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PCM II Exam 1 > Other endocrine lecture > Flashcards

Other endocrine lecture Flashcards

1
Q

Diabetes

Type I

A

body doesn’t make enough insulin

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2
Q

DB T2

A
  • body’s cells can’t let the insulin in to use it

Vessels are supersaturated with glucose

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3
Q

what happens as a result of DB

A

Glucose builds up in the blood stream (hyperglycemia)
and causes damage –

Blood vessels (plumbing) are full of
sugar but your body is in a state of starvation.
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4
Q

Diabetes Mellitus

Presentation/Symptoms:

A
  1. urinating often (bc so much glucose)
  2. –> makes you v thirst and tired
  3. blurry vision
  4. Cuts/bruises slow to heal
  5. tingling pain in hands and feet
  6. feeling v hungry even tho eating
  7. weight. loss even tho eating more
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5
Q

How do you diagnosis DM

A
  1. fasting plasma glucose >126mg/dl
  2. A1C levels are >6.5%
  3. random plasma glucose >200 mg/dl
  4. A1C >5.7 -> impaired glucose tolerance
  5. 75g two hours oral glucose tolerance test with plasma glucose >200mg/dL
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6
Q

Diabetes Mellitus

Sequelae/consequences:

A
  1. frequent infections (UTI, yeast)
  2. Retinopathy -> blindness
  3. Nephropathy -> kidney. failure
  4. Neuopathy. of feet. a nd hands
  5. increase in CV events. (MI, strokes), peripheral vascular dz, poor healing wounds
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7
Q 
DM: Type 1
Age of onset:
Body type:
Mechanism: 
DKA:
Clinical sx: 
Monitor: 
Target. A1C: 
Tx:
A 
childhood, adolesence
thin or normal
Pancreas can't make insulin d/t autoimmune
Yes DKA
Polydipia, polyuria, nocturia
Monitor B.S and HbA1C
<7.5
Insulin
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8
Q 
Type 2
Age of onset:
Body type:
Mechanism: 
DKA:
Clinical sx: 
Monitor: 
Target. A1C: 
Tx:
A 
adults, but young kids who are obsese
obese
impaired insulin secretion, increase resistance
No DKA
polydipsia, polyuria and nocturia
B.S and Hb1AC
<7
modify lifestyle, oral DM meds, insulin
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9
Q

sx of db

A
  1. Acanthosis nigracans- dark skin often on neck
  2. DB retinopathy
  3. DB neuropathy- ulcers on feet
    4.
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10
Q

Test for DB neuropathy

A
  1. Check for skin lesions/ infection, etc (don’t forget to
    check between the toes
  2. Pressure sensation using Monofilament testing (6 spots- 1 on big toe, pinky toe, 3 on upper feet, 1 on heel)
  3. Vibration sensation using tuning fork
  4. Superficial pain using pinprick/ temperature
    sensation
  5. Reflexes
  6. Pulses
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11
Q

Diabetic Peripheral neuropathy

A

affects 30%. of DB its d/t damaged peripheral nerves d/t poor controlled blood sugar

stocking. and glove pattern: usually. appears on feet and arms

burning, paresthesia, numbness

infections, amputations

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12
Q

tx Diabetic Peripheral neuropathy

A

control b.s
A1C <6.5
perform self foot exam routinely
anti neuropathy meds

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13
Q

how do document DB foot exam

A

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.

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14
Q

Metabolic Syndrome

• Also known as

A

syndrome x

insulin resistance syndrome

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15
Q

Metabolic Syndrome consists of

A
  1. abdominal obesity
  2. insulin resistance
  3. high BP
  4. high TAG levels (lipid abnormalities)
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16
Q

Metabolic Syndrome prevalence increases with what?

A

age

increasing body weight

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17
Q

causes of Metabolic Syndrome

A

idk
but most. likely. linked to:

  1. visceral fat causing oxidative stress that produces endothelial cell dysfunction, promoting vascular damage
    and atheroma formation
  2. hormonal changes that causes serum cortisol to increase -> abdominal obesity, insulin
    resistance, and lipid abnormalities
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18
Q

work up of metabolic syndrome

A
  1. Good past medical and family history (specifically
    hx of cardiac disease or DM)
  2. History of weight changes
  3. Lifestyle (i.e. sedentary, eating habits)**
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19
Q

what should we note about metabolic syndrome

A
  1. in some patients, certain meds can increase risk of MS: antipsychotics, antivirals, steriods
  2. Certain med conditions can increase risk: PCOS
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20
Q

tx MS

A

excercise
diet
treat HTN
Treat cholesterol (bc patients. will have low HDL cholesterol_

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21
Q
  1. Understand who needs a geriatric assessment
A

a

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22
Q

Understand how to assess the medications a geriatric patient is taking and how to use specific
tools/ criteria to help safely prescribe medication to a geriatric patient

A

a

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23
Q

Understand the assessment tools that need to be used for functional ability and risk of falls

A

a

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24
Q

Know some of the common pathology for vision impairment in the geriatric population and when
to refer to ophthalmology

A

a

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25
Q
  1. Have general understanding of how to assess cognitive decline
A

a

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26
Q
  1. Use the two-question method for screening for depression and know when to use PHQ-9
A

a

27
Q
  1. Know which vaccines are recommended in geriatric patient
A

a

28
Q

*Medication Assessment in older ppl

A
  1. Have patient bring in all medications and supplement to doctors visit, “brown bag
    check”
  2. Ask “What prescription medications, over the counter medicines, vitamins, herbs, or supplements do you use?”
  3. Review medications during every visit
  4. Use Beer’s Criteria or other medication clinical tools to reduce or avoid prescribing
    medication that can lead to adverse events
  5. “Start low, go slow” (start certain medications at lowest dose and increase slowly for older patients)
  6. Close followup after starting new medication
29
Q

what is Functional Ability

A

abilitiy of pt to perform daily task for living normal life (ADL- activities of daily living)

30
Q

• Activities of daily living (ADL) include

A
  1. self care

2. living independently: doing housework, using a phone, prepare meals

31
Q

useful scales for functional ability

A
  1. Katz Index if Independence in Activities of Daily Living

2. Lawton Instrumental Activities of Daily Living Scale

32
Q

______ pathologies can increase with age. examples

A

Vision pathologies can increase with age

glaucoma, cataracts, macular degeneration, poor night vision,

33
Q

Vision Assessment

A

there is no specific recommendation even through the USPSTF.

doc can do periodic assessment with Snellen Eye Chart

34
Q

when do we refer geriatric pt to opthamolodist

A
  1. monitor diabetic pt for diabetic retinopathy
  2. pt with increased risk for glaucoma: family. hx
    3.
35
Q

should we tell an older person not to drive?

A

no.
Remember many older patients continue to drive well into their 80s and sometimes
even into their 90s, consider assessing vision for driving safety

36
Q

Fall Risk:

reason for falls are ____

A

multifactoria

37
Q
  1. obtain relevant medical hisory, physical exam, cognitive and functional assessment
  2. determine multifactorial fall risks:
    ___
    3/ any indication for addition intervention
  3. Yes- > conduct multufactoral/ multicomponent intervention to address identified risk and prevent falls
A 
hx of falls
meds
gait, balance and mobility
visual acuity
other neuralgic impairments
muscle strength
HR and rhythm
postural HypoTN
feet and footwear
environmental hazards
38
Q
  1. obtain relevant medical hisory, physical exam, cognitive and functional assessment
  2. determine multifactorial fall risks:
    ___
    3/ any indication for addition intervention
  3. Yes- > conduct multufactoral/ multicomponent intervention to address identified risk and prevent falls
A 
hx of falls
meds
gait, balance and mobility
visual acuity
other neuralgic impairments
muscle strength
HR and rhythm
postural HypoTN
feet and footwear
environmental hazards
39
Q

Tools for assessment of balance problems to be
able to intervene to prevent falls and fall related
injuries

A
  1. Tinetti Balance and Gait Evaluation

2. ‘Get Up and Go’ test: perform a timed get up and go (TUG test)

40
Q

To reduce falls consider recommending

A 
Exercise
– Physical therapy
– Assessment of the home for hazard i.e.
carpets, steps, etc.
– Review medications
– Assessing vision
– Performing neurologic exam
41
Q

Testing Cognition

A
  1. Mental status i.e. orientation , screening tools
  2. Cranial nerves including vision screen
  3. Cerebellar status / motor system i.e. gait, Romberg, finger to nose, heel to shin
  4. Strength
  5. Sensation
  6. Reflexes
  7. Other i.e. Babinski, etc
42
Q

Screening tool cognition in detail

A

Mini mental status

MOCA: montreal cognition assessent

43
Q

MMS and MOCA both access for

A 
level of consciousness,
ATN and concentration
memory
language
visuospactial perception
calculation
exectuive functioning
mood and thoughts 
screening tools
44
Q

MMS and MOCA both access for

A 
level of consciousness,
ATN and concentration
memory
language
visuospactial perception
calculation
exectuive functioning
mood and thoughts 
screening tools
45
Q

two question method for depression screening

A

– “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?”

46
Q

if yes to two question method for depression screening, then do what

A

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

• Patient Health Questionnaire-9 (PHQ-9) – this can start the conversation about
depression

47
Q

_______ is the most common hearing

condition in older patients.

A

Presbycusis or age related sensorineural hearing loss

48
Q

what is Presbycusis or age related sensorineural hearing loss

A

Progressive symmetric loss of high frequency hearing

49
Q

Clinical presentation of prebycusis

A

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

50
Q

cause of prebycusis

A

loss of cochlear hair cells and ganglion cells in the vestibulocochlear nerve.

look at meds for ototoxicity

51
Q

Workup of prebycusis

A

otoscopic examination,
Audioscope examination,
the whispered voice
test

52
Q

what is the guideline for hearing problems

A

USPSTF recommends asking patients about their hearing but there is no guideline for
asymptomatic patients

53
Q

• Stress incontinence

A

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

54
Q

• Urge incontinence

A

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

55
Q

• Overflow incontinence

A

detrusor muscle underactibity of bladder outlet obstruction. there is continuous leakage of urine d/t incomplete bladder emptying

56
Q

Osteoporosis

A

Disease causing progressive bone loss

57
Q

Risk Factor for osteoporisis

A 
white females
older white males
post menopausal F
Certain chronic medical conditions
meds 
Vit D def
58
Q

w/u for osteoporisis

A

dual energy x-ray absorptiometry (DEXA scan) on woman 65 years or older

screening women <65 years whose 10-year fracture risk is high. Use FRAX Fracture Risk
Assessment Tool

59
Q

tx osteoporisis

A

lifestyle change: stop smoking, moderate etho intake,

bipshophonate therapy
hormone therapy

60
Q

Vaccinations Assessment

A

Make sure patient 65 and older are up to date on the following vaccine

  1. Tetanus or tetanus with pertussis vaccine
  2. Influenza vaccine
  3. Pneumococcal vaccine
  4. Herpes zoster vaccine
61
Q

Social Support Assessment

A

get a. good social history. this can help identify is a pt has help when sick or if they. can no longer perform Adls and need to go into a longterm care facility

62
Q

other social things we can do for patient
Consider social work or home health referrals if indicated
• Get to know patient’s advance directive (code status)
• Ask if they have a health care power of attorney in case the patient become
incapacitated due to illness or cognitive decline
\

A

and

63
Q

if pt has a caregiver, what should we do?

A

assess for elder abuse

consider burno0ut or depression and how it can impact health

PCM II Exam 1 (5 decks)

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