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Boards - Diabetes HTN HLD
OBGYN Qualifying Exam
212
Other
Post-Graduate
06/24/2020

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Term
WHO criteria for metabolic syndrome - 5
Definition
BP >140/90 or on anti-HTN
TG >150 or HDL <39
BMI 30+ or W:H >0.85
insulin resistance or DM2
microalbuminia 20+ mcg/m or A:Cr 30+

need insulin resistance and 2 criteria OR
no resistance and 3 criteria
Term
combined metabolic syndrome criteria - 9
Definition
BP >130-140/85-90 or on anit-HTN
waist >/= 35in
W:H >0.85
BMI 30+
BG >/= 110 or insulin resistance
TG >150
HDL <45-50
microalbumin >20
A:Cr >30
Term
management metabolic syndrome - 4
Definition
diet, exercise, weight loss, metformin
Term
non-pregnant DM screening ACOG
Definition
FHX, hx GDM, obesity -> fasting BG q3-5y
Term
non-pregnancy DM screening ADA
Definition
>45yo and obese OR BMI 25+ with risk factor do fasting or A1C
Term
incidence of DM1 and DM2
Definition
DM1 10%
DM2 90%
Term
lipid risk factors for DM2
Definition
HDL <35, TG >250
Term
diagnosis of diabetes
Definition
polyuria, polydypsia, weight loss + random glucose 200+
OR
2 of these - Fasting 126+, 2h 200+, A1C 6.5+
Term
diagnosis of pre-diabetes
Definition
fasting 100-125
2h 140-199
A1c 5.7-6.4
Term
yearly prevention for DM - 7
Definition
optho, nutrition, foot exam, lipids, microalbumin (5y after onset DM1), EKG, flu
Term
weight loss goal diabetes
Definition
10% in 6mo
Term
when to start and add meds in DM2
Definition
3mo A1C 7+ start med
6mo still 7+ add another
Term
A1C goal in DM, how often to monitor
Definition
<7, q3-6mo
Term
MOA metformin / glucophage
Definition
decreased hepatic glucose production, increased intestinal absorption, increased insulin action
Term
glucophage - effect on weight gain, hypoglycemia, and CV events/mortality
Definition
no weight changes or hypoglycemia
decreased CV
Term
thiazolidinediones - effect on weight gain, hypoglycemia, and CV events/mortality
Definition
weight gain possible, no hypoglycemia
increases HDL and decreased TG, can cause CHF
Term
GLPL1 receptor agonist - effect on weight gain, hypoglycemia, and CV events/mortality
Definition
weight loss, ?glycemia, no comment on cardio
Term
DPP4 inhibitors - - effect on weight gain, hypoglycemia, and CV events/mortality
Definition
no hypoglycemia, weight neutral
no comment on cardio
Term
sulfonulureas - 5
Definition
tolbutamine, chlorpropramide, glyburide, glipizide, glimiperide
Term
thiazolidinediones - 1
Definition
pioglutazone/actose
Term
GlP1 receptor agonists - 2
Definition
exenatide/buderon, liraglutide/victoza
Term
DPP4 inhibitors - 4
Definition
stigliptin, vildagliptin, saxagliptin, linagliptin
Term
SGL2 inhibitors - 3
Definition
invokana/canagglifolzin, faxiga/dapagliflozin, jardance/empagliflozin
Term
MOA sulfonuireas
Definition
increases insulin secretion
Term
MOA thiazolidinediones
Definition
increased peripherial insulin sensitivity
Term
GLP1 receptor agonists MOA
Definition
glucagon like peptide 1, insulin secretion increased, glucagon secretion decreased, slows gastric emptying
Term
DPP4 inhibitors MOA
Definition
inncreases incretin in gut, increases on demand insulin, decreases glucagon
Term
SGL2 inhibitors MOA
Definition
glucosuria
Term
SE metformin - 3
Definition
diarrhea, lactic acidosis, B12 deficiency
Term
contraindications metformin - 1
Definition
renal disease GFR <50
Term
SE sulfonulureas - 2
Definition
hypoglycemia, weight gain
Term
thiazolidinediones SE - 4
Definition
weight gain, edema, CHF, bone fractures
Term
GLP1 receptor agonist SE - 3
Definition
weight loss, GI sx, acute pancreatitis, medullary thyroid tumors
Term
DPP4 inhibitor SE - 3
Definition
uticaria, angioedema, pancreatitis
Term
SGL2 inhibitor SE - 2
Definition
yeast infection, fornuiers gangrene
Term
how to divvy up insulin in a new DM2 needing meds
Definition
0.6 U/kg/d, 1/2 at bedtime, 1/2 at meals
Term
when to increase insulin in DM2
Definition
increase 2-4U if fasting >130
Term
rapid insulin types - 3
Definition
aspart/novorapid
glylizine/apidra
lispro/humalog
Term
short acting insulin types - 3
Definition
regular = humilinR, novilinR, grTronto
Term
intermdiate insulin types - 2
Definition
NPH - humulinN, novolin NPH
Term
long acting insulin types - 2
Definition
detemir/levemir
glargine/lantus
Term
rapid insulin - onset, peak, duration
Definition
10-15m, 1-1.5h, 3-5h
Term
short insulin - onset, peak, duration
Definition
30-45m, 2-3h, 6.5h
Term
intermediate insulin - - onset, peak, duration
Definition
1-3h, 5-8h, 14-18h
Term
long acting insulin - onset, peak, duration
Definition
1-2h, 8-10h, 12-24h
Term
what complications of DM might a type 2 be unable to control just with glucose control
Definition
microvascular
Term
most common complication of pregnancy
Definition
GDM 2-7%
Term
hormones causing GDM
Definition
HPL and insulinase both made by placenta
Term
criteria for early GDM screening
Definition
BMI 25+ with one (FHX DM, inactivity, AA, latino, native A, asian , PI, prior >4000g, prior GDM, HTN, HDL <35, TG >250, PCOS, acanthosis, CVD)

BMI >40

A1C >5.7
Term
1h GTT is at how many weeks and how much glucose
Definition
24-28wk, 130-140
Term
2h GTT is not done why
Definition
increases diagnosis to 18% from 7% without improvement in outcomes and increased cost
Term
gluocse in 3h GTT
Definition
100g
Term
cutt off for 3h GTT
Definition
95/180/55/140
Term
maternal risks of GDM 4
Definition
pre-eclampsia/HTN, operative delivery, DM2, weight gain >40 lbs
Term
risk of DM2 after GDM
Definition
1/3 remain DM postpartum, 50% lifetime risk
Term
#1 and 2 most common fetal risks of GDM and %
Definition
hypoglycemia 50%
macrosomia 30-40%
Term
congenital anomalies associated with GDM and % - 4
Definition
cardiac 2-5x
ONTD 2-5x
femoral hypoplasia unusual facies (20% of the syndrome patients were DM babies)
caudal regression
Term
fetal organ and metabolic changes associated with GDM - 7
Definition
polyhydraminos, HSM, cardiomeagly, RDS, hyperbilirubinemia, hypocalcemia, stillbirth
Term
what increases the already increased risk of stillbirth in GDM - 2
Definition
poor glucose control, A1C >7
Term
fetal risk specific to maternal ketosis
Definition
neurologic damage
Term
incidence of polyhydraminos
Definition
3-4% of pregnancy
Term
definition polyhydraminos
Definition
AFI >24, MVP >8, severe AFI 35+
Term
causes of polyhydraminos - 2 categories and %
Definition
congenital 79%, idiopathic 50%
Term
causes of polyhydraminos - 13
Definition
T18, GI abnormalities, chorioangina, CCAM, muscular dystrophy, ONTD, anancephaly, hydrancephaly, holoprosencephaly, DM, HTN, macrosomia, hydrops
Term
GI anomalies associated with polyhydraminos - 6
Definition
esophageal atresia, TE fistula, SBO, hypoplastic jaw, swallowing disorders, abdominal wall defects
Term
# of CD needed to prevent 1 brachial plexus injury
Definition
443
Term
% of infants you thought were >4500g and really went
Definition
50%
Term
when you can offer CD for macrosomia in GDM
Definition
4500g
Term
when to avoid operative delivery in macrosomia suspected patient
Definition
>4000g, prolonged second stage
Term
complications of fetal macrosomia - 3
Definition
shoulder, clavicle fracture, brachial plexus injury
Term
causes of femoral hypoplasia unusual facies syndrome and % - 3
Definition
DM1 20%, AD, sporadic
Term
sings of femoral hypoplasia unusual facies syndrome - 19
Definition
upslanting eyes, short nose long tip, elongated pithilrym, thin upper lip,
macrognathia, clefts, low ears, hypoplastic femurs and UE, club foot, polydactyly, sindactyly, restricted elbow/shoulder ROM, inguinal hernias, pelvic/spinal abnormalities, PCKD/dysplasia, hypoplastic penis/labia, VSD, pulmonary stenosis, truncus arteriosis
Term
prognosis femoral hyopoplasia unusual facies syndrome
Definition
normal lifespan
Term
caudal regression signs - 5
Definition
sacral agenesis, sineromelia, renal agenesis, anal agensis, single umnbilical artery
Term
recommended kcal/d in GDM ideal, overweight morbid, underweight
Definition
under - 40
ideal - 30
over - 25
morbid - 15
Term
how meals are divided up in GDM
Definition
10% breakfast
20% lunch
30% dinner
30% snacks
Term
how macros are broken down GDM
Definition
40% carbs (complex high fiber)
20% protein
40% fats (<7% saturated)
Term
how many carbs per meal in GDM
Definition
15-30
Term
why do we use 1h PP in GDM - 4
Definition
decreased A1c, better control, less macrosomia, lower CD
Term
goal fasting, 1h, 2h glucose GDM
Definition
fast - 95
1h - 140
2h - 120
Term
when to start or increase insulin GDM
Definition
>30% higher than goal
Term
how much insulin to use per Kg in 1-3T
Definition
1T 0.7
2T 0.8
3T 0.9
term 1.0
resistant... 1-2
Term
how to break down insulin to start meds in GDM
Definition
calculate daily - 2/3AM, 1/3PM
AM - 2/3 NPH, 1/3 rapid
PM- 1/2 NPH, 1/2 rapid
Term
how to use carb ratio instead of rapid insulin
Definition
total units rapid needed a day / 500 = #

carb ration is 1:#
Term
why is metofmrin not first line
Definition
26-46% will need insulin evuntally
Term
dosing glyburide
Definition
2.5mg HS for elevated fasting
2.5mg breakfast for elevated PP
max 10mg/d
Term
why isnt glyburide used anymore - 6
Definition
infant and maternal hypoglycemia and macrosomia, 4-16% will require insulin anyways, increased birth injury
Term
in GDM what does exercise help reduce
Definition
macrosomia
Term
labor insulin management
Definition
check q2h, if >120 start drip at 1.25 U/h, stop if <70 and give 100-150 D5
Term
interpertation of PP GTT
Definition
impaired: fasting 100-125, 2h 140-199
diabetes: fasting >126, 2h >200
Term
how much glucose in 2h GTT
Definition
75
Term
when is a PP glucose test done
Definition
4-12wk
Term
if mom doesnt get PP diabetes, when is the next time she needs screenign
Definition
q3y
Term
3 methods for diagnosis of HTN
Definition
12-14 home values, continuous ambulatory values, 2 office values 2wk apart
Term
4 requirements when taking a BP
Definition
seated for 5min, arm at level of heart, no caffeine or smoking within 30min
Term
values for each stage of HTN
Definition
normal <120/80
elevated <130/80
stage 1 <140/90
stage 2 >140/90
Term
when do you start meds for HTN
Definition
130-140/90 if risk factors, >140/90 start meds
Term
when do you add a second HTN medication
Definition
>20 mmHg over goal
Term
what are the target BP goals for HTN
Definition
<130/80 for most, <140/90 if labile BP, orthostatic hypotension, medication SE, >70yo, frail
Term
what is the follow up schedule for HTN medication starts
Definition
routine in 4-6wk, urgency q1wk
Term
evaluation for HTN - 5
Definition
EKG to rule out LVH, Cr to rule out renal, P:Cr if Cr is high, K+ to rule out aldosterone, renin:ald if K+ is high
Term
lifestyle modifications for HTH in order from most mmHg reduction to least - 5
Definition
weight loss, diet change, exercise, Na reduction, smoking (no data on mmHg)
Term
how much does exercise decrease HTN
Definition
5-10 mmHg
Term
how much does diet decrease HTN
Definition
8-15 mmHg
Term
how much does weight loss decrease HTN
Definition
5-20 mmHg
Term
how much does Na reduction decrease HTN
Definition
2-8 mmHg
Term
5 risk factors for essential HTN
Definition
Na, alcohol >2/d, obesity, AA, FHX
Term
causes of secondary HTN - 10
Definition
renal, OSA, obesity, drugs, hyperthyroid, hyperparathyroid, aortic coarctation, cushings, pheochromocytoma, parimary hyper Ald / conns
Term
signs of renal disease causing HTN - 9
Definition
bruit, hematuria, edema, severe HTN >55yo, increased Cr after ACEI, UL small or big/palpable kidney, increased Cr, proteinuria
Term
3 drugs that can cause HTN
Definition
OCPs, NSAIDS, sudafed
Term
signs of hyperparathyroidism - 8
Definition
bone pain, kidney stones, psych disorders, polyuria, weight loss, weakness, apathy, Ca abnormalities
Term
signs of aortic coarctation - 10
Definition
usually asymptomatic, HA, leg fatigue, epistaxis, pulse in neck, delayed peripherial pulses, bruit over back, BP different in each arm, CXR notching / 3 sign, abnormal ECHO
Term
signs of cushings disease - 9
Definition
emotionally labile, muscle weakness, bruising, moon facies, central obesity, striae, osteoporosis, DM, hirsturism
Term
test for cushings disease
Definition
24h urine cortisol
Term
signs of pheochromocytoma - 9
Definition
palpitations, pallor, sweating, CP, HA, abd pain, tremor, weight loss, anxiety
Term
diagnosis of pehochromocytoma
Definition
urine and serum metanepherines
Term
lab changes in primary hypoaldosteronism - 2
Definition
low K, high Na
Term
4 requirements if on OCPs with HTN
Definition
well controlled, non-smoker, no vascular disease, <35yo
Term
define HTN urgency
Definition
<180/120 without end organ damage
Term
#1 cause HTN urgency
Definition
medication non-compliance
Term
management of HTN urgency
Definition
goal <160/100 in hours to days, outpatient, q1wk check in
Term
define HTN emergency - 6 parts
Definition
>180/120 with end organ dysfunction - brain, visual changes, renal, cardiac, pulmonary, hemoglobin
Term
management of BP in HTN urgency
Definition
drop MAP by 10-20% in 1h then 5-15% in 23h, slowly reintroduce PO meds and wean off drip
Term
what does rapid HTN reversal cause
Definition
cerebral ischemia
Term
meds used in drip for HTN emergency - 4
Definition
nitroprusside (not ideal), nicardipine, labetalol, enlaprilat
Term
complications of nitroprusside drip
Definition
tachyphylaxis - diminishing response to successive doses of the drug
Term
what HTN meds are used in someone without comorbidities - 4
Definition
HCTZ, CCB, ACEI, ARB
Term
what HTN medications are used in CHF - 5
Definition
ACEI, ARB, BB, HCTZ, aldosterone antagonists
Term
what medications are used in HTN with recent MI - 4
Definition
ACEI, ARB, BB, aldosterone antagonist
Term
what medications are usedin HTN with CKD - 2
Definition
ACEI, ARB
Term
what HTN medications are used in CAD - 2
Definition
BB, CCB
Term
what HTN medications are used in AFib/flutter for rate control - 2
Definition
BB, diltizam
Term
dosing of labetalol
Definition
200-2400mg in 2-3 doses
Term
dosing of nifedapine
Definition
30-120mg/d
Term
dosing of methyldopa
Definition
500-3000mg/d in 2-3 doses
Term
dosing of HCTZ
Definition
12.5-50mg/d
Term
fetal SE of labetalol - 3
Definition
IUGR, bradycardia, hypoglycemia
Term
maternal SE of labetalol - 8
Definition
bronchospasm, increased uterine tone, CHF, headache, fatigue, elevated TG/VDRL, lowers HDL
Term
contraindications to labetalol - 3
Definition
asthma, acute systolic CHF, conduction abnormalities
Term
MOA labetalol
Definition
vasodilation and decreased CO by inhibiting catecholamines at B adrenergic receptor
Term
MOA nifedipine
Definition
vasodilation by blocking Ca uptake
Term
SE nifedipine - 6
Definition
HA, tachycardia, orthostatic hypotension, edema, MI in CAD
Term
SE abrupt DC of BB
Definition
HTN and ischemic MI
Term
SE abrupt DC of CCB
Definition
coronary vasospasm
Term
MOA methyldopa
Definition
central a2 vasodilation
Term
SE methyldopa - 5
Definition
sedation, elevated LFT / hepatitis, hemolysis, fever, depression
Term
MOA clonidine
Definition
central a2 vasodilation
Term
SE clonidine - 3
Definition
dizziness, headache, dry mouth
Term
SE abrupt DC clonidine
Definition
rebound HTN
Term
SE abrupt DC methyldopa
Definition
nothing special
Term
MOA HCTZ
Definition
decrease plasma volume, venous return, CO, PVR by blocking Na reabsorption in distal convoluted tubule
Term
SE HCTZ fetal - 1
Definition
thrombocytopenia
Term
SE HCTZ - 6
Definition
volume depletion, electrolyte abnormalities, increased UA, low PLT, hypokalemia, arrhythmia
Term
what med should you be careful with on HCTZ and why
Definition
muscle relaxants, low K can potentiate their action
Term
monitoring required if on HCTZ
Definition
Cr and K 2wk post initiation
Term
MOA hydralazine
Definition
peripherial vasodilation
Term
SE hydralazine - 5
Definition
flushing, headache, SLE like reaction, tachycardia, hypotension
Term
SE hydralazine fetal - 1
Definition
NRFHT
Term
SE nitroprusside fetal - 1
Definition
cyanide toxicity
Term
SE nitroprusside - 4
Definition
cyanide toxicity, headache, nausea, vomiting
Term
SE nitroglycerine - 3
Definition
HA, tachycardia, methemoglobinemia
Term
contraindication nitroglycerine - 1
Definition
HTN encephalopathy
Term
why don't we use atenolol in pregnancy
Definition
IUGR
Term
SE ACEI fetal - 8
Definition
renal dysplasia, anuria/oligo, arterial hypotension, IUGR, RDS, pulmonary hypoplasia, limb defects, death
Term
why do you DC ACEI pre-op
Definition
prolonged hypotension during surgery
Term
SE ACEI - 3
Definition
cough 5-35% that improves in 1-4wk post DC, hyperkalemia, angioedema
Term
monitoring if on ACEI - 3
Definition
Cr and K in 1-2wk after starting, if takes NSAIDS monitor Cr
Term
MOA ACEI
Definition
blocks angiotensin II Causing arterial and venous dilation and natiuresis
Term
MOA dazazosin
Definition
blocks NE vasoconstriction in vascular smooth muscle
Term
SE dazazosin - 7
Definition
syncope after 1st dose, stress incontinence, weakness, dizziness, decreased cholesterol and LDL, increased HDL
Term
MOA minoxidil
Definition
direct relaxation of arterial wall smooth muscle
Term
SE minoxidil - 2
Definition
headache, tachycardi
Term
indication minoxidil
Definition
refractory HTN
Term
#1 cause of death in women
Definition
cardiovascular disease 44%
Term
risk reduction for cardiovascular disease - 8
Definition
stop smoking, DASH, exercise, weight loss, control BP, control glucose, control lipids, ASA 81mg/d
Term
who gets ASA for cardiovascular disease prrevention
Definition
>25% farmingham score
Term
describe cardiac chest pain - 8
Definition
exertional, <20min, squeezing, heaviness, radiation, nausea, diaphoresis, agitation
Term
what are the 2 cardiac enzymes and their onset, peak, duration
Definition
CPK - O 3-12h, P 18-24h, D 36-48h
TROP - O 3-13h, P 18-24h, D 10d
Term
management of an MI
Definition
MONA BAAA - morphine, O2 if low, nitro SL x3, ASA 325mg chewed, BB/metoprolol 25mg PO, atorvastatin 80mg PO, anti-PLT/tricagrelor, anti-coag
Term
how do you choose an anticoagulant in an MI
Definition
if going to PCI to heparin, if doing fibrinolytic do lovenox
Term
how do you management a suspected CVA - acronym
Definition
ACT GET CT - airway, circulation, temp, glucose, EKG, tox screen, CT
Term
when do you intubate in CVA - 2
Definition
hypoventilation, vomiting
Term
BP goal during CVA
Definition
<185/100, <200/100 if not getting thrombolytic, decrease 15% in 24h
Term
when does fever occurring during a CVA
Definition
1-2h
Term
why is fever concerning during a CVA
Definition
causes more ischemia
Term
why do you get glucose in a suspected CVA
Definition
hypoglycemia can present like CVA
Term
when should CT be done in CVA
Definition
within 1h
Term
other labs not in the acrynm you should get in a CVA - 6
Definition
hCG, CBC, CMP, INR, PTT, cardiac enzymes, don't forget to oxygenate
Term
inclusion criteria for thrombolytic for CVA
Definition
within 4.5h
Term
exclusion criteria for thrombolytic for CVA - 9
Definition
trauma/CVA within last 3mo, concern for SAH, BP >180/110, active bleeding, warfarin with increased INR, heparin with increased PTT, low PLT, abnormal glucose, bleeding suggested on CT
Term
how is LDL calculated
Definition
freidwald equation = LDL = total -HDL -(TG/5)
Term
what should you always correct before treating LDL
Definition
TG
Term
normal lipids <19yo
Definition
total <170, LDL <100, HDL >45
Term
normal lipids >20yo
Definition
total <200, LDL <100, HDL >50
Term
management of hyperlipidemia 0-19yo
Definition
lifestyle modifications, assess for familial hyperlipidemia syndrome and treat if has that
Term
management of hyperlipidemia 29-30yo
Definition
lifestyle modifications, assess if early FHX hyperlpipidemia or assess if DL >160
Term
management of HLD 40-75yo is guided by
Definition
ASCVD risk
Term
management of HLD based on ASCVD risk
Definition
- <5% - lifestyle
- 5-7.5% - LS, Rx if risks
- 7.5-20% - LS, moderate statin (high dose if risks)
- >20% - LS, high dose statin
Term
what are 3 things where you would just jump to a high dose statin regardless of ASCVD
Definition
DM with risk factors, vascular disease, LDL >190
Term
at what age do you consider not starting hyperlipidemia medications
Definition
75yo, discuss risks
Term
contraindications to statins - 3
Definition
pregnancy, myopathy, liver disease
Term
SE statins - 4
Definition
elevated LFT, liver failure, muscle pain, rhabdo
Term
#1 SE statins
Definition
muscle pain
Term
high dose statins - 2
Definition
atorvastatin 40/80mg, rotuvostatin 20/40mg
Term
moderate dose statins - 4
Definition
atorvastatin 10/20mg, rotuvostatin 5/10, simvastatin 20/40, pravastatin 40/80
Term
3 things other than statins used to treat HLD
Definition
PC5K inhibitors (repatha, proluvent), O3 FA (vascepa, lovaza), emtricitibine
Term
MOA HDL
Definition
clears LDL and VRDL
Term
how much LDL is needed to really protect cardiovascular
Definition
60
Term
2 things that increase LDL and which is best
Definition
niacin (increases it but no CV benefit), exercises (increases it and CV benefit)
Term
after starting statin when do you follow up and what is the goal
Definition
6-12wk, LDL decreased by 50% (high dose) or 25% (mod dose), LDL <100 (or <70 if risk factors)
Term
what do you do if someone does not meet their LDL goals at follow up after statin
Definition
educate on lifestyle and medication adherence, follow up again 6wk, if still not meeting goal increase dose or add an agent
Term
if someone has HLD what labs should you get - 4
Definition
glucose, TSH, hCG, urine protein
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