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[3b1⃣] Fam Med > Fam Med > Flashcards

Fam Med Flashcards

1
Q

What are the major risk factors for Breast CA - 7

A
  1. 1st degree relative with breast CA
  2. Prolonged estrogen exposure (menstruating outside of 12-45 y/o range vs utero DES vs HRT)
  3. Genetics (BRCA 1/2 mutation)
  4. Alcoholic
  5. Obesity
  6. Radiation
  7. Age 40-70 yo

Average Menopause onset = 51

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2
Q

Formula for BMI

A

(kg weight) / (height in m2)

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3
Q

Guidelines for PAP Smear Cervical CA Screening - 3

A
  1. [Age 21 - 65 every 3 years (cytology only)] ≥ 3x consecutively
  2. [Age 30-65 can alternatively get Co-HPV Testing every 5 years] ≥ 2x consecutively
  3. Risk Groups (immunocompro/CIN2, 3 or CA hx) need more frequent screening and voids out #1 and 2 if present

Immune system in under 21 yof clears HPV on its own within 1-2 years, thus < 21 yo don’t need testing

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4
Q

Guidelines for Lung CA screening - 3

A

low dose annual CT if fits all 3 criteria:

  1. [55-80 yo]
  2. smoked for 30 pack years
  3. still smoking or quit within last 15 years
  • Pack Year = [# of packs/day x # of years smoking]*
  • ex: [4 packs/ day x 30 years smoking = 120 pack years]*
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5
Q

Guidelines for ovarian CA screening

A

NO routine screening in asx women!

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6
Q

Guidelines for Breast CA screening - 3

A
  1. 45-54 get mammograms annually
  2. > 55 cont mammograms every year OR switch to every 2 years
  3. 40-44 have the option

No mamm in pt < 40 unless known BRCA mutation

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7
Q

What are characteristics of a breast lump that suggest malignancy - 5

A
  1. single
  2. solid (consider US to differentiate from cystic lesion)
  3. immobile
  4. >2 cm
  5. irregular borders
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8
Q

Pregnancy and Breast stimulation are normal causes of nipple discharge

What are pathologic causes? - 5

A
  1. CA (Intraductal/Paget’s/DCIS/Mammary duct ectasia)
  2. Hormone imbalance
  3. Trauma
  4. Abscess
  5. Meds (Antidepressant/Antipsychotics/AntiHTN)
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9
Q

What are the 6 characteristics of a Good Screening Test?

A
  1. HIGH Specificity and Sensitivity
  2. Detects disease in asx phase
  3. Minimum risk
  4. Affordable
  5. Acceptable to pt
  6. Tx available for disease
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10
Q

Risk factors for Cervical SQC - 5

A
  1. Early Sexual Intercourse
  2. High # of lifetime sex partners
  3. utero DES exposure
  4. Smoking
  5. Immunocompro
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11
Q

For Adults, list immunization recommendations for Influenza

A

Purple = Pt has Risk Factors

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12
Q

For Adults, list immunization recommendations for TDaP

A

Purple = Pt has Risk Factors

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13
Q

For Adults, list immunization recommendations for Pneumococcal vaccine

A

Purple = Pt has Risk Factors

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14
Q

For Adults, list immunization recommendations for Zoster

A

Purple = Pt has Risk Factors

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15
Q

For Adults, list immunization recommendations for HPV

A

Purple = Pt has Risk Factors

APPROVED FOR FEMALES AGE 9-26 yo

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16
Q

Dx for Menopause

A

No menstruation for 1 year straight!

Average Menopause onset = 51

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17
Q

What are the 5 A’s to counseling someone?

A

SD drinks GIN

aSk

aDvise

aGree

assIst

arraNge

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18
Q

Which interviewing technique should be used for teens?

A

HEE-AD-SS (HEEADS)

Home

Employment/Education

Eating

Activities

Drugs

Sex

Suicide Depression

Safety/Violence

Teens can be interviewed WITHOUT PARENTS

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19
Q

What are the guidelines for ANNUAL GC/Chlamydia Screening (Women vs Men)

A

Women

  1. ALL sexually active women < 25
  2. Sexually active women > 25 IF HIGH RISK

Men: Insufficient evidence :-(

ANNUAL GC/Chlamydia screening done via NAAT - vaginal or cervical swab

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20
Q

What are 3 ideal times to incorporate Preconception Counseling? ; Name the 6 important features of this type of counseling

A

[Urgent care visits/Walk-ins], Teen well check, Sports physicals

  1. Folic Acid px (400-800 mcg/day in any sexually active woman)
  2. Genetics screening
  3. STI screening
  4. Environmental (Smoking/EtOH)
  5. Lifestyle (Exercise/Diet)
  6. Medical hx (DM & Epilepsy = ⬆︎Folic Acid)
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21
Q

What are the major s/s of Pregnancy - 7

A
  1. Amenorrhea (this may be normal in teens)
  2. NV
  3. Breast TTP
  4. Urinary frequency
  5. [Hegar’s Uteral / Goodell’s Cervical Softening]
  6. [Chadwick’s Bluish vaginal & cervical hue]
  7. Uteral Enlargement

Remember to screen sex active women < 25 for Chlamydia

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22
Q

What are the options for unplanned pregnancy? - 4

A
  1. Cont pregnancy and raise the child
  2. Cont pregnancy and create adoption plan
  3. Terminate pregnancy medically
  4. Terminate pregnancy surgically

Abortion is legal up to 22 weeks gestation

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23
Q

Abortion is legal up to ____ weeks gestation ; How do you calculate Estimated Gestational age (EGA) - 2 options?

A

22 WG ; [Current Date - date of LNMP] = EGA

OR

serial testing of SERUM βhCG

( LNMP = last normal mentrual period)

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24
Q

Which labs do you order initially for newly discovered Prenatal? - 6

A
  1. CBC (detect anemias & platelet dysfxn)
  2. Blood Type & Screen (RH-D = RH neg, and these women need anti-D Ig)
  3. Rubella IgG
  4. Hep B surface antigen
  5. RPR
  6. HIV
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25
Q

What’s the best way to diagnose ectopic pregnancy or miscarriage? - 2

A
  1. SERUM βhCG level trend
  2. Progesterone ( ectopic/miscarriage < 5 - 25 < healthy pregnancy) - not reliable tho
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26
Q

How much and When is [RhoGam Anti-RhD] administered to pregnant women? - 4

A
  1. 50mcg during 1st trimester
  2. 300mcg at 28 WG
  3. 300 mcg within 3 days after delivery
  4. with any episodes of vaginal bleeding (if indicated)
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27
Q

Lab w/u for [1st trimester vaginal bleeding]

Remember: this is 25-50% chance of miscarriage

A
  1. Serum βhCG trend WITH Pelvic US
  2. CBC
  3. Saline Wet Mount for trichomonas
  4. GC/Chlamydia PCR
  5. Progesterone ( ectopic/miscarriage < 5 - 25 < healthy pregnancy) - not reliable tho
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28
Q

βhCG levels have to be ____ for pregnancy to be detected via transvaginal US, and usually _____ when transabdominal US can finally detect it

What are βhCG levels during:

A: Ectopic Preg/Miscarriage

B: Molar Pregnancy

A

βhCG levels have to be 1500-2000 for conclusive pregnancy detection via transvaginal US and usually >5000 for transABDominal US to finally detect it

A: Ectopic Preg/Miscarriage = low βhCG

B: Molar Pregnancy = > 100,000 βhCG!!!

βhCG should double every 2 days in normal pregnancy for first 7 weeks

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29
Q

Why are serial βhCG more important than point value βhCG?

A

[βhCG should double every 2 days x first 7 weeks] in normal pregnancy so tracking the velocity trend is important

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30
Q

What are the options for Mngmt of Miscarriage - 4

A
  1. Expectant: Watchful Waiting for products of conception to expel naturally in 2-6 weeks
  2. Surgical: [Dilitation & Curettage (D&C) (cant be done during infection)] or [Manual Vacuum Aspiration]
  3. Medical: 800mcg Vaginal Misoprostol - takes up to 2 weeks for expel

ALL REQUIRE 1 WEEK FOLLOW UP

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31
Q

Why is the TDaP given to ____ week gestation pregnant patients?

A

27-36 week ; Protects BABY from Pertussis

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32
Q

1st trimester is ___ weeks gestation

What are the 3 biggest questions to ask during history taking for these patients? Why?

A

< 14 weeks

  1. NV? - asking because this is treatable
  2. Vaginal Bleeding?
  3. Cramping/contractions?
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33
Q

2nd trimester is ___ weeks gestation

What are the 4 biggest questions to ask during history taking for these patients? Why?

A

14 - 27 weeks

  1. Leakage of Fluid? -OOP
  2. Vaginal Bleeding? -OOP
  3. Cramping/contractions? -OOP
  4. Fetal Movement? -OOP

It is a medical emergency when Fetal Movement is not felt by 24 wks!

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34
Q

2nd trimester is ___ weeks gestation

Fetal Movement should be felt when? ; It is a medical emergency when Fetal Movement is not felt by ____

A

14 - 27 weeks

It is a medical emergency when Fetal Movement is not felt by 24 wks!

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35
Q

3rd trimester is ___ weeks gestation

What are the 5 biggest questions to ask during history?

A

28 - 42 weeks

  1. Leakage of Fluid?
  2. Vaginal Bleeding?
  3. Cramping/Contractions?
  4. Fetal mvmnt?
  5. S/S Preeclampsia (HTN/edema/Proteinuria/spotty vision)
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36
Q

What does APGAR stand for? ; How is it done? ; How is it used?

A

Appearance, Pulse, Grimace(reflex irritability), Activity(tone), Respiration

Performed at 1 and 5 min postpartum, All scaled from 0 to 2 and then added together

[≤ 3 = Critical] / [4-6 = fair] / [7-10 = normal]

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37
Q

Why shouldn’t you be alarmed if newborn loses weight within first 2 days after birth?

A

Newborns lose up to 10% of birth weight in first several days, but by 2 weeks should return to original birth weight

Expect wt gain of ounce/day with maternal milk

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38
Q

DDx for infant fussiness? - 6 ; Give description of each

A
  1. Colic (bouts of fussing > 3 wks)
  2. Infection (do sepsis w/u, especially if fever in < 2 mo old)
  3. GI Reflux (occurs before 1 yo and manifest as “dribbling” regurgitation)
  4. Failure To Thrive (fail to gain wt)
  5. Milk Allergy (RARE and usually confused w/early feeding problems)
  6. Pyloric Stenosis (Non-bilious vomiting)
  7. Intussuception (usually males neonate - 2 yo)
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39
Q

What are the leading Etx of Infant Colic - 5

One of the main causes of Fussiness in Infants

A

paroxysmal FUSSINESS that’s…

[> 3 hrs for > 3 days/week for > 3 wks!]

  1. Baby’s Digestive system adapting to actual food
  2. GI imbalance of gut microflora between lactobacillus and coliforms
  3. Atopic Allergy
  4. ⬆︎ Motilin –> ⬆︎Peristalsis (RF: Smoking & Prematurity)
  5. Neurodevelopment problem
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40
Q

What are Risk factors for Infant Colic - 2 ; Best tx?

One of the main causes of Fussiness in Infants

A

paroxysmal FUSSINESS that’s…

[> 3 hrs for > 3 days/week for > 3 wks!]

Smoking during pregnancy vs prematurity –> ⬆︎Motilin

Best tx = STICK WITH BREAST MILK!

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41
Q

What is a healthy crying pattern for infants 2 wks, 6 wks and 3 mo in age?

A
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42
Q

Postpartum depression affects women during what time periods? What 2 methods are used to screen for this?

A

within 1st year > first 3 mo ;

  1. [PHQ2 –(if both +)–> PHQ9]
  2. Edinburgh Postnatal Depression Scale

Screen prenatal, postnatal and well child

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43
Q

Give brief descriptions that differentiate Postpartum

Blues vs Depression vs Psychosis

A
  • Blues = onsets after birth, peaking at postpartum day 5 and subsiding PPD14, worst w/lactation
  • Depression = onset right after birth - 12 months later. Traditional s/s. Previous Depression hx is RF
  • Psychosis = RARE but onsets IMMEDIATELY after birth
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44
Q

What are important components for newborn/infant HPI - 12

A
  1. [G1P1001 + 1st,2nd,3rd child?
  2. Planned vs Unplanned?
  3. Complicated pregnancy?
  4. Weeks of Gestation before delivery?
  5. GBS status
  6. Hep B vaccination status
  7. Hearing screening results
  8. Feeding hx (breast vs formula? frequency?)
  9. Describe 1st and 2nd stages of Labor
  10. Wt of Baby
  11. APGAR Score
  12. When Mom was d/c
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45
Q

What is the Rooting Reflex? ; When is it observed?

A

When stroking a newborn’s cheek–>they turn head toward stimulus (used for breastfeeding) ; birth-4 mo

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46
Q

When is Group B Strep screening done for pregnant women?

A

35-37 WG via rectovaginal swab

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47
Q

What are the advantages of Group Prenatal care? - 4 ; What’s the most important for black women?

A
  1. Educate/support each other
  2. More efficient for provider to give more education (prenatal, labor preparedness, adequacy of prenatal care)
  3. ⬇︎ Preterm delivery (especially in Blacks)
  4. ⬇︎lethal low birth wts in infants that are Preterm –> ⬇︎Racial disparities between black and white infant deaths
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48
Q

What is the normal Fetal Heart Rate and variability on a NST?

A

110 - 160/min (w/variability of 6-25)

Normal Fetus’ should have a reactive NST

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49
Q

For Antepartum patients, their NST (Non Stress Test) should be reactive

What does this mean?-4 Does this happen in pts in labor?

A

neurologically intact fetus should have

  1. two HR acclerations within a
  2. 20 min period that are
  3. 15 bpm over baseline
  4. for at least 15 seconds

THIS IS NOT REQUIRED FOR PTS IN LABOR

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50
Q

What are the 2 clinical features for diagnosing ACTIVE labor?

A

Labor = LAPD

  1. Strong Contractions every 3-5 min
  2. Cervix Dilation > 6 cm, growing at 1-2 cm/hr and effaced

Fetal Heart Tracing is IRRELEVANT to diagnosing active labor

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51
Q

Pregnant pt is a Jehovah’s Witness and doesn’t want blood during L & D

What are steps to ⬇︎ Maternal Blood Loss? - 3

A
  1. Clamp umbilical cord EARLY (2 min after delivery)
  2. Give Pitocin after birth to help placenta detach faster & ⬆︎Uterine tone to stop bleeding
  3. Uterine massage after placenta detaches to stop blood vessels from pumping
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52
Q

What are the Stages of Labor - 4

A

Labor = LAPD

1st: Latent phase = Strong Contractions q3-5 min

2nd: ACTIVE phase = Cervix is now 6 cm Dilated, [growing @ 1-2 cm/hr] and effacing

3rd: Pushing Time! since Cervix is now 10 cm FULLY DILATED

4th: Deliver Baby and then Deliver Placenta

https://www.youtube.com/watch?annotation_id=annotation_563008&feature=iv&src_vid=Xath6kOf0NE&v=ZDP_ewMDxCo

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53
Q

Criteria for PreEclampsia is Gestational HTN + Proteinuria

How do you clinically diagnose Gestational HTN? - 6

A
  1. NO previous HTN
  2. > 20 WG (2nd trimester)
  3. Systolic > 140
  4. Diastolic > 90
  5. At least 2 readings taken > 6 hrs apart
  6. BP taken in seated or semi-reclined position
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54
Q

Criteria for PreEclampsia is Gestational HTN + Proteinuria

How do you clinically diagnose Proteinuria for pregnant women - 3

A
  1. ≥300 mg protein on 24 hr urine

OR

  1. ≥ 30 mg/dL on dipstick
    OR
  2. At least 1+ on dipstick
    * Must occur at least 2 times at least 6 hours apart*
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55
Q

Criteria for PreEclampsia is Gestational HTN + Proteinuria

Which demographic are at greater risk for this?

A

Af American Women

greater risk of having PreEclampsia, it being severe and suffering placental abruptio and Eclampsia

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56
Q

Criteria for PreEclampsia is Gestational HTN + Proteinuria

What is the pathologic evolution of PreEclampsia? How do you evaluate for this?-3

A

PreEclampsia –> [SEVERE PreEclampsia (HA + vision changes)] –> HELLP and at anytime, Eclampsia is possible

  1. LFTs
  2. Renal Function (spot Urine protein/Creatinine ratio)
  3. CBC (look for thrombocytopenia & hemoconcentration)
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57
Q

Criteria for PreEclampsia is Gestational HTN + Proteinuria

How do you clinically diagnose SEVERE PreEclampsia? - 6

A

PreEclampsia –> [SEVERE PreEclampsia (HA + vision changes)] –> HELLP and at anytime, Eclampsia is possible

ANY ONE OF THE FOLLOWING:

  1. Systolic > 160
  2. Diastolic > 110
  3. RUQ pain
  4. Doubling of LFTs
  5. Platelets < 100K
  6. Pulmonary Edema
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58
Q

What are Late Decelerations in Fetal Heart Rate?-2 ; What does this possibly indicate?

A

Decelerations in FHR that

  1. Begin AFTER Contraction starts
  2. [Nadir lowest point] is AFTER peak of contraction

= Hypoxemia during contractions 2/2 Utero-Placental insufficiency

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59
Q

What does Early Decelerations indicate? Is this normal or abnormal?

A

Head compression when fetus is lower in pelvis; NORMAL

Late Decelerations occur AFTER peak of contraction while early decelerations “mirror” contraction wave

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60
Q

How do you manage FHR Late Decelerations? - 4

A
  1. Continuous Fetal Heart Monitoring
  2. Turn pt on side to ⬆︎ IVC venous return
  3. O2 face mask
  4. IV fluid bolus
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61
Q

What are alternatives to Epidural for L&D pain mngmt? - 4

A
  1. Water Immersion
  2. Intradermal sterile water injections
  3. Self Hypnosis
  4. Acupuncture
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62
Q

What are the 4 major causes of Postpartum Hemorrhage? - 4

A

The 4 T’s!

Tone (Uterine aTony)

Trauma (Perineal vs Cervix lacerations vs Uterine inversion)

Tissue (retinaed/invasive placental tissue)

Thrombin (rare bleeding DO)

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63
Q

How long should women breastfeed their newborns? - 2

A

AT LEAST 6 months, followed by [BF + complementary foods up until 12 mo.] (Remember: breast milk may take 3 days postpartum to release)

avoid pacifiers/educate women & partners/feed only on demand/immediate skin2skin contact postdelivery = good breastfeeding techniques

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64
Q

What are the 4 biggest things to assess during Postpartum checkup?

A
  1. Help at home?
  2. Rx (Prenatal viamins, other meds)
  3. Diet
  4. Mood
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65
Q

How should you test for TORCH infections in newborns?

A

T((Other))RCH = HepB/HIV/HPV/Syphillis

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66
Q

What is a normal Blood Glucose for newborn infants

A

> 45

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67
Q

Which meds are routinely given to all newborns? - 3

A

Give HEK to protect!

  1. Hep B Vaccine ( give to infants > 2000 grams)
  2. Erythromycin Ophthalmic IF INDICATED (GC-Chlamydia px)
  3. K Vitamin (prevents Hemorrhagic Disease of Newborn)
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68
Q

What are the salient physical findings of Congenital CMV? - 6

A
  1. Progressive BL Hearing Loss –> complete loss in 1 year
  2. Microcephaly–> developmental delay
  3. Intracranial CT calcifications –> developmental delay & seizures
  4. Hepatosplenomegaly w/Anemia (resolves within weeks)
  5. Rash w/Jaundice (resolves within weeks)
  6. Chorioretinitis

Tx = Parenteral Ganciclovir vs PO ValGanciclovir x 6 mo

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69
Q

What are the major benefits of Breastfeeding - 5

A
  1. ⬆︎GI maturity and motility–> ⬇︎Diarrhea
  2. ⬆︎newborn cognitive development
  3. ⬇︎Acute infections/illness(DM/obesity/CA/CAD/IBD)
  4. ⬇︎Maternal Breast & Ovarian CA
  5. ⬇︎Maternal Osteoporosis
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70
Q

When does s/s of inborn metabolic errors present?

A

Within 1-3 days after birth

Anorexia/Vomiting/Lethargy/Seizures/MetAcidosis

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71
Q

What is the purpose of Anticipatory Guidance in Infant Well Child exams?

A

helps parents anticipate child’s developmental, safety/immunization & nutritional needs

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72
Q

What are the main components of a Well Child Visit - 8

A
  1. Interval Hx (any problems since last visit/birth)
  2. Development (Use PEDS @ 2/6/9 mo.)
  3. Growth Curves
  4. Diet hx (breast or bottle?/foods?)
  5. Social hx (who lives with/environmental [lead tox for 5 y/o]/behavior)
  6. Physical Exam (dont forget Red Reflex)
  7. Anticipatory Guidance
  8. Immunizations

PEDS = Parents Evaluation of Developmental Status

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73
Q

What are the Caloric Requirements of 1-2 Month old infants who are Full Term? PreTerm? Very Low Birth Wt?

A
  • Term infant = 100 cal/kg/day
  • PreTerm infant = 115-135 cal/kg/day
  • VLBW (Very Low Birth Wt) = Up to 150 cal/kg/day

~25 grams/day wt gain is expected in Full Term infant

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74
Q

How much wt per day do you expect a Term infant to gain with the recommended _____ cal/kg/day?

A

~100 cal/kg/day ; ~25 grams/day wt gain

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75
Q

Which growth parameters are measured during well Child exams? - 3

A

Weight / Height (length) / Head Circumference

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76
Q

What is the Difference between Developmental Surveillance and Screening?

A

Dvpmental Surveillance (image) = Checks milestones by comparing child to expected behaviors by age. NOT AS SPECIFIC/SENSITIVE

vs

Dvpmental Screening (PEDS) = Evidence based, for kids 0-8 yo, elicits parents to answer 10 questions on their perspectives of their child

PEDS = Parents’ Evaluation of Dvpmental Status

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77
Q

T or F: Breast Milk has more than sufficient Vitamin D for infants

A

FALSE

(Supplement Breastmilk with liquid vitamin drops in newborns vs chewable multivitamins in toddlers)

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78
Q

By what ages should an infant double and triple their birth weight? What about Doubling length?

A

Double by 5 months, triple by 12 months ; Double length by 4 yo

Remember these are approximations

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79
Q

Why is their caution to using APAP around infant vaccinations?

A

Using APAP ⬇︎ Antibody response to the vaccine - ONLY USE IF ABSOLUTELY NECESSARY

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80
Q

Caloric requirements for 9 month infant?

A

100 cal/kg/day

Meats can be started at this age!

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81
Q

Which foods should never be given to infants less than 1 year old because of choking? - 4

A
  1. Popcorn
  2. Grapes
  3. Hot Dogs
  4. Hard Candy
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82
Q

DDx for RUQ abd mass in infant - 6

A
  1. Neuroblastoma (could be chest/neck/abd and age > 1 yo)
  2. Hepatic CA (will be asx)
  3. Hepatic Abscess
  4. Hydronephrosis w/UTI 2/2 obstruction @ uretopelvic junction
  5. Teratoma rare
  6. Wilms’ nephroblastoma (usually ~3 yo)
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83
Q

What is the most common cause of Left abd mass in infants?

A

Constipation (LLQ sigmoid colon)

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84
Q

DDx for RUQ abd mass in infants include Neuroblastoma

What would differentiate this from other dx?-3

A
  1. Urine elevated HVA/VMA
  2. CT: [heterogenous retroperitoneal nonrenal mass w/cystic areas] +/- calcifications
  3. Histo: small round blue cells forming rosettes

Most Neuroblastoma are 2/2 somatic NonFamilial mutations

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85
Q

DDx for RUQ abd mass in infants include Wilms’ Nephroblastoma

What would differentiate this from other dx?-3

A
  1. Renal US
  2. CT: Pseudocapsule from demarcation between tumor and renal parenchyma + Lung metz
  3. CXR: Lung metz

Usually around ~3 yo

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86
Q

DDx for RUQ abd mass in infants include Hepatic CA

What would differentiate this from other dx?-3

A
  1. ⬆︎AFP & bilirubin
  2. Abd XRay: Hepatic enlargement
  3. CT: Lung Metz
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87
Q

DDx for RUQ abd mass in infants include Teratoma

What would differentiate this from other dx?-2

A
  1. CT: well defined masses with solid and cystic components
  2. Xray: possible calcification of teeth or bony fragments

THIS IS RARE

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88
Q

What type of effects does Smoking have on neonates when taken during pregnancy?-2 What about Cocaine?

A
  • Tobacco–> low birth wt & colic
  • Cocaine –> low birth wt 2/2 vasoconstrictive placental insufficiency
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89
Q

Name Intrauterine Maternal factors that can –> IUGR (IntraUterine Growth Restriction)? - 5

A

Includes Alcohol use

Always consider Gestational Dating may be inaccurate

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90
Q

Name Intrauterine Placental abnormalities that can –> IUGR (IntraUterine Growth Restriction)? - 3

A

Always consider Gestational Dating may be inaccurate

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91
Q

Name Intrauterine Fetal abnormalities that can –> IUGR (IntraUterine Growth Restriction)? - 4

A

Always consider Gestational Dating may be inaccurate

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95
Q

What office tool (other than LMP) is used to estiamate gestational age?

A

Fundal height (+/- 3 cm margin of error)

(measured from superior aspect of enlarged uterus to pubic symphisis)

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96
Q

Name Factors that ⬆︎ Risk for Vertical transmission of HIV -6

A
  1. Unprotected Sex during pregnancy (chorioamnionitis and other STI ⬆︎HIV transmission)
  2. Maternal HIV load > 1000 copies
  3. Fetal Membrane rupture > 4 hrs prior to delivery in Mother not on HAART
  4. Vaginal Delivery
  5. Breastfeeding
  6. Premature Delivery < 37 WG
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97
Q

You’ve just discovered a positive rapid HIV test on pregnant pt in labor

Name Factors that will ⬇︎ Risk for Vertical transmission of HIV -3

A
  1. Giving HAART if viral load > 1000 copies
  2. C-section prior to onset of labor and rupture of fetal membranes
  3. NO Breastfeeding
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98
Q

What is the Ballard Tool?

A

Uses Physical and Neuromuscular signs to estimate gestational age

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99
Q

What constitutes a FULL term infant?

A

≥ 37 wks gestation

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100
Q

What clinical problems are associated with SGA (Small for Gestational Age)?-3 …and why?

A
  1. hypOglycemia BG < 45 (⬇︎ glycogen stores and gluconeogenesis)
  2. hypOthermia (⬆︎Surface area and ⬇︎SubQ insulation)
  3. Polycythemia presenting w/Respiratory distress (Chronic hypoxia)
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101
Q

Toddlers should stay in booster seats until they reach height of _____

A

4’9

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102
Q

Identify disease? AKA ____ ; What’s a possible etx? ; DDx?-2

A

Eczema Atopic Dermatitis (The itch that rashes) ; Allergies +/-Asthma ; Psoriasis vs Seborrhea

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103
Q

Identify disease? AKA ____ ; Tx - 4?

A

Eczema Atopic Dermatitis (The itch that rashes)

  1. Lubricate skin
  2. Anti-Inflammatories in short burst (Steroids > Calcineurin inhibitors)
  3. Antihistamines
  4. Tx associated skin infections
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104
Q

What’s the biggest risk factor for Early childhood caries? How can we prevent this?

A

Constant Teeth Bathing with milk/juice via bottle ; d/c bottle use by 12-15 month old

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105
Q

What are key things to remember regarding Iron in Toddler diets? Juice?

A
  1. Iron is crucial to CNS development (sources:iron fortified cereals/eggs/tuna) - REMEMBER PICKY EATING TODDLERS ARE AT⬆︎RISK FOR ANEMIA
  2. Juice LIMITED to 4-6 oz/day
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106
Q

Important Physical exam tips for Toddler well child checks - 2

A
  1. Listen w/stethoscope first in case pt cries later
  2. If exam is shortened, focus on Neurodvpment, Monitoring previous findings, New findings, Physical problems common in preschoolers

Neurodvpment = Language/FineMotor/GrossMotor/Cognition

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107
Q

What are the SocioEmotional Developmental Milestones for a

[3 year old-2] ; [4 year old-3] ; [5 year old-3]

A
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108
Q

What are the Language Developmental Milestones for a

[3 year old-2] ; [4 year old-3] ; [5 year old-5]

A
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109
Q

What are the Cognitive Developmental Milestones for a

[3 year old] ; [4 year old-5] ; [5 year old-3]

A
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110
Q

What are the Motor Developmental Milestones for a

[3 year old-4] ; [4 year old-4] ; [5 year old-5]

A
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111
Q

PICKY EATING TODDLERS ARE AT⬆︎RISK FOR ANEMIA

What test assess for this? When should it be ordered?-3

A

Hgb/Hct Fingerstick ;

  1. 1 y/o old
  2. Preschool/Kindergarten entry
  3. PRN at any age if Risk Factors are present

RF = special health/nonmeat diets/poverty

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112
Q

Which demographic of kids are at greatest risk for lead poisoning and why? What is a risk factor for lead Absorption?

A

6 mo-3 yo ; mouthing behavior and ⬆︎mobility ; Iron deficiency–> ⬆︎Lead Absorption!

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113
Q

What are the most common causes of anemia in kids? - 5

A
  1. ⬇︎ Iron (PICKY EATER/food allergies/gluten enteropathy/chronic GI blood loss)
  2. Sickle Cell
  3. alpha thalassemia
  4. G6PD deficiency
  5. Vitamin Deficiencies (folate B9 and Pyridoxine B6)
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114
Q

First line tx for Iron deficiency anemia in kids?

A

PO elemental iron supplement (2-4 mg/kg/day)

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115
Q

Name common food sources of Iron - 7

A
  1. Eggs
  2. Salmon
  3. Beef
  4. Tuna
  5. Whole Grain
  6. Dried Fruits
  7. Iron fortified cereals
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116
Q

What are the 3 core sx of ADHD?

A
  1. Attention deficit
  2. Hyperactive
  3. Impulsivity
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117
Q

What is the diagnostic criteria for ADHD? - 5

A
  1. Sx present for at least 6 mo. AND inappropriate for dvpmental age
  2. Sx start between 6-12 yo and not after 12 yo
  3. Evident in 2 or more settings (school/work/home)
  4. Sx interfere with ability to function
  5. Sx are not attritable to another DO
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118
Q

Name common conditions that contribute to a child’s school failure - 5

A
  1. Sensory impairment (hearing/vision problems)
  2. Sleep issues
  3. Mood DO
  4. Learning Disability (often accompanies ADHD)
  5. Conduct DO (defiance/aggression/truancy)
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119
Q

What are the major side effects of ADHD stimulant meds? - 4

A
  1. ⬇︎ APPETITE
  2. Insomnia
  3. ⬇︎Growth velocity in kids
  4. Tic DO in kids - rare (resolves with d/c)
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120
Q

What are the major Risk Factors for childhood obesity? - 5

A
  1. High Birth Wt
  2. Maternal DM during pregnancy
  3. Having Obese Parent
  4. Lower Socioeconomic status
  5. Genetics (PraderWilli/Cohen Syndrome)
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121
Q

What are the health complications of childhood obesity? - 6

A
  1. HTN
  2. HLD
  3. DMT2
  4. Sleep Apnea
  5. Steatohepatitis
  6. Slipped Capital Femoral Epiphysis (SCFE)
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122
Q

What are the screening guidelines for Type 2 DM in kids/teens? - 3

A
  1. Check Fasting BG at 10 yo or puberty (whichever comes first) every 3 years
  2. Check every 2 years if [BMI>85 %tile + DM RF]
  3. Check every 2 years if [>95 %tile alone]

%tile = Percentile

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123
Q

[Children BP percentile] is based on systolic BP in relation to weight and height percentile

What are the 4 BP percentile classifications for HTN in children

A

Only use meds for Stage 2/secondary HTN/end-organ damage and give 6 mo f/u to everyone

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124
Q

What are some causes of Secondary HTN in kids? - 6

A
  1. DM
  2. UTIs
  3. Catecholamine Excess (Neuroblastoma/Pheochromocytoma)
  4. Umbilical Artery vs Umbilical Vein placement –> Renal Dz
  5. Fam hx of Renal disease
  6. Coarctation of Aorta
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125
Q

In kids, how do you distinguish between Nutritional Weight gain and Underlying Endocrine disorder?

A

Endocrine DO –> Short Stature from ⬇︎ Growth

Only 1% of Overweight peds have Endocrine issues

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126
Q

What are the complications of GASP (Group A Strep Pharyngitis) - 6

A
  1. Rheumatic Fever
  2. PSGN
  3. PeriTonsillar abscess
  4. Mastoiditis
  5. Meningitis
  6. Bacteremia
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127
Q

Contraindications to Vaccine administration - 3

A
  1. allergy/sensitivity to specific vaccine
  2. Immunodeficiency of pt or household relative (sometimes)
  3. Moderate-Severe illness (wait until recovery)
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128
Q

What are the Vaccinations required prior to school entrance - 5

A
  1. MMR x 2
  2. Varicella x 2
  3. Hep B x 3
  4. TDaP x 5
  5. Polio x 5
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129
Q

For a 5 y/o, parents are usually concerned about their child’s _____ while the school is usually concerned about ____ & _____

A

knowledge base ; Language skills & Social Readiness

Be sure Health maintenance visits for 5 yo are guided by context child is entering elementary school for first time

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130
Q

BMI categorization is different for children than Adults

What is the BMI categories for a child/adolescent?

A

Age/Sex Percentile (used in kids) is found using BMI wheel

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131
Q

During 5 y/o well child checks, selective screening for Lead toxicity may be necessary

What questions are used to determine if selective screening for lead tox is needed? - 3

A
  1. Does your child live or regularly visits buildings built before 1950?
  2. Does your child live or regularly visits buildings built before 1978 that is being/has recently been renovated?
  3. Does your child have a sibling/playmate who has/did have lead poisoning?
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132
Q

What is Scarlet Fever? - 2

A

GASP Pharyngitis + [Diffuse/Erythematous/Papular Sandpaper Rash in Neck, Axilla, Groin]

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133
Q

What are classic s/s of GASP (Group A Strep Pharyngitis) - 5

A

Old CAFE

  1. Old = Ages 5-15 yo (Subtract 1 point if > 45 yo)
  2. Cervical Anterior LAD
  3. Absence of Cough/Rhinitis-Rhinorrhea/Conjunctivits
  4. Fever > 100.9 F
  5. Exudates Tonsillar (36% sensitivity)-image

Each gets 1 point for Centor criteria

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134
Q

What is the DDx for sore throat? - 8

A
  1. Viral Pharyngitis (Rhino/Adeno/Coronavirus)
  2. GASP
  3. Mononucleosis
  4. Epiglottitis
  5. Pertussis
  6. Retropharyngeal Abscess
  7. Viral Croup
  8. Allergic Pharyngitis/Rhinitis
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135
Q

What is the classic triad for infectious mononucleosis? Dx?

A
  1. Pharyngitis
  2. LAD - Posterior Cervical
  3. Fever

Dx = Monospot test (but this can only be done > 7 days after sx onset)

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136
Q

What is the problem with misdiagnosing Mononucleosis pts with GASP?

A

Pts with Mono who receive [Amoxicillin vs Ampicillin] for GASP –> 90% will develop iatrogenic prolonged pruritic maculopapular rash

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137
Q

When can you treat a child for GASP?

A

AFTER microbiological confirmation with RADT (RADT first and then –> reflex throat culture if RADT is negative just to double check)

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138
Q

The Centor Criteria is used to determine likelihood of GASP

Recite the criteria ; What is the McIsaac interpretation?

A

OldCAFE = Old:Age /Cervical LAD anteriorly / [Absence of Cough/congestion/conjunctivits] /Fever>100./9 /Exudates Tonsillar

Remember: 1 point is subtracted if > 45 yo

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139
Q

Pt has GASP and is indicated for tx

What are the abx choices? - 6

A
  1. PCN V***
  2. PCN G IM
  3. Amoxicillin
  4. Cephalexin (1st gen Cephalosporin)
  5. CefaDroxil (1st gen Cephalosporin)
  6. Erythromycin (for PCN allergy pts)
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140
Q

List a Vascular cause of Lower back pain

A

VITAMIN C

AAA

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141
Q

List the Infectious causes of Lower back pain - 9

A

VITAMIN C

  1. Pyelonephritis
  2. Osteomyelitis
  3. Herpes Zoster
  4. Epidural Staph A. Abscess
  5. Prostatitis
  6. PID
  7. Kidney Stones
  8. Endometriosis
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142
Q

List the Trauma causes of Lower back pain - 4

A

VITAMIN C

  1. Compression Fracture
  2. Disc Herniation
  3. Lumbar Strain
  4. Spinal Stenosis
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143
Q

List the Metabolic causes of Lower back pain - 5

A

VITAMIN C

  1. Osteoporosis which can–>Vertebral fx
  2. Osteomalacia
  3. HyperParathyroidism
  4. Paget’s Osteitis Deformans
  5. Diabetic Neuropathy
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144
Q

List the Inflammatory causes of Lower back pain - 6

A

VITAMIN C

  1. Ankylosing Spondylitis (morning stiffness over SI joint & lumbar spine)
  2. SacroiLitis
  3. Discitis
  4. Rheumatoid Arthritis
  5. Osteoarthritis
  6. Facet Arthropathy
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145
Q

List the Neoplastic causes of Lower back pain - 4

A

VITAMIN C

  1. Multiple Myeloma
  2. Metastasis
  3. lymphoma/leukemia
  4. osteosarcoma
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146
Q

List the Congenital causes of Lower back pain - 3

A

VITAMIN C

  1. Scoliosis
  2. Kyphosis
  3. Spondylolysis
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147
Q

What are the 4 most common causes of back pain?

A

Lumbar Strain (evidenced by paraspinal m. spasms) > OsteoArthritis > Herniated Disc > Spinal Stenosis

Most Back Pain is Mechanical

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148
Q

What are the classic positional changes for disc herniation? - 4 ; What are other classic s/s?-4

A

[Back Pain with sitting & bending]

[Back Relief with lying & standing]

  1. ⬆︎Pain w/coughing/sneezing
  2. Radiation down leg
  3. Paresthesia
  4. Muscle weakness (foot drop)
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149
Q

Which patients with lower back pain should receive imaging and/or referral? - 2

A
  1. Refractory to 1 month conservative tx
  2. Red Flags
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150
Q

How should the physical exam for lower back pain be performed?

A

Evaluate Standing, Sitting and Supine

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151
Q

____ (Thoracic/Lumbar/Sacral) mobility is the best measure of spine mobility

What does it suggest if ___ Flexion is restricted? - 3

A

LUMBAR flexion restriction =

  1. Disc Hernation
  2. Osteoarthritits
  3. Muscle Spasm
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152
Q

____ (Thoracic/Lumbar/Sacral) mobility is the best measure of spine mobility

What does it suggest if ___ Extension is restricted? - 2

A

LUMBAR extension restriction =

  1. Degenerative arthritis
  2. Spinal Stenosis
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153
Q

____ (Thoracic/Lumbar/Sacral) mobility is the best measure of spine mobility

What does it suggest if ___ Lateral motion is restricted? - 3

A

LUMBAR lateral motion restriction =

  1. (if on same side as bending) = Nerve compression or Osteoarthritis
  2. (if on CTL side as bending) = Muscle spasm
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154
Q

How can you use assessment of Gait to determine disc herniation location? - 2

A

Difficulty with…

Heel Walk = L5 Disc herniation

Toe Walk = S1 Disc herniation

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155
Q

⬇︎Patellar Reflex implies nerve impingement at the ____ level

A

L3-4

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156
Q

⬇︎Achilles Reflex implies nerve impingement at the ____ level

A

L5-S1

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157
Q

Pts, while supine, who can not straight leg raise > 80° either have ___ or ____ ; How do you differentiate between these two?

A

Sciatica or Tight Hamstrings ; Straight Raise leg to point of pain, lower slightly and then dorsiflex foot. Pain with this = Sciatica

NOTE: PAIN EARLIER THAN 30° = MALINGERING

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158
Q

Ipsilateral and Contralateral Straight leg test, based on sensitivities/specificities can be trusted when?

A
  • Ipsilateral straight leg test can be trusted if it’s negative
  • CTL straight leg test (asx leg is raised) can be trusted if it’s POSITIVE

These suggest large central disc hernation

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159
Q

When is the FABER test result positive?-3 ; What does this indicate?

FABER: Flexion, ABduction, External Rotation

A
  • Pain at Hip
  • Pain at Sacral Joint
  • Tested Leg can not lower to point of being parallel to opposite leg

This indicates [Hip joint SacroiLiac pain from SacroiLitis]

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160
Q

[Cauda Equina Syndrome] etx ; Clinical Presentation - 5

A

(Compression of S2 - S4 n. roots) –>

  1. Saddle Anesthesia (image)
  2. ⬇︎ Anocutaneous Reflex (perianal pinpoint does NOT cause anal sphincter contraction)
  3. Incontinence (urinary AND fecal)
  4. uL (uniLateral) Radiculopathy
  5. hypOreflexia (Conus Medullaris syndrome has HYPEReflexia)

Decompression required within 72 hours!!!

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161
Q

Demographic for Ankylosing Spondylitis ; Classic Presentation

A

15-40 yo ; morning stiffness over the sacroiLiac joint & lumbar spine

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162
Q

What is Spondylolisthesis?

A

ANT displacement of vertebra at any age that –> aching back & posterior thigh with activity & bending

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163
Q

What are the indications for getting Lumbar Spine films in Lower Back pain pts - 10

A
  1. > 50 yo
  2. Trauma recently
  3. Wrosening Neuro ∆
  4. Ankylosing Spondylitis hx (SI joint morning stiffness)
  5. Substance abuse (Drug vs EtOH)
  6. Malignancy hx (≥10 lb wt loss, nocturnal pain)
  7. > 100F Fever
  8. Prolonged Steroids (vertebral fx?)
  9. Osteoporosis (vertebral fx?)
  10. Refractory to 1 month conservative tx
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164
Q

What are the indications for getting MRI in Lower Back pain pts - 6

A
  1. Neuro deficits
  2. Radiculpathy
  3. Progressive motor weakness
  4. Cauda Equina compression
  5. Systemic DO (metastatic or infectious)
  6. Failed 4-6 weeks of conservative tx
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165
Q

Conservative Tx for Lower Back Pain - 9

A
  1. EXERCISE!!!!!
  2. NSAIDs
  3. ASA
  4. APAP
  5. Local therapy (heat/cold packets)
  6. Diazepam
  7. Cyclobenzaprine
  8. TENS (Transcutaneous Electrical Nerve Stimulation)-image
  9. Steroids if Sciatica is suspected
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166
Q

Abortion is legal up to ____ weeks gestation ; How do you calculate Estimated Due Date (EDD) - 3?

A

22 weeks ; [date of LNMP] + 1 year - 3 months + 1 week = EDD

  • THIS IS KNOWN AS NAEGELE’S RULE and is [+/- 2 wk accuracy]*
  • Use US to confirm BUT ONLY IN WOMEN < 20 WKS GESTATION*
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167
Q

Naegle’s Rule is the most accurate for determining gestation

When can you use Ultrasound to determine gestation? - 4

A
  1. Only in Women < 20 wks gestation OR…
  2. For discrepancy > 1 wk between US and another method during 1st trimester
  3. For discrepancy > 2 wk between US and another method during 2nd trimester
  4. For discrepancy > 3 wk between US and another method during 3rd trimester

(the earlier the better!)

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168
Q

When is Fundal height used for gestational dating? What are the rules? - 2

A

[28-42 wks: 3rd trimester] ;

  1. At 20 wks gestation, Fundus should be at Umbilicus. It goes ⬆︎ by 1 cm every week after
  2. After 20 wks, fundal ht in cm correlates with wks gestation
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169
Q

What is the relationship between Pregnant Women and Hot tubs?

A

They need to avoid them! Maternal heat exposure –> Miscarriage & Neural tube defects

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170
Q

Which foods should Pregnant women avoid? - 5

A
  1. Raw Eggs (Salmonella)
  2. Unpasteurized Milk (toxo and listeria)
  3. Soft Cheeses (listeria)
  4. Raw Fish/Shellfish
  5. Unwashed fruits/vegetables (toxo and listeria)
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171
Q

What supplements should normal Pregnant Women take? - 2 ;

How does this change for preggos with DM, epilepsy and previous children with neuro tube defects?

A
  1. [Folic Acid 0.4 - 0.8 mg/day]
  2. [Iron 30 mg/day]

Dietary or Epilepsy preggos =[Folic Acid 1 mg/day]

Previous child with NTD preggos =[Folic Acid 4 mg/day]

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172
Q

During Fetal development, what happens at…

4 weeks?

7 weeks?

27 weeks?

A

4 weeks = Neuro tube closes

7 weeks = Heart starts to beat and fetus moves!

27 weeks = Fetus opens eyes & detects light

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173
Q

What are the minimum things to check during Prenatal f/u? - 3

A
  1. Maternal wt
  2. Maternal BP
  3. Fetal HR (heard at 10-12 wks gestation)
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174
Q

Which Prenatal Vaccinations should be given? - 3

A
  1. FLU [Dead IM]
  2. [RhoGam Anti-RhD Ig] @ [<14 WG:1st trimester] + [28 WG] + [within 72 hrs after delivery] + [with any episodes of vaginal bleeding] (if indicated)
  3. Rubella after delivery

WG = Weeks Gestation

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175
Q

What is Hyperemesis Gravidarum?

A

Persistent NV during pregnancy

Normal NV Starts 4WG until 20WG

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176
Q

What are Dietary measures women with Hyperemesis Gravidarum can take? - 4

A
  1. Frequent but small meals
  2. Bland solid foods high in carbs, low in fat
  3. Salty morning foods
  4. Sour liquids > Water
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177
Q

When can a fetus have its sex determined via US?

A

[18WG: 2nd trimester]

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178
Q

Name the major risk factors for Placental previa? - 4

A
  1. > 35 yo
  2. Smoking
  3. Prior Pregnancy (especially if with twins!)
  4. Previous Uterine surgery like C-section
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179
Q

What are the 4 types of HTN in pregnancy?

A
  1. Chronic HTN (present before 20 WG and persist beyond 12 weeks postpartum)
  2. Gestational HTN (≥140 systolic or 90 diastolic BP without proteinuria in women after 20 WG)
  3. PreEclampsia
  4. Eclampsia
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180
Q

What complications do pregnant women with [SEVERE Gestational HTN] and/or PreEclampsia have? - 3

A
  1. PreTerm Delivery ( < 37 WG)
  2. SGA infants (Small for Gestational Age)
  3. Placental Abruptio

Women with mild Gestational HTN do NOT have these complications

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181
Q

What complications do pregnant women with Gestational DM have? - 6

A
  1. PreEclmapsia
  2. Fetal Macrosomia
  3. Birth Trauma
  4. C-sections requirement
  5. Neonatal mortality
  6. neonatal hypOglycemia, hyperbilirubinemia
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182
Q

Gestational DM is determined via _______ test. According to the the Carpenter Coustan criteria, how is this interpreted?

A

[3-hour glucose tolerance test] (measure pt BP after fasting and then 1,2,3 hrs after 100 gram glucose oral load);

at least 2 of:

  1. Fasting BG ≥ 95
  2. 1 hour BG ≥ 180
  3. 2 hour BG ≥ 155
  4. 3 hour BG ≥ 140
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183
Q

What are the common pregnancy rashes?-3 ; How do you treat them? -2

A

Topical Emollients and Steroids

Do not confuse with Cholestasis which –> whole body itching

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184
Q

When is Group B Strep screening done for pregnant women?

A

35-37 WG via rectovaginal swab

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185
Q

Postpartum contraception can be started when? What are the postpartum contraception options? - 5

A

Start after 6 weeks postpartum for expulsion & breastfeeding purposes..

  1. Progestin pills
  2. [DepoProvera Injectable Progestin]
  3. Progestin implant
  4. [Mirena Levonorgestrel IUD]
  5. Copper IUD (can be inserted immediately postpartum if needed)
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186
Q

At Postpartum visits, what 3 things should be talked about? What is the postpartum f/u for vaginal delivery? C-section?

A

Mood/Contraception/Breastfeeding

Vaginal delivery f/u = 6 wks postpartum

C-section = 2 wks postpartum

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187
Q

What is the DDx for Vaginal Bleeding and/or discharge in pregnant women? - 5

A
  1. Placenta Previa (Spontaneous bleeding after 20 WG)
  2. Placental Abruptio
  3. UTI (GC/Chlamydia/BV/Candidiasis)
  4. Cervical Trauma
  5. PROM (premature rupture of membranes) = fetal membrane rupture prior to labor. Preterm PROM –> premature birth
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188
Q

Home pregnancy test can detect Urine βHCG at levels of ____ while serum blood βHCG can be detected at levels of ____.

What is the pattern of βHCG? - 4

A

≥25 ; 5 mIU/mL

1st: βhCG doubles every 2 days for first 7 weeks
2nd: peaks at 12 weeks
3rd: rapidly declines until 22 weeks
4th: gradually rises again until delivery

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189
Q

You have a pt who’s newly became pregnant

What are the initial studies to be ordered? - 9

A
  1. Blood Type/Rh status
  2. Hgb/Hct (detects anemia)
  3. GC Chlamydia
  4. HIV
  5. Hep B and C
  6. Varicella hx
  7. Herpes hx (active labia lesions during pregnancy is ctd)
  8. PAP smear
  9. UA (detects proteinuria)
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190
Q

What is the Prenatal Maternal Quad Serum screening? When is this obtained?

A

Measures 4 chemical markers for fetal anomalies and down syndrome- 81% accuracy (QUAD = BUAD):

  1. βHCG⬆︎
  2. Unconjugated EsTriol⬇︎
  3. AFP⬇︎
  4. Dimeric inhibin A⬆︎ - only in QUAD screen

Performed 16 -18WG

Be sure to f/u abnml results with cell free fetal DNA test and US

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191
Q

When is routine ultrasound for fetal anomalies performed?

A

[18-21 WG: 2nd trimester]

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192
Q

What are 3 physical exam findings specific to Testicular Torsion? - 3

A
  1. Blue dot sign to upper pole w/TTP = Appendage torsion-image
  2. Loss of Cremasteric Reflex
  3. Prehn sign (Lifting testicles relieves pain which means NOT torsion but possibly epididymitis)
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193
Q

What are major causes of Testicular Torsion? - 6

A
  1. Congenital mesentery between epididymis and testis
  2. Congenital contraction of muscles which shorten spermatic cord –> initiates testicular torsion
  3. Congenital Bell Clapper deformity
  4. Undescended testes
  5. Recent genital trauma/exercise
  6. Idiopathic

Untreated Scrotal Pain > 12 hours –> less than 50% testicular viability

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194
Q

Epidemiology of Testicular CA ; Which demographic typically has it?

A

[Most common CA in males 15-35 yo] but only 1% of CA in ALL men ; Af Americans

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195
Q

What are the variable presentations for Testicular CA?-3 ; What are the guidelines for screening?

A
  1. Heavy sensation in lower abd, perianal, scrotum
  2. Testicular Nodule
  3. Testicular Painless swelling

NO SCEENING! No evidence to support routine screening in asx teens/young adults

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196
Q

What are the 3 types of Testicular Tumors

A
  1. Germ Cell (Seminomatous vs NonSeminomatous)
  2. Non-Germ Cell (Leydig vs Sertoli)
  3. Extragonadal (lymphoma vs leukemia vs melanoma)
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197
Q

What are 5 ways to build rapport with Teens during interview?

A
  1. Introduce yourself to teen first, look them in their eye, shake hand and sit down during interview
  2. Direct questions primarily to the teen (not parents)
  3. Use conversation icebreakers so they’re comfortable
  4. Allow teen to remain dressed and sit in chair during interview
  5. Ensure confidentiality
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198
Q

Describe the 3 major components to a proficient testicular exam

A
  1. Inspect for erythema, swelling and position (L sits Lower than R normally)
  2. Palpate for edema, size and TTP (start on unafected side)
  3. Transilluminate if necessary
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199
Q

DDx for scrotal pain in Teen male -9

A
  1. Epididymitis (Fever, Pyuria, CORD TTP)
  2. Trauma
  3. Inguinal Hernia
  4. Hydrocele (usually causes painless scrotal swelling)
  5. Henoch Schonlein Purpura
  6. Testicular Tumor
  7. varicocele
  8. Testicular Torsion
  9. Testicular Appendage Torsion
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200
Q

Dx for testicular torsion - 2

A
  1. [Radionuclide Scintigraphy (100% Sensitive)] = Confirms Testicular Torsion by revealing ⬇︎ intratesticular blood flow via radiotracer
  2. [Color Doppler US (88% sensitive BUT FASTER)] = Confirms Testicular Torsion by revealing ⬇︎ intratesticular blood flow via echogenicity + enlarged testicle
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201
Q

Tx of Testicular Torsion - 2

A
  1. Manual DeTorsion…STILL followed by [option 2 vs 3]
  2. Orchiopexy of affected testicle WITHIN 6 HOURS –> Px Orchiopexy of UnAffected testicle

Orchiopexy = (surgical repair of testes)

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202
Q

6 major causes of Syncope

A
  1. ⬇︎ Cardiac Output (Valvular Dz/HOCM/Pulm HTN/PE/Tamponade/myxoma/aFib)
  2. Bradyarrhythmia (SA Node dysfunction/AV Block)
  3. VAN - Vasovagal Autonomic Neurocardiogenic
  4. Dehydration
  5. CVA/TIA
  6. Metabolic (⬇︎Glucose vs ⬇︎Na+)

OBTAIN ECHOS ON ANY PT WITH SUSPICIOUS SYNCOPE!

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203
Q

Nausea & Sweating are preceding sx for what type of syncope?

A

Neurocardiogenic only

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204
Q

What are triggers of VAN (Vasovagal Autonomic Neurocardiogenic) Syncope? -6

A
  1. Pain
  2. Emotional distress
  3. Prolonged Standing
  4. Defecation
  5. Micturition
  6. Coughing

VAN Syncope is preceded by nausea & sweating

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205
Q

What are the 3 types of Dizziness?

A
  1. Presyncope (lightheaded)
  2. Disequilibrium (feeling off balance)
  3. Vertigo (sensation of room spinning)
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206
Q

5 most common causes of Vertigo?

A

BPPV > [Vestibular neuritis (assc w/URI)] > [Vestibular Migraine] > [Acute Labyrinthitis (will also have tinnitus and deafness)] > Otitis Media

Be sure to differentiate between Peripheral and Central Vertigo with Head Thrust test

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207
Q

Indication of Head Thrust Test ; Describe how to do the test

A

differentiates in nystagmus pts between peripheral & central vertigo;

pt looks at fixed target and their head is rapidly turned from the target. Normally, eyes remained fix on target, but in [Peripheral vestibular dysfunction pts] eyes move w/head and then horizontal saccade back to target after

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208
Q

BPPV (Benign Paroxysmal Positional Vertigo) etx and CP-3

A

Ca+ otoliths accumulated within semicircular canals –> Dizzines, Nystagmus and Nausea only

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209
Q

What are 4 physical exam findings for differentiating a Peripheal vertigo from Central vertigo using Nystagmus

A

Peripheral is…

  1. Unidirectional
  2. Does not change direction
  3. Stops when fixing on point
  4. Worsened with Frenzel glasses (since these prevent fixation)
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210
Q

What is MRI indicated for pts with Dizziness?

A

When there are findings to suggest CENTRAL lesion

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211
Q

Between abx and observation, what’s given for uncomplicated otitis media in kids …

< 6 months old

between 6 mo - 2 years old

> 2 yo

A

< 6 mo old = abx

between 6 mo - 2 yo = Cautious observation depending on certainty, social support, clinical picture

> 2 yo = observation only

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212
Q

What is a major Risk Factor for Maxillary Sinusitis? ; Is abx indicated in Uncomplicated Maxillary Sinusitis?

A

Recent hx of URI

​NO! (only when pain/purulent discharge is present)

Sinusitis Never Feels Merry

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213
Q

Why are abx NOT indicated in healthy pts with acute bronchitis?

A

most recover w/out abx so use observation instead

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214
Q

Tx for Peripheral Vertigo - 4

A
  1. [Diuretics + low salt diet] = ⬇︎endolymphatic pressure (especially in Meniere’s disease)
  2. Epley canalith repositioning maneuver
  3. Vestibular Rehabilitation
  4. Anticholinergics (meclizine,dimenhydrinate)
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215
Q

What major lifestyle changes should pt with Hyperlipidemia take to ⬇︎ASCVD risk - 5

ASCVD = AtheroSclerotic CardioVascular Disease

A
  1. < 7% of calories is Saturated Fat
  2. Cholesterol < 200 mg/day
  3. ⬆︎Soluble Fiber intake
  4. Exercise
  5. Wt loss (⬇︎Fat stores & improves HTN)

These are examples of SECONDARY ASCVD prevention

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216
Q

___ is the initial preferred imaging for suspected Angina. When is CT indicated?-2

A

CXR; s/s of PE or Aortic Dissection

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217
Q

Major SE of Atorvastatin - 3

A
  1. Myalgia
  2. Rhabdomyolysis–>Myoclobinuria–>Acute Kidney Injury
  3. Liver Dysfunction (Get LFTs before starting statin!)
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218
Q

Major SE of Metoprolol - 3

A
  1. Bradycardia
  2. hypotension
  3. heart block
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219
Q

Major SE of HCTZ - 5

A
  1. Dehydration
  2. hyponatremia
  3. hypokalemia
  4. renal dysfunction
  5. gout attack 2/2 ⬆︎serum uric acid
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220
Q

Major SE of [Lisinopril ACE inhibitors] - 4

A
  1. Angioedema
  2. Cough
  3. HyperKalemia
  4. Renal dysfunction
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221
Q

What are the 3 MAIN characteristics of Angina

A
  1. Substernal >20 min. PRESSURE
  2. Exertional
  3. relieved with NTG or rest
    * [Atypical = GOE 2 out of 3] /// [NonAngina = <2 out of 3]*
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222
Q

Name the 4 Medications that Prevent LV Remodeling in HF pts

A

“BANA helps HF pts live Loonger”

Beta Blockers (Metoprolol / Carvedilol)

[ACEk2 inhibitors AND ARBs]

[Nitrates + Hydralazine]

[Aldosterone Blockers (Spironolactone / Eplerenone)]

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223
Q

What therapies are used to treat Unstable Angina?-7

A

Pts with Unstable Angina Need OBAMAA too!

  1. NTG = VasoDilates Veins and Coronary Arteries
  2. Oxygen = Minimizes ischemia
  3. Beta Blockers = DEC HR –> DEC Arrhythmia risk and DEC O2 demand
  4. [ASA and Heparin] = limits thrombosis
  5. Morphine = Pain
  6. ACEk2 inhibitors within 24 hrs= DEC [L Ventricle Dilation/Remodeling]
  7. AtorvaSTATIN - comes later

ASA and Beta blockers can –> asthma exacerbation

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224
Q

The CHA2DS2 VASc score is used to determine _______ risk in pts with ______. Decsribe the Criteria

A

determines Thromboemobolism risk in pts with AFib

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226
Q

When should Men take QD ASA for cardiovascular px? When should Women? What is it helping in each?

A

Men = 45 - 79 to ⬇︎ MI

Women = 55 - 79 to ⬇︎ Stroke

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227
Q

What all labs should be ordered when concerned for Angina; and why?-6

A
  1. CBC: Anemia contributes to ischemia
  2. BMP: Electrolyte derangement
  3. BUN/Creatinine: Kidney Dz –> Heart Dz
  4. TSH: Hyperthyroidism –> ⬆︎O2 demand of heart
  5. Lipid Panel: Cardiac Risk
  6. ALT/AST: Obtain baseline before starting Statin
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228
Q

Criteria for Metabolic Syndrome X -4

A

DIVe –> ASCVD

≥ 3 of the following:

Dyslipidemia (TAG>150 vs HDL<50)

Insulin resistance (Fasting Glucose >110)

Visceral Waist Obesity (Men>40 inch / Women>35 inch)

Hypertension (BP> 130/85)

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229
Q

Common Causes of Chest Pain are usually CRGMP

Describe the Cardiac Causes -6

A

CRGMP

  1. ACS (Unstable,Stable,Prinzmetal Variant, MI)
  2. Cocaine
  3. Pericarditis
  4. Aortic Dissection
  5. Valvular
  6. [Non-ischemic Cardiomyopathy]

CRGMP = Cardiac/Respiratory/GI/Msk/Psych

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230
Q

Common Causes of Chest Pain are usually CRGMP

Describe the Respiratory Causes -5

A

CRGMP

  1. PE
  2. PNA
  3. Pleurisy
  4. PTX
  5. Pulm HTN/Cor Pulmonale

CRGMP = Cardiac/Respiratory/GI/Msk/Psych

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231
Q

Common Causes of Chest Pain are usually CRGMP

Describe the Gastrointestinal Causes -5

A

CRGMP

  1. GERD
  2. PUD
  3. Esophageal (dysmotility, inflammation)
  4. Pancreatitis
  5. Biliary (cholecystitis, cholangiits)

CRGMP = Cardiac/Respiratory/GI/Msk/Psych

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232
Q

Common Causes of Chest Pain are usually CRGMP

Describe the Musculoskeletal Causes -5

A

CRGMP

  1. Costochondritis
  2. Rib Fracture
  3. Muscular strain
  4. Herpes Zoster
  5. Myofascial syndrome

CRGMP = Cardiac/Respiratory/GI/Msk/Psych

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233
Q

Common Causes of Chest Pain are usually CRGMP

Describe the Psychogenic Causes -3

A

CRGMP

  1. Panic DO
  2. Hyperventilation
  3. Somatoform DO

CRGMP = Cardiac/Respiratory/GI/Msk/Psych

234
Q

When is Angina classified as Unstable -3

A

when chest pain is…

  1. > 20 min or ⬆︎in frequency
  2. New
  3. occurs at rest
235
Q

What is Cardiac Syndrome X ; Lab findings?-3

A

Exertional angina-like cp usually in Women ;

  1. Normal coronary angiogram
  2. Normal EKG
  3. Abnormal Exercise Stress test
236
Q

Based on the 3 characteristics of Angina, when is Angina:

Atypical?

NonAngina?

A
  1. Substernal >20 min. PRESSURE
  2. Exertional
  3. relieved with NTG or rest
    * [Atypical = ≥ 2 out of 3 +/- atypical sx] /// [NonAngina = <2 out of 3]*
237
Q

Which demographics typically have Atypical Angina? -3

A
  1. Diabetics
  2. Women
  3. Elderly
238
Q

In addition to smoking, being male, obesity and many others…age > ___ years old is a risk factor for CAD in males and ___ in females

A

​> 45 yo = Male

>55 yo = Female

Family hx is only risk factor is 1st degree relative has CAD at younger ages than these

239
Q

Tx for Stable Angina -3

A

Beta Blockers > Calcium Channel Blockers

+

ACE inhibitors

+

ASA

240
Q

Some pts present with SOB as the only sx of cardiac ischemia

What is this called?!

A

Anginal Equivalent

Example of Atypical Angina

241
Q

Compartment Syndrome/Peripheral arterial occlusion is one of the serious s/s of limb threatening injury!

What are its features? - 6

A

The 6 P’s!

  1. POOP (Pain Out Of Proportion)
  2. [Paresthesia - EARLY finding]
  3. [Pulselessness - LATE finding]
  4. Pallor
  5. Poikilothermia (inability to regulate body temp)
  6. Paralysis
242
Q

How do you determine if a pt is “weight bearing” or not? ; Why does this matter in Ankle injuries?

A

Weight bearing = Pt can take 4 steps independently ; SERIOUS Ankle injuries are NOT weight bearing

243
Q

Which ankle ligaments are most often damaged in ankle sprain? - 3

A
  1. ANTERIOR talofibular = MOST EASILY INJURED (ANT Drawer test dx)
  2. POSTERIOR talofibular
  3. Calcaneofibular (Inversion Stress test dx)

These are the Lateral Stabilizing ligaments which –>Lateral Ankle sprains are most common

244
Q

Name 2 classic physical exam maneuvers for diagnosing ankle injuries

A
  1. Negative Inversion test (pts ankle is inverted and if too lax = calcaneofibular ligament damage)
  2. Crossed Leg test (pt injured leg rest midcalf on knee to detect high ankle sprains)
245
Q

DDx for Ankle Pain - 8

A
  1. LATERAL ANKLE SPRAIN
  2. Medial Ankle Sprain
  3. Peroneal tendon tear
  4. Fibular Fracture
  5. Talar dome fracture (may interrupt perfusion–>avascular necrosis)
  6. SubTalar dislocation (high energy injury involving talocalcaneal & talonavicular joints)
  7. Ankle Arthritis of Tibiotalar joint
  8. Syndesmotic Sprain (has positive ankle squeeze test)
246
Q

Ankle Sprains are most common in the ED but < 15% are clinically significant

When is radiographic imaging actually indicated for ankle sprains?

A

Ankle Radiographs are indicated if there is …

[Malleolar Pain]

+

[(Bony TTP along distal 6 cm of posterior edge for EITHER malleolus) OR (NONWeight bearing immediately after injury and in ED)]

This is the Ottawa Ankle Rule

247
Q

Ankle Sprains are most common in the ED but < 15% are clinically significant

When is radiographic imaging actually indicated for foot sprains?

A

Foot Radiographs are indicated if there is …

[Midfoot Pain]

+

[(Bony TTP at either the navicular bone or the 5th metatarsal base) OR (NONWeight bearing immediately after injury and in ED)]

This is the Ottawa Ankle Rule

248
Q

Tx mngmt for Ankle Sprains - 3

A
  1. RICE (use for most msk injuries)

(Rest for first 3 days after injury + intermittent stretching

Ice 10 min at at time all throughout day

Compression

Elevation)

  1. Semi-Rigid Ankle support
  2. Ibuprofen
249
Q

What are key ways to prevent Ankle Re-Injury? - 3

A
  1. Daily Ankle & Proprioceptive Exercises
  2. Protective Semi-rigid ankle support when returning to sports
  3. No flip flops/sandals until ankle is fully healed
250
Q

Common s/s of HYPERthyroidism -9

A

TT Feels ARCHED

  1. [Tremor & Tachycardia]
  2. Fatigue
  3. Appetite ⬆︎ but Wt ⬇︎
  4. Reflexes ⬆︎
  5. Cardio (Tachycardia, Palpitations,Exertional SOB)
  6. Heat intolerance –> SWEATING
  7. Exopthalmous with lid lag
  8. Diarrhea w/ possible dyspepsia

Older pts may only have Fatigue and Cardio sx!

251
Q

Major causes of Goiter -7

A
  1. Iodine deficiency = MOST COMMON
  2. hypOthyroidism
  3. HYPERthyroidism
  4. Nodules
  5. Thyroid CA
  6. Pregnancy
  7. Thyroiditis (usually tender)
252
Q

What does it mean if TSH is ⬆︎ while T4 is ⬇︎

A
253
Q

What does it mean if TSH is mildly elevated (5-10) while T4 is Normal

A
254
Q

What does it mean if TSH is Normal while T4 is ⬆︎

A

Thyroid gland fails to receive negative feedback

255
Q

What does it mean if TSH is ⬇︎ while T4 is ⬇︎

A

TSH vs TRH deficiency

256
Q

What does it mean if TSH is ⬇︎ while T4 is Normal and T3 is ⬆︎

A

T3 Toxicosis!!!

257
Q

How soon will you see Exopthalmous with lid lag improve in hyperthyroid pts after tx?

A

YOU WON’T!! HYPERTHYROIDISM TX DOES NOT HELP EYE MANIFESTATIONS!!

258
Q

Graves’ disease usually affects 40-60 yo women with fam hx of thyroid disease

What are triggers of Graves’ disease? -3

A
  1. Stress
  2. high iodine intake
  3. Pregnancy
259
Q

S/S of hypothyroidism is mostly opposite of Hyperthyroidism

What are 6 distincitve s/s of hypothyroidism?

A

Mosty opposite of TT Feels ARCHED but may also have…

  1. Cardio: Diastolic HF
  2. Depression
  3. Menorrhagia
  4. Pedal Edema
  5. HTN
  6. BOTH HAVE FATIGUE
260
Q

DDx for Palpitations fall into 6 categories known as SPICED

What are the Substances causes for Palpitations? -5

A
  1. tobacco
  2. caffeine
  3. EtOH intoxication
  4. EtOH withdrawal
  5. Cocaine

SPICED: Substances/Pscyh/ID/Cardio/Endocrine/Drugs

261
Q

DDx for Palpitations fall into 6 categories known as SPICED

What are the Pscyhological causes for Palpitations? - 2

A
  1. Anxiety / Panic Attacks
  2. Hyperawareness of own heart beat

SPICED: Substances/Pscyh/ID/Cardio/Endocrine/Drugs

262
Q

DDx for Palpitations fall into 6 categories known as SPICED

What are the Infectious causes for Palpitations?

A

Any Febrile illness

SPICED: Substances/Pscyh/ID/Cardio/Endocrine/Drugs

263
Q

DDx for Palpitations fall into 6 categories known as SPICED

What are the Cardiovascular causes for Palpitations? -6

A
  1. Arrhythmia (aFib/aFlutter)
  2. Cardiomyopathy (HOCM/CHF)
  3. Anemia
  4. Valvular (MS/MVP/AS)
  5. CAD
  6. hypOvolemia

SPICED: Substances/Pscyh/ID/Cardio/Endocrine/Drugs

264
Q

DDx for Palpitations fall into 6 categories known as SPICED

What are the Endocrine causes for Palpitations? -4

A
  1. HYPERthyroidism
  2. Pheochromocytoma
  3. menopause
  4. ⬇︎Glucose

SPICED: Substances/Pscyh/ID/Cardio/Endocrine/Drugs

265
Q

DDx for Palpitations fall into 6 categories known as SPICED

What are the Drug Medication causes for Palpitations? -3

A
  1. Albuterol
  2. Stimulants
  3. Theophylline

SPICED: Substances/Pscyh/ID/Cardio/Endocrine/Drugs

266
Q

Most common causes of HYPERthyroidism -5

A
  1. Toxic Diffuse Goiter=MOST COMMON (Graves’ disease)
  2. Toxic Nodular Goiter (multi in older pts/solitary in younger)
  3. Thyroiditis (virus & pregnancy –> T4 leakage)
  4. Excess iodine intake
  5. Drug (Amiodarone) induced
267
Q

Pt with low TSH and HIGH T4 wants to be evaluated for HYPERthyroidism

What’s initial evaluation for HYPERthyroidism? - 3

A
  1. RAIU scan (RadioActive Iodine Uptake)
  2. Thyroid PerOxidase Ab (Common in Graves’ patients)
  3. Obtain Thyroid US FIRST if nodule is present
268
Q

Tx for HYPERthyroidism - 2

A
  1. Methimazole (Sx ⬇︎ by 1 month)
  2. RAI (RadioActive Iodine) oral (destroys overactive thyroid cells but eventually –> need for hormone replacement)
269
Q

What are the precautions of giving RAI (RadioActive Iodine PO) tx to patients? - 3

A
  1. CTD in pregnancy
  2. pt with RAI tx should NOT be near pregnant women or kids x 7 days after tx 2/2 urine/stool excretion
  3. Transient worsening of sx (including eye sx) may occur
270
Q

What are the main points to remember regarding f/u after RAI (RadioActive Iodine PO) tx in HYPERthyroid pts? - 3

A
  1. f/u every 3 months after tx to follow TSH UNTIL STABILIZED & d/c propranolol (if prescribed) when euthryroid
  2. Once TSH is STABILIZED, f/u can be every 6 months
  3. Inform patient of s/s of hypothyroidism since inevitably this will occur. Start HRT then
271
Q

RAI (RadioActive Iodine) destroys overactive thyroid cells but eventually –> need for hormone replacement

Once hypothyroidism occurs in s/p RAI HYPERthyroid pts, what is the tx course for treating the hypOthyroidism? - 4

A

1st: Thyroxine 1.5-1.8 mcg/kg
2nd: ⬆︎dose slowly (especially in elderly) and check TSH in 6 weeks
3rd: ONCE TSH IS STABLE, f/u can be 1-2x / year
4th: Monitor for relapse/need for second RAI

272
Q

Smoking is the single greatest contributor to death in USA

What 3 things do Smokers actually die of though?

A

Lung CA > Ischemic Heart disease > COPD

273
Q

What’s the most effective way to prevent death from pulmonary embolism? Why?

A

Prevent DVT from ever happening in first place ; >95% of PE deaths happen within 1-2 hours of onset, BEFORE pt can even obtain therapy

274
Q

How much does Obesity ⬇︎ Life Expectancy by?-4

A
  1. BMI > 32 in general –> DOUBLED mortality rate in Females
  2. [BMI 30-35 = ⬇︎life by 2-4 years]
  3. [BMI>40 = ⬇︎life by 20 years in Male]
  4. [BMI > 40 = ⬇︎ life by 5 year in Female]

Obesity is also strong RF for Venous AND Arterial Insufficiency

275
Q

DDx for unilateral leg swelling - 6 ; Give descriptions to differentiate them

Evaluate with Venous Doppler

A
  1. DVT (Rubor,Calor,Dolor,Tumor +/- Homan’s dorsiflexion pain)
  2. Venous Insuffiency (SOFT, hyperpigmentation of distal leg, malleoli ulceration)
  3. Cellulitis (Rubor,Calor,Dolor,Tumor)
  4. Peripheral Arterial Disease (Claudication hx, ABI<0.9)
  5. lymphedema (painless, starts @ foot–>entire limb)
  6. Ruptured popliteal cyst
276
Q

How is smoking related to vascular disease? -2

A
  1. Peripheral Arterial Disease (usually sub-patellar) is 4x more prevalent in DM pts
  2. PAD progression is majorly driven by smoking
277
Q

What can be used for DVT Px -6

A
  1. Heparin, unfractionated
  2. Lovenox
  3. Warfarin
  4. SCD (sequential compression devices)
  5. Compression Stockings
  6. Ambulation
278
Q

Describe the system used to diagnose and assess for DVT

A

Wells Criteria!

279
Q

2 greatest risk factors for DVT development

A
  1. Smoking
  2. Obesity
280
Q

What are the requirements for treating DVT OUTpatient? -5

A

Pt must be…

  1. Low risk for bleeding
  2. Good Kidney Function
  3. Hemodynamically stable
  4. Daily access to INR monitoring at home
  5. Stable and supportive at home
281
Q

DVT tx - 2

A

1st: [(Therapeutic Heparin vs Lovenox) x 5 days]
2nd: [(Warfarin px vs NOAC) x at least 3 months]

282
Q

Advantages of Lovenox over Unfractionated Heparin - 4

A

Lovenox…

  1. Longer half life = administered SubQ only 1-2/day (but note: this also means it takes longer to reverse if surgery is needed)
  2. No Lab monitoring
  3. FIXED Dosing
  4. ⬇︎probability of HIT Thrombocytopenia
283
Q

How should you manage a pt on Warfarin whose INR is now > 3? -3

Therapeutic INR = 2-3

A
  1. Hold Warfarin
  2. Vitamin K PO dose (or 5 mg IV dose if INR 5-9)
  3. Repeat INR in 1 day
284
Q

How much does HTN ⬇︎ Life Expectancy by?

A

20 years!!

285
Q

Guidelines for Colon CA screening - 6

A

starting at 50-75 yo

  1. ***[Colonoscopy every 10 years]*** and if unavailable…
  2. [FOBT every year] OR
  3. [FIT every year]OR
  4. [Barium Enema every 5 years]OR
  5. [CT Virtural Colography every 5 years]OR
  6. [Flexible Sigmoidoscopy every 5 years]OR

FIT (Fecal Immunochemical Test) looks for intact hgb in stool

286
Q

S/S of Menopause - 5

A
  1. Menstrual irregularity in older female (heavy/last>1 week) = perimenopause
  2. Hot Flashes (last 30 sec - 10 min)
  3. Atrophic vaginitis –> Vaginal Dryness, dyspareunia, urinary sx, smooth vaginal mucosa
  4. Palpitations
  5. Mood Swings
287
Q

What are risk factors for Osteoporosis? - 9

Bone Mineral Density (T-score) ≥ 2.5 SD BELOW mean

A
  1. PERSONAL OR FAMILY HX OF OSTEOPOROTIC FX
  2. ⬇︎Estrogen (postmenopause)
  3. LOW BMI (malnutrition/malabsorption)
  4. Sedentary lifestyle
  5. Poor Ca+ intake (body needs 1000mg/day premenopausal and 1200mg post)
  6. Smoking
  7. EtOH abuse
  8. White race
  9. CTS
288
Q

Preventitive measures for Osteoporosis? - 4

Bone Mineral Density ≥ 2.5 SD below mean

A
  1. Dietary Ca+ intake 1200-2500 mg/day
  2. Dietary VitD intake 600 IU/day
  3. Sun > 10 min/day
  4. Weight bearing exercises (walking,jogging,dancing)

Only use supplements WHEN ABSOLUTELY NEEDED

290
Q

Guidelines for Osteoporosis screening - 3

Bone Mineral Density (T-score) ≥ 2.5 SD BELOW mean

A
  1. Women ≥65 = DEXA
  2. Women < 65 get DEXA if fracture risk is ≥ a 65 yo WHITE woman (9.3% 10 year risk for osteoporotic fx) per FRAX score
  3. Grade i for Men

Bone Mineral Density (T-score) ≥ 2.5 SD BELOW mean

291
Q

Desribe the 3 components of a physical exam for abnormal uterine bleeding

A
  1. Pelvic: Look for vulvar/vaginal lesions, assess size & mobility of uterus since fixed uterus=uterine CA
  2. Neck: Assess Thyroid since thyroid dz–>uterine bleeding
  3. Skin: Look for abnormal bruises (bleeding DO) and jaundice (liver dz–>bleeding DO)
292
Q

Osteoporosis etx

A

⬇︎ Trabeculae bone density despite NORMAL mineralization

293
Q

Risk factors for Endometrial CA -3

A
  1. EEE - Excess Estrogen Exposure (HRT, neoplasm, [menstruation outside of 12-52], Nulliparity, Anovulation/PCOS)
  2. Tamoxifen
  3. Obesity

Smoking and Progestin OCP ⬇︎Endometrial CA Risk

295
Q

Name the most common locations for osteoporotic fractures? - 4

A
  1. Hip
  2. Vertebrae
  3. Distal Radius
  4. Proximal Humerus
296
Q

Based on DEXA, when is a pt classified as having Osteoporosis? What about Osteopenia?

A

OSTEOPOROSIS = Bone Mineral Density (T-score) ≥ 2.5 SD BELOW mean of Bone Mineral Density in Young health person

osteopenia = BMD Tscore between 1 - 2.5 BELOW mean

Normal = 0-1 below mean

297
Q

DDx for Abnormal uterine bleeding - 7

A
  1. CERVICAL POLYPS = MOST COMMON IN postpartum/PERImenopausal
  2. Endometrial Hyperplasia/Proliferation
  3. Endometrial CA
  4. Hormone-producing Ovarian tumors
  5. hypOthyroidism –> menorrhagia
  6. Steroids
  7. SSRIs
298
Q

Osteoporosis rx treatments - 4

A
  1. Bisphosphonates (Bone resorption inhibitors)
  2. Calcitonin
  3. Estrogen HRT
  4. PTH synthetic - cant use for > 2 years
299
Q

What tools are used for diagnosing AUB (Abnormal Uterine bleeding) in women, and why? - 5

A
  1. Transvaginal US = evaluates endometrial thickness (<5mm = ok), leiomyoma fibroids, ovaries
  2. Endometrial biopsy = gold standard for AUB in women w/high risk for endometrial CA
  3. CBC = looks for anemia/thrombocytopenia
  4. TSH = hypOthyroidism –> AUB
  5. FSH & LH = In menopause, FSH/LH⬆︎ due to lack of inhibin
300
Q

What are the Benefits-3 and Risk-4 of Hormone Replacement Therapy?

There is no right answer for whether women should use HRT

A

Pros

  1. Prevents Osteoporosis
  2. ⬇︎Menopausal sx (Atrophic vaginitis, Hot flashes)
  3. ⬆︎Cognitive/mental status

Cons:

  1. ⬆︎Breast CA risk if combined Estrogen/Proges is used >3 years
  2. ⬆︎Endometrial CA risk with Excess Estrogen
  3. STARTING HRT > 60 yo–> CAD
  4. HRT ⬆︎Stroke risk within first 2 years of use
302
Q

What are alternative tx for postmenopausal sx? - 4

A
  1. Yoga
  2. Acupuncture
  3. Tai Chi
  4. Qi Gong
303
Q

Primary skin lesions are initial uncomplicated lesions while Secondary skin lesions are consequences of disease progression/scratiching/infection of the primary lesions. Describe:

Macule?

Patch?

Papule?

Plaque?

A
  1. Macule: Flat, change in skin color < 1 cm
  2. Patch: Macule > 1 cm
  3. Papule: raised lesion with distinct borders < 1 cm
  4. Plaque “plaque”: Papule > 1 cm
304
Q

Primary skin lesions are initial uncomplicated lesions while Secondary skin lesions are consequences of disease progression/scratiching/infection of the primary lesions. Describe:

Nodule?

Tumor?

Vesicle?

Bullae?

A
  1. Nodule: Raised lesion w/out distinct borders within epidermis, dermis or SubQ
  2. Tumor: Solid Mass of SQ tissue that’s larger than nodule
  3. Vesicle: Raised lesion filled with clear fluid < 1 cm
  4. Bulla: Raised lesion filled with clear fluid > 1 cm
305
Q

Primary skin lesions are initial uncomplicated lesions while Secondary skin lesions are consequences of disease progression/scratiching/infection of the primary lesions. Describe:

Pustule?

Wheal?

A
  1. Pustule: Papule that contains pus, variable size
  2. Wheal: Area of elevated edema in upper epidermis
306
Q

What are the 2 best methods for preventing Skin CA?

A
  1. Avoid Excess Sunlight (clouds and water won’t work!)
  2. [SPF ≥ 15 Sunscreen] applied every 2 hours and after swimming/sweating
307
Q

Describe the ABCDE criteria for evaluating Melanoma

A

Asymmetry in ≥ 2 axes

Border is irregular

Colors of 2 or more

Diameter ≥ 6mm

Enlarging evolution of the lesion’s surface

308
Q

CP of Prostatits - 3

A
  1. Lower abd pain
  2. Perineal pain
  3. Penis and Testicle Pain +/- w/ejactulation
309
Q

The following skin conditions typically occur where:

Psoriasis?

Atopic Eczema? - 2

A

PSoriasis = ExtenSor surfaces

eczema atopic dermatitis = flexor surfaces & palms/soles (the itch that rashes!**)

310
Q

A: Describe Annular lesions

B: What is AIBE lesion stand for? Describe it

A

A: Circular erythematous macule or papule w/normal skin in center ;

B: [AIBE (Annular Iris Bulls Eye) lesion] Target lesion in which erythematous annular macule/papule has second ring or purplish papule or vesicle in center - image

311
Q

How does arrangement of skin lesions help with diagnosis? - 2

A

Linear arrangement = Contact rxn (tx=topical CTS) vs Herpes Zoster

312
Q

How does size make a difference in SQC? What about Nevus?

A

SQC > 2 cm = ⬆︎Risk for Metastasis & Recurrence

Nevus > 6 cm = Malignant

Image: Congenital nevus

313
Q

DDx for Oval shaped Erythematous Patch - 9 (Give brief descriptions to help differentiate)

A
  1. Eczema
  2. SQC (Raised w/fleshy borders,**scaly,erythematous)
  3. Actinic Keratoses (Flat borders, scaly)
  4. Basal Cell Carcinoma (waxy +/-telangiectasia, common on face, usually benign)
  5. Melanoma
  6. Fungal infection
  7. Psoriasis (Extensor surfaces)
  8. Lichen Planus (polygonal purple papules commonly @ wrist & above ankles)-image
  9. Seborrheic Keratoses (stuck-on brown appearance)
314
Q

When evaluating for BPH, what 3 things most be consider?

A
  1. LUTS (Lower Urinary Tract Sx): Urinary freq/urgency
  2. Similar conditions: UTI/Prostatitis/Prostate CA/OAB
  3. Complications if untreated: UTI/Obstructive nephropathy/Urinary Retention
315
Q

What all test are included in the evluation for BPH - 6

A
  1. Digital Rectal Exam (don’t forget to check rectal tone)
  2. UA (look for UTI, blood)
  3. Prostate specific antigen
  4. BUN/Cr
  5. [Max urinary flow rates > 15 mL/sec of at least 150 mL] rules out bladder outlet obstruction
  6. PVR volume
316
Q

Topical Corticosteroids (CTS) are best at treating what type of lesions?

A

burning or pruritc lesions 2/2 hyperproliferation, inflammation and immune involvement

Topical CTS work mostly by vasoconstricting in upper dermis

317
Q

What is the vehicle base of a topical Corticosteroids? ; Describe the 4 types of topical agents and what their best used for

A

substance in which active ingredient is dispersed and determines rate of skin absorption

  1. Creams = exudative inflammation since it dries out skin (can also use Gel for exudative inflammation)
  2. Gels = exudative inflammation (poison ivy)
  3. Ointments =Best on dry skin and has better absorption
  4. Lotions = Lotions contain EtOH which dries oozing lesions. Use Lotion on scalp since it leaves lil residue
318
Q

Common SE for Topical CTS (CorTicoSteroids) - 2

A
  1. Skin Atrophy
  2. hypOpigmentation (skin lightening)
319
Q

Tinea Capitis tx - 2

A
  1. Griseofulvin PO
  2. Terbinafine PO
320
Q

Tinea Unguium Onychomycosis tx - 3

A
  1. Terbinafine PO
  2. iTraconazole PO
  3. Griseofulvin PO (if absolutely necessary due to low keratin affinity)
321
Q

Which dermatologic fungal infections are treated with topical antifungal agents?-3 ; Good or bad pgn?

A

Tinea Magnum (image), Tinea Corporis, Tinea Cruris;

GOOD! Resolves within 2-4 wks post tx

322
Q

BPH mngmt - 7

A
  1. Alpha R Blockers for mod-severe sx (relaxes internal urethra)
  2. 5-alpha reductase inhibitors in men with prostates > 40 g or add if monotx with #1 doesn’t work
  3. Surgery
  4. Avoid Evening Drinking (includes EtOH, caffeine)
  5. Avoid Decongestants
  6. Avoid Antihistamines
  7. Avoid rushing the urination process
323
Q

Difference between Incisional biopsy and Punch biopsy? ; What are the advantages of these type of biopsies?-3

A
324
Q

Describe Excisional biopsy? ; This type of biopsy is most useful in diagnosing what type of skin CA?

A

Excisional = Removes Entire skin lesion with 2-3 mm margins ; Malignant Melanoma

325
Q

When would you use a Shave biopsy? ; How is this helpful cosmetically?

A

When lesion is elevated above surface ; Some MDs elevate lesion intentionally with lidocaine to shave –> avoids stiches

326
Q

What type of Skin CA is Surgical Excision used to treat?

A

Cutaneous SCC < 2 cm without high risk features

Will require 4 mm margin around tumor

327
Q

What type of Skin CA is Mohs Microscopic Surgery used to treat? - 4

A
  1. NONMelanoma > 2 cm
  2. CA that has lesions with indistinct margins
  3. Recurrent lesions
  4. Lesions close to sensitive structures (eyes,nose,mouth)
328
Q

What type of Skin CA is 5-FU used to treat? - 3

A
  1. Actinic Keratosis
  2. Bowens SCC in-situ - ALT TX
  3. Superficial SCC - ALT TX
329
Q

What type of Skin CA is Cryotherapy used to treat? - 2

A
  1. Bowens SCC in-situ
  2. Superficial SCC
330
Q

What type of Skin CA is Radiation used to treat?-2 ; Where on the body is it contraindicated for use and why?-2

A

lowrisk SCC in nonsurgical and elderly ; Trunk & Extremities due to atrophy and ulceration

331
Q

what are the 2 major complications of influenza in kids?

A
  1. Bacterial PNA (Strep Outpt vs Staph inpatient)
  2. Otitis Media

The younger the child, the greater the risk for complication

332
Q

What are the major RF for developing complications from influenza? - 7

A
  1. children < 5 yo
  2. children on long-term ASA (Kawasaki’s)
  3. Chronic Heart disease
  4. Chronic pulmonary disease
  5. Chronic Renal disease
  6. Immunosuppression
  7. DM
333
Q

Tx for Strep PNA? ; Tx for WAP(Walking Atypical PNA)?

A

[Amoxicillin 90mg/kg/day x 7] ; [Azithromycin 10mg/kg on day 1 followed by 5 mg/kg days 2-5]

334
Q

FLU = Fever, Lethargy/myalgia/headache, URI sx (cough,congestion)

What are major signs of a pt developing complications from influenza? - 4

A

FLU = Fever, Lethargy/myalgia/headache, URI sx (cough,congestion/clear rhinorrhea)

  1. Abrupt Sx onset > 7 days
  2. SOB
  3. Worsening Cough
  4. Difficulty maintaining hydration
335
Q

Guidelines for Obesity screening

A

Kids > 6 yo (Screen with BMI)

336
Q

Stages of treating childhood Obesity = Prevention –> Structured Wt Mngmt –> Comprehensive Multidisciplinary Intervention –> Tertiary Care

Describe the Prevention Stage

A
337
Q

Stages of treating childhood Obesity = Prevention –> Structured Wt Mngmt –> Comprehensive Multidisciplinary Intervention –> Tertiary Care

Describe the Structured Wt Mngmt Stage

A
338
Q

Stages of treating childhood Obesity = Prevention –> Structured Wt Mngmt –> Comprehensive Multidisciplinary Intervention –> Tertiary Care

Describe the Comprehensive Multidisciplinary Intervention Stage

A
339
Q

Stages of treating childhood Obesity = Prevention –> Structured Wt Mngmt –> Comprehensive Multidisciplinary Intervention –> Tertiary Care

Describe the Tertiary Care Stage

A
340
Q

What are physical exam pulm findings that do NOT indicate consolidation? - 2

A
  1. Wheezing
  2. Rhonchi (snoring sounds) = bronchial secretions usually
341
Q

How can lung crackles be used to determine stage of PNA - 2

A

Mid-inspiratory fine crackles = Acute PNA

vs

Late-inspiratory coarse crackles = Resolving PNA

Random Note: everything is LOUDER when heard over consolidation lung areas

342
Q

Major s/s of Bacterial PNA - 5

A
  1. CRACKLES
  2. Fever > 100.4 F / Chills
  3. SOB
  4. Cough
  5. Pleuritic CP

Strep PNA = MOST COMMON CAUSE

343
Q

Major s/s of Acute Bronchitis - 3

A
  1. Cough lasting 1-3 wks usually w/purulent sputum
  2. +/- Rhonchi (coarse low pitched rattling)
  3. +/- Wheezing (give B2 agonist)

etx = VIRAL self-limited large airway inflammation

344
Q

Influenza dx - 2

A

NasoPharyngeal Swab + Clinical

345
Q

Flu tx can ⬇︎ sx by 1 day if given within 2 days of sx onset

When is it indicated to give Flu tx AFTER 2 days of sx onset? - 2

A
  1. Concomitant Moderate-Severe community acquired PNA
  2. pt is clinically worsening at time of initial visit
346
Q

Mngmt elements for Pediatric PNA - 5

A
  1. Obtain [CXR (PA and lateral) in kids hypoxic, not responding to tx or inpatient]
  2. Uncomplicated Outpatient PNA in kids 5 yo-teens = Azithromycin (since there is ⬆︎chance of it being atypical PNA)
  3. Uncomplicated Outpatient PNA in kids 3 mo. - 5 yo = amoxicillin
  4. Inpatient PNA in kids 3 weeks - 5 yo = Ampicillin vs PCN G vs CefTriaxone
  5. Inpatient PNA in newborns - 3 weeks= Ampicillin vs Gentamicin
347
Q

What is a normal total cholesterol

A

< 170 mg/dL

348
Q

What is a normal LDL? ; At what LDL should you start treating with Statins?

A

< 130 mg/dL ;

[> 190 in pts over 21 yo = Use HIGH-dose Statins]

349
Q

Demogaphic for Dysmenorrhea ; Risk factors-5

Dysmenorrhea = painful menses starting hours-days before menstruation and lasting 3 days

A

Teens/Young Adults, starting 1-2 years after menarche

  1. Mood DO (Depression/Anxiety)
  2. Smoking
  3. Nulliparity (not having a lot of kids)
  4. Poor health
  5. Early Menarche
350
Q

What are normal physical exam findings for a Pelvic Exam? - 6

A
  1. Uterus Size of clenched fist (not > 8 wks)
  2. Uterus Midly tender on or immediately prior to menses
  3. Uterus can be Anteflexed or Retroflexed
  4. Cervical/Vaginal clear/white discharge (physiologic leukorrhea)
  5. Nabothian cervical cyst (intermittent inclusion cyst formed during metaplasia)
  6. Ovaries the size of an oyster and mild TTP

Knobby knubs on uterus may = mucosal leiomyoma fibroids

351
Q

Clinical criteria for diagnosing Menorrhagia - 2

A

[Menstrual Blood loss > 80 mL] + [menses > 7 days]

352
Q

What is Metorrhagia

A

Irregular frequent bleeding

353
Q

Clinical criteria for diagnosing PMS (PreMenstrual Syndrome)

A

At least 5 sx (from Group A and B) began 1 week before menses, improve during menses and resolve during week after menses

If sx occur irregularly or throughout menses = mood or personality DO

354
Q

Clinical criteria for diagnosing PMS (PreMenstrualSyndrome) relies on sx from Group A and Group B

Describe sx for Group A - 6

A

At least 5 sx (from Group A and B) began 1 week before menses, improve during menses and resolve during week after menses

A: (at least one)

  1. Mood lability
  2. irritability
  3. depression
  4. hopelessness
  5. anxiety
  6. ⬇︎libido
355
Q

Clinical criteria for diagnosing PMS (PreMenstrualSyndrome) relies on PMS sx

What is the Clinical Criteria for PMS? ; Name some of the PMS sx

A

PMS sx begin 1 week before menses (luteal phase) and resolves during week after menses (follicular phase)

Sx:

  • Bloating
  • Fatigue
  • HA
  • Hot Flashes
  • Breast Tenderness
  • Irritability/Mood Swings
  • ⬇︎Concentration
356
Q

DDx for Secondary Dysmenorrhea - 3

A
  1. Endometriosis (Also causes dyspareunia,pelvic pain, abn vaginal bleeding)
  2. Leiomyoma Fibroids (knobby knub uterus)
  3. Chronic PID (usually also has lower abd pain)
357
Q

DDx for Menorrhagia - 6

A
  1. Adenomyosis (symmetrical boggy uterus)
  2. Polyps cervical/uterine (also has intermenstrual vs postcoital bleeding)
  3. Molar Pregnancy
  4. Leiomyoma Fibroids (knobby knub uterus)
  5. Chronic PID (usually also has lower abd pain)
  6. hypOthyroidism
358
Q

What are the common s/s of Endometriosis - 6

A
  1. Dyspareunia (not found in Leiomyoma fibroids)
  2. Dysmenorrhea
  3. Cul-De-Sac Pain
  4. Immobile Retroflexed Uterus
  5. Nodules on Uterosacral ligaments
  6. Uterine motion tenderness
359
Q

RF for Endometriosis - 4

A
  1. 25-35 yo
  2. Nulliparity
  3. Mensturation [outside of 12-52 yo]
  4. excessively short or long menstural cycles
360
Q

What test would you order to initially w/u dysmenorrhea? - 5

A
  1. CBC
  2. Pregnancy test
  3. [US - Abd AND Intravaginal]
  4. TSH (thyroid sx may overlap w/menstrual DO sx)
  5. Von Willebrand’s testing only in TEENS with menorrhagia
361
Q

Primary Dysmenorrhea involves painful menses within first 2 days without pelvic pathology

What demographic typically displasy this? tx-2?

A

Women < 20 yo ;

1st: Ibuprofen 2 days prior to menses x 4 days

2nd: Combo OCP w/medium dose estrogen

362
Q

Tx for PMS (PrMenstrualSyndrome) - 6

A
  1. SSRIs - if severe
  2. Menstrual Diary
  3. Exercise
  4. [OCP - ethinyl estradiol + drospirenone] - if severe and also needs BCP
  5. Danazol (Androgen that ⬇︎ estrogen and inhibits ovulation but also –> wt gain & hirsutism)
  6. Leuprolide (GnRH R agonist that inhibits ovulation but also –> hot flashes)
363
Q

Indications for POIUD (Progesterone only IUD) - 3

Brand Name: Mirena

A
  1. Birth Control (some still have periods but w/⬇︎ bleeding)
  2. Leiomyoma Fibroids (MOA: ⬇︎Menstrual flow by ⬇︎Uterine volume and endometrial atrophy)
  3. Dysmenorrhea

This stays in place for 5 years!

364
Q

Side Effects / Complications of POIUD (Progesterone only IUD)- 8

A
  1. Irregular bleeding (possibly up to 6 mo.)
  2. Lower abd pain (do w/u if fever present)
  3. Breast TTP
  4. Bleeding & cramping x 3 days post insertion (ibuprofen tx)
  5. Uterine perforation during insertion
  6. Infectious risk within first 20 days of insertion
  7. Uterine expulsion
  8. dyspareunia
365
Q

Contraindications for Progesterone only IUD - 4

A
  1. Infection
  2. CA
  3. HA hx = relative ctd
  4. Vascular disease = relative ctd
366
Q

Describe ParaGard ; What demographic uses this? ; Side Effects?-2

A

Copper IUD that stays in uterus for up to 10 years ; Women who don’t want kids EVERR

  1. Dysmenorrhea
  2. Menorrhagia
367
Q

APGAR is used to assess newborn status immediately postpartum

Describe the grading system for Respiration?

A

APGAR

0 = not breathing

1 = breathing slow/irregular

2 = crying

368
Q

APGAR is used to assess newborn status immediately postpartum

Describe the grading system for Pulse?

A

APGAR

0 = No HR

1 = < 100 bpm

2 = > 100 bpm

369
Q

APGAR is used to assess newborn status immediately postpartum

Describe the grading system for Activity & tone?

A

APGAR

0 = no motion

1 = arms & legs flexed but not active

2 = Active Motion of extremities

370
Q

APGAR is used to assess newborn status immediately postpartum

Describe the grading system for Grimace & reflex irritability?

A

APGAR

Test response to stimulation (i.e. pinch)

0 = no rxn

1 = grimace

2 = grimace AND cough/cry/sneeze

371
Q

APGAR is used to assess newborn status immediately postpartum

Describe the grading system for Appearance?

A

APGAR

0 = entirely blue

1 = pink with blue extremities

2 = entriely pink

372
Q

Causes of insomnia in elderly -8

A
  1. DEPRESSION/ANXIETY
  2. OSA
  3. Environment (noisy, uncomfortable bed)
  4. Drugs (rx, caffeine, EtOH) -avoid caffeine/EtOH 5 hrs prior to bedtime
  5. Restless Leg Syndrome
  6. Cardiorespiratory DO–> SOB–> insomnia
  7. GERD
  8. Hyperthyroidism

Don’t confuse with Advanced Sleep Phase syndrome in which elderly get sleepy earlier and wake up at 3 AM

373
Q

What is the diagnositic criteria for Major Depression DO? - 3

A
  1. At least 5 out of 9 of SIG E CAPSS for
  2. ≥2 weeks
  3. At least 1 must be Sadness or Interest loss anhedonia

SIG E CAPSS

374
Q

The diagnositic criteria for Major Depression DO assess for 9 major sx

What are they?

A

SIG E CAPSS

Sadness most of day/everyday

Interest loss anhedonia most of day/everyday

Guilt & worthlessness

Energy deprived & fatigued

Concentration loss

Appetite ⬇︎

Psychomotor agitation/retardation observable by others

Sleep ∆ (insomnia vs Hypersomnia)

Suicidal ideation (thinking about it but haven’t acted yet)

375
Q

A pt has just experienced death in family and is bereaving

How long before MDs consider MDD as the dx instead? ; What are s/s of diagnosis being MDD?-6

A

2 months after loss ;

  1. Guilt about things irrelevant to the loss
  2. Thoughts of death not related to the loss
  3. Morbid preocupation with worthlessness
  4. Marked pscyhomotor retardation
  5. Prolonged functional impairment
  6. Hallcuinating about things that are not related to the loss
376
Q

Describe the clinical tool used to assess whether a pt is seriously contemplating suicide

A

SAD PERSONS

Each is worth 1 point and [normal <– 4–(outpt tx)–7 –> Hospitalize now!]​

Sex Male

Age external to 19-45

Depression diagnosis hx

Previous attempt hx

EtOH/substance abuse

Rational thinking impaired (psychosis, delusions, hallucinations)

Social support lacking

Organized plan

No significant Other

Sickness physically

377
Q

Common side effects of SSRIs/SNRIs - 4

A
  1. HA
  2. Sleep ∆
  3. GI distress
  4. ⬆︎Fall risk in elderly
378
Q

Risk factors for Elderly abuse - 5

A
  1. Dementia
  2. Shared living w/abuser (except in financial abuse)
  3. Caregiver is substance abuser or mentally ill
  4. Heavy dependence of caregiver on elder
  5. Social isolation of elder from everyone except abuser
379
Q

hypothyroidism, Parkinson’s disease and Dementia all can mimic or present with depression

What type of lab w/u is warranted to evaluate for Fatigue or Depression and why for each? - 3

A
  1. TSH (detect hypothyroidism)
  2. CBC (detect anemia and vitamin deficiencies)
  3. CMP (detect electrolyte, renal, hepatic problems)
380
Q

What are the 2 major tx modalities for insomnia?

A
  1. CBTi (Cognitive Behavioral Therapy for insomnia) - sleep hygiene instruction/sleep restriction/sleep compression
  2. Rx (Non-Benzos (Zolpidem) and Melatonin R Agonist)
381
Q

Main tx options for Major Depression Disorder - 5

A
  1. SSRI/SNRIs > TCAs
  2. CBT Psychotherapy
  3. Exercise
  4. Avoidance of recreational substances (includes EtOH!)
  5. ElectroConvulsive Therapy
382
Q

All SSRIs have a unique Side Effect profile. Give a brief description of the following:

Fluoxetine

Sertraline

Paroxetine

Fluvoxamine

A
  1. Fluoxetine = LONG 3 DAY HALF LIFE but SE c/w general SSRI SE
  2. Sertraline = Used in pregnancy/breastfeeding, worse SE are mostly GI distress
  3. Paroxetine = CATEGORY D, best studied SSRI in kids, and high risk of antidepressant d/c syndrome
  4. FluVoxamine = Very useful for OCD but causes Vomiting
383
Q

All SSRIs have a unique Side Effect profile. Give a brief description of the following:

Citalopram

EsCitalopram

A
  1. Citalopram = QT prolongation in pts > 60 yo
  2. Escitalopram = specifically for GAD
384
Q

Guidelines for HTN screening

A

Age > 18 yo

385
Q

What is a Normal BP? PreHTN? What is BP for HTN?

A
  • Normal = 120 / 80
  • PreHTN = Between [Normal and 140 / 90]
  • HTN = > 140 (or 150 in age older than 60) / 90

Must be HTN for [2 measurements], [5 min apart], [one on each arm] in [at least 2 visits]

386
Q

What are the serious / end-organ complications of chronic HTN (BP > 140/90) ? - 5

A
  1. Stroke
  2. Retinopathy
  3. Heart (aFib,failure,angina,LVH,CAD)
  4. Renal Failure
  5. PAD
387
Q

What are the recommended allotments for EtOH in Men-2? What about Women- 2?

A

Men = [≤ 2 drinks/ day] and [≤ 4 drinks/ social occasion]

Women = [≤ 1 drink / day] and [≤ 3 drinks/ social occasion]

1 drink = (12ozBeer / 10ozWine / 3ozWhiskey)

388
Q

Main causes of Secondary HTN - 12

A
  1. Renal Parenchymal Disease (⬆︎creatinine)
  2. Renal artery stenosis (Systolic > 180, Abd bruit, >55 yo)
  3. Primary Aldosteronism
  4. Pheochromocytoma (HA, diaphoresis, palpitations)
  5. Cushing Syndrome
  6. OSA
  7. hypOthyroidism
  8. Primary HyperParathyroidism
  9. Coarctation of Aorta
  10. Excess EtOH > 2 drinks/day
  11. Stress (via release of NorEpi & Angiotensin 2)
  12. Meds (OCP/Decongestants/NSAIDs/steroids)
389
Q

What are s/s of lower extremitiy Peripheral Artery Disease? - 5

A
  1. Diminished pulses
  2. Cold Skin
  3. Red Skin
  4. Hairless
  5. Thick toenails
390
Q

What are important elements for properly taking BP? - 4

A
  1. Pt seated quietly in chair with back supported for ≥5 min
  2. Arm supported at heart level
  3. Length of cuff ≥80% of arm
  4. width of cuff ≥40% of arm
391
Q

Lab w/u for NEW HTN pt during initial evaluation - 6

A
  1. EKG
  2. CBC (anemia ⬆︎risk for stroke/MI in HTN pts)
  3. CMP
  4. UA (check microalbuminemia)
  5. Blood Glucose
  6. Creatinine (serum and urine albumin/creatinine ratio)

Don’t order TSH unless thyroid disease is actually suspected

392
Q

What is the recommended HTN agents for:

NonBlack < 60 yo - 4

A

DACB

1st: Diuretic thiazides
2nd: ACE/ARBs
3rd: Ca+ channel blockers
4th: Beta blockers [Not JNC recommended]

393
Q

What is the recommended HTN agents for:

ALL Black people (except those with CKD) - 2

A

DC

1st: Diuretic thiazides
2nd: Ca+ channel blockers
* Blacks should always be started with* DC first since they have Darker Color :-)

394
Q

What is the recommended HTN agents for:

NonBlack ≥ 60 yo - 4

BP Goal is 150 / 90 unless there is CKD or DM

A

DACB

1st: Diuretic thiazides
2nd: ACE/ARBs
3rd: Ca+ channel blockers
4th: Beta blockers [Not JNC recommended]

395
Q

What is the recommended HTN agents for:

ANYONE with CKD (+/- proteinuria) - 3

BP Goal is 140 / 90

A

ACE/ARBs > Diuretic thiazides > CCB

396
Q

Why is it futile to ⬆︎ a pt’s [25 mg qd HCTZ regimen]

A

Doses of HCTZ > 25 mg DO NOT ⬇︎BP further

Be sure to start elderly at 6.25 mg qd since they are sensitive!

397
Q

List the main lifestyle modifications that contribute to BP control - 6

A

“this WEEENS you off HTN, HLD and DM!”

WtLoss / Eating / EtOH / Exercise / Na+ / SmokingCessation

DASH = diet rich in fruits/vegetables/lowfat dairy/low fat/fatty fish Omega3fattyAcids

398
Q

List the Blood Pressure Goals - 2

A
  1. Majority (includes CKD & DM pts) = <140/90
  2. Pts ≥ 60 yo WITH NO CKD OR DM = <150/90
399
Q

DDx for persistent cough & wheezing -10

A
  1. ASTHMA
  2. UACS-PND (Upper Airway Cough Syndrome Post Nasal Drip)
  3. GERD (dx: esophageal pH studies)
  4. Smoking
  5. Post-infectious cough
  6. COPD
  7. Vocal Cord dysfunction
  8. CHF (2/2 to infectious myocarditis in kids)
  9. NAEB (NonAsthmatic Eosinophilic Bronchitis)
  10. foreign body
400
Q

What are the comorbid conditions of asthma that requrie tx in order to help treat asthma itself? - 5

A
  1. GERD
  2. Obesity
  3. OSA
  4. Rhinitis/Sinusitis
  5. Depression
401
Q

Diagnostic clinical criteria for diagnosing Acute Sinusitis-2 in adults ; What about Chronic Sinusitis?

A

Must have 2 out of 4 clinical sx + Radiological evidence :

Sinusitis Never Feels Merry

  1. Smell loss
  2. Nasal congestion
  3. Facial fullness/pressure/pain
  4. Mucopurulent drainage

CHRONIC Sinusitis = same sx but last > 3 months

Biggest difference between bacterial and viral sinusitis is that viral gradually improves

402
Q

Why is it important to inquire about Aspirin in pts with Asthma?

A

21% of Adults with asthma have ASA-induced asthma and thus, should avoid ASA and NSAIDs

403
Q

What are the 5 factors that determine how severe asthma is?

A

Adult step-wise tx = BILIO

  1. sx frequency
  2. nighttime awakenings frequency
  3. Use of Albuterol for sx control frequnecy
  4. level of interference with normal activity
  5. Lung Function [FEV1 value & FEV1/FVC ratio]
404
Q

What is the biggest long term effect of uncontrolled asthma

A

inability to REVERSE airway obstruction 2/2 airway remodeling

405
Q

Viral Rhinosinusitis and Bacterial Sinusitis are difficult to distinguish

What is the main distinguishing factor? - 2

A

Viral Rhinosinusitis last < 10 days and is not worsening

406
Q

Dx for Asthma - 3

A
  1. ⬆︎FEV1 by > 12% with bronchodilator OR
  2. ⬆︎[FEV1 % Predicted] by > 10% with bronchodilator
  3. [Accurate H & P + #1] for kids

Be sure to obtain CXR to ensure nothing else causes cough

407
Q

Asthma Etx

A

Excess TH2 cells (recruited by hypersensitive APC to inhaled allergens) secrete IL4 –>activates [B-lymphocyte class switching for IgE Ab]–> IgE binds to Mast cells which will then secrete IL5 –> Recruits Eosinophils–>which release mediators like Leukotrienes –> REVERSIBLE AIRWAY OBSTRUCTION

408
Q

Tx for Allergic Rhinitis and/or Chronic Sinusitis - 3

A

Antihistamine

+

Nasal CorTicoidSteroid

+/- [nasal saline irrigation]

409
Q

List the 5 Step action plan for treating Asthma in Adults

A

BILIO

1st: B2 agonist ( use ≤ 2x/week)
2nd: Inhaled CTS
3rd: LABA vs LAA vs Leukotriene R blocker
4th: Increase Inhaled CTS
5th: Oral CTS +/- Anti-IgE

410
Q

Which Adults should receive the Pneumococcal 23 valent vaccine (Pneumovax) specifically? - 6

A

​ALL 19-64 yo with Chronic….

  1. Heart Disease (CHF,CAD,cardiomyopathy)
  2. Lung Disease (COPD, emphysema, asthma)
  3. Liver Disease [also give Hep B vaccine]
  4. Alcoholism
  5. DM [also give Hep B vaccine]
  6. ≥ 65 yo
411
Q

What is CAGE and how is it interpreted?

A

CAGE = Determines EtOH abuse; ≥ 2 positive answer = EtOH abuse/dependence

  1. ever tried to Cut back on drinking?
  2. Angry when someone criticizes ur drinking?
  3. Guilty about how much you drink?
  4. Eye opener needed in morning to prevent withdrawal/calm nerves?
412
Q

PE findings for Appendicitis (5)

A

PMR PD

  1. Peritoneal signs (Rebound, Guarding)
  2. McBurney’s point TTP
  3. [Rovsing’s LLQ TTP]
  4. [Psoas & Obturator sign]
  5. DEC bowel sounds
413
Q

DDx for RUQ abd pain - 5

A
  1. Biliary Colic 2/2 CholeDocholethiasis
  2. Cholecystitis
  3. Duodenal ulcer (also causes epigastric pain, relieved by antacids)
  4. Atypical acute pancreatitis
  5. Atypical Hepatitis (usually is chronic)
414
Q

classic w/u for RUQ abd pain - 6

A
  1. CBC (look for leukocytosis and anemia)
  2. CMP (look at electrolytes)
  3. LFTs (liver and biliary involvement)
  4. Lipase/Amylase (pancreas)
  5. UA (renal involvement)
  6. abd UltraSound > KUB(use for perforation/obstruction)
415
Q

Mngmt for [Gallstones with biliary colic] (2)

A
  1. [Elective Lap Chole]
  2. [Ursodiol (ursoDeoxycholic acid) in poor surgical candidates]
416
Q

Mngmt for Complicated Gallstones (Acute cholecystitis vs. CholeDocholithiasis vs. Gallstone pancreatitis)

A

Cholecystectomy within 72 hours!

Acute Cholecystitis = inflammation & distension of gallbladder from [cystic duct obstruction]

417
Q

After RUQ UltraSound, when is the following imaging indicated for Gallbladder stone pt:

HIDA

ERCP-2

A
  • HIDA = assess for gallbladder dysfunction when RUQ US shows no GB stones
  • ERCP = [use if Jaundice or gallstone pancreatitis is present suggesting CholeDocholelithiasis] or for [repeat episodes of biliary colic]

MRCP is similar to ERCP but is only diagnostic

418
Q

What is the % chance a pt who’s had TIA will have a stroke in 1 week? what about 1 month?

A

12% ; 15%

419
Q

What is the purpose of the NIHSS (National Institute of Health Stroke Scale)

A

Assess stroke-related neuro deficits, determines appropriate tx and predicts pgn

420
Q

You suspect a pt had a Stroke

After FIRST, ruling out Hemorrhagic stroke with _____, when should thrombolytic therapy be given? What should be given?

A

NonContrast Head CT; WITHIN 3 HOURS OF SX ONSET! ; IV Alteplase

421
Q

You suspect a pt had a Stroke

After FIRST, ruling out Hemorrhagic stroke with _____, when can Intra-Arterial therapy be given?

A

NonContrast Head CT; WITHIN 6 HOURS OF SX ONSET!

422
Q

What are some causes of aFib with RVR - 6

A
  1. Fever
  2. cardiac infection (myocarditis/pericarditis)
  3. volume depeletion
  4. Thyrotoxicosis
  5. Catecholamines
  6. AV node dysfunction
423
Q

What portion of stroke pts develop post-stroke depression? What’s the tx?

A

1/3 ; SSRIs

424
Q

Purpose of TUG (Timed Up & Go test)

A

Measures mobility and fall risk

pt may wear usual footwear and any assistive device they normally use

425
Q

Describe Todds Paralysis

A

Self-limited focal (ipsilateral UE and LE) paralysis after seizure that resolves naturally within 36 hours

426
Q

What w/u should be ordered for pt suspected of having stroke?

A
  1. Head CT/MRI
  2. EKG
  3. Renal function/CMP
  4. troponin
  5. O2 saturation
  6. CBC
427
Q

Pt just had a stroke recently and now wants px

What are the therapy regimens for prevention of stroke? - 3

A
  1. Give ASA vs [ASA + Clopidegrel] vs Warfarin after first stroke
  2. START WARFARIN FOR SURE after second stroke (if warfarin contraindicated, use only ASA)
  3. Give WARFARIN vs NOAC if pt has aFib after ANY stroke

Also make sure pt is on a Statin

428
Q

When should Rehab begin for stroke pts?

A

Within 1-2 days after stroke

429
Q

What’s the recommended sodium limit for pts with hx of stroke?

A

< 24 grams / day with a Mediterranean diet

430
Q

What is the recommended amount of physical activity adults should do?

A

≥40 min moderate intensity/session x 4/week (or every day if trying to lose weight!)

Moderate intensity = Target heart Rate = ([220-age) x 0.7]

431
Q

Name 4 NON-musculoskeletal causes of Shoulder Pain

A
  1. MI
  2. Lung CA
  3. Cholecystitis
  4. Rupturued Ectopic pregnancy
432
Q

Pt may possibly have Septic Glenohumeral Arthritis or Septic Subacromial Bursitis

How should you manage this pt? - 4

A
  1. Urgent US/MRI
  2. Urgent Orthopedic consult
  3. Aspiration w/culture
  4. Hospitalization if dx is confirmed
433
Q

CP of somone with Shoulder Impingement Syndrome

A
434
Q

CP of somone with Fracture of Clavicle or Sprain of AC joint

A
435
Q

CP of somone with Torn rotator cuff

A
436
Q

What does it mean to have loss of Active AND Passive ROM, vs just Active ROM?

A
  1. loss of Active AND passive ROM = Joint Disease
  2. loss of only Active ROM = muscle tissue disease
437
Q

What are the joint diseases (produce Active AND passive ROM restriction)?

A
  1. Adhesive Capsulitis (contracture of joint capsule)
  2. GlenoHumeral Arthritis
438
Q

What are the muscle tissue issues that only restrict Active ROM

A

Rotator Cuff Tear and impingement

439
Q

What are the major Stabilizers of the shoulder joint? - 3

A
  1. Labrum
  2. Rotator muscle group
  3. Glenohumeral Capsular Ligament
440
Q

Describe the “Empty-Can” test and which muscle it test for?

A

[90° ABduction of arm] + [30°flexion of arm forward] + [thumbs pointed toward floor] + [must resist downward pressure] –> Pain = [Supraspinatus Rotator cuff injury]

441
Q

Name the Rotator Cuff Muscles ; What are each of their functions?

A

Supraspinatus initiates shoulder ABduction

442
Q

What are the two test used to test for Shoulder Impingement?

A
  1. Neer
  2. Hawkins Kennedy (more specific)
443
Q

Rotator Cuff Tendinopathy is 1 of the 4 main causes of Shoulder Pain worst w/mvmnt

Describe CP-3 ; Name the other 3 major causes

A
  1. Positive Apleys Scratch test
  2. Weakness and pain with empty can test
  3. Limited ACTIVE ROM

Torn Rotator Cuff

Impingement Syndrome w/bursitis

Labral Tear

444
Q

Torn Rotator Cuff is 1 of the 4 main causes of Shoulder Pain worst w/mvmnt

Describe CP-2 ; Name the other 3 major causes

A
  1. Limited ACTIVE ROM w/major pain
  2. MAJOR weakness with strength testing

Rotator Cuff Tendinopathy

Impingement syndrome w/bursitis

Labral Tear

445
Q

Labral Tear is 1 of the 4 main causes of Shoulder Pain worst w/mvmnt

CP ; Name the other 3 major causes

A

Clunk and O’Brien’s test positive

Rotator Cuff Tendinopathy

Impingement syndrome w/bursitis

Torn Rotator Cuff

446
Q

Tx for Rotator Cuff injury/impingement - 3

A
  1. Rest
  2. Physical Therapy
  3. NSAIDs prn
447
Q

What is the leading cause of death in the U.S.

A

CAD

448
Q

What is the test of choice for diagnosing LVH? What does LVH look like on EKG?-2

A

Echo ;

EKG:

  1. LARGE S wave in V3
  2. ST depressions w/T wave inversion in V5-6
449
Q

All pts with Systolic HF ALSO has Diastolic HF, but not necessarily the other way around

Between Systolic and Diastolic HF pts, which have better pgn?

A

Diatolic HF w/preserved EF (HFpEF)

450
Q

What value of BNP indicates CHF dx

A

≥ 100 pg/mL

Note: BNP is excreted by Kidneys = Naturally Elevated in Renal Failure pts!

451
Q

Most common cause of CHF

A

Ischemic Cardiomyopathy (scarring of myocardium from ischemia –> ⬇︎systolic function)

Other causes include: MI vs Arrhythmia vs HTN

452
Q

For pts presenting with chest pain, how are their CAD pre-test probabilities categorized?

what about pts not presenting with chest pain?

A

Use the nomogram to calculate

low risk= < 10%

Intermediate risk= Everyone Else

HIGH risk = > 80%

Pts not presenting with chest pain, use ASCVD 10 year risk

453
Q

List the diagnostic test for CAD pts with Intermediate pre-test probability? - 3

A
  1. Exercise EKG Treadmill Testing =usually initial test (note: this test has low negative predictive value & not great for women)
  2. Stress Echo
  3. Nuclear Stress testing
454
Q

How do you slow the progression of CAD - 7

A
  1. Glucose control
  2. BP control
  3. Cholesterol control
  4. Weight control
  5. ASA
  6. Immunizations (Flu, Pneumo23)
  7. Beta Blockers
455
Q

Recommended target BP for diabetics

A

< 140 / 90

456
Q

What is the recommended guidelines for cholesterol management in Type 1 or 2 DM pts? - 2

A

DM1 or 2 pts ➕ LDL > 70 ➕ age 40-75 yo should be on

  1. moderate-intensity statin PERIOD
  2. OR HIGH-intensity if 10 year ASCVD risk ≥7.5%

Remember that ANY pt > 21 yo with LDL > 190 = Use HIGH-dose STATIN!

457
Q

Which tx is the mainstay of managing NYHA systolic HF? ; What are the other tx?

A

ACE inhibitors ;

  1. ARBs (alternative to ACE)
  2. Digoxin
  3. Lasix
  4. Beta Blockers (Metoprolol Succinate / Bisoprolol / Carvidolol)
  5. Eplerenone
458
Q

Main tx for Diastolic HF - 2

A
  1. Beta Blocker
  2. Diltiazem

This is because excessive Diuresis and preload reduction may exacerbate Dilated HF

459
Q

List the 9 main causes of Dyspnea

A

I CoughCCAAPPP

Interstitial Lung Disease

CHF

Cancer Lung

COPD (wheezing + Prolonged expiration)

Asthma (wheezing + Prolonged expiration)

Acute Coronary Syndrome (Angina/Cardiac MI)

PE

PNA

PTX

Don’t forget psychogenic, neuro related and Anemia

460
Q

Which 4 features, GREATLY predict the chances a pt has COPD

A
  1. > 40 pack year smoking
  2. ≥45 yo
  3. Max laryngeal height of 4 cm or less
  4. Self-reported hx of COPD
461
Q

List the major symptomatology differences between COPD and Asthma

A

COPD = macrophages/TKiller cells/neutrophils

Asthma = Mast cells/ Helper T cells/eosinophils

462
Q

Clinical diagnosis of COPD should be made when?-4 ; How is this confirmed?

A

All 4:

  1. Adult ≥ 45 yo (if younger, consider alpha1AntiTrypsin deficiency)
  2. Productive Cough
  3. SOB
  4. > 40 pack year smoking hx

Confirm with Spirometry of FEV1/FVC < 70% (or 5th %tile) & irreversible, DON’T USE CXR to diagnose COPD

463
Q

What are 3 great statements to say to smokers to help them quit

A
  1. Your lungs will work better within first year of quitting!
  2. When u quit, ur lungs won’t age as quickly
  3. Even if you quit and start again, there may be beneift for you

Get them in Group tx!

464
Q

Based on GOLD Criteria, how should COPD pts be treated?

A
466
Q

Tx for COPD Exacerbation-4

Which improves survival? Which ⬇︎future events?

A

“I’m having COPD Exacerbation! Give me DOPA! (but not really)”

  1. Duoneb (albuterol + ipratropium)
  2. O2 PRN via BiPAP (goal: 90-94% O2 Sat) -only when desat
  3. [Prednisone 40 mg qd x 5]
  4. Abx (Azithro-⬇︎future events vs Levoflox vs Doxy)-only in situations in image
467
Q

Progressive Dyspnea on exertion is a cardianl sx for what conditions? - 2

A
  1. Mitral Stenosis
  2. COPD
468
Q

Orthopnea differs from Paroxysmal Nocturnal Dyspnea in that it occurs while pt is awake EVERY time they lie down

Which conditions are associated with Orthopnea? - 6

A
  1. CHF which can –> Pulmonary Edema
  2. Pulmonary edema
  3. Asthma
  4. Chronic Bronchitis
  5. OSA
  6. Panic Disorder
469
Q

Most common sx of Pulmonary Embolism-5

A
  1. Pleuritic Chest Pain
  2. SOB
  3. Cough
  4. Tachypnea
  5. Tachycardia

Physical Exam: Rales, low Fever, Hemoptysis

470
Q

Clinical Presentation of Albuterol (SABA) overuse - 3

A
  1. Tachycardia palpitations
  2. Tremor
  3. hypOkalemia (especially if Diuretic Thiazide on board)
471
Q

What are the major causes of COPD exacerbation?

A
  1. Air pollution
  2. TracheoBronchial tree infection
  3. Idiopathic
472
Q

Recommended guidlines for screening for AtheroSclerotic CardioVascular Disease - 4

A
  1. in adults > 21 yo
  2. Draw Lipid Panel and assess major ASCVD risk factors
  3. at least 8 hours after last food intake
  4. every 4-6 years
473
Q

List beneficial effects of moderate EtOH intake - 2

A
  1. ⬆︎HDL
  2. ⬇︎clotting
474
Q

Describe the USPSTF grading system - 5

A

Grade…

  • (A): Service is Recommended and has net benefit that is substantial
  • (B): Service is Recommended and has net benefit that is moderate to substantial
  • (C): Service should not be routine and should be based on individual pt since net beneift is small
  • (D): Recommended AGAINST
  • (I): Insufficient Evidence
475
Q

Guidelines for Hepatitis C screening - 3

A
  1. One time screen in
  2. adults born between 1945-65
  3. who are high risk
476
Q

Guidelines for Prostate CA screening

A

NO routine screening in asx Men!

USPSTF Grade D

477
Q

Indications for Routine Exercise Stress Testing in asx pts - 2

A
  1. Males > 45 yo ➕
  2. ≥ 1 Risk factor for ASCVD (HLD,HTN,Smoking)

Do NOT get Exercise Stress Testing if ACS dx is already pretty certain

478
Q

What are the 3 C’s of addiction?

A
  1. Compulsion to use
  2. Control is lost
  3. Continues despite consequences
479
Q

When someone is attempting to change behavior, describe the stages they go through? - 4

A

PCAR

  1. PreContemplative = Not aware or don’t care about changing behavior
  2. Contemplative = Interested in changing behavior
  3. Active = ACTIVE in making behavior change
  4. Relapse = attempted change but is not longer doing it
480
Q

What food assessment tool is used to determine nutritional deficiencies and excesses over a month?

A

the REAP tool

(Rapid Eating and Activity assessment for Patients)

481
Q

[Atrial Fibrillation] is the most common tachyarrhythmia. It is often precipitated by what 4 things?

A

“Smh, SAME Afib as before!”

  1. Sympathetic tone ⬆︎
  2. Acute Systemic Illness (Hyperthyroid / HF / HTN)
  3. Mitral or Aortic Stenosis
  4. EtOH - excess
482
Q

You ask a pt with chest pain to characterize the chest pain

What characterization of chest pain typically excludes Acute Coronary Syndrome as the dx

A

describing it as STABBING = NOT ACS/CAD

Pleuritic, pulsating, positional also ⬇︎ ACS likelihood

483
Q

Many Women with MI don’t report having cp before the MI

Why is this?

A

Angina reported by women is most likely atypical and may not include actual chest pain! which –> Women are more likely to DIE from ACS even tho they’re diagnosed less

may include neck-jaw pain/NV/indigestion/SOB

484
Q

What are HPI items that suggest palpitations is cardiac-related? - 4

A
  1. palpitations > 5 min
  2. irregular beat
  3. previous heart disease hx
  4. Male
485
Q

EKG and physical exam aren’t enough to rule in or out ddx for palpitations

What is? - 2

A
  1. Exercise Stress Test
  2. +/- 2 week loop monitoring

Be sure there’s a HIGH Pre-test probability

486
Q

DDx for constant Knee pain in Adults - 10

A
  1. Pes Anserine Bursitis (2/2 overuse)
  2. Ligamental Sprain 2/2 acute trauma
  3. Inflammatory chronic arthropathies (RA, septic arthritis, Reiter’s)
  4. iLiotibial Band tendonitis (lateral knee pain)
  5. Septic arthritis
  6. Osteoarthritis
  7. Psoriatic arthritis
  8. Gout
  9. Popliteal Baker’s Cyst
  10. PatelloFemoral Anterior Knee syndrome (dx of exclusion)

Be sure to determine if pain is acute or gradual

487
Q

Give Descriptions that differentiate

Gout vs Rheumatoid Arthritis vs Osteoarthritis

A

Gout = great toe or knee

RA = ≥3 joints, bilateral (including hands & feet + subQ nodules)

Osteoarthritis = Asymmetrical involvement of Back, Hips, Knees worst w/activity (joint space narrowing on xray)

488
Q

You perform an Arthrocentesis on a pt with knee pain

Which labs do you order for the drawn fluid? - 6

A
  1. Cell count w/differential
  2. Glucose
  3. Protein
  4. Bacterial cx and sensitivity
  5. Polarized light microscopy for crystals
  6. Gross analysis for blood (simple joint effusion vs hemarthrosis)
489
Q

You perform a Knee joint Arthrocentesis

What do these colors of effusion represent?

Straw

Yellow/Green

Cloudy

Red/Pink

A

Straw = normal synovial fluid (in setting of effusion = OA, Meniscal degenerative injuries)

Yellow/Green Snot = Septic arthritis and Inflammatory arthritis

Cloudy = Crystals or ⬆︎WBCs

Red/Pink = Trauma (ACL damage/Acute Meniscal tear/Osteochondral fx-also has fat globules)

490
Q

Major side effects of NSAIDs - 5

A
  1. GI damage
  2. Secondary HTN
  3. Bleeding (DO NOT USE WITH WARFARIN)
  4. ⬇︎Efficacy of BP meds
  5. ⬆︎ Efficacy of Sulfonylureas –> possible hypoglycemia
491
Q

Which components of the knee does the Valgus and Varus stress test analyze? - 2

A
  1. Medial Collateral ligament
  2. Lateral Collateral ligament
492
Q

Which components of the knee does the McMurray test analyze? - 2

A
  1. Meniscus Medial
  2. Meniscus Lateral
493
Q

Carpal Tunnel Syndrome Clinical Presentation - 4

A
  1. Paresthesia vs Pain with Median n. Distribution worst at night
  2. [Thenar ABductor pollicis brevis] atrophy (⬇︎flexion/ABduction/Opposition)
  3. Tinel Sign (tapping over flexor surface ⬆︎ sx)
  4. Phalen Sign (flexing Wrist ⬆︎ sx)

CARPEL TUNNEL STARTS uL and –> BL

494
Q

Indications for obtaining Xray imaging for pt with knee pain - 3

A
  1. Uncertain diagnosis
  2. Assessment of Severity/location
  3. Refractory to conservative tx

Only obtain MRI if locking, popping or joint instability are concern

495
Q

Expected Xray findings for pt with osteoarthritis of knee - 4

A
  1. JOINT SPACE NARROWING (best predictor of disease progression)
  2. Subchondral sclerosis
  3. Subchondral cyst
  4. Osteophyte bone spurs (best correlate for degree of pain)
496
Q

EMG is the preferred dx test for Carpal Tunnel Syndrome but dx is usually made via clinical s/s

When is it indicated to obtain? - 3

A
  1. [Thenar ABductor pollicis brevis] atrophy present
  2. motor dysfunction present
  3. refractory to conservative tx
497
Q

Osteoarthritis tx - 7

A
  1. Exercise (Swimming/tai chi/resistance/wt loss)
  2. APAP
  3. NSAIDs
  4. IntraArticular CorticoSteroid injections (short term, for actively inflammed joints only and can only give ≤ 3 per year)
  5. Tramadol
  6. Omega3Fatty Acid supplement
  7. Acupunture
  8. SAM-e (S Adenosylmethionine) - same as NSAIDs
498
Q

Indications for referring Knee pain patient to orthopedics for knee replacement

A

When conservative tx have failed

499
Q

What are the major classes of drugs used to treat Chronic Pain - 2

A
  1. Opioids
  2. TCAs
500
Q

3 main causes of Dementia

A

Alzheimers > Vascular > DLB (Dementia with Lewy Bodies)

501
Q

Dementia with Lewy Bodies (DLB) CP - 3

A

DLB at the DMV

  1. Dementia confusion periodically
  2. MichaelJFox Parkinsonism (PARK + hamp) tht does NOT respond to dopaminergic tx
  3. Visual Hallucinations

Lewy Body= [LABS (Lewy α-synuclein BodieS)] that are Eosinophilic intracytoplasmic accumulations

502
Q

What is Respite Care and who does it help?

A

Replaces caregiver of disabled/elderly pt with fam member or paid professional for a block of time to allow stress decompression of caregiver ; Caregivers

Best example of Respite Care = Adult Day program

503
Q

What is the CAM score and describe its criteria

A

CAM score = Diagnosis Delirium and differentiates it from Dementia/Depression.

AIDA: Requires A and I, but only either D vs. A

Acute onset and fluctuating

Inattention (spell “world” backwards & forward)

Disorganized thinking (rambling/illogical)

Altered level of consciousness (intermittently not alert)

505
Q

How do Older Adults typically present with Depression?

A

With c/o somatic complaints (i.e. sleeping problems) instead of mood changes

506
Q

Broad DDx for Altered Mental Status (specifically Delirium)

Use VINNDIICAATE

A

V: [CVA/TIA] /HTN Encephalopathy/Arrhythmia/MI

I: Withdrawal / ilicits / Wernickes/Benzo/[Anticholinergics]/Antihistamines/opioids/TCA

N: Tumor

N: Seizures post-ictal / NPH / Pain

D: Na+ ∆/Glucose∆/⬆︎calcemia/ ⬇︎K+ /O2, CO2/B12 deficiency/Uremia/Dehydration

I: Encephalitis/Meningitis/UrosepsisUTI/PNA/Endocarditis

I: Fecal impaction/PostOp/⬇︎Sleep/Urine retention

C:

A:

A:

T: ICH/ SDH / Restraints

E: thyroid

Tx: Haloperidol, Risperidone, Quetiapine

507
Q

What does the MMSE (MiniMental State Exam) assess for?

A

Cognitive Function (NOT DELIRIUM)

New Alternative is now the MoCA (Montreal Cognitive Assessment)

508
Q

What is the score interpretation for the MMSE

A

< 19 = impaired

509
Q

Tx for Delirium

A

PO haloperidol - short course

alternatives: Aripiprazole/Olanzapine/Risperidone are better for Elderly

510
Q

List ways to minimize Delirium in hospital setting - 4

A
  1. Frequently Reorient and stimulate pt w/familiar staff
  2. Avoid delirium-causing meds (opioids/TCA/benzo/anticholinergics/antihistamine)
  3. Get the up and moving! (also ⬇︎decubitus ulcers)
  4. ⬇︎length of time for catheters!
511
Q

Alzheimer’s tx - 7 ; Which medication should be used last?

A

CLAV –> HANDU

  1. Donepezil - AChnesterase inhibitor
  2. Tacrine - AChnesterase inhibitor
  3. Rivastigmine - AChnesterase inhibitor
  4. Galantamine - AChnesterase inhibitor
  5. Memantine - NMDA R Blocker: USE LAST
  6. Respite Care for Caregivers (ex: Adult day program)
  7. Atypical antipsychotics - Olanzapine vs Risperidone (for acute psycosis)
512
Q

Colorectal CA risk factors - 8

A
  1. Age > 50 yo
  2. Black Male
  3. DM
  4. IBD
  5. Hereditary conditions (FAP)
  6. Colorectal/Endometrial/Ovarin/Breast/adenoma CA hx
  7. 1st degree relative with adenomas before 60 yo
  8. 1st degree relative with CRC

Fat intake ⬆︎risk for adenomas which –> ⬆︎risk for CRC

513
Q

Why is obtaining CT pelvis/abd and CXR appropriate for Colorectal CA w/u?

A

Clinical staging of CRC is based on depth of invasion and because of metz to Lung, Liver and Pelvic lymph nodes, imaging of these areas is warranted

514
Q

Is CEA used for Colorectal CA diagnosis or prognosis? explain

A

PROGNOSIS only! ; CEA > 5 = Worst Pgn

CEA can’t be used for dx because it’s found in benign conditions

515
Q

Describe a compassionate approach to delivering bad news - 7

A

SPIKESS

  1. Set up interview in private room, face2face
  2. Perception of what pt understands should be assesed
  3. Information should be delivered according to pt preference
  4. Knowledge given in non-tech and emotional way
  5. Empathetic responses given for Emotional response
  6. Strategy laid out
  7. Summarize everything!
516
Q

DDx for Fatigue -9

A
  1. DEPRESSION
  2. Anemia (CRC, menorrhagia, dietary)
  3. OSA
  4. CA
  5. CAD
  6. DM
  7. Sleep Restriction
  8. Thyroid DO
  9. Chronic Fatigue Syndrome (fatigue ≥ 6 mo. + 4 physical sx)
517
Q

Tx for Iron Deficiency Anemia - 2

A
  1. Ferrous Sulfate 325mg TID
  2. Docusate 100mg BID prn
518
Q

A child who has SOB with cough suggest what etx for the cough?

A

inflammatory cause for the cough (asthma)

519
Q

s/s of TB in kids - 4

A
  1. USUALLY NO s/s
  2. Failure to thrive
  3. nonproductive cough
  4. but.. productive cough w/systemic complaints = pulmonary dissemination
520
Q

Dx for TB for kids - 4

A

TST (Tuberculin Skin Test)

  1. > 5 mm in asx high risk kids
  2. > 10 mm in asx moderate risk kids
  3. > 15 mm in asx low risk kids
  4. Positive M.TB cx from sputum sample or morning gastric aspirate in sx kids
521
Q

Diagnostic clinical criteria for diagnosing sinusitis in Kids - 3

A

One of below…

  1. persistent b/l nasal discharge and/or daytime cough > 10 days w/no improvement
  2. # 1 that Worsens after initial improvement
  3. High Fever + Purulent nasal discharge > 3 days
522
Q

End-expiratory wheeze is classic finding for what disease?

A

Asthma

523
Q

classic physical exam findings for Allergies - 3

A
  1. Boggy Edematous Turbinates
  2. Clear nasal discharge
  3. Allergic Shiners - image
524
Q

What is Atopy - 3

A

Genetic predisposition to develop IgE mediated

  1. Asthma ➕
  2. Allergic Rhinitis ➕
  3. Eczema atopic dermatitis
525
Q

Kids with asthma who use inhaled Corticosteroids (although rare!) are at risk of what side effects? - 4

A
  1. ⬆︎BP
  2. ⬆︎BG
  3. Growth delay
  4. Cataracts

This occurs with HIGH DOSES and is rare

526
Q

Describe pathophysiology of an asthamtic exacerbation

A
527
Q

Crackles are typically heard on _____

Which conditions are Crackles associated with? - 4

A

Crackles are typically heard on Inspiration

  1. Pulmonary Edema
  2. Bronchitis
  3. PNA
  4. Intersttial disease
528
Q

Stridor in Kids is typically caused by what? - 3

A
  1. CROUP
  2. foreign body partial obstruction of larynx or trachea
  3. Laryngomalacia
529
Q

Some dx can be made by analyzing a pt’s Cough

What is DDx for Cough that is…

Dry-3

Wet

Barking-3

A
  • Dry= Asthma / Environmental / Fungal
  • Wet = Lower Respiratory infection
  • Barking = Croup / SubGlottic disease / Foreign body
530
Q

Some dx can be made by analyzing a pt’s Cough

What is DDx for Cough that is…

Brassy or honking-2

Paroxysmal-4

Worst at night-2

Associated with gagging/choking

A
  • Brassy/Honking= Tracheitis / Habitual
  • Paroxysmal= Pertussis / Chlamydia / Mycoplasma / Foreign body
  • Worst at night= Asthma / Sinusitis
  • Gagging/Choking = GERD
531
Q

PEF (Peak Expiratory Flow) in asthma is used for ___ (diagnosing vs monitoring) asthma

How do you calculate a pt’s personal best PEF?

A

MONITORING asthma progress

Average the PEF values for 14 consecutive “good” days together

532
Q

List the 5 step action plan for managing Asthma in kids

A

biiLO

  1. b2 agonist (use ≤ 2x/week)
  2. inhaled CTS
  3. increase inhaled CTS (if sx are daily!)
  4. LABA vs LAA vs Leukotriene R blocker (if sx thrughout day, everyday!)
  5. Oral CTS adjunct- short course considered #1-4

CTS = CorTicoSteroid

533
Q

Postconcussive syndrome can occur __(length of time)__ after any TBI (Traumatic Brain Injury).

Describe CP for Postconcussive Syndrome - 4

A

hours-days;

  1. Continued Confusion/Amnesia
  2. HA
  3. Mood changes
  4. Vertigo

This is Self-Resolving

534
Q

How are pain medications associated with Headache?

A

Chronic Analgesic use can –> Analgesic Rebound HA

MUST BE > 15 BL HA/month, worst with waking and exertion

535
Q

Brudzinski’s sign is used to diagnose ____. Describe it

A

Meningitis; Involuntary hip flexion when neck is passively flexed

536
Q

Kernig sign is used to diagnose ____. Describe it

A

Meningitis; With hip flexed 90º, Knee extension –> ⬆︎neck pain & resistance

537
Q

Name the common triggers of Tension & Migraine Headaches - 5

A

EEATS

  1. EtOH
  2. Estrogen (BC/HRT)
  3. [Aspartame & phenylalanine from diet soda]
  4. Tobacco
  5. Stressss (depression/anxiety/exercise)

Also Onions, Chocolate and Banans!

538
Q

What are the indications for obtaining neuroimaging in Headache pt? - 3

A
  1. unexplained abnormalities and HA patterns (HA awakening from sleep, abnormal reflexes)
  2. Pt is at higher risk for significant abnormality (age > 50)
  3. Results of study would alter mngmt of HA
539
Q

What are at-home, conventional ways to manage chronic HA -4

A
  1. HA diary
  2. Avoid Caffeine (especially in Diet Soda)
  3. 8 hours of sleep/night
  4. ⬆︎ Exercise
540
Q

Px for Migraine HA - 4

A

VTAP the migraine BEFORE it gets BAD, and SEND it away when it comes!

  1. Verapamil
  2. Topiramate
  3. Amitryptyline
  4. Propranolol
541
Q

Tx for Acute Migraine HA - 4

A

VTAP the migraine BEFORE it gets BAD, and SEND it away when it comes!

  1. Sumatriptan
  2. Ergots
  3. NSAIDs
  4. D2 Blockers (Metaclopramide/Prochlorperazine)
542
Q

Describe Dyspepsia (indigestion)

A

Upper abd pain w/belching, bloating, NV from bad digestion

This does NOT include heartburn/regurgitation from GERD

543
Q

DDx for Dyspepsia - 8

g**reatest to least

A
  1. Idiopathic Functional Non-ulcer dyspepsia
  2. PUD-image
  3. GERD
  4. Gastritis
  5. Med side effects
  6. Pancreatitis
  7. CA -rare
  8. Cardiac/Angina-rare
544
Q

CP of Gastritis

A

Epigastric pain that improves immediately after meal

Pts with s/s of Gastritis, GERD or PUD should first try trial of PPI for dx

545
Q

CP of Acute Pancreatitis - 4

A
  1. SEVERE Epigastric pain that radiates to back
  2. worst with eating
  3. associated w/NV
  4. dehydrated (tachycardia)
546
Q

When GERD can not be easily diagnosed (i.e. PPI trial did not ⬇︎ heartburn/regurgitation), what other dx tool can be used?

A

24-hour pH probe

547
Q

What is the order of diagnostic workup for a dyspepsia pt with possible PUD 2/2 H.Pylori - 4

A

SURF to the hp & then PAC it away for 2 weeks!

S–(if + and sx= treat) –> confirm eradication with U & R. Use F if alarming sx or sx persist even after confirmation of eradication

  1. Serum H.pylori IgG test (great 1st-time test / do BEFORE treatment / will not tell u if HP is eradicated since it remains high for years)
  2. Urea breath test (detects active infection​ / be sure pt is not on PPI, abx or bismuth during test)
  3. Rectal fecal antigen detection
  4. Find tissue to test for urease via endoscopy if alarming sx present or Urea breat test ctd
548
Q

After H.Pylori has been ruled out, you’ve diagnosed pt with Idiopathic Functional Non-Ulcer dyspepsia

Tx?

A

TCAs

549
Q

Tx for H.Pylori

A

SURF to the hp & then PAC it away for 2 weeks!

PPI BID x 2 weeks

Amoxicillin 1 gram BID x 2 weeks

Clarithromycin 500mg BID x 2 weeks

(metronidazole if PCN allergy)

550
Q

Guidelines for Intimate Partner Violence screening

A

Annual screen (or whenever red flags present) of ALL women of childbearing age

“Do you feel safe at home, and in your current environment?”

551
Q

Recommended screening guidelines for DM - 3

A
  1. Screen at any age if BMI > 25 AND risk factors (image)
  2. Start at 45 yo routine screening every 3 years if test are normal
  3. Screen asx adults < 45 yo if [BP > 135/80]
552
Q

pathophysiology of retinopathy in DM ; what things should you look for on fundoscopic exam?-3

A

Retinal vessel occlusion –> hypoxia –> ⬆︎VEGF –> Neovascularization –> Proliferative Retinopathy

  1. Microaneurysms (punctate dark lesions)
  2. Cotton Wool spots
  3. Retinal Hemorrhages
553
Q

What is Normal fasting blood glucose? ; What is normal postprandial blood glucose (1-2 hrs after meal)?

A

Fasting BG = 80-120

Postprandial BG should be < 180

554
Q

What is a way you can ensure bilateral dialogue with patients about a disease - 5

A

LEARN them!

Listen with empathy regarding pt perception of illness

Explain your perceptions and strategy for tx

Acknowledge differences/similarities between the 2 perceptions

Recommend tx while considering cultural parameters

Negotiate agreement!

555
Q
  • Foot exams in Diabetics should be performed annually*
  • This exam includes testing Sensation, Pedal Pulses and Inspection*

What does the Sensation component of the exam consist of?-2

A

10 gram monofilament

➕ (one of following)

  • vibration w/128 Hz tuning fork
  • pinprick sensation
  • Achilles ankle reflexes
556
Q

How often should HbA1C be obtained in DM pts - 3

A
  1. Once at diagnosis and then…
  2. 2x / year if HbA1c remains < 7
  3. 4x / year during med changes
557
Q

In DM pts, it’s important to annually check for diabetic Nephropathy

How is this done?

A

spot Urine Albumin-to-Creatinine ratio to check for microalbuminuria

558
Q

Everyone knows Metformin causes Lactic Acidosis (in setting of renal failure) and GI distress but…

what is a less reported but serious side effect of Metformin??

A

VitB12 deficiency

Be sure to order this lab in DM pts on Metformin

559
Q

What tx modality is used to prevent vision loss in DM pts

A

photocoagulation surgery

does NOT TREAT retinopathy

560
Q

How do you calculate Daily Caloric needs - 3

A

[Body wt in lbs] x 10 x [activity(image)]

  • Eating < ~Daily Calorie needs –> WtLoss*
  • [Body wt in lbs] x 10 = BMR*
561
Q

In terms of Weight loss, how many calories = 1 pound of weight loss? ; What’s the safe # of wt to lose?

A

3500 calorie decrease = 1 pound WtLoss ; Pts should only lose 1 lb/week

562
Q

Name the primary weight loss drugs-4 ; When are they indicated for use?-2

A
  1. Phentermine (noradrenergic appetite suppressant)
  2. Orlistat (GI lipase inhibtor)
  3. Lorcaserin (serotonergic R agonist appetite suppressant)
  4. Qsymia (appetite suppressant)

Indication: BMI > 40 or [BMI > 35 + comorbidity]

563
Q

Main causes of Dyspareunia - 4

A
  1. ENDOMETRIOSIS
  2. PID
  3. Menopause (atrophic vaginitis)
  4. POIUD (Progesterone Only IUD)
564
Q

Elderly pts who commit suicide mostly do it thru what means?

A

Drug OD

565
Q

What are the classical historical features of a Ruptured Achilles Tendon - 3

A

Mid aged male falls to ground and has the 3 P’s…

  1. Popping sound followed by
  2. Posterior ankle pain immediately after and
  3. Plantarflex disabled now
566
Q

What % of thyroid nodules are cancerous?

A

4-5%

and only 5% of thyroid nodules –> HYPERthyroidism

567
Q

___% of people with severe DM requiring insulin have retinopathy how many years after diagnosis?

A

40% of people with severe DM requiring insulin have retinopathy 5 years after dx

568
Q

What is the recommended HTN agents for:

NonBlacks with DM (+/- proteinuria) - 3

BP Goal is 140 / 90

A

ACE/ARBs > Diuretic thiazides > CCB

Blacks (as long as they dont have CKD) = DC still

569
Q

What feature of a physical exam suggest Lumbosacral sprain/strain?

A

Paraspinal muscle spasm

570
Q

Pt with Disc herniation comes to see you…

⬇︎Hip flexor strength suggest lesion at what level?

A

L2 - 4

“L2, 3 can’t flex (hips) to be a whore”

571
Q

What is the relationship between NSAIDs and Warfarin?

A

Their use together is CONTRAINDICATED!

Note: It’s ok to use NSAIDs in previous H.Pylori pts

572
Q

A pt with Gout can NOT use NSAIDS or Colchicine

How do you determine what the best tx is now?

A

Assess # of joints involved since….

≥2 joints = Arthrocentesis with intraArticular Corticosteroid injection

Polyarticular = Oral Corticosteroids

573
Q

Differentiate the following abortions:

Inevitable abortion

Threatened abortion

Missed abortion

Complete abortion

A
  1. Inevitable = early vaginal bleeding < 20 WG with cervical os open or dilated –>abortion will inevitably happen soon
  2. Threatened = early vaginal bleeding < 20 WG with cervical os closed is clearly a threat
  3. Missed = Fetal demise without cervical dilation…which is why we Missed it
  4. Complete = ALL PRODUCTS OF CONCEPTION COMPLETELY EXPELLED
574
Q

Gestational DM is determined via _______ test. When is this test even indicated?

A

[3-hour glucose tolerance test];

Obtain this test if :

[1 hour glucose > 130 after 50 gm load] –(obtain)—> [3-hour glucose tolerance test]

but remember, Fasting BG ≥ 126 OR 1 hour BG > 130 is positive result. Only 1 hour BG > 130 requires 3 hour GTT f/u

575
Q

classic s/s of Hepatitis - 4

A
  1. Jaundice
  2. icterus
  3. anorexia
  4. malaise
576
Q

Demographic for Acral lentiginous melanoma ; where is this found-2

A

dark-skinned people ; palms & soles ;

577
Q

How often should pts receive whole body skin exams?

A

every 6 months

in addition to SPF 15 suncreen, avoiding indoor tanning, wear sunhats to prevent skin CA

578
Q

what are alternative tx for hot flashes - 3

A
  1. Black Cohosh
  2. Flaxseed
  3. St. John’s Wart
579
Q

Diagnositc w/u for H.Pylori involves Serologic testing, if positive then treat, and then ONLYtesting for eradicatoin if indicated

When is it indicated to perform Urea breath test and Rectal fecal antigen detection? - 5

A

SURF to the hp & then PAC it away for 2 weeks!

  1. Pt with H.Pylori-associated ulcer
  2. Persistent sx despite tx
  3. H.Pylori associated MALT
  4. hx of resection for early gastric CA
  5. pt planning to resume chronic NSAID therapy
580
Q

When is having a family hx of CAD significant for a pt?

A

ONLY when that family member is a 1st degree relative with premature CAD (Male < 55 yo and Female < 65 yo)!!

581
Q

Neonatal Abstinence Syndrome

Classic Signs - 5

A

TYT Does Heroin

  1. Tremors
  2. Yawning
  3. Tachypnea
  4. Diarrhea
  5. High Pitched Cry

Caused by maternal opioid (Heroin) use during pregnancy

[3b1⃣] Fam Med (2 decks)

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