SARAH MICHELLE LIVE REVIEW STUDY GUIDE (COMPLETE) | VERIFIED 100%

SARAH MICHELLE LIVE REVIEW STUDY GUIDE (COMPLETE) | VERIFIED 100% What is the screening tool for the thyroid? - ANSWER TSH Level What is the normal range for TSH? - ANSWER 0.5-5.0 When do you order a full thyroid profile? - ANSWER If thyroid screening of TSH comes back abnormal, then we will reorder TSH and T3, T4. What disorder demonstrates a low TSH level and high T3 and T4 levels? - ANSWER Hyperthyroidism What disorder demonstrates a high TSH level and low T3 and T4 levels? - ANSWER Hypothyroidism What medication is used to treat hypothyroidism? - ANSWER Levothyroxine (Synthroid) What dose of Synthroid do you want to start your patient on? - ANSWER If patient is elderly or if they have a significant cardiac history then we are going to start at a lower dose of 12.5-25 mcg po daily. In a normal healthy patient, we will start at 25-50 mcg po daily. After initiation of medication for treatment of hypothyroidism, when do you recheck TSH level? - ANSWER 6-8 weeks When TSH level is stabilized, how often do you recheck their level? - ANSWER Every 6-12 months What is the go to medication for treatment of hyperthyroidism? - ANSWER Tapazole and PTU How do you manage treatment for hyperthyroidism in a pregnant patient? - ANSWER We need to use PTU instead if they are in their first trimester. After first trimester, then they can be switched to tapazole. What medication class is used to treat symptoms of hyperthyroidism? - ANSWER Beta-blockers- these help manage tachycardia and palpitations What are 2 other treatments for the hyperthyroidism? - ANSWER Thyroidectomy and radioactive iodine What labs are used to measure and evaluate kidney function? - ANSWER GFR, BUN, Creatinine What lab value is most accurate description of kidney function? - ANSWER GFR- this is going to tell us how the kidneys are filtering the blood and how well they are removing waste. What is a normal GFR value? - ANSWER >90 What GFR value indicates an absolute need to start a patient on dialysis? - ANSWER <15- this means that patient is in CKD stage 5 What is the second most important lab value to measure kidney function? - ANSWER Creatinine What is creatinine? - ANSWER A waste product in the blood. If your kidneys are functioning properly, then this waste product is removed by your kidneys. When kidney function decreases, your creatinine level starts to rise. What is a normal creatine value? - ANSWER Around 1 Why is BUN least telling for kidney function? - ANSWER Blood urea nitrogen is a normal waste product when your body breaks down urea. However, this is not specific to the kidneys. It can also indicate liver issues. What is a normal BUN level? - ANSWER 10-20 With which first-line BP medication do we want to check the BUN/Cr? - ANSWER ACE Inhibitors What finding on a UA id indicative of true kidney damage? - ANSWER Casts- WBC or RBC casts always need to be referred out When do we screen for microalbumin in the urine? - ANSWER We're always going to screen when DM and HTN is first diagnosed. What are the most common causes of CKD? - ANSWER HTN and DM Why is it important to perform early screening for microalbumin in the urine? - ANSWER Patients who have mild kidney damage do not have symptoms, this screening will ideally identify damage early and prevent progression. What stage of CKD do patients show true symptoms? - ANSWER Stage 3 or worse How often are we screening for micro albumin? - ANSWER Bare minimum is going to be annually for patients with DM or HTN or both. What is the normal range of microalbumin? - ANSWER < 30 What is the most common symptom of all anemias? - ANSWER Fatigue What is a normal hemoglobin level? - ANSWER 12-18 Women are on the lower end, and men are on the higher end What is a normal hemoglobin to hematocrit ratio? - ANSWER 3 to 1 36-54% What does MCV stand for? - ANSWER mean corpuscular volume What is a normal MCV? - ANSWER 80-100 What does low MCV indicate? - ANSWER Microcytic anemias What is the most common microcytic anemia? - ANSWER Iron deficiency anemia What is the biggest risk faction for the development of IDA is int he first year of life? - ANSWER The ingestion of cow's milk What does high MCV levels indicate? - ANSWER Microcytic anemia What are the most common microcytic anemias? - ANSWER B12 and folate What symptoms are common with B12 deficiency anemia? - ANSWER Neuro symptoms- the most common symptom is parasthesia What surgery typically leads to B12 deficiency anemia? - ANSWER Gastrectomy patients- who have part of their stomach removed Why do gastrectomy patients typically have B12 deficiency anemia? - ANSWER In order for B12 to be absorbed, it needs to be able to combine with intrinsic factor, which is produced in the stomach. If we remove a large portion of the stomach then we lose a lot of that intrinsic factor. What diabetes medication used long term can also lead to B12 deficiency? - ANSWER Metformin What is an abnormal lead level? - ANSWER >5, ideally no lead should be within the body What kind of symptoms may lead intoxication lead to? - ANSWER Cognitive delays and behavioral problems What are the 3 microcytic anemias? - ANSWER LIT Lead Iron Thalassemia What are the 2 macrocytic anemias? - ANSWER FAB Folate and B12 What are the components of a lipid profile? - ANSWER Total cholesterol HDl LDL Triglycerides What's a normal total cholesterol level? - ANSWER <200 What is a normal HDL level? - ANSWER 40-60, the higher the better What is a normal LDL level? - ANSWER <100 What is a normal triglyceride level? - ANSWER <150 How often should you be ordering a standard limpid profile on a patient? - ANSWER Every 5 years unless they are having symptoms, risk factors, on treatment, etc. What is LDL? - ANSWER Bad cholesterol, it is our major culprit in atherosclerosis in clogging up those arteries. What is HDL? - ANSWER Good cholesterol, it is cardio protective and helps remove excess cholesterol from the body. What are some factors that impact our total cholesterol? - ANSWER Smoking, diet, weight, and physical activity What does triglycerides assist in assessing? - ANSWER Insulin resistance and your true dietary intake If triglycerides get >500 then patient will be at really high risk for what? - ANSWER Pancreatitis What is the first line treatment for abnormal lipid levels? - ANSWER HMGCoA Reductase Inhibitors- Statin drugs What if a patient is having increased muscle pain on a statin, what is worst case scenario? - ANSWER Rhabdomyolysis What lab value will assess for rhabdomyolysis? - ANSWER CK level How high is a CK level going to be in rhabdo? - ANSWER 5 times the normal limit What can rhabdomyolysis lead to? - ANSWER Renal failure When a patient is on a statin, the kidney of concern, but what other organ is a concern as well? - ANSWER The liver When should LFT be completed when initiating statin therapy for a patient? - ANSWER Prior to initiating medication treatment and at least once in 12 weeks after therapy has been started. What drug are we monitoring when looking at the INR? - ANSWER Warfarin What is the therapeutic INR for a patient who is on Coumadin? - ANSWER Generally 2-3 What is the antidote to warfarin if their blood becomes too thin? - ANSWER Vitamin K What if a patient comes into the office with an INR of 7, what does this mean? - ANSWER Blood is too thin, patient is at an increased risk for a bleed. If a patient's INR is 5-10 and they are not actively bleeding, how do we treat that? - ANSWER We are going to hold their warfarin, and readjust the dose. If a patient's INR is >10, how do we treat this? - ANSWER This is when you give vitamin K. Deciding whether to give vitamin K PO or IV is dependent on our the patient is actively bleeding.