Fam Med - SUTM Ambu/CF

Question 1

Case File - Prenatal care - Indication for US in pregnancy

Answer 1

Not routinely mandatory for low-risk

High-risk situations: uncertain gestational age, size/date discrepancies, vaginal bleeding, multiple gestations, etc.

Question 2

Case File - Prenatal care - Recommended labs at initial prenatal visit

Answer 2

CBC
Hep B surface antigen, HIV testing, syphi­lis - rapid plasma reagin (RPR), rubella antibody

Urinalysis and urine culture
Blood type and Rh status with antibody screen

Pap smear, and cervical swab for gonorrhea and Chlamydia.

Question 3

Case File - Prenatal care - Optimal time for trisomy screen

Answer 3

1st trimester => nuchal translucency (NT) => US

10-13wks => NT, serum markers (hCG, PAPP-A)

2nd trimester => triple (AFP, hCG, estriol)

16-18-wks => quadruple (triple screen and inhibin-A)

if those results are concerning => invasive testing => chronic villous sampling (10-13 wks) or amniocentesis (16-18 wks)

Question 4

Case File - Prenatal care - Isoimmunization

Answer 4

Development of specific antibodies as a result of anti­ genic stimulation by material from the red blood cells of another individual.

For example, Rh isoimmunization means a Rh-negative woman who develops anti-D (Rh factor) antibodies in response to exposure to Rh (D) antigen.

Question 5

Case File - Prenatal care - Asymptomatic bacteriuria (ASB)

Answer 5

≥ 100,000 cfu/mL but no clinical symptoms

=> increase risk of acute pyelonephritis, preterm delivery, and low birth weight

=> should be treated

Question 6

Case File - Prenatal care - Antenatal testing

Answer 6

Procedure identifies if fetus is at risk for utero-placental insufficiency and perinatal death

Can include: non-stress test and biophysical profile

Question 7

Case File - Prenatal care - What radiation dose is harmful to fetal development? At which time during pregnancy?

Answer 7

5 Rad - Most commonly performed x-ray procedures, including dental, chest, and extremity x-rays, expose a fetus to only very small fractions of this amount of radiation

2-15 weeks => should be shielded or using US/MRI as alternatives

Question 8

Case File - Prenatal care - Folic acid recommendations

Answer 8

Start a folic acid supplement at least 1 month prior to attempting to conceive

Low-risk women = 400 to 800 μg
Higher risk => higher dose

Women with diabetes mel­litus or epilepsy = 1 mg
Women has previous child with a neural tube defect = 4 mg

Question 9

Case File - Prenatal care - Gestational diabetes screen recommendations

Answer 9

After 24wks of gestation => asymptomatic pregnant women (level B)

24-28wks => screened with 1-hour 50-g glucose challenge test.

=> if screening test is posi­tive, a 3-hour glucose tolerance test (GTT) should be performed

Question 10

Case File - Prenatal care- when Rh-negative women should receive Rho(D) immune globulin (RhoGAM)?

Answer 10

At 28 weeks

Before 12-week gestation in women with a threatened abortion and live embryo

Question 11

Case File - Prenatal care- when women be offered group B Streptococcus {GBS) screening by vaginorectal culture? Proper method?

Answer 11

35-37 weeks

Proper method = swab the lower vagina, perinea! area, and rectum.

Colonized women is treated with IV antibiotics

Question 12

Case File - Prenatal care- Vaccinations

Answer 12

Influenza = anytime during pregnancy is safe

(Tdap) = 27- 36 weeks’ gestation (regardless of prior vaccination status

Varicella, rubella, and the live attenuated intranasal influenza vaccinations are NOT advised during pregnancy

=> mothers with a rubella non-immune status => a rubella vaccination should be given after delivery of the infant (postpartum)

Question 13

Case File - Well-child care - When should the child be in front-facing car seat?

Answer 13

Rear-facing car seat until the age of 2 or until the child reaches the maximum height and weight limit for the car seat.

Question 14

Gastrointestinal Disease - Dyspepsia - Non-ulcer dyspepsia

Answer 14

A diagnosis of exclusion after appropriate tests (including endoscopy) does not reveal a specific cause.

Dyspepsia symptoms must be present for at least 4 weeks to make the diagnosis of non-ulcer dyspepsia

Question 15

Gastrointestinal Disease - Dyspepsia - What is suggested if GERD is associated with dysphagia?

Answer 15

Suggest the development of peptic stricture

Alternatively, a motility disorder or cancer may be present.

Question 16

Gastrointestinal Disease - GERD - Diagnostic tests

Answer 16

Not necessary for typical, uncomplicated cases of GERD, and therapy can be initiated.

Tests are indicated in atypical, complicated, or persistent cases (despite treatment).

Endoscopy should be performed if worrisome symptoms (anemia, weight loss, or dysphagia) are present.

Question 17

Gastrointestinal Disease - Diarrhea - Which bacteria usually present with elevated fecal WBC?

Answer 17

Salmonella, Campylobacter, Shigella, and enteroinvasive E. coli cause diarrhea with fecal leukocytes and often blood.

Absent in staphylococcal or clostridial food poisoning; and absent in viral gastroenteritis

Question 18

Gastrointestinal Disease - Diarrhea - The most common electrolyte/acid–base abnormalities seen with severe diarrhea?

Answer 18

Metabolic acidosis and hypokalemia.

Question 19

Gastrointestinal Disease - Constipation - Complications of Chronic Constipation

Answer 19

Hemorrhoids
Rectal prolapse
Anal fissures
Fecal impaction

Question 20

Gastrointestinal Disease - Constipation - Which must be frequently excluded in diagnosing IBS?

Answer 20

Obstruction (plain abdominal film)
IBD
Lactose or sorbitol intolerance
Malignancy (in older patients or those with family history)—colonoscopy, occult blood in stool

Question 21

Case file - Well-child care - Recommendation for immunization in 6mo old and up to date immunization?

Answer 21

Diphtheria, tetanus, and acellular pertus­sis {DTaP) no. 3, hepatitis B no. 3, Haemophilus influenza type b {Hib) no. 3, pneumococcal conjugate vaccine (PCV 13) no. 3, and rotavirus no. 3

inacti­vated polio vaccine {IPV) no. 3 can be given between 6 and 18 months

Question 22

Case file - Well-child care - When the child starts saying “mama” “dada”

Answer 22

nonspecifically between 6 and 9 months.

Becomes specific between 8 and 15 months.

Question 23

Case file - Well-child care - BMI in children

Answer 23

• Obese = >95 percentile
• Overweight = 85-95 percentile
• Healthy bodyweight = 5-85 percentile
• Underweight = <5 percentile

Question 24

Case file - Well-child care - Failure to thrive meaning

Answer 24

Weight is in 3rd - 5th percentile

or decelerations of growth in a short period of time

=> significant loss or gain weight should prompt a in-depth discussion about nutrition/caloric intake

Question 25

Case file - Well-child care - Developmental milestones for 1 month

Answer 25

Motor = Reacts to pain

Language = Responds to noise

Social = Regards human face and establishes eye contact

Question 26

Case file - Well-child care - Developmental milestones for 2 months

Answer 26

Motor = Eyes follow object to midline. Head up prone

Language = Vocalizes

Social = Social smile. Recognizes parent

Question 27

Case file - Well-child care - Developmental milestones for 4 months

Answer 27

Motor = Eyes follow object past midline. Rolls over

Language = Laughs and squeals

Social = Regards hand

Question 28

Case file - Well-child care - Developmental milestones for 6 months

Answer 28

Motor = Sits well unsupported. Transfers objects hand to hand (switches hands). Rolls prone to supine

Language = Babbles

Social = Recognizes strangers.

Mnemonic: Six strangers switch sitting at 6mo

Question 29

Case file - Well-child care - Developmental milestones for 9 months

Answer 29

Motor = Pincer grasp (10 mo). Crawls. Cruises (walks holding furniture)

Language = Says “mama,” “dada,”and “bye-bye”

Social = Starts to explore.

Question 30

Case file - Well-child care - Developmental milestones for 12 months

Answer 30

Motor = Walks. Throws object

Language = 1-3 words. Follows 1-step commands

Social = Stranger and separation anxiety

Question 31

Case file - Well-child care - Developmental milestones for 2 years

Answer 31

Motor = Walks up and down stairs. Copies a line. Runs. Kicks ball

Language = 2-3-word phrases. 1/2 of speech is understood by strangers. Refers to self by name. Pronouns

Social = Parallel play

Question 32

Case file - Well-child care - Developmental milestones for 3 years

Answer 32

Motor = Copies a circle. Pedals a tricycle. Can build a bridge of 3 cubes. Repeats 3 numbers

Language = Speaks in sentences. 3/4 of speech is understood by strangers. Recognizes 3 colors

Social = Group play. Plays simple games. Knows gender. Knows first and last name

Question 33

Case file - Well-child care - Developmental milestones for 4 years

Answer 33

Motor = Identifies body parts. Copies a cross. Copies a square (4 1/2 y) Hops on one foot. Throws overhand

Language = Speech is completely understood by strangers
Uses past tense to speak of things that happened before. Tells a story

Social = Plays with kids, social interaction

Question 34

Case file - Well-child care - Developmental milestones for 5&6 years

Answer 34

Motor (5) = Copies a triangle. Catches a ball. Partially dresses self
Language (5) = Writes name. Counts 10 objects

Motor (6) = Draws a person with 6 parts. Ties shoes. Skips with alternating feet
Language (6) = Identifies left and right

Question 35

Case file - Well-child care - recommendation for screening of high cholesterol for all children

Answer 35

At least one time between the ages of 9 and 11 and again between 17 and 21

Begin at age 2 in children with a family history of hyperlipidemia, premature car­diovascular disease, or other risk factors

Question 36

Case file - Well-child care - Dental recommendation

Answer 36

4-month visit => sources of systemic fluoride should be assessed.
- One of the most effective tools to prevent teeth decay is systemic fluoride.

6 months => infants should begin to receive appropriate topical (fluoride toothpaste) and systemic fluoride.

12-month visit => each appointment should include a complete dental screening during the physical examination and reassur­ance that the child has a regular source of dental care.

The American Academy of Pediatric Dentistry recommends that all children see a dentist by 12 months.

Question 37

Case file - Well-child care - Recommendation for car seat

Answer 37

Should be in the back seat whenever possible.
- If there is no back seat, only ride in the front seat if there is no air bag or if the air bag can be disabled.

Sit in a rear-facing car seat until the child is 2 years old or has reached the maximum height or weight limit of the rear-facing seat.

Use a booster-type seat along with the lap and shoulder seatbelts => ≥ 40 lb

Stop using the booster => sit with his or her back squarely against the back of the seat with the legs bent at the knees over the front of the seat. (at least 4 ft 9 in in height and 8 to 12 years of age)

No child should ride in the front seat unless they are 13 years or older and meet height and weight requirements.

Question 38

Case file - Well-child care - leading cause of death for < 1 and ≥ 1 y/o

Answer 38

≥ 1 y/o => accident and injury

< 1 => congenital abnormalities, short gestation, and sudden infant death syndrome (SIDS)