PCM Flashcards
Geriatric Patients with chronic diseases, mx & preventive steps? (5)
- Fall risk, Instability
- Osteoporosis (BMD, Diet, Ca supp)
- Mental Screening/ Geriatric Depression Score
- Screening: Mammogram, PAP
- Vaccine: Influenza yrly, pneumococcal
What type of anemia in Chronic disease ?
Normocytic Normochromic
HTN Macro, Micro complications
Macro: Chest pain, SOB
Micro: Eyes, Renal, Extremities Numb
Chronic Disease: Medication & Monitoring
What to ask? (5)
- Type
- Dosage, Timing
- Compliance
- Side effect: hypo/ hyper episodes
- Home monitoring, how frequent, when, values
Sugar control for DM patients
(Fasting, 2hr PP, HbA1C)
Fasting < 7
2hr PP < 6.8
HbA1C < 7
Which sense goes off first in DM patients?
(How to test?)
Vibration,
128 Hz tuning fork
Put at control (chest/forehead) then compare to at each toes
Colorectal Cancer screening:
(What test & when)
- low risk
- medium risk (relative)
- high (close relative <50)
Colonoscopy
- low : after 50y/o, annually till 75
-
medium :
40y/o or 10years less than relative diagnosed till 75
If normal, every 3-5 years - high : as above
Breast Cancer Screening
- Normal
- High risk (relative)
- BRCA Gene
- Personal Hx Breast Cancer
50 ; 74
- Normal
50- 74 y/o ; Every 2 years
- High risk (relative)
40- 59 y/o ; Every year
60 onwards ; Every 2 years
- BRCA Gene
MRI : 30-49 YEARLY
Mammogram:
40- 69 YEARLY; 2 yearly 70+
- Personal Hx Breast Cancer
MRI 30-49y/o
Mammo YEARLY 50-74 y/o
Cervical Cancer Screening
What and when, frequency
HPV Test
Once sexual activity OR 30- 65 y/o
Negative then every 5 years
Investigations for Chronic DM patients (5)
- Plasma Glucose, HbA1C, Fasting sugar (see control)
- Lipid profile (check for comorbid)
- Renal function, Liver function
- Urine Albumin-creatinine Ratio
- ECG
DM Management- Advice & Lifestyle (5)
- Exercise 30min for 5 days mod intensity
- Footcare
- Lose 10% of original weight in 6 months
- Low GI, high fibre diet
- Stop smoking
Metformin= B____nides
Sulphonylurea= Glic_____
AE=. ?
Metformin= Biguanides
Sulphonylurea= Gliclazide(-azide/amide)
AE= hypoglycaemia
Target HbA1C for control?
- Young
- Normal
- Elderly/ comorbid
- Young <6.5
- Normal <7
- Elderly/ comorbid <8
Sulfonylurea examples (4)
- Gliclazide
- Gliplizide
- Glibenclamide
- Glimepiride
When to start Insulin injection? (2)
When
- newly HbA1C > 10%
- on max oral drug HbA1C still > 7%
When does DM patient start HTN tx?
Target BP?
When Systolic >/= 140
Target <140/79
When DM patients start Dyslipidemia tx? (Statins)
If age >40, should start regardless value
How frequently DM follow up?
What must check every visit? (6)
3 monthly
- Weight, WC, BP, HbA1C, Plasma Glucose, Foot Pulse & Vibration
Eye, ECG and other blood & urine test do yearly
DM Med algorithm: (HbA1C)
- Mono therapy Metformin
- Mono/ Dual
- Dual
- Triple
- Insulin
- Mono therapy <6.5
- Mono/ Dual >6.5
- Dual >7.5
- Triple > 8.5
- Insulin >10
When is DM patient hypoglycaemic?
What to give?
- conscious
- unconscious
Glucose < 3.9mmol/L
- conscious 15g sugar
- unconscious IV D50% 50ml / IM Glucagon 1mg
Once statin started, how long have to TCA? What blood investigations?(2)
3 months
LFT, Lipid profile
What drug is nephro-protective, used in DM patients w Proteinuria ?
Once started how long TCA? With blood investigations?
ACE (-) : Perindopril
2 weeks
Check creatinine (if >30% baseline can reduce/ off)
BMD done how frequently? After age?
2 yearly after 50y/o
