FAM Med. UniUyo Flashcards
Definition of Family (hint: 4 lines)
A group of individuals who are related biologically, legally or by choice and from whom one reasonably expects a measure of support in form of food, clothing, shelter or emotional nurturing and who shares a past, present and future and includes all who contribute in one way or the other to the family culture
A family group consisting of two people living together, ususally a woman & a man, without children is called?
Dyad family
Family medicine is a primary care oriented specialty, T/F?
TRUE
Define Family Medicine
A group of individuals who are related biologically, legally or by choice and from whom one reasonably expects a measure of support in terms of food, clothing, shelter or emotional nurturing and who shares a past, present and future and includes all who contribute in one way or the other to the family culture.
Domains of Family medicine are (hint:3)
Hospital-based care, Family care & Primary care
Khan’s 7-stars doctor (hint: picture the start)
Community leader, Communicator, Care provider, Decision maker/Advocate, Manager, Researcher, Coordinator
In Tropical Africa, _____ are responsible for most snake bites?
Vipers
Which family of snake has venom with powerful neurotoxic effect leading to muscular paralysis?
Elapidae. e.g., Cobra, Mamba, Coral snakes
The Hydrophidae has what type of venom?
Myotoxic venom which causes necrosis of muscles
Most victims of snake bites are between the ages of _____ & _____
5 and 30yrs
Most bites of snakes occur on the feet, T/F?
TRUE
The effect of snake venom on a victim depends on _____ & ______
Type/family of snake AND amount of venom
Local swelling is most common in which families of snakes (hint:2)
Viperidae and Crotalidae
An early systemic symptom of venom of Viper is _________
Blood-stained spit
An early systemic sign of Elapidea venom is _____
Ptosis.
followed by Glosso-phayngeal palsy
List the toxins in Cobra venom
Neurotoxin , Cardiotoxin
List the toxins in Cobra venom
Neurotoxin , Cardiotoxin
An Hydrophidae bitten victim can present what systemic features?
Muscle pain & stiffness, external ophthalmoplegia, Trismus, Myoglobinuria, Proteinuria, renal failure
Mention the 5 poisonous families of snake
Viperidae, Crotalidae, Elapidae, Colubridae, Hydrophidae
Presence of species-specific venom of a snake can be confirmed by ________
Immunodiffusion
When do you give anti-venom serum?
When the victim starts showing signs of systemic venom poisoning
How do you administer Polyvalent Viper-Cobra-Mamba anti-venom serum
Give 50-100ml anti-venom serum in 200-300ml of isotonic saline via infusion for 1hour.
N/B: Test dose of 0.2ml s.c or IM shoild be given first.
Administering Tetanus toxoid is part of the mgt of a snack bitten patient, T/F?
TRUE
Aim of IMCI
To reduce death, illness and disability thereby promoting improved growth and development among children U5 yrs of age
The strategy of IMCI has 3 main components which are?
- Improving case mgt skill of health care staff
- Improving overall health system
- Improving family and community health practices
Define Under-5 mortality rate
U5MR IS DEFINED AS THE ANNUAL NUMBER OF DEATHS OF CHILDREN UNDER 5 YEARS OF AGE PER 1000 LIVE BIRTHS
U5 mortality is a reflection of a country’s health system and economy, T/F?
TRUE
IMCI incorporates Child Survival Strategy which includes (hint: 11)
G- GROWTH MONITORING
O- ORAL REHYDRATION THERAPY
B- BREAST FEEDING
I- IMMUNIZATION
F- FAMILY PLANNING
F- FOOD FORTIFICATION
F- FEMALE EDUCATION
E- ESSENTIAL DRUG LIST
T- TREATMENT OF COMMON ILLNESSES/INJURIES
H- HEALTH EDUCATION
E-ENVIRONMENTAL SANITATION
N/B You can put it “THE GOBIFFFE”
Danger signs on P/E with respect to IMCI
Anemia, Pyrexia, Dehydration, Dyspnea, Wasting, Jaundice
List the steps in IMCI implementation (hint: 6)
- History taking from parent/care giver
- Assess child(examination) for danger signs
- Classify the illness
- Take decision
- Counsel the mother/care giver
- Follow up
The commonest symptom that presents to primary care is ______
Dyspepsia
Dyspepsia is more common in men, smokers & those taking NSAIDs, T/F?
FALSE.
Common in women not men
Patients with dyspepsia have poor life expectancy, T/F?
FALSE
Dyspepsia is associated with poor health-related quality of life, T/F?
TRUE
The most important contributory factors to dyspepsia are _____&______
The presence of H. pylori and use of medications such as NSAIDs
Systemic conditions that can cause dyspepsia (hint: 9)
Adrenal insufficiency, congestive heart failure, diabetes mellitus, hyperparathyroidism, intra-abdominal nongastrointestinal malignancy, myocardial infarction, pregnancy, renal insufficiency, thyroid disease
Draw out NICE model Algorithm for the mgt of dyspepsia
Refer to Note
The key investigations in the diagnosis of dyspepsia are ______&______
Endoscopy and test for H. Pylori are the key investigations in the diagnosis of dyspepsia
Functional dyspepsia is a diagnosis of exclusion, T/F?
TRUE
What is the mgt of Functional dyspepsia
the mental health status of the patients should be evaluated and identifiable co-morbid conditions like depression, anxiety disorder, etc which can further worsen the quality of life, should be identified and treated.
PUD majorly affects what part of the GIT? (hint; 3)
It affects lower esophagus, stomach or duodenum
List the injurious/damaging factors that play a role in development of PUD (hint: 7)
List the protective factors (hint: 8)
The injurious factors include:
-gastric acid, pepsin, bile acids, NSAIDS, genetics, H. Pylori, ethanol.
The protective factors include:
-mucus, bicarbonate, prostaglandin, mucosal blood flow, alkaline tide, epithelial renewal, hydrophobic layer, epidermal growth factor (EGF)
Ratio of Gastric ulcer to Duodenal ulcer
1:4
Family hx is a risk factor of PUD, T/F?
TRUE
What blood group is a common risk factor for PUD?
Blood grouo O
Mention the risk factors for PUD (hint: 7 major, 3 minor)
- male sex
- family history
- smoking (cause and delay healing)
- stress
- common in blood group O
- nsaids (2-4 times increase in in GU and ulcer complications)
- H. Pylori: (if absent and no NSAIDS, ulcer unlikely)
Unproven risk factors: - corticosteroids
- alcohol
- diet
PUD may be silent in the elderly on NSIADs, T/F?
TRUE
P/E of a patient with PUD usually yields positive findings, T/F?
FALSE
Investigations for PUD (hint:4)
- Endoscopy (investigation of choice)
- Barium studies
- Serum gastrin
- H. Pylori test
Complications of PUD (hint: 7)
- Penetration
- Perforation
- Bleeding →haematemesis & melaena
- Pyloric stenosis →obstruction
- Anaemia
- Oesophageal stenosis
- Carcinoma (GU)
Aims of mgt of PUD (hint:4)
- Relieve symptoms
- Accelerate ulcer healing
- Prevent complication
- Minimise risk of relapse
The most important nutrients in nutritional anemia are ____, _____ & _____
Iron, Folate, Vitamin B12
Anemia is considered to be early manifestation of nutritional deficiency, T/F?
FALSE
The commonest causes of nutritional anemias are ______ & _____
The commonest causes are nutritional deficiencies and chronic infections with parasites and malaria
The major adaptations to anemia are in ______ system
Cardiovascular
The symptom of anemia depends on _____ & ____
the acuteness of onset and he severity of the anaemia
Lists the non-specific symptoms related to tissue hypoxia (hint: 4)
(1) Tiredness
(2) Lassitude
(3) Exertional dyspnoea
(4) Headache
Severe anemia can result in anemia & exudate in optics, T/F?
TRUE
Clinical features of anemia due to Iron deficiency (hint: 6)
- Smooth shining tongue (Actual soreness of the tongue is uncommon in IDA but common in pernicious anaemia)
- Angular stomatitis (R/O poor fitting dentures)
- Spoon nail (Koilonychia)
- Occasionally (Plummer Vinson syndrome of glossitis/dysphasia produced by post cricoids web).
- Pruiritus
- Abnormal food fads (pica)
The usual oral dose for the treatment of IDA contains _____mg of elemental iron?
The usual dose is 100-200mg of elemental iron daily e.g. ferrous sulphate 325mg. three times daily
Differential diagnosis of IDA (mention at least 3)
Lead poisoning, Thalassemia, Anemia of chronic inflammation
In children, IDA oral dose treatment is _____
Dose of ferrous iron-preparation should be 6mg/kg per day of elemental iron divided into 3 doses
Duration for iron stores to be replenished via oral iron intake
At least for 6 months
Indications for blood transfusion in IDA
Should only be used for severe iron deficiency (<4.0g/l) when associated with heart failure or prior to urgent surgery
Vitamin B12 is found exclusively in _____ tissue
Animal
The most striking feature of Vitamin B12 deficiency anemia is ______
peripheral neuropathy affecting the lower limbs most frequently.
Treatment of Vit B12 deficiency anemia
1000ug/day for the first week then 1000kg weekly until haematologic values normalize or for at least 6 months if neurologic complications exists, then 1000ug monthly for life
A confirmed vitamin B12 defiecncy patient should be placed on vit B12 for life, T/F?
TRUE
There is presence of neurological deficit in folate deficiency, T/F?
FALSE
Treatment of folate deficiency
Administration of FA-1mg/day
What is the treatment of the nutritional cause sideroblastic anemia
Pyridoxine (Vitamin B6)
Vitamin E is a powerful antioxidant, T/F?
TRUE
Chronic Vitamin A can cause macrocytic anemia, T/F?
FALSE
Chronic vitamin A toxicity cause a microcytic anaemia and leucopenia
Infection of the prostate(prostatitis) is a part of UTI, T/F?
TRUE
UTI occurs most frequently b/w the ages of ___ & ___ in women
16 & 35
Rates of asymptomatic bacteriuria increases with age in women, T/F?
TRUE
Which type of UTI is the most common cause of nosocomial infection
Pyelonephritis
Risk factors for UTI (hint: 25)
RISK FACTORS FOR UTI’S:
FEMALE GENDER- ANATOMY-PROXIMITY OF FEMALE URETHRA TO THE VAGINA& ANUS
AGE-↑ WITH ↑AGE
SEXUAL INTERCOURSE-↑ WITH FREQUENCY OF SEX
EXPOSURE TO SPERMICIDE IN FEMALE (IN DIAPHRAGM) & CONDOM
PREGNANCY-↓ IMMUNITY, ↓ESTROGEN
MENOPAUSE
IMMUNOSUPRESSION-↓ HOST DEFENCE
DM-↓IMMUNITY
PREVIOUS INFECTION (PROBABLY POORLY TREATED)
POOR PERINEAL HYGIENE
DEHYDRATION
DELAYED MICTURITION
OBSTRUCTION TO URINARY FLOW
-CONGENITAL ANOMALIES
-CALCULI
-URETERAL OCCLUSION
RESIDUAL URINE IN BLADDER
-NEUROGENIC BLADDER
-URETHRAL STRICTURE
-PROSTATIC HYPERTROPHY
VESICOURETERAL REFLUX
INSTRMENTATION OF URINARY TRACT
-INDWELLING URINARY CATHETER
-CATHETERIZATION
-URETHRAL DILATION
-CYSTOSCOPY
Chronic bacterial prostatitis may cause recurrent UTI in maales, T/F?
TRUE
Viruses are common causes of UTI in an immuno competent host, T/F?
FALSE.
VIRUSES ARE UNCOMMON CAUSE OF UTI’S IN AN IMMUNOCOMPETENT HOST
THEY ARE INCREASINGLY RECOGNIZED AS THE CAUSE OF LOWER UTI, ESPECIALLY HAEMORRHAGIC CYSTITIS AMONG IMMUNOCOMPROMISED PATIENT
Method of choice for diagnosing Viral UTI
DIAGNOSIS OF VIRAL LUTI’S IS BASED ON MOLECULAR TECHNIQUES AND REAL-TIME POLYMERASE CHAIN REACTION IS OFTEN THE METHOD OF CHOICE BECAUSE IT ALLOWS FOR QUANTIFICATION OF VIRAL LOAD
Drug of choice for viral UTI
CIDOFOVIR IS BECOMING A DRUG OF CHOICE IN VIRAL UTI’S
Mention mechanisms that maintain the Urinary tract’s sterility (hint: 4)
- ACIDITY OF URINE
- EMPTYING OF THE BLADDER @ MICTURITION
- URETEROVESICAL & URETHRAL SPINCTERS
- VARIOUS IMMUNOLOGIC & MUCOSAL BARRIER
Routes of infection in UTI are (hint: 3)
- Direct entry through the urether
- Hematologic route
- Lymphatic route
Clinical manifestations of Upper UTI (hint: 11)
-HIGH GRADE FEVER
-RIGORS/CHILLS
-VOMITTING
-SWEATING
-HEADACHE
-DIARRHOEA
-LOIN PAIN
-±ABDOMINAL PAIN
-OLIGURIA (IF AKI)
-LOIN TENDERNESS (COSTOVERTEBRAL ANGLE TENDERNESS)
-TACHYCARDIA
Clinical manifestation of Lower UTI (hint: 8)
-DYSURIA
-FREQUENCY
-URGENCY
-FEELING OF INCOMPLETE BLADDER EMPTYING
-SUPRAPUPIC PAIN AND TENDERNESS
-±STRANGURY
-HAEMATURIA
-OFFENSIVE URINE
UTI can be diagnosed using a urine dipstick, T/F?
TRUE
Typical symptoms + Presence of Leukocyte esterase & Nitrite
In asymptomatic patient, >10^5 CFU/microgram is significant (Asymptomatic bacteriuria), T/F?
FALSE.
>10.5 CFU ORGANISM/ML
Investigation for UTI are (hint: 3)
ALL PATIENTS:
1. DIPSTIC ESTIMATION OF NITRITE, LEUCOCYTE ESTERASE, GLUCOSE
2. MICROSCOPY/CYTOMETRY OF URINE FOR WHITE BLOOD CELLS, ORGANISMS
3. URINE CULTURE
In complicated UTI & also UTI in infants & children what other investigations should you carry out? (hint: 3)
-FBC, U/E/C, BLOOD CULTURES
Duration of treatment for uncomplicated LUT infection
FOR INFECTION OF THE LUT, TREATMENT FOR 3 DAYS IS THE NORM
Drug of choice for initial treatment of LUT infection is
TRIMETHOPRIM
Antibiotic class that can be used in treatment of UTI in pregnancy (hint: 2)
PENINCILLINS AND CEPHALOSPORIN ARE EFFECTIVE/SAFE IN PREGNANCY
Acute pyelonephritis is characterized by a triad of _____, _____ & ______
-LOIN PAIN
-FEVER
-TENDERNESS OVER THE KIDNEYS (COSTOVERTEBRAL ANGLE TENDERNESS)
The necrotizing form of pyelonephritis with gas formation is known as __________ and occasionally seen in _____ patients
EMPHYSEMATOUS PYELONEPHRITIS IS OCASSIONALLY SEEN IN DM PATIENT
Xanthogranulomatous pyelonephritis is characterized by ________
XTERIZED BY ACCUMULATION OF FOAMY MACROPHAGES & GENERALLY REQUIRES NEPHRECTOMY
Treatment of recurrent or chronic UTI
AMOXICILLIN/ CLAVUNATE- 500/125MG (ORALLY)- 12HRLY, OR
TRIMETHOPRIN- 300MG (ORALLY) DLY, OR
CEPHALEXIN- 500MG (ORALLY) 12HRLY, all for 10-14 days
What is Evidence-based medicine?
EBM is defined as “the conscientious, explicit and judicious use of current best available evidence in making decisions about the care of the individual patient.” by David Sackett
EBM is the integration of _______, _________& _________
EBM is the integration of best research evidence with clinical expertise and patient values
Types of evidence?
Disease oriented evidence (DOE) AND Patient oriented evidence that matters (POEM)
The most reliable and accepted evidence in the hierarchy of evidence is
Level I - Randomized controlled trial/meta-analysis/systemic review
Case series is in Level II of hierarchy of evidence, T/F?
FALSE.
Level III
Clinical practice guidelines are fixed protocol that must always be followed, T/F?
FALSE
They are not fixed protocol that must always be followed but intended for health providers to consider
Examples of solid state storage
A. Flash drive
B. Media card ( Memory stick, SD card, Compact flash)
Types of Optical storage device
- Compact disc (CD)
- Digital versatile disc (DVD)
Motherboard(MOBO) is a _______ component of a computer
Computation
Computer applications in medicine (hint: 12)
ALARMS symptoms in dyspepsia means
A-NAEMIA
L-OSS OF WEGHT (UNINTENTIONAL)
A-NOREXIA
R-ECENT ONSET OF PROGRESSIVE SYMPTOMS
M-ALAENA/HAEMATEMESIS
S-WALLOWING DIFFICULTY (DYSPHAGIA)
Define Ageing
Ageing can be defined as the time-related deterioration of the physiological functions necessary for survival and fertility.
Reasons for rising ageing population (hint: 3)
- Breakthroughs in healthcare = increased life expectancy.
- People choosing to have smaller families.
- Falling birth rates:
Later marriages
Better education about contraceptives.
increased number of women working.
Classify ageing
- Objective
- Subjective
- Functional
According to WHO, adult aged >65 is elderly, T/F?
FALSE
WHO: adults aged ≥ 65 years
List the concepts of ageing (hint: 5)
- CHRONOLOGIC AGEING (change in the no. of years lived)
- BIOLOGIC AGEING (changes in physiology)
- PSYCHOLOGIC AGEING (changes in behavior, personality & act)
- SOCIAL AGEING (changes in roles & relatonships)
- COGNITIVE AGEING (changes in the basic process of learning & memory)
Mnemonic: Biopsychosocial C^2
Biologic/biological ageing is also called ______ or _____
Senescence or Physiologic ageing
Social ageing is profoundly influence by the society’s culture, T/F?
TRUE
The two major categories of ageing theories are
The Programmed theories
The Damage of Error theories
A major hallmark of ageing is a decrease in inflammatory levels reflected by lower levels of circulating pro-inflammatory cytokines, T/F?
FALSE.
Increased levels
Hearing loss that occurs in ageing is usually to low frequency sound, T/F?
FALSE
High frequency sounds
Problem solving skills increase with age, T/F?
TRUE
Intellectual functioning defined as “stored” memory decrease with age, T/F?
FALSE.
Increases with age
Emotions play a significant role in appetite & digestion, T/F?
TRUE
Orthostatic hypotension is relatively common in the elderly, T/F?
TRUE
The symptoms of climacteric period are typically present for about ____ years
5 years
Autoimmue disorders increased in older adults, T/F?
TRUE
increase in findings of positive
rheumatoid factor, anti-nuclear antibody, and false-
positive syphilis screens in healthy older adults
Lipofusin is ageing pigment, TF?
TRUE
Adolescents are those b/w the ages of ___&___
10-19
Teenagers are those b/w the ages of __ to __
13-19years
Young people are those b/w the ages of __ & ___
10-24years
Youths are those b/w the ages of
15-24years
Young adults are those b/w the ages of
25-44years
Middle age are those b/w the ages of
45-64years
Adolescents are homogenous population, T/F
FALSE
The well known barriers limiting adolescents from accessing health services are? (hint: 2)
- Shyness
- Healthcare provider’s unsupportive and judgmental attitude
Health wise, adolescents are neglected & abandon population, T/F
TRUE
The importance of youth health is viewed in 3 subheadings
- Persistent health problem from childhood
- Manifest youth health problems
- Risk for later disease
Female adolescents are forced into conflicts and combatants more than male adolescents, T/F
FALSE
Female adolescents experience higher rates of domestic and sexual violence than boys, T/F
TRUE
According to Erik Erikson model, at the stage of adolescence there must be establishment of ______, _______ and _____ about life
identity, goals and purpose
The adolescent is faced with the resolution of number developmental tasks which include (hint: 5)
a). Adaptation to the physiological and anatomical changes associated with puberty and integration of a mature sexuality into a personal model of behavior
b). The progressive resolution of earlier forms of attachment to the parents and family and development through peer relationships of an enhanced capacity for interpersonal intimacy.
c). The establishment of individual identity incorporating a sexual identity and adaptive social roles.
d). Utilization of enriched intellectual competence with the requisition of a sense of community and world views
e) .Development of potentials for occupational and leisure activity with gradual commitment to those that are relevant to both the individual and the community.
Mention circumstances that can limit adolescent care strategy on guaranteed confidentiality
- information suggesting someone is in imminent danger,
- the suspicion or evidence of abuse, and
- the diagnosis of certain communicable diseases
N/B: all must be reported to the proper authority
The 5F’s in Adolescent care are
Facts
Fear
Fables
Family
Future
The 2 Strategies of breaking bad news are
SPIKES (Setting, perspective/perception, Invitation, Knowledge, Empathy/Emotion, Summary/Support)
BREAKS (Background, Rapport, Explore, Announce, Kindle, Summarize)
Define Grief
Grief is an intense, emotional, physical, social, spiritual and mental response to loss
Define Bereavement
Bereavement is the Entire experience of family members and friends in the Anticipation, Death and Subsequent adjustment to living following the loss of a loved one
Aggressiveness is an emotional reaction of Grief, T/F
FALSE
Social response
Overprotectiveness is an emotional reaction of Grief, T/F
FALSE
Mental response
Continuously thinking about the Loss
is _________ response to grief
Mental
Searching for actual meaning of loss
is _______ response to grief
Spiritual
Awareness of fragility of Life is _______ response to grief
Spiritual
Separation Anxiety/Fearfulness is _______ response to grief
Social
Concerning the Kübler-Ross Change Curve, state the stages of grief
Shock
Denial
Anger & Bargaining
Depression
Testing
Decision
Integration/Acceptance
Bereavement leave should be for 3 months, T/F
FALSE
no laid down rule to determine the duration of such leave
In the basic family stages,
- Sandwich generation is stage _____
- Empty Nesters is also referred to as _____
- The Golden years is ______stage of family
- Stage 3 is ______ family
-stage 4 (Families with adolescents “Sandwich Generation”)
-Stage Five: Launching children and moving on “Empty Nesters”
-Stage Six: Families in later life “Retirement, the Golden Years”
-Stage Three: Families with young children
Roles can only be given, T/F
FALSE
Roles can be inherited Or given
Family dynamics is always static, T/F
FALSE
The dynamics is never static, there are swings
Factors affecting family life
A. Mis-communication
B. Self image
C. Family crises
D. Social issues
E. Culture
F. Responsibilities and rewards
G. Types of families
H. Role expectations
I. Personal values
Mention lifestyle diseases (hint: 6)
Obesity
Neoplasm
Hypertension
Dyslipidaemias
Type 2 diabetes mellitus
Osteoarthritis
Primary prevention & treatment of many lifestyle diseases is via _________
Exercise
The recommended minutes of exercise per week
-for moderate-intensity=
-for vigorous-intensity=
at least 150min
at least 75min
What’s the recommended number of servings of fruit & vegetable per day
5
Moderate alcohol intake is defined as consumption of _____units per day in men and _____units per day in women
3-4 units in men
2-3units in women
A unit of alcohol is equivalent to ___grams
8g
Obesity is diagnosed when BMI is _____
30kg/m^2
The chief determinants of energy imbalance are lifestyle factors, T/F
TRUE
Individual total energy requirement depends on ______, ______ & _______
- the basal metabolic rate (BMR),
- thermic effects of food, and
- energy needed for the days physical activity(ies) needed
The incidence of overweight increases steadily after the age of ____ until the _____decade of life
20 until the 6th decade of life
Obesity can be seen in all ages, T/F
TRUE
Obesity results from the interaction of ______, _____ & _______
Genetic makeup, Environment, & Lifestyle
Men are more likely to be obese, T/F
FALSE
Men are more likely to be overweight, T/F
TRUE
BMI does not reflect distribution of body fat, T/F
TRUE
Calculation of BMI is not an effective estimation of risk in what subgroups (hint: 4)
- children and adolescents
- Individuals who are < 4 ft tall, or > 7 feet tall
- Competitive athletes and body builders
- Pregnant women
WHO categorization of obesity (underweight, healthy weight, Obesity I, Obesity II, Obesity III)
Risk factors for obesity (hint: 3)
- Family history of obesity
- Diet-high caloric, low fruits and vegetables, snack foods and fast –food consumption
- Low levels of physical activity
Structural social support has a direct effect on health, T/F
TRUE
Functional or perceived social support directly affects health by buffering stress
FALSE
It indirectly
Mention the forms of social support
Emotional
Esteem
Tangible or Instrumental
Information
Network
Social support influences health through two pathways namely
- Buffering of Stress
- The main effect hypothesis
People with more social support have a lower susceptibility to the common cold, T/F
TRUE