الدفعة الـ 20
A Question Bank of MCQ in Orthopaedics _ Trauma 2005.pdf
هذا نفسه Natarajan اللي في المجموعة، اللي قد نزله لا عاد ينزله مرة ثانية.
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مساء الفل....
الدكتور عادل عادةً يحب الطالب يكون فاهم المواضيع الآتية:
- Acne Vulgaris.
- Atopic Dermatitis.
- Seborrheic Dermatitis.
- Lichen Simplex.
- Lichen planus.
- Bullous Diseases.
- Erythroderma.
- Photosensitivity (Generally).
- Porphyria cutanea tarda.
- Urticaria.
- Psoriasis.
- Fixed drug eruption.
- Superficial Bacterial Infections (Folliculitis....)
- Gonorrhea.
- Fungal Infections (T. Pedis, capitis and of the nails).
- Viral Infections ( Warts 🤓, HSV).
- Scabies.
- Alopecia areata.
- SCC, BCC & Melanoma(Classifications & Modalities of treatment).
- Tuberous sclerosis.
- Neurofibromatosis.
ويحب ال
- Commonest Sign in every disease(if present).
- Commonest drugs (Uses & Adverse Effects) used in dermatology.
- Commonest procedures(Wood lamp, KOH...) used in dermatology.
- الفروقات في وصف ال LESIONS.
وإعذرونا على أي Spelling غلط 🙊🙊
مساء الفل....
الدكتور عادل عادةً يحب الطالب يكون فاهم المواضيع الآتية:
- Acne Vulgaris.
- Atopic Dermatitis.
- Seborrheic Dermatitis.
- Lichen Simplex.
- Lichen planus.
- Bullous Diseases.
- Erythroderma.
- Photosensitivity (Generally).
- Porphyria cutanea tarda.
- Urticaria.
- Psoriasis.
- Fixed drug eruption.
- Superficial Bacterial Infections (Folliculitis....)
- Gonorrhea.
- Fungal Infections (T. Pedis, capitis and of the nails).
- Viral Infections ( Warts 🤓, HSV).
- Scabies.
- Alopecia areata.
- SCC, BCC & Melanoma(Classifications & Modalities of treatment).
- Tuberous sclerosis.
- Neurofibromatosis.
ويحب ال
- Commonest Sign in every disease(if present).
- Commonest drugs (Uses & Adverse Effects) used in dermatology.
- Commonest procedures(Wood lamp, KOH...) used in dermatology.
- الفروقات في وصف ال LESIONS.
وإعذرونا على أي Spelling غلط 🙊🙊
Forwarded from Suleiman
Insulin regimens should be tailored individually to each patient. There are a variety of options for patients with T2DM. Treatment of T1DM requires intensive insulin therapy with a multi injection regimen or insulin pump.
Basal insulin regimens [28]
Description: Basal insulin is added to an oral antidiabetic drug regimen.
Indication: T2DM with persistently elevated A1C levels despite adequate treatment with noninsulin antidiabetics
Treatment options
Once-daily injection (recommended starting regimen)
Long-acting insulin (e.g., glargine) OR bedtime NPH insulin
Starting dose: 10 units/day OR 0.1–0.2 units/kg/day
Twice-daily NPH insulin: Consider for patients not meeting their glycemic target with bedtime NPH.
Starting dose: 80% of the previously prescribed bedtime NPH insulin dose, with two-thirds given in the morning and one-third at bedtime
Titration
Adjust according to glycemic monitoring.
Levels above target: Increase insulin dose by 2 units every 3 days until preprandial fasting glucose target is met.
If hypoglycemia due to insulin therapy occurs, reduce insulin dose by 10–20%.
If treatment remains insufficient despite appropriate adjustments , intensify treatment by either adding prandial insulin or considering a mixed regimen.
Not all noninsulin antidiabetics can be combined with insulin. Combination therapy with insulin and sulfonylureas should be avoided because of the risk of hypoglycemia and increased mortality! Once insulin is started, consider tapering and eventual discontinuation of sulfonylureas. Insulin combined with pioglitazone increases the risk of edema, weight gain, and congestive heart failure. Metformin is usually continued.
Addition of prandial insulin [28]
Description
Short-acting insulin or rapid-acting insulin is injected before major meals in patients already on a basal insulin regimen.
Prandial insulin can be added before one meal (the largest meal of the day) or several meals.
Indication: T2DM that is not adequately controlled with basal insulin alone
Starting dose
Basal insulin injections are continued at the previous dose.
4 units of short-acting or rapid-acting insulin before chosen meals
Titration: Adjust according to glycemic monitoring.
Increase prandial insulin dose by 1–2 units twice weekly until preprandial fasting glucose target is met.
If hypoglycemia occurs, reduce the corresponding prandial insulin dose by 10–20%.
Mixed insulin regimens [28]
Description
Twice-daily injections of a fixed combination of NPH mixed with either short-acting insulin or rapid-acting insulin; can be self-mixed or premixed
Simple regimens that require minimal patient education and time
Indication: Consider for patients with T2DM who are not meeting glycemic targets with a basal insulin regimen.
Starting dose
Self-mixed insulin
Calculate 80% of the current NPH dose.
Add 4 units of short-acting or rapid-acting insulin per injection.
Premixed insulin: Use the same previous total insulin dose (i.e., the same as for the twice-daily NPH regimen).
Titration
Adjust according to glycemic target.
If treatment results remain inadequate, consider a full basal-bolus regimen.
Mixed insulin regimens are simpler to use and reduce the number of injections required, as both types of insulin are combined into one injection.
Intensive insulin therapy [28][29]
This regimen provides optimal glycemic control as well as more flexibility in the daily diet and exercise plan, and it reduces the risk of complications in patients with good adherence.
Indications
T1DM
T2DM that cannot be sufficiently managed otherwise
Gestational diabetes mellitus
Full basal-bolus regimen: basal regimen with additional short-acting or rapid-acting insulin bolus before every major meal
Insulin pump [30]
Insulin (usually a rapid-acting insulin analog) is subcutaneously infused through a small device attached to the skin.
Basal rates and bolus insulin can be separately tailored to the patient's needs.
Basal insulin regimens [28]
Description: Basal insulin is added to an oral antidiabetic drug regimen.
Indication: T2DM with persistently elevated A1C levels despite adequate treatment with noninsulin antidiabetics
Treatment options
Once-daily injection (recommended starting regimen)
Long-acting insulin (e.g., glargine) OR bedtime NPH insulin
Starting dose: 10 units/day OR 0.1–0.2 units/kg/day
Twice-daily NPH insulin: Consider for patients not meeting their glycemic target with bedtime NPH.
Starting dose: 80% of the previously prescribed bedtime NPH insulin dose, with two-thirds given in the morning and one-third at bedtime
Titration
Adjust according to glycemic monitoring.
Levels above target: Increase insulin dose by 2 units every 3 days until preprandial fasting glucose target is met.
If hypoglycemia due to insulin therapy occurs, reduce insulin dose by 10–20%.
If treatment remains insufficient despite appropriate adjustments , intensify treatment by either adding prandial insulin or considering a mixed regimen.
Not all noninsulin antidiabetics can be combined with insulin. Combination therapy with insulin and sulfonylureas should be avoided because of the risk of hypoglycemia and increased mortality! Once insulin is started, consider tapering and eventual discontinuation of sulfonylureas. Insulin combined with pioglitazone increases the risk of edema, weight gain, and congestive heart failure. Metformin is usually continued.
Addition of prandial insulin [28]
Description
Short-acting insulin or rapid-acting insulin is injected before major meals in patients already on a basal insulin regimen.
Prandial insulin can be added before one meal (the largest meal of the day) or several meals.
Indication: T2DM that is not adequately controlled with basal insulin alone
Starting dose
Basal insulin injections are continued at the previous dose.
4 units of short-acting or rapid-acting insulin before chosen meals
Titration: Adjust according to glycemic monitoring.
Increase prandial insulin dose by 1–2 units twice weekly until preprandial fasting glucose target is met.
If hypoglycemia occurs, reduce the corresponding prandial insulin dose by 10–20%.
Mixed insulin regimens [28]
Description
Twice-daily injections of a fixed combination of NPH mixed with either short-acting insulin or rapid-acting insulin; can be self-mixed or premixed
Simple regimens that require minimal patient education and time
Indication: Consider for patients with T2DM who are not meeting glycemic targets with a basal insulin regimen.
Starting dose
Self-mixed insulin
Calculate 80% of the current NPH dose.
Add 4 units of short-acting or rapid-acting insulin per injection.
Premixed insulin: Use the same previous total insulin dose (i.e., the same as for the twice-daily NPH regimen).
Titration
Adjust according to glycemic target.
If treatment results remain inadequate, consider a full basal-bolus regimen.
Mixed insulin regimens are simpler to use and reduce the number of injections required, as both types of insulin are combined into one injection.
Intensive insulin therapy [28][29]
This regimen provides optimal glycemic control as well as more flexibility in the daily diet and exercise plan, and it reduces the risk of complications in patients with good adherence.
Indications
T1DM
T2DM that cannot be sufficiently managed otherwise
Gestational diabetes mellitus
Full basal-bolus regimen: basal regimen with additional short-acting or rapid-acting insulin bolus before every major meal
Insulin pump [30]
Insulin (usually a rapid-acting insulin analog) is subcutaneously infused through a small device attached to the skin.
Basal rates and bolus insulin can be separately tailored to the patient's needs.
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