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Fam med aquifer > Cases 6-10 > Flashcards

Cases 6-10 Flashcards

1
Q

Name 4 common end-organ damage manifestations caused by DM

A
  1. Cardiovascular disease
  2. Retinopathy
  3. neuropathy (defined by a decrease in ankle jerk reflex)
  4. nephropathy (DM is #1 cause of kidney failure)
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2
Q

which type of DM does DKA typically occur?

A

type 1

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3
Q

which type of DM does HHS typically occur

A

DM 2

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4
Q

At what age should someone without risk factors be screened for DM? (USPSTF)

A

40 - 70 years

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5
Q

What are the diagnostic criteria for DM?

A
  1. random glucose of 200mg/dL+ AND symptoms of hyperglycemia
  2. fasting blood glucose 126mg/dL or greater (needs confirmation)
  3. A1C greater than 6.5% (needs confirmation)
  4. Two hour plasma glucose 200mg/dL+ during oral glucose test (needs confirmation)
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6
Q

What is the most frequent cause of new blindness among adults? How can you prevent it?

A

diabetic retinopathy

laser photocoagulation can only slow the process

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7
Q

What are signs of proliferative retinopathy?

A

cotton wool spots

retinal hemorrhages

microaneurysms

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8
Q

What are optimal ranges for blood glucose? (fasting and postprandial)

A

fasting 180-120mg/dL

Postprandial (1-2 hours after meal) <180 mg/dL

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9
Q

what 3 things should be included in a diabetic foot exam?

A
  1. loss of proprioception (tuning fork, pinprick, ankle reflexes)
  2. pedal pulses
  3. inspection
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10
Q

What does the ACA say about goal BP for someone with HTN?

A

<130/80

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11
Q

According to ACC/AHA, when should statins be initiated? (4)

A
  1. individuals with ASCVD (ACS, stroke, TIA, PVD)
  2. 40-75 years of age with diabetes
  3. 40-75 with 10 year ASCVD risk >7.5%
  4. >21 age with LDL >190
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12
Q

What does the USPSTF recommend about aspirin? (ages 50-59 and age 60-69)

A

50-59 = low-dose ASA for the prevention of CVD and colorectal cancer who have a 10%+ ASCVD risk, not at risk for bleeding

60-69= DECISION TO INITIATE low-dose ASA for the prevention of CVD and colorectal cancer who have a 10%+ ASCVD risk, not at risk for bleeding

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13
Q

What is the A1C goal for diabetics?

A

close to or <7%

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14
Q

what is the algorithm for medication management of DM?

A

Step 1: lifestyle changes and monotherapy

  • if A1C is <9%, start with metformin and exercise/diet
  • If A1C is 9-10%, consider duel therapy (step 2) and exercise/diet
  • If A1C is >10%, consider metformin and insulin and exercise/diet

Step 2:

  • Duel therapy and exercise/diet
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15
Q

What are vaccines recommended for patients with diabetes?

A

influenza

Pneumovax

Hep B

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16
Q

fill the blanks

A
17
Q

What is the 1/2 life of warfarin? How long will it take to reach steady state?

A

40 hours

5-7 days (this is when to check INR after warfarin initiation)

18
Q

What are the 5 Wagner gradings?

A

Grade 1: Diabetic ulcer (superficial)
Grade 2: Ulcer extension (involving ligament, tendon, joint capsule or fascia)
Grade 3: Deep ulcer with abscess or osteomyelitis
Grade 4: Gangrene forefoot (partial)
Grade 5: Extensive gangrene of foot

19
Q

How are ulcers managed? (think about wagner grading)

A

Grade 1-2: Outpatient management, extensive debridement, wound care, and relief of pressure

Grade 3: typically a brief hospitalization, evaluation for possible osteomyelitis as well as PAD

Grade 5: surgical amputation consult

20
Q

What are the advantages of LMWH? (5)

A

does not require hospitalization for administration

long half-life so it can be administered sub-q 1-2 times daily

lab monitoring is not required

thrombocytopenia is less leikely

bleeding complications are less likely

21
Q

Do Xa inhibitors require labs and INR monitoring?

A

yes

22
Q

Can direct thrombin inhibitors or Factor Xa drugs be used in pregnancy? Heparin?

A

NO! But heparin can

23
Q

after a PE or DVT, how long should someone be antiocoagulated? What if it was caused by cancer?

A

3 months

Cancer = 6 months or more

24
Q

If someone on Warfarin has an elevated INR, what should you do?

A

Hold the warfarin and give vitamin K to reduce INR. Check INR in 24 hours

25
Q

Wells criteria for diagnosis of DVT. What does a score of 0 mean? 1-2? 3+?

A

0 = low probability

1-2 = moderate probability

3+ = high probability

26
Q

Essential HTN is ~98% of all causes of HTN. When should you test for secondary causes of HTN?

A

if HTN increases in severity

HTN has poor response to treatment

PE reveals possible secondary cause

27
Q

Do women typically experience typical or atypical angina?

A

atypical angina

28
Q

What are the 4 Ps of pain characteristics that decrease the likelihood of ACS?

A

Pleuritic pain (pain worsened by respiration)

Pulsating pain

Positional pain

reproduced by Palpation

29
Q

How long does most back pain take to resolve?

A

2-4 weeks

30
Q

There are 3 major categories of back pain: mechanical, visceral, and non-mechanical. Of the three, which one is most common?

A

mechanical (97% of all back pain)

31
Q

Name 6 red flags associated with lower back pain

A

Fever

unexplained weight loss

pain at night

bowel or bladder incontinence

neurologic symptoms

saddle anesthesia

32
Q

in disc herniation, pain is exacerbated by bending or sitting and relieved by standing or lying down.

A

True

33
Q

What are the major dermatomes of the leg?

A
34
Q

What nerve root is assocated with difficulty with heel walk? toe walk?

A

Heel walk = L5

Toe walk = S1

35
Q

What nerve is associated with patellar reflex? achilles reflex?

A

Patellar L4, 5

Achilles S1

36
Q

What is considered conservative therapy for back pain?

A

ASA/NSAIDs/or muscle relaxants

heat and ice

stay active

37
Q

When is it appropriate to CT a back?

A

if not improving or worsening after 6 weeks

Fam med aquifer (8 decks)

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