Practice AMC

8/2/2019 Practice AMC

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Practice at AMC


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5 classes of lipidlowering drugs, and how they impact on lipids

Type of drug Mechanism of action Major side effects Impact on lipids

Statins(rosuvastatin, atorvastatin,simvastatin, lovastatin,pravastatin, fluvastatin)

HMG CoA reductaseinhibitor

Myositis (


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How to Start Insulin to 72 yrs maleof 100 Kg

Mr Chu is a 72 year-old man with longstanding T2DM, with poor control onmaximum metformin, glyburide and pioglitazine. He weighs 100 kg.

Weight (kg) x 0.5 = total daily dose of insulin (TDD) = 100x 0.5 = 50 units

Half of insulin as rapid acting, half as long acting:

Aspart or lispro or glulisine or regular= 8 units tid ac meals Glargine or Detemir = 25 units

OR 60% Regular; 40% NPH = 10 units Regular tid ac meals, NPH 20 unitsqhs, NPH may need to be split into 2 doses)

Correction factor = 100/TDD= 100/50 = 2; 1 unit lowers glucose by 2mmol/L:

Premeal glucose 4-8 mmol/L, give 8 units Regular

Premeal glucose 8-10 mmol/L, give 9 units Regular Premeal glucose 10-12 mmol/L, give 10 units Regular, Premeal glucose > 12 mmol/L, give 11 units Regular

Glyburide and Pioglitazone will be stopped, Metformin will be continued toreduce weight gain on insulin and lower the dose of insulin required.


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Diagnosis of Gestational Diabetes

How do you diagnose gestational diabetes? (During pregnancy, no prior diagnosis ofdiabetes mellitus)

Positive screening test: 50 g (non-fasting): 1 hour post glucose > 10.3 mmol/L

2 hr OGTT 75 g (done if 1 hour screening glucose is between 7.8-10.2): at least two glucose readings greater than: Fasting glucose > 5.3

1 hour glucose > 10.6 2 hours glucose > 8.9 What are the A1C and glucose targets for the patient with diabetes in pregnancy? A1C < 6%

Fasting glucose 3.8-5.2 mmol/L 1 hr pc glucose 5.5-7.7 mmol/L 2 hr pc glucose 5.0-6.6 mmol/L What is the glucose target during labour? Glucose 4.0-6.7


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Our easy to use blood sugar calculator helpsyou to get your blood sugar conversion resultseither in mg/dl used by the American system or

in mmol/l used by the British system which isaccepted worldwide. Blood sugar conversion ismade easy as never before. Please note that72mg/dl of sugar equals to 4mmol/l of sugar.

One mmol/l = 18.18 mg/dL


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The fluctuation of blood sugar (red) and the sugar-lowering hormone insulin (blue) in humans during

the course of a day with three meals. The effects of a sugar-rich vs a starch-rich meal is highlighted
http://en.wikipedia.org/wiki/Insulinhttp://en.wikipedia.org/wiki/Sucrosehttp://en.wikipedia.org/wiki/Starchhttp://en.wikipedia.org/wiki/File:Suckale08_fig3_glucose_insulin_day.jpghttp://en.wikipedia.org/wiki/Starchhttp://en.wikipedia.org/wiki/Sucrosehttp://en.wikipedia.org/wiki/Insulin


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Giant Cell Arteritis

What are the symptoms of giant cell arteritis (temporal arteritis)? GCA symptoms are variable and may include any of the following.

i)New onset headache (occurs in two-thirds of patients). ii)Constitutional symptoms

iii)Jaw claudication iv)Tongue claudication v)Scalp tenderness vi)Arm claudication

vii)Visual disturbance including amaurosis fugax, diplopia or permanent vision loss. viii)Symptoms of polymyalgia rheumatica (including aching of the shoulder or hip

girdle).

A markedly elevated ESR is usually seen, although giant cell arteritis is occasionally

seen in patients with a normal ESR. Frequency of PMR and GCA increase with ageand the conditions are essentially not seen in individuals under 50 years of age.


9/23

Red Flags in Back Pain

In a patient complaining of back pain, what are the "red flags" on history that suggest a need for urgent surgical intervention? Whathistorical features suggest an underlying medical cause for the pain (such as a tumor, infection or an inflammatory problem)?

Surgical emergencies in patients presenting with back pain include the cauda equina syndrome (usually due to a tumor or massive discherniation) and aortic aneurysmal dissection or rupture. Historical features that should raise suspicion of these conditions include:

* Numbness (particularly "saddle anesthesia") * Focal weakness * Progressive neurological compromise in the lower extremities * Bladder or bowel incontinence * Complaints suggestive of heart failure or ischemia (aortic aneurysm) An underlying medical cause for back pain is suggested by the following features:

*Fever *Weight loss *Known history of malignancy *Recent infection *Immunosuppression *IVDU *Night pain Inflammatory back pain is more likely to occur in patients with IBD, psoriasis or uveitis. The following 5 questions are particularly useful

in assessing patients for inflammatory back pain. The presence of four of these five features provide a sensitivity of 0.95 and a specificityof 0.85 for spondylitis:

*Presence of morning stiffness *Improvement of pain with exercise *Onset before age 40 *Insidious onset *Duration of symptoms longer than three months Do not forget to consider visceral causes of back pain, such as pancreatitis, pyelonephritis, renal colic or a penetrating duodenal ulcer.


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Metric Units: BMI = Weight (kg) / (Height (m) x Height (m))

English Units: BMI = Weight (lb) / (Height (in) x Height (in)) x 703


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BMI (Body Mass Index) is a measurement of body fat based onheight and weight that applies to both men and women between theages of 18 and 65 years.

BMI can be used to indicate if you are overweight, obese,underweight or normal. A healthy BMI score is between 20 and 25.A score below 20 indicates that you may be underweight; a value

above 25 indicates that you may be overweight. You can calculate your BMI by using our BMI Calculator below, or

by using the BMI Formula.

Please remember, however, that this is only one of many possibleways to assess your weight. If you have any concerns about yourweight, please discuss them with your physician, who is in a

position, unlike this BMI calculator, to address your specificindividual situation.
http://www.bmi-calculator.net/bmi-formula.phphttp://www.bmi-calculator.net/bmi-formula.php


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Your waist to hip ratio is an important tool that helps you determineyour overall health risk. People with more weight around their waistare at greater risk of lifestyle related diseases such as heart diseaseand diabetes than those with weight around their hips. It is a simpleand useful measure of fat distribution.

Use a measuring tape to check the waist and hip measurements.- Measure your hip circumference at its widest part.- Measure your Waist Circumference at the belly button or justabove it.

The Waist to Hip Ratio Calculator indicates your probable healthrisks. People with more weight around the waist, face more health

risks than people who carry more weight around their hips.
http://www.bmi-calculator.net/waist-to-hip-ratio-calculator/waist-circumference.phphttp://www.bmi-calculator.net/waist-to-hip-ratio-calculator/waist-circumference.php


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BMI Classification

18.5 or less Under Weight

18.5 to 24.99 Normal Weight

25 to 29.99 Over Weight

30 to 34.99 Obesity Class 1

35 to 39.99 Obesity Class 2

40 or greater Morbid Obesity


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What is maximum heart rate? The maximum heart rate is the highest heart rate

achieved during maximal exercise. One simple methodto calculate your predicted maximum heart rate, usesthis formula:

220 - your age = predicted maximum heart rate Example: a 40-year-old's predicted maximum heart rate

is 180 beats/minute. There are other formula's that take into account, the

variations in maximal heart rate with age and gender. Ifyou are interested in learning more about these moreaccurate but slightly more complicated formula's, pleasesee these resources:


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What is maximum heart rate?The maximum heart rate is the highest your pulse rate can get. Tocalculate your predicted maximum heart rate, use this formula:

220 - Your Age = Predicted Maximum Heart Rate

Example: a 40-year-old's predicted maximum heart rate is 180.

Your actual maximum heart rate can be determined by a gradedexercise test.

Please note that some medicines and medical conditions mightaffect your maximum heart rate. If you are taking medicines or havea medical condition (such as heart disease, high blood pressure, ordiabetes), always ask your doctor if your maximum heart rate/targetheart rate will be affected. If so, your heart rate ranges for exerciseshould be prescribed by your doctor or an exercise specialist.


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What is target heart rate? You gain the most benefits and lessen the risks when you exercise in your target

heart rate zone. Usually this is when your exercise heart rate (pulse) is 60 to 80percent of your maximum heart rate. In some cases, your health care provider maydecrease your target heart rate zone to begin with 50 percent.

It is not recommended to exercise above 85 percent of your maximum heart rate.Intensity at that level increases both cardiovascular and orthopedic risk with

minimal, additional health-related benefit from the exercise. Always check with your health care provider before starting an exercise program.

Your health care provider can help you find a program and target heart rate zone thatmatches your needs, goals and physical condition.

When beginning an exercise program, you may need to gradually build up to a levelthat is within your target heart rate zone, especially if you have not exercisedregularly before. If the exercise feels too hard, slow down. You will reduce your risk ofinjury and enjoy the exercise more if you don't try to over-do it!

To find out if your are exercising in your target zone (between 60 and 80 percent ofyour maximum heart rate), stop exercising and check your 10-second pulse. If yourpulse is below your target zone, increase your rate of exercise. If your pulse is aboveyour target zone, decrease your rate of exercise.


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Target heart rate

You gain the most benefits and lessen the risks when you exercise in yourtarget heart rate zone. Usually this is when your exercise heart rate (pulse)is 60 percent to 80 percent of your maximum heart rate. In some cases,your health care provider might decrease your target heart rate zone tobegin with 50 percent.

Do not exercise above 85 percent of your maximum heart rate. Thisincreases both cardiovascular and orthopaedic risk and does not add anyextra benefit.

When beginning an exercise program, you might need to gradually build upto a level that is within your target heart rate zone, especially if you have notexercised regularly before. If the exercise feels too hard, slow down. Youwill reduce your risk of injury and enjoy the exercise more if you don't try toover-do it.

To find out if you are exercising in your target zone (between 60 percentand 80 percent of your maximum heart rate), stop exercising and checkyour 10-second pulse. If your pulse is below your target zone (see the chartbelow), increase your rate of exercise. If your pulse is above your targetzone, decrease your rate of exercise.


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What is your target zone?Target Heart Rate Zones by Age *

Age Target Heart Rate (HR) Zone (60 - 85%) Predicted Maximum HR

20 120 170 200

25 117 166 195

30 114 162 190

35 111 157 185

40 108 153 180

45 105 149 175

50 102 145 170

55 99 140 165

60 96 136 160

65 93 132 155

70 90 123 150

Your Actual Values(Actual values are determined from a graded

exercise test)

Target HR: Max. HR:

Age Target Heart Rate (HR) Zone (60 - 85%) Predicted Maximum HR

20 120 170 200

25 117 166 195

30 114 162 190

35 111 157 185

40 108 153 180

45 105 149 175

50 102

145 170

55 99 140 165

60 96 136 160

65 93 132 155

70 90 123 150

Your Actual Values(Actual values are determined from a graded

exercise test)

Target HR: Max. HR:


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What is your target zone?Target Heart Rate Zones by Age *AgeTargetHeart Rate (HR) Zone (60 - 85%)Predicted

Maximum HR20120

17020025117

16619530114 16219035111 15718540108 15318045105 14917550102 1451705599 1401656096 1361606593 1321557090

123150Your Actual Values(Actual values are determined from a gradedexercise test) Target HR:Max. HR:


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Age Target Heart Rate (HR) Zone (60-85%)

Predicted Maximum HeartRate

20 120-170 200

25 117-166 195

30 114-162 190

35 111-157 185

40 108-153 180

45 105-149 175

50 102-145 170

55 99-140 165

60 96-136 160

65 93-132 155

70 90-128 150

Your actualvalues

Target HR Max. HR

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