old persons 20/10

Question 1

A to E approach for assessment

Answer 1

Question 2

What are the actions of glucagon?

Answer 2

Increase Gluconeogenesis in liver
Increase Ketogenesis in the liver
Increase glycogenolysis and decrease glycogenesis in liver
Increase lipiolysis in adipose tissue

And the actions of insulin are opposite to these!

Question 3

What ratio plays a major role in regulation of gluconeogenesis?

Answer 3

The insulin/glucagon ratio.
(e.g. in diabetes the active level of insulin is decreased therefore the ratio decreases, hence increasing rate of gluconeogenesis and thus helping to promote hyperglycaemia)

Question 4

Triad of T1DM symptoms

Answer 4

Polydipsia, Polyuria, Thrist

Question 5

TD1M is

Answer 5

Is absolute insulin defiency
Type IV hypersensitivy
Beta cell destruction

Question 6

DKA type 1 or type 2?

Answer 6

DKA mainly affects people with type 1 diabetes, but can sometimes affect people with type 2 diabetes.

I guess those T2DM patients have relative to low insulin levels.

Question 7

T2DM?

Answer 7

Pancreas can’t make enough insulin (relative insulin deficiency)
OR
Cells cannot use insulin properly (insulin resistance)

Question 8

Why is there relative rise in glucagon when insulin is low (particularly in T1DM)?

Answer 8

Theres not necessarily a rise glucagon, its just that the Insulin/Glucagon ratio has decreased

Thus as Glucagon causes an increase in gluconeogensis and ketogenesis

Question 9

Obviously insulin secretion is mainly influenced by glucose, but what influences glucagon secretion?

Answer 9

1) Blood glucose levels primarily.
(insulin can also inhibit the secretion of glucagon. In a paracrine fashion)

https://www.ncbi.nlm.nih.gov/books/NBK279127/

Question 10

Why does T2DM typically not lead to DKA?

Answer 10

Because I guess there is not an absolute absence of insulin. Thus the insulin/glucagon ratio does not decrease too much. (As remember insulin and glucagon have opposing effects of one another)

Question 11

Effects of insulin

Answer 11

Decrease Gluconeogenesis in liver
Decrease Ketogenesis in the liver
Decrease glycogenolysis and Increase glycogenesis in liver
Decrease lipiolysis in adipose tissue

Question 12

Symptoms of T2DM?

Answer 12

They may present with the T1DM triad. But are most likely to present with:
-Lack of energy
-Persistent infections (genital thrush infections)
-Infections of feet
-Visual problems
-Slow healing

Question 13

Diagnosis of DM?

Answer 13

Presence of symptoms
1) Random plasma glucose conc of greater than or equal to 11.1 mmol/L
OR
Presence of symptoms
1)Fasting plasma glucose of greater than or equal to 7.0 mmo/L
OR
Presence of symptoms
1) Plasma glucose conc of greater than or equal to 11.1 mmol/L after oral glucose tolerance test.

Question 14

DKA triad of symptoms?

Answer 14

Question 15

DKA treatment:

Answer 15

Question 16

Signs of Vitamin D defiency?

Answer 16

osteomalacia (older; after fusion of epiphyses), rickets (in young)

Question 17

Parotitis

Answer 17

Parotid gland swelling

Pain on mastication, lack of salivary secretions, pain.

Question 18

Bell’s palsy?

Answer 18

In Stroke forehead is spared!

Question 19

Fraility score

Answer 19

Question 20

In geriatrics

Answer 20

When doing a history remember to do a multi systems check; e.g. bowels regularity and water works too

Question 21

Writing medical notes acronym?

Answer 21

SOAP
Subjective:
Chief Complaint (CC)
History of Present Illness (HPI)
History
Review of Systems (ROS)
Current Medications, Allergies
Objective:
Assessment:
Plan:

https://www.ncbi.nlm.nih.gov/books/NBK482263/

Question 22

Can AF cause Acute mesenteric ischaemia?

Answer 22

Yes, it can throw off an embolus

Question 23

Acute mesenteric ischaemia symptoms + signs?

Answer 23

**Acute (abrupt) severe **abdominal pain
Pain constant, central, or around watershed area. Or diffuse. Can be nausea + vomitting.

Signs:
Metabolic acidosis

Question 24

Acute mesenteric ischaemia treatment?

Answer 24

Thrombolysis = IV unfractionated Heparin
Surgery= Bypass graft

fluids + o2

Question 25

Acute Diverticulitis?

Answer 25

When Diverticula (are outpouchings of mucosa+submucosa through the muscularis layers) become inflamed and can perforate.

Question 26

SYmptoms of acute diverticulitis?

Answer 26

Abdominal pain at site of inflammation (usually left lower quadrant; sigmoid colon)
Fever
Bloating
Constipation
Haematochezia (blood in/with stools)

If perforated then signs of peritonitis.

Question 27

Peritonitis symptoms?

Answer 27

Depends. But generally: Abdominal pain and lie still.

Question 28

Peritonitis?

Answer 28

Is inflammation of the serosal membranes that line the abdominal cavity.
Causes=
Primary peritonitis = due to end stage liver disease (leads to ascites this predisposes to infection)
Secondary peritonitis = usually perforation occurs

Question 29

3 areas of gallstones blockage and name?

Answer 29

Neck of gallbladder= biliary colic
Cystic duct= Acute cholecystitis (Murphy’s sign)
Common bile duct= Ascending Cholangitis (Charcots triad= jaundice, RUQ pain, inflammation)