DMI - Insulin
True or false, in patients not using an insulin pump, bolus insulin alone is recommended for DMI.
What is False
Most nonpregnant adults should strive for an A1C level less than
What is 7%
Fill in the blank: Although nearly all patients with SLE have positive ___ titers, most patients with a positive titer do not have SLE
What is ANA
The positive likelihood ratio (LR+) for the diagnosis of SLE is 2.2, and the negative likelihood ratio (LR–) is 0.1.ANA titers can be falsely positive in many diseases that are characterized by autoimmunity and nonspecific antibody production.
Patient presents with symmetric small-joint arthropathy affecting the hands, wrists, and feet and is associated with joint pain and morning stiffness. What is your initial test
Rheumatoid factor
RF is an autoantibody produced from polyclonal β cell activation. However, (as we know) many conditions can cause +RF and a positive RF titer does not provide a definitive diagnosis of rheumatoid arthritis. The sensitivity and specificity are 69% and 85%, respectively; the LR+ is 4.86, and the LR– is 0.38
Which one of the following is considered a first-line treatment for chronic nonallergic rhinitis?
A. Intranasal corticosteroids.
B. Oral decongestants.
C. Combination decongestants and antihistamines.
D. Oral antihistamines.
What is A
What percentage of people with DMI use insulin pumps? Answer in 10% ranges (correct answer includes exact answer in range)
64%
What are advisable preprandial goals as well as max post prandial goal?
A. Pre 80-130, Post < 220
B. Pre 80-130, Post < 180
C. Pre 100-150, Post < 220
D. Pre 100-150, Post < 180
B. Pre 80-130, Post < 180
Which syndrome results from lymphocytic infiltration of exocrine glands, classically the salivary and tear glands.
What is Sjögren syndrome.
The clinical hallmark is dryness of the mouth and eyes (xerostomia and sicca). Because dry mouth and eyes are also common symptoms in other conditions, serologic testing can be helpful to identify patients with Sjögren syndrome.
Anticyclic citrullinated peptide antibody testing is useful in the diagnosis of which one of the following connective tissue disorders? (check one)
A. Sjögren syndrome.
B. Dermatomyositis.
C. Rheumatoid arthritis.
D. Scleroderma.
What is C
Because of the low sensitivity and specificity of RF for rheumatoid arthritis, other tests have been developed. An enzyme-linked immunosorbent assay should be considered to detect anticyclic citrullinated peptide antibodies in patients with a moderate clinical pretest probability of rheumatoid arthritis. Its pooled sensitivity and specificity are 67% and 95%, respectively; the LR+ is 12.46, and the LR– is 0.36
Rhinitis medicamentosa is a type of drug-induced rhinitis and refers to rhinitis secondary to
decongestant overuse
What are the times of onset, peak and duration of Lispro? Use single best answer
A. 15 mins, 60 mins, 6 hours
b. 15 mins, 30 mins, 4 hours
c. 5 mins, 30 mins, 5 hours
d. 5 mins, 60 mins, 4 hours
c. 5 mins, 30 mins, 5 hours
When prescribing lancets, how many should a DMI go through in a day?
What is 6-10
Testing is advised before meals, before exercise, before bedtime, occasionally postprandially, and anytime hypoglycemia is perceived.
Which one of the following test results has the greatest specificity for systemic lupus erythematosus?
A. Positive anti–double-stranded DNA antibody titer.
B. Positive antinuclear antibody titer with nucleolar pattern.
C. Positive antinuclear antibody titer with speckled pattern.
D. Positive anti-Smith antibody titer.
What is D
Anti-Smith antibodies have the greatest specificity for SLE (98.6%) and are included in the diagnostic criteria for SLE.13 However, their sensitivity is low (39.7%). Therefore, a positive test result is essentially diagnostic of SLE, but a negative result does not exclude it
Mixed connective tissue disease is an overlap syndrome which three conditions?
What are SLE, myositis, and scleroderma
Patients classically present with the Raynaud phenomenon, pulmonary hypertension, arthritis, and myositis.
Which one of the following statements about antihistamine therapy for chronic nonallergic rhinitis is correct?
A. Oral antihistamines are as effective as inhaled or intranasal antihistamines.
B. First- and second-generation antihistamines are equally effective.
C. The intranasal antihistamine azelastine has been shown to improve nasal congestion, rhinorrhea, postnasal drip, and sneezing.
D. Oral antihistamines are more effective for nonallergic rhinitis than for allergic rhinitis.
What is C
Which one of the following statements about dosing of insulin in patients with type 1 diabetes is correct? (check one)
A. Optimal dosing consists of mixed short- and intermediate-acting insulins twice daily.
B. Multiple injections result in better glucose control than continuous infusions.
C. Long-acting insulins are best for use in continuous pump infusions.
D. Frequent administration of rapid-acting insulin every two to four hours may be needed when the patient is ill.
D. Frequent administration of rapid-acting insulin every two to four hours may be needed when the patient is ill.
DAILY
DOUBLE
Which one of the following statements about the benefits of intensive insulin therapy in patients with type 1 diabetes mellitus is correct? (check one)
A. Intensive therapy prevents the progression of retinopathy.
B. Intensive therapy decreases rates of hypoglycemia.
C. All-cause mortality is not affected.
D. Treatment goals are less stringent for pregnant women.
After a positive ANA, what is the confirmatory test for drug-induced lupus?
What is Antihistone antibodies
Antihistone antibodies are classically associated with drug-induced lupus, although they may be present in other conditions such as SLE, auto-immune hepatitis, juvenile idiopathic arthritis, myositis, and scleroderma.
DAILY
DOUBLE
Anticyclic citrullinated peptide antibody testing is useful in the diagnosis of which one of the following connective tissue disorders? (check one)
A. Sjögren syndrome.
B. Dermatomyositis.
C. Rheumatoid arthritis.
D. Scleroderma.
An 85 yo male (Clark) works as a custodian at the hospital. He has had chronic rhinitis for the past ten years; generally improves during the weekend. Presuming he has had negative allergy testing what is the most likely cause of his rhinitis.
A. Atrophic
B. Senile
C. Occupational
D. Non-allergic rhinopathy
B or C
Occupational rhinitis is a result of occupational exposures, ranging from latex and flour to chemicals and particles. Symptoms typically worsen throughout the workweek and improve with time off. Determining and avoiding the trigger are key to treatment
What are three physiologic states that increase a patient's insulin requirements?
What are pregnancy, puberty, illness
Continuous glucose monitoring is associated with a reduction in A1c from __% to __%
7.6 to 7.1
ANA results are generally reported as a titer. What does a titer of 1:40 indicate (i.e. explain how titers work)?
Generally, the higher the titer, the more likely the patient is to have a connective tissue disorder. The titer shows how many times the patient's serum was diluted before the antibodies could no longer be detected. Thus, a titer of 1:640 shows a greater concentration of ANA than 1:40
After initially checking an ANA what follow up testing would be indicated for the clinical syndrome characterized by tight skin, interstitial lung disease, pulmonary hypertension, and diffuse organ fibrosis (need both)?
The condition is scleroderma. Further testing should include anticentromere and anti-Scl 70 antibodies
How long must symptoms be present before considering chronic nonallergic rhinitis.
What is 3 months
common underlying clinical characteristics such as nasal congestion and rhinorrhea, but without nasal, pharyngeal, or ocular itching; sneezing; pulmonary symptoms; eczema; or nasal polyps