02 55 yo male PE Flashcards
RISE mnemonic
Risk Factors
Immunizations
Screening Tests
Education
Most frequent causes of death for 55 yo male
cancer heart disease accident DM lung liver cirrhosis
ACC/AHA guidelines ASCVD risk
assess every 4 to 6 years in adults 20 to 79 who are free from ASCVD
USPSTF grades
A - high certainty substantial benefit
B - moderate certainty moder or high benefit or high certainty benefit is moderate
C - against service, net benefit is small in most patients
D - against, harms outweigh benefits
I - insufficient evidence
A or B screening recs for 55 year old man who smokes
CRC Obesity DM Lipids Tobacco use HTN Alcohol misuse LC if 30 + pack years Hep C one time 1945-1965 Depression
indications exercise stress testing
asx male over 45 with one or more RF (hypercholesterol, HTN, smoking, fam hx premature CAD)
3 Cs of addition
Compulsion to use
Lack of control
continued use despite adverse consequences
Five As of counseling for behavior change
Ask or address the behavior assess for interest Advise Assist with motivation Arrange for follow up
stages of behavior changes
precontemplative
contemplative
active
relapse
suspicious skin lesions
Asymmetry border irregularity color non-uniform diameter > 6 mm evolution or change over time
buproprion instructions fof smoking cessation
start one week before quit date with one pill a day for the first three days, then increase to one pill twice a day, morning and evening
after another four days, stop smoking and conitnue with pills bid
add nicotine gum if necessary
after two months on pills, gradually stop
managing high risk ASCVD
start ASA and moderate-to-high intensity statin
exercise test if appropriate (man) or sxs
approach to ecg
rate, PR interval, QRS, duration, QT inerval
P wave abnormality
axis, R wave progression, Q waves, level of voltate,
ST dep/ele and inverted T waves
