Endocrine 2 and Geriatric

Question 1

How do we do a geriatric medication assessment?

Answer 1

Have patient bring in all medications and supplement to doctors visit, “brown bag check”
• Ask “What prescription medications, over the counter medicines, vitamins, herbs, or supplements do you use?”
• Review medications during every visit
• Use Beer’s Criteria or other medication clinical tools to reduce or avoid prescribing medication that can lead to adverse events
• “Start low, go slow” (start certain medications at lowest dose and increase slowly for older patients)
• Close followup after starting new medication

Question 2

What is the cause of fall risks in older patients?

Answer 2

It is multifactorial.

(I think the answer to a question will be “multifactorial” or “all of the above”)

Question 3

How do we test for diabetic neuropathy?

Answer 3

1. Check for skin lesions/ infection, etc (don’t forget to
   check between the toes
2. Pressure sensation using Monofilament testing
3. Vibration sensation using tuning fork
4. Superficial pain using pinprick/ temperature
   sensation
5. Reflexes
6. Pulses

Question 4

What 4 vaccines do you need after 65?

Answer 4

Tetanus or Tetanus / Pertussis

Influenza

Pneumonia

Herpes Zoster

Question 5

What is the clinical presentation for age related hearing loss?

Answer 5

Progressive hearing loss along with tinnitus, vertigo, and loss of balance.

Question 6

What are the symptoms of Diabetes Mellitus 2?

Answer 6

Acute:

Severe glucose intolerance

High insulin sensitivity

Not associated with DKA

Polyuria, polydipsia, polyphagia, weight loss

Chronic

Retinopathy, glaucoma, MI, cataracts, acanthosis nigracans, diabetic neuropathy (diabetic foot)

Question 7

What two questions should you ask every patient in every office visit?

Answer 7

– “During the past month, have you been bothered by feeling down, depressed, or hopeless?”
– “During the past month, have you been bothered by little interest or pleasure in doing things?”

Question 8

What are the major types of incontinence in the elderly?

Answer 8

Stress incontinence

Involuntary leakage of urine that occurs with increases in intra-abdominal pressure (i.e. w/ exertion, sneezing, coughing, laughing)

Urge incontinence

Detrusor muscle overactivity, leading to uninhibited (involuntary) detrusor muscle contractions during bladder filling

Overflow incontinence

Continuous urine leakage due to incomplete bladder emptying

Detrusor muscle underactivity or bladder outlet obstruction

Question 9

What is the most common form of hearing loss in older patients?

Answer 9

Presbycusis or age related sensorineural hearing loss is most common hearing condition in older patients. Progressive symmetric loss of high frequency hearing

Question 10

What are the diagnostic criteria we can use to diagnose DM?

Answer 10

Fasting plasma glucose over 126 mg/dL

A1C of 6.5% or greater

Random plasma glucose of >200 mg/dL

75g two hour glucose tolerance test of 200 mg/dL or greater.

Question 11

What are the ADLs that we check for geriatric patients, and what scales might we see used in clinic to assess them?

Answer 11

Activities of daily living (ADL)
– Self care: eating, dressing, bathing, transferring between the bed and a chair, using the toilet,
controlling bladder and bowel functions (consider effort needed to button or unbutton short, wear shoes, climb up on bed)
– Living independently: doing housework, preparing meals, taking medications properly, managing finances, using a telephone

• Useful Scales
– Katz Index if Independence in Activities of Daily Living
– Lawton Instrumental Activities of Daily Living Scale

Question 12

What is the cause of age related hearing loss in older patients?

Answer 12

Loss of cochlear hair cells and ganglion cells in the vestibulocochlear nerve. Consider reviewing medication list for ototoxicity

Question 13

What are the symptoms of Diabetes Mellitus 1?

Answer 13

Acute:

Severe glucose intolerance

High insulin sensitivity, Ketoacidosis, Polyuria, polydipsia, polyphagia, weight loss

Chronic:

Retinopathy, glaucoma, MI, cataracts, acanthosis nigracans, diabetic neuropathy (diabetic foot)

Question 14

What are some sequelae of DM?

Answer 14

Vascular changes

Nephropathy

Retinopathy

Frequent infections

Neuropathy

Question 15

What is included in testing cognition?

Answer 15

– Mental status i.e. orientation , screening tools
– Cranial nerves including vision screen
– Cerebellar status / motor system i.e. gait, Romberg, finger to nose, heel to shin
– Strength
– Sensation
– Reflexes
– Other i.e. Babinski, etc

Question 16

What are the recommendations for vision assessment in geriatric patients?

Answer 16

• No specific recommendation even through the USPSTF
• Periodic assessment with Snellen Eye Chart
• Ophthalmologist referral to monitor diabetic patient for diabetic retinopathy
• Ophthalmologist referral for patient with increased risk for glaucoma i.e. family history, etc
• Remember many older patients continue to drive well into their 80s and sometimes even into their 90s, consider assessing vision for driving safety