Comorbidities

Question 0

Test for PAD (peripheral artery disease)

Answer 0

ABI (ankle brachial index)

Question 1

Screening for Depression

Answer 1

Beck depression inventory (BDI)

Question 2

ABI test

Answer 2

Measure BP in ankle and arm at rest, then repeat after 5 minutes walking in treadmill.
Uses a standard cuff and Doppler on the ankle.

Question 3

ABI normal results vs. those with PAD

Answer 3

Normal: pressures the same

In PAD: ankle lower than arm (narrowing arteries)

Question 4

Criteria for performing diagnostic ABI

Answer 4

Intermittent claudication 
Age over 50
Smoking
Hypertension
Dyslipidemia
Diabetes >10 years

Question 5

Lower extremity pain during physical activity that subsides with rest

Answer 5

Intermittent claudication

Question 6

ADA blood pressure goals

Answer 6

<130/80 mmHg for diabetics

Question 7

Recommendations for blood pressure between 130/80 and 139/89 mmHg in diabetic

Answer 7

Therapeutic lifestyle changes (weight loss, tobacco cessation, and limit sodium).

Question 8

Recommendations for blood pressure >140/90 mmHg in diabetics

Answer 8

Add medication if either is above this limit, in addition to lifestyle intervention.

Question 9

Which medication is considered first line for hypertension in diabetes?

Answer 9

ACE inhibitor (or ARB)

Question 10

What lipid abnormalities are common with Diabetes?

Answer 10

Low HDL and elevated triglycerides

Question 11

LDL goals for diabetics

Answer 11

<100 mg/dl, or less than 70 mg/dl in those with very high risk.

Question 12

When should a statin be started in a diabetic?

Answer 12

> 135 mg/dl if no other risk factors. It should be started in ALL patients with any increased CV risk regardless of lipid levels.

Question 13

What is the DPP?

Answer 13

Diabetes Prevention Program, a large multicenter study demonstrating onset of diabetes could be prevented/delayed when lifestyle modifications are implemented.

Question 14

Outcome of the healthy eating and increasing physical activity (weight loss) in DPP?

Answer 14

58% decreased risk for developing diabetes

Question 15

Recommendations based on DPP for preventing or delaying diabetes

Answer 15

1. Reduce weight 5 to 7 %
2. Low fat/high fiber diet
3. 150 minutes exercise/week

Question 16

Microalbuminuria test: Spot Urine

Answer 16

Measures albumin to creatinine ratio.
Most common method
Normal less than 30 mcg/dl

Question 17

Microabuminuria test: 24 hour urine

Answer 17

Compares the simultaneous urine and serum creatinine clearance

Question 18

Microabuminuria test: timed urine

Answer 18

i.e. overnight or 4 hours

Question 19

What does creatinine clearance estimate?

Answer 19

GFR-glomerular filtration rate

Depends on timed urine sample (usually 24 hours), provides direct method of estimating GFR.

Question 20

How is SCr used to measure renal function?

Answer 20

Serum creatinine is used to estimate GFR indirectly, calculated on patient age and weight. Subtle changes can herald major loss of renal function.

Question 21

How is BUN used to measure renal function?

Answer 21

Measures Blood Urea Nitrogen to indirectly measure GFR.
Less sensitive marker of early diabetic nephropathy, used with SCr to monitor renal function on a daily basis, and inexpensive/easy test.

Question 22

What is microalbumin?

Answer 22

Protein normally absent in urine or in small amounts when kidney function is normal.

Question 23

Why do the MAU?

Answer 23

Microalbuminuria tests for kidney functions, to detect early microalbuminuria to prevent or delay kidney function.

Question 24

What factors impact MAU testing?

Answer 24

Exercise within 24 hours of test, infection, fever, inflammatory proccesses, hyperglycemia, and hypertension.

Question 25

Definitions of albuminuria

Answer 25

Normal 30 mcg/mg (30-300 is albuminuria)

Question 26

How many tests to confirm microalbuminuria?

Answer 26

2 of 3 tests in 6 month period be elevated to confirm

Question 27

ALT use and reference range

Answer 27

Alanine Aminotransferase Test, a common liver function test for medication hepatotoxicity. Range is 8-20 U/L.

Question 28

Rate of depression is ___ times that of people without diabetes.

Answer 28

3

Question 29

Diabetes complication shown to have a direct association with depression include:

Answer 29

``` retinopathy neuropathic symptoms nephropathy hypertension sexual dysfunction ```

Question 30

Common atypical symptoms of depression in diabetics?

Answer 30

hypoglycemia/hyperglycemia despite objective findings, physical symptoms out of proportion with objective data, sexual dysfunction, chronic pain, worsening glycemic control, decline in self-care, poor adaptation to diabetes.

Question 31

Reports of which symptoms are more common with diabetic patients with depression?

Answer 31

neuropathic pain, GI problems, symptoms of hyperglycemia and hypoglycemia

Question 32

Definition of Major Depressive Disorder

Answer 32

Presence of 5 of 9 symptoms over a minumum of 2 weeks. I.e. sleep disturbance, weight change, fatigue, difficulty in decisions, feeling guilty/worthless, or suicidal thought/plan.

Question 33

Dysmymic disorder definition

Answer 33

Prolonged depressive symptoms, greater impairment of social/vocational functioning

Question 34

Adjustment disorder with depressed mood definition

Answer 34

Depression within 3 months of stressor, and is shorter and lasts 6 months or less

Question 35

How often should microalbumin be measured?

Answer 35

Starting 5 years after diagnosis in Type 1, and upon diagnosis in Type 2. Normal is <30 mcg/mg

Question 36

What are the ADA target goals for fasting lipids in Diabetics?

Answer 36

HDL 40 in men or >50 mg/dl in women | Triglycerides <150 mg/dl

Question 37

What percentage of people with Type 2 also have sleep apnea?

Answer 37

50%