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196 Cards in this Set
- Front
- Back
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A study of the whole person, covering the general health state and any obvious physical characteristics.
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The general survey
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What is the general survey?
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The study of the whole person, covering general health state and any obvious physical characteristics.
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An introduction to the physical exam that will follow, should give an overall impression, a "gestalt", of the person.
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The general survey
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T/F: Objective parameters used to form the general survey apply to only one body system.
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FALSE, these apply to the whole person
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When should the general survey begin?
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The moment you first encounter the person
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T/F: The general survey should begin the moment you first encounter the person.
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TRUE
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What are the four areas that make up the general survey?
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Physical appearance, body structure, mobility and behavior
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Physical appearance, body structure, mobility and behavior all make up the _____ ______.
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General survey
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What can be observed in the physical appearance portion of the general survey?
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Age, Sex, Level of consciousness, skin color and facial features
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What would be an abnormal finding during the general survey assessment of the physical appearance of the person's age?
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They could appear older than the stated age, as with chronic illness or chronic alcoholism.
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During the general survey, what would be an abnormal finding in assessing the physical appearance of the person's sex?
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Delayed or precocious puberty
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During the general survey, what may be an abnormal finding when assessing the physical appearance of the person's level of consciousness?
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They may be confused, drowsy, lethargic, etc.
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During the general survey, what may be an abnormal finding in assessing the physical appearance of the person's skin color?
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Pallor, cyanosis, jaundice, erythema, or any lesions
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During the general survey, what may be an abnormal finding when assessing the physical appearance of the person's facial features?
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Immobile, masklike, asymmetric drooping.
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During the general survey what is being observed when assessing body strucutre?
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Stature, Nutrition, Symmetry, Posture, Position and body build, contour
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Stature, nutrition, symmetry, posture, position and body build and body, contour are all assessed during which part of the general survey?
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Body structure
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During the general survey, what would be some abnormal findings in assessing the body structure stature?
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Excessively short or tall
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During the general survey, what would be some abnormal findings in assessing the body structure when it comes to nutrition?
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Cachectic, emaciated. Simple obesity-with even fat distribution. Centripetal obesity-fat concentrated in face, neck, trunk with the extremities as in Cushing syndome.
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During the general survey, what may be some abnormal findings when assessing the body structure when dealing with symmetry?
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Unilateral atrophy or hypertrophy. Asymmetric location of a body part.
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During the general survey, what may be some abnormal findings in body structure when dealing with posture?
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Rigid spine and neck; moves as one unit.
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During the general survey, what would be an abnormal finding in assessing the physical appearance of the person's sex?
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Delayed or precocious puberty
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During the general survey, what may be an abnormal finding when assessing the physical appearance of the person's level of consciousness?
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They may be confused, drowsy, lethargic, etc.
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During the general survey, what may be an abnormal finding in assessing the physical appearance of the person's skin color?
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Pallor, cyanosis, jaundice, erythema, or any lesions
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During the general survey, what may be an abnormal finding when assessing the physical appearance of the person's facial features?
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Immobile, masklike, asymmetric drooping.
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During the general survey what is being observed when assessing body strucutre?
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Stature, Nutrition, Symmetry, Posture, Position and body build, contour
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Stature, nutrition, symmetry, posture, position and body build and body, contour are all assessed during which part of the general survey?
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Body structure
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During the general survey, what would be some abnormal findings in assessing the body structure stature?
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Excessively short or tall
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During the general survey, what would be some abnormal findings in assessing the body structure when it comes to nutrition?
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Cachectic, emaciated. Simple obesity-with even fat distribution. Centripetal obesity-fat concentrated in face, neck, trunk with the extremities as in Cushing syndome.
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During the general survey, what may be some abnormal findings when assessing the body structure when dealing with symmetry?
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Unilateral atrophy or hypertrophy. Asymmetric location of a body part.
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During the general survey, what may be some abnormal findings in body structure when dealing with posture?
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Rigid spine and neck; moves as one unit.
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During the general survey, what would be some abnormal findings in body structure when assessing the person's position.
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Tripod-leaning forward with arms braced on chair arms; occurs with chronic pulmonary disease. Sitting straight up and resists lying down. Curled up in fetal position.
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During the general survey, when assessing the body structure, what are the normal observations of the person's body build, contour.
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1. Arm span (fingertip to fingertip) equals height.
2. Body length from crown to pubis roughly equal to length from pubis to sole. |
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During the general survey, what would be some abnormal findings in body structure when observing the person's body build, contour?
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Elongated arm span, arm span greater than height. (Marfan's syndrome) Missing extremities or digits, webbed digits or shortened limb.
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What is observed when doing a general survey of the person's mobility?
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Gait and Range of motion
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Gait and range of motion can be assessed during which part of the general survey?
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Mobility
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During the general survey, what are some abnormal findings in mobility when observing the person's gait?
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Exceptionally wide base. Staggered, stumbling. Shuffling, dragging, nonfunctional leg, Limping with injury, Propulsion-difficulty stopping
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During the general survey, what are some abnormal findings in mobility when observing the person's range of motion?
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Limited joint range of motion. Paralysis-absent movement, Movements jerky, uncoordinated, Tics tremors, seizures
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During the general survey, what should be observed when observing a person's behavior?
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Facial expression, Mood and affect, speech, dress and personal hygiene
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During the general survey, what are some abnormal findings in behavior that can be observed from facial expressions?
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Flat, depressed, angry, sad, anxious. However, note that anxiety is common in ill people. Also, some people smile when they are anxious.
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During the general survey, what are some abnormal findings in behavior that can be observed from the person's mood and affect?
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Hostile, distrustful, suspicious or crying
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During the general survey, what may be some abnormal findings in behavior when observing the patient's speech?
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Dysarthia and dysphagia.
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During the general survey, what are some abnormal findings in behavior when observing the person's dress?
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Clothing too large and held up by belt suggests weight loss, as does the addition of new holes in belt. Clothing too tight may indicate obesity or ascites. Consistent wear of certain clothing provides clues; long sleeves may conceal needle marks of drug abuse or thin arms of anorexia; Velcro fasteners instead of buttons may indicate chronic motor dysfunction.
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During the general survey, what are some abnormal findings in behavior when observing the person's personal hygiene?
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In a previously carefully groomed woman, unkempt hair and absent makeup may indicate malaise or illness.
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What are the four important steps when assessing a person's measurements?
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Weight, Height, BMI and waist circumference
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What are some abnormal findings when measuring a person's weight?
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An unexplained weight loss may be a sign of a short-term illness (ex fever, infectious disease of the mouth or throat) or a chronic illness (ex endocrine disease, malignancy, depression, anorexia nervosa and bulimia)
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This measurement table marks the optimal healthy weight for height and is an indicator of obesity or malnutrition.
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Body mass index table
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Weight gain usually is due to excess _____ intake.
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Calorie
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On the Body Mass Index Table <18.5 kg/m2 would be labled _______.
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Underweight
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On the BMI table, An underweight person would be less than ___kg/m2.
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18.5 kg/m2
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On the BMI table, 18.5-24.9 kg/m2 would be labled _______ weight.
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Normal weight
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What is considered a normal weight range on the BMI table?
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18.5-24.9 kg/m2
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On the BMI table, 25-29.9 kg/m2 would be labeled as _______ weight.
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Over weight
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What is considered to be in the overweight range on the BMI table?
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25-29.9 kg/m2
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On the BMI table, Class 1 Obesity ranges from ___-___ kg/m2
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30-34.9 m/kg2
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On the BMI table, a range of 30-24.9 kg/m2 would be labeled as what type of weight?
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(Class I) Obesity
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What range would a person be on the BMI table if they were (Class 2) Obesity?
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35-39.9 kg/m2
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On the BMI table, a range of 35.39.9 kg/m2 is considered to be what?
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(Class II) Obesity
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What range would a person be on the BMI table if they were (Class 3) or extreme Obesity?
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anything greater than 40 kg/m2
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If a person has a BMI of above 40 kg/m2 they are considered to be what?
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(Class III) or extreme obesity
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What may a female be at risk of if her waist circumference is greater than 35 inches?
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Type II diabetes, dyslipidemia and hypertension
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What may a male be at risk of if his waist circumference is greater than 40 incheas?
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Type II diabetes, dyslipidemia and hypertension
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What may someone be at risk for if their BMI is between 25 and 35 kg/m2?
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Cardiovascular disease (CVD)
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Cellular metabolism requires a stable core, or "____ ____" temperature of a mean of _____oC (____oF)
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"deep body" - 37.2oC and 99oF
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The body maintains a steady temperature through a thermostat, or feedback mechanism. Where is this regulated?
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In the hypothalamus
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What does the hypothalamus balance throughout the body when dealing with temperature?
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The hypothalamus balances heat production (from metabolism, exercises, food digestion, external factors) with heat loss (through radiation, evaporation of sweat, convection, conduction)
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This balances heat production with heat loss in the body.
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Hypothalamus (thermostat)
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What is the normal oral temperature in a resting person?
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37oC (98.6oF)
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What is the normal range of temperature in a resting person?
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36.8oC to 37.3oF (96.4oF to 99.1oF)
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What is the normal rectal temperature in a resting person?
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0.4o to 0.5oC (0.7o-1o F) higher than normal temperature
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What are four things that can influence normal temperature?
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Diurnal cycle, the menstruation cycle, exercise and age
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Where should an oral temperature be placed?
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At the base of the tongue in either of the posterior sublingual pockets-not in front of the tongue!
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T/F: An oral temperature should be placed in front of the tongue.
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FALSE
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How long should an oral thermometer be left in place if a person is afebrile?
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3 to 4 minutes
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How long should an oral thermometer be left in place if a person is febrile?
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8 minutes
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When taking an oral temperature, how long should you wait if the person has just taken hot or iced liquids?
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15 minutes
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When taking an oral temperature, how long should you wait if the person has just smoked?
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2 minutes
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When taking a person's temperature, this method has the advantages of swift and accurate measurements (usually 20 to 30 seconds) as well as safe, unbreakable, and disposable probe covers
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Electronic thermometer
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This temperature should only be taken when the other routes are not practical.
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Rectal thermometer
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T/F: When inserting a rectal temperature it is important to wear gloves.
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TRUE
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How far should an electronic temperature be inserted when taking a rectal temperature?
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only 2 to 3cm (1in)
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T/F: You should not use lubrication when inserting a rectal thermometer.
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FALSE
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This thermometer senses infrared emissions of the ear drum.
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Tympanic membrane thermometer
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What does 40.0 oC equal in Farenheight?
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104oF
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What does 37.0 oC equal in Farenheight?
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98.6oF
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What does 35oC equal in Fahrenheit?
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95 oF
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What are the five vital signs?
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Pulse, Respirations, Blood pressure temperature and pain.
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The amount of blood bumped into the aorta
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Stroke Volume
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What is the average stroke volume in an adult?
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70 mL
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What are we feeling when we take a pulse?
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The force of the stroke volume that flares the arterial walls and generates a pressure wave
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The force of the stroke volume that flares the arterial walls and generates a pressure wave can be felt in the perphery as the ______.
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Pulse
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T/F: Palpating the perpheral pulse gives the rate and rhythm of the heartbeat, as well as local data on the condition of the artery.
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TRUE
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What are three observations that should be obtained in checking the pulse?
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Rhythm, rate and force
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What should the pulse rate be in a normal adult?
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50-90 beats per minute
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What is a heart rate of less than 50 bpm?
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Bradycardia
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What is a rapid heat beat of over 90 bpm?
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Tachycardia
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What should the rhythm of the pulse be at?
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An even tempo
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When assessing the heart rhythm in children, a commonly found irregularity in children and young adults is ________ ______________. This is when the heart rate varies with the respiratory cycle, speeding up at the peak of inspiration and slowing to normal with expiration.
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Sinus arrhythmia
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When assessing heart rhythm, who may it be common to detect Sinus Arrhythmia in?
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children and young adults
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This irregularity is when the heart rate varies with the respiratory cycle, speeding up at the peak of inspiration and slowing to normal with expiration.
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Sinus arrhythmia
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The pulse force is recorded using a three point scale. What does it look like?
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3+--full, bounding
2+--normal 1+--weak,thready 0--absent |
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Review the table on pg135 of normal respiratory rates
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Starts at neonate 30-40 breaths per minute ---> normal adult is 10-20 breaths per minute
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What are the normal respiratory rates in an adult?
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10-20 breaths per minute
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What are the normal respiratory rates in a neonate?
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30-40
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This is the force of the blood pushing against the side of its container, the vessel wall.
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Blood pressure
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The maximum pressure felt on the artery during ventricular contraction
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Systole
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The elastic recoil, or resting, pressure that the blood exerts constantly between each contraction.
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Diastolic pressure
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The difference between the systolic and diastolic pressures that reflects the stroke volume.
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Pulse pressure
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How do you calculate pulse pressure?
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Diastolic pressure is subtracted from the systolic pressure
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The pressure forcing blood into the tissues, averaged over the cardiac cycle.
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Mean arterial pressure (MAP)
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What is the mean arterial pressure (MAP)?
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The pressure forcing blood into the tissues, averaged over the cardiac cycle.
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How do you calculate the mean arterial pressure (MAP)?
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It is a value closer to diastolic pressure plus one-third the pulse pressure.
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What factors can influence the average BP in young adults?
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Age, gender, race, diurnal rhythm, weight, exercise, emotions and stress
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When assessing BP it is important to know that the width of the rubber bladder should equal ___% of the circumference of the person's arm and the length of the bladder should equal ___% of the circumference.
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40%, 80%
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When assessing BP it is important to know that the width of the rubber bladder should equal ___% of the circumference of the person's arm and the length of the bladder should equal ___% of the circumference
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40%, 80%
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When assessing BP it is important to know that the width of the rubber bladder should equal ___% of the circumference of the person's arm and the length of the bladder should equal ___% of the circumference
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40%, 80%
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When assessing the person's blood pressure, why is it imporant that both feet be placed flat on the floor?
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Because BP has a false high measurement when legs are crossed versus uncrosses
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This is the period when Korotkoff sounds disappear during ausculation.
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Ausculatory gap
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What is the ausculatory gap?
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The period when Korotkoff sounds disappear during ausculation.
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When is it a good idea to take serial measurements of pulse and blood pressure?
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(1) When you suspect volume depletion, (2)when the person is known to have hypertension or is taking antihypertensive medications or(3) when the person reports fainting or syncope.
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When BP measured in the arm is excessively high, where should we take BP to compare it?
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Thigh pressure
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When BP is measured excessively high in the arm, we should take BP in the thigh to check for _____ of the aorta.
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Coarctation
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A congenital form of narrowing.
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Coarctation
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What is coarctation and where would we take BP to check for this?
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Coarctation is a congenital form of narrowing. We would take it in the thigh when the BP in the arm is excessively high.
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What are some signs of child abuse that can be observed during the general survey?
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Child avoids eye contact, the child exhibits no separation anxiety when you would expect it for age, the parent is disgusted by child's odor, sounds, drooling or stoolness.
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Weigh to the nearest ___g (1/2oz) for infants.
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10g
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Weigh to the nearest ___g (1/4lb) for toddlers.
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100g
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How should height be measured for a child who is less than two years old?
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in a supine position by using a horizontal measuring board
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what is another word for a flat ruler- used to measure a child's height by standing against this which is mounted on the wall.
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Stadiometer
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T/F: Healthy childhood growth is continuous but uneven, with rapid growth spurts occuring during infancy and adolescence.
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TRUE
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What should be done at each well-child visit up to age 2 years and then yearly up to 6 years?
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Measure the infants head circumference
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What should be done at each well-child visit up to age 2 years and then yearly up to 6 years?
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Measure the infants head circumference
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What should be done at each well-child visit up to age 2 years and then yearly up to 6 years?
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Measure the infants head circumference
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What should the newborns head measure between?
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32-38cm (average of 34cm)
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What could it mean if an infants head circumference is above 38cm?
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An enlarged head circumference occurs with increased intracranial pressure.
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T/F: With an infant reverse the order of vital sign measurement to respiration, pulse than temperature.
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TRUE
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In what order should vital signs be taken with an infant?
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respiration, pulse than temperature
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T/F: Adults tend to have higher fevers with illness than children do.
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FALSE, Up to ages 6 to 8 years, children have higher fevers with illness than adults do. Even with minor infections, fevers may elevate to 103-105oF (39.5-40.5oC)
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When assessing a newborn's respirations, it is important to know that if they are 2mos old and at greater than 60 breaths/min then this is known as:
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Tachypnea
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When assessing a newborn's respirations, it is important to know that if they are 2mos-12mos and at 50breaths/min then they have:
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Tachypnea
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What may tachypnea and/or labored respirations indicate in an infant?
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Pneumonia
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Children younger than 3 years have such small arm vessels that it is difficult to hear Korotkoff sounds with a stethoscope. What should be used instead?
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Use an electronic BP device that uses oscillometry, such as Dinamap, and gives a digital readout. Or use a Doppler ultrasound device to amplify sounds.
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Why should we use a Dinamap or Doppler ultrasound device instead of a stethoscope when measuring an child's BP?
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Because their arm vessels are so small and it is difficult to hear Korotkoff sounds.
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As the adult ages, changes in the body's temperature regulatory mechanism leave the aging person less likely to have a __________ but at greater risk for ______.
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Fever; Hypothermia
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When assessing the pulse of an aging adult the heart rate is still 50 to 90 bpm, but the rhythm may be slightly _________.
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Irregular
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A noninvasive method to assess arterial oxygen saturation.
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Pulse oximeter
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What is a pulse oximeter?
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A noninvasive method to assess arterial oxygen saturation.
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In measuring oxygen saturation using a pulse oximeter, a healthy person with no lung disease and no anemia normally has a Spo2 of ___-____%.
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97-98%
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In measuring oxygen saturation using a pulse oximeter, a healthy person with no lung disease and no anemia normally has a Spo2 of ___-____%.
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97-98%
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What does an Spo2 of 97-98% indicate?
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A healthy person with no lung disease and no anemia.
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What does an Spo2 of 97-98% indicate?
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A healthy person with no lung disease and no anemia.
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When sould we not use an Electronic Vital Signs Monitor?
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When a patient has a systolic BP of <90mmHg or with conditions of irregular heart rate, shivering, tremors or seizures.
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When sould we not use an Electronic Vital Signs Monitor?
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When a patient has a systolic BP of <90mmHg or with conditions of irregular heart rate, shivering, tremors or seizures.
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T/F: An Electronic Vital Signs Monitor should be used when a patient has a systolic BP of <90mmHG or with conditions of irregular heart rate, shivering, tremors or seizures.
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FALSE, that is when it should NOT be used.
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T/F: An Electronic Vital Signs Monitor should be used when a patient has a systolic BP of <90mmHG or with conditions of irregular heart rate, shivering, tremors or seizures.
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FALSE, that is when it should NOT be used.
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What is a Doppler ultrasonic flowmeter used for?
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taking blood pressure by checking the sound pumping through the artery in a rhythmic manner
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What is a Doppler ultrasonic flowmeter used for?
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taking blood pressure by checking the sound pumping through the artery in a rhythmic manner
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When taking BP, this is used to locate the peripheral pulse sites.
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Doppler ultrasonic flowmeter
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When taking BP, this is used to locate the peripheral pulse sites.
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Doppler ultrasonic flowmeter
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Through this technique you will augment Korotkoff sounds. Through this technique, you can evaluate sounds that are hard to hear with a stethoscope, such as those in critically ill individuals with a low BP, in infants with small arms, and in obese persons in whom the sounds are muffled by layers of fat.
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Doppler ultrasonic flowmeter
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Through this technique you will augment Korotkoff sounds. Through this technique, you can evaluate sounds that are hard to hear with a stethoscope, such as those in critically ill individuals with a low BP, in infants with small arms, and in obese persons in whom the sounds are muffled by layers of fat.
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Doppler ultrasonic flowmeter
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Who would you use a Doppler ultrasonic flowmeter to measure BP?
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Critically ill individuals with a low BP, infants with small arms and obese persons in whom the sounds are muffled by layers of fat
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Who would you use a Doppler ultrasonic flowmeter to measure BP?
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Critically ill individuals with a low BP, infants with small arms and obese persons in whom the sounds are muffled by layers of fat
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The 2003 Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure considers certain lifestyle modifications to be the foundation of hypertension control. What are some modifications that will help keep blood pressure under control?
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Lose weight if you are more than 10% above ideal weight, Limit alcohol intake to no more than 1oz of ethanol of beer, 10oz of wine, or 2oz of whiskey per day for men, or 0.5oz ethanol per day for women and lighter-weight people, Get regular aerobic exercise most days of the week, cut sodium intake from the average to less than, include the recommended daily allowances in your diet, stop smoking, reduce dietary saturated fat and cholestrol
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The 2003 Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure considers certain lifestyle modifications to be the foundation of hypertension control. What are some modifications that will help keep blood pressure under control?
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Lose weight if you are more than 10% above ideal weight, Limit alcohol intake to no more than 1oz of ethanol of beer, 10oz of wine, or 2oz of whiskey per day for men, or 0.5oz ethanol per day for women and lighter-weight people, Get regular aerobic exercise most days of the week, cut sodium intake from the average to less than, include the recommended daily allowances in your diet, stop smoking, reduce dietary saturated fat and cholestrol
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This abnormality is a deficiency in growth hormone in childhood and results in retardation of growth below the 3rd percentile, delayed puberty, hypothyroidism, and adrenal insufficiency.
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Hypopituitary dwarfism
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This abnormality is a deficiency in growth hormone in childhood and results in retardation of growth below the 3rd percentile, delayed puberty, hypothyroidism, and adrenal insufficiency.
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Hypopituitary dwarfism
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Describe Hypopituitary Dwarfism.
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Deficiency in growth hormone in childhood results in retardation of growth below the 3rd percentile, delayed puberty, hypothyroidism and adrenal insufficiency.
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This abnormality is an excessive secretion of growth hormone by the anterior pituitary resulting in overgrowth of the entire body. It causes increased height in weight and delayed sexual development.
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Gigantism
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Describe Gigantism.
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Excessive secretion of growth hormone by the anterior pituitary resulting in overgrowth of the entire body. It causes increased height in weight and delayed sexual development.
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A genetic disorder in converting cartilage to bone results in normal trunk size, short arms and legs, and short stature.
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Achondroplastic Dwarfism
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Describe Achondroplastic Dwarfism.
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A genetic disorder in converting cartilage to bone results in normal trunk size, short arms and legs and short stature.
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A serious psychological disorder characterized by severe and life-threatening weight loss and amenorrhea in an otherwise healthy adolescent or young women.
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Anorexia Nervosa
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Describe Anorexia Nervousa.
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Psych disorder, Severe and life threatening weight loss, amennorhea
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Either administration of adrenocorticotropin or excessive production of the ACTH by the pituitary will stimmulate the adrenal cortex to secrete excess cortisol. This causes:
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Cushing Syndrome (Endogenous Obesity)
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Describe Cushing syndrome (Endogenous Obesity)
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Caused by administration of adrenocorticotropin (ACTH) or excessive production of ACTH by the pituitary..... This stimulates the adrenal cortex to secrete excess cortisol
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Excessive secretion of growth hormone is adulthood, after normal completion of body growth, causes overgrowth of bone in the face, head ,hands and feet but no change in height.
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Acromegaly
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Describe Acromegaly.
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Excessive secretion of the growth hormone in adulthood, after normal completion of body growth, causes overgrowth of bone in the face, head, hands and feet but no change in height. Internal organs also enlarge and metabolic disorders may be present.
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T/F: Acromegaly can also cause a person's internal organs to enlarge and metabolic disorders.
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TRUE
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Connective tissue disorder, characterized by tall thin stature, arachnodactyl, hyperextensible joints, arm span greater than height. Early morbitity and mortality occur as a result of cardiovascular complications sich as mitral regurgitation and aortic disease.
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Marfan's syndrome
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Describe Marfan's syndrome.
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Connective tissue disorder characterized by tall think stature, arachnodactyl, hyperextensible joints, arm span greater than height. Early morbitity and mortality occur as a result of cardiovascular complications such as mitral regurgitation and aortic disease.
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Abraham Lincoln was suspected of having this connective tissue disorder.
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Marfan's syndrome
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A person with acute myocardial infarction would probably have (hypertension/hypotension)?
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Hypotension
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A person in shock would probably have (hypertension / hypotension)?
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Hypotension
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A person with a hemorrhage would probably have (hypertension / hypotension)?
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Hypotension
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A person experiencing vasodilation would probably have (hypertension / hypotension)?
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Hypotension
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A person with Addison's disease (hypofunction of adrenal glands) would probably have (hypertension / hypotension)?
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Hypotension
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What are some associated signs and symptoms of someone with hypotension?
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Increased pulse, dizziness, diaphoresis, confusion and blurred vision. The skin feels cool and clammy because the superficial blood vessels constrict to shunt blood to the vital organs.
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This type of hypertension occurs from no known cause but is responsible for about 95% of cases of hypertension in adults.
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Essential or primary hypertension
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What is considered normal blood pressure?
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<120 and <80
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What would be considered to be prehypertension?
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(120-139) or (80-89)
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What would be considered Stage 1 hypertension?
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(140-159) or (90/99)
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What would be considered for Stage 2 hypertension?
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>160 or >100
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If someone has a systolic BP between the range of (120-139) or a diastolic BP between the range of (80-89) then what is their BP classification?
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Prehypertension
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If someone has a systolic BP of (140-159) or a diastolic BP of (90-99), then what is their BP classification?
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Stage 1 Hypertension
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If someone has a systolic BP of >160 or a diastolic BP of >100, then what is their BP classification?
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Stage 2 Hypertension
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What are some major risk factors for cardivascular complications in patients with hypertension?
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Smoking, Dyslipidea, Diabetis mellitus, Age >60yrs, Gender (men and postmenopausal women), Family history of cardiovascular disease; women ,65yrs or men<55yrs
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