Final Exam Study Guide NR601

28 August 2024

**Final Exam Study Guide NR601 **

Glucose Metabolism Disorders

Types of Diabetes

  • Prediabetes:
    • May lead to Type 2 Diabetes.
    • Influenced by lifestyle changes (diet, exercise).
    • Diagnostic Criteria: FPG levels 100-125 mg/dL, OGTT levels 140-199 mg/dL, Hbg A1c 5.7-6.4%.
  • Type 2 Diabetes Mellitus (DM):
    • Affects 90% of diabetics.
    • Characterized by insulin resistance or inadequate insulin production.
    • Diagnostic Criteria: Hbg A1c >6.5% on two separate tests.
    • Influenced by lifestyle factors: family history, ethnicity, age, weight, exercise, diet.
    • Symptoms: Urinary frequency, increased thirst, lack of energy.
  • Type 1 Diabetes Mellitus (DM):
    • Accounts for ~8% of diabetics.
    • Autoimmune destruction of pancreatic beta cells leading to insulin deficiency.
    • Not influenced by lifestyle.
    • Typically diagnosed in childhood or young adulthood.

Initial Treatment Recommendations

  • Type 2 DM: Lifestyle modifications (diet, exercise), oral hypoglycemics, or insulin if necessary.
  • Type 1 DM: Insulin therapy.

Treatment Goals for Older Adults (Kennedy Table 14-2)

  • Adjust goals based on comorbidities, life expectancy, and risk of hypoglycemia.

Hbg A1C Goals Based on Complications (Dunphy p.925)

  • Individualized A1C goals based on the presence and severity of complications.

Weight Loss Recommendations (Kennedy)

  • Gradual and sustainable weight loss through dietary changes and increased physical activity.

Obesity

  • Hypertension, Type 2 DM, cardiovascular diseases, osteoarthritis, sleep apnea.

BMI Classifications (Kennedy)

  • Underweight: BMI < 18.5
  • Normal weight: BMI 18.5-24.9
  • Overweight: BMI 25-29.9
  • Obesity: BMI ≥ 30

Urology and Aging

UTI Risk Factors

  • Increased risk in women due to shorter urethra, postmenopausal changes.
  • In men, enlarged prostate (BPH) increases risk.

UTI Pathophysiology

  • Common bacterial causes: E. coli, Staphylococcus saprophyticus.

UTI Diagnostic Criteria

  • Symptoms: Dysuria, urgency, frequency, suprapubic pain.
  • Diagnosis confirmed by urinalysis (positive nitrites, leukocyte esterase, bacteria).

When to Treat

  • Symptomatic UTIs are treated with antibiotics based on culture and sensitivity.
  • Asymptomatic bacteriuria typically not treated unless pregnant or undergoing urological procedures.

Incontinence

  • Types: Stress, urge, overflow, functional.
  • Management: Pelvic floor exercises, bladder training, medications, surgical options.

Causes of Hematuria and Proteinuria

  • Hematuria: UTI, stones, malignancy, trauma.
  • Proteinuria: Glomerular diseases, hypertension, diabetes.

Sexuality and Aging

STIs

  • Increased risk due to age-related immune changes.
  • Education on safe practices is crucial.
  • Decline in sexual function due to hormonal changes, chronic illnesses, medications.

GSM (Genitourinary Syndrome of Menopause) (Kennedy, NAMS videos)

  • Signs/Symptoms: Vaginal dryness, irritation, urinary symptoms.
  • Diagnosis: Based on symptoms, physical examination.
  • Treatment: Local estrogen therapy, lubricants, moisturizers.

Menopause (Dunphy)

Menstrual Changes Physiology

  • Transition from regular menstruation to cessation, fluctuating estrogen levels.

Symptom Management

  • Hot flashes, mood changes, sleep disturbances managed with lifestyle modifications, hormone replacement therapy (HRT), non-hormonal options.

Erectile Dysfunction (Dunphy)

Diagnosis

  • Patient history, physical examination, hormone levels, nocturnal penile tumescence test.

Treatment – Medications

  • PDE5 inhibitors (e.g., sildenafil, tadalafil): First-line treatment.
  • Consider half-lives and interactions with other medications, particularly nitrates.

Comorbid Diagnoses

  • Commonly associated with diabetes, cardiovascular diseases, psychological issues.

This study guide organizes the content into a structured format, making it easier to review and understand each topic. Use this guide to focus your studies on key areas for the NR601 Final Exam.