Family Medicine Clerkship - Brainscape Flash Cards - fmCases 2 & 6
Case2: Men’s gen health: What are the leading causes of death in adult men?
malignant neoplasm, heart dz, accidents, DM, chr lung dz, chr liver dz, cirrhosis
Case2: Men’s gen health: Screening mnemonic for IPV?
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?”
Case2: Men’s gen health: Options for nutrition screening?
WAVE/REAP, 24hr re-call, 3-4 day diary
Case2: Men’s gen - Which men should receive screening exercise stress test?
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.
Case2: Men’s gen - Diet type shown to help w/ weight loss AND glycemic control?
Mediterranean (e.g. DASH) diet
Case2: Men’s gen - Diet type shown to help w/ weight loss AND lipid control?
Low-carb diets
Case2: Men’s gen - equation for target heart rate?
THR = (220 - age) * 0.7-0.8
Case2: Men’s gen - USPSTF recommendation for AAA u/s screening?
Men 65-75 who have ever smoked
Case6: DM f/u - What are the different dx criteria for DM2?
- random glucose ≥ 200 mg/dL PLUS sx of hyperglycemia
- FBG ≥ 126 mg/dL.
- A1C ≥ 6.5%.
- OGTT: more sensitive and ~more specific > fasting glucose, but difficult/poorly reproducible, not recommended routinely.
Case6: DM f/u - Staging of HTN
NL: both 160 or >100
Case6: DM f/u - elements of good DM foot exam?
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
Case6: DM f/u - Pulse strength
0 = absent \+1 = diminished, barely palpable. \+2 = average, slightly weak, but palpable. \+3 = full, brisk, easily palpable. \+4 = bounding pulse, ~visible.
Case6: DM f/u - Documenting reflexes
0 = No evidence of contraction 1+ = hypo-reflexic 2+ = NORMAL 3+ = hyper-reflexic 4+ = Clonus
Case6: DM f/u - Documenting muscle strength
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
Case6: DM f/u - Goal A1c for DM2 pts?
< 7%
Case6: DM f/u - TSH and B12 testing in DM2 pts?
Check B12 qYrif on metformin; ADA recommeds checking TSHqYr if DM1, new dx of dyslipid., or female > 50 at DM visit
Case6: DM f/u - immunizations for adults w/ DM
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
Case6: DM f/u - When should DM2 pts get their first eye exam?
ASAP after dx w/ DM2; if pt has DM1, 5 yrs after dx
Case6: DM f/u - idea FBG readings at home should be?
80 - 120 mg/dL
Case6: DM f/u - ideal (1-2hr)post-prandial readings at home should be?
< 180 mg/dL
Case6: DM f/u - Five finger model for DM follow-up goals?
- SMOKING CESSATION, 2. HTN ctrl, 3. Metformin, 4. Lipid Ctrl, 5. ~?glycemic ctrl
