NP AANP Adult Gero Boards 283 Questions with Complete Solutions What are the conditions needed for RBC Formation? - Correct Answer -Functional Erythropoietin mechanism (90% from kidney, 10% hepatic production) ----Erythropoietin supply is diminished in advancing renal failure, usually beginning with GFR<49ml.min -Uncompromised DNA Synthesis ---- Chronic inflammation, from autoimmune disorders (systemic lupus erythematous, rheumatoid arthritis and chronic infection) -Hemoglobin synthesis unimpaired by lack of iron, vitamin or global production -Intact marrow microenvironment Hemoglobin- what is it and what do you need to produce it? - Correct Answer iron-containing oxygen- transport protein found in red blood cells Adequate nutrition (iron, B vitamins, Vit C, Protein) and absorption (heme=iron, globin= protein) How do you know if the bone marrow is working - Correct Answer check the reticulocytes
Healthy: reticulocytes=1-2% of total RBC or replacement of RBC
In the presence of acute anemia:
Healthy pt should increase reticulocytes If pt's reticulocytes don't increase(reticulocytopenia) -> bone marrow might not be working appropriately Reticulocyte-cell, osis-increase in number of cells, penia- decreased number Causes of anemia - Correct Answer -blood loss (need 1 L or more for significant drop of hgb) (acute or chronic blood loss-erosive gastritis, menorrhagia, GI malignancy) -reduced RBC production (Vit B12, Folic acid, iron deficiency, use of chronic PPI) -Premature destruction of RBC (lifespan: 90-120d) 1 / 4
Chronic PPI use can cause which type of deficiency? - Correct Answer Vit B12 and iron malabsorption Metformin use can cause which type of deficiency? - Correct Answer Vit B12 malabsorption and deficiency Beta Thalassemia minor - Correct Answer Check homogenetic electrophoresis once microcytic hypochromic anemia Mediterranean ancestry To have a child with a thalassemia major both parents must have trait (1 in 4 chance with each pregnancy) Genogram Symbols - Correct Answer Hypothyroidism causes - Correct Answer -hashimoto thyroiditis (autoimmune in origin)
- Post-radioactive iodine (RAI) treatment (s/p graves disease thyroid cancer tx)
- frequent loose stool (hyperdefecation)
-Medications (lithium, amiodorone) When do you check the TSH after starting Synthroid for a patient that has hypothyroidism? - Correct Answer Check TSH 8 weeks after starting Synthroid Symptoms of hyperthyroidism - Correct Answer - Skin is smooth and silky -hyperreflexia -Mentation-> mind is racing -weight loss (10 lbs on average)
-oligomenorrhea -Heat intolerance etiologies for hyperthyroidism - Correct Answer Graves disease (autoimmune) 2 / 4
Toxic Adenoma (active thyroid nodule) Thyroiditis (viral, postpartum) Select medication use (Amiodarone, interferon) Thyroid testing - Correct Answer TSH (thyrotropin) -comes from the anterior pituitary lobes Free T4 (free thyroxine) -unbound, metabolically active portion of thyroxin Total T4 -rarely indicated What do the TSH and free T4 look like in a person with hypothyroidism? - Correct Answer Elevated TSH
(nl: 0.4-4)
Decreased Free T4 (nl: 10-27)
TSH is increased because it is trying to make the Thyroid work Medication Dosing for hypothyroidism - Correct Answer Synthryoid, Levoxyl (have a long 1/2 life) -bioidentical hormone Use ideal body weight in obesity, because they are not usually bound to fat 1.6 msg/kg/d in adults 1.0 msg/kg/d in elderly 4.0 msg/kg/d in children (children are still growing they need more- most likely refer) >/= 50% increase during pregnancy (increase levothyroxine dose by 33% as soon as pregnancy is confirmed, also check the TSH same day) 3 / 4
Consider titrating up over a 1-2 month time frame in the elderly population
SE: may feel jittery
Take at the same time with water on an empty stomach should not be taken within 2 hours of cation such as calcium, iron, aluminum, magnesium Desiccated thyroid preparations, what should you know? - Correct Answer T3/T4 combinations, porcine (pork) and Bovine (beef) origin-> some religious groups or vegans may want to know
Ex: Armour Thyroid, Nature-Thyroid, Bio-Thyroid, Westhroid
- grain= 60-65 mg Thyroid = Levothyroxine
typical daily dose: 60-120 mg/d
Treatment of Hyperthyroidism - Correct Answer At time of diagnosis:
-beta-adrenergic antagonist with Beta 1 or 2 blocker (Propranolol, nadolol) to help with tremors
Once labs come back:
Refer Radioactive iodine (RAI) -> patient will go onto being hypothyroid Recommendations for Treatment of patients with Subclinical hypothyroidism - Correct Answer Treat patients with TSH> 5 if the patient has a goiter or thyroid antibodies are present
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