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Early patient encounter > EPE > Flashcards

EPE Flashcards

1
Q

Enumerate errors due to misinterpretation of diagnostic test

A

Age
Sex
Ethnicity
Pregnancy
Body position
Chance
Lab error
Spurious (in vitro) results

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2
Q

is the tendency to prematurely close decision-making process and accept diagnosis before it and other possiblities have been fully explored

A

premature closure

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3
Q

Is when things are at the forefront of your mind because you have seen several cases recently or have been studying that condition

A

Availability bias

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4
Q

The tendency to look for the prototypical manifestation of disease and fail to accept another atypical variant

A

Representativeness bias

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5
Q

Is the tendency to look for confirming evidence to support a theory rather than looking for disconfirming evidence to refute it, even if the latter is clearly present

A

Confirmation bias

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6
Q

Is the tendency to believe we know more than we actually do, placing too much faith in opinion instead of gathered evidence

A

Overconfidence bias

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7
Q

the tendency to favor a diagnosis suggested by the patient rather than entertain another possibility

A

patient self-labeling

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8
Q

Psychiatric patients who present with medical problems are under-assessed, under-examined and under-investigated because problems are presumed to be due to their psychiatric condition

A

Psych-out error

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9
Q

Refers to the influence of either negative or positive feelings towards patients, which can affect our decision-making

A

Visceral bias

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10
Q

Describes the common human tendency to rely too heavily on the first piece of information offered (the “anchor”) when making decisions

A

Anchoring

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11
Q

What are the steps to reach diagnosis

A

Medical history
Physical examination
Data interpretation
Differential Diagnosis
Diagnostic studies

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12
Q

How to generate a differential diagnosis

A

Collect data

Distill the data into pertinent positive and negative findings

Create a problem presentation

Ad

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13
Q

Premise 1: anemia is a hemoglobin below the normal value

Premise 2: The patient has a hemoglobin below the normal value

Conclusion the patient is anemic

This reasoning is called

A

Deductive reasoning

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14
Q

Evidence: the patient has vomited blood. His hemoglobin 73 g/L. He is hypotensive and tachycardia. He has complaining of epigastric pain and and duodenoscopy showed a gastric ulcer

Conclusion: we are reasonably certain that the patient has a bleeding gastric ulcer

This type of reasoning is

A

Inductive reasoning

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15
Q

The patient has vomited blood. His hemoglobin is 73 g/L. He is hypotensive and tachycardia. We have no other history. The most likely cause (our best guess) is bleeding from upper gastro-intestinal tract

This type of reasoning is

A

Abductive reasoning

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16
Q

Illness script includes a summary of diagnosis which should list

A

Predisposing factors
Pathophysiology
Clinical findings

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17
Q

Give an account on clinical reasoning phases

A
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18
Q

Causes of primary hyperlipidemia

A

Onset of premature atherosclerotic disease

Physical signs of dyslipidemia

A family history of premature atherosclerotic disease or sever hyperlipidemia

Serum cholesterol > 190 mg/dL

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19
Q

Secondary (acquired) hyperlipidemia

A

Unhealthy diet and poor lifestyle regimen

Diabetes mellitus

Chronic kidney disease

Alcohol overuse

Hypothyroidism

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20
Q

Screening for hyperlipidemia could be done using

A

fasting lipid profiles

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21
Q

It is recommended that all men aged ___ or older and all women aged ___ or older be screened routinely for lipid disorders

A

35

45

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22
Q

Modifiable risk factors for atherosclerosis

A

Type 2 diabetes
Hypertension
Smoking
Dyslipidemia
Chronic kidney disease
Obesity
Metabolic syndrome

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23
Q

Used to calculate 10-year-ASCVD risk

A

Pooled Cohort Equation (PCE)

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24
Q

Primary prevention: Life style changes to reduce risk of ASCVD (DIET)

A

Mediterranean diet (high in vegetables, legumes, nuts and fish) is recommended

Replace saturated fats with monosaturated and polysaturated

Patient should reduce amount of sodium

25
Q

Primary prevention: Life style changes to reduce risk of ASCVD (EXERCISE)

A

At least 150 minutes per week of moderate-intensity activities

75 minutes a week of vigorous-intensity physical activities

26
Q

Primary prevention: Life style changes to reduce risk of ASCVD (OTHER)

A

Obesity: risk for ASCVD

Tobacco use: risk for ASCVD

Statin use: recommended if the 10 year ASCVD risk is high, statin should be used to reduce LDL

In any patient aged between 40-75 years with type 2 DM

In any patient aged between 40-75 with LDL exceeding 190

Aspirin: antithrombin (not recommended)

27
Q

Secondary prevention therapy for ASCVD

A

Anti-thrombin therapy is recommended unless contraindicated

28
Q

Common cause of low back pain

A

70% Lumbar “strain” or “sprain”

10% Degenerative changes

4% Osteoporosis compression fractures

Spinal stenosis

29
Q

History taking for acute low back pain steps

A

Duration of symptoms and onset

Location

Character or description of pain

Grading of pain

Relieving or exacerbating factors

30
Q

No relief with bed rest or worse at night may raise the red flag for

A

Cancer

31
Q

Morning stiffness points towards

A

Ankylosing Spondylitis

32
Q

Enumerate the red flags of acute lower back pain

A

Trauma
Unexplained weight loss
Neurological symptoms
Ages above 50
Fever
Intravenous drug use
Steroid use
History cancer

33
Q

What are the associated symptoms of acute lower back pain

A

Neurological history

Constitutional symptoms

History of cancer, IV, drug abuse or infections

Any previous spinal surgery

Any medications such as corticosteroids

34
Q

Numbness, weakness, bowel or bladder symptoms is a red flag for

A

Cauda equina

35
Q

Constitutional symptoms such as fever or unexplained weight loss is a red flag for?

A

Cancer

36
Q

Any medications such as corticosteroids can raise red flag for?

A

Compression fractures

37
Q

Physical examination for acute lower back pain

A

Observe gait and posture

Range of motion

Palpitation of spine

Palpitation of sciatic notch

38
Q

Pain increase by flexion reflects usually caused by

A

mechanical stress

39
Q

Pain precipitated by extensions is indicative of

A

Spinal stenosis

40
Q

Point of tenderness may indicate a

A

fracture or infection

41
Q

Para-spinal tenderness indicates

A

muscle spasm

42
Q

Tenderness of the sciatic notch with radiation to the leg indicates

A

nerve root compression

43
Q

X-ray, CT, MRI may be warranted for

A

worsening of symptoms despite proper treatment

44
Q

is risk factor for progression to diabetes

A

Prediabetes

45
Q

Occurs in adult hood. May be asymptomatic for years, due to immune system attaching b-cell leading to absolute insulin deficiency

A

Type II diabetes

46
Q

What are the risk factors for diabetes

A

Relative with diabetes
Race
History of CVD
Hypertension
HDL and triglyceride level
Physical inactivity

47
Q

Criteria for screening for diabetes or prediabetes in asymptomatic adult

A

Testing should be considered in obese adults

Patients with prediabetes

Women who were diagnosed with GDM tested every 3 years

Other patient test begins at age 35

If test is normal, it should be repeated minimum 3 year interval

people with HIV

48
Q

A1C under 6.4%
FPG: 100-125 mg/dL
OGTT: 140-199 mg/dL

A

prediabetes

49
Q

A1C: over 6.5%
FPG: over 126 mg/dL
OGTT: over 200 mg/dl

A

Diabetes

50
Q

What are the complications of diabetes?

A

Hypoglycemi

51
Q

History taking of diabetes

A

age, characteristic

52
Q

Physical examination for diabetes mellitus

A

Blood pressure, height, weight and BMI

Fundoscopic examination

Skin examination

Comprehensive foot examination

53
Q

If A1C is not available within past 3 months what must be done?

A

Fasting lipid profile, liver function, serum creatinine, GFR

54
Q

for diabetic patient, it is recommended to eat foods containing____

A

long-chain fatty acids such as fatty fish and nuts

55
Q

What it the physical activity recommended for diabetes

A

more than 150 min/week of moderate to intense exercise with no more than 2 consecutive days without exercise

Prolonged sitting should be interrupted every 30 min

56
Q

How to care for diabetic foot?

A

Identify ulcers and amputation. Patients with loss or prior ulceration or amputation must have feet inspected every visit.

57
Q

How to examine diabetic foot?

A

Inspection of the skin

Assessment of foot deformities

Neurological assessment

Vascular assessment

58
Q

When should patients measure their blood glucose level?

A

With adjustment of their drugs

Before driving

During long periods of driving

On sick days

When there are changes in diet and exercise patterns

Early patient encounter (2 decks)

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