Diabetes Follow up Mnemonic | DIABETIC-NPH Mnemonic – USMLE Step 2 CS

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Diabetes Follow up Mnemonic | DIABETIC-NPH Mnemonic

Diabetes Follow Up Mnemonic:

It is common to have a patient on your USMLE Step 2 CS exam who is just coming in medication refill. However, it is not as easy as to simply just send in the refills and say goodbye to your patient.

As a doctor, your job is to:

  • Find out whether patient is compliant with his/her medications and if they are not compliant then find out why.
  • Confirm dose and how frequent they take the medication. 
  • Find out whether they have been experiencing any common side effects with their medications (for example if they started having dry cough since they started taking ACE inhibitors).
  • Go through their medication list and make sure there is no major interactions.
  • Find out if the patient is experiencing any complications related to their disease. For example in case of diabetes, you should ask about having chest pain, changes in vision, bloating, erectile dysfunction, numbness/tingling sensation in their feet.
  • Obtain some lab work such as HbA1c, Basic Metabolic Panel (BMP), lipid panel & urine microalbumin.
  • Counseling the patient at the end of their visit – SEE BELOW

If you are having trouble remembering all the important questions to ask during your patient encounter then try this Diabetes Follow up Mnemonic | DIABETIC-NPH Mnemonic for USMLE Step 2 CS.
Diabetes Follow up Mnemonic | DIABETIC-NPH Mnemonic

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Diabetes Follow up Mnemonic – DIABETIC-NPH Mnemonic BEST USMLE Step 2 CS

PHYSICAL EXAMINATION 

NOTE: Make sure to wash your hands or wear gloves before you start physical examination. Make sure to ask for permission before you start each physical exam. Make sure to use proper draping (don’t forget to tie back patient’s gown). Make sure to explain the physical examination in layman’s term to your patient. Do NOT repeat painful maneuvers.

Diabetes Follow up Mnemonic | DIABETIC-NPH Mnemonic

DIFFERENTIAL DIAGNOSIS

In this case the DDx depends on the patient’s HPI and whether he/she has any other complains other than the request for refill prescription. For example if the patient is complaining of  “Chest pain” then you must do DDx for Chest pain, or if the patient is having problem with erection then you must do differential diagnosis for Erectile dysfunction and…

Diabetes Follow up Mnemonic | DIABETIC-NPH Mnemonic

DIAGNOSTIC WORK-UP 

  • Genital Exam : only if your patient has a complaint [e.g. erectile dysfunction.]Please NOTE that you are not required to do this on your actual exam) 
  • Random serum glucose or Fasting serum glucose: to check patient’s serum glucose level to determine whether their medications are effective.
  • HbA1c
  • Urinalysis
  • Urine Microalbumin: to check renal function.
  • Basic Metabolic Panel: to check BUN/Cr, which will in turn provide you information about your patient’s renal function. Also, to check for any electrolyte abnormalities. 
  • Complete Blood Count: to check for anemia. Remember that diabetic patients are at increased risk of developing chronic kidney disease which can eventually lead to anemia of chronic disease.
  • Cholesterol panel

Diabetes Follow up Mnemonic | DIABETIC-NPH Mnemonic

Diabetes Follow up Mnemonic | DIABETIC-NPH Mnemonic - USMLE Step 2 CS
COUNSELING
Diabetes Mellitus & Hypertension Counseling  –> MEDOWS

  • Medication [educate the importance of being compliant with the medication and taking them regularly and as prescribed. Also, educate on possible side effects to look out for]
  • Exercise [encourage to do daily walks plus at least 20 to 30 minutes of cardio every other day. Especially if patient is overweight or obese] 
  • Diet modification (LESS salty, fatty and fast food. MORE fruits and vegetables)
  • Ophthalmoscopic exam [Must be done once a year from the time diabetes was diagnosed. Ask if they have had one within the past year]
  • Weight management
  • Sugar check up daily
Diabetes Follow up Mnemonic | DIABETIC-NPH Mnemonic

Diabetes Follow up Mnemonic | DIABETIC-NPH Mnemonic - USMLE Step 2 CS
OTHER USEFUL LINKS:
Please visit the following links for even more great resources to help you with your USMLE Step 2 CS.

Diabetes Follow up Mnemonic | DIABETIC-NPH Mnemonic USMLE Step 2 CS Mnemonic

Diabetes Follow up Mnemonic | DIABETIC-NPH Mnemonic - USMLE Step 2 CS
FREE MEDICAL VIDEOS
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Diabetes Follow up Mnemonic | DIABETIC-NPH Mnemonic

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