Brand New 2023 NR 667 Study Guide With Best Solutions

Brand New 2023 NR 667 Study Guide With Best Solutions Liek: 1 Hollier: 17, 1 1. Hyperlipidemia Presentation: Most patients are asymptomatic until they develop ASCVD. • Xanthomata (lipid deposits around theeyes) • Corneal Arcus prior to age 50 years (white iris),normal • Angina • Bruits • MI • Stroke Diagnostics: • Fasting/non-fasting lipidprofile • Glucose, • UA and creatinine (fordetectionofnephroticsyndrome whichcan induce dyslipidemia), • TSH (for detection ofhypothyroidism) • CMP Diagnosis: Optimal goal is <100 mg/dL Pt with LDL >= 190mg/dL (without ASCVD or DM is a candidate for high-intensity statin) Non-pharmacologic Management/Education: • FIRST LINE: Lifestyle Modification; diet andexercise. • Diet toimproveserum lipids: Mediterranean diet, DASH,vegetarian, low-carb, and low-trans fat. • Decrease sugar and simplecarbs • Avoidalcohol • Increase fish diet with Omega-3 (salmon and sardines) twice aweek • Weight loss • Aerobic typeexercise Pharmacologic Management: • FirstLine: Atorvastatin 10mgonceaday at bedtime(perform liver function tests before initiation therapy and then 4-6 and 12 weeks and after doseincrease). a) Low Intensity (lowers LDLon averageby <30%): Simvastatin 10mg, Pravastatin 10-20mg, Lovastatin 20mg b) ModerateIntenstiy(lowers LDLonaverageby 30-49%): Atorvastatin 10-20mg daily, Rosuvastatin 5-10mg, Simvastatin 20-40mg, Pravastatin 40-80mg. lOMoAR cPSD|3013804 c) HighIntensity (lowers LDLonaverageby >50%): Atorvastatin 40-80mg daily. (Never start on 80mg, always titrate up). Rosuvastatin 20-40mg. • AVOID GRAPEFRUITJUICE! Watchforrhabdomylosis • INTOLERANCETO STATIN: Alternative Welchol (Bile Acid Sequestrants) 625 mgtab daily once aday. • Age 21-75 high intensitytherapy Follow up: q6-8 weeks re-check lipids until goal is achieved, then q 6-12 months to evaluate compliance Risk Factors: DM, FH of HD, HTN, low HDL, age (men older than 45 and women older than 55), smoking, obesity, CAD, PVD, microalbuminuria Refer: Nutritionist Differentials: • Hypothyroidism • Pregnancy • Diabete s 2. Hypertension Presentation: Most are not symptomatic, Occipital Headaches, headache on awakening in am, burry vision. Look for these clinical findings to rule out organ damage: Microvascular • Eyes(HTN retinopathy): AVnicking(causes whenarteriolecrossesontopof vein), papilledema • Kidneys: microalbuminuriaandproteinuria,elevatedserum creatinineand abnormal eGFR, peripheral or generalized edema Macrovascular • Heart: S3 (CHF), S4(LVH),carotid bruits,decreased orabsentperipheral pulses • Brain: TIA or hemorrhagicstroke Assessment/Exam: • Asymptomatic • Occipitalheadache • Blurry vision • Headache upon wakening • Exam ofopticfundi: Look for AVnicking,hemorrhage,papilledema • LVH (long standing HTN) • Perform exam of symmetricalpulses • Auscultate for Carotid bruits, abdominal bruits, and kidneybruits Diagnostic studies: EKG, fasting lipid profile, fasting blood glucose, TSH, CXR to R/O cardiomegaly. CBC, CMP,andurinalysis. Measure BP 5 minutesapart. Assess thepatients 10- lOMoAR cPSD|3013804 year risk for heart disease(ASCVD) Diagnosis: > 140/90 mm Hg start on B/P medication. Pharmacologic Management: • FIRSTLINE DIURETIC: Hydrochlorothiazide (HCTZ)25 mg/day (max 50mg/day) *May worsen gout and elevate lipids and glucose • ALTERNATIVE CCB: Amlodipinebesylate 5 mg /day. (Watch for lowerextremity edema) • ACE: lisinopril 10mg/day complicated HTN first line • Consider ACE/ARB inpatient with DM,proteinuria, HF. CONTRAINDICATED IN PREGNANCY • Ifstage 2, initiate2drugclasses (Diuretic & CCB mosteffectivein African American) Follow up: • 2-4weeks Referral : • Cardiology if EKG isabnormal Secondary HTN causes to consider: • CKD, renalarterystenosis,hyperthyroidism,phenochromocytoma, OSA,coarticationof the heart (SBP higher in the legs), oral contraceptives, corticosteroids, cocaine, NSAID, decongestants Differential: • Secondaryhypertension • White coatsyndrome • Pregnant lOMoAR cPSD|3013804 • Pregnancy inducedhypertension Education: lOMoAR cPSD|3013804 • • First: Lifestyle modifications:dietandexercise 30 minutesaerobic exercise 5 daysper week. • Weight loss (BMI 25 andup) • Limit alcohol (men:2 drinks or less per day; women: one drink or less perday) • Stop smoking • Stress management • Eat fatty cold water fish (salmon, anchovy) 3x a week • DASH • Medicationcompliance • Reduce sodium intake <1,500 mg/day) • Measure BP daily,bringlogtonext visit, bringhomecuff tocompareto office Liek: 1 Hollier: 29, 1 3. Diabetes type 2 - Presentation (assessment): insulin resistance in target tissues, abnormal insulin secretion, or decrease in insulin receptors. **Usually discovered on routine exam! • Polydipsia, Polyuria, Polyphagia, (showingsymptoms) • agitation, • nervousness, • obesity, • fatigue • Chronic skininfections • Women: chronic yeastinfection • blurry vision • Exam feet, pulses, nail thickness, odor, swelling,mobility • Thyroidpalpitation • Skinexam Diagnostics: EKG, CBC, CMP, LIPIDS, Microalbuminuria, TSH, A1C Diagnosis: • • • Fasting between 100-126 = impaired glucose Nonfasting less than 126 = normal values Fasting glucose>126mg/dl and confirmed on a differentday Hgb A1C >or equal to 6.5% lOMoAR cPSD|3013804 • Non-pharmacologic Management: • Monitor Blood glucose at home and diary(daily) • Lifestyle modification: diet andExercise • avoid alcohol • avoid smoking • Routine oralexams