MODULE 1: GASTROINTESTINAL PATHOPHYSIOLOGY ASSESSABLE QUESTIONS

Question 1

Mr. B, a 72-year-old male, presents to hospital complaining of abdominal discomfort. He comments that he has experienced a change in his bowel habits and he is suffering from extreme fatigue. He has recently lost a lot of weight without trying but says that this is most likely due to the fact that he has not been eating as he has lost his appetite (anorexia). His doctor suspects that he might have colon cancer and sends him for a colonoscopy.

a) b) c)

In Australia, how many people will develop colon cancer by the age of 75? What are the known risk factors for colon cancer?

On a previous colonoscopy, Mr. B had several polyps removed. What is a polyp and how can the presence of polyps increase the likelihood of developing colon cancer?

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Question 2

Master C, a 9-year-old male, presented to his GP complaining of the following: weight loss, diarrhoea, steatorrhoea, abdominal bloating and fatigue. He mother comments that he has had problems with his bowels since a small child but has recently began to have more serious issues. Blood tests reveal that he has mineral, vitamin and macronutrient deficiencies. The doctor refers Master C for a small bowel biopsy, which confirms that Master C has celiac disease.

a)  State the primary trigger for development of celiac disease, and describe the pathophysiology of the disease. 

b)  Relate Master C’s mineral, vitamin and macronutrient deficiencies to the pathophysiology of celiac disease. 

c)  Explain, in terms of the underlying pathophysiology, why Master C is experiencing the symptoms described above. 

MODULE 2: RESPIRATORY PATHOPHYSIOLOGY ASSESSABLE QUESTIONS

Miss J is a 21-year-old female who was diagnosed with asthma when she was 3 years of age. However, the asthma seems to have been getting worse in recent months. Miss J lives with her boyfriend who bought her a cat for her birthday four months ago. Miss J currently uses Salbutamol (Ventolin) to alleviate symptoms when she has an asthma attack.

a) Describe the alterations to normal structure and function that occur during an asthma attack.

b) Could the presence of Miss J’s cat be contributing to her exacerbation of asthma symptoms, and, if so, how?

c) Salbutamol is a sympathomimetic drug. How could a drug that mimics the sympathetic nervous system help to alleviate asthma?

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Question 2

Mr W is a 72-year-old male who has been diagnosed with emphysema. He has also been diagnosed with alpha-1-antitrypsin deficiency. He smoked 1 pack of cigarettes per day for 40 years and quit 3 years ago.

a) What is emphysema and how would cigarette smoking contribute to its development.

b) Does having an alpha-1-antitrypsin deficiency contribute to the development of emphysema, and, if so, how?

c) How does the pathophysiology of emphysema differ from the pathophysiology of chronic bronchitis?

MODULE 3: CARDIOVASCULAR PATHOPHYSIOLOGY ASSESSABLE QUESTIONS

Mr H, a 67-year-old male, visits his doctor for his annual check up. He is 180cm tall and weighs 137kgs. The doctor measures his blood pressure and finds that it is 160/110mmHg. Mr H is retired and spends most of his day indoors reading. He was diagnosed with diabetes mellitus 4 years ago.

a) What is hypertension and how does it develop?

b) What health and lifestyle factors described above are possibly contributing to Mr H’s high blood pressure?

c) What cardiovascular diseases is Mr H at risk of developing due to his hypertension?

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Question 2

Mr K, a 52-year-old male, experienced severe pain in his leg following bed rest for several weeks. On examination and ultrasound, his doctor reports that he has developed a deep vein thrombus in the leg, and prescribes him heparin.

a) Describe the alterations in structure and/or function that lead to thrombus formation?

b) Heparin activates the enzyme inhibitor antithrombin III. Explain in physiological terms how this drug would this help to limit the growth of a thrombus?

c) What other diseases/disorders is Mr K at risk of as a result of his deep vein thrombus?

MODULE 4: IMMUNE PATHOPHYSIOLOGY ASSESSABLE QUESTIONS

Miss A, a 4-year-old female, arrived in the Emergency Department via ambulance. She was experiencing anaphylaxis. The ambulance officers had administered epinephrine via Epipen. On practical examination she was found to have severe bronchospasm, skin flushing and angioedema. She seemed to be getting better as time progressed. However, four hours after her arrival at the E.D. the severe bronchospasms returned, accompanied by severe hypotension, hives and itchiness, tachycardia and oedema. Her mother explained to the doctors that Miss A has a peanut allergy and must have ingested something containing peanuts a party they were attending.

a)  What causes an anaphylactic reaction? 

b)  Miss A has experienced a biphasic episode of anaphylaxis. What percentage of people who have an anaphylactic exacerbation have a secondary attack and what implications might this have for nursing practice? 

c)  Explain what would be causing Miss A’s tachycardia. 

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Question 2

Mr L is a 70-year-old-male who has been suffering from anaemia, swollen cervical, inguinal and auxiliary lymph nodes, recurrent infections, and unexplained bleeding and bruising. A blood test and bone marrow biopsy confirm that he has Chronic Lymphocytic Leukaemia (CLL).

a) What alterations to normal biology lead to the development of leukaemia?

b) In terms of alterations to physiology, explain how CLL could lead to the symptoms listed in the case study.

c) Compare and contrast acute lymphoblastic leukaemia with chronic lymphoblastic leukaemia. Which type has the best prognosis, and state why this is?

MODULE 5: RENAL PATHOPHYSIOLOGY ASSESSABLE QUESTIONS

Question 1

Mr R, a 67-year-old-male, has suffered from type II diabetes mellitus for the past 11 years. He has also had severe hypertension in his mid 30s, and since then this has been poorly controlled with medication. He attempted to manage his diabetes mellitus through lifestyle regimens such as diet and exercise, but 4 years ago required insulin injections to control his BGLs. Over the last 2 years he has noticed that his urine output has been declining and recently he has reported very low urine output, sometimes producing almost none. Blood tests show that he has anaemia. He has extreme fatigue and recently has been suffering from confusion. Renal function tests show that Mr R is in stage 4 chronic renal failure.

a)    What is chronic renal failure, and how does it differ from acute renal failure? b) Explain how chronic renal failure can lead to anaemia? c) How do hypertension and diabetes contribute to renal failure?

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Question 2

Mr K, a 55-year-old male, has been experiencing severe flank pain for a few hours. He presents to hospital and is quickly diagnosed as having several renal calculi, one of which has entered his left ureter and is blocking the flow of urine from his left kidney to the bladder.

a) Explain how renal calculi form in the kidney and name the substances of which they consist.

b) If the renal calculi are not removed from the ureter, what effect might this have on the kidney?

c) What are the risk factors for renal calculi and how can these risks be minimised?

MODULE 6: NEUROLOGICAL PATHOPHYSIOLOGY ASSESSABLE QUESTIONS

Question 1

Mrs W is a 73-year-old female who arrived at the emergency department by ambulance after her husband noticed that she had begun to slur her speech, she had drooping of the left side of her face, and she said she felt numbness and tingling in her arm and face. Doctors suspect she has had a stroke. An MRI confirms that she has experienced a small ischaemic stroke. Her medical history reports that she was previously diagnosed with both hypertension, which has been poorly controlled with medication for 30 years, and hypercholesterolemia, which was diagnosed 15 years ago.

a) What is a stroke? Is an ischaemic stroke different from a haemorrhagic stroke?

b) Could Mrs W’s hypertension and hypercholesterolemia have contributed to her stroke, and, if so, how?

c) What are the warning signs of a stroke? Relate these signs to the underlying events in a stroke is?

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Question 2

Mr S, a 17-year-old-male was riding his motorbike when, he was hit by another motorist who was changing lanes. He was thrown several meters into the air and sustained an incomplete spinal injury as a result. He is told that his injury has occurred on the right hand side of his body at T6 and is classified as Bernard-Sequard syndrome. Below the level of his injury, Mr S is experiencing loss of movement on his right hand side and loss of some sensation on his left hand side.

a) What is an incomplete spinal cord injury?

b) Explain in terms of the injury why Mr S has only lost movement on the side of his injury and yet has lost sensation on the opposite side of his body below the injury.

c) Mr S’s spinal injury is at T6. What functions would be impaired due to a hemisection injury at this level?

MODULE 7: ENDOCRINE PATHOPHYSIOLOGY ASSESSABLE QUESTIONS

Question 1

Mrs. T a 48-year-old female, presented to her GP with the following symptoms: palpitations, tachycardia, angina, muscle weakness, fatigue, increased appetite and weight loss, nervousness, insomnia and intolerance to heat. She has also been experiencing amenorrhea. Her GP also notes that she has exophthalmos. He decides to take a blood sample for testing and the results indicate that Mrs. T has Grave’s disease.

a) What is the primary organ affected in Graves’ disease and explain the pathophysiology that causes Graves’ disease? 

b) Explain what causes exophthalmos. 

c) Briefly explain how Graves’ disease could cause the symptoms Mrs. T is experiencing. 

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Question 2

Mrs D, a 49 year-old female, had been experiencing polydipsia, polyuria, polyphagia and recurrent vaginal thrush infections. She finally saw her GP after a couple of months who ordered a glucose tolerance test. Mrs D was diagnosed with Type II diabetes mellitus.

a) Briefly describe the alterations in physiology that lead to the development of type II diabetes mellitus.

b) What is the difference between type I and type II diabetes mellitus?

c) Why can a glucose tolerance test help diagnose diabetes mellitus? Are there any other tests that can be used to diagnose type II diabetes, and, if so describe them?

MODULE 8: PATHOPHYSIOLOGY ASSOCIATED WITH OBESITY ASSESSABLE QUESTIONS

Question 1

The following question directly relates to the case study in module 8.

Mr D is a 57 year-old male, 182cm tall and weighing 143kgs. His average daily food consumption is 12,600kJ. Mr Dunkin’s laboratory tests show elevated fasting glucose (11 mmol/L) and insulin (21 mmol/L).

a) Calculate Mr D’s body mass index (BMI). Discuss how a BMI assessment alone is not the optimal way to test if a patient’s weight is increasing their health risk, and state what other measurements may be useful.

b) Mr D’s diet is high in highly processed foods that are high in saturated fat and sugar and low in fiber. What potential diseases is Mr D at risk of developing if he continues his current diet?

c) Mr D decides that he is going to lose weight and that he is going to cut all fat out of his diet. Using current journal articles (from the least 2 years) comment on whether this is the best method for losing weight.

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Question 2

Mrs O, a 32-year-old female, presented to her doctor complaining of severe pain in her knees. After several tests and scans it was determined that she had osteoarthritis. Mrs O currently weighs 156 kgs and in 155 cm tall. Over the past few years she has developed several other medical conditions including gallstones, hypertension and infertility.

a) What is osteoarthritis and how can obesity contribute to/cause this condition?

b) Describe the alterations to physiology caused by obesity which can lead to decreased fertility.

c) What are gallstones? How can their development relate to obesity?