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NRP511 Advanced Pathophysiology

Week 1 Discussion

Genetic Testing/Counseling

Genetic testing has grown in scope and popularity in recent years. You will likely experience patients inquiring about genetic counseling or potential candidates for consultation.

Address one of the following:

dentify and discuss who might be a good potential candidate for referral to genetic counseling. Referrals must at least have a specific reason why the referral was made.

Identify and discuss potential benefits of genetic testing/counseling at various points in the lifespan (e.g. pre-birth, adolescence, adulthood, etc.)

Identify any potential downsides to undergoing genetic testing/counseling.

 

NRP511 Advanced Pathophysiology

Week 2 Discussion

Patient Scenario: Review of Thyroid Lab Results

You review lab results with a patient. They are having mild symptoms of fatigue, constipation, and weight gain. The results are:

TSH- 4.8 (0.4-4.0mIU/L)

T4- 6.0 (4.6-12 ug/dl)

Address the following:

What is the possible diagnosis? Would you treat this? Why?

Discuss relevant pathophysiology for this thyroid scenario.

What is the most important education you would provide to the patient?

 

NRP511 Advanced Pathophysiology

Week 3 Discussion

Patient Scenario: Effects of tobacco use

Your patient presents to the clinic today and you notice in their chart that they continue to smoke after multiple discussions to quit. He is African American, 52 years old and has a history of hypertension and dyslipidemia. His BP is 138/88 on medication. His most recent cholesterol values are Total Cholesterol 250, HDL 38, LDL 160, Triglyceride 200.

Address one or more of the following:

Describe the pathophysiology related to tobacco use on the body and cardiovascular health.

How does tobacco use factor into his overall cardiovascular risk? (Consider utilizing this tool: ACSVD Risk Calculator – you can assume no diabetes).

What education would you provide to this patient? What strategies may you recommend for cessation to better ensure success?

 

NRP511 Advanced Pathophysiology

Week 4 Discussion

Sexual Dysfunction

Option #1 Sexual dysfunction is an important component in a person’s health that can be taboo and difficult to discuss in the clinic setting.

Address the following:

Review the pathophysiology of erectile dysfunction (ED) and discuss any potential causes of the condition.

Why should you be concerned with cardiovascular health in your patient with ED?

Discuss the education you would provide to the patient, including how you would facilitate a discussion about sexual health, or what referrals you may consider for a patient with ED.

OR (not both)

Option #2 – STD

A 21 year old male reports to your office for std/sti screening. He reports having sex with men (MSM). He has no symptoms.

 Questions to consider – you don’t have to address them all.

What do you want to ask in the sexual history? There are also lots of resources out there for how to take a sexual history for different groups. Here’s one resource: Taking a sexual history

What concerns do you have and why?

What testing should you do? What route of testing will you perform? 

Why would you need to test for hepatitis A, B, and/or C?

What does the USPSTF guidelines say about screening this individual?

 Is this patient a candidate for PREP?

 

NRP511 Advanced Pathophysiology

Week 5 Discussion

Antibiotic Resistance

Antibiotic resistance continues to be a serious and legitimate concern in medicine and the community.

Address one of the following, Patient A or Patient B, and respond to the prompt:

Patient A

Patient A is a 14-year-old boy accompanied by his mother to your clinic after several days of sneezing, coughing, and headache. You determine it is likely viral sinusitis. His mother is insistent you prescribe an antibiotic today. What education would you provide to the patient and parent?

Patient B

Patient B is a 34-year-old female, with no prior medical history, who arrives to your clinic today for symptoms of rhinitis, fatigue, sore throat, and occasional cough. She is afebrile and symptoms have been ongoing for 6 days. You determine its likely a viral infection. Discuss the relevant pathophysiology explaining any of the symptoms for this patient. What aspect could treatment modify?

Due Monday

Compare and contrast your responses with one classmate or respond to your faculty member.

 

NRP511 Advanced Pathophysiology

Week 6 Discussion

Patient Scenarios: Headaches and Chronic Pain Syndrome

Address one of the following, Patient A or Patient B, and respond to the prompt:

Patient A

You have a 42-year-old female patient present to your clinic with a many year history of “headaches”. Identify and discuss at least one question you may ask this patient regarding their chief complaint and the pertinent pathophysiology to support why you’re asking.

Patient B

You are seeing a 68-year-old male with medical history positive for chronic pain and multiple chronic medical comorbidities. You review the depression screen which seems to be positive today. Describe how depression can contribute to his chronic pain syndrome using relevant pathophysiology. How is this related to his other chronic disease and comorbidities?

 

NRP511 Advanced Pathophysiology

Week 7 Discussion

Fibromyalgia

Fibromyalgia has become a more common diagnosis in recent years and can come with a stigma. It is critical to not only have an accurate diagnosis but a clear understanding as to how this disease process contributes to symptoms. You have a patient present to the clinic today with Fibromyalgia in their past medical history and they describe diffuse pain “all over my body”.

Fibromyalgia can be looked at as a diagnosis of exclusion and often becomes a catch-all when we can’t explain what is happening.

Address the following (cite sources and justify answers):

Explain how you can be certain of the Fibromyalgia diagnosis. Should you always trust it is accurate because it is in their chart or because the patient says they have it?

Identify what questions you may ask this patient regarding this diagnosis and how it is relevant using pathophysiology.

Identify and discuss potential causes and/or contributing factors for this pain pattern. (Hint: inflammation)

 

NRP511 Advanced Pathophysiology

Week 8 Discussion

Patient Scenario: Crohn’s Disease

You have a patient that presents to the clinic today with a history of Crohn’s disease for many years with occasional flare ups. They follow up as directed with a GI specialist. They have a newer complaint today of bilateral knee pain with no history of injury.

Address the following:

Identify and discuss a potential concern or complication of Crohn’s disease using relevant pathophysiology to support.

Discuss ways Crohn’s disease is different from IBS.

Discuss if the history of Crohn’s disease and the new complaint of joint pain can be related? If yes, how so?

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