Doctor tengo diabti
What is the first line mediation for diabetes
Metformin
In suspected hypothyroidism what initial test is recommended for evaluation
TSH
What are the diagnostic criteria for CKD?
gfr <60 and/of ACR >30 for 3 months
What is the empiric treatment for Gonorrhea and Chlamydia infections
IM CTX 500mg once and Doxy 100mg BID for 7 days
Definition of Sepsis and septic shock
Clinical syndrome of life-threatening organ dysfunction by dysregulated host response
Sepsis with persistent hypotension requiring vasopressors despite adequate volume resuscitation and lactate of >2
What medication is contraindicated im diabetic patients with hx of DKA
SGLT-2i
What is the official stance of the US preventive task force for screening for hypothyroidism in patients without RF
Insufficient evidence
Per KDIGO what is the ideal SBP goal in CKD patients? In geriatric patients what would be an acceptable goal?
1. <120
2. <130
Name the warning signs of dengue
Severe abdominal pain or tenderness, persistent vomiting, Clinical/extravascular fluid accumulation, Mucosal bleeding, AMS, Hepatomegaly (>2cm), postural hypotension, Progressive increase in hematocrit concurrent decrease in plt count.
In which clinical settings is abx recommended to be given within 1 hour of presentation? In which should it be given in 3 hours of presentation?
Shock present
Shock absent and sepsis is possible
What are the contraindications for using metformin
<gfr 30
Hypersensitivity
Acute heart failure
chronic acidosis
What is the starting dose of synthroid in obese and non obese patients?
1.6 mcgxkg of actual
1.6 mcgxkg of ideal
In diabetics with ckd on maximum dose of metformin and sglt2. What other class of medication is recommended for further management? Per Kdigo what is the A1c goal?
GLP1, <8%
Empiric treatment of CAP out patient with and without comorbidities and inpatient
Outpatient: Amoxicillin, Macrolide, Augmentin, Respiratory FQ
Outpatient comorbidities: Augmentin or Oral cephalosporin + Macrolide or doxy. Monotherapy with respiratory FQ
Inpatient: Beta-lactam + macrolide, or a respiratory FQ
What is management of sepsis induced hypotension? Management of septic shock and escalation of therapy? Map goals?
30 ccs per Kg
Norepinephrine first line, vasopressin, epi/dobutamine
geriatric population 60-65, gen population 65 or more
Contraindications for Glp-1 use
MEN2, medullary thyroid, carcinoma, Severe gastroparesis, Pancreatitis, hypersensitivity
Name some of the medications associated with hypothyroidism. What medication interfere with synthroid absorption
1. lithium, amiodarone, valoproic acid
2. PPI, Sulcrafate, iron supplements, calcium carbonate
Metformin gfr contraindications for and maximum dose per gfr
<20
<30, 30-45 1,000mg daily, 45+ 2,000mg
What is the BP goal for starting Thrombolytics in ischemic stroke, what BP should be maintained after thrombolysis? In no reperfusion strategy, what is the BP goal for patient in first 24 hours? In hemorrhagic stroke, BP goal?
Before TPA <185/110 mm Hg, Maintain <180/105 after thrombolysis.
For non tpa BP <220/120 mm Hg
In acute hemorrhagic stroke SBP 130-140 for at least 7 days. Modest goal may be place in patients with initial SBP of >220
What is the indication for bicarbonate use in sepsis?
PH 7.2 or less, AKI stage 2 or 3
Name the A1C goal for each of the following
1. 50 y/o male
2. 67 y/o female without other medical conditions
3. 78 y/o male with Alzheimers and multiple chronic conditions
1. < 7.0
2. < 7.5
3. < 8.0
What are the diagnostic criterias for subclinical hypothyroidism? name the specific conditions in which you may start treatment
TSH >4.5
FT4 normal
Resistant depression
TSH >10
Hashimoto's
What are the indications for SGLT-2i in patients with CKD?
all diabetic ckd patients
ACR>200 in non diabetic CKD some evidence of benefits in those 100-200Management of status epilepticus in adults
0-5 min: ABCDE, IV access, O2, Dxt, positioning
5-20 min: IV Lorazepam 0.1mg per kg up to 4mg may be repeated once in 5-10 min. IM midazolam may be used
20-40 min: Keppra 40-60mg per Kg max 4,500mg, Fosphenytoin or phenytoin 20mgxkg max 1500mg
Refractory: ICU admission, continuous infusion of propofol, midazolam
What are the indications and dosing of hydrocortisone in setting of septic shock? Specific mechanisms and clinical outcome needed
Refractory shock (definition varies). Dosing 200mg IV daily. Manages underlying adrenal suppression (meh). Restoration of vascular tone and vasopressor sensitivity. No long-term benefits in mortality. Faster shock reversal and decreases ICU stays. Added benefits in severe CAP (Cape COD)