induced by a threat, leading to the release of stress hormone like adrenaline and cortisol

• The brain’s stress response system, involving neurotransmitters like norepinephrine, serotonin, dopamine, GABA, plays a role

• Overactive SNS stimulation and cortisol imbalance can result from long-term exposure to stress hormones, contributing to anxiety disorders

Presentation of Anxiety:

• Anxiety is presented as a psychological, physiological, and behavioral state triggered by a threat to well-being

• It is characterized by the increased arousal, autonomic and neuroendocrine activation, and specific behavior patterns like excessive worry

• The brain releases stress hormones like adrenaline and cortisol, leading to a fight or flights response

• Symptoms can include persistent or episodic anxiety, specific anxiety disorders, and a heightened flight or flight response.

• It can be triggered by various factors like medications, trauma, childhood experiences

(2) Discuss the impact of acute physical & mental health changes in individuals, whanau, and communities

Individuals experiencing acute physical and mental health changes may face challenges such as frequent relapses, poor physical health, financial issues, and difficulties in relationships

This can lead to an increased hospital admissions, homelessness risk, stigma and reduced quality of life. Families (whanau) may bear a burden of care, and communities may see higher rates of violence, suicide, and offending.

These impacts can strain support systems and hinder engagement in treatment, affecting the overall well-being of individuals, families, and communities

• 001- Diabetes LTC

(1) Provide an overview of the role of the pancreas and pancreatic hormones

The pancreas plays a crucial role in regulating blood sugar levels through the secretion of pancreatic hormones.

• Insulin in an anabolic hormone that promotes glucose uptake in cells, protein synthesis, and lipid formation

• Glucagon, a catabolic hormone increases blood sugar levels by stimulating glycogenolysis and gluconeogenesis

• Amylin, co-secreted with insulin, suppresses glucagon release

• C-peptide, a byproduct of insulin production, indirectly measures insulin levels

These hormones work together to maintain glucose homeostasis in the body

(2) Review the disordered processes that lead to the clinical manifestations of diabetes

The disordered processes that lead to the clinical manifestations of diabetes involve issues with insulin production or function.

In Type 1 diabetes,

• the immune system attacks and destroys insulin-producing beta cells in the pancreas, leading to little to no insulin production

• This results in high blood sugar levels, causing symptoms like polydipsia, polyuria, polyphagia, weight loss, fatigue, and other complications

In Type 2 diabetes,

• the body becomes resistant to the effects of insulin or doesn’t produce enough insulin to maintain normal glucose levels, leading to similar symptoms and complications

(3) Differentiate between the ‘types’ of diabetes

Type 1 Diabetes

• is an autoimmune condition where the body attacks insulin-producing cells, requiring lifelong insulin therapy

• Symptoms include:

  • polydipsia

  • polyphagia

  • polyuria

  • weight loss

  • fatigue

Type 2 Diabetes

• is often asymptomatic and can lead to chronic complications like infections, neuropathy, and retinopathy

Gestational Diabetes

• occurs during pregnancy, Cystic fibrosis-related diabetes affect those with CF

Monogenic Diabetes Syndromes

• include neonatal diabetes and MODY (Maturity-Onset Diabetes of the Young, more on that), caused by genetic mutations affecting insulin production

• MODY = stands for Maturity-Onset Diabetes of the Young. It is a type of monogenic diabetes syndrome characterized by mutations in a single gene. Individuals with MODY often develop diabetes at a young age, typically before the age of 25, an have a strong family history of diabetes, MODY is caused by specific genetic mutations that affect the production and function of insulin the body

(4) Understand the long term complications of diabetes

The long term complications of diabetes include:

• microvascular complications like capillary damage

• macrovascular complications such as atherosclerosis, neuropathies, and increased susceptibility to infections.

• these complications can lead to serious health issues affecting various parts of the body over time

• 001 - Cancer (Neoplasia)

(1) Define key terms related to neoplasia

• Neoplasia = the abnormal and uncontrolled growth of cells that may form a tumor

• Dysplasia = Abnormal development or growth of cells within a tissue or organ

• Autonomy = excessive cellular proliferation due to neoplastic cells ignoring genetic controls

• Anaplasia = loss of cellular differentiation in neoplastic cells

• Carcinogens = substances that can promote the formation of cancer

• Metastasis = the spread of cancer cells from on part of the body to another

• Benign tumor = non-cancerous growth that does no invade nearby tissues

• Malignant tumor = cancerous growth than can invade nearby tissues and spread to the other parts of the body

(2) Explain the genetic basis of cancer

The genetic basis of cancer involves mutations in genes that regulate cell growth and division

• these mutations can lead to uncontrolled cell proliferation, a hallmark of cancer

For example, mutations in oncogenes can promote cell growth, while mutations in tumor suppressor genes can inhibit normal cell cycle regulation, both contributing to cancer development.

Additionally, DNA repair genes, when mutated, can lead to genomic instability, allowing for further accumulation of mutations and progression on cancer

(3) Explain how carcinogens may lead to cancer

Carcinogens can lead to cancer through a process involving:

• Initiation,

  • is the initial mutation by exposure to a carcinogenic agent

• Promotion

  • occurs when prolonged exposure to promoters leads to further mutations activating oncogenes, resulting in unregulated cell growth

• Progression

  • Happens when tumor cells acquire independent growth, leading to uncontrolled mitosis without the need for promoting agents

This three-stage process can result in the development of cancer due to the multiple mutation and loss of growth controls in cells exposed to carcinogens

(4) Describe the characteristics of cancer cells

Cancer cells have specific properties that allow them to evade normal removal mechanisms, enabling them to persist.

These characteristics include:

• uncontrolled growths

• evasion of cell death

• ability to promote blood vessel growth

• invasion of surrounding tissues

They can also avoid growth suppressors and resist immune destroying

(5) Compare benign and malignant tumors

• Benign tumors have slow, variable growth, encapsulated with regular borders, localized effects, do not spread or form metastases, are not usually fatal without treatment and do not usually recur after surgical removal.

• Malignant tumors have variable growth irregular borders, invade and spread to form metastases, cause fatality without treatment, have local and systemic effects, may recur after removal

(6) Describe the growth of cancer, its spread and the development of metastasis

Cancer growth involves the uncontrolled division of abnormal cells.

• As cancer progresses, it can spread locally to nearby tissues and organs a process known an invasion.

• Metastasis occurs when cancer cells break away from the primary tumor and travel through the bloodstream or lymphatic system to form new tumors in distant parts of the body

• This process is crucial for cancer for enlarge and become life-threatening. Understanding the growth, spread, and metastasis of cancer is essential in diagnosis and treating the disease effectively

(7) explain tumor classification, grading and staging

Tumor classification involves categorizing tumors based on their origin and type. Grading assess the aggressiveness of the tumor cells

Staging determines the extent of cancer spread

Classification helps in identifying the tumor’s cell type, grading indicates the tumor’s cell type, grading indicates how abnormal the cells appear, and staging helps in planning treatment based on cancer’s spread

(8) Describe local and systemic clinical manifestations

Local clinical manifestations of cancer refer to symptoms and signs that occur at the site of the primary tumor, such as:

• pain

• swelling

• changes in organ function

Systemic clinical manifestations are symptoms that affect the whole body like:

• fatigue

• weight loss

• anemia

• cachexia = is the most sever form of malnutrition where a person can lose up to 80% of adipose and skeletal muscle mass. It is characterized by manifestations such as anorexia, early satiety, weight loss, taste alterations, and altered metabolism

• These can be caused by factors like inflammation, malnutrition such as anorexia, early satiety, weight loss, taste alterations, and altered metabolism

• 001 - Chronic renal (Kidney) Conditions

(1) Revise structure and function of the nephron and production of urine

The nephron is the functional unit of the kidney responsible for urine production.

It consists of the glomerulus, proximal tubule, loop of Henle, distal tube, and collecting duct

The nephron filters blood, reabsorbs essential substances like water and electrolytes, and secretes waste products to form urine

Additionally, the nephron plays a crucial role in regulating body fluid volume, maintaining pH and electrolyte balance, and producing erythropoietin and renin

(2) Describe the effects of HTN on the kidney

HTN can lead to damage in the kidneys by causing high blood pressure, which can result in increased force on the blood vessels.

This can lead to damaged in the arterioles, glomerulus, and capillaries, affecting the kidney’s ability to effectively filter blood.

The increased pressure can cause:

• glomerular hypertension

• hyperfiltration

• hypertrophy

• scarring (glomerulosclerosis) in the kidneys

• impacting their function

Additionally, HTN can be a contributing factor to CKD, affecting various body systems when renal function declines to less that 10%

(3) Describe pathophysiology of chronic pyelonephritis and clinical manifestations

Chronic pyelonephritis is characterized by persistent or recurrent kidney infections leading to scarring.

This condition is often associated with obstructive factors, causing:

• progressive inflammation

• destruction of tubules

• decreased urine concentration

Clinical manifestations include:

• HTN

• flank pain

• frequent urination

• dysuria

If left untreated, chronic pyelonephritis can progress to kidney failure. Treatment involves addressing any obstructions and administering antibiotic therapy

(4) Describe types of obstruction within the upper urinary tract, including the pathophysiology and clinical manifestations

Types of obstruction in the upper urinary tract include:

• strictures

  • involve the narrowing of the urinary tube, leading to blockages

• compression from various sources like tumors or inflammation & congenital compression

  • compression can occur due to factors like tumors or scarring, causing a physical blockage

• kidney stones

  • can obstruct the flow of urine leading to complications

• cancer

  • cancerous growths can also block the urinary tract, affecting urine flow

Clinical manifestations of upper urinary tract obstruction may include symptoms like:

• frequency

• urgency

• poor stream force

• felling of fullness in the bladder after urination

(5) Describe the pathophysiology of CKD and clinical manifestations and treatment options

Chronic Kidney Disease (CKD) is characterized by damage to:

• tubules

• decreased Glomerular Filtration Rate (GFR)

• Glomerular hypertension

• hyperfiltration

• hypertrophy

It involves:

• glomerulosclerosis

• inflammation

• fibrosis

• proteinuria

Clinical manifestations include:

• Fluid and electrolyte imbalance

• HTN

• oedema

• increased potassium

• metabolic acidosis

• hypocalcemia

Treatment involves:

• diet control

• medications

• blood pressure management

CKD progresses to end-stage when less that 1-% of renal function remains, impacting all body systems

• 001 - Review of the Respiratory System

(1) Review the structure and function of the Respiratory system, related to breathing and respiration and perfusion

The respiratory system consists of the lungs, airways, and muscles involved in breathing.

• Its main function is to facilitate the exchange of oxygen and carbon dioxide between the body and the environment

• During breathing, air is inhaled through the nose or mouth, travels down the trachea, enters the lungs through the bronchial tubes, and reaches the alveoli where gas exchange occurs.

• Oxygen is taken up by the blood to be exhaled.

• Perfusion refers to the process of blood flow through the lungs where oxygen is picked up and carbon dioxide is released. This process is essential for maintaining proper oxygen levels in the body and removing waste carbon dioxide

(2) Introduce tests relating to measurement of ventilation

Tests relating to the measurement of ventilation include:

• Tidal volume (TV)

• Vital capacity (VC)

• Forced vital capacity (FVC)

• Forced expiratory volume in 1 second (FEV1)

• Residual volume (RV)

• Total Lung Capacity (TLC)

These tests help assess different aspects of lung function and efficiency

(3) Gain an overview of the development of the respiratory system in the unborn

The development of the respiratory system in the unborn occurs in 5 stages:

1. Embryonic (0-7 weeks)

2. Pseudoglandular (7-16 weeks)

3. Canalicular (16-25 weeks)

4. Saccular (25-36 weeks)

5. Alveolar (36 weeks - 6-8 years)

This progression involves with formation of different structure with the lungs to support breathing and respiration

(4) Consider the effects of aging on the respiratory system

Aging leads to various changes in the respiratory system, including:

• diminished ventilatory response

• hypercapnia

• reduced elastic fibers in the lungs

• increased anterior-posterior diameter

• osteoporosis of vertebrae

• calcification of ribs

• decreased respiratory muscle strength

• decreased cough efficiency

• reduced cilia activity

• “baggy” alveoli

These changes can make older individuals more vulnerable to ventilatory failure during high-demand states and decrease the overall efficiency of the respiratory system

001 - Long Term Respiratory Conditions

(1) Review the structure and functioning of structures in the respiratory system

The respiratory system consists of structures like the lungs, bronci, trachea, and alveoli.

• The lungs are the main organs where gas exchange occurs

• the bronchi and trachea help in air passage

• Alveoli are tiny air sacs where oxygen is taken up the blood and carbon dioxide is released.

These structures work together to facilitate breathing and gas exchange in the body

(2) Discuss processes and effects of mismatched ventilation and perfusion

Mismatched ventilation and perfusion occur when there is inadequate ventilation (air) in well-perfused lung areas or inadequate perfusion (blood) in well-ventilated lung areas.

This can lead to impaired gas exchange, resulting in conditions like:

• hypoxemia (low arterial oxygen)

• hypoxia (cells lacking oxygen)

For example, in conditions

like right heart failure, there might be ventilation without perfusion,

while in acute asthma or pneumonia, perfusion might occur without proper ventilation

This mismatch can lead to imbalances in oxygen and carbon dioxide levels in the blood, impacting overall respiratory function

(3) Describe the pathophysiology, clinical manifestations and treatment of long-term respiratory conditions such as; Chronic bronchitis & Emphysema

Chronic bronchitis is characterized by:

• chronic inflammation

• hyperplasia of bronchial mucous glands

• destruction of cilia

• bronchial wall thickening

Clinical manifestations include:

• persistant cough

• purulent sputum

• dyspnea

• cyanosis

Treatment involves:

• smoking cessation

• pulmonary rehabilitation

• pharmacologic therapy

• supplemental oxgen

Emphysema involves:

• irreversible enlargement of air spaces

• obstruction of airflow

• air trapping

Clinical manifestations include:

• persistant cough

• dyspnea

• wheezing

• barrel chest

Treatment focuses on managing symptoms and preventing complications

• 001 - Coronary Artery Disease and Peripheral Vascular Disease

(1) Understand what atherosclerosis is and how it leads to CAD and PVD

Atherosclerosis is is the hardening of arteries due to plaque formation, leading to blockages that obstruct blood flow, causing hypoxia and tissue death

This process can result in coronary artery disease (CAD) by affecting flood flow to the heart, potentially leading to heart attacks

Additionally, atherosclerosis can lead to peripheral vascular disease (PVD) by impacting blood flow to other parts of the body, such as the legs, causing issues like pain and tissue damage

(2) Identify the risk factors for CAD and PVD

The risk factors for Coronary Artery Disease (CAD) and Peripheral Vascular Disease (PVD) include:

• smoking

• diabetes

• being overweight

• having heart disease

• high cholesterol

• high blood pressure

• advancing age

• family history of atherosclerosis

Modifiable risk factors for CAD and PVD are:

• dyslipidemia

• HTN

• smoking

• T2DM

• obesity

These factors contribute to the development of atherosclerosis, which is a key mechanism leading to CAD and PVD

(3) Discuss the pathophysiology of CAD and PVD

Coronary Artery Disease (CAD) and Peripheral Vascular Disease (PVD) are both primarily caused by atherosclerosis.

In CAD,

atherosclerosis plaques narrow and harden coronary arteries, reducing blood flow to the heart

This can lead to angina and heart attacks

In PVD, on the other hand,

is characterized by narrowing, blockage, or spasms in blood vessels outside the heart and brain, restricting blood flow to limbs

Atherosclerosis is a common cause of PVD, as plaques harden and narrow arteries, affecting peripheral circulation

Other causes include infections, injuries, or irregularities in limb muscles or ligaments

(4) Recognise the clinical manifestations/symptoms of CAD (such as angina) and PVD

Clinical manifestations/symptoms of CAD include angina, which is chest discomfort or pain due to reduced blood flow to the heart muscle

Symptoms of PVD can include no symptoms in 50% of people, intermittent pain during activity and rest, numbness, coldness, skin discoloration, non-healing sores or ulcers, and gangrene

Risk factors for PVD include:

• smoking

• diabetes

• obesity

• heart disease

• high cholesterol

• high blood pressure

• age

• family history of athersclerosis

• 001 - Intestinal Disorders

(1) Chrohn’s Disease: pathophysiology, manifestations, treatment

Chrohn’s Disease involves chronic inflammation in the GI tract, commonly in the terminal ileum and colon.

• It leads to impaired mucous production, thickened intestinal wall and fistulas

• Symptoms include:

  • diarrhea

  • weight loss

  • abdominal pain

  • possible bleeding

• Treatment includes:

  • symptom management

  • pharmacologic treatment

  • dietary changes

  • surgical options like re-sectioning the affected area

(2) Ulcerative Colitis: pathophysiology, manifestations, treatment

Ulcerative Colitis is an inflammatory disease affecting the colon and rectum, characterized by ulcerations in the innermost layer of the bowel wall without extending through all layers

• Clinical manifestations include:

  • periods of remission/exacerbation

  • diarrhea

  • bloody stools

  • cramps

  • weight loss

  • anemia

  • fever

• Treatment involves:

  • symptom management

  • dietary changes

  • in sever cases, surgical removal of the rectum and part of the bowel

(3) Diverticulitis: pathophysiology, manifestations, treatment

Diverticulitis is the inflammation or infection of small herniations in the colon walls known as diverticula

• It is caused by increased intraluminal pressure leading to hypertrophy and contraction of gut wall muscles, narrowing the colon diameter

• Symptoms include:

  • abdominal pain

  • bloating

  • flatulence

  • changes in bowel habits

  • and in severe cases, lower left quadrant pain, palpable mass, infection symptoms, and bleeding

• Treatment involves:

  • increasing dietary fiber

  • fluid intake

  • fiber supplements

  • stool softeners

  • weight reduction

  • and in sever cases, a clear liquid diet, antibiotics, and surgery if necessary

• 001 - Bone Disorders

(1) Rheumatoid Arthritis: pathophysiology, manifestations, treatment

Rheumatoid arthritis is an autoimmune disease where the body’s immune system mistakenly attacks its own tissues, leading to inflammation in the joints

• This causes pain, swelling, and stiffness

• Overtime, it can result in bone erosion and cartilage damage

• Treatment includes medications to reduce inflammation and slow down the progression of the disease, as well as physical therapy and lifestyle changes to manage symptoms

(2) Osteoarthritis: pathophysiology, manifestations, treatment

Osteoarthritis is characterized by the breakdown of articular cartilage faster than it can be repaired

• This leads to thinning inflammation, and erosion of cartilage

• Fissures develop in the cartilage, and the subchondral bone softens

• Osteophytes (bone spurs) form near the joint due to tissue repair attempts

• Manifestations include:

  • joint pain

  • stiffness

  • reduced range of motion

• Treatment involves:

  • pain management

  • physical therapy

  • weight management

  • and in sever cases, surgery like joint replacement

(3) Osteoporosis: pathophysiology, manifestations, treatment

Osteoporosis is characterized by greater bone resorption that replacement, leading to porous, lights, and fragile bones

• Manifestations include:

  • pain

  • bone deformity

  • kyphosis

  • loss of height

  • fractures

• Treatment involves:

  • minimizing risk factors

  • maintaining a adequate diet rich in calcium and Vitamin D

  • engaging in regular weight-bearing exercises

  • using medications like bisphosphonates to inhibit osteoclast activity, managing pain, and ensuring proper rest

  • Risk factors:

    • include post-menopausal decrease in estrogen

    • low BMI

    • dietary deficiencies

    • genetics

    • hormone-related conditions

    • excessive alcohol

    • smoking

    • caffeine

    • certain medications

• 001 - Mental Health LTC

(1) Describe pathophysiology and symptoms of generalized anxiety disorder.

Generalized Anxiety Disorder (GAD) is characterized by excessive, uncontrollable worry and anxiety lasting at least 6 months.

Symptoms include:

• sleep disturbances

• difficulty concentrating

• excessive sweating

• palpitations

• muscle tension

• restlessness

• fatigue

The pathophysiology involves abnormalities in neurotransmitters like serotonin and norepinephrine, as well as genetic and environmental factors contributing to an overactive fear response in the brain

(2) Discuss treatment for generalized anxiety disorder

The treatments for GAD include:

• Cognitive Behavioral Therapy (CBT)

• sleep hygiene

• nutrition

• mindfulness

• acupuncture

• yoga

• exercise

• pharmacological options like SSRIs and SNRIs

These treatments aim to address symptoms such as excessive worry, sleep disorders. difficulty concentrating, and physical symptoms like sweating, palpitations, and muscle tension

The combination of these approaches can help individuals manage and alleviate the symptoms of GAD

(3) Describe pathophysiology and symptoms of depression

Depression is characterized by symptoms like:

• depressed mood

• loss of interest in activities

• fatigue

• weight/appetite changes

• feelings of worthlessness

• insomnia/hyperinsomnia

• psychomotor changes

• difficulty concentrating

• suicidal thoughts

It involves neurobiological factors like:

• neurotransmitter imbalances

• neuroanatomical changes

• HPA dysregulation

• inflammatory processes

Adolescents may show irritability, self-harm, and school issues, while older adults may exhibit memory problems, personality changes, and social withdrawal

(4) Discuss treatment for depression.

The treatments for depression include:

• talking therapies

  • involve counselling and psychotherapy

• medications

  • can include antidepressants

• lifestyle interventions

  • involve exercise, nutrition, and other self-care practices

• emerging treatments like the potential use of LSD

(5) Describe pathophysiology and symptoms of schizophrenia

Schizophrenia is a mental disorder characterized by a combination of symptoms including:

• hallucinations

• delusions

• disorganized thinking

• negative symptoms like reduced emotional expression

The pathophysiology involves:

• Neuroanatomical changes in the brain, such as enlarged ventricles and decreased gray matter volume in certain areas, are observed in individuals with schizophrenia

• Neurotransmitter imbalances, especially involving dopamine, play a significant role in the development of symptoms associate with schizophrenia

(6) Discuss treatment for schizophrenia

Treatment options for schizophrenia include:

• medications such as typical anti-psychotics like chlorpromazine and haloperidol, as well as atypical anti-psychotics like olanzapine, risperidone, clozapine and quetiapine

• Psychotherapy is also a key component, involving family and patient support, education, and community support like Home Based Treatment

• Psychiatric treatment

• Community services

• social support

• bio-psycho-social models

These all are essential in addressing schizophrenia

(7) Describe pathophysiology and symptoms of bi-polar disorder

Bipolar disorder is characterized by:

• abnormal periods of elevated mood and activity

• poor judgement

• distractibility

• decreased need for sleep

• grandiosity

The pathophysiology involves neurobiological factors like:

• neurotransmitter imbalances

• neuroendocrine dysregulation

• neuroanatomical changes

• inflammation

These factors contribute to the mood swings and behavioral changes seen in bipolar disorder

(8) Discuss treatment for bi-polar disorder.

The treatment for bipolar disorder includes psychotherapy such as:

• Cognitive Behavioral Therapy (CBT)

• Psychoeducation

• Medication options consist of:

  • mood stabilizers

  • antipsychotics

  • antidepressants

These treatments aim to manage symptoms like elevated mood, increased mood, increased activity, poor judgement, distractibility, decreased need for sleep, and grandiosity associated with bipolar disorder

(9) Discuss impact of MH changes on the individual, whānau and community

MH changes can have a significant impact on individuals, families, and communities

Individuals may experience challenges in daily functioning, relationships and overall well-being

Families play a crucial role in providing support, stability, and social interaction for individuals with mental disorders. This can affect the family’s dynamics and well-being

Communities may also be impacted by the increased need for mental heath services, resourcesm and awareness to support affected individuals and families, contributing to the overall mental health landscape

• 001 - Stress & Chronic disease

(1) consider the useful role stress plays in our lives

Stress plays a useful role in our lives by preparing our bodies to confront perceives threats through adaptive responses.

It can be beneficial in moderate amounts, known as eustress, leading to increased energy levels, improved performance, and focus

Stress motivated action and enhances adaptive capacity, making it a normal and helpful response to challenges

(2) outline the stages of the stress response

The stages of stress response are:

1. Alarm

   the body’s CNS is activated, preparing for fights or flight

2. Resistance

   involves extended hormone response to stress

3. Exhaustion

   occurs when stress persists, leading to a breakdown of compensatory methods and onset of disease

(3) Identify pathways involved in the stress response

The pathways involved in the stress response are the nervous and endocrine systems.

The nervous system responds through the SNS, releasing catecholamine neurotransmitters like noradrenaline and adrenaline

The endocrine system responds through the HPA Axis, involving the release of hormones like cortisol, aldosterone, growth hormones, and antidiuretic hormone (ADH)

(4) consider when stress becomes a harmful state

Stress becomes a harmful state when it is chronic.

Chronic stress, which is the repeated activation of the stress response overtime, can lead to various health problems. It contributes to:

• high blood pressure

• atherosclerosis

• brain changes linked to anxiety and depression

• obesity

Chronic stress also affects the immune system, making individuals more susceptible to diseases like:

• CVA issues

• cancer

• metabolic syndrome

• diabetes

• inflammatory conditions such as irritable bowel syndrome and asthma

(5) Identify the impacts of long term stress and how these relate to chronic conditions.

Long-term stress can lead to chronic conditions such as:

• high blood pressure

• atherosclerosis

• anxiety

• depression

• addiction

• obesity

• CVA disease

• cancer

• metabolic syndrome

• diabetes

• inflammatory conditions

• impaired wound healing

• decreased bone density

• autoimmine disorders

Chronic stress affects the immune system leading to dysregulation or pro-inflammatory cytokines, which can result in increased blood lipids, abdominal adiposity, and inflammatory conditions

• 001 - Endocrine Lifespan

(1) Describe the actions of thyroid hormones

Thyroid hormones actions:

• stimulate metabolism

• increase heat production

• boost cardiac output

• aid in the breakdown of carbohydrates, fats, and proteins for energy

• accelerate peristalsis

• crucial for normal growth and neural maturation

• Thyroid hormones play a vital role in regulating various physiological processes in the body

(2) Describe the pathophysiology, clinical manifestations, diagnostic criteria and treatment for hyperthyroidism and hypothyroidism

Hyperthyroidism is caused by excess thyroid hormone due to overstimulation of the thyroid gland or decreased TSH production.

Graves’ disease is a common form, where autoimmune IgG binds to TSH receptors, leading to thyroid hyperplasia

Symptoms include:

• weight loss

• heat intolerance

• tremors

• palpitations

Diagnostic tests include:

• TSH

• T3 & T4 levels

• radioactive iodine uptake

Treatment involves:

• medications

• radioactive iodine therapy

• surgical removal of the thyroid gland

Hypothyroidism results from thyroid hormone deficiency due to various causes.

Symptoms include:

• fatigue

• weight gain

• cold intolerance

• constipation

• dry skin

Diagnosis is made through TSH, free T4, total T3, and autoantibody levels

Treatment involves lifelong thyroid hormone replacement therapy

(3) Know the actions of glucocorticoids

Glucocorticoids stimulates:

• glucose production

• gluconeogenesis

• mobilize fats

• inhibit immune responses

• inhibit bone formation

• stimulate gastric secretion

• contribute to the stress response

They play a role in metabolic function, stress response, inflammation, and immune responses.

Excess secretion can lead to Cushing’s Syndrome

(4) Discuss the pathophysiology, clinical manifestations, diagnostic criteria and treatment of Cushing’s syndrome

Cushing’s syndrome is characterized by:

• excess glucocorticoids from the adrenal cortex

• leading to metabolic alterations

• obesity in trunk, face, and upper back

• glucose intolerance

• thin skin

• abdominal striae

• immune suppression

• behavioral changes

• impaired stress response

• osteoporosis

It can be caused by long-term use of glucocorticoids or tumors in the pituitary, adrenals, or other sites.

Diagnosis involves cortisol levels in urine, imagine for tumors, and treatment includes removing the cause, tapering glucocorticoids, and surgical removal of tumors, chemotherapy, or radiation

• 001 - Stroke/TIA

(1) Identify the modifiable and non-modifiable risk factors of TIA/stroke

Non-modifiable risk factors for TIA/Stroke include:

• age

• gender

• family history

• ethnicity

Modifiable risk factors include:

• HTN

• hyperlipidemia

• smoking

• obesity

• poor diet

• inactivity

• excessive alcohol use

These factors can be addressed through lifestyle changes and medical interventions to reduce the risk of TIA/Stroke

(2) Discuss the pathophysiology of stroke

The pathophysiology of stroke involves the interruption of blood flow to the brain, leading to brain cell damage.

Ischemic strokes which make up 87% of cases, are caused by a blockage in blood vessels due to atherosclerosis.

This blockage can be thrombotic (from a clot forming at the site) or embolic (from a clot travelling to the brain)

Hemorrhagic strokes, accounting for 13% of cases, result from the rupture of a blood vessel

The lack of oxygen and nutrients reaching brain tissue during a stroke causes cell death and subsequent neurological deficits

(3) Discuss the clinical manifestations, diagnosis and management of stroke

Clinical manifestations of stroke can include:

• hemiparesis

• sensory loss

• visual deficits

• dysarthria

• aphasia

• ataxia

• vertigo

• loss of consciousness

Diagnosis involves imagine studies like CT or MRI.

Management includes medications like antiplatelets, anticoagulants, and thrombolytics, as well as rehabilitation therapies to address motor impairments, sensory deficits, and speech/language issues

(4) Identify and discuss the long-term impact of stroke

The long-term impact of stroke can be disabling of fatal. Around 85% of strokes following TIAs can result in disability or death.

However, with prompt and appropriate treatment, this percentage can be reduced significantly to 1-2%

This highlights the importance of early intervention and management in minimizing the long-term consequences of stroke

• 001 - Degenerative Disorders of the CNS

(1) Consider the difference between cognitive and neurological functioning.

Cognitive functioning refers to mental processes like thinking, learning, and memory.

• Cognitive health is linked to brain health, focusing on abilities like judgement and language

Neurological functioning involves the nervous system’s structures and neurotransmitters

• Neurological health encompasses the overall state of the nervous system, including brain structures and neurons.

In summary, cognitive functioning pertains to mental processes, while neurological functioning relates to the nervous system’s physical components

(2) Examine Parkinson’s disease and consider the aetiology, risk factors, pathophysiology and clinical manifestations of this condition

Parkinson’s disease is a progressive degenerative disorder of movement characterized by the premature loss of dopamine-producing neurons in the substantia nigra and the accumulation of Lewy Bodies.

The degeneration o these neurons leads to an imbalance between dopamine and acetylcholine, affecting muscle movement.

Risk factors include:

• age

• genetics

• environmental factors

Clinical manifestations include:

• resting tremor

• bradykinesia

• muscle rigidity

• postural instability

Diagnosis is based on cardinal motor signs like resting tremor and bradykinesia, and imaging tests may be used to support diagnosis

(3) Discuss diagnosis, medications and the treatment of Parkinson’s disease.

Diagnosis or parkinson’s disease is based on cardinal motor sign like resting tremor and bradykinesia, along with health history and physical assessment. Imaging may support diagnosis

Medications like levodopa-carbidopa are used to manage symptoms by replacing dopamine

Treatment focuses on improving quality of life and lessening symptoms, as there is no cure for PD

(4) Consider how Parkinson’s disease impacts whanau and communities

Parkinson’s disease impacts whanau by causing stress and changes i relationships de to communication difficulties and altered physical functioning.

In communities it leads to a significant number of diagnosed individuals, predicted to increase, affecting mostly European/Pakeha and Asians. This disease affects communities by increasing healthcare needs and potentially impacting workforce productivity

(5) Examine Multiple Sclerosis and consider the aetiology, risk factors, pathophysiology and clinical manifestations of this condition

Multiple Sclerosis (MS) is an autoimmune disorder characterized by demylelination of white matter in the CNS.

Risk factors include:

• genetic predisposition

• viral infections like Epstein-Barr

• low Vitamin D levels

• smoking

• obesity

• environmental triggers

The disease is more common in females of European descent aged 20-40

Symptoms vary but can include:

• fatigue

• weakness

• numbness

• coordination issues

• cognitive impairment

The chronic stage involves glial scarring and axon degeneration, leading to progressive disability

(6) Discuss diagnosis, medications and the treatment of Multiple Sclerosis.

Diagnosis of Multiple Sclerosis involves:

• Health history

• neurological assessment

• CSF analysis for IgG

• MRI scans

Medications focus on:

• reducing relapses

• managing symptoms

• acute relapse treatment

Treatments aim to:

• improve quality of life

• minimize disability through rehabilitation

• involve MDT approach

Physiotherapy during remission periods is beneficial for patients

(7) Consider how multiple sclerosis impacts whanau and communities

Multiple sclerosis impacts whanau by causing stress and concern for loved ones, changes in diet and activity, difficulty in communication, and altered relationships

In communities, MS affects approximately 11,000 NZers, with predicted increases in diagnosis. European/Pakeha and Asians have higher rates.

This condition leads to physical impairments, loss of mobility, falls, and dysphagia-related choking, and urinary retention and constipation, affecting both the individual and their support network

• 001 - Reproductive Health LTC (Men’s)

(1) State the common conditions and trends in male reproductive health

Common conditions and trends in male reproductuve health include:

• testicular cancer

  • is a significant health issue

• cryptorchidism (undescended testicle)

  • affects 3% of full-term boys and 30% of premature boys

• puberty changes

  • puberty trends are also important to monitor for overall reproductive health

(2) Discuss the global prevalence of infertility and its impact on risk of future chronic disease and wellbeing

The global prevalence of infertility is significant, with 1 in 6 individuals affected

Infertility is associated with a higher risk of chronic diseases like malignancies and cardiovascular issues

Addressing infertility is crucial not only for reproductive needs but also for overall health and wellbeing, as it can provide insights into future health risk.

Therefore, infertility should be viewed as part of a continuum of care throughout life, rather than just a standalone concern

(3) Discuss male factor infertility, common causes, modifiable factors and how it is measured.

Male factor infertility refers to infertility issues originating from the male partner

Common causes include:

• low sperm count

• poor sperm motility

• abnormal sperm morphology

Modifiable factors like:

• smoking

• excessive alcohol consumptions

• obesity

• -can impact male fertility

Male infertility is measured through semen analysis, which evaluates sperm count, motility, and morphology

(4) Discuss fertility treatment options and controversy around treatment selection and risks

Fertility treatment options include in vittro fertilization (IVF) and intrauterine insemination (IUI)

IVF carries risks like higher rates of congenital malformations, preterm birth, and epigenetic changes in offspring

IUI is considered low cost and low risk, closer to natural conception.

Controversies exists due to the higher risks associated with ART, making it a debated topic in the medical field

• 001 - Reproductive Health LTC (Women’s)

(1) Discuss the aetiology, risk factors, pathophysiology, and treatment of endometriosis

Endometriosis is a condition where tissue similar to the lining inside the uterus grows outside the uterus, causing pain and sometimes fertility issues

The exact cause is unknown, but possible factors include:

• genetics

• hormonal imbalances

• retrograde menstruation

Risk factors include:

• family history

• starting menstruation at an early age

• short menstrual cycles

The pathophysiology involves the abnormal growth of endometrial-like tissue outside the uterus, leading to inflammation, scarring, and pain

Treatment options include:

• medications like birth control pills

• pain relievers

• hormone therapy

• surgery to remove the growths

(2) Discuss the aetiology, risk factors, pathophysiology, and treatment of Polycystic Ovarian Disease

Polycystic Ovarian disease (PCOS) is a common endocrine disorder in reproductive-age females.

Its aetiology involves hormonal imbalances impacting reproductive, metabolic, and cardiovascular health

Risk factors include:

• genetics

• insulin resistance

• inflammation

Pathophysiology includes:

• excess androgen production

• irregular menstrual cycles

• ovarian cysts

Treatment involves:

• lifestyle changes

• medication to regulate hormones

• fertility treatments if needed

(3) Discuss the physiology of menopause and its part in female reproduction

Menopause is a natural part of aging characterized by the end of monthly menstruation due to decreased ovarian function.

It marks the cessation of ovulation typically occurring around 51.5 years in NZers

Premature menopause, before 40 years, can be caused by genetics, immune disorders or medical procedures

During perimenopause, hormonal fluctuations lead to irregular menstrual cycles until menopause

Reduced fertility during this period is due to unpredictable estrogen and progesterone levels, eventually declining to low levels post-menopause, along with a decrease in testosterone levels.

Menopause plays a crucial role in female reproduction by signaling the end o the reproductive years