Endocrine + Geriatric

Question 1

DM Presentation

Answer 1

urinating often, feeling very thirsty, extreme fatigue, blurry vision, cuts/bruises that are slow to heal, tingling, pain or numbness, extreme hungry, weight loss

Question 2

How do you diagnose DM?

Answer 2

• FPG - 126 or greater
• A1C level - 6.5% or greater
• A1C >5.7 impaired glucose tolerance
• 75g 2 hr oral glucose tolerance test with a plasma glucose level of 200 mg per dl or greater

Question 3

What are some consequences of DM?

Answer 3

• frequent infections
• retinopathy
• nephropathy
• neuropathy of feet and hands
• vascular changes

Question 4

How do you test for diabetic neuropathy?

Answer 4

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 5

DM Peripheral Neuropathy

Answer 5

• presents as burning, paresthesia or numbness, usually distal limb
• treatment: good control of blood sugar, perform self foot exam routinely, anti-neuropathy medication

Question 6

What does metabolic syndrome consist of?

Answer 6

– Abdominal obesity
– Insulin resistance
– Elevated blood pressure
– Lipid abnormalities

• etiology is unknown
• women with PCOS are more prone to develop MS

Question 7

What is extremely important for geriatric health plans?

Answer 7

1. Medication effect - because they are probably on a lot (avoid adverse affects; meds can work different)

Question 8

Medication Assessment includes…

Answer 8

• 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 9

What is functional ability?

Answer 9

Ability of this patient to perform daily task for living there normal life also known as activities of daily living (ADL)
Activities of daily living (ADL)
1. Self care
2. Living independently

Question 10

What is included in self care? living independently?

Answer 10

– 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

Question 11

Why is important to check vision on geriatric patients?

Answer 11

driving

Question 12

Vision Assessment

Answer 12

• No specific recommendation
• Periodic assessment with Snellen Eye Chart
• Ophthalmologist referral to monitor diabetic patient for diabetic retinopathy
• Ophthalmologist referral for patient with increased risk for glaucoma

Question 13

Fall Risk

Answer 13

multifactorial - important to know cause so you can treat

Question 14

Testing Cognition includes…

Answer 14

Neurologic physical exam including
– Mental status  
– Cranial nerves including vision screen
– Cerebellar status / motor system
– Strength
– Sensation
– Reflexes
– Other

Question 15

Depression Assessment

Answer 15

• unable to perform ADLs, inability to drive, loss of spouse or partner can lead to risk of social isolation
• This social isolation can lead to depression
• Depression can be difficult to diagnose in older patients
• depression is underdiagnosed in the elderly and may go untreated

Question 16

What two questions do you ask to check geriatric depression?

Answer 16

– “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?”
– “yes” to these questions prompts a more detailed questionnaire

Question 17

What is the most common hearing condition in older patients?

Answer 17

Presbycusis or age related sensorineural hearing loss

Question 18

Clinical presentation of hearing loss

Answer 18

progressive hearing loss along with tinnitus (ringing in the ears), vertigo and feeling off balance (increases patient risk for falls)

Question 19

How do we workup hearing loss? treatment?

Answer 19

1. otoscopic examination, Audioscope examination, and the whispered voice test
2. Hearing aids, auditory rehabilitation, cochlear implantation

Question 20

What is stress incontinence?

Answer 20

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

Question 21

What is urge incontinence?

Answer 21

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

Question 22

What is overflow incontinence?

Answer 22

– Continuous urine leakage due to incomplete bladder emptying
– Detrusor muscle underactivity or bladder outlet obstruction

Question 23

What is important for history for osteoporosis?

Answer 23

• previous falls
• white, old women
• family history

Question 24

What vaccinations should adults 65+ get?

Answer 24

– Tetanus or tetanus with pertussis vaccine
– Influenza vaccine
– Pneumococcal vaccine
– Herpes zoster vaccine

Question 25

How do we asses their social support assessment?

Answer 25

• good social history
• get to know pt’s advance directive (code status)
• assess for elder abuse