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, fasting lipid panel and Urine Microalbumin/Creatinine ratio.
- 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
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.
- Eye examination: Funduscopic exam
- Neck exam: Carotid auscultation
- Cardiovascular exam: Palpation, auscultation
- Pulmonary exam: Auscultation
- Abdominal exam: Auscultation, palpation, percussion
- Extremities: Inspect feet for infection or ulcers, Check peripheral pulses
- Neurologic exam: Motor, Sensation (i.e., Monofilament testing), DTRs, Babinski Reflex
Diabetes Follow up Mnemonic | DIABETIC-NPH Mnemonic
DIFFERENTIAL DIAGNOSIS
In this case the differential diagnosis 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 differential diagnosis 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: to measure your patient’s average blood sugar levels over the past 3 months in order to determine whether their diabetes is controlled or needs additional intervention.
- Urine Microalbumin/Creatinine ratio: to screen for diabetic nephropathy and to monitor kidney function in those who have been diagnosed with kidney disease or taking medications that can affect the kidneys.
- Basic Metabolic Panel: to check the Estimated Glomerular Filtration Rate (eGFR), BUN/creatinine ratio and also 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.
- Fasting Lipid Panel: to calculate the Atherosclerotic cardiovascular disease (ASCVD) risk.
Diabetes Follow up Mnemonic | DIABETIC-NPH Mnemonic
- 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
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Diabetes Follow up Mnemonic | DIABETIC-NPH Mnemonic