MEQ for the following Family Medicine course activities:

1- cardiovascular disease primary prevention

2- ECG interpretation
3- Palliative Care medicine

Case 1
47 year old male teacher presented to your chronic diseases clinic for routine follow up. He
has a newly diagnosed diabetes mellitus type 2 and well-controlled with lifestyle. His last fol-
low up was more than one year ago.

1- What lab investigations you will consider for this visit ? (mention three)

A: fasting lipid profile (must be included), Hemoglobin A1c, fasting blood glucose, random blood
glucose, kidney function test with albumin:creatinine ratio, liver function test, thyroid function test,
creatinine-kinase, vitamin D

2- What is your advice for this patient?

A: Therapeutic lifestyle prevention, share decision about a cardiovascular disease prevention

through lipid control and to consider metformin

1- Hypothyroidism
2. Nephrotic syndrome
3. Chronic kidney disease (CKD)
4. Primary biliary cholangitis (PBC)
5. Obstructive jaundice
6. Diabetes
7. Obesity
8. Cushing's syndrome
9. Pheochromocytoma
10. Drugs ( thiazides, beta blockers, OCP, antipsychotics, retinoids like Accutane etc.)
11. Alcohol intake
12. Smoking
3- What are secondary causes of hyperlipidemia ? (mansion three)
4- What are the modalities for primary cardiovascular disease prevention for this patient?

A: Therapeutic lifestyle intervention, and pharmaceutically with statin (HMG-CoA reductase in-
hibitors).

Case 2
65 year old woman presented to emergency department with chest pain. ECG done and was
normal.

1a- What are the changes you expect on ECG in case of a cute coronary syndrome?

A: ST segment changes (elevation or depression)

1b- What is the natural progression STEMI (ST segment elevation myocardial infarction) on
ECG?

A: The natural progression of ECG changes seen in myocardial infarction is peaked T waves to ST
segment elevation, to Q wave development, to T wave inversion

2- You want to role out acute coronary syndrome, so what’s your next step?

A: To do stress ECG (pharmacological or treadmill) and cardiac enzymes.

3- what are the causes of ST elevation an ECG?

(mention three)

A: ST elevation myocardial infarction, Prinzmetal angina, post cardioversion, acute pericarditis,

acute myocarditis, pulmonary embolism, Brugada syndrome, hypothyroid, hypothermia, ventricu-
lar, aneurysm etc.

Case 3
86 year old male who is terminally ill due to bronchogenic carcinoma following up in your
palliative care medicine clinic for pain control.

1- How can you assess the pain intensity on this patient? Mention two

A: Visual analog scales, facial pain scale, numeric rating scales, verbal rating scale, multidimen-
sional tool, McGill pain assessment tool, pain map tool etc.

2- What are the pharmacological treatment for pain? Mention three

A: Non- opioids such as acetaminophen, NSAID, COX-2 inhibitors. Opioids such as oxycodone,
hydrocodone, codeine, Morphin, fentanyl and Hydromorphine.

3- What are the side effects Opioids?

A: Constipation, dry mouth, nausea, vomiting, sedation, confusion, pruritus, myoclonus, hallucina-
tion urinary retention, and respiratory depression.

4- Patient’s pain assessment indicates severe pain, what should you include in your prescrip-
tion for pain control?

A: Regular analgesics (best use morphine), PRN analgesics, laxatives, and PRN anti-emetics
Faisal Almohaileb
2022 January 3