509 - Lec 9 - Cp Implications Of Specific Disesases

Front 1

Insulin major actions: (3)

Back 1

1. inhibit glucose production by liver.
2. pormote glucose metabolism within the cell.
3. synthesis of glycogen, fat, and protein.

Front 2

insufficient insulin results in: (2)

Back 2

1. inability to use glucose as a fuel.
2. increase lipolysis of stored fat, mobilization of free fatty acid as fuel.

Front 3

what does leptin do?

Back 3

from fat, it suppresses hunger for a while, but too much will stop leptin production.

Front 4

how much is normal fasting blood glucose? (FBG)

Back 4

80-109 mg/dl

110-125 = impaired FG

Front 5

what would qualify as imparied glucose tolerance? (IGT)

Back 5

2hr value of 120-200 mg/dl on OGTT

Front 6

Which DM is autoimmune?

Back 6

Type 1

Front 7

What are symptoms of DM 1?

Back 7

polyuria, weight loss

Front 8

how to control DM 1?

Back 8

insulin, diet, and exercise results in vascular and neural changes eventualy

Front 9

Which DM is juvenile?

Back 9

Type 1, usually before age of 25.

Front 10

How does DM 1 work?

Back 10

autoimmune attack of beta cells in pancreas that produce insulin, leading to lack of complete insulin in body

Front 11

how does type 2 DM work?

Back 11

resistance to insulin action and inadequate compensatory insulin secretory response

Front 12

what are risk factors of DM 2?

Back 12

obesity, inactivyt, diet, stress ,medications (corticosteroids), lung/heart transplant patients.

Front 13

how is DM 2 controlled?

Back 13

diet, exercise, hypoglycemic agents, sometimes insulin.

Front 14

describe diabesity (related to obesity)

Back 14

1 - insulin resistance
2 - sarcopenia
3 - sarcopenic obesity

Front 15

what is the relationship between HTN and DM?

Back 15

twice as prevalent and accelerated!

Front 16

what is relationship between CAD and DM?

Back 16

CAD more prevalent and MI and infarction may be silent!

you should screen with GXT.

Front 17

How many DM patients have cardioautonomic dysfunction?

Back 17

1/2

Front 18

what is relationship between DM and nephropathy?

Back 18

1/4 have nephopathy.
muscle atrophy and decr: Hct = decreased exercise tolerance

Front 19

what is relationship between DM and pulmonary conditions?

Back 19

high rate of pulmonary infections,
slee related breathing problems,
mucus plugging.
hyperglycema can inhibit nitric oxide causing pulmonary dilation.

Front 20

What is leading cause of death in DM?

Back 20

CVD. 70% of the time.
Also accounts for 75% of reason of hospitalization.
Mostly affects small blood vessels, by accelerating atherosclerosis.

Front 21

What are long term DM management strategies? (4)

Back 21

1. maximize aerobic capacity and efficiency.
2. improve physical endurance and exercise capacity.
(benefits glucose control, but beware hypoglycemia after exercise, improves QOL)
3. education about DM.
4. improve QOL and well being.

Front 22

Exercise guidelines for DM: Resting HR? Response?

Back 22

Elevated resting HR with blunted respoinse

Front 23

Exercise guidelines for DM: BP?

Back 23

postural hypotension.
mal-adaptive HR and BP response due to autonomic neuropahty.

Front 24

Exercise guidelines for DM: blood glucose

Back 24

should decrease during exercise, but can increase.
could have rebound effect 4-6 hrs later.

Front 25

When do you go into diabetic coma?

Back 25

>300 mg/dl

Front 26

at what glucose level do you avoid exercise?

Back 26

>250mg/dl

Front 27

what are symptoms of diabetic coma?

Back 27

skin is dry, tongue is dry, foul smelling breath, very thirsty, deep respiration, vomiting, rapid and feeble pulse, low BP, acute abdominal pain, severe fatigue.

Front 28

what to do about diabetic coma?

Back 28

give insulin immediately.
EMERGENCY.

Front 29

how to avoid exercise induced hypoglycemia? (4)

Back 29

1. eat carbs 30 min before exercise.
2. start moderately and gradually increase intensity.
3. avoid exercise to the injected muscle.
4. have a snack available for each 30-45min of exercise.

Front 30

what are symptoms of hypoglycemic coma?

Back 30

pale, sweating, sudden onsent, may follow insulin injection, moist tongue, shallow respiration, full and rebounding pulse, normal BP and NO abdomninal pain.

Front 31

what to do about hypoglycemic coma?

Back 31

provide rapidly absorbed carbohydrates - fruit juices, candy bars, sugary sodas.

Front 32

at what glucose level should you postpone testing?

Back 32

>200mg/dl.
if <100, then ingest some carbohydrates.

Front 33

What is PAOD?

Back 33

chronic, progrsesive disease characterized by limited blood flow to one or more extermities.

Front 34

What are signs and symptoms of PAOD?

Back 34

1. decreased sensation.
2. edema.
3. tissue demarcation and necrosis.

Front 35

What is claudication?

Back 35

pain, cramps, stiffness in one or both calves, and sometimes thighs.

Front 36

how long does claudication last?

Back 36

resolves in 2-3 minutes.

Front 37

when does claudication occur?

Back 37

at same time and distance, same level of exercise.

Front 38

How do you grade claudication?

Back 38

1. unlimited walking.
2. walks greater than 4/ blocks.
3. < 4 blocks.
4. resting pain. (referred to MT)

Front 39

What are visual signs of PAOD in LE?

Back 39

1. muscular atrophy.
2. hair loss.
3. thick and down curving nails.
4. dry skin.
5. cyanotic appearance of skin.
6. wounds that are slow to heal.

Front 40

what are palpable signs of PAOD?

Back 40

1. bruits in abdomen.
2. abdominal aneurysm.
3. femoral, popliteal, posterior tibial and dorsal pedialis pulse.
4. feet conditions.

Front 41

What are 4 PAOD clinical tests?

Back 41

1. rubor dependency test.
2. venous filling time test.
3. grading exercise impairment (6min walk).
4. ankle-brachial index.

Front 42

what are the scores of the ankle-brachial index?

Back 42

.9 to 1 = normal.
.8 to .9 = mild.
.5 to .8 = moderate.
<.5 = severe.

Front 43

What are some imaging/scanning techniques for PAOD?

Back 43

ultraound duplex scanning. (post-surgical assessment).
arteriography. (for invasive intervention.)

Front 44

What are some exercise protocol for PAOD?

Back 44

walking paitnet to claudication endpoint and beyond.
can use heel lift on affected side.
continuous session for >30 mionutse.
done at least 3 times a week for at least 6 months.

Front 45

Reasons to refer PAOD to MD? (5)

Back 45

1. worsening claudication.
2. resting pain.
3. ischemic ulcers.
4. wounds/fissures with DM or severe PAOD.
5. significant worsening of ABI.

Front 46

what is aortic aneurysm / dissection?

Back 46

dilation of the aorta, often in abdominal aorta but also in thoracic and aortic root.

Front 47

what are 3 causes of AA?

Back 47

atherlsclerosis.
HTN.
smoking history.

Front 48

At what size is AA prone to rupture?

Back 48

greater than 5 cm.

Front 49

What are symptoms of AA?

Back 49

sharp tearing pain in chest, abdomen, or upper back.
Short of breath, LOC, hypotension.

Front 50

What are treatments for AA?

Back 50

blood pressure control.
surgery via sternotomy or graft placement or stent placement.

Front 51

5 factors leading to HTN?

Back 51

1. atherosclerosis.
2. tortuosity of arteries.
3. increased intimal thickening.
4. increased media fibrosis.
5. sclerosis of heart valves.

Front 52

4 non drug treatments of HTN?

Back 52

1. controlw eight.
2. low salt / fat diet.
3. increase exercise.
4. stop smoking.

Front 53

What are deep vein thrombosis caused by?

Back 53

venous injury.
stasis.
hypercoaguability.

Front 54

who are prone to DVT?

Back 54

1. vein injury or tissue swelling.
person prone to venous stasis.
3. hypercoaguability states.

Front 55

Describe DVT. (3)

Back 55

1. popliteal vein or more proximal.
2. likely to be more symptomatic.
3. pulmonary emboli are detected in 50% of patients.

Front 56

describe deep calf thrombosis:
(4)

Back 56

1. thrombi usually small.
2. usually asymptomatic.
3. can extend into proximal veins.
4. lower rate of PE.

Front 57

8 signs/ symptoms of DVT:

Back 57

1. suually unilateral.
2. pain & tenderness.
3. swelling.
4. warmth and maybe discolouration.
5. distal edema.
6. prominent superficial veins.
7. fever or chills.
8. 50% have had silent PE.

Front 58

How to evaluate DVT?

Back 58

1. trendelenburg test.
2. homan's sign doesn't work.k
3. ultrasound/dopper.
4. Wells Score

Front 59

what are the items in Wells score?

Back 59

1. active cancer.
2. paralysis, paresis, or recent plaster immobilization of LE.
3. recent bedridden >3 days or major surgery within 4 weeks.
4. localized tenderness along DV distribution.
5. swollen entire LE.
6. calf swelling by 3cm.
7. pitting edema.
8. collateral superficial veins.
9. no alternate diagnosis that is likely.

Front 60

What are PT treatments for DVT?

Back 60

1. walking programs.
2. stationary biking.

Front 61

What is pulmonary embolism?

Back 61

blockage of blood flow through pulmonary artery.

Front 62

What are signs and symptoms of PE? (7)

Back 62

`. dyspnea.
2. tachypnea.
3. pleuritic chest pain.
4. persistent cough.
5. hemoptysis.
6. cyanosis.
7. pleural rub.

Front 63

What are treatment options of PE?

Back 63

1. anticoagulants.
2. tPa.
3. vena cava filter.
4. surgical resection.
5. DVT prevention.