Is "smoking cessation" really always the answer?

[brownie]

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Just took an NBME where I got two questions wrong to more seemingly relevant preventions. I know it is a "step 1 meme", but is it true? Should I go against my gut and choose smoking cessation every time?

 

[notbobtrustme]

yea, pretty much, especially if it's a life-style question.

 

[BlueArc]

Goljan says that the cheapest treatment is usually the answer.

 

[sadaca]

Yea expect I picked the cheapest treatment for someone to increase HDL in a uworld q, I picked exercise and the answer was Niacin. haha
Also for another q on uworld, It said the patient had DM, was smoker, HTN, obese etc all these bad things and then asked what was the factor which increased his chances of MI in future, ans was DM.
I guess those are exceptions, otherwise I've noticed its always smoking lol Did you guys see these qs too?

 

[Miracoli]

Also for another q on uworld, It said the patient had DM, was smoker, HTN, obese etc all these bad things and then asked what was the factor which increased his chances of MI in future, ans was DM.
I guess those are exceptions, otherwise I've noticed its always smoking lol Did you guys see these qs too?

because DM is considered as CAD risk equivalent. So your LDL target shoud be <100

 

[notbobtrustme]

because DM is considered as CAD risk equivalent. So your LDL target shoud be <100

yep, the leading cause of death in DM patients is an MI, so it makes sense treating their DM would reduce CVD.

 

[pacman2018]

because DM is considered as CAD risk equivalent. So your LDL target shoud be <100

except you don't treat to target goals anymore... I assume the new guidelines won't be on USMLEs for a while though

 

[Donald Juan]

I think in teenagers you need to go with safe driving; vehicular accidents are number one cause of death.

 

[Miracoli]

except you don't treat to target goals anymore... I assume the new guidelines won't be on USMLEs for a while though

What does the new guideline say?

 

[pacman2018]

What does the new guideline say?

patients get statins based on risk factors rather than levels. i.e. even if a patient has an LDL of 50, but has an MI, they still get a "high intensity" statin. there are a bunch of risk calculators out there for smart phones. just search for ASCVD calculator and there should be some free apps. here are the new guidelines:

http://circ.ahajournals.org/content/early/2013/11/11/01.cir.0000437738.63853.7a.full.pdf

 

[notbobtrustme]

except you don't treat to target goals anymore... I assume the new guidelines won't be on USMLEs for a while though

afaic, that **** doesn't exist until Step 1 is over. Concentrate on what you need to know for boards, not what's out there in real life.

 

[Miracoli]

patients get statins based on risk factors rather than levels. i.e. even if a patient has an LDL of 50, but has an MI, they still get a "high intensity" statin. there are a bunch of risk calculators out there for smart phones. just search for ASCVD calculator and there should be some free apps. here are the new guidelines:

http://circ.ahajournals.org/content/early/2013/11/11/01.cir.0000437738.63853.7a.full.pdf

I got your point, thanks.

 

[sazerac]

What if the patient has ulcerative colitis? Should you prescribe smoking then?

 

[notbobtrustme]

What if the patient has ulcerative colitis? Should you prescribe smoking then?

nicotine patch works, iirc.