Endocrine II Flashcards
How do you diagnosis DM
Fasting plasma glucose level of 126 mg per dL or greater
A1C level of 6.5% or greater
A random plasma glucose level of 200 mg per dL or greater
A1C > 5.7 impaired glucose tolerance
a 75-g two-hour oral glucose tolerance test with a plasma glucose level of 200 mg per dLor greater
consequences of DM
Sequelae/consequences:
Frequent infections (urinary tract, vaginal (yeast), skin (yeast, cellulitis))
Retinopathy => blindness
Nephropathy => kidney failure
Neuropathy of feet and hands => ulceration/infection/gangrene/loss of limb, increase in falls.
Vascular changes => increase in cardiovascular events (MIs, strokes) and peripheral vascular disease & poorly healing wounds -> infection/gangrene/loss of limb.
Skin PE finding in DM
acanthosis nigracans
steps in a DM foot exam
- Check for skin lesions/ infection, etc (don’t forget to check between the toes
- Pressure sensation using Monofilament testing
- Vibration sensation using tuning fork
- Superficial pain using pinprick/ temperature sensation
- Reflexes
- Pulses
describe diabetic peripheral neuropathy
Diabetic Peripheral neuropathy
Affects 30% of patients with DM, caused by damaged to the peripheral nerves due to poorly controlled blood sugar
Stocking and glove pattern
Presentations: burning, paresthesia and/or numbness, usually distal limb, symmetric polyneuropathy
Complications:
Infection, ulcer formation and injury can go unnoticed due to the paresthesia/ numbness.
Amputation (toes, foot, maybe even limb)
Treatment: Good control of blood sugar (ideally A1C <6.5), perform self foot exam routinely, anti-neuropathy medication
what should be included within in a SOAP note for a DM foot exam
Diabetic foot exam
– No lesions, callus on examination of feet, toes, between toes
– Dorsalis pedis pulse +2
– Vibratory sense intact bilaterally
– decrease sensation to monofilament in left lateral foot, right great toe vs Sensation intact to monofilament.
what are the four important components of metabolic syndrome?
Also known as Syndrome X or Insulin Resistance Syndrome Consists of – Abdominal obesity – Insulin resistance – Elevated blood pressure – Lipid abnormalities
Prevalence increases with age and increasing body weight
what needs to included within the workup of metabolic disease?
• Workup:
– Good past medical and family history (specifically hx of cardiac disease or DM)
– History of weight changes
– Lifestyle (i.e. sedentary, eating habits) ***
what does the physician need to ask the patient to do to have a good medication assessment?
• 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
what is functional ability?
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)
– 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
what are Activities of daily living (ADL)?
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
how should vision be assessed for older patients?
Vision Assessment:
• 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
what is important to know about falls in the elderly?
falls are multifactorial!
what does a PE testing cognition entail?
Neurologic physical exam including – 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
what is the most common cause of hearing loss in older adults?
Presbycusis or age related sensorineural hearing loss is most common hearing condition in older patients.
Progressive symmetric loss of high frequency hearing
• Clinical presentation: progressive hearing loss along with tinnitus (ringing in the ears), vertigo and feeling off balance (increases patient risk for falls)
• Cause: loss of cochlear hair cells and ganglion cells in the vestibulocochlear nerve. Consider reviewing medication list for ototoxicity.
• Workup: otoscopic examination, Audioscope examination, and the whispered voice test
• USPSTF recommends asking patients about their hearing but there is no guideline for asymptomatic patients
• Treatment: Hearing aids, auditory rehabilitation, cochlear implantation
