Family Med SG4

Question 1

When to refer for upper endoscopy

Answer 1

Alarm or extra-esophageal symptoms. Or if the patient does not respond to test and treat after 8 wks

Question 2

Therapies for use after H pylori infection is ruled out

Answer 2

TCAs (modes benefit), capsaicin, peppermint oil, caraway oil, and artichoke leaf

Question 3

First line treatment for H pylori eradication

Answer 3

PPI triple therapy for 10-14 days. PPI BID plus clarithromycin BID plus amox BID

Question 4

Alternative PPI triple therapy for penicillin allergy x 14 d

Answer 4

PPI BID plus clarithromycin BID plus metronidazole BID

Question 5

Quadruple therapy x 10-14 days

Answer 5

PPI QD or BID or ranitidine BID plus tetracycline TID plus metronidazole QID plus bismuth QID

Question 6

Indications for testing H pylori eradication after abx treatment (5)

Answer 6

Patients with H pylori assoc ulcers. Persistent sx despite T and T. H pylori associated MALT. Post-resection of early gastric cancer. For patients planning to resume chronic NSAID therapy

Question 7

How to evaluate for eradication of H pylori

Answer 7

Fecal antigen testing. If that’s pos, retreat for salvage therapy and if sx continue, they need an upper endoscopy with bx. If the fecal antigen testing is neg and the patient still has sx, do urease breath test, If neg, refer for endoscopy

Question 8

Risk factors for complications from the flu

Answer 8

Kids less than 5 yo (esp <2yo), chronic pulm disease, congenital heart disease, metabolic conditions (DM), chronic renal disease, immunosupp, longterm aspirin therapy (like for Kawasaki disease)

Question 9

Most common complication of the flu

Answer 9

otitis media, strep pneumonia

Question 10

Other complications of the flu

Answer 10

Laryngotracheobronchitis and bacterial pneumonia; neurologic (aseptic meningitis, GB, febrile seizures, myositis and myocarditis

Question 11

Metabolic syndrome definition

Answer 11

Atleast 3 of the following : Hypertriglyceridemia, Low HDL, Elev fasting blood glucose, and excessive waist circumference, hypertension

Question 12

Egophony

Answer 12

When patient says “E,” doc hears “Ay.” Sign of consolidation.

Question 13

Tactile fremitus

Answer 13

When patient says 99 or toyboat, increased vibration means consolidation. Areas of decreased vibration mean effusion

Question 14

Lung sounds that do not mean consolidation

Answer 14

wheezes, rhonchi (snoring, assoc with larger bronchial secretions and airway narrowing, usually clear after coughing)

Question 15

BMI cut offs in kids

Answer 15

5-85%ile is healthy; 85-95 is overweight; 95 on up is obese

Question 16

Fine mid inspiratory crackles verus scoarse late inspiratory crackle

Answer 16

Fine mid is acute PNA. Late course is resolving

Question 17

Typical pneumonia

Answer 17

Strep pneumo. No prodromal sx. Abrupt onset. Young kids and older adults

Question 18

Atypical pneumonia

Answer 18

Mycoplasma or chlamydia. HA, GI sx, arthralgias, cough, fever. Young adults and adolescents. Interstitial pattern on CXR

Question 19

Viral pneumonia

Answer 19

Flu, RSV, adenovirus, rhinovirus, paraflu. Prodromal sx. Young kids (4 mos-4years)

Question 20

Bronchiolitis

Answer 20

Caused by viruses such as RSV. Peak age 6 mos. Starts with viral illness and progresses to wheezing. Infants require supportive treatment while recovering

Question 21

McIsaac Score

Answer 21

Indicates whether to evaluate for GABHS strep pharyngitis with rapid strep or cx

Question 22

Original McIsaac criteria

Answer 22

Fever over 38, cough absent, tonsillar exudates, tender anterior cervical adenopathy

Question 23

McIsaac rule modifiers

Answer 23

Age less than 15 (add 1 pt), Age greater than 45 (subtract 1 point)

Question 24

McIsaac rules

Answer 24

Less than or equal to 1 point just give symptomatic treatment. 2-3 points rapid strep. 4 or more throat culture or start empiricic abx

Question 25

In the setting of community acquired pneumonia, when is CXR indicated?

Answer 25

If patient is hypoxic or isn’t responding to treatment. All kids admitted to the hospital for PNA should get a CXR

Question 26

When can you start antivirals for flu after the 48 hour window?

Answer 26

if the child has moderate to severe CAP with findings consistent with influenza or if they are clinically worsening at the time of initial outpatient visit

Question 27

Management of PNA in 3 mos to adolescents

Answer 27

Amoxicillin (covers strep). However, for school-age kids with sx more concerning for atypical pneumonia, use macrolide like azithromycin

Question 28

PNA 0-3 wks

Answer 28

Admit all infants. Ecoli/GBS/Listeria. Ampicillin and gentamycin

Question 29

3wks-6mos PNA

Answer 29

Admit if suspect bacterial PNA. Strep pneumo, chlamydia, viruses. Azithromycin (outpatient). Erythromycin or cef (inpt)

Question 30

3mos-5 yrs PNA

Answer 30

Admit if meet certain high risk criteria. Strep pneumo, mycoplasma, chlamydia, viruses. Ampicillin or Penicillin G

Question 31

PNA in over 5 yo

Answer 31

Admit if meet certain high risk critera. Chlamydia, mycoplasma, strep pneumo. Amoxicillin (outpt) or inpt Amp or penicillin

Question 32

Reasonable weightloss in kids less than 7 yo

Answer 32

If BMI less than 95 percentile and no complications, should maintain weight. If over 95 percentile or have complications, should decrease weight to 85th percentile

Question 33

Reasonable weightloss in kids over 7 yo

Answer 33

If BMI between 85 and 95, weight loss is recommended to achieve 85%ile

Question 34

Screening for obesity complications in a 10 yo

Answer 34

DM, HLD, fatty liver

Question 35

How do you screen for DM in an overweight 10 year old?

Answer 35

All 10 year olds with BMI over 85 and RF or over 95 should get fasting blood glucose. Recheck every 2 years

Question 36

How do you screen for HLF in a 10 year old?

Answer 36

Check fasting lipids on all kids over 85%ile, kids with family history of HLD or who are overweight. Goal total cholesterol s less than 170 and LDL less than 130. Initial treatment for kids is diet and exercise.

Question 37

When can you initiate statin treatment in kid?

Answer 37

Must be over 10 yo, who are either Tanner stage 2 (male) or post-menarche AND LDL over 190 or LDL over 160 with RF

Question 38

How to screen for fatty liver in an overweight 10 year old?

Answer 38

Check AST and ALT at age 10 if BMI is over 95% or over 85% with risk factors. Check every 2 years. Refer to GI for levels greater than twice the ULN

Question 39

Patients with TIA have what chance of stroke within one week?

Answer 39

8-12% chance within one week and 11-15% within one month