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Assessment & Evaluation Flashcards

1
Q

5 A’s of Motivational Interviewing

A

Ask
Assess
Advise
Agree
Arrange/Assist

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2
Q

HPI

A

-age of onset
-highest weight ever? lowest or best weight
-rate of gain: 1 yr ago, 1 mo ago
-inciting factors: any major life events
-past weight loss attempts/surgeries & outcomes
-motivations
-nutrition understanding

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3
Q

Psych screens
-Trauma
-Anxiety
-Depressions

A

-Trauma: PCL-5
-Anxiety: GAD7
-Depressions: PHQ9

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4
Q

Sedentary time risk

A

> 3h/day increases CV risk

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5
Q

Family History & risk of obesity

A

40%- 1 sibling
50%- 1 parent
80%- 2 parents
90%- monozygotic twin

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6
Q

Sleep & risk of obesity
-ideal
-short
-very short

A

-ask about duration, quality, etc

-ideal 7-8 hrs
-short 5-6 hrs, 20% inc. overweight, 57% inc. obesity
-very short, <5 hrs, 30% inc. overweight, 2x inc. obesity

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7
Q

Screens for OSA

A

-STOP-BANG more sensitive
-Epworth Sleepiness Scale more specific

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8
Q

PMH that may require Rx alternatives

A

-palpitations
-nephrolithiasis
-seizures

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9
Q

Body fat % and obesity cutoffs
-NHANES
-ACE
-OMA

A

(Male, Female)
-NHANES: 32, 44
-ACE: 25, 32
-OMA: 30, 35

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10
Q

Waist Circumference for abdominal obesity (WHO)
-M, F, cm, in
-Asian

A

(M, F)
-94, 80 cm inc. risk [37, 31.5 in]
-102, 88 cm highest risk [40, 34.5 in]

Asian: 90, 80 cm [35.5, 31.5 in]

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11
Q

Body Comp Analysis: 8 methods (and limitations of each)

A

1- Calipers (user dep, not optimal at high BMI)
2- DXA (not all can distinguish visc & subQ, machine wt limits @ high BMI)
3- Air plethysmography [Bod Pod] (clothing and Hydration dependent)
4- BIA (Hydration dependent, no exercise for 8 hrs, try BM before, no caffeine or EtOH x 12 hrs, keto diet can affect bc diuresis)
5- Underwater weighing densitometry (time-consuming, need adequate exhalation)
6- CT/MRI (weight limits)
7- Deuterium Oxide dilution hydrometry (not commercially available)
8- Indirect Calorimetry [Metabolic cart]

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12
Q

PE:
-scale
-BP cuff sizes

A

-scale up to 600 lbs

-BP level w heart after 5’ rest
L: 14.2-17.7
XL: >17.7 (45 cm)

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13
Q

OSA findings:
-Neck circ
-Mallampati

A

M: >17”
F: >16”

Mallampati 3 or 4

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14
Q

Acne associated with (2)

A

PCOS
Cushings

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15
Q

Acrochordons associated with…

A

= skin tags
insulin resistance

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16
Q

Bruising assoc with…

A

Cushing
Hypothyroid
Vit def
Lipedema

17
Q

Hyperpigmentation assoc with…

A

Acanthosis nigricans - IR & DM
Hyperpig w Cushings

18
Q

Dry & scaly skin assoc w…
-heels

A

Hypothyroid
Nutrient def
-Heels: above plus DM & EFA deficiency

19
Q

Differences (dist, gender, age onset, pain, assoc, genetics)
-MSL-osis (Madelung, Launois), HIV
-DD, FMLosis
-Lipedema, APL-ophy

A

[] = lookalike condition

-MSL-osis (Madelung, Launois) [HIV]
1. upper (can be global in women)
2. males
3. adult
4. no pain
5. neuropathy, EtOH
6. AD or AR, **tRNALys mut uncommon

-DD [FMLosis]
1. global
2. female
3. any age
4. +pain
5. AutoI dz, DM
6. AD, sex influence

-Lipedema [APL-ophy]
1. Legs +/- arms, **feet spared
2. female only
3. pub-20’s
4. +pain
5. lymphedema
6. AD, incomplete penetrance, sometimes +FH

20
Q

TDEE =

A

5 components:

RMR (60-75%) +
TEF (10%) +
NEAT (150-500 cal/d) +
EPOC +
Exercise (15-30%)

21
Q

RMR formulas (2)

A
  1. Mifflin-St Jeor best for obesity (factor of 10x weight)
  2. Harris Benedict, wt also heavily factored
22
Q

BMR vs RMR

A

BMR = 12 hr fast, first thing in AM, dark room, recumbent, calm
RMR = less stringent

23
Q

RQ

A

= CO2 prod / O2 consumption

Carbs - 1.0
Fat - 0.7

24
Q

EKG indications

A

-symptomatic
-risk factors (DM, obesity, met synd)
-strong FH cardiac dz
-meds
-pre-exercise eval
-pre-op eval

25
Q

EKG findings in obesity

A

-L axis dev
-T wave
-PAC’s w OSA
-Hypertrophy (HTN)
-QT abnL

** many reversivle w substantial wt loss!

26
Q

STOP-BANG

A

Snoring
Tiredness
Obs apnea
Pressure (HTN)
-
BMI
Age
Neck circ
Gender

27
Q

AHI

A

5-15/hr - mild
15-30 - mod
>30 - severe

28
Q

DM vs pre-DM cutoffs

A

Pre-DM:
A1C = 5.7-6.4
FG = 100-125

DM:
A1C >= 6.5
FG >= 126

29
Q

IR

A

-fasting insulin >= 25

-HOMA-IR:
0.5-1.4 normal
>1.9 early
>2.9 significant IR

-TG:HDL >2.5 in women, >3.5 men

30
Q

Some slides left out… testing alg for Cushing, etc

A

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