NUR 6501 - PATHO MODULE 5 KNOWLEDGE CHECK. QUESTIONS AND ANSWERS.
MODULE 5 KNOWLEDGE CHECK
Question 1
1 out of 1 points
A 52-year-old obese
... [Show More] 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.
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