Spring Semester Exam 2 Flashcards
What are the leading causes of mortality in the US?
Modifiable risk factors
The most common causes of disease, disability, premature death, and healthcare burden can be attributed to what 4 health behaviors?
- Smoking
- Poor diet
- Physical inactivity
- Alcohol consumption
What is the USPSTF recommendation/grade for behavior change counseling regarding smoking?
- Ask all adults about tobacco use, advise them to stop, provide intervention/cessation information (A)
- Ask all pregnant women… (A)
- Ask all school-aged children and adolescents (B)
What is the USPSTF recommendation/grade for behavior change counseling regarding alcohol misuse?
Screen adults aged 18+ for alcohol misuse, provide counseling (B)
What is acceptable alcohol use for men and women daily?
Men: no more than 2 drinks per day
Women: no more than 1 drink per day
What is considered heavy drinking for men and women daily?
Men: more than 2 drinks per day on average
Women: more than 1 drink per day on average
Define binge drinking for men and women.
Men: 5 or more drinks in one sitting
Women: 4 or more drinks in one sitting
What is the USPSTF recommendation/grade for behavior change counseling regarding healthy diet and physical activity for cardiovascular disease prevention?
Offer adults who are overweight or obese and have additional cardiovascular disease risk factors counseling interventions (B)
What are the 5 A’s for behavior change counseling?
- Assess health risks and patient’s stage of readiness for change
- Advise health risks and behaviors that contribute to them
- Agree to identify a target behavior, barriers/benefits of change
- Assist by offering resources, strategies, support; create an action plan
- Arrange for monitoring and follow-up
Describe the stages of change model.
- Pre-contemplation
- Contemplation
- Preparation
- Action
- Maintenance –> Stable Behavior
- Relapse
What is the goal when a patient is in the pre-contemplation stage?
Patient will begin thinking about change
What is the goal when a patient is in the contemplation stage?
Patient will examine benefits and barriers
What is the goal when a patient is in the preparation stage?
Patient will discover the elements necessary for decisive action
What is the goal when a patient is in the action stage?
Patient will take decisive action
What is the goal when a patient is in the maintenance stage?
Patient will incorporate change into daily lifestyle
What is the goal when a patient is in the relapse stage?
Learn from temporary success and re-engage in the change process
When is motivational interviewing most appropriate?
When patients are in the pre-contemplative and contemplative stages
What are the 4 principles of MI?
- Express empathy
- Develop discrepancy
- Roll with resistance
- Support self-efficacy in the patient
What is the OARS model of MI?
- Open-ended questions
- Affirmations
- Reflective listening
- Summaries
What is a person’s confidence that she/he can carry out a behavior necessary to reach a desired goal?
Self-efficacy
When are physicians less likely to detect alcohol problems?
- When screening tools are not used universally
2. In patients who they do not “expect” to have alcohol problems (women, higher SES, white)
What is SBIRT?
- Screening - universal screening for quickly assessing use and severity of alcohol, illicit drugs, and prescription drug use/misuse/abuse
- Brief Intervention - brief MI given to risky or problematic substance users
- Referral to Treatment - referrals to specialty care for patients with substance use disorders
The primary goal of SBIRT is to identify and effectively intervene with those who are a ___ risk for psychosocial or health care problems related to their substance use.
Moderate or high
How much is one drink (wine, beer, spirits)?
5 oz glass of wine
12 oz glass of beer
1.5 oz spirits (80 proof)
What are some brief and valid pre-screening tools?
NIAAA Single-Question Screen, NIDA Single-Question Drug Screen, US AUDIT-C
What are some tools that should be used if a person screens positively in pre-screening?
AUDIT (Alcohol Use Disorders Identification Test), DAST (Drug Abuse Screening Test)
How is the AUDIT Scored?
- Low Risk (0-7): Zone I, Screening and Feedback
- At-Risk (8-15): Zone II, Brief Intervention
- Harmful Use (16-19): Zone III, Monitoring and Possible Brief Outpatient Treatment
- Dependent Use (20+): Zone IV, Referral for Evaluation and Treatment
How is the DAST 10 Scored?
1 point for each Yes
0: No Problems Reported, No Action
1-2: Low Level, Monitor, reassess at a later date
3-5: Moderate level, further investigation
6-8: Substantial level, intensive assessment
What are the 4 steps in the brief negotiated interview?
- Build rapport (raise the subject, explore pros and cons)
- Provide feedback (ask permission, give information, elicit reactions)
- Build readiness to change (1-10 scale)
- Negotiate a plan
What is the single largest preventable cause of morbidity and mortality in the US?
Tobacco use
Nearly ___% of adults smokes.
20
What are the three major aspects of HIPAA?
- Allows employees to change jobs without a gap in health insurance coverage
- Standardizes electronic health care transactions
- Regulates the privacy and security of health information
HIPAA pre-empts state law unless the state law…
…provides greater privacy protections to a patient’s information or affords greater access to information rights to a patient
What is a one major federal law governing human subject research?
Common Rule
What are the four elements to be proven in a malpractice suit?
- Duty
- Breach of duty
- Causation
- Damages
Who has the burden of proof in a malpractice suit?
Plaintiff
What is that which a reasonably careful physician would do under the same or similar circumstances?
Duty
What is a deviation from the standard of care and what are the two ways it may occur?
Breach of duty via omission or commission
Causation requires a reasonable degree of ___.
Medical certainty
What are the three ways a physician may be involved in the legal system?
- Defendant
- Treating physician
- Expert witness
What type of discussion involves dealing with the actual question directly or meeting the patient’s style of resistance by remaining focused on the facts?
Content discussion (often effective, authoritarian, may lead to debates or impasses)
What type of discussion involves commenting or asking about the underlying emotion or frustration and empathizing?
Process discussion (leads to better compliance)
What is a group of diverse medical and health care systems, practices, and products that are not presently considered part of conventional medicine?
Complementary and alternative medicine
___ medicine is used together with conventional medicine. ___ medicine is used in place of conventional medicine.
Complementary; alternative
What type of medicine combines mainstream medical therapies and CAM therapies and demonstrates some high-quality scientific evidence of safety and effectiveness?
Integrative medicine
What are the 5 domains of CAM?
- Alternative medical systems
- Mind-body interventions
- Biological-based therapies
- Manipulative and body-based methods
- Energy therapies
What are the four classifications for evaluating CAM therapies?
- Unsafe/prove
- Safe/proven*
- Unsafe/unproven
- Safe/unproven*
The main principle of ___ is: in a relaxed state, one can access the unconscious for self-control.
Hypnosis
What is the provision of materials in the form of food to organisms for the purpose of supporting life?
Nutrition
What is defined as the set of foods that an individual ingests?
Diet
What are characteristics of successful weight losers?
Regimented program low in fat (24%) and kcal (1400), exercised vigorously almost daily to expend about 350 kcal
A healthy eating pattern limits what 4 things?
Saturated fats, trans fats, added sugar, sodium
What are the USDA quantitative recommendations regarding added sugars, saturated fats, sodium, and alcohol?
<10% of calories from added sugars
<10% of calories from saturated fates
2,300 mg/day of sodium
Moderation for alcohol
For substantial health benefits, engage in moderate-vigorous aerobic exercise for ___minutes/week.
150
How does one determine if a patient is safe to exercise?
Treadmill stress test or clinically
Define high risk for exercise.
Known or equivalent cardiovascular, pulmonary, or metabolic disease
Define moderate risk for exercise.
2+ CAD risk factors
Define low risk for exercise.
Asymptomatic with no known CAD; men <45, women <55; no more than 1 risk factor
What are exercise risk factors?
- Age
- Family history
- Cigarette smoking
- Sedentary lifestyle
- Obesity
- Hypertension
- Hypercholesterolemia
- Impaired fasting glucose
- NEGATIVE RISK FACTOR: HDL 60
Moderate risk requires clearance prior to starting a ___ exercise program. High risk requires clearance prior to starting a ___ exercise program.
Vigorous; moderate
What are the 4 components of an exercise prescription?
- Frequency (at least 5 days weekly)
- Intensity (Borg scale)
- Time (150 min/week for low-moderate intensity, 75 for vigorous)
- Types
What are the 4 components of a complete nutrition assessment?
- Anthropometric data
- Biochemical evaluation
- Dietary history
- Clinical observation - nutrition physical examination
What are the aspects of anthropometric data?
Height, weight, BMI
How is BMI calculated?
Weight (kg)/Height (m^2) or Weight (lbs)/Height (in) * 703
What are the BMI statuses?
- Underweight: <18.5
- Normal: 18.5-24.9
- Overweight: 25.0-29.9
- Obese: 30.0+
What is a common measure used to assess abdominal fat content?
Waist circumference (men >40 in, women >35 in at risk)
What are the aspects of biochemical evaluation?
- Glucose levels
2. Serum lipid data
What is the difference between broad and focused questions?
Broad/background: topic overview for foundational learning
Focused/foreground: discrete questions about a broader topic
What are the CRAAP criteria for evaluating information resources?
- Currency (timeliness)
- Relevance
- Authority (source)
- Accuracy
- Purpose (the reason the information exists)
