METABOLIC

Question 1

What is the most common etiology for hypothyroidism?

Answer 1

Hashimoto’s (autoimmune)

Question 2

What are the classic sxs of hypothyroidism?

Answer 2

Constipation, weight gain, fatigue, cold intolerance, menstral irregularities, and hair loss

Question 3

The TSH is elevated – what diagnosis?

Answer 3

Hypothyroidism

Question 4

What should we remember about TSh levels in the elderly?

Answer 4

They are higher than normal, thus higher target ranges (4-6)

Question 5

How do we treat hypothyroidism?

Answer 5

Levothyroxine (Synthroid)

Question 6

What is the most common cause of hyperthyroidism?

Answer 6

Graves disease

Question 7

What are the classic sxs of hyperthyroidism?

Answer 7

heat intolerance, weight loss, hyperdefecation, anxiety, and tachy/palpitations

Question 8

TSH is low – what diagnosis? What else do you check?

Answer 8

Hyperthyroidism

Need to check free T4 (which would be elevated)

Question 9

How do we treat hyperthyroidism?

Answer 9

Beta Blockers, PTU or Methimazole

Question 10

What would the diagnostics show that would indicate diabetes?

Answer 10

NON-fasting glucose >200

Fasting glucose >126

2-h OGTT >200

HbA1c >6.5

Question 11

What are some lifestyle recommendations we can make for diabetes?

Answer 11

Mediterranean diet, high fiber, weight loss, exercise!

Question 12

In a healthy elderly person, what should the goal A1c be?

Answer 12

7-7.5%

Question 13

In a complex elderly person what should the A1c goal be?

Answer 13

7.5-8%

Question 14

Can we use the sliding scale in a nursing home setting?

Answer 14

NO

Question 15

How do we give corrective insulin doses for the elderly?

Answer 15

1 unit for every 40-50mh/L in excess of 140 at fasting

Question 16

If an elderly person has poor oral intake how do we treat their diabetes? In comparison to someone with good oral intake?

Answer 16

Poor intake = Basal + Correction only

Good Intake = Basal & Prandial insulin + correction (rapid-acting asprat or lispro)

Question 17

What does a diabetic pt need done annually?

Answer 17

eye & dental exams

Comprehensive foot eval

Lipid profiles (not needed once stable)

Microalbuminuria

Serum Cr

Question 18

What does a diabetic pt need done initially after their diagnosis?

Answer 18

Screen for PAD

Sxs of neuropathy

Detailed eye exam

Question 19

What is considered concerning weight loss in the elderly?

Answer 19

> 2% in 1 month

10lbs in 6 months

> 4% in 1 year

Question 20

In a hospitalized pt we are concerned about malnutrition what must we consider checking?

Answer 20

Dietary intake, hypoalbuminemia, hypocholesterolemia

CBC, CMP, ESR, CXR, TSH, albumin & pre-albumin

Question 21

Should ensure be taken before meals?

Answer 21

NO – use in-between meals, don’t give during meal time