Referral and Collaborations

Question 1

Serum fasting blood glucose > 126 mg/dl on more than one occasion OR random plasma glucose > 200 mg/dl with signs of hyperglycemia OR plasma glucose > 200mg/dl 2 hours after glucose load (OGTT) OR glycated hemoglobin A1c > 6.5%.

Answer 1

Positive screen for diabetes

Question 2

Total cholesterol < 200 mg/dl, triglycerides < 150 mg/dl, LDL < 100 mg/dl, HDL between 40-60 mg/dl.

Answer 2

Normal lipid levels

Question 3

Stage 1: SBP 130-139 or DBP 80-89; Stage 2: SBP >140 or DBP > 90.

Answer 3

HTN

Question 4

Level between 10-20 mg/dl which may become elevated with dehydration.

Answer 4

Normal BUN

Question 5

Level between 0.5-1.5 mg/dl which is most sensitive indicator for renal function (i.e. GFR)

Answer 5

Normal serum creatinine

Question 6

Liver enzymes which could be indicative of liver damage or disease if high (hepatitis, cirrhosis, mononucleosis, use of statins, etc.).

Answer 6

AST and ALT

Question 7

More common in women and onset between ages 20-40 years. Presentation commonly Graves’ disease.

Answer 7

Hyperthyroidism

Question 8

Nervousness, anxiety, increased sweating, fatigue, lability, fine tremors, hyperreflexia of DTRs, increased appetite, weight loss, fine hair, exophthalmos, tachy, heat intolerance.

Answer 8

Hyperthyroidism

Question 9

TSH low, T3 and T4 increased, thyroid radioactive iodine uptake and scan high (Graves’).

Answer 9

Hyperthyroidism

Question 10

Primary thyroid disease, pituitary deficiency of TSH, hypothalamic deficiency of TRH, iodine deficiency, Hashimoto’s thyroiditis.

Answer 10

Hypothyroidism

Question 11

Extreme weakness, fatigue, arthralgias, cramps, cold intolerance, constipation, weight gain, dry skin, hair loss, brittle nails, puffy eyes, extremity edema, brady, slowed DTRs, hypoactive BS.

Answer 11

Hypothyroidism

Question 12

TSH elevated, T4 low or normal, T3 may be decreased but not reliable indicator, hyponatremia, hypoglycemia.

Answer 12

Hypothyroidism

Question 13

Specialist referral needed, propranolol for symptoms, methimazole 30-60mg TID or propylthiouracil 300-600mg QID for small goiters, possibly radioactive iodine for large goiters, possibly surgery or Lugol’s solution (preop) to reduce vascularity of gland.

Answer 13

Hyperthyroidism

Question 14

Levothyroxine (Synthroid) 50-100mcg daily; increase dose 25mcg every 1-2 weeks until stable; decrease dose for ages 60 years and above.

Answer 14

Hypothyroidism

Question 15

Inpatient/emergency management of both thyroid crisis (1) and myxedema coma (2)

Answer 15

Hyperthyroidism (1) and Hypothyroidism (2)

Question 16

Flu-like symptoms 3 weeks or more, fever, night sweats, weight loss, CD4 < 200 cells and/or presence of opportunistic infection. Would order antigen/antibody combination immunoassay and proceed to antibody differentiation immunoassay if positive (ELISA).

Answer 16

HIV