fmCase 2

Question 1

Major risk factors for CV disease

Answer 1

Sedentary lifestyle
Tobacco use
Excess alcohol use
High stress
Poor diet
Obesity
Old, male, FHx

Question 2

3 C’s of tobacco addiction

Answer 2

(1) Compulsion to use,
(2) lack of Control, and
(3) Continued use despite adverse consequences.

Question 3

Stages of behavioral change

Answer 3

Pre-contemplative
Contemplative
Active
Relapse

Question 4

Screening for alcohol problems

Answer 4

CAGE

Question 5

BMI equation and severity

Answer 5

kg/m^2

normal 18-25

Question 6

Exam findings of dyslipidemia and atherosclerosis

Answer 6

Arcus corneus
Acanthosis nigricans
Xanthelasmas

Question 7

ABCDE of suspicious skin lesions

Answer 7

Asymmetry
Border irregularity
Color non-uniform
Diameter >6 mm
Evolution or change over time

Question 8

Risks and benefits of PSA screening

Answer 8

• Benefits: Prolonged life from early detection and treatment, Psychological reassurance of a negative screen or detection at treatable stage
• Harms: Pain and discomfort with prostate biopsy, Psychological effects of false-positive, Complications (ED, bowel/bladder, death) from treatment of prostate cancer that may not ever have caused symptoms

Question 9

Colon cancer screening options

Answer 9

1) Colonoscopy (preferred method)
2) Annual testing of three stools for blood and a flexible sigmoidoscopy test every five years
3) Double-contrast enemas every five years
4) CT colography (virtual colonoscopy) is being studied, but still experimental.

Question 10

Lung cancer screening

Answer 10

USPSTF: fair evidence that screening with CT
scan, chest x-ray, or sputum cytology can detect lung cancer at an earlier stage. However, poor evidence that screening decreases mortality. Potential for significant harms.

Question 11

ECG system of reading

Answer 11

1. Rate, rhythm, PR interval
2. QRS duration, and QT interval.
3. P waves, Q waves
4. Axis
5. R wave progression
6. Level of voltage
7. ST depression or elevation
8. Inverted T waves

Question 12

Labs to assess for DM and CV disease

Answer 12

Glucose and a Lipid panel
(Fasting x8 hours - Non-fasting TG may be significantly higher than fasting, but the total cholesterol, LDL-c and HDL-c generally do not vary that much)

Question 13

Smoking cessation effective methods

Answer 13

*Annual quit rate for smokers without any medical interventions 2–3% per year

*Oral medications: 12-month quit rates 1.5–3 x placebo
*Group settings
*Counseling sessions
*Problem-solving skills, assistance with social support, relaxation/breathing techniques
can increase quit rates.

Question 14

Resources of smoking cessation

Answer 14

Set a quit date
1-800-QUIT-NOW
www.smokefree.gov
Bupropion one week before the quit date (one pill a day for the first three days, then increase to one pill twice a day, morning and evening. After another four days, stop smoking and continue on the pills twice a day. May add nicotine gum for bad cravings, if needed.
After about two months on the pills, gradually stop.)

Question 15

Exercise prescription

Answer 15

Cardiovascular fitness: 30 min 3x weekly

Weight loss: 20–30 minutes a day

Intensity guidelines: Target heart rate (THR) range and estimated rate of
perceived exertion (RPE):
Calculation: THR = (220 – age) x 0.7–0.8
RPE: There is fairly good correlation between THR and RPE. After
medU | Instructors http://www.med-u.org/communities/instructors/fmcases/case_…
8 of 9 6/12/12 3:47 PMmeasuring THR while exercising several times, patients can use RPE to
gauge their level of exercise. Using the Borg scale, patients should
exercise to a level of 12–14.

Question 16

Target HR

Answer 16

THR = (220-age) X 0.7 to 0.8

Good correlation with rate of perceived exertion (RPE)

Borg scale, use level 12-14 (quite an effort, you feel tired but can continue)

Question 17

Follow-up of tubular adenoma with low-grade dysplasia

Answer 17

Repeat colonoscopy in 5-10 years