1. Contraindications for HRT
    • • Known or suspected pregnancy
    • • History of breast cancer
    • • History of hormone-sensitive cancer
    • • Unexplained uterine bleeding
    • • Liver disease (this especially applies to oral ET)
    • • History of blood clots
    • • Confirmed cardiovascular disease
    • Danger Signs of HRT: abn. Vag bleeding, calf pain, chest pain, SOB, hemoptysis, severe headache, vision probs, breast changes abd. Pain, and jaundice
  2. Discuss the assessment, treatment, and follow up of a patient with a positive PPD using evidence-based protocols and guidelines.
    • The CDC's recommendations found in Morbidity and Mortality Weekly Report (MMWR)
    • The management of TB depends on the classification of the disease based on the pathogenesis and diagnostic results.
    • Class 0 and 1 no tx. Class 1 should have a repeat test several months after exposure.

    Class 2 Main purpose of preventive therapy is decrease the risk that LTBI will progress to active TB. Isoniazid (INH) 300mg/day 6-12 months.

    Class 3 requires multidrug therapy. Initial tx regimen: isoniazid, rifampin, pyrazinamide (PZA) and ethambutol is used to prevent MDR TB. Once drug susceptibility to isoniazid and rifampin is demonstrated, administration of these two drugs is continued after the initital 2 months of multidrug therapy.

    Monthly follow up evals at the least
  3. DX of TB
    TB skin tests

    Chest x-ray or sputum smears may be recommended in high risk populations

    Dx of active disease:

    3 sputum specimens for BOTH smear exam and culture

    presumptive dx can be made with detection of acid fast bacilli (AFB)

    a positive sputum culture for M. tuberculosis is essential to confirm but can take weeks

    TB skin test is helpful: absence does not exclude Dx

    PA CXR
  4. Using the National Cholesterol Education Program Adult Treatment Panel III guidelines how would you manage a 56 year old male with type 2 diabetes and is a smoker
    • National Cholesterol Education Program ATP III Guidelines
    • ATP III counts diabetes as a CHD risk equivalent., age and smoker also increases risk. According to the guidelines The LDL cholesterol goal is <100 mg/dL.
  5. ATP III TLC guidelines
    • Reduced intakes of saturated fats and cholesterol
    • ● Therapeutic dietary options for enhancing LDL lowering (plant stanols/sterols and increased soluble fiber)
    • ● Weight reduction
    • ● Increased regular physical activity
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