SARAH MICHELLE LIVE REVIEW STUDY GUIDE| Complete Questions and Answers 100% Correct| A+ Rated Solution Guide| Latest 2024

SARAH MICHELLE LIVE REVIEW STUDY GUIDE| Complete Questions and
Answers 100% Correct| A+ Rated Solution Guide| Latest 2024
SARAH MICHELLE LIVE REVIEW
STUDY GUIDE| Complete Questions and
Answers 100% Correct| A+ Rated Solution
Guide| Latest 2024
What is the screening tool for the thyroid?
TSH Level
What is the normal range for TSH?
0.5-5.0
When do you order a full thyroid profile?
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?
Hyperthyroidism
What disorder demonstrates a high TSH level and low T3 and T4 levels?
Hypothyroidism
What medication is used to treat hypothyroidism?
Levothyroxine (Synthroid)
What dose of Synthroid do you want to start your patient on?
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?
6-8 weeks
When TSH level is stabilized, how often do you recheck their level?
Every 6-12 months
What is the go to medication for treatment of hyperthyroidism?
Tapazole and PTU
How do you manage treatment for hyperthyroidism in a pregnant patient?
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?
Beta-blockers- these help manage tachycardia and palpitations
What are 2 other treatments for the hyperthyroidism?
Thyroidectomy and radioactive iodine
What labs are used to measure and evaluate kidney function?
GFR, BUN, Creatinine
What lab value is most accurate description of kidney function?
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?
>90
What GFR value indicates an absolute need to start a patient on dialysis?
<15- this means that patient is in CKD stage 5
What is the second most important lab value to measure kidney function?
Creatinine
What is creatinine?
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?
Around 1
Why is BUN least telling for kidney function?
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?
10-20
With which first-line BP medication do we want to check the BUN/Cr?
ACE Inhibitors
What finding on a UA id indicative of true kidney damage?
Casts- WBC or RBC casts always need to be referred out
When do we screen for microalbumin in the urine?
We're always going to screen when DM and HTN is first diagnosed.
What are the most common causes of CKD?
HTN and DM
Why is it important to perform early screening for microalbumin in the urine?
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?
Stage 3 or worse
How often are we screening for micro albumin?
Bare minimum is going to be annually for patients with DM or HTN or both.
What is the normal range of microalbumin?
< 30
What is the most common symptom of all anemias?
Fatigue
What is a normal hemoglobin level?
12-18
Women are on the lower end, and men are on the higher end
What is a normal hemoglobin to hematocrit ratio?
3 to 1
36-54%
What does MCV stand for?
mean corpuscular volume
What is a normal MCV?
80-100
What does low MCV indicate?
Microcytic anemias
What is the most common microcytic anemia?
Iron deficiency anemia
What is the biggest risk faction for the development of IDA is int he first year of
life?
The ingestion of cow's milk
What does high MCV levels indicate?
Microcytic anemia
What are the most common microcytic anemias?
B12 and folate
What symptoms are common with B12 deficiency anemia?
Neuro symptoms- the most common symptom is parasthesia
What surgery typically leads to B12 deficiency anemia?
Gastrectomy patients- who have part of their stomach removed
Why do gastrectomy patients typically have B12 deficiency anemia?
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?
Metformin
What is an abnormal lead level?
>5, ideally no lead should be within the body
What kind of symptoms may lead intoxication lead to?
Cognitive delays and behavioral problems
What are the 3 microcytic anemias?
LIT
Lead
Iron
Thalassemia
What are the 2 macrocytic anemias?
FAB
Folate and B12
What are the components of a lipid profile?
Total cholesterol
HDl
LDL
Triglycerides
What's a normal total cholesterol level?
<200
What is a normal HDL level?
40-60, the higher the better
What is a normal LDL level?
<100
What is a normal triglyceride level?
<150
How often should you be ordering a standard limpid profile on a patient?
Every 5 years unless they are having symptoms, risk factors, on treatment, etc.
What is LDL?
Bad cholesterol, it is our major culprit in atherosclerosis in clogging up those
arteries.
What is HDL?
Good cholesterol, it is cardio protective and helps remove excess cholesterol from
the body.
What are some factors that impact our total cholesterol?
Smoking, diet, weight, and physical activity
What does triglycerides assist in assessing?
Insulin resistance and your true dietary intake
If triglycerides get >500 then patient will be at really high risk for what?
Pancreatitis
What is the first line treatment for abnormal lipid levels?
HMG-CoA Reductase Inhibitors- Statin drugs
What if a patient is having increased muscle pain on a statin, what is worst case
scenario?
Rhabdomyolysis
What lab value will assess for rhabdomyolysis?
CK level
How high is a CK level going to be in rhabdo?
5 times the normal limit
What can rhabdomyolysis lead to?
Renal failure
When a patient is on a statin, the kidney of concern, but what other organ is a
concern as well?
The liver
When should LFT be completed when initiating statin therapy for a patient?
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?
Warfarin
What is the therapeutic INR for a patient who is on Coumadin?
Generally 2-3
What is the antidote to warfarin if their blood becomes too thin?
Vitamin K
What if a patient comes into the office with an INR of 7, what does this mean?
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?
We are going to hold their warfarin, and readjust the dose.
If a patient's INR is >10, how do we treat this?
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.
What 2 labs can we use to evaluate the pancreas?
Amylase and lipase
What are the 2 main labs we can use to evaluate the liver?
AST and ALT
What does a BNP tell us about?
The heart
What is going with the heart when the BNP is elevated?
Heart failure
What 2 labs are inflammatory markers?
ESR and CRP
Will we have increased inflammatory markers with irritable bowel disease or
inflammatory bowel disease?
Inflammatory bowel disease
When are we going to order a D-Dimer?
When evaluating for a clot
At what HA1c level is a patient diagnosed with diabetes?
6.5% or greater
What random plasma glucose level would be indicative of diabetes?
>200 WITH SYMPTOMS
What is Amoxicillin most commonly used to treat?