Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Amir SAM > Diabetes > Flashcards

Diabetes Flashcards

1
Q

How do you treat diabetes

A

1.st line: Metformin

2nd line: DPP-4 inhibitor, SGLT2 inhibitor, Glp1 receptor agonist (these reduce death)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are clinical feature of diabetic nephropaty

A

Hypertension

proteinuria

derranged kidney function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the best way to check for diabetic nephropathy?

A

look at proteinuria first thing

creatinine goe up higher later

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are you particularly at risk of if you have diabetes with diabetic nephropathy?

A

much higher risk of cardiovascular events

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the parts of the kidney that are impacted by diabetic nephropathy

A
  1. glomerular:
    1. Mesangial expansion
    2. basement membrane thickening
    3. Glomerulosclerosis
  2. vascular
  3. tubulo interestial
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How long does it take for someone with diabetes to develop reanal failure

A

30-40 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

WHat are risk factors that impact whether someone get diabetic nephropathy

A

age at which you get diabetes

racial factors

age of presentation

loss due to cardiovascular morbidity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are ways to prevent the onset of diabetic nephropathy in someone with diabetes

A
  1. diabebetic control
  2. blood pressure control
  3. suppression of RAAS
  4. stop smoking
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the antihypertensives that you give to diabetics

A

ACE inhibitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

If someone get’s a cough with an ACE inhibitor and is diabetic, what is the next drug you would give

A

ARB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Which of the following are feature of diabetic nephropathy:

A. affects all patient with diabetes over time

B associated with decreased BP

C. progressively increasing proteinuria

D. Unrelated to glycaemic control

E, Associated with a low risk of cardiovascular events

A

C. progressively increasing proteinuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Regarding ACE inhibition in patients with diabetes

A. ACE inhibitors cause improvement in the creatinine within days of starting

B. Ace inhibitors cause an increase of the creatinine within days of starting

C. ACE inhibitors increase microalbuminuria

A

B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What happens if you give somone with renal artery stenosis an ACE inhibitor?

A

fall in GFR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Regarding ACE inhibitors in patients with diabetes

A. ACE inhibitors are useful in patients with diabetes and resultant renal artery stenosis

  1. ACE inhibtors increase microalbuminuria
  2. ACE inhibitors prevent end stage renal failure
  3. ACE inhibitors cause hypokalaemia
A
  1. ACE inhibitors prevent end stage renal failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

if you give some an ACE for their diabetic nephropathy what happens to their kidney function

A

inititally drops off massively but then it plateau and the fall is much less than without and therefore over many years it is more favourable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What should you do if someone has been given an ACE inhibitor and they have renal artery stenosis

A

you have to take them off it

AND THEN

call a nephrologist might need to be dialised for a while

BUT they will fully recover

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the problems/ implications of renal failure

A
  1. Electrolyte imbalance: hyponatraemia, hyperkalaemia
  2. ACIDOSIS
  3. fluid retention
  4. retention of waste products: urea, creatinine, urate, phosphate, middle molecules
  5. LESS secretion of EPO and Vitamin D
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

WHat are symptoms of renal failure

A

tiredness - anaemia (lack of EPO)

SOB and oedema

Pruritus - renal bone disease (lack of vit. D)

nocturia, feeling cold, twitching (later on)

poor apetite, nausea, loss of taste, weight loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the lack of kidney functions and how do they manifest

A

Hyperkalaemia- arrthmias, cardiac arrest

Pulmonary oedema- fluid retention

Nause and vomitting- acidosis

Malnutrition cachexia - loss of apetite and taste

Fits & increasing coma - hypnatraemia

DEATH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are renal replacement therapies?

Where are they done?

A

Dialysis

  • haemodialysis:
    • HOSPITAL based but can be done at home
  • peritoneal dialisis
    • HOME treatment

Transplantation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the aims of renal replacement therapy

A

correct electrolytes

remove waste product

restore fluid balance

improve symptoms

maintain quality of life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

When do you refer for renal replacement therapy?

Do you start it then?

A

eGFR of below 20

No just discuss and organise

and then you may start at 10ml/min (benifits outweigh the risks)

Need to start at 6 or less

24
Q

What do you need to tell the patient about

A

Risks of renal failure

types of renal replacement failure and then establish the access

25
Q

What are the different accesses for renal replacement therapy

A

fistula

PD catheter

transplant assesment

26
Q

At what eGFR does someone have to be on dialysis?

At what eGFR woudl it be beneficial?

A

At what eGFR does someone have to be on dialysis? 10

At what eGFR woudl it be beneficial - 6

27
Q

What are the risks adn benifits of dyalisis?

A

Benifit

improve uraemic syndrome (reduce pruritus, nausea and tiredness)

correct fluid balance (less SOB and oedema)

Avoid life threatning complication like acidosis, hyperkalaemia and pulmunary oedema resistant to diuretics

RISKS

infection

hypotension

reduces quality of life (travel, family life)

28
Q

What does dialysis not treat

A

anaemia

vitamin D (renal bone diasease)

AND comorbidities

SLE, diabetes and vascular disease

29
Q

What are the 2 different type of dialysis

A

haemodialysis: 3 times a week - 4 hours (needs a fistula and catheter)

peritoneal dialysis: Home base: daily and continuous, less haemodynamic stress but need a peritoneal access

GOOD becauses avoid the swings, done at home and less dietary and lfuid restrictions

30
Q

WHat are the benifits and risks of transpantation

A

benefits:

  1. better renal replacement - because also good for anaemia and renal bone disease
  2. Costs less in long term
  3. prolongues life
  4. good for quality of life

RISKS:

  1. older and sicker patients not eligible
  2. immunosuppression (increased infection and malignancy)
  3. surgical complications
  4. worse off if the transplant fails
31
Q

how do you predict survival of patients on dialysis?

What do it take into account

A

body mass index

heart failure

peripheral vascular disease

dysrhythmia

active malignancy

severe behavioural disorder

total dependency

unplanned dialysis

32
Q

Is dialysis always beneficial?

A

no study where people over 75 year of age with 2 comorbidities were put on dialysis

SURVIVAL Was the same

33
Q

What BMI is considered high (obese) in white and asian people

A

white - 25

asian- 23.9

34
Q

SOme is obese what would you advise him regarding gym

A. encourage regular exercise

B. ban him from doing any exercise at all and recommend rest adn repeat of his BP

C. advise him to see his GP beofre allowing him to exercise in the gym

D. refer him to casualty for blood pressure control

A

A. encourage regular exercise

35
Q

if someone has hypertension what would you look for

A

Fundoscopy

36
Q

What happens in the different grades of hypertension?

A

Grade 1: silver wiring

Grade 2: AV nipping

Grade 3: flame shaped haemorrhage

Grade 4: papilloedema

37
Q

What could papilloedema indicate

A

high ICP- possibly brain tumour

hypertension

38
Q

WHat are feature of long standing hypertension exist

A

left ventricular hypertrophy (ECG)

feel a heave

hear a bruit

hear an S4

39
Q

WHat grade is this

A

grade 3

see flame haemorrhage

40
Q

What are 6 causes of hypertension

A
  1. Conn’s
  2. Cushing’s
  3. Phaechromocytoma
  4. renal artery stenosis
  5. Acromegaly
  6. co arctation of the aorta
  7. essential
41
Q

What are investigation would you like to do?

if someone presents with hypertension

A
  • FBC
  • U&E low K+ high Sodium
  • ECG look for LVH
  • Urinalysis (renal disease and nephritis)
  • Fasting glucose
  • Lipids
42
Q

What percentage of people have secondary hypertension

A

10%

43
Q

What are specific investigations to diagnose secondary causes of hypertension

A

renin aldosterone ration

24 hour urine for catecholamines

24 hour urine cortisol

glucose tolerance test

44
Q

Someone presents with

renin 0.4 (1.1-4.5)

aldosterone 1600 (100-450)

24 hour urine catecholamine normal

What does he have

A

Conn

45
Q

How do you treat conn’s

A

surgery remove it

46
Q

patient presents with

renin: 7.4 (1.1-4.5)
aldosterone: 900 (100-450)

24 hour urine catecholamines is normal

What does this patient have

A

renal artery stenosis

47
Q

What is the gold standard way of diagnosing renal artery stenosis

A

Digital subtraction angiogram

48
Q

what does this patient have?

Renin: 2.4 (1.1 -4-5)

Aldosterone: 300(100-450)

24 hour urine for catecholamines RAISED

A

phaechromocytoma

49
Q

how does phaechromocytoma present?

A

anxiety

palpitation

headache

sweating

50
Q

What is the treatment for phaechromocytoma?

A

MEDICAL EMERGENCY

alpha blockade

51
Q

How do you manage a phaechromocytoma

A
  1. alpha blockade (rehydrate if needed)
  2. beta blockade
  3. localise the lesion
  4. surgery (many weeks after alpha blockade)- laprascopic adrenalectomy
52
Q

What does an MIBG scan show

A

is a radioactive scan and shows where the tumour is

the bladder always lights up

53
Q
A
54
Q

How do you treat essential hypertension?

A
55
Q
A

Amir SAM (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions