EPE Flashcards
Enumerate errors due to misinterpretation of diagnostic test
Age
Sex
Ethnicity
Pregnancy
Body position
Chance
Lab error
Spurious (in vitro) results
is the tendency to prematurely close decision-making process and accept diagnosis before it and other possiblities have been fully explored
premature closure
Is when things are at the forefront of your mind because you have seen several cases recently or have been studying that condition
Availability bias
The tendency to look for the prototypical manifestation of disease and fail to accept another atypical variant
Representativeness bias
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
Confirmation bias
Is the tendency to believe we know more than we actually do, placing too much faith in opinion instead of gathered evidence
Overconfidence bias
the tendency to favor a diagnosis suggested by the patient rather than entertain another possibility
patient self-labeling
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
Psych-out error
Refers to the influence of either negative or positive feelings towards patients, which can affect our decision-making
Visceral bias
Describes the common human tendency to rely too heavily on the first piece of information offered (the “anchor”) when making decisions
Anchoring
What are the steps to reach diagnosis
Medical history
Physical examination
Data interpretation
Differential Diagnosis
Diagnostic studies
How to generate a differential diagnosis
Collect data
Distill the data into pertinent positive and negative findings
Create a problem presentation
Ad
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
Deductive reasoning
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
Inductive reasoning
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
Abductive reasoning
Illness script includes a summary of diagnosis which should list
Predisposing factors
Pathophysiology
Clinical findings
Give an account on clinical reasoning phases
Causes of primary hyperlipidemia
Onset of premature atherosclerotic disease
Physical signs of dyslipidemia
A family history of premature atherosclerotic disease or sever hyperlipidemia
Serum cholesterol > 190 mg/dL
Secondary (acquired) hyperlipidemia
Unhealthy diet and poor lifestyle regimen
Diabetes mellitus
Chronic kidney disease
Alcohol overuse
Hypothyroidism
Screening for hyperlipidemia could be done using
fasting lipid profiles
It is recommended that all men aged ___ or older and all women aged ___ or older be screened routinely for lipid disorders
35
45
Modifiable risk factors for atherosclerosis
Type 2 diabetes
Hypertension
Smoking
Dyslipidemia
Chronic kidney disease
Obesity
Metabolic syndrome
Used to calculate 10-year-ASCVD risk
Pooled Cohort Equation (PCE)
Primary prevention: Life style changes to reduce risk of ASCVD (DIET)
Mediterranean diet (high in vegetables, legumes, nuts and fish) is recommended
Replace saturated fats with monosaturated and polysaturated
Patient should reduce amount of sodium
Primary prevention: Life style changes to reduce risk of ASCVD (EXERCISE)
At least 150 minutes per week of moderate-intensity activities
75 minutes a week of vigorous-intensity physical activities
Primary prevention: Life style changes to reduce risk of ASCVD (OTHER)
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)
Secondary prevention therapy for ASCVD
Anti-thrombin therapy is recommended unless contraindicated
Common cause of low back pain
70% Lumbar “strain” or “sprain”
10% Degenerative changes
4% Osteoporosis compression fractures
Spinal stenosis
History taking for acute low back pain steps
Duration of symptoms and onset
Location
Character or description of pain
Grading of pain
Relieving or exacerbating factors
No relief with bed rest or worse at night may raise the red flag for
Cancer
Morning stiffness points towards
Ankylosing Spondylitis
Enumerate the red flags of acute lower back pain
Trauma
Unexplained weight loss
Neurological symptoms
Ages above 50
Fever
Intravenous drug use
Steroid use
History cancer
What are the associated symptoms of acute lower back pain
Neurological history
Constitutional symptoms
History of cancer, IV, drug abuse or infections
Any previous spinal surgery
Any medications such as corticosteroids
Numbness, weakness, bowel or bladder symptoms is a red flag for
Cauda equina
Constitutional symptoms such as fever or unexplained weight loss is a red flag for?
Cancer
Any medications such as corticosteroids can raise red flag for?
Compression fractures
Physical examination for acute lower back pain
Observe gait and posture
Range of motion
Palpitation of spine
Palpitation of sciatic notch
Pain increase by flexion reflects usually caused by
mechanical stress
Pain precipitated by extensions is indicative of
Spinal stenosis
Point of tenderness may indicate a
fracture or infection
Para-spinal tenderness indicates
muscle spasm
Tenderness of the sciatic notch with radiation to the leg indicates
nerve root compression
X-ray, CT, MRI may be warranted for
worsening of symptoms despite proper treatment
is risk factor for progression to diabetes
Prediabetes
Occurs in adult hood. May be asymptomatic for years, due to immune system attaching b-cell leading to absolute insulin deficiency
Type II diabetes
What are the risk factors for diabetes
Relative with diabetes
Race
History of CVD
Hypertension
HDL and triglyceride level
Physical inactivity
Criteria for screening for diabetes or prediabetes in asymptomatic adult
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
A1C under 6.4%
FPG: 100-125 mg/dL
OGTT: 140-199 mg/dL
prediabetes
A1C: over 6.5%
FPG: over 126 mg/dL
OGTT: over 200 mg/dl
Diabetes
What are the complications of diabetes?
Hypoglycemi
History taking of diabetes
age, characteristic
Physical examination for diabetes mellitus
Blood pressure, height, weight and BMI
Fundoscopic examination
Skin examination
Comprehensive foot examination
If A1C is not available within past 3 months what must be done?
Fasting lipid profile, liver function, serum creatinine, GFR
for diabetic patient, it is recommended to eat foods containing____
long-chain fatty acids such as fatty fish and nuts
What it the physical activity recommended for diabetes
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
How to care for diabetic foot?
Identify ulcers and amputation. Patients with loss or prior ulceration or amputation must have feet inspected every visit.
How to examine diabetic foot?
Inspection of the skin
Assessment of foot deformities
Neurological assessment
Vascular assessment
When should patients measure their blood glucose level?
With adjustment of their drugs
Before driving
During long periods of driving
On sick days
When there are changes in diet and exercise patterns
