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Family Medicine > Case 2: Male Annual Exam > Flashcards

Case 2: Male Annual Exam Flashcards

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
Q

Depression (Grade C)

A

Do not routinely screen adults for depression when staff assisted depression care supports are not in place

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26
Q

2 depression screening questions

A
  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
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27
Q

USPSTF Grade D (not recommended) for asymptomatic 55 year old man who smokes

A 
Bacteriuria
Bladder cancer
Pancreatic cancer
Testicular cancer
Spirometry for COPD
Genital herpes
Gonorrhea
Hemochromatosis
Hep B
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28
Q

USPSTF Grade I (insufficient evidence)

A
  • 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
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29
Q

USPSTF Prostate recs

A

Grade D - risks outweigh the benefits - do not do it!

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30
Q

ACS and AUA prostate recs

A

men 55-69 should discuss with doctors the benefits and side effects of prostate cancer screening and treatment

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31
Q

Colon cancer screening options (3)

A
  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
Q

Indications for exercise stress testing

A

Asymptomatic male pts > 45 yrs with at least one of following:

  • hypercholesterolemia
  • hypertension
  • smoking
  • family history of premature coronary artery disease
33
Q

AHA diet recommendations for lowering heart disease risk

A
  • eat fish 2x/week (more fatty fish high in omega3 fatty caids)
  • eat oils in tofu, soybeans, conola, walnuts, flaxseeds
34
Q

Do vitamin C, E, and folic acid reduce heart attacks or strokes?

35
Q

Three Cs of addiction

A

Compulsion to use
Lack of control
Continued use despite adverse consequences

36
Q

Five A’s of Counseling for Behavior Change

A 
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
Q

Stages of behavior change

A

Pre-contemplative
Contemplative
Active
Relapse

38
Q

Pre-contemplative stage of behavior change

A

Not aware of need to change or not interested in changing behavior

39
Q

Contemplative stage of behavior change

A

Currently interested in changing behavior

40
Q

Active stage of behavior change

A

Currently making behavior change

41
Q

Relapse stage of behavior change

A

attempted behavior but not longer making change

42
Q

Screening for alcohol misuse

A
  1. Quantify amount of alcohol drinking

2. CAGE questions

43
Q

CAGE

A

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
Q

Check fasting lipids how often?

A

Every 4-6 years after age 21

Draw these labs in fasting state at least 8 hrs after last food intake

45
Q

What is affected by fasting?

What stays the same?

A

Affected: triglycerides
Same: LDL-C, HDL-C, total cholesterol

46
Q

Individuals with clinical ASCVD (3)

A

1) acute coronary syndrome (MI or unstable angina)
2) Stroke or TIA atherosclerotic in origin
3) Peripheral vascular disease

47
Q

Treatment for individuals with clinical ASCVD

A

High intensity statin

48
Q

Individuals with diabetes 40-75 with diabetes

A

Moderate intensity statin

High intensity statin if ASCVD risk > 7.5%

49
Q

Individuals > 21 with LDL > 190 (thought to have genetic hyperlipidemia and high ASCVD risk)

A

High intensity statin

50
Q

Individuals 40-75 with 10 year ASCVD risk > 7.5%

A

Moderate or high intensity statin

51
Q

Groups > 21 that qualify for statin (4)

A
  • Individuals with clinical ASCVD
  • 40 to 75 with diabetes
  • > 21 and LDL > 190
  • 40 to 75 with ASCVD risk > 7.5%
52
Q

Low intensity statin (5)

A

Simvastatin 10 mg

Pravastatin 10-20 mg

Lovastatin 20 mg

Fluvastatin 20-40 mg

Pitavastatin 1 mg

53
Q

Moderate intensity statin (7)

A

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
Q

High intensity statin (2)

A

Atorvastatin 40-80 mg

Rosuvastatin 20-40 mg

55
Q

ASCVD risk factors (7)

A
  • age
  • gender
  • hypertension
  • systolic blood pressure
  • total and HDL cholesterol
  • diabetes
  • smoking status
56
Q

To reduce LDL cholesterol

A
  • 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
Q

Exercise recommendation for low cholesterol

A

Moderate to vigorous intensity physical activity 3-4 times/week for 40 minutes/session

58
Q

ECG changes that suggest coronary artery disease (3)

A
  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
Q

U waves abnormal when

A

> 1.5 mm in any lead

60
Q

1.5 mm U wave associated with (9)

A
  • bradycardia
  • hypokalemia
  • hypercalcemia
  • hypomagnesemia
  • drug effects: digitalis, quinidine, procainamide
  • CNS disease
  • hyperthyroidism
  • left ventricular hypertrophy
  • mitral valve prolapse
61
Q

Annual quit rates for smokers without any medical interventions

62
Q

Interventions that help quit rates (6)

A
  • group setting/with significant other
  • oral medications
  • one on one counseling
  • practical problem solving skills practice
  • social supports
  • relaxation/breathing techniques
63
Q

Meds for smoking cessation

A
  1. Buproprion (first line)

2. Varenicline (if failed buproprion or pt specifically requests it)

64
Q

How to take buproprion

A

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
Q

JNC 8 Hypertension guidelines (3)

A
  1. Age < 60 (general population): < 140/90
  2. Age ≥ 60 (general population): < 150/90
  3. All ages w CKD or DM: < 140/90
66
Q

Anti HTN in general non black population (including those with diabetes)

A

First line: thiazide diuretic, CCB, ACEI, or ARB

67
Q

Anti HTN in general black population (including those with diabetes)

A

First line: thiazide diuretic or CCB

68
Q

If population > 18 with CKD

A

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
Q

If goal BP is not reached within a month of treatment

A

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
Q

Exercise recommended for patients with MSK problems (arthritis)

A

Swimming

Water jogging

71
Q

CV fitness exercise

A

40 minutes 3 times a week

72
Q

Weight loss exercise

A

20-40 minutes every day

73
Q

Intensity guideline metrics

A

Target heart rate

Estimated rate of perceived exertion (RPE)

74
Q

Target heart rate formula

A

THR = (220-age) x 0.8

75
Q

Borg perceived level of exertion scale - patients should exercise at what level?

A

12-14 (somewhat hard: quite an effort, feel tired but can continue)

76
Q

Managing high risk for ASCVD risk

A
  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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