Swanson - Primary Care 2

Question 1

What is the most important initial treatment for DKA?

Answer 1

High volume isotonic or half normal saline fluids and regular insulin by IV pump

Question 2

What is the benefit of tight glycemic control in T1DM?

Answer 2

Decreases micro vascular complications like retinopathy, nephropathy, and neuropathy

Question 3

What is the appropriate rate of fluid infusion in DKA ?

Answer 3

Large volumes of NS at 5-10mL/kg/hr or 2-3 L in first few hours

Question 4

What is alpha-Lipoic acid?

Answer 4

Potent antioxidant that enhances glucose uptake and prevents glycosylation of tissues. May improve diabetic neuropathy

Question 5

Which medications provide general cardiovascular benefit to diabetic patients?

Answer 5

ACEI or ARB, Statins, Aspirin

Not Ca channel blockers

Question 6

How much fat should be consumed in diabetic patients?

Answer 6

Reduce total fat content to limit caloric intake

Question 7

When should Lantus and Lispro be given?

Answer 7

Lantus long acting give evening or before bed

Lispro (is not listless) fast acting give within 30 min of meal

Question 8

What are the recommendations for blood glucose control in critically ill hospitalized patients?

Answer 8

Keep BG at or below 180, and avoid tight control between 81-108 as this has higher mortality

Question 9

What is the pathophysiology of Graves’ disease?

Answer 9

Autoimmune process where antibodies stimulate thyroid receptors

Question 10

What is the best initial test for diagnosing hyperthyroidism? What is useful to narrow down the underlying cause?

Answer 10

Serum TSH then free T4 (get T3 if T4 is normal)

Do radioactive iodine uptake to narrow (I.e. Differentiate graves from multinodular goiter from nodules etc.)

Question 11

What is the effect of hypothyroidism on BP? What CV drugs can predispose to Hothyroid?

Answer 11

Increases systemic vascular resistance, diastolic BP goes up

Amiodarone (contains iodine) can lead to iatrogenic HoThyroid

Question 12

How often should TSH be monitored in hypothyroid patients?

Answer 12

q4-6 weeks

Question 13

Which groups should be screened for HIV?

Answer 13

Al people between 13-64 years, unless prevalence documented

Question 14

What is the treatment of subacute thyroiditis?

Answer 14

Start thyroid replacement therapy to correct hypothyroidism, close monitoring of TSH

Question 15

What is the best choice for treatment of prolactinoma?

Answer 15

Bromocriptine, because recurrence after surgery is high

Question 16

What is the most likely cause of Cushing’s syndrome if corticosteroid use has been ruled out?

Answer 16

Pituitary adenoma

Question 17

What drugs are approved for the treatment of ankylosing spondylitis, Crohn’s, psoriatic arthritis, and Rheumatoid arthritis?

Answer 17

anti-TNF-alpha agents - Adalimumab and Infliximab

Question 18

Which infections can cause Addison’s disease?

Answer 18

African trypanosomiasis, histoplasmosis, HIV, paracoccidiomycosis, syphilis, TB

Question 19

What are the possible ophthalmological complications of SLE?

Answer 19

Keratitis, Optic Neuropathy, Sicca syndrome, uveitis

Question 20

What tests should be conducted for initial work up of HIV infection?

Answer 20

All usual basic labs, HIV genotyping cell count and CD4 count

toxo gondii IgG, Hep C Ab,CMV IgG, VDRL, TB, Pap smear

Question 21

What are examples of symptomatic HIV infection (not AIDS defining opportunistic infections)?

Answer 21

Oral thrush, aseptic meningitis, thrombocytopenia, vulvovaginal candidiasis, cervical dysplasia, fever, diarrhea, leukoplakia

Question 22

Which vaccines are safe in HIV infected individuals?

Answer 22

Most all NON-live vaccines

Question 23

What are the most common symptoms seen in acute retroviral syndrome?

Answer 23

Fever, LAD, pharyngitis, myalgias, arthralgias in >75%

Other = maculopapular rash, nausea, vomiting and diarrhea

Question 24

Which opportunistic infection associated with HIV requires continued ppx?

Answer 24

Coccidiomycosis

Question 25

What is the appropriate treatment for concurrent Hep B in someone with HIV?

Answer 25

Adefovir

Question 26

What are the AIDS-associated malignant neoplasms associated with low CD4 count?

Answer 26

Kaposi sarcoma, systemic high grade B cell lymphoma (immmunoblastic and Burkitt), primary lymphoma of brain

Question 27

What is the most important test to obtain if suspecting osteoporosis?

Answer 27

Central DXA to assess bone mineral density

Question 28

What is the current recommendation for mammograms?

Answer 28

yearly or biannual mammos starting at 40 yo

Question 29

What is the most common type of breast cancer?

Answer 29

Infiltrating ductal carcinoma

Question 30

What is the most likely cause of unilateral bloody nipple discharge?

Answer 30

Intraductal papilloma

Question 31

What is an alternative therapy for menopause symptoms?

Answer 31

SSRI or SNRI

Question 32

What is clomiphene used for?

Answer 32

Ovulation induction in patients treated for infertility