DM and MS Flashcards
1
Q
Impaired Fasting Glucose
A
FPG 100-125
2
Q
Impaired Glucose Tolerance
A
Based on result of 2h OGTT
140-199
3
Q
Hba1c Prediabetes Range
A
5.7-6.4%
4
Q
Hba1c level diagnostic for DM
A
6.5% or greater
5
Q
Goal Hba1c for a diabetic pt (ADA)
A
less than 7%
6
Q
In US, DM is leading cause of (3)
A
non-traumatic amputations
blindness
end stage renal disease
7
Q
Preferred diagnostic test for DM
A
Fasting Plasma Glucose (after 8 hour fast) venous or cap stick
8
Q
Diagnostic Criteria for DM
A
Classic s/s hyperglycemia plus random BG 200+
Hba1c 6.5% or higher
FPG 126 or higher
2 hour OGTT of 200 or higher
9
Q
who is recommended to do SMBG
A
all insulin-treated DM pts
pts on sulfonylureas
pts not achieving glycemic control goals.
10
Q
Type 1 pts should SMBG
A
3-4x/day
11
Q
type 1 pts should test urine ketones when
A
during acute illness
when BG consistently elevated
s/s DKA are present
12
Q
DM pt should not exercise when
A
BG 250
ketones positive
13
Q
Type 1 pt should eat before exercise
A
15g CHO before moderate activity
more food for more activity
14
Q
who should carry a readily-absorbable CHO on person
A
Type 1
pts on sulfonylureas or meglinitides
15
Q
ADA recommended BG for DM pts before and after meals
A
before: 90-130
after: less than 180
16
Q
drugs that can antagonize (oppose) hypoglycemic effects of insulin
A
corticosteroids
thiazide/loop diuretics
sympathomimetics
thyroid hormone
17
Q
drugs than can increase hypoglycemic effects of insulin
A
alcohol
anabolic steroids
MAOIs
salicylates
18
Q
can mask tachycardia from hypoglycemia
A
nonselective beta blockers
19
Q
Peak action of rapid-acting insulin
A
1 hour
20
Q
Duration of action of rapid-acting insulin
A
3-4 hours
21
Q
Three types of rapid-acting insulin
A
Apidra (glulisine)
Humalog (lispro)
Novolog (aspart)
22
Q
Onset of short-acting (regular) insulin
A
30 min-1 hour
23
Q
Peak of action of short-acting (regular) insulin
A
2-4 hours
24
Q
Duration of action of short-acting (regular) insulin
A
6-8 hours
25
Types of short-acting (regular) insulin
Novolin R
| Humulin R
26
Onset of Intermediate-Acting (NPH) insulin
1-3 hours
27
Peak of Action of Intermediate-Acting (NPH) insulin
6-8 hours
28
Duration of action of Intermediate-Acting (NPH) insulin
12-16 hours
29
Types of Intermediate-Acting (NPH) insulin
Novolin N
| Humulin N
30
Onset of Action of Long-Acting insulin
2-6 hours
31
Peak of Action of Long-Acting insulin
none
32
Duration of Action of Long-Acting insulin
12- 24 hours
33
DCCT
Diabetes Control and Complications Trial
Demonstrated intensive glucose control dramatically reduced the development and progression of complications; also increased risk of hypoglycemia
34
UKPDS-UK Prospective Study
demonstrated a decrease in complications in patients who had Type 2 DM
35
alcohol consumption is dangerous in DM pts (especially those on insulin) because
alcohol inhibits gluconeogenesis and can cause hypoglycemia
| May also impair ability to recognize and treat HoG
36
swan neck deformity
affects most distal joint of finger, occurs in RA
37
ulnar deviation, drift
all fingers angle toward ulnar side, occurs in arthritis
38
Valgus deformities
distal arm of joint points away from midline (brings joints closer)
39
Bunion
Hallux valgus deformity of big toe
40
Genu valgum
Valgus deformity of knees (together)
41
Talipes valgus
Eversion of feet (walk on instep)
42
Varus deformities
distal arm of joint points toward midline (moves joints apart)
43
Talipes varus
inversion of feet
44
Genu varum
bow legs
45
Lordosis
exaggerated curvature of lumbar spine; "sway back"; often in pregnant women
46
Scoliosis
lateral curvature of spine, increased when bending forward
47
Kyphosis
increased curvature of thoracic spine; often in elderly with OA
48
Pes planus
flat foot
49
Pes cavus
high instep
50
isometric exercise
contraction of muscle but no joint or extremity movement--Kegels, Quad sets
51
isotonic exercise
muscle contraction resulting in movement
52
clonus
rhythmic contraction of muscle
53
fasciculations
involuntary muscle twitches
54
most significant RF of OA
age-still not part of normal aging process
55
finger nodules caused by OA
Herberden's and Bouchard's nodules
56
Total Hip Dislocation Precautions
Keep legs abducted
No internal rotation
No flexion 60-90 degrees
No adduction (wedge pillow, pillow bt legs)
57
Hereditary metabolic disturbance of purine metabolism leading to excess uric acid crystals that are deposited in body tissues and joints.
Gout
58
Ankylosing Spondylitis
Type of RA
| systemic inflammatory condition of vertebral column and sacroiliac joints
59
Strain vs. Sprain
Strain: stretching of the muscle and its fascial sheath
Sprain: injury to ligaments surrounding a joint caused by twisting motion
60
Compression of median nerve at wrist; entrapment neuropathy
Carpel Tunnel Syndrome
61
3 ways to reduce a fracture
Closed reduction
Open reduction
Traction
62
fat embolism presentation
confusion, respiratory distress, petechiae along chest, axilla, and neck
63
s/s of compartment syndrome (6Ps)
```
Pain
Pallor
Pulselessness
Paresthesia
Paralysis
Pressure
```
64
goal of skin traction
control muscle spasms and immobilize before surgery for short periods Ex. Buck's extension traction
65
Skeletal traction is used when
a joint needs rest; usually large trauma or infected TJR needs to be removed.
66
Bone growth outside the skeleton--bony fragments in soft tissue
Heterotopic ossification
67
s/s Hip fracture
leg shortened and externally rotated
severe pain
muscle spasms
sometimes ecchymotic
68
when to amputate stump post op
Elevate 1st 24h to reduce edema
| Don't elevate past 24h or leave flexed, can cause contracture
69
First sign of osteoporosis
Back pain
| fracture
70
skeletal disorderof abnormally rapid bone turnover that results in excess localized overgrowth of bone
Paget's disease
71
malignant tumor of plasma cells in bone marrow
multiple myeloma
72
pyogenic infection of bone and surrounding tissue
osteomyelitis
| most commonly Staph
73
once insulin is started in treating DKA, monitor for these two complications
hypokalemia and hypoglycemia
74
immediately given to treat DKA
isotonic or hypotonic fluids to rehydrate
75
ng tube given to DKA pt because
to relieve n/v and prevent aspiration
76
HHNC treatment
hypotonic saline
insulin ( bolus or drip)
KCl
77
elevated BUN seen in
DKA and HHNC
78
on a sick day a diabetic should test for ketones if BG is below? how often?
240; q4h
79
on a sick day a diabetic should call MD if BG is
over 300 two times
80
on a sick day a diabetic should test BG
every 4 hours, use more insulin if needed.
81
stenosing tenosynovitis
trigger finger
82
tennis elbow
epicondylitis-pain radiates down dorsal forearm
83
Osteoporosis treatments
No cure--goal is to manage pain and prevent fracture
WB exercise
Ca in diet
Biphosphates
84
osteomalacia treatment
increase Ca Vitamin D, and light exposure
85
tumor may be chondrogenic or osteogenic
osteosarcoma
86
s/s of multiple myeloma
back pain
anemia
thrombocytopenia
bleeding tendencies
87
osteomyelitis can complicate into
sepsis
88
Most Type 2 diabetics can control BG through weight loss because
weight loss increases the number and sensitivity of insulin receptor sites
89
First step tx for newly diagnosed prediabetic
attain ideal weight; 10-15 lbs. may increase glycemic control
90
insulin action
Anabolic, storage hormone
moves glucose from blood into muscle, liver, and fat cells
stimulates glycogen storage in liver and muscle; inhibits glycogenolysis
91
glucagon action
released when BG decreases
| stimulates glycogenolysis--glycogen breakdown and glucose release from liver
92
glucose cannot be stored in the liver without
insulin
93
osmotic diuresis leading to electrolyte and fluid loss in diabetics results from
excess glucose in urine pulling water with it
94
DM especially prevalent inthese groups
elderly
| Blacks, hispanics, native americans
95
timing of adult DM screening
begin at age 45, repeat every three years is normal, more often if pt has risk factors
(BMI >25, other rfs)
96
cause and treatment of somogyi phenomenon
gradual excessive admin of insulin; decrease insulin or give bedtime snack
97
cause and treatment of dawn phenomenon
surge in cortisol or GH; change time of evening insulin
98
once proteinuria starts in dm nephropathy (middle stage) treat with
diuretics
| low salt diet, protein modifications
99
final stage of nephropathy treatment
dialysis or transplant
100
the early/asymptomatic stage of nephropathy goal is
prevention
| prompt treatment of anything that impairs kidney function: UTIs, HTN
101
can decrease proteinuria even in non-HTN DM nephropathy patients
ACE inhibitors
102
to prevent nephropathy
HTN management
| low protein diet
103
Kyphosis is associated with
OA
103
gangrene-amputation triad
Neuropathy +
Vascular disease (large vessel insufficiency+autonomic neuropathy leading to dry cracked skin, decreased sweating) +
infection
104
Risk of spinal HA
Myelogram
105
Exam of action potentials made by skeletal muscle contractions to differentiate muscle and nerve disease
Electromyogram (EMG)
106
Radioisotope scan Nsg
Dose of ri 2hours prior
Empty bladder
Increase fluids after
107
Degree of uptake on RI bone scan indicates
Degree of blood flow
Increased-osteoporosis, osteomyelitis, ca, fx
Decreased-AVN
108
After arthrocentesis
Compression dsg, observe for leakage or bleeding
109
The longer a dislocated joint remains in reduced. The greater the risk of
AVN
110
Impingement syndrome can progress to
RCT
111
A pt with a rotator cuff injury can't
Flex and abduct shoulder
112
Stages of fracture healing
Hematoma
| Granulation Tissue
113
Because irreversible tissue damage from compartment syndrome can happen in only 4-6 hours
Neurovascular checks must be done on time
114
Pain from compartment syndrome
Unrelenting, greater than expected, and worse on passive ROM
115
S/S Hip Fx
Leg shortened and externally rotated
| Severe pain and muscle spasms
116
If delayed going to OR with a hip fx
Apply Buck's traction to immobilize hip
117
Increase fluids in a pt with a cast due to increased risk of
Constipation and renal calculi
118
Surgeries to repair hip fracture
Hemiarthroplasty (treat with total hop dislocation precautions)
Or
ORIF (nothing to dislocate)
119
onset of rapid acting insulin
15 min
