Family Flashcards
What are the cancers for which screening does not exist?
Endometrial, ovarian, skin, lymphoma
What is a normal PSA?
Less than 4
What test can be used to assess the stability of the calcaneofibular ligament?
inversion stress test
What factors are taken into consideration in grading an ankle sprain?
loss of function, ecchymoses, severity of pain, severity of swelling
What should be used for compression of ankle injuries/
semirigid support
What is in the differential for lateral ankle tenderness?
lateral ankle sprain (A), peroneal tendon tear (due to inversion injury) (D), fibular fracture (E), talar dome fracture (often related to ankle sprain) (G), and subtalar dislocation (H).(often high energy)
Distinguish basal cell carcinomas from squamous cell carcinomas
basal cell carcinomas - plaque like, waxy/transulcent. rarely itchy. usually slow growing and rarely malignat
squamous cell - fleshy, irregular borders, bleed easily, more frequently malignant
What are examples of end organ damage in diabetes?
neuropathy, nephropathy, coronary heart disease, cerebrovascular disease,
What is the mortality rate of HHNK?
often 15-20%
Describe HHNK vs. DKA
few ketones, glucose often >600, no metabolic acidosis
What proportion of the population is affected by diabetes?
8.3%
What should you look for on fundoscopic exam to evaluate for diabetic retinopathy?
Retinal hemorrhages - are dark blots with indistinct borders that indicate partial obstruction and infarction.
Cotton wool spots are white spots with fuzzy borders and they indicate areas of previous infarction. They accompany hemorrhages.
Microaneurysms
What proportion of diabetic neuropathy is asymptomatic?
up to 50%
What tests should be performed to screen for diabetes?
fasting lipid profile, spot albumin-creatinine ratio, B12 levels (metformin lowers B12), TSH, lipid profile
What can be done to improve cardiovascular outcomes in diabetic patients?
quit smoking, lower BP, add statin, lifestyle modification (diet, exercise), consider aspirin in patients with existing CV risk (hasn’t been shown to improve mortality except in patients with increased CV risk
What are the classifications of blood pressure?
<120 - normotensive
120-139 - prehypertensive
if less than 60, anything greater than 140 is hypertension
If greater than 50, anything greater than 150 is hypertension
What is the cause of most hypertension?
98-99% is essential hypertension with no known identifiable cause
rest are secondary hypertension
How should BP be measured?
should be seated for 5 minutes, arm at heart level, length of bladder at least 80% width of arm circum, width at least 40% arm circumference
What are the BP med recommendations for different populations of patients (consider age and race). What meds are not recommended?
General non-black population <140/90
Calcium channel blocker or thiazide diuretic
-beta blockers, t blockers, non-selective diuretics not recommended
What are potential side effects of thiazide diuretics to consider?
can cause electrolyte abnormalities (e.g. hyponatremia), should be avoided in patients with hx of gout because can precipitate flares, can cause incontinence in older patients, can cause hypotension (so start at low dose like 6.25mg)
What lifestyle change modifies BP the most?
weight reduction
What are some of the best prognostic indicators of death (1 and 2)
age is 1, LVH (in patients both with and without hypertension)
What tests are suggested for patients diagnosed with hypertension?
EKG (look for LVH), UA, hematocrit (look for anemia), serum K, serum Cr, (not serum Na/serum Cl) , lipid panel, serum Ca (look for hyperparatyhroidism that might indicate renal damage from kidney stones)
When should you prescribe aspirin in patients with hypertension?
wait till BP is within normal range to avoid risk of hemorrhagic stroke