Advanced pathophysiology Which of these three is related to imply airways? Describe the concepts of: a. Ventilation b. Diffusion c. Perfusion.? 2. Function of: a. Cilia

 

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Parts  1 and 2  have the same questions, however, you must answer with references and different writing always addressing them objectively, that is as if you were different students. Similar responses in wording or references will not be accepted.

Part 1: Advanced pathophysiology

1. Which of these three is related to imply airways? Describe the concepts of:

a. Ventilation

b. Diffusion

c. Perfusion. 

2. Function of:

a. Cilia 

b. Goblet cells in airways.

3. Gas exchange in Lungs: where does it occurs? 

a. Which are structures that participate on it?

4. Function of Pneumocystis type II in Alveoli.

5. Functions of the Pulmonary System.

6. Function of Surfactant.

7. What is compliance related to Lungs and chest wall? 

a. Mention one disease where compliance is decreased.

8. What are expected changes in Lungs in elderly populations?

9. What is Orthopnea and Paroxysmal Nocturnal Dyspnea?

10. What is Hypoxia and what is Hypoxemia?

11. Pneumothorax

a. Concept

b. Types

c. symptoms

12. Pleural effusion: what is exudative vs transudate? Empyema, Hemothorax, Chylothorax: concepts.

13. Restrictive lung diseases: which are…?

14. What is a Pulmonary Edema?

15. What is Acute Lung Injury (ARDS)?

16. Where is located the damage in ARDS?

17. What is Obstructive Lung Disease? 

a. Which are Obstructive Lung diseases?

18. Pathophysiology of

a. COPD 

b. Chronic Bronchitis?

19. Events that occur in Asthma Pathophysiology.

20. What is Pneumonia? 

a. What is most frequent etiology for Community Acquired Pneumonia?

21. What is Pulmonary embolism? 

a. What is Virchow Triad?

22. What is pulmonary hypertension? 

a. Causes for it.

23. Cancers related to cigarettes smoking.

24. What is Cor Pulmonale?

25. What is Cystic Fibrosis? 

a. Features of this disease.

Part 2: Advanced pathophysiology

1. Which of these three is related to imply airways? Describe the concepts of:

a. Ventilation

b. Diffusion

c. Perfusion. 

2. Function of:

a. Cilia 

b. Goblet cells in airways.

3. Gas exchange in Lungs: where does it occurs? 

a. Which are structures that participate on it?

4. Function of Pneumocystis type II in Alveoli.

5. Functions of the Pulmonary System.

6. Function of Surfactant.

7. What is compliance related to Lungs and chest wall? 

a. Mention one disease where compliance is decreased.

8. What are expected changes in Lungs in elderly populations?

9. What is Orthopnea and Paroxysmal Nocturnal Dyspnea?

10. What is Hypoxia and what is Hypoxemia?

11. Pneumothorax

a. Concept

b. Types

c. symptoms

12. Pleural effusion: what is exudative vs transudate? Empyema, Hemothorax, Chylothorax: concepts.

13. Restrictive lung diseases: which are…?

14. What is a Pulmonary Edema?

15. What is Acute Lung Injury (ARDS)?

16. Where is located the damage in ARDS?

17. What is Obstructive Lung Disease? 

a. Which are Obstructive Lung diseases?

18. Pathophysiology of

a. COPD 

b. Chronic Bronchitis?

19. Events that occur in Asthma Pathophysiology.

20. What is Pneumonia? 

a. What is most frequent etiology for Community Acquired Pneumonia?

21. What is Pulmonary embolism? 

a. What is Virchow Triad?

22. What is pulmonary hypertension? 

a. Causes for it.

23. Cancers related to cigarettes smoking.

24. What is Cor Pulmonale?

25. What is Cystic Fibrosis? 

a. Features of this disease.

Part 3: Advanced pharmacology

 

Case Study

Chief complaint: “I’m here for a medication refill because I ran out of my medicines”.

HPI:  Mrs. Allen is a 68-year-old African American who presents to the clinic for prescription refills. The patient indicates that she has noticed shortness of breath which started about 3 months ago. The SOB gets worse with exertion, especially when she is walking fast, and it is resolved when she is resting. She reports that she is also bothered by shortness of breath that wakes her up intermittently during her sleep. Her symptoms of shortness of breath resolve after sitting upright on 3 pillows. She also has lower leg edema pitting 1+ which started 2 weeks ago. She indicates that she often feels light headed at times with intermittent syncope episodes while going up a flight of stairs, but it resolves after sitting down to rest. She has not tried any over the counter medications at home.

She started taking her medications, but failed to refill the prescriptions because she cannot afford the medications as she only works part-time and lives alone. In addition, she reports that she does not think taking all these medications would help her condition anyway.

PMH: Primary Hypertension, Previous history of MI 1 year ago

Surgeries:

1 year ago-Left Anterior Descending (LAD) cardiac stent placement

Allergies: Penicillin

Vaccination History:  Up-to-date

Social history:

High school graduate married and no children. Drinks one 4-ounce glass of red wine daily. She is a former smoker and stopped 5 years ago.

Family history:

Both parents are alive. Father has history of MI and valvular heart disease; mother alive and cardiac history is unknown. He has one brother who is alive and has history of MI 5 years ago at age 52.

ROS:

Constitutional: Lightheaded and faint with exertion. Respiratory: Shortness of breath with exertion. + Orthopnea. Cardiovascular: + 2 pitting leg edema for 3 weeks. Psychiatric: Non-contributory.

Physical 3xamination:

Vital Signs: Height: 5 feet 1 inches Weight: 175 pounds BMI: 32, Obese, BP 160/92, T 98.0, P 111, R 22 and non-labored

HEENT: Normocephalic/Atraumatic, Bilateral cataracts; PERRLA, EOMI; Teeth intact. Negative for gum disease. 

NECK: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement. 

LUNGS: + Mild Crackles on inspiratory phase not clearing with cough. Equal breath sounds. Symmetrical respiration. No respiratory distress. 

HEART: Normal S1 with S2 during expiration. An S4 is noted at the apex; + systolic murmur noted at the right upper sternal border without radiation to the carotids. Pulses are 2+ in upper extremities and 2+ in pedal pulses bilaterally. 2+ pitting edema to her knees noted bilaterally. 

ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses. 

GENITOURINARY: No CVA tenderness bilaterally. GU 3xam deferred. 

MUSCULOSKELETAL: + Heberden's nodes at the DIP joints, hands. + Crepitus, bilateral knees. Slow gait but steady. No Kyphosis. 

PSYCH: Normal affect. Cooperative. 

SKIN: No rashes. Positive for dry skin.

Labs: Hgb 13.2, Hct 38%, K+ 4.0, Na+137, Cholesterol 228, Triglycerides 187, HDL 37, LDL 190, TSH 3.7, glucose 98.

A:

Primary Diagnosis: Congestive Heart Failure (CHF)

Secondary Diagnoses: Primary Hypertension, Obesity, Osteoarthritis (OA)

Differential Diagnosis: Peripheral Vascular Disease (PVD)

Plan:

Medications: Tylenol 650 mg PO Q4 hours as needed for arthritis pain

Labs: UA; Brain natriuretic peptide (BNP); LFTs and TSH; 12-lead EKG, Chest X-ray; Initial 2D echo with Doppler; Ankle-brachial index.

Additional lab results: Echo results 1 week ago: Left ventricular EJ Fraction decreased to 35 %

BNP – not available.

As a future FNP, you need to determine the medications for CHF/ASCVD. (Arteriosclerotic Cardiovascular Disease).

Questions:

1.    According to the ACC/AHA guidelines, what medications should this patient be prescribed?

2.    Does he need medication(s) given his history of MI?