May 30th-2, 2021 Flashcards
20M aboriginal man, new DMII post psych admission for bipolar depression, BMI 48, non-smoker, rarely ETOH, BP 130/85: 6 lifestyle advice
- aim 5-10% weight loss
- 150-300min of moderate exercise weekly with
- aim 2-3 sessions of 30 minute session of resistance training
- avoid sitting for >30minutes a day
- low sodium diet <6G per day
- aim 3 serves wholegrain daily
20M aboriginal man, new DMII post psych admission for bipolar depression, BMI 48, non-smoker, rarely ETOH, BP 130/85: care plan, 1 additional person:
- aboriginal healthcare worker
- endocrinologist
20M aboriginal man, new DMII post psych admission for bipolar depression, BMI 49 now, non-smoker, rarely ETOH, BP 130/85: what 2 weight loss mx?
- pharmacotherapy: orlistat/phentermine
- bariatric surgery referral (sleeve gastrectomy, roux-en-y bypass)
38M schizo, has 4/52 depot paliperidone, T2DM, dyslipidaemia, obesity, on basal insulin 6/12 ago, Hba1C: 8.5%, 20 cigs a day, takeaway foods, no ETOH, 5 things contributing to poor glucose control
- occult infections: urinary
- poor injection technique
- poor insulin compliance
- improper storage of insulin
- obesity
- increase in high glycemic index foods
- antipsychotic medication
- smoking
- sedentary lifestyle
38M schizo, has 4/52 depot paliperidone, T2DM, dyslipidaemia, obesity, on basal insulin 6/12 ago, Hba1C: 8.5%, 20 cigs a day, takeaway foods, no ETOH, 3 further questions to characterise smoking cessation?
- time from rise to first cigarette
- withdrawal symptoms
- readiness to quit smoking
38M schizo, has 4/52 depot paliperidone, T2DM, dyslipidaemia, obesity, on basal insulin 6/12 ago, Hba1C: 8.5%, 20 cigs a day, takeaway foods, no ETOH, 5 smoking cessation interventions: Pharma and non-pharma
- varenicline
- manage triggers and removing barriers
- nicotine replacement such as patches
- agree on a quit day
- join Quitline
- motivational interviewing
60F aboriginal, unwell past 4/7, vomiting, diarrhoea from ?grandchild, T2DM, metformin 1G BD, Lantus 30sc bd, ran out of insulin 3/7 ago, lethargic, confused, increased thirst. 3 ddx
hyperosmolar hyperglycaemic
viral gastroenteritis
hypernatraemia
60F aboriginal, unwell past 4/7, vomiting, diarrhoea from ?grandchild, T2DM, metformin 1G BD, Lantus 30sc bd, ran out of insulin 3/7 ago, lethargic, confused, increased thirst. 2 Ix
finger prick random blood glucose level
point of care Ketones
70F, sudden loss of vision, painless, 2/24 ago, hx of T2DM, HTN, dyslipidaemia, non-compliant with meds, 6/12 vision in left eye, movement only in right eye, 4 ddx?
- left retina detachment
- left vitreous haemorrhage
- central retinal artery occlusion
- temporal arteritis
- central retinal vein thrombosis
- optic neuritis
70F, sudden loss of vision, painless, 2/24 ago, hx of T2DM, HTN, dyslipidaemia, non-compliant with meds, 6/12 vision in left eye, movement only in right eye, 4 mx to delay progression of diabetic retinopathy?
- improve glycemic control with medication
- treat hypertension ACEi
- treat dyslipidaemia: statin
- commence fenofibrate 96mg, oral daily
70F, sudden loss of vision, painless, 2/24 ago, hx of T2DM, HTN, dyslipidaemia, non-compliant with meds, 6/12 vision in left eye, movement only in right eye, 6 important factors in insulin therapy
- need to rotate injection sites
- subcut on the abdomen is preferred site
- proper storage of insulin (room temp for up to a month)
- ensure NDSS application to access syringes/needles/strips
- pre-post prandial self glucose monitoring
- sick day management
- hypoglycaemic management
58M bothersome discomfort in his feet, T2DM last 15y, met form XR 2G daily, tingling, burning, no weakness, aspirin 100mg for IHD, atorvastatin 40mg, cholesterol, fenofibrate 96mg, prindopril/amlo 10/10, bisopolol 5mg BD, Spiro 12.5mg for HF, esomeprazole 20mg for GORD, 4 components of exam for peripheral neuropathy
h,i,a,b
- 10 gram monofilament for light touch at metatarsal joints
- ankle reflexes
- vibration sensation with 128hz tuning fork
- pin-prick sensation
58M bothersome discomfort in his feet, T2DM last 15y, met form XR 2G daily, tingling, burning, no weakness, aspirin 100mg for IHD, atorvastatin 40mg, cholesterol, fenofibrate 96mg, prindopril/amlo 10/10, bisopolol 5mg BD, Spiro 12.5mg for HF, esomeprazole 20mg for GORD, 3 Pharma for peripheral neuropathy?
- pregabalin
- amitriptyline
- velafaxine
- topical nitrate spray
58M bothersome discomfort in his feet, T2DM last 15y, met form XR 2G daily, tingling, burning, no weakness, aspirin 100mg for IHD, atorvastatin 40mg, cholesterol, fenofibrate 96mg, prindopril/amlo 10/10, bisopolol 5mg BD, Spiro 12.5mg for HF, esomeprazole 20mg for GORD, current Hba1C is 9.8%, 2 Pharma changes, does not want insulin
- add sglt2 inhibitor - dapagliflozen 10mg, po daily
- increase statin to 80mg, po nocte
58M bothersome discomfort in his feet, T2DM last 15y, met form XR 2G daily, tingling, burning, no weakness, aspirin 100mg for IHD, atorvastatin 40mg, cholesterol, fenofibrate 96mg, prindopril/amlo 10/10, bisopolol 5mg BD, Spiro 12.5mg for HF, esomeprazole 20mg for GORD, 3 points of discussion for SGLT2 inhibitors?
- can help with marginal weight loss
- increased risk of genitourinary infections
- needs to withhold if having any surgeries to reduce risk of euglycaemic ketoacidosis
