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Family Med > Family Med SG12 > Flashcards

Family Med SG12 Flashcards

1
Q

Most common cause of sudden scrotal pain

A

Epidydimitis (but moderat pain deveoping gradually over a few days is also suggestive)

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2
Q

Most common cause of painless scrotal swelling

A

hydrocele

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3
Q

Torsion of testicular appendage happens in what age group

A

Prepubertal boys

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4
Q

Varicocele sx

A

Pts can be asymptomatic or may complain of a dull ache or fullness of the scrotum upon standing. More common on the left side

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5
Q

Cause of indirect versus direct inguinal hernia

A

Indirect is secondary to persistent process vaginalis. Direct is due to weakness in transversalis fascia area of Hasselbach’s triangle

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6
Q

HSP

A

Nonthrombocytopenia purpura, arthralgias, renal disease, abdominal pain, GI bleeding, and occasionally scrotal pain. Onset of scrotal pain can be acute or insidious. Treatment is supportive

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7
Q

What nerves travel to the scrotum and can be the cause of referred pain to the scrotum?

A

Genitofemoral, ilioinguinal, posterior scrotal

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8
Q

Retrocecal appendicitis

A

is a rare cause of referred scrotal pain

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9
Q

After surgical untwisting of the testicle, patient should avoid contact sports for how long?

A

1 month

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10
Q

Differentiating COPD from asthma

A

Significant reversibility (greater than 12% increase in FEV1 with bronchodilator therapy)

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11
Q

FEV1/FVC in asthma

A

May be normal to decreased in asthma. But is always less than 70% in COPD

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12
Q

FVC in COPD and asthma

A

FVC is normal to decreased in COPD. FVC is always decreased in asthma

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13
Q

Cells involved n COPD

A

Macrophages, T killer cells, and neutrophils

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14
Q

Cells involved in asthma

A

Mast cells, T helper cells, and eosinophils (allergy things)

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15
Q

Chronic bronchitis

A

Productive cough for at least 3 mos for the past 2 years

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16
Q

Acute bronchitis

A

Cough and SOB of 2-3 week duration

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17
Q

COPD exam findings

A

Increased AP diameter of the chest, Decreased diaphragmatic excursion. End expiratory wheezing. Prolonged expiratory phase. Max laryngeal height less than 4 cm at full inspiration

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18
Q

Four items on history that are predictive of COPD

A

Smoking over 40 pack years. Self reported hx of COPD. Max laryngeal height less than 4 cm. Age over 45

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19
Q

FVC

A

Total amt of air the patient can take INTO the lungs. Whereas FEV1 is amt the patient can blow out

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20
Q

In COPD, why is amt of air not exhaled as much?

A

Either physical obstruction (mucus) or airway narrowing caused by inflammation

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21
Q

The severity of COPD is based on what?

A

FEV1. Mild is over 80, moderate is 50-80, severe is 30-50, very severe is less than 30 OR less than 50 wth chronic respiratory failure

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22
Q

CXR findings in COPD

A

Note: do not use xray to dx COPD. Findings include hyperinflation, hyperlucency, rapid tapering of vascular markings

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23
Q

Treatment of COPD

A

Bronchodilators [Beta ags (short and long acting). Inhaled long acting anticholinergics (ipratroprium). Oral methylxanthines] Second, inhaled steroids. Third, systemic steroids. Fourth, smoking cessation

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24
Q

For COPD patients, combining bronchodilators from different pharmacologic classes may improve efficacy and decrease side effects

A

right

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25
Q

How do you manage maintenance therapy of moderate COPD?

A

Maintenance therapy of inhaled anticholinergics (ipratroprium or tiotroprium) alone or in combo with SABA

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26
Q

MDI and spacer versus nebulizer

A

MDI and spacer achieves equal or better results than a nebulizer

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27
Q

Which COPD patients get inhaled steroids?

A

FEV1 less than 50 (severe) and repeat exacerbations. An inhaled steroid combined with LABA is more effective than the individual components

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28
Q

When are oral steroids useful for COPD patients?

A

During acute COPD exacerbation. May improve lung function for about 20% of patients with stable COPD. There are lots of side effects.

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29
Q

How does smoking cessation affect COPD?

A

Can reduce the RATE of FEV1 decline. Complete abstinence (not just reduction in smoking) is needed. Lung function decreases at twice the rate in patients who continue to smoke versus those who quit. Quitting provides benefit whenever the person quits, however the major benefit is in the first year. Even if the person relapsed, there was a benefit to having stopped

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30
Q

Who should get the pneumococcal vaccine

A

All patients 65 and older. COPD patients less than 65 with FEV1 less than 40%

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31
Q

When are antibiotics given during a COPD exacerbation?

A

If the patient has all 3 of: increased dyspnea, increased sputum volume, increased sputum purulence. Or if the pt has 2 of the cardinal sx and increased sputum purelence is one. OR if the patient required mechanical ventilation (invasive or non-invasive)

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32
Q

Noninvasive mechanical ventilation during a COPD exacerbation has what benefits?

A

Improves respiratory acidosis, increased pH, decreases need for ET tube, reduces PaCO2, RR, severity of breathlessness, length of hospital stay, and mortality

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33
Q

Leading cause of death in the US

A

CAD

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34
Q

CHF is more common in what demographic?

A

Older women

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35
Q

All patients with systolic dysfunction also have concomitant diastolic dysfunction

A

But you can have diastolic dysfunction wihtout systolic dysfunction (preserved EF)

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36
Q

Number 1 and 2 causes of new onset CHF

A

Significant CAD is number 1. Uncontrolled hypertension leading to diastolic dysfunction is number 2

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37
Q

Types of non-ischemic cardiomyopathy

A

Dilated, hyperttrophic, arrhythmogenic RV dysplasia, restrictive cardiomyopathy

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38
Q

New onset CHF- what endocrine disorder must be ruled out?

A

Hypothyoridism because it can precipitate CHF. The heart muscle is weak and cannot relax normally. Hyperthyroidism can do it too but it is a much less common cause of CHF. In this case, leads to increased cardiac work

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39
Q

Cephalization of pulmonary vasculature

A

Typically, pulmonary vessels are not well seen in the upper lung fields. In CHF, however, they become engorged and can be seen extending from the hilum

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40
Q

Kerley B lines

A

Small linear densities 2-3 cm in length in the periphery of the lung fields on PA view. Represent interstitial fluid in the lung tissue

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41
Q

T wave inversions on EKG

A

Prior injury or acute ischemia

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42
Q

ST depressions with T wave inversions in lateral precordial leads

A

Signs of LVH

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43
Q

Diastolic dysfunctin

A

EF over 45% with sx of HF

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44
Q

Thalium or sestamibi as nuclear agent are more sens and specific than what?

A

Excerise tolerance test (AKA Exercise EKG)

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45
Q

CAC scoring

A

Coronary artery calcium score. Sensitivity similar to nuclear stress testing and stress ECHO. However, specificity is very low

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46
Q

First choice BP med in patients with DM, HTN, and albuminuria

A

Ace-I and thiazides

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47
Q

DM goal A1C

A

less than 7%

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48
Q

Cholesterol- the old LDL goals

A

If CAD, goal is LDL less than 100. If CAD plus ongoing risk factors, then LDL goal is less than 70

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49
Q

Aspirin

A

Reduces risk of MI in patients with CAD. In women, it is a preventative measure for stroke

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50
Q

Rapid changes in weight

A

Are assoc with increased risk of heart disease

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51
Q

Systolic HF management

A

ACE-I reduces mortality and hospitalizations. ARB reduces mortality. Beta blockers reduce mortality. Spironolactone improves mortality for class III and IV (not I or II). Digoxin, loop diuretics are used but do not decrease mortality

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52
Q

CCB in CHF?

A

No role for CCBs in CHF

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53
Q

Digoxin in CHF

A

Improves symptoms and reduces hospitalizations, but does not improve mortality

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54
Q

Loop diuretics in CHF

A

Minimize fluid overload and enhance effects of other meds

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55
Q

Beta blockers in CHF

A

Reduce mortality. Neg ionotropic and chronotropic effects acan worsen HF initially. Generally should not be started in setting of decompensated CHF

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56
Q

Amlodipine in CHF

A

Don’t use it. It increases peripheral edema

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57
Q

Thiazoladinediones such as rosiglitazone (Avandia) and pioglitazone (Actos)

A

Worsen heart failure

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58
Q

Diastolic dysfunction management

A

No randomized trials. Either BB or non-dihydropyridine CCB (diltiazem) can be used. They slow HR, increase ventricular filling time, and decrease BP

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59
Q

Primary dysmenorrhea occurs in what age group

A

Women in their teens and twenties. Classically appears 1-2 years after menarche. Incidence decreases as a woman has more children. Birth control use and timing can impact symptoms

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60
Q

Risk factors for primary dysmenorrhea

A

Depression/anxiety, smoking, early onset menarche, Overall lower state of health or other social stressors

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61
Q

Menorhagia or menses

A

Blood loss greater than 80 mL or menses over 7 days

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62
Q

Features of PMS

A

Breast soreness, wt gain, bloating, diarrhea, constipation, fatigue, behavioral sx, easy crying. Diagnosic criteria: must affect a pt’s life. Must rule out depression

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63
Q

Premenstrul dysphoric disorder

A

More severe than premenstural syndrome. Sx have to significantly impair a woman’s life. PMDD is like PMS with even more severe emotional sx

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64
Q

Normal uterus

A

6-8 wks size (clenched fist), may be mildly tender just prior to or during menses, smooth in contour and mobile

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65
Q

Normal ovaries

A

Size of an oyster, May be slighlty larger during ovulation due to physiologic cysts. Mild tenderness on palpation of theovaries is normal

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66
Q

Normal cervix

A

Nabothian cysts are formed during the process of metaplasia where normal columnar glands are covered by squamous epithelium. It is not normal for the cervix or vagina to be blueish (may indicate endometriosis)

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67
Q

Racial prevalence for fibroids

A

More common in African Americans (3x)

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68
Q

What decreases the risk of fibroids?

A

OCP use, increased parity, and smoking

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69
Q

What increases the risk of fibroids?

A

Early menarche, family history of fibroids, and increased alcohol use

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70
Q

Symptoms of fibroids

A

Menorrhagia (most common), anemia, dysmenorrhia, increased urinary freq (secondary to pressure) and difficulty achieving pregnancy. Does NOT cause intermenstrual bleeding

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71
Q

Chronic PID

A

Can be a cause of menorrhagia in 1/3 of women. Lower abdominal pain, unrelated to menses, is usually associated

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72
Q

Adenomyosis

A

Endometrial tissue grows into the muscular wall of the uterus. More frequently in parous than nonparous women. Ultrasound shows heterogeneous boggy uterus (but symm and mobile). MRI is more spec for dx. Not currently any surgical treatment

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73
Q

Symptoms of adenomyosis

A

Menorrhagia, some urinary and GI sx secondary to mass effect

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74
Q

Cervical stenosis

A

Can be congenital or acquired (related to cryotherapy or LEEP). Uterus becomes distended with blood. Dysmenorrhea not responsive to NSAIDs. Minimal menstrual flow. Uterus will feel diffusely enlarged

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75
Q

Endometriosis

A

75% will have either chronic pelvic pain or dysmenorrhea. Dyspareunia is common in endometriosis and rare in fibroids. Bowel or bladder x that cycle with mesnese, fatigue, abnomal vaginal bleeding, and some effects on fertility

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76
Q

Sx of endometriosis

A

Pain in cul-de-sac, immobile and retroflexed uterus, nodules on uterosacral ligaments or pain with uterine motion

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77
Q

Symptoms of ovarian cysts

A

Recurrent and chronic lower quadrant non-midline pelvic pain either midcycle or assoc with menses. May come and go unrelated to ovulation

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78
Q

Uterine polyps

A

Do not typically cause pain. Women may have abnormal bleeding specifically intermenstrual or postcoital

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79
Q

Thyroid disorders causing abnormal bleeding

A

Tyroid disorders primarily affect freq of menses and should be considered if other causes of abnormal bleeding are excluded

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80
Q

CT and MRI looking for pelvic pathology

A

CT does not give good view an dis not used for gyn problems. MRI used for adenomyosis and fibroids, to more accurately asses change in tumor volume preop, better analysis of ovarian masses, expensive and time consuming. NOT used as initial study for anything

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81
Q

Management of dysmenorrhea secondary to fibroids

A

Ibuprofen (decr prostaglandins), IUD (Mirena works but paraguard is not a treatment for fibroids), Combined hormonal contraception (nuvaring, ortho-evra patch, oral pill), depo-provera, hysterectomy, myomectomy, uterine artery embolization

82
Q

IUD (Progesterone Mirena) for fibroids?

A

Effective for reducing menstrual flow in addition to pain; Can decrease overall uterine volume (though not the size of the fibroids) by fostering endometrial atrophy. After one cycle, RTO to have string checked

83
Q

Side effects of the Mirena IUD

A

Expulsion, pain with intercourse, irreg bleeding, partner may feel the string

84
Q

Depo-provera

A

One shot q 12 weeks. Side effectsare bone density loss after several years of use, may take 9-18 mos for a woman to regain regular menses. Higher rate of irreg bleeding when initiated. Potential weght gain

85
Q

What intervention reduces bleeding more at one year than any other medical treatment?

A

hysterectomy. Indicated when the uterus is enlarged 14-16 wks with or without symptoms or when there is any fibroid that is growing rapidly or any time a pt has failed other management

86
Q

Uterine artery embolization as a treatment for fibroids

A

there are complications! Risk of urgent hysterectomy, post procedural pelvic pain, postembolization syndrome (pain, cramping, fever), potential ovarian failure, necrosis of fibroids. Reserved for women who cannot tolerate other hormonal tx. NOT an option for just dysmenorrhia or menorrhagia without uterine fibroids

87
Q

Paraguard IUD

A

Increases risk of dysmenorrhea and menorrhagia. This is NOT a treatment for fibroids

88
Q

Treatment of dysmenorrhea without uterine pathology

A

acupuncture (improves QOL), TENS (transcutaneous electric nerve stimulation), thiamine plus vit E, presacral neurectomy and ulnar nerve ablation (insufficient evidence)

89
Q

Management of PMS

A

SSRIs (works for both psych and physical sx), OCP, Danazol, Other GnRH agonists (leuprolide), oopharectomy, spironolactone (inconsistent effectiveness), vit B6 (inconsistent), regular exercise (mildly effective)

90
Q

SSRIs for PMS

A

Works for both psych and physical sx. Most effective treatment. Intermittent treatment just as effective as daily treatment. You can start 14 days before period and continue until menses start OR start on first day of sx and continue until start of menses or 3 days later. If one med doesn’t work, another in the same class might. Follow up after 2-4 cycle

91
Q

OCPs for PMS

A

Effective for dysmenorrhea, anovulation and in some cases menorrhagia

92
Q

Danazol for PMS

A

Androgen with progesterone effects. Inhibits ovulation. Side effects are weight gain, suppressed HDL and hirsutism

93
Q

Other GnRH agonists for PMS

A

Leuprolide is an example. Ovulation inhibitor. Anti-estrogen effects (hot flashes) make this not as popular

94
Q

Oopharectomy for PMS?

A

Only in severe refractory cases

95
Q

Spironolactone for PMS

A

inconsisten effectiveness for bloating and breast tenderness

96
Q

Vit B6 for PMS

A

inconsistent effectiveness. Overdose can cause a peripheral neuropathy

97
Q

Regular exercise, decrease carbs in the luteal phase, and relaxation therapy

A

these all have a mild effect on PMS

98
Q

Frenzel glasses

A

prevent fixation and bring out nystagmus (particularly peripheral, bc it can be inhibited by fixating on something)

99
Q

Head thrust test

A

Normal head thrust test in the presence of vertigo measn the peripheral vestibular system is intact and that the lesion is central

100
Q

Peripheral versus central nystagmus

A

Peripheral exampls are Meniere’s disease, vestibular neuritis, BPPV, positive head thrust, unidirectional nystagmus that does not change direction, nystagmus resolves with gaze fixation. Central is a CNS problem (stroke, TIA, vestibular migraine), head thrust is normal and nystagmus changes direction, nystagmus does not resolve with gaze fixation

101
Q

Meniere’s disease classic triad

A

unilateral hearing loss, tinnitus, vertigo

102
Q

Treatment of Meniere’s disease

A

Diuretics and low salt diet to decrease endolymphatic pressure and abate symptoms

103
Q

Second most common cause of vertigo

A

Most common is BPPV. Second most common is vestibular neuritis. Commonly assoc with recent URI. Caused by inflamm of vestibular branch of CN 8. Labrynthitis is when the infection ALSO affects the hearing branch of CN8 so you get tinnitus and/or hearing loss in addition to the vertigo

104
Q

Treat with Abx versus watchful watiitng versus don’t treat with abx

A

Treat: OM in t treat with abx OM over 2 yo (well, abx are optional), maxillary sinusitis, viral URIs

105
Q

OM treat with antibiotics?

A

Less than 6 mos treat, 6 mos-2 yr watchful waiting, over 2 yrs don’t treat (but optional really)

106
Q

Vestibular suppressant meds

A

Can be effective in the short term treatment of vertigo. Anticholinergics (mezclizin and dimenhydramine) also have anti-emetic effects. Nonselective phenothiazine anti-emetics (metoclopramide and promethazine) can be useful adjuncts. All these meds can cause sedation so should be avoided in elderly

107
Q

RF for obesity in kids

A

Prader-Willi syndrome, Bardet-Biedl syndrome, Cohen Syndrome, high birthweight, maternal DM, FH of obestity (one parent incr x3, two parents, x 10), family dynamics, lack of safe place for physical activity, low cognitive stimulation at home, low SES

108
Q

Three critical periods of excessive weight gain

A

Infancy, Adolescence, Early menarche

109
Q

Infancy weight gain and breast milk

A

More breast milk, less obesity

110
Q

Sequelae of childhood obestity

A

Pickwickian syndrome, restictive lung disease (but not asthma), Blount disease, SCFE, and all the others (HTN, OSA, etc)

111
Q

SCFE and puberty

A

typically happens in obese patients with delayed puberty

112
Q

SCFE on plain xray of the pelvis

A

widening of the physis

113
Q

DM dx in kids

A

the three criteria (the four of adult minus the hga1c)

114
Q

Criteria for testing for DM type 2 in kids

A

BMI over 85%ile or weight to height ratio over 85%ile or weight over 120% ideal for height plus 2 of any: FH of DM2 in first or second degree relative, race/ethnicity non-white, signs of insulin resistance (PCOS, HTN, HLD, acanthosis nigricans). Start screening at age 10 or onset of puberty. Screen every 2 years with fasting glucose

115
Q

Hypertension in kids cut offs

A

Normal is less than 90%ile. PreHTN is 90-95. Stage 1 is 95-99 plus 5 mmHg. Stage 2 is 99+ plus 5 mm Hg

116
Q

Most BP elevation in kids over 6 yo is due to what?

A

primary hypertension

117
Q

Flu vaccine for kids

A

The first year of immunization, kids less than 9 yo need 2 doses 1 month apart. Thereafter, annual single dose of vaccine

118
Q

Hep A vaccine

A

Routinely recommended at 12 and 18 mos

119
Q

Weight age

A

Age at which weight plots at 5oth percentile

120
Q

Mood disorders prevalence and age

A

Prevalence increases with age

121
Q

Kids with ADHD and mood disorders

A

Kids with ADHD have a higher rate of mood disorders. Oppositional defiance disorder and conduct disorder have high comorbidity rates with ADHD

122
Q

Screening in kids

A

85 to 95%ile get fasting lipid panel. 85-95%ile and RFs- obtain fasting lipid plus LFTs plus fasting glucose, Above 95%ile with or without RF get above plus BUN/Cr

123
Q

Weightloss maximum rate

A

Not more than 1 lb/month in preteens. Not more than 1 lb/week in teens

124
Q

Management of preHTN in kids

A

Therapeutic lifestyle changes, ask school nurse to record weekly blood pressure, follow up in office q 6 mos. Reserve treatment with meds to kids whose BPs are consistently very high or evidence of target organ damage (LVH), some say low sodium diet

125
Q

Management of ADHD

A

80% of kids with ADHD will respond to stimulants.

126
Q

Are kids with ADHD on stimulants at any higher risk for substance abuse?

A

No

127
Q

Tic disorder is a side effect of stimulants

A

Seen in less than 1% of kids. In most cases, tic resolves when med is stopped.

128
Q

Slight decrease in growth velocity is SE of stimulants

A

Effect resolves when meds are stopped

129
Q

American Academy of Peds mandates developmental screening at what ages?

A

9 mos, 18 mos, and 30 mos check up. Specific autism screening is recommended at 18 mos and 2 years

130
Q

Formulas

A

Ready to feed formula, powder, formula concentrate

131
Q

Never give cows milk to infant under what age?

A

1 yr. Could collitis, leading to anemia

132
Q

Most babies regain birthweight by when?

A

1-2 weeks old

133
Q

What is the caloric requirement of a 1-2 month old

A

100-120 cal/kg/day. Preterm infants require 115-130

134
Q

Average daily weight gain for a term infant

A

20-30 grams per day

135
Q

Moro reflex

A

Symmetric abduction and extension of arms, followed by adduction of the arms. Present birth until 4 mos. Can be used to detect peripheral problems like congenital MSK abnormalities or neural plexus problems

136
Q

Four domains of developmen

A

gross motor, fine motor, language, social

137
Q

Patient’s Evaluation of Developmental Status

A

Parents are asked to answer 10 questions on PEDs response form. Used for kids 0-8yo. Evidence based

138
Q

Two months milestones

A

Lift head, follow past midline, laugh, smile spontaneously

139
Q

Four months

A

Roll over/sit, follow to 180 degrees, turn to rattling sound

140
Q

Six months

A

Sit without support, look for dropped yam, turn to voice, feed self, babbles, feeds self, stranger recognition (prelude to stranger anxiety)

141
Q

Nine months

A

Pull to stand, take 2 cubes, dada/mama, wave bye bye

142
Q

Twelve mos

A

Pull to stand, stand alone, first steps, put a block in a cup, bag 2 cubes, 1 or 2 more words than mama/dada, play patacake

143
Q

Fifteen mos

A

Stoops and recovers, walks well, few words, drinks from a cup

144
Q

Eighteen mos

A

Walks backward, run, scribble, build a tower of 2 cubes ,3-6 word vocab, remove clothes

145
Q

2.5 years

A

jump, throw a ball, tower of 6-8 cubes, point to 6 body parts, name 1 picture, put on clothing, wash hands

146
Q

Two month anticipatory guidance

A

Solid foods (around 4 mos can start rice cereal); vit D (400 units/day, esp those on mostly breast milk), childcare, sleep (most sleep through the night by 4-6 mos), safety

147
Q

Children under what age should not be in the front?

A

13 years old

148
Q

Immunizations at 2 month visit

A

first dose of the following: Dtap, Hib, IPV, PCV-13, rotavirus, hep B (second dose now, first was given in nursery)

149
Q

MMR and Hep A are not given until 12 mos of age

A

Right

150
Q

Hep A and Rota

A

Rota is 2 or 3 doses. Hep A is 2 doses

151
Q

Pneumoccocal number of doses

A

four

152
Q

Kids should double bithweight by when?

A

5 mos. Triple by 12 mos

153
Q

Kids should double birth legnth by when

A

4 years

154
Q

Absence of red reflex may indicate

A

Cataracts, glaucoma, retinoblastoma, chorioretinitis

155
Q

Six month anticipatory guidance

A

Childproof the home. Car seat placement. Use of walker is recommended against. New foods can be added every 5 to 7 days. Developmental change (stranger anxiety, start reading to her, 2 naps per day and will prob sleep through the night)

156
Q

Acetomoniphen and vaccines

A

Acetominophen can lower antibody response for some immunizations. It should be administered only if completely necessary

157
Q

Nine month old

A

Wave bye bye. Sit without support

158
Q

Most frequently diagnoised neoplasm in infants

A

Neoblastoma. More than half of patients present before age 2

159
Q

Neuroblastoma

A

May present as painless mass in neck, chest, or abdomen. May have pain from mets to bone marrow or skeleton. Fever, pallor and weight loss are common presenting symptoms

160
Q

Teratoma

A

Rare, malignant tumor. May present as painless abdominal mass without other sx or may cause pressure effects on neighboring structures resulting in pain

161
Q

Wilms tumor

A

AKA nephroblastoma. Asymp RUQ mass. May present with abdominal pain and/or vomitting. Patients may be hypertensive. Median age at dx is 3 yo

162
Q

Most common cause of left sided abdominal mass in an infant

A

constipation. Usually mobile on palpation

163
Q

First imaging study to evaluate for this baby’s mass

A

abdominal ultrasound. Purely cystic masses are less likely to be malignant

164
Q

Prognosis of neuroblastoma

A

In infants less than 1 yo, these tumors may spontaneously regress, even if they have already metastasized. Non-amplification of the n-myc gene is favorable prognostic factor

165
Q

Genetics of neuroblastoma

A

There are familial forms but these account for only 1% of cases

166
Q

Beckwidth-Weidemann syndrome

A

Assoc with Wilms tumor, omphalocele, hemihypertrophy, hypoglycemia, LGA

167
Q

Any patient presenting with insomnia

A

should be screened for depression and anxiety

168
Q

Treatments for insomnia in the elderly

A

CBT forinsomnia, medication treatments (zolpidem=ambien and melatonin receptor agonists)

169
Q

CBT for insomnia

A

Includes sleep hygeine instruction and sleep restriction with cognitive restructuring. CBT is the most effective treatment (better than meds!).

170
Q

Meds for insomnia in the elderly

A

Zolpidem (Ambien) and melatonin receptor agonists. Combining CBT and meds can be very efficacious in some patients.

171
Q

Exercise as treatment for insomnia

A

Not very good evidence

172
Q

Medical conditions assoc with depression

A

Hypothyroidism, Parkinson’s disease, dementia

173
Q

Factors that increase a patient’s risk for COMPLETED suicide

A

Male, older, having a previous SA

174
Q

Factors that make you more likely to attempt suicide

A

Being a widow, living alone, perceive health status as poos, poor sleep quality, lack confidante, stressful life event

175
Q

Most common means of suicide in the elderly

A

Drug overdose

176
Q

What is special about depression in the elderly?

A

Increased risk of diabilities in mobility and ADL. Completed suicide is more common in older depressed patients. The chance of spontaneous remission of depression is much lower in the elderly than in younger kids

177
Q

MDD versus bereavement

A

MDD dx not given unless sx present 2 mos after the loss.

178
Q

Dementia screening tools

A

Mini cognitive exam (faster and more sens/specific) and mini mental status exam

179
Q

SSRIs

A

Citalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, escitalopram

180
Q

TCAs

A

Block reuptake of norepi and seratonin. Nortriptyline, amitryptiline, clomipramine, doxepin

181
Q

MAO-Is

A

Block reuptake and catabolism of norepi and seratonin. Phenelzine. Tanylcypramine

182
Q

SNRIs

A

Venlafaxine, duloxetine

183
Q

Norepi and dopamine reuptake inhib

A

Burproprion

184
Q

Serotonin antage and reuptake inhib

A

Nefazadon, trazadone

185
Q

Norepi and seratonin antag, antihistaminic effects

A

mirtazapine (Remeron)

186
Q

Seratonin partial agonist and reuptake inhib

A

Vilazadone HCl

187
Q

Common side effects associated with SSRIs and SNRIs

A

HA, insomnia/drowsiness, nausea/diarrhea, hyponatremia due to SIADH, seratonin syndrome, increased risk of GI bleed, increased risk of falls in the elderly

188
Q

TCAs cause arrhythmias

A

yes

189
Q

Psychotherapy and meds

A

Psychotherapy (CBT nad interpersonal therapy) are as effective as psychotropic

190
Q

Exercise as treatment for depression

A

Small but statistically signig positive effect

191
Q

How long do you keep a person on SSRI trial for depression?

A

In first episode, trial of med for at least 9-12 mos. Recurrent episodes of depression are treated for 2-3 years

192
Q

SSRIs and pregnancy

A

Paxil is pregnancy D, but the rest are category C

193
Q

Fluoxetine (prozac)

A

Long half life, so efects last for weeks after discontinuation. Most problematic side effects are agitation, restlessness, decreased libido in women, and insomnia

194
Q

Sertraline (Zoloft)

A

Frequently used in pregnancy and breast feeding. Approved specifically for OCD, panic, and PTSD. More GI side effects than the other SSRIs

195
Q

Paroxetine (Paxil)

A

Strong anti-anxiety effects, best studied SSRI in kids, side effects are signif weight gain, impotence, sedation, and constipation. Due to its short half life, needs to be tapered

196
Q

Fluvoxamine (Luvox)

A

Particularly useful in OCD, greater freq of vomitting compared to other SSRIs

197
Q

Citalopram (Celexa)

A

Side effects are nausea, dry mouth, and somnolence

198
Q

Ecitalopram (Lexapro)

A

Approved specifically fo GAD. Fewer side effects than citalopram

199
Q

Hispanics and depression

A

Hispanics (and Af am) have their depression identified less frequently. They more freq present with somatic than mood complaints. US born hispanics experience depression at similar rates to other ethnic groups but rates of depression in immigrant histpanics is 50% lower than US born hispanics. Psychosis is no more common but sx of perceptual distortion (celajes) are more common and must be differentiated

200
Q

Risk factors for elder abuse

A

dementia, shared living situation of elder and abuser, care giver substance abuse or mental illness, heavy dependence of caregiver on elder (but not opp), social isolation of the elder

201
Q

Adherence to anti-depressant meds in the eldery

A

Is only 50%

Family Med (16 decks)

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