diabetes cpc

Question 1

definition of dm

Answer 1

fastibng glucose >7
HbA1c >48
2hr fasting glucose in a GTT >11.1

Question 2

what is the 1st test needed

Answer 2

ABG

Question 3

what disturbance is this

Answer 3

metabolic alkalosis
pH is high - alkalosis
CO2 is high
high bicarb

Question 4

how do you determine whether acidosis/alkalosis

Answer 4

Question 5

causes of metabolic alkalosis

Answer 5

H+ loss - eg from vomiting
hypokalaemia
ingestion of bicarb - Used to have sodium bicarb for peptic ulcer

Question 6

describe resp compensation for metabolic alkalosis

Answer 6

met alkalosis inhibits breathing -> CO 2 rise -> partial compensation
Compensation is the improvement of pH at expense of making CO2 worse

Question 7

calculation for osmolality

Answer 7

osmolality = 2(Na + K) + U + glucose

Question 8

Answer 8

381 mosm/kg

Question 9

calculation for the anion gap

Answer 9

Na + K - Cl - bicarb

Question 10

if no anion gap can it be DKA

Answer 10

no - ketones are anions and would -> high anion gap

Question 11

causes of hypokalaemia

Answer 11

intesinal loss - diarrhoea, vomiting, fistula

renal loss - mineralocorticoid excess (conn’s syndrome), diuretics, renal tubular disease

redistribution - insulin, alkalosis

Question 12

causes of hypokalaemia

Answer 12

intesinal loss - diarrhoea, vomiting, fistula

renal loss - mineralocorticoid excess (conn’s syndrome), diuretics, renal tubular disease

redistribution - insulin, alkalosis

Question 13

how does hypokalaemia lead to alkalosis

Answer 13

low K means shift H into cells
-> extracellular alkalsis

Question 14

how does alkalosis -> low K

Answer 14

more K moves into the cells instead of H

Question 15

causes of hypokalaemia

Answer 15

GI loss - diarrhoea, vomiting

renal loss
* hyperaldosteronism, excess cortisol
* increased Na delivery to distal nephron
* osmotic diuresis

redistribution into cells
* insulin
* B agonists
* alkalosis

rare causes - renal tubular acidosis type 1 and 2, hypomagnesaemia

Question 16

pathophysiology in kidney of low K causing alkalosis

Answer 16

lack of intracellular K
-> increased excretion of H+ in exchange fro Na
-> acid urine and generaton of bicarb

Question 17

Answer 17

cushings

Question 18

which is the likely dx

Answer 18

Adrenal tumour not possible - suppress ACTH
And here she has high ACTH

Ectopic slightly more than pit because so high - but both ACTH driven ones are possible

Question 19

why does ectopic ACTH -> such low K

Answer 19

High ACTH gives high cortisol binds to aldo receptor

Question 20

causes of ectopic acth

Answer 20

lung cancer
other cancer

Question 21

Answer 21

Collapse and consolidation
All given by increased vocal resonance

Question 22

Answer 22

Pneumonia - peculiar distribution

Airway pulled to R - small endobronchial lesion -> collapse and consolidation, likely to be a cancer

Question 23

how do we distinguish acute renal failure (ATN) and chronic renal failure due to dm

Answer 23

biopsy

Question 24

diff in px between acute renal failure (ATN) and chronic renal failure due to dm

Answer 24

ATN - dialyse for 3 wks - recover
diabetic glomerular kidney disease - end stage renal failure, will need lifelong dialysis

Question 25

Answer 25

tubular necrosis

Question 26

pathology with this adrenal gland

Answer 26

Very thick zona fasiculata - driven by ACTH

Question 27

what is this pathology and rx

Answer 27

inferior STEMI - right coronary artery
Reciprocal changes - infart goes behind heart

aspirin
GTN
beta blocker
pain relief
thrombolysis/primary angioplasty

Question 28

what ix needed

Answer 28

CT head