FAMILY MEDICINE AQUIFER329 QUESTIONS AND ANSWERS (A+)

FAMILY MEDICINE AQUIFER/329 QUEST u u u




IONS AND ANSWERS (A+) u u u




What disease can hyperthyroidism unmask? -
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√Answer :Diabetes
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Unmasks glucose intolerance and adversely effects glucos
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e and lipid management
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Quiz :What diseases are associated with T1D? -
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√Answer :Hashimotos
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Graves u




*autoimmune diseases* u




Quiz :What is a key component of HHS treatment? -
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√Answer :Fluid replacement
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In many cases several liters
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Quiz :What is the most common underlying cause of HHS?
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- √Answer :Decreased fluid intake
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UTI
Pneumonia u




MI, stroke and PE can also precipitate it
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Quiz :Screening for TIID? - √Answer :Normal starts at 45
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Or

Overweight with one or more risk factors: u u u u u u u




Physical inactivity u u




High risk ethnicity u u u

,First degree relative with diabetes
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Impaired glucose previously u u u




Stage 2 hypertension (140/90)
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Low HDL and High TG
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gestational diabetes u




PCOS
CVD HX u u




acanthosis

Quiz :Symptoms of hyperglycemia -
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√Answer :Unexplained weight loss
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Polyuria

Quiz :Dx of diabetes - √Answer :A1C: greater than 6.5
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2 hour postprandial over 200
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Fasting over 126 u u




Random over 200 with symptoms of hyperglycemia
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Quiz :What causes vision changes in someone with diabet
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es - u




u√Answer :Darks spots: new blood vessels forming and leak
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ing u




Blurriness: macular edema u u u




Vision changes are a late complication of diabetic changes.
u
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40% of patients requiring insulin develop retinopathy 5 year
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s later
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Quiz :What do retinal hemorrhages look like and what caus
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es them? - √Answer :Dark blots with indistinct borders—
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indicate partial obstruction and infarction
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,Quiz :What are cotton wool spots and what does it mean? -
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√Answer :White spots with fuzzy borders
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Previous areas of infarction, usually with hemorrhages
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Quiz :What do microaneurysms look like in the eye? -
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√Answer :Punctuate dark lesions— well circumscribed
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Quiz :What causes neovascularization? -
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√Answer :Hypoxia and vessel occlusion
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Quiz :Parts of a diabetic foot exam -
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√Answer :Dorsalis pedis and posterior tib pulses
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Ankle jerk reflex u u u




Filament testing u u




Skin for hair loss, breaks in skin, bony prominences etc
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Quiz :What labs should be ordered for someone with diabet
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es that hasn't been seen for a year? - √Answer :A1C
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Lipid panel u




TSH u




Creatine/ GFR u u




B12 levels (metformin Lowers this)
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Spot albumin to creatinine ratio (testing for microalbuminuri
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a)

Quiz :When should moderate intensity statin be administrat
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ed? - √Answer :Age 40-75 with LDL over 70 and DM
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Quiz :When to use high intensity statin? -
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√Answer :Moderate risk plus 7.5% estimated 10 yr CVD ris
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k

, Quiz :Goal BP for patients with diabetes? -
u u u u u u u




√Answer :Less than 130/80
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(That is stage 1 hypertension)
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Quiz :Does aspirin decrease risk of heart disease in someo
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ne with diabetes and no other CVD risk factors? -
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√Answer :No
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**only give them aspirin if they have hex of CVD... aka over
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50 with HTN, HLD, smoking, microalbuminuria and are not
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at an increase risk of bleeding
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Quiz :What A1C is known to decrease microvascular compl
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ications? - √Answer :Less than 7 u u u u u




Quiz :Tx based on A1C - √Answer :Les than 9=metformin
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Between 9-10 dual oral therapy u u u u u




Above 10=insulin u




Quiz :How long do you wait before starting someone on the
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next step of therapy? -
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√Answer :3 months of therapy where the A1C doesnt drop t
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o below 7
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Quiz :What is tx goal for patients with essential hypertensio
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n? - √Answer :<130/80
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Quiz :When do you start 1 or 2 drugs? -
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√Answer :start 2 drugs if more than 20/10 increased from th
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e goal
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use one drug in the in between
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