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NURS 6512: Advanced Health Assessment and Diagnostic Reasoning Dr. Katherine Elizabeth Chike-Harris January 1st, 2021

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CASE STUDY: Focused Throat Exam Lily is a 20-year-old student at the local community college. When some of her friends and classmates told her about an outbreak of flu-like symptoms sweeping her campus during the past 2 weeks, Lily figured she shouldn't take her 3-day sore throat lightly. Your clinic has treated a few cases similar to Lily's. All the patients reported decreased appetite, headaches, and pain with swallowing. As Lily recounts these symptoms to you, you notice that she has a runny nose and a slight hoarseness in her voice but doesn't sound congested. Episodic/Focused SOAP Note Patient Information: Initials: L Age: 20 Sex: Female Race: Unknown S. CC: “Sore throat” HPI: 20-year-old (race: unknown) female student at the local community college is concerned after her friends and classmates told her about an outbreak of flu-like symptoms going around at her campus during the past 2 weeks. She has had a sore throat for 3 days and has been experiencing a decreased appetite, headaches, and pain with swallowing. We have already treated a few cases that reported similar symptoms to the patient which include decreased appetite, headaches, and pain with swallowing. Current Medications: Multivitamin 1 tablet by mouth daily Allergies: NKDA PMHx: Immunizations: current, last tetanus: 07/15/19, no past major illnesses or surgeries. Soc Hx: Student living on campus at the local community college, denies history of tobacco & alcohol use, denies current tobacco & alcohol use. Health Promotion: Do you have working smoke detectors in the house? Yes Fam Hx: Mother: Diabetes Father: Hypertension ROS: • GENERAL: Reports decreased appetite, No weight loss, fever, chills, weakness or fatigue. • HEENT: Eyes: No visual loss, blurred vision, double vision or yellow sclerae. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose. Patient reports sore throat and pain upon swallowing. • SKIN: No rash or itching. • CARDIOVASCULAR: No chest pain, chest pressure or chest discomfort. No palpitations or edema. • RESPIRATORY: No shortness of breath, cough or sputum. • GASTROINTESTINAL: No anorexia, nausea, vomiting or diarrhea. No abdominal pain or blood. • GENITOURINARY: No burning on urination. Pregnancy. Last menstrual period, 12/15/20. • NEUROLOGICAL: Reports headaches, No dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. No change in bowel or bladder control. • MUSCULOSKELETAL: No muscle, back pain, joint pain or stiffness. • HEMATOLOGIC: No anemia, bleeding or bruising. • LYMPHATICS: No enlarged nodes. No history of splenectomy. • PSYCHIATRIC: No history of depression or anxiety. • ENDOCRINOLOGIC: No reports of sweating, cold or heat intolerance. No polyuria or polydipsia. • ALLERGIES: No history of asthma, hives, eczema or rhinitis. O. Physical exam: • General: Lily is a well-developed, well-nourished female that is alert and cooperative. Lily is pleasant and responds to questions appropriately. • Vital Signs: BP: 120/80, P: 80, R: 18 and regular, Temp: 97.8 orally. Weight: 115 lbs, Height: 5’4”, BMI: 19.7 • HEENT: PEERLA, EOMI, oronasopharynx is clear • Neck: Carotids no bruit, jvd or tmegally • Chest/Lungs: CTA AP&L • Heart/Peripheral Vascular: RRR without murmur, rub or gallop; pulses+2 bilat pedal and +2 radial • Abdomen: Benign, nabs x 4, no organomegaly; no suprapubic tenderness- no rebound • Genitourinary/Rectal: External genitalia intact, no cervical motion tenderness, no adnexal masses. • Musculoskeletal: Symmetrical muscle development, muscle strength 5/5 all groups. • Neurological: CN II- XII grossly intact, DTR’s intact. • Skin/Lymph Nodes: No edema, clubbing, or cyanosis; no palpable nodes. Diagnostic results: Included below A. Differential Diagnoses Acute laryngitis: Acute laryngitis is known as a self-limiting condition. Acute laryngitis is caused from a viral infection, environmental irritants, postnasal drainage which is secondary to allergic rhinitis which is poorly controlled, and voice overuse (Dains et al., 2019). The patient may complain of a sore throat. In addition, the patient’s loudness and quality of their voice are impacted from the illness. Hoarseness is commonly known to progress throughout the patient’s day. Upon indirect examination of the patient’s larynx, redness and edema of the vocal cords is observed and in mild cases physical pathology may be absent (Dains et al., 2019). A patient with suspected acute laryngitis will not require diagnostic studies if the hoarseness has been present for less than three weeks. Group A βhemolytic streptococcal pharyngitis: Streptococcal pharyngitis is most common in patients who are between the ages of 5 and 15 years old. In addition, patients will present with a history of a known exposure, a sudden onset of a fever, a severe sore throat, malaise, and it is common during the fall and wintertime (Dains et al., 2019). Also, the patient will not present with a cough or upper respiratory tract symptoms. The patient will present with a temperature 38.5°C (101.5° F), exudate, and anterior cervical lymphadenopathy (Dains et al., 2019). Diagnostic studies include a positive rapid strep antibody screen and a strep culture. It is also good to recognize for future reference that Group A Streptococcus pharyngitis is an initiator of acute rheumatic fever (ARF) (Oliver et al., 2020) Mononucleosis: Mononucleosis is responsible for causing approximately 5% of sore throats. It is a common illness in young adults. Also, approximately 90% of the cases are caused by the Epstein-Barr virus. There are two types of Epstein Barr viruses, which have been shown to infect humans (Monteiro et al., 2020). They are known as EBV1 and EBV2. The patient commonly presents with a history of a gradual onset, low grade fever, mild sore throat, posterior cervical lymphadenopathy, weight loss, and pronounces malaise and fatigue (Dains et al., 2019). A diagnosis is made with a positive Monospot test and a complete blood count with results showing higher than 50% lymphocytosis. Furthermore 50% of all cases present with splenomegaly and GAS presents in approximately 10% to 20% of the cases (Dains et al., 2019). It is great to be aware of other conditions that mononucleosis is capable of causing, unilateral acute dacryoadenitis is caused by infectious mononucleosis (Cvetanovic, et al., 2020). Peritonsillar or retropharyngeal abscess: Patient’s will present with a history of recurrent tonsillitis, a sore throat, difficulty swallowing, respiratory tract symptoms, fever, and malaise (Dains et al., 2019). The patient’s physical findings include orthopnea, dyspnea, symmetrical swelling, abscess, and trismus. A patient should be immediately referred for a CT scan, head and neck radiographs, and laryngoscopy. Gonococcal pharyngitis: Patients with gonococcal pharyngitis will present with a history of orogenital sexual activity. Also, the patient may not have any symptoms. Upon physical assessment findings include pharyngeal exudate and bilateral cervical lymphadenopathy (Dains et al., 2019). Diagnosis is reached with a gram stain and gonorrhea culture. P. This section is not required for the assignments in this course (NURS 6512) but will be required for future courses. References Cvetanović, M., Veselinović, A., Trenkić-Božinović, M., Stojanović, K., Trajković, I., & Veselinović, D. (2020). Acute Dacryoadenitis Associated with Infectious Mononucleosis. Acta Medica Medianae, 59(1), 149–152. https://doi- Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment & clinical diagnosis in primary care (6th ed.). Elsevier Mosby. Jane Oliver, Arlo Upton, Susan J. Jack, Nevil Pierse, Deborah A. Williamson, & Michael G. Baker. (2020). Distribution of Streptococcal Pharyngitis and Acute Rheumatic Fever, Auckland, New Zealand, 2010–2016. Emerging Infectious Diseases, 26(6), 1113–1121. Monteiro, T. A. F., Costa, I. B., Costa, I. B., Corrêa, T. L. D. S., Coelho, B. M. R., Silva, A. E. S., Ramos, F. L. de P., Filho, A. J. M., Monteiro, J. L. F., Siqueira, J. A. M., Gabbay, Y. B., & Sousa, R. C. M. (2020). Genotypes of Epstein-Barr virus (EBV1/EBV2) in individuals with infectious mononucleosis in the metropolitan area of Belém, Brazil, between 2005 and 2016. The Brazilian Journal of Infectious Diseases: An Official Publication of the Brazilian Society of Infectious Diseases, 24(4), 322–329. https://doi-

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Test Bank - Essentials of Pathophysiology (4th Edition by Porth) Your text1 here 1

Table of Contents
Table of Contents 1
Chapter 01 - Cell Structure and Function 2
Chapter 02 - Cellular Responses to Stress, Injury, and Aging 8
Chapter 03 - Inflammation, the Inflammatory Response, and Fever 15
Chapter 04 - Cell Proliferation, Tissue Regeneration, and Repair 22
Chapter 05 - Genetic Control of Cell Function and Inheritance 26
Chapter 06 - Genetic and Congenital Disorders 32
Chapter 07 - Neoplasia 38
Chapter 08 - Disorders of Fluid, Electrolyte, and Acid-Base Balance 45
Chapter 09 - Stress and Adaptation 52
Chapter 10 - Disorders of Nutritional Status 59
Chapter 11 - Disorders of White Blood Cells and Lymphoid Tissues 65
Chapter 12 - Disorders of Hemostasis 72
Chapter 13 - Disorders of Red Blood Cells 79
Chapter 14 - Mechanisms of Infectious Disease 86
Chapter 15 - Innate and Adaptive Immunity 93
Chapter 16 - Disorders of the Immune Response 100
Chapter 17 - Control of Cardiovascular Function 107
Chapter 18 - Disorders of Blood Flow and Blood Pressure 113
Chapter 19 - Disorders of Cardiac Function 120
Chapter 20 - Heart Failure and Circulatory Shock 127
Chapter 21 - Control of Respiratory Function 134
Chapter 22 - Respiratory Tract Infections, Neoplasms, and Childhood Disorders 140
Chapter 23 - Disorders of Ventilation and Gas Exchange 147
Chapter 24 - Structure and Function of the Kidney 153
Chapter 25 - Disorders of Renal Function 160
Chapter 26 - Acute Kidney Injury and Chronic Kidney Disease 166
Chapter 27 - Disorders of the Bladder and Lower Urinary Tract 173
Chapter 28 - Structure and Function of the Gastrointestinal System 180
Chapter 29 - Disorders of Gastrointestinal Function 187
Chapter 30 - Disorders of Hepatobiliary and Exocrine Pancreatic Function 193
Chapter 31 - Mechanisms of Endocrine Control 199
Chapter 32 - Disorders of Endocrine Control of Growth and Metabolism 206
Chapter 33 - Diabetes Mellitus and the Metabolic Syndrome 212
Chapter 34 - Organization and Control of Neural Function 219
Chapter 35 - Somatosensory Function, Pain, and Headache 225
Chapter 36 - Disorders of Neuromuscular Function 231
Chapter 37 - Disorders of Brain Function 238
Chapter 38 - Disorders of Special Sensory Function 245
Chapter 39 - Disorders of the Male Genitourinary System 251
Chapter 40 - Disorders of the Female Genitourinary System 257
Chapter 41 - Sexually Transmitted Infections 263
Chapter 42 - Structure and Function of the Skeletal System 269
Chapter 43 - Disorders of the Skeletal System 275
Chapter 44 - Disorders of the Skeletal System 282
Chapter 45 - Structure and Function of the Integumentum 288
Chapter 46 - Disorders of Skin Integrity and Function 294

,Test Bank - Essentials of Pathophysiology (4th Edition by Porth) 2



Chapter 01 - Cell Structure and Function


1. The nucleus _________, which is essential for function and survival of the cell.


A) is the site of protein synthesis


B) contains the genetic code


C) transforms cellular energy


D) initiates aerobic metabolism


2. Although energy is not made in mitochondria, they are known as the ​power plants​ of the cell because
they:


A) contain RNA for protein synthesis.


B) utilize glycolysis for oxidative energy.


C) extract energy from organic compounds.


D) store calcium bonds for muscle contractions.


3. Although the basic structure of the cell plasma membrane is formed by a lipid bilayer, most of the
specific membrane functions are carried out by:


A) bound and transmembrane proteins.


B) complex, long carbohydrate chains.


C) surface antigens and hormone receptors.


D) a gating system of selective ion channels.


4. To effectively relay signals, cell-to-cell communication utilizes chemical messenger systems that:


A) displace surface receptor proteins.


B) accumulate within cell gap junctions.


C) bind to contractile microfilaments.

,Test Bank - Essentials of Pathophysiology (4th Edition by Porth) 3


D) release secretions into extracellular fluid.


5. Aerobic metabolism, also known as oxidative metabolism, provides energy by:


A) removing the phosphate bonds from ATP.


B) combining hydrogen and oxygen to form water.


C) activating pyruvate stored in the cytoplasm.


D) breaking down glucose to form lactic acid.


6. Exocytosis, the reverse of endocytosis, is important in _______ into the extracellular fluid.


A) Engulfing and ingesting fluid and proteins for transport


B) Killing, degrading, and dissolving harmful microorganisms


C) Removing cellular debris and releasing synthesized substances


D) Destruction of particles by lysosomal enzymes for secretion


7. The process responsible for generating and conducting membrane potentials is:


A) diffusion of current-carrying ions.


B) millivoltage of electrical potential.


C) polarization of charged particles.


D) ion channel neurotransmission.


8. Epithelial tissues are classified according to the shape of the cells and the number of layers. Which of
the following is a correctly matched description and type of epithelial tissue?


A) Simple epithelium: cells in contact with intercellular matrix; some do not extend to surface


B) Stratified epithelium: single layer of cells; all cells rest on basement membrane


C) Glandular epithelium: arise from surface epithelia and underlying connective tissue


D) Pseudostratified epithelium: multiple layers of cells; deepest layer rests on basement membrane

, Test Bank - Essentials of Pathophysiology (4th Edition by Porth) 4


9. Connective tissue contains fibroblasts that are responsible for:


A) providing a fibrous framework for capillaries.


B) synthesis of collagen, elastin, and reticular fibers.


C) forming tendons and the fascia that covers muscles.


D) filling spaces between tissues to keep organs in place.


10. Although all muscle tissue cells have some similarities, smooth muscle (also known as involuntary
muscle) differs by:


A) having dense bodies attached to actin filaments.


B) containing sarcomeres between Z lines and M bands.


C) having rapid contractions and abundant cross-striations.


D) contracting in response to increased intracellular calcium.


11. Which of the following aspects of the function of the nucleus is performed by ribosomal RNA (rRNA)?


A) Copying and carrying DNA instructions for protein synthesis


B) Carrying amino acids to the site of protein synthesis


C) Providing the site where protein synthesis occurs


D) Regulating and controlling protein synthesis


12. Breakdown and removal of foreign substances and worn-out cell parts are performed by which of the
following organelles?


A) Lysosomes


B) Golgi apparatus


C) Ribosomes


D) Endoplasmic reticulum (ER)


13. Impairment in the function of peroxisomes would result in:

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