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Module 10: Mali: Endocrine > CA-Lecture > Flashcards

CA-Lecture Flashcards

1
Q

what are 7 sxs you see with type 1 diabetes?

A
  1. polyuria
  2. weakness and fatigue
  3. polyphagia wieht weightloss
  4. blurred vision
  5. vulvovaginitis
  6. nocturnal enuresis
  7. SYMPTOMATIC
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2
Q

what are 6 sxs associated with diabetes 2?

A
  1. polyuria and thirst +/-
  2. weakness +/-
  3. recurrent blurred vision
  4. vulvovaginitis or puritis ++
  5. periphreal neuropathy ++
  6. OFTEN ASYMPTOMATIC
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3
Q

what are the 4 qualifications for the dx of DM?

A
  1. fasting glucose over 126
  2. 2 hour fasting GTT over 200
  3. A1C over 6.5%
  4. classic sxs of hyperglycemia a random glucose over 200
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4
Q

what are the 4 things of self-monitoring of blood glucose can be used to guide?

A
  1. diet
  2. physical activity
  3. preventing hypoglycemia
  4. adjusting medication
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5
Q

what are 3 microvascular complications of DM?

A
  1. retinopathy
  2. nephropathy
  3. neuropathy
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6
Q

what is the macrovascular complications of diabetes?

3 things this can lead to?

A
  1. atherosclerosis increases:

-coronary artery disease (AMI)

-cerebrovascular disease

-periphreal arterial disease

-gangrene of food

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7
Q

what are 3 complications that occur with DM Type 1?

0

3

4

A
  1. ESRD in 40%–major cause of death

  1. blindness caused by
    - severe proliferative retinopathy
    - viterous hemmorhages
    - retinal detachment
  2. neuropathy leading to
    - gastroparesis
    - diabetic diarreah
    - resting tachycardia
    - postural hypotension
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8
Q

what are 4 complications from T2DM?

A
  1. ESRD in less than 20%
  2. blindness
  3. neuropathy
  4. macrovascular disease leading to AMI, CVA as main cause of death
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9
Q

diabetic retinopathy:

when to refer type 1 diabetics?

A

refer 5 years after dx

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10
Q

diabetic retinopathy:

when to refer to optamologist for type 2?

A

refer at the time of dx

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11
Q

what are the number of patients with signs of retinopathy in DM type 1?

A
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12
Q

what percent of type 2 DM will have diabetic retinopathy after 16 years?

A

60%

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13
Q

diabetic retinopathy:

non-proliferative retinopathy

what is this?

what are 5 presentations of this?

A

earliest stage of retinal involvement with DM

  • microaneurysm
  • dot hemmoraghes
  • exudates
  • retinal edema
  • macular edema (#1 cause of decreased visual acuity in DM type 2)
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14
Q

diabetic retinopathy:

proliferative retinopathy

what is this?

what is an indication of pre-proliferative?

A

growth of new capillaries and fibrous tissue with normal retina and viterous chamber

pre-proliferative:

cotton-wool spots (small infarcts of retina)

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15
Q

what are two other opthalmologic complications that can occur in diabetics?

A

cataracts

-subcapsular in DM TYPE 1

glaucoma

-occurs in ~6% of DM patients

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16
Q

what occurs in 1/3 of patients with DM?

A

diabetic nephropathy=kidney failure!!

**thats why important to treat HTN and control hyperglycemia**

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17
Q

what is the first sign of kidney failure or diabetic nephropathy?

A

proteinuria

so check urine annually

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18
Q

when should you get a nephrologist involved with diabetic nephropathy?

A

with eGFR less than 30

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19
Q

what are the general things you worry about in type 1 and type 2 diabetes?

A

type 1: kidneys

type 2: heart and stroke

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20
Q

diabetic nephropathy

what test do you want to order to monitor?

how do you prevent this?

A
  1. check urinary albumin (spot urine albumin-to-creatinine ration or UACR at least annully)

***increased BP is associated with increased microalbuminuria***

PREVENT THIS BY ACE INHIBITOR

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21
Q

what is the most common complication of DM both type 1 and 2?

percent

A

diabetic neuropathy

**50% of type 2 are affected**

**control of sugars can slow or prevent its progression**

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22
Q

what are the 3 types of PERIPHREAL diabetic neuropathy?

A
  1. distal symmetric polyneuropathy
  2. isolated periphreal neuropathy
  3. painful diabetic neuropathy
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23
Q

periphreal neuropathy:

distal symmetric polyneuropathy

what is the location for this?

2 things that may occur?

A

loss of function in stocking-glove pattern; in feet because nerves most vulnerable

  • motor and sensory nerve conduction may be delayed
  • ankle jerks may be absent
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24
Q

diabetic neuropathy:

autonomic neuropathy

what is this caused from?

what are 7 presentations?

A

long standing DM

includes:

  1. orthostatic hypotension
  2. gastroparesis
  3. erectile dysfunction
  4. N/V/D
  5. fecal incontinence
  6. incomplete bladder emptying
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25
Q

periphreal neuropathy foot test

4 things that are decreased

A
  1. dulled perception of vibration and temp

  1. pain mild to severe, or none if very progressed
  2. sensory neuropathy examined with filament
26
Q

those who can’t feel the filament in the foot exampl are it increased risk for what?

A

unprecieved neuropathic injury…

…since they can’t feel the are more likely to get hurt and not know!

27
Q

periphreal neuropathy:

what can happen to the apperance of the foot initially? leads to?

A

clawing of the toes and displacement of the submetatarsal fat pads from dennervation of the small muscles of the foot

results in altered biomechanics and increased foor pressure

28
Q

periphreal neuropathy:

charcots arthropathy

A

caused from

  1. decreased pain/sensation
  2. high food pressures
  3. repetitive stress

left untreated leads to rocker bottom deformity and ulceration

29
Q

what are 4 ways to manage diabetic ulcer?

A
  1. mechanical unloading to decrease pressure
  2. debridement and abx
  3. healing time ~8-10 weeks
  4. prevent w/therapeutic footwear
30
Q

what should you do for patients with loss of protective threshold?

A

referr to podiatry!

31
Q

what are 6 things you wanna inspect for when doing the diabetic foot exam?

A
  1. skin cracking
  2. superficial fungal infections
  3. hair growth
  4. nail trimming
  5. ulcers and calluses
  6. joint deformities
32
Q

diabetic foot exam:

assesing blood flow

3

A
  1. assess temp

  1. check distal pulses
    - PT
    - DP
33
Q

diabetic foot exam:

checking neurological function

A
  1. sensation
    - vibration
    - proprioception (up down)
    - monofilament test
  2. ankle reflex
  3. gait
34
Q
A

test these locations with the microfilament

35
Q

what might be the earliest sign of periphreal neuropathy?

A

unable to feel vibrations for at least 8 seconds

36
Q

what is the leading cause of death in DM type 2?

A

Heat disease

37
Q

are AMIs more likely in diabetics?

A

yes 3-5 more times likely

38
Q

what are the 4 cardiovascular complication prevention strategies for diabetics?

A
39
Q

what is PVD in diabetics? 4 presentations?

A

athlerosclerosis

clinical manifestations:

  1. ischemia of lower extremities
  2. impotence
  3. intestinal angina
  4. gangrene of the feet
40
Q

what should you do if a patient has no palpable distal pulses?

A

order ABI, consider referral to vascular surgeon for endarterectomy and bypass

***(in addition to reducing other contributing factors – lower cholesterol, BP, tobacco cessation)***

41
Q

what are 6 other physical complications from diabetes that you may notice looking at the patient??

A
  1. candidal infection
  2. shin spots
  3. eruptive xanthomas
  4. dupuytren contractures
  5. carpel tunnel
  6. diabetic cheiroarthopathy (chronic progressive stiffness of the hand secondary to contracture and tightening of the skin over joints)
42
Q

what are 7 components of a complete diabetic evaluation?

A
  1. age and characterisics of onset of diabetes
  2. eating patterns, physical activity habits, nuitritional status, weight history, growth and development in children
  3. common comorbidities, psychosocial problems, and dental disease
  4. diabetes education** **histroy
  5. review of previous tx regimens and response to therapy (A1c records)

6 medication adherence, barriers to medication adhereance, meal plan, activity patterns, readiness for behavior change

  1. results of glucose mononitoring and patients use of date

8. hyoglycemia episodes and patients awareness of this

9. hx of micro and macrovascular issues

43
Q

what are 7 comorbid conditions you worry about with diabetes?

A
  1. obstructive sleep apnea
  2. fatty liver disease
  3. periodontal diseaes
  4. cognitive impairment
  5. hearing impairment
  6. fracture
  7. cancer
44
Q

what are 9 aspects of the diabetic physical exam?

A
  1. height and weight
  2. blood pressure
  3. fundoscopic examination
  4. thyroid palpation
  5. thryoid palpation
  6. skin examination (acanthosis nigricans and insulin injection sites)
  7. foot exam
    - pedial and posterior tibialis pulses
    - presense or absence of paterllar and achhiles reflexes
    - deremination of proprioception, vibration, and monofilament sensation
45
Q

what is this?

A

acanthosis nigricans

46
Q

what is this?

A

candidal infection

47
Q

what are the 6 labs you would consider ordering for a diabetic patient?

A
  1. A1c every 3 months

  1. yearly
    - lipid panel (HDL, LDL, tri)
    - LFT
    - urine albumin, with albumin to creatine ratio
    - serum creatinine/eGFR
    - TSH in type 1, or women over 50
48
Q

what is the target A1c for someone with diabetes?

A

less than 7

49
Q

what is the pre and post prandial goals for someone with diabetes?

A

preprandial: 80-130
postprandial: less than 180

50
Q

what are the correlations between A1c and Blood glucose?

A
51
Q

what are 5 referrals you shoudl consider making for diabetics to help you manage their care?

A
  1. annual dilated eye exam
  2. family planning for women of reproductive age
  3. registered dietician
  4. diabetes self-management education
  5. dentist for comprehensive periodontal examination
52
Q

what are 5 nessacary pieces of diabetic education that should be included in their education?

A
  1. medical nuitrition therapy
  2. weight management
  3. physical activity
  4. tobacco cessation
  5. immunizations
53
Q

what are the daily reccomendations for percent of meal:

carbohydrates

fat

protein

A

carbohydrates: 45-65%

fat (unsaturated): 25-35%

protein: 10-35%

54
Q

what are two things in the diet you want to limit?

A

carbohydrates

cholesterol

55
Q

if a pt is obese what do you want to limit?

A

caloric restriction

56
Q

if someone is taking insulin what do you want to limit?

A

carbohydrates

57
Q

what types of foods should you be choosing?

A

high fiber and low glycemic index

58
Q

how often should diabetic patients have…

smoking cessation talks

blood pressure evaluations

dilated eye exams

foot exams

dental exams

A

smoking cessation talks: EVERY VISIT

blood pressure evaluations: EVERY VISIT

dilated eye exams: ANNUALLY

foot exams: ANNUALLY, or every visit if abnormal

dental exams: ANNUALLY

59
Q

what three vaccinations should you make sure all diabetics get?

A
  1. pneumococcal
  2. influenza
  3. hepatitis B
60
Q

how often should someone get the pneumococcal vaccine?

A

at dx and also repeated once if older than 65

Module 10: Mali: Endocrine (5 decks)

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