SARAH MICHELLE LIVE REVIEW
STUDY GUIDE (COMPLETE)
What is the screening tool for the thyroid? ✔️Ans - TSH Level What is the normal range for TSH? ✔️Ans - 0.5-5.0 When do you order a full thyroid profile? ✔️Ans - 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?✔️Ans - Hyperthyroidism What disorder demonstrates a high TSH level and low T3 and T4 levels?✔️Ans - Hypothyroidism What medication is used to treat hypothyroidism? ✔️Ans - Levothyroxine (Synthroid) What dose of Synthroid do you want to start your patient on? ✔️Ans - 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? ✔️Ans - 6-8 weeks When TSH level is stabilized, how often do you recheck their level? ✔️Ans - Every 6-12 months What is the go to medication for treatment of hyperthyroidism? ✔️Ans - Tapazole and PTU How do you manage treatment for hyperthyroidism in a pregnant patient?✔️Ans - We need to use PTU instead if they are in their first trimester. After first trimester, then they can be switched to tapazole. 1 / 4
What medication class is used to treat symptoms of hyperthyroidism? ✔️Ans
- Beta-blockers- these help manage tachycardia and palpitations
- ACE Inhibitors
What are 2 other treatments for the hyperthyroidism? ✔️Ans - Thyroidectomy and radioactive iodine What labs are used to measure and evaluate kidney function? ✔️Ans - GFR, BUN, Creatinine What lab value is most accurate description of kidney function? ✔️Ans - 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? ✔️Ans - >90 What GFR value indicates an absolute need to start a patient on dialysis?✔️Ans - <15- this means that patient is in CKD stage 5 What is the second most important lab value to measure kidney function?✔️Ans - Creatinine What is creatinine? ✔️Ans - 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? ✔️Ans - Around 1 Why is BUN least telling for kidney function? ✔️Ans - 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? ✔️Ans - 10-20 With which first-line BP medication do we want to check the BUN/Cr? ✔️Ans
What finding on a UA id indicative of true kidney damage? ✔️Ans - Casts- WBC or RBC casts always need to be referred out 2 / 4
When do we screen for microalbumin in the urine? ✔️Ans - We're always going to screen when DM and HTN is first diagnosed.What are the most common causes of CKD? ✔️Ans - HTN and DM Why is it important to perform early screening for microalbumin in the urine?✔️Ans - 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? ✔️Ans - Stage 3 or worse How often are we screening for micro albumin? ✔️Ans - Bare minimum is going to be annually for patients with DM or HTN or both.What is the normal range of microalbumin? ✔️Ans - < 30 What is the most common symptom of all anemias? ✔️Ans - Fatigue What is a normal hemoglobin level? ✔️Ans - 12-18 Women are on the lower end, and men are on the higher end What is a normal hemoglobin to hematocrit ratio? ✔️Ans - 3 to 1
36-54%
What does MCV stand for? ✔️Ans - mean corpuscular volume What is a normal MCV? ✔️Ans - 80-100 What does low MCV indicate? ✔️Ans - Microcytic anemias What is the most common microcytic anemia? ✔️Ans - Iron deficiency anemia What is the biggest risk faction for the development of IDA is int he first year of life? ✔️Ans - The ingestion of cow's milk What does high MCV levels indicate? ✔️Ans - Microcytic anemia 3 / 4
What are the most common microcytic anemias? ✔️Ans - B12 and folate What symptoms are common with B12 deficiency anemia? ✔️Ans - Neuro symptoms- the most common symptom is parasthesia What surgery typically leads to B12 deficiency anemia? ✔️Ans - Gastrectomy patients- who have part of their stomach removed Why do gastrectomy patients typically have B12 deficiency anemia? ✔️Ans - 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?✔️Ans - Metformin What is an abnormal lead level? ✔️Ans - >5, ideally no lead should be within the body What kind of symptoms may lead intoxication lead to? ✔️Ans - Cognitive delays and behavioral problems What are the 3 microcytic anemias? ✔️Ans - LIT Lead Iron Thalassemia What are the 2 macrocytic anemias? ✔️Ans - FAB Folate and B12 What are the components of a lipid profile? ✔️Ans - Total cholesterol HDl LDL Triglycerides What's a normal total cholesterol level? ✔️Ans - <200 What is a normal HDL level? ✔️Ans - 40-60, the higher the better
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