P1. p 67-74 Flashcards
Eight things
What are the lifestyle medicine vital signs ?
Which of these are tested/validated ?
How often should be they be checked ?
BR 67
Feet - exercise ** \
Fingers - smoking, EtOH (AUDIT-C**) > BMI **
Forks - diet /
Sleep - sleep
Stress - stress
Love - emotional well-being
** Tested & validated
++ Assess at every visit ++
BR 67
What are the main components of daily total energy expenditure ?
What percentage does each contribute ?
BR 67
Resting energy expenditure 60-75% of total => 70%
Physical Activity 15 to > 30% of total => 20%
Thermic (effect of food) = 10% => 10%
BR 67
Mnemonic - ‘RAT’ (on a wheel)
How to assess the physical activity vital sign ?
What is/ is not adquately assessed by this method ?
BR 67
Easily & quickly measured using the two-item exercise vital sign:
1) “How many days a week do you engage in moderate to strenuous exercise such as a brisk walk?”
2) “On average, how many minutes per day do you exercise at this level ?”
While this provides general information about CV exercise, it does not address strength & resistance exercises, balance or flexibility exercises (BR 68)
BR 67
Why is it important to also assess strength training ?
What is an easy way to assess this ?
BR 68
Strength training should also be assessed because:
1) It can increase Basal metabolic expenditure
2) It improves Activities of daily living
3) It reduces the risk for falls (esp in elderly)(Tumbles)
Ask: “How many days a week do you engage in strength training or resistance exercises?”
BR 68
Mn: BAT (Humberto)
Give an example of a mini sleep assessment
BR 69
Questions for a mini sleep assessment:
1) Typical weekday hours of sleep
2) Typical weekend hours of sleep
3) Perceived sleep quality
BR 69
What is a simple way to assess a patient’s emotional well being ?
BR 69
To assess a patients emotional well-being ask them to rate the following on a scale of 1 (lowest) to 5 (highest):
1) I am Satisfied with my life
2) In most ways my life is Close to my IDeal
BR 69
Mn: SCID (Skid - Mary Ann J)
AUDIT-C brief alcohol screen for hazardous drinkers & active alcohol use disorders.
- Three questions, each yielding 0 to 4 points
- Positive Men 4 or more, women 3 or more
Q1: “How often do you have a drink containing alcohol ?”
Q2: How many standard drinks containing alcohol do you have on a typical day
Q3: How often do you have 6 or more drinks on one occasion ?
BR 70
Why is BMI important ?
How is it calculated ?
What are the categories of BMI ?
BR 70
BMI is associated with at least 20 health conditions including MSk disorders, CV disease, diabetes, chronic kidney disease, and several cancers.
BMI = weight (kg)/ height (m)^2
BMI = [weight (pounds) / height (inches)^2] x 703
Categories:
< 18.5 - underweight
18.5-24.9 Normal (lowest risk ~ 19 to 22)
25-29.9 Overweight
>30 Obese:
- 30-34.9 Class 1
- 35.0-39.9 Class 2
>40 Class 3 (extreme obesity)
What are diseases increased with high waist circumference ?
What are the cutoff values for men & women ?
BR 71
Higher risk of NIDDM, hypertension, and CV disease
Cutoff for ‘increased’:
Men >= 40 inches (102 cm)
Women >= 35 inches (>= 88cm)
What are the cutoff values for waist/hip ratio ?
BR 71
Normal waist:hip standards:
Men ratio <= 0.90
Women ratio <= 0.85
What are the 2017 standards for BP & hypertension ?
What is the prevalence of hypertension in adults > 60 yrs
How often should one screen for hypertension ?
BR 72, UpToDate
Seventh Report of Joints National Committee on Prevention/ Detection / Evaluation & Rx of High Blood Pressure
Normal BP < 120 / < 80 mmHg
Elevated BP: systolic 120-129 / < 80 mmHg
Stage 1: systolic 130-139 OR 80-89 mmHg
Stage 2: systolic > 140 OR > 90 mmHg
If there is a disparity in category between the systolic and diastolic pressures, the higher value determines the stage.
Prevalence - greater than 50% of those > 60 yrs old
Screen at each periodic visit (q 6-12 mos)
Name a fitness testing option to assess each of the following:
1) Cardiorespiratory fitness (2)
2) Muscular endurance
3) Flexibility
4) Body composition (avoid …)
5) Muscular strength
BR 73
Tests for each of the following:
Step testing, 6 min walk test for cardiorespiratory fitness
Squats, pushups & sit-ups for muscular endurance
Sit & reach test for flexibility (like a step)
Skin calipers for body composition (avoid bioimpedance - affected by hydration etc)
Strength - difficult unless weights or ability to apply a load (eg bench or squat press)
BR 73
Renal: Cr, BUN, Na K, CO2, Cl
Glucose
Calcium
Albumin + Total Protein
LFT’s: ALP, ALT, AST, Bili
Total of 14 tests - K (6), L (4), Prot (2), Ca, Glu
What screening/diagnostic BLOOD tests are part of a lifestyle-related assessment ?
BR 73
1) Complete metabolic panel (14 blood tests)
2) Fasting lipids: T-chol, LDL, HDL, TG, +/- particle size
3) hsCRP
4) HbA1c, fasting [Glucose] +/- OGT, fasting [insulin], possible C-peptide & HOMA-IR.
5) Vitamin D
6) TSH
- I also think a ferritin, B12 should be checked as a baseline, +/- Magnesium.
List 4 different diagnostic criteria for diabetes
BR 74 & UpToDate
1) HbA1c > 6.5%*
2) FPB > 126 mg/dL (7.0 mmol)*
- fasting means NPO for at least 8 hours
3) 2Hr [glucose] > 200 mg/dL (11.1 mmol/L) during 75g OGTT*
4) RND [Glu] > 200 mg/dL (11.1 mmol/L) plus classic symptoms (polyuria, polyphagia, polydypsia)
*= in the absence of unequivocal hyperglycemic, Dx required TWO abnormal test results from the same sample, or in two separate test samples.
