Endocrine 2/Geriatrics

Question 1

Type 1 diabetes

type 2

outcome of both?

Answer 1

pancreas doesn’t produce insulin… autoimmune disorder destroying the pancreatic cells

body can’t sense the insulin that the body is secreting

hyperglycemia

Question 2

symptoms of diabetes

Answer 2

polyuria
polydipsia
fatigue
blurred vision

Question 3

***how do you diagnose diabetes?

***fasting glucose

***A1C

***random glucose

Answer 3

fasting glucose greater than 126mg/dL

A1C level of 6.5 or greater

random plasma glucose level of 200 mg/dL or greater

Question 4

consequences of Diabetes

Answer 4

recurrent infection –> UTIs, yeast infection, cellulitis

diabetic retinopathy –> (microhemorrhages in the eye) blindness

nephropathy –> kidney failure

neuropathy of hands and feet

vascular changes –> MI, siezures, strokes

Question 5

most common onset of type 1 diabetes?

body type?

Answer 5

childhood to adolescent

thin or normal weight

Question 6

Acanthosis nigracans?

Answer 6

a skin rash around the neck.. associated with people with diabetes

Question 7

test for neuropathy?

Answer 7

inspection of feet

pressure sensation through monofilament testing

pinprick/temp sensation

reflexes

pulses

Question 8

Diabetic peripheral neuropathy?

Answer 8

stocking and glove pattern. damage to peripheral nerves due to poorly controlled blood sugar –> numbness, paresthesia, burning.

they may not feel wounds or cuts.

Question 9

Metabolic Syndrome?

Answer 9

“Syndrome X”

come with a huge belly

A1C is high enough for insulin resistance, lipids abnormal.

increased risk for diabetes, CAD

visceral fat causes oxidative stress or whatever.

Question 10

someone with metabolic syndrome, what’s the best thing to ask them during your workup?

Answer 10

Lifestyle… major key to figuring it out… –> sedentary lifestyle / eating habits

Question 11

Beers criteria

Answer 11

medications to always avoid for older patients.

NSAIDS, antihistamines, muscle relaxants

Question 12

What do you have your patients to do with their medication?

what is the rule you use for geriatric patients?

Answer 12

you have them bring it all in, everything

review the meds and use beer’s criteria to avoid prescribing bad medication

“start low, go slow” –> start medication at low dose and increase slowly

Question 13

Functional ability?

what is it dependent upon?

Answer 13

ability of this patient to perform daily task for living their normal life.

dependent on 2 factors

1) self care –> bathing, feeding yourself, dressing, controlling bladder, etc
2) live independently –> paying bills, using the phone, housework, making food, do laundry

Question 14

Vision assessment?

why is this important for geriatrics?

Answer 14

check them with snellen eye chart

they can’t see anything that’ll affect how they live

opthalmologist referral to monitor diabetic patient for retinopathy

referral with increased risk of glaucoma

older patients are more prone to vision pathology so you want to check those things

Question 15

Fall risk?

what does the treatment include?

Answer 15

multifactorial

they don’t see well, or something.. find it through a good history

treatment is treating whatever the cause is.

Question 16

Testing Cognition?

Answer 16

you do this with a thorough neurological exam.

this is through a questionairre

Question 17

Depression Assessment?

what do you ask?

what happens if they say yes to them?

Answer 17

patients become older, more frail, they get social isolation

depression for old people have mimic cognitive things or they won’t bathe anymore because they are depressed.

2 questions –> “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”

if yes –> you give them a patient health questionnaire-9 (PHQ-9)

Question 18

Hearing loss?

what 2 things do you do to check if they have hearing loss?

what can you also do?

treatment?

Answer 18

sensory hearing loss

older males that complain that other people say they can’t hear anything

whisper test, otoscopic examination

send to audiologist

treating hearing aids

Question 19

Urinary incontinence types?

Answer 19

stress incontinence –> leakage with increase in intra-abdominal exertion –> sneezing, coughing, laughing

urge –> detrusor is overactive so constantly feeling the urge

overflow –> residual urine so slow leakage.. detrusor under activity

mixed (stress and urge together)

Question 20

Osteoporosis?

who is affected?

Answer 20

progressive bone loss

older white males, postmenopausal females

those with vitamin D deficiency

Question 21

Vaccination Assessment?

what 4 do they need to have?

Answer 21

make sure they’re up to date on over 65 years

Tetanus
Influenza
Pneumococcal vaccine
Herpes Zoster vaccine (shingles)

Question 22

Social Support Assessment

1) code status
2) what are you planning for?
3) who do you check on?

Answer 22

obtain a good social history to make sure you get details so you know their plan.

— get to know the patient’s advance directive (code status)

— get home health involved.. pretty much planning for the future.

make sure no caregiver abuse or caregiver burnout.