Diabetes Mellitus
In caring for a patient with DM, microalbuminuria measurement should be obtained how often?
Annually
A patient deemed "euthyroid" has this thyroid Stimulating level (TSH)
between 0.4-4.5 u/mL
What is one of the most serious complications of giant cell arteritis?
Blindness
GCA is an autoimmune vasculitis that is most common in patients 50-85 y/o. A systemic disease affecting medium and large sized vessels, GCA also causes inflammation of the temporal artery.
SIGECAPS is used to screen for this mental health disorder
What is depression?
SIGECAPS used to screen for symptoms of depression. Need anehdonia/dysphoria plus 3 or 4 minor SIGECAPS symptoms to meet criteria
Sleep, Interest** (anehdonia/dysphoria is required for a depression diagnosis), Guilt, Energy, Concentration, Appetite, Psychmotor retardation/agitation, Suicidal thoughts/intent
A person having thoughts of suicide
What is suicidal ideation?
Hemoglobin A1C best provides information on glucose control over how many days?
90-120 days
How soon should you repeat a TSH after initiating treatment of hypothyroidism with levothyroxine?
Testing should be done at 6-8 week intervals because of the very long half life of levothyroxine (it takes this long to see a change).
A person with this diagnosis has a hard time focusing and sitting still making finishing things very hard.
What is ADHD?
The USPSTF recommends the PCP screen this population for depression
What is all patients ages 12 and up
Person with this diagnosis feels very sad and has difficulty thinking clearly
The criteria for diagnosing diabetes requires two abnormal blood sugar tests, except in this situation..
An elevated blood sugar test accompanied by signs of acute hyperglycemia (polyuria/polydipsia/polyphagia)
Which of the following is the least helpful test for the assessment of thyroid disease?
A. Total T4
B. TSH
C. Free T4
D. TPO antibodies
A. Total T4
Only a very small percentage of T4 circulates free and is metabolically active (99% is bound to plasma proteins). Measuring the small amount of Free T4 is most helpful to confirm an abnormal TSH.
In a healthy person what percentage of the body's total daily physiological insulin secretion is released basally?
50-60%
The person with this diagnosis has a hard time talking about their feelings, understanding people's actions, being social
What is autism spectrum disorder
Individual experiences moods that alternate between depression and the elation
What is Bi-Polar DO?
The most common cause of HHS/HHNK
What is the failure of DM2 patients to take DM medications in times of acute illness
Patients taking thyroid hormone supplementation are educated to take the pill in what way?
A. At the same time each day on an empty stomach
B. With dairy to enhance absorption
C. In early evening within 1 hour of dinner
D. Only in the morning
Many interactions can occur- soy, iron, dairy, aluminum, sucralfate, calcium- all inhibit absorption
Can be AM or PM, empty stomach and same time of day is key
Smoking and medication interactions are also present
Which hormone is in excess in Cushing's syndrome?
Cortisol
The most common form of Cushing's is caused by long term exposure to corticosteroids. The body can also produce an excessive amount of cortisol from the adrenal gland.
Pharmacological medication of choice used for treating alcohol withdrawal
What is benzodiazepine?
A sudden surge of severe discomfort that peaks within minutes, expected or unexpected to include chest pain, chills, shortness of breath, fear of loss of control
A DM2 patient with history of CABG has a A1C of 8.2 despite being on metformin w/lifestyle changes x 3 months. Which medication will be added at this time?
liraglutide, GLP-1RA
due to CVD benefits, alternative next best option would be SGLT2i also with CVD benefits but requires functional GFRs
A 70kg woman will require what daily dose of thyroid hormone replacement?
112 mcg day
Based on 1.6mcg/kg/day as a target to estimate a patients replacement need.
On average, need 75-125mcg/day
Start at 50mcg-100mcg depending on the patient, 25mcg w/elderly
All of the following blood tests can be used to help confirm the diagnosis of Addison's disease in a 34 y/o woman who complains of progressive weakness, poor appetite, weight loss and hyperpigmentation except:
A. Sodium
B. Potassium
C. Cortisol
D. Folate
D. Folate
Addison's disease occurs when there is an inadequate amount hormones produced by the adrenal glands.
Glucocorticoid hormones such as cortisol help maintain glucose control and help the body respond to stress
Mineralocorticoid hormones (aldosterone) regulate sodium and potassium balance.
The opioid dependent patient will begin to demonstrate Grade 1 or 2 signs/symptoms of withdrawal within this time frame
What is 8-12 hours?
24-72 hours for Grade 3& 4 symptoms
Grade 1- lacrimation, rhinorrhea, diaphoresis, yawning, restless, insomnia
Grade 2- piloerection, muscle twitch, myalgia, arthralgia, abd. pain
Grade 3- tachycardia, HTN, tachypnea, fever, anorexia, nausea extreme restless
Grade 4- diarrhea, vomit, dehydration, hyperglycemia, hypotension, curled up position
The SSRI to avoid in patients being treated with propanolol
What is fluoxetine (Prozac)?
good for OCD/Panic/depression, can interact w/BB and enhance/increase effects of BB therapy