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Fam med aquifer > Cases 1-5 > Flashcards

Cases 1-5 Flashcards

1
Q

Does USPSTF recommend teaching patients breast exams? Do they recommend clinical breast exams?

A

They do not recommend teaching breast exams

USPSTF does not have a recommendation for clinical breast exams

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2
Q

When should cervical cancer screening begin?

A

age 21

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3
Q

How often should women between 21-29 get screened for cervical cancer?

A

every 3 years

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4
Q

How often should women between 30-65 get screened for cervical cancer?

A

every 3 years with cytology alone

OR

every 5 years with cytology and HPV testing

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5
Q

Should women over 65 get screened for cervical cancer?

A

women may choose to stop screening at 65 if their last three screens were normal

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6
Q

What happens to false negatives with an increase in sensitivity?

A

a decrease is false negatives

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7
Q

What happens to false positives with an increase in specificity?

A

decrease in false positives

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8
Q

What does the USPSTF say about skin cancer screening?

A

insufficient evidence to recommend for or against screening

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9
Q

What does the USPSTF say about lung cancer screening?

A

low dose CT scan for those between the ages of 55-80 who have smoked 30+ years

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10
Q

What does the USPSTF say about breast cancer screening?

A

every 2 years starting at age 50-74

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11
Q

What does the american cancer association say about breast cancer screening?

A

start at 40 every year

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12
Q

If a breast lump is felt, what is the diagnostic process?

A

Ultrasound to determine if cystic or solid:

  • If cystic, fine needle aspiration then send for cytology
  • If solid, mammogram
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13
Q

What are risk factors for breast cancer?

A

family history (first degree)

unopposed estrogen

BRCA mutation

Advanced age

smoking

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14
Q

At what age should women be screened for osteoporosis?

A

Women >65 should get a DEXA scan

Women <65 with a risk factor of a 65yo or greater should get a DEXA scan

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15
Q

With regards to preventative visits, what does the RISE mnemonic stand for?

A

Risk factors

Immunizations

Screening tests

Education

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16
Q

What is the leading cause of death in a 55yo male in the US? Second leading cause? Third?

A
  1. malignancy
  2. Heart disease
  3. Unintentional accident
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17
Q

What are four major risk factors for ASCVD?

A
  1. HTN
  2. HLD
  3. DM
  4. Tobacco
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18
Q

Define normal BP

A

<120 and <80

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19
Q

Define pre-hypertension

A

120-129 and <80

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20
Q

define stage 1 HTN

A

130-139 OR 80-89

21
Q

define stage 2 HTN

A

140+ OR 90+

22
Q

Define the following for BMI: underweight, normal, overweight, obese

A

underweight = <18.5

normal = 18.5 - 24.9

Overweight = 25 - 29.9

obese = 30+

23
Q

What are the ABCDEs of skin lesions

A

Assymetry
Border irregularity
Color non-uniform
Diameter > 6mm
Evolution or change over time

24
Q

Name 12 common causes for insomnia in the ederly

A
  1. poor sleep environment
  2. drugs
  3. sleep apnea
  4. restless leg syndrome
  5. periodic leg movement (involuntary leg jerking) and REM sleep behavior disorder
  6. Disturbances in sleep-wake cycle (jet lag or shift work)
  7. depression and anxiety
  8. CHF
  9. pain or pruritis
  10. GERD
  11. hyperthyroidism
  12. Circadian rhythm change
25
Q

What are risk factors for completed suicide?

A

male

older age

previous attempts

military service

26
Q

What are the diagnostic criteria for major depression?

A

5+ SIG E CAPS symptoms for at least 2 weeks

Sleep disturbances
Interest loss
Guilt
Energy decreased
Concentration decreased
Appetite increase or decrease
Psychomotor retardation
Suicidal ideation

27
Q

How do you initially screen for depression? What do you do if positive?

A

PHQ-2 then PHQ-9 if positive

28
Q

What are common side effects of SSRI/SNRIs?

A

HA
Sleep disturbances
GI upset
Sexual dysfunction

29
Q

What is first-line therapy for insomnia in the elderly?

A

Cognitive Behavioral Therapy for Insomnia (CBT-I)

30
Q

What are approved drugs for insomnia in the elderly?

A

Zolpidem, esZopiclone

Doxepin (TCA)

suvorexant (Orexin receptor antagonist)

31
Q

What labs should you order in someone who is depressed or fatigued?

A

CBC (anemia)

CMP

TSH

32
Q

What are the 6 Ps pf compartment syndrome?

A

Pain (out of proportion)
Pallor
Pulselessness
Paresthesia
Perishing cold
Paralysis

33
Q

what ligament does the anterior drawer test in the ankle?

A

anterior talofibular ligament

34
Q

what ligament does the inversion stress test evaluate in the ankle?

A

calcaneofibular ligament

35
Q

Describe a grade I ankle sprain

(tear, pain, swelling, bruising, fucntional loss, instability, stretching of joint)

A

Tear = no tear or minimal
Pain = mild pain
Swelling = mild swelling
Bruising = no bruising
Functional loss = no functional loss
Instability = no instability
Stretching of joint = no excessive stretching

36
Q

Describe a grade II ankle sprain

(tear, pain, swelling, bruising, fucntional loss, instability, stretching of joint)

A

Tear = incomplete tear
Pain = moderate pain
Swelling = moderate swelling
Bruising = moderate bruising
Functional loss = moderate functional loss
Instability = moderate instability
Stretching of joint = some stretching

37
Q

Describe a grade III ankle sprain

(tear, pain, swelling, bruising, fucntional loss, instability, stretching of joint)

A

Tear = complete tear
Pain = moderate to severe pain
Swelling = severe swelling 4cm above the fibula
Bruising = bruising present
Functional loss = complete functional loss
Instability = severe instability
Stretching of joint = significant stretching

38
Q

What is the inversion stress test? What ligament does it test?

A

physician manually inverts the patients ankle

tests the calcaneofibular ligament

39
Q

What is the cross-leg test? What ligament does it test?

A

Have the patient cross their leg

looks for syndesmotic sprains (ligaments between tibia and fibula)

40
Q

What is the most effective compression device for ankle injury?

A

semi rigid ankle support

41
Q

When are radiographs of the ankle indicated?

A
  1. pan in the malleolar zone AND bony tenderness along the distal 6cm of the posterior edge of malleolus

OR

  1. inability to bear weight immediately after injury and in the emergency room
42
Q

When are radiographs of the foot indicated?

A
  1. Pain in the midfoot zone AND pain at navicular bone or base of 5th metatarsal

OR

  1. inability to bear weight immediately after injury and in the emergency room
43
Q

What are 7 common signs of hyperthyroidism?

A

Heat intolerance
Tachycardia
Fatigue
Weight loss
Tremor
Increased sweating
Exertional dyspnea

44
Q

define clonus

A

dorsiflex the patient’s foot results in a series of abnormal plantar flexions

45
Q

What type of antibodies are produced in Grave’s disease

A

thyrotropin antibodies

46
Q

What is the most common manifestation of graves ophthalmopathy?

A

eyelid retraction and exophthalmos

(causes corneal irritation cuz you can’t close your eyes very well)

47
Q

What is the most commonly used medication to treat Graves? How long does it take to see improvements in symptoms? How long does it take to truly suppress thyroid production?

A

methimazole

1 month to see symptom improvement

3 months for thyrod suppression

48
Q

If a patient with Graves doesn’t want to be treated with medication, what can you offer? How long after initial treatment should patients be seen for TSH blood work? Once treatment is confirmed, how often should you check blood TSH levels?

A

radioactive iodine

2-3 months after initial treatment

1-2 times yearly

49
Q

What is a typical starting dose of levothyroxine? If the patient is not repsonding, should you jack the dose up? When determining the correct dose, how often should the patient be seen?

A

1.5mcg/kg

NO! slowly titrate it up.

6 weeks

Fam med aquifer (8 decks)

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