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ASSIGNMENT 1

How ill you evaluate a 26 year old male coming for the first time with Diabatesmellitus.

I will evaluate this 26 year old male coming for the first time with Diabatesmellitus by detailed assessment of his history of the disease, clinical features, physical examination & laboratory evaluation

1. HISTORY&CLINICAL FEATURES

• Clinical Symptoms

• Dietary habits, weight history

• Physical activity

• Infections, particularly skin, foot, dental and genitourinary organs.

• Symptoms and treatment of complications associated with diabetes: eye, heart, kidney, nerve, genitourinary (including sexual function), and peripheral vascular and cerebrovascular systems.

• Current medications including dietary Supplements and alternative therapies with a focus on medications known to induce diabetes-s (e.g., steroids)

Psychosocial, cultural and economic factors that might influence the management of diabetes

Alcohol/drug use

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2. PHYSICAL EXAMINATION

Weight, height, body mass index (BMI), waist circumference, Hip circumference, & W/H ratio

Cardiovascular system: heart, blood pressure, peripheral vascular including pulses and bruits (abdominal, carotid, femoral arteries)

Thyroid examination

Foot: nails, web spaces, ulcers, pulses, calluses, structural deformities, protective sensation and shoes. Palpation of dorsalis pedis & posterior tibial pulses, ankle brachial index.Propioreception, vibration & monofilament sensation.

Other examinations as guided by the patient's symptoms and/or concerns:

Skin: infections or diseases such as acanthosis nigricans, skin tags

Neurological symptoms: sensory state of hands and feet, muscle wasting, deep tendon reflexes

Mental health: screen for depression and/or anxiety

Dilated retinal examinations.

Referral to a dentist to assess oral health

3. LABORATORY EVALUATION

• Fasting plasma glucose &Posy prandeal plasma glucose•Hb A1C• Lipid profile: total cholesterol, high-density lipoprotein (HDL

cholesterol), low-density lipoprotein (LDL cholesterol) and triglycerides

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• RFT: Serum creatinine & Blood urea GFR Haemogram TSH I in case of dyslipedemia

Liver function test: alanine aminotransferase (ALT) or aspartate aminotransferase (AST)

• Urine: ketones, glucose, protein, microalbuminuria, albumin to creatinine ratio, protein to creatinine ratio and culture if microscopic is abnormal or symptoms of infection present

• Urine micro albumin tests can identify patients with early diabetic nephropathy when intervention may be most effective in delaying or preventing end-stage renal disease. Single tests for urinary micro albumin and urinary creatinine can accurately detect urinary micro albumin excretion.

Biothesimetry, Peripheral arterial Doppler study. ECG, X-ray chest, echocardiogram if needed.

DR.K.A.NAZARJUNIOR ADMINISTRATIVE MEDICAL OFFICERDMO (H), PALAKKAD