PC3 Test 3
Untreated Cushing's syndrome can lead to all of the following except: A. rheumatoid arthritis B. hypertension C. type 2 diabetes D. osteoporosis
A. RA
Approximately what percentage of the population will develop diverticulosis by the time they reach 50 years of age? A. 10% B. 20% C. 33% D. 50%
33%
Treatment for H. Pylori ulcer
1) Rabeprazole 20mg BID + Amoxicillin 1 g BID x 5 days then Rabeprazole 20mg BID plus clarithromycin 500mg + tinidazole 500mg BID x 5 days 2) Bismuth subsalicylate 2 tabs QID + metronidazole 500mg TID + tetracycline 500mg QID + omeprazole 20mg BID (10-14 days)
10. Osteoporosis is defined as having bone density more than _____ standard deviation (s) below average bone mass for a healthy young adult: A. 1 B. 1.5 C. 2.5 D. 4
2.5
When to use insulin in diabetes (4)
1. all type 1 diabetics 2. at time of dx if glucose >250-300 3. when acutely, critically ill, surgical or non surgical, to keep glucose 140-180 4. when 2 or more insulin secretagogues at optimized use are inadequate to maintain glycemic control
Treatment of GERD (4)
1. antacids 2. H2RA for 6 weeks 3. omeprazole for 8 weeks 4. referral to GI and prob GI endoscopy
Special considerations with metformin (4)
1. do not initiate or continue with impaired renal function 2. avoid in heart failure 3. risk of lactic acidosis 4. omit day of and 2 days after surgery due to risk for dehydration
Red flags in GERD
1. dysphagia 2. odynophagia 3. GI bleeding (resulting in anemia) 4. unexplained weight loss 5. persistent chest pain
List the symptoms of diverticulitis
1. fever 2. leukocytosis 3. diarrhea 4. LLQ
Risks for pancreatitis (3)
1. gallstones 2. excess alcohol use 3. elevated triglyceride levels
Mild diverticulitis is treated with:
1. increased fluid intake & adequate rest 2. cipro + metronidazole or bactrim
Treatment of Graves
1. methimazole 2. propylthiouracil * both carry hepatotoxicity warnings
Initial testing for a person with thyroid nodule
1. obtain TSH level 2. thyroid scan can show areas of increased uptake 3. FNA is advised regardless of TSH... "is more helpful and cost effective in arriving at a definitive diagnosis than ultrasound or thyroid scan.
2 most concerning potential complications with cholecystitis
1. pancreatitis (acute or chronic) 2. empyema and perforation (really bad)
Top 5 things you need to know about Bell's Palsy
1. paralysis of CN 7, exact cause unknown, prob inflammation of the nerve in the temporal bone 2. Linked to viral infections: HSV, herpes zoster, Epstein barr, CMV, adenovirus, rubella, mumps. 3. You diagnosis clinically- if you are worried about a tumor or fracture --> get imaging. "Appropriate antibody testing for Lyme disease should be obtained." 4. Temporary, symptoms get better in a few weeks, with complete recovery by 6 months usually 5. Start: corticosteroids. "Current evidence demonstrates little benefit in the use of antivirals." Eye problems? send them to the eye doc, use tear substitutes/lubricants.
Treatment for temporal arteritis
1. refer 2. steroids for 6months to 2 years
Three things to prevent diverticulosis and diverticulitis
1. regular aerobic exercise 2. adequate hydration 3. high fiber diet
MOA of glp-1 agonists (3)
1. stimulates insulin production by pancreas 2. inhibits PP glucagon release 3. slows gastric emptying think GLP- gastric, liver, pancreas
Treatment for chronic pancreatitis (5)
1. stop drinking 2. manage pain 3. supplement endocrine/exocrine function 4. low fat diet 5. surgery for pseudocysts unresolved
1st line prophylactic treatment option for the prevention of tension-type headache is: A. nortriptyline B. verapamil C. carbamazepine D. valproate
A
7. Untreated Cushing's syndrome can lead to all of the following except: A. rheumatoid arthritis B. hypertension C. type 2 diabetes D. osteoporosis
A
Among the following beta blockers, which is the LEAST EFFECTIVE in preventing migraines A. acebutolol B. metoprolol C. atenolol D. propranolol
A
COX-2 contributes to: A. inflammatory response B. pain transmission inhibition C. maintenance of gastric protective mucosal layer D. renal arteriole dilation
A
Clinical presentation of type 1 DM usually includes all of the following except: A. report of recent unintended weight gain B. ketosis C. persistent thirst D. polyphagia
A
Crohn's disease is associated with increased risk of malignancy involving the A. small bowel B. large intestine C. duodenum D. stomach
A
Diagnostic testing in inflammatory bowel disease often reveals A. evidence of inflammation B. notation of intestinal parasites C. normal results D. characteristic intra abdominal mass on radiological imaging
A
Elevated lipase levels can be a result of all of the following conditions except A. hepatic failure B. renal failure C. perforated duodenal ulcer D. bowel obstruction or infarction
A
Lower GI hemorrhage associated with diverticular disease usually manifests as A. painless event B. condition noted to be found with marked febrile response C. condition accompanied by severe cramp-like abdominal pain D. common chronic condition
A
Major risk factors for diverticulosis include all of the following except A. low fiber diet B. family history of the condition C. older age D. selective connective tissue disorders
A
Pertaining to the use of sliding scale insulin in response to elevated blood glucose, which of the following best describes current best practice? A. The use of this type of sliding scale insulin therapy is discouraged as this method treats hyperglycemia after it has already occurred. B. Sliding scale insulin in response to elevated glucose is a safe and helpful method of treating hyperglycemia C. Delivering insuling in this manner is acceptable within the acute care hospital setting only D. The use of sliding scale insulin is appropriate in the treatment of type 1 dm only.
A
Prophylactic treatment for migraine headaches includes the use of A. amitriptyline B. ergot derivative C. naproxen D. clonidine
A
Risk factors for acute pancreatitis include all of the following except A. hypothyroidism B. dyslipidemia C. abdominal trauma D. thiazide diuretic use
A
The H2RA most likely to cause drug interactions with phenytoin and theophylline is A. cimetidine B. famotidine C. nizatidine D. ranitidine
A
What is the most common adverse effect noted with alpha-glucosidase inhibitor use? A. GI upset B. hepatotoxicity C. renal impairment D. symptomatic hypoglycemia
A
Which of the following characteristics applies to Type 2 DM? A. major risk factors are heredity and obesity B. pear shaped body type is commonly found C. exogenous insulin is needed for control D. physical activity enhances insulin resistance
A
Which of the following is an unlikely consequence of untreated metabolic syndrome and IR in a woman of reproductive age A. hyperovulation B. irregular menses C. acne D. hirsutism
A
Which of the following is most consisten with the presentation of a patient with acute colonic diverticulitis? A. cramping, diarrhea, and leukocytosis B. constipation and fever C. right sided abdominal pain D. frank blood in the stool with reduced stool caliber
A
Which of the following is most consistent with presentation of a patient with acute colonic diverticulitis? A. cramping, diarrhea, leukocytosis B. constipation, fever C. right sided abdominal pain D. frank blood in stool with string like thin stool
A
Which of the following is most likely to be found in a 40yo woman with new onset reflux esophagitis? A. recent initiation of estrogen-progestin hormonal therapy B. recent weight loss C. report of melena D. evidence of H pylori
A
Which of the following is not an "alarm" finding in the person with GERD symptoms? A. weight gain B. dysphagia C. odynophagia D. iron deficiency anemia
A
Which of the following is usually not seen in the diagnosis of acute cholecystitis? A. elevated serum creatinine B. increased alkaline phosphatase level C. leukocytosis D. elevated AST
A
You consider prescribing insulin glargine because of its: A. extended duration of action B. rapid onset C. ability to prevent end organ damage D. ability to preserve pancreatic function
A
You see a 48yo woman who has been taking a COX-2 inhibitor for the past 3 years. In counseling her, you mention that long term use of COX-2 inhibitors is associated with all of the following except A. hepatic dysfunction B. gastropathy C. cardiovascular events D. cerebrovascular events
A
You see a 72yo woman who reports vomiting and ab cramping occurring over the past 24 hours. In evaluating a patient with suspected appendicitis, the clinician considers that: A. the presentation can differ according to the anatomical location of the appendix B. this is a common reason for acute abdominal pain in elderly patients C. vomiting before onset of abdominal pain is often seen D. The presentation is markedly different from presentation of pelvic inflammatory disease
A
First line therapy for Crohn's disease or ulcerative colitis is A. oral aminosalicylates B. parenteral corticosteroids C. antibiotics D. immune modulators
A Asacol Azulfidine
Intervention in microalbuminuria for a person with DM includes which of the following? (more than one) A. improved glycemic control B. strict dyslipidemia control C. use of an ARB or ACEI D. use of an ACEI with an ARB
A, B, C
Generally, testing for type 2 diabetes in asymptomatic undiagnosed individuals older than 45yo should be conducted every.....
3 years
Average incubation period for the organism N. meningitides?
3-4 days
A1C level for pre diabetes
5.7-6.4
Peak effect of NPH insulin
6-14 hours
Peak effect of lispro
30 min - 1.5 hour
Increased parathyroid hormone secretion is most usually due to A. Parathyroid adenoma B. Toxic goiter C. Increased TSH D. Excessive blood levels of calcium
A. parathyroid adenoma
When evaluating a patient with acute headache, all of the following observations would indicate the absence of a more serious problem EXCEPT A. onset of headache with exertion, coughing, or sneezing B. hx of previous identical headache C. supple neck D. normal neuro exam
A.... That's SNOOP Onset with exertion = red flag
What is the diagnostic criteria for diabetes: A1C
A1C 6.5% or more Should repeat if the random is less than 200. Do not need to repeat if the A1C is elevated AND random is above 200 OR DM symptoms
43yo woman has a 12 hour history of sudden onset of right upper quadrant abdominal pain with radiation to the shoulder, fever, chills. She has had milder episodes in the past. Exam reveals marked tenderness to the RUQ. Most likely dx? A. hepatoma B. acute cholecystitis C. acute hepatitis D. cholelithiasis
B
58yo man with type 2 diabetes who is using a single 10 unit daily dose of long acting insuling glargine. HIs fasting blood glucose has been between 141 and 180. Which is the best next step? A. Continue current dose B. Increase by 4 C. Increase by 1 D. increase by 6
B
A gallstone that is not visualized on standard x ray is said to be A. radiopaque B. radiolucent C. calcified D. unclassified
B
Hemoglobin A1C should be tested: A. at least annually for all patients B. at least two times a year in patients who are meeting treatment goals and who have stable glycemic control C. monthly in patients whose therapy has changed tor who are not meeting glycemic goals D. only via standardizes laboratory testing because of inaccuracies associated with point of service testing
B
In prescribing prednisone for a patient with Bell's palsy, the NP considers that it's use: A. has not been shown to be helpful in improving outcomes B. should be initiated as soon as possible C. is likely to help minimize ocular symptoms D. may prolong the course of the disease
B
Risk factors for the development of cholelithiasis include all of the following except: A. rapid weight loss B. male gender C. obesity D. Native american
B
Teaching a Type 2 Diabetic patient taking basal insulin such as degludec (Tresiba) about using rapid acting insulin such as aspart (Novolog) to help with management of pp hyperglycemia, the NP advises starting an injection of ____ units prior to the largest meal A. 1 B. 4 C. 8 D. 12
B
The International Diabetes Federation's diagnostic criteria for metabolic syndrome include A. an obligatory finding of persistent hyperglycemia B. notation of ethnic specific waist circumference measurements C. documentation of microalbuminuria D. family history of type 2
B
The most common form of esophageal cancer in the US is A. squamous cell B. adenocarcinoma C. basal cell carcinoma D. melanoma
B
The use of GLP-1 agonist has been associated with the development of A. leukopenia B. pancreatitis C. lymphoma D. vitiligo
B
To rule out free air in the abdomen in the evaluation of acute diverticulitis, what do you order A. barium edema B. plain abdominal film C. abdominal ultrasound D. lower endoscopy
B
Which of the following best describes ethnicity and insulin sensitivity? A. little variation exists in insulin sensitivity among different ethnic groups B. African americans are typically less sensitive to the effects of insulin when compared wiht people of European ancestry C. Mexican americans are likely the most insulin sensitive ethnic group residing in North America D. the degree of insulin sensitivity has little influence on insulin production
B
Which of the following is least likely to be found in a patient with gastric ulcer? A. history of long term naproxen use B. age younger than 50 C. previous use of h2ra antacids D. cigarette smoking
B
Which of the following is likely to be reported in a patient with persistent GERD? A. hematemesis B. chronic sore throat C. diarrhea D. melena
B
Which of the following is most likely to be found in a person with acute cholecystitis? A. fever B. vomiting C. jaundice D. palpable gallbladder
B
Which of the following meds is a prostaglandin analogue A. sucralfate B. misoprostol C. esomeprazole D. metoclopramide
B
Which represents the most appropriate diagnostic test for the patient (29yo right side facial asymmetry..) A. CBC with WBC diff B. lyme disease antibody titer C. CT scan head with contrast D. BUN with creat
B
Which statement is true re: bariatric surgery? A. Gastric bypass is an effective weight loss treatment with minimal side effects B. lap banding is significantly more effective upon 2 year follow up C. liposuction decreases risk of cv events D. all surgery improve control of diabetes
B
Who is at greatest risk of esophageal cancer? a. 45yo woman with a hx of 6 term pregnancies b. 75yp male who stopped smoking 15 years ago c. 34yo man who eats a high fat diet d. 58yo female vegetarian
B
You prescribe a fluoroquinolone antibiotic to a 54 yo woman who has occasional GERD that she treats with antacid. You advise that she should take the antimicrobial A. with the antacid B. separated from the antacid use by 2 to 4 hours before or 4 to 6 hours after taking the fluoroquinolone C. without regard to antacid use D. apart from the antacid by about 1 hour on either side of the fluoroquinolone dose
B
To avoid the development of acute diverticulitis, treatment of diverticulosis can include A. avoiding foods with seeds B. the use of fiber supplements C. ceasing cigarette smoking D. limiting alcohol
B.
A large fleshy thyroid gland with large follicles lined by active cells is most likely indicative of A. Hashimotos B. Graves C. Toxic goiter D. Thyroid cancer
B. Graves
What are the real names of Actos and Avandia? What kind of drugs are they?
Actos = pioglitazone Avandia = rosiglitazone thiazolidinedione aka TZD aka glitazones
20yo male presents to the clinic for an athletic physical. He is obese BMI >85% for his age and sex. What 2 others factors would indicate the need to screen this child for Type 2 dm? A. cousin with type 1 & obese parents B. parents with HTN & hyperlipidemia C. acanthosis nigricans & grandmother with type 2 D. Caucasian ethnicity and parents with hyperlipidemia
C
24yo man presents with a 3 month history of upper abdominal pain. He describes it as an intermittent, centrally located "burning" feeling in his upper abdomen, most often occurring 2 to 3 hours after meals. His presentation is most consistent with the clinical presentation of A. acute gastritis B. gastric ulcer C. duodenal ulcer D. cholecystitis
C
57yo male is in need of a evaluation for Barrett esophagus. You recommend A. H pylori B. CT scan C. upper GI endoscopy with biopsy D. barium swallow
C
58yo man recently began taking an antihypertensive medication and reports that his "heart burn" has become much worse. He is most likely taking A. atenolol B. trandolapril C. amlodipine D. losartan
C
64yo male patient with a diagnosis of esophageal columnar epithelial metaplasia. You realize he is at risk for: A. esophageal stricture B. GERD C. esophageal adenocarcinoma D. H pylori colonization
C
65 yo man with hx of ACS and migraine. Which of the following agents represents the best choice for acute headache abortive therapy for this patient A. verapamil B. ergotamine C. acetaminophen D. sumatriptan
C
68yo man with suspected acute colonic diverticulitis. What imaging study will you order? A. flat plate B. ultrasound C. CT scan with contrast D. barium enema
C
All of the following medications are recommended as possible first line medications for treatment of concomitant hypertension when seen with type 2 diabetes in a 48 yo man of european ancestry except: A. thiazide diuretic B. CCB C. alpha adregergic receptor antagonist D. ARB
C
Anemia of chronic disease that often accompanies IBD? A. microcytic, hypochromic B. macrocytic, normochromic C. normocytic, normochromic D. hyperproliferative
C
Antiepileptic drugs useful for preventing migraine headaches include all of the following except A. divalproex B. valproate C. lamotrigine D. topiramate
C
CV effects of hyperinsulinemia include A. decreased renal sodium reabsorption B. constricted circulating volume C. greater responsiveness to angiotensin II D. diminished sympathetic activation
C
Diagnostic testing in IBS often reveals A. evidence of underlying inflammation B. anemia of chronic disease C. normal results on most testing D. mucosal thickening on ab radiological imaging
C
Five years or more after type 2 diabetes mellitus diagnosis, which of the following medications is less likely to be effective in controlling plasma glucose? A. metformin B. pioglitazone C. glipizide D. insulin
C
IBD is a term usually used to describe A. ulcerative colitis and ibs B. C diff colitis and crohns C. Crohns and ulcerative colitis D. inflammatory colitis and ileitis
C
In caring for a patient with diabetes, microalbuminuria measurement should be obtained: A. annually if urine protein is present B. periodically in relationship to glycemia control C. yearly D. with each office visit related to DM
C
Risk factors for giant cell arteritis include all EXCEPT: A. female gender B. older age C. osteoarthritis D. Northern European descent
C
Skip lesions are usually reported during colonoscopy in A. IBS B. ulcerative colitis C. Crohns disease D. C diff colitis
C
Sytemic corticosteroid therapy would be most appropriate in treating A. tension headache B. migraines occurring on a weekly basis C. intractable or severe migraines and cluster headaches D. migraines during pregnancy
C
The following lab findings support a diagnosis of acute pancreatitis except A. elevated serum amylase B. elevated lipase C. jaundice D. upper abdominal tenderness without localization or rebound
C
The meglitinide analogues are particularly helpful adjuncts in type 2 diabetes care to minimize risk of: A. fasting hypoglycemia B. nocturnal hyperglycemia C. pp hyperglycemia D. pp hypoglycemia
C
The pathyphysiology of IBS can be best described as A. inflammatory bowel disease B. patching inflammatory process in the small bowel that most teens grow out of it C. condition that is the result of abnormal gut motor/sensory activity D. an overstimulation of pancreatic beta cell production
C
Treatment for IBS? A. high fat, low res diet B. high fiber, low fat diet and stress modification C. antispasmodics and loperamide for diarrhea predomincance D. TCAs for constipation predominance
C
When caring for a patient with DM, hypertension, and persistent proteinuria, the NP prioritizes the choice of antihypertension and prescribes: A. furosemide B. methyldopa C. fosinopril D. nifedipine
C
Which diagnostic test provides the most direct information about a thyroid nodule? A. plain film x ray B. ultrasound C. Fine needle aspiration D. CT scan
C
Which of the following is most consistent with the presentation of a patient with colonic diverticulosis? A. diarrhea and leukocytosis B. constipation and fever C. few or no symptoms D. frank blood in the stool with reduced stool caliber
C
Which of the following should be periodically monitored with the use of a thiazolidinedione? A. CK B. ALP C. ALT D. Cr
C
You examine a 29yo woman who has sudden onset of right sided facial asymmetry. She is unable to close her right eyelid tightly, frown, or smile on the affected side. Her exam is otherwise unremarkable. This representation likely represents paralysis of CN: A. III B. IV C. VII D. VIII
C Bell's palsy = acute paralysis of CN VII in the absence of brain dysfunction
17yo Amanda.... you consider her risk factors for type 2 DM would likely include all of the following EXCEPT: A. obesity B. native american C. family history of type 1 D. personal hx of PCOS
C.
COX-1 contributes to A. the inflammatory response B. pain transmission C. maintenance of gastric protective mucosal layer D. renal arteriole constriction
C.
Headaches associated with giant cell arteritis are most likely to occur in the: A. occipital area B. vertex area C. temporal area D. frontal area
C. temporal
The most important treatment for slowing the progression of diabetic neuropathy is generally recognized as: A. immediate surgical correction for s/s complications B. Treatment with aldose reductase inhibitors C. Tight & stable glycemic control D. dietary supplementation
C. tight & stable glycemic control
Which of the following is characterized by impaired beta cell function and diminished sensitivity to insulin A. recurrent hypoglycemia B. impaired glucose tolerance C. Type 2 diabetes D. Type 1 diabetes
C. type 2 diabetes
Neuropathies are a common complication of diabetes and effect up to 50% of all diabetics. ID the most common form of neuropathy in most patient's with diabetes. A. focal neuropathies B. cranial neuropathies C. Distal polyneuropathy D. plexopathies
C. distal polyneuropathies
Sulfonylureas are a class of drugs to treat type 2 diabetes. The key advantage of these medications is: A. decreased insulin secretion B. improved insulin secretion C. decreased insulin resistance D. improved lipid profile
B. improved insulin secretion
Managing DM can be difficult with the many options available. Identify which of the following agents is most effective in reducing the A1C levels: A. Glitazones B. Insulin C. Secretagogues D. Metformin
B. insulin
The NP orders a dexascan for the patient. When the results return, the test revealed a T- 2.5 result which indicates A. normal bone scan result B. osteoporosis C. mild osteopenia D. moderate osteopenia
B. osteoporosis
What's the goal for a 45yo man with diabetes and hypertension? A. BP <140/90 B. A1C less than 7 C. Triglyceride 200-300 D. HDL 35-40
BP 140/90 or less
Most common treatment of Cushing's disease is A. tapering or ceasing corticosteroid use B. eliminating trigger medications C. antineoplastic therapy D. surgical intervention
D. surgery. Remember- Cushing's disease = tumor = cut it out.
In the older adult with type 2 diabetes with gastroparesis the use of which of the following should be avoided: A. insulin glargine B. insulin aspart C. glimepiride D. liraglutide
D... aka victoza
52yo male: obesity, diabetes, tobacco use. These are several risk factors for: A. CVA B. guillan barre C. multiple sclerosis D. seizure disorder
CVS
5. A 46yo woman complains of fatigue, weakness, lethargy, decreased concentration and memory, and increased facial hair over the past 12 months. She also reports gaining over 30 pounds in the past 3 months. She has a history of asthma with repeated flares during the last 6 months requiring multiple doses of prednisone. A likely diagnosis is: A. Type 2 diabetes B. Cushing's syndrome C. Cushing's disease D. Central obesity
Cushing's syndrome
Whats the difference between cushing's syndrome & cushing's disease?
Cushings disease identifies a specific cause of Cushing's syndrome as tumor: pituitary tumor causing over production of ACTH.
A 46yo woman complains of fatigue, weakness, lethargy, decreased concentration and memory, and increased facial hair over the past 12 months. She also reports gaining over 30 pounds in the past 3 months. She has a history of asthma with repeated flares during the last 6 months requiring multiple doses of prednisone. A likely diagnosis is: Type 2 diabetes Cushing's syndrome Cushing's disease Central obesity
Cushings syndrome
64 yo male with diagnosed Barrett esophagus has shown no signs of dysplasia in two consecutive evaluations within the past year. You recommend additional surveillance testing should be conducted every A. 6 months B. 12 months C. 2 years D. 3 years
D
Acanthosis nigricans is commonly noted in all of the following areas except A. groin folds B. axilla C. nape of the neck D. face
D
All of the following are risks for lactic acidosis in individuals taking metformin except: A. presence of chronic renal insufficiency B. acute dehydration C. recent radiographic contrast dye use D. history of allergic reaction to sulfonamides
D
All of the following are typically noted in a young adult with the diagnosis of acute appendicitis except: A. epigastric pain B. positive obturator sign C. rebound tenderness D. marked febrile response
D
Colonic diverticulosis most commonly occurs in the walls of the A. ascending colon B. descending colon C. transverse D. sigmoid
D
Hemoglobin A1C best provides information on glucose control over the past days: A. 21 to 47 B. 48 to 68 C. 69-89 D. 90-120
D
Long term PPI use is associated with all of the following except A. increased risk of pneumonia in hospitalized patients B. increased risk of C Diff colitis in hospitalized patients C. reduced absorption of calcium and magnesium D. reduced absorption of dietary carbs
D
Measures to prevent colonic diverticulosis and diverticulitis include all of the following except A. increased whole grain intake B. regular aerobic exercise C. adequate hydration D. refraining from excessive alcohol intake
D
Metformin has all of the following effects except A. improved insulin mediated glucose uptake B. modest weight loss with initial use C. enhanced fibrinolysis D. increased LDL production
D
Peptic ulcer disease can occur in any of the following locations except A. duodenum B. stomach C. esophagus D. large intestine
D
Risk factors for Barrett esophagus include all of the following except A. history of cigarette B. being older than 50 yo C. male D. african american ethnicity
D
Secondary causes of hyperglycemia potentially include the use of all of the following medications except: A. high dose niacin B. systemic corticosteroids C. high dose thiazide diuretics D. low dose angiotensin receptor blockers
D
The NP examines a patient and finds a positive Murphy's sign. Murphy's sign can be described as abdominal pain elicited by: A. from tip toes, patient drops onto heels B. percussion of abdomen C. Asking the patient to cough D. RUQ abdominal palpation
D
The use of a thiazolidinedione is not recommended in all of the following clinical scenarios except A. 57yo man who is taking a nitrate B. 62 yo woman with heart failure C. a 45 yo man who is using insulin D 35 patient with newly diagnosed type 2 dm
D
The use of which of the following medications can induce thyroid dysfunction? A. sertraline B. venlafaxine C. burpropion D. lithium
D
The use of which of the following medications has the potential for causing the greatest reduction in A1C? A. biguanide B. thiazolidinedione C. sulfonylurea D. an insulin form
D
Thyroid scan on a 48yo woman with thyroid mass. "Cold spot" is reported. This is consistent with A. autonomously functioning adenoma B. Graves C. Hashimotos D. thyroid cyst
D
Which of the following classes of medications is commonly recommended as part of the first line therapy in the newly diagnosed person with type 2 diabetes? A. alpha glucosidase inhibitor B. meglitinide C. thiazolidinedione D. biguanide
D
Which of the following is the most common serious complication of cholecystitis? A. adenocarcinoma of the gall bladder B. gallbladder empyema C. hepatic failure D. pancreatitis
D
Which of the following patients has prediabetes? A. 70yo man with fasting glucose = 99 B. 84yo woman with 1hour PP of 98 C. 33yo man with A1C = 5.4 D. 58yo woman with a 2hour PP = 152
D
Which of the following statements is not true concerning the effects of exercise and IR? A. approximately 80% of the body's insulin mediated glucose uptake occurs in skeletal muscle B. with regular aerobic exercise, IR is reduced by approximately 40% C. the IR reducing effects of exercise persist for 48 hours after the activity D. Hyperglycemia can occur as a result of aerobic activity
D
Immune modulators are often used for intervention in A. ulcerative colitis B. ibs C. Crohns D. A & C
D ex. humira adelimumab
Common secondary headache causes include all of the following except A. brain tumor B. intracranial bleeding C. intracranial inflammation D. cluster headache
D remember secondary = some other cause, ex structural, anatomical...
Which of the following should be periodically monitored with the use of a biguanide? A. creatine kinase B. alkaline phosphatase C. alanine aminotransferase D. creatinine
D remember: no metformin if renal impairment. Check creatinine and GFR
NSAID-induced peptic ulcer can best limited by the use of A. antacid B. h2RA C. antimicrobial D. misoprostol
D.
Treatment for cluster headaches include the use of A. NSAIDs B. oxygen C. triptans D. all of the above
D.
Which of the following WBC forms is an ominous finding in the presence of severe bacterial infection? A. neutrophil B. lymphocyte C. basophil D> metamyelocyte
D.
All of the following are secondary symptoms for DM, except: A. interstinal ileus B. cardiac arrythmias C. foot fractures D. hammer toes
D. Hammer toes
The NP notes that the patient's fasting plasma glucose consistently runs between 100 and 125mg/dl. This finding is consistent with A. Type 2 Diabetes B. Type 1 diabetes C. episodic hypoglycemia D. Impaired oral glucose tolerance
D. Impaired oral glucose tolerance
There are several risk factors that place a patient at high risk of developing type 2 diabetes. Identify the risk factors associated directly with type 2 DM: A. 1st degree relative DM B. elevated BP C. obesity or being overweight D. All of the above
D. all of the above
You see an obese 25yo man with acanthosis nigricans and consider ordering A. FBS B. LFT C. RPR D. ESR
FBS
The ADA and the WHO agree that the appropriate 2 hour post prandial plasma glucose level is 180. T/F.
False
What is the diagnostic criteria for diabetes: plasma glucose
Fasting (8 or more hours) = 126 or more Random = 200 or more + symptoms (3 P's, weight loss, hyperglycemic crisis)
Who is at risk for gall stones? (8)
Fat Fair Female Forty to fifty (or more) hyperlipidemia diabetes pregnancy European-native american ancestry
MOA of exenatide (Byetta)
GLP-1 agonist... stimulates insulin production in response to an increase in plasma glucose remember it works by gastric emptying, decrease glucagon in liver, increase insulin in pancreas GLP 1 = "tides"
Trulicity and Victoza are what kind of drugs
GLP-1 agonists end in "--tide": liraglutide, dulaglutide, exenatide...
Which two diabetes meds should you NOT use together because they have similar MOAs....
GLP-1 receptor agonist and DPP-4 inhibitors
Difference in presentation of gastric and duodenal ulcer
Gastric: worse after eating but lessens with in an hour of eating bc the food is a buffer Duodenal: most common, burning experienced 2 hours after eating when pH decreases and emptying occurs.
The most abundant immunoglobin found in the blood, lymph, and intestines is A. IgD B. IgM C. IgG D. IgA
IgG
What's the diagnosis for a patient with two separate readings of a fasting glucose 113 and 118.
Impaired fasting glucose
Oral glucose tolerance test level for prediabetes
Impaired glucose tolerance = 140-199 after 75gram load
WHO diagnostic criteria for metabolic syndrome (6)
Insulin resistance (type 2 or impaired fasting glucose) plus two or more: A. abdominal/ central obesity defined as waist to hip ration >0.9 (men), >0.85 (women), or BMI 30 or more B. Hypertriglyceridemia 150 or more C. Low HDL <35 for men, <39 for women D. High BP >140/90 or documented HTN E. microalbuminuria with urinary albumin to creatinine ratio 30mg/g, or albumin excretion rate 20mcg/min
Name some DDP-4 inhibitors
Januvia, sitagliptin Onglyza, saxagliptin Tradjenta, linagliptin end in "-gliptin"
Pain in diverticulosis is where?
LLQ
What do you need to check periodically on a patient taking Actos
LT
Name it •Characterized by headache, jaw claudication, scalp tenderness, visual symptoms, throat pain •Affected temple has indurated, reddened, cord-like and tender artery
Temporal arteritis
MOA SGLT2 inhibitors
Lowers renal glucose threshold, increasing urinary glucose excretion
42yo female reports galactorrhea for several months. the HCG is negative and her prolactin is elevated 75. The NP would next consider: A. MRI of the head B. endocrinology C. intact PTH D. neurosurgery referral
MRI of the head
36yo female episodic attacks of severe vertigo, usually associated with ear fullness. Her attacks last several hours and she reports being well prior to and after these episodes. The NP attributes this to: A. labryinthitis B. meniere's disease C. BPPV D. vestibular neuritis
Meniere's disease
peak effect of insulin glargine
No peak.
You suspect a pt to have GERD. Diagnostic testing?
No specific diagnostic testing is needed
Murphy's sign
RUQ pain on palpation, associated with cholecystitis
Extrapyramidal side effects may develop as a side effect of antipsychotic medications. The treatment may include all except: A. amantadine Symmetrel B. methylphenidate Ritalin C. bentopine Cogentin D. trihexyphenidyl Artane
Ritalin
1. ______ are considered the major metabolic hormones because they target virtually every tissue in the body. A. Insulin & glucose B. Parathyroid & T4 C. T3 & T4 D. Estrogen & testosterone.
T3 and T4
2. _____ is the major regulator of the thyroid. It is secreted by _____. A. TSH.... anterior pituitary. B. TRH ...... hypothalamus C. PTH..... parathyroid D. TSH..... hypothalamus.
TSH... ant pituitary
Gold standard testing for appendicitis
abdominal CT
The psoas sign is
abdominal pain elicited by passive extension of the hip, seen in appendicitis
Describe the obturator sign
abdominal pain elicited by passive flexion and internal rotation of the hip, seen in appendicitis
Diagnostics for suspected gall stones
abdominal ultrasound
What do you prescribe to prevent recurrence of duodenal ulcer in a middle aged man
abx
The NP recognizes the most common cause of cerebellar disease is: A. cerebellar neoplasm B. 5-FU or dilantin C. hypothyroidism D. alcoholism
alcoholism
Acarbose is what type of drug
alpha glucosidase inhibitors
Which diabetes drug works on the intestines
alpha glucosidase inhibitors, acarbose (Precose), miglitol (Glyset)
Parkinson Disease is cause by...
alteration in dopamine- containing neurons within midbrain
Cushing's is
an excess of cortisol
As an NP choosing pharmacological interventions to prevent recurrence of duodenal ulcer (H pylori +) in a middle aged man, you prescribe: A. PPI B. H2RA C. antimicrobial Rx D. antacid
antimicrobial rx
Sara comes into the clinic and presents with numerous petechiae on her arms. She is NOT taking warfarin. The NP proceeds to query about other drug use and determines the potential agent is A. antihypertensive agent B. oral contraceptive agents C. aspirin or aspirin compounds D. anticonvulsant agents
aspirin
The following are autoimmune disorders except: A. hashimoto's B. sjogren's C. asthma D. goodpasture's syndrome
asthma
The most appropriate time to begin screening for renal nephropathy in a patient with type 2 is:
at the time of diagnosis
The basic deficit of a decreased supply of hemoglobin to the developing red cell is a characteristic of ALL of the following anemias EXCEPT A. iron deficiency B. sideroblastic anemia C. anemia of chronic disease D. autoimmune hemolytic anemia
autoimmune hemolytic anemia
Consideration should be given to setting a1c goal in a 22yo man with a 8 year history of type 1 who has no comorbid conditions equal to or less than A. 5.5 B. 6 C. 6.5 D. 7
b
4. Which electrolyte is most affected by the parathyroid hormone? A. Potassium B. Calcium C. Phosphate D. iron
calcium
40yo female patient presents to the office for a physical exam. Which of the following characteristics is considered a risk factor for type 2 dm? A. osteopenia b. hx of hypothyroidism c. central adiposity c. mediterranean descent
central adiposity
Tobacco is responsible for all of the following cancers EXCEPT A. bladder cancer B. cervical cancer C. pancreatic cancer D. laryngeal cancer
cervical
What's worse cholelithiasis or cholecystitis
cholecystitis
9. All of the following are common sites of fracture in patients with osteoporosis except: A. Proximal femur B. Distal forearm C. Vertebrae D. clavicle
clavicle
The first choice of therapy for a patient who is positive for HIV and has oral candidiasis would be A. clotrimazole troch 5x day or nystatin suspension 3-5x day B. griseofulvin 500mg po bid C. fluconazole 100-200mg po daily D. ketonozole 200mg po bid
clotrimazole or nystatin
Name it: headache occurs at the same time of day for several weeks then disappears, often behind one eye, severe "ice pick" piercing pain, steady, intense, may awaken at night
cluster
The NP sees a 55 yo male patient who presents with a headache. He states the headaches that seem to come on one right after the other, occur daily, usually starting an hour or two after he has gone to sleep. He describes it as steady intense pain behind his left eye. Most likely dx? A. tension headache b. migraine C. cluster headaches D. focal
cluster
50yo male experiencing chronic, episodic headache that can wake him up at night. The headache may last 15 minutes or up to 3 hours and has recently reported daily episodes over a period of 4-8 weeks. You suspect A. migraine headaches B. potential brain tumor C. tension headache D. cluster headache
cluster headache
MOA of alpha-glucosidase inhibitors
delays intestinal carb absorption by reducing PP digestion of starches and disaccharides via enzyme action inhibition it's in the name... they inhibit glucosidase: enzymes that breakdown glucose
Multiple sclerosis is most likely caused by?
destructive process of the nerve fiber protecting myelin
Name 3 risk factors for trans-ischemic attacks:
diabetes CAD vascular spasms HTN HLD
MOA of sulfonylureas
enhances insulin release
Name the WBCs responsible fighting against parasitic infections, hypersensitivity reactions, and autoimmune conditions are: A. eosinophils B. monocytes C. neutrophils D. basophils
eosinophils
The Gold standard for the definitive diagnosis of sickle cell anemia is A. reticulocyte count b. peripheral blood smear c. sickle cell test d. hemoglobin electrophoresis
hemoglobin electrophoresis
Which is hereditary neurological condition? A. meningitis B. seizure disorder C. Creutzfeldt- jacob disease D. huntington's
huntington's
In the first weeks of anemia therapy with parenteral vitamin B 12 in a 69yo female patient with hypertension who is takicng HCTZ, the patient should by monitored for A. hypernatremia B. dehydration C. acidemia D. hypokalemia
hypokalemia
What are metamyelocytes
immature neutrophils, even worse than bands. Can be an ominous marker associated with appendix rupture
Jan is having biological treatment for pancreatic cancer. This type of treatment is considered A. chemo B. immunotherapy C. radiation treatment D. surgical intervention
immunotherapy
44yo male comes in for routine physical. Fasting glucose = 112, LDL = 95, A1C = 6.3. Repeat labs are exactly the same. What is the diagnosis? A. impaired fasting glucose b. type 2 c. hyperlipidemia d. impaired oral glucose tolerance
impaired fasting glucose
Patient has fasting glucose values of 105 & 114 that were measured 2 separate days a week apart. What's the diagnosis? A. impaired fasting glucose B. type 2 diabetes C. impaired oral glucose D. type 1
impaired fasting glucose
Plasma glucose levels for prediabetes
impaired fasting glucose = 100 to 125
All of the following statements about Parkinson's are true except: A. it affects nearly 1% of the population B. incidence is greater in women than in men C. treatment is primarily pharmacologic D. average age onset is 55-60yo
incidence is greater in women
(Lots of lab values...) A1C = 7.4, fasting = 159, creat 1.1. What do you do? A. increase lisinopril B. increase pioglitazone C. add a fibrate D. add niacin
increase pioglitazone
MOA of DDP-4 inhibitors
increases incretin which increases insulin release from beta cells and decreases glucagon release release from alpha cells works in the intestines, acts on the pancreas
Mechanism of action of metformin
increases insulin's action in the peripheral tissues and reduces hepatic glucose production think glucophage: phagocytosis of glucose in the tissues
MOA of DPP-4 inhibitors
increases level of incretin, increasing synthesis and release of insulin from pancreatic beta cells
Most potent risk factor for duodenal ulcer
infection with H. pylori
A 42 yo woman has just been diagnosed with Type 2 dm with an A1C of 12.5. The patient has a history of alcohol abuse and active hepatitis c with LFTs >2x normal. Which of the following medications is the best choice for this patient due to her severe liver impairment? A. insulin b. metformin c. thiazolidindiones d. sulfonylureas
insulin
Mechanism of action of pioglitazone
insulin sensitizer... decreases insulin resistance in the periphery and in the liver resulting in increased insulin- dependent glucose disposal and decreased hepatic glucose output.
29yo female: pale conjunctiva, pale nail beds, tachycardia, heart murmur, cheilosis, stomatitis, splenomegaly, koilonychia, and glossitis. You suspect: A. Vitamin B 12 deficiency B. folic acid deficiency C. iron deficiency anemia D. chronic fatigue syndrome
iron deficiency anemia
Which of the following is the most common anemia worldwide? A. iron def anemia B. pernicious anemia C. folate deficiency anemia D. anemia of chronic disease
iron deficiency anemia
A healthy 36yo man presents to the clinic. He inquires whether he should take an iron supplement. The NP appropriately responds with: A. excess iron is easily excreted B. iron def anemia is a common problem found in men your age C. this is a prudent effort to ensure your health D. Iron supplements may lead to Fe overload in absence of true deficiency
iron supplements may lead to overload
Temporal arteritis is an emergency because
it can cause blindness! and its permanent!
20yo patient sees the NP for an annual physical. She states "I've had all my HPV shots... will I need to have a pap at age 21 like everyone else or since I've had the vaccine I can just skip it." Correct reply? A. yes between 21-29 you will need a pap every 3 years B. annual pap spears from 21 on C. Unless you are symptomatic, you can wait til 30 D. No since you are protected you don't need pap smears
between age 21-29 you need them every 3 years
Metformin is what type of drug
biguanide
Criteria for type 2 DM
blood glucose of 126 or more after an 8 hour or more fast on more than one occasion
In a healthy person, what percentage of the body's total daily physiological insulin secretion is released as basally? A. 10-20% B. 25-30% C. 50-60% D. 75-85%
c
Recommended A1C goal in a 79yo woman with a 20 year history of type 2 diabetes who has difficulty ambulating, uses a walker, and has a cardiac ejection fraction of 35% and a history of heart failure should be equal to or less than A. 7 B. 7.5 C. 8 D.8.5
c
Pernicious anemia is usually caused by A. dietary deficiency of vitamin B 12 B. lack of production of intrinsic factor by the gastric mucosa C. RBC enzyme deficiency D. micronutrient deficiencies caused by malabsorption
lack of intrinsic factor
Metformin should be discontinued for the day of and up to 48 hours after surgery because of increased risk of A. hypoglycemia B. hepatic impairment C. lactic acidosis D. interaction with most anesthetic agents
lactic acidosis
Acute diverticulitis usually has pain where
left lower quadrant
Onset of action of Lispro Humalog
less than 30 minutes
What is the initial therapy for a new diabetic with A1C = 9.3%?
lifestyle management + Metformin + additional agent
Name 3 physiologic hormonal triggers for females that can influence the onset or severity of a migraine.
menses ovulation pregnancy
A female patient presents experiencing a headache that has lasted 12 hours describing it pulsates and is moderate to severe intensity. The patient also notes that she notices that the headache becomes worse when she gets up to walk around. Most likely dx? A. tension headache b. migraine without aura C. focal headache D. cluster
migraine without aura
What kind of headache can be caused by red wine, menstruation, or stress?
migraine without aura
Stu is a 49yo with a slightly reduced H&H. You proceed to ask additional questions pertaining to diet and your next action is: A. start an iron prep supplement b. order fecal occult blood testing c. start daily dosing of folic acid D. repeat the blood work / labs
order fecal occult blood testing
What is Collin's sign
pain radiating to the tip of the right scapula associated with cholelithiasis
The NP knows that one of the following is the most common serious complication of cholecystitis? A. hepatic failure B. adenocarcinoma of the gall bladder C. gall bladder empyema D. pancreatitis
pancreatitis
The NP draws labs on a new female patient in her late 40's. In reviewing the results, the NP finds that the TSH is high and the free T4 are low. All other results are within expected ranges. This indicates that the patient most likely has.....
primary hypothyroidism
MOA of glipizide
promote the pancreas to secrete more insulin
Most of the body's iron is obtained from: A. animal based food sources B. endoplasmic reticulum production C. vegetable based food sources D. recycled iron content from aged red blood cells
recycled red blood cells
MOA of metformin
reduces hepatic glucose production reduces intestinal glucose absorption increase insulin sensitivity by increasing glucose uptake & utilization in the peripheral tissues
Worst case scenario for GERD....
reflux induced esophageal injury --> esophageal stricture and Barrett esophagus or esophageal cancer
Name it: pressing, nonpulsatile bilateral band like pain, lasts all day, "feels like someone is squeezing"
tension headache
If amylase & lipase levels are ________, the diagnosis of pancreatitis is confirmed
three times the upper limit
Of all four types of strokes, the one that has a gradual onset and considered the most common is: A. thrombotic B. embolic C. Lacunar D. hemorrhagic
thrombotic
Name the sulfonylurea drugs
glipizide glyburide glimepiride
Thyroid scan on a patient with Grave's disease will show a
"hot spot" = metabolically active gland
Initiating basal insulin start with 10u/day OR:
0.1-0.2U/kg/day
Slide 33 of ppt DM1 describes the calculation for TDD as
0.3 to 0.5 units/kg Dose for initiation therapy is 1/2 TDD
With which two diabetes drugs should we worry about pancreatitis
1. GLP-1 agonist 2. DPP- 4 inhibitors
Headache Red Flags (SNOOP)
1. Systemic: fever, weight loss 2. Neurologic: confusion, nuchal rigidity, HTN, papilledema 3. Onset: sudden, abrupt, "thunderclap", with exertion 4. Onset: older than 50, younger than 5 5. Previous history
A male patient, age 52, just had a screening colonoscopy with negative results. He asks the NP when he should have the next. No significant history. Correct reply? A. annually B. 5 years C. 10 years D. 3 years
10 years
An A1C greater than _____ would qualify a patient for combination injectable therapy
10%
Which of the following represents peak ages for occurrence of appendicitis? A. 1-20 B. 20-40 C. 10-30 D. 30-50
10-30
Exercise recommendations for type 2 diabetics
150 min per week of moderate activity such as walking, at least 3 times per week at 50-70% of maximum heart rate with nor more than 2 consecutive days without exercise Resistance training 2 or more times per week Vigorous is potentially contraindicated with retinopathy
What is the diagnostic criteria for diabetes: oral glucose tolerance test
2 hour = 200 or more after a 75gram load
Peak effect of regular insulin
2-3 hours
Dose for elderly patient on levothyroxine
25mcg which is about 75% less than the average adult
The NP provides a well woman visit for a healthy 38 yo. Patient asks when she should begin having mammograms. No significant history. Correct response? A. at age 40 B. now C. only if we find a lump D. age 50
40
John B is a 55yo 95kg man who is newly diagnosed with type 2 DM. His A1C = 10.5%. You decide to prescribe insulin glargine to manage his DM. The recommended initial starting dose for the insulin glargine is: A. 19 units B. 15 units C. 10 units D. 5 units
A. 19 units
Diabetes and pre diabetes utilize fasting glucose to determine if the condition is present. There are several diagnostics tests to evaluate glucose. The impaired fasting glucose is one of the two conditions to determine prediabetes. The impaired fasting glucose is characterized by fasting glucose levels between: A. 100 to 125mg B. none C. 140-199 D. 125-140
A. 100-125
Identify the noninvasive test that provides the highest specificity for neuropathy. A. fine microfilament B. tuning fork C. biothesiameter D. coarse microfilament
A. fine microfilament
3. Why do us primary care providers only really about T4 and not really about T3?
Although T3 is the more important hormone in terms of action & effects in the body, T3 is "made" in the liver & a little bit in the kidney. T4 is "pro T3". So, we really just need to make sure there is enough T4 in the body because the liver will take care of turning it into T3 to do work. Only need to check T3 if you have a abnormal TSH + normal T4. Concerns of thyrotoxicosis.
The H2RA most likely to cause drug interactions with phytoin and theophylline is: A. famotidine b. cimetidine C. nizatidine D. ranitidine
B cimetidine
Which of the following is most consistent with the presentation of a patient with colonic diverticulosis? A. frank blood in stool B. few or no symptoms C. constipation and fever D. diarrhea and leukocytosis
B few or no symptoms
Rebound tenderness is aka
Blumberg's sign
26 yo man presents with acute abdominal pain. Part of the work up for acute appendicitis, you order a WBC with diff. You anticipate A. WBC = 4500, neutrophils 35%, bands 2%, lymphocytes 45% B. WBC = 14000, neutrophils 55%, bands 3%, lymphocytes 38% C. WBC = 16,500, neutrophils 66%, bands 8%, lymphocytes 22% D. WBC = 18,100, neutrophils 55%, bands 3%, lymphocytes 28%
C shift to the left!
ID the risk factor from the list that is associated with more severe symptoms of diabetic neuropathy A. decreased lipid absorption B. young age of DM onset C. being tall D. newly diagnosed DN
C. being tall
Which of the following drug classes represents drugs that sensitize the body to insulin and or controls hepatic glucose production? A. sulfonylureas B. meglitinides C. biguanides D. alpha glucosidase
C. biguanides sensitize the body to insulin = improve glucose uptake by cells --> glucophage! meglitinides are like sulfonylureas- they stimulate insulin alpha glucosidase inhibit the break down of starches
The NP starts insulin on a new type 1 diabetic using the basal/bolus approach method. The patient weighs 176 pounds. What is the starting dose of insulin glargine? A. 18 units per day B. 40 units per day C. 15 units per day D. 20 units per day
D. 20 units
What's the difference between diverticulosis and diverticulitis?
Diverticulosis is the presence of diverticula: pouch like protrusions in the descending/sigmoid segments Diverticulitis is inflammatory changes of the mucosa and those pouches,
Fiber is good if you have ______ but not good if you have ______
Diverticulosis...... IBS
Levothyroxine is administered with caution in the elderly because of potentially worsening of which condition: A. obesity B. diabetes C. hypertension D. dyslipidemia
HTN
What's worse: IBS or IBD
IBD
"Patchy gut" is associated with what diagnosis
IBD: Crohn's
Alternating constipation & diarrhea are associated with ?
IBS
IBS or IBD? The etiology is considered to be an alteration in small large bowel motility.
IBS
What is the Somogyi effect?
Rebound hyperglycemia after insulin induced hypoglycemia causes excess secretion of glucagon and cortisol
How often do you check the diabetics feet?
Visual- every visit Monofilament- annually
Which med should you avoid in the patient with a severe sulfa allergy?
glipizide
Which of the following will confirm a diagnosis of diabetes mellitus? A. A1C = 6.3 B. fasting insulin level of 2mcU/ml C. glucose tolerance test of 140 at 2 hours D. fasting glucose of 135
fasting of 135
The BEST serum lab test to perform to spot an iron deficiency anemia early, before it progresses to full blown anemia is A. hematocrit B. ferritin level C. reticulocytes D. hemoglobin
ferritin level
Which of the following is most likely to be noted in a person with colorectal cancer? A. gross rectal bleeding B. nausea and vomiting C. few symptoms D. weight loss
few symptoms are noted
8. Along with her clinical presentation, all of the following blood tests can be used to help confirm a diagnosis of Addison's disease except: A. Sodium B. Potassium C. Cortisol D. folate
folate
Name it: 64yo woman, 3 month history of upper ab pain. discomfort is intermittent, centrally located burning feeling, most often with meals and mild nausea. H2RA makes it a little better. She uses diclofenac on regular basis for OA pain.
gastric ulcer
Results of hemogram and reticulocyte count in a person with anemia of chronic disease include: A. anisocytosis B. reticulocytosis C. microcytosis D. macrocytosis
reticulocytosis
6. A toxic goiter is associated with ______ in thyroid hormone output. A. A rise B. A fall C. Normal activity
rise
Fecal occult blood testing is MOST effective in identifying A. cancer in traverse colon B. cancer in the right colon C. polyps in the colon D. cancer in the sigmoid colon
sigmoid
Regulating H+H levels on a patient with sickle cell anemia, you want to maintain levels: A. strictly normal range B. fluctuations around normal C. slightly below normal D. slightly above normal
slightly below
MOA of acarbose
slows the breakdown of starches and sugar in food in your intestines so this slows down increases in blood glucose
Caroline is an elderly adult, is homeless and has iron deficiency anemia. She smokes and drinks when she can and also has an ulcer. Which of the following is NOT considered a risk factor of iron deficiency anemia: A. ulcerative disease B. smoking C. age over 60 D. poverty
smoking
Invokana, Farxiga, Jardiance are what kind of drug
sodium-glucose cotransporter 2 inhibitor SGLT2 inhibitor they end in "--gliflozin" canagliflozin, dapagliflozin, empagliflozin
Best test for H Pylori
stool antigen testing
Intervention in anemia of chronic disease most often includes A. parenteral iron B. oral vitamin b 12 C. treat underlying cause D. transfusion
treat underlying cause
A 52 yo patient that presents with an initial onset of severe headaches is considered a red flag patient. T/F?
true
Long term PPI use is associated with increased risk of pneumonia and C diff colitis in hospitalized patients. T/F
true
Increased ICP... headache will be worse when?
upon wakening
What is the dawn effect?
usually between 2 a.m. and 8 a.m.) increase in blood sugar (glucose)
A hallpike maneuver is performed to elicit A. vertigo B. headache C. seizure D. syncope
vertigo
MOA of thiazolidinediones
works on the PPAR receptors in the muscle, adipose, and other tissues to promote glucose uptake in these peripheral tissues which is why it can cause edema in HF patients: water follows the molecules into the tissues
