Family Medicine Flashcards
Drugs that commonly cause weight gain
Glucocorticoids, TCA’s, some SSRI’s, some antipsychotics and antiepileptics
Cancers for the overweight (increased risk)
non-Hodgkins lymphoma
Multiple Myeloma
Organ cancers
Metabolic syndrome haves (and notable have nots (not required))
Fasting blood glucose above 100 mg/dl BP>130/85 Triglycerides >150 mg/dl HDL<40 for men, 50 for women >40'' abdominal waist circumference for men, >35" for women
No mention of LDL, no mention of BMI
What are the physician’s five A’s of behavioral training
Assess, Advise, Agree, Assist, Arrange
Who benefits from a statin? (4 patients) – later said to use statins for any cholesterol lowering
- Current ASCVD
- LDL > 190 mg/dl
- Diabetes age 40-75
- Estimated Risk Poole of >7.5% for 10 year ASCVD risk
What drugs can cause changes in lipid concentrations? (up)
Thiazides, beta blockers, oral estrogens, protease inhibitors
Why should you pause when using bile acid sequestrants on a standard metabolic syndrome patient?
They can raise triglycerides
Under what age should you treat acute otitis media with antibiotics? What age can you for sure wait? What to do in between?
< 6 months for auto antibiotics, 6-24 mo cautious obs, >2 years additional obs
Antibiotics that can cause vertigo?
Aminoglycosides (streptomycin)
Distinguish between common peripheral vs central presentations of vertigo
Unidirectional vs. multidirectional
Inhibited by focus vs uninhibited
Short lived vs more persistent
Test for identifying BPPV
Dix-Hallpike maneuver
How to distinguish central from peripheral?
Head thrust maneuver - indicates vestibular issue
Anticholinergic agents for vertigo and safety for pregnancy?
Meclizine - occasional is safe for baby, promethazine, short term doses
What types of people are more likely to present with atypical angina? What is considered “anginal equivalents?”
Diabetics, women, elderly – weakness or shortness of breath on exertion considered equivalents
Are hypertension and dyslipidemia independent risk factors for PE?
NO, but obesity is
What is considered unstable angina?
Pain on increasingly less exertion/at rest OR new onset worsening in severity, frequency, duration
What is cardiac syndrome X?
angina pain- abnormal stress test, normal cath. Good prognosis, more common in women
Who gets low dose aspirin?
50-59, >10% 10 yr risk of CVD, no increased bleed risk, have life expectancy of 10 yrs.
60-69, same criteria plus more tailored
> 70, < 50 - no evidence
What to use for secondary prevention of CVD in high risk groups?
First beta-blocker, but if contraindicated, CaCB also effective
What lab test do you need to run before initiating statin?
ALT
Stages of labor
First phase: latent: contractions but less than 6 cm
active: 6cm to fully dilated
Second Stage: Full dilation to baby being delivered
Third stage: begins with birth of baby, ends with delivery of placenta
Criteria for pre-eclampsia
Two blood pressures >140/90 6 hours apart in a woman who previously had normal blood pressure and >20 weeks gestation AND proteinuria of 300 mg on 24 hours or +1 on dipstick twice
What does HELLP syndrome stand for
Hemolysis, Elevated Liver enzymes and Low Platelets
What qualifies as severe preeclampsia?
Any of these
Severe HTN (160/110)
Doubling of serum transaminases or RUQ pain
Platelet count < 100
Pulmonary edema
What is the indication of late decelerations?
May be utero-placental insufficiency, meaning baby is not receiving enough oxygen during contractions
What is labor dytocia
Obstructed labor - failure to progress if no change in cervix after 2 hours of active labor (multiparous usually 2cm / hour, uniparous usually 1 cm/hour)
Causes of postpartum hemorrhage (4 T’s)
Tone, Trauma, Tissue, Thrombin
Weight patterns of early infants
Slight weight loss at first as mother’s milk comes in, then 1 oz/ day weight gain
Reducing menstrual flow with fibroids options?
Progesterone releasing IUD, abates bleeding, reduces dysmennorhea
How to diagnose delirium?
Confusion Assessment Method (CAM)
Difference between activities of daily living (ADL’s) and Instrumental activities of daily living (IADL’s)
ADL’s basics needed for self care, IADL’s - things needed to live independently (laundry, bills, etc.)
Medicines most likely to cause delirium?
Meds with anticholinergic effects:
Opiods, benzos, sedating antihistamines, tricyclic antidepressants, some antinausea agents
Empirical UTI treatment while waiting for gram stain and culture?
Cephtriaxone
What is riskier about atypical antipsychotics than typical?
More prone to longQT syndrome (but less prone to Tardice)
What treatment methods have roles in Alzheimers
Vitamin E (controversial), Cholinesterase inhibitors (donazepil, rivastigmine), Memantidine (NMDA antagonist), antipsychotics
How common is asymptomatic bactiuria in older patients and what should you do as a result?
50%, don’t get a repeat culture to show “cure” after UTI
Chronic vs acute bronchitis?
Productive cough for 1-3 weeks vs productive cough for at least 3 months for at least 2 years
Difference in pathogenesis of COPD and asthma
COPD - cytotoxic t cells,leading to irreversible change, asthma, th1 and eosinophils leading to reversible change
Diagnostic finding of COPD?
Post-bronchodilator PFT of <70% FEV/FVC
Stages of COPD
FEV1/FVC <0.7 for all
Mild: FEV1>=80% asymptomatic
Moderate: 50
Side effects of prednisone
osteoporosis, hypothalamus suppression, femur head necrosis, steroid myopathy
Treatment order of COPD
Start with inhaled anticholinergics (ipratropium, tiotropium) plus short beta agonists. More severe, add glucocorticoids.
Should all smoker’s be screened by PFT’s for COPD?
No, not asymptomatic ones
Who gets antibiotics with COPD?
If they have increased sputum purulence and (dyspnea or sputum volume) or if mechanical ventilation is needed
What are signs of testicular torsion?
Lack of cremasteric reflex, neg Blue dot sign (bluish discoloration at the upper pole meaning appendiceal torsion) and negative Prehn sign (physical lifting of the testes does not relieve pain like it would in epidydimitis)
How can diagnosis of testicular torsion be confirmed?
Color Doppler ultrasonography or radionucleotide scintigraphy
Most common cancer in men 15-35?
Testicular cancer - still very rare (1.6/100,000 in AA males, the highest rate)
How quickly does testicular torsion need to be addressed if you want to save the testicle?
6 hours for 90% saved rate
