Case 2 - 55 yo male annual exam

Question 1

Cardiovascular disease risk factors

Answer 1

sedentary lifestyle, tobacco use, high stress, poor diet, obesity, older age, male gender, family history

Question 2

Stages of behavior change

Answer 2

1. Pre-contemplative: not aware of need to change or not interested in changing
2. Contemplative: currently interested in changing behavior
3. Active: currently making a change
4. Relapse: attempted behavior change, but no longer making the change

Question 3

Nutrition history

Answer 3

• number of meals and snacks in a 24 hour period
• dining-out habits
• frequency of consumption of fruits, vegetables, meats, poultry, fish, dairy, desserts

Question 4

Strategies for more complete nutritional history

Answer 4

• 24 hour dietary recall
• WAVE - weight, activity, variety, excess
• Food frequency questionnaire - food intake over a month
• rapid eating and activity assessment for patients - whether patient shops or cooks, and how willing they are to eat healthier
• Dietary intake records (food diaries)

Question 5

BMI - how to measure? classifications?

Answer 5

BMI = weight in kg/ height in m2
Normal = 18-25 
Overweight = 25-30
Obese - greater than 30
Morbidly obese - greater than 40

Question 6

Screening for 55 year old male

Answer 6

Prostate cancer screening - USPTF recommends against PSA, ACS recommends PSA after age 50
Colon cancer screening - colonoscopies after 50
Lung cancer screening - USPTF does not recommend lung cancer screening
Labs: lipids, glucose (fasting)

Question 7

Smoking cessation counseling (5 As)

Answer 7

1. Ask or address behavior needing change
2. assess interest in behavior change
3. advise on methods to change
4. assist with motivation
5. arrange for follow-up

Question 8

Treatment for smoking cessation

Answer 8

• oral medications somewhat effective (1.5-3 times placebo)
• annual quit rate without meds = 2-3%
• counseling has been shown to help

Question 9

Initial management of obesity, hyperlipidemia, hypertension and elevated glucose

Answer 9

educate patient, obtain stress test, start 81mg aspirin daily, repeat fasting lipid panel in three months, counsel with nutrition and exercise, follow up in one month

Question 10

Exercise prescription

Answer 10

• for cardiovascular fitness: 30 minutes three times per week
• THR = 220-age * 0.8