CS 5 Flashcards
What are the obesity related complications?
Back pain, osteoarthritis, atherosclerosis cardiovascular issues, sleep apnea
What are the laboratory studies done for obese patients?
Glucose (HbA1c)
TSH
Lipids
Hepatic enzymes
What is the approach for obese patients?
Underlying conditions causes of obesity, complications of obesity, possible comorbidities
What are the non-medical causes of obesity? Common causes? Endocrine disorder causes?
Sedentary lifestyle, over eating; menopause, pregnancy, sleep deprivation, smoking cessation, medications (sulfonylurea, TCAs, Oral contraception; Endocrine disorder such as hypothyroidism, Cushing disorder
What terminates palpitations caused by supraventricular tachycardia?
Terminate symptoms by vagal maneuvers (coughing and valsalva)
How can premature ventricular contraction present?
Isolated forceful beats at rest
Examples of palpitation?
Irregular, forceful, weird, fast
What substance can cause palpitations?
Caffeine, stimulants, and amphetamine, alcohol abuse or withdrawal
What are the metabolic causes of palpitations?
Hyperthyroidism, hypoglycemia, anemia,Pheochromocytoma
What are the medications that can cause palpitations?
Anticholinergic, vasodilators, bronchodilators, stimulants
What are the neuropsychiatric causes of palpitations?
Insomnia, anxiety disorders
What are the basic markers that are done for patients who have palpitations?
ECG, CBC, glucose, electrolytes, TSH
Preemployment medical evaluations fall into that category?
Access fitness for workers with strain US occupation. Aggressive preventative care, substance-abuse or mental health disorders, general preventative care/wellness examination.
What should be done for patient gives you a form to fill out?
Explain that you were for the format you leave the room and you are mailed to the patient
What should be noted in your patients note for patients with pre-employment visit?
Reason for obvious disqualification for patient to perform the job without public risk
What are the Positive physical examination test done for rotator cuff impingement or tendonopathy? Rotator cuff tear?
Pain with external rotation of the shoulder and abduction. (Subacromial tenderness, normal range of motion with positive impingement test (Neer); Similar to previous, pain with external rotation, Age >40
What are you differential diagnosis for shoulder pain?
Rotator cuff tear or tendonopathy, or impingement, Adhesive Capsulitis, Bicep tendon apathy/rupture, Glenohumeral osteoarthritis
What are the stages of Smoking Cessation?
Precontemplation, Contemplation, Preparation, Action, Maintenance
What are the stages in smoking cessation?
Precontemplation, contemplation, preparation, action, maintenance, identification.
In the stages of smoking cessation what does precontemplation mean?
Not willing to acknowledge negative consequences
What should be the approach to encouraging a patient to quit smoking?
Explain the consequences, personalized risk
What should be the approach in recommending a patient to stop smoking?
Mentioned counseling and drug therapy and Follow up phone calls to reinforce positive changes
What are some questions you can ask in HPI for smoking cessation patients?
Are there any situations that tend to reinforce smoking? Have you tried to quit before? How did it go?
Delineate motivational interviewing for smoker cessation patients?
Indications (comorbid problems), Principles (Acknowledge the resistance to change, discuss discrepancies between behavior and long-term goals, personalize, Enhance motivations for quitting), Technique (OARS) open ended questions reflect Affirmation & summarize the main points
Close encounter for smoking patients?
Identify factors that made me quitting easier or harder,Express preferences on quitting strategies for treatment. Provide a quit date
How would you characterize shoulder pain?
Acute (<2weeks)or chronic, Traumatic or Atraumatic, intrinsic or extrinsic (Including radicular and referred pain), location (anterior, posterior, superior, diffuse)
What are the symptoms for adhesive capsulitis, frozen shoulder syndrome?
Decreased both passive and active range of motion and shoulder joint. Painful and progressive. More stiffness and pain.
Describe the common causes of shoulder pain?
Rotator cuff impingement or tendinopathy, rotator cuff tear, biceps tendinopathy/rupture, glenohumeral osteoarthritis, adhesive capsulitis
How do patients with rotator cuff impingement or tendinopathy present?
Pain with abduction and external rotation shoulder, subacromial tenderness, normal range of motion with positive impingement test (Neer, Hawkins)
How does rotator cuff tear presents?
Similar to rotator cuff tendinopathy however patient is usually less than 40 and there’s weakness with external rotation
How did patience with Adhesive Capsulitis (frozen shoulder) present?
Decreased active and passive range of motion. More stiffness and pain
How Do you patience with bicep tendon apathy/rupture present?
Anterior shoulder pain, pain with lifting carrying or overhead reaching. Weakness is less common.
What two can be damaged and a patient who has a humeral fracture? What can be the results?
Axillary nerve can be injured in proximal humerus fracture, causing sensory loss alongthe lateral aspect of the deltoid region.
Radial nerve can be injured in a fracture of the mid shaft/distal third of the humerus causing wrist drop
What are the bio metric measurements for patients who are obese?
Blood pressure and pulse, weight, BMI, waist circumference
What are the laboratory studies that should be done for obese patients or patients who experience excessive weight gain?
Glucose or hemoglobin A-1 C, TSH, lipids, hepatic enzymes
What are the three parts in evaluating patients with obesity?
Ruling out any underlying disorder’s, complications, comorbid conditions
How is BMI measured?
Weight in kilograms divided by height in meters squared
What is considered severe obesity?
BMI greater than 40 or greater than 35 with weight related complications
What are the differential diagnosis for obesity or weight gain?
Nonmedical causes include sedentary lifestyle or over-eating. Medical causes include pregnancy, menopause, smoking cessation, sleep deprivation, and medications ( oral contraception, sulfonylurea, tricyclic) and endocrine disorder (hypothyroidism Cushing’s syndrome)
What should you say with patients who inquires about weight loss treatment?
I will follow up to address appropriate options for your case
What are the differential diagnosis for palpitations?
Structural heart disease, cardiac conduction disease, medications, other, metabolic disorders, neuropsychiatric disorder’s
What are the structural heart disease that can cause palpitations?
Valvular heart disease, cardio myopathy
What are the Cardiac conduction disease that can cause palpitations?
Atria fibrillion, super ventricular arrhythmia/ectopy , ventricular arrhythmia/ectopy
What are the metabolic disorders that can cause palpitations?
Hyper thyroidism, pheochromocytoma, Hyperglycemia, anemia
Neuropsychiatric disorders that can cause palpitations include?
Anxiety disorders, insomnia
Medication that can cause palpitations include?
Stimulants, vasodilators, bronchodilators, anti-cholinergics
Other substances that can cause palpitations include?
Caffeine, cocaine, amphetamines, alcohol abuse or withdrawal
What are some of the things I look for to support a cardiac source for palpitations?
Irregular heartbeat, prolonged symptoms greater than five minutes, underlying heart disease
How may patients terminate the palpation sensation?
Vagal maneuvers like coughing or Valsalva which suggest supraventricular tachycardia
What question should be asked in family history as a relates to obese patients?
Is there obesity in your family? Do any of your close family members have heart disease diabetes or thyroid disorder?
Questions that should be asked to obesity patients as it pertains to medication?
Do you take any medications? Have you taken steroid medication recently?
What should be discussed during the closing encounter for obesity patients?
Clarify patient’s concerns. Review any complications or comorbidities and additional findings.
What should we do response in a obese patient requires about weight loss treatment to?
Acknowledge their concern and expressed that they will be follow up like to address the appropriate options
When are x-rays necessary for obese patients?
If patient expressed symptoms of osteoarthritis as a pertains to weight-bearing joints
What is benign ectopy?
Occasional skip beats that occur rest and disappears with activity in an otherwise healthy well conditioned patient
What are family history questions should be asked for patients who had palpitations?
Any heart conditions that run in the immediate family? And when your family died unexpectedly at a young age?
What should be done if the pre-employment form ask you to measure blood pressure?
Measure blood pressure
What diagnostic test are very common for preemployment patient?
Fasting glucose, lipid panel, urine toxicology, tuberculin skin test
What test should be ran for preemployment patients who experience high risk exposure?
Chest x-ray and pulmonary function test for patients with inhalation exposure to hazardous particulates
How does the glenohumeral Osteoarthritis present?
Gradual onset of anterior or deep shoulder pain usually caused by trauma.
Decreased active and passive abduction and external rotation
How does Biceps tendinopathy/rupture?
Anterior shoulder pain. Pain with lifting caring or overhead reaching. Weakness is less common
Adhesive capsulitis (frozen shoulder) how does it present?
Decrease passive and active range of motion. More stiffness than pain
What should be done in pre-employment encounter in which there has been and how Laois and exposure to hazardous particulates?
Chest x-ray and pulmonary function test
