Family Medicine Clerkship - Brainscape Flash Cards - fmCases 2 & 6

Question 1

Case2: Men’s gen health: What are the leading causes of death in adult men?

Answer 1

malignant neoplasm, heart dz, accidents, DM, chr lung dz, chr liver dz, cirrhosis

Question 2

Case2: Men’s gen health: Screening mnemonic for IPV?

Answer 2

SAFE:
Stress/safety: “Do you feel safe in your relationship?”
Afraid/Abused: “Have you ever been in a relationship where you were threatened, hurt, or afraid?”
Friends/Family: “Are your friends or family aware that you have been hurt? Could you tell them and would they be able to give you support?”
Emergency Plan: “Do you have a safe place to go and the resources you need in an emergency?”

Question 3

Case2: Men’s gen health: Options for nutrition screening?

Answer 3

WAVE/REAP, 24hr re-call, 3-4 day diary

Question 4

Case2: Men’s gen - Which men should receive screening exercise stress test?

Answer 4

Asymptomatic male patients over 45 years of age with one or more risk factors (hypercholesterolemia, hypertension, smoking, or family history of premature coronary artery disease) may obtain useful prognostic information from exercise testing.

Question 5

Case2: Men’s gen - Diet type shown to help w/ weight loss AND glycemic control?

Answer 5

Mediterranean (e.g. DASH) diet

Question 6

Case2: Men’s gen - Diet type shown to help w/ weight loss AND lipid control?

Answer 6

Low-carb diets

Question 7

Case2: Men’s gen - equation for target heart rate?

Answer 7

THR = (220 - age) * 0.7-0.8

Question 8

Case2: Men’s gen - USPSTF recommendation for AAA u/s screening?

Answer 8

Men 65-75 who have ever smoked

Question 9

Case6: DM f/u - What are the different dx criteria for DM2?

Answer 9

1. random glucose ≥ 200 mg/dL PLUS sx of hyperglycemia
2. FBG ≥ 126 mg/dL.
3. A1C ≥ 6.5%.
4. OGTT: more sensitive and ~more specific > fasting glucose, but difficult/poorly reproducible, not recommended routinely.

Question 10

Case6: DM f/u - Staging of HTN

Answer 10

NL: both 160 or >100

Question 11

Case6: DM f/u - elements of good DM foot exam?

Answer 11

NEURO: monofilament PLUS one of: 128 Hz tuning fork, pinprick or Achilles reflex; PULSES bilat; INSPECTION for: hair loss, temp changes, breaks in skin, pressure calluses, ulcers/infection and bony abnormalities; FOOTWEAR for abnl wear patterns

Question 12

Case6: DM f/u - Pulse strength

Answer 12

0 = absent
\+1 = diminished, barely palpable.
\+2 = average, slightly weak, but palpable.
\+3 = full, brisk, easily palpable.
\+4 = bounding pulse, ~visible.

Question 13

Case6: DM f/u - Documenting reflexes

Answer 13

0 = No evidence of contraction
1+ = hypo-reflexic
2+ = NORMAL
3+ = hyper-reflexic
4+ = Clonus

Question 14

Case6: DM f/u - Documenting muscle strength

Answer 14

0/5 = No movement
1/5 = Barest flicker of mov’tof the muscle, though not enough to move the structure to which it’s attached.
2/5 = Vol mov’t which is not sufficient to overcome the force of gravity.
3/5 =Vol mov’tcapable of overcoming gravity, but not any applied resistance.
4/5 = Vol mov’tcapable of overcoming “some” resistance
5/5 = Normal

Question 15

Case6: DM f/u - Goal A1c for DM2 pts?

Answer 15

< 7%

Question 16

Case6: DM f/u - TSH and B12 testing in DM2 pts?

Answer 16

Check B12 qYrif on metformin; ADA recommeds checking TSHqYr if DM1, new dx of dyslipid., or female > 50 at DM visit

Question 17

Case6: DM f/u - immunizations for adults w/ DM

Answer 17

FLU qYr;
PNEUMOCOCCAL to all pts w/ DM > 2 y/o + boost at 64 y/o if no vacc in past 5 yrs AND boost if nephrotic syn, CRF or immunocomp;
HEP B: all adults w/ DM

Question 18

Case6: DM f/u - When should DM2 pts get their first eye exam?

Answer 18

ASAP after dx w/ DM2; if pt has DM1, 5 yrs after dx

Question 19

Case6: DM f/u - idea FBG readings at home should be?

Answer 19

80 - 120 mg/dL

Question 20

Case6: DM f/u - ideal (1-2hr)post-prandial readings at home should be?

Answer 20

< 180 mg/dL

Question 21

Case6: DM f/u - Five finger model for DM follow-up goals?

Answer 21

1. SMOKING CESSATION, 2. HTN ctrl, 3. Metformin, 4. Lipid Ctrl, 5. ~?glycemic ctrl