FAMILY MEDICINE - AAFP NEWLEY
UPDATED CLEAR NOTES
ACC rec - pre-op clearance Correct Answer preoperative
clearance for noncardiac surgery state that preoperative
intervention is rarely needed to lower surgical risk.
-A resting 12-lead EKG is recommended for males over 45,
females over 55, and patients with diabetes, symptoms of chest
pain, or a previous history of cardiac disease.
LAB - BNP Correct Answer > 400 = Congestive HF > tx =
furosemide
* test for Left ventricular function *
tx - prophylaxis for surgery-related cardiac complications Correct
Answer Beta-blockers!
-study showed that mortality from cardiac causes was 65% lower
in the patients receiving atenolol. 30min b4 sx and x7 d postop
screening - before start lipid-lowering therapy Correct Answer
secondary dyslipidemia include diabetes mellitus, hypothyroidism,
obstructive liver disease, chronic renal failure, and some
medications
,CI - in heart failure Correct Answer 1. NSAIDs, including high-
dose aspirin, should be avoided in patients with heart failure.
They cause sodium and water retention, as well as an increase in
systemic vascular resistance which may lead to cardiac
decompensation.
2. Cilostazol (Pletal)
tx - HTN in pregnancy Correct Answer beta-blocker
tx - late after MI; decrease mortality Correct Answer beta-blocker
tx - Congestive heart failure Correct Answer ACE-inhibitor
most predictive of increased perioperative cardiovascular events
associated with noncardiac surgery in the elderly? Correct Answer
1. major risk factors such as unstable coronary syndrome (acute
or recent myocardial infarction, unstable angina), decompensated
congestive heart failure, significant arrhythmia (high-grade AV
block, symptomatic ventricular arrhythmia, supraventricular
arrhythmias with uncontrolled ventricular rate), and severe
valvular disease.
2. Intermediate predictors are mild angina, previous myocardial
infarction, compensated congestive heart failure, diabetes
mellitus, and renal insufficiency.
,3. Minor predictors are advanced age, an abnormal EKG, left
ventricular hypertrophy, left bundle-branch block, ST and T-wave
abnormalities, rhythm other than sinus, low functional capacity,
history of stroke, and uncontrolled hypertension
assoc - hypothyroid Correct Answer increased LDL
AE - lithium Correct Answer thyroid problems
-Lithium therapy can elevate calcium levels by elevating
parathyroid hormone secretion from the parathyroid gland. This
duplicates the laboratory findings seen with mild primary
hyperparathyroidism. If possible, lithium should be discontinued
for 3 months before reevaluation
tx - stop in a patient w/ diabetic gastroparesis Correct Answer
exenatide (byetta)
amylin analogues (pramlintide)
tx - geriatric DM in nursing home Correct Answer insulin glargine
(lantus)
management - hypothyroidism Correct Answer A free T4 level is
needed to evaluate the proper dosage of replacement therapy in
secondary hypothyroidism
, MOA - metformin Correct Answer increases insulin sensitivity
DX - DM Correct Answer any ONE of the following:
-symptoms of diabetes (polyuria, polydipsia, weight loss) PLUS a
casual glucose level ≥200 mg/dL;
-a fasting plasma glucose level ≥126 mg/dL;
-or a 2-hour postprandial glucose level ≥200 mg/dL after a 75
gram glucose load.
dx - recurrent kidney stone Correct Answer check serum
parathyroid hormone
dx - solitary thyroid nodule Correct Answer red flags:
1. male
2. age < 20y; > 65y
3. rapid growth
4. dysphagia, neck pain, hoarseness
5. h/o head/neck radiation
6. family h/o thyroid cancer
7. hard/fixed, > 4cm
8. cervical LAD
UPDATED CLEAR NOTES
ACC rec - pre-op clearance Correct Answer preoperative
clearance for noncardiac surgery state that preoperative
intervention is rarely needed to lower surgical risk.
-A resting 12-lead EKG is recommended for males over 45,
females over 55, and patients with diabetes, symptoms of chest
pain, or a previous history of cardiac disease.
LAB - BNP Correct Answer > 400 = Congestive HF > tx =
furosemide
* test for Left ventricular function *
tx - prophylaxis for surgery-related cardiac complications Correct
Answer Beta-blockers!
-study showed that mortality from cardiac causes was 65% lower
in the patients receiving atenolol. 30min b4 sx and x7 d postop
screening - before start lipid-lowering therapy Correct Answer
secondary dyslipidemia include diabetes mellitus, hypothyroidism,
obstructive liver disease, chronic renal failure, and some
medications
,CI - in heart failure Correct Answer 1. NSAIDs, including high-
dose aspirin, should be avoided in patients with heart failure.
They cause sodium and water retention, as well as an increase in
systemic vascular resistance which may lead to cardiac
decompensation.
2. Cilostazol (Pletal)
tx - HTN in pregnancy Correct Answer beta-blocker
tx - late after MI; decrease mortality Correct Answer beta-blocker
tx - Congestive heart failure Correct Answer ACE-inhibitor
most predictive of increased perioperative cardiovascular events
associated with noncardiac surgery in the elderly? Correct Answer
1. major risk factors such as unstable coronary syndrome (acute
or recent myocardial infarction, unstable angina), decompensated
congestive heart failure, significant arrhythmia (high-grade AV
block, symptomatic ventricular arrhythmia, supraventricular
arrhythmias with uncontrolled ventricular rate), and severe
valvular disease.
2. Intermediate predictors are mild angina, previous myocardial
infarction, compensated congestive heart failure, diabetes
mellitus, and renal insufficiency.
,3. Minor predictors are advanced age, an abnormal EKG, left
ventricular hypertrophy, left bundle-branch block, ST and T-wave
abnormalities, rhythm other than sinus, low functional capacity,
history of stroke, and uncontrolled hypertension
assoc - hypothyroid Correct Answer increased LDL
AE - lithium Correct Answer thyroid problems
-Lithium therapy can elevate calcium levels by elevating
parathyroid hormone secretion from the parathyroid gland. This
duplicates the laboratory findings seen with mild primary
hyperparathyroidism. If possible, lithium should be discontinued
for 3 months before reevaluation
tx - stop in a patient w/ diabetic gastroparesis Correct Answer
exenatide (byetta)
amylin analogues (pramlintide)
tx - geriatric DM in nursing home Correct Answer insulin glargine
(lantus)
management - hypothyroidism Correct Answer A free T4 level is
needed to evaluate the proper dosage of replacement therapy in
secondary hypothyroidism
, MOA - metformin Correct Answer increases insulin sensitivity
DX - DM Correct Answer any ONE of the following:
-symptoms of diabetes (polyuria, polydipsia, weight loss) PLUS a
casual glucose level ≥200 mg/dL;
-a fasting plasma glucose level ≥126 mg/dL;
-or a 2-hour postprandial glucose level ≥200 mg/dL after a 75
gram glucose load.
dx - recurrent kidney stone Correct Answer check serum
parathyroid hormone
dx - solitary thyroid nodule Correct Answer red flags:
1. male
2. age < 20y; > 65y
3. rapid growth
4. dysphagia, neck pain, hoarseness
5. h/o head/neck radiation
6. family h/o thyroid cancer
7. hard/fixed, > 4cm
8. cervical LAD
