Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

From Flashcardlet > Family Medicine Case Files wk 1 & 2 > Flashcards

Family Medicine Case Files wk 1 & 2 Flashcards

1
Q

Partner notification for STDs: Mandatory? How reported?

A
  • yes, it is mandatory
  • either the patient notifies the partner, or if they refuse to the department of health will notify the partner
  • health care provider has legal and ethical obligation to inform the partners that they are at risk
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Best tx for sprained ankle?

A

“PRICE”

  • Protection
  • Rest = to promote healing, but early rehab is necessary
  • Ice = minimizes swelling
  • Compression = reduces swelling
  • Elevation = reduces swelling
  • plus NSAID or acetaminophen as needed for the pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Best tx for sprained ankle?

A

“PRICE”

  • Protection
  • Rest
  • Ice
  • Compression
  • Elevation
  • plus NSAID or acetaminophen as needed for the pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the most common cause of ankle sprains? What is more common, medial or lateral sprains? Why?

A
  • inversion of an ankle that is plantar flexed

- lateral is more common than medial, because the lateral ligaments are relatively weaker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the 3 ankle sprain grades? What are their associated sx?

A
  1. grade 1 - stretching of ATFL = pain and swelling, but NO mechanical instability and little to NO functional loss, can bear weight with mild pain
  2. grade 2 - partial tear of ATFL = more severe pain, swelling, and BRUISING + mild-moderate joint instability + loss of range of motion
  3. grade 3 - complete tear of ATFL and CFL with partial tear of PTFL = significant joint instability, LOSS of function + INABILITY to bear weight
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Ottawa Ankle Rules

A
  • have very high sensitivity for ruling out significant malleolar and midfoot fractures
  • apply to adults who have normal mental status, dont have any other painful injuries, and are seen w/in 10 dyas of their injury
  • X-rays of the ankle should be performed if:
    1. bony tenderness of the posterior edge or tip of the distal 6 cm of either the medial or lateral malleolus
    2. patient unable to bear weight immediately or when examined
  • foot X-rays should be performed if:
    1. bony tenderness over the medial midfoot, base of 5th metatarsal (lateral midfoot)
    2. pt is unable to bear weight
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Ottawa Ankle Rules

A
  • have very high sensitivity for ruling out significant malleolar and midfoot fractures
  • X-rays of the ankle should be performed if:
    1. bony tenderness of the posterior edge or tip of the distal 6 cm of either the medial or lateral malleolus
    2. patient unable to bear weight immediately or when examined
  • foot X-rays should be performed if:
    1. bony tenderness over the medial midfoot, base of 5th metatarsal (lateral midfoot)
    2. pt is unable to bear weight
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Sprain

A

-stretching or tearing injury of a ligament

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Strain

A

-stretching or tearing injury of a muscle or tendon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Empty can test: describe? what structure does it test? what injury does it identify?

A
  • arm abducted, elbow extended, thumb pointing down, pt elevates arm against resistance
  • tests: supraspinatus
  • positive = rotator cuff injury or tear
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Empty can test: desribe? what structure does it test? what injury does it identify?

A
  • arm abducted, elbow extended, thumb pointing down, pt elevates arm against resistance
  • tests: supraspinatus
  • positive = rotator cuff injury or tear
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

External shoulder rotation test: describe? what structure does it test? what injury does it identify?

A
  • elbows at sides and flexed at 90*, pt externally rotates against resistance
  • tests: infraspinatus Teres minor
  • positive = rotator cuff injury or tear
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Lift off test: describe? what structure does it test? what injury does it identify?

A
  • pt places dorsum of hand on lumbar back and attempts to lift hand off back
  • tests: subscapularis
  • positive = rotator cuff injury or tear
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Drop-arm rotator cuff test: describe? what injury does it identify?

A
  • pt is unable to lower his arm slowly from raised position

- positive = large rotator cuff tear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Drop-arm rotator cuff test: describe? what injury does it identify?

A
  • pt is unable to lower his arm slowly from raised position

- positive = large rotator cuff tear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Anterior drawer ankle test: describe? what structure does it test? what injury does it identify?

A
  • pull forward on the pt’s heel while stabilizing the lower leg with the other hand
  • tests: anterior talofibular ligament
  • positive = ATFL tear
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Squeeze test: describe? what structure does it test? what injury does it identify?

A
  • compresses tibia and fibula at midcalf
  • tests: syndesmosis
  • positive: pain at anterior ankle joint (below where squeezing) = syndesmotic injury
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Inversion stress test: describe? what structure does it test? what injury does it identify?

A
  • invert pts ankle with one hand while stabilizing the lower leg with the other hand
  • tests: calcaneofibular ligament
  • positive: excessive mvmnt or palpable “chunk” or talus on tibia = ligament tear
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Lachman test: describe? what structure does it test? what injury does it identify?

A
  • with pt knee in 20* flexion, pull forward on the upper tibia while stabilizing the upper leg
  • tests: ACL
  • positive: excessive translation with no solid endpoint = ACL tear
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Varus stress test: describe? what structure does it test? what injury does it identify?

A
  • with the pts leg in full extension and at 30* flexion, add lateral-directed force on the knee and medial-directed force on the ankle
  • tests: lateral collateral ligament
  • positive: excessive translation = tear
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Varus stress test: describe? what structure does it test? what injury does it identify?

A
  • with the pts leg in full extension and at 30* flexion, add lateral-directed force on the knee and medial-directed force on the ankle
  • tests: lateral collateral ligament
  • positive: excessive translation = tear
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Ottawa knee Rules:

A
  • knee x-rays should be performed when any of these are present:
    1. age 55+
    2. isolated patella tenderness
    3. tenderness of head of the fibula
    4. inability to flex the knee to 90*
    5. inability to bear weight for four steps immediately and in the exam room (regardless of limping)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the imaging study of choice for musculoskeletal injuries?

A
  • plain x-rays –> must do at least 2 views that are at 90* to each other
  • if normal and sx continue, then do an MRI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the most common cause of persistently stiff, painful, or unstable joints following sprains?

A

-inadequate rehab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What to do if you suspect the pt has limited ROM bc of pain?

A

-inject lidocaine into the joint to numb it then repeat the exam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Next step in therapy for unstable angina w/ possible MI that presents to ER?

A

“MONA”

  • Morphine = pain relief & decrease circulating catecholamines –> reduces hearts oxygen consumption
  • Oxygen
  • Nitro
  • Aspirin
  • plus: beta-blocker to reduce MI damage & GP IIb/IIIa inhibitors to reduce morbidity and mortality
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the first priority when treating a pt with a possible MI?

A

-getting an ECG and chest X-ray while giving meds to decrease damage to heart and to reduce bp = nitro and beta blockers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What changes seen in EKG indicate angina?

A
  • ST elevation or depression

- T-wave inversion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What EKG changes can be seen with an MI and what labs are also seen?

A
  • EKG: also see ST-segment elevation or depression &/or T-wave inversion
  • *NOT all MIs will have EKG changes!!
  • labs: elevated CK-MB &/or elevated troponin levels
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What do Q waves mean?

A
  • can indicate cardiac pathology, but usually mean there is an old infarct
  • when Q waves are present the benefits of thrombolytic tx is uncertain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

NY Heart Association Functional Classification of Angina

A
  1. Class I = angina only with unusually strenuous activity
  2. Class II = angina with slightly more prolonged or slightly more vigorous activity than usual
  3. Class III = angina with usual daily activity
  4. Class IV = angina at rest
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Why are ACEi given after an MI?

A
  • reduce short-term mortality when started w/in 24 hrs of acute MI
  • prevent left ventricle remodeling and recurrent ischemic events
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What cardiac problem can hypoMg cause?

A

-torsades de pointe ventricular tachy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are the 9 risk factors for CAD?

A
  1. DM
  2. Dyslipidemia
  3. Age
  4. HTN
  5. Smoking
  6. Family hx of early CAD
  7. Male gender or postmenopause women
  8. LVH
  9. Homocystinemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is the target LDL in a pt with a hx of CAD and at high risk for future cardiac events?

A

-70 mg/dL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is the minimal decrease in BMI that can provide benefit to the patient?

A

-5% decrease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is cardiogenic nausea and vomiting associated with?

A

-larger MI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Chest pain with angina v. MI?

A
  • chest pain with angina usually resolves in less than 5 min with rest
  • chest pain with an MI should be suspected when the pain lasts longer than 20-30 min
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What does unequal carotid pulses or upper extremity pulses indicate?

A
  • aortic dissection

* *but most patients with dissection will not have uneven pulses!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Ddx for chest pain

A

See pg 233 of case files!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What are the 2 most common cause of chest pain in the outpatient setting?

A
  1. musculoskeletal causes

2. GI cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What EKG changes make the dx of an MI most difficult?

A

-Left bundle branch block

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Systolic murmur that decreases in intensity when the pt is lying down?

A
  • hypertrophic cardiomyopathy

- lying down increases ventricular filling = decreases obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Outflow murmur that increases in intensity when lying down?

A

-functional outflow murmur that can be common in athletes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What typically happens to murmurs with the valsalva maneuver?

A
  • most decrease in intensity

- murmurs from hypertrophic cardiomyopathy will INCREASE with the valsalva though!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Athletes with which 4 types of murmurs should be held from participation?

A
  1. Systolic murmur with an intensity greater than 3/6
  2. Diastolic murmur
  3. Holosystolic murmur
  4. Continuous murmur
    * * or any other suspicious murmur!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Which 4 strains does the HPV vaccine work against?

A
  • 6 & 11 = genital warts

- 16 & 18 = cervical dysplasia and cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What should all sexually active adolescents be screened for?

A
  • chlamydia and gonorrhea via cervical sampling in females and a leukocyte esterase test in males
  • all should also be offered HIV testing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What are the recommendations for Tdap?

A

-the childhood series, plus a booster at ages 11-12, and then once every 10 years after that

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Which 5 groups of pts should get a hep A vaccine?

A
  1. Live in areas with high infection rates
  2. Travel to high-risk areas
  3. Have chronic liver dz
  4. Use IV drugs
  5. Men who have sex with men
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

When are complete physical examinations in adolescents reccommended?

A

-once during early adolescence, once in mid adolescence, and once in late adolescence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What are the recommendations for HTN screening?

A

-annual screening in all adolescents via bp measurements

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What 7 tests should be done in a pt with diagnosed with HTN?

A
  1. Blood glucose
  2. Serum potassium
  3. Creatinine
  4. Ca levels
  5. Hematocrit
  6. Urinalysis - to look for proteinuria or cells
  7. EKG
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

How is HTN and the risk CV disease related?

A

-risk of CV dz doubles with each increase in bp of 20/10 mmHg above 115/75 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What is preHTN?

A

-bp btwn 120-139 systolic and 80-89 diastolic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What is the target bp for HTN in average pts? In diabetics and pts with kidney dz?

A
  • 140/90 in “normal pts”

- 130/80 in diabetics and pts with kidney dz

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What can happen to the bp if the cuff is too small?

A

-falsely elevated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

How many elevated bps to diagnose HTN?

A

-two properly taken bps at 2 different visits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Stage 1 HTN bp?

A
  • systolic 140-159

- diastolic 90-99

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Stage 2 HTN bp?

A
  • systolic: > 160

- diastolic: > 100

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What are the alcohol reccomendations for a pt with HTN?

A

-no more than 2 a day for men and no more than 1 a day for females

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What is the DASH diet plan high in?

A
  1. Potassium

2. Calcium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What is the first-line primary tx for HTN?

A

-thiazide diuretics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What is the most common cause of HTN in children? What tests should be done?

A
  • renal parenchymal dz

- tests: urinalysis, urine culture, and renal ultrasound

64
Q

Further testing to be done with initial workup of hyperlipidemia? (4)

A
  1. Blood glucose
  2. Creatinine
  3. Liver function tests
  4. TSH
65
Q

Reccomendations for measuring lipid levels?

A
  • every 5 years in all adults over the age of 20

- can be fasting or nonfasting

66
Q

What is the target for total cholesterol?

A

-less than 200

67
Q

What is the target for HDL?

A

-60 or greater

68
Q

What are the 5 factors used to determine the LDL goal?

A
  1. Cigarette smoking
  2. HTN
  3. Low HDL –> high HDL = negative risk factor (so subtract 1 from total risk factors)
  4. Age (45+ for men and 55+ for females)
  5. Family Hx of premature CHD (male < 55 or female < 65)
69
Q

LDL goal for pt with CHD or CHD equivalent?

A

-100 mg/dL or less

70
Q

LDL goal for pt with zero to one risk factor?

A
  • 160 mg/dL or less
71
Q

LDL goal for pt with 2+ risk factors?

A

-130 mg/dL or less

72
Q

LDL goal for pts with very high risk of CHD? AKA “therapeutic option”

A

-70 mg/dL or less

73
Q

4 Common Secondary causes for dyslipidemia?

A
  1. DM
  2. Hypothyroidism
  3. Obstructive liver dz
  4. Chronic renal failure
74
Q

What 3 common types of drugs can cause dyslipidemia?

A
  1. Progestins
  2. Anabolic steroids
  3. Corticosteroids
75
Q

Effects of statins?

A
  • vv LDL **
  • ^^ HDL
  • vv TGs
76
Q

Statins: sfx

A
  • myopathy & myalgia

- increased liver enzymes

77
Q

Statins: contraindications

A
  1. Active or chronic liver dz

2. When pt is taking p450 inhibitor

78
Q

Bile acid sequestrants: names

A
  1. Cholestyramine
  2. Colestipol
  3. Colesevelam
79
Q

Bile acid sequestrants: effects

A
  • vv LDL **
  • ^^ HDL
  • no effect on TG
80
Q

Bile acid sequestrants: sfx?

A
  1. GI distress, constipation

2. Decreased absorption of other meds

81
Q

Bile acid sequestrants: contraindications?

A

-dybetalipoproteinemia = TG > 400

82
Q

Nicotinic acids: name

A

-ex. Niacin

83
Q

Nicotinic acids: effects

A
  • vv LDL
  • ^^ HDL
  • vv TG **
84
Q

Nicotinic acids: sfx?

A
  1. Flushing
  2. Hyperglycemia
  3. Hyperuricemia
  4. Upper GI distress
  5. Hepatotox
85
Q

Nicotinic acids: contraindications?

A
  1. Absolute: chronic liver dz & severe gout

2. Relative: DM, hyperuricemia, & peptic ulcer dz

86
Q

Fibric acids: name?

A
  1. Gemfibrozil
  2. Fenofibrate
  3. Clofibrate
87
Q

Fibric acids: sfx?

A
  1. Dyspepsia
  2. Gallstones
  3. Myopathy
88
Q

Fibric acids: contraindications?

A
  1. Severe renal dz

2. Severe hepatic dz

89
Q

Cholesterol absorption blockers: name

A

-ex. Ezetimibe

90
Q

Cholesterol absorption blocker: effects?

A
  • vv LDL **
  • ^^ HDL
  • vv TG
91
Q

Cholesterol absorptiom blocker: sfx?

A
  1. Abdominal pain

2. Diarrhea

92
Q

Cholesterol absorption blockers: contraindictaions?

A
  1. Hepatic insufficiency

2. Active liver dz

93
Q

Sciatica

A
  • pain along the path of the siatic nerve that radiates to the butt and the back of the thigh
  • usually caused by a herniated disk of the lumbar region of the spine
94
Q

Cauda equina syndrome sx (4)

A
  1. Increasing neurological deficits and leg weakness
  2. Bowel and urinary incontinence
  3. Sensory loss in a saddle distribution
  4. Bilateral sciatica
95
Q

12 Red Flag sx of low back pain?

A
  1. Unrelenting night pain
  2. Unrelenting pain at rest
  3. Neuromotor deficit
  4. Fever
  5. Loss of bowel or bladder control
  6. Suspicion of ankylosing spondylitis
  7. Trauma
  8. History or suspicion of cancer
  9. Osteoporosis
  10. Chronic corticosteroid use
  11. Immunosuppression
  12. Drug or alcohol abuse
96
Q

What are 4 cancers that commonly involve the spine?

A
  1. Multiple myeloma
  2. Metastatic prostate cancer
  3. Metastatic breast cancer
  4. Metastatic lung cancer
97
Q

What is sciatica a classic sign of?

A

-a herniated disc

98
Q

What makes sciatica worse?

A
  • valsalva
  • sneezing
  • coughing
99
Q

What does the straight-leg-raise test for? What else can be used?

A
  • sciatica

- contralateral leg raise test can also be used

100
Q

What is the conservation tx for sciatica?

A
  1. NSAIDS
  2. Short-course steroids
  3. Avoidance of sitting
101
Q

What is spinal cord stenosis? Who is it commonly seen in?

A
  • spinal canal narrowing that puts pressure on the spinal cord
  • can be congenital or acquired
  • more common in pts over 65 yrs old
102
Q

Spinal stenosis: ssx?

A
  1. lower back pain
  2. Leg pain
  3. Leg weakness
  4. Pseudoclaudication = occurs after walking various distances while the vascularity in the legs remain intact.
    * * Pain is relieved by bending over or sitting.
103
Q

Initial tx of spinal stenosis?

A
  1. NSAIDS
  2. Physical therapy
  3. Epidural corticosteroids
104
Q

What is the most common cause of low back pain? What is the possible physiology?

A
  • lumbar strain is the most common
  • probably caused by an incomplete tear in the annulus fibrosus that leaks fluids that cause local inflammation and irritation
105
Q

What are the 4 tx of acute mechanical back pain?

A
  1. NSAIDS
  2. Muscle relaxants
  3. Heat
  4. Early mobility –> NO more than 2 days of bed rest!
106
Q

When should imaging be done for a herniated disc? Which is best?

A

-an MRI should be done AFTER 4 weeks

107
Q

What 3 medications can be used to tx an essential tremor?

A
  1. Propanol
  2. Primidone
  3. Gabapentin
108
Q

What 3 medications are known to cause or enhance a physiologic tremor?

A
  1. Inhaled Beta-agonist (ex. albuterol)
  2. Levothyroxine
  3. Lithium
109
Q

What can be a cause of tremor in a pt younger than 40?

A

-wilson’s dz

110
Q

What is the primary tx for Parkinsons? What are some long term use sfx?

A
  • levadopa, best for motor sx

- sfx: drug-induced dyskinesia and psychosis w

111
Q

What can be used to tx levadopa-related motor complications in parkinsons?

A
  • dopamine agonists:
    1. Catechol O-methyltransferase inhibitors
    2. MAOis
112
Q

What are common psych probs seen with parkinsons?

A
  1. Depression
  2. Dementia
  3. Psychosis
113
Q

What 4 drugs can be used to suppress tics in tourettes?

A
  1. Haloperidol
  2. Pimozide
  3. Trifluoperazine
  4. Fluphenazine
114
Q

What are the 4 ways to assess a patient’s volume status?

A
  1. Skin turgor
  2. Mucous membranes
  3. Specific gravity of urine
  4. Orthostatic bp
115
Q

What are 4 sx of pulmonary edema?

A
  1. Shortness of breath
  2. Lower-extremity edema
  3. JVD
  4. Abnormal lung sounds (ex. Rales)
116
Q

Why can pts with kidney disease have vomitting?

A
  • due to the build up of urea and other toxins

- persistent vomiting = need tx!

117
Q

What kind of anemia can be seen with kidney disease and why?

A
  • normocytic anemia

- decreased epo from the kidneys

118
Q

What are patients with Chronic kidney disease most likely to die of?

A

-more likely to die of CV dz before they develop ESRD and need dialysis

119
Q

Definition of End Stage Renal Disease

A
  • irreversible loss of kidney function
  • the patient is permanently dependent on renal replacement therapy (either dialysis or transplant)
  • GFR < 15
120
Q

What are the 3 most common causes of chronic kidney disease?

A
  1. Diabetes
  2. HTN
  3. Glomerulonephritis
121
Q

What is a normal GFR for a woman?

A

-btwn 100 and 120

122
Q

What is used to monitor ots at risk for kidney disease?

A
  1. Serum creatinine to estimate GFR

2. Random urinalysis for albuminuria

123
Q

Tx for volume overload associated with chronic renal failure?

A
  1. Sodium restriction

2. Loop diuretics

124
Q

What does it mean when small kidneys are seen on imaging?

A
  • reflects irreversible disease

- they should rarely be biopsied bc the results will not alter the tx

125
Q

What is metabolic syndrome?

A
  • insulin resistance
  • characterized by:
    1. Abdominal obesity = waist circumference > 102 cm in men and > than 88 cm in women
    2. Dyslipidemia = TG > 150 mg/dL & HDL < 40 in men and < 50 in women
    3. Elevated bp = > 130/85
    4. Impaired fasting glucose = > 110 mg/dL
126
Q

What BMI is considered underweight? Normal? Overweight? Obese? Extremely obese?

A
  • underweight: < 18.5
  • normal: 18.5-24.9
  • overweight: 25.0-29.9
  • obese: I-30-34.9 II-35-39.9
  • extreme obesity III: > 40
127
Q

What blood tests should be drawn on any obese pt?

A
  1. Fasting glucose - to look for DM and impaired glucose tolerance
  2. Fasting lipids - to look for metabolic syndrome and to determine CV dz risks
  3. TSH - screen for hypoTH
  4. Liver enzymes - look for fatty liver dz
128
Q

What is the gold standard for an obesity tx plan?

A
  • combination of:
    1. Dietary restrictions
    2. Increased physical activity
    3. Behavioral therapy
129
Q

What are the exercise recommendations for weight loss?

A

-at least 30 min a day of moderate to vigorous physical activity for 5 days a week

130
Q

Which pts are potential candidates for bariatric surgery?

A

-pts with BMI > than 40, or greater than 35 with comorbid conditions

131
Q

In which 4 groups of patients is a BMI not an accurate assessment of lean body mass to body fat ratio?

A
  1. Highly muscled people (ex. Body builders, weight lifters, athletes)
  2. Pregnant women
  3. Patients with symptomatic congestive heart failure
132
Q

What 2 drugs are indicated for long term tx of obesity?

A
  1. Orlisat

2. Sibutramine

133
Q

What is the target HbA1C for diabetics usually?

A

-6.5% or less

134
Q

What is the target LDL range for a diabetic?

A

-70 to 100

135
Q

What is the maximum target bp for diabetics?

A

-130/80

136
Q

What are the 6 risk factors for gestational diabetes?

A
  1. > 25 yrs old
  2. High-incidence race = native american, african american, hispanic, south or east asian, or pacific islander
  3. BMI > 25 or more
  4. History of glucose intolerance
  5. Previous history of gestational diabetes
  6. History of DM in a first degree family member
137
Q

Diagnostic criteria for DM?

A
  1. Random glucose of 200 mg/dL or more along w/ classic sx that include polydipsia, polyuria, polyphagia, frequent infections, and weight loss
  2. Fasting glucose > 125 mg/dL on at least 2 occasions
  3. 2-hr plasma glucose of 200 mg/dL or more after a 75g glucose load
138
Q

What does metformin do?

A
  1. Acts on liver to decrease glucose output during gluconeogenesis
  2. Also improves insulin sensitivity in the liver and muscle
    In addition:
  3. Reduces insulin levels
  4. Potential for weight loss
  5. Decrease in TGs
  6. Decrease in LDL
    ** doesnt cause hypoglycemia!!
139
Q

Common side effects of metformin? How can they be reduced?

A
  • nausea and diarrhea and other GI sfx are common

- can be decreased by giving smaller doses and taking meds with meals

140
Q

What is a dangerous sfx of metformin?

A
  • lactic acidosis
  • the risk of lactic acidosis is increased by renal insufficiency
  • contraindicated in: women with creatinine > 1.4 and > 1.5 mg/dL in men, hepatic insufficiency, congestive heart failure
141
Q

What is the oral drug of choice for DM?

A

-metformin!

142
Q

Sulfonylureas: MOA

A

-act as insulin secretagogues, stimulate beta cells to secrete insulin

143
Q

Sulfonylureas: sfx

A
  1. Weight gain

2. Hypoglycemia

144
Q

Thiazolidinediones: MOA

A
  1. Improve insulin sensitivity in muscle and in adipose tissue
  2. Decrease hepatic gluconeogenesis and increase peripheral glucose utilization
    Also:
  3. Decrease TGs
  4. Increase HDL
145
Q

Where are thiazolidinediones metabolized?

A
  • in the liver!

* *so they can be used in pts with renal dz!

146
Q

Disadvantages of thiazolidinediones?

A
  1. Slight increase in LDL
  2. Weight gain
  3. Slow onset of action
  4. Can cause water retention
147
Q

Metlitinides: MOA

A
  • short acting secretagogues, increase insulin secretion from the pancreas
  • taken no more than 1 hr before meals
  • have rapid onset and short duration of action
  • useful in pts that have have blood sugars that vary with meal time but have constant sugars throughout the day
148
Q

Disadvantages of meglitinides?

A
  1. Risk of hypoglycemia
  2. Expensive
  3. Should not be used in pts with hepatic dysfunction
149
Q

Alpha-glucosidase inhibitors: MOA

A
  • delay carbohydrate absorption via inhibiting alpha glucosidase
  • decreases postprandial hyperglycemia
  • can be beneficial to pts with erratic eating habits bc hypoglycemia will not occur if meals are skipped
150
Q

Alpha-glucosidase inihibitors: sfx

A
  • GI side effects, including gas and bloating

- contraindicated in ketoacidosis and in hepatic disorders

151
Q

Pramlitide: MOA

A
  • amylinomimetic agent that is similar in action to human amylin
  • inhibits inappropriately high glucagon secretion during hyperglycemia (ex. After meals)
  • works in both type 1&2 DM
  • does not impair physiologic response to hypoglycemia
152
Q

Pramlinitide: sfx

A
  1. Hypoglycemia

2. Nausea & diarrhea

153
Q

GLP-1 Agonists: MOA

A

-synthetic peptide that stimulates insulin release

154
Q

GLP-1 Agonist: sfx

A

-nausea, vomiting, diarrhea, and acute pancreatitis

155
Q

DPP-4 inhibitor: MOA? How is it used?

A
  • ex. Januvia
  • inhibits DDP-4 = enzyme that inactivates incretin hormones like GLP-1 and GIP, which both stimulate the release of insulin from beta cells
  • Uses:
    1. As monotx in pts that cant control DM with diet and exercise alone
    2. In combo with metformin, sulfonylurea or thiazolidinedione as second-line tx
156
Q

DPP-4 inhibitor: sfx?

A
  1. upper respiratory syndromes

2. severe hypersensitivity (ex. Anaphylaxis)

157
Q

What risks are present for a fetus of a diabetic mother as opposed to a fetus of a mother with gestational DM?

A

-fetal malformations bc the increased serum levels of glucose are present earlier in the pregnancy (5-10 weeks) during the critical organogenesis stages, versus gestational DM where the increased serum glucose usually doesnt occur until 20 weeks when the fetal organs have already formed

From Flashcardlet (79 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions