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Sam: Endocrine > Clin Assess > Flashcards

Clin Assess Flashcards

1
Q

When is gestational diabetes diagnosed?

A

During second or third trimester

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2
Q

Fasting blood sugar greater than _____ is a diagnosis of diabetes.

A

> 126

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3
Q

Fasting is defined as no caloric intake for at least _____ hours

A

eight

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4
Q

2 hour plasma glucose greater than _____ during an OGTT is diagnoistic of diabetes.

A

200

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5
Q

A1c of _____ or higher is diagnostic of diabetes

A

6.5%

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6
Q

In a patient with classic symptoms of hyperglycemia or hyperglycemia crisis, a random plasma glucose greater than _______ is diagnostic of diabetes

A

200

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7
Q

Testing should be considered in all adults who are overweight. This means a BMI greater than?

A

25 in or 23 in Asian Americans

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8
Q

What are some risk factors for diabetes?

A
  1. Physical activity (or lack thereof)
  2. First-degree relatives with diabetes
  3. High-risk race/ethnicity (AA, latino, native, Asian, pacific islander)
  4. Women who deliver a baby weight >9 pounds
  5. Hypertension (>140/90) and high triglycerides (>250)
  6. PCOS
  7. A1c > 5.7%, IGT, or IFG of previous testing
  8. Other clinical conditions associated with insulin resistance (severe obesity, acanthosis nigracans)
  9. History of CVD

**this will without a doubt be question, memorize some of these

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9
Q

When should we start testing for diabetes as a general screening?

A

45 years

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10
Q

If results are normal after diabetic screening, how often should we retest?

A

Every 3 years – with consideration of more frequent testing depending on initial results

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11
Q

When should we test for Type 2 diabetes in asymptomatic adults patients? and at what age?

A

Testing should be considered in adults at any age who are overweight or obese and who have one or more additional risk factors

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12
Q

When should we test for T2DM in children?

A

When they are overweight or obese and have two or more additional risk factors.

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13
Q

List important features of a medical history that are important to gather with a diabetic patient.

Think of it like this – we already know how to take a good history, but what is more important to dig into for a diabetic patient.

A
  1. Age and characteristic of onset (was it asymptomatic, DKA?)
  2. Diet, nutritional status
  3. Exercise
  4. Any other comorbid conditions, psychosoical problems, and dental disease
  5. Screen for depression and diabetes distress
  6. History of smoking, alcohol consumption, and substance abuse.
  7. Diabetes education, self-management, and support history and needs
  8. Results of glucose monitoring and patient’s use of data
  9. History of DKA?
  10. History of hypoglycemic episodes, awareness, and frequency and causes.
  11. Increased blood pressure? Increased lipids?
  12. Ask about microvascular complications – retinopathy, nephropathy, and neuropathy (sensory including history of foot lesions, autonomic, including sexual dysfunction and gastroparesis)
  13. Macrovascular complications: coronary heart disease, cerebrovascular disease, and peripheral arterial disease.
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14
Q

List important parts of a physical exam with a diabetic patient.

Just think about class – what did we do?

A
  1. Height, weight, BMI; growth and pubertal development in children
  2. Blood pressure determination, including orthostatic measurements
  3. Fundoscopic – BIG ONE
  4. Thyroid palpation
  5. Skin exam
  6. Comprehensive foot exam (inspection, palpation of dorsalis pedis and posterior tib pulses, presence/absence of patellar and Achilles reflexes, determination of proprioception, vibration, and monofilament sensation)
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15
Q

What labs would we order for a diabetic patient?

A
  1. A1c, if the results are not available within the past 3 months

For the rest of these, if they have not been ordered in the last year they need to be:

  1. Fasting lipid profile, including total, LDL, HDL – cholesterol and triglycerides, as needed. Activity will help lower LDL. Want HDL >40 and want LDL > 100
  2. LFTs
  3. Spot urinary albumin to creatinine ratio
  4. Serum creatinine and eGFR
  5. TSH
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16
Q

What other medical professionals do we need to encourage diabetics to see?

A
  1. Eye care professional for annual dilated eye exam
  2. Family planning for women of reproductive age
  3. Registered dietician for medical nutrition therapy
  4. Dentist!
  5. Diabetes self-management education and support
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17
Q

Why should we refer to DSME and DSMS (Diabetes self-management education and support)?

A

Because it facilitates knowledge, skills, and ability necessary for diabetes self-care

Improves clinical outcomes, health status, and quality of life

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18
Q

Why should we refer to a dietician for medical nutrition therapy?

A

To promote support of healthful eating patterns and to address individualized nutrition needs

Maintain the pleasure of eating – nonjudgemental messages about food choices

Provide individuals with practical tools for developing healthful eating patterns (rather than macros, micros, or single foods)

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19
Q

What percentage of food intake should come from carbohydrates?

A

45-65%

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20
Q

What percentage of food intake should come from fat?

A

25-35%

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21
Q

What percentage of food intake should come from protein?

A

10-35%

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22
Q

What are some goals of nutritional therapy?

A
  1. Limit carbohydrate and cholesterol intake
  2. If obese, caloric restriction for weight reduction
  3. If insulin, carbohydrate counting
  4. Choose items with high fiber and low glycemic index.
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23
Q

How many minutes of physical activity should children get every day?

A

60 minutes

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24
Q

Adults with diabetes should get how many minutes of exercise/week

A

150 minutes of moderate–intensity aerobic physical activity

Spread over 3 days/week with no more than 2 consecutive days without exercise

25
Q

Along with cardiovascular activity, what else should type 2 diabetes patients be doing?

A

Resistance training 2x/week

26
Q

In terms of smoking, what must we encourage our patients to do?

A

Quit. Obviously. Terrible flashcard. I just didn’t want anyone to forget about it.

Advise all patients not to use cigarettes, other tobacco products, or e-cigs. Include smoking cessation counseling and other forms of treatment as routine component of diabetes care.

27
Q

Immunizations.

A

Don’t forget about these either.

28
Q

In terms of psychosocial issues, what should we routinely screen for?

A

Attitudes about the illness

Depression, diabetes-related distress, anxiety, eating disorders, and cognitive impairment

29
Q

Patients over this age should be considered for evaluation of cognitive function and depression

A

65

30
Q

What are some common comorbidities associated with diabetes?

A
  1. Fatty liver disease
  2. Obstructive sleep apnea
  3. Cancer
  4. Fractures
    Type 1 –> associated with osteoporosis
    Type 2–> increased risk of hip fractures
  5. Low testosterone in men
  6. Periodontal disease
  7. Hearing impairment
  8. Cognitive impairment
31
Q

What might we consider if someone is doing self-monitoring with hypoglycemia unawareness and/or frequent hypoglycemic episodes?

A

Continuous glucose monitoring

32
Q

How often should we obtain an A1c in patients who are meeting treatment goals (and who have stable glycemic control)?

A

At least two times a year

33
Q

How often should we perform an A1c in patients whose therapy has changed or who are not meeting glycemic goals?

A

Quarterly

34
Q

What is our A1c goal for non-pregnant females?

A
35
Q

Why might we want a more stringent A1c goal such as

A

If it can be achieved without causing significant hypoglycemia or other adverse effects

This might include those with short duration of diabetes, type 2 diabetes treated with lifestyle or metformin only, long life expectancy, or no significant CVD

36
Q

When might we have less stringent A1c goals? (such as

A

May be appropriate for patients with a history of severe hypoglycemia, limited life expectancy, advanced microvascular complications, extensive comorbid conditions, or long-standing diabetes self-management education, appropriate glucose monitoring, and effective doses of multiple glucose-lowering agents including insulin.

37
Q

Preprandial capillary plasma glucose should be between?

A

80-130

38
Q

Peak post-prandial capillary plasma glucose should be?

A
39
Q

What is the preferred treatment for the conscious individual with hypoglycemia?

A

Glucose (15-20g)

although any form of carbohydrate that contains glucose may be used.

40
Q

What should be prescribed for all individuals at increased risk of severe hypoglycemia?

A

Glucagon

41
Q

Hypoglycemia unawareness or one or more episodes of severe hypoglycemia should trigger what?

A

Re-evaluation!

42
Q

How often should we screen for diabetic kidney disease?

A

At least once a year.

assess urinary albumin and estimated GFR

43
Q

How can we prevent diabetic retinopathy?

A

Optimize glycemic control, BP, and serum lipids

44
Q

When should we start screening for diabetic retinopathy?

A

Type 1 – should have an initial dilated and comprehensive EYE EXAM by an ophthalmologist within 5 years of onset

Type 2 – should have an initial dilated and comprehensive EYE EXAM by an ophthalmologist at the time of diagnosis!

45
Q

If eye exams are normal, they can be pushed to every _____ years

A

two

46
Q

How often should we check eyes in a pregnant women?

A

BEFORE PREGNANCY, every trimester, and for 1 year postpartum

47
Q

When do we start screening for neuropathy?

A

Type 2: All patients should be assessed for diabetic peripheral neuropathy at diagnosis

Type 1: begin assessment within 5 years after diagnosis

48
Q

What does a neuropathy exam consist of?

A
  1. Careful history
  2. 10g monofilament test
  3. At least one of the following: pinprick, temperature, or vibration sensation
49
Q

How do we treat diabetic neuropathy/

A
  1. Optimize glucose control to prevent or delay the development of neuropathy in patients with Type 1 and to slow the progression of neuropathy in those with Type 2
  2. Assess and treat patients to reduce pain related to diabetic peripheral neuropathy and symptoms of autonomic neuropathy
50
Q

How often should we perform a comprehensive foot evaluation?

A

Each year

51
Q

Besides diabetes, if patients have these symptoms and/or disorders we need to refer to a foot care specialist.

A

Patients who smoke, lower extremity complications, loss of protective sensations, structural abnormalities, or peripheral arterial disease

52
Q

Patient-centered approach is how we are supposed to tackle diabetes (according to that book). This approach includes a comprehensive plan to:

A
  1. Address blood pressure and lipid control
  2. Smoking prevention and cessation
  3. Weight management
  4. Physical activity
  5. Healthy lifestyle choices
53
Q

Translating Research Into Action for Diabetes (TRIAD) found it useful to divide interventions into that affected process of care and intermediate outcomes. This means taking control of what activities?

A
  1. Periodic testing of A1c, lipids, and urinary albumin
  2. Examining retina and feet
  3. Advising on ASA use
  4. Advising on smoking cessation
54
Q

Those who do not have health insurance tend to have a A1c _____ higher than someone with converage

A

0.5%

55
Q

____ ______ rather than A1c should be used to diagnose acute onset of Type 1 Diabetes individuals with symptoms of hyperglycemia.

A

Blood glucose

56
Q

What are our “foundations of care” for diabetic patients?

A

Self-management education, nutrition, counseling, physical activity, smoking cessation, immunizations, psychosocial care, medications

57
Q

What are our “basis for initial care”?

A

Diabetes self-management education, diabetes self-management support, medical nutrition therapy, counseling on smoking cessation, education on physical activity, guidance on routine immunizations, and psychosocial care.

58
Q

Who should be part of an “on-going” care team?

A

Physicians, nurse practitioners, PA’s, nurses, dieticians, exercise specialists, pharmacists, dentists, podiatrists, mental health professionals.

59
Q

Leading causes of death for DM patients?

A

CAD – atherosclerotic cardiovascular disease (acute coronary syndromes), history of MI, stable/unstable angina, coronary or other arterial revascularization, stroke, TIA, PAD

Sam: Endocrine (3 decks)

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