Family medicine Flashcards
age range gardisil is approved for
9-26
gardisil recommended for age range
11-18
normal range for BMI
18.5-25
zoster vax recommended at what age?
60
birth years for 1 time hep C screening
1945-1965
BMI range for morbid obesity
40+
diameter suspicious for melanoma
> 6 mm
5 of 9 criteria for depression
SIG E CAPS Sleep Interest (loss of) Guilt Energy Concentration Appetite Psychomotor Suicidal ideation
SSRI most likely to cause SSRI discontinuation syndrome
paroxetine
SSRI for GAD
Escitalopram
SSRI w/strong anti-anxiety effects
Paroxetine
SSRI with long half life
fluoxetine (prozac)
good SSRI for panic, OCD and PTSD
Sertraline
SSRI good for OCD, but Greater frequency of emesis
fluvoxamine
herb to tx depression
st. john’s wort
time cutoff for bereavement vs MDD
2 months
positive ankle squeeze test
Syndesmotic sprain
3 lateral ankle ligaments
all end with fibular
Atf Cf Ptf
anterior talofibular, calcaneofibular, and posterior talofibular ligaments
ottawa ankle rule
There is pain in the malleolar zone AND either bony tenderness along the distal 6 cm of the posterior edge of either malleolus OR inability to bear weight 4 steps both immediately after the injury and in the emergency department (C).
ottawa foot rule
There is pain in the midfoot region AND one of the following: (a) bony tenderness at either the navicular bone or base of the 5th metatarsal OR (b) inability to bear weight four steps immediately after the injury and in the emergency department.
A1C diagnostic of DM
> 6.5
posprandial glucose target 1-2 hours after meal
should be < 180 mg/dl
fasting glucose target
80 -120 mg/dl
if sugars are >200, what else needed to dx DM?
sx
Dx of PAD
ankle-brachial index <.9
pretest probability formula for DVT
Wells criteria
Wells criteria for DVT: width of leg circumference that is positive
greater than 3 cm
grade of ulcer with abscess or bone involvement
grade 3
length of time to use heparin in DVT to transition to warfarin
5 days
htn if >60 years old
150/90
BP cuff L and W requirements (2)
bladder of the cuff should be at least 80% of the arm circumference , and the width of the cuff must be at least 40% of the arm circumference
anti-hypertensive NOT to use in blacks
ACE inhibitors
reasons for ASA in men vs women
men to prevent MI
women to prevent ischemic stroke
myotome of dorsum of foot, lateral foot
L5, S1
cutoff for cervical cancer screening if negative paps
age 65
zoster offered at what age?
60
pneumovax at what age?
65
NSAIDS effect on warfarin
increase effectiveness
age at which NSAIDs increase GI bleeding risk
65
group to be screened for chlamydia
sexually active 24+ younger
naegele’s rule for EDD (3)
add 1 year
subtract 3 mos.
add 1 week
definition mab
abortion w/o dilation of cervix
rubella titer (non-immune and immune)
non-immune = 1:3 immune = 1:10
sensitivity of Down’s screening in triple screen and quad screen, respectively
70, 80
liver percussion 5-7-9 rule
upper borders
5th intercostal space in the midclavicular line
7th intercostal space in the midaxillary line
9th intercostal space in the scapular line
Obturator sign
Passively internally rotate hip
2 ways to elicit psoas sign
Have patient flex hip agains your resistance
Or
Passively extend hip
problem drinking vs risky/hazardous drinking
problem is problems in daily life
risky hazardous is >4 drinks/sitting
2 signs of portal htn
SPLENOMEGALY and VENOUS PATTERNS(veins away from umbilicus)
abdominal veins going up
IVC obstruction
patch
macule greater than 1 cm
bulla
fluid-filled, greater than 1 cm
1st line adult tx for tinea capitis
griseofulvin
2 meds besides HRT, SSRIs for hot flashes
clonidine
gabapentin
GERD/PUD sx w/o warning signs.
1st step?
4-8 week PPI trial
Center criteria of strep 5
NFALT
Fever Tonsillar exudate Lymphadenopathy Age less than 15 No cough
infant return to birthweight at (time)
2 weeks
colic rule of 3
3 hours day
3X/week
over 3 weeks
paroxysmal
postpartum blues resolve by
10 days
age of infant where fever MUST be evaluated
under 2 months
external shoulder rotation with elbows down tests (2)
infraspinatous
teres minor
internal shoulder rotation with elbows down tests (1)
subscap
shoulder impingement testing (2)
neer/hawkins
- pronate wrist and raise arm in front passively while holding AC joint.
- flex elbow to 90 degress, push hand down slightly
sign to distinguish epididymitis from torsion
prehn sign
lifting testicle relieves epididymitis, not torsion pain
blue dot sign on scrotum
testicular appendix torsion
Dx of COPD (2)
Fev1/fvc less than 70% or below 5th percentile.
2 high intensity statins
Atorvastatin 40-80 mg
Rosuvastatin 20-40 mg
age must treat otitis media
less than 6 months
3 types of dizziness
vertigo
presyncope
disequilibrium
vertigo with hearing changes, tinnitus
most likely dx
meniere’s
HEEADSSS interview
Home
Education/Employment
Eating disorder screening
Activities / Affiliations /Aspirations
Drugs (including alcohol, tobacco, steroids)
Sexuality
Suicidal behavior (along with depression and mental health concerns)
Safety (abuse, fights, weapons, seatbelts, etc.)
Asymmetrical Tonic Neck Response of infant
Turning the newborn’s head to one side causes gradual extension of arm toward direction of infant’s gaze with contralateral arm flexion–like a fencer.
TORCH infections
Toxoplasmosis, Other transplacental infections, including HIV, hepatitis B, human parvovirus, and syphilis, Rubella, Cytomegalovirus and Herpes virus type 2.
sheets of lymphocytes with interspersed macrophages
Burkitt Lymphoma
newborn with sensorineural deafness, eye abnormalities (retinopathy, cataracts), and patent ductus arteriosus.
congenital rubella
newborn with microcephaly, jaundice, hepatosplenomegaly, low birth weight, and petechiae at birth.
CMV
Marfanoid body habitus, a hypercoaguable state, and possible developmental delay. The condition can be diagnosed by testing for increased methionine in a patient’s urine or blood
homocystinuria
Children present by six months of age with hepatomegaly, ataxia, seizures, and progressive neurologic degeneration. Fundoscopic exam reveals a “cherry-red” macula
defect in sphingomyelinase occurs in Niemann-Pick disease
inherited in an autosomal recessive pattern. Individuals present with hypoglycemia, hepatomegaly, and metabolic acidosis
defect in glucose-6-phosphatase occurs in Von Gierke’s disease
Age for mmr, hepA
1 yr
Age cutoff Dtap vs Tdap
DTap until 7 yrs
random sugar cutoff for DM2 (with sx present
200
2 hour GTT cutoff for DM2
200
error with a BP cuff too large
too low BP
(cuff should span 2/3 of arm circumference
Calorie deficit to drop 1 pound?
Reasonable goal = .5 to 1 pound/week
3500
quantitative pilocarpine iontophoresis testing
dz?
CF
exhaled NO test
dz?
primary ciliary dyskinesia
bruton tyrosine kinase gene sequencing
dz?
X-linked agammaglobulinemia
most effective postcoital birth control
copper IUD
2 shots for all pts with chronic liver dz
hep A
hep B
4 screenings if PID
HIV, syphilis, cervical cancer, hep B
normal JVD pulse
less than 3 cm
pulmonary nodules are not cancer if stable for?
over 2 years
risk of not treating hyperthyroidism
bone loss
3 labs to order in a female with amenorrhea, -BHCG
PRL, TSH, FSH
osteomyelitis pathogen after stepping on nail
pseudomonas
acute tx (2) of central retinal artery occlusion
ocular massage
high flow O2
odynophagia
pain with swallowing
endopthalmitis
infection of aqueous or vitrious humor
hypopyon
WBCs in anterior chamber eye
Direct vs indirect Coombs
Direct if autoimmune hemolytic anemia (ig on rbc)
Indirect if checking serum for unbound ig. Trx or maternal
while testing for gestational DM, abnormal 1 hour test cutoff
140
gestational DM 3 hr GTT cutoffs at 1,3 hours
180, 140
timeline concerning for rebound headaches (time analgesics used)
3 months
timeline for tPA
3 hours
age for dexa in women
65
Td vs TDap in adulthood
Tdap once as an adult
them td q10 yrs
pneumonia shot regimen for 65+
PCV13
PPSV23 6-12 mos. later
pneumonia shot regimen for very high risk adults
PCV13
PPSV23 6-12 mos. later
pneumonia shot regimen for under 65 w/risk (DM, COPD, etc)
PPSV23 alone
