Swanson - Primary Care 2 Flashcards
What is the most important initial treatment for DKA?
High volume isotonic or half normal saline fluids and regular insulin by IV pump
What is the benefit of tight glycemic control in T1DM?
Decreases micro vascular complications like retinopathy, nephropathy, and neuropathy
What is the appropriate rate of fluid infusion in DKA ?
Large volumes of NS at 5-10mL/kg/hr or 2-3 L in first few hours
What is alpha-Lipoic acid?
Potent antioxidant that enhances glucose uptake and prevents glycosylation of tissues. May improve diabetic neuropathy
Which medications provide general cardiovascular benefit to diabetic patients?
ACEI or ARB, Statins, Aspirin
Not Ca channel blockers
How much fat should be consumed in diabetic patients?
Reduce total fat content to limit caloric intake
When should Lantus and Lispro be given?
Lantus long acting give evening or before bed
Lispro (is not listless) fast acting give within 30 min of meal
What are the recommendations for blood glucose control in critically ill hospitalized patients?
Keep BG at or below 180, and avoid tight control between 81-108 as this has higher mortality
What is the pathophysiology of Graves’ disease?
Autoimmune process where antibodies stimulate thyroid receptors
What is the best initial test for diagnosing hyperthyroidism? What is useful to narrow down the underlying cause?
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.)
What is the effect of hypothyroidism on BP? What CV drugs can predispose to Hothyroid?
Increases systemic vascular resistance, diastolic BP goes up
Amiodarone (contains iodine) can lead to iatrogenic HoThyroid
How often should TSH be monitored in hypothyroid patients?
q4-6 weeks
Which groups should be screened for HIV?
Al people between 13-64 years, unless prevalence documented
What is the treatment of subacute thyroiditis?
Start thyroid replacement therapy to correct hypothyroidism, close monitoring of TSH
What is the best choice for treatment of prolactinoma?
Bromocriptine, because recurrence after surgery is high
What is the most likely cause of Cushing’s syndrome if corticosteroid use has been ruled out?
Pituitary adenoma
What drugs are approved for the treatment of ankylosing spondylitis, Crohn’s, psoriatic arthritis, and Rheumatoid arthritis?
anti-TNF-alpha agents - Adalimumab and Infliximab
Which infections can cause Addison’s disease?
African trypanosomiasis, histoplasmosis, HIV, paracoccidiomycosis, syphilis, TB
What are the possible ophthalmological complications of SLE?
Keratitis, Optic Neuropathy, Sicca syndrome, uveitis
What tests should be conducted for initial work up of HIV infection?
All usual basic labs, HIV genotyping cell count and CD4 count
toxo gondii IgG, Hep C Ab,CMV IgG, VDRL, TB, Pap smear
What are examples of symptomatic HIV infection (not AIDS defining opportunistic infections)?
Oral thrush, aseptic meningitis, thrombocytopenia, vulvovaginal candidiasis, cervical dysplasia, fever, diarrhea, leukoplakia
Which vaccines are safe in HIV infected individuals?
Most all NON-live vaccines
What are the most common symptoms seen in acute retroviral syndrome?
Fever, LAD, pharyngitis, myalgias, arthralgias in >75%
Other = maculopapular rash, nausea, vomiting and diarrhea
Which opportunistic infection associated with HIV requires continued ppx?
Coccidiomycosis
What is the appropriate treatment for concurrent Hep B in someone with HIV?
Adefovir
What are the AIDS-associated malignant neoplasms associated with low CD4 count?
Kaposi sarcoma, systemic high grade B cell lymphoma (immmunoblastic and Burkitt), primary lymphoma of brain
What is the most important test to obtain if suspecting osteoporosis?
Central DXA to assess bone mineral density
What is the current recommendation for mammograms?
yearly or biannual mammos starting at 40 yo
What is the most common type of breast cancer?
Infiltrating ductal carcinoma
What is the most likely cause of unilateral bloody nipple discharge?
Intraductal papilloma
What is an alternative therapy for menopause symptoms?
SSRI or SNRI
What is clomiphene used for?
Ovulation induction in patients treated for infertility
