Endocrine

Question 1

diabetes defintion

Answer 1

impaired metabolism caused by lack of insulin from pancreas or decreased sensitivity of insulin receptors in tissue

Question 2

causes of diabetes

Answer 2

• type 1 genetic
• type 2 lifestyle, prolonged high blood sugar
• gestational
• CF pancreatic involvement

Question 3

Type 1 DM prevalence and pathophys

Answer 3

5-10%, commonly diagnosed in children
autoimmune destruction of beta cells leading to lack of insulin production

Question 4

T1DM treatment

Answer 4

insulin dependent
insulin injections, diet, exercise

Question 5

DM prevalence in US

Answer 5

11% pop, 37 mil, 8.5 mil undiagnosed
7th leading cause of death
increasing risk with age 65+
more prevalent in valley

Question 6

rate of amputation in DM patients

Answer 6

10-15% experience diabetic ulcer
60% of diabetic amputees have re amputation

Question 7

diagnose DM by what criteria?

Answer 7

A1C
fasting plasma GLC
oral GLC tolerance test (gestational)

Question 8

A1C levels

Answer 8

normal: <5.7
prediabetic: 5.7-6.4
diabetes: 6.5

Question 9

risk factors for diabetes

Answer 9

smoking
1st degree relative
CV disease Hx
hypertension Hx
Hyperlipidemia Hx
sedentary
45+
women: PCOS, gestational diabetes
obesity

Question 10

gestational diabetes

Answer 10

increased insulin resistance, increases blood GLC levels
diagnosed in later 1/2
may normalize after birth or remain
tend to deliver large babies
include complications: respiratory, jaundice, hypoglycemia

Question 11

obesity risk factors

Answer 11

diet
sedentary
genetics
metabolic conditions: hypothyroidism, Cushing, PCOS
poor sleep
meds
prenatal

Question 12

obesity complications

Answer 12

CV: HTN, CAD, hyperlipidemia, L ventricle dysfunction, cardiomyopathy
Pulmonary: restrictive ling disease, obstructive sleep apnea
GI: GERD, gallstones, fatty liver disease
MSK: OA, PF, altered biomechanics
Cancer: increased risk
T2DM

Question 13

obesity treatment

Answer 13

lose adipose tissue while maintaining muscle
5-10% weight loss has clinically significant effects
diet modification
increase activity/exercise
gastric bypass
pharm: ozempic

Question 14

ACSM recommendations for obesity

Answer 14

freq: 5x week aerobic, 2-3 resistance/flexibility
intensity: mod aerobic intensity, 60-70% 1RM
time: 30 min day 150 week aerobic, 2-4 sets 8-12 reps, 10-30 s 2-4x stretch
type: prolonged rhythmic aerobic, resistance machine/free weights, static/dynamic/PNF stretching

Question 15

metabolic syndrome

Answer 15

5 risk factors with 3 or more confirming diagnosis
1. abdominal obesity
2. high triglycerides >150
3. low HDL women <50, Men <40
4. elevated BP >130/85
5. elevated fasting GLC >100

Question 16

s/s of diabetes

Answer 16

frequent urination
increased thirst
extreme hunger
extreme fatigue
blurry vision
irritability
slow healing cuts
frequent infecctions
unusual weight loss
N/T in hands/feet

Question 17

DM complications

Answer 17

integumentary: skin infection, wounds
eye: galucoma, cataracts, retinopathy
feet
CVA
nephropathy
CV: HTN
ketoacidosis medical emergency

Question 18

PT considerations for DM wounds

Answer 18

daily routine/activites
footwear
foot deformities
prior Hx of infections, surgery
neuropathy
caludications
current wounds location, onset, trauma, history of same location
compare to uninvolved foot
pain response

Question 19

diabetic foot characteristics

Answer 19

size/deformity
rounded
deep wounds
maceration around wounds from drainage
callused
red wounds
heavy drainage

Question 20

Wagner ulcer classification

Answer 20

0-5
0: intact
1: superficial ulcer, no subcutaneous
2: deep ulcer involving subcutaneous, tendon or bone exposure
3: deep infected ulcer including abscess
4: partial foot gangrene affecting digits
5: full foot gangrene requiring surgery

Question 21

DM MSK examination

Answer 21

ROM/strength BL
contractures
foot deformities

Question 22

common foot deformities in DM

Answer 22

claw toe: MTP hyperextension, PIP/DIP flexion
hammer toe: MTP hyperextension, PIP flexion, DIP extension
pex cavus/pes planus
prior amputation - altered weight bearing causing deformity

Question 23

Neuro exam for DM

Answer 23

coordination in walking, balance
DTR
sensation: semmes weinstein 10g monofilament
vibration. sharp/light sensation
proprioception

Question 24

monofilament testing

Answer 24

measure for loss of protective sensation
10 sites on foot: toes 1/3/5, 3 points across ball of foot, triangle around heel, dorsal foot proximal to digit 1
4.17/1g: normal sensation
5.07/10g: protective sensation
6,1/75g: loss of protective sensation
insensate: no perception of 75g

Question 25

diabetic neuropathy

Answer 25

related to high blood GLC levels 15% of DM pts develop diabetic ulcer over weight bearing surface 40x more likely to have amputation due to poor wound healing

Question 26

DM neuropathy subjective scales include:

Answer 26

NSS: neuropathy symptom scale modified NSS Michigan neuropathy screening instrument diabetic neuropathy symptom score (DNS)

Question 27

CV exam for DM

Answer 27

vitals, temperature skin integrity posture pitting edema w circumferential measure/figure 8 cap refill ankle brachial index color

Question 28

common gait deviations w DM

Answer 28

reduced gait speed reduced ankle mobility hip circumduction increased knee flexion shorter step length/stride wide stance width increased double limb support time

Question 29

pt education w DM

Answer 29

daily foot inspection LEAP monthly sensation screening daily shoe checks daily warm foot wash and moisturizer cut toenails straight across white socks to check for wounds/drainage proper shoes no barefoot walking no hot water/heating pads followup w Dr on new wounds

Question 30

LEAP: LE amputation prevention

Answer 30

1. annual foot screening 2. pt edu 3. daily foot inspection 4. footwear 5. manage simple foot problems

Question 31

recommended shoes for diabetic foot wounds

Answer 31

min-no risk factors: athletic shoes some risk factors: large toe box, inserts minor deformity/single problem: prescription/off shelf shoes major deformity: Klenzak brace/AFO, custom molded uncontrolled deformity: crow boot

Question 31

footwear considerations DM

Answer 31

offloading abnormal pressure on ulcer - contact casting - modified shoes - wound dressing

Question 32

charcot foot cause and stages of development

Answer 32

cause: severe peripheral neuropathy and repeated trauma with loss of protective sensation; abnormal response to repeated injury causing severe destruction of foot architecture stages: 0: inflammatory, warmth/swelling/pain 1: destruction, weakened ligaments, joint subluxation 2: bone callus, consolidation of fractures 3: fixed deformity and instability

Question 33

benefits of ther ex for DM

Answer 33

improved glycemic control weight reduction/adipose reduction decreased hyperlipidemia/HTN slow down CV disease reduced stress improved QOL

Question 34

ACSM recommendations for diabetes

Answer 34

aerobic: 3-7x week, no more than 2 days w/o activity; mod-vigorous, 150 min/wk, prolonged rhythmic activities resistance: 3x week nonconsecutive, 50-85% 1RM, 8-10 major m groups, 1-3 sets 10-15 reps flexibility/balance: 2-3 x wk, light-mod, 10-30 s 2-4x stretch, static/dynamic/stretching/yoga

Question 35

relative contraindications to exercise for DM

Answer 35

blood GLC levels: 70-100: snack every hour of exercise w hydration, or more often for intense 100-300: proceed, 1-2+ hours requires more carbs and water 300+ oral meds: try 10-15min exercise and recheck BG, stop if rising, if not continue monitoring 300+ on insulin: check for ketones, stop if positive, continue if not and monitor

Question 36

absolute contraindications to exercise DM

Answer 36

BG: <70, hypoglycemia - s/s shaking, dizzy, hunger, headache, pale, jerky, seizure, tingling hyperglycemia: >300 w ketones, SOB/fruity breath, nausea/vomiting, dry mouth both emergency

Question 37

diabetic foot exam

Answer 37

examine appearance and wounds at all surfaces/under/between toes, toenails temperature/color cap refill monofilament, 3 types in 10 std positions shoe examination barefoot and shoe gait sensation: light touch, vibration big toe joint proprioception achilles DTR ROM balance MMT