Case Files 1-6 (C) Flashcards Preview

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1

Screening tests for cardiovascular conditions

  1. Blood pressure measurement (HTN)
  2. Lipid measurement (dyslipidemia)

2

Recommendations for:

Influenza vaccine

Tetanus vaccine

Annually and every 10 years, respectively

3

Intervention designed to prevent a disease before it occurs

Primary prevention

 

Examples:

Statin medication to reduce LDL in order to lower the risk of CAD

Removal of colon polyps to prevent the development of colon cancer

4

Intervention intended to reduce the recurrence or exacerbation of a disease

Secondary prevention

 

Example:

Use of a statin medication after a person has had a MI

5

Criteria for effective screening

  1. Disease should be of high enough prevalence to make the effort worthwhile
  2. Time frame during which the person is asymptomatic, but during which the disease/risk factor can be identified
  3. Available test that sufficient sensitivity and specificity, is cost-efective, and is acceptable to patients
  4. Must be an intervention that can be made during the asymptomatic period that will prevent the development of the disease or reduce the morbidity/mortality

6

Gold standard for clinical preventive medicine

USPSTF

(United States Preventive Services Task Force)

7

USPSTF grades

A: offer/provide this service

B: offer/provide this service

C: offer/provide only if there are other considerations that support offering/providing

D: discourage use of this service

I: insufficient evidence

8

When should screening begin for lipid disorders?

Level A:

Men >35

Women >45

 

Level B:

Adults >20 who are at increased risk for cardiovascular disease

 

 

9

Screening recommendation for abdominal aortic aneurysm

Level B for men 65-75 who have smoked at any point

 

Level C (no recommendation) for men who have never smoked

 

Level D for women, regardless of smoking status

10

Screening for colorectal cancer

Men and women older than 50

 

FOBT annually, sigmoidoscopy every 3-5 years, and colonoscopy every 10 years

*An abnormal FOBT or sigmoidoscopy leads to the performance of a colonoscopy

11

Tdap recommendation

All adults between 19 and 65 should receive a booster of Tdap in place of a scheduled dose of Td due to waning immunity against pertussis

12

Pneumococcal polysaccharide vaccination

Recommended as a single dose for all adults >65

*Recommended at a younger age for adults who are alcoholics/smokers, have chronic cardiovascular/pulmonary/renal/heptic disease, diabetes, an immunodeficiency, or who are functionally asplenic 

13

62M with recently diagnosed emphysema presents to your office for a routine exam. He has not had any immunizations in more than 10 years. Which immunizations would be most appropriate for this individual?

Tdap

Pneumococcal (d/t chronic lung disease)

Influenza

 

14

Two most common causes of dyspnea and wheezing in adults

  1. COPD
  2. Asthma

15

Presents earlier in life, may or may not be associated with cigarette smoking, and is characterized by episodic exacerbations with return to relatively normal baseline lung functioning

Asthma

16

Presents in midlife or later, is usually the result of a long history of smoking, and is a slowly progressive disorder in which measured pulmonary functioning never returns to normal.

COPD

17

Mainstays of medical therapy for both asthma and COPD

  1. Oxygen
  2. Bronchodilators
  3. Steroids

18

Cough and sputum production on most days for at least 3 months during at least 2 consecutive years

Chronic bronchitis

19

Shortness of breath caused by the enlargement of respiratory bronchioles and alveoli (destruction of lung tissue and elastin)

Emphysema

 

Pink puffer: pink from polycythemia (2/2 chronic hypoxia), enlarged chest b/c lungs cannot deflate, and puffing because slow breaths = less obstruction

20

A rare cause of COPD that should be considered when emphysema develops at younger ages (<45), especially in nonsmokers

α1-antitrypsin deficiency

21

Pathologic changes in COPD

Mucous gland hypertrophy with hypersecretion, ciliary dysfunction, destruction of lung parenchyma, and airway remodeling

 

By the time dyspnea develops, lung function has been reduced by about half and the COPD has been present for years

22

Barrel Chest + Distant Heart Sounds

COPD

A result of hyperinflation of the lungs

23

FVC and FEV1 in COPD

Both the FVC and FEV1 are reduced, but the ratio of FEV1 to FVC is less than 0.7

 

*Reversibility is defined as an increase in FEV1 of greater than 12% or 200 mL

 

Mild: FEV1 > 80

Moderate: FEV1 50-80

Severe: FEV1 30-50

Very Severe: FEV1 < 30

24

Treatment for:

Mild COPD (FEV1 >80%)

Moderate COPD (FEV1 50-80%)

Severe COPD (FEV1 30-50%)

Very severe COPD (FEV1 <30%)

Mild: short-acting bronchodilators

Moderate: long-acting bronchodilators

Severe: inhaled steroids

Very severe: long-term oxygen therapy and consider surgical interventions

25

Albuterol

Ipratropium

Short-acting bronchodilators for Stage I COPD

Albuterol = β2-agonist

Ipratropium = anticholinergic

 

Inhaled medications are preferred over oral

26

Salmeterol

Tiotropium

Long-acting bronchodilator for Stage II COPD

Salmeterol = inhaled β2-agonist

Tiotropium = inhaled anticholinergic

27

Fluticasone

Triamcinolone

Mometasone

Inhaled steroids for Stage III COPD

 

They do not affect the rate of decline of lung function, but do reduce the frequency of exacerbations. Long-term treatment with oral steroids is not recommended (use inhaled).

28

Should also consider when seeing a patient with suspected acute exacerbation of COPD

Pulmonary embolism

CHF

MI

 

*Systemic steroids shorten the course of exacerbation and may reduce the risk of relapse (40 mg prednisolone for 10-14 days is recommended)

29

59M with a known history of COPD presents with worsening dyspnea. On exam he is afebrile. His breath sounds are decreased bilaterally. He is noted to have JVD and 2+ pitting edema of the lower extremities. What is the most likely cause of his increasing dyspnea?

Cor pulmonale

AKA right heart failure due to chronically elevated pressures in the pulmonary circulation

30

45M presents with sudden onset of monoarticular joint pain. The first diagnosis that needs to be excluded is...

Infected Joint

 

Cartilage can be destroyed within the first 24 hrs of infection