tamerbashir
Forum Elite
Topics: 20
Posts: 284
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1-A 50-year-old man with a 20-year history of type
2 diabetes mellitus has had sensory neuropathy for 2 weeks.
Pulses are decreased at the ankle. There is no peripheral edema. His serum
glucose levels have been between 150 mg/dL and 200 mg/dL over the past 6
months. Which of the following is the most effective measure to prevent
serious foot infections?
A) Use of support hose
B) Use of well-fitted shoes
C) Prophylactic antibiotics
D) Daily aspirin and dipyridamole
E) Decrease in serum glucose level
2-A 67-year-old woman comes to the physician for her first influenza virus
vaccination. She has a history of untreated hypertension. Her blood pressure is
160/100 mm Hg, and pulse is 100/min. Shortly after administration of the
influenza virus vaccine, she develops shortness of breath, hives, and angioedema.
Which of the following is most likely to have prevented this reaction?
A) Inquiry about an egg allergy
B) Heterophile agglutination test
C) Skin test with histamine reagent
D) ß-Adrenergic blocking agent therapy
E) Amantadine therapy
F) Insulin therapy
G) Rimantadine therapy
3-An asymptomatic 52-year-old man comes for a
follow-up
examination 1 month after he passed renal calculi. He
has a history of renal
calculi 2 years ago. Serum uric acid and calcium
levels and urinary
oxalate excretion are within normal limits. Urinary
calcium excretion is
increased. In order to avoid recurrence of renal
calculi, which of the
following is the most appropriate pharmacotherapy for
this patient?
A
) Bicarbonate
B
) Calcium lactate
C
) Methenamine mandelate
D
) Probenecid
E
) Thiazide diuretic
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| Adam
Forum Senior
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1- B
2- C ??
3- E
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| gatita007
Forum Junior
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b
a
e
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| sherry39
Forum Junior
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e
a
a
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| guangyu
Forum Elite
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B
A
E
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| peter90036
Forum Elite
Topics: 28
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BAE
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| dr.wad
Forum Senior
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E
A
E ( thiazude >>hypocalciuria .
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| colgirl
Forum Newbie
Topics: 0
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e......a.....e
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| peter90036
Forum Elite
Topics: 28
Posts: 315
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if a person has had diabetes 20 years, and has now neuropathy and vasculopathy
is the control of glucose still as important to prevent diabetic foot?
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| dr9576
Forum Newbie
Topics: 4
Posts: 42
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E that's a recent neuropathy. so can be manged by glucose controling
A sensitivity to egg, I think beacsue of the cultivation material.
A Thaizide diuretics cause hyperclacemia
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| peter90036
Forum Elite
Topics: 28
Posts: 315
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"development of neuropathy can be delayed significantly by maintaining glycemic level"
"People with neuropathy or evidence of increased plantar pressure may be adequately managed with well-fitted walking shoes or athletic shoes. "
2004 http://care.diabetesjournals.org/cgi/content/full...
2007 http://www.diabetes.org/for-health-professionals-...
the question is not fair either, it should not have had these options but included pt education and frequent visits to doctor.
...so more time waste, = i dont know ... in practice all these should be done.
2005 http://jama.ama-assn.org/cgi/content/full/293/2/2...
Diabetes confers a dramatically increased risk of foot ulceration, but available evidence suggests that this risk may be reduced to some degree by appropriate screening and intervention measures. Clinicians should screen all patients with diabetes to identify those at risk for foot ulceration. This includes reviewing relevant past history, identifying any current foot deformities, and especially assessing for loss of protective sensation with a monofilament. Other helpful screening methods include assessing for peripheral vascular disease by measuring ABIs, ensuring that the patient is wearing appropriate footwear, and checking for high plantar pressure when possible.
Screening allows the clinician to assign the patient to a risk category that dictates both the type and frequency of foot interventions needed. Effective interventions include patient (and clinician) education. Possibly effective interventions include optimizing glycemic control, smoking cessation, intensive podiatric care, and debridement of calluses. The value of prescription footwear for ulcer prevention is unclear. In selected cases, evaluation for surgical procedures may be indicated. Each of these interventions, when used appropriately, may reduce the risk of foot ulceration and its devastating consequences.
Edited by peter90036 on 03/23/08 - 08:21 PM
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| Jcala
Forum Junior
Topics: 10
Posts: 44
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E
A
E
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| solitarius
Forum Junior
Topics: 7
Posts: 71
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E....question is: "the most effective measure "..that is always a blood glucose control
A
E
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| aspire
Forum Senior
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E
A
E
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| DrVirgo
Forum Hero
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Posts: 3,342
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1. Which of the following is the most effective measure to prevent
serious foot infections?
B) Use of well-fitted shoes
-he already has neuropathy and arterial problems... If he hurts his foot he won't feel it, and then arterial insuffiency will lead to poor wound healing and infections... if left untreated this can lead to tissue necrosis, gangrene, and if left untreated for way too long it could lead to him havin to get an amputation... Prevent this from happening by telling him to wear properly fitting shoes so he won't get hurt in the first place.
2. Which of the following is most likely to have prevented this reaction?
-She had an ALLERGIC reaction.
The influenza vaccine is produced in embryonated eggs.
So the answer is
A) Inquiry about an egg allergy
3. Calcium Stones!
In order to avoid recurrence of renal
calculi, which of the
following is the most appropriate pharmacotherapy for
this patient?
E ) Thiazide diuretic -Remember: Thiazides retain Calcium!... The goal is to have LESS Calcium in the renal tubules so less calcium precipitation to stones.
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| DrVirgo
Forum Hero
Topics: 1041
Posts: 3,342
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peter90036 wrote:
"development of neuropathy can be delayed significantly by maintaining glycemic level"
.
True, but once it has already developed, like in this patient, glycemic control won't help much.
Prevent injuries by education on proper foot care -well fiting shoes falls within that category.
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