AAFP Flashcards
Management in a patient with symptoms of preeclampsia?
further evaluation, including a 24-hour urine for quantitative measurement of protein, blood pressure monitoring, and laboratory evaluation that includes hemoglobin, hematocrit, a platelet count, and serum levels of transaminase, creatinine, albumin, LDH, and uric acid.
A peripheral smear and coagulation profiles also may be obtained.
Antepartum fetal testing, such as a nonstress test to assess fetal well-being, would also be appropriate.
In a DM patient, where should they inject their insulin to prevent exercise induced hypoglycemia?
Abdomen
Treatment of DM in pregnancy?
Human insulin- doesn’t cross placenta.
Oral agents cross the placenta and make cause severe neonatal hypoglycemia
Acute asthma attack that is not responsive to B2 agonist should be treated with?
Oral corticosteroids
Management strategy to help prevent Premenstrual Syndrome?
Spirinolcatone during the luteal phase
Which class of medications are associated with increase risk of fall in elderly patients?
benzodiazepines, antidepressants, antipsychotics, antiepileptics, anticholinergics, sedative hypnotics, muscle relaxants, and cardiovascular medications.
Urge Incontinence?
occurs when patients sense the urge to void but are unable to inhibit leakage long enough to reach the toile
Stress incontinence?
coughing, lifting, sneezing
Overflow incontinence?
occurs when the bladder cannot empty normally and becomes overdistended
Functional incontinence?
cases where lower urinary tract function is intact but other factors such as immobility and severe cognitive impairment lead to incontinence
Treatment of Narcolepsy?
Stimulants, such as methylphenidate
Evaluation of Pulmonary Embolism?
check D-dimers to establish diagnosis
genetic QT syndrome is best diagnosed by?
Resting EKG that shows a QTc >460 msec in females and >440 msec in males.
This syndrome especially places young people at risk for sudden death. Management may include β-blockers, an implantable cardioverter-defibrillator, and no participation in competitive sports.
What dietary supplement has the best evidence of efficacy in the treatment of osteoarthritis of the knee?
Glucosamine sulfate
Antipsychotic with the least weight gain?
Aripiprazole
Symptoms and Lab findings of Multiple Myeloma. What would be the confirmatory test?
Diagnosis is confirmed by bone marrow examination showing >10% plasma cells in the marrow.
The serum level of monoclonal immunoglobulin is typically >3 g/dL
How to manage a small pneumothorax (<15% of lung volume) without apparent lung disease?
outpatient with analgesics and follow-up within 72 hours.
CT of the lung is needed in complicated cases, including patients with known lung disease or recurrent pneumothoraces.
A chest tube is required only when the pneumothorax involves >15% of lung volume.
Exercise recommendations for healthy adults?
engage in 30 minutes of accumulated moderate-intensity physical activity on 5 or more days per week.
Treatment of symptomatic terminally ill patient?
Morphine/Opiates
Indications for Pneumococcal vaccine?
All persons between the ages of 19 and 64 who smoke should receive this vaccine.
One-time revaccination after 5 years is recommended for persons with chronic renal failure, asplenia (functional or anatomic), or other immunocompromising conditions.age 65
Treatment for outpatient diverticulitis?
Amox/Clavulanic acid
What is fecal incontinence, specifically “overflow”?
commonly seen in institutionalized elderly due to medications causing constipation
Most important for preoperative assessment surgical risk in a patient with longstanding RA?
Cervical spine imaging to detect atlantoaxial subluxation would be most important for preventing a catastrophic spinal cord injury during intubation
Most frequent cause of constant unilateral obstruction in adults?
Septal devation
What muscle relaxant to avoid in substance abuse?
Carisoprodol is metabolized to meprobamate, which is a class III controlled substance
Muscle strength scale
Muscle strength is scored on a scale of 0 to 5.
The inability to contract a muscle is scored as 0. Contraction without movement constitutes grade 1 strength. Movement with the effect of gravity neutralized is grade 2 strength, while movement against gravity only is grade 3 strength. Movement against gravity plus some additional resistance indicates grade 4 strength. Normal, or grade 5, strength is demonstrated by movement against substantial resistance.
Which anti-hypertensive meds cause ankle edema?
The most common side effects of calcium channel blockers, such as amlodipine, are due to vasodilation.
One result of this may be peripheral edema, but it can also cause dizziness, nausea, hypotension, cough, and pulmonary edema.
Behcet’s Syndrome
recurring genital and oral ulcerations and relapsing uveitis.
It is more common in Japan, Korea, and the Eastern Mediterranean area, and affects primarily young adults.
The cause is unknown. Two-thirds of patients will develop ocular involvement that may progress to blindness.
Patients may develop arthritis, vasculitis, intestinal manifestations, or neurologic manifestations.
This disease is also associated with cutaneous hypersensitivity; 60%–70% of patients will develop a sterile pustule with an erythematous margin within 48 hours of an aseptic needle prick
What test is best at detecting the rate of Down syndrome in the first trimester of pregnancy?
Chorionic villus sampling
can be offered at 10–13 weeks gestation, and has a 97.8% detection rate for Down syndrome—the best detection rate of studies offered in the first trimester
Conventional therapy for acute pericarditis?
NSAIDS
In patients with chronic renal disease with chronic normocytic anemia will have the best predictive outcome if you raise the hemoglobin level to:
10-12 g/dl
patients who had hemoglobin levels targeted to normal ranges did worse than patients who had hemoglobin levels of 10–12 g/dL
Vocal cord dysfunction?
an idiopathic disorder commonly seen in patients in their twenties and thirties in which the vocal cords partially collapse or close on inspiration.
It mimics, and is commonly mistaken for, asthma.
Symptoms include episodic tightness of the throat, a choking sensation, shortness of breath, and coughing.
A careful history and examination reveal that the symptoms are worse with inspiration than with exhalation, and inspiratory stridor during the episode may be mistaken for the wheezing of asthma
Pulmonary function tests (PFTs) are normal, with the exception of flattening of the inspiratory loop, which is diagnostic of extra-thoracic airway compression
What symptom makes the D/X of PE more likely, in a patient with sudden onset of dyspnea?
Chest Pain
Nursemaid’s elbow?
one of the most common injuries in children under 5 years of age.
It occurs when the child’s hand is suddenly jerked up, forcing the elbow into extension and causing the radial head to slip out from the annular ligament.
In a child with an acute asthma attack not responding to oral prednisolone and MDI albuterol should be given what?
IV magnesium sulfate.
intravenous magnesium sulfate has been shown to improve lung function and reduce the need for hospitalization
SIDS vs. suffocation?
most common cause of death during the first 6 months of life in the United States, with a peak incidence at 2–4 months of age and a quick dropoff by the age of 6 months.
Suffocation should be considered when there is documentation of any of the following: infant age older than 6 months, previous similar sibling deaths, simultaneous twin deaths, or evidence of pulmonary hemorrhage
Management in reducing oxalate stone formation?
Potassium citrate should be taken at mealtime to increase urinary pH and urinary citrate.
A low-sodium, restricted-protein diet with increased fluid intake reduces stone formation.
Oxalate restriction also reduces stone formation. Oxalate-containing foods include spinach, chocolate, tea, and nuts, but not yellow vegetables
Initial imaging for a possible stress fracture?
Xray
These are usually negative initially, but are more likely to be positive over time. If the initial films are negative and the diagnosis is not urgently needed, a second plain radiograph can be performed in 2–3 weeks.
Signs and Sx of Ethylene Glycol poisoining? Antidote?
patient who appears intoxicated but does not have an odor of alcohol, and has anion gap acidosis, hypocalcemia, urinary crystals, and nontoxic blood alcohol levels
The American Academy of Clinical Toxicology criteria for treatment of ethylene glycol poisoning with an antidote include a plasma ethylene glycol concentration >20 mg/dL, a history of ingesting toxic amounts of ethylene glycol in the past few hours with an osmolal gap >10 mOsm/kg H O2 (N 5–10), and strong clinical suspicion of ethylene glycol poisoning, plus at least two of the following: arterial pH <20 mmol/L, or urinary oxalate crystals.
Antidote: Fomepizole
Safe to give in Diabetics with Chronic renal disease?
Glipizide
Treatment in patients with essential tremor that are not responsive to Beta blockers?
Primadone
Criteria for pre-eclampsia
blood pressure of 160/110 mm Hg or above on two occasions, 6 hours apart. Other criteria include proteinuria above 5 g/24 hr, thrombocytopenia with a platelet count <100,000/mm3, liver enzyme abnormalities, epigastric or right upper quadrant pain, and alteration of mental status
which drug can elevate calcium by increasing PTH levels?
Lithium
which DM medications delay gastric emptying?
Pramlinitide and Exenatide–> C/I in DM gastroparesis
Dupuyten’s contracture is commonly seen in?
Diabetes Mellitus
Probiotics
can lessen the severity and duration of infectious diarrhea
recommended time to screen for gestational diabetes in asymptomatic women with no risk factors
24-28 weeks
Self-Determination Act requires that
hospitals ask patients about advance directives
Normal Ejection Fraction
55-75%
common presenting symptom of obstructive sleep apnea
excessive daytime sleepiness
recommended in the treatment of all four stages of COPD, from mild through very severe
Short-acting inhaled ß2 -agonists such as albuterol (Ventolin HFA), as needed for dyspnea
In assessing the nutritional status of an infant it is useful to know that birth weight is expected to be regained within
14 days
The advance directive specifications contained in an individual’s living will become effective
when the individual becomes unable to communicate health care wishes
oppositional defiant disorder
pattern of negativistic, hostile, and defiant behavior lasting at least 6 months. The child will often lose his or her temper, argue with adults, actively defy or refuse to comply with adults’ requests or rules, deliberately annoy people, blame others for his or her mistakes or misbehavior, be easily annoyed by others, appear angry and resentful, or be spiteful or vindictive. At least four of these behaviors must be present to meet the criteria for diagnosis.
In patients with type 2 diabetes mellitus, intensive glycemic control has not been shown to be beneficial for which one of the following diabetic complications
CV disease
Women older than 65 years of age who have low serum TSH levels, indicating physiologic hyperthyroidism, are at increased risk for
hip fracture
Tx for Non bulls Impetigo
Topical Mupirocin
Antidepressant in children/adolescents
SSRI- fluoxetine
Fibromyalgia is characterized by tender trigger points
along the medial border of each scapula
Tx of Alopecia Areata
Intralesional triamcinolone (Kenalog) – corticosteroids
risk factor for intermittent claudication
Diabetes mellitus and cigarette smoking are significant risk factors for intermittent claudication, as are hypertension and dyslipidemia.
findings would indicate that the patient suffers from severe anorexia nervosa?
Hypotension, bradycardia, and hypothermia
Risk of developing esophageal adenocarcinoma from barrel’s esophagus?
<1%
treatment for an uncomplicated urinary tract infection,
Nifurantoin for 5 days
First line tx for pyelonephritis
Ciprofloxacin
Patient presents with pleuritic chest pain. what would you order?
EKG, chest film
What test can differentiate between cardiac and pulmonary disease?
BNP
Treatment for Raynaud’s
Nifedipine
What’s a “double effect”?
used to justify medical treatment designed to relieve suffering when death is an unintended but foreseeable consequence. It is based on two basic presuppositions: first, that the doctor’s motivation is to alleviate suffering, and second, that the treatment is appropriate to the illness.
