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Case 7
fam med cases
9
Medical
Graduate
01/25/2011

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Cards

Term
Causes of Death
Definition
1) Smoking
2) Obesity
3) Diabetes
4) Hypertension
Term
Health risks of obesity
Definition
Hypertension
Dyslipidemia
Type 2 diabetes
Coronary heart disease
Stroke
Gallbladder disease
Osteoarthritis
Sleep apnea
Respiratory problems
Endometrial cancer
Breast cancer
Colon cancer
Term
Why do diabetic foot ulcers occur?
Definition
impaired sensation (distal
symmetric polyneuropathy) and impaired perfusion (diabetes vasculopathy
and peripheral vascular disease).

evaluate pedal pulses (strongest indicator of periph vasc disease
Term
How do you grade ulcers?
Definition
Grade 1: superficial, outpatient
Grade 2: deep ulcer no bone, outpatient
Grade 3: deep ulcer +cellulits +abscess, may need hosp
4) Local gangrene, emergent hosp
5) Extensive gangrene, emergent hosp
Term
Ddx of unilateral leg swelling
Definition
Cellulitis (infectious process, usually + fever)
DVT (swelling, pain, discoloration, inc risk w/ smoking, ocp, obesity)
Venous Insufficiency (can follow DVT, dull ache on standing that resolves w elevation)
Lymphedema (generally painless, chronic dull, heavy sensation in leg)
PVD (claudication w exercise, smoking is major risk, diabetes is major risk factor)
Term
Studies to order in unilateral leg swelling
Definition
Doppler US
D-dimer (can rule out DVT)
CBC
BUN, glucose, Cr
Coag studies
HbA1C
Wells criteria, high prob 3 or more (cancer, paralysis, bedridden, tenderness along venous sys, leg swollem calf swelling, pitting edema, colateral superficial veins, alt. dx present)
Term
Management of DVT
Definition
Goals: inhib growth, thromboembolic resolution, prev of recurrence

Heparin (IV, req hospitalization)
LMWH ( long half life, no lab monitoring, Outpatient)
Warfarin (6-12 wks if isolated event, 3 months if first time, 12m-indef if recurrent)

Criteria for Outpatient (hemodyn stable, good kidney fcn, low risk of bleeding, stable home env, daily INR monitoring access)
Term
INR monitoring in Warfarin
Definition
check 3 days after
INR >5 and <9 discontinue and repeat in 24 hours
INR> 9, hold warfarin and give oral vit K
Term
When to screen for intherited thrombophilia?
Definition
Initial thrombosis before 50 wo risk factor
fam hx
recurrent venous thrombosis
thombosis in unusual vascular beds (portal, hepatic etc)
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