Family Med SG7

Question 1

SIGECAPS

Answer 1

Depressed mood plus: decreased interests, guilt feelings, decreased energy, decreased concentration, psychomotor agitation, decreased appetitis, suicidal thoughts, decreased or increased sleep

Question 2

dysthymia

Answer 2

state of chornic depressed mood persent for 2 or more years on most days of life

Question 3

Management for post-stroke depresion

Answer 3

SSRIs

Question 4

ADLs

Answer 4

bathing, dressing, eating, transferring, urinary and fecal continence, toiletry, walking

Question 5

IADLS

Answer 5

light housework, preparing meals, taking meds, shopping for groceries or clothes, telephone, managing money

Question 6

Measuring orthostatics

Answer 6

Supine BP and pulse. Wait 3 min while patient is standing. Measure BP and pulse. A decrease in 20 mm Hg systolic or 10 mm Hg diastolic OR increaes in pulse over 20bpm (over 16 in the elderly) is positive test

Question 7

FAST (Face arm speech test)

Answer 7

Stroke instrument to be used outside of the hospital. Face- smile. Arms- raise both arms. Speech- repeat simple sentence. Time- Time is impt. Call 911 immediately

Question 8

Hypokalemic periodic paralysis

Answer 8

Episodes of general or focal weakness. Episodes begin in childhood or adolescene. Paralysis most often occur in rest period following exercise

Question 9

Hemiplegic migraine

Answer 9

Most often in kids and adolescents with cessation of sx by adult life

Question 10

ECG monitoring

Answer 10

Should be performed the first 24 hours after a stoke for monitoring

Question 11

Management of afib

Answer 11

IV diltiazem, IV beta blocker, or IV verapamil to slow the heart rate. Cardiovrsion via electrical shock or meds if needed.

Question 12

Risk of stroke in afib patients

Answer 12

Is greates with Afib over 48 hours or who have not been given 3 wks of anticoag therapy before shock

Question 13

Administration of tPa within how many hours?

Answer 13

THREE

Question 14

If symptoms less than 3 hours, preferentially route to a certified stroke center

Answer 14

right

Question 15

Antithrombotic therapy for noncardioembolic stroke or TIA

Answer 15

Daily antiplatelet therapy (aspirin, aspirin plus dipyridamole, or ticlidopine); Clopidogrel

Question 16

Advantages/disadvantages of aspirin versus Aggrenox versus ticlidopine

Answer 16

Aspirin reduces stroke risk by 18 percent. Aspirin plus ER dipyridamole (Aggrenox) reduces risk by 37%. Ticlidopine is marginally better than Aspirin alone, but it has side effects and is costly.

Question 17

Clopidogrel versus aspirin

Answer 17

Use in aspirin sensative patients. Exceeds beenfit of aspirin in stroke patients wit comorbid and prior MI

Question 18

Antithrombotic therapy for cardioembolic events

Answer 18

Warfarin, Aspirin, carotid endarterectomy

Question 19

When does rehab after stroke begin?

Answer 19

24 to 48 hours after stroke

Question 20

What is the goal LDL for patients with CAD or symptomatic atherosclerotic disease

Answer 20

Less than 100. But for very high risk people with multiple risk factors, goal is less than 70

Question 21

Five year old should be able to

Answer 21

Dress herself, name color, draw a person with at least 6 body parts, copy a square and a triangle, hold a pencil correctly when writing, skip, hop, and stand on one foot, talk in complete sentences using correct tenses and pronouns, fully understandable speech

Question 22

Required vaccines for school entrance

Answer 22

MMR, Varicella Two; Hep B three; Polio (FDR FOUR); DTAP 5 (tap with 5 fingers)

Question 23

Vaccines not required for school but recommended

Answer 23

Flu annually; Rota and Hep A three; Pneumococcal and Hib x 4

Question 24

When should vaccines be postponed

Answer 24

Moderate to severe illness, including fever, otitis, diarrhea, and vomitting. Patients with a mild illness (with or without fever) should get their vaccines

Question 25

Screening for anemia, lead and TB

Answer 25

Is based on risk factors

Question 26

Anemia risk factors

Answer 26

Low iron diet, poverty, decreased access to food, special health needs

Question 27

Lead toxicity risk factors

Answer 27

Live in or visit a house built before 1950. House built before 1973 that is being or has been remodeled in the last 6 mos. Sibling or playmate with lead poisoning

Question 28

TB risk factors

Answer 28

Exposure to family member or contact with TB. Birth in high risk country. Travel to high risk country. Kids with HIV. Incarcerated adolescents

Question 29

ADHD diagnosis

Answer 29

Not made until 7 yo. Sx must be more freq or severe compared to other kids the same age. Present in at least 2 settings. Present for at least 6 mos

Question 30

Mono

Answer 30

Fever, pharyngitis, lymphadenopathy, posterior cervical adenopathy is common and spec, palatal petechia (also see in GABHS), hepatosplenomegaly, may have generalized rash

Question 31

GABHS pharyngitis

Answer 31

High fever, anterior cervical lymphadenopathy, tonsillar exudates, palatal petechiae, strawberry tongue, no rhinorrhea, cough or conjunctivitis

Question 32

If mono patients are misdiagnosed as strep and given amoxicillin, what happnes?

Answer 32

90% of patients will develop prolonged pruritic maculopapular rash

Question 33

Scarlet fever

Answer 33

Feature of GABHS pharyngitis. Diffuse sandpaper-like texture in body folds and creases (Pastia’s lines)

Question 34

Complications of GABHS pharyngitis

Answer 34

Rheumatic fever, post-strep glomerulonephritis, tonsillar abscess, bacteremia, endocarditis, mastoiditis, meningitis, OM, and cervical lymphadenitis

Question 35

Peritonsillar abscess

Answer 35

Fever, difficulty swallowing, neck or ear pain, muffled hot potato voice, asymm tonsillar enlargement and deviation of the uvula

Question 36

Epiglottitis

Answer 36

Emergency! Caused by HIB. Age 1-6yo. Rapid onset. Ill-appearing, high fever (over 103). Inspiratory stridor, hot potato voice, dysphagia, drooling. Seated in tripod position. Upper airway obstruction

Question 37

Pertussis

Answer 37

Runny nose, low grade fever, and mild cough. Consider this diagnosis when cough has worsened and has been present for at least 14 days

Question 38

Viral croup

Answer 38

Prodrome of mild fever. Barking cough, inspiratory stridor, and hoarse voice. Dx made clinically. Steeple sign on xray is suggestive

Question 39

GABHS pharyngitis management

Answer 39

Penicillin VK. Penicillin G if patient unlikely to finish course. Amoxicillin liquid for kids. First generation cephalosporins are as effective as penicillins. They are also broader. Recommend for patients with an allergy to penicillin. Macrolides (erithromycin) are reserved for patients with penicillin allergy

Question 40

Note about the use of abx for strep throat

Answer 40

Abx helps patient feel better only one day sooner. Pt should stay home from school until she has had 24 hours of antibiotics