Dec 1, 2017

🔴MCQs: Which of the following represents...


Edited: Dec 1, 2017

Select the one best response.

Which of the following represents the currently recommended goal for blood pressure control in a diabetic?

a. Less than 160/90

b. Less than 145/95

c. Less than 140/90

d. Less than 130/85

e. Less than 120/70

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  • Excessive thirst and hunger. Frequent urination (from urinary tract infections or kidney problems). Weight loss or gain. Fatigue.Irritability. Blurred vision. Slow-healing wounds. Nausea.
  • Recommendations for prescribing: • Do not administer corticosteroids unless absolutely indicated or more conservative measures have failed. • Keep dosage and duration of administration to the minimum required for adequate treatment. Monitoring recommendations: • Screen for tuberculosis with a purified protein derivative (PPD) test or chest radiograph before commencing long-term corticosteroid therapy. • Screen for pregnancy in reproductive age women; recommend contraceptive measures. • Screen for diabetes mellitus before treatment and at each clinician visit. • Teach patient about the symptoms of hyperglycemia. • Screen for hypertension before treatment and at each clinician visit. • Screen for glaucoma and cataracts before treatment, 3 months after treatment inception, and then at least yearly. • Monitor plasma potassium for hypokalemia and treat as indicated. • Obtain bone densitometry before treatment and then periodically. Treat osteoporosis. • Weigh daily. Use dietary measures to avoid obesity and optimize nutrition. • Measure height frequently to document the degree of axial spine demineralization and compression. • Watch for fungal or yeast infections of skin, nails, mouth, vagina, and rectum, and treat appropriately. • With dosage reduction, watch for signs of adrenal insufficiency or corticosteroid withdrawal syndrome. Patient information: • Prepare the patient and family for possible adverse effects on mood, memory, and cognitive function. • Inform the patient about other possible side effects, particularly weight gain, osteoporosis, and aseptic necrosis of bone. • Counsel to avoid smoking and excessive ethanol consumption. Prophylactic measures: • Institute a vigorous physical exercise and isometric regimen tailored to each patient's abilities or disabilities. • Administer calcium (1 g elemental calcium) and vitamin D 3 , 400-800 units orally daily. -Check spot morning urines for calcium; alter dosage to keep urine calcium concentration < 30 mg/dl (< 7.5 mmoi/L). -If the patient is receiving thiazide diuretics, check for hypercalcemia, and administer only 500 mg elemental calcium daily. • If the patient has pre-existent osteoporosis or has been receiving glucocorticoids for ;, 3 months, consider prophylaxis: - Bisphosphonate such as alendronate (70 mg every week orally), zoledronate (5 mg every year intravenously) for up to 3-5 years; Or - Denosumab (60 mg every 6 months subcutaneously) for up to 3-5 years. • Avoid prolonged bed rest that will accelerate muscle weakness and bone mineral loss. Ambulate early after fractures. • Avoid elective surgery, if possible. Vitamin A in a daily dose of 20,000 units orally for 1 week may improve wound healing, but it is not prescribed in pregnancy. • Fall prevention strategies: walking assistance (cane, walker, wheelchair, handrails) when required due to weakness or balance problems; avoid activities that could cause falls or other trauma. • For ulcer prophylaxis, if administering corticosteroids with nonsteroidals, prescribe a proton pump inhibitor (not required for corticosteroids alone). Avoid large doses of antacids containing aluminum hydroxide (many popular brands) because aluminum hydroxide binds phosphate and may cause a hypophosphatemic osteomalacia that can compound corticosteroid osteoporosis. • Treat hypogonadism. • Treat infections aggressively. Consider unusual pathogens. • Treat edema as indicated. References: - CURRENT Medical Diagnosis & Treatment FIFTY-SIXTH EDITION (CMDT) - 2017: 1209
  • Type 1 diabetes Polyuria, polydipsia, and weight loss associated with random plasma glucose of 200 mg/dl (11.1 mmol/L) or more. Plasma glucose of 126 mg/dl (7.0 mmol/L) or more after a n overnight fast, documented on more than one occasion. Ketonemia, ketonuria, or both. Islet autoantibodies a re frequently present. Type 2 diabetes Many patients are over 40 years of age and obese. Polyuria and polydipsia. Ketonuria and weight loss generally are uncommon at time of diagnosis. Candida vaginitis in women may be aninitial manifestation. Many patients have few or no symptoms. Plasma glucose of 1 26 mg/dl or more after an overnight fa st o n more than one occasion. Two hours after 75 g oral glucose, diagnostic values are 200 mg/dl (11.1 m mol ) or more. HbA1c 6.5% or more. Hypertension, dyslipidemia, and atherosclerosis are often associated.

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