Family Medicine Flashcards
Name the 3 groups that you screen for diabetes and how often
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
What FPG is impaired, what is diabetes
6.1-6.9 = impaired
7+ = diabetes
What A1C is prediabetes, what is diabetes?
6.0-6.4% = prediabetes
6.5%+ = diabetes
Target for glycemic control in most patients?
7 or less
In what populations would you have an increased A1C target and what would it be
7.1-8.5% in people with
- recurrent severe hypoglycemia/hypoglycemia unawareness
- limited life expectancy
- frail/elderly with dementia
What antihyperglycemic drug class has evidence for improving outcomes in patients with HFpEF?
SGLT2i
In what diabetic patients are Statin + ACEi/ARB + ASA indicated?
CV disease (cardiac ischemia, PAD, CVD)
In what diabetic patients are Statin + ACEi/ARB indicated?
Microvascular disease (neuropathy, retinopathy, kidney disease (ACR 2+))
OR
Age >55 with additional CV risk factors (e.g. hypertension, smoking, albuminuria, low HDL)
In what diabetic patients is Statin-only indicated?
Age 40+
Age 30+ and diabetes >15 years
Other indications based on lipid guidelines
What meds should diabetic patients hold when at risk of dehydration (vomiting/diarrhea)
Sulfonylureas
ACEi
Diuretics/direct renin inhibitors
Metformin
ARBs
NSAIDs
SGLT2 inhibitors
Breast cancer screening mammography is recommended to whom in Ontario? How often?
Women aged 50-74, q2 years
Cervical cancer screening is recommended to whom in Ontario? How often?
Every 3 years in women >21 (or >25) who has ever been sexually active.
Stop after age 70 if 3+ normal paps
Colon cancer screening for people with average risk?
FIT q2 years
or flexible sigmoidoscopy q10 years
Define “average risk” for colorectal cancer?
50-74 years old
No first-degree relative diagnosed with CRC
No personal hx of pre-cancerous polyps requiring surveillance or IBD
Colon cancer screening for patient with 1 first-degree relative with CRC or an advanced adenoma
Colonoscopy q5-10 years started at age 40-50 or 10 years younger than diagnosis of FDR (or could use FIT q1-2 yrs)
Who should get lung cancer screening? What method? How often?
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
At what age is DEXA indicated for osteoporosis screening?
65+ years for both men and women
Name RFs for fracture that would indicate DEXA screening in men/women >50yo
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
At what age should lipid testing as part of CVD risk estimation be performed?
Frequency?
Men >40
Women >50 (conflicting, other resource says >40 or post-menopausal)
Until age 75
q5 years for FRS <5%, q1yr for FRS >5%
Primary prevention based on 10-year CVD risk:
Risk <10%
Risk 10-19%
Risk >20%
Risk <10% - Retest q5 years
Risk 10-19% - Mod-intensity statins
Risk > 20% - high-intensity statins
Antibiotic for strep throat in adults
Oral Penicillin V 500mg BID-TID for 10 days
Antibiotic for strep throat in children
Penicillin V or Amoxicillin (latter tastes better in suspension so preferred for young kiddos)
What are the components of the centor score
Cough absent = +1
Exudate = +1
Nodes (anterior) = +1
Temp >38 = +1
Old (>45) = SUBTRACT 1
Really young (3-14) = +1
Describe the scoring of CENTOR score
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
Most common pathogens causing AOM
Streptococcus pneumoniae
nontypeable Haemophilus influenzae
Moraxella catarrhalis
Antibiotic therapy for AOM
Oral amoxicillin
Amox-clav if RFs for H influenzae
List the components of the CURB 65 score for pneumonia severity
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
Most common AB for treatment of suspected bacterial pediatric CAP?
Amoxicillin (v effective against S. Pneumoniae)
Clue on auscultation that CAP is more likely viral?
Diffuse, bilateral auscultatory findings (i.e. nonfocal)
What ages count as family hx of premature CVD
Men <55, Women <65
2 alternative targets to measure other than LDL-C
non-HDL-C
Apo B
Name 5 statin-indicated conditions
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)
High risk indication for primary prevention w/ statins
FRS >20%
Intermediate risk indication for primary prevention w/ statins
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)
LDL target on statin therapy
<2.0 or >50% reduction
2nd line therapy to lower LDL-C in patients with clinical CVS if targets not reached on maximal statin therapy?
Ezetimibe (cholesterol absorption inhibitor)
ADEs of statin therapy
Headache
GI upset
Increased LFTs
Myalgias –> myopathy –> myositis (^CK) –> rhabdomyolysis (rare) –> AKI
Name 4 things that statins interact with
CYP3A4 metab
Antifungals
Macrolides (eryth/clarith)
Grapefruit
Valproate
Once the LDL-C target has been achieved, attempts should be
made to achieve a TC/HDL-C ratio of
<4.0
Exercise recommendation to reduce CVD risk
150min of moderate-to-vigorous intensity aerobic physical activity per week in bouts of 10+ minutes
Questionnaire for depression during pregnancy + when to use it
Edinburgh Perinatal/postanal Depression Scale (EPDS)
- use between 28-32 weeks in all pregnancies + 6-8 weeks postpartum
According to the CCS algorithm (CHADS-65) for OAC therapy in AF, when is OAC indicated?
CHF
Hypertension
Age 65+
Diabetes
Prior stroke/TIA
According to the CCS algorithm (CHADS-65) for OAC therapy in AF, when is Antiplatelet therapy indicated?
No CHADS2 RFs but CAD or PAD
List the components/interpretation of CHA2DS2-VASc
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
Blood marker to measure in suspected heart failure
BNP or NT-proBNP
5 Initial standard therapies in HFrEF
ACEi/ARB then sub ARNI
Beta-blocker
MRA (e.g. spironolactone)
SGLT2-inhibitor
(+minimum diuretic dosage to maintain euvolemia)
Total daily intake of elemental Ca through diet/supplements in individuals >50 yo should be
1200mg
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?
400-1000 IU
800-1000 IU
2000 IU
In what populations should pharmacotherapy be initiated after BMD scan?
High risk (10-year >20%, prior fragility fracture of hip/spine, >1 fragility fracture)
OR Mod risk (10-20%) + additional RFs, discuss w/ patient
2 tools that can be used to estimate 10-year risk of a major osteoporotic fracture?
CAROC (Canadian Association of Radiologists and Osteoporosis Canada)
FRAX (Fracture Risk Assessment Tool of the WHO)
2 pharmalogical therapies for smoking cessation (other than nicotine replacement)
Varenicline (Champix)
Bupropion
Contraindication to bupropion
Seizure disorder/predisposition
General step-up therapy protocol in COPD
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)
Never give ___ alone in COPD
ICS
The only thing you should NOT do in Asthma is _____ monotherapy
LABA
(always give with ICS, and never for acute exacerbations)
What qualifies as Intermittent asthma
2 or less daytime sx/week
2 or less nighttime awakenings/month
FEV1 >80%
What qualifies as mild persistent asthma
> 2 daytime sx/week
3-4 nighttime awakenings/month
FEV1 >80%
What qualifies as moderate persistent asthma
Daily
1+ nights/week
FEV1 60-80%
What qualifies as severe persistent asthma
++Daily
Nightly FEV1 <60%
Med protocol for intermittent asthma
SABA PRN + low dose ICS PRN
Med protocol for mild persistent asthma
SABA PRN + daily low dose ICS
Med protocol for moderate persistent asthma
SABA PRN
+ med dose ICS OR low dose ICS + LABA
OR
low-dose ICS-fomoterol (fast-onset LABA) PRN
Med protocol for severe persistent asthma
SABA PRN + med-dose ICS-LABA
OR
Daily/PRN med-dose ICS-fomoterol
Ipratropium bromide =
Tiotropium bromide =
Ipra = SAMA
Tio = LAMA
What is an asthma med used in emergencies only?
IV magnesium sulfate
CAM criteria for delirium
1) Acute onset + fluctuating course
2) Inattention
3) Disorganized thinking OR altered LOC
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?
> 150/90
What is the most common etiology of urinary incontinence in the elderly (both men and women)?
Urge incontinence
What is the most common etiology of dementia (Major Neurocognitive Disorder)?
Mixed dementia (Alzheimer’s + concurrent cerebrovascular disease)
