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Family Medicine > Case 2: Male Annual Exam > Flashcards

Case 2: Male Annual Exam Flashcards

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1
Q

RISE Mnemonic for annual visits

A
  1. Risk factors: assess risk factors for serious medical conditions
  2. Immunizations
  3. Screening tests
  4. Educate patients on healthy choices/living
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2
Q

Most frequent causes of death in 55 year old male

A
  • malignant neoplasm
  • heart disease
  • accident
  • diabetes
  • chronic lung disease
  • chronic liver disease
  • cirrhosis
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3
Q

RFs for cardiovascular disease

A
  • sedentary lifestyle
  • stress
  • premature family history
  • excess alcohol use
  • obesity
  • poor diet
  • low selenium
  • high homocysteine
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4
Q

How often to assess major ASCVD risk factors in patients who are free from ASCVD?

A

Every 4 to 6 years in patients 20 to 79

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5
Q

Manifestations of atherosclerotic disease

A

Claudication

Angina pectoris

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6
Q

Claudication

A

Leg pain with activity [peripheral atherosclerotic disease]

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7
Q

Angina pectoris

A

Chest pain with activity [coronary artery atherosclerosis]

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8
Q

Effects of moderate alcohol intake (2)

A
  1. Increases HDL

2. Decreases platelet adherence to one another

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9
Q

Things that increase HDL levels

A
  1. Moderate alcohol intake
  2. Exercise
  3. Niacin
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10
Q

American Heart Association recommendations on alcohol

A

Do not start drinking for heart protective effects if you don’t already drink

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11
Q

Flu vaccine

A

Annually

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12
Q

Tetanus vaccine

A

TDAP between 11-64

Td booster every ten years

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13
Q

Zoster

A

After age 60 (one time)

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14
Q

Vaccines to avoid in immunocompromised patients, close contacts, pregnant women (4)

A

Live vaccines

  • MMR
  • OPV
  • zoster
  • Varicella
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15
Q

Does prevalence affect sensitivity and specificity

A

Yes

Even if high specificity, if low prevalence, number of false positives will be high

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16
Q

USPSTF A

A

The USPSTF recommends this service. There is high certainty that the service improves health outcomes - net benefit is substantial.

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17
Q

USPSTF B

A

The USPSTF recommends this service. There is high certainty that the service improves health outcomes - net benefit is fair or fair certainty that the net benefit is moderate - substantial.

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18
Q

USPSTF C

A

The USPSTF recommends against routinely providing this service. There is moderate or high certainty that health outcomes are not improved - net benefit is small. However there may be occasions that warrant provision of this service in a patient.

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19
Q

USPSTF D

A

The USPSTF recommends against providing this service. There is moderate or high certainty that the service does not have any net benefits or harms outweigh benefits.

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20
Q

USPSTF I

A

There is insufficient evidence to recommend for or against the service.

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21
Q

Recommendations (7) for 55 year old asymptomatic man who smokes (USPSTF A/B)

A 
Colorectal cancer 
Obesity
Diabetes mellitus 
Lipid disorders 
Tobacco use 
Hypertension 
Alcohol misuse
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22
Q

Lung cancer screening

A

Annual screening with low dose CT in patients 55 to 80 with 30 pack year history who are currently smoking or have quit within past five years

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23
Q

Hep C virus screening

A

One time screening for patients born between 1945 to 1965

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24
Q

Depression (Grade B)

A

Screen adults for depression when staff-assisted depression care supports are in place to assure accurate diagnosis, effective treatment, and follow-up

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25
Depression (Grade C)
Do not routinely screen adults for depression when staff assisted depression care supports are not in place
26
2 depression screening questions
1. Over the past 2 weeks have you felt down, depressed, or hopeless? 2. Over the past 2 weeks, have you felt little interest or pleasure in doing things
27
USPSTF Grade D (not recommended) for asymptomatic 55 year old man who smokes
``` Bacteriuria Bladder cancer Pancreatic cancer Testicular cancer Spirometry for COPD Genital herpes Gonorrhea Hemochromatosis Hep B ```
28
USPSTF Grade I (insufficient evidence)
- prevention of MV injuries with seatbelt use and avoiding drinking under influence - family violence - intimate partner violence - illicit drug use - skin cancer - glaucoma - oral cancer - thyroid disease
29
USPSTF Prostate recs
Grade D - risks outweigh the benefits - do not do it!
30
ACS and AUA prostate recs
men 55-69 should discuss with doctors the benefits and side effects of prostate cancer screening and treatment
31
Colon cancer screening options (3)
1. Colonoscopy q10 years 2. Sigmoidoscopy + FOBT q5 years 3. Double contrast enemas q5 years *Rectal exam and test for occult blood are not adequate screening
32
Indications for exercise stress testing
Asymptomatic male pts > 45 yrs with at least one of following: - hypercholesterolemia - hypertension - smoking - family history of premature coronary artery disease
33
AHA diet recommendations for lowering heart disease risk
- eat fish 2x/week (more fatty fish high in omega3 fatty caids) - eat oils in tofu, soybeans, conola, walnuts, flaxseeds
34
Do vitamin C, E, and folic acid reduce heart attacks or strokes?
NO
35
Three Cs of addiction
Compulsion to use Lack of control Continued use despite adverse consequences
36
Five A's of Counseling for Behavior Change
``` Ask/Address the behavior needing change Assess for interest in behavior change Advise on methods to change behavior Assist with motivation to change behavior Arrange for follow up ```
37
Stages of behavior change
Pre-contemplative Contemplative Active Relapse
38
Pre-contemplative stage of behavior change
Not aware of need to change or not interested in changing behavior
39
Contemplative stage of behavior change
Currently interested in changing behavior
40
Active stage of behavior change
Currently making behavior change
41
Relapse stage of behavior change
attempted behavior but not longer making change
42
Screening for alcohol misuse
1. Quantify amount of alcohol drinking | 2. CAGE questions
43
CAGE
Have you ever - felt the need to cut down drinking - felt annoyed by criticism of your drinking - had guilty feelings about drinking - taken a morning eye opener
44
Check fasting lipids how often?
Every 4-6 years after age 21 Draw these labs in fasting state at least 8 hrs after last food intake
45
What is affected by fasting? What stays the same?
Affected: triglycerides Same: LDL-C, HDL-C, total cholesterol
46
Individuals with clinical ASCVD (3)
1) acute coronary syndrome (MI or unstable angina) 2) Stroke or TIA atherosclerotic in origin 3) Peripheral vascular disease
47
Treatment for individuals with clinical ASCVD
High intensity statin
48
Individuals with diabetes 40-75 with diabetes
Moderate intensity statin | High intensity statin if ASCVD risk > 7.5%
49
Individuals > 21 with LDL > 190 (thought to have genetic hyperlipidemia and high ASCVD risk)
High intensity statin
50
Individuals 40-75 with 10 year ASCVD risk > 7.5%
Moderate or high intensity statin
51
Groups > 21 that qualify for statin (4)
- Individuals with clinical ASCVD - 40 to 75 with diabetes - > 21 and LDL > 190 - 40 to 75 with ASCVD risk > 7.5%
52
Low intensity statin (5)
Simvastatin 10 mg Pravastatin 10-20 mg Lovastatin 20 mg Fluvastatin 20-40 mg Pitavastatin 1 mg
53
Moderate intensity statin (7)
Atorvastatin 10-20 mg Rosuvastatin 5-10 mg Simvastatin 20-40 mg Pravastatin 40-80 mg Lovastatin 40 mg Fluvastatin 40 mg bid Pitavastatin 2-4 mg
54
High intensity statin (2)
Atorvastatin 40-80 mg Rosuvastatin 20-40 mg
55
ASCVD risk factors (7)
- age - gender - hypertension - systolic blood pressure - total and HDL cholesterol - diabetes - smoking status
56
To reduce LDL cholesterol
- reduce calories from saturated fats (animal fats, coconut oil, palm oil) to 5% - reduce trans fats (hydrogenated oils, vegetable shortenings, pre packaged baked goods and chips)
57
Exercise recommendation for low cholesterol
Moderate to vigorous intensity physical activity 3-4 times/week for 40 minutes/session
58
ECG changes that suggest coronary artery disease (3)
1. ST segment depression or downsloping ST segment (ischemia) 2. Convex ST segment elevation (acute injury) 3. Q waves > 25% of succeeding R wave and > 0.04 seconds (infarction)
59
U waves abnormal when
>1.5 mm in any lead
60
1.5 mm U wave associated with (9)
- bradycardia - hypokalemia - hypercalcemia - hypomagnesemia - drug effects: digitalis, quinidine, procainamide - CNS disease - hyperthyroidism - left ventricular hypertrophy - mitral valve prolapse
61
Annual quit rates for smokers without any medical interventions
2-3%
62
Interventions that help quit rates (6)
- group setting/with significant other - oral medications - one on one counseling - practical problem solving skills practice - social supports - relaxation/breathing techniques
63
Meds for smoking cessation
1. Buproprion (first line) | 2. Varenicline (if failed buproprion or pt specifically requests it)
64
How to take buproprion
Start one week before quit date - one pill first three days - two pills (one morning, one evening) for remainder - at day7: stop smoking and continue pills - gradually stop pills after 2 months on pill
65
JNC 8 Hypertension guidelines (3)
1. Age < 60 (general population): < 140/90 2. Age ≥ 60 (general population): < 150/90 3. All ages w CKD or DM: < 140/90
66
Anti HTN in general non black population (including those with diabetes)
First line: thiazide diuretic, CCB, ACEI, or ARB
67
Anti HTN in general black population (including those with diabetes)
First line: thiazide diuretic or CCB
68
If population > 18 with CKD
Initial (or add on): ACEI or ARB to help improve kidney outcomes - this applies to all CKD patients regardless of race or diabetes status
69
If goal BP is not reached within a month of treatment
a) increase dose of initial drug or b) add second agent: thiazide, CCB, ACEI, ARB * *If BP still not controlled, continue to titrate or add another agent (do not use ACEI or ARB in same patient) * *If BP still not controlled with 3 drugs use anti-HTN from other classes
70
Exercise recommended for patients with MSK problems (arthritis)
Swimming | Water jogging
71
CV fitness exercise
40 minutes 3 times a week
72
Weight loss exercise
20-40 minutes every day
73
Intensity guideline metrics
Target heart rate | Estimated rate of perceived exertion (RPE)
74
Target heart rate formula
THR = (220-age) x 0.8
75
Borg perceived level of exertion scale - patients should exercise at what level?
12-14 (somewhat hard: quite an effort, feel tired but can continue)
76
Managing high risk for ASCVD risk
1. Start aspirin 2. Begin moderate to high intensity statin 3. Consider exercise stress test 4. presence of high sensitivity CRP is a minor RF for ASCVD which might be helpful if there was clinical uncertainty

Family Medicine (10 decks)

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