Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Family Medicine > Cases > Flashcards

Cases Flashcards

1
Q

Factors associated with increased breast cancer risk (11 things)

A

Family history, menarche before 12 or menopause after 45, BRCA 1 or 2, advanced age, female, increased breast density, advanced age at first pregnancy, exposure to diethylstilbestrol, hormone therapy, therapeutic radiation, obesity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Four factors associated with decreased breast cancer rates

A

pregnancy at early age, late menarch/early menopause, high parity, medications like SERMs and NSAIDS and Aspirin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Does the practice of regular breast self-exam by trained women reduce breast cancer mortality?

A

no

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Does the USPTSF recommend breast self exams?

A

NO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Does the American Cancer society recommend breast exams?

A

women should know how their breasts normally feel and report any changes. Breast self exam is an option of women starting in their 20s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

American cancer society recommendations for clinical breast exams?

A

part of periodic health exam every three years for women in 20s and 30s, every year for 40 and over.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

5 factors associated with increased risk of cervical cancer

A

early onset of intercourse, greater # of sexual partners, DES exposure, cigarette smoking, immunosuppresion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

difference between gardasil and cervarix

A

gardasil: types 6, 11, 16, 18 approved for ages 9-26. Cervarix: types 16, 18, 31, and 45 for ages 10-25.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

average age of menopause

A

51

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

smoking affect on menopause

A

smokers go through menopause a few years earlier than nonsmokers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

hallmark of perimenopause

A

menstrual irregularity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

8 risk factors for osteoporosis

A

low estrogen, lack of physical activity, inadequate calcium intake, family history, history of previous osteoporotic fractures, dementia, cigarette smoking, white

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

USPSTF osteoperosis screening in postmenopausal women younger than 60

A

insufficient evidence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

USPSTF DEXA recommendations

A

recommends screening DEXA in all women 65 years and older and 60-64 who have increased fracture risk.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How often to get Td and when to replace with Tdap

A

Td every ten years. Tdap should replace a single dose of Td for adults 19-64 if they’ve never had a Tdap

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which type of Pap allows for later HPV testing if pap is abnormal?

A

the liquid based system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

how much earlier can mammography detect cancer than self exam

A

1 or 2 years earlier

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

does mammography decrease breast cancer mortality?

A

yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

sensitivity of mammography

A

60-90%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

is there a radiation risk with mammography

A

negligible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Mammography in women younger than 40

A

not indicated unless they fall into high risk category such as known BRCA mutation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

women btwn 40 and 50 of average risk mammogram suggestions

A

individualized

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

upper age at which mammography screening should be discontinued

A

no specific- as long as woman is in good health and would be candidate for breast cancer treatment she should be screened.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

when should pap smears be performed

A

cerivcal cancer screening starts at 21 every 2 years btwn 21 and 29 and every 3 years btwn 30 and 65. HIV positive and compromised immunity or history of CIN 2, 3, or cancer or DES need more frequent screening. women btwn 65 and 70 who have had 3+ normal paps within ten years may stop screening.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what makes a pap smear ‘adequate’

A

must contain over 5,000 squamous cells and have sufficient endocervical cells in order to be a sample of the transformation zone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Categories of epithelial abnormalities in PAPs

A

Atypical squamous cells (ASC): some abnormal cells. may be infection, irritation, precancerous.
Low grade squamous intraepithelial lesion (LSIL)- may progress to high grade lesion but most regress.
High grade squamous intraepithelial lesion (HSIL)- significant precancerous lesion.
Squamous cell carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Factors of a breast lump that increase likelihood of malignancy

A

presence of a single, hard, immobile lesion of approximately 2 cm or larger with irregular borders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

breast lump-> suspected cystic lesion- what are next steps?

A

aspiration can be attempted and fluid sent of cytology.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

breast lump-> solid lesion- what are next steps?

A

mammography.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What diagnostic test is helpful for distinguishing a solid mass from a cystic lesion in the breast?

A

ultrasound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Physiological causes of nipple discharge

A

pregnancy, excessive breast stimulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Pathologic causes of nipple discharge

A

prolactinoma, breast cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

work up of nipple discharge

A

imaging studies like mammogram, ultrasound, ductogram, and/or biopsy. consider hormonal testing to exclude endocrinological reasons. review and d/c any meds that may be the cause.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Osteoporosis prevention

A

postmenopausal women need to take between 1200 and 1500 mg of calcium and 800 IU of Vitamin D a day. Calcium tablets can be combined with Vitamin D in the form of cholecalciferol. Calcium in more than 500mg doses should be divided for absorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

losing 5-10% of body weight, patients can significantly reduce risk of what three diseases

A

diabetes, HTN, and Cardiovascular disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

The key aspects of the preventive exam

A

RISE: Identifying risk factors for serious medical conditions, updating Immunizations, ordering appropriate screening tests, Educating patients about living a healthy lifestyle and reducing risk of disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Screening should be considered for conditions that are ___ and ____

A

important and treatable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Major modifiable risk factors for heart disease

A

Sedentary lifestyle, tobacco use, excess alcohol. high stress, poor diet, obesity,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Three known cardiovascular risk factors

A

older age, male gender, family history

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Tobacco addiction characterized by the 3 Cs

A

compulsion to use, lack of control, and continued use despite adverse consequences.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

four stages of behavior change

A

pre contemplative (not aware of need to change or not interested in changing), contemplative- currently interested in changing behavior. active- currently making change, relapse- attempted but no longer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

possible protection from moderate alcohol consumption

A

cardiovascular protection- small increase in HDL, may contain other chemicals that act as anti oxidants or inhibit platelet aggregation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

The CAGE questions

A

felt you needed to Cut down? felt Annoyed by criticism? had Guilty feelings? taken a morning Eye opener?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

A brief nutritional history should include:

A

number of meal and snacks eaten in a 24 hour period, dining-out habits, frequency of consumption of fruits, vegetables, meats, poultry, fish, dairy, desserts.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

WAVE pocket card tool

A

dialogue about Weight, Activity, Variety, and Excess. eating appropriate number of servings of each food group and whether he or she is eating too much fat/sugar etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Food frequency questionnaire

A

covers food intake over period of a month. often used in combination with 24 hour recall, it is the quickest way to determine nutritional deficiencies and excesses.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Rapid eating and activity assessment for patients (REAP)

A

brief validated questionnaire that assesses diet related to the food guide pyramid. questions about patient shopping and preparing their own food, trouble shopping/cooking, diet, limits foods, how willing they are to change.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

BMI calculation

A

weight in kg/height in meters squared

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Normal BMI range

A

18-25

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Overweight BMI range

A

25-30

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Obese BMI range

A

> 30

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Very Obese BMI range

A

35-40

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Morbidly Obese range

A

> 40

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What measurements can you use to further determine risk and need for weight loss

A

body fat distribution, waist circumference, and waist-hip ratio

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Three clinical findings associated with dyslipidemia and atherosclerosis

A

arcus corneus, acanthosis nigricans, xanthelasmas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

ABCDE of skin lesions

A

Asymmetry, border irregularity, color non uniform, diameter >6mm, evolution or change over time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

USPSTF on PSA

A

recommends against it.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

ACS and AUA on PSA

A

recommend testing be offered to men starting at age 50 but that physician should discuss with patient the harm and benefit of screening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Potential benefits of PSA

A

prolonged life from early detection and tx of prostate cancer, psychological reassurance of a negative screen or detecting at treatable stage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Potential harms of PSA

A

pain and discomfort associated with prostate biopsy, psychological effects of false-positive test results, complications (including erectile dysfunction, urinary incontinence, bowel dysfunction, even death) from treatment of prostate cancer they may have never caused symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Available methods of colon cancer screening

A

Colonoscopy (preferred), annual testing of three stools for blood and a flexible sigmoidoscopy test every five years, double contrast enemas every five years, CT colography (virtual colonoscopy) is experimental

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Lung cancer screening (USPSTF)

A

screening with CT, CXR, or sputum cytology can detect lung cancer at an earlier stage than lung cancer would be detected in an unscreened population. However- poor evidence that any screening strategy for lung cancer decreases mortality. invasive and high false positive risk-> significant harms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

4 steps of assessing an ECG

A
  1. look at rate, PR, QRS, and QT interval
  2. look for abnormalities in P waves
  3. assess axis, R wave progression, presence of Q waves, levels of voltage.
  4. look for ST depression or elevation and inverted T waves
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Labs to assess risk for diabetes and CVD

A

draw glucose and a lipid panel. drawn in fasting state at least 8 hours after last food

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

5 As when counseling for behavior change

A
  1. Ask or Address behavior needing change
  2. Assess for interest in behavior change
  3. Advise on methods to change
  4. Assist with motivation
  5. Arrange for follow up
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

are oral meds successful for smoking cessation

A

oral meds somewhat effective (12 month quit rates 1.5-3 times the placebo)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Annual quit rate for smokers without any medical interventions

A

2-3% a year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Three things to do when a patient is ready to quit smoking

A

set a quit date, have patient call 1-800-QUIT-NOW or www.smokefree.gov, instruct pt to start bupropion one week before quit date

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Bupropion dosing schedule

A

start with one pill a day for first three days, then increase to one pill twice a day, after four days, stop smoking and continue on pills twice a day. may add nicotine gum for bad cravings, if needed. after about two months on the pills- gradually stop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

initial management of obesity, hyperlipidemia, elevated blood pressure, and glucose (6 things)

A
  1. educate pt about increased CVD and cerebrovascular risk
  2. obtain stress test
  3. initiate 81 mg aspirin daily
  4. f/u in one month
  5. repeat fasting lipid panel in 3 months, initiate meds if necessary
  6. counsel to reduce calories consumed and increase exercise
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Exercise prescriptions should include what specific recommendations

A

type of exercise, precautions, specific workloads, duration and frequency, intensity guidelines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Calculation of target heart rate

A

(220-age) x 0.7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Borg rating of perceived exertion scale

A

6- no exertion, 9- very light, 11- light, 13- somewhat hard, 15- hard, 17- very strenuous/fatigued, 19- extremely hard

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

follow up of tubular adenoma with low grade dysplasia

A

repeat colonoscopy in 5-10 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

What percentage of population has hypothyroidism

A

5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

medical conditions associated with depression (3)

A

hypothyroidism, parkinsons, dementia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

what percentage of parkinson’s patients experience depressive symptoms

A

60%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

which is more sensitive- mini cog or MMSE?

A

mini-cog (99%) . the MMSE is only 91%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Diagnostic criteria for major depressive disorder

A

depressed mood or anhedonia and at least five of the following 8: sleep, interest, guilt, energy, concentration, appetite, psychomotor, suicidal ideation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Major depressive disorder vs. bereavement

A

MDD only if symptoms are present two months after the loss. Guilt about other things, thoughts of death, morbid preoccupation with worthlessness, marked psychomotor retardation, prolonged funtional impairment, hallucinatory experiences other than hearing deceased person.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

In what ethnic group is depression identified less frequently?

A

hispanics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

how do hispanic patients tend to present with depression?

A

somatic complaints like myalgias or fatigue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

which group has a lower rate of depression- US born hispanics or immigrants?

A

immigrants have up to 50% lower rate of depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Factors that increase a patient’s likelihood of completing a suicide attempt

A

white male, previous attempt, suicide in elderly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

most common means of suicide in elderly

A

drug overdose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

SSRI examples

A

citalpram (celexa), fluoxetine (prozac), fluvoxamine (luvox), paroxetine (paxil), sertraline (zoloft), escitalopram (lexapro)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Venlafaxine (effexor)

A

serotonin and NE reuptake inhibitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

Bupropion (wellbutrin)

A

NE and dopamine reuptake inhibitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

nefazodone (serzone) and trazodone (desyrel)

A

serotonin antagonist and reuptake inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

mirtazapine (remeron)

A

NE and serotonin antagonist, antihistaminic effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

duloxatine (cymbalta)

A

serotonin and NE reuptake inhibitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

TCA antidepressants

A

nortriptyline (pamelor), amitriptyline clomipramine, doxepin (sinequan). block reuptake of NE, 5HT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

MOA-Is

A

Phenelzine (nardil), tranylcypromine (parnate). block pre-synaptic catabolism of NE and 5HT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

SSRI/SNRI side effects

A

headaches, sleep disturbances, GI problems, hyponatremia due SIADH, serotonin syndrome, increased GI bleeding, elderly- increased risk for falls, possible adverse effects on bone density.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

TCA side effects

A

cardiac arrhythmias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

common causes of insomnia in elderly

A

environmental (noise or bedding), drugs/alcohol/caffeine, sleep apnea, parasomnias (restless leg syndrome, period leg movement and rapid eye movement sleep behavior disorder), disturbances in cycle (shift work), psychiatric disorders (Depression and anxiety), cardiorespiratory disorders, pain or pruritis, GERD, hyperthyroidism.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

risk factors for elder abuse

A

dementia, shared living situation of elder and abuser (except $ abuse), caregiver substance abuse or mental illness, heavy dependence of caregiver on elder, social isolation of elder from people other than abuser

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

Geriatric depression scale- short form (GDS-SF)

A

over the past week: are you satisfied with your life? have you dropped many of your activities and interests? do you feel that your life is empty? bored easily? good spirits? afraid something bad will happen? happy? helpless? stay at home or go out and do things? memory problems?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

screen for common causes of insomnia, fatigue, depression

A

comprehensive metabolic panel- electrolyte, renal, hepatic problems. TSH, CBC (anemia and vitamin def.), ESR (rheumatologic disease), EKG (if on TCAs etc)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

What two behavioral treatments for insomnia have met evidence based criteria for efficacy?

A

sleep restriction-sleep compression therapy and multi component cognitive behavioral therapy for insomnia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

pharmacologic treatment of insomnia

A

side effects are prolonged sedation and dizziness. non benzodiazepines (i.e. zolpidem (ambien) and melatonin receptor agonists) are safest.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

first line pharm approach to major depress. disorder

A

SSRI or SNRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

fluoxetine (prozac)

A

long half life. can cause agitation, restlessness, decreased libido in women, insomnia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

sertraline (zoloft)

A

used in pregnancy. approved for OCD, panic, and PTSD. more GI side effets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

paroxetine (paxil)

A

strong anti anxiety effects, best studied SSRIs in children, side effects include significant weight gain, impotence, sedation, and constipation. due to short half life, paroxetine is most likely of all ssris to cause antidepressant discontinuation syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

fluvoxamine (luvox)

A

particularly useful in OCD, greater frequency of emesis compared to other SSRIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

citalopram (celexa)

A

most common side effects include nausea, dry mouth, and somnolence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

escitalopram (lexapro)

A

approved specifically for generalized anxiety disorder, fewer side effects than citalopra

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

for first episode of major depressive disorder- tx duration

A

9-12 months of meds, stopping sooner is high risk for recurrence.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

recurrent episodes of depression are treated for how long

A

2-3 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

allow how long for depression meds to be fully effective, but follow up in how long?

A

4-6 weeks to be effective, but f/u in 2 weeks to monitor side effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

for patient who is seriously considering suicide, a tool to assess severity of the situation is the ___ scale (acronym)

A

SAD PERSONS: sex (male), age (under 19 or over 45), depression, previous attempts, ethanol or other substance abuse, rational thinking impaired, social supports lacking, organized plan, no significant other, sickness (7 out of 10 suggests hospitalization)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

differential diagnosis for ankle pain

A

sprain, fracture of distal fibular, fracture of talus, peroneal tendon, subtalar injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

what percent of ankle injuries are clinically significant fractures?

A

less than 15%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

compartment syndrome

A

serious life and limb-threatening complication of extremity trauma. rising pressure in a muscle compartment impairs perfusion to that same muscle compartment.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

causes of compartment syndrome

A

fractures, crush injuries, burns, arterial injuries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

signs and symptoms of compartment syndrome

A

Pain, Pallor, Pulselessness, paresthesias (burning, itching, prickling, or tingling), poikilothermia (can’t regulate body temp), paralysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

what is the most reliable sign of compartment syndrome

A

paresthesias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

most common mechanism of injury for ankle sprain

A

plantarflexion and inversion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

Medial ankle sprain mechanism of action

A

forced eversion and dorsiflexion.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

why are medial ankle sprains less common than lateral?

A

bony articulation btwn the medial malleolus and the talus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

history of a snap or tear is diagnostically significant in what injury

A

knee injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

is a history o fa snap or tear diagnostically significant in ankle injuries?

A

no

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

which ligaments are most often damaged in ankle injuries caused by plantarflexion and inversion

A

lateral stabilizing ligaments- anterior talofibular, calcaneofibular, posterior talofibular).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

Anterior drawer test

A

assesses integrity of the anterior talofibular ligament (most easily injured). knee flexed 90 degrees. one hand holds tibia and exerts a slight posterior force while the other brings calcaneus and talus forward on tibia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

inversion test

A

when ankle i inverted it does not appear lax, indicating calcaneofibular ligament is intact

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

what ligament is the strongest of the lateral complex

A

posterior talofibular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

crossed-leg test

A

detects high ankle tibiofubular syndesmotic sprain. while patient is sitting with one leg crossed over the other, pressure is applied to the medial side of the knee. high ankle sprain will produce pain in the syndesmosis area.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

Grade I ankle sprain

A

stretching and/or small tear of a ligament. slight/no functional loss. mild tenderness, mild swelling. usually no ecchymosis. no mechanical instability: no streatching or opening of the joint with stress.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

Grade II ankle sprain

A

incomplete tear. moderate functional impairment, loss of some motor function. difficulty bearing weight. tenderness and pain. mild to moderate swelling. ecchymosis common. moderate instability, stretching of the joint with stress, but a definite stopping point.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

Grade III ankle sprain

A

complete tear and loss of integrity of ligament. inability to bear weight. severe swelling, ecchymosis. mechanical instability. significant stretching of the joint with stress, without stopping point.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

most common acute ankle injury

A

lateral ankle inversion sprain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

Medial ankle stability is provided by

A

the strong deltoid ligament, the anterior tibiofibular ligament, and bony mortise.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

Peroneal tendon tear

A

usually due to an inversion injury or reptitive trauma. may occur in conjunction w/ankle sprain. persistent pain posterior to the lateral malleolus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
135
Q

Talar dome fracture

A

may occur in conjunction with an ankle sprain, and initial x rays may miss a talar dome fracture.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
136
Q

ankle tendonitis

A

inflammatory condition, usually involving the posterior tibialis tendon. swelling/warmth may be present in the affected area. worsens initially with aggravating activity only. may then progress to discomfort at any time. chronic. worse during the day and after exercise.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
137
Q

subtalar injury

A

often due to a high-energy injury. a dislocation involves the talocalcaneal and talnavicular joints. pain, swelling, deformity, are present.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
138
Q

tarsal tunnel syndrome

A

entrapment of the tibial nerve. pain, tingling, and burning sensations along the sole of the foot. pain along the inside of the ankle and/or bottom of the feet and shooting pain.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
139
Q

syndesmotic injury

A

generally involves the interosseus membrane and the anterior inferior tibiofibular ligament. pain and disability are often out of proportion to the injury. one would expect a positive ankle squeeze test.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
140
Q

infection of the ankle joint

A

less common. appropriate history and physical exam neede. symptoms include painful range of active and passive motion, edema, erythema, warmth, and fever.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
141
Q

arthritis of ankle

A

less common than in some other joints. chronic process, more commonly seen in older people. the tibiotalar joint is generally involved and condition may occur as result of prior injury, obesity, or history of rheumatoid disease.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
142
Q

ottawa rules

A

decision tool designed to help in evaluation of adults w/acute ankle and midfoot injuries. 97-100% sensitive. also used to exclude fractures in children under 5.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
143
Q

according to ottawa rules, radiographs of ankle needed if:

A

pain in malleolar zone AND either bony tenderness along distal 6cm of posterior edge of either malleolus OR inability to bear weight both immediately and in the emergency department

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
144
Q

according to ottawa rules, radiographs of foot needed if:

A

there is pain in the midfoot region AND bony tenderness at either the navicular bone or base of fifth metatarsal OR inability to bear weight both immediately and in emergency department.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
145
Q

management of ankle sprain

A

RICE: (rest for first 72 hours only, Ice several times throughout the day for ten minutes at a time, Compression with tape, elastic wrap, or semi rigid ankle support, Elevation.) Ibuprofen TID PRN. Daily ankle exercises- inversion, eversion, plantar and dorsi flexion, calf stretching, single leg balancing. proprioceptive exercises help prevent and reduce the likelihood of re-injury.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
146
Q

dysuria Rx

A

if pt has no hx of allergy to sulfa, trimethoprim-sulfamethoxazole may be used for empirical tx for uncomplicated lower UTIs. a quinolone like cipro may be used if high uropathogen resistence to trimethoprim-sulfamethoxazole.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
147
Q

DDx of heart palpatations

A

cardiac dysrhthmias, anxiety/panic disorder, anemia, hyperthyroidism, drug/caffeine abuse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
148
Q

hyperthyroidism causes increased heart rate and cardiac output due to

A

increased peripheral oxygen needs, and increased cardiac contractility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
149
Q

weight loss in hyperthyroidism is due to

A

increased calorigenesis (heat produced by consumption of food), and increased gut motility and the associated hyperdefecation and malabsorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
150
Q

exercise intolerance and fatigue in hyperthryoidism is caused by

A

oxygen consumption and CO2 production, respiratory muscle weakness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
151
Q

60-80% of hyperthyroidism is caused by

A

toxic diffuse goiter (graves’)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
152
Q

hypervascularity of thyroid may result in a bruit or thrill upon auscultation in what disease

A

graves’

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
153
Q

worldwide most common cause of goiter

A

lack of iodine.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
154
Q

ankle clonus

A

elicited by rapidly dorsiflexing the foot, causing alternate contraction and relaxation of the gastrocnemius and soleus muscles.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
155
Q

lid lag

A

elicited by hasving pt follow with his eyes your finger moving slowly from their upper to lower field of vision. if lid lag- upper eyelid lags behind the upper edge of the iris as teh eye moves downward.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
156
Q

how to differentiate btwn hyperthyroidism and anxiety

A

in anxiety, peripheral manifestations of excess thyroid hormones are absent- the skin is cold and clammy. panic attacks. ask about brief periods of overwhelming terror

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
157
Q

why does anemia cause palpaitations?

A

tachycardia from hypovolemia. heart responds to low blood volume by speeding up to increase the exposure of blood to oxygenation in the lungs. anemia can cause dyspnea on exertion bc of the lack of oxygen carrying capacity of the blood. A common source of anemia in menstruating women is heavy periods.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
158
Q

tests to order on a patient with palpitations

A

TSH, T4, ECG, CBC (anemia), Radioactive iodine uptake test and scan (RAIU)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
159
Q

thyroid ultrasound

A

evaluation of thyroid nodules and thyroid enlargement. US characteristics of a nodule can be used to stratify risk of malignancy and US can guide the fine needle aspiration of nodules that are not easily palpated.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
160
Q

Management of hyperthyroidism

A

propranolol can be used for symptomatic relief of adrenergic symptoms (tachycardia, tremor, heat intolerance)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
161
Q

management of hypothyroidism

A

easier to manage than hyperthyroidism. can be managed with one or two blood tests a year.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
162
Q

levothyroxine

A

increase dose slowly, especially in elderly. aim for dose of 1.5-1.8mcg per kg. check TSH one month after starting. in primary- once a stable TSH level is achieved, blood work can be checked annually.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
163
Q

At risk populations for DM

A

Native Americans, African, and Asian Americans, Latin Americans, Pacific Islanders.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
164
Q

how many people in US have undiagnosed diabetes

A

7 million

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
165
Q

preferred method for diagnosing diabetes

A

HbA1c (>6.5%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
166
Q

American Diabetes Association screening recommendations

A

overweight or obese (BMI over 25) pts who have 1+ :sedentary lifestyle, race, 1st degree relative w/DM, previously impaired fasting glu, HTN, HDL 250, history of gestational DM or baby >9lbs, PCOS, CVD. If none of those risks- screening begins at 45 yo. If results normal, testing repeated at 3 year intervals- more frequent if risk factors or borderline results.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
167
Q

USPSTF screening recommendations for DM

A

screen for type 2 DM in asymp adults w/sustained BP greater than 135/80.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
168
Q

leading cause of death in DM patients

A

cardiovascular disease (i.e. coronary heart disease and stroke)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
169
Q

most common cause of new cases of blindness among adults of working age

A

diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
170
Q

do diabetics on insulin or oral hypoglycemics have greater chance of retinopathy

A

40% in insulin, 24% w/oral hypoglycemic agents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
171
Q

how likely is glaucoma in diabetics

A

40%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
172
Q

prevalence of neuropathy in DM

A

7% at one year, increasing 50% at 25 years for type 1 and 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
173
Q

what % of DM patients have nephropathy

A

20-40%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
174
Q

Fatalismo

A

holding to a belief that control over one’s DM is external to self.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
175
Q

utility of EMR

A

templates increase likelihood the pt will receive the recommended care. Assists in evaluating how the physician is caring for specific patient populations. helps the physician improve reimbursement by creating reports of pt care data for specific measures of care, such as HbA1c or blood pressure control for medicare and medicaid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
176
Q

why is examining the thyroid in diabetics important?

A

thyroid disease can lead to diabetes and hyperlipidemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
177
Q

Diabetic foot exam should include:

A

testing for loss of protective sensation: sensory testing can be conducted with a 10g monofilament, tuning fork, pinprick, ankle reflexes. Assessment of pedal pulses: evaluate for peripheral vascular disease, strongest risk factor for delayed ulcer healing and amputation in diabetes patients. Inspection- inspect of breaks in skin.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
178
Q

what is the strongest risk factor for delayed ulcer healing and amputation in diabetes patients

A

peripheral vascular disease (test pedal pulse)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
179
Q

four reasons for ordering lab tests in DM patients

A

monitoring diabetic control, assessing end organ damage, monitoring side effects of treatment, uncovering management complications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
180
Q

recommended lab tests for DM patient

A

HbA1c (4-12 week period. measure at dx and at least 2x a year in pts who are stable and meeting goal. quarterly when therapy is changing or goal not being met), electrocardiogram (die from CVD. test at baseline), Sport urine albumin:creatinine ratio (screening for microalbuminuria. many rx like metformin are renally excreted. annual monitoring is required to identify renal insuff and avoid drug tox). Serum B12 (metformin can cause asymp subnormal b12), TSH, fasting lipids, fingerstick blood sugar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
181
Q

how often to test spot urine albumin:creatinine ratio in DM?

A

annually

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
182
Q

when to test B12 in DM?

A

if patient exhibits signs of neuropathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
183
Q

ADA and USPSTF recommendations for TSH testing in DM

A

do not recommend for or against ordering TSH.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
184
Q

how often to do fasting lipid profile in DM

A

at diagnosis, every three months until control is achieved, annually once lipids are well controlled.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
185
Q

when to do a fingerstick blood sugar in DM

A

only if pt is experiencing acute symptoms of hyperglycemia or hypoglycemia at time of visit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
186
Q

ADA/European Association for the Study of Diabetes (EASD) Consensus Algorithm for Management of DM II [FIRST TIER]

A

Step 1: Diagnosis. If HbA1c > 6.5%. lifestyle change + metformin.
Step 2: Assessment: If HbA1c >8%, continue lifestyle and metformin and add sulfonylurea (glyburide, glipizide, or glimepiride) or basal insulin (glargine, detemir, or protamine hagedorn NPH).
Step 3: Reassessment: If HbA1c >8, continue lifestyle and metformin, add basal insulin or (if already on insulin) intensify insulin regimen, consider discontinuing sulfonylurea to avoid hypoglycemia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
187
Q

ADA/European Association for the Study of Diabetes (EASD) Consensus Algorithm for Management of DM II [SECOND TIER]

A

Explore other Tx options: adding rapid acting insulin with meals, thiazolidinediones: pioglitazone (actos) or rosiglitazone (avandia) may be useful for those who cannot tolerate the GI effects of metformin or have hypoglycemia with sulfonylureas. Can increase risk of heart failure, edema, and bone fractures. Meglitinides, GLP 1 analogs, DPP4 inhibitors, amylin analog, alpha glucosidase inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
188
Q

in the diabetes prevention program (DPP) what was the most successful method to prevent diabetes?

A

lifestyle alteration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
189
Q

what improves cardiovascular risk improvement more- BP and lipid control or glycemic control?

A

BP and lipid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
190
Q

barriers to insulin tx

A

pts opposed to injecting (need education), drawing up insulin if visually impaired or poor dexterity (insulin pens), misconception that it causes complications, physicians reluctant to rx insulin cause don’t have time to teach pts how to use it.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
191
Q

first line therapy for CHF in DM patients

A

ARBs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
192
Q

when should a statin be used regardless of lipid level?

A

for patients with known CVD or over 40 with one risk factor for CVD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
193
Q

NCEP ATP III guidelines for dyslipidemia

A

target non HDL cholesterol as a second goal after lowering LDL. Non HDL cholesterol may be a stronger predictor of CVD bc it represents the atherogenic VLDL remnants as well as the LDL.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
194
Q

when to use aspirin therapy

A

secondary prevention in diabetes patients with history of CVD or in those deemed at moderate or high risk of CVD. primary prevention in DM pts with increased CV risk (over 40 who have HTN, smoking, dyslipidemia, fam history, or albuminuria).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
195
Q

what can be used instead of aspirin for CVD if pt has aspirin allergy

A

clopidogrel (75mg)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
196
Q

what is the most important modifiable cause of premature death in DM

A

smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
197
Q

DM I patients should have their first eye exam when

A

five years after dx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
198
Q

immunizations in DM pts

A

annual vaccination for influenza, pneumococcal polysaccharide vaccine for all diabetes patients over two years old. one time revaccination is recommended for pts over 64 if first received greater than 5 years ago or have nephrotic syndrome, CKD or immunocomp.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
199
Q

DDx for leg swelling

A

cellulitis, DVT, venous insufficiency, lymphangitis, peripheral arterial disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
200
Q

single greatest contributor to mortality in US

A

smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
201
Q

three leading specific causes of smoking attributable death

A

lung cancer, ischemic heart disease, COPD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
202
Q

known health risks of obesity

A

HTN, dyslipidemia, DM, coronary heart disease, stroke, gall bladder disease, osteoarthritis, sleep apnea, respiratory problems, endometrial cancer, breast cancer, colon cancer,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
203
Q

Wagner Ulcer grading system

A

Grade 1: superficial ulcer, involves full skin thicnkess. outpatinet management.
Grade 2: deep ulcer. penetrating down to ligaments and muscle, no bone involvement or abscess formation.
Grade 3: deep ulcer, cellulitis or abscess formation, often osteomyelitis (evaluate for myelitis. may need hospitalization(
Grade 4: localized gangrene. surgery/amputation.
Grade 5: extensive gangrene/whole foot.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
204
Q

organism in small skin break cellulitis vs. large skin break.

A

small = strep, large = staph.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
205
Q

homan’s sign

A

classic sign of DVT. pain on passive dorsiflexion of the foot

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
206
Q

most robust risk factors in development of DVT

A

smoking and obesity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
207
Q

ankle brachial index

A

ABI. can be done to determine the presence of PAD. an ABI <0.9 is consistent with the disease.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
208
Q

doppler ultrasound of lower extremity

A

confirms w/good sensitivity and specificity if DVT is present. Best predictive value for a DVT. can be overused.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
209
Q

D dimer

A

small protein fragment present in blood after a clot is degraded by fibrinolysis, sensitive but not specific.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
210
Q

Well’s Criteria For Dx of DVT

A

active cancer =1pt, paralysis/paresis/immobilization cast=1pt, bedridden 3+ days or surg=1pt, localized tenderness=1pt, entire leg swollen=1pt, calf swelling more than 3cm compared to asymp leg= 1pt, pitting edema= 1pt, collateral superficial veins=1pt, alt dx as likely = -2pts. 3points is high probability, 1-2 is moderate,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
211
Q

management of DVT- criteria to treat on an outpatient basis

A

hemodynamically stable, good kidney function, low risk for bleeding, stable and supportive home environment, daily access to international normalized ratio (INR) monitoring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
212
Q

warfarin tx duration for DVTs

A

isolated calf thrombophelbitis: 6-12 weeks. first time event from surg or trauma - 3 months, first episode of idiopathic thromboembolic disease= 6 months. recurrent= 12 months to indefinitely

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
213
Q

titration of warfarin

A

half life is 40 hours, so 5-7 days to reach stable state. check INR three days after warfarin initiation to make sure its not too high. if INR is >5 and 9, hold warfarin and give an oral dose of vit k

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
214
Q

screening for inherited thrombophilia

A

no absolute indications. initial thrombosis occurring prior to age 50 w/out immediate risk factor. family history. recurrent, starting in unusual vascular beds- portal, hepatic, mesenteric, cerebral.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
215
Q

definition of high blood pressure

A

systolic > 140, diastolic > 90

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
216
Q

official diagnosis of HTN

A

must be at least two elevated measurements- at least 5 minutes apart, one in each arm, on two or more visits- in order to accurately diagnose a patient with HTN. a patient cannot be diagnosed with HTN if patient is acutely ill or in acute pain.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
217
Q

USPSTF HTN screening recommendations

A

screen for high BP in pts without known HTN starting at age 18.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
218
Q

JNC guidelines- evaluation of pt w/possible new dx of HTN has three goals

A
  1. assess presence or absence of target end organ disease (heart, brain, kidneys, PVD, eyes), 2. assess lifestyle and identify other CV risk factors or concomitant disorders that may affect prognosis and guide tx. (metabolic synd, fam history of CVD, smoking, etoh, cocaine, age, sedentary, microalbuminuria) 3. reveal identifiable causes of high BP (apnea, CKD, hyperaldosteronism, pheochrom, coarctation, rx, OTC, herbals, cocaine,)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
219
Q

studies recommended for a new dx of HTN

A

ECG, urinalysis, H/H (low hematocrit can mean anemia in HTN and makes major CV event more likely), serum potassium, serum creatinine or corresponding GFR, fasting serum cholesterol panel, urinary albumin excretion or albumin/creatinine ratio (optional except for those with DM or kidney disease), serum Ca

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
220
Q

Tx for stage 1 HTN without compelling indications

A

Thiazide. may consider ACEI, ARB, BB, CCB or combo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
221
Q

Tx for stage 2 HTN without compelling indication

A

2 drug combo (thiazide and ACE, ARB, BB, or CCB)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
222
Q

Tx for HTN + heart failure

A

thiazides, BB, ACEI, ARB, aldosterone antagonists

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
223
Q

Tx for HTN + post MI

A

BB, ACEI, Aldo antagonist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
224
Q

Tx for HTN + CAD risk

A

thiazides, BBs, ACEIs, ARBs, CCBs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
225
Q

Tx for HTN + DM

A

Thiazides, BBs, ACEIs, ARBs, CCBs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
226
Q

Tx for HTN + CKD

A

ACEIs, ARBs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
227
Q

Tx for recurrent stroke prevention

A

thiazides, ACEIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
228
Q

most cost effective antiHTN drug on market

A

Hydrochlorothiazide (4.30 for a month)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
229
Q

possible problems with hydrochlorothiazide

A

may cause hyponatremia, avoid in gout pts, problem if urine incontinent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
230
Q

what 2 ethnic groups have lowest rates of BP control

A

mexican americans and native americans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
231
Q

causes of resistant HTN

A

improper BP measurement, excess sodium intake, inadequate diuretic therapy, medication issues (inadequate doses, drug interactions, excess alcohol, secondary HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
232
Q

ATP III dyslipidemia therapy recommendations

A
  1. CHD pts (or w/ CAD, PAD, AAA, DM) should start lifestyle modifications and an LDL lowering drug simultaneously
  2. determine major risk factors (cigarette smoking, HTN, low HDL (under 40), fam history of premature CHD, age)
  3. If 2+ risk factors present w/out CHD, assess 10 year CHD risk. take LDL drug after 3 months of lifestyle changes if LDL is still above 130.
  4. almost all ppl with 0-1 risk factor have 10 year risk of less than 10%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
233
Q

palpatations ddx (5)

A

dysrhthmia, CHD, valvular heart disease, anxiety/panic, vasomotor symptoms of menopause.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
234
Q

Framingham risk score Risk Factors for CHD

A

total cholesterol, DM, smoking, Age, HTN, elevated LDL, male gender

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
235
Q

NCEP ATP III Risk factors for CHD

A

smoking, age, HTN, elevated LDL, fam history of CHD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
236
Q

USPSTF screening recommendations for CHD

A

screen adults over 18 for high BP, routinely screen men over 35 and women over 45 for lipid disorders adn treat abnormal lipids in people who are at increased risk for coronary heart disease. recommends AGAINST routine screening with resting ECG, treadmill test, or EBCT in adults at low risk.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
237
Q

Typical CHD chest pain

A

radiates to one or both shoulders or arms. precipitated by exertion. more likely ACS or ischemic.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
238
Q

The three Ps of pain- characteristics that decrease the likelihood of ACS

A

Pleuritic- worsened by respiration, exacerbated when lying down. causes of pleuritic chest pain include pulm embolism, pneumothorax, viral or idiopathic pleurisy, pneumo, and pleuropericarditis.
Positional pain
Reproduced by Palpation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
239
Q

Characterizing chest symptoms using PQRST

A

Provocation/palliation, Quality, region/radiation, severity, temporal elements, associated symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
240
Q

most common structural heart disease presenting with palpitations

A

mitral valve prolapse

241
Q

mitral valve prolapse on auscultation

A

midsystolic click followed by crescendo-decrescendo murmur. best heard at apex. enhanced by valsava and decreased by squatting

242
Q

in patients at low risk for CHD, the test most helpful in exluding disease is

A

exercise stress electrocardiography

243
Q

USPSTF aspirin therapy recommendations

A

initiate aspirin in men 45-79 to reduce MI risk. initiate in women 55-79 to reduce ische1mic stroke risk. benefit weighed against risk of GI hemorrhage.

244
Q

causes of lower back pain

A

lumbar strain/sprain (70%), age related degenerative joint changes in the disks and facets (10%), herniated disc (4%), osteoporotic fracture (4%)

245
Q

risk factors for lower back pain

A

prolonged sitting, with truck driving having highest rate (then desk jobs), deconditioning, suboptimal lifting and carrying habits, obesity (maybe)

246
Q

lifetime prevalence of LBP

A

60-80%

247
Q

congenital causes of LBP

A

scoliosis, kyphosis, spondylolysis

248
Q

traumatic causes of LBP

A

lumbar strain, compression fracture

249
Q

metabolic causes of LBP

A

osteoporosis, hyperparathyroidism, paget’s disease, osteomalacia

250
Q

infectious causes of LBP

A

pyelonephritis, osteomyelitis, discitis, herpes zoster, spinal or epidural abscess

251
Q

inflammatory causes of LBP

A

ankylosing spondylitis, sacroiliitis, rheumatoid arthritis

252
Q

neoplastic causes of LBP

A

multiple myeloma, metastatic disease, lymphoma, leukemia, osteosarcoma

253
Q

degenerative causes of LBP

A

disc herniation, osteoarthritis, facet arthropathy, spinal stenosis

254
Q

Vascular causes of LBP

A

aortic aneurysm, diabetic neuropathy

255
Q

visceral causes of LBP

A

prostatitis, PID, ovarian cyst, endometriosis, kidney stones, cholecystitis, pancreatitis

256
Q

Radiologic findings associated with LBP

A

spondylolysis, disc-space narrowing, spinal instability, spina bifida occulta

257
Q

what percentage of LBP resolve within one month

A

90%

258
Q

for patients who are out of work greater than 6 months, what % chance is there returning to work?

A

50%

259
Q

classic signs of disc herniation

A

exacerbated when sitting or bending and relief while lying or standing, increased pain with coughing and sneezing, pain radiating down leg/foot, parasthesias, muscle weakness like foot drop

260
Q

what position makes scoliosis more easily visualized

A

lumbar flexion

261
Q

what is the best measure of spine mobility?

A

lumbar flexion

262
Q

restriction and pain during flexion are suggestive of…

A

herniation, osteoarthritis, or muscle spasm

263
Q

pain with lumbar extension is suggestive of

A

degenerative disease or spinal stenosis

264
Q

with lateral motion, pain on the same side as bending is suggestive of

A

bone pathology such as osteoarthritis or neural compression

265
Q

pain on the opposite of lateral bending is suggestive of

A

muscle strain

266
Q

difficulty with heel walk is associated with

A

L5 herniation

267
Q

difficulty with toe walk is associated wtih

A

S1 herniation

268
Q

if pain is reduced by squatting, suggests

A

central spinal stenosis

269
Q

most neuropathic back pain is due to impingement of which three nerve roots

A

L4, L5, S1

270
Q

decreased patella reflex implies

A

impingement at L3-L4

271
Q

decreased achilles reflex implies

A

impingement of L5-S1

272
Q

decreased rectal tone with back pain can indicate

A

disc herniation and/or cauda equina syndrome

273
Q

passive straight leg raise/Lasegue’s sign

A

leg raised less than 80 degrees, lower and then dorsiflex. positive if there is pain with dorsiflexion- radiates down posterior/lateral thigh. stretching of S1 or L5

274
Q

Pain with straight leg raise earlier than 30 degrees

A

malingering

275
Q

pain in opposite leg during a straight leg raise is suggestive of

A

root compression due to complete disc herniation

276
Q

crossed leg raise

A

positive if pain is increased in contralateral leg- not sensitive but very specific

277
Q

FABER test

A

flexion, abduction, external rotation. pathology of hip joint or sacrum.

278
Q

pelvic compression test

A

performed by forcibly pressing together hips. positive test elicits pain in the sacroiliac joint

279
Q

Pain worse with movement and sitting that improves while lying down. Dx

A

lumbar strain

280
Q

pain worse with movement and sitting that improves while lying down, and radiation down the leg

A

disc herniation

281
Q

cauda equina syndrome

A

spinal compression resulting from a large mass effect (such as acute disc herniation or tumor) causing pain radiating down the leg and numbness of the leg. decompression within 72 hours needed.

282
Q

red flags signaling cauda equina syndrome

A

urinary incontinence or retention, saddle anesthesia, anal sphincter tone decreased or fecal incontinence, bilateral lower extremity weakness or numbness, progressive neurological deficits

283
Q

red flags signaling LBP is from cancer

A

history of cancer, weight loss, age over 50 or under 17, failure to improve with therapy, pain more than 4-6 weeks, night pain or pain at rest

284
Q

red flags signaling vertebral fractures

A

corticosteroid use, trauma over age 50, age over 70, history of osteoporosis, recent car accident, previous vertebral fracture

285
Q

two red flags of herniated nucleus pulposus

A

major muscle weakness (strength 3 of 5) and foot drop

286
Q

spondylolisthesis

A

anterior displacement of vertebra or the vertebral column in relation to the vertebrae below. aching back and posterior thigh that increases with activity of bending

287
Q

when to do diagnostic testing (imaging etc) in LBP

A

after 4-6 weeks of conservative treatment

288
Q

guidelines for plain x ray films in LBP (AHCPR)

A

age under 20 and over 70, trauma, strenuous lifting + osteoporosis, prolonged steroid use, cancer, fever/chills, pain worse when supine or severe at night

289
Q

criteria for lumbar films (deyo series)

A

age over 50, trauma, neuromotor defect, weight loss of 10lbs, ankylosing spondylitis, drug/etoh abuse, history of malignancy, 100 degree fever, revisit w/out improvement

290
Q

Is CT recommended in back pain?

A

no

291
Q

indications for MRI in LBP

A

neurological deficit, radiculopathy, progressive motor weakness, cauda equina compression, suspected systemic disorder, failed 6 weeks conservative treatment,

292
Q

differential diagnosis for knee pain

A

osteoarthritis, rheumatoid arthritis, SLE< gout, pseudogout, psoriatic arthritis, knee strain

293
Q

causes of knee pain in children and adolescents

A

patellar subluxation, tibial apophysitis (osgood-schlatter), patellar tendonitis

294
Q

causes of knee pain in adults

A

patellofemoral pain syndrome, overuse, traumatic injuries, inflammatory arthropathies,

295
Q

locking or popping symptoms in knee pain

A

ligament or menisci injuries

296
Q

PHQ-2 Depression screen

A

during the past month: have you often been bothered by feeling down, depressed or hopeless? Have you often been bothered by little interest or pleasure in doing things?

297
Q

Lachman’s test

A

assess ACL.

298
Q

valgus and varus stress tests

A

assess functioning of medial and lateral collateral ligaments.

299
Q

McMurray test

A

assess the medial and lateral medisci. positive ive click is felt or causes pain.

300
Q

Phalen’s test

A

flex wrist by having patient place dorsal surfaces of hands together in front of him for 30-60 seconds to reproduce symptoms

301
Q

The three most helpful findings in predicting the electrodiagnosis of carpal tunnel syndrome are

A

hand symptom diagrams, hypoalgesia, weak thumb abduction strength testing

302
Q

discoid lesions

A

discrete erythematous plaques with scaling

303
Q

theater sign

A

mild to moderate pain after prolonged sitting. patellofemoral pain syndrome

304
Q

anterior knee pain, no trauma, overuse, mild pain after prolonged sitting

A

patellofemoral pain syndrome

305
Q

lateral knee pain, no trauma, pain aggravated with activity

A

iliotibial band tendonitis

306
Q

general knee pain, trauma/noncontact deceleration forces. moderate to severe joint effusion, swelling within 2 hours of pop

A

ACL sprain

307
Q

medial joint line pain, trauma, misstep or collision, immediate onset of pain/swelling after trauma

A

MCL sprain

308
Q

lateral joint line pain, trauma. varus stress. immediate onset of lateral knee pain.

A

lateral collateral ligament sprain

309
Q

medial or lateral joint line, trauma/sudden twisting injury. can occur with chronic degenerative process. mild effusion. possible atrophy of the vastus medialis obliquus portion of the quadriceps

A

meniscal tear

310
Q

generalized extreme pain with any movement. elevated WBCs. elevated ESR. abrupt onset of pain/swelling

A

septic arthritis

311
Q

generalized or joint line tenderness, pain aggrevated by weight bearing activities relieved by rest. not acute trauma. crepitus on exam

A

osteoarthritis

312
Q

extreme pain with any movement, also painful to touch. acute pain and swelling without prior trauma. arthrocentesis with clear or slightly cloudy synovial fluid

A

gout

313
Q

synovial fluid findings: clear straw colored transudative fluid

A

OA, degenerative meniscal injury. simply joint effusion

314
Q

synovial fluid findings: dark, discolored bloody aspirate

A

Acute meniscal tear, anterior or posterior cruciate ligament tear (knee sprain).hemarthrosis

315
Q

synovial fluid findings: dark, discolored w/fat globules

A

Osteochondral fracture. hemarthrosis w/ fat globules

316
Q

synovial fluid findings: turbid to very turbid fluid, high white cell count (15k to >200k)

A

septic arthritis

317
Q

synovial fluid findings: slightly turbid, crystals

A

inflammation. SLE, gout, RA

318
Q

is knee x ray required to diagnose OA?

A

no

319
Q

a ‘merchant’s view’ on x ray

A

top view of the knee obtained with knee bent at a 45 degree angle, showing the alignment of the patella in the groove of the femur (evaluates the patellofemoral joint)

320
Q

Major radiographic features of OA

A

joint space narrowing, subchondral sclerosis, osteophytes, subchondral cysts

321
Q

what radiographic feature best predicts disease progression in OA

A

joint space narrowing

322
Q

preferred test to dx meniscal or ligamentous damage

A

MRI

323
Q

what test to order in setting of locking, popping, or joint instability (knee)

A

MRI

324
Q

Intra-articular steroid injections

A

no more than 3 injections per year, no more than 1 injection per month. long acting triamcinolone preferred over methylprednisolone. combine 1ml of steroid with 3-4ml local anesthetic.

325
Q

three OA treatments that are A level evidence

A

water exercise, NSAIDs ad corticosteroid injections.

326
Q

when to do nerve conduction velocity study on carpal tunnel pts

A

if symptoms don’t improve w/conservative tx, motor dysfunction, thenar atrophy

327
Q

breast cancer screening in ages 50-74

A

biennial mammography

328
Q

cervical cancer screening for women over 65

A

should not be screened if they have adequat normal pap smears.

329
Q

Lipid disorder screening (USPSTF)

A

screen women over 45 if they are increased risk for coronary heart disease, no recommendation for women over 20, strongly recommends women over 35

330
Q

AAA Screening recommendation

A

one time US to screen for AAA for men 65-75 who have any history of smoking. recommended against for women

331
Q

USPSTF recommendation for carotid artery stenosis screening

A

against if aysmpt

332
Q

zoster vaccine

A

60 and older

333
Q

tetanus booster every _ years

A

10

334
Q

pneumococcal vaccine

A

once at 65 years old

335
Q

most common sexually transmitted bacterial infection in the US

A

chlamydia

336
Q

USPSTF chlamydia screening recommendations

A

Strongly recommends (A): all sexually active non/pregnant 24 and younger. Non-preg women 25 and older at increased risk. Recommends (B) all preg women 24 and younger, preg women over 25 at increased risk, advises against screening women age 25 and older if not at increased risk. Insuff evidence for or against screening men

337
Q

USPSTF folic acid recommendation

A

all women planning or capable of pregnancy take a daily supplement containing 400-800 mcg of folic acid.

338
Q

when to increase folic acid dose beyond 400-800mcg

A

1mg in pts with DM or epilepsy, 4mg in pts who bore a child w/previous neural tube defect.

339
Q

HTN drugs to avoid during pregnancy

A

ACEIs, ARBs, thiazide diuretics

340
Q

bleeding can occur in early pregnancy around time of missed menses as a result of…

A

invasion of trophoblast into the decidua (implantation bleed)

341
Q

gestational age 5 weeks- findings

A

embryo is 1/8 inch in size. has heartbeat. brain/spinal cord rapidly developing.

342
Q

gestational age 8 weeks- findings

A

enlargement of uterus detected on bimanual exam

343
Q

gestational age 10-12 weeks- findings

A

fetal heart tones elicited by hand-held doppler

344
Q

gestational age 12 weeks- findings

A

uterine fundus palpated above symphysis pubis

345
Q

gestational age 18-20 weeks- findings

A

fetal movement (quickening) detected by mother

346
Q

gestational age 20-36 weeks- findings

A

uterine enlargement, measure in centimeters, approximates gestational age and will become a routinely elicited physical exam finding.

347
Q

Naegele’s Rule

A

start w/first day of last normal period, then add 1 year, subtract 3 months, add 1 week.

348
Q

abortion is legal up to ___ weeks of pregnancy

A

22

349
Q

Adolescent interview: HEEADSSS

A

Home, education/employment, eating, activities, drugs, sex, suicide, safety

350
Q

goodell’s sign

A

softening of cervix

351
Q

hegar’s sign

A

softening of the uterus

352
Q

chadwick’s sign

A

bluish-purple hue on the cervix and vaginal walls is caused by hyperemia

353
Q

cervical os dilated w/obvious bleeding lends support to dx of…

A

spontaneous abortion

354
Q

1st trimester bleeding DDx

A

spontaneous abortion syndrome (loss of preg before 20 weeks), ectopic pregnancy, idiopathic bleeding in normal pregnancy

355
Q

inevitable abortion

A

dilated os

356
Q

incomplete abortion

A

some but not all of intrauterine contents have been expelled

357
Q

missed abortion

A

fetal demise w/out cervical dilation and or uterine activity

358
Q

septic abortion

A

w/intrauterine infection

359
Q

complete abortion

A

products of conception have been completely expelled from uterus

360
Q

threatened abortion

A

simply a pregnancy complicated by bleeding before 20 weeks gestation

361
Q

Rh D negative women should receive

A

50mcg dose of Rho(D) Immune Globulin (i.e. RhoGAM) to prevent hemolytic disease of newborn

362
Q

Kleihauer-Betke testing

A

to estimate the quantitative amount of fetal Hg in the maternal circulation to help with dosing RhoGam

363
Q

what four measurements are taken in the second trimester

A

biparietal diameter, head circumference, abdominal circumference, femur length.

364
Q

DDx for cough and wheezing

A

upper airway cough syndrome (post nasal drip), asthma, non asthmatic eosinophilic bronchitis, vocal cord dysfunction, COPD, CHF, GERD

365
Q

serious, less common causes of persistent cough

A

pulmonary conditions (bronchogenic carcioma of lung, sarcoidosis, TB), cardiac conditions like CHF

366
Q

etiologies of wheezing

A

asthma (most common cause), upper airway cough syndrome, COPD, CHF, foreigh body aspiration, persistent bronchitis, vocal cord dysfunction, PE

367
Q

co-morbidities- conditions that may require tx to improve the control of asthma

A

GERD, obesity, obstructive sleep apnea, rhinitis or sinusitis, stress and depression

368
Q

pathophysiology of asthma

A

chronic inflammatory disease of the airways. involves mast cells, eosinophils, t lymphocytes, macrophages, neutrophils, and epithelial cells. Chronic inflammation leads to airway hyperresponsiveness and limitation of airway flow (obstruction). persistent inflammation can lead to airway edema, long term inflammation can lead to airway remodeling and permanent loss of lung function

369
Q

fever, colored nasal drainage, headaches, face pain, toothache, failure to respond to decongestants, failure to improve after viral URI, nasa congestion of obstruction. initial improvemen,t then reoccurence of worsening sympt

A

acute sinusitis

370
Q

nasal congestion and drainage, mild headache, symptoms less than 10 days and not worsening

A

viral rhinosinusitis

371
Q

at least 2: nasal obstruction, mucopurulent drainage, face pain, decreased smell, some pts may have only minimal symptoms such as worsening nasal congestion, more than 12 weeks

A

chronic sinusitis

372
Q

distinctive diagnostic abnormalitiy in patients with asthma

A

reversible obstructive findings on spirometry

373
Q

patients who respond to inhaled steroids like asthma patients but have normal spirometry and normal CXR

A

non asthmatic eosinophilic bronchitis

374
Q

flattening of inspiratory loop on spirometry

A

vocal cord dysfunction

375
Q

tx for intermittent asthma

A

SABA PRN

376
Q

step 2 asthma tx

A

low dose ICS

377
Q

step 3 asthma tx

A

low dose ICS + LABA or medium dose ICS

378
Q

step 4 asthma tx

A

medium dose ICS + LABA

379
Q

asthma exacerbation management

A

oral corticosteroids

380
Q

what immunizations to asthma pts need

A

influenza vaccine and pneumococcal polysaccharide (23 valent), up to date tetanus-diptheria

381
Q

when is chadwicks sign usually visible and what is it

A

venous congestion–> bluish discoloration of cervix. visible by 8-10 weeks

382
Q

calculating due date

A

40 weeks after beginning of last menstrual period

383
Q

when does hCG peak?

A

10-12 weeks

384
Q

gestational sac often visualized by ___ weeks gestation

A

4-5

385
Q

a fetal pol is visualized by ___weeks

A

5-6

386
Q

presence of ____ indicates infection with Hep B and warrants further investigation

A

Surface antigen

387
Q

if positive for Hep B surface antigen, test for ___

A

hep B core antigen (active infection)

388
Q

high risk groups for gonorrhea and chlamydia screening in pregnant women

A

under 25, not married, black, history of STDs or multiple sexual partners, communities w/high infection rates

389
Q

Hep C antibody testing should be offered to pregnant women with risk factors such as:

A

contact w/prison inmates, IV drug use, HIV positive, multiple sexual partners, tattoos, elevated liver enzymes

390
Q

HIV screen in pregnant women

A

recommended for all.

391
Q

rubella and syphilis screen in pregnant women

A

universal screening recommended

392
Q

how much weight is normal to gain in pregnancy

A

20-25 lb gain

393
Q

prenatal visit schedule

A

every 4 weeks until 28 weeks, every 2 weeks from 28-36 weeks, weekly from 36 weeks until delivery

394
Q

at 10 weeks, fundus is palpable at

A

pelvic brim

395
Q

at 20 weeks, top of fundus is at level of

A

umbilicus

396
Q

all pregnant women should be screened for asymptomatic bacteriuria at ___ weeks

A

12-16

397
Q

flu vaccine in pregnancy

A

recommended (IM preparation, killed and safe). mist/attenuated is not recommended

398
Q

triple or quad screen

A

second trimester. AFP, hCG, unconjugated estriol, dimeric inhibin A. not performed until 15-21 weeks gestation

399
Q

women should be offered routine US scanning for structural anomalies between ___ weeks

A

18-20

400
Q

risk of spontaneous abortion in amniocentesis

A

1:400-1:200

401
Q

screening for Gestational diabetes.

A

at risk - screen at 24-28 weeks. measure serum glucose 1 hour after oral ingestion of a 50g glucose solution. normal if fasting is <140.

402
Q

most common cause of life threatening infection in newborns

A

GBS (sepsis, meningitis, and pneumonia)

403
Q

what four signs of labor should patient be alerted to

A

vaginal bleeding, vaginal discharge, gush of fluid, regular contractions

404
Q

DDx of vaginal discharge and potential bleeding in third trimester

A

placenta previa, bacterial vaginosis, vaginal candidiasis, UTI, cervical trauma, placental abruption, PROM, preterm labor, uterine rupture

405
Q

risks for placenta previa

A

prior pregnancy, over 35 yo, smoker, previous twins, uterine surg (including prior c section)

406
Q

standard tx for bacterial vaginosis

A

metronidazole, 500mg BID, 7 days

407
Q

tx for vaginal candidiasis

A

clotrimazole

408
Q

uterine contractions, vaginal bleeding, abdominal tenderness, non-reassuring fetal heart tracing

A

placental abruption. placenta peels away from inner wall of uterus.

409
Q

PROM

A

premature rupture of membranes- large gush or steady trickle of clear vaginal fluid. 8-10% of term pregnancies

410
Q

Rhogam immunization

A

if pt is Rh negative, Rhogam immunization should be given at 28 weeks, within 72 hours after delivery, with any episodes of bleeding

411
Q

eclampsia

A

describes the occurrence of one or more convulsions in the presence of preeclampsia without the presence of another underlying neurologic disorder

412
Q

most common skin eruptions in pregnancy

A

pruritic urticarial papules and plaques of pregnancy (PUPPP), prurigo of pregnancy, pruritic folliculitis [serious conditions- cholestasis of pregnancy, pustular psoriasis, pemphigoid gestationis]

413
Q

tx of skin eruptions in pregnancy

A

relief of symptoms. topical emollients and glucocorticoids.

414
Q

most infants with down’s have between 4 and 6 of following signs

A

flat facial profile, excessive skin at nape of neck, slanted palpebral fissures, hypotonia, hyperflexibility of joints, dysplasia of pelvis, anomalous ears, dysplasia of midphalanx of fifth finger, transverse palmar simian crease, poor moro reflex

415
Q

postpartum follow up

A

2 weeks for c section (wound healing), 6 weeks for vaginal delivery

416
Q

postpartum blues

A

mild, often rapid fluctuations in mood within first two weeks. peaks around day 5. resolve with time

417
Q

postpartum depression

A

occurs in 5% of women. onset of clinical depression within first four weeks post partum.

418
Q

Ddx of pain radiating to back ,N/v

A

cholecystitis, biliary colic, duodenal ulcer, hepatitis, pancreatitis

419
Q

alcohol dependence

A

3 or more: tolerance, withdrawal, larger quantity, desire to cut down, significant time spent obtaining or recovering, social/recreational tasks are sacrificed, use continues despite physical problems

420
Q

CAGE

A

cut down? annoyed by questions? guilt? eye opener?

421
Q

physical exam techniques to rule out appendicitis

A

psoas sign (passive extension of patient’s thigh as the y lie on side with knees extended or asking the patient to flex thigh and hip causes abdominal pain). obturator sign (examiner has patient supine with right hip flexed to 90 degree, take right ankle in right hand with left hand rotate patients hip by moving knee back and forth)

422
Q

difference between cholecystitis and biliary colic

A

cholecystitis is similar to biliary colic but is a stone that cannot be dislodged so symptoms last longer than 4-6 hours

423
Q

biliary colic

A

RUQ pain, epigastric pain or chest pain that is constant, alsts less than 4-6 hours, radiates to back. follows fatty meal.

424
Q

two classic (rare) physical exam signs of pancreatitis

A

grey-turner’s sign: ecchymotic discoloration in flank. Cullen’s sign: ecchymotic discoloration of perumbilical region

425
Q

preferred study to evaluate RUQ

A

Abdominal ultrasound.

426
Q

untreated symptomatic gallstones biliary colic- risk of progression ___% to complications such as:

A

70%. cholangitis, panreatitis, cholecysitis, choledocholitiasis, gallstone ileus, mirizzi synrome

427
Q

mirizzi syndrome

A

gallstone compression of hepatic duct

428
Q

Ursodiol

A

atypical symptoms of biliary colic with visible stones. if symptoms resolves, may have been from gallstones

429
Q

HIDA scan

A

functional study of gallbladder. may reproduce pain. do if not visible stones on gallbladder US

430
Q

ERCP indication

A

jaundice and/or gallstone pancreatitis suggestive of common duct stone. postoperative patient who did not have an intraoperative cholangiogram and who presents with repeat episode of biliary colic

431
Q

MRCP

A

similar diagnostic modality that sues magentic resonance. unlike ERCP, is diagnostic only.

432
Q

Ddx for erythematous patch of skin on 68 year old man

A

squamous cell carcinoma, basal cell carcinoma, melanoma, actinic keratosis, eczema, fungal

433
Q

macule

A

close your eyes and run fingers over it, don’t know its there. completely flat.

434
Q

patch

A

macule >1cm in diameter

435
Q

papule

A

solid, raised, distinct border, <1cm

436
Q

plaque

A

solid, raised, flat topped >1cm

437
Q

nodule

A

raised, solid, may be epidermis, dermis, or subcut.

438
Q

tumor

A

solid mass of skin or subcut. larger than nodule

439
Q

vesicle

A

raised lesion <1cm, filled with clear fluid

440
Q

Bulla

A

circumscribed, fluid filled lesion >1cm in diameter

441
Q

pustule

A

circumscribed, elevated lesion containing pus

442
Q

wheal

A

an area of elevated edema in upper epidermis

443
Q

annual skin cancer screening by full body skin examination by health care provider is what recommendation by USPSTF

A

I

444
Q

tinea pedis

A

athlete’s foot. ubiquitous dermatophyte infection.

445
Q

5 things a consent form must have

A

nap of the procedure, diagnosis, risks, benefits, alternatives

446
Q

sun exposure increases risk of what three things

A

squamous cell carcinoma, actinic keratosis, basal cell carcinoma

447
Q

international prostate symptom score

A

ask pt- over the past month or so, how often have you: had sensation of not emptying bladder, had to urinate again soon, stop and start, difficult to postpone, weak stream, push or strain to begin, nocturia

448
Q

punch biopsy procedure and wound care

A

disinfect biopsy area with povidone solution. use disposable sterile gown and gloves. infiltrate area with 1% lidocaine w/out epinephrine using 23 guage. drape. disposable punch to obtain a biopsy from periphery. put in formalin jar. place steri-strip to approximate the edge of the skin at site. compressive dressing. keep dry for 3 days

449
Q

dx: scaly lesion, thick, pink macular to papular area, edges are fleshy. borders often bleed

A

squamous cell carcinoma

450
Q

dc: plaque like or nodular with waxy/translucent appearance, ulceration and telangiectasia. no itching or color change.

A

basal cell carcinoma

451
Q

dx: growing, spreading, pigmented lesions.

A

melanoma

452
Q

60: of primary skin cancers

A

basal cell

453
Q

single greatest risk factor for non melanoma skin cancer

A

percent of lifetime sun exposure obtained before 18 years of age

454
Q

lichen planus

A

common in middle age. primary lesion is a 2 to 10mm flat topped papule w/irregular angulated border commonly on flexor surfaces of wrists and legs above ankles.

455
Q

seborrheic keratoses

A

usually elevated, hyperpigmented lesions on face and trunk. stuck on appearance.

456
Q

other conditions w/symptoms similar to BPH

A

UTI, prostatitis, medication side effects, overactive bladder, prostate cancer

457
Q

complications of untreated BPH

A

UTIs, acute urinary retention, obstructive nephropathy

458
Q

obtain PSA if:

A

life expectancy is >10 years, PSA level will influence BPH treatment

459
Q

tx for actinic keratosis

A

5-FU

460
Q

two BPH drugs

A

alpha adrenergic antagonists (tamsulosin, alfuzosin, terazosin) and 5-alpha reductase inhibitors (finasteride and dutasteride)

461
Q

tx for tinea capitis

A

oral therapy is required. Griseofulvin. 20-25mg/kg/day, for 6-12 weeks

462
Q

Tx for Tinea unguium (onychomycosis)

A

griseofulvin. Terbinafine (250mg/day for 12 weeks if toes, 6 weeks if fingernails). itraconozaole 200mg BID as pulse therapy (1 weeks of iraconazole, 3 weeks off)

463
Q

two drug families effective against dermatophytes

A

azoles and allylamines

464
Q

Group I (strongest) topical steroids

A

augmented betamethasom dipropionate, halobetasol propionate. for psoriasis, lichen planus, severe eczema, alopecia areata,

465
Q

Group II topical steroids

A

desoximetason fluocinonide. for psoriasis, lichen planus, severe hand eczema, alopecia areata

466
Q

Group III topical steroids

A

betamethasone diproprionate, triamcinolone acetonide.

467
Q

group IV topical steroids

A

fluocinolone acetonide, traiamcinolone acetonide.

468
Q

Group VII (weakest) topical steroids

A

hydrocortisone 1%, 2.5%

469
Q

most common site of osteoporosis fractures

A

vertebrae, hip, distal radius, proximal humerus.

470
Q

USPSTF v. ACOG v. ACS breast cancer recommendations

A

USPSTF: biennal for 50-74. ACOG: mamm every 1-2 years women 40-49, annually after. ACS: annual mamm for all 40+

471
Q

colon cancer screening

A

everyong 50-75

472
Q

ACOG cervical cancer screening recs

A

first pap at 21, biennial pap from 21-30, over 30 w/three consecutively normal paps- every 3.

473
Q

risk factors for endometrial cancer

A

any increased exposure to estrogen. tamoxfen, obesity, anovulatory cycles, estrogen secreting neoplasms, early menarche, late menopause, nulliparity

474
Q

protective factors for endometrial cancer

A

smoking and OCPs

475
Q

Ddx for abnormal bleeding in postmenopausal woman

A

cervical polyps, endometrial hyperplasia, endometrial cancer, proliferative endometrium, iatrogenic, systemic disorders, genital tract pathology

476
Q

most cost effective initial test in women with abnormal uterine bleeding at low risk for endometrial cancer

A

transvaginal ultrasound

477
Q

osteoporosis tx

A

biphosphoanates. inhibit bone resorption and reduce bone turnover, increasing bone mineral density. decrease risk of vertebral and non vertebral fractures. generic (more affordable): alendronate (fosamax) and risedronate (actonel). Parathyroid hormone (forteo)- approved by FDA for those w/osteoporosis and high risk for fracture. given subcutaneously. decreases fracture risk by 50-65%. no demonstrated efficacy and safety beyond two years.

478
Q

pulsating moderate to severe headache, nausea, vomiting, photophobia, phonophobia, unilateral, 4-72 hours.

A

migraine

479
Q

mild to moderate, pressing headache. photo/phonophobia, bilateral, occipital tenderness,

A

tension

480
Q

severe headache with rhinorrhea, lacrimation, facial sweating, miosis

A

cluster headache

481
Q

potentially life threatening diagnoses to consider with headache

A

bacterial meningitis (fever, chills, stiff neck, URI, new rash), intracranial hemorrhage (trauma, acute change in pattern of headaches, first or worst headache, HTN), brain tumor (first headache in pt over 50yo, abnormal thinking, weight loss)

482
Q

depedence: syndrome characterized by maladaptive pattern of opioid use causing impairment. at least three:

A

tolerance, withdrawal, increasing doses, desire or inability to cut down, sig. time spend searching, interferes with activities, continued use despite problems

483
Q

mental status exam

A

appearance, psychomotor, speech, affect, mood, thought process, thought content, level of awareness, attention

484
Q

only recommend neuroimaging a headache if

A

patient has migraine with atypical headache patterns or neurologic signs, patient is at higher risk of a significant abnormality, study results would alter management

485
Q

side effects of triptans

A

dizziness, sleepiness, nausea, fatigue, paresthesias, throat tightness or closure, chest pressure

486
Q

side effects of ergot alkaloids

A

MI, tachyarrhythmias, stroke HTN, Rash, nausea, vomiting, diarrhea, dry mouth

487
Q

prophylactic therapies for headaches

A

beta blockers, neuristabilizers (divalproex, topiramate), TCAs, CCBs, feverfew, Mg, B2

488
Q

Ddx of epigastric pain

A

GERD, PUD, Anxiety, abdominal muscle strain, gastritis

489
Q

differentiating btwn GERD and PUD

A

GERD: classic heartburn and regurg (burning chest with bitter taste), occurs after meals, pregnancy, obesity, girdles. PUD: episodic or recurrent aching. gnawing, or hunger like pain. gastric ulcer 5-15 min after eating until stomach empties, duodenal ulcer pain relieved by eating

490
Q

complications of GERD

A

esophagitis, peptic strictures from fibrosis and constriction, barrett’s esophagitis, 2-5% may further -> adenocarcinoma

491
Q

complications of PUD

A

hemorrhage, perforation into the peritoneal cavity or adjacent organs, ulcer scar healing or inflammation with impaired gastric emptying can lead to gastric outlet obstruction syndrome.

492
Q

onset of heartburn and regurg in patient over 55yo

A

refer to GI. increased chance of cancer

493
Q

most common cause of lower GI bleeding in patients over 50yo

A

diverticulitis

494
Q

most common cause of non cardiac chest pain

A

GERD

495
Q

is FIT or FOBT more sensitive and specific for detecting occult lower GI bleed

A

FIT

496
Q

medications that may potentiate GERD symptoms

A

CCBs, beta agonists, alpha adrenergic agonists, theophylline, nitrates, and some sedatives.

497
Q

therapies used for dyspepsia after H pylori infection is ruled out

A

TCAs, capsaicin, peppermint oil, caraway oil, artichoke leaf.

498
Q

first line regimes for H pylori

A

PPI triple therapy for 10-14 days (PPI BID + clarithromycin BID + Amoxicillin QD), ALternative PPI therapy for 14 days (if PCN allergy. PPI BID, clarith BID, metrodnidazole BID), Quadruple therapy for 10-14 days (PPI QD OR Ranitidine BID, tetracycline TID, metronidazole , bismuth subsilacylate)

499
Q

accepted indications for testing to prove H pylori eradication after antibiotic therapy

A

patients with H pylori associated ulcers, persistent dyspeptic symptoms despite the test and treat strategy, individuals with H pylori associated MALD lymphoma, post resection of early gastric cancer

500
Q

to evaluate eradication of H pylori:

A

perform fecal antigen testing, if positive- retreat with salvage therapy, upper endo/EGD to rule out ulcer disease, prolonged PPI therapy for symptoms. if fecal antigen testing negative, perform urease test.

501
Q

RUQ pain ddx

A

cholecystitis, biliary colic, congestive hepatomegaly, hepatitis, perforated duodenal ulcer, retrocecal appendicitis

502
Q

LUQ pain ddx

A

gastritis, splenic disorders (abscess, rupture)

503
Q

RLQ pain ddx

A

appendicitis, cecal divertiulitis, meckels’ diverticulitis, mesenteric adenitis.

504
Q

LLQ pain ddx

A

sigmoid diverticulitis

505
Q

red flag signs of severe or life threatening abdominal pathology

A

abrupt onset of severe pain, shock with hypotension and tachy, distension, peritoneal irritation signs, absent bowel sounds, fever, vomiting, diarrhea, weight loss, menstrual changes, trauma, prior surgeries, blood in emesis or stool, severity of pain, rigid abdomen, rebound tenderness, mass, ascites

506
Q

red flags for women who may have been victimized by intimate partner

A

migraines, frequent headaches, chronic pain syndrome, heart and BP, arthritis, stomach ulcers, pain during sex, cervical cancer, depression, unexplained findings

507
Q

domestic violence screening

A

ACOG suggests screening all patients at all visits

508
Q

Obstetrical history (GTPAL)

A

G: number of pregnancies, T number of term, P number of preterm, A number of abortions, L number of living

509
Q

strongest risk factor for elevated cholesterol

A

elevated BMI

510
Q

metabolic syndrome

A

at least three: hypertriglyceridemia, low HDL, elevated blood glu, excessive waist circumference, HTN

511
Q

lung sounds that indicate consolidation

A

egophany, tactile fremitus, dullness to percussion, crackles, whispered pectroliloquy

512
Q

lung sounds that do not indicated consolidation

A

wheezes, rhonchi

513
Q

BMI screening

A

AAP and AAFP recommend universal screening, USPSTF= insufficient evidence

514
Q

focal crackles in febrile child without underlying lung disease

A

pneumonia.

515
Q

fine crackles at mid inspiration v. coarse late inspiratory crackles

A

fine/mid insp: acute pneumonia. coarse/late = resolving

516
Q

McIsaac score-

A

indicates whether to evaluate for Group A beta hemolytic stretococcal pharyngitis with a strep antigen test or culture. Fever, no cough, tonsillar exudate, tender cervical adenopathy, less than 15yo. if greater than 45, -1pt. if total is 2-3pts, order rapid strep test. if total is greater than or equal to 4, order culture or start abx

517
Q

for children 3 months to adolescence, 1st line tx for uncomplicated pneumonia is

A

amoxicillin. covers strep

518
Q

school aged children with symptoms more concerning for atypical pneumonia, tx is

A

macrolide. azithromycin

519
Q

most common pneumonia pathogen in infants <3weeks and tx

A

e coli, GBS, listeria. Tx: ampicillin and gentamicin

520
Q

most common pathogen of pneumonia in 3 week-6 months and Tx

A

strep pneumo, chlamydia, adenovirus, influenza, RSV, parainfluenza. Tx: erythromycin, cefotaxime, or cefuroxime. Azithromycin if outpatient

521
Q

pneumonia pathogens if 3 months to 5years old, tx

A

strep pneumo, mycoplasma, chlamydia, adenovirus, influenza virus, parainfluenza, rhinovirus, RSV. tx PCN or ceftriaxone

522
Q

pneumonia pathogens in children > 5 years old, tx

A

chlamydia, mycoplasma, strep pneumo. Tx: IV antibiotic

523
Q

recommend diabetes screening fro al 10 year olds with

A

BMI>85%ile and risk factors, and BMI>96%ile w/out risk factors. re-check every two years

524
Q

check fasting lipid profile on every child with:

A

BMI over 85%ile

525
Q

drug tx for children with hyperlipidemia if

A

older than 10 who are either tanner stage 2 or post menarche and LDL over 190 or 160 w/risks

526
Q

define A fib

A

rapid irregular and chaotic atrial activity without definable p waves on electrocardiogram

527
Q

presentation of A fib

A

dizziness, syncope, dyspnea, or palpitations

528
Q

etiology of a fib

A

fever, myocarditis, volume contraction, thyrotoxicosis, endogenous catcholamines, AV nodal dysfunction

529
Q

USPSTF recommendations for screening cerebrovascular disease

A

screen all adults over 18 for HTN. screen adults over 20 for hyperlipidemia if at increased CAD risk (i.e. diabetic, HTN, fam history), ask all adults about tobacco use, discuss aspirin chemoprevention in all men uncer 45 for primary prevention of MI

530
Q

left hemiplegia, spatial and perceptual dificulties, inattention to ppl in left visual field, denial of stroke disability. Where is infarct

A

Right middle cerebral infarct affecting right parietal hemisphere

531
Q

impairment of BP, respiratory function, heartbeat, and consciousness. where is infarct?

A

brainstem

532
Q

expressive and receptive aphasia, left facia weakness

A

left MCA

533
Q

what fraction of stroke survivors develop depression

A

1/3

534
Q

FAST test for stroke

A

Face: can they smile, Arms: can they raise both, Speech: can they repeat a sentence. Time: call 911

535
Q

LP in stroke pts if

A

meningitis suspicion, endocarditis, CNS vasculitis or if possibility of subarachnoid hemorrhage.

536
Q

management of A fib

A

IV diltiazem, IV BBs or verapamil to slow rate. cardioversion via electrical shock or meds

537
Q

ticlopidine

A

marginally better than aspirin alone for preventing stroke

538
Q

most states require what vaccines for school entrance

A

hep B, DTaP, polio, MMR, varicella

539
Q

immunization contraindications

A

allergy or sensitivity to specific vaccine, immunodeficienct states such as HIV or chemo, postpone vaccines when patients have moderate to severe illness- fever, otitis, diarrhea, vomiting. if illness is mild, get vaccine. tx with antimicrobials will not interfere with vaccines

540
Q

ADHD diagnosis

A

not made until child is>6 years old. Symptoms must be more frequent or severe compared to others same age, present in at least two settings, at least 6 months

541
Q

AAP and AAFP recommendations on childhood BMI screening

A

universal screening using percentile score

542
Q

most common cause of a sore throat

A

viral pharyngitis

543
Q

what distinguishes infectious mononucleosis from other causes of viral pharyngitis (but not from group A strep)

A

palatal petechiae of posterior oropharynx

544
Q

presentation of group A strep pharyngitis

A

high fever, cervical lymphadenopathy, tonsillar exudate, palatal petechiae, strawberry tongue.

545
Q

pertonsillar abscess presentation

A

fever, difficulty swallowing, neck or ear pain, muffled hot potato voice.

546
Q

Tx of group A pharyngitis

A

PCN po, PCN iv, amoxicillin, first gen cephalosporin, macrolides

547
Q

fussy infant ddx

A

colic, pyloric stenosis, intussusception, allergy to breast milk, GERD, infection

548
Q

APGAR score

A

appearance, pulse, grimace, activity, respiration

549
Q

normal pattern of infant weight gain and loss

A

normal infants lose up to 10% of birth weight in first several days. by 2 weeks of age, return to birth weight. milk production begins 48-72 hours after delivery.

550
Q

4 week old milestones

A

more alert, smoother movements, listen to voices, respond to mother, eyes wander, recognizes sounds

551
Q

fever in infant under 2 months of age

A

potentially serious sign of infection. thorough lab eval and cultures of blood, CSF, and urine. admit to hospital for observation and possibly abx

552
Q

USPSTF recommendations for postpartum depression screening

A

all adults in practices that have systems in place to ensure accurate dx, tx, and follow up- most primary care don’t have that in place.

553
Q

PHQ-2

A

shortest and most readily utilized rapid screen for depression. if both questions are positive, follow up with PHQ-9

554
Q

PHQ-9

A

little interest, feeling down, trouble sleeping, tired, appetitie, bad about yourself, concentration problems, fidgety, thoughts of being dead

555
Q

edinborough postnatal depression scale

A

i have been able to laugh and see funny side, looked forward with enjoyment, have blamed myself for wrong things, anxious, scared, unhappy, sad, crying, harming myself.

556
Q

wessel definition of colic

A

unexplained paroxysmal bouts of fussing and crying that lasts at least three hours a day, at least three times a week, for longer than three weeks.

557
Q

Ddx for shoulder pain

A

impingement syndrome/subacromial bursitis, shoulder instability, rotator cuff tendonitis, torn rotator cuff, labral pathology

558
Q

anatomic stabilizers of the shoulder joint

A

labrum, glenohumeral ligaments, rotator muscle group

559
Q

non musculoskeletal causes of referred shoulder pain

A

myocardial infarction, lung cancer, cholecystitis, ruptured ectopic pregnancy

560
Q

musculoskeltal scauses of shoulder pain that restrict passive ROM

A

adhesive capsulitis (contracture of capsule. DM and following injury), glenohumeral arthritis (less common site of OA than hip)

561
Q

tx for tinea pedis

A

tolnaftate (tinactin) BID

562
Q

pt carrying arm in adducted and internally rotated position may indicate

A

posterior dislocation

563
Q

poor posture or rounded shoudlers may indcate what shoulder injury

A

impingement syndrome

564
Q

boney deformity in the area of the clavicle or AC joint may indicate

A

fractured clavicle or sprain of AC joint

565
Q

what muscle does empty can test examine

A

supraspinatous

566
Q

what does apley scratch test indicate?

A

if there is pain/decreased ROM- rotator cuff tendonitis. unable to raise arm above head: rotator cuff tear. significant pain/decreased ROM: impingement, bursitis

567
Q

neer test

A

subacromial space impingement

568
Q

hawkins kennedy test

A

supraspinatous tendon impingement

569
Q

yergason’s test

A

bicepts tendonitis

570
Q

USPSTF breast cancer screening recs

A

mammo every 2 years if 50 and older.

571
Q

cancer screenings NOT recommended by USPSTF

A

PSA, chest x ray, total body skin exam for skin cancer, pancreatic cancer screening, testicular cancer screening

572
Q

6 steps of the SPIKES strategy for delivering bad news

A

setting up interview, perception, invitation, knowledge, address Emotions, strategy and summary.

573
Q

Tx iron deficiency anemia in adult male

A

ferrous sulfate 325 TID, docusate sodium 100mg BID for constipation, colonoscopy

574
Q

USPSTF screening tests and recs for adolescents

A

rubella for females of child bearing, chlamydia and gonorrhea- women under 25, HIV and syphillis- sexually active men at increased risk

575
Q

ddx of SOB

A

COPD, asthma, lung cancer, pneumonia, acute bronchitis, CHF

576
Q

four items predictive of presence of COPD

A

smoking more than 40 pack-years, self reported history of chronic obstructive airway disease, max laryngeal height of 4cm or less, age > 45 years

577
Q

findings on chest x ray that are not diagnostic but may be suggestive of advanced COPD

A

hyerpinflation, hyperlucency, rapid tapering of vascular markings

578
Q

when to add inhaled glucocorticosteroids to COPD regimen

A

if FEV1 <50% of predicted

579
Q

immunizations for COPD patients

A

influenza (every adult over 50), pneumococcal polysaccharide vaccine (all adults 65 and older), TdaP (Td every 10 years following TdaP)

580
Q

abx should be given to people with exacerbations of COPD if they:

A

have increased dyspnea, increased sputum, and increase sputum purulence, require mechanical ventilation

581
Q

DSM IV criteria for dementia

A

acquired impairment in memory with: exec function loss, language loss, praxis loss, gnosis loss

582
Q

USPSTF screening dementia

A

insufficient evidence

583
Q

movements of labor: engagment

A

widest part of fetus entered pelvic inlet

584
Q

movements of labor: descent

A

wisest part of fetus is btwn ischial spines

585
Q

movements of labor: flexion

A

when fetus is in the occiput anterior position the fetal head is flexed

586
Q

movements of labor: internal rotation

A

fetal head must rotate in order to further descend

587
Q

movements of labor: extension

A

occurs as the fetal head passes under the symphysis pubis, which occurs during crowning

588
Q

movements of labor: external rotation

A

head realigns with shoulders

589
Q

movements of labor: expulsion

A

anterior shoulder of fetus pushed out first, then posterior shoulder

590
Q

normal fetal heart rate baseling

A

110-160

591
Q

reassuring fetal heart rate tracing

A

two heart rate accelerations at least 15 secs, peaks at least 15 beats per min above base line, moderate varriability

592
Q

how to manage late decelerations in fetal heart rate

A

continuous monitoring, place pt on her side to decrease pressure on vena cava

593
Q

use of Aspirin in women v men

A

in women- preventive for stroke, given to all patients with identified CAD

594
Q

systolic heart failure management

A

ACEIs, ARBs, Digoxin, Loops, BBs (can initially worsen failure), spironolactone

595
Q

what common HTN med does not have role in heart failure management

A

CCBs. TZDs worsen

596
Q

DDx for dysmenorrhea

A

adenomyosis, cervical stenosis, chronic PID, endometriosis, fibroids, ovarian cysts

597
Q

uterine leiomyoma (fibroids)

A

most common benign tumors of the uterus. risks- early menarch, fam history, alcohol

598
Q

study of choice for pelvic path

A

Ultrasound

599
Q

when to tx otitis media with abx

A

children under 6 months. wait if btwn 6mo and 2 years. dont treat if over 2

Family Medicine (1 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions