267 (clinical)

Question 1

what is T2DM characterised by?

Answer 1

1. insulin resistance
2. impaired insulin secretion
3. increased hepatic glucose production due to increased gluconeogenesis and glycogenolysis
4. impaired incretin release

Question 2

what are incretins?

Answer 2

a group of metabolic hormones that stimulate a decrease in blood glucose levels. Incretins are released after eating and augment the secretion of insulin

Question 3

earliest manifestation in the development of T2DM? (as in, at the prediabetes stage)

Answer 3

insulin resistance
(postprandial hyperglycaemia in diabetic range not usually seen till 5-10 years later)
(increased beta-cell output of insulin can compensate for insulin resistance for a good while)

Question 4

some factors that worsen insulin resistance?

Answer 4

genetics
elevated free fatty acids
hyperglycaemia
pregnancy
obesity
sedentary lifestyle
ageing
various meds inc. steroids, anti-psychs, estrogens

Question 5

insulin’s effect on the liver?

Answer 5

suppresses hepatic gluconeogenesis and glycogenolysis

more potent than the effect of hyperglycaemia alone

Question 6

seriousness of microvascular v. macrovascular disease (quote)

Answer 6

“clearly, patients will die from their macrovascular disease, but suffer from their microvascular disease”

Question 7

what should be done to avoid PO nausea and vomiting?

Answer 7

avoid hypotension
give high concentration of oxygen
treat pain
avoid sudden movement

Question 8

what is aspiration pneumonitis?

Answer 8

severe inflammation of the lungs caused by the aspiration of gastric contents

Question 9

what are some potential causes of post-op hypotension?

Answer 9

blood loss,
vasodilation causing pooling of blood in the extremities, anaesthetic agents
narcotics

Question 10

what is shock?

Answer 10

a condition of circulatory impairment leading to inadequate vital organ perfusion and oxygen delivery relative to the individual’s metabolic needs

Question 11

what is shock characterised by?

Answer 11

a decrease in BP (a 20–30% decrease from the patient’s baseline) and an increase in heart rate

Question 12

why is shock not an uncommon occurrence in PO patients?

Answer 12

surgical patients may have had significant blood loss leading to hypovolaemic shock,

or may have had misdistribution of circulation from vasodilation due to central neural blockade

Question 13

management of patient with shock?

Answer 13

lie the patient flat with the legs elevated and provide supplemental oxygen (if not already in use).

call for medical assistance

check the patient’s peripheral return at the fingernail beds to assess whether peripheral shutdown has occurred, signalling compensation

medical management may include fluid resuscitation therapy

Question 14

medical management of shock in the case of misdistribution of circulation from an epidural or spinal injection of local anaesthetic?

Answer 14

medications such as metaraminol (a potent sympathomimetic agent) may be used to provide some vasoconstriction to increase the BP