FAMily Med SG9

Question 1

How do you use progesterone levels to tell whether the pregnancy is viable?

Answer 1

Less than 5 is an evolving miscarriage. Over 25 is sustainable intrauterine pregancy. But algorithms using progesterone measurements have been assoc with a higher use of sugical management and missed ectopics (since 85% of ectopics will have a normal progesterone

Question 2

How can you use ultrasound to predict EDD throughout the trimesters?

Answer 2

In the first trimester, the crown-rump length is measured and the accuracy is within 1 week. If the EGA based on the ultrasound is greater than 1 week, you go by the ultrasound. In the second trimester, you do way more than 1 crown-rump measurement; you take a total of 4 measurements. These include biparietal diameter, head circumference, abdominal circumference, and femur length. In the second trimester, the accuracy is +/- 2 weeks and the same rules apply as in the first trimester. In the third trimester, the accuracy is pus or minus 3 weeks and you do not change the EGA

Question 3

How to manage an inevitable abortion?

Answer 3

You have 3 options- expectant management (but can take months), surgical managemen (D and C or vacuum), or medical management (vaginal misoprostol, then repeat on day 3)

Question 4

What is the time to completion for medical management of inevitable abortion

Answer 4

3-4 days; and the success rate is 95%

Question 5

Most frequent causes of death for a 55 yo M

Answer 5

Malignancy, heart disease, accident, DM, chronic lung disease, chronic liver disease, and cirrhosis

Question 6

Minor risk factors for CVD (those used for calculating the ASCVD)

Answer 6

Sedentary lifestyle, stress, premture family hx, excess alcohol use, obesity, poor diet, low selenium, and high homocysteine

Question 7

What is a MAJOR risk factor for CVD?

Answer 7

Current smoking

Question 8

What are the guidelines in terms of assessing the risk of your patients for CVD?

Answer 8

Assess major risk factos every 4 to 6 years in adults 20-79 who are free from atherosclerotic cardiovascular disease

Question 9

How effective are oral meds (like buproprion or varenicline) in helping smokers quit?

Answer 9

They increase the quit rate at 12 mos by twice. However, the quit rate is only like 2%, so they increase it to 4%

Question 10

What interventions have been proven to increase quit rates?

Answer 10

Group setting, oral meds, one-on-one counseling in combo with med, providing problem solving skills, assistacne, with social supports, and use of relaxation breathing techniques

Question 11

CAGE questinairre for drinkers

Answer 11

Felt the need to cut down, felt annoyed by criticism of your drinking, had guilty feeling about drinking, morning eye opener

Question 12

Waist circumference and waist-hip ratio are independent risk factors for what?

Answer 12

obesity

Question 13

Definition of metabolic syndrome

Answer 13

Any 3 of the following 5: fasting glucose over 100, BP over 130/85, triglycerides over 150, HDL less than 40 for men or less than 50 for womne, abdominal obesity (waist circumference over 40 for men or over 35 for women)

Question 14

Corneal arcus

Answer 14

Physical exam finding associated with dyslipidemia

Question 15

Melanoma ABCDE

Answer 15

Assymetry, borders irreg, color heterogenous, diameter over 6 mm, evolution over time

Question 16

When do you get the zoster vaccine?

Answer 16

Age 60

Question 17

Lung cancer screening

Answer 17

Pts 55-80 with 30 pack years who currently smoke or smoked in the last 15 years

Question 18

Hep C screening

Answer 18

One time screen for adults born between 1945 and 1965

Question 19

Screening questions for depression

Answer 19

Over the past 2 weeks, have you felt down, depressed, or hopeless? Over the past 2 weeks, have you felt little pleasure in doing things?

Question 20

Options for colon cancer screening

Answer 20

Colonoscopy every 10 years; Annual testing of 3 stools for blood plus flex sig every 5 years; Double contrast enema every 5 years; Virtual colonoscopy is considered experimental

Question 21

Lipid screening guidelines

Answer 21

Every 5 years, a lipid panel should be done. Treat with statins all patients over 20 yo with LDL over 190

Question 22

ECG changes that suggest existing coronary disease

Answer 22

ST depression or downsloaping ST suggests ischemia; ST elev is MI; Q waves suggest infarction

Question 23

U waves on ECG

Answer 23

Very nonspecific. Can be associated with bradycardia, hypokalemia, hypercalcema, or hypomagnesemia

Question 24

USDHandHS recommendations for exercise

Answer 24

Men participate in at least 150 min of moderate intensity aerobic exercise per week as well as muscle strengthening at least twice a week

Question 25

Recommendation for AAA screening

Answer 25

This is a B level recommendation. A one time abdominal ultrasound of the aorta in males 65-75 who have smoked

Question 26

Diet recs to lower heart disease

Answer 26

Fish twice a week. Oils in tofu, soy, canola, walnuts, flaxseed. Studies show that Vit C, E, and folic acid do NOT reduce the risk of MI or stroke

Question 27

What are the top 4 causes of mortality in the US

Answer 27

Top is smoking. Next obesity, then DM, then hypertension

Question 28

Cancers that are increased by obesity

Answer 28

Endometrial, breast, colon

Question 29

Wagner ulcer grading system for diabetic ulcers- stages 1 through 5

Answer 29

Stage 1 involves full skin but no underlying tissue damage; Stage 2 is down to ligaments and muscle but no bone; Stage 3 is deep cellulitis or abscess, often with osteomyelitis; Stage 4 is localized gangrene; Stage 5 is extensive gangrene that involves the whole foot

Question 30

Management of ulcers by grade

Answer 30

Grade 1 and 2- outpatient management with extensive debridement and treatment for infection if needed. Grade 3- evaluate for osteomyelitis and peripheral arterial disease and may require hospitalization. Grade 4 and 5 are emergent hospitalization and surgical consult for possible amputation

Question 31

Homan’s sign

Answer 31

Classic sign of DVT. Pain on passive dorsiflexion of the foot

Question 32

Risk factors for DVT besides the obvious

Answer 32

hypertension, hyperlipidemia, CHF, hyperhomocysteinemia, disease that increases blood viscosity (like polycythemia vera, sickle cell disease, and multiple myeloma)

Question 33

Diagnosing peripheral arterial disease

Answer 33

ABI less than 0.9

Question 34

What is the greatest modifiable risk factor for peripheral arterial diseaes?

Answer 34

Smoking

Question 35

Other risk factors for peripheral arterial disease besides the obvious

Answer 35

Chronic renal insufficiency, elevated CRP, hyperhomocystenemia

Question 36

Well’s criteria for diagnosis fo DVT

Answer 36

Get 1 point for: Active cancer, paralysis/paresthesias/recent plaster immobilization of the legs, bedridden/major surgery, localized tenderness along distribution of deep vein, entire leg swollen, calf swelling greater than 3cm than asymptomatic leg, pitting edema, collateral superficial veins. Subtract 2 points if alternative diagnosis as or more likely than DVT. If 3 points- high likelihood of DVT. If 1-2 pts, moderate chance. Less than that, low

Question 37

Criteria to treat DVT as an outpatient

Answer 37

Hemodynamically stable, good kidney function, low risk for bleed, stable and supportive home environment, daily access to INR monitoring

Question 38

Summary about LMWH versus unfractionated heparin

Answer 38

LMWH can be administred fewer times per day, lab monitoring not required, less likely to cause thrombocytopenia, and may be used outpatient. For unfractionated, it is titrated based on the aPTT and requires hospitalization because it is IV

Question 39

Treatment duration of Warfarin based on the event

Answer 39

For isolated calf thrombophlebitis, you can do 6-12 weeks; For first time provoked event, do 3 mos; for first time unprovoked event, do 6 mos; for recurrent event (provoked or not) or inherited thrombophilia, do 12 mos to lifetime

Question 40

How long does it take Warfarin to reach stable state?

Answer 40

5-7 days, because the half life is 40 hours

Question 41

Checking INR after you have started someone on warfarin

Answer 41

If INR is between 5 and 9, discontinue the Warfarin and repeat INR in 24 hours. If INR is greater than 9, hold the warfarin and give PO vitamin K

Question 42

When to screen for inherited thrombophilias

Answer 42

Initial thrombosis prior to age 50 without obvious provoking event; family hx of venous thromboembolism; recurrent venous thromboembolism; thrombosis occuring in unusual vascular beds such as portal, hepatic, mesenteric, or cerebral veins

Question 43

Five MAJOR risk factors for coronary heart disease

Answer 43

In addition to elevated LDL, these are smoking, hypertension, HDL less than 40, family history of premature CHD in a male relative less than 55 or female less than 65, age in men over 45 or women over 55

Question 44

Medical conditions that cause dyslipidemia

Answer 44

Type 2 DM (or insulin resistance); cholestatic or obstructive liver disease; nephrotic syndrome; hypothyroidism; acute hepatitis; alcohol is a secondary cause; meds

Question 45

Meds that cause dyslipidemia

Answer 45

Thiazide diuretics, beta blockers, oral estrogens, protease inhibitors

Question 46

Metabolic syndrome is associated with a higher risk of what disease?

Answer 46

CHD, CM, hepatic steatosis, HCC (maybe as a result of hepatic steatosis), cholangiocarcinoma, CKF, OSA, hyperuricemia/gout