NUR 6501 / NUR6501 PATHO MODULE 5 KNOWLEDGE CHECK

MODULE 5 KNOWLEDGE CHECK  Question 1 1 out of 1 points A 52-year-old obese Caucasian male presents to the clinic with a 2-day history of fever, chills, and right great toe pain that has gotten worse. Patient states ...

MODULE 5 KNOWLEDGE CHECK  Question 1 1 out of 1 points A 52-year-old obese Caucasian male presents to the clinic with a 2-day history of fever, chills, and right great toe pain that has gotten worse. Patient states this is the first time that this has happened, and nothing has made it better and walking on his right foot makes it worse. He has tried acetaminophen, but it did not help. He took several ibuprofen tablets last night which did give him a bit of relief. Past medical history positive or hypertension treated with hydrochlorothiazide and kidney stones. Social history negative for tobacco use but admits to drinking “a fair amount of red wine” every week. General appearance: Ill appearing male who sits with his right foot elevated. Physical exam remarkable for a temp of 101.2, pulse 108, respirations 18 and BP 160/88. Right great toe (first metatarsal phalangeal [MTP]) noticeably swollen and red. Unable to palpate to assess range of motion due to extreme pain. CBC and Complete metabolic profile revealed WBC 14,000 mm3 and uric acid 8.9 mg/dl. The APRN diagnoses the patient with acute gout. Question 1 of 2: Describe the pathophysiology of gout. Selected Answer: At the cellular level, purines are synthesizes to purine nucleotides, which are used in the synthesis of nucleic acids, adenosine triphosphate, cyclic adenosone monophosphate(cAMP),and cyclic guanosine triphosphate monophosphate(cGMP). Uric acid is a breakdown product of purine nucleotides. A defeciency of the enzyme HGPRT can lead to an increased production of uric acid. A complete absence of HGPRT can occur in the X-linked Lesch-Nyhan syndrome, with males at risk for hyperuricemia, neurologic alterations, and sometimes gouty arthritis. Correct Answer: Gout is an inflammatory response to excessive quantities of uric acid in the blood and other body fluids including synovial fluid. The elevated level of uric acid lea to the formation of monosodium urate crystals in and around joints. When the uric acid levels exceed approximately 6.8 mg/dl, it crystalizes and forms an insoluble precipitate that are deposited into connective tissue through the body. When crystallization occurs in synovial fluid, it triggers Tumor Necrosis Factor (TNF)-α, which causes the release of inflammatory cytokines and interleukins. The result is an acute inflammatory response within the joint. Gout is caused by a defect in purine metabolism and kidney function. Uric acid is a byproduct of purine nucleotides. People with gout may have an elevated level of purine synthesis accompanied by a rise in uric acid level. Response Feedback : [None Given]  Question 2 1 out of 1 points A 52-year-old obese Caucasian male presents to the clinic with a 2-day history of fever, chills, and right great toe pain that has gotten worse. Patient states this is the first time that this has happened, and nothing has made it better and walking on his right foot makes it worse. He has tried acetaminophen, but it did not help. He took several ibuprofen tablets last night which did give him a bit of relief. Past medical history positive or hypertension treated with hydrochlorothiazide and kidney stones. Social history negative for tobacco use but admits to drinking “a fair amount of red wine” every week. General appearance: Ill appearing male who sits with his right foot elevated. Physical exam remarkable for a temp of 101.2, pulse 108, respirations 18 and BP 160/88. Right great toe (first metatarsal phalangeal [MTP]) noticeably swollen and red. Unable to palpate to assess range of motion due to extreme pain. CBC and Complete metabolic profile revealed WBC 14,000 mm3 and uric acid 8.9 mg/dl. The APRN diagnoses the patient with acute gout. Question 2 of 2: Explain why a patient with gout is more likely to develop renal calculi. Selected Answer: Renal stones are more prevalent in people with gout than people who do not. Renal stones can form in the collecting tubules, pelvis, or ureters, causing obstruction, dilation, dilation, and atrophy of the more proximal tubules and leading eventually to acute failure. Stones deposited directly in renal interstitial tissue initiate an inflammatory reaction that leads to chronic renal disease and progressive renal failure. Correct Answer: Most uric acid is eliminated from the body through the kidneys. Urate is filtered at the glomerulus and undergoes reabsorption and excretion within the proximal renal tubules. In primary gout, urate excretion by the kidneys is sluggish. This may be caused by a decrease in glomerular filtration of urate or acceleration in urate reabsorption. This allows for urate crystals to be deposited in the renal tubules. Response Feedback: [None Given]  Question 3 1 out of 1 points Stan is a 45-year-old man who presents to the clinic complaining of intermittent fevers, joint pain, myalgias, and generalized fatigue. He noticed a rash several days ago that seemed to appear and disappear on different parts of his abdomen. He noticed the lesion below this morning and decided to come in for evaluation. He denies recent international travel and the only difference in his usual routine was clearing some underbrush from his back yard about a week ago. Past medical history non-contributory with exception of severe allergy to penicillin resulting in hives and difficulty breathing. Physical exam: Temp 101.1 ˚F, BP 128/72, pulse 102 and regular, respirations 18. Skin inspection revealed a 4-inch diameter bull’s eye type red rash over the left flank area. The APRN, based on history and physical exam, diagnoses the patient with Lyme Disease. She ordered appropriate labs to confirm diagnosis but felt it urgent to begin antibiotic therapy to prevent secondary complications.