Exam 2 Flashcards
1
Q
What’s the female athlete triad?
A
- Disordered eating. 2. Amenorrhea. 3. Osteoporosis.
2
Q
Describe a mechanism and provide an example of how a drug’s actions can be enhanced by food/nutrient consumption
A
- MAOI (phenelzine, Nardil) used to tx depression and anxiety disorders. - Tyramine containing foods causes an increased release of synaptic catecholamine NTs.
3
Q
T/F. Motivational interviewing is a specific construct and technique with guidelines.
A
- False. It is a style of being with people. It is a collaborative conversation style for strengthening a person’s own motivation and commitment to change.
4
Q
What foods boost immune function?
A
Fruits rich in antioxidants: oranges, cantaloupe, papaya, berries. Vegetables rich in antioxidants: sweet potatoes, broccoli, carrots, spinach, bell peppers, asparagus, onions, beets. Protein source: chicken, turkey, fish, beef, dairy, eggs, legumes, soy foods. Omega-3 FA: salon, cold-water fish, nuts, seeds, plant oils Vitamin D sources: fatty fish (salmon, sardines, tuna), fortified foods (milk, OJ, tofu, soy, cereal) Probiotics: yogurt, milk, kefir
5
Q
How is vitamin D tested? What is the health level according to Institute of Medicine?
A
Blood 25-hydroxyvitamin D determines vitamin D status. IOM found 20 ng/mL needed for bone health.
6
Q
Levels of prevention
A
1.) Primordial: prevent penetration of risk factors into population 2.) Primary: limit incidence of dz by controlling causes/risk factors in prone group – no dz yet 3.) Secondary: interrupt the dz before it becomes symptomatic – asymptomatic dz 4.) Tertiary: limit physical and social consequences of symptomatic dz – reduce complications of dz
7
Q
Understand the concepts of primary and secondary prevention.
A
Primary prevention: reduce risk of initial adverse event (before disease dx is made). This is more difficult; often requires that an entire population be treated. May be less cost-effective than secondary. For individuals, this requires accurate estimate risk. Secondary prevention: reduce risk of a new adverse event in pt with known disease. This is mostly for individuals after an adverse event. More intuitive, demonstrated to improve outcomes, cost-effective.
8
Q
Which herbs may cause serious health risks?
A
Belladonna Bitter orange Coltsfoot Comfrey Ephedra Golden ragwort Kava Licorice Goldenseal Lobelia Scotch broom Skullcap
9
Q
What is the screening recommendation for TB in the Asian/pacific islander population?
A
- Screen only high-risk populations: BCG vaccinated, IV drug users, homeless shelter residents, former prisoners, recent arrival from high TB rate country (all countries except Australia, Canada and W.Europe), people at high risk to convert from latent to active (immunocompromised and DM)
10
Q
Signs / symptoms of acute dental pain
A
- Less than 12-24 hours - Short or no resolution with analgesics - +/- swelling - Patient may need to take frequent drinks of cool water to calm tooth
11
Q
What diseases/pathologies is the black/AA population at high risk for?
A
- Cancers: Colon/rectal, prostate, breast - Infant mortality - HIV/AIDS
12
Q
What is Ludwigs angina?
A
- Complication of a dental infection of the floor of the mouth that obstructs the airway
13
Q
What are the screening recommendations for breast cancer in the black population?
A
- Per ACS: mammo q year after 40, clinical breast exam yearly after age 20 - Per USPSTF: mammo q2 years when 50-79 (discuss starting at 40). No CBE or SBE.
14
Q
What is hookah? Risk?
A
Known as Narghile, Shisha, Goza. 45 minutes use = 60 cigarettes smoked. 50x the quantity of carcinogens as a cigarette. Higher levels of chemicals and metals than cigarette. CO levels 8x higher, tar 72x higher, nicotine 4x higher. Results in higher concentrations of nicotine being absorbed. Water is used to “filter” the smoke but does not remove the toxins, some places replaced by alcohol.
15
Q
Prostate CA incidence in black population? Mortality in comparison to whites?
A
- 1 in 5 vs 1 in 6 in general population. If 1st degree relative, 1 in 3. - 2.4 times higher mortality
16
Q
If you were training at an Olympic training facility, what’s on a plate for easy training, moderate training, and heavy training?
A
Easy training: half fruits/veg, quarter lean protein, quarter whole grains + 1 tsp fats.
Moderate training: quarter lean proteins, 1/3 grains, 1/3 fruit/veg + 1 Tbl fats.
Heavy training: half grains, quarter fruit/veg and quarter lean proteins + 2 Tbl fats.
17
Q
What is the screening recommendation for DM in the Hispanic population?
A
- Same as general population. Pre-diabetics who are Hispanic are more likely to convert to DM2 than general population.
18
Q
How can diet improve immune function (in athletes but also people in general)?
A
Immune function is best when person has adequate calories, protein, carbs and fat to maintain energy balance and support exercise energy expenditure. Athlete should consume carbs before/during/after long training to offset suppressive effect of exercise on immune function. Eat foods rich in antioxidants to combat oxidative stress. Lean proteins have iron and zinc for immune function. Omega-3 FA for anti-inflammatory. Vitamin D for immune defense. Probiotics for GI and immune health.
19
Q
What are the three categories of amenorrhea in women?
A
- Women who have never had a menstrual period by age sixteen, 2. Women who have not had a period for 2-3 months or more, 3. Women who have irregular periods that vary from 35 to 90 days.
20
Q
How does the risk of oral cancer when smoking a pipe compare to other tobacco products?
A
2-3.5 times higher
21
Q
Factors that contribute to dental caries
A
- Diet/nutrition - Poor oral hygiene - Xerostomia
22
Q
What are cigars? What are the characteristics of them?
A
“Any roll of tobacco wrapped in leaf tobacco or any substance containing tobacco.” Contain 100-444 mg nicotine, pH 8, over half the nicotine is free so doesn’t have to be smoked to be absorbed, can take 1-2 hours to smoke and the smoke has higher concentrations of toxins.
23
Q
Describe how a drug can alter food intake via alteration in oral intake. Provide an example.
A
- Anticholinergics block salivary secretion = dysphagia, oral infections, esophagitis - Alter taste: clarithromycin (bitter taste), metronidazole (metallic taste) - Antibiotics change flora in oral cavity = opportunistic infections - Antineoplastic agents damage oral mucosal lining
24
Q
What is the righting reflex?
A
- Need to fix things, come up with answers, problem solve, give advice, tell him/her what they need to do, be in control
25
What (and where) are banned substances that athletes should be wary of?
NCAA and IOC (int’l Olympic committee) have banned many substances in foods and beverages not traditionally considered supplements, such as Vitamin Water. Taurine, Caffeine, Guarana seed extract, L-theanine, green tea extract, ecgc, rooibos tea extract or glucosamine
26
Soda that has the worst effect on dental caries according to Dr. Harvey
- Mountain dew
27
Criteria for appropriate screening tests
- Disease should be common enough - Morbidity and mortality of the target condition must be substantial - Effective prevention intervention or therapy must exist. This therapy must give a more beneficial outcome when applied to pre-symptomatic stage than to symptomatic stage. - Applicable to population and suitable for general routine application. - Test accuracy maintained, limited screening-related adverse effects
28
What is the screening recommendation for cervical cancer in the Hispanic population?
- Same as general population
29
According to the National Center for Complementary and Integrative Health Medicine and National Center for Health Statistics, what are the most alternative medicine therapies?
Natural produces Deep breathing (asthma, labor and delivery, emergency situations) Yoga, Tai chi, or Qi Gong Osteopathic/chiropractic manipulations Meditation Special diets Homeopathy Progressive Relaxation Guided Imager
30
What nutrients help healing and in what are they found?
Protein promotes healing. (yogurt, beans, fish, poultry, lean meats) Omega-3 FA (walnuts, soy, flax, fish) Vitamin C aids tissue repair, wound healing, and positive immune function (citrus, tomatoes, kiwi, melons) Vitamin A helps promote cell growth and development (sweet potatoes, carrots, papaya, bell pepper) Zinc is involved in would healing and immune function (almonds, seeds, beef, seafood) Calcium and vitamin D for bone development and repair
31
Characteristics of motivational interviewing
- Collaborative - Goal-oriented - Language of change: DARNCAT (desire, ability, reasons, need, - Elicit and explore person’s own argument for change
32
Foods with high cariogenic potential. Give examples
- High fermentable CHO content - Sticky consistency - Small particles in mouth - Causes pH to fall below 5.5 - Highly processed - Eg: pre-sweetened cereals, breads, muffins, dried fruits, cookies, potato chips
33
How do you monitor sweat rate (calculate fluid loss) and what's the recommendation to replace it?
Weigh before and after a workout to calculate fluid loss. For every pound lost, replace that with 3 cups, or 24 oz, of water.
34
Risk factors for infant mortality in the black population
- Maternal age = 35 - Unmarried mothers - Smokers - Lower income and/or education - Inadequate prenatals - Contributing: maternal preconception health, infection (no vaccines), stress, racism, social/cultural differences
35
What are the classification systems of dyslipidemias?
Fredrickson: based on lipoprotein analysis. 6 types. Doesn’t include HDL, clumsy in practice. Phenotypic: NCEP cut points: Biochemical: based on LDL and HDL levels, coupled with risk factor
36
What are the signs and symptoms of disordered eating?
Likelihood increases ad more signs/symptoms are evident (but does not confirm disordered eating): amenorrhea, dehydration, GI problems, hypothermia (cold intolerance), stress fx (overuse injuries), significant weight loss, muscle cramps, weakness, fatigue, dental/gum problems
37
Describe the use of Chantix for smoking cessation. SE? Contraindicated?
AKA Varenicline. Binds to receptor and to a certain extent activates it, the blocks nicotine from binding. Binds to nicotine receptors, does not dump dopamine. Dosage is increasing from 0.5 mg daily. Comes in self-starter kit, 1 week before stopping nicotine. Off label is used with NR or bupropion. SE: nausea (take with water + banana), insomnia, constipation, flatulence, vomiting, dreams. Contraindicated in pilots, heavy equipment users, seizure hx. Monitor liver function in elderly pts, renal impairment also restricts dosing. Concern for heart and mental effects – not shown in study but drug does not help with fatal self harm, depression, suicidal thoughts and some pts committed suicide.
38
What diseases/pathologies is the Asian/Pacific islander population at high risk for?
Osteoporosis (fewer hip fx than whites, similar rate of vertebral fx)
TB
39
How does the NRT nasal spray work? Benefits and side effects?
Prescription, fastest onset, peak absorption 5-10 min, 2 sprays = 1 dose. Pt 1-2 doses/hr. Do not sniff, swallow or inhale the spray → stomach → pain. SE = nasal irritation, stomach upset, HA, dizziness.
40
How does SHS exposure affect infants/children?
Learning problems due to effects on hippocampus - slows memory development. 2x likely child will become addicted if they start smoking. Bronchitis/PNA, asthma, poor lung development, increases risk of leukemia & URI.
41
How does the absorption of spit tobacco compare to smoking a cigarette?
3-4x that of a cigarette, peak is 20-30 min after using, still absorbing 60 min after removing from the mouth. Decrease acid levels (ammonium bicarbonate) = increase free nicotine (free-basing). Acetic acid increases salivation which increases absorption.
42
How do NRT gum and lozenges work? Side effects?
OTC, leave on tongue (do not chew or crush) the lozenge or stomach pain, chew and park the gum (don’t chew too much or stomach pain). Start with 2 mg if using \>30 min after waking, start with 4 mg if using
43
How does the NRT inhaler work? SE?
Not like an e-cig – absorbed through mouth not lungs. Peak absorption = 15-20 min. 20 min puffing = 4 mg nicotine. SE = irritation, stomach upset, HA, dizziness.
44
What’s the ratio of carbs to protein in chocolate milk?
3 grams carb to 1 gram protein.
45
What are the medications of greatest concerns with patients using CAM?
Anticoagulants (warfarin/Coumadin) Arrhythmia meds Seizure medications Meds to prevent organ rejection
46
What are considered dental emergencies?
- Acute pain - Abscess - Cellulitis - Injury
47
Give an example and mechanism of how a drug sequesters nutrients and alters absorption
- Colestipol (Colestid): anti-lipidemic agent. - This resin sequesters bile salts and prevents entry into circulation, causing its excretion into the feces. In addition to binding bile salts, it will sequester fat-soluble vitamins and increase their fecal elimination.
48
What are the sports food categories, their composition and their primary use?
Sports drinks: primary use is to provide fluid + carb + electrolytes and prevent excess fluid losses in hot or humid environments. Composition is carb based with electrolytes. (15 grams CHO to 8oz) Sports bars: primary use is a portable CHO and protein. Composition is 40-60 g CHO and 6-20 g protein. Sports gels/gummies/chews: primary use is bite sized carbs. Composition is 20-25 g CHO per serving.
49
What is the recommendation on creatine use for athletes?
Athletes should be careful using this supplement since there is no long-term data. Athletes below age 18 should not use creatine at all.
50
When was nicotine and tobacco first regulated by FDA?
2009
51
4 (or 5) Stages of epidemiological transition
1.) Infectious dz / famine 2.) Receding pandemics 3.) Degenerative dz 4.) Delayed degeneration 5.) Inactivity/obesity/DM
52
Recommended ways to help pts with smoking cessation? (Dr. Hoff)
Always ask – many docs don’t. Education & counseling by physicians, allied health workers, organized support groups. Pharmacologic – nicotine delivery.
53
Order of risky behaviors by highest risk of transmission to lowest risk for HIV
- Anal sex - Vaginal sex - Oral sex - Substance use
54
Target heart rate measurement
- 220 – Age = MHR
55
What is Saw Palmetto and how is it used as a supplement? What is the danger/concern?
Comes from a fan palm that grows in southeast; has dark berries that are used as antiseptic and help with coughs. Popular to treat BPH, some will use for milk diuretic or sedative. Caution: If pt has bleeding problem, may increase bleeding time. Overall safe to try.
56
Guidelines for colon cancer screening in average and high risk individuals
- Average: USPTF recommends screening using FOBT, sigmoidoscopy, colonoscopy at age 50 years and continuing to age 75 - Special population: blacks \> whites. Consider screening at age 45. - Special population: 76 to 85 may have considerations for which screening is necessary. Recommendation against screening older than 85.
57
Incidence of breast cancer between white and black populations. What about mortality?
- 40: higher in whites than AA - Mortality = highest in AA at all ages and stages
58
Pulpitis
- Nerve necrosis
59
How long is the duration of treatment for the patch? Risk?
Best results when patch is used for 6 months or longer, target dose x 1m, then decrease by 7-14 mg every 2-4 wks. Risk: site reaction, dependence with long term use, vivid dreams and nausea. Also make sure to give pt another nicotine input for first 24 hrs before the patch reaches steady state.
60
What is echinacea and how is it used as a supplement? What is the danger/concern?
Aka coneflower; Kolbinger’s favorite. It’s a plant from the same family as sunflower, thistle, and black-eyed Susan. In pills, applications and teas – used as immune booster (as effective as Tamiflu early on). Can reduce duration and severity of URI. Problem: quality control, active ingredient. May cause allergic reaction or cause asthma flare.
61
What are the guiding principles for integrative medicine?
1. Holistic care: treating the whole person, physical, emotional, social and spiritual needs. 2. Active learning: these type of clinicians see themselves as teacher and facilitators – the patient is the one who actually produces the healing. 3. Natural healing: your body has the ability to heal itself, these treatments encourage the natural healing process. 4. Prevention: take preventative steps to promote good health.
62
What is Coenzyme Q10 and how is it used as a supplement? What is the danger/concern?
Used in migraine treatment. Studied in Japan for link to improved heart disease, HTN, CHF, PD, and statin induced myopathy. It is manufactured by the body, also contained in meats and fish. Used to produce energy for cell development and repair.
63
Epidemiological triangle
- Agent, host and environment
64
Causes of xerostomia
- Age: reduced salivary flow - Radiation induced - Meds (all the anti meds)
65
According to research, what are the top causes of death in people with diabetes?
Ischemic heart disease (40%), other heart disease (15%), DM, cancer, stroke, infection.
66
Which pt is easier to treat – smoker or chewer? Why?
Harder to treat than smokers because they’re saturating their brain with nicotine. Don’t get addicted as fast as smokers but once addicted, “they’re a nightmare.”
67
4 components of fitness
- Aerobic - Muscular - Flexibility - Body composition
68
Anticariogenic food examples
- Bring pH to original stage, prevents plaque attachment, stimulate saliva - Eg. cheese (tyramine), teas (catechins: black and green)
69
What is the second leading cause of unnecessary deaths?
- Obesity
70
Know the current strategies for reducing cardiovascular risk.
1. Therapeutic intervention in patients with known disease (secondary prevention). 2. Identification and targeting of high-risk individuals (primary prevention). 3. General recommendations for the entire population.
71
What is third hand smoke?
Pollutants from tobacco smoke remain on surfaces and in dust after active smoking has ceased. Re-emitted into gas phase or react with environmental oxidants to produce secondary toxicants. Leads to DNA damage.
72
What study confirmed the relationship of elevated systemic blood pressure with CAD?
Framingham data collected since end of WWII
73
Preventive medicine approaches
1.) Holistic medicine: cooperation among all involved from physical, mental, emotional, social and spiritual aspects 2.) Complementary/alternative medicine (CAM): diverse medical and health care systems, practices and products that are not traditional Western medicine 3.) EBM: care for patient using best research evidence 4.) Integrative medicine: combines both conventional and CAM
74
Describe recovery nutrition for athletes.
Eat or drink 0.7 carb/pound body weight after exercise and again in 2 hours. Protein in addition to carb intake can contribute to body’s increase stores of glycogen for future workout needs. CHOCOLATE MILK. Restore fluids and electrolytes lost in sweat by weighting before and after and replacing lost weight. Begin nutrition recovery within 15-60 min following performance.
75
What is the MOA for Bupropion? Directions for us? Max dose? Side Effects? Safe to use on which pts?
MOA = increased dopamine in reward center mimics nicotine, and may act as nicotinic receptor blocker. Directions = 1-2 weeks before quitting, beginning taking SR 150 mg daily, increase to twice daily on day 4 and continue until no longer needed. Stop smoking 1-2 weeks after starting. Max dose = 300 mg/day.
76
Define guideline
- Best and safest path when managing clinical (esp. difficult) situations
77
Give an example and mechanism by which food/nutrients decrease drug metabolism
- Simvastatin: HMG-CoA reductase inhibitor to tx hypercholesterolemia. - Grapefruit increases bioavailability of drugs through inhibition of CYP 34A in gut and liver.
78
Describe moderate vs vigorous exercise
- Moderate: can carry on conversation. - Vigorous: breathing to hard and fast to carry on conversation
79
Strategies for increasing physical activity globally
- Social, behavioral - Information - Environment - Policy
80
What is synergistic risk?
The idea that risk of CHD summates with more comorbidities (such as HTN, hyperlip, low HDL-C, DM, cigs, LVH)
81
Transtheoretical model stages of change
1.) precontemplation 2.) contemplation 3.) preparation 4.) action 5.) maintenance 6.) termination
82
USPSTF recommendation for HTN screening
- A: Screen adults aged 18 and older
83
Explain synergistic risk with CAD.
The addition of multiple overlapping risk factors significantly increases risk of CAD in a hypothetical 55 year old man or woman. Shows the synergy between the multifactorial risk contributing, including BP, cholesterol, HDL-C, DM, cigarettes, and LVH by ECG.
84
What are the side effects of Wellbutrin? For who is it safe and who should not use? In which patients is Wellbutrin contraindicated.
SE: HA, insomnia (don’t take at bedtime), dry mouth, agitation, seizure, emergent HBP. Safe use: CVD pts, COPD pts, on other antidepressants. Contraindicated: LOC \>39 min in last 5 yrs, skull fx, inter-cranial bleed. Not suggested if pt has seizure hx, brain tumor, stroke, brain surgery, use of drugs that lower seizure threshold like alcohol, anorexia/bulimia, hx abuse (amphetamine high is a result of this drug – triggers relapse).
85
How is ginseng used as a supplement and why is it used? What is the danger/concern?
Used to reduce fatigue in cancer patients as well as antioxidant effect to help some heart disorders; modestly improves thinking and learning new tasks; also improves mood and sleep. Some use for type 2 diabetes Recommended for short term use (3 months or less).
86
The idea that risk of CHD summates with more comorbidities (such as HTN, hyperlip, low HDL-C, DM, cigs, LVH)
False. The opposite is true.
87
How are dyslipidemias managed? (Screening, primary and secondary prevention)
Screening: every adult over 20. Primary prevention: behavior modification through diet/exercise/weight control, etc. sometimes pharmacologic. Secondary prevention: behavior modification as above PLUS pharmacologic through statins, bile acid finders, fibric acid derivatives.
88
Is ovarian CA screen by way of CA-125 marker recommended for screening?
- No, lack of specificity.
89
How can you as a physician help your patient protect themselves in the avenue of alternative medicine?
Information investigation: direct them to the best sites Check your attitude: if you’re closed, they may not be open about what they’re using Look for complementary therapies: usually work better than complete replacement of conventional care
90
States of consciousness
- Walking, dreaming, sleeping and fourth state (restful alertness, which is accessed by transcendental meditation)
91
Relative cariogenicity of water in relation to sucrose in relation to soda?
- Water = 0 - Sucrose = 1.0 - Soda = 1.05
92
What are the concerns with SHS exposure in utero?
Aggressive behavior, conduct disorder, AA/SA, depression, ADHD, cog impairment. Fetal growth retardation, reduced birth rate, cleft/lip palate, worse CF, miscarriage, placental abruption, placenta previa, SIDS.
93
What is the Framingham Heart study?
Showed risk of coronary artery disease and mortality is related to serum cholesterol (total).
94
What is the gold standard in terms of agency for making recommendations about screening?
- USPSTF
95
What are CHD risk equivalents?
ASCVD determines risk equivalents to be – DM, noncoronary atherosclerotic arterial disease (such as peripheral arterial disease, AAA, carotid dz), and multiple risk factors that confer a 10 year risk of CHD \>20%.
96
What options and focuses are there for integrative health education?
50+ institutions – main streaming of acupuncture, massage, nutrition counseling along with conventional treatments. Focus is on chronic disease. Whole medical systems: traditional Chinese medicine, Ayurvedic medicine, homeopathy, naturopathic medicine.
97
What is the screening recommendation for prostate cancer in the black / AA population?
- Start discussion about PSA in 40s - DRE in 40s - Don’t screen with DRE or PSA if life expectancy is \<10 years.
98
What is the most important thing a physician can do for the victim of domestic violence?
- Ask about it. If they deny it once, you can ask about it at the next visit.
99
What are the symptoms of recovery/withdrawal? When do they peak? How long do they last?
Depression, insomnia, irritability, anxiety, difficulty concentrating, restlessness, weight gain, increased appetite, decreased heart rate, craving. Peak within first few days, last several weeks to months.
100
SE with Adolescent tobacco use?
Less physically active, more breathing problems, slowed lung growth, risk of depression, increased suicide attempts.
101
How are supplements regulated (if at all)?
Manufacturers of dietary supplements are not required to obtain pre-market approval from FDA No evidence of positive effect for the majority of supplements sold
102
What did the 20-year follow up study from the Framingham study show regarding DM and CHD mortality? In other studies, what is shown when relating mortality due to heart disease in men and women with or without DM.
Annual CHD deaths per 1000 person… Men: 17 DM vs. 8 non-DM. Women: 17 DM, 4 non-DM. Studies show that ischemic heart disease in men and women, triple the amount of deaths are in men or women with diabetes. Similar statistics are true for the category of all heart disease.
103
What is the CAD risk with HTN?
Best current estimate is linear relationship with dBP: 7mmHg increase = 27% increase in CAD risk. Lowering dBP by 4-6 mmHg reduces CAD risk by 15% and reduces stroke risk by 42%.
104
Define physical fitness
- Good health or physical condition, especially as the result of exercise and proper nutrition
105
Depression. What does it put one at risk for? Screening recommendation?
- Increased risk for morbidity and mortality of chronic dz - USPSTF recommends screening adults
106
Define muscular fitness. Examples of these activities
- Strength and endurance of your muscles - Examples: weights, push-ups
107
Know how and why major risk factors increase the risk of CVD.
CHD is multifactorial. Major: Dyslipidemias HTN Tobacco use DM CRD (renal dz) Major risk factors are synergistic! Other: CRP Age Fmhx Obesity Sedentary life Psychological
108
How is garlic used as a supplement and why is it used? What is the danger/concern?
Allicin gives garlic the aroma – this is responsible for health benefits as an antioxidant. Commonly used to treat HTN, CVD and high LDL. Sometimes used to prevent cancer of stomach & colon – if eaten raw. Caution if using anti-clotting meds.
109
What are NIH’s 6 recommendations?
1. Check with your doctor/provider for who they recommend. 2. Find out as much as you ca about provider-education, training, licensing, and (state) certifications. 3. Is the new provider willing to work with your conventional health provider? 4. Has the provider worked with problems like you have? 5. Don’t assume your health insurance will cover costs. 6. Keep all providers up to date on who you see and what you take.
110
What diseases/pathologies is the Asian/Pacific islander population at high risk for?
- Osteoporosis (fewer hip fx than whites, similar rate of vertebral fx) - TB
111
Explain delayed menarche in athletes.
Intensive physical training and negative energy balance alter the hypothalamic pituitary set point at puberty, prolong the prepubertal stage, and delay pubertal development and menarche in a variety of sports.
112
How important are the major risk factors?
More than 90% of CHD events occur in individuals with at least 1 elevated risk factor.
113
Incidence of physical violence by intimate partner
- About 1 in 4 for women, about 1 in 10 has been raped by an intimate partner - About 1 in 7 for men - Severe physical violence
114
Give an example and mechanism of how food increases absorption of a drug
- Ondansetron (Zofran) = antiemetic. - Absorption of this drug increased in presence of food. Doesn’t appear to alter therapy outcomes.
115
How do we test iron status?
CBC and Serum Ferritin
116
Describe how a drug can alter food intake via alteration in gastrointestinal function. Provide an example.
- NSAIDs decrease PGE2 synthesis resulting in increased acid secretion, decreased mucus secretion and impaired mucosal blood flow. - Anticholinergic agents block Ach-mediated SM contraction. - Antibiotic-induced death of gut flora gives rise to opportunistic infections of GI tract
117
United/unified quantum field alternate names
- Unity, over soul, constitution of the universe, tao, the good and the beautiful, being, the infante, bliss, pure consciousness, unmanifest, samhita, wholeness
118
What does the MRFIT study show?
Diabetes amplifies risk. The CVD death rate/10000 person was higher in people with diabetes than without, and this trend was true for every # of additional risk factors. Deaths in people with diabetes vs. without diabetes and no additional risk factors was 31 to 6. With one RF, was 59 to 12. Two additional RFs was 91 to 22. Three RFs was 125 to 47.
119
Each episode of LGBT victimization increases the likelihood of self-harming behavior by what multiplier on average?
- 2.5 x
120
JNC-8 HTN definition and recommendations for initiation of HTN tx
- 140/90 - \> 60 = 150/90 - Tx at 140/90 if DM and CKD - Initiation of tx: see above. Confirm diagnosis with 2 BP readings 1 to several weeks apart. Watch for FPs (empty bladder, seated at rest x 5 mins, legs uncrossed, arm at heart level, both arms, consider ambulatory BP monitoring, white coat).
121
What makes someone part of a high risk population?
- Biology and genetic factors - Culture - Health disparity
122
Dental caries triad
- Bacteria, CHO and tooth
123
How to treat HTN?
Regular, moderate exercise. Optimize weight. Na reduction. Smoking cessation. Limit alcohol. Adequate K and Ca intake. Lipid-lowering diet. Drug therapy for many, lifestyle alterations for ALL.
124
Give an example and mechanism by which food/nutrients can compete with a drug for renal excretion
- Lithium (Eskalith) = monovalent cation to treat manic-depressive illness. - Lithium competes with Na (at Na/K ATPase) in kidney. High Na diet = more Li excreted = low plasma Li = decreased effectiveness. Low Na diet = less Li excreted (more absorbed) = more plasma Li = increased effectiveness, but potentially too high dose.
125
What is the best post-workout drink (and why)?
Low-fat chocolate milk. Has protein AND carbs.
126
Define health screening
- Identifying apparently healthy individuals who may be at increased risk of a disease or condition.
127
Power 9 according to Dan Buettner
- Move naturally - Purpose - Down shift - 80% rule - Plant slant - Wine @ 5 - Belong - Loved ones first - Right tribe
128
Current recommendations for adult vaccines
- Personal immunity: tdap/td, influenza - Herd immunity: tdap, influenza
129
Vascular studies recommended for CV dz screening
- Per USPSTF, current evidence insufficient to assess balance of benefits vs harms of using non-traditional risk factors to screen asymptomatic men and women with no history of CHD to prevent event. This includes: CRP, ABI, leukocyte count, fasting blood glucose, periodontal dz, carotid intima-media thickness, coronary artery calcification, homocysteine and lipoprotein. - AAneurysm: after age 65 if smoked 100+ packs of cigs in life, screening recommended. - ABI: not a good screening for PVD
130
How is risk assessment done as part of dyslipidemia management?
Basic principle: intensity of ASCVD-preventative therapy is based on individual risk assessment independent of lipid levels. (Higher risk = more than one marker or single severe marker like MI in sibs or smoking.) Screening: lipid profile for well adults \>20yo every 5 yrs.
131
Which of these common OTC drugs may interact with herbals? ASA, pseudoephedrine, Allegra (fexofenadine)
All three.
132
USPSTF grading scale
- A: recommended, high certainty that net benefit is substantial - B: recommended, high certainty that net benefit is moderate - C: recommends against, moderate to high certainty that the net benefit is small - D: recommends against, moderate to high certainty that the screening has no benefit or the harms outweigh the benefits - I: current evidence insufficient
133
What are the forms of spit tobacco?
Chew, Snuff, Snus. Chew: Redman/Beech, loose leaf/long cut, plugs/twist, “bolus” or “wad.” Snuff: MOST USED. Copenhagen & Skoal. Moist or dry, finely ground. 1 can Kodiak = 4 pks cigs. 1 pinch Copenhagen = 25-60 mg nicotine compared to 1mg inhaled in cig. Snus: parked between upper lip and gum. Marketed to women: no spitting. “bridge product.” Decreased TSNA d/t the processing.
134
Describe a mechanism and provide an example of how a drug’s actions can be antagonized/inhibited by food/nutrient consumption
- Warfarin (Coumadin): anticoagulant used to tx DVT and PE. - It inhibits the actions of vitamin K. Inhibitory effects can be overcome by excessive vit K in the diet.
135
Compare and contrast the physician’s vs healer’s goals in terms of achieving health
- Physician: no pain, nml labs, nml PEX - Healer: achieving bliss.
136
Define natural products. Be aware of some of the used Natural Product used by patients today.
Herbal Medicines, botanicals, vitamins, other dietary supplements. Fish oil/omega 3 FA Glucosamine Echinacea Flaxseed oil/pills Ginseng Combination herb pills Ginkgo Chondroitin Garlic supplements Coenzyme Q10
137
Recommendation for daily iron intake?
Women: 18, men: 8mg/day.
138
What is O’Shea’s quick and dirty calculation for normal weight?
- 5’ gives you 100 lb regardless of male/female - Female: each 1” over, add 5 lb - Male: each 1” over, add 6 lb - Allow 5-10% leeway each side for target fitness etc.
139
2013 ACC/ACH guidelines on screening and tx of blood cholesterol
- Assess risk factors q 4-6 years for ages 20-79
- Estimate risk pooled cohort equations for ages 40-79. If low, consider assessing 30 year risk at ages 20-59.
- Tx: four groups recommended to have tx
1. ) Individuals with clinical ASCVD (atherosclerotic CV disease)
2. ) Individuals with primary elevations of LDL \> 190 mg/dL
3. ) 40-75 yo with DM and LDL 70-189 without clinical ASCVD
4. ) Individuals without ASCVD or DM who are 40-75 yo with LDL 70-189 and a 10-year ASCVD risk of 7.5 % or higher
140
St. .John’s Wort may interact with which of the following medication classes? Antidepressants, DM drugs, seizure medications, oral contraceptives, anti-anxiety medications, BP meds (nifedipine, Verapamil).
All of them.
141
Who is at risk for STIs? When to start screening? HPV screening guidelines?
- Anyone who has had intercourse. 24 and younger = high risk group. - Hx of vaginal intercourse, begin screening even with monogamous claim especially in high risk group. Screen with risky behaviors. Screen with urine test (dirty). - HPV: start at 3 years after onset of sexual activity. 30 – 65: co-testing q 5 years or pap only q 3 years. HPV alone not recommended. \>65: stop screening as long as no prior CIN3. After hysterectomy stop screening unless done for cervical CA.
142
From what side of the quantum field do healers project awareness from? Physicians?
- Left side (existence) for healers - Right side (gross reality) for physicians
143
What are the normal responses from patients when encountering the righting reflex? To the empathic style?
1.) Righting reflex response - Not validated - Resist - Withdraw 2.) Empathic style - Affirmed - Accepted - Approach
144
Current screening recommendations for testicular cancer. Which age group is most common incidence of testicular cancer seen in?
- No std or routine screening test for early detection per NCI. Most often found by men first. - Rare, most common cancer in men aged 15-34
145
Body composition is based on what?
- Amount of fat tissue relative to other tissue in your body
146
Is thirst a reliable indicator of hydration status? What percent loss of body weight due to dehydration does thirst indicate?
No. Thirst may indicate a 1% loss of body weight due to dehydration. A 2% loss in fluid can decrease performance by 10-15%.
147
Define mind, body medicine
- Interactions among brain, mind, body and behaviors and ways in which emotional, mental, social, spiritual and behavioral factors can affect health.
148
How to health and wellness differ?
- Health: state of being free from illness or injury - Wellness: physical, mental and social wellbeing - Note: can be healthy and not well, can be near death and still enjoy wellness
149
Risk factors for DM in Hispanic population
- Genetics - Overweight/obesity especially abdominal weight - Sedentary lifestyle - Access to health care - Lower SES
150
What are light cigarettes?
Identified by silver or gold, etc, and claimed to release less nicotine due to perforations in the stick. However there is no such thing because the perforations were blocked by filters swollen with saliva or by the user’s fingers. Also light cigs tend to be long and without a filter – feminine. (More dangerous)
151
Define Integrative Medicine/CAM.
A combination of conventional medicine and alternative medicine, which includes practices for physical, mental, and spiritual health.
152
Most important drug to monitor if pt is quitting tobacco products?
Coumadin: spit tobacco contains high levels Vitamin K – affects Coumadin metabolism more than smoking. It can take up to 2.5 months for Coumadin to regulate as a patient quits spit tobacco.
153
Define sensitivity and specificity
SnNout = Sensitivity, when negative result is obtained on a test with high sensitivity, it rules out disease. Measures proportion of actual positives which are correctly identified.
TP / (TP+FN).
SpPin = Specificity, when positive result is obtained on a test with high specificity, it rules in disease. Measures proportion of actual negatives which are correctly identified.
TN / (FP+TN).
154
What is the screening recommendation for colorectal cancer in the black/AA population?
- Same as general population: age 50 unless personal hx of Crohn’s or FHx of colorectal cancer.
155
How many lb of body fat will you lose if you stand instead of sit for 2.5 hours each day?
- 11 lb
156
Describe the treatments for spit tobacco users.
All treatments are off-label: NRT – gum, patch, lozenge. No nasal spray or oral inhaler. Same dosing for Varenicline (best) and bupropion (not recommended). Titrate up to 3 patches as needed.
157
Risk factor for violence in future relationships
- Unhealthy relationships during adolescence
158
Benefits of quitting tobacco use?
Within 20 min, HR drops. At 12 hours, CO2 levels drop to normal. 2wks-3mo heart attack risk falls and lung function improves. 1-9m coughing and SOB decrease. 1 year: CHD is ½ that of a smoker’s. 5-15 yrs stroke risk it that of a nonsmokers and risk of cancer (mouth, throat, and esophagus) decreases. 10 yrs lung cancer risk is half of non-smoker’s, bladder/kidney/pancreas CA decreases. 15 yrs CHD risk is back to non-smoker risk.
159
SPIKES mnemonic for delivering bad news
- S: setting - P: patient perspective (what patient understands) - I: information (how much do they want to know) - K: knowledge (use plain language, let patient speak) - E: empathize - S: strategize (next steps)
160
Current recommendations for mammography
- 50-74: USPSTF biennial screen - Before 50: biennial screening should be individual decision including patient values. - \> 75: current insufficient to assess benefits and harms - Method for screening: digital mammography or MRI instead of film insufficient evidence
161
Benefits of physical activity
- Maintain healthy weight - Mental health - Builds and maintains healthy bones, muscle and joints - Boosts energy - Improves sleep - PEX reduces risk of dying of heart dz/stroke, developing HTN, cholesterol, DM, obesity, osteoporosis
162
What does research show that fish oil (omega3 FA) help for? What are concerns?
CV disease: reduce risk of MI, stroke, atherosclerosis, preventing blood clots Depression: eating fish lowers risk Hypertension: small reductions Lipids: significantly reduce triglyceride levels, also improve HDL levels, may rise LDL RA: combined with anti-inflammatory meds, shows improved joint pain May improve cognitive function in elderly. Concerns: may increase blood glucose (diabetic pts be careful), heavy metal and toxins, high doses may increase risk of bleeding and lower immune system response.
163
Barriers to delivery of preventive care
- Government: disease care system instead of health care - Patients: lack of knowledge/motivation, cost, anxiety, culture - Clinicians: lack of preventive training, lack of confidence in preventive medicine impact, time, inadequate reimbursement - Office: untrained, lack of teamwork efficacy, focus on disease mgmt. instead of wellness prevention, inadequate tracking/delivery and follow-up
164
How are E-cigs used? Risks?
Vaporizes nicotine in the heater, concern about heavy metal exposure. Cause relapse in former smokers, normalizes use of cigs, nicotine directly to lungs, no legal age for use, gateway to cigs, flavored. Liquid solution composition includes propylene glycol or vegetable glycerin, which are used to thicken suppositories and can coat lungs - also a carcinogen. E-juice or smoke juice is dangerous because lethal adult dose = 40-60mg and child dose = 1mg (1 teaspoon). Refill bottles have up to 7000mg nicotine and are not childproof. Known contents: carbonyls (formaldehyde, acetaldehyde), heavy metals (tin, lead, chromium, cadium, copper, nickel), volatile organic compounds toluene, xylene), and TSNA’s (carcinogenic) – NNN, NAB, NAT, NNK.
165
Signs and symptoms of coronal caries. What about root caries?
1. sensitivity to hot/cold and sweets 2. pain on biting - Note: same signs/symptoms for root caries
166
What are the protein recommendations for athletes?
1.2-1.7 grams protein per kg body mass for athletes. If trying to lose fat mass, in rehabilitation or increase lean body mass, up to 2.0 g/kg. Consume 20-30 grams high quality protein after training and every 4 hours while awake. Eat 2 hours after exercise.
167
How does the patch work?
Long acting, 21mg=17 mg nicotine absorbed, 24 hrs to steady state, apply to clean, clear skin, leave on either 16-24 hrs. FDA approved, do not cause TSNAs to develop, safe and can control dose. Use NRT (nicotine replacement therapy) products in combination with this. Patch is long acting.
168
What does the American Dietetic Association recommend for performance hydration?
(Very individual though) Drink 16 oz 2 hours before activity + another 8-16 oz 15 before activity. Drink 6-12 oz every 15 min during exercise + 24 oz for every pound of weight lost after exercise. If exercise longer than one hour, use sports drink with carbs and small amt sodium to replenish.
169
What’s the prevalence of dyslipidemias in US?
Declining but still very high – 50% US have total chol\>200 mg/dl. 20% above 240.
170
Coping responses for victims of domestic violence
- Disturbances of eating/sleeping - Substance abuse - Depression - Suicide - PTSD
171
Why treat DM in pts to improve CHD?
Tight control of BG in insulin-dependent DM may improve CHD prognosis. Reduced LDL by 34%, reduced CV and PV events by 41%.
172
Describe how a drug can alter food intake via alteration in appetite. Provide an example.
- TCAs (amitriptyline) block H1 in CNS stimulating appetite - SSRIs (fluoxetine aka Prozac) increase accumulation of serotonin in CNS. Suppresses desire to eat and may result in weight loss and anorexia.
173
How should an athlete fuel before exercise?
Consume carb-rich snack or meal before exercise, include small amts of protein in pre-performance meals (reduce soreness in muscles after workout), and choose low fat and low fiber meals to ensure optimal digestion. Eat 3-4 hours before a performance and drink sports drink or water, fruit or jam sandwich, etc. 30-60 min beforehand.
174
Screening recommendation for weight.
- Age 2
175
Bacterial etiology of dental caries
- Strep mutans - Actinomyces genus has been associated with root caries
176
What is the bodily reaction to nicotine use?
Increases HR, BP, RR. Suppresses insulin output. Sudden release of glucose.
177
Function of iron? Types and sources?
Transports oxygen and makes hg. Meat, poultry, fish, egg yolks, iron-fortified cereal/bread/grain, legumes, nuts/seeds, dark green leafy veg, dried fruits. 2 types include heme (animal) and non-heme (plant based). Need heme! – Use cast iron pots to boost iron.
178
Current PSA screening recommendation. Controversy surrounding use/misuse of PSA testing.
- 70 not recommended on any man with less than 10-15 year life expectancy.
179
What is the definition of a cigarette? Why is this important to know?
“Any roll of tobacco wrapped in paper or any substance not containing tobacco.” Contain 21 mg inhaled nicotine per pack (8-14 per cig). Important to know because this relates to product regulation.
180
Why would an athlete need higher vitamin D?
To promote immune function and reduce exercise-related inflammation.
181
Explain how tobacco meets the criteria for addiction?
Habit – learned behavior, practiced (muscle memory) Chemosensory response – mouth, throat, and nose: smell releases dopamine, recycled smoke leads to satisfaction and pleasure (they seek others’ second hand smoke) Brain – Tolerance, withdrawal, and continued use. These three meet criteria for addiction
182
How does the science of epidemiology impact our approach to prevention?
- Epidemiology is used to investigate and protect against the 6 Ds: death, dz, discomfort, disability, dissatisfaction, destitution.
183
Benefits of yoga, pilates and tai chi
- Reduce stress - Increase strength - Increase flexibility - Increase energy
184
How is flaxseed used as a supplement and why is it used? What is the danger/concern?
Whole or crushed mixed with water or juice. Sold in powder, meal or flour forms, liquid or capsule also. Rich source of EFA (alpha-linolenic acid). Treats cholesterol, blood sure problems; relieve menopause; anti-inflammatory. Problem with absorption with some medications.
185
Healer’s worldview
- Unified quantum field
186
Components of motivational interviewing
- Empathy (take perspective of others, stay out of judgment, recognize feelings, communicate feelings) - OARS to evoke patient (open-ended, affirms, reflective listening, summarizes)
187
How do other nutrients and minerals affect iron absorption?
Vitamin C increases iron absorption; calcium inhibits
188
Why treat DM? (For cardiac health)
Tight control of blood sugars in insulin-dependent DM may improve CHD prognosis – reduced LDL by 34%, reduced CV and PV events by 41%.
189
Exercise recommendation from the US Surgeon General
- Min 30 mins moderate-intense PEX at least 150 minutes a week - For youth: 60 mins of moderate-vigorous PEX every day
190
Risk of suicide in LGB youth
- 4 x more likely in LGB youth. If from highly rejecting family, 8.4 x more likely than those without rejecting (or low) family - 3 x more likely in questioning youth
191
What nutrients help athletes achieve optimal bone health and where do we find them?
Adequate Calcium and vitamin D to prevent osteoporosis and promote bone density. Vitamin D is needed for calcium absorption. Calcium: milk, yogurt, cheese, broccoli, leafy greens. Vitamin D: eggs, fish (trout, salmon, sardines), mushrooms, fortified foods.
192
What is the relation of DM with CAD?
Leading cause of death in DM over age 40, 77% hospitalizations of diabetics are for CVD. Worse for type 1 with clear relation to duration. DM can be called a “risk equivalent.”
193
How do you treat/prevent the Triad?
Used to start them on the pill but not recommended anymore. Meet with nutritionist to assess nutritional needs, strategize energy expenditure
194
What is a surrogate marker?
- Lab measurement or physical sign used as a substitute for clinically meaningful endpoint that is a direct measure of how a patient feels, functions or survives. Expected to predict the effect of the therapy.
195
What diseases/pathologies is the Hispanic population at high risk for?
- DM (50% more likely to die of DM than whites) - Cancer (stomach, liver and uterine cervix) – d/t infectious agents.
196
How is gingko used as a supplement and why is it used? What is the danger/concern?
Used to treat circulation problems (claudication), dementia (AD) due to the flavonoids (antioxidant) and terpenoids (to dilate blood vessels). Some evidence to help with depression, SAD, tinnitus or glaucoma. Caution: taking a thiazide diuretic or aspirin or anticlotting drugs.
197
What are the treatment options for tobacco addiction?
Counseling (individual, telephone), group programs, hypnosis/laser (no research support), social media (blogs, twitter, Fb), medications (OTC gum/lozenge/patch, rx: Chantix, Wellbutrin, nasal spray; herbal non-nicotine stuff)
198
Daily calcium intake recommendation? Who needs extra?
Males and females age 9-18 need 1300mg (4 servings of dairy/day). Age 19+ need 1000 mg/day (3 servings). Female athletes with amenorrhea encouraged to take 1500mg/day until menses restore. Men underweight or undernourished + decreased testosterone levels as a result encouraged to consume 1500 mg calcium per day until weight restored.
199
Define aerobic fitness. Examples of these activities
- Ability to take in and use o2 to produce energy - Examples: jogging, walking, X-country skiing, bicycling
200
Infant mortality risk for black population
- Black women are 2.3 times more likely to have an infant die than white women
201
What diseases/pathologies is the American Indian population at high risk for?
- Suicide: incidence about same between whites and American Indian, however highest in American Indian between 20-24 (~30%) whereas in whites it is between 40-60s. - Substance abuse (5 x more likely to die of an etoh-related death) - Fetal alcohol spectrum disorders
202
What are some strategies for managing sweat loss?
Avoid losing over 2% body weight in exercise. Calculate weight loss and sweat rate under different training conditions. If your sweat is salty and contains high sodium, consume sodium during exercise in
203
What is the current screening recommendation for osteoporosis?
- All women \>= 65 yo -
204
What is glucosamine and how is it used as a supplement? What is the danger/concern?
Osteoarthritis treatment. Safe to use, less side effects than NSAIDS (NIH study). Made from skeletons of shellfish. May reduce effect of hypoglycemic drugs. Also concern for additives – often high Mn.
205
Four step process in motivational interviewing
1.) Engaging: connection (open questions, reflection, listening) – 20% of conversation 2.) Focusing: setting agenda 3.) Evoking: elicit change talk (patient’s own motivations for change) 4.) Planning: plan of action (SMART goal setting: specific, measurable, attainable, realistic, timely)
206
What are the 5 leading preventable deaths in the US? Causes?
1.) Heart disease: tobacco, HTN, hyperlipids, DM, poor diet, overweight, lack of PEX 2.) Cancer: tobacco, poor diet, lack of PEX, overweight, sun exposure, hormones, etoh, viruses/bacteria, radiation, chemicals 3.) Chronic LRTIs: tobacco, air pollutants, allergens, occupational agents 4.) Cerebrovascular dz: HTN, hyperlipds, heart dz, DM, overweight, tobacco, etoh, lack of PEX 5.) Unintentional injuries: lack of restraint, lack of helmet, unsafe products, etoh/drug use, occupational hazard, unsafe home/community
207
Patients who are at high risk for experiencing an adverse effect d/t drug-nutrient interaction.
- Long-term dosing regimens - Self-medicate - Have a pre-existing nutritional dz - Extensive surgery - Take meds at meal times - High potency vit and/or mineral use - Consume large amount of etoh - Receiving enteral /parenteral nutrition - Alter their diet during a dosing regimen - Have poor dietary habits - That gain or lose large amounts of weight
208
What value(s) is used to determine the effectiveness of a screening test? Explain the meaning of these value(s).
- Predictive values (+ve or –ve values) +: likelihood that a patient with a positive test has the disease -: likelihood that a patient with a negative test is free of the disease
209
Pathologies and disease that come from physical inactivity and sedentary lifestyle
- Psych disorders, cancers, metabolic cancers, CV diseases, pulmonary diseases, musculoskeletal disorders
210
Pathologies/disease resulting from physical inactivity/sedentary lifestyle
- Depression, anxiety, Cancers (breast, colon, prostate and lung), obesity, DM, CHD, cardiomyopathy, CHF, hypercholesterolemia, HTN, atherosclerosis, emphysema, asthma, LBP, OA, osteoporosis
211
What are nutrition goals for gluten sensitivity?
Gluten free diet as permanent eating style (no wheat, rye, barley, triticale and spelt) to eliminate sx like indigestion, abd pain, diarrhea, chronic fatigue. Oats may be cross contaminated but don’t contain gluten. Prevents complications of Celiac disease like anemia, vitamin/mineral deficiencies, and bone mineral disturbances.
212
Know the role of non-modifiable risk factors in atherogenesis.
Age, gender and FH: cannot be changed. Must work around modifiable risk factors to improve risk for CVD.
213
Upward causation is associated with who’s worldview – physician’s or healer’s
- Physician’s worldview. Causation rises from base level of elementary particles and their interactions. Consciousness is an epi-phenomenon.
214
What is the recommended range of total fat, and how does this change for athletes?
Total fat should be 20-35% of total energy intake per day. Athletes need more fat because it is rich in calories. Often young athletes do not meet their fat needs.
215
T/F. Mind = body for physician.
- False. This is according to healer.
216
Explain the safety concerns with using CAM products.
Natural products like herbal medicines/botanicals are sold as “dietary supplements” and thus are not required to be regulated by the FDA. Manufacturer does not have to prove the safety and effectiveness of a dietary supplement before it is available to the public. NIH has 2 safety concerns: 1. Possibilities of drug interactions and 2. Product contamination – hidden prescription drugs and compounds especially weight loss, sexual health and athletic performance.
217
What drugs are important to monitor for pts undergoing smoking cessation?
Cytochrome p450: smoking is a CYP1A2 inducer so affects drugs like clozapine, caffeine, and theophylline because clearance is slower after quitting. Antipsychotics: haloperidol – increased clearance with tobacco cessation. Insulin: may need to decrease dose by half. Opiates: smokers tend to need more pain medication than non-smokers. Estradiol: tobacco affects oral ERT so transdermal is better treatment for smokers. Coumadin: spit tobacco contains high levels of vitamin K, affects Coumadin metabolism more than smoking. Can take up to 2.5 months for Coumadin to regulate as a patient goes through tobacco cessation.
218
Current recommendations for vision screening
- Snellen not accurate in ped/elderly age groups. - Peds: screen for vision impairment in all children at least once between ages 3 and 5. - Elderly: no screening recommendation for this group - Blacks \> white risk for glaucoma
219
Give an example and mechanism of how food decreases absorption of a drug
- Alendronate (Fosamax) used to tx bone resorption. - Must be taken during fasting state. Presence of liquids can reduce absorption by 60%.
220
Risk factors for breast cancer in black population
1.) Non-modifiable - Age, sex, early menarche, late menopause, more aggressive cancer 2.) Modifiable - weight, lack of PEX, DM, etoh consumption, breast feeding (protective) in AA population lower than whites, less aggressive tx, delayed f/u
221
Risk factors for colorectal cancer? Protective factor(s)?
- Risk: obesity (abdominal), DM, red/processed meats, etoh, tobacco, SES - Protective: physical activity
222
What influences urine color?
Blood in urine after a workout, B vitamins (water soluble), diet.
223
BMI to consider tx
- \> 35
224
Social determinants of health. Examples
1.) Neighborhood and built environment - toxic exposures, supermarkets, trails 2.) Health and healthcare - access, primary care, literacy 3.) Social and community context - civic and social involvement (cuts in half your odds of dying next year, recall of health messages) - incarceration/institutionalization 4.) Education - level of education (~ 5 years added to life if college grad compared to HS drop out), language/literacy, cognitive skills to make decisions 5.) Economic stability - poverty, employment, food and housing security
225
Physiologic changes and benefits seen during and from transcendental meditation when restful alertness is achieved
- o2 consumption decreases (more so than sleeping) - rise in skin resistance - decrease in blood lactate - decrease in reaction time - decreased illness - IQ increase - Increased self-actualization - Increased creativity - Decreased hospital admissions
226
Foods with low cariogenic potential
- Relatively high protein, moderate fat, minimal CHO - High concentration of Ca and P - Cause pH greater than 6 - Stimulates saliva secretion - Eg: peanuts, meat, milk, eggs, some veggies
227
How should an athlete fuel during exercise?
Sports drinks that contain carbs and electrolytes but avoid ingredients that may slow digestion. Eat easily digested carb-rich foods during endurance such as banana or sports foods or bite sized granola. Drink fluids with carb gels or carb rich foods to fuel transport to muscles. Most important to replace water. Optimal fuel blend = mix and timing of fluids, carb and electrolytes. Too little fluid or too much carb → cramping and intestinal probs.
228
What are tobacco specific nitrosamines?
28 cancer causing chemicals. Can lead to oral cancer.
229
Give an example and mechanism by which food/nutrients increase drug metabolism
- Ethinyl estradiol (component of oral contraceptive). St. John’s wort increases or induces expression of CYP 34A. Ultimately, increasing metabolism of CYP 34A dependent drugs decreasing bioavailability.
230
What is the lipid hypothesis?
Elevated serum cholesterol levels are directly linked to atherosclerosis.
231
Risk factors for osteoporosis in the Asian/Pacific Islander population
- Smaller frames, lower BMI - Consume less calcium
232
Give an example and mechanism by which nutritional status (protein status for example) can alter the distribution of drugs
- Phenytoin (dilantin): anticonvulsant - 95% of absorbed phenytoin is usually protein bound. Hypoproteinemia results in increase in free drug availability.
233
What is the risk of CAD with smoking?
3x increase in risk of AMI, 2x increase in risk of CHD death. Leading preventable cause of death. Stopping reduces event risk by 50% in first 1-2 yrs.
234
Risk factors for HIV/AIDS in the black population
- Behaviors: anal sex (20% of those surveyed bw 20-39) and other risky behaviors (substance abuse) - Residing in an urban poverty area
235
What are omega-3 FA and where are they found? What is the recommendation (and danger) of taking the supplement?
Alpha-linolenic acid, an EFA, found in plant foods, flax seeds and walnuts. DHA (docosahexaenoic acid) found in animal foods, cold water fish like salmon or sardines. Recommended to get Omega-3 FA from fish – danger is heavy metals & toxins. Supplements come in liquid, capsule and pills. Most can take 3 grams without side effects. High doses may increase risk of bleeding, lower immune response, and increase blood glucose.
236
What are the 5 A’s and 5 R’s of tobacco user treatment? What’s the difference?
5 A’s used for people who are ready to quit; 5 R’s if they’re not. Ask: Identify users Advise: strongly urge users to quit Assess: determine willingness to quit Assist: aid the patient Arrange: schedule follow-up Relevance: why is it personal? Risks: identify negative consequences Rewards: identify benefits Roadblocks: what are the barriers? Repetition: re-eval with each visit
237
What are the determinates of health (not SDOH) according to healthypeople.gov? What percentage is attributed to lifestyle factors?
- Social factors, individual behavior, biology/genetics, policymaking, health services - 55% (behavioral patterns 40% and social circumstances 15%)
238
What’s the problem with osteoporosis in athletes?
Loss of bone, especially an athlete, can be setup for injury – stress fx, slow to repair if athlete is under fueled. Repeated stress fx and unexplained injuries = red flag to evaluate eating/exercise.
239
Give an example and mechanism of how divalent cations can affect absorption of drug
- Cipro = antimicrobial - It binds divalent cations (eg. Ca, Fe, Zn) forming complex preventing absorption of the drug. Avoid liquids containing these cations such as dairy, juices or liquid supplements.
240
Give an example and mechanism of how gastric acidity alters nutrient absorption
- Omeprazole (Prilosec): PPI to suppress gastric acid secretion - Increasing pH reduces extraction of protein bound nutrients. Vit B12 absorption decreases when on this drug shown over long term use (\>4 years).
241
Risk/benefit modeling used in recent recommendation re: use of low dose CT in heavy smokers \> 55 years of age
- USPSTF recommends annual screening for lung cancer with low-dose CT in adults 55-80 who have a 30 pack-year smoking hx and currently smoke or have quite in past 15 years. - Stop if person is outside 15 year non-smoking history or develops a health problem that substantially limits expectancy.
242
What changed about disease process when light cigarettes were developed?
Lung cancer moved from upper lobes to lower lobes – due to deeper inhalation and longer smoking.
243
How are HDL-C levels related to CHD incidence?
4 studies of men and 2 in women show decreased CHD incidence with increase in HDL-C. (Protective)
244
Which is better: animal-derived protein or plant-derived protein, and why?
Animal-derived is higher quality because they have all the EAA where as some plant-based proteins contain low amounts of 1 or more EAA.
