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Clerkship > Family Medicine > Flashcards

Family Medicine Flashcards

1
Q

Name the 3 groups that you screen for diabetes and how often

A

1) Age <40, low-mod risk –> no screening
2) Age >40 or high-risk –> screen q3 years
3) Very high risk, specific RFs –> screen q6-12 mo

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2
Q

What FPG is impaired, what is diabetes

A

6.1-6.9 = impaired
7+ = diabetes

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3
Q

What A1C is prediabetes, what is diabetes?

A

6.0-6.4% = prediabetes
6.5%+ = diabetes

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4
Q

Target for glycemic control in most patients?

A

7 or less

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5
Q

In what populations would you have an increased A1C target and what would it be

A

7.1-8.5% in people with
- recurrent severe hypoglycemia/hypoglycemia unawareness
- limited life expectancy
- frail/elderly with dementia

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6
Q

What antihyperglycemic drug class has evidence for improving outcomes in patients with HFpEF?

A

SGLT2i

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7
Q

In what diabetic patients are Statin + ACEi/ARB + ASA indicated?

A

CV disease (cardiac ischemia, PAD, CVD)

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8
Q

In what diabetic patients are Statin + ACEi/ARB indicated?

A

Microvascular disease (neuropathy, retinopathy, kidney disease (ACR 2+))
OR
Age >55 with additional CV risk factors (e.g. hypertension, smoking, albuminuria, low HDL)

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9
Q

In what diabetic patients is Statin-only indicated?

A

Age 40+
Age 30+ and diabetes >15 years
Other indications based on lipid guidelines

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10
Q

What meds should diabetic patients hold when at risk of dehydration (vomiting/diarrhea)

A

Sulfonylureas
ACEi
Diuretics/direct renin inhibitors
Metformin
ARBs
NSAIDs
SGLT2 inhibitors

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11
Q

Breast cancer screening mammography is recommended to whom in Ontario? How often?

A

Women aged 50-74, q2 years

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12
Q

Cervical cancer screening is recommended to whom in Ontario? How often?

A

Every 3 years in women >21 (or >25) who has ever been sexually active.
Stop after age 70 if 3+ normal paps

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13
Q

Colon cancer screening for people with average risk?

A

FIT q2 years
or flexible sigmoidoscopy q10 years

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14
Q

Define “average risk” for colorectal cancer?

A

50-74 years old
No first-degree relative diagnosed with CRC
No personal hx of pre-cancerous polyps requiring surveillance or IBD

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15
Q

Colon cancer screening for patient with 1 first-degree relative with CRC or an advanced adenoma

A

Colonoscopy q5-10 years started at age 40-50 or 10 years younger than diagnosis of FDR (or could use FIT q1-2 yrs)

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16
Q

Who should get lung cancer screening? What method? How often?

A

Current/former smokers ages 55-74 if smoked cigarettes daily for at least 20 years cumulative
Low-dose CT
Every year up to 3 years in a row

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17
Q

At what age is DEXA indicated for osteoporosis screening?

A

65+ years for both men and women

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18
Q

Name RFs for fracture that would indicate DEXA screening in men/women >50yo

A

Fragility fracture
Use of high-risk meds (e.g. glucocorticoids)
Fracture/osteopenia seen on XR
Current smoking
++Drinking
Low body weight (<60kg) or major weight loss (>10% of body weight @ 25yo)
RA
Parental hip fracture
Other diseases that increase risk

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19
Q

At what age should lipid testing as part of CVD risk estimation be performed?
Frequency?

A

Men >40
Women >50 (conflicting, other resource says >40 or post-menopausal)
Until age 75
q5 years for FRS <5%, q1yr for FRS >5%

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20
Q

Primary prevention based on 10-year CVD risk:
Risk <10%
Risk 10-19%
Risk >20%

A

Risk <10% - Retest q5 years
Risk 10-19% - Mod-intensity statins
Risk > 20% - high-intensity statins

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21
Q

Antibiotic for strep throat in adults

A

Oral Penicillin V 500mg BID-TID for 10 days

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22
Q

Antibiotic for strep throat in children

A

Penicillin V or Amoxicillin (latter tastes better in suspension so preferred for young kiddos)

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23
Q

What are the components of the centor score

A

Cough absent = +1
Exudate = +1
Nodes (anterior) = +1
Temp >38 = +1
Old (>45) = SUBTRACT 1
Really young (3-14) = +1

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24
Q

Describe the scoring of CENTOR score

A

0-1 (1-7% chance)–> no culture or AB
2-3 (8-34%) –> culture all, treat only if +
4+ –> culture all, treat with AB clinically

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25
Q

Most common pathogens causing AOM

A

Streptococcus pneumoniae
nontypeable Haemophilus influenzae
Moraxella catarrhalis

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26
Q

Antibiotic therapy for AOM

A

Oral amoxicillin
Amox-clav if RFs for H influenzae

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27
Q

List the components of the CURB 65 score for pneumonia severity

A

Confusion = +1
Urea >7mmol/L = +1
RR >30 = +1
BP (SBP <90 or DBP <60) = +1
>65 = +1

0-1 –> outpt management
2 –> admission or close outpt monitoring
3-5 –> admission, manage as severe

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28
Q

Most common AB for treatment of suspected bacterial pediatric CAP?

A

Amoxicillin (v effective against S. Pneumoniae)

29
Q

Clue on auscultation that CAP is more likely viral?

A

Diffuse, bilateral auscultatory findings (i.e. nonfocal)

30
Q

What ages count as family hx of premature CVD

A

Men <55, Women <65

31
Q

2 alternative targets to measure other than LDL-C

A

non-HDL-C
Apo B

32
Q

Name 5 statin-indicated conditions

A

1) Clinical atherosclerosis (ACS, angina, stroke/TIA, PAD)
2) Abdominal AA
3) DM (>40 years old, >15 yrs in pt >30 years old, microvascular complications)
4) CKD (>3 mo & ACR >3 or eGFR <60, >50yo)
5) LDL-C >5 mmol/L (or documented familial hypercholesterolemia)

33
Q

High risk indication for primary prevention w/ statins

A

FRS >20%

34
Q

Intermediate risk indication for primary prevention w/ statins

A

FRS 10-19% &
- LDL-C >3.5 OR
- Non-HDL-C > 4.3 OR
- Apo B >1.2 OR
- Men >50 & Women >60 w/ 1 additional RF (low HDL-C, impaired FG, high waist circumference, smoker, htn)

35
Q

LDL target on statin therapy

A

<2.0 or >50% reduction

36
Q

2nd line therapy to lower LDL-C in patients with clinical CVS if targets not reached on maximal statin therapy?

A

Ezetimibe (cholesterol absorption inhibitor)

37
Q

ADEs of statin therapy

A

Headache
GI upset
Increased LFTs
Myalgias –> myopathy –> myositis (^CK) –> rhabdomyolysis (rare) –> AKI

38
Q

Name 4 things that statins interact with

A

CYP3A4 metab
Antifungals
Macrolides (eryth/clarith)
Grapefruit
Valproate

39
Q

Once the LDL-C target has been achieved, attempts should be
made to achieve a TC/HDL-C ratio of

A

<4.0

40
Q

Exercise recommendation to reduce CVD risk

A

150min of moderate-to-vigorous intensity aerobic physical activity per week in bouts of 10+ minutes

41
Q

Questionnaire for depression during pregnancy + when to use it

A

Edinburgh Perinatal/postanal Depression Scale (EPDS)
- use between 28-32 weeks in all pregnancies + 6-8 weeks postpartum

42
Q

According to the CCS algorithm (CHADS-65) for OAC therapy in AF, when is OAC indicated?

A

CHF
Hypertension
Age 65+
Diabetes
Prior stroke/TIA

43
Q

According to the CCS algorithm (CHADS-65) for OAC therapy in AF, when is Antiplatelet therapy indicated?

A

No CHADS2 RFs but CAD or PAD

44
Q

List the components/interpretation of CHA2DS2-VASc

A

CHF history
Hypertension
Age >75 (+2)
Diabetes
Stroke (+2)
Vascular Disease
Age 65-74 (+1)
Sex category Female
1+ for males or 2+ for females –> consider anticoag. 2+/3+ should be started on OAC

45
Q

Blood marker to measure in suspected heart failure

A

BNP or NT-proBNP

46
Q

5 Initial standard therapies in HFrEF

A

ACEi/ARB then sub ARNI
Beta-blocker
MRA (e.g. spironolactone)
SGLT2-inhibitor

(+minimum diuretic dosage to maintain euvolemia)

47
Q

Total daily intake of elemental Ca through diet/supplements in individuals >50 yo should be

A

1200mg

48
Q

For healthy adults at low risk of vitamin D deficiency, routine supplementation of what dose is recommended? Mod risk of deficiency? Upper end of daily dose not requiring monitoring?

A

400-1000 IU
800-1000 IU
2000 IU

49
Q

In what populations should pharmacotherapy be initiated after BMD scan?

A

High risk (10-year >20%, prior fragility fracture of hip/spine, >1 fragility fracture)
OR Mod risk (10-20%) + additional RFs, discuss w/ patient

50
Q

2 tools that can be used to estimate 10-year risk of a major osteoporotic fracture?

A

CAROC (Canadian Association of Radiologists and Osteoporosis Canada)
FRAX (Fracture Risk Assessment Tool of the WHO)

51
Q

2 pharmalogical therapies for smoking cessation (other than nicotine replacement)

A

Varenicline (Champix)
Bupropion

52
Q

Contraindication to bupropion

A

Seizure disorder/predisposition

53
Q

General step-up therapy protocol in COPD

A

SABA or SAMA PRN if symptoms infrequent
LABA or LAMA
LABA + LAMA (highly symptomatic patients)
Consider +ICS if eosinophils high (superiority to dual therapy unclear)

54
Q

Never give ___ alone in COPD

A

ICS

55
Q

The only thing you should NOT do in Asthma is _____ monotherapy

A

LABA
(always give with ICS, and never for acute exacerbations)

56
Q

What qualifies as Intermittent asthma

A

2 or less daytime sx/week
2 or less nighttime awakenings/month
FEV1 >80%

57
Q

What qualifies as mild persistent asthma

A

> 2 daytime sx/week
3-4 nighttime awakenings/month
FEV1 >80%

58
Q

What qualifies as moderate persistent asthma

A

Daily
1+ nights/week
FEV1 60-80%

59
Q

What qualifies as severe persistent asthma

A

++Daily
Nightly FEV1 <60%

60
Q

Med protocol for intermittent asthma

A

SABA PRN + low dose ICS PRN

61
Q

Med protocol for mild persistent asthma

A

SABA PRN + daily low dose ICS

62
Q

Med protocol for moderate persistent asthma

A

SABA PRN
+ med dose ICS OR low dose ICS + LABA

OR
low-dose ICS-fomoterol (fast-onset LABA) PRN

63
Q

Med protocol for severe persistent asthma

A

SABA PRN + med-dose ICS-LABA
OR
Daily/PRN med-dose ICS-fomoterol

64
Q

Ipratropium bromide =
Tiotropium bromide =

A

Ipra = SAMA
Tio = LAMA

65
Q

What is an asthma med used in emergencies only?

A

IV magnesium sulfate

66
Q

CAM criteria for delirium

A

1) Acute onset + fluctuating course
2) Inattention
3) Disorganized thinking OR altered LOC

67
Q

For adults older than 60 years of age (without DMII), at which blood pressure should pharmacological therapy be recommended (in addition to non-pharmacologic recommendations) for treatment of hypertension?

A

> 150/90

68
Q

What is the most common etiology of urinary incontinence in the elderly (both men and women)?

A

Urge incontinence

69
Q

What is the most common etiology of dementia (Major Neurocognitive Disorder)?

A

Mixed dementia (Alzheimer’s + concurrent cerebrovascular disease)

Clerkship (6 decks)

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