Aquifer Case 2: 55 yo male Wellness Visit Flashcards
what is the RISE mnemonic or preventative visits?
Ⓡisk factors: identify risks for serous medical conditions during history and PE
Ⓘmmunizations
Ⓢcreening tests
Ⓔducation
what are the most frequent causes of death for a 55 year old male in the US?
- malignant neoplasm
- heart disease
- unintentional injury (accident)
- chronic lower respiratory disease
- diabetes mellitus
- chronic liver disease and cirrhosis
- CVA
what are the risk factors for cardiovascular disease?
major risk factors:
1. HTN
- high cholesterol
- DM
- tobacco
minor risk factors:
1. sedentary
- stress
- premature family history
- excess alcohol
- obesity/diet
how often should you asses CVD risk factors?
every 4-6 years in adults 20-79 who are free from ASCVD (according to the American College of Cardiology/American Heart Association)
what are the 3C’s of addiction?
Ⓒompulsion to use
lack of Ⓒontrol
continued use despite adverse Ⓒonsequences
what are the five A’s of counseling for behavior change?
Ⓐddress the behavior needing change
Ⓐssess for interest in behavior change
Ⓐadvise on methods to change behavior
Ⓐssist with motivation to change behavior
Ⓐrrange for followup
what are the stages of behavior change?
- pre-contemplative
- contemplative
- active
- relapse
how effective are oral medications in helping smokers quit?
somewhat effective
quit rate at 12 months is 1.5-3 times the placebo quit rate
most smokers quit multiple times before being actually successful; smoking is a chronic disease
what interventions improve smoking quit rates?
- when patients are engaged in a group setting
- oral medications are somewhat effective at helping people stop smoking, with quit rates at 12 months 1.5 to 3 times the placebo quit rate
- when combined with medication, a series of one-on-one counseling sessions (as in a physician’s office) enhances quit rates
- providing practical problem-solving skills, assistance with social supports, and use of relaxation/breathing techniques can increase quit rates
- financial or material incentives such as those provided in the workplaces, clinics and hospitals appear to increase cessation rates while in place.
which medications help with smoking cessation?
bupropion is DOC
varenicline is reserved for people who fail bupropion due to side effects
what are the effects of moderate alcohol intake?
- small increase in HDL
- prevent platelets from sticking together = decreased clot formation = decreased MI and stroke risk
this is all under research and AHA doesn’t recommend drinking wine/other alcohol to gain these potential benefits
what are the effects of red wine?
flavonoids and other antioxidants in red wine can reduce heart disease risk but this is all inconclusive
what is the screening tool for alcoholism?
- AUDIT = alcohol use disorders identification test –> 10 questions
- AUDIT-C is only 3 questions on a scale of 0-12 where 4 in men and 3 in women is positive:
a) how often do you have a drink containing alcohol
b) how many standard drinks containing alcohol do you have in a typical day
c) how often do you have six or more drinks on one occasion
3. SASQ = single-item alcohol screening questionnaire = how many times in the past year have you had 4/5 drinks in a day (women vs. men)
what are ways to get a complete nutrition history?
- 24-hour dietary recall
- daily dietary intake record aka food diary
- food frequency questionnaire
- usual diet history
make sure to include dining out habits and frequency of consumption of fruits, vegetables, meats, poultry, fish, dairy, and dessert
what is a 24 hour dietary recall?
ask about each meal separately
WAVE = Weight, Activity, Variety, Excess
what is a food frequency questionnaire?
food intake over the period of a month
REAP = Rapid Eating and Activity assessment for Patients = questionnaire that assesses diet related to the food guide pyramid and dietary guidelines
what do you need to hit on when taking a family history?
- review documented family history
- ask specifically about immediate family members
- check for new diagnoses
how do you calculate BMI?
BMI = weight in kg/height in m^2
what are the normal, overweight and obese ranges for BMI?
underweight = below 18.5
normal = 18.5-24.9
overnight = 25-29.9
obese = 30+
what are the PE finding associated with dyslipidemia?
- corneal arcus
- xanthelasmas
- acanthosis nigricans
what are the ABCDE of suspicious skin lesions?
Ⓐsymmetry Ⓑorder irregularity Ⓒolor non-uniform Ⓓiameter 6+ mm Ⓔvolution/change over time
what is the recommendation for zoster vaccine?
should be given to every adult at 50
it’s a 2 vaccine series given 2-6 months apart
adults over 60 who previously go the live zoster vaccine should be revaccinated with the recombinant vaccine
which condition are indications for the PPSV23 vaccine?
- immunodeficiency
- HIV
- CKD
- cancer
- anatomical or functional asplenia =
- cerebrospinal fluid leaks or cochlear implants
- CHD
- smokers
- nursing home residents
- high risk indications for HepA, HepB or MMR vaccine
what is the USPSTF grading system for recommendations?
A: The USPSTF recommends this service. There is high certainty that the service improves health outcomes; net benefit is substantial
B: 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
C: The USPSTF recommends selectively offering or providing this service to individual patients based on professional judgment and patient preferences. There is at least moderate certainty that the net benefit is small
D: 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
I: There is insufficient evidence to recommend for or against the service
what are the A and B recommendations for a 55 year old asymptomatic male who smokes?
A recommendations
1. colorectal cancer screen for adults 50-75
- HIV screen for adolescents and adults
- syphilis screen for adults at increased risk
- smoking cessation
- high BP
B recommendations
1. alcohol misuse screening
- depression
- DMII for adults 40-70 who are overweight or obese
- obesity
- hepatitis B and C
- latent TB
- lung cancer
C recommendations = prostate cancer
what are the screening recommendations for prostate cancer?
class C = selectively recommended PSA test for men 55-69
what are the benefits and harm of prostate screening?
benefit = prolonged life from early detection and treatment or psychological reassurance they don’t have cancer
harm = serious complication or death from treatment of prostate cancer that would not have caused symptoms if left undetected during his lifetime – pain and discomfort of a prostate biopsy and psychological effects of false positive test results
what are the colon cancer screening recommendations?
starting at age 50 to 75
what are the methods available for colon cancer screening?
- fecal occult blood testing
- sigmoidoscopy
- colonoscopy
- Fecal Immunochemical Testing (FIT Test)
- fecal DNA Testing
- CT Colography
how often should you assess for CVD risk?
every 4-6 years
include HDL and total cholesterol
treat with statins in all patients over 21 with an LDL>190
how do you approach EKG interpretation?
- examine rate, PR interval, QRS, and QT interval
- look for abnormalities in P waves
- assess axis, R wave progression, presence of Q waves and level of voltage
- look for ST depression or elevation and inverted T waves
what EKG changes suggest existing coronary artery disease?
- ST depression or downsloping ST segment (ischemia)
- Q waves (infarction)
- convex ST segment elevation (injury to the myocardium)
