Family med Flashcards
Neonate should visit
within 1-2 Weeks of birth
Infant should visit at
at 2, 4,6, 9, and 12 months
Toddler should visit at
15, and 18 months; 2 and 3 years old
Preschoolers should visit
annual visits beginning at 3 years old
Primary school age visit
annual visits 5 through 10 years old
Middle school age visit
annual visits 10 through 13 years old
Middle and late adolescent period should visit
annual visits 13 through 19 years old
Social smile
8 wks
Fixes head and follows by turning head
3 months
Head control
4 months
Sits unsupported
9 months
Palmar grasp and transfer toys
9 months
Polysyllabic babble (Mama, Dada)
7 months
Fear of strangers
10 months
Mature pincer
12 months
Walks at
18 months
Feeds self
18 months
6-10 words
18 months
— Posterior Fontanelle
— Anterior Fontanelle
: Usually, cannot be palpated after two months of age
Generally, closes between 10-24 months of age, the fontanelles of premature infants tend to close later.
The minimal acceptable weight gain in the neonatal period and infancy is
30 g/day through 3 months of age
20 g/day 3-6 months
10 g/day 6-12 months.
Newborn screening program
Thyroid function test (TFT) for Congenital Hypothyroidism Phenyl-ketonuria (PKU)
Hearing screening
Screening of vision is done at ___ years of age by Visual Acuity Testing and Cover/uncover Test for Amblyopia.
3
It is normal for infants to have occasional ________until 3 months of age
strabismus
universal screening of all newborn infants for hearing loss at birth_________
“before 1 month of age”
AAP recommends universal screening of Hb for anemia at
12 months.
AAFP, AAP and NICE recommend initiating an evaluation for ADHD for any child ____ year presenting by academic or behavioral problem
4-18
USPSTF recommends screening children aged _______ years and older for obesity
6
The Egyptian Pediatric Clinical Practice Guidelines Committee recommends starting daily iron supplementation from age 6 months through ______ years (19 if girl)
12
Infants who are exclusively breastfed or receive less than 1 liter of formula daily should be supplemented with 400 IU of vitamin D daily, starting in the first few days of life and continuing until they are
12 months
Infants should never have a bottle in bed, and babies should be weaned to a cup by ______
12 months
SSHADESS stands for
Strength or interests
School
Home
Activities
Drugs/Substance use
Emotions/Depression
Sexuality
Safety
HEADSSS risk assesment
Home
Education/Employment/Eating
Activities
Drugs
Suicidality/Depression
Sexuality/Sexual behavior
Safety
Spirituality
USPSTF recommends screening for major depressive disorder (MDD) in adolescents aged
12 to 18 years
PHQ-2 (Patient Health Questionnaire-2) is a useful screening tool that when positive should be followed by the PHQ-9 for more definitive diagnosis.
For depression screening
Exercise recommendations adults
A. Low to moderate level aerobic activity
* Frequency: Daily
* Duration: 30 minutes or more of cumulative activity, may split into three ten-minute activities daily
* Example: walking, using stairs instead of elevator
B. Moderate to vigorous aerobic activity
* Frequency: 3-5 times per week
* Duration: >20-30 minutes moderate intensity
* Example: football, biking, swimming, and running
Guidelines recommend calculating global CHD risk every____ years for all adults over age _____years or those with 2 or more risk factors, in order to consider risk modification.
5
40
The USPSTF (US preventive service task force) recommends low-dose aspirin use for the primary prevention of cardiovascular disease (CVD) in adults aged ______ years who have a _____ or greater 10-year CVD risk, are not at increased risk for bleeding, have a life expectancy of at least 10 years, and are willing to take low-dose aspirin daily for at least 10 years.
40 to 59
10%
Blood pressure readings should be obtained at _____ office visit and at least____ every 2 years.
every
once
The USPSTF recommends screening all men regardless of risk starting at age ____, and women at high risk at age ______; men and women should be screened earlier if high risk.
35
45
Cervical cancer screening
Routine cytology (Pap smear), Every 3 years in a sexually active woman aged 21 until 65.
Breast cancer screening
Mammography every 2 years, starting at 40 until 74
Colorectal cancer screening
Fecal occult blood testing (annually)
Sigmoidoscopy (every 5 years)
Colonoscopy (every 10 years)
Starting at 45 till 75
Lung cancer screening
Low dose CT annually, starting at 50 and ending at 80
Screening in adolescents
✔ Screening for primary hypertension
✔ Screening for iron deficiency anemia
✔ Screening for hepatitis B virus infection
✔ Screening for obesity :
✔ Screening for depression by PHQ2 and confirm by PHQ9
Immunization in adolescents
By age 11 to 12 years, they should have received
A booster dose of tetanus if > 5 years elapsed since last dose
Meningococcal vaccine
HPV
Annual influenza
Pneumococcal if high risk for infection
✔ Screening for Fall ➡ Timed get up and go test
- < 20 seconds = Independent
- > 30 seconds = High risk
Finger test is used to screen for
hearing impairment in geriatrics
Advise travelers to use at least DEET
20%
The most common cause of travelers diarrhea is
enterotoxigenic E coli (ETEC)
For diarrhea, ________ has antisecretory and antimicrobial properties, to | stool frequency and shorten the duration of illness (15 mL or 2 tablets every 30 minutes for up to 8 doses)
bismuth subsalicylate
Offer _________ vaccine fortravel to certain parts of sub-Saharan Africa and tropical South America.
yellow fever
Offer the _________ vaccine for travel to Saudi Arabia during the Hajj (required by the Saudi Arabian government)
meningococcal
Suspect ______ in any child with fever >38°C with no obvious cause. If any ‘Red’ flags, admit/refer for emergency assessment.
UTI
Around 2-5% of pregnant women have _________, defined as pure growth of >105 organisms/mL
asymptomatic bacteriuria
Criteria for pre diabetes
FPG 100 mg/dL to 125 mg/dL (IFG) OR
2-h PG during OGTT 140 mg/dL to 199 mg/dL (IGT) OR
Hemoglobin A1C 5.7-6.4%
Criteria for the diagnosis of diabetes Type 2
FPG >126 mg/dL. Fasting is defined as no caloric intake for at least 8 h.
OR
2-h PG >200 mg/dL during OGTT.
OR
Hemoglobin A1C >6.5%.
OR
In a patient with classic symptoms of hyperglycemia or hyperglycemic crisis, a random plasma glucose >200 mg/dL.
Treatment Goal of Diabetes
> Set A1 C/blood glucose target (HbA 1 c<7%)
Diabetes physical activities recommendation
> 150+ min/week of moderate-to-vigorous activity over at least 3 days/week with no more than 2 consecutive days without exercise.
> All adults, with type 2 diabetes, should decrease the amount of time spent in daily sedentary behavior.
> Prolonged sitting should be interrupted every 30 min for blood glucose benefits, particularly in adults with type 2 diabetes.
Diabetic foot care for patient
- Do not smoke
- Inspect feet daily
- Wash feet daily and dry carefully
- Avoid temperature extremes
- Do not walk barefoot
- Do not use adhesive tapes
- Do not soak feet
- For dry skin, use cream
- Wear properly fitting stockings
- Do not cut coms and calluses
- Shoes should be comfortable
- Cut nails straight across
- Notify your physician of blisters or sores on foot
Most common cause of fatigue
- Upper respiratory tract infection
- Iron deficiency anemia
- Acute bronchitis or bronchiolitis
- Adverse effect of a medication taken at the proper dose
- Depression or other mental disorder.
Medications associated with fatigue
- Antihistamines
- Corticosteroids
- Antidepressants
- Beta-blockers
- Muscle relaxants
- Patients describe a brief spinning sensation brought on when turning in bed or tilting the head back to look up.
- The dizziness is quite brief, usually seconds.
- Patients may experience nausea but rarely vomit.
- Ear pain, hearing loss, and tinnitus are absent
Benign paroxysmal positional vertigo
- Characterized by the rapid onset of severe, persistent vertigo, nausea, vomiting, and gait instability, spontaneous vestibular nystagmus, a positive head impulse, and gait instability without a loss of the ability to ambulate
Vestibular neuritis
- Acute vertigo with hearing loss, ipsilateral facial paralysis, ear pain, and vesicles in the auditory canal and auricle are typical features
Herpes zoster oticus
- Spontaneous episodic vertigo lasts for minutes to hours, usually associated with unilateral tinnitus, hearing loss, and ear fullness.
- The vertigo associated with Meniere disease is often severe and associated with nausea and vomiting and disabling imbalance
Meniere disease
Medications that can cause vertigo
- Alcohol
- Antihistamine
- Antiarrhythmics,
- Antihypertensives,
- Antidementia
- Benzodiazepine
Antiepileptics
- Traumatic peripheral vestibular injury following direct concussive head trauma,
- Symptoms of vertigo, nausea, and vomiting, and imbalance are maximal at onset and improve over days to months, depending on the severity of the injury.
Labyrinthine concussion
________examination can help distinguish central from peripheral causes of vertigo.
HINTS (head-impulse, nystagmus, test of skew)
__________can diagnose benign paroxysmal positional vertigo.
Dix-Hallpike maneuver
patient looks straight ahead; alternate eye cover testing checks for ability to maintain vertical alignment of the eyes. Deviation of the covered eye after uncovering suggests a central cause.
Test of Skew
Three general classes of drugs can be used to suppress the vestibular system:,
Antihistamines - Meclizine, dimenhydrinate, diphenhydramine
Benzodiazepines - diazepam, lorazepam, clonazepam, alprazolam
Antiemetics - ondansetron, prochlorperazine, promethazine, metoclopramide, domperidone
6- If the office blood pressure is between 140/90 mmHg and 180/120 mmHg, offer _________________ to confirm the diagnosis of hypertension.
ambulatory blood pressure monitoring (ABPM) or home blood pressure monitoring (HBPM)
In people with type 2 DM, or aged > 80 years old or with symptoms of postural hypotension (falls or postural dizziness): measure blood pressure with the
person either supine or seated then measure blood pressure again with the person standing for at least 1 minute before measurement. If the systolic blood pressure falls by 20 mmHg or more when the person is standing, consider diagnosis of postural hypotension.
white-coat effect also known as
masked hypertension
Always ask about asthma before prescribing ____________ and advise patients to stop using them if asthma worsens.
NSAIDs
5 “A”s approach
Ask,
Advise
Assess
Assist
Arrange
Ask every tobacco user if he or she is willing to try to quit at this time (e.g., within the next _______).
30 days
The approved non-nicotine medications are_______
bupropion and varenicline.
Red flags for abdominal pain
- Sudden onset of severe pain
- Pain that interrupts sleep
- Bilious vomiting
- Hematemesis, hematochezia
- Hypotension, tachycardia
- Patient lying very still
- Guarding and/or rigidity (focal or diffused)
- Rebound tenderness (focal or diffused)
- Absent bowel sounds
- Gross abdominal distention
- Pain out of proportion to abdominal findings
- Age > 50 years
- Previous abdominal surgery
- History of CAD and/or atrial fibrillation
Most airlines allow women to fly up to______weeks of pregnancy
37
Acute diverticulitis : sy,ptoms
- Pain in the left lower quadrant
- Fever & leukocytosis
- Possible abdominal mass
- Guarding & rebound guarding
- Constipation, Diarrhoea
Diet recommendations for diabetes
✔ 80 % of your daily CHO of low glycemic index
✔ 20 % of Moderate glycemic index
Acute Conjunctivitis; bacterial vs viral
✔ Bacterial :
- $ Yellow Sticky discharge
✔ Viral :
- $ Association with URTI
- Watery discharge
Low UTI (cystitis) vs Upper UTI (pyelonephritis) symptoms
✔ Lower UTI (Cystitis) ➡ local symptoms :
- Dysuria
- Urgency
- Low abdominal pain
✔ Upper UTI (Pyelonephritis) ➡ Systemic symptoms :
- Loin pain
- Fever
- Rigors or hematuria
▶ Follow up should be initially for HTN
✔ Every 1-4 weeks till BP is controlled then ✔ Every 3-6 months if controlled
✔ Monthly if controlled
▶ Relievers : taken only when needed for athsma
- Inhaled LABA + Corticosteroid
- Inhaled SABA + Corticosteroid
▶ Controllers : taken daily to prevent symptoms for asthma
- Inhaled Corticosteroids
- Inhaled LABA
- Anticholinergics
- Leukotriene modifiers
______are both are not licensed for use during pregnancy nor breastfeeding
Varenicline or bupropion
