Well adult Flashcards
Diagnostic reasoning steps
1-7
1) ID problem
2) Assessment/history
3) Differential diagnosis
4) Diagnostics
5) Select diagnosis
6) Treatment
7) Implement, evaluate/follow up
Diagnostic reasoning step 1
1) ID problem: clarify chief complaint
Diagnostic reasoning step 2
2) Assessment/history: OLDCART
culture, religion, ethics, systematic observation, 7 characteristics of a symptom
Diagnostic reasoning step 3
3) Differential diagnosis
don’t limit thinking, narrow 3-5
focal reasoning: single limited # body systems (sore throat)
constitutional reasoning: multiple systems (fever, fatigue)
Diagnostic reasoning step 4
4) Order labs/diagnostics
- what data will test give (consider specificity and sensitivity)
- would treatment change plan if I knew test results (i.e. MRI of back treatment will be the same if disc is ruptured)
- cost/benefit, unnecessary discomfort
Diagnostic reasoning step 5
5) select diagnosis
refer if necessary
Diagnostic reasoning step 6
6) Select treatment plan
Primary
Secondary
Tertiary
Diagnostic reasoning step 7
7) Implement and evaluate follow up
ie diabetics q 3 months hypertensive q 6 months
Specificity
Define
Example
# of people who specifically do not have the disease: # of people who are free of disease who are identified as not having disease DO NOT HAVE DISEASE % of people who do not have strep will test negative for strep
Sensitivity
Define
Example
PEOPLE WHO HAVE THE DISEASE ARE VERY SENSITIVE
% of people who strep that will test positive for strep
Rapid strep has 85% sensitivity
SO….
85% of people who have strep will test positive for strep
(15% of people who have strep will test negative for strep)
CAGE
50% sensitivity
50% of people who are alcoholics will test positive for alcoholic disorder BUT
50% who are alcoholics will test negative for alcoholic disorder
Primary prevention
Define
Example
Interventions that prevent injury or disease
Immunizations
Education/counseling
Nutrition to children to prevent obesity, seat belt safety, folic acid supplementation
Secondary prevention
Define
Example
interventions to prevent illness or mortality by DETECTING disease early i.e. SCREENING
mammogram, lipid panel, colonoscopy
Tertiary prevention
Define
Example
interventions to prevent complications or problems for ESTABLISHED disease
cardiac rehab, treatment for hyperlipidemia, beta blockers in CAD
HAVE disease PREVENT bad outcome
Barriers to preventive care - - - -
- inadequate reimbursement for recommended services
- fragmentation of health care
- insufficient time
- clinician uncertainty of which to offer
Screening - diagnostic? - symptoms? - - (effective if) give example
- not diagnostic
- asymptomatic period*** find disease when someone is asymptomatic
- determine suspicious of disease, and those who need further work up if nonsuspicious
- effective if:
detect disease earlier than symptoms
earlier diagnosis will effect outcome
Example: PSA/endometrial not recommended- recommend postmenopausal women to report bleeding because symptoms will announce the disease, PSA used to be annual age 50- not a lot of evidence will change outcome and can cause harm (death, HA, PE)
Recommended age colon cancer screening
Age 50 for average risk
Abdominal U/S for aortic aneuryms in patients age ______ who _______
65-75 who smoke or ever smoked
LIFESTYLE ASSESSMENT Nutrition Exercise Stress Relationship/living situation Smoking:
Smoking: pre-contemplative contemplative determination action maintenance relapse
Alcohol
Recommended amount
CAGE
AUDIT/AUDIT-C
Drugs
women 1 drink a day men 2 drinks
Cut down Annoyed Guilty Eye-opener
AUDIT-C 3 questions frequency, # drinks, binge
AUDIT- 10 questions total 40
Drugs: CAGE-AID
SCREENING
Ht/wt/BMI
BP
Lipids
BMI: >25 overweight, >30 obesity q pt q visit
BP: q pt q visit, 120/80, 120-140/80-90 pre hypetension, 140/90 hypertension
Lipids: starting at age 20 and q 4-6 years
SCREENING Cancer: -cervical -colon -breast -prostate (endometrium) -skin -lung
- cervical: 21-29 q 3 years pap alone, 30+ q 3 years with pap alone or q 5 with pap/HPV
- colon: 50-75 Fecal occult q year, Flexible sigmoidoscopy q 5 years, Virtual colonoscopy q 5years, Colonscopy q 10 years
- breast: 40+ q year (task force says 50)
- prostate/endometrium- not recommended
- skin: no screening per say, always looking just like thryoid, mouth, testes, ovaries
- lung: age 55-80 patients with 30 pack year history (current or within last 15 years): CT scan
SCREENING
- STDs including chlamydia and HIV
- Osteoporosis
- Vitamin D
- Diabetes
-STDs
chlamydia: high risk women
-Osteoporosis: 65+
-Vitamin D- not a lot of evidence
Diabetes: recommend q 3 years at age 45 (6.4; fasting glucose>125)or younger if at risk ie overweight, hyperlipidemia, asian/AA, HTN, family hx
SCREENING
- thyroid
- hearing/vision/glaucoma
- dental/oral cancer
- thyroid: ATA 35+ q 5 years
- hearing/vision/glaucoma: ACO 40+ q 2-4 years
- dental/oral cancer: no standard; dentist q 6 months
SCREENING SPECIAL POPULATIONS Rubella Syphillis Ovarian cancer Lung Cancer
Rubella: pregnant or could become pregnant get titer
Syphillis: other STD’s, sexual risk factors, pregnant women, pay attention to rash
Ovarian cancer: routine no recommended, transvaginal U/S or CA125
Lung cancer: 55-80 30 pack year history
